Annals of Military and Health Sciences Research
Year:2008 | Volume:6 | Issue:1 (SERIAL NUMBER 21)|Papers Count:18

Background: Surgical site infection is a major concern in surgery and has a high prevalence rate in many developing countries. There are many controversies on the use of drains as they may not reduce the risk of infections. In this pilot experimental study, we are introducing a modification in placing tube drains to reduce the risk of surgical site infections.Materials and methods: Ninety albino male rats were used in three groups. In group one (test), the drains were placed subcutaneously, and were then fixed to the skin after making a two-turn crossing-over circular loop. In group two (control), the drain was just simply tied to the skin and in group three (sham), a skin incision was created without any drain placement. Animals were followed for signs of infection for one week and were then examined for microbiologic evidences of infection.Results: There were no significant differences among groups in terms of clinical signs of infection; however, the colonization rate by gram positive cocci was significantly lower in test group (p<0.001).Conclusion: This finding implies that our method may impair retrograde transfer of germs into the surgical site hence reducing the rate of infections.

Background: Hepatitis is used for an extended range of clinical situations due to injuries from viral attacks, toxic and pharmacologic substances or immune mediated attacks on the liver which lead to inflammation and finally hepatic cell necrosis. Mostly, acute hepatitis is due to viral infections. These agents are A, B, C, D, E and G hepatitis viruses, which B and C are the most important.Material and methods: In this interventional study, 230 soldiers were selected randomly. In both preeducational (pre-test) and post-educational (post-test) stages, all soldiers were examined with questionnaire about hepatitis transmission and then the results of two stages were compared.Results: All 230 cases were male and mean age was 22.58 years old. All soldiers were associated of arts. The mean scores of awareness and attitude levels were 11.31 (±4.41) and 8.85 (±2.78) pre-educational (pre-test) which in post-educational (post-test) stage became 13.96 (2.98) and 11.46 (±1.80), respectively. All scores were evaluated out of 20.Conclusions: This study showed that education affects the awareness and attitude levels of soldiers about Hepatitis transmission strongly. So, it is proposed to have regular programs for this issue.

Background: Respiratory distress syndrome is one of the most important of mortality and morbidity in premature newborns. The aim of this study was to determine the effect of body position on oxygen saturation in hospitalized premature infants with respiratory distress syndrome (RDS).Material & Methods: In an interventional analytic study, 69 premature infants with RDS were evaluated.Patients had a mean gestational age (±SD) of 31.4 (±2.41) weeks (range: 28-35 weeks) with a mean birth weight (±SD) of 1446.6 (±218.90) gram (range: 850-2400 gram). Infants were studied both supine and prone positions. Each posture was maintained for 3 hours. Oxygen saturation was monitored by trans-cutaneous palsoxymeter and mean of oxygen saturation was measured for 3 hours. All patients were premature, oxygen dependent and had RDS.Results: Mean (±SD) of oxygen saturation during 3 hours in prone and supine positions were 92.54% (±2.24%) and 91.78% (±2.35%) respectively (p=0.001). Also mean (±SD) of oxygen saturation at the end of each 3-hours period prone and supine positions were 91.30% (±2.42%) and 90.30% (±3.15%) respectively (p=0.006).Conclusions: These findings suggest that, in premature infants with RDS oxygen saturation was significantly higher in the prone compared with the supine posture.

Background: Pregnancies ended in abortion are among the most common causes of visits to Gynecology clinics. Ultrasonography is an easy, accessible and cost-benefit modality to diagnose cases of abortions. It also differentiates abortion from other causes of first-trimester bleeding. It helps to select the best therapeutic approach particularly the necessity of performing curettage.Material and methods: A descriptive study was conducted on 159 patients presenting to Imam Hossien Medical Center during the years 1380 to 1383. Data were collected from files of patients which were sampled non-randomly.Results: The mean age of patients was 28.1 (±5.1). Abortion was mostly observed in patients between 20-30 years of age; Sixty nine percent of abortions were in weeks <12, and 31% were in weeks 12-20; Most patients (37.7%) had gravid 1. The most common sign was spotting; Mean pregnancy duration was 10 (± 2.2) weeks. Incomplete abortion was the most common form. 11 cases of Hydatidiform mole were found, one resulted in Choriocarcinoma. Subchorionic hemorrhage was seen in 87% of patients in the weeks between 10-20. Live fetuses were seen in 10 cases in which the presence of heart beat indicated continuing of pregnancy in 90% of cases.Conclusion: According to the prevalence of Incomplete Abortions in this study, sonographic findings were important in performing curettage. The difference between age of occurrence of Hydatidiform mole from that in the literature and the role of subchorionic hemorrhage in cases ended in abortion is recommended to reevaluate in the future studies.

