Fatal Sickling Associated Microvascular Occlusive Crisis in a Young Military Recruit with Sickle Cell Trait: A Case Report

Background. Sickle cell trait(SCT), a heterozygous state characterized by the presence of hemoglobin AS, occurs in varied frequency in the Indian population with highest prevalence in Central and southern India. SCT is compatible with a normal lifespan and not commonly regarded as a cause of morbid illness or death in contrast to sickle cell disease, its homozygous counterpart. Case Presentation. We describe a case of fatal sickling associated microvascular crisis, identified on post mortem evaluation in a previously undiagnosed 20-year-old military recruit with sickle cell trait. The individual presented with repeated episodes of presyncope during his training and was evaluated for cardiac anomalies and heat syncope. During the terminal episode, he collapsed and died of severe metabolic complications as he struggled to complete an organised run during routine training activities. Conclusion. To our knowledge, this is the first report of fatal sickling associated crisis in a military recruit with sickle cell trait from India. This case serves to remind all medical officers of the armed forces of the importance of screening a recruit who is unable to complete exertional physical training for the presence of sickle cell trait.

A Case Report of Hydrocephalus in a US Military Recruit

ABSTRACT We present a case of chronic non-communicating hydrocephalus (NCH) in a US military recruit. Non-communicating hydrocephalus is a pathologic obstruction of cerebrospinal fluid (CSF) resulting in enlargement of the ventricles and elevated intracranial pressure. The patient is an 18-year-old male recruit who was evaluated in the Naval Medical Center emergency room for left hip pain and incidentally was found to have profound ventriculomegaly on head imaging. The diagnosis and evaluation of hydrocephalus is greatly dependent on clinical history and supported by radiographic imaging. Based on these factors, one can determine if the hydrocephalus is either acute or chronic and communicating or non-communicating.

Anaphylaxis to MMR Vaccine Mediated by IgE Sensitivity to Gelatin

The measles-mumps-rubella (MMR) vaccine is generally well tolerated, and reports of anaphylaxis to the vaccine are rare. IgE-mediated reactions to vaccines are often caused by additives or residual vaccine components. An inability to obtain proper immunizations can be a disqualifying component to military service. We report a case of anaphylaxis to the MMR vaccine in a new military recruit sensitized to gelatin IgE.

Association Between Musculoskeletal Injuries and the Canadian Armed Forces Physical Employment Standard Proxy in Canadian Military Recruits

Introduction Musculoskeletal injuries (MSKIs) and recruitment are major challenges faced by modern military forces. The Canadian Armed Forces uses a physical employment standard (PES) proxy to determine occupational fitness and job suitability. It is unknown whether the performance on the PES proxy can be also used as predictor of MSKIs. The purpose of this study was to investigate for relationships between age, sex, body composition, aerobic fitness, performance on the Canadian Armed Forces PES proxy (FORCE evaluation), and risk of sustaining a MSKI requiring intervention in the Training Rehabilitation Program (MSKI-TRP1) during Canadian Basic Military Qualification. Materials and Methods This was a retrospective analysis of MSKIs in recruits introduced in the Training Rehabilitation Program (TRP1) in 2016 and 2017. A two-tailed t-test and a multivariate stepwise logistic regression were completed to investigate the interrelationships of sex, age, FORCE performance (20 m rushes, sandbag lift, intermittent loaded shuttles, sandbag drag) and health-related characteristics (waist circumference, predicted peak oxygen consumption [$\dot{V}$O2peak]), and odds for sustaining a MSKI-TRP. Results The MSKI-TRP1 intervention rate observed was 4.3%. Rehabilitation duration was an average (SD) of 87 (76) days; nearly 80% of MSKI-TRP were lower body injuries. MSKI-TRP recruits were older, had a lower score on FORCE, and had a larger mean waist circumference and lower $\dot{V}$O2peak than non-TRP1 recruits (all P < 0.01). Recruits with performance lower than 1 SD below mean on the 20 m rushes, intermittent loaded shuttle, or sandbag drag were 2.69 (1.89–3.83), 2.74 (1.91–3.95), and 2.26 (1.52–3.37) times more likely to sustain a MSKI-TRP1, respectively (all P < 0.01). Recruits with $\dot{V}$O2peak lower than 1 SD below mean were also 2.19 (1.30–3.70) times more likely to sustain a MSKI-TRP. Neither sex, age, nor waist circumference impacted the risk of MSKI-TRP1 when controlling for FORCE performance. Conclusions The Canadian Armed Forces PES proxy performance can be used to assess the odds of sustaining a MSKI-TRP1 in Canadian military recruit training.

Case series of coronavirus (SARS-CoV-2) in a military recruit school: clinical, sanitary and logistical implications

IntroductionA new coronavirus, called Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2), has emerged from China in late 2019 and has now caused a worldwide pandemic. The impact of COVID-19 has not been described so far in a military setting. We therefore report a case series of infected patients in a recruit school in Switzerland and the herein associated challenges.MethodsRetrospective review of COVID-19 cases among Swiss Armed Forces recruits in the early weeks of SARS-CoV-2 pandemic in the canton of Ticino, the southernmost canton of Switzerland. Positive cases were defined with two positive PCR testing for SARS-CoV-2 from nasopharyngeal swabs. Serological testing was performed with a commercially available kit according to manufacturers’ instructions.ResultsThe first case was likely contaminated while skiing during weekend permission. He became symptomatic 4 days later, tested positive for SARS-CoV-2 and was put into isolation. He showed complete symptom resolution after 48 hours. Quarantine was ordered for all recruits with close contact in the past 2 days, a total of 55 persons out of 140 in the company. Seven out of nine recruits in one particular quarantine room became mildly symptomatic. SARS-CoV-2 PCR was positive in one of them. Seven days after initial diagnosis, the index patient and the other one from the quarantine retested positive for SARS-CoV-2, although they had been completely asymptomatic for over 96 hours. Serological testing revealed positive for both patients. All others showed negative IgM and IgG.ConclusionsYoung healthy recruits often showed a mild course of COVID-19 with rapid symptom decline but were persistent SARS-CoV-2 carriers. This illustrates how asymptomatic patients may be responsible for covert viral transmission. An early and prolonged establishment of isolation and quarantine for patients and close contacts is essential to slow down the spread of SARS-CoV-2, especially in the confined space of a military environment.

A Case Report of Mixed Osteomalacia and Low Bone Density from Vitamin D Deficiency as a Cause of Bilateral Tibial Stress Fractures in a Young Male Military Recruit from Singapore

Despite being a tropical country, vitamin D deficiency is common in Singapore. All young Singaporean males between the age of 18 and 21 years have to undergo mandatory military service. Stress fractures occur in military recruits, and risk factors include a sudden increase in physical activity and vitamin D deficiency. We report the bone histomorphometry findings from a case of bilateral tibial stress fractures in an 18-year-old military recruit who had vitamin D deficiency. The histomorphometry showed a mixed osteomalacia and osteoporosis pattern. This case is unique as it shows that stress fractures from a marching exercise can occur in apparently healthy well young man with vitamin D deficiency despite living in a tropical country.