Fibrinogen and inflammatory cytokines in spontaneous sputum of sulfur-mustard-exposed civilians - Sardasht-Iran Cohort Study

Sulfur mustard (SM) causes late complications in respiratory system of exposed individuals. In this preliminary study, the levels of IL-1 alpha and beta, TNF, IL-1Ra, IL-6 and fibrinogen in the spontaneous sputum of SM-exposed individuals were examined 20 years after exposure and the correlation with pulmonary function was tested. The participants were categorized into two major subgroups (hospitalized and non-hospitalized) based on the severity of the clinical complications immediately after exposure. Every participant was visited by a physician; the respiratory functions were checked using spirometry and were categorized as normal, mild, moderate or severe pulmonary complications. The levels of cytokines in the sputum and serum samples were measured using ELISA method. The mean values of TNF, IL-1 alpha and IL-1 beta were 524.15, 115.15, 1951.33 pg/ml respectively, and the mean levels of IL-1Ra and IL-6 were 6410.52 and 124.44 pg/ml respectively; fibrinogen was 71.59 ng/ml and index of IL-Ra/IL-1 beta was 7.78. There was more TNF-alpha and IL-1 beta and less IL-1Ra and fibrinogen in the sputum of the hospitalized subgroup. The level of TNF-alpha and IL-1 beta also increased in moderate and severe pulmonary status comparing with the group with mild disorders, while fibrinogen was lower or decreased significantly in problematic patients. IL-1 beta and TNF showed positive correlation (r=0.5, and r=0.59, respectively); fibrinogen and IL1Ra/IL-1 beta have negative correlation with lung function according to the GOLD classification (r=-0.4, and r=-0.61, respectively). It is concluded that sputum cytokines and fibrinogen, reflect the degree of the severity of airway inflammation and the cytokine levels in the sputum might be completely different from the serum fluctuations. (C) 2013 Elsevier B.V. All rights reserved

Stages of change for physical activity in sulfur mustard victims 20 years after exposure

Mustard gas (MG) is one of the well-known chemical substances that have been used as chemical warfare agents. In the present study, the stage of change of physical activity and the total physical activity min/week of victims exposed to MG in Sardasht, Iran (1988) 20 years after exposure were measured. The aim of this study was to investigate the proportion of victims in each stage of change and the causative factors associated with reduced physical activity such as MG-related pulmonary complications in a sample of the victims. In a historical cohort study, 357 victims with a history of mustard gas exposure were studied. An algorithm was applied to evaluate the stage of change in physical activity, which was defined as being engaged in moderate to vigorous physical activity for at least 30 minutes on most days per week. Physical activity was measured using the Global Physical Activity Questionnaire (GPAQ). The distribution of the stage of change for physical activity was as follows: 60.5 in precontemplation, 20.7 in contemplation, 3.9 in preparation, 0.8 in action and 14.1 in maintenance. There was a significant difference between the control and exposed groups in pre-adoption stages (precontemplation stage, contemplation stage and preparation stage) and post-adoption stages (action stage and maintenance stage) of physical activity (P < 0.001). The findings of the present study can contribute to improving health behaviors and to the administration of health promotion programs in the victim populations

Association of physical activity and IL-10 levels 20 years after sulfur mustard exposure: Sardasht-Iran cohort study

IL-10 is an anti-inflammatory cytokine that is important in the regulation of inflammatory processes in different conditions. Sulfur mustard (SM) intoxicated patients are suffering from different inflammatory diseases in their lung, skin and eyes. Physical activity (PA) is reported to control inflammation by reducing pro-inflammatory and inducing anti-inflammatory cytokines. Our previous study revealed lower PA and more sedentary lifestyle among SM exposed population. This study aimed to determine the relationship of PA with IL-10 production in SM exposed subjects. Baseline, mitogen-induced and the serum levels of IL-10 were evaluated. In a historical cohort study, Sardasht-Iran Cohort Study (SICS), 372 SM exposed participants were studied 20 years after exposure and were compared with 128 unexposed control participants. The Global Physical Activity Questionnaire (GPAQ developed by WHO) was used to obtain a self-reported measure of physical activity. Whole blood culture supernatants and serum samples were used for IL-10 measurement by ELISA technique. In both the control and exposed groups mitogen-induced IL-10 production was significantly elevated with severity of PA intensity (p < 0.05). In the control subjects with moderate PA intensity, the mitogen-induced IL-10 production was higher than the corresponding in the exposed group (p<0.05). In the exposed group, mitogen-induced IL-10 production had significant positive correlation with total PA, total transport PA, total recreational PA and total moderate intensity work (p<0.05). The positive relationship between high PA and the levels of anti-inflammatory cytokine IL-10 indicates a need to encourage a more active lifestyle among the SM exposed subjects who have various inflammatory complications. (C) 2009 Elsevier B.V. All rights reserved

Physical activity of the civilian chemical victims of Sardasht 20 years after sulfur mustard exposure

