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.

Oral squamous cell cancer protein-protein interaction network interpretation in comparison to esophageal adenocarcinoma.

AIM: The aim of this study is to present the oral Squamous Cell Cancer protein-protein interaction network interpretation in comparison to esophageal adenocarcinoma. BACKGROUND: Oral squamous cell cancer (OSCC) is a common disease worldwide, with poor prognosis and limited treatment. Thus, introducing molecular markers through network analysis can be helpful. METHODS: STRING database (DB) was applied for network construction through Cytoscape 3.4.0. Clue GO handled the gene annotation for the retrieved clusters. Eight proteins were indicated to be differential in the network constitution. RESULTS: The centrality and clustering analysis indicate that TP53 plays an over-significant role in network integrity among eight most central proteins including TP53, AKT1, EGFR, MYC, JUN, CDH1, CCND1, and CTNNB1. The suggested biomarker set is very similar to the related biomarker panel of esophageal adenocarcinoma. CONCLUSION: The ontology analysis implies that the prominent proteins are involved in regulation of smooth muscle cell proliferation, regulation of fibroblast proliferation, and response to UV-A processes. In conclusion, these proteins and their associated biological processes may be more critical compared to other reported biomarkers for OSCC. Nevertheless, validation studies are required for confirming the pivotal role of potential candidates. Similar biomarker panel of this disease and esophagus adenocarcinoma is corresponded to the origin of the two malignancies.

Clinical Practice Guidelines for Prevention, Diagnosis and Management of Early and Delayed-onset Ocular Injuries Due to Mustard Gas Exposure.

PURPOSE: To develop clinical practice guidelines (CPGs) for prevention, diagnosis, treatment and follow-up of ocular injuries caused by exposure to mustard gas. METHODS: The clinical questions were designed by the guideline team. Websites and databases including National Guidelines Clearinghouse, National Institute for Clinical Excellence, Cochrane, and PubMed were searched to find related CPGs and explore possible answers to the clinical questions. Since there were no relevant CPGs in the literature, related articles in Persian and English languages were extracted. Each article along with its level of evidence was summarized. Additionally, hand search was performed by looking the reference list of each article. Consequently, recommendations were developed considering the clinical benefits and side effects of each therapeutic modality. The recommendations were re-evaluated in terms of customization criteria. All recommendations along with the related evidence were scored from 1 to 9 by experts from all medical universities of Iran. The level of agreement among the experts was evaluated by analyzing the given scores. RESULTS: The agreement was achieved for all recommendations. The experts suggested a number of minor modifications which were applied to the recommendations. Finally, CPGs were developed with 98 recommendations under three major domains including prevention of injury, diagnosis and management of the acute and delayed-onset mustard gas ocular injuries. CONCLUSION: Considering the lack of CPGs for the prevention, diagnosis, and management of mustard gas-induced keratitis, these recommendations would be useful to prevent the serious ocular complications of mustard gas and standardize eye care services to the affected individuals.

Epidemiological Study of Child Casualties of Landmines and Unexploded Ordnances: A National Study from Iran.

