JOURNAL OF MILITARY MEDICINE
Year:2008 | Volume:9 | Issue:4 (34)|Papers Count:14

Introduction: Bacillary dysentery is caused by Shigella organism. Infections caused by Shigella species are an important cause of diarrheal disease, in both developing and developed countries in current study, different epidemiological aspects of shigellosis in Iran are discussed.Material and Methods: In our research, different epidemiological aspects of Shigella including its species distribution were studied. To study the changes in epidemiological patterns of shigellosis in Iran, recently published reports on distribution of Shigella spp. were reviewed and then compared.Results: The results showed that recently epidemiological pattern of shigellosis is changed in Iran.Discussion: Epidemiological pattern of shigellosis in Iran is similar to those seen in developed countries. This finding may reflects hygienic improvement in the country in recent years.

Introduction: Bacterial endotoxins are component of the lipopolysaccharide that their exposing results to diarrhea, vomiting, fever, shock, intravascular coagulation and death. In this study the effects of water disinfection with chlorine on release and removal of endotoxin was investigated.Materials and Methods: Various forms and concentrations of free chlorine were used for disinfection of E.Coli (ATCC: 25922) and removal of originated endotoxin. The study was carried out in a batch experiment reactor with 50ml volume. Ultimate disinfection contact time was 40 minutes. The plate count was used for bacterial counts and determination of bacterial viability. Detection of endotoxin was been carried out by spectrophotometric absorbance in 535nm. After chlorination of water, the sampling was carried out with sequence time of 5, 10, 20, 30 and 40 minutes.Results: Chlorine as a conventional disinfectant resulted in bacterial death and release of endotoxin and in conventional disinfection contact time (15-30min) has no effect on endotoxin removal. Various forms of free chlorine and concentrations of NO3 were not effective in releasing and removal of endotoxin.Discussion: Since endotoxin has various adverse health effects; and in the field and military conditions chlorination is the ultimate alternative for purification of water; therefore, selection and application of appropriate disinfectants for effective disinfection and control of related by-products such as endotoxin and other microbial toxins is of importance.

Introduction: Hospital has been established many parts to service delivery to patients and must be necessary integration between parts, because defect in one of them led to creation of problem in service delivery of patient. Overall for promotion of qualitative and quantitative level of therapeutic and diagnostic services in emergency department, notation to 3 fundamental axes is essential. If we notice this item, we can expect this department can delivery effective and desirable services. This study aims reviewing structure, process & performance of hospitals affiliated Baqyatallah University of Medical Science and comparing with existing standards of Ministry of Health.Methods: This study is a descriptive – analytical study which has been done in 3 hospitals affiliated Baqyatallah University of Medical Science in 1386. For gathering data, we used questionnaire and reviewing of documents and offices. We used SPSS software for analyzing those data (Manwithney and Sperman tests).Results: The results show studied hospitals with % 76.04 average rates were relatively desirable. The activities indicator with %94 was desirable. The management indicator with %87.27 and the facilities & equipment indicator with %79.01 were relatively desirable. The manpower indicator with %65.83, process indicator with %58.33 and instructions indicator with %70.37 were mediocre. Also there was relationship between manpower and facilities & equipment.Discussion: The most of hospitals from the view point of indicators were desirable but notification to manpower, instructions and educational process indicators is essential. In this respect that hospitals are military, regarding standards of emergency department to response crisis is very important.

This research was performed to determine the level of the humoral immunity in military persons vaccinated against meningococcal meningitis type A and C in IRAN. Each person was given a subcutaneous injection of 50µg of group A and C polysaccharides vaccine. Blood samples were collected from 150 combatants before vaccination as well as at 1, 4, 7 month after vaccination. Antibody level in the sera was measured by passive hemaglutination. A titer 16 (1-2 mg/ml) in the serum was considered as protective. 3.3% of persons had a protective level of antibody in the circulating before vaccination. One month after vaccination, 89% of persons had protective level of antibody in their sera. The circulating antibody level in only 7.4% of vaccinated did not rise to a protective level. About 3.3% vaccinated did not produce specific antibody at all. The antibody level in vaccinated persons four month after vaccination not only did not rise but also it showed a decrease in circulating antibody level, but the number of combatants with protective levels of antibody did not decrease. The antibody levels in vaccinated combatants seven month after vaccination continued to fall, and in 18% of combatants the antibody levels fell below the protective level. Regarding to a relative low level of circulating antibody after vaccination in immune combatants and a lower rate (82%) of immune individuals (as compared with the results of other investigations who report an immune rate of %90 up to 95%) as well as the continuous fall in circulating antibody after very short rise, the results of present investigation indicate that the polysaccharide vaccine which was used in this study does not provide a high rate of protective immunity. Probably, type of vaccine is important and in other researches used vaccines of another companies.

