بررسی عوارض چشمی دیررس گاز خردل در مجروحین شیمیایی جنگ ایران وعراق

نوع مقاله : مقاله پژوهشی

نویسندگان

1 کمیته پژوهشی دانشجویی، اینترن دانشکده پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران ، ایران

2 دانشیار گروه چشم پزشکی دانشگاه علوم پزشکی شهید بهشتی، تهران ، ایران

3 کارشناس ارشد آمار زیستی، مربی گروه علوم پایه، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

4 چشم پزشک، استاد دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

5 متخصص چشم پزشکی . فلوشیپ جراحی پلاستیک و ترمیمی چشم. بیمارستان لبافی نژاد. دانشگاه علوم پزشکی شهید بهشتی

چکیده

مقدمه و اهداف
چشم در مقابل گاز خردل به علت سطح رطوبت آن خیلی حساس است، با توجه به عوارض دیررس این گاز، این مطالعه جهت بررسی عوارض طولانی مدت گاز خردل  انجام گرفته است.
 مواد و روش ها
این پژوهش به روش توصیفی در 300 نفر از مجروحین شیمیائی جنگ تحمیلی که سن آنان بین 75-40 سال بود و از زمان مصدومیت آنان 33-28 سال گذشته بود، انجام گرفت. یک معاینه کامل چشمی توسط یک متخصص چشم انجام شد. عوارض در چهار گروه شامل : طبیعی، خفیف، متوسط و شدید تقسیم بندی گردید، نتایج توسط آزمونX2 مورد قضاوت آماری قرار گرفت و سایر نتایج در قالب آمارهای توصیفی اعلام گردید.
یافته ها
از 300 مجروح جنگی 37.5%سن بین 50-46 سال،79% سابقه یک بار مصدومیت،13.4%سابقه دوبارمصدومیت،  6.6% سابقه سه بار مصدومیت و1% بیش از سه بار،42% سابقه بستری،77.6% سابقه مصرف دارو، بیشترین شکایات، خارش (42.3%)، سوزس (38.3%) و احساس خشکی چشم (37%). بیشترین عوارض پلک ها اختلال غدد میبومین (39.4%). بیشترین عوارض ملتحمه، آنومالی های عروقی (46.6%). بیشترین عوارض ناحیه لیمبوس، ایسکمی (12%) و بیشترین عوارض قرنیه، اختلال سلول های اپی تلیال (13.4%) بودند. اعمال جراحی قبلی انجام شده: بستن پونکتوم اشکی (19.4%)، پیوند قرنیه نفوذی (0.33%)، تارسورافی (0.66%)، کشیدن ملتحمه روی قرنیه (1%)، پیوند غشای آمنیونی (0%)، پیوند سلول های بنیادی (66/2%) و پیوند لایه ای قرنیه (66/0%) بودند. از نظر شدت ضایعات: نرمال(53.34%)، خفیف(33/33%)، متوسط(9.33%) و شدید(4%) بودند.
 نتیجه گیری
یافته های پژوهش نشان داد که گازخردل دارای عوارض تاخیری در چشم است وآنومالی های عروقی ملتحمه و اختلال سلول های اپی تلیال قرنیه بیشترین عوارض بودندوعوارض خفیف نسبت به متوسط و شدید بیشتر بود.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Delayed Ocular Complications of Mustard Gas in Iranian Veterans

نویسندگان [English]

  • Paria Ghasemi-Broumand 1
  • Hossein Mohammad Rabie 2
  • Seyed Mehdi Tabatabaee 3
  • Mohammad Ghassemi-Broumand 4
  • Kourosh Shahraki 5
1 Student Research Committee, Intern, School of Medicine, Shahid Biheshti University of Medical Sciences.Tehran.Iran.
2 Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 MSc in Biostatistics, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Professor in Ophthalmology, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Ophthalmuc plastic and reconstructive surgery fellowship. Shahid beheshti university of medical sciences. Tehran. Iran
چکیده [English]

