Journal of Military Medicine
Year:2003 | Volume:4 | Issue:4|Papers Count:24

In respect of disagreement among specialists about psychological impacts of war, this study was performed for assessment of signs, symptoms and diagnosis of disease type in 52 psychological casualties of war by using demographic questionnaire and interviews. The analysis collected data showed that psychological symptoms accompanied by somatic are wide spread in addition most important psychological disorders and neurotic or reactive impairments and Post Traumatic Stress Disorder (PTSD) which is the most common clinical feature. Based on this study we can say that, naturally, terrible stresses of war impair the personality organization and with predisposing factors reduce to presentation of psychological impairments that in this study is PTSD, like many other studies, and is better to call this entity Post War Stress Disorder.

This study was carried out in 1990 on 35 randomly selected pilots in the Revolutionary Guards, aimed at identifying the prevalence rate of psychological disorders and work fatigue. The study was based on the SCL90 method. The required data was collected using the SCL90 test and the work fatigue test. This information was analyzed by spss. The result revealed that the overall indicator of the severity of the illness among the group under survey was higher than normal society. Generally, about 8.5% of them suffer from psychological disorders. The prevalence of the following symptoms was higher than the rest: obsession, paranoia, depression and anxiety. Furthermore, among 8.5% of the pilots, sever work fatigue was observed. This study also showed a significant relation between Work Fatigue and the prevalence rate of psychological disorders. This relation was mostly observed between Work Fatigue and physical complaints, anxiety and depression. Based on these results, researchers made following suggestions: Modification and improvement in the recruiting system of the piloting students, use of accredited psychological tools in the recruiting system, providing consultations for reduction of stress in pilots, and arranging "how to encounter stress" courses for pilots.

In spite of all attempts for safe blood transfusion, there are a variety of complications such as viral infections, alloimmunisation, hemolysis and immunosupression. Nowadays the main subject of blood transfusion services in the world is provision of safe blood, and one of the best ways is the patient"s own blood or autologous blood. In this study, patients who were candidate for elective surgery consulted to Tehran blood transfusion center. With respect to the type of surgery and hematocrit more than 30%, about 10% of whole body blood (350-450cc) had been taken out. Collection of blood ceased 72 hour before surgery. After negative viral tests, the blood units, were preserved separately at 2-6 QC and handed over to hospital before operation. When it was not used, returned to blood transfusion center and with those units which had viral infections, autoclaved and then discarded. Forthy six cases included in the study, of whom 36 (78.3%) were females. The patients had average 13-72 years of age and weighing 40-105 kg. 19 patients (41.3%) donated one unit of blood, 24 patients (52.2%) two units, 2 patients (4.3%) three units and 1 patient (2.2%) four units. The only complication occurred in one patient was vasovagal reaction and resolved with sweet liquid diet. Ten patients (21.7%) needed no blood and in 31 patients (67.3%) allogen blood was not used. In plastic surgery- the most common type of surgical operations (41.3%)- ENT, general surgery, Gynea & obst and maxillo- fascillary operations, autologus blood provided 100% the need of the patients and no allogenic blood was used, But in orthopedic surgery, 56.3% of necessary blood was provided with autolog blood. No blood transfusion complication was seen. Autologus blood as the safest blood, reduced necessity of allogenic blood by 70% and can be used more successfully by accurate planning and introduced to the patients who are candidate for elective surgery.

Vascular pooling has the responsibility of circulating blood throughout the body and feeding various tissues, any kind of disorder in this system threatens the vitality of the organ, thus this function is considered a vital system for the body. During the 8 years of the imposed war (Iran-Iraq) numerous casualties suffered from severe problems due to damages in the vascular system, such as hemorrhage, sever decrease in blood pressure (shock), loss of organs (amputation). Due to the lack of precise and informative data regarding the various circulatory damages till the end of the war, and on the other hand abundance of radiology records inthe Shahid Mustafa Khomeini hospital-one of the hospitals in which war casualties were admitted - we decided to study about 3000 radiographic films of the injuries registered in the hospital. Among them, the 157 angiographic films which were suspected to be caused by vasocirculatory disorders were separated and analyzed once again.

