JOURNAL OF MILITARY MEDICINE
Year:2006 | Volume:8 | Issue:2 (28)|Papers Count:13

Introduction: It is estimated that in our country, Iran, there is a portion of 6% contribution to formation of all accidents and unfavorable natural disasters of the world and as Iran is on the middle part of the Alp - Himalaya earthquake belt, the most important disaster is believed to be the earthquake. After the terrible earthquake of Manjil, in which more than 20000 people were killed, another deadly earthquake struck in Barn city in Kerman province (South East of Iran in 1990 occurred at 5.22 a.m. 26 December 2003) with the magnitude of6.5 on the scale of Richter. More than 40000 people were killed; destruction of about 85% in this city was reported and almost all brick dwellings especially in the ancient parts of the city were completely destroyed; from the economical point of view, the loss was estimated to be 1.5 billion dollars. Material and Methods: In this study, quality of generated solid wastes, collection and transportation of them before and after the earthquake have been determined with regard to the data and statistics from municipalities, health centers of the Province as well as observations and interviews around Barn city.Results: Results showed that solid wastes generated before the earthquake was about 120 ton per day and the wastes collection system was home by home. The final disposal site at that period was between Darestan Mountains, 22 kilometers far from the east of Barn; transportation was accomplished by both pickups and trucks. According to the results of this study it was found that after the recorded earthquake, about 200 ton solid wastes had been generated daily which were transported to the previous landfill after collection from camps and transferred to established stations. Then, wastes were ignited daily but construction rubbishes were transferred to a valley intended as a disposal site which was located at a distance of 20 km from Barn. Because of no direct supervising, the latter rubbishes were distributed along the road of Barn to Bravat. Discussion: In any earthquake, two actions with regard to the earthquake wastes and its management should be taken before and after the earthquake. It should be kept in mind that any prepared previous planning related to earthquake and its solid wastes can reduce extra budgeting and will have economical savings. With regard to our experience in Barn earthquake with all problems and challenges, presentation of basic solutions related to solid wastes management before and after earthquake, can produce a clear guideline in this regard.

Introduction: Acquired immunodeficiency syndrome (AIDS) is a disease with high morbidity and mortality. Nurses are occupationally at risk of the AIDS and it is important for them to know the ways of transmission, prevention, and control of infection. The purpose of this study was to assess their knowledge about HIV/AIDS.Materials and Methods: This cross sectional, descriptive study was conducted with all nurses of Baqiyatallah (a.s.) hospital for the purpose of assessing their knowledge about HIV/AIDS. Data, including demographic data and 33 questions about HIV/AIDS were obtained from the nurses, using a questionnaire. Two hundred subjects were selected by simple randomized method and the percentage, correlation; and SPSS12 was used for analysis of data.Results: In this study, the subjects were 129 female (64.5%) and 71 male (35.5%). The analysis of data showed that the mean ages was 31.16±0.5 years old. The most frequent literacy was BSc (69.5%). The mean occupational periods was 6.81±0.4 years. Research findings showed moderate knowledge levels were as high or excellent 13.5%, as a good manner 34.5%, moderate manner 43% and weak 9%. The lowest correct response was 1.5%, of precautions and the most correct response was about dental procedure transmission (94%).Discussion: Findings suggest that, the knowledge level of the nurses about the routes of transmission was moderately low and there were misconceptions at high level. As the nurses is at high risk of occupational transmission of acquired immunodeficiency syndrome (AIDS), we recommend the strategies for AIDS risk reduction and preventing the illness; the most important role of the nurses is to focus on education and information for individuals, and communities.

Introduction: A previous survey reported high mortality rate in land mine accidents in Eylam, I.R. Iran (36.4%). Responding to the survey, the actual intervention aimed at reducing land mine mortality by setting up a rural trauma system in land mine infested areas of Eylam.Materials and Methods: An intervention study of prehospital and emergency trauma care was carried out. Health personnel at rural clinics and layman villagers were trained and equipped for trauma care. Prehospital medical data were gathered on mine injured from 2002 to 2005 (n = 288). Outcome indicators (treatment impact on physiological severity and trauma mortality) were gathered at one referral surgical center. Results: In the rural clinics 109 health workers had been trained on advanced life support procedures including practice on animal models. At village level 4'725 lay people were trained in basic life support as first helpers. The system managed 288 casualties with penetrating mine injuries. The median ISS (Injury Severity Score) of the study population was 20.37, there were 40% major trauma victims (ISS >15). The overall mortality in the 4 year study period was 27%. The physiological condition was described by Physiologic Severity Score (PSS); PSS in-field was 6.409 and comparing to hospital admission, PSS (7.43), it was significantly improved in most trauma victims [CI of difference 95%, (-1.172 - - 0.980)].Discussion: Low-tech and low-cost prehospital trauma programs improve trauma care in rural LR. Iran. Compared to historical control, the intervention significantly reduced mortality rate in land mine victims.

