جستجوی مقالات مرتبط با کلیدواژه "جانبازان شیمیایی" در نشریات گروه "پزشکی"

Sedentary lifestyle and physical fitness decline due to war-related complications lead to body composition changes in chemical warfare veterans and increase the risk of cardiovascular diseases. This study aimed to investigate the effect of eight weeks of interval aerobic training on body composition indices of chemical warfare veterans. This was a quasi-experimental study with a pre-test-post-test design. The sample consisted of 17 chemical warfare veterans with 35-25% disability percentage who were randomly assigned to either an experimental (10 subjects) or a control group (7 subjects). The chemical warfare veterans participated in an interval aerobic training program at 60-45% heart rate reserve intensity for eight weeks. Body composition indices were measured using a Body Composition Analyzer model 356 made in South Korea. Repeated measures ANOVA was used to compare pre-test and post-test means. Interval aerobic training had a significant effect on body weight, body mass index, waist-to-hip ratio, body fat percentage, fat-free mass, visceral fat levels, and visceral fat area. The training intervention did not have a significant effect on total body water, soft lean mass, and body minerals (P<0.05). The reduction in body weight, body mass index, body fat percentage, and visceral fat levels following eight weeks of interval aerobic training leads to a favorable change in body composition and a decrease in overweight and obesity and potentially obesity-related cardiovascular disease risk factors.

Chronic obstructive pulmonary disease (COPD) and asthma are one of the main side effects of mustard gas exposure. So the propose of present study was survey the effect of combined training of resistance and aerobic training in water on serum level of interleukin 6 (IL-6) and some pulmonary parameters(FVC, FEV1 and FEV1/FVC) in Chemical veterans caused by mustard gas.For this propose, 24 inactive Chemical veterans were selected and randomly divided into experimental (n=12) and control group (n=12). Experimental group did resistance training (3 session per week with 70% heart rate reserve) and aerobic training in water (2 session per week with 70% heart rate reserve) for 10 weeks. Blood sample and spirometry test was done before and after training period. Data was analyses with paired and independent ttest at significant level of p<0.05.Data analyzing showed that IL-6 level in experimental group was significantly lower than control group (p=0.020). Also FVC, FEV1 and FEV1/FVC levels n experimental group were significantly higher than control group (p value respectively 0.035, 0.021 and 0.003). reverse and significant relationship were found between IL-6 with FVC (p=0.01), FEV1 (0.001) and FEV1/FVC (0.008).Probably combined training of resistance and aerobic training in water trough reducing inflammatory factor of IL-6 can have beneficial effect on pulmonary index such as FVC, FEV1 and FEV1/FVC levels. Thus this training can be used as complementary therapy in Chemical veterans caused by mustard gas

More than 100,000 Iranian veterans suffer from chemical damage caused by mustard gas. The aim of this study was to determine the body composition status of chemical warfare veterans with chronic obstructive pulmonary disease (COPD).

This is a cross-sectional study. 97 chemical warfare veterans with COPD in Karaj, Iran were included in the study. The Patients were divided into two groups low and medium to high disease severity according to spirometry parameters. The body composition parameters were evaluated using the Bioelectrical Impedance Analysis method. 

Mean age, height and weight of patients were 49.19±3.86, 171.85±6.11, 79.24±11.09, respectively. 65.6 % of them were overweight or obese. According to spirometry indexes, 55.7% (n=54) of veterans had low disease severity and 44.3% (n=43) had moderate to high disease severity. There was a significant difference between chemical veterans with low severity of COPD and moderate to high severity of COPD in body fat-free mass (p-value=0.031), body muscle mass (p-value=0.026) and body water (p-value=0.031) indices. All three indices in the group of veterans with moderate to high disease severity had a higher mean than the veterans with low disease severity. But no significant difference was observed in the fat mass index between these two groups (p-value=0.527).

According to the findings of this study, the severity of the disease in chemical veterans with COPD had an increasing effect on fat-free mass and muscle mass body composition.

