JOURNAL OF MILITARY MEDICINE
Year:2005 | Volume:7 | Issue:2|Papers Count:19

Introduction: War injury is reported as a risk factor of hepatitis B and C, and it is suggested to be also a risk factor for hepatitis D. This study was conducted with the aim of assessing the correlation between war injury and hepatitis D in hepatitis B patients.Material and Method: In this observational (cross - sectional) study, 280 HBsAg positive subjects were divided to a group with the history of war injury (n = 12) and a group without such history (n = 268). Two groups were compared by the means of frequency of hepatitis D (Anti HDV Ab) and other risk factors including history of blood transfusion, surgery, intravenous drug abuse, dentistry interventions, traditional phlebotomy, tattoo and endoscopy.Results: 3 subjects with the history of war injury (25%) and 13 subjects without such history (4.9%) had hepatitis D. Odds ratio of HDV in subjects with the history of war injury versus those without such history was 5.10 (95% CI = 1.3 - 20.5). History of blood transfusion was reported more in patients with war injury than those without such history (p=0.002). History of surgery, intravenous drug abuse, dentistry interventions, traditional phlebotomy, tattoo and endoscopy was not different in two groups (p>0.05).Discussion: Although this study had a low sample size in the group with history of war injury, and confounding effect of blood transfusion and sex is possible, this study reports history of war injury as a possible risk factor for hepatitis D. Further studies will help to clarify more results. If such study replicates our results, screening of HDV in war injured veterans will be helpful.

Introduction: HIV/AIDS is one of the serious infectious diseases and has increased rapidly. Nowadays, the best way of its control is community education and establishing a rational attitude toward this disease especially in the high-risk groups e.g. youth. Material and Method: This is a descriptive cross-sectional study carried out with the aim of determination and evaluation of knowledge and attitude of soldiers at Yazd Shahid Sadoughi Training Garrison about HIV in the summer of 2004. In this research on 1500 soldiers who had entered the Shahid Sadoughi Training Garrison, 240 soldiers were randomly selected. The instrument for data collection was a self–Administered questionnaire used after determining its validity and reliability, and then knowledge and attitude of the soldiers about HIV were studied by it. Results: Based on the findings, mean age of soldiers was 21.35 ±3.2 years, and 76.6% had high school and higher education. The most important sources of their information about HIV/AIDS included: lessons at school and college (85.4%), family and friends (75.4%), newspapers and magazines (68.8%) and radio -TV (30.8%). The mean level of knowledge and attitude of soldiers was respectively 27. 29 and 3.32 which was evaluated as moderate. The knowledge and attitude rank of soldiers was significantly related to their education level (P=0.001). Discussion: In contrast to various studies carried out in other countries, in this study we understood that the role of TV and mass media in informing people was less than other resources in other countries. Although average knowledge of the soldiers toward HIV/AIDS showed relatively good information, there were significant misconceptions, especially about HIV positive people among the soldiers. According to the results, it is suggested that separate educational classes should be held for soldiers with different levels of literacy, and promoting knowledge level of soldiers about HIV/ AIDS must be regarded seriously by using strategies such as education by teachers and mass media.

Introduction: Utilization of chemical weapons has long somatic effects so that Iranian war chemical victims are frequently referred to hospitals for treatment. Observance of patient rights is very important about these victims so this study was conducted to determine the observance of patient rights in war chemical victims. Material and Method: In this study, 100 war chemical victims were selected by stratified sampling according to criteria such as more than 25% injury, and being referred to the hospital at least every two months. Instrument was a questionnaire which had two parts: Demographic data and data about patient rights. Each question was answered as low, medium and high. Results: Results show that 45% of victims with respiratory problems present to hospital frequently. 40% believe that speed of treatmental procedure is low. 50% have high information about treatmental procedures. Necessary information is given before examination or treatment in 30% of cases. 80% of samples believe that their privacy and medical information were kept secret. Only 10% were sure about access to medical team in emergency situations and there was significant relationship between percent of injury and incontinence (P=0.01). Discussion: Although patient rights were respected in medium way in the majority of cases, each of personnel must try harder to keep patient rights.

