@2024 Afarand., IRAN
ISSN: 2008-2630 Iranian Journal of War & Public Health 2020;12(2):109-114
ISSN: 2008-2630 Iranian Journal of War & Public Health 2020;12(2):109-114
Health Problems in Survivors Exposed to Sulfur Mustard with Severe Respiratory Complications
ARTICLE INFO
Article Type
Descriptive & Survey StudyAuthors
Soroush M.R. (1)Akhavizadegan H. (2)
Mousavi B. (*3)
(*3) Prevention Department, Janbazan Medical and Engineering Research Center (JMERC) , Tehran, Iran
(1) Janbazan Medical and Engineering Research Center (JMERC),, Tehran, Iran
(2) Urology Department, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran
Correspondence
Address: Janbazan Medical and Engineering Research Center (JMERC), Tehran, IranPhone: -
Fax: -
mousavi.b@gmail.com
Article History
Received: March 15, 2020Accepted: May 14, 2021
ePublished: June 17, 2020
ABSTRACT
Aims
The complications of sulfur mustard (SM) in lungs, eyes, and skin of exposed survivors have already been studied. This study evaluates health problems of other than the usual affected organs in survivors with severe respiratory injuries.
Instrument & Methods In this descriptive cross-sectional study, 292 chemical warfare veterans with severe pulmonary complications due to exposure to sulfur mustard were examined by two physicians in 2016. Health problems in the veterans were recorded and a clinical examination was performed. Data using SPSS software version 2016 and Chi-square test and Lambda correlation coefficient were analyzed.
Findings The most common problems of chemical warfare victims with severe pulmonary complications were related to musculoskeletal problems 92.1% (low back pain 68.8%), neurological system 88.4%(headache 78.1%), auditory system 81.8%(Hearing loss 62%), gastrointestinal tract 78.1% (reflux 74.3%), kidney and urinary tract (65.1%), cardiovascular (52.4%), immune system disorders (43.4%) and infertility 10.6%. The mean systolic and diastolic blood pressure of the veterans were 121.1±14.7 and 79.7±8.8mmHg, respectively. Most of them were under treatment of respiratory corticosteroids (72.2%) and oral corticosteroids (45%). There were no significant relationships between gender, age, frequency of exposure to sulfur mustard, and the prevalence of physical complaints and musculoskeletal diseases, nervous system, gastrointestinal tract, cardiovascular system, and hearing loss (p>0.05).
Conclusion The most important health problems were musculoskeletal, neurological, hearing loss, and gastrointestinal problems. Moreover, the rate of using corticosteroids was very high while the rate of Infertility was less prevalent than previous studies. These results will help investment policies aiming at considering future health promotion planning.
Instrument & Methods In this descriptive cross-sectional study, 292 chemical warfare veterans with severe pulmonary complications due to exposure to sulfur mustard were examined by two physicians in 2016. Health problems in the veterans were recorded and a clinical examination was performed. Data using SPSS software version 2016 and Chi-square test and Lambda correlation coefficient were analyzed.
Findings The most common problems of chemical warfare victims with severe pulmonary complications were related to musculoskeletal problems 92.1% (low back pain 68.8%), neurological system 88.4%(headache 78.1%), auditory system 81.8%(Hearing loss 62%), gastrointestinal tract 78.1% (reflux 74.3%), kidney and urinary tract (65.1%), cardiovascular (52.4%), immune system disorders (43.4%) and infertility 10.6%. The mean systolic and diastolic blood pressure of the veterans were 121.1±14.7 and 79.7±8.8mmHg, respectively. Most of them were under treatment of respiratory corticosteroids (72.2%) and oral corticosteroids (45%). There were no significant relationships between gender, age, frequency of exposure to sulfur mustard, and the prevalence of physical complaints and musculoskeletal diseases, nervous system, gastrointestinal tract, cardiovascular system, and hearing loss (p>0.05).
Conclusion The most important health problems were musculoskeletal, neurological, hearing loss, and gastrointestinal problems. Moreover, the rate of using corticosteroids was very high while the rate of Infertility was less prevalent than previous studies. These results will help investment policies aiming at considering future health promotion planning.
