Journal of Military Medicine
Year:2005 | Volume:7 | Issue:3|Papers Count:16

Introduction: Military personnel need health care. Knowledge about causes and frequency of healthcare utilization and correlated variables provides the planners a valuable data. Current study was performed to assess Causes of health care references and correlated variables during military training of sepah. Material and Method: This cross sectional study was performed on military personnel who were passing training course in 2002 in Sepah military training centers in Tabriz, Varamin and Hamedan. Sample size was 2203. subjects were visited by the physicians. Demographic data including: age, educational level, marital status, history data including: past history of medical disease, surgery, fractures, medications, sports, wearing glasses, familial diseases, smoking habits, dominant hand, weight, BMI and physical examination including: plantar of foot curve, knee alignment, ligament flaccidity, visual acuity was registered. Health care utilization was assessed as the main outcome. Results: In the study period, 2636 visits (by 1146 subjects, 52.6% total ) to the outpatient clinic were registered. Mean visits for all, and clients were 1.19 and 2.3, respectively. Mean visits for soldiers and others was 2.4 ± 0.7 and 1.95 ± 0.6, respectively. Cause of visit was physical injury in 821 cases (71.6%), respiratory infections in 242 cases (21.1%) and others in 83 cases (7.3%). The kind of physical injury was musculoskeletal in 494 cases (60.1%), superficial injuries in 271 cases (33%) and cuttings in 56 subjects (6.9%). Health care utilization was seen more in those with ligament flaccidity (p=0.04). Health care utilization was not correlated with, educational level, past history of medical disease, surgery, fractures, medications, sports, wearing glasses, familial diseases, smoking habits, dominant hand, plantar of foot curve, knee alignment, or visual acuity (p>0.05). Discussion: The results of this study showed that more than 50% of personnel in training period need health care, in a significant proportion, the cause is physical injuries. This study revealed that ligament flaccidity as a risk factor of health care utilization during military training period in Sepah. Screening of the military personnel before training period is suggested to decrease the need for healthcare

Introduction: Several studies have reported data indicating that there are positive relationship between cigarette smoking and military staff especially soldiers. According to population pyramid of Iran, a main group of people are youth and have situated in military period. This study determined the prevalence of cigarette smoking among soldiers of Guilan province. Material and Method: In a cross sectional study, self– completion anonymous questionnaires were administered to 612 selected soldiers with quota random sampling in Guilan .The questionnaire consisted of two sections; section one dealt with sociodemographic data, including: age, duration of conscription, marital status, parent’s education, cigarette smoking among parent and other family members and section two assessed details cigarette smoking at now. Data analyzed with SPSS 11.5 software and χ² test and logistic regression were used. Results: The mean age was 21.8 ± 2 (range from 18 to 29 years). Mean duration of entrance to military services was 8 ± 5.8 months. 82.2% were single, 25% were illiterate or ≤5 grade education, 37.1% had 12 grades and 37.9 % had more than 12 grades education. 233 persons (38.1%) were ever smokers and 157 subjects (25.7%) were current smokers. Among current smokers, 82.2% were started smoking before the entrance to military services. Among smokers, the mean age for starting smoking was 16.8 ± 3.2 years. There was a significant correlation between current smoking and cigarette use by friends and family members, marriage situation and regular exercise according of χ² test but in logistic regression models, cigarette smoking by friends was the only affecting factor on smoking in participants (p< 0/00001). Discussion: Although this study showed that there is not any difference between cigarette smoking among soldiers and normal population but noticing time of starting of smoking reveals that appropriated preventive programs are needed to control of this problem among youth.