Introduction: Disasters are typically described as low probable events with great impacts. In disastrous situations, the number of patients presenting to the medical facilities within hospitals increases. Meantime, health care managers must recognize the risk, to proceed with enhancement of power and standards, and decrease the disasters consequences.Materials and Methods: This cross-sectional study, was conducted in the second half of 2004.Managers (n=21) working at Baqiyatallah(a.s), Jamaran and Najmieh hospitals from Baqiyatallah Medical Sciences University; Hazrat Rasoul, Shohada-ye Haftom-e Tir hospitals from Iran University of Medical Sciences; Taleghani and Shohada-ye Tajrish hospitals from Shahid Beheshti Medical University; and Emam, and Shariati hospitals from Tehran University of Medical Sciences, were our study population. The data was collected by a self-constructed questionnaire and check list. Content validity and test-retest were used to determine validity and reliability of the instrument. Data analysis was carried out with SPSS11, using ANOVA and Tukey tests.Results: The findings of the study showed that hospitals vulnerability (3.30 of 5) because of disaster was desirable. Performance of disaster committee (2.85 of 5) was passable. Staff organizing system and capacity of critical wards were undesirable. Crisis management and command system with mean score of 1.88 of 5 and registry system (1.66) were undesirable. Finally, staff training and hospital facility in crisis situation were passable at Tehran hospitals.Discussion: Communication and power failures, evacuation and resources allocation were hospital challenges in disaster. Hospitals have been required to have and exercise on disaster/ emergency palm, Adjusting hospital emergency incident command system (HEICS) is the standard using in Iran hospitals.

Introduction: Suicide is a self intentionally death. Suicide and Suicidal behavior may exist in all people, but the prevalence of Suicide is more in soldiers. Suicidal ideation, attempt, and completion are discrete, but overlapping phenomena. This study considered numerous factors potentially related to suicidal ideation in Soldiers, including psychological status, family problems, addiction to drugs and cigarette, military related problems, and sociodemographic background.Methods and Materials: 1329 Soldiers were randomly selected from the Sepah Infantry Forces in variant areas. All the Soldiers were requested to complete the BSSI Beck suicidal scale ideation. As well as Goldberg's General Health Questionnaire (GHQ-28). Data were analyzed by Correlation tests.Results: Prevalence of suicidal ideation was 8.5%. Also the results revealed that the psychological factors, family problems, Socio-demographic background, and military related problems were significantly associated with suicidal ideation.Discussion: Overall, the suicidal ideation can be controlled in soldiers by appropriate methods.

Introduction: Staphylococcus aureus produces different extra-cellular protein toxins and virulence factors. One of the most important extra-cellular proteins is enterotoxin which causes staphylococcal food poisoning (SFP) effect. These toxins pass from the digestive tract to the blood circulation and consecutively activate the nerve centre of the emetic reflex, causing nausea, vomiting, abdominal cramps and diarrhea, which can lead to dehydration of the organism. Numerous detection methods are based on the evidence of the enterotoxins directly (ELISA, reversal passive latex agglutination and others), but DNA amplification methods like PCR (polymerase chain reaction) can show the presence of enterotoxigenic strains of S. aureus before the expression of enterotoxins on the base of specific gene sequences.Materials and Methods: In this study, S. aureus strains were isolated from nose of carriers and patients, and environmental specimens were confirmed by biochemical test. Primers were designed and the PCR was used to amplify the staphylococcal enterotoxin A gene (sea) and the staphylococcal nuclease gene (nuc). DNA amplification fragments of 279 bp for the staphylococcal nuclease gene (nuc) and 552 bp for staphylococcal enterotoxin A gene (sea) was confirmed by digestion enzymes. S. epidermidis used as negative control and did not yield a PCR product.Results: To investigate the distribution of staphylococcal enterotoxin (sea) gene in S. aureus, 98 samples obtained from environment were analyzed by Multiplex PCR and 89 confirmed as S. aureus. Six (6.74%) S. aureus isolates were found to be positive for enterotoxin type A gene. Nine (9.18%) bactria isolates were found to be positive for S. aureus by biochemical methods but did not confirm by molecular analysis.Discussion: This method is a rapid, sensitive, specific and inexpensive alternative for traditional biochemical and serological assays and can be used for detection of agent produced type A staphylococcal enterotoxin.

Introduction: Chronic pruritus, as one of the most prevalent complications in enormous Sulfur Mustard victims, can lead to long term disability. Due to side effects and low efficacy of long term therapy with some drugs, like corticosteroids, or low efficacy of some others like first generation anti-histamines, we decided to compare the efficacy and side effects of Cetirizine, Hydroxizine and Doxepin.Materials and Methods: This randomized double-blind study was done on 75 veterans in Baqiyatallah (a.s.) hospital during 2005. Pruritus Score (PS) and Visual Analysis Score (VAS) were measured for all patients before initiating the treatment. Patients were randomly divided into three 25 groups: group one received Doxepin capsule, 10 mg/day; group two received tablet of Hydroxyzine 25 mg/day; and the third group received Cetirizine tablet 10 mg/day for one month.After one month treatment and also one month follow up, pruritus indecies were measured again and compared with the first day scores.Results: Patients in all three groups had significant decreases in their PS and VAS after one month therapy (P<0.05), but in most of them, the indecies returned to the base score after one month follow up. 18 veterans in Hydroxyzine group, 14 in Doxepin, and 6 patients in Cetirizine group suffered from sedation, as drug side effects. In conclusion, Hydoxyzine and Doxepin had neady the same efficacy (p>0.05) in decreasing of pruritus scores, while Cetirizine, although causeda significant (P<0.05) decline, but it was not as much as the formers.Discussion: Both Doxepin and Hydroxyzine had nearly the same efficacy, but considering that Doxepin had lower adverse effects than Hydroxyzine, we think that it is a better choice to treat pruritus of veterans.

