MEDICAL JOURNALS OFFER A NARROW WINDOW INTO REALITIES OF WAR

"I can't give links to these articles because most of them aren't available on-line at all, and the ones that are require a (very expensive) subscription. These are the PubMed abstracts.

Salah-ed-Din's revenge?Emerg Infect Dis. 2005 Oct;11(10):1625-8.

Gastroenteritis outbreak in British troops, Iraq. Bailey MS, Boos CJ, Vautier G, Green AD, Appleton H, Gallimore CI, Gray JJ, Beeching NJ.

Army Medical Directorate, Camberley, UK. mark@ramc.org

Gastroenteritis affected many British military personnel during the war in Iraq. In the first month, 1,340 cases were seen; 73% of patients required hospital admission and 36% were hospital staff. In a survey of 500 hospital staff, 76% reported gastroenteritis, which was more likely in clinical workers.

Blind Alley? Ophthalmology. 2006 Jan;113(1):97-104. Epub 2005 Nov 10.

Ocular war injuries of the Iraqi Insurgency,January-September 2004. Mader TH, Carroll RD, Slade CS, George RK, Ritchey JP, Neville SP.

PURPOSE: To document the types and causes of ocular and ocular adnexal injuries treated by United States Army ophthalmologists serving in Iraq during the Iraqi Insurgency. DESIGN: Prospective hospital-based observational analysis of injuries. PARTICIPANTS: All coalition troops, enemy prisoners of war, and civilians with severe ocular and ocular adnexal injuries. METHODS: We prospectively examined severe ocular and ocular adnexal injuries that were treated at the 31st Combat Support Hospital during the portion of the Iraqi Insurgency that took place from January 20 through September 12, 2004. MAIN OUTCOME MEASURES: Incidences and characteristics of ocular and ocular adnexal injuries. RESULTS: During the time observed, 207 patients suffered severe ocular or ocular adnexal injuries, including 132 open globes. Blast fragmentation from munitions caused 82% of all injuries. The most common single cause of injury was the improvised explosive device (IED), which caused 51% of all injuries. Of 41 eye excisions, 24 were caused by IEDs. CONCLUSIONS: During the portion of the Iraqi Insurgency covered in our report, munitions fragments were the most common cause of ocular and ocular adnexal injuries. The single most common cause of injury was the IED, which produced devastating ocular and ocular adnexal injuries. The authors' findings indicate that polycarbonate ballistic eyewear could have prevented many, but not all, of the ocular injuries we report.

Note: The ocular adnexa means the structures near the eyeball, such as the eyelids and tear glands.

Ophthalmology. 2005 Oct;112(10):1829-33.

Intraocular foreign body injuries during Operation Iraqi Freedom. Thach AB, Ward TP, Dick JS 2nd, Bauman WC, Madigan WP Jr, Goff MJ, Thordsen JE.

OBJECTIVE: To evaluate the number of intraocular foreign body (IOFB) injuries that occurred in Operation Iraqi Freedom, and to determine the cause of injury, the type of foreign body, and the associated injuries to other body systems. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Fifty-five United States military personnel with an IOFB injury during Operation Iraqi Freedom. INTERVENTION: Pars plana vitrectomy, foreign body removal, and additional surgical procedures as the clinical situation dictated. MAIN OUTCOME MEASURES: Cause of injury, size of corneal/scleral laceration, number of foreign bodies, type of foreign body, time to foreign body removal, visual acuity, number of enucleations, and injuries to other body systems. RESULTS: The foreign body was caused by a propelled explosive in 20 patients (36%) and a nonpropelled explosive in 31 patients (56%), and the cause of the foreign body was not known in 4 patients (7%). The size of the laceration of the cornea and/or sclera averaged 5.4 mm (range, 0.2-18). There were an average of 1.7 foreign bodies in the injured eye (range, 1-6). The size of those foreign bodies measured ranged from <1 mm to 12 x 14 mm. The most common type of foreign body was metal (68%), followed by glass (14%), stone/cement (14%), bone (5%), and cilia (3%). The time from injury to foreign body removal averaged 20.6 days (range, 0-90). No cases of endophthalmitis were seen. The most common associated injury was to the upper extremity, face, lower extremity, and neck. CONCLUSIONS: Unlike trauma in the civilian sector, IOFB injuries in a military setting tend to be caused by explosive devices, which often result in multiple foreign bodies and simultaneous injuries to other body systems. Because of the lack of availability of specialty care in the combat theater, there is often a delay in removal of the foreign body.

Is there a doctor in the house?

5: Am J Trop Med Hyg. 2005 Oct;73(4):713-9.

