Iraq-Iran chemical war: calendar, mortality and morbidity / 中华创伤杂志(英文版)

<p><b>OBJECTIVES</b>To review the calendar, mortality and morbidity of Iraq-Iran chemical war among Iranians based on researchers'reports.</p><p><b>METHODS</b>We used national and international databanks such as PubMed, ISI, Scopus, Irandoc and Iranmedex and studied 350 articles related to chemical agents and their effects on different organs. The main criteria for qualification of articles were relevancy orientation and being published in approved medical journals.</p><p><b>RESULTS</b>The Iraqi army invaded to west and southwest Iran using chemical weapons such as nerve agents (NAs) and sulfur mustard (SM). Most victims were civilians including women and children. These attacks had imposed more than 150 types of diseases and complications on Iranians and the frequency of death was 2%-3%. Most reports were about respiratory problems and a few were in the domain of socio-economic damages.</p><p><b>CONCLUSION</b>At present, 25 years after the end of war, the victims are faced with different complications induced by chemical agents and it is estimated that they will be continuously troubled by these problems in future.</p>

Long-term effects of mustard gas on respiratory system of Iranian veterans after Iraq-Iran war: a review / 中华创伤杂志(英文版)

To review long-term respiratory effects of mustard gas on Iranian veterans having undergone Iraq-Iran war. Electronic databases of Scopus, Medline, ISI, IranMedex, and Irandoc sites were searched. We accepted articles published in scientific journals as a quality criterion.The main pathogenic factors are free radical mediators. Prevalence of pulmonary involvement is approximately 42.5%. The most common complaints are cough and dyspnea. Major respiratory complications are chronic obstructive pulmonary disease, bronchiectasis, and asthma. Spirometry results can reveal restrictive and obstructive pulmonary disease. Plain chest X-ray does not help in about 50% of lung diseases. High-resolution CT of the lung is the best modality for diagnostic assessment of parenchymal lung and bronchi. There is no definite curative treatment for mustard lung. The effective treatment regimens consist of oxygen administration, use of vaporized moist air, respiratory physiotherapy, administration of mucolytic agents, bronchodilators, corticosteroids, and long-acting beta-2 agonists, antioxidants, surfactant, magnesium ions, therapeutic bronchoscopy, laser therapy, placement of respiratory stents, early tracheostomy in laryngospasm, and ultimately lung transplantation. High-resolution CT of the lung is the most accurate modality for the evaluation of the lung parenchyma and bronchi. The treatment efficacy of patients exposed to mustard gas depends on patient conditions (acute or chronic, upper or lower respiratory tract involvement). There are various treatment protocols, but unfortunately none of them is definitely curable.

significance of BODE [BMI, obstruction, dyspnea, exercise] index in patients with mustard lung

Chronic Obstructive Pulmonary Disease [COPD] secondary to sulfur mustard exposure, known as mustard lung, is an important late pulmonary complication. The BODE [Body mass index, Obstruction, Dyspnea, and Exercise] index has been established as a valuable tool for determining the adverse consequences of COPD. The aim of this study was to evaluate the role of the BODE index in patients with mustard lung. Eighty-two consecutively stable patients with mustard lung with all levels of severity were entered this study. The following parameters were recorded in all patients: standard spirometry, pulse oximetry, health-related quality of life, the BODE index. Additionally, the severity of COPD was determined by GOLD [Global initiative for chronic Obstructive Lung Disease] staging. The correlation of the BODE index with pulmonary parameters was determined. The mean age of the patients was 47.30 -/+ 7.08 SD years. The mean BODE index was 3.16 -/+ 2.25 SD. There was a statistically significant inverse correlation between the BODE index and oxygen saturation [r=-0.30, p=0.007]. Also a statistically significant correlation was found between the BODE index and quality of life [r=0.80, p=0.001]. The BODE index was not correlated with age of the patients and duration of disease. The results of this study showed that the BODE index is correlated with important clinical parameters and can be used in clinical practice

Status of dental health in chemical warfare victims: The case of Isfahan, Iran.

