[Prevention of infectious diseases during military deployments]

This paper aims to introduce the importance of infectious diseases among military personnel in the peace time as described for the humanitarian force to be deployed in conflict areas during both war time operations and maneuvers has been developed. Referring to the texts and numerous articles that were published in this field, their results are summarized. Physical, occupational and environmental conditions of the military and as a new activity that are associated with exposure to multiple incidents including multiple trauma, mental and psychological problems and infectious disease. It is necessary that these three categories of military medicine to be seriously pursued. The literature review indicated that annual military force based on the mission at the beginning of vaccination against polio, hepatis A, tetanus, varicella, DT, menangococ, influansa, MMR, Japanese B encephalitis, yellow fever, smallpox and anthrax. And the year of internal medicine, dental and eye screening and fallow up from the response to vaccination

[ role of negative pressure wound therapy in the treatment of war wounds]

Wartime injuries are frequently high-energy wounds. In modern warfare wounds involve in many cases the musculoskeletal system and therefore military orthopedic surgeons have assumed a pivotal role in the frontline treatment of these injuries. The majority of injuries were caused by exploding [approximately 55 percent] and approximately 20 percent were from gunshot wounds. The increased numbers of extremity injuries have led to the necessity for new technologies in managing complex war wounds. In warfare situations and particularly from long-distance evacuations, it became necessary to develop alternate forms of wound management. Sometimes, due to massive secretion, dressing changes were necessary twice daily. Therefore, starting 2003 negative pressure wound therapy [NPWT] dressings were instituted to treat the complex war injury. However, the use of NPWT for the care of complex war wounds at battlefield trauma hospitals and/or in the aeromedical evacuation transport system aboard aircraft is still a new application of this wound treatment not yet accepted as doctrine

Evaluation the microbial and physio-chemical quality of drinking water in military units

Background: About 60% of body weight contains water. This study aimed to evaluate the quality of drinking water in military units. Materials and methods: This is a descriptive cross-sectional study on water specimen of military units. The specimen was sent to the quality for microbial and physio-chemical control lab related to Tehran University of Medical Sciences. The result was compared with the ISIRI number 1503 and 1014. Results: Our findings indicated that total hardness, Mg, So4 and Po4 of some military units were over the standard. Only in one unit a solar desalination was used and all parameters were under the standards. Conclusion: It is needed to improve the quality of drinking water in some units

[Serologic prevalence of hepatitis E in Iran and the risk of bioterrorism]

The Hepatitis E is a kind of viral infectious disease that involves the liver and can be variable from a simple and asymptomatic to a fulminant and lethal disease. The cause of this disease is HEV, that has a 10-35% prevalence in developing countries and Iran is in endemic area. The importance of HEV is its mortality in pregnant women. Literature search using the Medline [1966 to July 2008], EMBASE/Excerpta Medica [1980 to December 2008], OVID [1966 to December 2010], Google Scholar [for Local websites and medical journals], SID, websites of Iranian universities and IranMedex was done. In most study, Serologic Prevalence of Hepatitis E was about 7.8% and there was significant relationship between age and HEV positive test. probably this prevalence is higher in the mean age 49.7 years and 40-59 age range. According to the get prevalence [most study: 7.8%], so Iran could be one of the endemic area for HEV. We suggest that hepatic patients should be evaluated for HEV routinely in Iran and pregnant women have special importance. We recommend that more studies should be performed in all of the provinces, specially in their villages. Also because of low immunity in soldiers and teenagers', bioterrorism of HEV is possible

