JMedCBRDef, Vol 3, 2005 www.jmedcbr.org 1 Journal of Medical Chemical, Biological and Radiological Defense EVALUATION OF DELAYED TOXIC EFFECTS OF SULFUR MUSTARD POISONING IN SEVERELY INTOXICATED IRANIAN VETERANS: A CROSS- SECTIONAL STUDY Mahdi Balali-Mood,* 1 Mehrdad Hefazi, 1 Mahmoud Mahmoudi, 8 Ishagh Jalali, 6 Davoud Attaran, 3 Masoud Maleki, 2 Mohammad-Reza Etezad Razavi, 5 Gholamali Zare, 1 Mahmoud- Reza Jaafari, 7 Abbas Tabatabaee 4 1 Medical Toxicology Center and 2 Department of Dermatology, Imam Reza Hospital; 3 Department of Respiratory Medicine and 4 Department of Clinical Pathology, Ghaem Hospital; 5 Department of Ophthalmology, Khatamolanbya Hospital; 6 Department of Electrophysiology, Mashhad School of Medicine; 7 Mashhad School of Pharmacy, Biotechnology Research Center, Department of Electron Microscopy; 8 Immunology Research Center, Bu-Ali Research Institute Mashhad, Iran * Corresponding author: Prof. Mahdi Balali-Mood Director, Medical Toxicology Center Imam Reza Hospital, Mashhad University of Medical Sciences Mashhad 91735-348, Iran. Tel: +98 - 511- 8819301 / 8598973 / 8594594 Fax: +98-511- 8813714 / 8593038 Mobile: + 98 - 9151157000 E-mail: mbalalimood@irantox.org, mbalalimood@hotmail.com, m-balali@mums.ac.ir ABSTRACT Background Sulfur mustard (SM) is a chemical warfare agent (CWA) that was widely used during the World War I and by the Iraqi forces against the Iranian soldiers and even innocent civilians between 1983 and 1988. Early toxic effects of SM in Iranian veterans have already been published, but late complications in different organs and the relationship between local and systemic toxicities have not been previously reported. Objectives The aim of this study was to investigate the delayed toxic effects of SM poisoning in severely intoxicated Iranian veterans and to evaluate the developing stages of late complications, as well as the possible correlations between different organ complications. Methods All SM-intoxicated veterans in the province of Khorasan, Iran who had severe clinical complications according to their previous follow-ups were studied. Respiratory, neuromuscular, dermatological, ophthalmological, hematological and immunological complications were evaluated through clinical and paraclinical investigations including cell blood counts (CBC), flow cytometry, serum immunoglobulins (Igs) and complements, arterial blood gas (ABG) analyses, pulmonary function tests (PFT), chest X-ray (CXR), high- resolution computed tomography (HRCT) of the chest, bronchoscopy, electromyography (EMG), nerve conduction velocity (NCV) and skin biopsy for both light and electron microscopy. Patients were graded according to their severity of complications in different