CITATION LINKS
[1]Marrs TT, Maynard RL, Sidell F, editors. Chemical warfare agents: Toxicology and treatment. 2nd Edition. New Jersey: John Wiley & Sons, Inc; 2007.
[2] Taebi Gh, Soroush MR, Modirian E, Khateri S, Mousavi B, Ganjparvar Z, et al. Human Costs of Iraq's chemical war against Iran; an epidemiological study. Iran J War Public Health. 2015;7(2):115-21. [Persian]
[3]Saladi R, Smith E, Persaud AN. Mustard: A potential agent of chemical warfare and terrorism. Clin Exp Dermatol. 2006;31(1):1-5.
[4]Somani SM, Romano Jr JA, Romano JA, Salem H, Lukey BJ. Chemical warfare agents: Toxicity at low levels. 1st Edition. Florida: CRC Press; 2000.
[5]Balali Mood M, Hefazi M. Comparison of early and late toxic effects of sulfur mustard in Iranian veterans. Basic Clin Pharmacol Toxicol. 2006;99(4):273-82.
[6]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.
[7]Emad A, Rezaian GR. The diversity of the effects of sulfur mustard gas inhalation on respiratory system 10 years after a single, heavy exposure analysis of 197 cases. Chest.1997;112(3):734-8.
[8]Moaiedmohseni S, Ghazanfari T, Araghizadeh H, Soroush MR, Yaraee R, Hassan ZM, et al. Long-term health status 20 years after sulfur mustard exposure. Toxin Rev. 2009;28(1):3-7.
[9]Namazi S, Niknahad H, Razmkhah H. Long-term complications of sulphur mustard poisoning in intoxicated Iranian veterans. J Med Toxicol. 2009;5(4):191-5.
[10]Panahi Y, Naderi M, Zare MA, Poursaleh Z. Ocular effects of sulfur mustard. Iran J Ophthalmol. 2013;25(2):90-106. [Persian]
[11]Hejazi S, Soroush MR, Moradi A, Khalilazar S, Mousavi B, Firooz A, et al. Skin manifestations in sulfur mustard exposed victims with ophthalmologic complications: Association between early and late phase. Toxicol Reports. 2016;3:679-84.
[12]Etezad-Razavi M, Mahmoudi M, Hefazi M, Balali-Mood M. Delayed ocular complications of mustard gas poisoning and the relationship with respiratory and cutaneous complications. Clin Exp Ophthalmol. 2006;34(4):342-6.
[13]Ghasemi H, Ghazanfari T, Babaei M, Soroush MR, Yaraee R, Ghassemi-Broumand M, et al. Long-term ocular complications of sulfur mustard in the civilian victims of Sardasht, Iran. Cutan Ocula Toxicol. 2008;27(4):317-26.
[14]Ghasemi H, Ghazanfari T, Yaraee R, Soroush MR, Ghassemi-Broumand M, Poorfarzam S, et al. Systemic and ocular complications of sulfur mustard: A panoramic review. Toxin Rev. 2009;28(1):14-23.
[15]Ghassemi-Broumand M, Agin K, Kangari H. The delayed ocular and pulmonary complications of mustard gas. J Toxicol Cutan Ocul Toxicol. 2004;23(4):293-302.
[16]Ghassemi-Broumand M, Aslani J, Emadi S-N. Delayed ocular, pulmonary, and cutaneous complications of mustards in patients in the city of Sardasht, Iran. Cutan Ocul Toxicol. 2008;27(4):295-305.
[17]Soroush MR, Ghanei M, Assari S, Khoddami Vishteh HR. Urogenital history in veterans exposed to high-dose sulfur mustard: A preliminary study of self-reported data. Urology Journal. 2009;6(2):114-19.
[18]Shohrati M, Davoudi M, Ghanei M, Peyman M, Peyman A. Cutaneous and ocular late complications of sulfur mustard in Iranian veterans. Cutan Ocul Toxicol. 2007;26(2):73-81.
