ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Taebi   Gh. (1 )
Soroush   M.R. (1 )
Modirian   E. (2 )
Khateri   S. (1 )
Mousavi   B. (1 )
Ganjparvar   Z. (1)
Momtazmanesh   K. (1 )
Sedighi Moghadam   M.R. (* )






(* ) Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
(1 ) Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
(2 ) Emergency Department, Medical Faculty, Qazvin University of Medical Sciences, Qazvin, Iran

Correspondence

Address: No. 17, Farokh Street, Moghadas Ardabili Street, Yaman Street, Chamran Highway, Tehran, Iran
Phone: +982122418180
Fax: +982122418180
moghadam_office@yahoo.com

Article History

Received:  October  27, 2014
Accepted:  March 15, 2015
ePublished:  April 20, 2015

BRIEF TEXT


… [1-11] From the winter of 1984, widespread chemical attacks were started by Iraq against Iran, and during a period of five years, several attacks were carried out against Iranian military and residential areas [12]. … [13-17] Local or inhaled exposure to sulfur mustard affects the eyes and skin tissues and respiratory tract. Although this gas in high concentrations can be fatal, it has been used as a deterrent for Iranian fighters due to its injurious effects on the respiratory tract [18], eye [19, 20] and skin [21-23]. The results of conducted studies show that the most common organs exposed to sulfur mustard are respiratory system (42.5%), eye (39.3%), and skin (24.5%), respectively [9]. … [24]

So far, various statistics of injuries caused by exposure to chemical agent in Iran-Iraq war has been reported and the number of victims has been between 34 and 60 thousand [9, 11, 25].

The aim of this study was to evaluate the epidemiological situation of Iranian chemical veterans, based on information available at the Foundation of Martyrs and Veterans Affairs.

This is a descriptive study.

Chemical veterans who had chronic lesions approved by Foundation of Martyrs and Veterans Affairs, up to April 2015, were studied.

Non-declared

Veterans’ information on age, gender, level of education, region of residence, percentage of injury, and life status was extracted from database available on the Foundation of Martyrs and Veterans Affairs. Data related to various chemical injuries of Iranian veterans, were classified based on chronic problems resulted from respiratory, eye, and skin complications. Descriptive statistical analysis was performed by SPSS 20 software.

Up to April 2015, 554990 veterans were registered. 455818 (89.3 %) veterans aged 40 to 60 years, 42353 (8.3%) of them aged 60 or above 60, and 12301 (2.2%) of veterans aged less than 40 years old. The age of 44478 (8.2%) of veterans were unknown. 493214 (88.9%) of subjects had 50% injury and less. Of the total registered veterans, 63417 (11.4%), had chemical injuries. Most chemical veterans were living in Tehran, Isfahan, Khorasan Razavi, Kerman, Fars and Mazandaran provinces (Table 1). 62149 (98%) of chemical veterans were male. The mean age of chemical veterans was 51.11 ± 5.73 at the time of study, and 54899 (86.6 %) of veterans aged 41 to 60 years. 31273 (49.3%) of veterans had high school diploma and higher education. 34340 (54.1%) had 25% injury or less, and only 3175 (5.0%) had 50% injury or higher (Table 2). The total number of chemical injuries registered in the database of Foundation of Martyrs and Veterans Affairs was 151770 cases. Pulmonary injury with 59373 frequency (39.1%) was the most frequent problem in all groups faced with mild, moderate and severe injuries, and the eye and skin problems with 46782 frequency (30.8%) and 45615 frequency (30.1%) were in the subsequent places, respectively (Table 3).

During Iran-Iraq war from 1980 to 1988, Iran exposed to chemical attack for 387 times and almost 60 thousand people have been suffered from physical and mental injuries caused by these attacks [25]. The number of people injured by chemical weapons and had chronic complications, up to 2005, has been reported 34000 [9]. The number of people who have suffered due to exposure to sulfur mustard is 52195 [11]. Over 10 years, the number of victims exposed to chemical agents has been increased up to twice [9]. The most common problem caused by exposure to chemical agent has been the incidence of pulmonary complications [9]. In the present study, the percentage of veterans suffered pulmonary complications was lower than the previous studies, but still it was more abundant than other injuries. Comparison between severities of complications indicates a reduction in percentage of severe pulmonary veterans up to one-twentieth. In the previous mentioned study, eye and skin injuries were in the next ranks that the results of this study are likewise. The main differences in the results of two studies are a significant increase in the prevalence of skin problems and approximately 10% reduction of ocular complications showed by the present study. In addition, this study shows a reduction in the prevalence of severe pulmonary lesions, but an increase in ocular lesions. … [26, 27]

Analysis of these results requires further studies to determine the course of disease in patients exposed to chemical agents.

Only veterans whose injuries were eligible for the medical commission and were confirmed by that authority were enrolled in this study. Some contained information in the records of the Medical Commission of Foundation of Martyrs and Veterans Affairs are not currently logged in data banks.

Given the high number of chemical veterans after nearly three decades of the first chemical attack to Iran and the possibility of increase in number of registered cases, it is necessary to conduct a comprehensive research on the method of detection and diagnosis of patients, methods of determining disability, recognition of late complications and new methods of treatments, optimization of health management, clinical governance and increase in safety and control of medical errors in treatment.

Medical Committee of the Foundation of Martyrs and Veterans Affairs, Department of Statistics and Information Technology and Center for Chemical Victims are appreciated.

Non-declared

This study has been confirmed by Institutional Ethical Committee of Biomedical Research Foundation of Martyrs and Veterans Affairs.

This study has been done by financial support of Janbazan Medical and Engineering Research Center (JMERC).