Introduction: Mitochondrial DNA (mtDNA) sequence analysis of the hypervariable control region has been shown to be an effective tool for personal identification. The high copy, resistance to degradation, short size (as compared with nuclear DNA) and maternal mode of inheritance make mtDNA analysis particularly useful when old age or degradation of biological sample prohibits the detection and analysis of nuclear DNA. Material and Method: This study reports mtDNA polymorphisms in HV1 of the non coding D-loop region from 30 persons (10 unrelated families in 3 sequential maternal generations). Results: 32 polymorphic nucleotide positions were found in this region. The sequence of HV1 and its polymorphism were completely similar in each family. The average number of nucleotide differences between families in this region was 5.2 nucleotides. Discussion: We will expect approximately 5 nucleotide differences in HV1 sequence in two unknown, unrelated samples and no difference in maternal related samples. This method specially can be used for identification of war victims.

Introduction: Otomycosis is a prevalent fungal infection of external ear that is seen in tropical and subtropical climates of world. That is one of the most ordinary problems specially observed by ENT MDs. The study was done on patients who had reffered to ENT clinic for 2 years (2002-2004). Material and Method: 35 patients (23 cases were male and 12 cases were female) were studied with clinical diagnosis of otomycosis. In order to diagnosis the disease, samples were directly observed in 10% KOH preparation and were cultured in two media: saborou dextrose agar with and without chloramphenicol. We used laboratory methods and different separated test for determining fungal species. Results: In this study among 20 cases with Para clinical diagnosis of otomycosis about 12 cases were male (34.3%) and 8 cases were female (22.8%). Most cases were in age group 30-40 years old. The separated fungal factors were: Aspergillus niger 14 cases (43.7%), candida albicans 5 cases (15.6%), Aspergillus fumigatus 4 cases (12.5%), other Aspergillus SP. 3 cases (9.4%), Aspergillus glucous, penicillium SP., candida SP., From each 2 cases (6.2%). Discussion: In this study the most frequent separated fungi from affected patients were Aspergillus and candida species. That is in accordance with the other studies of researchers in Iran and other countries. Since the prevalence of otomycosis was 57.1% among our patients, accurate preventive and diagnostic measures are necessary. The present study shows that otomycosis cannot be diagnosed based solely on clinical symptoms and it needs laboratory confirmation.

Introduction: Para nasal sinuses are air cavities around the nose that allocates many diseases to them. Between military personnel ENT illness is one of the most prevalent problems. Acute Sinusitis is the most common disease that involves sinuses, most probably maxillary and frontal sinuses. Recent advances in radiologic imaging and new endoscopic techniques have improved both diagnostic and therapeutic capability. Transillumination of frontal and maxillary sinuses is a clinical approach to sinusitis. In this study, we aimed to evaluate the value of sinus transillumination examination in the diagnosis of acute sinusitis. Material and Method: The study was conducted in the form of a processing research on 100 subjects with the signs and symptoms of acute sinusitis that referred to baqiyatallah otolaryngology clinic during the year 2003. Conducting the transillumination examination of the sinuses, computed tomography (as the gold standard for diagnosis) was performed for all the subjects. All data were collected and sensitivity, specificity and predictive values of transillumination were measured according to CT-scan findings. Considering P value < 0.05, all the date were analyzed using spss software version 11.5. Results: Of all, 74 subjects were male and 26 subjects were female. Mean age of the subjects was 33 year (SD=3.1). 64 subjects’CT-scan findings were positive (patient). In this study the conformity percent of transillumination with abnormal CT scan were 73.5% and 60.1% for maxillary and frontal sinuses, respectively (sensitivity). These values on normal CT scan and transillumination examination were 63.5% and 90% for maxillary and frontal sinuses, respectively. Discussion: This study reveals that performing transillumination examination can be helpful as a diagnostic test for sinusitis especially in ruling out the sinus involvement (especially for frontal sinus). Given the high prevalence of sinusitis, its serious complications and lack of imaging equipments in military areas, transillumination examination is highly recommended to physicians.