[19]Balali-Mood M, Hefazi M, Mahmoudi M, Jalali E, Attaran D, Maleki M, et al. Long-term complications of sulphur mustard poisoning in severely intoxicated Iranian veterans. Fundam Clin Pharmacol. 2005;19:713-21.
[20]Balali-Mood M, Hefazi M. The clinical toxicology of sulfur mustard. Arch Iran Med. 2005;8(3):162-79.
[21]Zojaji R, Balali-Mood M, Mirzadeh M, Saffari A, Maleki M. Delayed head and neck complications of sulphur mustard poisoning in Iranian veterans. J Laryngol Otol. 2009;123(10):1150-54.
[22]Kroenke K, Koslowe P, Roy M. Symptoms in 18,495 Persian Gulf War veterans: latency of onset and lack of association with self-reported exposures. J Occup Environ Med. 1998;40(6):520-8.
[23]Somani Satu M, Lukey BJ, Romano Jr. JA, Romano JA, Salem H, editors. Chemical warfare agents: Toxicity at low levels. Boca Raton: CRC Press; 2001. pp. 245-60.
[24]Ghanei M, Khedmat H, Mardi F, Hosseini A. Distal esophagitis in patients with mustard gas induced chronic cough. Dis Esophagus. 2006;19(4):285-8.
[25]Eisen SA, Kang HK, Murphy FM, Blanchard MS, Reda DJ, Henderson WG, et al. Gulf War veterans' health: Medical evaluation of a US cohort. Ann Intern Med. 2005;142(11): 881-90.
[26]Gholamrezanezhad A, Saghari M, Vakili A, Mirpour S, Farahani MH. Myocardial perfusion abnormalities in chemical warfare patients intoxicated with mustard gas. Int J Cardiovasc Imaging. 2007;23(2):197-205.
[27]Azizi F, Keshavarz A, Roshanzamir F, Nafarabadi M. Reproductive function in men following exposure to chemical warfare with sulphur mustard. Med War. 1995;11(1):34-44.
[28]Ghanei M, Rajaee M, Khateri S, Alaeddini F, Haines D. Assessment of fertility among mustard-exposed residents of Sardasht, Iran: A historical cohort study. Reprod Toxicol. 2004;18(5):635-9.
[2] Taebi Gh, Soroush MR, Modirian E, Khateri S, Mousavi B, Ganjparvar Z, et al. Human Costs of Iraq's chemical war against Iran; an epidemiological study. Iran J War Public Health. 2015;7(2):115-21. [Persian]
[3]Saladi R, Smith E, Persaud AN. Mustard: A potential agent of chemical warfare and terrorism. Clin Exp Dermatol. 2006;31(1):1-5.
[4]Somani SM, Romano Jr JA, Romano JA, Salem H, Lukey BJ. Chemical warfare agents: Toxicity at low levels. 1st Edition. Florida: CRC Press; 2000.
[5]Balali Mood M, Hefazi M. Comparison of early and late toxic effects of sulfur mustard in Iranian veterans. Basic Clin Pharmacol Toxicol. 2006;99(4):273-82.
[6]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.
[7]Emad A, Rezaian GR. The diversity of the effects of sulfur mustard gas inhalation on respiratory system 10 years after a single, heavy exposure analysis of 197 cases. Chest.1997;112(3):734-8.
[8]Moaiedmohseni S, Ghazanfari T, Araghizadeh H, Soroush MR, Yaraee R, Hassan ZM, et al. Long-term health status 20 years after sulfur mustard exposure. Toxin Rev. 2009;28(1):3-7.
[9]Namazi S, Niknahad H, Razmkhah H. Long-term complications of sulphur mustard poisoning in intoxicated Iranian veterans. J Med Toxicol. 2009;5(4):191-5.
[10]Panahi Y, Naderi M, Zare MA, Poursaleh Z. Ocular effects of sulfur mustard. Iran J Ophthalmol. 2013;25(2):90-106. [Persian]
[11]Hejazi S, Soroush MR, Moradi A, Khalilazar S, Mousavi B, Firooz A, et al. Skin manifestations in sulfur mustard exposed victims with ophthalmologic complications: Association between early and late phase. Toxicol Reports. 2016;3:679-84.
