Annals of Military and Health Sciences Research
Year:2007 | Volume:5 | Issue:2 (SERIAL NUMBER18)|Papers Count:23

Background: Pneumonia is the second most frequent nosocomial infection. The incidence ranges from 4 to 50 cases per 1000 hospital admissions. The purpose of this study was to determine the prevalence of nosocomial lower respiratory tract infection caused by multi drug resistance bacteria in patients submitted in Baqyiatallah hospital during one year of period.Materials and Methods: The study was conducted prospectively during a period of 12 months from March to February 2005 in Baqyiqtallah hospital in Tehran, Iran and focusing on respiratory tract microbiology in the first 24 h following diagnosis of acute respiratory distress syndrome. Bacterial strains were isolated from various clinical samples of patients and identified by the conventional methods. Susceptibility testing was performed on isolates using the agar disc-diffusion technique.Results: The prevalence of nosocomial pneumonia during this study period was 41.7%.The most nosocomial infections were belonged to intensive care unit (ICU). The most prevalent organism was Staphylococcus aureus (41.4%) followed by Pseudomonas auroginosa (26.7%).Conclusion: Nosocomial pneumonia rate in current study was lower than those reported by other researchers; however, the most prevalence of nosocomial pneumonia was from ICU and patients with more than 50 years of ages. There is a need to study more the causes of nosocomial pneumonia and development of preventative strategies in order to prevent the spread of nosocomial infections.

Background: To determine the incidence and risk factors of acute mountain sickness (AMS) in trekkers in different pathways of Damavand. Although it is well known that Iranian trekkers suffer from acute mountain sickness (AMS) in south pathway of Damavand, not much is documented about the incidence of AMS in the other pathways of Damavand Mountain, trekkers that go to high altitude from different pathways and their related contributing factors.Material and Methods: This study was a descriptive cohort study. During four weeks (in summer 2006) a population of 207 trekkers was studied. AMS symptoms, were assessed by an extensively used standard questionnaire (Lake Louise), applied at 2900 m above sea level, and during descent from summit Damavand (about 4200m) at south and north east pathways of Damvand in Iran Alborz Mountain.Results: The overall incidence of A.M.S. was 53.5%. The mean age of trekkers was 35.08 (±11.88) and 85.8% of the study population was men. Men did not differ significantly higher rate of AMS from women. The incidence being increased in those who begin climbing from south pathway (P=0.001), amateur climbers (P=0.000), a previous AMS experience or high altitude illness (P=0.031), a history of upper respiratory infection during last week (P=0.017), begging hour of ascent (P=0.02) and sleep in high altitude (P=0.01).There was not any relation between AMS and age and descending rate (P<0.05).Conclusions: Data show a strong relation between experiences mountaineer, history of AMS, pathway of climbing and the incidence of acute mountain sickness at Damavand Mount that didn't report previously.

Background: Nicotine dependency appears very quickly and strongly affected by environments condition. Smoking caused secondary death by immionosystem debilitation. Almost 25.6% of high school student in Tehran have smoking experience. The men who are in hard condition of battle were dependent on nicotine 2 more time. This study was done to determine Relative Risk (RR) of smoking in conscripted soldier in Tehran since 2005-6Materials and Methods: This descriptive cross sectional study was done on 385 conscript of NEZAJA Garrison. Clustered stratified sampling was done to select the samples from 3 tehran NEZAJA Garrison. The diagnose of disease based on DSM-IV-TR criteria by psychologist interview and diagnosis. The diagnosis based on self report of NEZAJA conscript.Results: Most of the conscript of NEZAJA has primery education (42. 1%), rural (50. 9%) and 14. 3% of them were smoker 22. 1% of them have history of smoking. (87. 3%) of them had been smoker in selective service. The most incidence of smoking addiction was occur before selective service period (22%) and (13%) in period of selective service. Sectional prevalence in selective service period (7%) is less than before selective service period (14. 3%). The prevalence of smoking was less before selective service period (22.1%) and (19.5%) in selective service period (RR=2. 02). There is increase in prevalence of smoking about 7.3% in selective service period.Conclusion: This study on the conscripts of NEZAJA garrison showed the service in army despite of prescription and limitation of Tehran garrison based on smoking forbiddance, there is an increase in smoking addiction.

