title: Complications and Carcinogenic Effects of Mustard Gas--a Systematic Review and Meta-Analysis in Iran.
abstract: BACKGROUND
  Catastrophic effects of mustard gas as a chemical warfare agent have always been a major problem for those exposed to this agent. In this meta-analysis it was tried to evaluate carcinogenesis, ocular, cutaneous and respiratory complications of mustard gas exposure among Iranians who had been exposed to this agent during the Iran-Iraq war.
  
  
  METHODS
  In this meta-analysis, the required data were collected using keywords "mustard gas", "sulfur mustard", "cancer", "neoplasm", "respiratory complications", "ocular complications" , "lung disease", "chronic complication", "eye", "skin", "cutaneous complication", "carcinogenesis" and their combination with keywords "Iran", "Iranian", "prevalence", "mortality" and their Farsi equivalent terms from the databases of SID, Iranmedex, Magiran, Pubmed, Science Direct, Google Search engine, Gray Literature and Reference of References. To determine the prevalence of each complication and perform meta-analysis, CMA: 2 (Comprehensive Meta-Analysis) software with a randomized model was used.
  
  
  RESULTS
  Of the 542 articles found, 7 national articles, consistent with the aims of this study were selected. Meta- analysis of seven papers revealed that cancer risk, especially cancer of the respiratory system was elevated, so that the relative risk (RR) of cancer role of mustard gas was inconsistent from 2/1 to 4 in this survey. Also prevalence of delayed skin disorders due to sulfur mustard was 94.6%, pulmonary complications 94.5% and ocular complications 89.9%. The incidence of various cancers in victims exposed to mustard gas was 1.7% worldwide where the rate was 2.2% in Iranian victims of the Iraq-Iran war.
  
  
  CONCLUSIONS
  Based on present study the prevalence of delayed mustard gas related cutaneous, pulmonary and ocular complications is above 90% and risk of carcinogenesis is higher in comparison to worldwide statistics. This may suggest need for long-term and persistent follow-up and rehabilitation procedures for populations exposed to this agent.
authors.affiliation: Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Iran E-mail : agh1343@gmail.com, dr.reza.piri@gmail.com.
authors.forename: Yunes
authors.initials: Y
authors.lastname: Panahi
authors.forename: Nasrin
authors.initials: N
authors.lastname: Gholami
authors.forename: Morteza
authors.initials: M
authors.lastname: Ghojazadeh
authors.forename: Farnaz
authors.initials: F
authors.lastname: Moslemi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Naghavi-Behzad
authors.forename: Saber
authors.initials: S
authors.lastname: Azami-Aghdash
authors.forename: Alireza
authors.initials: A
authors.lastname: Ghaffari
authors.forename: Reza
authors.initials: R
authors.lastname: Piri
mesh_terms: D063646:Carcinogenesis / Q000187:drug effects*; D002619:Chemical Warfare Agents / Q000633:toxicity*; D005123:Eye / Q000473:pathology; D005134:Eye Neoplasms / Q000139:chemically induced* / Q000401:mortality; D006801:Humans; D007492:Iran / Q000453:epidemiology; D007493:Iraq; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000139:chemically induced* / Q000401:mortality; D009092:Mucous Membrane / Q000187:drug effects / Q000473:pathology; D009151:Mustard Gas / Q000633:toxicity*; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000401:mortality
chemical_list: D002619:Chemical Warfare Agents; D009151:Mustard Gas