  Regulatory T cells (Treg) are the subgroups of lymphocytes that control inflammation response and regulates homeostasis by mechanisms of cellular contact and secretion of soluble agents. Here, we investigated percentage of Treg in peripheral blood of sulfur mustard-exposed patients with CD4, CD25, CD127, FOXP3 markers in comparison with healthy individuals and the correlation between these cells and long-term pulmonary complications.

In this study, 12 sulfur mustard-exposed patients and 12 healthy volunteers were invited. Clinical inspections of both groups were done by pulmonary specialists as well as spirometric evaluation that was conducted by pulmonary function test operators. After isolation of peripheral blood mononuclear cells, the percentage of Treg cells was determined by flow cytometry.

Percentage of Treg cells was not significantly different in those exposed to sulfur mustard. Also, there was no significant correlation between spirometric parameters and percentage of these cells.

According to the current study, there is no difference in the percentage of Treg cells between exposed patients with mild pulmonary complications and healthy volunteers and more studies are needed to understand the role of these cells in the pulmonary complications of these patients.

Aims: Studies have shown that the perception of God and life expectancy are important in adapting to chronic diseases and their consequences. The purpose of this study was to compare the level of perception of God and life expectancy among the veterans with spinal cord injuries, chemical veterans, and ordinary people.
Instruments & The present study was a causal-comparative study conducted in Urmia in 2016. 30 veterans with spinal cord injuries were selected by census method, 50 chemical veterans were randomly selected and 50 ordinary people were selected by cluster sampling. The research instruments were perception of God Scale and Miller's Hope Questionnaire (MHS). Data were analyzed by multivariate analysis of covariance analysis, multivariate analysis of variance analysis and Bonferroni post hoc test, using SPSS 22 software.
In the total score of perception of God, there was a significant difference between chemical veterans and ordinary people (p=0.001). In the challenge component, there was a significant difference between chemical veterans and ordinary people (p=0.003) and between veterans with spinal cord injuries and ordinary people (p=0/011). Also there was a significant difference in life expectancy between two groups of chemical veterans and veterans with spinal cord injuries (p=0.007).
There is a difference between the level of perception of God and the life expectancy among the veterans with spinal cord injuries, chemical veterans, and ordinary people.

Aims: This study received support and social stress among spinal cord injuries and chemical and ordinary people in the city of Urmia.
The research method was causal-comparative, Data was analyzed by SPSS 22 software especially from the target population sample of 150 patients (30 men veterans with spinal cord injuries and 50 chemically injured veterans and 50 normal individuals) From July to October 2016 through the Medical Commission martyr Foundation and Veterans Affairs percent of spinal cord injury or chemical injury were received. Sampling for spinal cord injuries all count, chemical veterans randomly sampling method and ordinary people cluster sampling method were used. Social support and stress scale questionnaire Duke (1991) was completed by them and to analyze the data, multivariate analysis of variance was used.
Findings: The results showed that social support among two groups of spinal cord injuries and chemical veterans (P=0/03) and ordinary people and chemical veterans (P=0/03) was a meaningful difference. But chemical veterans and ordinary people there are significant differences in the variables of social stress (P=0/002). No significant difference between spinal cord injuries and ordinary people in social support. Also results showed that the two groups of spinal cord injuries with chemical veterans and spinal cord injuries with other people, there was no significant difference between them in social stress.
As a result of stress and social support among ordinary people is different from spinal cord injuries and chemical.

Aims: Exposed to the war and chemical weapons, the veterans experience severe mental reactions. One of such experiences is the death coming feeling that finally leads to some disorders such as death depression and death anxiety. The aim of the study was to compare the death depression and anxiety in the chemically-injured and non-chemically-injured veterans in Sardasht Township.
Instrument & In the comparative-causal descriptive study, 100 veterans including 50 chemically-injured and 50 non-chemically-injured veterans of Sardasht Township were studied in 2016. The subjects were selected via available sampling method. Data was collected by the death anxiety index and the death depression questionnaire. Data was analyzed by SPSS 16 software using MANOVA and independent T test.
Findings: The mean score of death anxiety in the chemically-injured veterans was significantly higher than the non-chemically-injured veterans (p=0.001). The mean scores of death hoplessness, death failure, and total depression score in the chemically-injured veterans were significantly higher then the non-chemically-injured veterans (p=0.001). Nevertheless, the mean scores of loneliness and death acceptance were not significantly different in the groups, respectively (p>0.05).
The levels of death anxiety and death depression in the chemically-injured veterans of Sardasht Township were higher than the non-chemically-injured veterans.

