Severe heat stroke with multiple organ dysfunction.
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Anti-Inflammatory Agents, Non-Steroidal↗
Biomedical subjects
Patricia A Deuster
Publications and source records attributed to Patricia A Deuster.
Pyridostigmine, diethyltoluamide, permethrin, and stress: a double-blind, randomized, placebo-controlled trial to assess safety.
OBJECTIVE: To determine whether short-term human exposure to pyridostigmine bromide, diethyltoluamide, and permethrin, at rest or under stress, adversely affects short-term physical or neurocognitive performance. PARTICIPANTS AND METHODS: A multicenter, prospective, double-blind, placebo-controlled crossover trial exposing 64 volunteers to permethrin-impregnated uniforms, diethyltoluamide-containing skin cream, oral pyridostigmine, and corresponding placebos was performed. Each participant had 4 separate sessions, ensuring exposure to all treatments and placebos under both stress and rest conditions in random order. Outcomes Included physical performance (handgrip strength and duration, stair climbing, and pull-ups [males] or push-ups [females]), neurocognitive performance (computerized tests), and self-reported adverse effects. RESULTS: Permethrin was undetectable in the serum of all participants; pyridostigmine levels were higher Immediately after stress (41.6 ng/mL; 95% confidence Interval, 35.1-48.1 ng/mL) than rest (23.0 ng/mL; 95% confidence Interval, 19.2-26.9 ng/mL), whereas diethyltoluamide levels did not significantly differ by stress condition. Heart rate and systolic blood pressure increased significantly with stress compared with rest but did not vary with treatment vs placebo. Physical and neurocognitive outcome measures and self-reported adverse effects did not significantly differ by exposure group. CONCLUSION: Combined, correct use of pyridostigmine, diethyltoluamide, and permethrin is well tolerated and without evidence of short-term physical or neurocognitive impairment.
Adult↗
Initial evaluation of N,N-diethyl-m-toluamide and permethrin absorption in human volunteers under stress conditions.
OBJECTIVES: This was a pilot study to determine (1) whether it is feasible to effectively blind human subjects to the presence of the insect repellents N,N-diethyl-m-toluamide (DEET) and permethrin; (2) whether DEET affects the absorption of permethrin; and (3) whether combat videotape viewing and mental arithmetic are stressful. METHODS: Ten volunteers were exposed to DEET, permethrin, and stress (1-hour combat videotape plus mental arithmetic) in a double-blind, randomized, placebo-controlled trial. Outcome measurements included hemodynamics, plasma DEET and permethrin levels, and questionnaires to assess blinding. RESULTS: Highly sensitive serologic assays readily detected DEET but not permethrin. Staff members and subjects were effectively blinded to both. The videotape-math combination was stressful by both self-report and hemodynamic measures. CONCLUSIONS: It is possible to blind subjects with respect to DEET and permethrin. Permethrin on clothing does not enter the bloodstream at appreciable levels. Combat videotapes and mental arithmetic can be stressful.
Adult↗
Effects of dehydroepiandrosterone and alprazolam on hypothalamic-pituitary responses to exercise.
CONTEXT: The hypothalamic-pituitary-adrenal axis (HPA) is restrained by activation of gamma-amino-butyric acid receptors. Alprazolam (APZ) and dehydroepiandrosterone (DHEA) are purported to be gamma-amino-butyric acid agonists and antagonists, respectively. OBJECTIVE: Our objective was to examine the effects of APZ and DHEA alone and in combination on HPA axis activity. DESIGN: This was a double-blind, crossover, placebo-controlled study. SETTING: The study setting was the general community. PARTICIPANTS: Subjects consisted of 15 men (age, 20-45 yr) with a body mass index of 20-25 kg/m2. INTERVENTIONS: DHEA (100 mg/d) or placebo was given for 4 wk, followed by a 2-wk washout; participants ingested 0.5 mg APZ or placebo 10 and 2 h before high-intensity exercise. OUTCOME MEASURES: We measured basal and exercise-induced ACTH, arginine vasopressin (AVP), cortisol, DHEA, and GH responses. It was hypothesized that DHEA would enhance and APZ would blunt exercise-induced ACTH and cortisol release. RESULTS: DHEA significantly increased the AVP response to exercise (P < 0.01). APZ treatment significantly increased basal GH and blunted plasma cortisol, ACTH, AVP, and DHEA responses to exercise (P < 0.05). DHEA and APZ in combination significantly increased the GH response to exercise (P < 0.01). CONCLUSIONS: DHEA may alter a subset of receptors involved in AVP release. Together DHEA and APZ may up-regulate GH during exercise by blunting a suppressive (HPA axis) and potentiating an excitatory (glutamate receptor) system.
