مجله طب نظامی
سال چهاردهم شماره 1 (پیاپی 47، بهار 1391)

Crimean Congo Hemorrhagic Fever (CCHF) is a viral disease transmitted to human by ticks and contact with the blood or animal tissues and hospital contacts are the other ways of its transmission. This research was done to determine the epidemiologic trend of CCHF patients in Qom province. This descriptive-analytical study was performed on all patients diagnosed, treated and followed with the laboratory diagnosis of CCHF from 2001-2011. The data were analyzed by Chi-square test or Fisher’s exact test using SPSS 17 software. 34 suspected cases of CCHF were diagnosed, treated and followed during the studied years. 9 cases (26.5%) were confirmed, 11 cases (32.5%) were probable and the rest 14 cases (41%) only had some symptoms. The mortality rate of the confirmed cases was 22%. The most frequent age group was 15-35 years (70.5%) and most of the cases (91.3%) resided in urban areas. Most of patients were house wives, farmers, students and butchers and 85% of patients mentioned the history of contact with livestock. CCHF is endemic in Qom province, especially in urban areas. Those exposed to livestock particularly butchers and slaughter house workers and farmers are at the risk of this disease; therefore there is the need for health and treatment authorities’ special care in this field.

Military Medicine plays its role by providing the military forces’ health needs. Considering the growing trend of wars, terrorism and natural disasters, military medicine is evolving nowadays. The aim of this study was to design the Military Emergency Medicine curriculum in Iran. This study is a mixed method (qualitative and quantitative) research that its qualitative part was performed by review of global experiences on military medicine curriculum and tits quantitative part was carried out by collecting the view pints of national experts on the subject through the Delphi method. Data was collected by taking notes from several references and two researcher-made questionnaires. All “absolutely agree” or “relatively agree” viewpoints were selected as the curriculum elements and the confirmed curriculum was designed by experts and finally evaluated, reviewed and confirmed in an expert committee. 92% of experts believed that establishing the Military Medicine course in Iran is essential and the major priority was identified as Military Emergency Medicine. The curriculum was designed in the form of a four-year period consisting of theoretical part (35 courses), clinical part (36 months of rotation) and the thesis research (6 courses). The four-year Military Emergency Medicine curriculum including 35 theoretical courses, a 36-month rotational clinical part and 6 courses of thesis research can play a dominant role in military medicine for training capable physicians in order to serve the injured people and critical patients in war conditions and accidents.

Sleep is one of the effective important factors on health. Sleep disorders are of common disorders that accompany chronic obstructive pulmonary disorder. This study was applied to assess the relationship between sleep quality and general health in chemical warfare victims with bronchiolitis obliterans.

In this descriptive correlation study conducted in 2008, 93 chemical warfare victims with bronchiolitis obliterans who referred to the subspecialty respiratory clinic of one of Tehran military hospitals were selected by convenience sampling method. Sleep quality was measured with Pittsburgh Sleep Quality Index (PSQI) and general health with the 12-item General Health Questionnaire (GHQ-12). Data was analyzed by SPSS 15 software using descriptive statistical methods such as central indices and inferential statistical tests including Pearson correlation coefficient.

77.4% of subjects had not desirable general health. The average of sleep quality scores was poor. There was significant relation between other sleep quality subscales and also its global score and general health except for the two subscales of sleep duration and sleep sufficiency (p<0.05).

The sleep quality and general health is undesirable in most of chemical warfare victims with bronchiolitis obliterans and there is direct correlation between these two variables. There for paying the attention to the promotion of general health and sleep quality is essential in these patients.

