mustard gas

Predicting the presence of respiratory diseases at minimal cost in individuals exposed to chemical weapons, is an ideal goal. This study employed Machine Learning and Logistic Regression methods to develop and compare predictive models for determining the health status of individuals and eventually compare the efficiency of these models’ performance.

This cross-sectional analytical study was conducted on 320 male individuals in Sardasht City who were affected by the harmful effects of Mustard gas (a sulfur-based chemical warfare weapon) in 2023. Predictors such as age, gender, and FEV₁ at the first measurement and again two years later were used. This article has measured FEV₁ values of 2005 and 2007. Using SPSS 22 software, the researcher utilized a modified version of the Logistic regression formula that calculates the probability of occurrence, tailored to meet the specific needs of the problem.

The mean FEV₁ value at the first measurement (2005) was 73.10±20.70, and at the second measurement (2007) was 82.10±21.81. Calculated predictive accuracy for the ML 0.9, ML 0.8, ML 0.7, ML 0.6, ML 0.5 Logistic Regression models were 0.813, 0.809, 0.806, 0.813, 0.813, and 0.806, respectively. The agreement between the logistic regression models and ML 0.9, ML 0.8, ML 0.7, ML 0.6, ML 0.5 were 98.8%, 98.8%, 98.4%, 98.4%, and 99.6%, respectively. No significant differences were observed in the performance of Machine Learning and Logistic Regression models on data from chemical warfare casualties.

Using the FEV1 is recommended for the early detection of pulmonary diseases in individuals with respiratory disorders.

Sulfur mustard (SM) or mustard gas is a blister chemical agent that causes pulmonary damage by triggering inflammation and oxidative injury. Alterations in microRNA (miR) transcript levels are found in pulmonary diseases and even inflammation. Therefore, we evaluated the expression levels of miR-20a-5p, miR-21-5p, and two target transcripts (transforming growth factor-beta [TGF-β1] and TGF-β receptor 2 [TGFR2]) in lung, serum, and skin samples from patients exposed to SM. Total RNA was extracted from lung, serum, and skin samples of patients with moderate (n=10) and high (n=10) SM exposure, as well as 10 healthy subjects. Following the synthesis of complementary deoxyribonucleic acid using real-time polymerase chain reaction, we determined the expression levels of miR-20a-5p, miR-21-5p, TGF-β1, and TGFR2 transcripts. Furthermore, we evaluated the sensitivity and specificity of the chosen miRs by employing receiver operating characteristic (ROC) curves and calculating the area under the ROC curve. The results showed that miR-20a-5p and miR-21-5p expressions in the groups with moderate and high SM exposure were significantly lower than the normal controls. The expression analysis demonstrated that TGFR2 was significantly less expressed in skin samples exposed to SM in both groups of patients compared with healthy controls. Furthermore, the TGF-β1 expression in the skin samples of the group with moderate SM exposure was lower than that of the normal control group. Our findings suggest that miR-20a-5p, miR-21-5p, TGF-β1, and TGFR2 expressions could be used as potential biomarkers for discriminating SM-exposed patients from healthy individuals.

Delayed mustard gas keratopathy (DMGK) is the main chronic outcome in eye-chemical injured patients. The aim of this study was the histopathological evaluation of mustard-exposed cornea after more than 30 years.

Fourteen corneas after Lamellar keratoplasty were evaluated in this study. Corneal tissues were prepared by histologic methods and stained by H&E.

The main histopathological findings in these cases were the presence of severe stromal edema and corneal scar. In the sections with visible superficial epithelium, subepithelial bullae formation was observed. Focal or diffuse disruption of Bowman's membrane and replacement with fibrosis were also seen. There was no evidence of stromal vascularization and inflammation in all specimens.

After more than 30 years, an extensive corneal scar is seen in sulfur mustard exposed patients. Scar tissue without vascularization and fibroblastic proliferation is the main finding in the sulfur mustard exposed cornea. This pathology result is different from other scars. No evidence of inflammation or immune cell infiltration should be considered in managing DMGK.