Background: Little evidence is available regarding the dental health of victims of chemical warfare in Iran. Therefore, in this study, we examined the decayed, missing, and filled teeth index (DMFT), community periodontal index of treatment needs (CPITN), and saliva secretion rate of chemical warfare victims living in the province of Isfahan in Iran. Materials and Methods: This case-control study was conducted with 300 chemical warfare victims as the treatment group and 300 age-matched individuals without exposure to chemical warfare as the control group. DMFT and CPITN indices and saliva secretion rate were measured and compared between the two groups. Results: Chemical warfare victims had significantly higher scores than the control group for decayed teeth (4.25±3.88 vs 3.52±2.81; P=0.009), missing teeth (8.79±9.3 vs 6.15±8.43; P<0.001), total DMFT index (17.00±6.72 vs 13.20±6.89; P<0.001), and CPTIN (2.81±0.81 vs 1.71±1.04; P<0.001). However, no significant difference was observed between the two groups in filled teeth (4.00±4.2 vs 3.59±2.48; P=0.148). The level of saliva secretion in warfare victims was significantly lower than that in the control group (1.71±0.05 vs 3.85±1.95 cc/5 min; P<0.001). Conclusion: Chemical warfare victims have relatively poor dental/oral health. Chemical injury might cause a dysfunction in saliva secretion, with decrease in saliva secretion increasing the risk for tooth decay and periodontal disorders. Further research is required to find out the exact underlying mechanisms and the factors associated with poor dental/oral health in chemical warfare victims.

[Quality of life of chemically-disabled war veterans involved in pulmonary complications of sulfur mustard gas in Sardasht]

Chemical gases, particularly Sulfur Mustard, have a negative impact on physical, psychological, social and spiritual aspects of quality of life of those suffering from this gas. It is so serious that even 20 years after being exposed to Sulfur Mustard, we can witness people who are still suffering from various damages of organs particularly the pulmonary system. This research aimed at determining the quality of life of chemically-disabled war veterans with pulmonary complications of Sulfur Mustard from physical, social, psychological, and spiritual aspects. This was a descriptive study in which 260 chemically-disabled war veterans living in Sardasht, Iran then, were randomly selected for the study. It should be mentioned that all these people are now treated as chemically-disabled war veterans suffering from the pulmonary complications of Sulfur Mustard Gas and were living in Sardasht at the time of bombardment of that city. Having been acquainted with the procedure, they were then asked to fill in the questionnaires. The results showed that quality of life in 71.5% of the samples was moderate, only in 5.8%, it was considered as good. 11.9% of them in physical domain, 8.1% in psychological domain, 1.9% in social domain, and 22.8% in spiritual domain had a good quality of life. Based on the findings, the quality of life in the social, physical and psychological domains was 1.9%, 11.9% and 8.1% poor, therefore; responsible organizations can help these people in various ways by, for example, providing them with low price drugs, which are usually costly in the market, public transportation designed especially for chemically-disabled war veterans, improving insurance services and developing public services in Sardasht. The researchers, finally suggests a qualitative study be performed on each domain of quality of life of chemically-disabled war veterans

Diffusing capacity for lung carbon monoxide [DLCO] in chemical lung injuries due to the use of mustard gas in the poisoned soldiers of Iran-Iraq war 2006

To assess the Mustard gas exposure effects on pulmonary system, particularly on diffusing capacity for lung carbon monoxide [DLCO] and simple spirometry. Sixty-five sulfur mustard- poisoned soldiers from Mostazafan and Janbazan organization were referred to our center in 2005. Complete history, physical examination, chest X ray, Echocardiography, Arterial blood gas, high - resolution computerized tomography, diffusion capacity for lung carbon monoxide and spirometry of these were performed and compared this result with normal value. The mean value of indices in studied injured subjects was: Spirometry: forced expiratory volume in one second [FEV1] = 70.4, Forced vital capacity [FVC] = 66.5, EFE 25-75=81.1, FEV1/FVC=101.9, Flow 25% = 28.7, Flow 50%= 72.9, Flow 75%= 100.1, Sample volume: Functional residual capacity of lungs [FRC] = 131.5, residual volume [RV] = 157.3, RV/TLC= 169.1, Total lung capacity [TLC] = 91.3, KCO= 131.6, TLCO= 116.3. No significant correlation was observed between TLCO values with HRCT, echocardiography, ABG and spirometry values [P>0.05]. We recommend TLCO and RV/TLV tests to assess severity of Injuries as there is no a suitable criterion to measure the real consequences of mustard gas on affected combatants and Biological markers are also needed to determine cause- effect relations

Urogenital history in veterans exposed to high-dose sulfur mustard a preliminary study of self-reported data