BACKGROUND: Despite landmine-risk education programs and extensive demining activities on the Western border of Iran, landmines and unexploded ordnance (UXOs) still cause civilian and child casualties three decades after the Iraq-Iran war (1980-1988). The objective of this study was to understand the epidemiological patterns and risk factors of injury in child casualties of landmines and UXOs in Western and Southwestern Iran. METHODS: Children who were 18 years old or younger at the time of study and who sustained injuries from landmines and UXOs were identified through a search at the Iranian National Veterans Registry. These children participated in a 5-day gathering. The information on socioeconomic status, health-related issues, quality of life, health care utilization, and clinical profiles concerning the landmine and UXO injuries were collected. The method of data collection consisted of three component surveys: health interview, social survey, and medical examinations. Social surveys and health interviews were conducted in a face-to-face method by utilizing a questionnaire consisting of 39 questions addressing household and individual components, including information on time and type of injuries, physical activity, mental health, and quality of life. A comprehensive team of physicians in different subspecialties evaluated and examined children to assess the current medical and psychiatric conditions and physical activity, and recommended and arranged further medical, rehabilitation, or surgical planning. RESULTS: Seventy-eight child casualties were identified and participated in the study. The mean age of the participants at the time of study was 16.11 years old (SD=2 years). The mean age of victims at the time of injury was 8.2 years (SD=3.12 years; ranged from 2 to 15 years old). Sixty-seven (85.9%) of the children were male. Provinces of Kurdistan and Kermanshah had the highest number of casualties, with a total number of 54 children (68.3%). Eighty percent of the injuries were caused by landmines, and UXO explosions were reported in 20% of the cases. Overall, 24 children (30%) had received some landmine-risk education before or after the events. Sixty percent of the explosions had happened in the morning between 9:00 am and 12:00 pm. Playing and grazing livestock were the most prevalent activities/reasons at the time of injury, which were reported in 77% of the subjects. Sixty-three percent of incidents had multiple casualties and in only 13 explosions were the children the only victims of the explosion. The most prevalent injuries were amputations in 41 subjects (52.56%), followed by hearing loss in 23 subjects (29.5%). Amputations were more common in upper extremities (62%) than in lower extremities (38%). CONCLUSION: Landmines and UXOs comprise a significant safety hazard to the children living in the Western border of Iran decades after the Iraq-Iran War. The large number of injuries and lack of risk training among victims suggest that landmine cleanings and landmine-risk education should be age-specifically targeted and expanded substantially.

Do UV-blocking Soft Contact Lenses Meet ANSI Z80.20 Criteria for UV Transmittance?

PURPOSE: To compare ultraviolet (UV) ray transmission in four UV-blocking soft contact lenses with Z80.20 standards set by the American National Standards Institute (ANSI). METHODS: Four soft contact lenses including Acuvue Oasys (Johnson & Johnson, Ireland), Acuvue 2 (Johnson & Johnson, Ireland), Zeiss CONTACT Day 30 (Zeiss, Germany), and Sauflon 55 UV (Sauflon, UK) were evaluated for UV transmission. One-way ANOVA testing was performed to compare mean values of UVA and UVB transmission for the contact lenses. RESULTS: Acuvue Oasys, Acuvue 2, Zeiss CONTACT Day 30 and Sauflon 55 UV showed UV-B transmittance values of 0.24%, 1.46%, 10.37%, and 2.52%, respectively. Corresponding values for UV-A transmittance were 20.81%, 33.49%, 44.03% and 42.53%, respectively. One-way ANOVA showed a statistically significant difference among the tested contact lenses in terms of UV-B (P < 0.001) and UV-A (P < 0.001) transmission. CONCLUSION: Acuvue Oasys met the ANSI criteria for UV transmission and may thus be a good choice for eye and vision care specialists and contact lens wearers seeking UV protection.

Spectral transmittance of UV-blocking soft contact lenses: a comparative study.

BACKGROUND: Three major parts of sunlight consist of visible, ultraviolet and infrared radiation. Exposure to ultraviolet radiation (UVR) can result in a spectrum of skin and ocular diseases. UV-blocking contact lenses help provide protection against harmful UV radiation. We studied the ultraviolet and visible light rays transmission in some soft UV-blocking contact lenses. MATERIAL AND METHODS: Four available tinted soft lenses (Acuvue Moist, Zeiss CONTACT Day 30 Air spheric, Pretty Eyes and Sauflon 56 UV) have been evaluated for UV and visible transmission. One-way ANOVA testing was performed to establish is there a statistically significant difference between the UV regions and visible spectra means for the contact lenses (α=0.05). RESULTS: Pretty Eyes, Zeiss CONTACT, Acuvue Moist and Sauflon 56 UV showed UV-B transmittance value of 0.65%, 10.69%, 1.22%, and 5.78%, respectively. Pretty Eyes and Acuvue Moist had UV-A transmittance values of 32% and 34%, Sauflon 56 UV and Zeiss CONTACT had transmittance values of 48% and 43%, respectively. All of the studied lenses transmitted at least 94.6% on the visible spectrum. The results of the one-way ANOVA statistical analysis show that a statistically significant difference exists within the group of contact lenses tested for the visible (p<0.001), UV-B (p<0.001) and UV-A (p<0.001) portions of the spectrum (α=0.05). CONCLUSION: Acuvue Moist has the best UV-blocking property and also visible transmission between other tested contact lenses in this study.