Introduction: Health condition in military personnel as a special population is always of significant notice and because of no wide data publication; there is limited information about. Regarding the type of missions, personnel of Islamic Revolution Corps (Sepah) are at risk of physical and mental stress and evaluation of health status among them is necessary to improve their performance. Material and Method: This is a pilot survey of 232 personnel from five forces of Sepah. Health related information from past to present was collected via history taking and physical and laboratory examinations. Statistical analysis was performed with SPSS 11.5 (SPSS® Inc.) with significance level of 0.05. Results: Mean age (±SD) was 34.1±6 years (91.1% male). 63.5% had education level above bachelors and 16.8% had some degrees of war disability. There was history of at least one type of chronic disease in 13.3% of subjects and hepatitis B, meningitis and tetanus vaccination coverage rates were 47%, 45.3% and 78.8% respectively. About 58.6% of subjects had complaint of at least on medical condition that the most important were: respiratory complaint (28.9%), psychoneurologic complaint (28.4%). In physical examination 44.4% had at least one positive sign that are mostly related to skin, eye, nose and musculoskeletal disorders. Discussion: results of this pilot survey and available evidences shows that military personnel suffer from wide range of health problems and proper health management may result in improved performance among them. Thus we suggest comprehensive monitoring of health items and risk factors within all Sepah personnel.  

Introduction: Happiness and satisfaction in any marriage requires that both wife and husband try for it. Marriage compatibility will of course influence the couple’s psychological health, life satisfaction and even the rate of income, educational success and job satisfaction. On the other hand marriage incompatibility can result in social relationships disorder, tendency to social deviations and decline of cultural value in husband and wife. According to what is described above, the aim of this study is assessment of marital adjustment and marriage compatibility. Material and Method: The research method was descriptive and in this 900 couple of staff and theirs spouse were chosen in there using multi-phase cluster method in 2003. The utilized tool for collection of data is ENRICH Marital Satisfaction Questionnaire. Results: The result of the research showed that 10.2 percent of husbands and 19.7 percent of wife’s involved marital maladjustment, 51.4 percent of husbands and 49.7 percent of wife’s occasionally involved non-satisfaction. The most prevalence of maladjustment dimensions was conflict resolution and sexual relationship. Discussion: The ability of conflict resolution and increase of sexual relation require having skills on above dimensions. These skills are educable and trainable. By increase of couple ability on conflict resolution and sexual relation, they’re marital satisfaction have be increasing.

Introduction: This study has been performed in order to obtain a general concept of the psychological situation of the new soldiers of the “Materiel and Logistics Command ship” of a military unit and to prevent abnormal behaviors. Material and Method: All soldiers of four training courses of Shahid Hemmat boot camp (N= 4196) were selected and studied. SCL-90-R and individual questionnaire and interview was used for data collection. Data were analyzed by statistical methods (Mean, standard deviation and t-test). Results: The results of this study showed that, 16.2% of the studied sample had some degree of psychological problems. Married people had more psychological problems than the singles; also those with one of their parents died showed more problems than those who have lost both (or have both their parents alive). These problems were more seen in the soldiers who were the householder. Psychological problems were more in soldiers who have lost their father than those who have their father alive. The results showed that the most common symptoms are related to obsessive-compulsive, paranoid thoughts, interpersonal sensitivity and somatoform complaints. Discussion: An interview was conducted for the soldiers who were considered to have psychological problems. Based on the results of the test and interview, decision for continuing their military service and their deployment was made; so that, they wouldn’t meet hazardous situations. Therefore it is recommended to consider this in deployment of soldiers with psychological problems.