Background and Aim: Eyes are very sensitive to Sulfur Mustard gas (SM) because they have wet surfaces. Considering the late complications of eye due to mustard gas exposure in warfare patients, the present study was conducted to evaluate the late complications of the eye.
Materials and Methods: In the current descriptive study, we evaluated 300 male patients aged between 40-75 years old whose mustard gas injury period was about 27-32 years before. A complete eye examination by an ophthalmologist was done. The complications were divided in 4 grades: normal, mild, moderate, and severe. The results were reported as x2 and relative frequencies.
Results: Out of 300 warfare patients, 37.5% were aged 46-50 years old, 79% were injured with mustard gas once, 13.4% twice, 6.6% three times, and 1% more than 3 times, 42% had hospitalization, and 77.6% used drugs. The most common symptoms were itching (42.3%), burning (38.3%), and dryness (37%) and the most prevalent complication of the lid was MGD (39.4%). Also, the most prevalent complication of Conjunctiva was vascular anomalies (46.6%), the most common complication of limbus was ischemia (12%), and the most common complication of cornea was epithelial defect (13.4%). Among the prevalent ocular surgeries were punctual occlusion (19.4%), penetrating keratoplasty (PK) (0.33%), tarsoraphy (0.66%), conj.flap (1%), amniotic membrane transplantation (0%), stem cell graft (2.66%), and lamellar keratoplasty (LK) (0.66%), in the order of frequency. The degrees of complications were 53.34% for normal, 33.33% for mild, 9.33% for moderate, and 4% for severe cases.
Conclusion: Conjunctival vascular abnormalities and epithelial defect were the most significant signs among the sulfur mustard chemical war victims. Having reached the mentioned conclusions, it can be stated that mild complications were more than moderate and severe ones.

کلیدواژه‌ها [English]

  • Mustard gas
  • Delayed ocular complications
  • Veterans
  1. Marzban Rad S. Chemical warfare agents clinical characteristics and treatment ehran:Jahad;1989 .pp, 13,82,91. [In Persian].##
  2. Foroutan A. Medical Experiences of Iraq’s Chemical Warfare . Tehran ,Iran : Taimourzadeh; 2004; 180-188. [In Persian]. ##
  3. Agency   For   Toxic   Surface   and   Disease  Registry( ATSDR), Toxicological Profile For Mustard Gas Atlanta, GA.U.S Department Of Health And Human Service Public Health, Service. 1992; 101-103. ##
  4. United Nations Security Council .Report of the specialists appointed.by the Secretary-General to investigate allegations by the Islamic Republic of Iran concerning the use of chemical weapons. United Nations Report S/16433:1984. ##
  5. Brooks P, LawleyPD.The Reaction Of Mono And Difunctional Alkylating Agents With Nucleic Acids.Biochem J 1961; 80: 496-503. ##
  6. Papirmeister B, Feister AJ, Robinson SL, Ford. RD. Medical Defense Against Mustard Gas: Toxic Mechanisms And Pharmacological Implications . Boca Raton, Florida : CRC Press; 1991. ##
  7. Mann I , Pirie A , Pullinger BD . An experimental and clinical study of the  reaction of the anterior segment of the eye in chcjnical injury, with special reference to cP chemical warfare agents .Br J Ophthalmo l 1948 ; XII (Vl) : 171. ##
  8. Friendenwald JS, Scholz RO, Snell A et al. Studies on the physiologyt bio chemistry and cytopathology of the cornea in relation to injury by mustard gas and allied toxic agents.Introductionand outline .Bull Johns Hopkins Hospital1948 ; 2:81-101. ##
  9. Javadi MA .The ocular complications of mustard gas. Bina J Ophthalmol 1997;3(1):21-28. [In Persian]. ##

10. Ghassemi-Broumand M,AginK,AmiriZ.lateophthamic and respiratory complications of mustard gas exposure .Bina J Ophthalmol 2004;9(2):165-171 . ##

11. Sign VP. Sociopsychological Perspective On Chemical Warfare. Chemical Warfare Agents. San Diego, Academic Press Inc 1992; 1-36 & 52-57. ##