The present investigation aimed to study the effects of wearing NBC garments with and without a face mask and impermeable rubber suits on five parameters of aerobic fitness: cardiopulmonary endurance, speed or velocity, agility, flexibility and the number of sit ups. It was a quasi- experimental study recruiting 60 volunteer male trainees. Their mean age, height, and weight were 24.59 years, 174.95,cm, and 69.72 kg, respectively. The volunteers were randomly allocated to 4 groups: A to D; and pre and post-tests were performed. All individuals in all groups were wearing normal combat clothing (NCC) in the pretests. In the post-tests; however, standard NBC garments without (C) and with (B) a facemask, NCC (A) and impermeable rubber suit (D) were worn. Data were analyzed using ANOVA and student t-test. P values less than 0.05 was considered as significant. Results indicated that in group C, where standardNBC garments were used, only the cardiopulmonary endurance parameter was significantly affected. However impermeable rubber suits repressed the speed of physical activity and not other parameters.

Accidents are increased among developing countries. To evaluate the severity of such injuries (secendery prevention), many different scoring system have been devised so far. One of the most common system in this regard is Injury Severity Scoring (ISS) which we used in our study to score traumatized patients reffered to emergency services at Al Zahra medicale center, Isfah, Iran. Prospectively, 380 traumatized patients were chosen for this study. All the cases involved were transfered to the emergency services of Al Zahra hospital which is an academic center affiliated to Isfahan University of Medical Sciences. Special sheets were already prepared to enlist patients required information such as age, sex, trauma type, literacy status, etc. The collected date were then analyzed with T test and regression test using spss software. P values of less than 0.05 were considered significant. As many as 83% of patients were men and 70% of all the cases were literate. Traumas were penetrating in 50.5% of all. The age of patients ranged between 26.3 -14.15 years. The period of hospitalization varied from 7.59 - 5.32 days.Those with blunt trauma stayed for 7.37 - 7.11 days while it was 3.2 t06.9 days for penetrating ones. (P=0.000l) Blunt traumas occurred more frequently in women while men experienced penetrating traumas more. (P=0.03) Head traumas were more severe in woman (P =0.02) and also in blunt traumas (P=0.0l) The ISS value varied from 8.9 to 12.63 and was usually higher in blunt traumas than in penetrating ones (P=0.003). No relations between age and ISS could be sought.The findings revealed that compared with penetrating traumas, trauma severity score is higher in blunt traumas. Besides, there were no significant relations between sex and trauma severity.

Electromagnetic field treatment exerts its lethal effect primarily by producing pores in the cytoplasm membrane. And different antibiotics affect on bacteria are dissimilarly and their mechanism of action is different from each other. Researchers have shown that electromagnetic field treatment enhances wound healing. In the present work at first the effect of gentamicin, tetracycline, erythromycin and vancomycin on Staphylococcus aureus, has been studied by disk diffusion test. This bacterium causes a wide variety of suppurative disease in humans, including superficial and deep abscesses and wound infections. Gentamicin, tetracycline and erythromycin inhibit the protein synthesis and vancomycin inhibits the cell wall synthesis of sensitive bacteria. S. aureus was resistant to gentamicin, tetraciclin and erythromycin and susceptible to vancomycin. Then combined effect of electromagnetic fields of 12 G and 21 G and the above mentioned antibiotics on the growth of Staphylococcus aureus was studied. The result of analysis of sensitivity of S. aureus to the studied antibiotics after exposing to electromagnetic fields for different periods of time shows that these fields have no significant effect on the susceptibility of the bacterium against tetracycline, erythromycin, and vancomycin but affect the susceptibility pattern of the bacterium against gentamicin. Probably the combined effect of some antibiotics and electromagnetic fields can increase the wound healing.

Barn earthquake has been one of the most catastrophic natural disasters in recent years. Considering the presence of military forces in search and rescue missions, medical and assistance activities done by the medical department of Sepah in this event in the light of the importance of military forces special characteristics are discussed in this article. The following items could be mentioned as some of the most significant aspects of Sepah activities in this event: reporting the first news about the event, starting search and rescue missions in the first hour after the disaster by the first brigade of Barn as the first assisting forces, settling 2 field hospitals as the first Iranian field hospitals in the disaster area, transporting 937 assistant, medical and health care personnel to the disaster area in the first day, settling 23 field emergency and 13 field assistance centers in the area, settling 8-post hospital care centers over the country, transporting 11792 casualties to different hospitals around the country. Regarding this disaster experiences and exclusive abilities of military forces, a special role for these forces in search and rescue missions should be considered.

