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Pregnancy is a risk factor for the progression of diabetic retinopathy (DR) in women with pre-gestational diabetes. Australian screening guidelines recommend DR screening in the first trimester of pregnancy. The rates of DR screening in pregnant patients with pre-gestational diabetes are unknown in Australia.To determine the rates of DR screening in pregnant women with pre-gestational diabetes at Alice Springs Hospital Diabetes Antenatal Care and Education (DANCE) clinic.Retrospective review of women with pre-gestational diabetes who attended the DANCE clinic between July 2016 and June 2020.There were 146 pregnancies in 144 individual women included in this review. There were 93% (n = 134) who identified as Aboriginal but not Torres Strait Islander. DR screening was performed in 23 (16%) pregnancies, in which DR was present in six (26%) and no retinal abnormality was found in 17 (74%). Of seven (5%) women who had a history of DR, only three had a screen during the pregnancy period. The location of the DR screen included Alice Springs Hospital (17%, n = 4), Alice Springs general practice clinics (35%, n = 8) and remote NT community clinics outside of Alice Springs (39%, n = 9). The trimesters in which women received their DR screens were: trimester 1, 45%, n = 10; trimester 2, 39%, n = 9; trimester 3, 17%, n = 4.The minority of pregnant women who attend the DANCE clinic at Alice Springs Hospital received DR screening in adherence with national guidelines.

Introduction We present a real-world experience of a U.S. Navy Hospital Ship deployed amid a global Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surge and the challenges of navigating policy while maintaining a mission-focused itinerary in an operational environment. Materials and Methods We performed a chart review of SARS-CoV-2 cases from April 18 to September 20, 2022, within a closed population of fully vaccinated adults onboard the USNS Mercy (T-AH 19) during the 5-month 2022 Pacific Partnership mission to Guam, Vietnam, Palau, Philippines, and the Solomon Islands. Results There were 123 total SARS-CoV-2 cases over the course of the mission, constituting 16.6% of the total crew (123/741). No more than 14 service members were actively infected at a given time (1.9%, 14/741). The average number of active cases at any given time was 0.8 (1.9 SD, 0.1% [0.8/741]), and just 14 of these were shipboard secondary cases. No significant operational requirements of the ship were impacted by infection-related manning shortages, there were no hospitalizations, and all infected members experienced full recovery. Conclusions Despite ongoing cases throughout the majority of the mission, a healthy immunized crew experienced no serious cases and minimal impact on operational effectiveness.

The coronavirus (COVID-19) pandemic continues to bring challenges in identification and management of which the “happy hypoxic” or silent hypoxia presentation has been found to present its own unique challenge. A 67-year-old African American COVID-19 positive female presents to the emergency department (ED) with a chief complaint of decreased oral intake and responsiveness, oriented and stable, with oxygen saturations found to drop as low as 47%. The patient was successfully managed with supplemental oxygen and determined to be a “happy hypoxic” with recent polysubstance abuse. Silent hypoxia or the “happy hypoxic” patient is another unique phenomenon associated with the variable presentations of COVID-19. Multiple etiologies and pathophysiologic explanations exist to explain this stable patient whom would otherwise be expected to require aggressive management with a poor prognosis. An alternative diagnosis should be explored for those silent hypoxic patients with symptoms.

We discuss a 23-year-old active duty male who presented to the emergency department with left shoulder pain after deadlifting heavy weights the day prior. His physical examination revealed a nontender and otherwise unremarkable left shoulder with full range of motion and mild tenderness to palpation in the left upper quadrant of the abdomen. A bedside focused assessment with sonography for trauma (FAST) examination showed free fluid in the abdomen and a computed tomography scan showed a splenic laceration and splenomegaly. He later tested positive for infectious mononucleosis. This is the first case report of atraumatic splenic laceration after heavy weight lifting. This case illustrates the importance of a broad differential and high index of suspicion in the patient with undifferentiated abdominal pain in order to diagnose a potentially fatal disease.