[12]Etezad-Razavi M, Mahmoudi M, Hefazi M, Balali-Mood M. Delayed ocular complications of mustard gas poisoning and the relationship with respiratory and cutaneous complications. Clin Exp Ophthalmol. 2006;34(4):342-6.
[13]Ghasemi H, Ghazanfari T, Babaei M, Soroush MR, Yaraee R, Ghassemi-Broumand M, et al. Long-term ocular complications of sulfur mustard in the civilian victims of Sardasht, Iran. Cutan Ocula Toxicol. 2008;27(4):317-26.
[14]Ghasemi H, Ghazanfari T, Yaraee R, Soroush MR, Ghassemi-Broumand M, Poorfarzam S, et al. Systemic and ocular complications of sulfur mustard: A panoramic review. Toxin Rev. 2009;28(1):14-23.
[15]Ghassemi-Broumand M, Agin K, Kangari H. The delayed ocular and pulmonary complications of mustard gas. J Toxicol Cutan Ocul Toxicol. 2004;23(4):293-302.
[16]Ghassemi-Broumand M, Aslani J, Emadi S-N. Delayed ocular, pulmonary, and cutaneous complications of mustards in patients in the city of Sardasht, Iran. Cutan Ocul Toxicol. 2008;27(4):295-305.
[17]Soroush MR, Ghanei M, Assari S, Khoddami Vishteh HR. Urogenital history in veterans exposed to high-dose sulfur mustard: A preliminary study of self-reported data. Urology Journal. 2009;6(2):114-19.
[18]Shohrati M, Davoudi M, Ghanei M, Peyman M, Peyman A. Cutaneous and ocular late complications of sulfur mustard in Iranian veterans. Cutan Ocul Toxicol. 2007;26(2):73-81.
[19]Balali-Mood M, Hefazi M, Mahmoudi M, Jalali E, Attaran D, Maleki M, et al. Long-term complications of sulphur mustard poisoning in severely intoxicated Iranian veterans. Fundam Clin Pharmacol. 2005;19:713-21.
[20]Balali-Mood M, Hefazi M. The clinical toxicology of sulfur mustard. Arch Iran Med. 2005;8(3):162-79.
[21]Zojaji R, Balali-Mood M, Mirzadeh M, Saffari A, Maleki M. Delayed head and neck complications of sulphur mustard poisoning in Iranian veterans. J Laryngol Otol. 2009;123(10):1150-54.
[22]Kroenke K, Koslowe P, Roy M. Symptoms in 18,495 Persian Gulf War veterans: latency of onset and lack of association with self-reported exposures. J Occup Environ Med. 1998;40(6):520-8.
[23]Somani Satu M, Lukey BJ, Romano Jr. JA, Romano JA, Salem H, editors. Chemical warfare agents: Toxicity at low levels. Boca Raton: CRC Press; 2001. pp. 245-60.
[24]Ghanei M, Khedmat H, Mardi F, Hosseini A. Distal esophagitis in patients with mustard gas induced chronic cough. Dis Esophagus. 2006;19(4):285-8.
[25]Eisen SA, Kang HK, Murphy FM, Blanchard MS, Reda DJ, Henderson WG, et al. Gulf War veterans' health: Medical evaluation of a US cohort. Ann Intern Med. 2005;142(11): 881-90.
[26]Gholamrezanezhad A, Saghari M, Vakili A, Mirpour S, Farahani MH. Myocardial perfusion abnormalities in chemical warfare patients intoxicated with mustard gas. Int J Cardiovasc Imaging. 2007;23(2):197-205.
[27]Azizi F, Keshavarz A, Roshanzamir F, Nafarabadi M. Reproductive function in men following exposure to chemical warfare with sulphur mustard. Med War. 1995;11(1):34-44.
[28]Ghanei M, Rajaee M, Khateri S, Alaeddini F, Haines D. Assessment of fertility among mustard-exposed residents of Sardasht, Iran: A historical cohort study. Reprod Toxicol. 2004;18(5):635-9.