Background and Objective: In many jobs such as military personnel especially in chemical attacks must use protective clothes to avoid physical, chemical and environmental damages. Such clothes should cause the minimal physiological, mental and organic limitations on the body, beside their protective features. The aim of this study is to compare the Iranian NBC protective clothes with usual combat clothes, in terms of their effects on Aerobic capacity of the subjects.Materials and methods: This is an experimental study. Thirty healthy male individuals according to inclusion criteria recruited for this study. After selecting type of clothes performed a physical activity according to Bruce treadmill test while wearing NBC protective clothing with mask, NBC protective clothing without mask and usual combat clothing. After physical activity such parameters as exhaustion time and distance were measured. Aerobic capacity (Vo2max) was also predicted with Bruce equation.Results: data showed that Aerobic capacity (Vo2max) in NBC protective clothing with mask was 43.4±7.91ml/kg/min, in NBC protective clothing without mask 52.05±8.37 ml/kg/min and in usual combat clothes was 59.57±6.54 ml/kg/min. This difference was significant (p<0.001). These three sets of clothes had the different values in Parameters such as exhaustion time and distance. In the case of tolerance time and aerobic capacity (Vo2max) the results obtained from the usual combat clothes showed greater values than NBC protective clothing with and without mask (P<0.05).Conclusion: The results showed that Iranian NBC protective clothes with mask cause that the person has a less tolerance time, because the aerobic capacity (Vo2max) for these clothes was observed as less than NBC protective clothes without mask and usual combat clothes.

Background: Osteoporosis is a major and growing public health problem in bone sexes but particularly in Post-Menopausal women.The aim of this study is evaluation of T Score and BMD mean in vertebra and femoral neck for estimation of Frequency of osteopenia and osteoprosis in post-menopausal women of military families, which had not other secondary osteoporosis risk factors.Materials and Methods: In a cross sectional study we studied 200 post menopausal women that were not menopause more than 5 years and had not secondary cause of osteoporosis. Lumbar vertebra and femoral neck bone density measured by DEXA (Norland ZR-63, for Atkinson, WI, USA) system.Results: Mean age of patients was 57.2±4.2 and T Score mean in lumbar spines and femoral neck was -1.09±1.11 and -1.69±1.05 respectively.Frequency of osteoporosis was 25.5% and 7% and osteopenia was seen in 51% and 47.5% respectively. Over all, osteoporosis Frequency was 26% and osteopenia Frequency was 52.5% respectively.Conclusion: This study showed post menopausal osteoporosis is most common in military families same another research and according to high prevalence of postmenopausal osteoporosis that induces mortality and morbidity and high treatment cost and long term health cares, the human community needs to comprehensive studies about prevention, causes, prevention and treatment of osteoporosis.

Backgrounds: Rheumatoid arthritis is a chronic inflammatory disease and rest splinting may reduce inflammation and swelling and pain in acute joints, the aim of this study is to determined effect of Rest splint in reduction of inflammation in wrist and hand joints of rheumatoid arthritis patients.Materials and methods: in 50 rheumatoid arthritis patients (according to ACR criteria 1987) prescribed thermoplastic rest splint in either hands randomly for one month at night, and before and after study assessment of pain (VAS) and duration of morning stiffness and swelling and range of motion of wrist and PIP and MCP joints and hand volume and grip strength performed.Results: in final assessment of splinted hand there was significant less pain (p=0.002), less morning stiffness (p=0.01), less swelling (p=0.0003), less tenderness (p=0.004) and better range of motion of wrist (p=0.0005). In addition in final assessment in splinted and unsplinted hands there was less swelling (p=0.006), less tenderness (p=0.03) and better range of motion of the wrist (p=0.04) in splinted hands, but there was not any significant change in pain and morning stiffness, joint count, flexion of MCP and PIP joints, hand volume and grip strength.Conclusions: according to results we offer more using of this splint in treatment of RA patients.

