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Etemad L, Moshiri M, Balali-Mood M. Advances in treatment of acute sulfur mustard poisoning - a critical review. Crit Rev Toxicol 2020; 49:191-214. [PMID: 31576778 DOI: 10.1080/10408444.2019.1579779] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sulfur mustard (SM) is a blistering chemical warfare agent that was used during the World War I and in the Iraq-Iran conflict. The aim of this paper is to discuss and critically review the published results of experiments on the treatment of SM poisoning based on our clinical and research experience. The victims must remove from the contaminated zone immediately. The best solution for decontamination is large amounts of water, using neutral soap and 0.5% sodium hypochlorite. Severely intoxicated patients should be treated according to advanced life support protocols and intensive care therapy for respiratory disorders and the chemical burn. Sodium thiosulfate infusion (100-500 mg/kg/min) should be started up to 60 min after SM exposure. However, N-acetyle cysteine (NAC) is recommended, none of them acts as specific or effective antidote. The important protective and conservative treatment of SM-induced pulmonary injuries include humidified oxygen, bronchodilators, NAC as muculytic, rehydration, mechanical ventilation, appropriate antibiotics and respiratory physiotherapy as clinically indicated. Treatment of acute SM ocular lesions start with topical antibiotics; preferably sulfacetamide eye drop, continue with lubricants, and artificial tears. Treatment for cutaneous injuries include: moist dressing; preferably with silver sulfadiazine cream, analgesic, anti-pruritic, physically debridement, debridase, Laser debridement, followed by skin autologous split-thickness therapy as clinically indicated. The new suggested medications and therapeutic approaches include: anti-inflammatory agents, Niacinamide, Silibinin, Calmodulin antagonists, Clobetasol, full-thickness skin grafting for skin injuries; Doxycycline; Bevacizumab, and Colchicine for ocular injuries. Recommended compounds based on animal studies include Niacinamide, Aprotinin, des-aspartate-angiotensin-I, Gamma-glutamyltransferase, vitamin E, and vitamin D. In vitro studies revealed that Dimethylthiourea, L-nitroarginine, Methyl-ester, Sodium pyruvate, Butylated hydroxyanisole, ethacrynic acid, and macrolide antibiotics are effective. However, none of them, except macrolide antibiotics have been proved clinically. Avoidance of inappropriate polypharmacy is advisable.
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Affiliation(s)
- Leila Etemad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Mahdi Balali-Mood
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences , Birjand , Iran
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Ghasemi H, Owlia P, Jalali-Nadoushan MR, Pourfarzam S, Azimi G, Yarmohammadi ME, Shams J, Fallahi F, Moaiedmohseni S, Moin A, Yaraee R, Vaez-Mahdavi MR, Faghihzadeh S, Mohammad Hassan Z, Soroush MR, Naghizadeh MM, Ardestani SK, Ghazanfari T. A clinicopathological approach to sulfur mustard-induced organ complications: a major review. Cutan Ocul Toxicol 2013; 32:304-24. [PMID: 23590683 DOI: 10.3109/15569527.2013.781615] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Sulfur mustard (SM), with an old manufacturing history still remains as potential threat due to easy production and extensive effects. OBJECTIVES Increasing studies on SM indicates the interest of researchers to this subject. Almost all human body organs are at risk for complications of SM. This study offers organ-by-organ information on the effects of SM in animals and humans. METHODS The data sources were literature reviews since 1919 as well as our studies during the Iraq-Iran war. The search items were SM and its all other nomenclatures in relation to, in vivo, in vitro, humans, animals, eye, ocular, ophthalmic, lungs, pulmonary, skin, cutaneous, organs and systemic. Amongst more than 1890 SM-related articles, 257 more relevant clinicopathologic papers were selected for this review. RESULTS SM induces a vast range of damages in nearly all organs. Acute SM intoxication warrants immediate approach. Among chronic lesions, delayed keratitis and blindness, bronchiolitis obliterans and respiratory distress, skin pruritus, dryness and cancers are the most commonly observed clinical sequelae. CONCLUSION Ocular involvements in a number of patients progress toward a severe, rapid onset form of keratitis. Progressive deterioration of respiratory tract leads to "mustard lung". Skin problems continue as chronic frustrating pruritus on old scars with susceptibility to skin cancers. Due to the multiple acute and chronic morbidities created by SM exposure, uses of multiple drugs by several routes of administrations are warranted.
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Affiliation(s)
- Hassan Ghasemi
- Immunoregulation Research Center, Shahed University, Tehran, Iran.