Introduction: Psychological health and low self esteem both are known to be accompanied with delayed phase of exposure to chemical warfare agents. According to the reported correlation of these two in different populations, we assessed this association in the chemical warfare agent exposed veterans.Methods and materials: In this cross sectional study, 134 chemical warfare agent exposed veterans were selected randomly from Sardasht residents. Patients were grouped according to HADS scores into group Ianx (with anxiety, n=103), IIanx (without anxiety, n=31), according to the presence of co-morbid depression, to groups Idep (with depression, n=87) and IIdep (with anxiety depression, n=47), and according to the number of psychiatric co-morbidities, Icom (without anxiety and depression, n=17), IIcom (with anxiety or depression, n=44), and IIIcom (with anxiety and depression, n=73). Rosenberg Self-Esteem Scale was compared separately in groups Ianx vs. IIanx, in groups Idep vs. IIdep, and groups Icom vs. IIcom vs. IIIcom.  4.6. Group Ianx ± 11 years. Mean (SD) Rosenberg Self-Esteem Scale was 11.4. Results: 86 subjects were male, with mean (SD) age of 48 in comparison to group IIanx, reported poorer Rosenberg Self-Esteem Scale. The same result was seen for comparison of Groups Idep and IIdep. Comparing groups Icom and IIcom and IIIcom showed that increasing the number of psychiatric co-morbidities is correlated with poorer Rosenberg Self-Esteem Scale.Conclusion: Psychological health and low self esteem are associated in chemical warfare agent exposed veterans. This highlights the need for attention to one of them, if another is disturbed. This can help psychiatrists and psychologists to improve their mental health.

Introduction: Physically induced joints pain is a relatively common finding in military personnel. Occupational factors like level of activity, style of job performance and individual factor like physical composition of body, sex are described as the risk factors. In this study we describe the pattern of joint -involvement in the military personnel and compare it with nonmilitary patients. Methods: This descriptive-comparative cross-sectional study was performed in 3 military and 3 non-military hospitals in a 3 year period. A census of all patients with confirmed physically induced joint pain was performed. Patient data in 3 fields of demographic data, occupation (job category) and involved joints was requested. Using frequency matching for sex, age, height and weight 1230patient enrolled in the study. Analysis performed using chi-square test. Results: 640 (52%) patients were military patients and 630(51.2%) patients were male. No significant difference was present in mean age, weight, height and work experience. Male gender was predominant in military patients (53.1%) but in non-military patients it was 49.1%. Distribution of military patients in job categories of combat, logistic, engineering, cultural, security and non- governmental were 179(28%), 218(34%), 102(16%), 51(8%), 90(14%), 0% respectively. The distribution has significant association with being military and non-military patients (p<0.001), similar association was present in male patients (P<0.001) but not in females.Discussion: According to the finding of this study, military patients especially male patients and the ones in security and combat categories are under more physical stress and pressure and are more prone to have joints injuries. Routine evaluation of physical and health and general health, using selected personnel with appropriate body composition in mentioned job categories and enhancement of physical fitness should be considered in military personnel to prevent such Injuries.

Introduction: Biological dosimetry is one of the most important methods to estimate radiation dose in over exposed individuals. Chromosomal analysis is the common biodosimetry method. Dicentrics score in peripheral blood lymphocytes (PBL) chromosomes at the first mitosis following in vitro growth stimulation for dose estimation. Each laboratory should establish its own dose-response curves. In this study we constructed calibration curve using standard protocol for culture room of Medical Faculty of Baqiyatallah (a.s) University of Medical Sciences.Material and methods: The whole peripheral bloods from 3 healthy donors were exposed to different doses of gamma ray (0.25-4Gy). Then lymphocytes were isolated and cultured in complete RPMI-1640 medium. 500 mitoses were analyzed for scoring dicentric chromosomes at each radiation dose for every person after standard metaphase preparation and staining slides.Results: Dose-response curve was constructed based on mean of dicentrics per cell at each radiation dose. Frequency of dicentrics apparently has increased linear quadratically with dose.Discussion: in this study we obtained linear quadratic curve. It seems that there is a nearly good consistence between our dose- response curves with similar studies. This calibration curve is valid for dose estimation of low LET radiation over exposed victims.