Short-term consumption of oral omega-3 and dry eye syndrome.

PURPOSE: To assess the effect of oral omega-3 fatty acids on tear break-up time (TBUT), Schirmer's score, and Ocular Surface Disease Index (OSDI) through a double-blind clinical trial. DESIGN: Randomized, double-blind clinical trial. PARTICIPANTS: Sixty-four patients with dry eye symptoms between the ages of 45 and 90 years were randomized into 2 groups: 33 persons in the treatment group and 31 persons in the placebo group. METHODS: The treatment group received 2 capsules of omega-3 (each containing 180 mg eicosapentaenoic acid [EPA] and 120 mg docosahexaenoic acid [DHA]) daily for 30 days, and the placebo group received 2 medium-chain triglyceride oil capsules daily for 1 month. The outcomes were measured 1 month after the intervention. MAIN OUTCOME MEASURES: The primary outcome measure was an increase from baseline in TBUT at day 30. Secondary outcome measures were a decrease from baseline in the OSDI score and an increase in the Schirmer's score at day 30. RESULTS: In the placebo group, before the intervention, the mean TBUT, OSDI, and Schirmer's scores were 4.5 ± 2.1 seconds, 36.4 ± 13.8, and 6.0 ± 2.6 mm, respectively, and 1 month later were 4.7 ± 2.6 seconds, 37.6 ± 13.5, and 6.2 ± 2.5 mm, respectively. In the treatment group, these values were 3.9 ± 1.7 seconds, 38.7 ± 16.5, and 5.8 ± 2.5 mm before the intervention and 5.67 ± 2.6 seconds, 29.3 ± 15.9, and 6.8 ± 2.8 mm after the intervention, respectively. Repeated-measures analysis of variance showed that improvements in TBUT, OSDI, and Schirmer's scores were significantly better in the treatment group than in the placebo group. The changes in the treatment and placebo groups were 71% and 3.3% for TBUT (P < 0.001), 26% and 4% (P=0.004) for dry eye symptoms, and 22.3% and 5.1% for Schirmer's score (P=0.033), respectively. CONCLUSIONS: This study demonstrated that oral consumption of omega-3 fatty acids (180 mg EPA and 120 mg DHA twice daily for 30 days) is associated with a decrease in the rate of tear evaporation, an improvement in dry eye symptoms, and an increase in tear secretion.

Association of serum immunoglobulins levels and eye injuries in sulfur mustard exposed: Sardasht-Iran Cohort Study.

In this study the associations between ocular problems and serum levels of immunoglobulins in sulfur mustard (SM) exposed population 20 years after exposure in context of Sardasht-Iran Cohort Study was explored. Serum immunoglobulins (Ig) levels including IgM, IgA, IgE, IgG, and subclasses of IgG (IgG1, IgG2, IgG3 and IgG4) in 372 SM-exposed patients were titrated and compared with 128 unexposed controls considering their ocular problems. In exposed patients with tearing and blurring of vision, serum IgM levels were significantly lower than matched controls (P=0.026 and 0.027, respectively). Serum IgM levels in exposed patients with normal ocular conditions were significantly lower (P<0.050) than that of matched controls. Serum levels of IgA, IgE and IgG and IgG3 levels were not significantly different between the two groups with abnormal and normal ocular conditions. Mean serum IgG1 levels in exposed patients with normal ocular conditions were significantly higher than the matched controls (P<0.05) except for tearing and photophobia. Mean serum IgG2 levels in exposed with blurring of vision and without tearing, ocular pain, photophobia, lids and bulbar conjuctival abnormalities were significantly higher than that of matched controls (P<0.050). Mean serum levels of IgG4 in exposed patients with normal ocular conditions and most of the abnormal ocular conditions were significantly lower than the matched controls (P<0.05). The results of the current study showed that even 20 years after SM exposure serum immunoglobulins are different from matched normal controls and the levels of IgM and IgG4 are associated with some aspects of ocular surface problems.

