Long-term complications of sulphur mustard poisoning in intoxicated Iranian veterans

Namazi, Soha; Niknahad, Hossein; Razmkhah, Hasan

doi:10.1007/bf03178265

Cited by 51 publications

(23 citation statements)

References 19 publications

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“…In other studies conducted in Iran, varied prevalence for cancer and delayed complications has been reported (Marzban, 1986;Emad and Rezaian, 1997;Agin and Broumand, 2004;Riazi et al, 2004;GhasemiBroumand et al, 2006;Gilasi et al, 2006;GhasemiBroumand et al, 2007;GhasemiBroumand and Amiri, 2008;Namazi et al, 2009;Ghabili et al, 2013). Despite the announcement of different figures and statistics for carcinogenesis, respiratory, cutaneous and ocular complications, literature review indicates that no appropriate conclusion has been achieved from these studies.…”

Section: Introductionmentioning

confidence: 95%

Complications and Carcinogenic Effects of Mustard Gas - a Systematic Review and Meta-Analysis in Iran

Panahi¹,

Gholami²,

Ghojazadeh³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: Catastrophic effects of mustard gas as a chemical warfare agent have always been a major problem for those exposed to this agent. In this meta-analysis it was tried to evaluate carcinogenesis, ocular, cutaneous and respiratory complications of mustard gas exposure among Iranians who had been exposed to this agent during the Iran-Iraq war. Materials and Methods: In this meta-analysis, the required data were collected using keywords "mustard gas", "sulfur mustard", "cancer", "neoplasm", "respiratory complications", "ocular complications" , "lung disease", "chronic complication", "eye", "skin", "cutaneous complication", "carcinogenesis" and their combination with keywords "Iran", "Iranian", "prevalence", "mortality" and their Farsi equivalent terms from the databases of SID, Iranmedex, Magiran, Pubmed, Science Direct, Google Search engine, Gray Literature and Reference of References. To determine the prevalence of each complication and perform meta-analysis, CMA: 2 (Comprehensive Meta-Analysis) software with a randomized model was used. Results: Of the 542 articles found, 7 national articles, consistent with the aims of this study were selected. Metaanalysis of seven papers revealed that cancer risk, especially cancer of the respiratory system was elevated, so that the relative risk (RR) of cancer role of mustard gas was inconsistent from 2/1 to 4 in this survey. Also prevalence of delayed skin disorders due to sulfur mustard was 94.6%, pulmonary complications 94.5% and ocular complications 89.9%. The incidence of various cancers in victims exposed to mustard gas was 1.7% worldwide where the rate was 2.2% in Iranian victims of the Iraq-Iran war. Conclusions: Based on present study the prevalence of delayed mustard gas related cutaneous, pulmonary and ocular complications is above 90% and risk of carcinogenesis is higher in comparison to worldwide statistics. This may suggest need for long-term and persistent follow-up and rehabilitation procedures for populations exposed to this agent.

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Section: Introductionmentioning

confidence: 95%

Complications and Carcinogenic Effects of Mustard Gas - a Systematic Review and Meta-Analysis in Iran

Panahi¹,

Gholami²,

Ghojazadeh³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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“…But the highest unconventional application of SM occurred in Iran-Iraq war (1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988). During that period, it injured more than hundred thousand Iranians, which one-third of them are still suffering from late effects (Kehe and Szinicz, 2005;Namazi et al, 2009;Tahmasbpour et al, 2016a). Respiratory system is the primary target for SM toxicity following inhalation exposure (Ghanei and Harandi 2007).…”

Section: Introductionmentioning

confidence: 96%

Sulfur mustard causes oxidants/antioxidants imbalance through the overexpression of free radical producing-related genes in human mustard lungs

Marzony

Nejadmoghadam

Ghanei

et al. 2016

Environmental Toxicology and Pharmacology

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“…Lung disease pathogenesis in these individuals is often dominated by bronchiolitis obliterans, with a distinctive pattern of peribronchial collagen deposition and a constellation of symptoms including productive cough, difficult expectoration, and chronic dyspnea (Ghanei and Harandi, 2011; Saber et al, 2012). Cross-sectional studies have confirmed that respiratory complications increase with time following mustard exposure (Namazi et al, 2009). In a group of 197 Iranian veterans, 10 years of a single high dose SM exposure, pulmonary sequelae included bronchitis (58%), asthma (10%), bronchiectasis (8%), large airway narrowing (9%), and pulmonary fibrosis (12%) (Emad and Rezaian, 1997; Tang and Loke, 2012).…”

Section: Introductionmentioning

confidence: 98%

Mustard vesicant-induced lung injury: Advances in therapy

Weinberger

Malaviya

Sunil

et al. 2016

Toxicology and Applied Pharmacology

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Most mortality and morbidity following exposure to vesicants such as sulfur mustard is due to pulmonary toxicity. Acute injury is characterized by epithelial detachment and necrosis in the pharynx, trachea and bronchioles, while long-term consequences include fibrosis and in some instances, cancer. Current therapies to treat mustard poisoning are primarily palliative and do not target underlying pathophysiologic mechanisms. New knowledge about vesicant-induced pulmonary disease pathogenesis has led to the identification of potentially efficacious strategies to reduce injury by targeting inflammatory cells and mediators including reactive oxygen and nitrogen species, proteases and proinflammatory/cytotoxic cytokines. Therapeutics under investigation include corticosteroids, N-acetyl cysteine, which has both mucolytic and antioxidant properties, inducible nitric oxide synthase inhibitors, liposomes containing superoxide dismutase, catalase, and/or tocopherols, protease inhibitors, and cytokine antagonists such as anti-tumor necrosis factor (TNF)-α antibody and pentoxifylline. Antifibrotic and fibrinolytic treatments may also prove beneficial in ameliorating airway obstruction and lung remodeling. More speculative approaches include inhibitors of transient receptor potential channels, which regulate pulmonary epithelial cell membrane permeability, non-coding RNAs and mesenchymal stem cells. As mustards represent high priority chemical threat agents, identification of effective therapeutics for mitigating toxicity is highly significant.

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Long-term complications of sulphur mustard poisoning in intoxicated Iranian veterans

Abstract: Results of this study indicate that respiratory complications generally increase over time. Therefore, follow-up of veterans exposed to SM is recommended. This may lead to early diagnosis of SM complications and help prevent the late manifestations of this toxicity.

Cited by 51 publications

References 19 publications

Complications and Carcinogenic Effects of Mustard Gas - a Systematic Review and Meta-Analysis in Iran

Complications and Carcinogenic Effects of Mustard Gas - a Systematic Review and Meta-Analysis in Iran

Sulfur mustard causes oxidants/antioxidants imbalance through the overexpression of free radical producing-related genes in human mustard lungs

Mustard vesicant-induced lung injury: Advances in therapy

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