Annals of Military and Health Sciences Research
Year:2004 | Volume:1 | Issue:4 (Serial Number 4)|Papers Count:10

Background: Coronary artery bypass graft (CABG) surgery is one of the most common surgical procedures in this era. The out come of this procedure depend on many factors, one of them is patient's underlying disease like diabetes. Materials and Methods: In this study we compared the results of CABG in diabetic versus non-diabetic patients. One hundred diabetic and one hundred non-diabetic candidates for operation has been selected and short term mortality and morbidity rates after surgery have been studied. Results: The morbidity rate in diabetics was 23% and in non-diabetics it was 20%. The mortality rate was 4% and 3% in diabetic group and non-diabetic group, respectively. The patients than 70 older had  significant increase in the complications after operation (P-value<0.05). Although hypertension was significantly higher in diabetic group but this factor has no effect on the incidence of complications in each group. Sixty patients had 3 vessels involvement in diabetic group, and 21 of them complicated after operation. This factor significantly increase the complications after operation in diabetic group (P-value<0.001). Conclusion: Diabetes has a relatively small positive effect on increasing overall morbidity after surgery. It seems that cardiovascular and infectious complications of bypass surgery are more prevalent in diabetic group. More studies are needed to accurately determine the impact of diabetes on post-op mortality and morbidity.  

Background: Most of the critically ill patients require mechanical ventilation and about %40 of time the patient receiving mechanical ventilation is spent in process of weaning. Materials and methods: In this study we compared three methods of weaning: Synchronised Intermittent Mandatory Ventilation (SIMV), Pressure Support Ventilation (PSV) of 5cm H2O and T-Piece in success of weaning, reintubation rate and outcome in 89 patients.75 Patients were Randomly Assigned In 3 groups of 25 In SIMV, PSV,T-Piece group and 14 in fourth group who had self extubation. All patients were followed until death or discharge of ICU. Results: Datas Like duration of mechanic alventilation, duration of hospitalization, reintubation and outcome were compared between groups. In PSV group the mean time of hospitalization (5.4±4.49 Days) (p<0.001), frequency of Reintubation (80%) (p=0.001), mortality rate (4%) (p=0.001) were significantly lower than other. Conclusion: The mortality rate was independently related to duration of mechanical ventilation (p=0.001) and reintubation (p<0.0001). This study has shown that pressure support of 5cm H2O Is suitable method and Advocated for Weaning.  

Background: Bleeding time is the most reliable test to assess platelets' function. We initiated this study to determine the relationship between preoperative bleeding time and postoperative hemorrhage.Materials & Methods: 149 patients underwent elective coronary artery bypass grafting surgery with no history of bleeding disorders, from winter 1380 till the first six month of 1381, were enrolled in a prospective descriptive study. Preoperative bleeding time, postoperative blood loss from left, right and mediastinal chest tubes and total blood loss during and after operation, duration of extracorporeal blood circulation, grafts' number and infused packed red blood cells and platelets units were measured. Results: There was no significant relation between total blood loss from thoracic tube with operation time (r =0.03), extracorporeal blood circulation time (r =0.21), graft number (r=0.09) and infused packed red blood cells units (r=0.03) or infused platelet units (r =0.12) (P>0.05). But the relations between bleeding time (sec) and blood loss from left (r=52), right (r=0.81) and mediastinal (r=0.79) chest tube and total blood loss of thoracic tube (r =0.70) (P<0.05) were significant. Conclusion: Bleeding time measurement is recommended to predict the postoperative bleeding.  

Background: According to the high prevalence of UTI in childhood, and regarding different sign and symptoms in different ages, it would be so important and difficult to diagnose it based on clinical and Laboratory findings, as one of the most important infectious disease in pediatric Medicine. The goal of this study is to determine the prevalence of the microorganisms which cause pyelonephritis as well as sensitivity and resistance to Antibiotics in order to make a good decision in Empiric Antibiotic therapy for pediatric pyelonephritis. Materials and Methods: One hundred and seventy patients (152 females) of monoclonal culture-positive pyelonephritis (>105colony counting), aged 2 months to 12 years, were investigated in Bahrami Pediatric Hospital (Tehran, Iran) during 1996-2003. Results: The most prevalent Microorganisms causing pyelonephritis were E.coli (61%), Enterobacter (33%), Klebsiella (3%), Pseudomonas Aeroginosa (1%), Staphilococcus Epidermidis (1%), Proteus (0.5%), and coagulase-negative staphilococcus (1.7%). The overall sensitivity rate of the above-mentioned microorganisms to antibiotics was: 93% to Ampicillin, 76% to Amikacin, 67% to Gentamycin, 19% to Co-trimoxazole, 85% to Nalidixic Acid, 78% to Nitrofurantoin, 19% to Cephalexin, 96% to Ceftriaxon,  and 96% to Ceftizoxime. Comparing antibiotic sensitivity in two periods (1996-1999 and 2000-2003), revealed that the sensitivity to Amikacin (100% to 90%), Cotrimoxazole(38% to 16%),and Nalidixic Acid (96% to 83%) were significantly decreased (P<0.05). Conclusion: According to this data, the best empiric therapy in pediatric febrile UTI is intravenous Ceftriaxone and the best oral prophylactic antibiotics for recurrent UTI are Nalidixic Acid and Nitrofurantoin. However, Co-trimoxazole and Cephalexin are not appropriate.  