Evaluation of relationship between the serum levels of inflammatory mediators and ocular injuries induced by sulfur mustard: Sardasht-Iran Cohort Study.

Ocular damages induced by sulfur mustard (SM) are the important problems in exposed patients. The damaging mechanisms are not clearly understood. In the present study the relationship between the serum levels of inflammatory mediators and ocular injuries induced by SM was evaluated. Bulbar conjunctiva and limbal tissue abnormalities were significantly more frequent in the expose versus control group (P=0.004 and 0.048 respectively). The serum levels of IL-1alpha and TNF-alpha in the exposed group with and without Slit lamp findings were significantly lower than their counterpart in the control group. The serum levels of IL-1beta in the exposed group with Slit lamp findings were significantly lower than their counterpart in the control group. The serum levels of IL-1beta in the controls with Slit lamp findings were significantly higher than the controls without Slit lamp findings. The serum levels of IL-1Ra and MMP-9 in the exposed group with and without Slit lamp findings do not display any significant differences as compared to the similar controls. The serum levels of IL-6 in the exposed group with or without Slit lamp findings were significantly lower than their counterpart in the control group (P=0.048 and 0.008 respectively). The serum titers of the CRP and RF in the exposed group without Slit lamp findings were significantly elevated versus their counterpart in the control group (P=0.004 and 0.011 respectively). The serum levels of these inflammatory cytokines except for IL-1Ra and MMP-9, decreased in SM exposed subject independent of ocular problems. More local studies on the eyes are needed to clarify the exact role of this cytokines in ocular problems of chemical.

External urethral stenosis: a latent effect of sulfur mustard two decades post-exposure.

BACKGROUND: Sulfur mustard (SM), a chemical weapon used widely during World War I and against Iranians during the Iran-Iraq War of the 1980s, causes massive inflammatory tissue damage in the immediate post-exposure period, resulting in debilitating chronic disease in years to decades following contact with the agent. These syndromes most often are pathologies of the lungs, eyes, and skin, the primary target organs of SM. Typically, they are characterized by severe and increasingly painful inflammation, often accompanied by fibrosis and constriction of the anatomic channels needed for normal life, such as the small airways of the lungs and, in the present report, the urethra. METHODS: The present case study is a 43-year-old man with a history of heavy SM exposure to the groin in 1984. RESULT: Within 1 year after exposure, the patient was found to have developed meatal stricture, occlusion of the external urethral meatus, and difficulty in urination. Two years post-exposure, he underwent ventral meatotomy and meatoplasty. CONCLUSION: This case presents a unique example of the latent effects of SM exposure to the groin, and will be of value in the prevention of similar injury and complications to persons at risk of SM exposure in the future.

Long-term ocular consequences of sulfur mustard in seriously eye-injured war veterans.

