Skin is the first organ exposed to sulfur mustard (SM). The mechanism of SM-induced cutaneous injury has not been fully clarified so far, which is a major obstacle to the development of effective treatments for SM-induced injury. So far, there is no satisfactory therapy for acute symptoms and long-term complications. This review summarized recent researches on the mechanisms of SM-induced cutaneous injuries and the therapies for acute symptoms and long-term complications.
Humans ; Mustard Gas ; poisoning ; Skin ; drug effects ; injuries

PURPOSE: Fatigue affects the quality of life. Evidence shows that the phenomenon of fatigue is experienced differently depending on the type of disease and its consequences. The aim of the study was to explicate the meanings of the experience of living with fatigue in chemically injured veterans. METHODS: The hermeneutic phenomenology approach was used in this study, with an emphasis on Van Mennen's viewpoint and approach. According to Van Mennen, six overlapping dynamic activities are recommended to conduct a phenomenological study. During unstructured interviews, the participants were asked to describe their daily living experiences with fatigue. The participants were individuals who were chemically injured due to exposure to mustard gas. After examining every statement in the interview text, extractions of the meaning units, clustering, and themes were performed. RESULTS: The data explication was based on the third to sixth stages of Van Mennen's approach. The experience living with fatigue was classified into four essential themes: fatigue as a chronic condition, as an unstable and affected situation, as a physical condition of the entire individual, and as a mental condition of the entire individual. CONCLUSION: Due to unique social interactions and pathogenicity, victims of mustard gas experience fatigue differently than patients with other chronic diseases.
Chronic Disease ; Fatigue ; Humans ; Interpersonal Relations ; Mustard Gas ; Qualitative Research ; Quality of Life ; Sulfur ; Veterans

OBJECTIVETo study the damage of DNA in rat bone marrow cells induced by mustard gas.

METHODMale SD rats were randomly divided into six groups. Physiological saline, propylene glycol and mustard gas(0.2, 0.4, 0.8, 1.6 mg/kg) were given separately by i.p. injection. 5 rats in each group were killed after 0, 24, 48, 72 hours of exposure. The DNA damage in rat bone marrow cells was assayed by single cell gel electrophoresis (SCGE).

RESULTSThere is no significant difference of DNA damage among all groups at 0 h(P > 0.05). The rates of DNA migration and the lengths of DNA migration of the rat bone marrow cells in propylene glycol group at 24, 48, 72 hours were 15.4% +/- 0.21%, 16.0% +/- 0.19%, 15.7% +/- 0.23% and (11.4 +/- 0.2), (13.5 +/- 0.3), (12.8 +/- 0.2) micron respectively, and they were significantly higher than those of physiological saline group at the same time(P < 0.05). The rates of DNA migration and the lengths of DNA migration of the rat bone marrow cells in mustard gas groups at 24, 48, 72 hours were significantly higher than those in physiological saline group and propylene glycol group at the same time(P < 0.05).

CONCLUSIONMustard gas could induce DNA damage in rat bone marrow cells. The damage was likely to rise as the dose increased and was time-dependent.

Animals ; Bone Marrow Cells ; drug effects ; ultrastructure ; Comet Assay ; DNA Damage ; Dose-Response Relationship, Drug ; Male ; Mustard Gas ; toxicity ; Rats ; Rats, Sprague-Dawley ; Time Factors

OBJECTIVETo establish an animal model of sulfur mustard (SM)-induced acute lung injury in rats through different routes and compare the morphological changes in lung tissue and cells.

METHODSOne hundred and thirty-six male rats were selected and randomly divided into 5 groups, namely peritoneal cavity SM group (n=32), trachea SM group (n=32), peritoneal cavity propylene glycol group (n=32), trachea propylene glycol group (n=32), and normal control group (n=8). The rats in peritoneal cavity SM group were injected intraperitoneally with diluted SM (0.1 ml, 8 mg/kg), and the rats in trachea SM group were injected intratracheally with diluted SM (0.1 ml, 2 mg/kg). Once the rats were sacrificed at 6, 24, 48, and 72 h after SM treatment, morphological changes in lung tissue and cells were observed by light and electron microscopy.