12. SohrakptirH.Clinical Manifestation Of Chemical Agents On Iranian Combaionts During Iran-Iraq Conflict “Proceeding Of First World Congress On New Compounds In Biologioi and Chemical Warfare: Toxicological Evaluation.Chent ,Belgium: 1984; 291. ##

13. GhassemiBroumand M ,Agin K ,Kangari H. The Delayed Ocular and Pulmonary Complications of Mustard Gas.Jcutaneous  and Ocular Toxicology 2004; 23 (4): 293-302. ##

14. Steward S, Elder D. System Of Ophthalmology. St. Louis, Mosby; 1972 : 1133-1158. ##

15. Javadi MA, Eynollahi B, Jadidi K. Determination of the late ocular complications after mustard gas injury.Abstract of Papers. The Seventh Iranian Ophthalmology Conferences ,Isfahan.Iran. 1997:43-44. [In Persian]. ##

16. Salouti R. Determination of the late corneal complications in Iranian casualties exposed to mustard gas. Abstracts of Papers, The Seventh Iranian Ophthalmology Conferences, Isfahan,Iran.1997;74. [In Persian]. ##

17. Javadi M A, Baradaran AR .Limbal Stem Cells transplantion on 22 veterans of chronic and delayed onset mustard gas keratitis .Iranian Journal of Ophthalmol. 2005, 17(4), 37-45 . [In Persian]. ##

18. Ghassemi-Broumand M:The evaluation of the ocular complications in 1000 warfare patients,five years post injury with chemical gases .Abstract of papers,The Annual Iranian Ophthalmology Conferences,Tehran ,Iran ,1994:82. [In Persian]. ##

19. Javadi M A,Feizisep. Mustard Gas .Ocular Injuries in Chemical Warfare Victims.Tehran.Iran, FarhangFarda pup;winter1393. [In Persian]. ##

20. Ghasemi H, Ghazanfari T, Babaei M, Soroush M, Yaraee r, Ghassemi-Broumand.M, Javadi MA, Foroutan A, VaezMahdavi MR, Shams J, Pourfarzam S, Moaiedmohseni S, JalaliNadoushan MR, Owlia P, Panahi Y, Hassan Z, Faghihzadeh S. Long-term Ocular Complications Of Sulfur Mustard In The Civilian Victims Of Sardasht, Iran. CutanOculToxicol 2008;27(4):317-326. [In Persian]. ##

21. Hassan Ghasemi,ToobaGhazanfari, Mohammad Ghassemi-Broumand, Mohammad Ali Javadi, Mahmoud Babaei, Mohammad Reza Soroush, RoyaYaraee, SoghratFaghihzadeh,  Shahriarpoorfarzam, ParvizOwlia,MohammadMehdiNaghizadeh, Mohammad Etezad-Razavi, KhosroJadidi, MostafaNaderi, Zuhair Mohammad Hassan. Long term ocular  concequences of sulfur mustard in seriously eye injured war veterans. Cutaneous and Ocular Toxicology 2009:28(02),pp.71-77. [In Persian]. ##

22. Mohammad Ghassemi-Broumand, Asllani J, EmadiS.N.Delayed ocular, pulmonary and cutaneous complications of mustards in patients of the city of Sardasht.Cutaneous and Ocular Toxicology 2008; 27(04) :295-305[In Persian]. ##

23. Ghasemi .H,Ghazanfari. T ,Soroush .M R  Yaraee .R, Poorfarzam. S Ghassemi-Broumand.M,  Babaei. M ,Javadi. MA, Owlia. P,Naghizadeh. M M ,Zuhair. M H. Systemic and Ocular complications of sulfur mustard a panoramic review .Toxin Reviews2009;28(01):14-23 . [In Persian]. ##

24. Emadi N,HosseiniK,Soroush M ,Khodae M ,Ghassemi –Broumand M , DavoodiSM,AmiraniO,Haines D .External urethral stenosis :A latent effect of sulfur mustard 2 decades post-exposure .International journal of dermatology .2009. 00,1-4. [In Persian]. ##

25. Ghassemi-BroumandM,RahmaniS,Ghasemi .H,GhasemiBorumandPouria.Effects of visible & non visible radiation on theEye. Tehran.Iran,Tiemourzadeh;1389. [In Persian]. ##