INTRODUCTION: Sulfur mustard (SM) has been used as a dangerous chemical warfare agent since the early 20th century. Although many descriptive studies about SM-induced ocular injuries are present in the medical literature, few of them have been conducted over a large group with serious ocular involvement. MATERIALS AND METHODS: This descriptive study was conducted on 149 severe SM-intoxicated war veterans. Ocular history, anterior and posterior segment findings using a slit lamp, and direct and indirect ophthalmoscopic findings were recorded. Severity of the disease was also recorded based on a chart of the Foundation of Martyrs and Veterans Affairs. RESULTS: Ocular complains included photophobia (73.2%), sense of decreased vision (72.5%), dry eye sensation (66.4%), foreign body sensation (61.1%), tearing (46.3%), and pain (43.0%). Slit lamp findings were meibomian gland dysfunction (MGD; 96%), blepharitis, punctal closure, trichiasis, tear break-up time, and tear meniscus layer abnormality (80% to 90%). Conjunctival disturbances included vascular abnormality, ischemia, hyperemia, subconjunctival fibrosis, and pterygium. Limbal changes were abnormal vessels, limbal tissue loss and pigment loss, and pannus formation. Corneal problems included epithelial and stromal disturbances, calcium deposition, and melting. The most frequent previous surgeries were punctal closure, lamellar keratoplasty (LK), and stem cell allograft. Severity of intoxication included mild (17%), moderate (25%), and severe (57%). CONCLUSION: Chronic blepharitis and decreased tear secretion are the 2 most important and influencing factors in progression of ocular problems in SM injuries. The more severe the initial exposure, percentage of disability, and duration of ocular involvement, the higher the likelihood of mustard gas keratopathy.

Long-term ocular complications of sulfur mustard in the civilian victims of Sardasht, Iran.

Eyes are very sensitive to sulfur mustard (SM) gas because they have wet surfaces. The severity of ocular damage is related to the dose and duration of exposure to SM, and recovery may take up to several years after the exposure. We conducted a large cohort study to evaluate the ocular signs and symptoms of 367 chemical war victims in Sardasht City, Iran, 20 years after their exposure to mustard gas. The results of these chemical war victims (i.e., the cases) were compared with the results for 128 unaffected civilians (i.e., the controls). Photophobia was the most significant symptom in the cases (36.8%) (compared with 20.3% in the controls) (p < or = .001). Ocular surface discomfort (burning, itching, and redness) was the second most significant symptom in the cases (29.2%) (compared with 19.5% in the controls) (p = .034). Other symptoms such as foreign-body sensation, tearing, pain, blurring of vision, and dry eye sensation were not significantly different between the 2 groups. In the slit-lamp findings, bulbar conjunctival abnormality was the most significant sign in the cases (9.3%) (compared with 1.6% in the controls) (p = .004). Limbal tissue changes were the second most significant sign in the cases (3.0%) (compared with 0.0% in the controls) (p = .048). Other slit-lamp findings related to tearing and abnormalities in the lids and cornea were not significantly different between the 2 groups. Our findings in the present study showed that photophobia and ocular surface discomfort (burning, itching, and redness) were the most significant symptoms. In addition, bulbar conjunctival abnormalities and limbal tissue changes were the most significant signs among the sulfur mustard chemical war victims.

Delayed ocular, pulmonary, and cutaneous complications of mustards in patients in the city of Sardasht, Iran.

The purpose of our study was to evaluate the late ocular, pulmonary, and cutaneous complications of mustards, 19 years after exposure in 600 patients of the city of Sardasht, Iran. In this case study, we evaluated 600 warfare patients aged 19 to 80 years whose mustard gas injury dated back to 19 years before evaluation in Sardasht. Our results showed that 5.2% of our cases were aged 19-20 years, 18.5% were aged 21-30 years, 31.7% were aged 31-40 years, 23.5% were aged 41-50 years, 12.2% were aged 51-60 years, 5.5% were aged 61-70 years, and 3.4% were aged 71-80 years. There were 50.3% male patients in our study, and 83.2% of the patients were married. Primary ocular manifestations were present in 96.2% of the cases, respiratory manifestations in 80.7%, and cutaneous manifestations in 83.8%, with a hospitalization rate of 64.7%. Ophthalmic, respiratory, and dermal medications were administered in 72.8%, 66.7%, and 61.8% of cases, respectively. The degree of ocular complications was mild in 36.7% and moderate in 1%. Respiratory complications were mild in 45% and moderate in 0.8%. Cutaneous complications were mild in 31.3% and moderate in 0.2.%. Late mild respiratory complications were significantly more frequent than ocular and cutaneous complications. In conclusion, late mild pulmonary complications were more frequent than mild ocular and cutaneous complications; however, moderate ocular complications were more frequent than moderate pulmonary and cutaneous complications.