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      Evacuaciones estratégicas por motivo cardiovascular en personal militar español (2007-2020) Translated title: Strategical evacuations due to cardiovascular causes in Spanish military personnel (2007-2020)

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          Abstract

          RESUMEN Introducción y Objetivos: Las evacuaciones estratégicas por razones médicas son aquellas que se realizan cuando la baja no se puede recuperar para el desempeño de la misión y es transportada hasta territorio nacional. El objetivo de este estudio es describir las bajas españolas evacuadas estratégicamente por causas cardiovasculares, así como describir el personal militar español fallecido por causa cardíaca en zona de operaciones. Material y Métodos: Estudio transversal retrospectivo en el que se incluyen a todos los militares españoles evacuados por razones médicas desde zona de operaciones hasta el Hospital Central de la Defensa “Gómez Ulla” (Role 4) durante los años 2007 y 2020. Resultados: Treinta y seis bajas fueron evacuadas sobre el Role 4 español por causas cardiovasculares, de las cuales 25% fueron diagnosticadas de fibrilación auricular, 22,2% de infarto de miocardio, 11,1% de trombosis venosa aguda, y 5,5% de crisis hipertensiva, flutter auricular y bloqueo auriculoventricular, respectivamente. La zona de operaciones desde donde se originaron más evacuaciones fue Afganistán (31%), seguido por Líbano (28%) y las navegaciones internacionales (14%). Un total de 13 militares españoles han fallecido en zona de operaciones por motivo cardiovascular. Conclusiones: La fibrilación auricular y el síndrome coronario agudo han sido los principales diagnósticos entre las bajas evacuadas por motivos cardiovasculares. Los autores consideramos imprescindible que las Fuerzas Armadas españolas cuenten con un servicio de Cardiología en Role 4, que además de realizar labores asistenciales, sirva de órgano de reconocimiento médico previo a misión y forme parte del apoyo sanitario a las operaciones internacionales.

          Translated abstract

          ABSTRACT Introduction and Objectives: Strategic evacuations for medical causes are those that are carried out when the casualty cannot be recovered for the mission and is transported to national territory. The objective of this study is to describe the Spanish casualties strategically evacuated due to cardiovascular causes, as well as to describe the Spanish military personnel who died due to cardiac causes in the area of operations. Material and methods: Retrospective cross-sectional study in which all Spanish military personnel evacuated for medical reasons from the area of operations to the Central Defense Hospital “Gómez Ulla” (Role 4) during the years 2007 and 2020 were included. Results: Thirty-six casualties were evacuated on Spanish Role 4 due to cardiovascular causes, of which 25% were diagnosed with atrial fibrillation, 22,2% with myocardial infarction, 11,1% with acute venous thrombosis, and 5.5% of hypertensive crisis, atrial flutter, and atrioventricular block, respectively. The area of operations from where the most evacuations originated was Afghanistan (31%), followed by Lebanon (28%) and international navigations (14%). A total of 13 Spanish soldiers have died in the area of operations for cardiovascular reasons. Conclusions: Atrial fibrillation and acute coronary syndrome have been the main diagnoses among the casualties evacuated for cardiovascular reasons. The authors consider it essential that the Spanish Armed Forces have a Role 4 - Cardiology department that, in addition to performing care tasks, serves as a unit for medical examination prior deployment and take part into the medical support for international military operations.

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          Most cited references39

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          Prevalence of and risk factors for autopsy-determined atherosclerosis among US service members, 2001-2011.