Introduction: Psychiatric readmission of military personnel causes additional costs to the military health systems. The aim of this study was to describe the cases of psychiatric readmissions of the military personnel in Baqiyatallah and Noorafshar hospitals. Material and Method: In this observational (cross sectional) study, 669 psychiatric readmissions in Baqiyatallah and Noorafshar hospitals during two years of 2000-2001 were analyzed. Demographic data (including age, sex, job, marital status, and educational level), psychiatric history (including cigarette smoking, addiction, legal history, number of psychiatric drugs, history of psychotherapy, history of ECT, and presence of stressors in life) and readmission related variables (including last diagnosis, number of re-hospitalizations, stability of patients at discharge, cause of readmission, and cause of stopping of the drug) were registered, trough an interview between a psychologist and the patients. Results: 88% of patients were male. Mean age of the patients was 36.7 ± 8.17 years. In 41%, educational level was primary. 56% were jobless. The most prevalent diagnosis was mood disorders (42%) following with psychosis (30%). 67% of patients were re-hospitalized because of poor compliance. Sense of improvement, side effects, no access to medications, no access to physicians were in cause of stopping the medications in 50%, 43%, 5%, and 2%. Discussion: Close follow up of the patients, outpatient visits with a short time interval and using family support (especially in patients with mood and psychiatric disorders) may probably decrease the rate of psychiatric re-hospitalizations, which prevents excessive costs. In order to achieve a better patient perception of the disorder and importance of using the drugs, expression and description may be used.

Introduction: At the time of disaster, hospitals play role as the most important unit in rendering treatment services. Actually one of the worldwide protocols in disaster management especially in hospital commanding which has ability of facing crisis in each scale is Hospital Emergency Incident Command System (HEICS); a standard by which the medical community has found success and common ground in the area of disaster management. The following is an outline of the suggested phases which may be necessary to implement the Hospital Emergency Incident Command System (HEICS) Program into Iran hospitals and also the substitution rules for adjusting HEICS positions. Material and Method: Assessment and matching of HEICS organizational chart with the same common charts in Iran hospitals, HEICS implementation experience in American and European hospitals. Results: Review of both organizational charts suggests that HEICS positions could be readily substituted by current Iranian ordinary hospital positions; however certain revisions should be performed. In this regard we tend to categorize all HEICS positions into three distinct groups, including: A - Positions which are initially available with exactly correspondent titles and job descriptions. B - Positions, which can be easily filled with some personnel who have the ability in advance; however, they need to be addressed briefly (e.g. a general surgeon as the Triage unit leader). C - Few others, which their equivalent jobs are not available in Iranian hospitals, can be alternated with a related specialist after a comprehensive training course (e.g. Psychological Support Unit Leader) Discussion: Taken together, HEICS implementation in Iran hospitals obligates steps include HEICS Concept Briefing; Commitment to Adopt the HEICS Plan; Establishment of the HEICS Implementation Committee; Management Briefing; Revision of the Hospital's Disaster/Emergency Plan and the last and the most is proper choosing of responsible persons for related positions

Introduction: Cholera is a disease with mild to severe diarrhea that causes high mortality if not promptly diagnosed. Since cholera is an endemic and epidemic disease in some areas of Asia including I.R.IRAN, the aim of this study is an analysis on the recent epidemic (Summer 2005) in I.R.IRAN. Material and Method: In this review study, cholera epidemic in I.R.IRAN and factors affecting its spread are analyzied and methods for its control and prevention are provided. Bacterial culture and serotyping had been performed in all patients. Disease status in I.R.IRAN and other countries in last 10 years have been compared. Results: Results show that cholera was epidemic in I.R.IRAN in summer of ‏2005. 1150 persons were infected, of which 11 died. This outbreak frightened millions of people. Everybody refused to use fruits and vegetables with the slightest warning from health authorities. In addition, national economy was damaged. Discussion: Findings infer that although health authorities acted hurriedly leading to a lot of concern and financial loss, the intelligent control system in the Ministry of Health could control the first phase of the epidemic and prevent more impact.