Introduction: Epilepsy is one of the most common neurological disorders, which afflicts about 1%-2% of people in the world. The diagnosis of epilepsy is of special importance since it affects different aspects of life. It’s also crucial from the point of security in soldiers who may exempt from the draft due to proved epilepsy. In this study confirmation of epilepsy in soldiers has been assessed. Material and Method: Here is a retrospective survey on 113 soldiers who have claimed to suffer from epilepsy and been admitted to Baqiyatallah hospital from 1996 to 2003. The data were gathered by the aid of questionnaire provided on the basis of valid references and the opinion of psychologist. This also includes personal information, types of episodes, EEG, Psychological consult and final diagnosis. Data analyzed with SPSS 11 Software. Results: The mean age of the patients was 20±2 within the range of 19-25 years old. The mean duration of hospitalization was 8±2 days while 57% of patients were hospitalized between 6-10 days. By this survey the frequency of epilepsy is 57.1%. The most common diagnosis was generalized and tonic- clonic seizure. The often diagnosis are following: Pseudoseizure (12%), depression (9%), headache (5%), syncope (0.9%), no problem (8%) and no diagnosis (8%). Discussion: Because epilepsy is a life threatening disease and diagnosis needed to mobile monitoring especially in soldiers, we considered to health center of military to make new facilities for diagnosis of epilepsy.

Introduction: Subject show that 20-25% of adolescents suffer from psychological disorders. Family factors, especially psychological disorders of parents, are important risk factors for psychiatric health in adolescence. Material and Method: In a cross- sectional study throughout the country, 5317 adolescents aged between 15-18 y/o, fulfilled a general health questionnaire (GHQ-28) and a demographic one during the summer IMAM KHOMEINI festival in LAVASAN. Data were analyzed by descriptive statistics and statistical tests (Variance & Pierson). Results: Health state levels were meaningfully different in boys and girls in all of the four subscales (64% in girls and 72.2% in boys). As the adolescents grow elder, the healthy feeling is decreased. Number of sisters and brothers, parental education and father’s occupational state, significantly influence the level of  mental health in all four subscales. There is also a positive correlation between child’s educational development and his/her mental health state. Those, whose parents suffer from psychological disorders, feel less healthy. Adolescents from GYLAN province, showed the least mental health level. Discussion: Based upon the cut-off point of 5.5 for the scales of GHQ questionnaire, 36% of girls and 26.8% boys suffer from psychiatric symptoms. High prevalence of psychiatric symptoms in our study group can be due to the problems and stressors of fathers which not only affect the veteran himself, but also his family.

Introduction: Despite rarity of health profile of veterans with different types of casualties has been reported to be different, there is lack of data in this field. The aim of this study was to assess the correlation between types of injury and cause and time of mortality in Iranian veterans. Material and Method: This study was a retrospective study. 1709 deceased charts were reviewed from all deceased veterans between 1980 and 2002 whose data was registered in Veterans Affair. Types of injury were psychiatric, physical and chemical in 486, 1167 and 371 subjects respectively. Results: The most frequent cause of death was disease and then unintentional injury, respectively, in all 3 groups. The most frequent kind of disease (as a cause of death) was cardiovascular disease in both psychiatric and chemical exposed veterans, and pulmonary diseases within traumatic injuries group. Death after chemical injury was seen to be sooner than others, and later in traumatic and psychiatric injuries (p<0.05). Discussion: This study showed that however main causes of mortality in veterans with different types of injury is the same, the kind of disease and time of death are different between these groups. This reminds the need for specific intervention planning for any of veteran subgroups. Such a health planning can be done by developing various teams consisted of expert panels.

Introduction: Damage to the upper and lower respiratory tracts, alveolar cells, aggregation of fluids, enhancement of PMNs and lymphocytes and reversible damage to lung, bronchia and finally interstitial lung disease are the most important effects of sulfur mustard (S.M). Previous studies have shown many chemical warfare victims suffering from severe lung complications. On the other hand, after one decay exposure to S.M., they have gone under different treatment. So that, some researchers believe that all respiratory tract symptoms may not be directly dependent on S.M effect. The aim of this project was the study of S.M. induced lung damage. So that, without involvement of any treatment, the effect of S.M could be studied directly and independently. Material and Method: Twenty four rats aged 8-10 weeks, 150 gr, were divided in two group as test and control. Test group were exposed to 1 ml S.M in acetone for 30 minutes (1270 mg/ml). Control group were exposed to acetone only. The rats were killed at 2, 4 and six months. The lungs were removed for pathology study. Results: The results after 2 months showed no visible damage to lung tissue. After 4 months, hyperplasia of pneumocytes type 1, 2 was seen with no sign of serious damage but some inflammation. After 6 months, in addition to acute and chronic lung inflammation, alveolar wall thickening was seen. Discussion: It seems that SM induces lung damage, inflammation and alveolar wall thickening in long time.