To date, little information exists regarding urogenital disease in those who have been exposed to sulfur mustard [SM]. We report the self-reported history of urologic conditions and findings on physical examination in a group of male veterans 19 to 26 years after exposed to high-dose sulfur mustard. Data on urologic health conditions of a nationwide health survey were used in this study. This survey included all 289 Iranian male veterans who had been exposed to high doses of SM between 1983 and 1989. Demographic data, exposure-related data, health status, and also self-reported lifetime history of urologic tract infections, pyelonephritis, urinary calculi, kidney failure, and urogenital neoplasms were specifically concerned. The mean age of the veterans was 45.0 +/- 7.5 years [range, 30 to 75 years]. An interval of 19 to 26 years had passed from exposure to SM. Fifty veterans [17.3%] had a positive history of urinary calculi, 25 [8.7%] had recurrent urinary tract infections, 5 [1.7%] had BPH, and 2 [0.7%] had kidney failure. None of them had experienced urogenital malignancies. Neither recurrent urinary tract infections nor urinary calculi were significantly associated with age, medications and their doses, or SM-reduced late complications in other organs. This study adds the prevalence of self-reported urologic conditions to our limited knowledge on SM-exposed veterans' health condition, without finding any link neither to demographic, nor to the severity of health complications related to SM exposure

[Incidence of acneform lesions in previously chemically damaged persons-2004]

Chemical gas weapons especially nitrogen mustard which was used in Iraq-Iran war against Iranian troops have several harmful effects on skin. Some other chemical agents also can cause acne form lesions on skin. The purpose of this study was to compare the incidence of acneform in previously chemically damaged soldiers and non chemically damaged persons. In this descriptive and analytical study, 180 chemically damaged soldiers, who have been referred to dermatology clinic between 2000- 2004, and forty non-chemically damaged people, were chosen randomly and examined for acneform lesions. SPSS software was used for statistic analysis of the data. The mean age of the experimental group was 37.5 +/- 5.2 and that of the control group was 38.7 +/- 5.9 years. The mean percentage of chemical damage in cases was 31 percent and the time after the chemical damage was 15.2 +/- 1.1 years. Ninety seven cases [53.9 percent] of the subjects and 19 people [47.5 percent] of the control group had some degree of acne. No significant correlation was found in incidence, degree of lesions, site of lesions and age of subjects between two groups. No significant correlation was noted between percentage of chemical damage and incidence and degree of lesions in case group. Incidence of acneform lesions among previously chemically injured peoples was not higher than the normal cases

Markel cell carcinoma on mustard Gas scar: a case report

Merkel cell carcinoma [MCC] is a rare primary neuroendocrine carcinoma of the skin in elderly individuals, on sun exposed areas of the body, with the head and neck being the most common sites. Excessive ultraviolet exposure may play an etiologic role in the development of it. Exposure to mustard gas can cause skin reactions and increase risk of skin neoplasms and probably MCC. The Aim of this study was to report this interesting case and review the published literature on MCC. In this article a 60 year old man with a history of exposure to chemical warfare sulphur Mustard gas in Iraq-Iran conflict and development of a hemorrhagic nodular mass with a duration of 3 months on his scalp, that based on histology, immunohistochemical staining and was diagnosed as MCC is presented. This was the first reported case of Merkel cell carcinoma in Iran exposed to sulphur Mustard gas. Sulphur Mustard gas can be an etiologic factor for this tumour

[Alanin aminotransferase activity in veterans exposed to sulfur mustard]

Until now, few studies have focused on late effect of sulfur mustard on the liver; at present there is no data published on liver enzymes in sulfur mustard exposed veterans. The current study was conducted with the aim of determining alanine aminotransferase [ALT] levels in veterans exposed to sulfur mustard. In this cross-sectional study, 263 sulfur mustard exposed veterans were selected from among individuals referring to the respiratory clinic in Bagiyatallah hospital in 2005. ALT was determined in all subjects. Demographic data, exposure related variables, respiratory status and Body Mass Index [BMI] were collected. ALT over 40 unit/liter was considered as abnormal. From a total of 263 sulfur mustard exposed veterans, 43 [16.3%] patients had an elevated ALT level. Range of ALT was 3-94 with a mean [SD] of 26.43 +/- 15.22 unit/liter. ALT was correlated with the BMI [r=0.153, p=0.013]. ALT was not significantly correlated with age, grading of chemical and overall disability. Mean ALT levels in patients with BMI > 25 [28.81 +/- 15.05] were significantly higher than those with BMI less than 25 [21.93 +/- 14.58] [p=0.001]. Mean ALT level was higher in those with FEV1/FVC, in comparison to others [p<0.05]. ALT was not significantly correlated with other study variables [p>0.05]. Although any conclusion of the impact of mustard gas on ALT needs a controlled study, we mean while suggest serial measurement of the activity of this enzyme and other measures of liver status

[Body mass index in veterans exposed to chemical warfare agents with chronic bronchiolitis]