Although nearly 50 years have been passed from the beginning of Cardio-Pulmonary Resuscitation (CPR), the survival rate is still poor. Previous researches indicate that different factors affect CPR. This study was carried out with the aim of determining the relationship between CPR and the time of referring to the emergency department. This retrospective correlation study was performed on patients referring to the emergency department of Alborz province Social Security hospitals from March 2009 till March 2011 and had undergone CPR. 558 files were selected by census method and the data were collected from files and supervisor notes by a form. Results were analyzed by Chi-square test and Spearman’s correlation coefficient using SPSS 15 software. Generally, 32% of CPR operations were successful and 68% had failed. Most CPRs were done at 9:00 p.m. and 3:00 a.m. and the least frequency was related to the early hours of morning. 25.5% of CPRs were done during the morning shift, 23.5% during the evening shift and 51% during the night shift. No significant difference was observed between CPR results and work shifts (p=0.513) and there was no significant relation between the CPR team’s shift change time and CPR results (p=0.462). There’s no relation between CPR results and referral time. Other aspects of CPR such as improving the skill of treatment staff, forming a professional CPR team and updating the knowledge and nursing and medical techniques should be considered in planning the reduction of unsuccessful CPRs.

Considering the importance of air transport and evacuation in the current era and lack of professional forces, educating specialized human power seems to be essential. This research was conducted to investigate the effect of air transport training of nurses by lecture method and e-learning on nurse’s learning levels. This clinical trial was carried out in 2011 in one of Tehran selected hospitals on 60 nurses of different wards who were selected by purposive sampling method. Samples were divided into two 30-member groups and were trained by lecture and e-learning. The effect of training was measure in three levels of knowledge, apprehension and application before, immediately after training and 4 weeks later. Data were analyzed by SPSS 17 software using repeated measures ANOVA test and independent T-test. The mean and standard deviation of scores in all learning levels in the lecture group before, immediately after and 4 weeks after training were respectively 12.03 ± 2.822, 21.10 ± 3.294 and 19.30±4.01 (p<0.001) and were 14.3 ± 3.0706, 21.13 ± 4.416 and 21.33 ± 3.177 in the e-learning group. No significant difference was observed between the groups in the post-test, but a significant difference (p=0.03) demonstrated the effectiveness of e-learning in the recall stage. Due to the effectiveness of multimedia software in the recall stage and time saving, using this method in nurses’ on-the-job training is highly suggested.

The survey of storage pest while entry and maintenance in the warehouse is of special importance in pest control. The aim of this study was to determine the obvious and hidden contamination of stored cereals and beans with insect pests in the warehouses of Tehran. This descriptive cross-sectional study was carried out in 2010 in the central warehouses of Tehran province. Sampling of cereals and beans was performed according to the method of Standards Institute and Industrial Research of Iran. Products’ waste percentage was determined by calculating and weighing the damaged seeds per 100 grams of sample. Overall, the mean contamination of cereals was 0.005 (± 0.001) grams per 100 grams regardless of the sampling time and the product type. The highest and lowest rate of contamination was respectively observed in split pea and wax bean. Obvious live pests were observed in lentil, split pea and red bean and hidden pests were seen in rice and lentil. Among the identified live insect pests Callosobruchus maculates and Oryzaephilus surinomensis were more abundant, respectively. The rate of contamination of cereals and beans in the warehouses of the two studied units is less than the permitted limit and products have the needed quality. The warehouse management system is desirable for controlling pests and preventing their growth, but the isolation of hidden pests shows that the screening methods of products on entry time are inappropriate.

The most common disorder among warriors is Post Traumatic Stress Disorder (PTSD). Inhibition is an important concept in psychology and gets impaired in PTSD patients. This study was carried out with the aim of comparing the cognitive and behavioral inhibition in veterans with and without PTSD. This descriptive post-event study was performed on 44 veterans of the Rehabilitation Center for Veterans and the Imam Khomeini Veterans Rehabilitation Center in Mashhad in 2011. Samples were selected by available sampling method and were studied in two PTSD and non-PTSD groups. The data were evaluated using Stroop test and Go/No-go test and then were analyzed by independent T-test and MANCOVA using SPSS 16 software. The two groups had significant difference in terms of their overall performance in Stroop and Go/No-go tests. There was a significant difference in correct responses, incorrect responses and no responses in the Stroop test, and the mean reaction time of correct responses and the number of errors in Go/No-go test between the two groups (p<0.05). There was no significant difference in the reaction time of congruent words, the reaction time of incongruent words and the interference score of the Stroop test and the mean reaction time of incorrect responses in Go/No-go test (p>0.05). Behavioral inhibition is impaired in PTSD patients and is a predisposing factor of excitation, aggression, re-experiencing of the harmful event and appearance of unwanted and annoying thoughts that are considered as the major symptoms of the mentioned disorder.