          Autopsies of US service members killed in the Korean and Vietnam wars demonstrated that atherosclerotic changes in the coronary arteries can appear early in the second and third decades of life, long before ischemic heart disease becomes clinically apparent. To estimate the current prevalence of coronary and aortic atherosclerosis in the US armed forces. Cross-sectional study of all US service members who died of combat or unintentional injuries in support of Operations Enduring Freedom and Iraqi Freedom/New Dawn between October 2001 and August 2011 and whose cardiovascular autopsy reports were available at the time of data collection in January 2012. Prevalence of atherosclerosis was analyzed by various demographic characteristics and medical history. Classifications of coronary atherosclerosis severity were determined prior to data analysis and designed to provide consistency with previous military studies: minimal (fatty streaking only), moderate (10%-49% luminal narrowing of ≥1 vessel), and severe (≥50% narrowing of ≥1 vessel). Prevalence of coronary and aortic atherosclerosis in the US armed forces and by age, sex, self-reported race/ethnicity, education, occupation, service branch and component, military rank, body mass index at military entrance, and International Classification of Diseases, Ninth Revision, Clinical Modification, diagnoses of cardiovascular risk factors. Of the 3832 service members included in the analysis, the mean age was 25.9 years (range, 18-59 years) and 98.3% were male. The prevalence of any coronary atherosclerosis was 8.5% (95% CI, 7.6%-9.4%); severe coronary atherosclerosis was present in 2.3% (95% CI, 1.8%-2.7%), moderate in 4.7% (95% CI, 4.0%-5.3%), and minimal in 1.5% (95% CI, 1.1%-1.9%). Service members with atherosclerosis were significantly older (mean [SD] age, 30.5 [8.1] years) than those without (mean [SD] age, 25.3 [5.6] years; P < .001). Comparing atherosclerosis prevalence among with those with no cardiovascular risk factor diagnoses (11.1% [95% CI, 10.1%-12.1%]), there was a greater prevalence among those with a diagnosis of dyslipidemia (50.0% [95% CI, 30.3%-69.7%]; age-adjusted prevalence ratio [PR], 2.09 [95% CI, 1.43-3.06]), hypertension (43.6% [95% CI, 27.3%-59.9%]; age-adjusted PR, 1.88 [95% CI, 1.34-2.65]), or obesity (22.3% [95% CI, 15.9%-28.7%]; age-adjusted PR, 1.47 [95% CI, 1.10-1.96]), but smoking (14.1% [95% CI, 8.0%-20.2%]) was not significantly associated with a higher prevalence of atherosclerosis (age-adjusted PR, 1.12 [95% CI, 0.73-1.74]). Among deployed US service members who died of combat or unintentional injuries and received autopsies, the prevalence of atherosclerosis varied by age and cardiovascular risk factors.
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            Case reports: Death of active duty soldiers following ingestion of dietary supplements containing 1,3-dimethylamylamine (DMAA).

            Dietary supplements and their associated adverse events are not uncommon in the U.S. military, and selected dietary supplements have been associated with a number of nontraumatic deaths in service members. Specific ingredients and dietary supplement products in the civilian community are often associated with multiple adverse events and some have subsequently been removed from the marketplace; the most notable in the last decade is ephedra. We present case reports for two soldiers who were taking commercially available dietary supplements containing multiple ingredients to include the sympathomimetic, 1,3-dimethylamylamine (DMAA); both collapsed during physical exertion from cardiac arrest and ultimately died. A presentation of their clinical courses and a discussion of the history and pharmacology of dietary supplement ingredients, including DMAA, are provided. Our cases highlight concerns that DMAA in combination with other ingredients may be associated with significant consequences, reminiscent of previous adverse events from other sympathomimetic drugs previously removed from the market.
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              • Article: not found

              Coronary artery disease in combat casualties in Vietnam.

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                Author and article information

                Journal
                sm
                Sanidad Militar
                Sanid. Mil.
                Ministerio de Defensa (Madrid, Madrid, Spain )
                1887-8571
                March 2022
                : 78
                : 1
                : 9-14
                Affiliations
                [5] Madrid orgnameAcademia Central de la Defensa orgdiv1Escuela Militar de Sanidad España
                [1] Madrid orgnameHospital Central de la Defensa “Gómez Ulla” orgdiv1Servicio de Cardiología España
                [2] Madrid orgnameHospital Central de la Defensa “Gómez Ulla” orgdiv1Servicio de Anestesiología y Reanimación España
                [4] Madrid orgnameHospital Central de la Defensa “Gómez Ulla” orgdiv1Servicio de Urgencias España
                [3] Madrid orgnameHospital Central de la Defensa “Gómez Ulla” orgdiv1Servicio de Cardiología España
                Article
                S1887-85712022000100009 S1887-8571(22)07800100009
                10.4321/s1887-85712022000100002
                7cf111fc-b7c4-4ede-94cd-08e601419adc

                http://creativecommons.org/licenses/by/4.0/

                History
                : 24 February 2021
                : 27 December 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 39, Pages: 6
                Product

                SciELO Spain

                Categories
                Artículo Original

                Cardiología,Sanidad Militar española,Role 4,evacuación,Cardiology,Spanish Military Health,evacuation

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