Aims: As a chronic disease, the physical side-effects in the chemically-injured veterans continually affect the quality of life of the veterans. Based on the studies, sport activities and exercises might enhance their mood, rehabilitate their physical conditions, and result in their mental relaxation. In addition, such activities might reduce the disabilities connected to such conditions. The aim of this study was to investigate the effects of a sport program on the quality of life of the veterans with severe chemical injuries in Markazi Province.
Instrument & In this semi-experimental study, 12 veterans of Markazi Province, Iran, with severe chemical injuries were entered the study according to inclusion criteria in 2014. The subjects were selected purposefully. A sport exercise program was conducted in 6 months. The program included planned and moderate sport activities, health advices, and a massage program via multimedia educational packages. The activities were done at home. The quality of life was assessed before and after the exercise program using quality of life questionnaire connected to health. Data was analyzed by SPSS 16 software using paired T test.
Findings: There was a significant difference between the mean score of different aspects of quality of life after the intervention and the mean score before the intervention. And after the intervention, there were increases in the mean scores of the dimensions of quality of life including physical activities, limitations for the physical role, limitations for the emotional role, vitality, mental health, social functioning, physical pain, and general health (p A planned sport program enhances the dimensions of the quality of life of the veterans with severe chemical injuries.

Suffering is a subjective phenomenon that affects all dimensions of an experiencing person, family members and health team. Relieving suffering of each individual is a principal goal of health team. It seems that chronic process of disease and numerous physical problems, along with psychological, social and economical problems in the chemical victims, each can by itself involves a source of suffering in this group of patients. The aim of this study was to clarify chemical victim's experiences of the Iran-Iraq war in terms of nature and structure of suffering sources. This is a qualitative study with phenomenological method. Twelve military chemical victims were selected based on purposive sampling with the maximum variety. The study data were gathered through in-depth and non-structured interviews and, thus were analyzed by “Parse” method. The findings of this study are summarized in these core concepts: “Suffering as a value resource”, “Physical problems as a source of suffering”, “society as a source of suffering”, “The economic problems as a source of suffering”, “Disturbance in family comfort as a source of suffering”. Participant's experiences reflect that victims need to be understood by health team, officials and members of the society. Moreover, some steps can be taken to reduce the suffering including increasing social respect, supporting family clubs. Also providing other social supports such as educational programs to improve their caring of themselves and offering appropriate facilities proportionate with needs of victims can be mentioned.

Background & Sulfur Mustard (SM) has been widely used as a chemical warfare agent against Iranian in Iraq-Iran conflict. Many years after exposure، people who have been exposed to SM are still suffering from its late complications including ocular، coetaneous، respiratory and psychological disorders. SDF-1α (Stromal-Derived Factor-1α) or CXCL12 is a member of C-X-C chemokine family that its important role in recruitment of progenitor and stem cells from bone marrow to peripheral blood after injury and inflammation has been approved in many studies. The aim of this study was to determine the serum levels of SDF-1α in chemical victims who were exposed to mustard gas many years ago in comparison with an unexposed control group. 174 SM chemical victims and 39 unexposed participants as controls were studied. Clinical evaluation was down by specialists. Pulmonary function was carried out by spirometry and according to the classification of Medical Committee of Iranians foundation of martyr and veterans affairs classifications، chemical victims classified to three groups with mild، moderate and severe pulmonary complications. The serum levels of SDF-1α were measured by a sandwich ELISA technique. The serum concentration of SDF-1α in SM exposed group was significantly reduced compared to the controls (p=0. 046). The serum SDF-1α levels in the exposed participants with severe pulmonary complications was significantly lower than in controls (p=0. 054). However this reduction was not significant in exposed group with mild and moderate lung injuries. According to the significant reduction of the serum concentration of SDF-1α in the exposed participants comparing to the unexposed control group and its significant reduction in exposed participants with severe lung injury، it could be concluded that down-regulation of this chemokine could be one of the important factors in late clinical complications of sulfur mustard.