Background: Spinal Anesthesia has numerous indications in lower abdomen surgery, but duration of analgesia and anesthesia is one of the limitations of this method. Lidocaine-the most common drug in Spinal anesthesia causes a short term anesthesia & analgesia which is lower than one hour. Today different kinds of drugs are for enhancing onset increasing intensity and analgesia duration in spinal anesthesia such as magnesium sulfate which it blocks NMDA receptors.Materials and Methods: In the randomized double blind clinical trial study, 80 patients candidate for first cesarean surgery in Shariati Hospital were divided in to two groups. In control group 2ml Lidocaine 5% + 0.5ml sterile water was injected and in the study group 2ml Lidocaine 5% + 0.5ml magnesium sulfate 10% without preservative was injected. The patients were immediately tilted to head up position.Results: Level of sensory block was evaluated by pin-prick test in midclavicular line. Analgesia duration was considered from the time of injection until the patient's request for analgesic or complaining of pain. Anesthesia level was T6 in most patients. Analgesic duration in case group was between 160.8+49.1 min, in control group was 113.3+7.3 min. That is statistically significant (p=0.001).Conclusions: When Mgs04 is added to lidocaine in spinal anesthesia, the duration of analgesia is increased significantly (P<0.05). This increase of duration of analgesia was not accompanied by increase of side effects. Based on the results of our study, complications such as nausea, vomiting, dyspnea during the surgery and in the recovery room, hypotension during surgery were not statistically different between two groups (p>0.05). 

Background: Nasal polyps are benign tumor that has yellow gray calor similar to mole form, and commonly are bilateral, pedenculated, multiple and, mobile that original from nasal, sinus mucosa and lateral wall of nasal. Mostly of polyps has tendency to relapse because polyps polyps has manifestation of allergy and underlying allergy is not controllable treatment has chemical and surgery method. endoscopic surgery of polyp is a new technique that was done primarily 100 years ago bye hirchmann and subside with past surgery method and this surgery was done on baghiyatallah hospital sinus end of 1376 on this technique polyps remove polyps from puncturing middle meatus and reduce the recurrence ratio.Method: On this study that was a retrospective study the prevalence of recurrence ratio of nasal polyp after sinus endoscopic surgery that was done during 1380- 1384 on baghiyatallah hospital followed this result compared with non -endoscopic study. Overall 200 patients selected randomized that minimal age of ratio was 3 years and maximal age was 89 years. On this group 100 patients operated with endoscopic surgery and 100 patient with non -endoscopic surgery.Result: The average of age in this patients was 40 years and most of them were male recurrence of nasal polyp on non endoscopic group was 75 patient (75%) and 25 patient (25%) was without relapse until 1382. and on the sinus endoscopic surgery 36 patient (36%) had recurrence and 52 patient (52%) had not recurrence and is not present information about residual patient. The mean time of survival on the non surgical endoscopy was 60 month and on the sinus endoscopy surgery group was 41 month and 24 month survival was 95% and 36 month survival was 36 month and 60 month survival was 50% and 84 month survival was 25%. 95% of patient who had surgical operation with non - endoscopic procedures they remained at least 12 month without recurrence and with endoscopic procedure they remained at least 24 month without recurrence. 50% of patient, who had non - endoscopic sinus procedures, remained at least 66 month without recurrence and in endoscopic this time was at least 72 month.Conclusion: In this study that did in baghiyatalla hospital Recurrence ratio of patient after sinus endoscopic surgery) was less and life time (remission) without recurrence was the more.

Background: Appropriate treatment of pneumococcal meningitis especially in children is an important problemdue to high mortality, morbidity and multiple drug resistance. We studied antibiogram in pneumococcal meningitis older than two months, Shohada and Imam Hosein hospitals, 1380-1385. Materials and Methods: In this prospective and cross sectional process research we measured antibiogram in 20 positive bacterial culture in CSF with qualitative disck diffusion test.Results: Antibiotic resistance of 20 Streptococcus pneumoniae patient was: penicillin R. in 35%, chloramphenical R. in 10%, third generation cephalosporins R. in15%, rifampicin R. in 5%. Conclusion: Antibiotic Resistance of our study is compatible with other studies. There is an important rising antibiotic resistance among Streptococcus pneumoniae. Therefore it seems that third generation cephalosporin’s alone and better with vancomycin is a suitable therapy.  