Mustard is one of the most destructive chemical gases used in chemical warfare. Several studies showed effectiveness of inhaled morphine as a secondary treatment for the improvement of dyspnea. Therefore, this study aimed at determining the efficacy of low dose inhaled morphine for respiratory function improvement in patients who were exposed to the mustard gas.

This study was designed as a cross-over double-blinded clinical trial. Patients exposed to mustard gas were randomly assigned into two groups: 1) received 0.4 mg of morphine by inhalation and 2) received 5 ml of normal saline serum as a placebo in the same manner. After a washout period of one week, the first group received the placebo and the second group received morphine for 5 days. Spirometric indices, expiratory flow peak, exercise test, severity of dyspnea, and quality of life were evaluated as respiratory function parameters. Data analysis was done using SPSS software Version 16.

The mean maximum expiratory flow was significantly higher among cases who used morphine in comparison with the placebo group (p<0.05). Moreover, the severity of dyspnea, quality of life, and the frequency of coughing during the day were significantly improved among the recipients of morphine (p<0.05) while the spirometric indices and exercise tolerance tests were similar between the two groups (p>0.05), but the mean peak expiratory flow (PEFR) was significantly higher among the patients receiving morphine than the placebo patients (p<0.001).

The use of inhaled morphine had a significant positive effect on the respiratory system of people exposed to mustard gas. We can use low doses of inhaled morphine to improve the respiratory function of these patients as a secondary therapy.

Amongst the chemical warfare agents, blistering (vesicant) agents can be significant materials. The most important agent in this group is sulfur mustard (mustard gas) which is known as “King of chemical warfare (CW) agents “. Exposure to this agent, seriously causes damages in several organs, such as the eyes. This article reviews the ophthalmological aspects of sulfur mustard with reference of its management.

A wide-ranging search in PubMed databases, Thomson Reuters and Scopus was done and different aspects of chemical properties of sulfur mustard, its mechanism of action and effects on eyes, clinical finding, diagnostic evaluation, initiate actions, pharmaceutical and surgical interventions was reported.

Sulfur mustard can alkylate DNA and RNA strands and break down structures of protein and lipid of cell membrane. This may impair cell energy production, and leads to cell death. Exposure to sulfur mustard, therefore, causes such problems for organs, including irreversible damage to the eyes.

Understanding the mechanism of the sulfur mustard effect and the early training in prevention injuries will cause fewer complications and damage to organs, including the eyes. Washing the eyes with tap water or eyewash solutions, using mydriatic drops, anti- inflammatory drugs, matrix metalloproteinase inhibitors and antibiotics may help to the management of poisoning. Surgical interventions including tarsorrhaphy, amniotic membrane transplantation, stem cell transplantation and corneal transplantation could reduce the harm to the victims.

During the Iran-Iraq war, the Iraqi regime frequently used sulfur mustard gas as a weapon in various residential areas, including Sardasht, causing multiple and severe long-term destructive effects on all living organisms, including humans. The pulmonary system is among the most essential organs with varying severity involved in sulfur mustard chemotoxicity in the long term. This study aimed to evaluate the effects of Rad23B (rs1805329) polymorphism on the severity of lung complications in patients exposed to SM gas 30 years ago.

The study explored 106 severe and 105 mild PBMC patients exposed to SM gas. Furthermore, 47 PBMC samples were added to the study as a non-exposed group (control). Genotyping of rs1805329 was performed using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP).

The results revealed no significant differences in genotype frequencies between the mild, severe, and the unexposed group. Moreover, no statistically significant difference was observed in genotypic frequency in all co-dominant, dominant, recessive, and over-dominant models.

The obtained data indicated that the rs1805329 of Rad23B was not associated with the severity of the lung complications of patients exposed to sulfur mustard 30 years ago.

A great number of Iranian military forces have sustained sulfur mustard gas exposure during the Iran-Iraq war of 1980-1988 and have survived with dental care needs. Accordingly, this study aimed to discover the prevalence of intraoral lesions and periodontal diseases associated with the percentage of being chemical veterans.