Report of one case of neurobrucellosis

The neurobrucellosis can affect any part of the central or peripheral nervous system. The clinical syndromes are ultimately diverse and clinical picture may be confused by the coexistence of two or more clinical syndromes in the same patient. The most common neurologic manifestation is a sub-acute or chronic meningoencephalitis. Acute toxic manifestations [e.g., headache, neck ache, backache, insomnia, depression and muscle weakness] are seen during the acute phase of infection. Incidence of neurobrucellosis cannot be exactly estimated. The most important clinical syndromes include: Brucella meningitis and encephalitis, vascular syndromes, myelopathy and spinal disease and psychiatric disturbances. Diagnosis is made by reviewing patient history, physical examination, CSF and serum serological and other laboratory studies. Treatment is difficult. Doxycycline in addition to rifampin and streptomycin are the best-studied regimen which should be continued until CSF is clear. In the year following treatment, serum agglutinins fall to normal. The efficacy of corticosteroids is not proved. Neurobrucella has a better prognosis rather than other forms of chronic meningitis and the lesser of mortality; however, incidence of minor sequella [not limiting the normal life] is high. We presented one case of neurobrucellosis with presentation Acute toxic manifestations infection, include headache, neck ache, backache, insomnia, depression and muscle weakness several days before admission. The serologic study of both serum and CSF will usually reveal normal. But antibody against Brucella demonstrated in CSF by enzyme - linked immunosorbent assay [ELIS]. Doxycycline in addition to rifampin; ceftriaxon cotrimoxazol started for patient and patient cured. The diagnosis of neurobrucellosis require differentiation from other chronic meningitis, encephalitis, and granulomatous disease, most importantly tuberculosis and fungal infectious.early diagnosis and treatment are crucial factors leading to a good outcome

[ case of idiopathic CD4+ lymphocytepenia]

Opportunistic infections are common in patient with cell mediated immunodeficiency. We report here a case of multiple opportunistic infections and lymphoproliferative disease in patient eith idiopathic cd4+ lymphocy topenia. A 45 years old man was admitted in our hospital due to respiratory distress and diffuse skin lesions

BX of skin lesions and cdture of synovied fluid contained TB infection and prepared smear of synovid fluid contained aspergilus. The white blood cde count was 1000/ml with pmn [63%] and lymphocyte[28%] and cd4 [10.4%]. persistent cd4+ lymphocy to penia below 300/ml and lack of evidence for HIV1, 2 infection and also HTLV1, 2 infection svggests that immunosupression was due to idiopathic cd4+ lymphocytopenia [ICL] the paticnt was treated with antifungal and antibiotics and clinically improved. One years lates he almittes due to left side paresis. In brain MRI a lesion was seen in frontal. Also there was multiple lymph in inguinal region. Biopsy of lymph node showed lympo proliferative disordes. Unfortunately despite treatmen he died

Toxoplasmosis in HIV/AIDS patients in Shiraz, southern Iran

Toxoplasma gondii is an intracellular protozoan parasite, and causes zoonotic infection. Human latent toxoplasmosis occurs in about half the world's population though most cases are asymptomatic. Toxoplasma encephalitis [TE] has become one of the more frequent opportunistic infection in HIV infected patients. This retrospective and descriptive study was carried out at the Referral Behavioral Counseling and Modification Center in Shiraz, Iran. We were able to review the medical records of 208 HIV infected patients. They were examined and their records were screened via the standardized data collection sheet for demographic characteristics. Diagnoses of TE based on the presence of at least two of the following findings: a history of neurological symptoms, neurological signs, suggestive CT, clinical and radiological response to antitoxoplasmosis medication. The seroprevalence of toxoplasmosis among 208 HIV/AIDS patients was [18.2%] [38 patients] while 4 [10.4%] and 34 [89.6%] subjects showed Toxoplasma seropositivity with and without TE respectively. The majority of these patients were in the 25-34 age group, male, unemployed, single and residence in Shiraz, southern Iran. Toxoplasmosis is a silent disease, which poses many diagnostic and therapeutic challenges. Based on findings of this study, we support a screening program of Toxoplasma infection. Primary chemoprophylaxis should be routinely given to all HIV infected with Toxoplasma seropositive status. Also HIV infected individuals with Toxoplasma seronegative status may be advised about preventive behavioral practice

[Effect of oral Rifampin in prophylaxis of Staphylococcus Aurous nasocarriers of hemodialysis patients]

Background: patients on hemodialysis exhibit higher susceptibility of infection because of decreased immunity. Several microbial pathogens are responsible for the variety of infections. Staphylococcus aurous is one of the most important bacterial agents that specially colonized the skin, nasal mucosa and pharynx. The nasal carriage rate is estimated to be about 42% to 60% in similar studies that is greater than then general population [20% - 40%]. Staphylococcus aurous is one of the most important causes of shunt infection, exit site infection, bacteremia, septicemia, bone and joint infection in hemodialysis patients

Material and methods: we conducted a clinical trial before and after treatment in which culture specimens were collected from anterior nasal nares of hemodialysis patients and were cultured