Background: Breast cancer is the most common malignancy in women. Some biologic markers are used for determination of prognosis and prediction of treatment response. Cytokeratin 7 (CK7) is an Intermediate filament protein of epithelial cells. The purpose of this study is to determine the expression of cytokeratin 7 in primary breast cancer and it's correlation with grade, stage and axillary lymphnode involvement.Materials and Methods: This was a cross-sectional study performed on 75 samples of patients with breast cancer admitted in Mostafa Khomeini Hosptial (2000-2005). After preparing the samples, a tissue section from each sample was obtained. One of the tumoral sections and one of the lymphnode sections were stained by H & E. We determined the type of the tumor, the number of lymphnodes, the stage and the grade of the tumor. We studied cytokeratin 7 with monocolonal antibady by IHC.Results: Our study showed that 93.3% of samples were positive for cytokeratin 7. 70.7% of patients had lymphnod involvement, 57.3% of samples were in stage 11and the most of patients (42.7%) were in grade 11.In this study, we found significant relation between cytokeratin 7 and lymphnode involvement (P=0.002), lymphnode number (P=0.004) and stage (P=0.002). We didn't find any relationship between CK7 and grade.Conclusion: According to he results of previous studies and our study, it seems that cytokeratin 7 is a prognostic factor in breast cancer. But further investigations with more specimens and long-time follow- p are required to clarify the exact role of cytokeratin 7 in prognosis of breast cancer.

Background: Fistula is one of the most complications after total laryngectomy. We innovate a new method that is simple and without complications specially pharangocutaneous fistula with this study we try to achieve an objective confirmation of the efficacy given by innovative method for closure of defect in total laryngectomy against the conventional method for closure.Materials and methods: Study was done as clinical trial, experimental type. 40 patients with SCC of larynx in T3 or T4 grade were chosen. All patients were done total laryngectomy by standard method, 20 patients (case group) were repaired by new method for closure and 20 patients were repaired by standard method (Control group). Lengths of operation and hospital stay, bleeding, hematoma, seruma and fistula formation were charted for every patient and statistically analyzed.Results: Min age of control group was 59.8±7.8 years and in case group 61.3±6.4 years. Length of operation in control group was 150±23.2 minutes and in case group 130±18.7 minutes (p<0.001). Length of hospital stay in control group was 10.5±1.6 days and in case group was 3.1±0.2 days (p<0.001). Bleeding, hematoma, seroma were not seen in any groups. Pharyngo cutaneous fistula was occurred in 3 patients in control group and none in case group.Conclusions: New method for closure would shorten the length of operation and hospital stay. Because the lack of fistula, we hadn't psychologic and traumatic side effects of tube feeding. This method had no complications. We suggest use of this innovative method as a simple and efficase for closure of wounds of total laryngectomy.

Background: evaluation of a550ciation between CEA amount and stage of colorectal cancer and answer to this question: If CEA amount increases appropriately with stage progression?Materials and Methods: this descriptive research was performed on 120patients with colorectal cancer, who were admitted in Taleghani hospital from beginning to end of the year 1384. The necessary information was gathered throu9h questionnaire and evaluated by spss program (version 11.5)Results: Acquired information showed that in stage D, in most cases, CEA amount was more than 100 ng/ml which means 30 times more than normal range, but in other stages of disease was no significant correlation between CEA amount and stage.Conclusion: about association between CEA and stage of colorectal cancer, which was the major goal of this research, information show that in the most of cases ( 66,6%) in stage D, CEA amount was 30 times more than normal range, but in other stages of disease was no significant correlation between CEA amount and stage. So CEA amount lonely can't be definite preventatives for rate of progression of disease. Although amount of more than 100 ng/ml will probably express metastasis of colorectal cancer (stage D).