This cross-sectional study was conducted in the summer of 2009 on 40 chemical veterans. The patients were examined using dental mirrors under dental unit light, as well as a periodontal probe, to evaluate soft tissue attachment. The clinical results were then documented on medical records. Data were analyzed using the Chi-square test and two independent sample t-tests in SPSS software (version 19). A p-value less than 0.05 was considered statistically significant.

The study population was composed of 40 patients with a mean age of 50.7±9.32 years, mean pocket depth of 1.47±0.31 mm, and mean bleeding on probing of 0.35±0.24 mm. Furthermore, 55% and 27.5% of the patients had xerostomia and temporomandibular joint dysfunction, respectively. However, no significant association was found between these factors and the percentage of being veterans.

The study findings showed that 96.7% of the patients had bleeding on probing problem. The mean score of plaque index that is a practical measurement on evaluating oral hygiene was 2.06±0.99. Therefore, informing chemical veterans about their periodontal health by performing regular dental assessments by dental specialists and instructing oral hygiene seem to be this group’s need.

Aims Following the application of chemical weapons against Iran by Iraq, approximately 100,000 people were affected by chemical weapons. This study aimed to assess the quality of life in mustard gas victims. Information & Methods In this meta-analysis study, PubMed, Scopus, Google Scholar, IranMedex, Magiran, and SID databases were searched until 2019. The extracted data were analyzed by the random-effect model. The heterogeneity of studies was assessed by the I2 index, and the data is analyzed by STATA 12.1. Findings The average quality of life by SF-36 and SGRQ questionnaires was reported based on seven studies including 1241 victims. SF-36 showed that the Pooled score of the physical component scale is 28.33 (95% CI: 24.02-32.63), whereas the MCS is 35.83 (95% CI: 29.07- 42.59). The victims achieved the least score, 21.76 (95% CI: 19.99-23.53) for the physical component in the subscale of Role Function-Physical, and the mental component score in the Role Function-Emotional subscale that is recorded as 31.36 (95% CI: 17.70-45.01). The result from the SGRQ questionnaire showed 66.9 (95% CI: 56.7-77) as the Pooled total average of the quality of life and the symptom subscale recorded 79.05 (95% CI: 68.8-89.3) as the highest score for the chemical victims in Iran. Conclusion The quality of life of chemical weapon victims is very low. These victims possess poor physical and mental components. While they have a better situation in the mental component comparing to the physical.

War causes more death and disability than many major diseases. There are few studies in the context of the deleterious impact of war on fertility potential; therefore, in this study, we tried to review articles about the adverse effects of war on male/ female fertility potential

In this study, a total of 183 articles related to the effects of war on fertility potential were examined by a systematic search using known international medical databases.

Among these studies, there were limited studies on the effects of war on female infertility and most studies examined the effects of war on sperm parameters and male infertility. The physical and psychological trauma of war can increase the risk of infertility in men and women. Presence of reproductive system toxins in weapons, stressful periods of war and direct damage to the reproductive system can impair the fertility of men and women. The way war affects male fertility is not clear, but the higher degree of stress during wartime seems to play an important role. Using reproductive toxicants during the war also increases the risk of impairment in reproductive function in men. Some studies have shown the harmful effects of Sulfur mustard as a war chemical toxin especially on sperm quality and male infertility. Oxidative stress induced by free radicals is a major mechanism for the direct effects of Sulfur mustard on male infertility.

The study of past research suggests that exposure to war may be an independent risk factor for reproductive disorders and infertility in men. For female infertility, war leads to menstrual dysfunction.

To report the chronic effect of mustard gas exposure on visual pathway measured by visual evoked potentials.Patients and

 The present study included 150 participants in three groups. The case group included 50 patients with chronic mustard gas exposure inflicted on them during the Iran - Iraq war (1980 - 1988).  The first control group included fifty veterans of the Iran -  Iraq war with no history of exposure to mustard gas and the second control group included 50 age and sex matched participants with no history of involvement in the war. Visual evoked potentials including latency and amplitude of VEP, P100 peak wave were measured in all participants and were compared between groups.