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Abolghasemi H, Radfar MH, Rambod M, Salehi P, Ghofrani H, Soroush MR, Falahaty F, Tavakolifar Y, Sadaghianifar A, Khademolhosseini SM, Kavehmanesh Z, Joffres M, Burkle FM, Mills EJ. Childhood physical abnormalities following paternal exposure to sulfur mustard gas in Iran: a case-control study. Confl Health 2010; 4:13. [PMID: 20630096 PMCID: PMC2917398 DOI: 10.1186/1752-1505-4-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 07/14/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mustard gas, a known chemical weapon, was used during the Iran-Iraq war of 1980-1988. We aimed to determine if exposure to mustard gas among men was significantly associated with abnormalities and disorders among progenies. METHODS Using a case-control design, we identified all progenies of Sardasht men (exposed group, n = 498), who were born at least nine months after the exposure, compared to age-matched controls in Rabat, a nearby city (non-exposed group, n = 689). We conducted a thorough medical history, physical examination, and appropriate paraclinical studies to detect any physical abnormality and/or disorder. Given the presence of correlated data, we applied Generalized Estimating Equation (GEE) multivariable models to determine associations. RESULTS The overall frequency of detected physical abnormalities and disorders was significantly higher in the exposed group (19% vs. 11%, Odds Ratio [OR] 1.93, 95% Confidence Interval [CI], 1.37-2.72, P = 0.0002). This was consistent across sexes. Congenital anomalies (OR 3.54, 95% CI, 1.58-7.93, P = 0.002) and asthma (OR, 3.12, 95% CI, 1.43-6.80, P = 0.004) were most commonly associated with exposure. No single abnormality was associated with paternal exposure to mustard gas. CONCLUSION Our study demonstrates a generational effect of exposure to mustard gas. The lasting effects of mustard gas exposure in parents effects fertility and may impact child health and development in the long-term.
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Affiliation(s)
- Hassan Abolghasemi
- Research Center for Chemical Injuries, Baqiyatollah Medical Sciences University, Vanak Square, Tehran, Iran
| | - Mohammad H Radfar
- Urology & Nephrology Research Center, Shahid Beheshti University of Medical Sciences 9th Boostan Street, Pasdaran Avenue, Tehran, Iran
| | - Mehdi Rambod
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak, Tehran, Iran
| | - Parvin Salehi
- Research Center for Chemical Injuries, Baqiyatollah Medical Sciences University, Vanak Square, Tehran, Iran
| | - Hossein Ghofrani
- Research Center for Chemical Injuries, Baqiyatollah Medical Sciences University, Vanak Square, Tehran, Iran
| | - Mohammad R Soroush
- Janbazan Medical and Engineering Research Center (JMERC), Chemical Warfare Victims Research Unit, Velenjak, Tehran, Iran
| | - Farahnaz Falahaty
- Research Center for Chemical Injuries, Baqiyatollah Medical Sciences University, Vanak Square, Tehran, Iran
| | - Yousef Tavakolifar
- Research Center for Chemical Injuries, Baqiyatollah Medical Sciences University, Vanak Square, Tehran, Iran
| | - Ali Sadaghianifar
- Research Center for Chemical Injuries, Baqiyatollah Medical Sciences University, Vanak Square, Tehran, Iran
| | - Seyyed M Khademolhosseini
- Research Center for Chemical Injuries, Baqiyatollah Medical Sciences University, Vanak Square, Tehran, Iran
| | - Zohreh Kavehmanesh
- Research Center for Chemical Injuries, Baqiyatollah Medical Sciences University, Vanak Square, Tehran, Iran
| | - Michel Joffres
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Frederick M Burkle
- Harvard Humanitarian Initiative, Harvard School of Public Health, Harvard University, Boston, USA
| | - Edward J Mills
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Yanai J, Dotan S, Goz R, Pinkas A, Seidler FJ, Slotkin TA, Zimmerman F. Exposure of developing chicks to perfluorooctanoic acid induces defects in prehatch and early posthatch development. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2008; 71:131-133. [PMID: 18080903 DOI: 10.1080/15287390701613280] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
There is increasing concern over the widespread use of perfluorinated chemicals, which accumulate in various tissues and penetrate the mammalian fetus. A chick model was established for the rapid evaluation of teratogenicity of these chemicals, an important issue because developmental defects often occur at lower exposures than those required for adult systemic toxicity. Chicken eggs were injected with varying doses of perfluorooctanoic acid prior to incubation. Observed were defects in hatching, increased incidence of splayed legs, and interference with the appropriate development of yellow plumage. All these defects are potentially related to essential molecular/biochemical and functional development of the chick. Because of the relationship between structural defects and vulnerability of the developing brain, our model points to the need to evaluate neurobehavioral teratogenicity, which may involve even lower doses.
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Affiliation(s)
- Joseph Yanai
- The Ross Laboratory for Studies in Neural Birth Defects, Department of Anatomy and Cell Biology, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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