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Chemical warfare victims: Early cutaneous findings and late skin complaints Mousavi B, MD, MPH

Chemical warfare victims: Early cutaneous findings and late skin complaints Mousavi B, MD, MPH Soroush MR, MD, Honari G, MD. Janbazan Medical and Engineering Research Center (JMERC) www.jmerc.ac.ir. Iran – Iraq war (1980-1988) :. 200,00 0 lost their lives 400,00 0 war injured

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Chemical warfare victims: Early cutaneous findings and late skin complaints Mousavi B, MD, MPH

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  1. Chemical warfare victims: Early cutaneous findings and late skin complaints Mousavi B, MD, MPH Soroush MR, MD, Honari G, MD

  2. Janbazan Medical and Engineering Research Center (JMERC) www.jmerc.ac.ir

  3. Iran – Iraq war (1980-1988) : 200,000 lost their lives 400,000 war injured Chemical warfare history 100,000 hospitalization 55000chemical victims 10% Moderate & Severe 90% Mild

  4. What is sulfur mustard gas? AKA vesicants or blistering agent Lipophilic liquids and cytotoxic alkylating agent Easy penetrate Upon contacts with skin : 80 percent evaporates 20 percent penetrates the skin 10 percent binds to the skin sites

  5. Mustard gas • Quickly cyclizes in tissue • Alkylates cell components (DNA, proteins) • DNA damage leads to: • cell death • mutation

  6. Direh

  7. Study objectives This study was part of a Health monitoring project in chemical warfare victims The specific objective of the study was to assess the relationship between early and late skin complaints in Chemical warfare survivors suffering from moderate to severe complications

  8. Methods (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

  9. Results Mean age: 44.9 (SD 8.7) years Range : 21-75 yrs Mean age at the time of exposure: 23.3 (SD 8.5) years Range: 1-53 yrs

  10. Results Marital status: Married: 146 Single: 3 Education : Illiterate: 10.7% Less than 12 yrs of education: 35.5% High school certificate and above: 53.8%

  11. Results Time of Chemical Exposure: 1985 – 1986 83% 1985: 58.5% 1986: 24.5% Exposure frequency: (1-6) 33.7% (n= 50) > once

  12. Results Early cutaneous findings were based on: • Medical records : 21% (n = 31) • Patient recall : 79% (n = 118)

  13. Skin complaints at the time of study

  14. Skin complaints at the time of study

  15. Skin lesions at the time of exposure

  16. Cutaneous findings at the time of exposure

  17. 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%)

  18. Results A significant relationship between early cutaneous lesions and developing latent skin complaints (Odds ratio =13.5, P<0.001)

  19. Early cutaneous lesions and developing latent skin complaints

  20. Discussion Early cutaneous lesions Risk of developing latent skin complaints

  21. Discussion Odds of having blister among cases with latent skin complaints

  22. Limitation: Part of the data was collected based on patient recall after 22 years of exposure “Recall bias”

  23. Peace is not a gift from God to man, but a gift from man to himself

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