JOURNAL OF MILITARY MEDICINE
Year:2018 | Volume:20 | Issue:1 |Papers Count:15

The scorpion sting has long been a medical problem for people, especially those in the military forces. At the time of the Iran-Iraq war, it was one of the main health problems of Iranian soldiers, especially in the southern fronts and headquarters in the east of Khuzestan province. In Iran, more than 40, 000 cases of scorpion stings are reported annually, and despite the provision and production of antidote, the cases leading to hospitalization and the need for treatment are still high.Military forces, due to their missions, are entering the natural habitats of these venomous arthropods and are being stung. An interruption in the access of injured people to appropriate treatment facilities, including antidotes, may threaten the person's life, increase the length of hospitalization and treatment costs, and reduces the combat capability of the military unit. Therefore, control and preventative measures of scorpion stings can be a practical way to deal with this health problem. In this review, all methods of controlling scorpions in different conditions depending on the behavior of the species are considered, and practical and methodological approaches are recommended.It is essential to carry out studies on medical entomology and the identification of scorpions in any area, prior to conducting maneuvers and building military camps and installations. Environmental and physical control measures are used in a variety of ways, including traps, chemical and biological control of scorpions in military environments, as well as specialized training in this field.

Vaccines have long been used for a variety of pathogens. Advances in basic immunology and recombinant DNA technology have fundamentally transformed the process of formulating a concept, optimizing antigens, and selecting the most effective delivery approach for vaccines The development of vaccines used in the field of biodefense has increased progress in the production, immunological mechanisms and new vaccination approaches.DNA vaccines have emerged in the last decade as a completely novel strategy for vaccination to combat bioterrorism and biodefense. At first, their ability to induce antigen-specific T cell responses was considered as the main strength. Over time, however, it became clear that DNA vaccines are also effective in eliciting antibody responses. DNA vaccines incorporate a natural or modified gene from a pathogen, which encodes the protective antigen. DNA vaccines can be delivered directly in the form of plasmids. The vaccinated hosts will only generate immune responses against the biodefense antigen expressed by the DNA vaccines. Biodefense vaccines are critically important to protect populations against the emerging pathogens. With the increase of the outbreaks of viral diseases, multiple technologies are being used for the development of preventive countermeasures including DNA vaccines In this review article, we investigated the applications and mechanisms of the delivery of vaccines and the use of DNA vaccines in the field of biodefense.

Background and Aim: Prevention is a necessary and urgent task due to the widespread prevalence of various acute and chronic diseases. Nurses, in order to play their professional role and responsibility, need to know the choices, needs and abilities of patients in reality, their communication and their social context. The present review was conducted with two objectives: 1. determining the effect of a continuous care model on the outcomes of acute and chronic diseases, and, 2. describing and assessing the quality of methodology of published papers in this field.Methods: This is a systematic review conducted on 2017. A systematic search was conducted using PRISMA guidelines to retrieve all national and international studies using a Continuous Care Model.Findings: In the initial search, 3074 papers were retrieved, and following PRISMA screening guide, 51 relevant articles were identified. The final studies were classified and reviewed based on the authors, year, type of research with the number of studied groups, the aim of the research, the sampling method, the characteristics of the research samples in terms of the number of people and the type of disease, the method of data collection and final conclusion.Conclusion: According to the review of the studies carried out with the continuous care model and the effectiveness of all of them on the different outcomes of the study, it can be stated with certainty that this indigenous model corresponds with the culture of Iran is an effective, simple, efficient and reliable model and can be used in promoting and improving the various aspects of acute and chronic diseases. The quality of conducting intervention studies using this Continuous Care Model was relatively good, but the reporting style and quality of the studies are inadequate.

Background and Aim: Healthcare workers, in particular nurses, are at risk from many occupational hazards.These hazards not only affect the physical, psychological and social health care workers, but also impose heavy financial burdens on an organization. The aim of the current study is to determine the level of occupational hazards and related factors in health care workers in military hospitals.Methods: This cross-sectional study was carried out in 2016-2017 on 375 medical staff working in three military hospitals located in the southern cities of Iran. A valid and reliable researcher-made questionnaire (demographic and occupational hazards) was used to gather data by non-randomized quota sampling method.Data were analyzed by SPSS software version 18.Results: The mean (SD) of occupational hazards was 2.53 (0.66) and assessed as moderate. Among occupational hazards, ergonomic hazards 3.36 (1.09) were the most prevalent occupational hazard, and chemical hazards 1.73 (0.84) was the least important source of occupational hazards. According to the independent t-test and one-way analysis of variance, there was a statistically significant association of occupational hazards and variables such as gender, marriage status and organizational position (P<0.05).Conclusion: Considering the level and type of occupational hazards of medical staff in military environments, managers can take into account ergonomic considerations, designing appropriate preventive programs, and continuing training courses to reduce occupational hazards and burnout. This will help improve quality of life associated with health and the working life of staff.

