© Springer International Publishing Switzerland 2015
Mahdi Balali-Mood and Mohammad Abdollahi (eds.)Basic and Clinical Toxicology of Mustard Compounds10.1007/978-3-319-23874-6_1515. Summary and Conclusion
(1)
Medical Toxicology Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
(2)
Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, 1417614411, Iran
(3)
Toxicology and Poisoning Research Centre, Tehran University of Medical Sciences, Tehran, Iran
(4)
Endocrinology & Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
15.1 Introduction
15.2.5 Delayed Complications and Long-Term Effects of SM Poisonings – Experience of Iran-Iraq War (Chap. )
Abstract
Mustard compounds (MC) were initially synthesized in the nineteenth century and then considered to be used as the chemical warfare agents (CWA). Both nitrogen (NM) and sulfur mustard (SM) on exposure induce skin blister and thus called vesicant or blistering agents. But NM has never been used as a CWA; it is used as an anticancer medicine. Acute toxic effects of SM appear after variable periods of latency (minutes to weeks) depending on the dose, mode of exposure, environmental temperature, and the individual. Delayed toxic effects of SM in the survivors of the WW1 and the Iranian and Kurdish veterans have been evident along with social problems for both the patients and the governments of the involved countries. The main objective of the book was to provide a scientific information and practical guide on MC for the scientists, health professionals, and regulatory bodies who are involved in teaching, research, medical care of the patients, and policy/regulatory making. The International organizations such as the OPCW, UN, WHO, Red Cross as well as the national authorities of chemical weapon conventions and military toxicologists shall also benefit from this book. The most advantage of this book is that almost all chapters have been written by experts in the field. Meanwhile, delayed complications and long term effects of SM poisonings is an issue that has been very well explained according to target organs and tissue injuries in this book.
Keywords
Nitrogen compoundssulfur mustardnitrogen mustardchemical warfare agentspoisoningintoxicationtoxicity15.1 Introduction
Mustard compounds (MC) were initially synthesized in the nineteenth century and then considered to be used as the chemical warfare agents (CWA). Both nitrogen (NM) and sulfur mustard (SM) on exposure induce skin blister and thus called vesicant or blistering agents. SM (but not NM) was used during the world war one (WW1) and then by the Iraqi army against the Iranian troops and even civilians on a large scale. NM is used as an anticancer medicine.
SM is an alkylating agent that initially reacts with ocular, respiratory, and cutaneous tissues, resulting in acute poisoning and even death. Acute toxic effects of SM appear after variable periods of latency (minutes to weeks) depending on the dose, mode of exposure, environmental temperature, and the individual. Delayed toxic effects of SM in the survivors of the WW1 and the Iranian and Kurdish veterans have been evident along with social problems for both the patients and the governments of the involved countries.
The main objective of the book was to provide a scientific information and practical guide on MC for the scientists, health professionals, and regulatory bodies who are involved in teaching, research, medical care of the patients, and policy/regulatory making. The International organizations such as the OPCW, UN, WHO, and Red Cross as well as the national authorities of chemical weapon conventions and military toxicologists shall also benefit from this book. The most advantage of this book is that almost all chapters have been written by very expert scientists and clinicians who have had a real experience of management of patients intoxicated with SM. Meanwhile, delayed complications and long term effects of SM poisonings is an issue that has been very well explained according to organ and tissue targets in this book.
Furthermore, the most important features of the book are as follows:
1.
Provides basic information on MC for regulatory authorities in different departments of works, environment, industries, military, and health.
2.
A practical guide for the occupational, environmental, toxicological, military, medical, and health workers on safe use of MC and appropriate treatment of patients who receive NM and for possible SM exposure.
3.
A reference book for the clinical toxicologists, military and emergency physicians who are involved in teaching and research on MC and for all medical and health professions who are responsible in prevention, diagnosis and treatment of MC poisonings.
4.
Provides updated information on different aspects of MC including basic/clinical pharmacology and toxicology, and clinical management of SM or NM exposure.
Lack of scientific knowledge on MC in medicine and toxicology have made a lot of confusion among some health professionals and scientists specially on differentiation between NM and SM. There are problems with NM administration and its toxic effects in patients who receive this chemical as an antineoplastic agent that must be clarified. Also, malpractice on the clinical management of patients who exposed to SM during the chemical war or in occupational settings are important matters that must be clarified to scientists and health professional. Following the use of chemical warfare agents (CWA) by the Iraqi army against the Iranian and Kurdish people during the Iraq-Iran war and the recent claims for the use of CWA in Syria, many toxicologists and health professionals are now more interested to learn more about different aspects of the CWA including MC.
In the present book, all basic and clinical aspects from history, chemistry, synthesis, and toxicity of MC to target organs/tissues, biomarkers, epidemiology, occupational and environmental exposure, risk assessment, clinical management and guidance on prevention and control have been covered. Therefore, this book is a practical guide for different occupational, environmental, toxicological, medical and health professionals and also for the authorities who are involved in different aspects of mustard compounds. It could be also used as a reference book for MC by the postgraduate students and researchers in the universities.
The following items have been critically reviewed in this book in separate chapters:
1.
Chemistry
2.
History of use and epidemiology
3.
Basic pharmacology and toxicology
4.
Clinical pharmacology and toxicology
5.
Delayed complications and long term effects of sulfur mustard poisonings – Experience of Iraq-Iran war
6.
Upper respiratory complications of sulfur mustard poisoning
7.
Lower respiratory complications of sulfur mustard poisoning
8.
Dermatological complications of sulfur mustard poisoning
9.
Ophthalmological complications of sulfur mustard poisoning
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