It is well documented that inhalation of sulfur mustard (SM) causes injury to the respiratory system. Many Iranian civilians and war veterans are suffering from late respiratory complications of SM exposure. Recent studies have shown that bronchiolitis obliterans (BO) is the major cause of respiratory complications following SM exposure. In this review, we focus on the clinical, pulmonary, radiological, immunological and pathological manifestations in SM-induced BO with intent to provide a practical, clinical and paraclinical guideline for diagnosis and step-wise workup of these patients, which may be used to manage similar lung injuries induced by other similar inhaled toxins.

Gastroesophageal reflux disease (GERD) is widely associated with asthma, chronic cough, and laryngitis. Many studies have focused on acidic reflux; however, acid is just one of many factors that can cause pulmonary injury. The discrepancy between the high frequency of GERD in asthmatic patients and the ineffective reflux therapy outcomes in these patients suggests that GERD may cause injury through other mechanisms, such as pepsinogen, pepsin, bile salts, or other components of reflux materials, instead of the acid. Research using appropriate and innovative methodologies to investigate these potential inflammatory agents in patients with GERD is required to determine the underlying factors associated with pulmonary disorders in these patients.

Background: Hepatitis B (HB) vaccination is the most effective measure for preventing hepatitis B virus (HBV) infection and its consequences. HB vaccination has been a part of the Expanded Program on Immunization (EPI) of Iran since 1993. To extend HBV immunization, mass HBV vaccination was planned for adolescents born during 1989-1992. Objectives: The aim of the present study was to assess the prevalence of HBV infection in Tehran blood donors after implementing national HB vaccination program. Patients and Methods: Prevalence of HBV infection was determined in all of Tehran blood donors born during 1989-1993 as cases and the ones born during 1986-1988 as controls. All the participants were recruited after medical interviews. Serum samples taken from the participants as well as other blood donors were tested according to the IBTO standards for hepatitis B surface antigen (HBsAg). Initially, positive samples were tested with appropriate confirmation methods. Statistical comparisons were performed using chi-square test. Prevalence estimates were age-adjusted by the direct method for comparisons across subgroups. Results: The prevalence of HBV infection was 57/100 000, 350/100 000, and 265/100 000 among accepted blood donors born during 1989-1993 (cases), 1986-1988 (nonconcurrent controls), and 1989-1993 (concurrent controls), respectively. The prevalence of HCV infection in the same group of blood donors was 28/100 000, 38/100 000, and 31/100 000, respectively. Conclusions: HBV prevalence was significantly lower among blood donors born during 1989-1993, which reflected the positive impact of EPI program and extended mass vaccination against HBV.

Estimation of residual risk is essential to monitor and improve blood safety. Our epidemiologic knowledge in the Iranian donor population regarding transfusion transmitted viral infections (TTIs), is confined to a few studies based on prevalence rate. There are no reports on residual risk of TTIs in Iran. In present survey, a software database of donor records of Tehran Blood Transfusion Center (TBTC) was used to estimate the incidence and residual risk of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections, by applying the incidence rate/window period (IR-WP) model. A total of 1,207,155 repeat donations was included in the analysis and represented a mean of 8.4 donations per donor over 6 years. The incidence amongst repeat donors was estimated by dividing the number of confirmed seroconverting donors by the total number of person-years at risk. The residual risk was calculated using the incidence/window period model. Incidence rate and residual risk for HBV, HCV and HIV infections were calculated for total (2005-2010) and two consecutive periods (2005-2007 and 2008-2010) of the study. According to the IR-WP model, overall residual risk for HIV and HCV in the total study period was 0.4 and 12.5 per million units, respectively and for HBV 4.57/100,000 donations. The incidence and residual risk of TTIs, calculated on TBTC's blood supply was low and comparable with developed countries for HIV infection but high for HCV and HBV infections. Blood safety may therefore be better managed by applying other techniques like nucleic acid amplification tests.

Background/Aim:Gastro-esophageal reflux has been suggested to be associated with several pulmonary complications such as asthma, and post-transplant bronchiolitis obliterans (BO). Pepsin or bile salts in the sputum is shown to be an optimal molecular marker of gastric contents macro/micro aspiration. In this study, we investigated sputum pepsin as a marker of micro-aspiration in sulfur mustard (SM) exposed cases compared to healthy controls.Materials and Methods:In a case controlled study, 26 cases with BO and 12 matched healthy controls were recruited and all cases were symptomatic and their exposure to SM was previously documented during Iran-Iraq conflict. Pepsin levels in sputum and total bile acids were measured using enzymatic assay. The severity of respiratory disorder was categorized based upon the spirometric values.Result:The average concentration of pepsin in sputum was higher in the case group (0.29 ± 0.23) compared with healthy subjects (0.13 ± 0.07; P ± 0.003). Moreover, the average concentration of bile acids in the sputum cases was not significantly different in comparison to the controls (P = 0.5).Conclusion:Higher pepsin concentrations in sputum of SM exposed patients compared with healthy control subjects indicate the occurrence of significantly more gastric micro-aspiration in SM exposed patients.