Impact of illness and non-combat injury during Operations Iraqi Freedom and
Enduring Freedom (Afghanistan). Sanders JW, Putnam SD, Frankart C, Frenck RW, Monteville MR, Riddle MS, Rockabrand DM, Sharp TW, Tribble DR. U.S. Naval Medical Research Unit No. 3, Cairo, Egypt, AE 09835.

Historically, non-combat injuries and illnesses have had a significant impact on military missions. We conducted an anonymous cross-sectional survey to assess the prevalence and impact of common ailments among U.S. military personnel deployed to Iraq or Afghanistan during 2003-2004. Among 15,459 persons surveyed, diarrhea (76.8% in Iraq and 54.4% in Afghanistan), respiratory illness (69.1%), non-combat injuries (34.7%), and leishmaniasis (2.1%) were commonly reported. For all causes, 25.2% reported that they required intravenous fluids, 10.4% required hospitalization, and 5.2% required medical evacuation. Among ground units, 12.7% reported that they missed a patrol because of illness, and among air units, 11.7% were grounded because of illness. The incidence of diarrhea and respiratory infections doubled from the pre-combat to combat phases, and the perceived adverse impact of these illnesses on the unit increased significantly during the combat phase. Despite technologic advances in warfare and preventive medicine, illness and non-combat injuries have been common during operations in Iraq and Afghanistan, resulting in frequent transient decreases in operational efficiency.

J R Army Med Corps. 2005 Jun;151(2):101-4. The role of the physician in modern military operations: 12 months experience in Southern Iraq.

Grainge C, Heber M.

OBJECTIVES: To examine the profile of medical morbidity and the role of the physician in modern conflict. METHODS: Retrospective survey of admission records at a British Military Field Hospital on operational duty in Southern Iraq. RESULTS: 62.5% of 4870 admissions to the Field Hospital in Shaibah during the first 12 months of military operations in Iraq were under the care of physicians. Of these 1531 (31.4%) were due to diarrhoea and vomiting (D&V) and 764 (15.7%) due to heat illness. The incidence of heat illness rose with ambient temperature, but soldiers were more likely to be admitted with heat illness shortly after arrival in theatre than when fully acclimatised. There was also a steady flow of admissions with a broad spectrum of medical pathology requiring the clinical skills of a general physician. CONCLUSIONS: A general physician is a necessary part of the clinical team in modern conflict. The incidence of D&V and of heat illness on military operations remains high. Planners for any operation in tropical climates should take this into consideration and put
preventative measures into place early.


War is hell: J Psychosoc Nurs Ment Health Serv. 2005 Jul;43(7):18-28.

War-related mental health problems of today's veterans: new clinical awareness. Reeves RR, Parker JD, Konkle-Parker DJ.

1. Veterans of the military conflicts in Iraq and Afghanistan may have been exposed to significant psychological stressors, resulting in mental and emotional disorders. 2. Posttraumatic stress disorder (PTSD) is characterized by symptoms in three domains: reexperiencing the trauma, avoiding stimuli associated with the trauma, and symptoms of increased autonomic arousal. 3. Treatment of PTSD often requires both psychological and pharmacological interventions. 4. In addition to PTSD, other mental disorders may be precipitated or worsened by exposure to combat, including depression, anxiety, psychosis, and substance abuse.

J R Army Med Corps. 2005 Jun;151(2):95-100.

Diagnosis and outcome of psychiatric referrals to the Field Mental Health Team,
202 Field Hospital, Op Telic I. Scott JN.

OBJECTIVES: To assess referrals to a Field Hospital Mental Health Team (FMHT), assign a diagnosis, provide appropriate treatment, and decide whether suitable for safe return to unit in theatre (RTU), or evacuation home on psychiatric grounds (evac). METHODS: All documented referrals to the FMHT of 202 Field Hospital during the Op Telic 1 study period of 17 March (day 1) to 23 July 2003 (day 129) were included. Data were collected on rank, gender, diagnosis, outcome (whether RTU or evac), and whether TA before mobilisation. Diagnosis was assigned by ICD-10 criteria. RESULTS: The FMHT documented 170 cases, 12 of whom were seen twice and one on three occasions, resulting in 184 referrals, all of whom were British. The commonest diagnosis was adjustment reaction (F43), accounting for 68% of all cases (n = 116). These were divided between chiefly theatre-related (n = 77) or chiefly home-related (n = 39) reactions. The majority (94%) of these cases were RTU. Referrals where the diagnosis was a Depressive disorder (F32, n = 23) or Intentional self-harm (by sharp object. X(78, n = 7) were evacuated. Outcome was similar for Regular and TA personnel, with on average 72% of cases RTU. The majority of cases seen were ORs, reflecting their numbers in theatre. Only 14 NCOs and 14 officers were referred. Thirteen of the latter were TA before mobilisation. Gender was not associated with outcome, or TA status, but was associated with rank, in that significantly more female officers were referred. The FMHT role tasks emerged as (a) psychiatric triage and treatment, (b) psychological support of hospital staff, and (c) welfare and pastoral care liaison. CONCLUSION: The utility of the psychiatric management model employed, built upon previous military medical doctrines, was tested in a modern theatre of conflict, and seemed to prove its worth.