Background: Thalassemia is accounted as the most common hereditary anemia through our region. Due to abnormality in synthesis of globin chains in red blood cell resulted from this disease, these globules have not natural life and then will die immediately. Appropriate therapy for this disease includes a regular monthly blood injection. However, in the approach patients will inevitably confront with side effects particularly iron overloads and iron sediment along tissue of body critical organs including heart, ductless glands and liver. Examining more research examples, by the study it attempted to determine more precisely plenty of adenoidal abnormality between the Iranian thalassemia patients for pre diagnosis and offering necessary medical measures.Materials and Methods: This was a descriptive research and included all the patients suffering from thalassemia major referring to medical centers linked with the Iranian blood transition institute. Census applied for sampling from all the patients. Initially, reports of adenoidal experiments as well as other associate parameters provided from medical folders.Results: From 437 understudy thalassemia patients, sexual mutation rate (SMR) was investigated along various age groups. There was no difference in those patients who, suffered from intermediate thalassemia and there was no relation between various age groups in the case of SMR classification (P=0/00). Average of ferritin had no statistic difference among al 5 groups (P=0/6).Conclusion: Comparison of results between present research and similar studies conducted through Iran and those performed in abroad on growth abnormalities and puberty in thalassemia patients show that subject patients of this study statistically suffer from fewer difficulties than in case of patients in other studies.

Background: Focal hyperhidrosis is not rare, affecting nearly 3% of the population. This condition is often socially and professionally debilitating, leading to significant quality of life impairment. Hence, its treatment is an issue of importance. To determine the comparative efficacy of tap water iontophoresis to iontophoresis with atropine.Materials and Methods: We undertook a single-blinded right-left clinical trial in 16 patients with palmoplantar hyperhidrosis attending to dermatology clinic of Loqman Hospital during 2006. We compared the efficacy and the duration of symptom relief following iontophoresis with atropine to iontophoresis with tap water according to both objective (Iodine Test) and subjective (patients' judgment) criteria.Results: therapeutic efficacy was 81.25% after 5 weeks and 100% after 10 weeks of iontophoresis. Following treatment with tap water iontophoresis and atropine iontophoresis, patients reported similar improvement in two hands. Atropine iontophoresis was superior to tap water only after five sessions; however it was not statistically significant (P> 0.05).Conclusion: We postulate that the similar efficacy of atropine iontophoresis when compared with tap water iontophoresis relates to mechanism of action of iontophoresis which is not affected by atropine, additionally.

Background: chronic sinusitis is defined by the presence of a characteristic group of symptoms, with no radiologic imaging as part of the diagnosis. Nevertheless, many clinicians currently use the sinus CT scan for two important clinical purposes: (1) as a diagnostic test confirming the presence of chronic sinusitis and (2) as an indicator of disease severity. In the present study, we examined radiologic correlates of the patients symptoms for rhino sinusitis.Materials and methods: two hundreds consecutive patients undergoing computed tomography (CT) scans of the sinuses were studied at Milad hospital. University Patients were evaluated prospectively with a questionnaire based on their symptoms, and their CT scans were graded according to the Lund-Mackay scoring system.Results: Of the 198 patients, 111(56.1%) had positive scans (Lund-McKay score, >1). The most sensitive and specific symptoms were nasal congestion (78.4%) and recurrent cough (69%) respectively. The Kappa coefficient for nasal discharge and nasal congestion were 0.171 and 0.181 indicating poor agreement between them and CT positivity. The patients suffering from nasal congestion and recurrent cough significantly had more severe sinusitis according to their Lund- McKay score than who didn't.Conclusion: Based on this study, it appears that the specificity and predictive value of nasal discharge, nasal congestion and recurrent cough are more significant than others. Additional validating data may provide guidance for improving the sensitivity and specificity of symptom-based diagnostic instruments for sinusitis.

Background: Steroids therapy remains controversial for the patients with stroke, but some physicians administrate it yet, in such a patient. For this reason, in a double-blind clinical trail, we evaluated the dexamethasone effects on the motor function of the patients with stroke.Materials and methods: In a double-blind clinical trail, and in contrast to placebo, eighty patients presented with hemiplagia and with the impression of stroke enrolled in two groups that received dexamethasone and placebo. In the first admission day, the patients evaluated for risk factors, muscle force, level of consciousness, sphincter and speech disorders. Muscle forces reevaluated for five days later. All the data extracted with a checklist and compared by descriptive statistics and x2, t test, Mann-Whitney, Friedman and repeated measure AN OVA tests.Results: Four patients excluded from the study for death. The age mean was 67.93±8.84 and 39 and 37 were male and female respectively. Except for sex and smoking, there was no difference in two groups. The muscle forces improved significantly in the patients in each groups (P value=0.000), but we didn't find any difference between them (P value=0.59). Also we didn't see any steroid complication.Conclusion: This study failed to demonstrate any benefit of dexamethasone in improving the motor function of stroke patients.