Introduction: Unavailability of healthy water in military practices can cause problems in hand hygine maintaining. This study compared the effect of antibacterial gel and soap in hand hygine maintaining.Materials and Methods: This experimental study was conducted in two groups of 35 military personnel of the Ayatollah Kashani air force center in Kashan city with simple random sampling in 2006. Two samples were taken from hands 5 minutes before and after using soap or antibacterial gel. The sample was cultured in BA and EMB media, and then biochemical experiments were done. Effectiveness of two methods was compared statistically with Mc Nemar, chi-Square and Hest. P<0.05 was considered as significantly different.Results: The most common microorganism in either group before intervention was coagulase positive staphylococcus. Antibacterial gel reduced the colony count as 93.5% of coagulase positive staphylococcus, and 100% of all other bacteria (P<0.001). Colony count of bacteria did not reduce with soap significantly (p>0.25).Dissension: Antibacterial gel was more effective than water and soap for hand hygiene maintaining, and in other hand gel didn't need water and its usage was very easy for military personnel. So, in low hygiene areas, we recommend using antibacterial gel instead of soap for hand hygiene maintaining in military practices.

Introduction: Suicide is a sign of psychosocial problems and causes a million life losses each year. Studies considering suicide pattern in veterans seems to be essential. Current study was conducted with the aim of evaluation the suicide risk factors as a cause of mortality in Iranian veterans.Materials and methods: In this retrospective study, 1463 death cases were selected, from all 1709 charts were collected in Janbazan Organization, demographic data and disability variables were extracted from charts. Cause of death was determined by commission as group1 for suicide and group2 for others. Frequency of different types of suicide (hanging, using medication, self burning, drowning, gunshot, unclear and others) was also determined.Results: The Cause of death in 70 subjects (4.9%) was suicide. Frequencies of different types of suicide were hanging 19 (27.1%), using medication 15 (21.4%), self burning 14 (20%), drowning 8 (11.5%), gunshot 3 (4.3%), unclear 10 (14.3%) and others 1 (1.4%). A significant correlation between suicide and marital status, injury percent, chemical exposure, history of PTSD, history of trauma, history of psychiatric hospitalization, surgery, psychiatric medication and drug medical disorder was seen. There was not any correlation between suicide and history of war prison.Discussion: Suicide is a considerable cause of death in Iranian veterans, whose victims die at the age of less than 40 years. It highlights the importance of this topic in this population. Some subpopulations are at higher risk of suicide.

Introduction: Narcotics cause immune suppression in the form of decline in the number of lymphocytes and immunoglobulin levels, which lead to the susceptibility to dangerous infections. In recent years injectable narcotics named Temgesic and Norgesic have found te be extensively used. Considering unknown complications of injecting new narcotics, this study has been planned in order to determine mortality rate and common infections in various narcotics.Materials and Methods: This cross-sectional study was performed on all hospitalized Patients in the ward 'of infectious diseases of Alzahra hospital in Isfahan, during years 2004-2005. Patients were divided into five groups including addicted to heroin, injecting opium, Norgesic, Temgesic and a group that did not use specifically a single narcotic. Symptoms on arrival, type of disease as well as type of discharge in the form of death, personal consent, running away or recovery were registered and analyzed.Results: Within 2 years, up to 690 hospitalizations occurred in the ward of infectious diseases, which 104 cases had complications of injecting narcotics, comprising 15% of all hospitalizations. Mean age was 31.01. Study showed that 61.1% of patients were heroin addicts, 14.5% Norgesic, 6.1% Temgesic, 3.3% opium and 14.4% belonged to group of users of various substances. Users of Norgesic were clearly younger than heroin and opium groups. The most common complication in heroin users was abscess of injection site and in Norgesic users' endocarditis (p<0.05). Four cases (10%) in 2004 and 9 cases (17%) in 2005 have died, also 17.9% of hero in group and 37.5% of Norgesic hospitalized cases. 70% of patients had fever on presentation. Tachycardia and tachypnea were seen in half of patients and most of patients had normal blood pressure.Discussion: In addition to more severe complications and causing more dangerous diseases, the new narcotics like Norgesic, also cause much higher mortality. The use of these substances has shown an increase in 2005 in comparison to 2004 with higher mortality due to complications of injecting narcotics.