مجله طب نظامی
سال ششم شماره 4 (پیاپی 18، زمستان 1383)

Aims. In I.R.IRAN, all men aged 18 years old must enlist for the national military service. Upon enlistment, conscripts undergo medical examinations to establish their level of fitness those who are not medically fit for service are exempted. Exemption is granted on a permanent or temporary basis, depending on the conscript’s physical, familial and educational status. The aim of this study was to determine the diseases that merit exemption. Methods. A cross-sectional study was conducted on 563 military conscripts from Shahrekord in 2001. The conscripts completed a health questionnaire and underwent a thorough medical examination. Results. Eye and musculoskeletal and neuropsychiatric diseases have the highest rates of exemption (37.8%, 16%, 14%). Myopia (55.4%), fracture (40.1%) and epilepsy (25.4%) were the most prevalent complaints of eye disease, musculoskeletal disorders and neuropsychiatric diseases, respectively. Conclusion. Health screening of conscripts upon enlistment is recommended.

Aims. Although there are several studies dealing with early deaths due to mustard gas exposure, few studies have evaluated the delayed pattern of death in veterans suffering wartime exposure. This study was conducted to estimate the overall and cause-specific mortality rates and the proportion of each cause of death in deceased mustard-exposed veterans. Methods. A retrospective mortality study was carried out from 1986 to 2003 on all death certificates in the Janbazan Organization demographic, war related and medical data were extracted from the subjects’ files. Causes of death, having been established by the death commission, were categorized as disease, trauma, suicide, homicide and gas exposure. Overall and cause - specific delayed mortality rates were associated with mustard. Results. Of 34,000 participants, 1,005 died within the period of the study. The overall mortality rate was 19.07 per 10,000 people each year. The most frequent cause of death was disease (72.2%), followed by trauma (16.1%), suicide (2.3%) and homicide (0.8%). In 2.8%, the cause of death was undetermined. 12.1% of all the deaths were due to mustard gas exposure. Conclusion. Exposure to mustard gas is not associated with high mortality in the late phase.

Aims. Chronic lung disease and several psychiatric disorders such as depression, anxiety and post-traumatic stress disorder are prevalent in chemical-warfare-agents exposed veterans. Although all these disorders may result in impaired sleep, few studies have assessed sleep in this population. The aim of this study was to assess sleep quality in chemical-warfare-agents exposed veterans.Methods. In this observational study, we used the Pittsburgh Sleep Quality Index to assess the sleep quality of 94 chemical-warfare-agents exposed veterans with stable chronic pulmonary disease. The patients were non-randomly selected from those referring to the pulmonologist.Results. 78 veterans (77 males and 1 female) completed the questionnaire and entered the study. Mean age (SD) of the veterans was 42.11 ± 8.10. Mean disability percent (SD) was 29.8 ± 15.5. Quality of sleep was reported to be good in 5 (7%) and poor in 73 (93%). Duration between going to bed and falling asleep was 5 minutes to 3 hours with a mean (SD) of 46 ± 31. Quality of sleep was not related to age, disability percent, duration between injury and study (p>0.05), but with job (p<0.016). Conclusion. This study reported poor sleep in chemical-warfare-agents exposed veterans. With respect to the potential impact of poor sleep quality on the function and quality of human beings’ lives, it is necessary to pay attention to this aspect of veterans’ lives. While this is a cross-sectional study, no causal relation between the impaired quality of sleep and pulmonary disease, psychiatric disorders or drugs can be concluded. More studies are recommended to assess any correlation between these physical and psychological characteristics and sleep quality.

Aims. Sulfur mustard gas, a cytotoxic and gene toxic agent, leads to the necrosis of the epithelial cells of the respiratory and gastrointestinal tracts. These lesions result in severe diarrhea and weight loss. This research was conducted to determine the effects of sulfur mustard gas on the ileum and goblet cells due to their significance in the absorption of ions, electrolytes and some other nutrients. Methods. 66 Albino Nmri mature male Rats weighting 200 + 20g were randomly selected and then randomly assigned into 11 groups. The first group served as the control group. The second group, receiving thyroids buffer as solvent of Sulfur Mustard (SM), served as the sham group. The other 3 groups received doses of 2.5, 5 and 10 mg/kg intra peritoneal (IP) injections of SM, respectively. At day 2 and weeks 2 and 8, the animals were slaughtered and samples of their ileum were prepared and fixed in the bouins solution. The samples were then dehydrated and embedded in paraffin wax and sectioned serially, measuring 5 m m in thickness. The sections were stained by hematoxyline -Eosin and Alician blue. Microscopic graticule Holland eye- piece and motic software were used to examine the samples both morphologically, quantitatively and qualitatively. Results. The results of the research showed that sulfur mustard injection caused severe weight loss in the short term, but this reduction is less noticeable in the long term. Moreover, a significant reduction in the number of goblet cells was observed (P<0.001). Conclusion. The reduction of goblet cells in the 2.5mg group and 24 hours’ time was not statistically significant, which could be due to the low toxicity effect of this dose. However, the number of goblet cells in the 5 and 10mg/kg groups with 24 hours’ duration versus the sham group was statistically reduced (p<0.001). This reduction was due to the death of stem cells and a cessation of cell division. The importance of stem cells in producing goblet cells and consequently their role in protecting epithelial cells merits further research.

