Journal of Archives in Military Medicine
Volume:2 Issue: 1, Feb 2014

For decades, the exercise stress test (EST) has been known as a well-established non-invasive diagnostic test in patients with suspected or known cardiovascular disease (CVD). However, EST is also used for several other purposes in the armed forces including fitness assessment and adjustment training in simulated non-conventional environments such as altitude chambers. While exercise stress test is a part of periodic health check-up in specific groups of the military forces such as aviators, divers, and commanders, its diagnostic value for cardiovascular disease (CVD) detection is unclear in asymptomatic healthy subjects with low and intermediate cardiovascular risk according to the current clinical practice guidelines. Furthermore, it is demonstrated that it has a modest sensitivity and specificity for the diagnosis of coronary artery disease (67-72% and 69-90% respectively) in symptomatic patients. Hence, the hidden half of the test including non-electrical variations such as hemodynamic changes would be taken into the account or results of other tests such as arterial evaluations would be combined to provide a diagnostic battery. Meanwhile, its performance is also related to the CVD pre-test probability and the prevalence of the disease in the target population. On the other hand, not only the heart, but also vessels and kidneys can be evaluated by EST. Current evidence demonstrates that the hemodynamic response to exercise and exercise-induced micro-albuminuria are associated with cardiac, renal, and arterial functional status. In addition, impaired hemodynamic response to exercise predicts the development of renal dysfunction in the future..In conclusion, EST would be particularly important in the early detection of cardiac, vascular, and renal diseases in military personnel; however, justification and arrangements for the testing must be individually assessed, and this process can be facilitated by decision analysis methods..

Skeletal fractures produced by bullet impacts are unique and yet their mechanism remains poorly understood.. To understand the initiation and propagation of direct ballistic skeletal fractures on cylindrical bones.. We observed the effect of 9 mm spherical non-deforming steel projectiles fired at increasing velocities of 10 ft/s (3 m/s) to 200 ft/s (60 m/s) (pre-impact kinetic energy of 0.013-5.35 J) directly upon skeletally mature deer femora. Skeletal damage was assessed following micro-computed tomography and fluorescent microscopy.. A cascade of injury severity was identified, with fractures first seen at a pre-impact kinetic energy of 1.08 J and progressing from localized micro-fragmentation and indentation to long radiating fractures. Bone indentation was found to increase with increasing projectile speed.. The deformation and resultant fracture process occurs as a reproducible cone crack cascade with an expanding zone of fragmentation. This knowledge should aid clinicians in understanding the formation of fracture fragments, the forces exerted on these fragments and the areas of residual weakness to ensure optimal skeletal management..

A major problem in the development of required chemical compounds in a variety of industries such as pharmaceutical, agricultural, paint and polymer industries is to easily access the chemical starting materials. One class of these materials is quinoline derivatives. Synthesis of these compounds, despite their simple chemical structures is relatively complicated and their synthesis design and purification are challenging. Quinoline derivatives were synthesized and explored for their anticancer, antitinephritic, antitumor, anti-inflammatory and analgesic activity, as antiallergetic agents for treating Alzheimer’s disease (AD). Possible formation of 5- and 7-substituted quinolines during the Skraup reaction using m-substituted anilines is well understood. However, there are conflicting reports on the composition of the products from certain reactions.. As part of our research, we are interested in the development of synthetic strategies for preparation of 7-methyl-8-nitroquinoline selectively from a prepared mixture of 5- and 7-methyl quinoline as a key material to study its biological activities as well as to develop other corresponding quinoline derivatives for our research purpose.. Synthesis and characterization of 7-methylquinoline using the Skraup methodology was reported. A subsequent nitration reaction was also carried out using a mixture of 5- and 7-methylquinoline to obtain pure 7-methyl-8-nitroquinoline selectively. In this project, in the first step, a mixture of 7-methylquinolin and 5-methylquinolin was prepared from the reaction of m-toluidine and glycerol. In the next step, 7-methyl-8-nitroquinoline was selectively synthesized and subsequently characterized using conventional methods such as NMR, IR, GC-MS and elemental analysis.. The compound 7-methyl-8-nitroquinolin was selectively synthesized in a two-step reaction with an excellent yield.. 7-methyl-8-nitroquinolin as a key starting material was obtained through a two-step synthesis from m-toluidine. Skraup synthesis was employed to produce a mixture of 7- and 5-methylquinoline in a 2:1 ratio, which was then used for a nitration reaction using nitric acid and sulfuric acid without further purification. The final reaction selectively produced 7-methyl-8-nitroquinolin with an excellent yield..