T-2 mycotoxin is the most toxic trichothecene produced by Fusarium species especially Fusarium sporotrichioides. This species is the contaminant of cereal grains that can cause severe diseases among humans and animals and it may lead to death. Tri16 gene encodes an acyltransferase that catalyzes the formation of ester side groups at C-8 in biosynthesis pathway of T-2 toxin. The aim of the present study was to design a molecular method for identification of Fusarium species based on Tri16 gene, capable of producing T-2 toxin. In this experimental study, the DNA of 111 T-2 producing and nonproducing Fusarium strains (including 89 Fusarium isolates and 22 standard Fusarium spp.) were evaluated. After purifying the strains and preparing the cultures in Potato Dextrose Broth (PDB), the DNA was extracted using liquid Nitrogen and lysing buffers and by Phenol, Chloroform and Isoamyl alcohol (PCI) solutions. The gene was detected in all T-2 producing and nonproducing strains using the designed and selected primers based on Tri16 gene and PCR optimization. All T-2 toxin producing Fusarium strains including F usarium sporotrichioides (4 species), F usarium langsethiae (1 species) and F usarium Poae (1 species) contained the Tri16 gene fragment (1380 bp). Important T-2 toxin producing species such as Fusarium sporotrichioides and Fusarium langsethiae could be identified with the designed molecular protocol designed based on Tri16 gene. In addition, weakly T-2 producing species can be identified with this method.

The stress of workplace and night shift is associated with changes in serum cortisol levels that can cause physical and mental disorders in nurses. Considering the importance of nurse health and patient safety, this study was conducted to evaluate the effect of oral glucose intake on cortisol levels in night-shift nurses.

In this experimental study done in 2011, 60 male nurses of two educational hospitals in Tehran were selected by purposive sampling method and were divided into two groups. Cortisol and blood glucose concentration were measured in both groups at 4 a.m. Afterward, the case group received 75gr of oral glucose dissolved in 250ml of water in syrup form and the control group received just the same volume of water. Again the blood glucose and cortisol concentrations were measured in both groups after an hour with glucometer and ELISA test. Data were analyzed using Kolmogorov-Smirnov test, independent and paired T-test and Pearson correlation test by SPSS 15 software.

Plasma cortisol concentrations in both case and control groups reduced an hour after glucose intake. Although cortisol levels were different in both groups after the intervention, the difference was not statistically significant (p>0.05).

Although blood glucose level is effective on body cortisol secretion cycle, no significant correlation exists between the intake of glucose-rich meals at the end of a night-shift and reduction of cortisol concentrations.

Autonomic dysreflexia is a sympathetic imbalance syndrome that early diagnosis of its signs and symptoms and its treatment can prevent its dangerous complications. This study was designed for evaluation of veterans’ knowledge about autonomic dysreflexia and assessing the effect of training on their knowledge. In this quasi experimental study, 60 male veterans with spinal cord injury who had referred to one of the hospitals of Veterans Foundation for lab tests or resided in the rest homes of Tehran were selected by available purposive sampling. Data were collected by a researcher- made questionnaire containing the demographics and questions on knowledge about autonomic dysreflexia and its common signs. Data were analyzed by SPSS 11 software using Kolmogorov-Smirnov test and paired T-test. The mean age of samples was 46.42 ± 5.29 and the mean duration of their spinal damage was 25.5 ± 6.37 years. 24(40%) had traumatic injury above the T6 level and the most frequent signs of the disease were respectively: hypertension, pulsing headache, spasm increase and head & neck diaphoresis. The mean knowledge score of samples was 1.136 ± 0.38 out of 6 before intervention that increased to 5.48(±0.596) after educational promoting (p<0.001). Promoting and closed supervising of this group of veterans is recommended considering their aging and increasing the risk of atherosclerosis and exacerbation of autonomic dysreflexia complications.