role of serum level of interleukin-6 in severity of pulmonary complications of sulfur mustard injuries

Diverse studies suggest that interleukin-6 [IL6], as a member of cytokines family, has a major role in inflammatory processes of airways and lungs. In this study, an attempt was made to determine the serum level of IL6 in sulfur mustard [SM] injured patients and its comparison with controls. The measured IL6 mean level in patients with chemical injuries [0.76 +/- 0.3 ng/ml] was significantly higher than the control group's mean level [0.34 +/- 0.12 ng/ml]. Furthermore, patients with moderate to severe symptoms had a serum level of [0.95 +/- 0.92 ng/ml] which was significantly higher than mild [0.47 +/- 0.54] and control [0.34 +/- 0.12] groups. The outcome of this research program demonstrates that an increase in serum level of IL6 can have a role in pulmonary complications of SM, similar to other well defined pulmonary diseases. However, further studies are required to clarify the role and mechanism of IL6 in such patients

Prevention and treatment of respiratory consequences induced by sulfur mustard in Iranian casualties

About 100,000 Iranian have been exposed to chemical weapons during Iraq-Iran conflict [1980-88]. After being spent of more than two decades, still about 30,000 of them are under follow-up treatment. The main aim of this study was to review various preventive and therapeutic methods for injured patients with sulfur mustard in different phases. For gathering information, we have used the electronic databases including Scopus, Medline, ISI, IranMedex, Irandoc sites. According to this search strategy, 104 published articles associated to respiratory problems and among them 50 articles related to prevention and treatment of respiratory problems were found and reviewed. There is not any curative treatment for sulfur mustard induced lung injuries, but some valuable experienced measures for prevention and palliative treatments are available. Some useful measures in acute phase include: Symptomatic management, oxygen supplementation, tracheostomy in laryngospasm, use of moist air, respiratory physical therapy, mucolytic agents and bronchodilators. In the chronic phases, these measures include: Periodic clinical examinations, administration of inhaled corticosteroids alone or with long-acting beta 2 agonists, use of antioxidants, magnesium ions, long term oxygen supplement, therapeutic bronchoscopy, laser therapy, and use of respiratory tract stents. Most treatments are symptomatic but using preventive points immediately after exposure could improve following outcomes

Vascular endothelial growth factor in bronchoalveolar lavage fluid in sulfur mustard exposed lung patients

To determine the levels of vascular endothelial growth factor isoform consisting of 165 amino acids [VEGF165] in Bronchoalveolar Lavage fluid from Mustard Exposed Patients. Bronchoscopy with Bronchoalveolar Lavage was performed on sulphur mustard exposed patients. A total of 39 patients with documented exposure to Sulfur Mustard during the Iran-Iraq war participated in this study, of which 38 patients were males and one patient was female. The mean +/- SD age of patients was 41 +/- 6.6 years. The mean time after exposure to sulfure mustard was 19 +/- 1.7 years. Eighteen patients had concomitant war injuries but they were not related to the respiratory system. While twenty-two patients had a history of submassive persistent hemoptysis. There was no case with massive hemoptysis. Most of the patients had small airway obstruction [FEV1/FVC% = 78.14 +/- 9.76 and FEV% = 82.79 +/- 18.23]. Twenty-three patients had significant air trapping in the chest. High Resolution Computed Tomography was compatible with BOS. VEGF 165 concentrations in BALF were 36.87 +/- 34.68 pg/ml. When corrected to total protein of Bronchoalveolar Lavage Fluid [BALF] it was 0.76 +/- 0.70 pg/mg. BALF of VEGF did not correlate with hemoptysis or air trapping in chest HRCT. Thus, there was also no correlation between level of VEGF165 in BALF and any of PFT indexes [FVC, FEV1, MMEF or PEF]. Although VEGF is one of the cytokines which has an important role in chronic pulmonary disorders, it seems that it has no essential role in the severity of Mustard Lung Disease

Clinical differentiation between resistant asthma and chronic bronchiolitis: testing a practical approach

Intractable asthma is a challenging clinical problem. This study was conducted to determine whether a subset of patients with Intractable asthma may be misdiagnosed and have a form of bronchiolitis instead and also to determine the effectiveness of macrolide therapy in these patients. Seventy six patients with Intractable asthma were re-treated with recommended maximal doses of oral prednisolone for 5 days, beclomethasone, cromolyn sodium, salbutamol and ipratropium bromide for 30 days. Thirty five patients were considered as unresponsive and constituted the study group. They underwent high-resolution CT [HRCT] scan following which they were offered with video-assisted thoracoscopic surgical biopsy. Group 1 [n=27] refused biopsy and each was treated with macrolide therapy, while Group 2 [n=8] underwent biopsy, and then received macrolide therapy. The patients were treated and followed for three months. The study group consisted of 27 patients, with a mean age of 46.9 +/- 11.1 years. The mean duration of time between the onset of symptoms and the start of this study was 8.1 years. In group 2, no patient had pathologic findings of asthma, and 7/8 had a form of bronchiolitis. There was significant improvement in dyspnea, cough and pulmonary function indices at the end of the 3-month in both groups [p<0.001]. Our results suggest that patients with Intractable asthma could be misdiagnosed and some of them have some forms of chronic bronchiolitis. We believe that any patient who does not respond to standard treatments for Intractable asthma should be evaluated with expiratory HRCT; those with significant air trapping should be considered for a course of macrolide therapy or biopsy for better identification of the underlying disease