Sulfur mustard was employed as a chemical warfare agent by the Iraqi forces in the borderline regions of Iran during the Iraq-Iran war (1980-1988). The short-and long-term biological effects of sulfur mustard agent have been studied in both basic and clinical aspects. One organ that was primarily affected was the respiratory system. Among the adults, regular physical activity positively affects the respiratory system as well as the individual's ability to perform important daily tasks. We investigated the self reported physical activity in chemical victims 20 years after sulfur mustard exposure, compared the data with those of the matched counterparts, and explored any potential association with BMI. The exposed group was 357 and the control group was 125 individuals. Physical activity was measured using the global physical activity questionnaire (GPAQ) that evaluates work, recreational, transport and sitting activities. A significant difference was found between the control and exposed groups in terms of total physical activity MET (metabolic equivalent), total physical activity min/week and total transport-related physical activity min/week in BMI > 30 kg/m(2). In addition, total work-related physical activity showed a significant difference between the control and exposed groups with BMI <25 kg/m(2). The results show that a significant correlation was present between the increase of body weight and the reduction of total physical activity and MET in exposed group 20 years after sulfur mustard exposure

Tear and serum MMP-9 and serum TIMPs levels in the severe sulfur mustard eye injured exposed patients

Introduction: Sulfur mustard (SM) intoxication produces local and systemic changes in the human body. In this study, the relationship between tear and serum matrix metalloproteinase (MMP)-9 and serum tissue inhibitors of metalloproteinases (TIMPs) are assessed in serious eye-injured SM-exposed casualties. Methods: A group of 128 SM-exposed patients with serious ocular injuries in three subgroups (19 mild, 31 moderate, and 78 severe cases) is compared with 31 healthy controls. Tear and ocular status and serum MMPs and MMP-9/TIMPs complex levels were evaluated using enzyme-linked immunosorbent assay (ELISA). Results: Serum level of MMP-9 was significantly higher in the SM-exposed group compared to the control group (P = 0.009). Mean serum MMP-9 level in the SM-exposed group with ocular abnormalities was significantly higher than that in the SM-exposed group without ocular abnormalities. SM-exposed people with corneal calcification had significantly higher serum MMP-9/TIMP-1 level compared to the SM-exposed ones without this problem (P = 0.045), The SM-exposed group with severe ocular injuries had significantly higher MMP-9/TIMP-1 than the controls (P = 0.046). The SM-exposed group had significantly lower levels of MMP-9/TIMP-4 complex than the controls (P < 0.001). The SM-exposed group with tear meniscus and fundus abnormality had significantly higher MMP-9/TIMP-4 levels than the SM-exposed group without these problems (P = 0.009 and P = 0.020). Conclusion: Serum MMP-9 level had increased in SM-exposed groups with ocular problems, while TIMP-1 and TIMP-2 levels had remained unchanged. Serum TIMP-4 drastically decreased in SM-exposed group, which clearly explains the severity of the systemic and ocular damages

Long-term health status 20 years after sulfur mustard exposure

To describe the long-term health status of Sardasht civilians 20 years after sulfur mustard exposure, a historical cohort study was carried out in Sardasht (Iran) that included 372 exposed and 128 unexposed civilians. Their symptoms, diagnoses, drug use, and general health were compared. The most common complaints were about the respiratory system (93.5), eyes (52), skin (94.7), and anxiety and depression (69.2). Respiratory (42.5), skin (75.5), ophthalmic (19.6), and mental (62.7) diseases were diagnosed by specialists and they were more common in the exposed group than the control group (P<0.001). Most of the exposed group had used drugs (70.6), which was more than control group (42.8). It seems that exposure to sulfur mustard caused a lot of health problems in Sardasht. Identifying the pathophysiology of these problems can help them more, but more investigation is needed

Long-term pulmonary complications in sulfur mustard victims of Sardasht, Iran

Sulfur mustard (SM) has widely been used against the military and civilians during the Iraq-Iran war (1980-1988). It mostly affects the respiratory system. A large historical cohort study was designed to evaluate the pulmonary status of non-military victims in Sardasht, Iran, in comparison with a matched control group 20 years after a single massive exposure. The exposed group was divided into two subgroups of hospitalized and non-hospitalized based on the severity of the injuries indicated by hospitalization a few days following exposure. All participants' respiratory symptoms and signs were evaluated by internists. Dyspnea (n = 261; P = 93.2) was the most common symptom. Chronic cough, cough severity, sputum, hemoptysis, dyspnea, pattern of dyspnea, severity of dyspnea (P < 0.001 for all), and chest pain (P = 0.003) were statistically significantly different between the two groups. Wheezing was the most common pulmonary finding (11.4). There was also a statistically significant difference in the auscultation of wheezing (P = 0.045) and rhonchi (P = 0.018) between the hospitalized and control groups. Considering objective findings, pulmonary involvement was observed in 24.3 (n = 68, P = 0.007)