Arrhythmogenic Right Ventricular Cardiomyopathy as a Cause of Palpitations and Syncope in an Otherwise Healthy Active Duty Female

ABSTRACT Identifying the cause of palpitations and syncope in the healthy, active duty military population is important. Most often, the causes are benign, but more malignant etiologies should not be overlooked. In this case, we present a 22-year-old active duty female soldier who developed exercise intolerance, palpitations, and ultimately one episode of exercise-induced syncope. Outpatient evaluation with Holter monitor revealed sustained ventricular tachycardia while exercising. Electrocardiogram revealed findings concerning for arrhythmogenic right ventricular cardiomyopathy based on the 2010 Revised Task Force Criteria. Further investigation with cardiac magnetic resonance imaging helped confirm the diagnosis. Sotalol was used as an antiarrhythmic therapy and an automatic implantable cardioverter defibrillator was implanted to reduce the risk of sudden cardiac death. This case represents an uncommon cause of palpitations and syncope. Arrhythmogenic right ventricular cardiomyopathy should be on the differential diagnosis in the active duty population who present with exercise-induced syncope.

Representation of Iraqi prisoners' abuse in Judith Thompson's palace of the end: a politico-cultural perspective

The paper is a study in the representation of the systematic abuse inflicted by the American Female Soldier (being an image of American militarism) upon the Iraqi prisoners in the Abu Ghraib jail. The American misconducts exercised are based on political and cultural grounds: it is dramatically evident that the American Female Soldier has prejudicially transformed the stage into a battleground, whereon, post colonially, the Iraqi prisoners are viciously addressed by demeaning terms.

Transcendent Ephemera

This essay considers our response to printed ephemera, analyzing British examples of the seventeenth and eighteenth centuries, specifically elegies, broadside ballads, and the life story and advertised theatrical performing of the eighteenth-century female soldier Hannah Snell, using methods from folklore, musicology, and literary study. The formats of the ephemera, and their performative modes seemingly identify these expressions as impermanent; at the same time, examining them collectively, we recognize an ironic gesture for lasting universal human sentiment and meaning. The ubiquitousness of these recurring forms, conjoined with resistance to scholarly theorizing of expression popular across social ranks, leaves their conventions and parameters understudied and deserving of more exploration and analysis. As the psalmist observed, humans feel ourselves to be walking on a fleeting path. Ephemera speak to and from this experience of precarious temporality with a paradoxical coupling between representations of topical particularities on the one hand, and, on the other, oft-repeated patterns that invoke and formulaically echo a collective past.

Sex differences in response to exercise heat stress in the context of the military environment

Women can now serve in ground close combat (GCC) roles, where they may be required to operate alongside men in hot environments. However, relative to the average male soldier, female soldiers are less aerobically fit, with a smaller surface area (AD), lower mass (m) with higher body fat and a larger AD/m ratio. This increases cardiovascular strain, reduces heat exchange with the environment and causes a greater body temperature increase for a given heat storage, although a large AD/m ratio can be advantageous. Physical employment standards for GCC roles might lessen the magnitude of fitness and anthropometric differences, yet even when studies control for these factors, women sweat less than men at high work rates. Therefore, the average female soldier in a GCC role is likely to be at a degree of disadvantage in many hot environments and particularly during intense physical activity in hot-arid conditions, although heat acclimation may mitigate some of this effect. Any thermoregulatory disadvantage may be exacerbated during the mid-luteal phase of the menstrual cycle, although the data are equivocal. Likewise, sex differences in behavioural thermoregulation and cognition in the heat are not well understood. Interestingly, there is often lower reported heat illness incidence in women, although the extent to which this is influenced by behavioural factors or historic differences in role allocation is unclear. Indeed, much of the extant literature lacks ecological validity and more work is required to fully understand sex differences to exercise heat stress in a GCC context.

Postdeployment Fertility Challenges and Treatment in the Modern Era

Current war-fighting environments have shifted dramatically over the past decade, and with this change, new types of injuries are afflicting American soldiers. Operative Enduring Freedom and Operation Iraqi Freedom have noted an increased use of sophisticated improvised explosive devices by adversaries. Injuries not frequently seen in previous conflict are dismounted complex blast injuries, which involve multiple proximal amputations, pelvic fractures, and extensive perineal wounds. Thus, an unforeseen consequence of the decreased mortality rate after these complex blast injuries is a new wave of U.S. service members facing the challenges of recovering from the catastrophic amputations and genitourinary injuries. New applications of sperm retrieval methods may be used in these specific populations, as they recover and wish to purse family-building goals. Spinal cord injuries, traumatic brain injuries, and considerations unique to the female soldier are explored in this review of urologic care in wounded veterans.

Encephalitis on deployment in Kenya: think beyond the infections

A 34-year-old female soldier presented with fever and behavioural changes while deployed in Kenya and was diagnosed with encephalitis. The patient underwent urgent aeromedical evacuation to the Queen Elizabeth Hospital, Birmingham for further management. Microbiology tests excluded common infectious causes that are endemic in the East Africa region. However, an autoantibody screen was positive for antibodies against the N-methyl-D-aspartate receptor (NMDAR). Full body imaging confirmed the presence of limbic encephalitis and an ovarian mass suggestive of a teratoma. The patient was diagnosed with ovarian teratoma-associated anti-NMDAR encephalitis, a potentially fatal disease. The patient underwent surgery to remove the teratoma and commenced immunotherapy with steroids, plasma exchange and rituximab. This case highlights the diagnostic challenges of fever with behavioural changes in military personnel deployed in a tropical environment.