Background: Psoriasis of scalp is a multi-factorial disease and one of the suggested theories is role of yeasts. Hence, current study has performed to determine the prevalence of yeast in culture of the scalp and anti-yeast antibody in serum of psoriatic patients in comparison with control population.Materials and methods: Current study is a comparative cross-sectional survey among 80 subjects in two groups of 40 persons including psoriatic patients and control group. They were selected in a simple random manner among those attending to dermatology clinic of Imam-Khomeini Medical Center of Tehran during 2000.Results: 38 patients (95%) in psoriatic group and 5 subjects in control group had positive culture of scalp for yeasts (P=0.0001). There was a significant difference between psoriatic and control group from point of antibodies against Candida Albicans and Pityrosporum Ovale (P=0.0001).Conclusion: Yeasts may have an important role in pathogenesis of psoriasis disease and therefore using anti-yeast agents may be therapeutic choice for scalp psoriasis.

Background: The aim of this study is comparison of early maladaptive schemas between patients with personality disorders (cluster B) and normal subjects. Materials and Methods: In this research participants were fifty patient soldiers with personality disorders (cluster B) according to diagnosis psychiatric group and sixty health individuals (according to general health inventory scores). Both of them completed young schema questionnaire.Results: There was significant difference between normal and patient subjects in 12 schema of 15 schema in this questionnaire. In abandonment, unrelenting standards and self-sacrifice there was not significant difference.Conclusion: cognitive elements especially schema have important role in vulnerability to the mental disorders.

Introduction: Awareness during anesthesia is an unfavorable side effect for patients and about half of them worry about it. This side effect differs depending on different conditions of patient and anesthetic's drugs. According to special drug limitations in pregnant women we studied awareness rate among pregnant women during cesarean section with general anesthesia from 1384 to 1385 in shohada hospital. Material &methods: It was a cross sectional study during 1384-1385 and included all patients with more them 18 yrs old age and ASA class I which had cesarean section with classic general anesthesia and they didn't have any systemic problem during or after operation. 24 hrs after surgery they were interviewed by special questionnaire containing 10demographic questions and 14questions about symptoms during surgery and anesthesia. Our results were presented in diagrams and we used K2 test for statistical analysis. Results: None of the patients heard the new born cry during anesthesia. One of the most common things due to awareness during general anesthesia was hearing personal voices and instrument sounds (about 3%). The most common thing was inability to move during anesthesia (about 8%). Dreaming during cesarean section anesthesia was about 2.3%.Conclusion: If we considered all the mentioned things as awareness, our drug limitation use during cesarean section causes relative high prevalence of awareness during anesthesia. 

Background: Appendiceal duplication is one of the rare appendiceal anomalies with an incidence between 0.004% and 0.009% appendectomy specimens. Herein we present a 34 year old woman with appendiceal duplication, which caused in acute abdomen.Case presentation: A 34-year-old woman was admitted on an emergency basis with a 1O-dayabdominal pain, loss of appetite, nausea, and. There was localized tenderness at Mc Burney's point, moderate rebound tenderness, guarding the blood count showed leukocytosis (WBC: 16800/mm3) with a shift to the left.Appendectomy was done and patient discharge after 3 days. Because fecal fistula and limited response to conservative management right hemicolectomy was done and pathology reports a second appendix in iliocecal junctionConclusion: In conclusion, appendiceal duplications are a rare finding. They may be confused with cecal diverticular disease or even colorectal cancer. The classification system of these abnormalities is important as a missed Type B appendix may result in serious clinical and medico-legal consequences. In addition, a double appendix can be associated with other congenital abnormalities. It is therefore important that trainee surgeons are aware of the anatomical anomalies and malpositions of the appendix.