Background: Mental disorders represent an important source of morbidity among military personnel and are a commend reason for early separation from the military, and the most frequency of premature elimination from the army was personality disorder. The goal of this study is evaluation of prevalence of personality disorder in soldiers separated from military service.Materials and Methods: In this study 102 awoles and 105 soldiers referred to the clinic of 506 Army hospitals, evaluated by clinical interviews on the basis of DSM-4 criteria. The results were then analyzed by statistical soft ware of SPSS 13.Results: In this study, the frequencies of personality disorders in awols 73 percent and in the soldiers referred to clinic 22 percent (p value 0.00).The frequencies of the most personality disorders (hysterionice, borderline, and antisocial) in awols are respectively 29, 18, and 23 percent and in soldiers referred to clinic are 16.2, 3.8, and 1 percent which there was a significant difference between two groups (p value in borderline 0.02, hysterionic 0.00, and antisocial 0.00).Conclusion: The frequencies of personality disorders in awols were more common than community and soldiers which referred to clinic of hospital. Other trails are need to determine relationship between the Personality disorders (Axis II) & separation from military service.

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in all peripheral nervous system e of it is one of the most important causes of disability in patients. This study was designed to compare the efficacy of Iuontophoresis and medical treatment for idiopathic CTS.Materials and Methods: 60 consecutive patients with CTS confirmed by electromyography participated randomly in two experimental groups (drug therapy), and Iuontophoresis. Interventions in each group include 20 daily treatment Iuontophoresis (4ma, positive electrode, 15 min/session) applied to the area over the carpal tunnel of the wrist region. Measurements were performed before and after treatment and included pain assessment, electromyo and neurography measurement (motor and sensory latency, motor and sensory nerve conduction velocity), grip strength.Results: Improvement was significantly more pronounced in Iuntophoresis group than drug therapy group for variables, motor latency (P<0.000), sensory latency (P<0.005), hand grip (P<0.000), and pain relief (P<0.000). In clinical findings atrophy was not observed. Nocturnal pain and paresthesia were reduced 80% in Iuntophoresis group but 46.6% in control group.Conclusion: results indicate both Iuntophoresis and drugs were effective, but Iuntophoresis was better than drugs. Further investigation is needed to investigate the effects of combination of these treatments in patients with mild to sever CTS.

Background: Lapacho is a herb that use for the treatment in herbal medicine of brezil, America and Europe. The FDA gave Lapacho a clean bill of health in 1981. The medicinal part of the tree is the bark.The active ingredient of lapacho is called lapachol. (3-7%) Te comella undulate is a species of bignoriaceae distributed in south of Iran that contains of 2-7% lapachol. This study compares topical extract of tecomella undulata bark with topical diclofenac in the knee asteorthritis.Material and Methods: The clinical trial study was double blind patients with primary knee osteoarthritis were recruited using strict inclusion and exclusion criteria from Shiraz medical school clinics. All patients received topical agent. In group a received alcholic extract of tecomella undulota bark (20%) and in group B received topical diclofenac. (4 times a day for 4 weeks). Subjects under went 2 office visitis 4 weeks after start of treatment and 2 weeks after finish of treatment. Evaluations measure tools were NRS and WOMAC.Results: We have shown that 4 weeks of treatment with this extract of tecomella undulata bark relieved the symptoms of primary knee osteoarthritis significantly better than the topical diclofenac solution. The percentage improvement in NRS and WOMAC subscale score that we observed with topical extract of tecomella undulata brak therapy (41-48%) were similar to those reported for oral NSAID treatment.Conclusions: te comell undulate extract is a safe and effective approach for knee osteoarthritis with high success rate.

Background: Periodontal disease causes allocation of Bacteries in blood circulation, Bacteriemy may causes reactions from host that make some changes in blood vessels and difficulties of atherosclerosis.Previous studies have demonstrated that periodontal pockets are related with total cholesterol and low density lipoprotein cholesterol (LDL). In this study, we studied extent of blood LDL and Triglyceride level in patients with periodontal and compared the results with those who had non periodontal involvement and find the relation between periodontal disease and risk of probability increase of blood LDL and Triglyceride.Materials & Methods: Eighty healthy people who referred to the out-patients clinics of Dentistry faculty, Azad University, Tehran, during 2003 were evaluated in this case control study. 40 patients with periodontitis constitude the case and 40 without any periodontal disease made up the control group. Plaque index, Bleeding on probing (BOP), Probing Pocket Depth (PPD) and clinical attachment loss were measured and recorded.Triglyceride (TG), LDL, HDL, cholesterol LDL/HDL was determined for both groups and their levels have measured.Results: Spearman correlation test results a direct relation between PPD and cholesterol and LDL and between BOP and cholesterol and LDL in the control group. (r=0.382, p=0.015) Conclusion: Our results demonstrated that with starting periodontal disease the Cholesterol and LDL level increased.

