مجله طب نظامی
سال بیست و چهارم شماره 6 (پیاپی 115، شهریور 1401)

War's nature is constantly changing over time with the progress in military technology and weapons of war, which has led to a diverse pattern of tissue injuries. Developments in personal protective equipment and body armor, rapid transfer from the battlefield to medical centers, improved resuscitation measures, bleeding control, and wound management have increasingly contributed to the wounded survival. However, the injured suffer tissue injuries of various degrees, thereby undergoing complicated and prolonged treatments. An increasing incidence of injuries caused by explosive devices in modern wars has more complicated treatment and recovery of the injured, highlighting the need for modern treatment methods based on stem cells in military medicine. Stem cells can be harvested from various sources such as bone marrow, adipose tissue, skeletal muscle, skin, umbilical cord blood and Wharton's jelly, placenta and amniotic fluid, and with the ability of self-renewal, proliferation, and differentiation into functional cells of different tissues, anti-inflammatory, paracrine and immune system modulating activities have been considered as a promising therapeutic approach to many battlefield injuries and their complications. Recent research in this area reveals the development of solutions to reduce critical consequences when facing the injuries caused by warfare. Thereby, in this review, in addition to outlining the most important tissue injuries in modern combat, recent developments in the use of stem cells for the regeneration of injured tissues have been highlighted.

Using the extracellular matrix (ECM) and biological scaffolds have created a new field in repairing non-healing tissue injuries due to the promising results. These materials provide a suitable milieu for the cells' survival, proliferation, and differentiation due to their biocompatibility and growth stimulating factors, and accelerate tissue repair. The present study investigated the importance of ECM in the healing and regeneration of tissue damages, especially in combat.

In order to obtain the data, the keywords of ECM, war injuries, tissue injuries (such as skin, muscle, brain-spinal, pulmonary, visceral, kidney, and bone), and tissue repair were used. Using these words, the articles were searched in the reliable databases of Scopus, PubMed, ScienceDirect, IranDoc, and Google Scholar during the period 2002-2022. Finally, the most important findings were reported as a narrative review article.

According to the results of the reviewed studies, it can be said that the use of ECM obtained from different tissues in the form of prepared powders, hydrogels and bio-scaffolds is able to heal the damages and injuries of different tissues such as nervous (brain and spinal cord), visceral (liver and kidney), bone, skin, muscle, and lung, which have been damaged due to various reasons, especially in combat.

Using the valuable therapeutic potential of ECM, as a suitable and available method for repairing tissue injuries and damages, can greatly improve the non-healing tissue injuries and wounds, especially in combat, and lead to proper and even normal tissue function.

One of the major challenges in feeding intensive care patients is the appropriate time to start gastrointestinal nutrition. This study aimed to compare the consequences of early and late gastric nutrition in trauma patients under mechanical ventilation in the intensive care unit.

This prospective cohort study was conducted in Zanjan in 2020-2021. In this research, 78 mechanically ventilated trauma patients were selected by convenience sampling. Patients were divided into early and late gastrointestinal nutrition groups according to their feeding time. In these patients, outcome variables, residual gastric volume (within five days), aspiration pneumonia (first, third, and fifth days), and laboratory nutritional indices (first, third, fifth, and tenth) were assessed. Data were analyzed by SPSS v.22 software at the significance level of 0.05.

The results of repeated measures ANOVA showed that the gastric residual volume in the early gastrointestinal nutrition group (0) was significantly lower than in the late gastrointestinal nutrition group (11.42±32.28; P<0.001). The pneumonia aspiration with Cochran's Q test did not show a statistically significant difference between the two groups (P<0.05). In addition, comparing the laboratory indicators with repeated measures ANOVA showed that total protein and calcium in the late gastrointestinal nutrition group showed a statistically significant increase. As well, phosphorus, magnesium, and lymphocyte showed a statistically significant increase in the early gastrointestinal nutrition group (P<0.05). However, these indicators did not show clinically significant differences between the two groups. The stepwise multiple regression model results showed the role of disease severity in predicting the laboratory indicators of total protein, calcium, lymphocyte, and phosphorus. Furthermore, consciousness level played a role in predicting the magnesium index.

Regarding the effect of early feeding on the remaining volume of the stomach, it is recommended to start early feeding in trauma patients.

Physical injuries affect the psychological dimension of human beings. This study aimed to investigate the impact of physical injuries on the psychological dimension of people.

This is a cross-sectional descriptive study that was conducted on traffic police staff who were referred to Valiasr hospital in Tehran, Iran due to injuries between April 2015 and November 2021. The required information was collected from the database using medical documents and registered files of injured employees. After coding data, SPSS version 26 software was used for statistical analysis.