Adjuvants, Immunologic↗
Sex-related differences in stimulated hypothalamic-pituitary-adrenal axis during induced gonadal suppression.
CONTEXT: Sex-related differences in the stress response are well described in the animal literature but in humans are inconsistent and appear to reflect both the method used to stimulate the hypothalamic-pituitary-adrenal (HPA) axis and the age of the subjects. Sex-related differences in reproductive steroid levels further confound efforts to define the specific role of the sex of the individual in stress axis responsivity. OBJECTIVE: The aim of this study was to address this role independent of differences in reproductive steroid levels. We compared HPA axis response to pharmacological (CRH) and physiological (exercise) stressors in two groups of young to middle-aged (18-45 yr) men (n = 10 and 8) and women (n = 12 and 13) undergoing gonadal suppression with leuprolide acetate (monthly im injection of 7.5 mg in men and 3.75 mg in women). DESIGN: Exercise and CRH stimulation tests were performed during induced hypogonadal conditions. SETTING: The study was conducted at a National Institutes of Health Clinical Center Outpatient Clinic. PATIENT OR OTHER PARTICIPANTS: Male and female normal volunteers participated in the study. MAIN OUTCOME MEASURES: The main outcome measures were stimulated ACTH and cortisol levels. RESULTS: Both CRH (1 microg/kg) stimulation and graded treadmill exercise stimulation occurred in the month after the second leuprolide injection to ensure gonadal suppression. Despite the absence of sex differences in estradiol or testosterone at the time of testing, men showed increased stimulated ACTH (repeated-measures ANOVA for CRH, P < 0.005) and cortisol (repeated-measures ANOVA for exercise, P < 0.05) compared with women. Among the summary measures, area under the curve (AUC) for cortisol was significantly greater in men than women after exercise. Although the AUC for ACTH was not significantly different across sexes, the initial AUC (0-30 min) was significantly greater in men for both procedures. No significant sex differences were found in a measure of adrenal responsivity, the cortisol to ACTH ratio, for either procedure. Cortisol-binding globulin levels did not differ between men and women and were not correlated with stimulated HPA axis measures. These data confirm earlier reports of sex differences in stimulated HPA axis activity and demonstrate that these differences exist even under induced hypogonadal conditions (i.e. in the absence of characteristic differences in reproductive steroids).
Adolescent↗
Ingestion of tyrosine: effects on endurance, muscle strength, and anaerobic performance.
Acute tyrosine ingestion is thought to improve aerobic endurance, muscle strength and endurance, and anaerobic power of men undergoing severe physiologic stress. In a double-blind, crossover study, 20 men (32 +/- 1 y old) underwent 2 loadcarriage treadmill sessions, 1 after taking tyrosine (150 mg/ kg L-crystalline tyrosine) and 1 after taking placebo. Tyrosine dosage was based on subject weight and ingested 30 min before load carriage. A physical performance battery was administered after the load carriage: maximal and submaximal handgrip, pull-ups, and stair stepping with weight. Total time on treadmill was not significantly lengthened with ingestion of tyrosine (118.9 +/- 1.4 min) as compared with placebo (119.2 +/- 1.2 min). Total power for stair stepping (tyrosine 223 +/- 8 watts, placebo 216 +/- 9 watts) and muscle strength and endurance (handgrip) was not significantly improved by tyrosine ingestion. The results indicate that acute ingestion of tyrosine by healthy men has no measurable effect on endurance, muscle strength, or anaerobic power.
Adult↗
Femoral neck stress fractures and metabolic bone disease. 2001.
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Bone Diseases, Metabolic↗
Health assessment of U.S. Army Rangers.
PURPOSE: Assess the health behaviors of U.S. Army Rangers, including their diet and physical activity patterns, and their use of alcohol, tobacco, and nutritional supplements. METHODS: Army Rangers (N=38) completed selected self-report and food frequency questionnaires, and anthropometric measures (height, weight, circumferences) were taken. RESULTS: Dietary patterns were collected from questionnaires that asked respondents to report the frequency of usual consumption from a list of foods over a period of 1 year. The data collected indicated a diet high in fat (38.0% of energy) and low in carbohydrates (41.9%). Protein intake (17.9% of energy) was consistent with recommendations for endurance and strength training athletes. Hours engaged in physical activity averaged 12 per week. Overall, 76% of the volunteers reported using alcohol on a regular basis, and 52.6% used some form of tobacco: 50% reported using either snuff or chewing tobacco. The use of supplements was high with 13% taking creatine and ephedrine products on a regular basis. CONCLUSION: Although physical activity patterns indicated a high level of activity, dietary and other health behaviors, such as smoking, alcohol use, and patterns of supplement use, suggest that health education programs may be important in this select Army population.
Adolescent↗
Attitudes and knowledge about continuous oral contraceptive pill use in military women.