TABLES and CHARTS

Show attach file


CITIATION LINKS

[1]Murray CJL, King G, Lopez AD, Tomijima N, Krug EG. Armed conflict as a public health problem. Br Med J. 2002;324(7333):346-9.
[2]Levy BS, Sidel VW. War & public health in the twenty-first century. New England J Public Policy. 2003;19(1):167-78.
[3]Kibong K, Tsay OG, Atwood DA, Churchill DG. Destruction and detection of chemical warfare agents. Chem Rev. 2011;111(9):5345-5403.
[4]Mangerich A, Esser C. Chemical warfare in the First World War: reflections 100 years later. Arch Toxicol. 2014;88(11):1909-11.
[5]Szinicz L. History of chemical and biological warfare agents. Toxicology. 2005;214(3):167-81.
[6]Qaderi Kangavar R. regional and trans-regional financial and arms assistance to Iraq during the imposed war against Iran. Negin Iran. 2010;8(32):51-70. [Persian]
[7]Razavi SM, Razavi MS, Pirhosseinloo M, Salamati P. Iraq-Iran chemical war: Calendar, mortality and morbidity. Chin J Traumatol. 2014;17(3):165-9.
[8]Balali-Mood M, Shariat M. Treatment of organophosphate poisoning. Experience of nerve agents and acute pesticide poisoning on the effects of oximes. J Physiol Paris. 1998;92(5):375-8.
[9]Khateri S, Ghanei M, Keshavarz S, Soroush M, Haines D. Incidence of lung, eye, and skin lesions as late complications in 34,000 Iranians with wartime exposure to mustard agent. J Occup Environ Med. 2003;45(11):1136-43.
[10]Khateri Sh. Casualties of chemical warfare in Iran: Response of Iranian civil society to the tragedy. Meiji Gakuin Univ Institut Reposit. 2011;10(34):9-19.
[11]Zargar M, Araghizadeh H, Soroush MR, Khaji A. Iranian casualties during the eight years of Iraq-Iran conflict. Rev Saúde Pública. 2007;41(6):1065-6.
[12]Ghazanfari T, Faghihzadeh S, Aragizadeh H, Soroush MR, Yaraee R, Mohammad Hassan Z, et al. Sardasht-Iran cohort study of chemical warfare victims: Design and methods. Arch Iran Med. 2009;12(1):5-14.
[13]Khateri Sh, Janati Moheb A. Iraqs use of chemical weapons against Iran: UN documents 1984-1988. Tehran: Foundation of Preservation of Works and Dissemination of the Values of Holy Defense; 2010. pp. 26-37.
[14]United Nations Security Council. Report of the Specialists Appointed by the Secretary General to Investigate Allegations by the Islamic Republic of Iran Concerning the Use of Chemical Weapons (Document S16433). New York, USA: United Nations Security Council; 1984, March 26.
[15]Iraq’s Chemical Warfare Program [Internet]. Washington, D.C.: Central Intelligence Agency; 2007-04 [Updated 2007 Apr, 23]. Available from: https://www.cia.gov/library/reports/general-reports-1/iraq_wmd_2004/chap5.html.
[16]Requena L1, Requena C, Sánchez M, Jaqueti G, Aguilar A, Sánchez-Yus E, et al. Chemical warfare. Cutaneous lesions from mustard gas. J Am Acad Dermatol. 1988;19(3):529-36.
[17]Smith KJ, Hurst CG, Moeller RB, Skelton HG, Sidell FR. Sulfur mustard: Its continuing threat as a chemical warfare agent, the cutaneous lesions induced, progress in understanding its mechanism of action, its long-term health effects, and new developments for protection and therapy. J Am Acad Dermatol. 1995;32(5Pt1):765-76.
[18]Sohrabpour H. Clinical manifestations of chemical agents on Iranian combatants during Iran-Iraq conflict. Arch Belg. 1984;Suppl:291-7.
[19]Ghasemi H, Ghazanfari T, Ghassemi-Broumand M, Javadi MA, Babaei M, Soroush MR, et al. Long-term ocular consequences of sulfur mustard in seriously eye-injured war veterans. Cutan Ocul Toxicol. 2009;28(2):71-7.
[20]Lagali N, Fagerholm P. Delayed mustard gas keratitis: Clinical course and in vivo confocal microscopy findings. Cornea. 2009;28(4):458-62.
[21]Andreassi L. Chemical warfare and the skin. Int J Dermatol. 1991;30(4):252-3.
[22]Hefazi M, Maleki M, Mahmoudi M, Tabatabaee A, Balali-Mood M. Delayed complications of sulfur mustard poisoning in the skin and the immune system of Iranian veterans 16-20 years after exposure. Int J Dermatol. 2006;45(9):1025-31.
[23]Momeni AZ, Enshaeih S, Meghdadi M, Amindjavaheri M. Skin manifestations of mustard gas. A clinical study of 535 patients exposed to mustard gas. Arch Dermatol. 1992;128(6):775-80.
[24]Devereaux A, Amundson DE, Parrish JS, Lazarus AA. Vesicants and nerve agents in chemical warfare. Decontamination and treatment strategies for a changed world. Postgrad Med. 2002;112(4):90-6.
[25]Hashemian F1, Khoshnood K, Desai MM, Falahati F, Kasl S, Southwick S. Anxiety, depression, and posttraumatic stress in Iranian survivors of chemical warfare. J Am Med Assoc. 2006;296(5):560-6.
[26]Modirian E, Eskandari A. Veterans’ satisfaction analysis of disability rating commission. Iran J War Public Health. 2010;2(2):16-21. [Persian]
[27]The United Nations Monitoring, Verification and Inspection Commission (UNMOVIC). Iraq’s storage, handling and deployment of chemical and biological munitions. UN document S/2004/693. August 2004; Appendix I:7.