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Some medications used in the treatment of SLE may similarly impact on an individuals ability to safely execute flight or air traffic control duties. We propose an aeromedical disposition decision flowchart that would guide aviation medicine practitioners in the management of individuals diagnosed with SLE to ensure optimal and safe performance in their respective occupational settings.Seah BZQ, Chua CG. A proposed aeromedical disposition flowchart for systemic lupus erythematosus. Aerosp Med Hum Perform. 2020; 91(10)826832.BACKGROUND Frequent migraine headaches are disabling and aeromedically disqualifying. Four new monoclonal antibody medications, targeting calcitonin gene-related peptide (CGRP), have been approved by the U.S. Food and Drug Administration (FDA) since 2018, with more expected in the coming years. These medications present new alternatives for the treatment of migraine unresponsive to other therapeutic and prophylactic agents.CASE REPORT We present a case of a 45-yr-old commercial pilot who presented with migraine headaches increasing in frequency to 1315 per month in spite of the use of propranolol for prophylaxis and sumatriptan for abortive treatment of the headaches. Upon presentation, he was not flying due to his frequent headaches and he was started on monthly subcutaneous injections of fremanezumab. Following his second injection, his headaches stopped entirely, and he has continued on the medication and not experienced another migraine headache. He underwent an aeromedical neurology evaluation and consideration for Authorization of Special Issuance of Medical Certificate, which was granted by the Federal Aviation Administration (FAA).DISCUSSION This is the first case to our knowledge of the successful use of an anti-CGRP monoclonal antibody medication in an active pilot. The pilot appears to be a super responder to the medication, having achieved complete remission of a nearly life-long condition. Though only a small portion of treated individuals will see this sort of response, these medications represent an effective additional option for migraine prophylaxis in the pilot population.Garber MA, Sirven JI, Roth RS, Hemphill JM. Migraine prophylaxis using novel monoclonal antibody injections in a commercial pilot. Aerosp Med Hum Perform. 2020; 91(10)824825.INTRODUCTION Due to the standard collegiate academic calendar (two semesters), U.S. Air Force Reserve Officers Training Corps (ROTC) cadets have an approximate 3-mo break over the summer in which physical training (PT) is neither regulated nor required. The purpose of this investigation was to determine if significant changes in cadet physical fitness assessment (PFA) scores occur after a 3-mo summer break when training is not mandatory.METHODS Male (N 28) and female (N 10) cadets performed the PFA in April and August. Cadets were split into two groups depending on if they participated in field training over the summer [FT; N 12 (men 6, women 6)] or did not [NFT; N 26 (men 22, women 4)] to determine if engaging in field training had any effect on performance.RESULTS Cadets performed significantly better on run time (7%), pushups (7.6%), sit-ups (5.8%), and overall composite score (3.6%) before summer break compared to after. Significant time group interactions were observed for abdominal circumference and run time. Abdominal circumference paired samples t-tests indicated that while the FT group did not differ between the spring and fall time points, the NFT did. find more There was a main effect for time in which cadets had a significantly larger abdominal circumference in the spring compared to the fall semester.CONCLUSION Nonmandatory physical training over summer break may significantly decrease a cadets performance on the PFA. Additionally, it appears that even the inclusion of field training for some cadets was not enough to prevent the detraining that took place over summer break.Mackey CS, Johnson Q, Dawes JJ, DeFreitas JM. Physical performance among Air Force ROTC cadets following non-mandatory training. Aerosp Med Hum Perform. 2020; 91(10)818823.BACKGROUND The increased utility of CT coronary angiography (CTCA) in cardiovascular screenings of aircrew has led to the increased detection of asymptomatic coronary artery disease (CAD). A systematic review of studies relevant to the interpretation of CTCA for the occupational fitness assessment of high-risk vocations was performed, with findings used to describe the development of a pathway for the aeromedical disposition of military aviators with asymptomatic CAD.METHODS Medline was searched using the terms CT coronary angiogram and screening and prognosis. The inclusion criteria were restricted to study populations ages > 18 yr, were asymptomatic, were not known to have CAD, had undergone CTCA, and with their associations with major adverse cardiovascular events (MACE) and other relevant cardiac outcomes reported.RESULTS Included in this systematic review were 10 studies. When compared to subjects with no or nonobstructive CAD, those with obstructive CAD on CTCA had hazard ratios (HR) for cardiac events ranging from 1.42 to 105.48. Comparing subjects with nonobstructive CAD and those without CAD on CTCA, a lower HR of 1.19 for cardiac events was found. The annual event rates of subjects with no CAD on CTCA were extremely low, ranging from 0 to 0.5%.CONCLUSIONS Based on the findings, we suggest that CTCA should only be performed in aircrew with higher cardiac risk profiles. Those found to have no CAD or minimal CAD (i.e., 25% stenosis) in a non-left main coronary artery on CTCA can be returned to flying duties. All other results should be further evaluated with an invasive angiogram.Cheong RWL, See B, Tan BBC, Koh CH. Coronary artery disease screening using CT coronary angiography. Aerosp Med Hum Perform. 2020; 91(10)812817.BACKGROUND Scuba diving activities expose divers to serious accidents, which can require early hospitalization. Helicopters are used for early evacuation. On the French Mediterranean coast, rescue is made offshore mainly by a French Navy Dauphin or at a landing zone by an emergency unit EC 135 helicopter.METHODS We retrospectively analyzed diving accidents evacuated by helicopter on the French Mediterranean coast from 1 September 2014 to 31 August 2016. We gathered data at the Center for Hyperbaric Medicine and Diving Expertise (SMHEP) of the Sainte-Anne Military Hospital (Toulon, France), the 35 F squadron at Hyres (France) Naval Air Station, and the SAMU 83 emergency unit (Toulon, France).RESULTS A total of 23 diving accidents were evacuated offshore by Dauphin helicopter and 23 at a landing zone on the coast by EC 135 helicopter without hoist. Immersion pulmonary edema (IPE) accounted for one-third of the total diving accidents evacuated by helicopter with identified causes. It was responsible for at least half of the deaths at the dive place.