The result of the present study showed significant delay in mean latency of VEP, P100 peak in the case group compared to both control groups, while the difference in amplitude of VEP, P100 peak was not statistically significant.

A significant delay in the latency of VEP, P100 peak among patients with a chronic history of mustard gas exposure was found, which might be due to disturbances in visual pathway caused by mustard gas exposure.Keywords: Mustard gas; Evoked potentials; Visual; Iran.

Among the blistering (vesicant) chemical warfare agents (CWA), sulfur mustard is the most important since it is known as the “King of chemical warfare agents”. The use of sulfur mustard has caused serious damages in several organs, especially the eyes, skin, respiratory, central and peripheral nervous systems after short and long term exposure, incapacitating and even killing people and troops. In this review, chemical properties, mechanism of actions and their effects on each organ, clinical manifestations, diagnostic evaluation of the actions triage, and treatment of injuries have been described.

Exposure to Sulfur Mustard (SM) leads to short- and long-term adverse effects on various organs, including the skin. Despite several studies on long-term clinical manifestations of skin toxicity in SM-exposed individuals, the pathogenesis of SM-induced skin disorders is not fully understood.

As part of Sardasht-Iran Cohort Study (SICS), this study aimed to find out the possibility of any correlation between the serums level of Nitric Oxide (NO) and skin problems due to the long-term effect of SM as well as the kind of skin illness. In this historical cohort study, 372 male SM-exposed subjects and 128 age-matched unexposed controls were studied. Clinical evaluation was carried out for all participants, and their serum concentration of NO was measured.

According to our results, the Mean±SD serum level of NO in the exposed group with skin disorders were significantly higher than that in the exposed group without skin disorders (1483.00±488.754µg/mL vs. 1364.50±487.887µg/mL; P=0.024). Also, among the exposed group, there was a significant elevation of serum NO associated with the type of lesion. For ezxample, specific lesions like mustard scar were associated with higher levels of NO compared to non-specific lesions like xerosis, itching, seborrheic dermatitis, etc. Also, a significant elevation in serum NO levels was found in the exposed subjects with pigmentation disorders (both hypo- and hyper-pigmentation) compared to the exposed participants without these skin problems (P

Our results show the highest serum level of NO in the exposed group with specific lesions and the lowest or normal level of NO in the unexposed group with no skin illness. The elevated serum levels of NO may be associated with the progression of some skin complications in the SM-exposed subjects. This finding serves as a basis for further research on the molecular mechanisms and pathways involved in the pathogenesis of skin disorders in SM-exposed patients.

Little is known about pulmonary complications induced by Sulfur Mustard (SM), as a chemical warfare agent, especially considering its long term effects. The present study was carried out to investigate the association of α1-Antitrypsin (A1AT), Complement component C5a, and Secretory Immunoglobulin A (sIgA) with long-term pulmonary complications on SM-exposed individuals, 20 years after the exposure.

Sardasht-Iran Cohort Study (SICS) is a historical cohort study on 372 SM-exposed individuals and 128 age-matched unexposed participants. The clinical evaluations and Spirometry were performed on all the participants according to American Thoracic Society Criteria. Also, we assessed the salivary levels of A1AT, C5a, and sIgA using ELISA assay.

The results indicated significant associations between salivary levels of A1AT, C5a, and sIgA with chronic cough in the exposed victims. Also, there were associations between C5a and sIgA with dyspnea in SM-exposed victims with chronic cough compared with those in the exposed victims without chronic cough. The salivary levels of C5a significantly decreased in severe pulmonary involvement. Moreover, a significant relationship was observed between the salivary levels of C5a and pulmonary function testes.

According to the findings, the salivary level of C5a might reflect the severity of pulmonary involvements following SM exposure. A1AT, as a protective agent, has correlations with cough and dyspnea. Although no strong correlation was found between the salivary levels of these factors with persistence of pulmonary complications, they can be effective in the development and progression of pathological changes in the lungs of the SM-exposed victims.