War of the Worlds?Emerg Infect Dis. 2005 Aug;11(8):1218-24.

Multidrug-resistant Acinetobacter extremity infections in soldiers. Davis KA, Moran KA, McAllister CK, Gray PJ.

War wound infection and osteomyelitis caused by multidrug-resistant (MDR) Acinetobacter species have been prevalent during the 2003-2005 military operations in Iraq. Twenty-three soldiers wounded in Iraq and subsequently admitted to our facility from March 2003 to May 2004 had wound cultures positive for Acinetobacter calcoaceticus-baumannii complex. Eighteen had osteomyelitis, 2 burn infection, and 3 deep wound infection. Primary therapy for these infections was directed antimicrobial agents for an average of 6 weeks. All soldiers initially improved, regardless of the specific type of therapy. Patients were followed up to 23 months after completing therapy, and none had recurrent infection with Acinetobacter species. Despite the drug resistance that infecting organisms demonstrated in this series, a regimen of carefully selected extended antimicrobial-drug therapy appears effective for osteomyelitis caused by MDR Acinetobacter spp.

Oh yeah, bad stuff happens to Iraqis too

East Mediterr Health J. 2004 Jan-Mar;10(1-2):12-8.

Supplementary feeding of malnourished children in northern Iraq. Agha SY. Department of Public Health, College of Medicine, University of Dohuk, Dohuk,
Iraq.

The effectiveness of the supplementary feeding programme for malnourished
children aged 6 months to 3 years in Dohuk province, northern Iraq was evaluated.The enrolment criterion was child weight > or = 2 standard deviations below standard eight-for-age. Children enrolled in the programme in January 2001 were followed over 7 months. Children received high-protein high-energy biscuits in the first month and a monthly child ration for preparing soyabean mix throughout. Their families received food rations in the first 4 months. Improvement was noticed for all children, particularly in the first month. Problems with the rations and within the growth monitoring units resulted in significant drop-out. Use of standard growth charts may be a way to overcome this problem. High-protein biscuits should be distributed throughout instead of the mix.

Burns. 2005 Sep;31(6):687-91.

Epidemiology of burns at the Italian Red Cross Hospital in Baghdad. Carini L, Grippaudo FR, Bartolini A.

This study describes the epidemiology and patterns of moderate to severe burn injuries (%BSA>or=20-90) treated at the Italian Red Cross Hospital in Baghdad, Iraq, during the medical mission of the tenth Italian Red Cross Contingent, from 3 April to 19 May 2004. Burn injuries sustained by members of the civilian population admitted to the Burns Unit, irrespective of age and sex, are analysed (n=48). Differences in risk distribution between different segments of the population are reported and typical injury patterns are identified. The six injury patterns identified are labelled "child scaldings", "domestic accidents", "unsafe working conditions", "suicide attempts", "injuries among children in role-play" and "war related injuries". The results show that burn injury incidence is particularly high for women and children. There is a pronounced difference between genders after adulthood (age 15 and up). The mortality rate is higher in females. Most of the burns occurred in the home: a public health education campaign might help reduce the incidence of these injuries.

Note: Lack of electricity and use of kerosene heaters and gasoline generators in homes probably contributes to the rate of these injuries

Mil Med. 2005 Jun;170(6):501-4.

Medical problems of detainees after the conclusion of major ground combat during
Operation Iraqi Freedom.

Murray CK, Roop SA, Hospenthal DR.

After the conclusion of major ground combat operations during Operation Iraqi Freedom, the focus of the mission changed, although intense armed conflict continued. Included in this mission was management of security detainees, including provision of their medical care. We retrospectively reviewed the admission records identified at a short-term holding facility over 2 months and diagnoses of detainees admitted to a combat support hospital over 4 months as a health care service utilization statistics review. Six thousand six hundred thirty-one detainee encounters occurred at the short-term facility with approximately 45% of detainees reporting medical problems during each daily evaluation. Most frequent complaints were neurological (11%), gastrointestinal (10%), and respiratory (8%). Two hundred nineteen detainees' admission diagnoses were retrospectively reviewed from the combat support hospital, 98 (45%) due to gunshot or fragmentary injuries and 121 (55%) to other medical problems. Medical problems included cardiac (29%), gastrointestinal (17%), neurological (14%), musculoskeletal (11%), and pulmonary (6%) disease. Medical problems not traditionally dealt with in a combat theater, including management of transplant recipients, patients with cardiac valve replacement, and cancer patient, were also seen."
Iraq Today