Introduction: Earthquake is an inevitable disaster happening in countries like Iran. The aim of this study is to evaluate the first aid and transportation indices in the Bam devastating earthquake. Reviewing the results of such studies can demonstrate the weak and strong points, and find out solutions to strengthen the weak points and improve the supplement qualities in other natural disasters. Material and Method: A cross-sectional study was done on 292 victims of BAM earthquake, which were hospitalized in baqiyatallah and some other Tehran hospitals. The victims were investigated regarding to the demographic variables, the situation during earthquake ,the time that the first rescuer reached the place ,the time period during which the victims were rescued and the time period during which the victims were sheltered in different locations and some other important indexes related to triage and transportation. The interview was done by a standard form which was our main data-gathering tool. Results: The average age of the studied victims was 30.22±0.82 years. 140(60.6%) of these victims were married and others were single. 245 of the victims were asleep during the earthquake. In 176 cases (60.7%) the relatives were the first rescuers. The average time for rescuing the victims was 1.12±0.12 hours and the average time period of rescuing victims and obtaining first medical-aids was 14.6± 0.18 hours, average time period for the presence of the victims in the first and second location were 7.5± 0.08 and 13.52 ±1.2 hours respectively. Discussion: as the first rescuers were the relatives of the victims, it can be concluded that medical aid should be taught to people to prepare them for inevitable disaster. The results show that the rescuer need too much time to reach the location and rescue the victims which indicate the need for a vast programmed country-wide system.

Introduction: Clostridium botulinum is a spore-forming bacterium that produces lethal neurotoxin, the causative agent of a paralytic disease known as botulism. Diagnosis of botulism is obtained by detecting the neurotoxin or bacterium in a suspected food sample. The standard method for detecting the toxin is the mouse bioassay. It is highly sensitive and specific, but costly, time-consuming, laborious, and requires handling of laboratory animals; thus, only a limited number of samples can be analyzed at one time. Other methods such as ELISA technique were used for detection of the toxin, but the antibody raised against one type had cross reactivity with other types. In this study, a Multiplex Polymerase Chain Reaction (PCR) assay was developed for detection of C. botulinum types A, B, and E. Material and Method: C. botulinum types A, B, and E have formerly been confirmed by the biochemical methods as well as mouse bioassay. For detection by PCR, three primer pairs with equal melting temperatures were designed, each being specific to botulinum neurotoxin gene type A, B, or E and enables a simultaneous detection of the three serotypes. Results: DNA amplification fragments of 782 bp for C. botulinum type A alone, 205 bp for type B alone, and 389 bp for type E alone were obtained and confirmed by digestion enzymes. Clostridium perfringens was used as negative control and did not yield a PCR product. Discussion: This method is rapid, sensitive, specific and can be used for detection of three types of Clostridium botulinum human pathogen.

Introduction: Brucellosis is a zoonotic disease with global prevalence. It has been prevalent in different parts of Iran, since previous decades. The control of brucellosis is urgent from medical and economic point of view. Accurate diagnosis of the agent of disease in clinical samples has been highlighted as the first step of disease control. Different culture and serologic methods have the vital role in diagnosis of brucellosis although they have shown some practical difficulties as well. In the present investigation, the species specific primer set for B. abortus were used and PCR protocol were evaluated with clinical and veterinary samples. Material and Method: Standard B. abortus were obtained from national reference laboratory and kept under laboratory conditions. All primer set specific for different targets of bacteria were studied and evaluated by computer software. The genomic fragment of IS711 were selected for the study. The genomic extraction were then achieved and the primer set were optimized for the laboratory conditions. All clinical (human & veterinary) isolates were then tested with optimized primer set and the results were compared with other data sets. Results: Among 42 serologic positive samples, the bacteria were isolated from only six samples. 10 animal samples were examined with both culture and PCR methods. The sensitivity of PCR was 60% while the sensitivity of culture was 40%. Meanwhile, the PCR sensitivity for 5 human samples (80%) were less than culture method (100%). Discussion: Serologic results for clinical samples were compared with culture results and also with PCR. Although the PCR set were optimized in our laboratory the results of PCR were not in accordance with culture method. All clinical samples were mentioned as positive according to serologic results while brucella spp. were not isolated from all samples. We could expect more sensitivity from PCR set, but one culture positive sample was negative with PCR. This could be due to specific gene target of B. abortus even not all strains of B. abortus were practically detectable with tested primer sets. The future work could be focused on multiplex PCR for all strains of B. abortus.  