Background: Measles is a contagious viral respiratory infection that accompany with skin rash and koplik spots. Vaccination against measles caused reduction of this disease in the world but miniepidemiy of measles occur in young adult and is still an important health problem in our country. Materials and methods: A Total of 360 soldiers were enrolled this study. The response rate of immunity against measles was evaluated. The age and education level were considered and serum level of IgG and IgM with cut-off OD were measured using ELlSA test. statistical analysis was made by SPSS software. Results: All of the cases were man with a mean age of 0.49+0.89 years. Of these, 22.5% had negative serology. There was significant difference between age and serologic results (P<0.02). High education level associated with higher serum positivity. Soldiers with low educational level, are susceptible for measles. Of cases, 22.8% were not immune against measles. Conclusion: Based on our findings, soldiers with lower level of education should be immunized against measles.  

Background: Lipid peroxidation (LP) is the major cause of damages to cell membrane that may lead to cell death. Reactive radicals generated in cell membrane can initiate oxidation of membrane polyunsaturated fatty acids (PUFA). Formation of hydroperoxides through free radical chain reaction causes modification of membrane molecules. Erythrocytes derived from normal individuals and certain patients react differently to the damages caused by LP products. These differences could be attributed to the efficiency of the antioxidant activity in the cells. In this study the rate of LP formation and antioxidant system change Was compared in RBCs obtained from major β-thalasemia, Iron deficient anemia (IDA) and control group;(n=30in each group). Materials and Methods: Lipid peroxidation was measured using thiobarbituric acid (TBA) reagent with spectorophotometric method. Results: Incubation of RBCs in presence of H2O2 shows that the concentration of malondialdehyde (MDA), the main LP product, is significantly higher in RBCs obtained from patients as compared to control group. Increased LP formation in major β -thalasemic and Iron deficient patients was 43% and 22% respectively. Conclusion: Correlation between LP formation and antioxidant activities was investigated in vitro, in presence and absence of various antioxidants such as; reduced glutathione, albumin and alpha-tocopherol. Both glutathione and catalase activities were lower in RBCs derived from patients as compared to their respective controls. According to the results vitamin E have a positive role in patients with major β-thalasemia.  

Background: Maligant Oncocytoma is an extremely rare tumor, specially in major salivary gland. To date, about 50 cases have been reported in the literature, mostly in parotid (34 cases). Distant metastasis has been reported in several cases. Recurrence rate is 25-52 percent.Case: We report a 20 years old man who had a right parotid mass since one year ago. The mass had been traumatized (blunt trauma) 2 months before our visit. Facial nerve was intact. Total parotidectomy with facial nerve preservation was performed. Conclusion: Most desirable therapy is curative surgery. Chemotherapy and radiotherapy have little effect. Patients must be followed up for long term, because fatal distant metastasis and recurrence are common.  

Background: Depleted uranium (DU), a waste product of uranium enrichment, has several civilian and military applications. It was used as armor, piercing, ammunition in international military conflicts and was claimed to contribute to health problems, known as the Gulf War syndrome and the Balkan syndrome. In this essay we discuss the use and production of depleted uranium and its effects on human health and also the way to reduce the side effect of these weapons will be discussed. Materials and methods: For this review article, we have searched through internet by the following key words; depleted uranium, uranium weapons. We have found more than 20 related articles. Results: Some soldiers, civilians and specially children who live in polluted area might suffer from kidney damage from depleted uranium if sufficient amount are breathed in, or contaminated soil and water are swallowed. The risk of cancer from internalized DU is comparable to other carcinogenic heavy metals. Since DU remains in air and objects people who live in polluted area will suffer from different genetic problems for many years. Conclusion: Our recommendations include annual water sampling in areas of high contamination, Frequent health evaluation of veterans who have been exposed to DU, environmental clean up, Survey of the outbreak of cancer, especially Lymphomas and Leukemia, in people who are in danger, participation of the responsible organizations and inhibition of production of such weapons

Background: Each year, millions of children are exposed to some form of extreme stressor. The traumatic events include war, natural disaster, painful medical procedure, limb amputation, severe burns, sexual and physical abuse, witnessing an extreme traumatic situation, sudden death of parents, home sickness, the loss of beloved objects or pets and even hearing about such an event involving a family member. Every year, three millions children are diagnosed as having posttraumatic stress disorders. The increasing strikes of wars, the event of September 11,2001and the unceasing social attacks in the Middle East underscore the importance of understanding how children react to this events. Materials and methods: This study is a review article and is based on 48 reputable sources about PTSD, published in 2000-2003. Results: The symptoms, of PTSD in children are fear, intrusion of recurrent memories of the event, replay the event in his or her mind, disorganized and agitated behavior, irritability, nervousness about everyone and every thing around, avoidance of thoughts, feelings or places that reminds the child of what happened and psychological numbness... Early intervention, social and parental support will help the child to cope the event. The body of lecture is about children and their psychological responses to war and the risk factors of PTSD and how a child copes with traumatic events and provides solutions for the reduction of psychological impression of war. Conclusion: Children are one of the wings affected by the war and this would influence their mental development, accurate intervention and diagnosis of the symptoms could duration and intensity of psychological disorders.