RESULTSIn the peritoneal cavity SM group, the epithelial cells of bronchioles maintained intact with increased exudate and bleeding in alveolar cavity and large areas of pulmonary consolidation under the light microscope. In the tracheal SM group, focal ulcer formed in the epithelial cells of bronchioles with increased exudate and bleeding in alveolar cavity, partial pulmonary consolidation, and compensatory emphysema in peripheral alveolar space under the light microscope. The alveolar interval areas were widened obviously in both groups in a time-dependent manner. Under the electron microscope, we observed local loss of cellular membrane in type I alveolar epithelium, broken or lost microvilli in cells of typeⅡalveolar epithelium and fuzzy mitochondrial crista as well as the appearance of ribosome detached from rough endoplasmic reticulum in both two groups. Compared with those in the trachea SM group and the control group, the ratio of the alveolar septum average area to the visual field area in the peritoneal cavity SM group at 6, 24, 48, and 72 h was significantly higher (P<0.05).

CONCLUSIONThe lung tissue injury through the intraperitoneal route is more severe than that through the tracheal route, while focal ulceration of bronchioles epithelial cells appears in the case of tracheal route. The degree of injury increases over time in both groups, and the cellular damage is approximately the same in both groups.

Acute Lung Injury ; chemically induced ; pathology ; Animals ; Disease Models, Animal ; Lung ; pathology ; Male ; Mustard Gas ; toxicity ; Peritoneum ; Pulmonary Alveoli ; pathology ; ultrastructure ; Rats ; Trachea

OBJECTIVESulfur mustard (SM) causes various systemic disturbances in human beings. This study aimed to assess paraclinical changes caused by exposure to SM gas in Iranian veterans during the war between Iraq and Iran.

METHODSA literature review was carried out in international and national medical databases including ISI, Medline, Scopus, Iranmedex and Irandoc. Both Farsi and English literature were searched.

RESULTSSearch of the literature yielded 422 medical articles related to SM poisoning. Among them, 30 relevant articles were thoroughly reviewed. The most important reported complications were leukopenia, neutropenia, lymphopenia, eosinophilia, thrombocytopenia, increased bleeding time, positive C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), decreased T helper cells, natural killer cells, IL6, and IL8 levels, elevation of serum immunoglobulins, decreased levels of T3, T4 and cortisol, increased level of adrenocorticotropic hormone (ACTH), proteinuria, hematuria, and elevated liver enzymes. Also, there were some changes in chest assessments.

CONCLUSIONSSM causes profound systemic complications in victims, even years after exposure. The paraclinical changes can be observed in hematology, immune system, biochemistry, hormonal profile and some imaging studies.

Alanine Transaminase ; blood ; Chemical Warfare Agents ; poisoning ; Hormones ; blood ; Humans ; Immune System ; drug effects ; Male ; Mustard Gas ; poisoning ; Myocardial Perfusion Imaging ; Spirometry ; Veterans

OBJECTIVETo evaluate the protective efficacy of gossypin (3,3',4',5,7,8-hexahydroxyflavone 8-glucoside) by administering it intraperitoneally, for dose, time, and vehicle dependent effects against sulphur mustard (SM), administered through percutaneous route in mice.

METHODSSM (diluted in PEG-300) was administered percutaneously. The protective efficacy of gossypin was evaluated by administering it intraperitoneally (50, 100, 200, and 400 mg/kg), in various vehicles (water, PEG-300 and DMSO), and time intervals (30 min prior, simultaneous and 2 h post). The time dependent protection of gossypin (200 mg/kg in PEG-300; i.p.) was also evaluated using selected biochemical variables (GSH, GSSG, MDA, total antioxidant status, Hb, WBC count, RBC count, glutathione peroxidase, glutathione reductase, and superoxide dismutase) and liver histology. The protection of gossypin by oral route was also evaluated against percutaneously administered SM.

RESULTSThe protection against systemic toxicity of SM (LD50 8.1 mg/kg) was better when gossypin was given with PEG-300 (8.0 folds) than DMSO (5.7 folds). No protection was observed when gossypin was administered with water. Good protection (8.0 folds) was observed when gossypin was administered (200 mg/kg in PEG-300; i.p.) at 30 min prior or simultaneous to SM exposure, but no protection was observed when gossypin was administered 2 h post to SM exposure. A significant weight loss was observed 7 days after SM administration (2 LD50), with a significant increase in RBC and Hb. A significant decrease in total antioxidant status of plasma, liver GSH and GSSG levels, and in the activities of glutathione peroxidase, glutathione reductase and superoxide dismutase was also observed 7 days after SM administration. SM treated mouse liver also showed necrosis. A significant protection was observed when gossypin (200 mg/kg in PEG-300; i.p.) was administered either as a pretreatment (30 min before) or simultaneous treatment, and not as a post treatment (2 h). The protective efficacy of gossypin was better through oral route when administered with DMSO (4.8 folds) than with PEG-300 (2.4 folds). No protection was observed when gossypin was administered orally with water.