War, as an unpleasant and stressful phenomenon is able to precipitate all psychiatric disorders. For the first time during the US civil war (1861 to 1865) in a documentary and formal study, physicians noticed a kind of neurotic disorder among the soldiers active in war and named it Nostalgia. Later on, other names and terms such as Fright Neurosis, and Effort syndrome were used. Therefor, since an eight-year war was imposed on our country and numerous young people took part voluntarily in this war, psychological analysis of soldiers is of great importance. Rendering medical service to these courageous devoted soldiers would be possible, if their psychological problems caused by this imposed war are thoroughly and precisely studied. Thus the purpose of this study is to determine psychological disorders in soldiers of the holy defense.

Iran because of its size, geographical location, and climatical diversity is among the most disastrous countries in the world. Earthquake, both on the economic devastation and loss of life, is the most devastating natural disaster. In the last 10 years, there have been about 950 earthquakes in Iran and as a result 37,600 people were killed and 53,300 injured. These figure do not include casualties of Barn earthquake. Crisis resulting from natural disasters, requires special management sy~tem.Disaster management system in Iran, because of encountering several natural disasters and a long-lasting recent war, has enough experience in this regard, specially in using nongovernmental emergency systems, such as Red Crescent and Basij. / However, in the past, disaster management were mainly limited to the rescue, saving lives and reconstructions after the disaster and other dimensions of crisis management including prevention (reducing the effect of disaster) and readiness to respond and quickness of response in an effective way and also an organized management seems to be lacked. In this paper, we will discuses the medical management in Barn earthquake. Wewill discuss the management of the human resources, transportation of injured, equipment and medical care personnel and suggestions will be given to overcome some of the problems in the disaster management.

Recenty crimean congo heamorrhagic fever has been spread across the world including: Kosovo, Afghanestan, Pakestan, Iraq and Cuba. The mechanisms of transmission is not well understood. Perhaps, many socio- economical factors may be involved. Crimean congo haemorrhogic fever has been increased since 1999 in Iran. The disease can be transmitted to human either by the contact with contaminated human and animal blood or by specific ticks bite (Hyaloma spp). However, it has to be said that the disease was present in the past as endemic form in north west of Iran. This article is going to explain 8 cases of CCHF who are infected with the virus in South Africa. In a few cases, mode of transmission was considered either nosocomial or airborne infection. It should be said, that the CCHF virus was weapnized by some super power countries which poses a great threat to the World. Therefore, considerable attention should be paid to this issue.

The global outbreak of severe acute respiratory syndrome (SARS) originated in Foshan, Guangdong province of China, as early as 16 November 2002, has infected more than 4000 people in 30 countries .The agent that causes SARS has now been conclusively identified by WHO colaborative researches. The SARS virus is a new coronavirus unlike any other known human or animal virus in the coronavirus family. The virus is transmited by close contact with patients and there are evidences that it can be transmited via feces. The incubation period of SARS is usually 2-7 days but may be as long as 10 days. All patients presented with fever (temperature higher than 38°C for over 24 hours), and most presented with rigor, dry cough, dyspnea, malaise, headache, and hypoxemia. A few patients have reported diarrhoea during the febrile prodrome. Pulmonary infiltrates appeared in chest radiographs early, even before the start of dyspnoea. Early in the course of disease, the absolute lymphocyte count is often decreased. Overall white cell counts have generally been normal or decreased. At the peak of the respiratory illness, up to half of patients have leukopenia and thrombocytopenia or low normal platelet counts. Early in the respiratory phase, elevated creatine phosphokinase levels and hepatic transaminases have been noted. Renal function has remained normal in the majority of patients. Scientists have completed full sequencing of the genome of the SARS coronavirus and it seems that viruse has been originated from domestic animals. Molecular tests like RT-PCR can be used to- detect genetic material of virus in various specimens (blood, stool or respiratory secretions). 96% of persons developing SARS recover spontaneously. Treatment includes a variety of antibiotics and antiviral agents such as ribavirin. Steroids have also been given. Mortality rate is around 5%. Majour Precoution for Prevention and control of SARS includes not to travele to infected countries and survilanse. Health care personnel should apply appropriate infection control precautions for any contact with patients with suspected SARS.

