Long-term ocular consequences of sulfur mustard in seriously eye-injured war veterans

Ghasemi, Hassan; Ghazanfari, Tooba; Ghassemi-Broumand, Mohammad; Javadi, Mohammad Ali; Babaei, Mahmoud; Soroush, Mohammad Reza; Yaraee, Roya; Faghihzadeh, Soghrat; Poorfarzam, Shahriar; Owlia, Parviz; Naghizadeh, Mohammad Mehdi; Razavi, Mohammad Etezad; Jadidi, Khosrow; Naderi, Mostafa; Hassan, Zuhair Mohammad

doi:10.1080/15569520902913936

Cited by 58 publications

(49 citation statements)

References 21 publications

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“…Similarly, during the chronic phase, symptomatic interventions such as therapeutic bronchoscopy, laser therapy, and respiratory tract stents have been used, but with only limited effectiveness (Razavi et al, 2013). Inhaled corticosteroids and long-term β2 adrenergic agonists minimize scarring leading to reduced airway stenosis and obstruction (Ghasemi et al, 2009). Frequent follow-up and aggressive treatment of infections have also been shown to slow the progression of symptoms.…”

Section: Limitations Of Current Therapeutic Strategiesmentioning

confidence: 99%

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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Section: Limitations Of Current Therapeutic Strategiesmentioning

confidence: 99%

Mustard vesicant-induced lung injury: Advances in therapy

Weinberger

Malaviya

Sunil

et al. 2016

Toxicology and Applied Pharmacology

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“…C-1-1- Patients with the following signs and symptoms of the chronic and delayed ocular injuries should be regarded as the mild form: [18222737394048555657585960]…”

Section: Resultsmentioning

confidence: 99%

Clinical practice guidelines for prevention, diagnosis and management of early and delayed-onset ocular injuries due to mustard gas exposure

Rajavi

Safi

Javadi

et al. 2017

J Ophthalmic Vis Res

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Purpose:To develop clinical practice guidelines (CPGs) for prevention, diagnosis, treatment and follow-up of ocular injuries caused by exposure to mustard gas.Methods:The clinical questions were designed by the guideline team. Websites and databases including National Guidelines Clearinghouse, National Institute for Clinical Excellence, Cochrane, and PubMed were searched to find related CPGs and explore possible answers to the clinical questions. Since there were no relevant CPGs in the literature, related articles in Persian and English languages were extracted. Each article along with its level of evidence was summarized. Additionally, hand search was performed by looking the reference list of each article. Consequently, recommendations were developed considering the clinical benefits and side effects of each therapeutic modality. The recommendations were re-evaluated in terms of customization criteria. All recommendations along with the related evidence were scored from 1 to 9 by experts from all medical universities of Iran. The level of agreement among the experts was evaluated by analyzing the given scores.Results:The agreement was achieved for all recommendations. The experts suggested a number of minor modifications which were applied to the recommendations. Finally, CPGs were developed with 98 recommendations under three major domains including prevention of injury, diagnosis and management of the acute and delayed-onset mustard gas ocular injuries.Conclusion:Considering the lack of CPGs for the prevention, diagnosis, and management of mustard gas-induced keratitis, these recommendations would be useful to prevent the serious ocular complications of mustard gas and standardize eye care services to the affected individuals.

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“…Based on the chart of the Iranian Ophthalmic Foundation of Martyrs and Veterans Affairs [20], those veterans who were categorized as severe SM induced ocular involvement were invited to participate in this study from all provinces of Iran. Common ocular findings in this group include corneal ischemia, vascular abnormalities, neovascularization, melting, thinning, hyaline deposition, or diffuse corneal opacity [21]. The study methodology was approved by the Ethics Committee of the Janbazan Medical and Engineering Research Center (JMERC) and Shahed University, Tehran, Iran.…”

Section: Methodsmentioning

confidence: 99%

“…Chronic and long term ocular discomfort and the constant fear from impending blindness induce a continuous and long lasting distress that may cause different types of psychological disorders [4]. The psychological sequela in military veterans may persist as long as 50 years after exposure to mustard gas [5].…”

Section: Introductionmentioning

confidence: 99%

Impact of psychological problems in chemical warfare survivors with severe ophthalmologic complication, a cross sectional study

Ghaedi

Ghasemi

Mousavi

et al. 2012

Health Qual Life Outcomes

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BackgroundSulfur mustard (SM) has been used as a chemical warfare agent since the early twentieth century. Despite the large number of studies that have investigated SM induced ocular injuries, few of those studies have also focused on the psychological health status of victims. This study has evaluated the most prominent influences on the psychological health status of patients with severe SM induced ocular injuries.MethodsThis descriptive study was conducted on 149 Iranian war veterans with severe SM induced eye injuries. The psychological health status of all patients was assessed using the Iranian standardized Symptom Check List 90-Revised (SCL90-R) questionnaire. The results of patients' Global Severity Index (GSI) were compared with the optimal cut-off point of 0.4 that has previously been calculated for GSI in Iranian community. The Mann-Whitney U test, T tests and effect sizes (using Cohen's d) were employed as statistical methods. Data were analyzed using SPSS software.ResultsThe mean age of patients was 44.86 (SD = 8.7) and mean duration of disease was 21.58 (SD = 1.20) years. Rate of exposure was once in 99 (66.4%) cases. The mean GSI (1.46) of the study group was higher compared to standardized cut off point (0.4) of the Iranian community. The results of this study showed that the mean of total GSI score was higher in participants with lower educational levels (effect size = 0.507), unemployment (effect size = 0.464) and having more than 3 children (effect size = 0.62). Among the participants, 87 (58.4%) cases had a positive psychological history for hospitalization or receiving outpatient cares previously and 62 (41.6%) cases had a negative psychological history. In addition, the mean of GSI in participants with negative psychological history was lower than those with positive psychological history (Mean Change Difference = -0.621 with SD = 0.120). There was a significant difference between positive and negative psychological history with respect to GSI (P < 0.001).ConclusionThe study showed that severe ophthalmologic complications in chemical survivors are accompanied with destructive effects on psychological health status. Appropriate management may improve psychological health status in these patients.

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Long-term ocular consequences of sulfur mustard in seriously eye-injured war veterans

Cited by 58 publications

References 21 publications

Mustard vesicant-induced lung injury: Advances in therapy

Mustard vesicant-induced lung injury: Advances in therapy

Clinical practice guidelines for prevention, diagnosis and management of early and delayed-onset ocular injuries due to mustard gas exposure

Impact of psychological problems in chemical warfare survivors with severe ophthalmologic complication, a cross sectional study

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