EVALUATION OF DELAYED TOXIC EFFECT OF SULFUR MUSTARD POISONING IN SEVERELY IN TOXICATED IRANIAN VETERANS: A CROSS SECTIONAL STUDY

Abstract

Background Sulfur mustard (SM) is a chemical warfare agent (CWA) that was widely used during the World War I and by the Iraqi forces against the Iranian soldiers and even innocent civilians between 1983 and 1988. Early toxic effects of SM in Iranian veterans have already been published, but late complications in different organs and the relationship between local and systemic toxicities have not been previously reported. Objectives The aim of this study was to investigate the delayed toxic effects of SM poisoning in severely intoxicated Iranian veterans and to evaluate the developing stages of late complications, as well as the possible correlations between different organ complications. Methods All SM-intoxicated veterans in the province of Khorasan, Iran who had severe clinical complications according to their previous follow-ups were studied. Respiratory, neuromuscular, dermatological, ophthalmological, hematological and immunological complications were evaluated through clinical and paraclinical investigations including cell blood counts (CBC), flow cytometry, serum immunoglobulins (Igs) and complements, arterial blood gas (ABG) analyses, pulmonary function tests (PFT), chest X-ray (CXR), highresolution computed tomography (HRCT) of the chest, bronchoscopy, electromyography (EMG), nerve conduction velocity (NCV) and skin biopsy for both light and electron microscopy. Patients were graded according to their severity of complications in different