Background and Aim: Skilled and expert manpower is essential for quick and proper response to accidents and fast and accurate relief and rescue operations. The aim of this study was to assess the knowledge of the Red Crescent Society's rapid reaction teams on rescue equipment in the prevalent natural and man-made disasters.Methods: This cross-sectional study was conducted in the first half of 2017. A sample of 120 respondents from the Red Crescent Society of Tehran, Iran was selected based on the Cochran’s formula. A researcher-made questionnaire was used to collect data and SPSS18.0 software was used to analyze data.Results: A total of 84 (74%) of the participants in the study were in the range of 20-30 years old. A total of 61 (50.44%) had a bachelor's degree. The results indicated that the mean rank of knowledge status is 21.45 points higher than average. People who have been involved in more than 16 operations were more knowledgeable about rescue equipment. People with experience of one to ten maneuvers had a lower score than those with experience of more than ten maneuvers. Also, people who have taken part in training courses scored higher grades.Conclusion: In general, the knowledge of the Red Crescent Societies' rapid response teams to rescue equipment in the natural and man-made disasters in the city of Tehran, Iran is in an acceptable status but far from ideal. Achieving this goal is possible through powerful manpower, proper organization, continuing education and training, adequately equipping search and rescue teams and providing the opportunity to benefit from the experiences of the United Nations and experienced countries.

Background and Aim: Evaluation is one of the most important ways to improve the quality of education. The main goal of evaluation is improving the programs and activities of faculty members. Evaluation can be used as feedback to improve weaknesses and understand the strengths of teachers. This study aimed to investigate the factors affecting faculties' evaluation from the viewpoint of faculties and students.Methods: This study was done as quantitative, factor analysis and cross-sectional study in a Military University of Medical Sciences in Tehran, Iran in 2016. In the factor analysis phase sample study included 116 University professors, 84 students and 62 experts in medical education, and in the cross phase included 344 students. The data collection tool was the Faculty' Educational evaluation questionnaire obtained from confirmatory factor analysis, consisted of 4 dimensions, teaching quality (20 questions), personal characteristics (8 questions), education law (5 questions) and professional features (16 items). Data analysis was conducted through confirmatory factor analysis, t-test, ANOVA and Friedman tests by SPSS19 and Amos 18 softwares.Results: Based on confirmatory analysis, all dimension of educational evaluation had a significant impact on the confidence level of 99 percent. The standardized regression coefficient was 0.48, in teaching quality, 0.43 in personal characteristics, 0.29 in education law and 0.37 in professional features. Among the Faculty' Educational evaluation dimension, from the perspective of student, individual characteristics (82.0±66.3) had the highest mean. Mean and standard deviation of Faculty' Educational evaluation 61.0±37.3, respectively. Friedman test showed personal characteristics had the highest rank among other dimensions and the mean difference between dimensions is statistically significant.Conclusion: The behavior and performance of teachers in the classroom can be an effective way to improve academic performance. Familiarizing faculties with a variety of items available in the form of faculty evaluation by school development centers and planning to upgrade faculty performance is recommended.

Background and Aim: The rapid development of information and communication technology has impacted all areas including healthcare. Due to the proliferation of electronic sources that provide health information, adequate eHealth literacy of patients seems to be a necessity. The aim of this study was to assess the level of e-Health literacy of patients referred to a military hospital and identify factors related to e-Health literacy.Methods: This descriptive study was conducted in a military hospital in Tehran, Iran in August 2017. The tool for gathering data was the Persian version of the e-Health literacy scale (P-eHEALS) which completed by patients. Simple random sampling was used to select patients. Furthermore some additional personal and demographical variables were collected to explore their relation to e-Health literacy. The independent-sample T test and analysis of variance (ANOVA) were used for comparison between groups. Spearman correlation and multiple linear regression were used to assess the correlation between study parameters and eHEALS score.Results: A total of 223 patients participated in the study, including 118 men and 105 women. The mean score for eHEALS was 25.35±8.256, which was considered low. Patients were aware of online health resources and knew how to search, locate and use these resources. However, patients lacked skills to evaluate and differentiate between high and low quality resources and did not feel confident in using the information they found to make health decisions.Conclusion: e-Health literacy was low among patients referred to a military hospital. Findings suggest they need to develop their knowledge of e-Health.

Background and Aim: The weaning process from mechanical ventilation in chronic obstructive pulmonary diseases (COPD) is a time-consuming process required for the care of these patients. This study aimed to: 1.decide cut-off points of combined and common indices RSBI, P0.1, NIF, CROP, and IWI in the population of COPD patients; and 2. compare different weaning factors from the mechanical ventilator of combined, RSBI, P0.1, NIF, CROP, and IWI indices in the population of COPD patients.Methods: This observational, prospective multi-center triple-blinded study was conducted from January 2013 to March 2014 in the population of hospitalized COPD patients in the critical care units of selected Military hospitals in Tehran, Iran. Patients were divided into two groups with cut-off points determining the first group (n =90) and different predictive weaning factors from the mechanical ventilator determining the second group (n= 90). The process of weaning from the mechanical ventilator was performed in the same way in both groups and was based on the defined protocol. ROC analysis was used to determine cut off points in the first group and predictive factors in the second group.Results: Six indices combined, RSBI, IWI, P0.1, NIF, and CROP were compared from different predicting weaning factor's view. Generally, RSBI, combined, IWI, P0.1, NIF, and CROP indices were devoted the most favorably factors to itself, respectively. The highest area under the curves were devoted to RSBI (0.927) and combined (0.891) indices.Conclusion: Although the proposed index has more components than other common indices in weaning process from mechanical ventilator, the RSBI index in addition to simplicity, provided the most desirable characteristics of predictive weaning from mechanical ventilator. It is also suggested that corrected RSBI index (RSBI application alongside tight subjective and objective signs and symptoms of respiratory distress) be used in the population of chronic obstructive pulmonary patients.