OBJECTIVE: The goal of this study was to determine attitudes toward oral contraceptive pill (OCP)-induced amenorrhea among U.S. Army women. METHODS: A volunteer sample (N = 154) of Army Active Duty, Reserve, and National Guard women completed an anonymous survey. RESULTS: Desire for temporary amenorrhea was high with 86% (+/- 6%, 95% confidence interval [CI]) and 83% (+/-6%, 95% CI) desiring amenorrhea during field training and deployments, respectively. Fifty-four percent were unaware that OCPs can induce amenorrhea; only 7% (+/-4%, 95% CI) have used this practice during deployment. If made available with education, 49% (+/-8%, 95% CI) would use this practice. Logistic burdens of menstruation were associated with higher rates of desirability for OCP use with soldiers desiring OCPs rating their inconveniences significantly higher than those who did not desire OCPs (p < 0.05). CONCLUSION: Although a significant number of soldiers desire OCP-induced amenorrhea, a large deficit in knowledge exists. Routine education as an Army-wide standard is warranted.
Age Distribution↗
Choline ingestion does not modify physical or cognitive performance.
OBJECTIVES: This study was undertaken to determine whether choline ingestion improves physical and cognitive performance following exhaustive load carriage exercise. METHODS: In a double-blind crossover study, 13 men (28 +/- 2 years) underwent four test sessions: load carriage treadmill and no-load carriage test sessions after taking choline or placebo. Physical and cognitive performance batteries were administered at the end of the test sessions. RESULTS: Choline ingestion (50 mg/kg body weight) significantly (p < 0.05) increased plasma choline concentrations during the load and no-load carriage test sessions. However, plasma choline did not decrease during the placebo load carriage test session, an indication that load carriage does not deplete circulating choline. There were no differences in performance on physical tasks, and choline ingestion had no effect on reaction time, logical reasoning, vigilance, spatial memory, or working memory. CONCLUSION: In healthy men, supplemental choline did not affect physical or cognitive performance after exhaustive physical activity.
Adult↗
Musculoskeletal injuries in an Army airborne population.
To maintain operational readiness, military personnel engage in vigorous physical and training activities that carry risk for injury. A 1-year prospective cohort study, starting April 1996, was conducted at Fort Bragg, North Carolina among 1,965 members of the 82nd Airborne Division to quantify musculoskeletal injuries. Information collected included type of injury, site, circumstances, and resultant limited duty days. These soldiers suffered 508 overuse injuries (including 38 stress fractures), 1,415 traumatic injuries (including 100 fractures), and 101 unclassified injuries. Injury rates were 6.8% per soldier per month for traumatic injury and 2.4% for overuse injury (totaling 1.2 injuries per soldier per year). Injuries resulted in 22,041 limited duty days, averaging 11 days per injury and 13 days per soldier (4.5% of total workdays). Fractures and stress fractures/reactions produced the most days lost per case. Most of these injuries resulted from military-specific activities.
Adult↗
Depressive mood symptoms and fatigue after exercise withdrawal: the potential role of decreased fitness.
OBJECTIVE: Depressive symptomatology is more prevalent among sedentary than physically active individuals. The present prospective study examines whether withdrawal of regular aerobic activity provokes depressive mood symptoms and fatigue, and to what extent reductions in fitness levels contribute to the development of these symptoms. METHODS: Forty participants (mean age of 31.3 +/- 7.5 years, 55% women) who exercised regularly (> or = 30 minutes aerobic exercise > or = 3 times/week) were randomized to aerobic exercise withdrawal (n = 20) or to continue regular exercise (n = 20) for 2 weeks. Protocol adherence was documented using ambulatory actigraphy. Negative mood was measured with the Profile of Mood States (POMS), depressive symptoms with the Beck Depression Inventory-II (somatic and cognitive-affective components), and fatigue with the Multidimensional Fatigue Inventory (MFI). Fitness levels were documented by cycle ergometry testing. RESULTS: Fatigue and somatic depressive symptoms emerged after 1 week of exercise withdrawal (p = .05) and subsequently predicted the development of cognitive-affective depressive symptoms at 2 weeks (beta = 0.62; p = .046). Exercise withdrawal also resulted in increased negative mood (POMS; p < or = .01), and this increase was correlated with decreases in fitness level (r = -0.36, p = .03). Decreased fitness was related to increased POMS fatigue (p = .003) when statistically adjusting for baseline fitness levels and group condition. CONCLUSION: Depressed mood and fatigue are commonly observed in individuals deprived of usual exercise activities, and the increase in fatigue may be partially mediated by reduced fitness levels. These findings may explain mood changes in response to short-term exercise withdrawal such as injuries and recovery from medical procedures that do not require full bedrest.
Adult↗