Introduction: The phlebotomine sandfly, Phlebotomus papatasi, is the  main vector of Leishmania major, the causative agent of rural zoonotic cutaneous leishmaniasis in Iran. Knowledge of the genetic and population differentiation of sandflies will be useful for planning interventions in leishmaniasis transmission. Cytochrome b gene, Elongation factor–1a gene and a surface protein gene of Wolbachia bacteria were used as markers. Material and Method: Sandflies were sampled from different regions of Iran using sticky papers, funnel traps, CDC miniature light traps and aspirator. Each sandfly was dissected in a drop of autoclaved 1x TE on a clean microscope slide, to pull off the head and posterior abdomen to identify of sandflies and rest of body for extraction of DNA. Both primers were used for sequencing each sandfly DNA. Results: Three fragments of Cytochrome b were amplified and sequenced. Thirty three CB1 haplotypes among the 189 sequences, Seven CB3 haplotypes among the 44 sequences and 49 Cyt b Long haplotypes among the 149 sequences were identified. The prevalence of the surface protein gene of Wolbachia was high. Elongation factor-1a gene implified by PCR. However, some part of fragment often gave sequences that were not readable. Discussion: Phylogenetics analysis of all the three fragments of Cyt b identified a single haplotype network. Unlike Cyt b, the wsp gene of Wolbachia did not show any polymorphism which are consistent with the absence of cryptic sibling species of P. papatasi. No well-differentiated lineage was found, and no lineage predominated in different habitats of Gerbil burrows and peridomestic animal shelters or geographical isolation by distance.

Introduction: Aid and transport chain is one of the important processes in taking care of the patients. In proper places special personnel give these care to the casualties. In this study we evaluated the conditions of first aid and transport during Sabalan mountain climbing in 2003 in Ardabil province. Material and Method: This cross – sectional analytic study carried out by collecting the information by designing a group of Questionnaire forms from medical centers in the field containing: 1 field hospital, 3 field emergency units, 4 First Aid stations. The statistical indices were analyzed by SPSS 11.5 software. Results: Some of the main results suggested that medical equipments, drugs and materials and instruments in the places, medical centers environment, equipments, the time of transferring an injured person from emergency unit to a field hospital were acceptable and suitable, but the time of transferring the injured person from the field and first aid station, to field emergency unit, Communication tools, registration systems and the transportation of files and data were not properly acceptable. Discussion: There are still some defects in some parts of aid and transportation chains. Making a proper situation for better and faster transport, proper communication in different levels, making concise files and collecting and transporting them with casualties in a proper way, are the main topics that must be considered.

Introduction: Drinking water has important role in transmission of waterborne diseases. Provision and supply of safe drinking water for armed forces is a very important health issue that can affect the military power of a country. Among disinfection methods of drinking water, chlorination is the most and oldest method being used in military centers. The aim of this study is to assess the operation of hypo-chlorinators as the only method of disinfection of drinking water in military centers. Material and Method: 182 centers all over the country were sampled in this descriptive study. Data has been collected with a questionnaire and was analyzed with SPSS software. Results: Operation of hypo - chlorinators and chlorimetry was done correctly only in 35/5% of military centers and the system operators were not sufficiently trained. In more than 50% of residual chlorine tested, destruction and outfit of hypo-chlorinator systems and lack of chlorine supply were the main reasons for reporting the presence of no residual chlorine in drinking water. Another noteworthy reason was improper dosages of dilute liquid chlorine to their storage tanks. Discussion: It is shown that there were problems in operation and maintenance of hypo-chlorinators. Training the personnel for removing the problems, supported by management and supply of suitable equipments is recommended.