After Iraq-Iran war the community encountered with many of the war wounded who suffer from the outcome of the chemical gases which were used by Iraq. These outcomes are divided into early and Late complications. Reproductive outcomes such as spontaneous abortion, low birth weight and preterm labor are delayed outcomes. There are limited studies about these outcomes. The aim of this study was to survey pregnancy outcome in wives of the chemical war wounded and to determine the relation between chemical gas exposure and such results as low birth weight, preterm labor, intra uterine fetal death, fetus abnormality and altered sex ration. We randomly sampled 50 chemically injureds from 2100 chemically injureds in Kerman and obtained questionnaire data concerning chemical gas exposure and reproductive health experience. In these 50 selected chemical victims, there were 120 pregnancies..Among the 120 pregnancies, there were 19%LBW, 13%preterm labor and 8% abortion, low birth weight, Abortion and preterm labor correlation with mothers and fathers age, education and severity of chemical injuries were analyzed in SPSS system. Except for parents age, in other variables p were less than 5% suggesting that the relationship is significant.

Bioterrorism events have been rare until recently. Many clinical laboratories may not be familiar with handling specimens from a possible bioterrorism attack. Therefore, they should be aware of their own responsibilities and limitations in the handling and treatment of such specimens, and what to do if they are requested to process clinical samples. The Centers for Disease Control and Prevention has developed the Laboratory Response Network to provide an organized response system for the detection and diagnosis of biological warfare agents based on laboratory testing abilities and facilities. There are potentially many biological warfare agents, but probably a limited number of agents would be encountered in case of an attack, and their identification and laboratory safety will be discussed

In this article we have analyzed the psychological problems in children of martyrs and the dead personnel. The analyzed problems relate to 2001. The research method was descriptive and comparative and the collected information were related to 673 people between 12 & 36 years of age who reside in Tehran and are chosen in equal proportion among the families of martyrs and dead personnel, both girls and boys, with random method. The tool utilized for collection of data was SCL 90-R test. The collected data with this method were analyzed by statistical t tests and the obtained results showed that the disorders were Paranoia, aggression, obsession, disorder in inter personal relationships, body form disorders, psychosis and phobia respectively. Besides the analysis indicated that, regardless of phobia in other clinical comparisons among the martyrs and late soldiers children, there was a meaningful difference (P=0.01) which shows that the rate of the disorder symptoms in dead personnel children are more than that of martyrs children

Rheumatic symptoms were commonly described among soldiers who served in previous wars. To describe the frequency of rheumatology consultations, along with the diagnoses, and abnormal results on serologic testing in Gulf War veterans evaluated for Gulf War syndrome. The medical records of the first 250 consecutive Gulf War veterans referred to the comprehensive clinical evaluation program at Wilford Hall Air Force Medical Center and Brooke Army Medical Center, San Antonio, Tex, were reviewed for demographic characteristics and frequency of subspecialty consultations. A retrospective review of rheumatic diagnoses and the frequency of abnormal serologic test results was recorded. of the 250 Gulf War veterans evaluated in the comprehensive clinical evaluation program, 139 (56%) were referred for rheumatology consultation, which was the most common elective subspecialty referral. Of the patients evaluated, 82 (59%) had soft tissue syndromes, 19 (14%) had rheumatic disease, and 38 (27%) had no rheumatic disease. The most common soft tissue syndromes were patellofemoral syndrome (33 patients [25%]), mechanical low back pain (23 patients [18%]), and fibromyalgia (22 patients [17%]). Of the 19 patients with rheumatic disease, 10 had osteoarthritis, 2 had rheumatoid arthritis, 2 had gout, and 1 each had systemic lupus erythematosus, Behcet disease, parvovirus arthritis, psoriatic arthritis, and hypothyroid arthropathy. Abnormal serologic test results were common among the Gulf War patients regardless of the presence or absence of rheumatic disease. The rheumatic manifestations in Gulf War veterans are similar to symptoms and diagnoses described in previous wars and are not unique to active duty soldiers. Overall, the results of serologic screening were poor predictors of the presence of rheumatic disease.

Battlefield is an inevitable accident with different mass casualties from superficial to very serious injuries; the most important point is triage and immediate management of severe injuries. Most of the patients receive different management from fronts to the second line hospitals and a comprehensive record of injuries and treatment is necessary. In this study, we reviewed the medical records of some war casualties that were admitted in Shohada hospital surgery ward between 1984and 1986. In these cases we evaluated the trauma data registration and medical records. From 151 patients medical records 69 (45.7%) were complete and 82 (54.3%) incomplete and not useful. However, the records in 96 (63.6%) cases were enough, while 55 (36.4%) cases were unsuitable to evaluate. Because of these two problems some reoperations and sometimes unnecessary operations had been happened, which obviously had increased the number of expired patients. Unsuitable medical records in martyred was 61.1 percent and unsuitable data transfer was 50 percent, so we have to revise the medical guide lines and records in our military forces.

