chemical warfare victims: early cutaneous findings and late skin complaints mousavi b, md, mph
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Chemical warfare victims: Early cutaneous findings and late skin complaints
Mousavi B, Mousavi B, MD, MPHMD, MPH Soroush MR, Soroush MR, MDMD,,
Honari G, Honari G, MDMD
Janbazan Medical and Engineering Research Center (JMERC)Janbazan Medical and Engineering Research Center (JMERC)
www.jmerc.ac.irwww.jmerc.ac.ir
Iran – Iraq war (1980-1988)Iran – Iraq war (1980-1988): :
200,00200,0000 lost their liveslost their lives400,00400,000 war injured0 war injured
Chemical warfare historyChemical warfare history 100,000 100,000 hospitalizationhospitalization
5500055000 chemical victimschemical victims
10% 10% Moderate & SevereModerate & Severe
90% 90% MildMild
What is sulfur mustard gasWhat is sulfur mustard gas??
AKA vesicants or blistering agent vesicants or blistering agent
Lipophilic liquids and cytotoxic alkylating agentLipophilic liquids and cytotoxic alkylating agent Easy penetrateEasy penetrate
Upon contacts with skinUpon contacts with skin : : 80 percent evaporates 80 percent evaporates 20 percent penetrates the skin 20 percent penetrates the skin
1010 percent binds to the skin sitespercent binds to the skin sites
Mustard gas
Quickly cyclizes in tissue
Alkylates cell components (DNA, proteins)
DNA damage leads to: cell death mutation
Direh
Study objectivesStudy objectives
This study was part of a Health monitoring This study was part of a Health monitoring project in chemical warfare victimsproject in chemical warfare victims
The specific objective of the study was to The specific objective of the study was to assess the relationship between early assess the relationship between early and late skin complaints in in Chemical warfare survivors suffering from moderate to suffering from moderate to severe complicationssevere complications
Methods Methods (N=149)(N=149)First,
All cases were interviewed for any skin complaints
Then,
History of the skin reactions at the time of exposure
- Patients recall, and
- Medical records
The most severe reactions were considered
ResultsResults
Mean ageMean age::
44.944.9) ) SD 8.7SD 8.7 ( (yearsyears
Range : 21-75 yrsRange : 21-75 yrs
Mean age at the time of exposure: age at the time of exposure: 23.3 (SD 8.5) years 23.3 (SD 8.5) years
Range: 1-53 yrsRange: 1-53 yrs
9.5%
25.2%
54.4%
10.9%
0%
10%
20%
30%
40%
50%
60%
<30 30-39 40-49 >50
Age Distribution
ResultsResults
Marital status:Marital status: Married: 146 Married: 146 Single: 3Single: 3
Education :Education : Illiterate: 10.7%Illiterate: 10.7% Less than 12 yrs of education: 35.5%Less than 12 yrs of education: 35.5% High school certificate and above: 53.8High school certificate and above: 53.8% %
ResultsResults
Time of Chemical ExposureTime of Chemical Exposure:: 1985 – 1986 83% 1985 – 1986 83%
1985: 58.5%1985: 58.5% 1986: 24.5%1986: 24.5%
Exposure frequency: (1-6) 33.7%33.7%) ) n= 50n= 50 > ( > (onceonce
ResultsResults
Early cutaneous findings were based on:
Medical records : 21% (n = 31) Patient recall : 79% (n = 118)
Skin complaints at the time of studySkin complaints at the time of study
92.6%
7.4%
0%
20%
40%
60%
80%
100%
Yes No
Skin complaints at the time of studySkin complaints at the time of study
83.9%
72.5%
57.0%
15.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Skin lesions at the time of exposureSkin lesions at the time of exposure
91.9%
8.1%
0%
20%
40%
60%
80%
100%
Yes No
Cutaneous findings at the time of exposureCutaneous findings at the time of exposure
78.5%71.8%
85.0% 86.6%
0%10%20%30%40%50%60%70%80%90%
Combination of skin lesions
Blister, redness, scaling and dispigmentation: 100(67.1%)
Redness, scaling and dispigmentation: 16 (10.1%)
Scaling and dispigmentation: 10 (6.7%)
No skin lesions : 12 (8.1%)
ResultsResults
A significant relationship between A significant relationship between early cutaneous lesions and early cutaneous lesions and
developing latent skin complaints developing latent skin complaints (Odds ratio =13.5, P>0.001)(Odds ratio =13.5, P>0.001)
EEarly cutaneous lesions and developing arly cutaneous lesions and developing latent skin complaintslatent skin complaints
Early cutaneous Early cutaneous lesionslesions
Odds ratioP value
Blister14.3.000
Redness5.2.006
Scaling9.1.000
Dispigmentation6.8.001
Discussion
Early cutaneous lesions
Risk of developing latent skin complaints
Discussion
Odds of having blister
among cases with latent skin complaints
Limitation:
Part of the data was collected based on patient recall after 22 years of exposure
“ Recall bias”
Peace is not a gift from God to man, but a gift from man to
himself
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