Case Report of Improvement in Long-COVID Symptoms in an Air Force Medic Treated With Transcranial Magnetic Stimulation Using Electro-Magnetic Brain Pulse Technique.

Long-coronavirus disease (COVID) is an ill-defined set of symptoms persisting in patients following infection with COVID-19 that range from any combination of persistent breathing difficulties to anosmia, impaired attention, memory, fatigue, or pain. Recently, noninvasive transcutaneous electrical brain stimulation techniques have been showing early signs of success in addressing some of these complaints. We postulate that the use of a stimulation technique with transcranial magnetic stimulation may also similarly be effective. A 36-year-old male suffering from symptoms of dyspnea, anosmia, and "brain fog" for 2 years following coronavirus infection was treated with 10 sessions of Electro-Magnetic Brain Pulse (EMBP®), a personalized transcranial magnetic stimulation protocol guided by the patient's electroencephalograph (EEG). At the conclusion of the treatment, the patient had improvements in mood, sense of smell, and brain fogging. Dyspnea also decreased with a gain of 11% forced expiratory volume 1/forced vital capacity. A high-sensitivity athletic training cognitive test showed an overall 27% increase in aggregate score. A significant portion of this was attributed to changes in visual clarity and decision-making speed. Post-treatment EEG showed a shift from predominantly delta waves to more synchronized alpha wave patterns during the resting state. Brain stimulation techniques appear to be showing early signs of success with long-COVID symptoms. This is the first case describing the use of a magnetic stimulation technique with quantitative test results and recorded EEG changes. Given the early success in this patient with cognition, dyspnea, and anosmia, this noninvasive treatment modality warrants further research.

Two Fifth-Generation Fighter Pilots Discovered with Latent Autoimmune Diabetes.

BACKGROUND: Fighter pilots undergo extensive medical screening but may still miss rare diseases like latent autoimmune diabetes in adults (LADA). LADA patients have circulating autoantibodies directed against pancreatic beta cell antigens and present with frank diabetes late in life which may elude conventional military flight screening.CASE REPORT: Two fifth-generation fighter pilots, a 38-yr-old man (patient 1) and a 27-yr-old man (patient 2), with no significant past medical histories developed symptoms of fatigue, weight loss, episodic polyuria, and arthralgia. Patient 1's symptoms were initially thought to have been caused by COVID-19, but he subsequently tested negative for viral infection. Lab work instead showed elevated TSH, HgbA1C 11.4%, positive GAD-65, anti-TPO, and anti-islet cell antibodies. Patient 2 developed symptoms following a military deployment and a 72-h diarrheal illness. Due to flight status, patient 2 did not seek expert medical attention for several months, but lab work found HgbA1C of 10.4%, positive GAD-66, and ZnT8 antibodies. Both patients were started on insulin therapy. Patient 1 was also started on levothyroxine for hypothyroidism and retired from flying duties. Patient 2 eventually transitioned to metformin without insulin and returned to flying duties with an aeromedical waiver.DISCUSSION: Our patients maintained peak physical fitness throughout their selection and aviation careers, which likely delayed their clinical presentation. Current USAF flight rules prohibit insulin use with flying fighter aircraft. Early antibody screening during pilot selection may be a cost-effective means of diagnosis as traditional screening techniques are unlikely to detect LADA.Zhang JX, Berry J, Kim NM, Gray JJ, Fotheringham S, Sauerwein TJ. Two fifth-generation fighter pilots discovered with latent autoimmune diabetes. Aerosp Med Hum Perform. 2022; 93(2):106-110.

Explosive Decompression with Resultant Air Gas Embolism in a Fourth Generation Fighter at Ground Level.

BACKGROUND: Arterial gas embolism (AGE) is a rare condition in the flying community most often only ever seen in flight while operating at high altitude or incidents involving hypobaric chambers. This article describes a severe case of AGE that occurred in a pilot of a fourth generation fighter aircraft at ground level. The environmental control system (ECS) malfunctioned, causing an overpressurized cockpit and a subsequent explosive decompression when the pilot opened the canopy to egress. CASE REPORT: The ECS onboard fourth generation fighter aircraft is composed of many computer-controlled subsystems. When these components fail, the system can potentially overpressurize the cockpit. Combined with opening the canopy without prior venting, this overpressurization can lead to a situation akin to a diver surfacing too quickly. A pilot experienced this scenario and subsequently developed symptoms of arterial gas embolization-one form of decompression illness (DCI). We reviewed the design of the environmental control system and recommend that the cockpit must be slowly depressurized to decrease risk of injury from rapid decompression. DISCUSSION: Literature review showed three similar cases of ground-based overpressurization causing AGE symptoms, although these cases were maintenance personnel intentionally testing aircraft cabin integrity and not associated with aircraft intending flight.7 The lessons learned from this case can be used to identify and hopefully prevent severe DCI from ground level cockpit overpressurization and to further general understanding of aircraft ECS. Zhang JX, Berry JR, Beckstrand DP. Explosive decompression with resultant air gas embolism in a fourth generation fighter at ground level. Aerosp Med Hum Perform. 2016; 87(11):963-967.