Background and Aim: The implementation of inactive and biological defense can play a major role in reducing the vulnerability of public health. Therefore, this study aimed to institutionalize the system for monitoring the production and supply of raw materials for herbal medicines for the promotion of health, prevention and treatment of diseases.Methods: This study has 6 stages: 1) determination of the region's climate; 2) determination of physicochemical characteristics of the soil; 3) comprehensive review of the plant's requirements; 4) selection and cultivation of selected plants in the green spaces; 5) introducing medicinal properties of medicinal plants; and 6) production of organic and safe medicinal plants.Results: The findings of this research showed that the climate of Tehran city varies from dry to wet conditions, and a wide range of medicinal plants can be cultivated depending on the conditions of each region. In the climatic region of the studied area, plants such as Aloysia citrodora, Hypericum perforatum, Hyssopus officinalis, Valeriana officinalis, Nigella sativa, Melissa officinalis, Borago officinalis, Lavandula stoechas, Portulaca oleraceaand Salvia officinalis can be cultivated.Conclusion: Although this study was performed on a small scale, it could be a model for larger-scale centers such as universities and organizations. This study can also simulate the cultivation of medicinal plants, change the pattern of common green space design and make better use of marginal and inert areas and in long-term, offer substitutes for some of the chemical drugs by medicinal herbs.

Background and Aim: Both Chronic Obstructive Pulmonary Disease (COPD) and mustard lung victims of chemical injury (unlike asthma and allergy) are known respiratory diseases with a substantial genetic background and there are no highly effective medications for either disease. Considering the many similarities between the two diseases, both can be considered simultaneously under one category. Therefore, we assessed the expression of miR-20a and miR-92a as representatives of the miR-17.92 cluster due to the effective interference of these two miRNAs in the signaling pathways of inflammation and hypoxia in the pulmonary serum (consisting of Mustard Lung and COPD, simultaneously).Methods: Stem-Loop Real-Time Quantitative Polymerase Chain Reaction was used to examine the expression of miR-20a and miR-92a simultaneously in patients with COPD (n=25) and mustard lung (n=50).Results: The results showed that the expression of both miR-20a and miR-92a was significantly down regulated in patients with COPD and chemical injuries when compared to the control group. The expression of each of two miRNAs in the moderate and severe phases of the disease was more down regulated in the mild stage, and miR-92a showed a further down regulation compared to miR-20a (p<0.05).Conclusion: The down regulation of miR-20a and miR-92a might be due to alterations in 1- genomic and/or 2- environmental and/or 3- ecogenomic (affected by epigenomic) factors which requires intensive research in this field. Our results may shed light on new effective strategies for the treatment of respiratory diseases by regulating the mir17.92 cluster by regulating related factors. The members of the oncogenic miR17.92 cluster are significantly upregulated in lung cancer and have the potential to be used as biomarkers in the non-invasive screening of respiratory diseases. Furthermore, these miRNAs can be used for distinguishing respiratory diseases from lung cancer and cardiovascular diseases (also known as COPD comorbities).

Background and Aim: The motor ability of persons with amputation is generally lower compared with those without amputation. One of the most important factors affecting motor ability in amputees is the function and comfort in using a prosthetic limb. The aim of this study was design, production and assessment of an ankle turner unit of prosthesis in subjects with unilateral below knee amputation Methods: In this applied research, to provide the possibility of rotation of the ankle section of the prosthetic limb in required conditions and the ability to return and disengage to the initial position, a very light weight unit was designed. After the design phase, the unit was produced using light and durable materials by milling and cutting machinery. The unit was designed and made to be compatible with mating sections of the host prosthetic limb without the need for change in the host prosthetic limb or use of any interface. The effect of this unit on the ability to sit cross-legged and to kneel was evaluated in 20 patients.Results: The produced unit improved transversal rotation in the ankle joint of the prosthetic limb. To provide effective ankle range of motion in amputee patients, this unit was tested on 20 persons with unilateral transtibial amputation. In all patients, transversal rotation range of motion of the foot ankle resulted in a significant improvement in patterns for cross-legged sitting (p=0.04) and kneeling positions (p=0.006).Conclusion: In general, using this unit increases the effective range of motion in amputated limbs which can be beneficial to motor ability of the amputee patients.