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Title

COMPARISON OF THE EARLY AND LATE TOXIC EFFECTS OF SULFUR MUSTARD IN IRANIAN VETERANS

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Abstract

 Introduction: Sulfur mustard (SM) is an alkylating agent that initially reacts with ocular, respiratory and cutaneous tissues resulting in acute poisoning and even death. Delayed toxic effects of SM and their managements are different from the early effects and thus compared based on the experiences in Iranian veterans.Early Toxic Effects: Acute toxic effects appear after variable periods of latency (minutes to weeks) depending on the dose, mode of exposure, environmental temperature, and on the individual. The first clinical effects occur on the eyes with a sensation of grittiness, progressive soreness, lacrimation, photophobia, blepharospasm, conjunctival injection, corneal ulceration and even blindness. Respiratory effects occur with rhinorrhea, laryngitis, productive cough, dyspnea and tracheobronchitis. Adult respiratory distress syndrome and bronchopneumonia were the common causes of death in Iranian veterans. Skin lesions varied from erythema to bullous necrotization of the skin. Initial leukocytosis and lymphpenia returned to normal within three to four weeks in recovered patients, but marked cytopenia with bone marrow failure occurred in fatal cases.Delayed Toxic Effects: Delayed toxic effects of SM in 236 Iranian veterans were on the respiratory tract (78%), CNS (45%), skin (41%) and eyes (36%). Comparison of early (one week after exposure) and late (two years after exposure) toxic effects of SM poisoning in 77 veterans indicated that dermal and eye complications tend to decrease, but respiratory complications generally deteriorate over the years inducing chronic lesions and even cancers.Managements: Sodium thiosulfate, chloramine, silver sulfadiazine cream, sulfacetamide eye drop and supportive treatment are recommended for the early toxic effects, whereas follow up preventive and supportive care therapy are required for the late toxic effects of SM.

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