CONCLUSIONPercutaneous administration of SM induces oxidative stress and gossypin can protect it as a prophylactic agent by intraperitoneal or oral routes.

Administration, Cutaneous ; Animals ; Blood Cell Count ; Body Weight ; drug effects ; Chemical Warfare Agents ; toxicity ; Female ; Flavonoids ; administration & dosage ; pharmacology ; Hemoglobins ; metabolism ; Liver ; cytology ; drug effects ; pathology ; Mice ; Mustard Gas ; administration & dosage ; toxicity ; Oxidative Stress ; drug effects ; Time Factors

To review long-term respiratory effects of mustard gas on Iranian veterans having undergone Iraq-Iran war. Electronic databases of Scopus, Medline, ISI, IranMedex, and Irandoc sites were searched. We accepted articles published in scientific journals as a quality criterion.The main pathogenic factors are free radical mediators. Prevalence of pulmonary involvement is approximately 42.5%. The most common complaints are cough and dyspnea. Major respiratory complications are chronic obstructive pulmonary disease, bronchiectasis, and asthma. Spirometry results can reveal restrictive and obstructive pulmonary disease. Plain chest X-ray does not help in about 50% of lung diseases. High-resolution CT of the lung is the best modality for diagnostic assessment of parenchymal lung and bronchi. There is no definite curative treatment for mustard lung. The effective treatment regimens consist of oxygen administration, use of vaporized moist air, respiratory physiotherapy, administration of mucolytic agents, bronchodilators, corticosteroids, and long-acting beta-2 agonists, antioxidants, surfactant, magnesium ions, therapeutic bronchoscopy, laser therapy, placement of respiratory stents, early tracheostomy in laryngospasm, and ultimately lung transplantation. High-resolution CT of the lung is the most accurate modality for the evaluation of the lung parenchyma and bronchi. The treatment efficacy of patients exposed to mustard gas depends on patient conditions (acute or chronic, upper or lower respiratory tract involvement). There are various treatment protocols, but unfortunately none of them is definitely curable.
Adult ; Chemical Warfare ; Chemical Warfare Agents ; pharmacology ; Humans ; Iran ; Lung ; diagnostic imaging ; Lung Injury ; chemically induced ; epidemiology ; Male ; Middle Aged ; Mustard Gas ; pharmacology ; Respiratory System ; drug effects ; Survivors ; Tomography, X-Ray Computed ; Veterans ; statistics & numerical data

The Department of Veterans Affairs(VA) maintains some large automated databases that provide the opportunity for studying long-term health effects of military service. The Beneficiary Identification and Record Locator Subsystem(BIRLS) is an excellent source of vital status information on veterans. The VA Patient Treatment File(PTF) is a computerized hospital discharge abstract system of inpatient records, including patients' demographic data, surgical and procedural transactions, and patient movements and diagnosis. The computerized Agent Orange Registry data include veteran's name, address, some information on military service, and findings at the time of his physical examination. The US conducted 235 atmospheric nuclear tests from 1945 through 1962. Many of the 250,000 test participants were exposed to low levels of radiation. The overall average radiation dose was estimated as 0.6 rem per year. In 1976, a claim relating acute myelocytic leukemia to radiation exposure from nuclear weapon testing received extensive publicity. Several thousand "atomic veterans" have sought medical care and compensation from VA for medical conditions that they believe are related to the nuclear weapon testing. Many WWII veterans have contracted the US VA about health problems that they attribute to their exposure to mustard gas. From 1962 to 1971, 75 million liters of herbicides, including over 41 million liters of the phenoxy herbicide Agent Orange, were sprayed on almost 9% of Vietnam. Many studies have been conducted to determine the association of various cancers with military service in Vietnam. Some diseases have been compensated for Vietnam veterans. Health problems reported following the Gulf War include a wide variety of symptoms similar to those found in acute combat reaction, posttraumatic stress disorder, and chronic fatigue. Health problems associated with war have continued and in some ways intensified. Therefore, The United States developed a plan for establishing a national center for the study of war-related illnesses and post-deployment health issues.
Americas* ; Citrus sinensis ; Compensation and Redress ; Diagnosis ; Fatigue ; Gulf War ; Herbicides ; Humans ; Inpatients ; Leukemia, Myeloid, Acute ; Military Personnel ; Mustard Gas ; Nuclear Weapons ; Persian Gulf Syndrome ; Physical Examination ; Stress Disorders, Post-Traumatic ; United States* ; Veterans* ; Vietnam