26. Khateri S ,Ghanei M, KeshavarzS,Soroush M, Haines D. Incidence Of Lung ,Eye,And Skin Lesions As Late Complications In 34000 Iranian With Wartime Exposure to Mustard Agent.Joccup Environ Med Nov 2003;45(11):1136-1143. [In Persian]. ##

27. Protocol of Percentage of Chemical Warfare Victims.Tehran,Iran.1390. [In Persian]. ##

28. Ghasemi H, Ghazanfari T, Yaraee R, Ghassemi-Broumand M, Soroush MR, Pourfarzam S,  Masdari Z, Faghihzadeh S, Babaei M, Javadi MA, Kiuchi Y, Naghizadeh MM, Hassan ZM. Evaluation of relationship between the serum levels of inflammatory mediators and ocular injuries induced by sulfur mustard: Sardasht-Iran Cohort Study.IntImmunopharmacol.2009. [In Persian]. ##

29. Ghasemi H Ali Mostafaie, RoyaYaraee ,Zuhair Mohammad Hassan Abbas Rezaei,MahmoudMahmoudi, , SoghratFaghihzadeh , Ghazanfari T, Mohammad- Reza SoroushSussan K. Ardestani, Mahmoud Babaei ,Mohammad Reza Jalali- Nadoushan, Mohammad Ghassemi-Broumand, ToobaGhazanfari. Association of serum immunoglobulins levels and eye injuries in sulfur mustard exposed: Sardasht-Iran Cohort Study.2013, International Immunopharmacology,Article in press. [In Persian]. ##

30. Ghazanfari, T., Faghihzadeh, S., Aragizadeh, H., Emadi, N., Falahati, F. et al. Sardasht-Iran cohort study of chemical warfare victims: Design and methods Archives of Iranian Medicine, Volume 12, Number 1, 2009: 5 – 14. [In Persian]. ##

31. Balali, M.: The evaluation of late toxic effects of sulfur mustard poisoningin1428Iranianveterans.In:Proceedingsoftheseminar on late complications of chemical warfare agents in Iranian veterans. Veteran Foundation, Tehran, Iran, 1992, pp. 15–37. ##

32. Riazi A, Jadidi K, KarimiZarchi AA, Naderi M. Incidence of refractive errors in victims of chemical weapons as delayed effects. Journal of Toxicology – Cutaneous and Ocular Toxicology. 2004;23(3):207-14. [In Persian]. ##

33. Solberg, Y., M. Alcalay& M. Belkin: Ocular injury by mustard gas. Surv.Ophthalmol. 1997, 41, 461–466##

34. Javadi, M. A., S. Yazdani, H. Sajjadi, K. Jadidi, F. Karimian, B.Einollahi, M. R. Ja’farinasab& M. Zare: Chronic and delayed-onset mustard gas keratitis: report of48  patients and review of literature. Ophthalmol. 2005, 112, 617–25[In Persian]. ##

35. Ghassemi-Boroumand M, KaramyGh, pourfarzamSh, Emadi SN, Ghasemi H. Late concurrent ophthalmic, respiratory. Cutaneous and psychiatric complications of chemical weapons exposure in 476 war patients. Daneshvar Medicine 2007;70(4): 81-92. [In Persian]. ##

36. Etezad-Razavi M, Mahmoudi M, Hefazi M, Balali-Mood M. Delayed ocular complications of mustard gas poisoning and the relationship with respiratory and cutaneous complications. Clinical and Experimental Ophthalmology. 2006;34(4):342-6. [In Persian]. ##

37. Javadi MA, Yazdani S, Kanavi MR, Mohammadpour M, Baradaran-Rafiee A, Jafarinasab MR, Einollahi B, Karimian F, Zare M, Naderi M, Rabei HM. Long-term outcomes of penetrating keratoplasty in chronic and delayed mustard gas keratitis. Cornea. 2007;26(9):1074-8. [In Persian]. ##

38. Geeraets WJ, Abedi S, Blanke RV. Acute corneal injury by mustard gas.Southern Medical Journal. 1977;70(3):348-50. ##