Results: in a total of 74 patients, 35 cases were culture positive [47/3%]. Rifampin 300mg twice daily was prescribed for patient with positive culture for 5 days. In five month follow up, 21 cases had negative culture after 1 month and 19, 18, 16 and 14 specimens had negative culture for the further evaluation, respectively [90/4%, 85/7%, 76/1%, 66/6%]

Conclusions: there was not a significance difference between the duration of hemodialysis and the colonization rate of staphylococcus aurous [p >0.05]

[Investigation of changes in levels of liver trans-aminases in measles affected patients hospitalized in Be'sat hospital in 1379]

Background: One of measles manifestations -especially in adolescents- is liver malfunction which can vary from just changes in liver enzymes to hepatitis with prominent jaundice. It is important to screen hepatitis patients in order to special medical treatment and avoidance of prescribing hapatotoxic drugs and some pain relief medications. In addition, patients of such complications are high risk for long duration of hospitalization and secondary complications and long duration of the disease

Materials and methods: This was a cross-sectional study of 172 patients selected from 180 patients with clinical measles admitted in Be'sat hospital of NAHAJA. CBC and liver enzymes were checked

Results: Patients aged between 18 to 24 years. Mean of hospitalization time was 6.48 +/- 2.37days and ranged from 2 to 14. Mean of white blood count was 4153.85 +/-1706.08 and ranged from 1700 to 13000. PMNs percentage was 61.01+/-16.27 in mean and ranged from 26% to 89%. Mean of total PMN count was 2591.38+/-1409.42 [from 513 to 10270]. ALT [SGPT] was 40.86+/-33.68 in mean [from 10 to 280]. Mean of AST [SGOT] was 53.23+/- 35.76 ranged from 15 to 250. Total bilirobin was 0.9+/-0.31 [from 0.2 to 2.1] in mean. Mean of direct bilirobin was 0.2+/-0.8 ranged from 0.1 to 0.8. ALKP was 195.19+/-88.6 [from 41 to 590]. 9.5 %of patients [16 patients] had liver malfunction [2 times increase of enzymes levels]. No one had jaundice at the time of admit. Comparison of evaluation of lab values of the patients with duration of hospitalization with Pearson test, only in two cases PMN percentage and total PMN had significant relation [P<0.05]

Conclusions: When measles patients had no complications such as secondary bacterial infections and had no history of hepatotoxic drugs, increase in liver enzymes levels is mild and had no significant clinical interest

Investigation of changes in levels of liver trans-aminases in measles affected patients hospitalized in Be'sat hospital in 1379

One of measles manifestations -especially in adolescents- is liver malfunction which can vary from just changes in liver enzymes to hepatitis with prominent jaundice. It is important to screen hepatitis patients in order to special medical treatment and avoidance of prescribing hapatotoxic drugs and some pain relief medications. In addition, patients of such complications are high risk for long duration of hospitalization and secondary complications and long duration of the disease. This was a cross-sectional study of 172 patients selected from 180 patients with clinical measles admitted in Be'sat hospital of NAHAJA. CBC and liver enzymes were checked. Patients aged between 18 to 24 years. Mean of hospitalization time was 6.48 +/- 2.37days and ranged from 2 to 14. Mean of white blood count was 4153.85 +/- 1706.08 and ranged from 1700 to 13000. PMNs percentage was 61.01 +/- 16.27 in mean and ranged from 26% to 89%. Mean of total PMN count was 2591.38 +/- 1409.42 [from 513 to 10270]. ALT [SGPT] was 40.86 +/- 33.68 in mean [from 10 to 280]. Mean of AST [SGOT] was 53.23+7- 35.76 ranged from 15 to 250. Total bilirobin was 0.9 +/- 0.31 [from 0.2 to 2.1] in mean. Mean of direct bilirobin was 0.2 +/- 0.8 ranged from 0.1 to 0.8. ALKP was 195.19+7-88.6 [from 41 to 590]. 9.5%of patients [16 patients] had liver malfunction [2 times increase of enzymes levels]. No one had jaundice at the time of admit. Comparison of evaluation of lab values of the patients with duration of hospitalization with Pearson test, only in two cases PMN percentage and total PMN had significant relation [P<0.05]. When measles patients had no complications such as secondary bacterial infections and had no history of hepatotoxic drugs, increase in liver enzymes levels is mild and had no significant clinical interest