One of the leading risk factors for various diseases is obesity, a nutritional burden and an independent factor which increases mortality. Patients with chronic bronchiolitis due to mustard gas have low levels of physical activity, owing to respiratory problems, and comorbidities like psychological disorders. The aim of this study was to assess obesity in veterans exposed to chemical warfare agents. In a descriptive cross-sectional study, 434 veterans exposed chemical warfare agents, admitted to the chest of clinic of Baqiyatallah Hospital during 2006 were studied. Patients were divided into three age groups as follows: 30-39, 40-49 and 50-59 years. Respiratory symptoms, including dyspnea, cough, sleep fragmentation and bloody sputum, pulmonary function and body mass index [BMI] were assessed in subjects. Mean BMI was 26.4 +/- 3.9 kg/m2 in patients, 26.3 +/- 4.1 kg/m2 in 30-39, 26.3 +/- 3.9 kg/m2 in the 40-49, and 27.1 +/- 3.9 kg/m2 in 50-59 year olds. In addition, 32.9%, 35.9%, 32.9% and 17.6% of patients had normal weight, and 54.7%, 61.3%, 64.8% and 82.4% were overweight or obese in all patients, 30-39, 40-49 and 50-59 age groups. BMI was not correlated with the severity of cough, sleep fragmentation, dyspnea, the presence of bloody sputum and respiratory volumes. The prevalence of obesity and overweight in was veterans exposed to chemical warfare agent seems to be higher than in the normal population. Given the importance of obesity, there should be more focus on balancing weight in patients with chronic pulmonary diseases; in this regard, such patients will benefit greatly from collaboration between nutritionists, endocrinologists, pulmonologists and psychologists

Being a wife of a veteran with psychiatric problem or chemical warfare exposure: a preliminary report from Iran

The aim of the present study was to examine the relationship between marital satisfaction with psychological health in women whose husbands had either suffered from psychiatric problems or been exposed to chemical warfare during Iraq-Iran imposed war. Participants were selected from the war-affected women in Mazandaran province in north of Iran whose husbands had either suffered from a psychiatric problem [psychiatric group] or had been exposed to chemical warfare [chemical group] during Iran-Iraq war [each consisted of 52 women]. Women were requested to fill in The Evaluation and Nurturing Relationship Issues Communication and Happiness [ENRICH] questionnaire, Symptom Check List 90-Revised [SGL-90-R] as well as a demograhic form. We found significant negative relationships between SCL-90-R scores and the marital satisfaction scores in both groups. The results failed to indicate significant differences between the two groups on marital satisfaction and demograhic characteristics such as age, number of children, handicapped percentage, and educational level. It seems that wives whose husbands had either psychiatric problems or had been exposed to chemical warfare, suffered from diverse psychological problems and medical ailments

Multiple large cherry angiomas after exposure to sulfur mustard gas in Iranian veterans in Iraq-Iran war: a historical cohort study

Sulfur mustard [SM] is a blistering agent which has been used as a chemical warfare agent in many wars since 1917. It has been used several times by Iraqi forces during Iraq Iran war [1980-88]. Lungs, skin and eyes are the three major targets affected by SM. We had observed an increased number of cherry angiomas, benign vascular tumors, in Iranian veterans after exposure to SM, so we decided to assess number and size of cherry angiomas in Iranian veterans several years after exposure to SM. In this historical cohort study, 99 veterans exposed to SM were compared to 52 non-exposed individuals. Participants were examined for number and maximum size of cheny angiomas and the findings were compared between the two groups. All participants were male. The age range in case group was from 30 to 60 years [mean +/- SD: 42.7 +/- 7.6] and in control group was from 30 to 65 years [mean +/- SD: 39.9 +/- 9.9]. In case group, number of angiomas and maximum size of them were significantly greater than those in control group [P=0.001 and P=0.0001; respectively]. There was a direct correlation between number of angiomas and maximum size of them in case group [P=0.0001]. Most of lesions were located in trunk and upper extremities. SM seemed to be responsible for the presence of multiple cherry angiomas in veterans several years after exposure. Maximum size of angiomas in veterans was significantly greater than those were observed in non-exposed individuals

Cutaneous reactions in nuclear, biological and chemical warfare.