Background: at the beginning of the new millennium, with the appearance of terrorist threats including bioterrorism. The brightness of future turned dark. The most important way of confronting with bioterrorist activities as the first priority is improving the knowledge of the health and medical team at the aim of diagnosis and quick reaction against such events.Materials and methods: the present research id a quasi- experimental study. Research population consisted of 65 nurses who posses necessary quality as under- research population, at this study questionnaires have been used for collecting information.Findings: the knowledge of nurses concerning bioterrorism was 14.79% before training while after training it reached to 94.43% the nurses attitude toward bioterrorism was 55.50% before training and after training it reached to 85.46%.Conclusion: Education had a positive effect on nurses knowledge and attitude

Background: Crimean-Congo hemorrhagic fever (CCHF) is a viral hemorrhagic fever of the Nairovirus group. Although primarily a zoonosis, sporadic cases and outbreaks of CCHF affecting humans do occur. The disease is endemic in many countries in Africa, Europe and Asia. Onset of symptoms is sudden, with fever, myalgia, dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia. There may be nausea, vomiting and sore throat early on, which may be accompanied by diarrhea and generalised abdominal pain. IgG and IgM antibodies may be detected in serum by ELISA. This study was performed to evaluate the patients with CCHF disease who admitted in Amir-Almomenin Hospital of Zabol.Material & Methods: This is a cross sectional study. Medical records of CCHF patients who admitted in Amir-Almomenin Hospital of Zabol were assessed. The results were analyzed with SPSS (ver. 14) software.Results: 65 patients were enrolled in this study from 2003 to 2005. 52 (80%) were male and 13 (20%) were female. Five patients were died (mortality rate = 8%). Signs and symptoms were fever (98.4%), headache (80%), myalgia (72.3%), nausea & vomiting (60%), abdominal pain (49.2%), skin rash (13.8%), and splenomegaly (4%). Lab. Findings were included thrombocytopenia (100%), leucopenia (70.7%), and anemia (20%).Discussion: CCHF is a known disease in this region of IRAN. Suspected cases admit in hospital and diagnostic tests and therapeutic measures are performed immediately thus mortality rate of our study (8%) was lower than similar studies. The number of male patient (52) was greater than female patient (13) and this may be due to employment contacts. In our experience, fever and headache were common symptoms. In endemic area of CCHF disease, if we see a patient with fever, headache and history of animal contact, we should think about CCHF. This virus can spread from patient to HCWs, thus universal precautions must be perform in hospitalized patients. There is no effective vaccine for this disease. Control of ticks is important for prevention of disease. Agricultural workers and others working with animals should use insect repellent on exposed skin and clothing.

Introduction: Spinal cord injury leads to increased incidence of urinary infection because of sensory and motor derangements as well as alteration in function of urinary system. Pathogenic factors vary based on differences in geographic regions. Urinary infection in the most common nosocomial infection and more that 80% of its cases are due to urinary catheters. In this study, bacteria causing urinary infection in spinal cord injured and hospitalized patients have been investigated. Materials & Methods: In this descriptive analytic study which was performed from 1384 to 1385, patients were divided into groups A and B. Group A consisted of 145 spinal cord injured patients who were unable to void bladder naturally and had presented to Al-Zahra hospital, Isfahan due to symptoms of urinary infection. There were 150 hospitalized men with urinary catheter in group B without fever or urinary symptoms at the time of hospitalization that developed symptoms of urinary infection after 48 hours of admission. After completing questionnaire, urine samples were obtained from each person according to bladder voiding method and quickly sent for analysis plus culture. Patients who had taken antibiotics within the preceding 2 weeks were omitted from study. For evaluation of pyuria in diagnosis of urinary infection, patients were divided into 2 groups, one with urinary symptoms and negative urine cultures and the other with urinary symptoms but with positive urine cultures. Statistical analysis was performed using SPSS (version13) software. P<0.05 was considered significant and meaningful difference. Results: The age range of patients under study in group A was 34-54 and in group B was 40-58. There were 120 culture positive cases in group A. According to results obtained from culture of urine samples in spinal cord injured patients, the organisms isolated were E. Coli 64 cases (43.8%), Klebsiella 24 cases(16.4%), Enterococci 11 cases(7.5%), Pseudomonas aeroginosa to cases(6.8%), Staphylococcus aureus 5 cases(3.4%), Serratia 3 cases(2.1%), Staphylococcus epidermidis 2 cases (1.4%) and proteus 1 case (0.7%). Most of positive urine cultures were detected in patients who used indwelling catheters. There was a meaningful relation between pyuria and urinary infection (P<0.05). Results of urine cultures from hospitalized patients were as follows: E.coli 85 cases(56.7%), Klebsiella 24 cases(16%), Enterococci 15 cases(10%), Pseudomonas aeroginosa 12 cases(8%), Coagulase negative staphylococci 5 cases (3.3%) and 9 cases (6%) of Staphylococcus aureus, Serratia and Proteus.Conclusion: According to the results of this study, the most common organisms causing urinary infection were similar in the two groups and included Escherichia coli, %), Klebsiella, Enterococcus and Pseudomonas in decreasing order of frequency. This similarity could lead us to similar approached to the two groups. One the other hand, colonization of nosocomial organisms in spinal cord injured patients, probably occurs because of repeated hospitalization and catheterization at hospital.