Leishmaniasis is one of the zoonotic diseases caused by protozoa of trypanosomatidae family. The cutaneous type with various manifestations is endemic in Iran and affects people of many provinces. Outbreaks may occur in military personnel who deploy these endemic areas.. The main objective of this study was to evaluate the most important epidemiologic features of leishmaniasis in Iranian military personnel from 2005-2010..Patients and This was a cross-sectional study. Data was gathered from the regional passive surveillance system of the Iranian army and double checked by the Deputy of Health of Aja University of Medical Sciences. Analysis was performed by the STATA Software using appropriate statistical functions.. During the 6 years of study, 3767 cases of cutaneous leishmaniasis were reported, 15% of the total reported infectious diseases (excluding upper respiratory infections, which were not included in this study). Cutaneous leishmaniasis was the third most prevalent infectious disease. Sixty nine percent of cases were reported in autumn. Most were related to three provinces: Isfahan, Khuzestan and Bushehr. Two thirds of the reports were from the Air Force.. There has been a decline in the overall trend of cutaneous leishmaniasis in the recent years, but there are still peaks in some provinces particularly during autumn. Army health commanders must do their best to prevent the disease and control its cycle, especially in high endemic areas..

Due to nurses’ important role in patients’ quality of care and health promotion, it is vitally important that nurses remain productive. Undoubtedly, burnout is one of the factors that has the greatest effect on productivity. If the strong relationship between burnout and productivity is proven, then managers can be encouraged to provide better conditions for nurses to be more productive.. The current study was conducted to investigate the relationship between productivity and burnout in nurses of the Aja Hospitals in Tehran.. This cross-sectional study was carried out on 322 clinical nurses working in Aja Hospitals in Tehran. The subjects were recruited by multi-stage sampling methods in 2012-2013. Data was collected using the Persian version of the productivity questionnaire which was prepared by Nayeri et al. and the Maslach Burnout Inventory, which was then analyzed by SPSS software Version: 19, IBM Company.. The findings showed that many nurses (35.1%) obtained a high productivity score. From the viewpoint of burnout intensity, the majority of nurses (85.4%) were at medium to high levels in the dimension of emotional exhaustion. Moreover, most (79.8%) obtained high scores in the dimension of depersonalization. In the dimension of personal accomplishment, 61.5% of nurses felt little success. Pearson’s correlation coefficient indicated a weak statistical reverse relationship between total productivity score and burnout dimensions (P < 0.001).. Based on the high levels of burnout found in this study, greater awareness and knowledge of the contributing factors are essential in order to increase nurses’ productivity. Formulating policies in order to remove these contextual factors, prophylaxis, treatment and training methods, and adaptive coping strategies, are also required..

Mental challenges are among the most frequent complications of wars, afflicting individuals directly or indirectly involved in military confrontations. Post-traumatic stress disorder (PTSD) is one of the most common disorders in such situations.. Our goal is to assess mental health of spouses of Iraq-Iran war veterans with post-traumatic stress disorder (PTSD).. In this cross-sectional study, two groups of the spouses of the veterans, 40 cases diagnosed with PTSD as the case group and 40 cases who were not, as the control group, were enrolled into the study and compared. Mental health was assessed using the general health questionnaire (GHQ-28) which has four major domains including somatic symptoms, anxiety and insomnia, depression, and social malfunction.. Twenty-two patients (55%) in case group and 11 patients (27.5%) in control group had impaired general health status (P < 0.05, P value = 0.02). Nineteen patients (47.5%) in case group and 9 patients (22.5%) in control group complained of somatic symptoms (P value = 0.001). Anxiety and insomnia (45% vs. 22.5%) (P value = 0.002) and depression (47.5% vs. 25%) (P value = 0.008) were more common in the case group.. Although imposed Iran-Iraq war ended 25 years ago, we observed that spouses of veterans with PTSD have more somatic complaints and poorer mental health compared to spouses of veterans without PTSD. Further studies seem essential regarding proper management and provision of psychology consultation services along with medical treatments to raise mental health of their spouses..

Hypoxia is a serious threat in aviation. Aviators are trained in a type of hypobaric chamber (altitude chamber) in order to become familiar with the symptoms of hypoxia. This chamber simulates an altitude of 25,000 feet or more. Hypoxia could have an effect on various organs of the body, such as the liver.. The purpose of this study was to investigate alanine aminotransferase and aspartate aminotransferase alterations, as tissue damage markers, in aviators following altitude chamber experience..Patients and A cross-sectional study was carried out in 37 normal healthy male military aviators (age 22-43 years, height 165-192 cm and weight 63-105 kg) conducted in a hypobaric chamber. Total alanine aminotransferase and aspartate aminotransferase activities were assayed in their serum, before and after altitude chamber experience, by the international federation of clinical chemistry (IFCC) method. Statistical analysis of a paired Student’s t-test was performed.. The mean serum activities of aspartate aminotransferase (P = 0.001) and alanine aminotransferase (P = 0.014) were significantly increased following altitude chamber experience.. Results suggest that subsequent to altitude chamber experience, there is a rise in the serum activities of aminotransferase..