Afghanistan is .a mountainous country without connection to any seas or oceans. Up to 2003, the population of this country was 28,717,213 with 31 percent literate people. The present study has considered papers, articles and information from different relevant scientific websites and required information about health indexes and previllent infectious diseases in Afghanistan were collected. According to these survey, Afghanistan is one of the poorest countries in the world. The health indexes, especially life expectancy index (46-47 year) are disappointing. Every year lots of people die from different diseases, particularly Malaria, Tuberculosis, Leishmaniasis, Cholera, Measles, Poliomyelitis and Diarrhea. This country has these disappointing health problems because of many wars that have faced in the last three decades

Lead exposure can induce hypertension in human and experimental animals. The exact mechanism of lead-induced hypertension is unknown but many factors such as changes in responsiveness of adrenergic system may be involved. In this study the effects of acute and subacute lead exposure (28 days) on responsiveness of thoracic aorta were investigated. Sprague Dawley rats (200-250 gr) were used. After removal of thoracic aorta and placing in ice-cold Krebs solution, fatty and-connective tissue was cleaned. Aortic rings (2-3 mm) were sectioned and mounted in tissue baths for the measurement of isometric contraction. The tissue baths contained 10ml Krebs solution at 37°C and gassed with %95 O2/ %5 CO2.Aorta rings were placed under optimal resting force of 2 gr for 45 min, and then exposed twice to 40-mmol/l KCl. The contraction response to the second exposure to KCl was taken as reference for other calculations. The contractile responses were evaluated by adding incremental doses of different factors such as phenylephrine, prazosin, clonidine, yohimbine, dopamine and SCH in the presence or absence ofL-NAME and indomethacin. The results showed that acute and subacute lead exposure significantly increases contractile response. It also seems that adrenergic system is not solely responsible for this effect and other factors such as changes in Ca?+exchange, nitric oxide and cyclooxygenase rout may be involved.

Disasters are usually inevitable. However, by preparation of necessary equipment and material prio~ to emergencies, we would be able to improve the situation of others and ourselves. In response to disease and emergencies and for survival, there are three main priorities: water, food and shelter. Among which, food is the most important needs. Disasters can be divided in two general categories: Natural disasters such as earthquake flood, storms, etc, and man-made disasters such as biological, chemical and nuclear war and conflicts. Each of disasters and emergencies has different effects on food and nutrition. Proper planning and management reduce the consequences of crises. In this paper, different aspects of this issue such as programming, Supply, storage, estimation, distribution, consumption and also facilities and equipment needed in crisis, in the country will be discussed and desirable models of planning in crisis and disasters will be introduced.

Uranium (Z=92) as the heaviest natural element consists of the three following isotopes with the respected abundance e38U=99.2746%,235U=O.72%, 234U=O.OO54%). Depleted Uranium is the product or byproduct of 8.11Yprocess in which the percent of235U or 234U reduces. Today, Depleted Uranium is used in radiation shielding plates, counterweights and balance in jetliners, armor piercing munitions and reinforcing armored military vehicles. Environmental and occupational exposure occurs mostly by ingestion or inhalation, respectively. Recently some theories have been proposed about mechanisms involving radiation damage by alpha emitting particles like uranium; according to them in addition to DNA damage as a critical target molecule, some other extranuclear critical sites exist and involve. In this article, By stander theory and Second Event theory are discussed and epidemiologic and experimental evidences reviewed

Management of difficult airway is one of the challenges in anesthesia and use of Percutaneous Transtracheal Jet Ventilation (PTJV) and a fiber optic bronchoscope is as a life saving procedure in difficult airway management. An 80-year high risk ASA CLASS IV patient with more than 80% upper airway obstruction due to a large tumor, scheduled for left radical tonsillectomy, was a candidate for tracheostomy before surgery. We performed the procedure by local Anesthesia, PTJV and intubated the patient by fiber optic bronchoscope after general anesthesia (GA). Therefore, tracheostomy obviated while surgery was done successfully.