Nuclear, biological and chemical warfare have in recent times been responsible for an increasing number of otherwise rare dermatoses. Many nations are now maintaining overt and clandestine stockpiles of such arsenal. With increasing terrorist threats, these agents of mass destruction pose a risk to the civilian population. Nuclear and chemical attacks manifest immediately while biological attacks manifest later. Chemical and biological attacks pose a significant risk to the attending medical personnel. The large scale of anticipated casualties in the event of such an occurrence would need the expertise of all physicians, including dermatologists, both military and civilian. Dermatologists are uniquely qualified in this respect. This article aims at presenting a review of the cutaneous manifestations in nuclear, chemical and biological warfare and their management.

Management of military medicine in new war defense

Management of military medicine service during a war faces two major kinds of weapons, conventional and unconventional.Now a days,production and application of unconventional agents and weapons of mass destruction [chemical,biological,nuclear and remote control weapons] which are called new arsenal, threaten more and more the health and life of living things and human beings every day. Super powers use these kinds of weapons for their sovereignty on other countries.The main goal of military medicine management is to maintain the health of military staff during war and peace with increasing the awareness of personnels by functional methods.The objective of this article is to emphasise roles of management of military medicine in defence during new wars. This is an original article in which the records of imposed war and the pattern of military health management in modern war counterattacks and the evidence from countries involved in these kinds of wars and crisis are mentioned and Persian and English literature were used as examples. Results show that the responsibility of military health management in modern war counterattacks is not just limited to the times of war and crisis; these issues should also be considered in the peace time as well as war and crisis in order to achieve its objectives. Preparation, providing required conditions, and acquiring information about weapons, their application and the methods to tackle them, should all be done in this phase and necessary training should be provided for military personnels and people who are in danger. Debate on using modern weapons is now of great importance since the types of weapon and their destructive effects -even if used in a limited level- have been changed. Ignoring this issue can easily affect the moral and military capabilities of ordinary people as well as military personnel and has a special importance. Although the application of these weapons may not be as widespread as before, current destructive effects of these weapons is now much greater than before. Special attention should be paid to this issue

Long-term pulmonary complications of sulphur mustard gas exposure in Iranian chemical war victims

Sulphur Mustard [SM] is a major threat around the world not only on the battle field but also to civilian population. It has been used by Iraqi troops against Iranian veterans and resulted in severe inhalation injury and pulmonary complications in Iranian soldiers. To determine the long-term pulmonary sequelae of SM gas exposure on Iranian veterans of Iraqi -Iran conflict, chemical victims of Babol, who have been referred for follow up examination to Shaheed Beheshti Hospital clinic [were studied]. A total of 220 male chemical exposed victims and 92 age matched healthy controls were studied. Diagnosis of SM-related disease was confirmed on the basis of prior history of SM gas exposure and excluding other unrelated diseases. The results were regarded positive if the FEVI% or FVC% or absolute FEVI volume increased by 15%, 20% or 180 ml respectively compared with baseline value. In statistical analysis, the frequency of respiratory signs and symptoms, radiographic changes of chest radiographs, and the proportion of persons with abnormal PFT results were determined and compared with age matched controls. Emphysema in 2%, cor pulmonale in 4% and severe respiratory disease requiring permanent supportive treatment in 4.5% of patients. Abnormal radiographic findings were detectable in 64% of chest radiographs which were remarkable in only 13%. Obstructive airway disease was detected in 110 [50%] patients and 11 [5.4%] controls [P<0.0001]. The degree of obstruction was mild, moderate or severe in 13.5%,73% and 13.5% of patients and 80%, 20% and 0% of controls respectively. Restrictive airway disease was observed in 22 [10%] patients and 11 [12%] controls [P=NS]. Normal PFT was seen in 40% of patients and 83% of controls [P<0.0001]. Only 30% of patients with obstructive airway disease were responsive to bronchodilator test. The findings of the present study show that, a remarkable number of Iranian veterans are suffering from chronic lung diseases several years after exposure to SM gas

Bioterrorismo: onde estamos e para onde vamos? / Bioterrorism: where have we been and were are we going?

Objetivo: revisar os principais aspectos das armas químicas e biológicas que, propositalmente ou por um desastre, poderiam afetar a integridade física de criança e indivíduos em geral. Método: levantamento bibliográfico. Resultados: säo abordados casos de bioterrorismo já perpetrados anteriormente, apresentados os principais microrganismos envolvidos com suas variáveis epidemiológicas, laboratoriais e clínicas, bem como condutas de tratamento e profilaxia. Säo mencionados programas de planejamento de vigilância epidemiológica para os profissionais da Saúde estarem aptos a reconhecer e abordar o tema. Conclusöes: o bioterrorismo deixou de ser uma ameaça e está sendo uma triste realidade atual. Um conhecimento mais amplo sobre o assunto nos prepara melhor para uma possível eventualidade médica.