Background: Despite the availability of effective anti tubercle chemotherapy for more than 50 years and major advances in the biology of M. tuberculosis, TB remains the leading cause of adult mortality attributable to a single pathogen. The analysis of tuberculosis and tracing of the source of infection require the ability to discriminate among Mycobacterium tuberculosis strain. In present study Restriction Fragment Length Polymorphism (RFLP) analysis was used to study the molecular epidemiology of tuberculosis in Tehran.Material and methods: Mycobacterium tuberculosis isolates from 292 patients with culture positive tuberculosis during 2002-2003. Extraction of bacterial DNA and DNA fingerprinting with RFLP using IS6110 as probe, was performed by standard protocols. The digested DNA is separated according to fragment size on agarose gel by electrophoresis and southern transferred on to a membrane. The DNA probe was labeled with (HRP) and hybridizing to the genomic targets.Result: Among 292 culture M. tuberculosis, 232 (79.4%) belonged to clusters and 60 (21.6%) did not. 39 Drugs resistant M. tuberculosis isolates were examined 33%of these were identical pattern IS6110. 4.9% of the isolates represented the Beijing genotype.Conclusion: Based on the obtained data it appears that tuberculosis among the study population in Tehran mainly from reactivation of latent infection.

Background: Recognizing that allogenic transfusion is best avoided in all patients, we implemented a policy of transfusion avoidance in coronary artery bypass graft surgery with use of acute normovolemic hemodilution (ANH) technique. ANH is a blood conserving technique and a form of pre-operative autologous donation (PAD).Blood stored at the bedside at room temperature (up to 6 hrs.) ANH technique preserves factors and coagulation of stored blood and also has several advantages in physiologic aspect. Thrombelastogrphy is a noninvasive diagnostic instrument designed to monitor and analyze the coagulation state of a blood sample in order to assist in assessment of patient clinical haemostatic condition.Material and methods: A prospective, randomized, clinical trial conducted in 130 patients scheduled for CABG surgery with CPB that divided to two 65 persons, A (ANH) and B (non-ANH) group. Patients underwent ANH with avg. of 500 ml whole blood removed after induction of anesthesia and hemodilution was replaced with crystalloid solution. Hemoglobin, platelets, TEG analysis and homodynamic changes pre and post operation, amount of blood transfusion during surgery and in ICU checked in both groups.Result: this study shows that amount of Hb, plt, in ANH group was greater than B group. Changes in components of R, K, ANGLE, MA in ANH group were statistically significant, that show greater preservation of coagulation factors, platelets, (amount and function) and fibrinogen in ANH group. Changes in homodynamic postoperatively were less in ANH group.Conclusion: performance of ANH in CABG is effective in reduce in blood transfusion and post operation bleeding.

History and goal: Knowledge of X-Ray related factors connected with individual dosimeter can be beneficial in diminishing the rate of x-ray intake. Keeping in mind the above mentioned goal, we planned and prepared this study with the help of all radiology staff of the hospital.Materials and procedures: This research is a descriptive, analytic and a sectional study which was performed in the year 1385. All radiology staff of the army hospitals in Tehran was bulk examples. A check list and a questionnaire form were used to collect data and information. We also made use of SPSS software for data purpose.Achievements: Results obtained in this study indicate that individual maximum dose received individually was 29.0 milisilvert; the rate of this dose was seen in persons who lacked University education. And a minimum dose received was 0.05 millisiurt which was received by individuals who were less than 30 hours in contact with the preparation of unison. Many medical tests were performed at the following army hospitals: Golestan, 502, 204 and Mostafa Khomeini hospitals. The X-Ray rate at the mentioned hospitals was 100%.Results obtained: Dose received by all individuals as classified parameters expected was standard and acceptable. Therefore organizing X-ray safety workoshops especially in connection with promoting security level of unison production staff at all centers is an absolute must.