Aims. Cutaneous leishmaniasis, endemic in many parts of I.R.IRAN, is considered a big health problem. The aim of this survey was to find out the vectors and reservoirs of the disease. Methods. The present study was carried out in Taibad (Khorasan proveince in the east of I.R.IRAN). Throughout this two-year study (1999-2000) sand- flies with sticky traps were collected. The sand-flies’ fauna and their seasonal abundance were identified. In addition, in order to find out the reservoir of the diseases the rodents of the area were collected. Results. This study showed that the Ph. sergenti is the most common species in the area. It must be noted that other epidemiological evidence in Taibad was indicative of the existence of anthroponotic Cutaneous leishmaniasis. Furthermore, Cutaneous leishmaniasis has been increasing since 1996. Conclusoin. Based on the finding of this study, distribution of rural sand flies in Taibad, non- identified carriers of leishmaniasis and not contamination of collected rodents it seems that common leishmaniasis is the urban type. Confirmation requires molecular research.

Aims. Turkmenistan, one of the newly-independent countries of the former Soviet Union, borders the Islamic Republic of IRAN through Mazandaran, Golestan and Khorasan provinces. The expansion of relationships between the two countries in recent years has increased cross-border travels, affecting the health of those inhabiting the adjacent areas. Information is available on endemic infectious diseases in Turkmenistan. This study was carried out to assess the geographical pathology and health situation of Turkmenistan. Methods. In this study, common infectious diseases and health situation of Turkmenistan has been assessed using scientific Journals and the Internet. Results. Data indicate that the health situation of Turkmenistan is not desirable as the prevalence of diseases such as malaria (incidence rate 3 in 100000) and T.B (incidence rate 44.7 in 100000) have been on the increase in recent years and AIDS, hepatitis B (15-30% carrier), hepatitis C, gonorrhea (incidence rate 32.4 in 100000), syphilis (incidence rate 37.5 in 100000), C utaneous and Visceral leishmaniasis and sand-fly fever are common. Conclusion. Turkmenistan borders Mazandaran, Golestan and Khorasan Provinces to prevent probable transmission of diseases into our country, it is necessary to expand health surveillance in border areas and inform the military personnel deployed there about the health situation and common infectious diseases.

Aims. Sea- sickness is one of the problems occurring during the transportation of military personnel by sea. In this study, the effect of the Sea-Band on alleviating motion sickness (nausea and vomiting) was investigated. Methods. 94 volunteers from Islamic Revolutionary Guard Crop’s (Navy Crop) navy personnel were randomly divided into two groups: in 50 people (the test group) the Sea-Band was placed on the Nigan point, while in the other 44 (the control group) it was placed on a placebo point. Data, collected through a questionnaire including demographic and medical characteristics, were analyzed by t-test. Results. The mean age of the participants was 25.2 years. While in the test group nausea and vomiting were observed only in 22% and 14% of the individuals, respectively, in the control group, nausea and vomiting occurred in 61% and 21%, respectively. Statistical analysis of these data revealed a significant difference (p < 0.05) between the two groups. Conclusion. A very cost- effective and non-invasive technique, the Sea-Band seemed to be useful in the alleviation of motion sickness symptoms. This technique may also be useful in the prevention of nausea and vomiting in other clinical conditions.

Aims. Job stress undermines effective performance as well as mental health among military personnel. The present study was conducted to verify job stress affecting military personnel. Methods. The subjects (49 females, 195 males and 8 not identified) were selected randomly. The questionnaires were composed of: 1) the Osipow Job Tension Questionnaire, 2) a research-made scale regarding aviation stress and 3) a job satisfaction questionnaire. The validity and reliability of the scales were confirmed in a pilot study. Results. Results revealed that 67% of the personnel suffered from a high level of stress and that 11% of them also showed severe stress levels. We also found that work stress was significantly associated with family and career stress. Furthermore, the results showed that 56% of the subjects showed stress on Responsibility subscale and 32% had stress on Role Boundary subscale. 50% of the subjects had high levels of tension, and 29% showed medium levels. 62% of the participants showed a moderate level on job satisfaction. Conclusion. It can be concluded that job stress is more effective than life-related stress in increasing stress levels among military personnel. Moreover, the study demonstrated that role stress in work is one of the main components of causing stress among military personnel. Finally, it was found that there was a negative and significant association between the job satisfaction and work stress. These results are supported by previous studies.

Aims. Antipersonnel landmines threaten the lives of a wide range of people from farmers and children living or playing at landmine-contaminated areas to military personnel dispatched to such areas for clearing operations. Mine-victim assistance programes are extremely costly. Results. Global statistics show that landmines cause 800 deaths and thousands of injuries every month. Most of the wounded live in rural areas, the lack of medical facilities increasing the death. According to an international survey, there are 60-70 million landmines in 70 countries in the world, killing and maiming military personnel and civilians alike. Long after wars in different areas of the world have ended, the indiscriminate use of landmines continue to deny the right to life and liberty of large numbers of civilians. In I.R.IRAN, in West Azarbayejan, Ilam, Khoozestan, Kordestan and Kermanshah provinces, there are still landmines threatening civilians. The aim of this study was to assess traumas inflicted by antipersonnel landmines. Methods. This article deals with the irreversible traumas which antipersonnel landmines inflict upon those inhibiting landmine-contaminated areas. Conclusion. Through such appropriate strategies as utilizing robots and special shoes, raising awareness and establishing research centers and data banks it is possible to reduce traumas caused by antipersonnel landmines.