Among the 120 injured people, the highest average score evaluated by the GHQ questionnaire was obtained by the ear, nose, and throat group (22%), upper limb (20%), eye (19%), lower limb (17%), and digestion (14%), which shows that in some cases (physical scale, anxiety and sleep disorder, symptoms of social action, symptoms of depression) are exposed to damage. The urology-affected group got the lowest score among the different groups with 8%, which indicates that this group is in a very favorable state in terms of mental health.

The results of this study showed that the most type of physical injury that affected the psychological dimension of people was the ear, nose, and throat injury, and the least injury was related to urology.

An accurate evaluation of hospitals' performance in dealing with disasters can be a major role in improving hospital preparedness. The Hospital Disaster Risk Management Evaluation (HDRME) Model was developed and approved in 2018 using international models and the opinion of experts. This research was conducted with the aim of validating a questionnaire for evaluating disaster risk management in hospitals based on the standards and measures of this model.

In this validation study, a questionnaire based on the HDRME Model including 200 measures in 8 domains (management and leadership, risk assessment, planning, prevention and mitigation, preparedness, response, recovery, and key performance results) was designed. The face validity and content validity were verified both qualitatively and quantitatively (using experts’ opinions, CVR, and CVI). The reliability of the questionnaire was evaluated by Cronbach's alpha method and Inter class correlation coefficient (ICC). The questionnaires were completed by two surveyors separately and independently in 30 hospitals at Tehran University of Medical Sciences, and the results were compared and analyzed.

The face validity and content validity of the questionnaire were approved by experts. The results showed that Cronbach's alpha and Inter class correlation coefficient (ICC) was 0.99, which showed that the questionnaire had good reliability. The average score of the hospitals from the questionnaire was 36%. The highest score was related to the domain of prevention/mitigation (51/22) and risk assessment (44/81), and the lowest score was related to the domain of planning (24/75) and recovery (26/97).

The questionnaire designed from the disaster risk management evaluation model has good validity and reliability and could be used as a valid questionnaire to evaluate this issue in the country's hospitals.

The preparation of the healthcare staff is one of the influencing factors in providing the correct treatment, care, and proper control to deal with biological threats. Since the preparation of nurses is understood under the influence of variables of knowledge, attitude, performance, and sense of danger, so this study aims to determine the level of knowledge, attitude, performance, and sense of danger of military clinical nurses in facing biological threats with special emphasis on COVID-19 disease.

The present study is a cross-sectional descriptive-correlation study that was conducted in 2021 using stratified random sampling in 600 military clinical nurses in selected hospitals of East Azerbaijan. The validity and reliability of the nurses' preparation questionnaires were evaluated by calculating the content validity ratio (CVR=0.94) and content validity index (CVI=0.83). The information obtained from the questionnaires was entered into SPSS statistical software and the data analysis was performed at a significance level of 5%.

The preparedness of military clinical nurses in facing biological threats during the covid-19 pandemic had a significant correlation with the variables related to knowledge, attitude, performance, and sense of perceived risk (P<0.001). Univariate regression analysis showed that male nurses had a weaker level of knowledge and attitude and sense of perceived risk regarding the covid-19 disease. But female nurses had better performance than male nurses. In this study, history of suffering from this disease (P=0.683) and work shift (P=0.877) did not have a significant relationship with the performance of nurses in the face of covid-19 disease.

The level of knowledge and performance of clinical nurses is favorable and the level of their attitude and sense of perceived risk is average. It seems that in order to ensure the readiness of nursing staff against biological threats such as the covid-19 epidemic and to maintain it at the desired level, it is necessary to carry out interventions such as continuous training and in-service training.

Human monkeypox is a zoonotic disease caused by the Poxviridae family. Recently, the cases of this disease have been increasing worldwide. The aim of this study was to review and update information in the field of history, epidemiology, disease transmission, clinical symptoms, diagnosis, treatment, vaccination, and prevention of monkeypox.

The present study is a review article that extracts related articles by searching the domestic database (Science Information Database [SID] and Magiran) and foreign databases, including Web of Science, Pubmed, Science Direct, Scopus, and Google Scholar with the keywords of monkeypox disease, monkeypox virus, Poxviridae, monkeypox outbreak, smallpox virus.

This re-emerging disease is often endemic in central and western Africa. Since May 2022, an outbreak of this disease has been reported in non-endemic countries as well. According to the World Health Organization, in the recent outbreak, the disease was first observed in developed countries, especially in European countries, and often in men with sexual contact. Outbreaks in some parts of the world have raised concerns about another pandemic similar to COVID-19. Monkeypox is currently a significant threat to public health, so it requires urgent multidisciplinary collaboration between clinics and basic sciences to investigate the origin and chain of disease transmission, Rapid diagnostic techniques, vaccine evaluation, and treatment and control strategies.

The experiences from past pandemics, especially the Covid-19 pandemic, are among the opportunities that can be used to deal with and control emerging and re-emerging diseases such as monkeypox.