Background: Trigger points have been described as a cause of pain in clinical practice and an extremely common source of musculoskeletal pain. Stretching can effectively inactive trigger points and provide symptomatic relief. This study compares muscle stretching immediately after inject of lidocaine vs. stretching with the ethyl chloride spray in the treatment of the trigger points.Material and methods: patients with trigger point in gluteal muscles were recruited using strict inclusion and exclusion criteria from Shiraz medical school clinics. Subjects under went 2 office visits and 2 phones follow up. In group A stretching was with spray of ethyl chloride and in group B stretching of muscle injected was done immediately after injection. Evaluation measure tools were 0-10 NRS, VAS and BPI.Results: In respect to VAS and NRS there was statistical significance difference between both groups 1 month and 2 month after treatment. There was statistical significance difference between both groups in all measurement aspect of BPI except (general activity and walking) one month after treatment.Conclusions: muscle stretching immediately after injection of lidocaine was more effective (at least up to 2 month) than stretching after spray of the ethyl chloride in the symptomatic treatment of gluteal trigger points and improvement of functional activity of the patients.

Background: infertility is defined as one year of unprotected coitus without conception. By artificial reproductive technology, rate of multiple pregnancies is increased to 35%. This leads to an increase in cesarean section rate, prematurity, perinatal mortality.Materials and methods: This study is designed as retrospective descriptive- analytic. All of the pregnant women with twin gestation coming to Taleghani, Mahdieh, and Imam Khomeini hospital during the years 1996-2003 were included in the study sequentially, regardless of age or parity. Excluding criteria was past history of preterm delivery, abortion, hypertension and previous cesarean section. For the data analysis, we used the Z test.Results: we compared 76 spontaneous twin pregnancies with 74 twin pregnancies after IVF and 76 twin pregnancies after ovulation induction, with respect to these parameters: hypertension, birth weight, gestational age, mode of delivery, abortion, premature rupture of membrane, preterm delivery, APGAR score, perinatal mortality. We did not find any significant difference in having hypertension, gestational age at birth, premature rupture of membrane, abortion, preterm delivery, APGAR score, still birth and neonatal death between three groups. Mean maternal age in spontaneous group was 26.5 years old, in IVF group 34 years old and in induction group 30 years old. There were significant numbers of primiparous women in the IVF and in induction group. The cesarean rate was significantly higher in IVF group (Z>1.96) and the vaginal delivery rate was significantly higher in spontaneous twin pregnancy (Z>1.96).Conclusion: There is no difference in perinatal outcomes in 3 groups.

Background: mammary disorders are among the most important elements causing women to present to a physician. Mammary disorders can Vary form benign masses to malignant cancerous tumors. The occurrence and the elements contributing to the occurrence of asymptomatic breast tumors in the women having presented to Army staff’s family Hospital within the term from Oct 2005-2006.Materials & methods: this is a descriptive- analytical study carried out on 660 subjects. The subjects were sleeted at random from among the mummer presenting. To the clinic for reasons other than mammary disorders. They were subjected to full breast examinations. Questionnaires were distributed among the subjects in order to survey the elements contributing to the occurrence of breast tumors and the results from the completed questionnaires were analyzed.Results: 5 numbers of total 660 patients were examined in this research had breast tumors and only one case had malignant mass.20% of them malignant 20% cyst and 60% were fibroadenoma.Conclusions: frequency of asymptomatic breast tumors in this study are (0.7%) and 80% of them is benign where as 20% of asymptomatic breast mass was malignant therefore self examination and examination by physician periodically, specially in high risk patient is important.

Background: Carpal tunnel syndrome is the most common entrapment neuropathy. Non-surgical treatment for carpal tunnel syndrome is frequently offered to those with mild to moderate symptoms. The effectiveness of some non-surgical treatment for carpal tunnel syndrome remains unknown.Objective: This study designed to compare the short term efficacy of local corticosteroid injection and laser treatment for mild to moderate idiopathic carpal tunnel syndrome.Materials & Methods: 44 hands in 33 consecutive patients with carpal tunnel syndrome confirmed by electrodiagnostic study were allocated randomly in two experimental groups. One group received local corticosteroid injection and the other received low level laser therapy. Measurements were performed before and 8 weeks after treatments, and included pain assessment by visual analogue scale (VAS) and electrodiagnostic measurement (motor and sensory latencies & motor and sensory action potential amplitudes).Result: There was a significant symptomatic and electrodiagnostic improvement in both the injection and laser groups (P<0.05). However, there was no significant difference in any of the outcome measures between the two groups (P>0.05).Conclusion: LLLT was effective in treating carpal tunnel syndrome as well as local corticosteroid injection at least in short-term. Long-term efficacy needs more investigation.