Background &

Chemical attacks in war can make short term and long term personal، family and social damages and limited social relationships of victims as compared to ordinary people. The aim of this study was to investigate the relationship between social support and health promoting behaviors in chemical veteran in Ilam province 2012-13. Methods & Materials: This cross-sectional study was performed in the entire moderate and severs chemical veterans، who they were covered by the Department of Veterans and Martyrs of Ilam province. Information was collected by using standard questionnaires for health-promoting behavior and Multidimensional scale of perceived social support (family، friends، and important people). The reliability and validity of these instruments was desirable. Inclusion criteria were percentage of disability with moderate and sever levels and enough physical strength to answer questions، and exclusion criteria were also lack of cooperation and have no permanent residence in Ilam province. After data collection، all data were analyzed by SPSS statistical soft ware and Pearson correlation coefficient and linear regression.

All of 239 veterans indicated that all of them were men with mean and standard deviation age 51. 17± 8. 87 years and there is a significant relation between all subscales of social support and health-promotion behavior subscales (p<0. 05). Among the subscales of social support، friend support had the highest correlation with health-promoting behaviors (r= 0. 391)، and support from important people showed the lowest correlation (r= 0. 367). The all regression models of health promotion behavior and its subscales were significant.

There is a relation between perceived social support especially friend support and health-promotion behaviors، therefore suggest that the friend as a resource support was used in design of educational programs.

many peoples such as chemical veterans due to exposing in chemical gas may be having a dysfunction in their respiratory systems which disrupt daily activity. The purpose of this research was the relationship between job satisfaction and mental health in chemical veterans of Golestan province. for this purpose, 125 chemical veterans were selected from Golestan’s veterans as samples. In this study, two questionnaires were used to evaluate veterans: Wysocki & Kromm job satisfaction, Goldberg mental health questionnaire. These tests were used to analyze data: K-S test to determine normality of data, Descriptive Statistics, The Pearson’s correlation coefficient, ANOVA test and LSD Post hoc test at level (p ≥ 0.05). The results of Pearson’s test showed that there is a positive significant relation between mental health in chemical veterans (p=0.001, r=0.3). Also, the result of the research about the difference between job satisfaction and mental health according to chemical veterans’ education degrees showed that there is a significant difference only in job satisfaction based on education degree. The results showed a positive significant relation between job satisfaction and mental health in chemical veterans. Therefore the study recommends that there should be more attention to chemical veterans’ job satisfaction, which will help to improve the mental health of these people.

By passing two decades of the imposed war, the side effects of using chemical weapons by Saddam regime against Iran has still remained especially in the lungs, eyes and skin of the survivors who were faced with these weapons. The purpose of this paper is to study the related problems of war disabled people affected by chemical weapons in the Hajj season regarding hot and dry weather and the huge crowd in Saudi Arabia. This qualitative research with thematic analysis is done as a combination of field observation, depth interviews with officials and physicians of the caravans and ordinary ones. Data was collected and analyzed in regard to the problems of war disabled people affected by chemical weapons. The results have shown that most of chemical survivors because of lung damage suffer from severe respiratory infections and finally pneumonia after cold. Also, the most important health challenges for this group are such as: the exacerbation of skin trauma, immune disorders because of immune system weakness, early fatigue, decrease of blood oxygen in the lungs especially in crowded places and the possibility transmission of respiratory infections in rooms with 4 and 5 persons. Because of sending some of the war disabled people affected by chemical weapons,out of specific caravan, it is necessary for the caravan managers and personnel to pay more attention to the health and examination of this group before trip and to provide the travel requirements for maintaining their health in the hajj season. Also, it is recommended to compile a care and treatment protocol for this group in Hajj season.

Mustard gas or sulfur mustard (SM) is one of the most important alkylating chemical warfare agents that was widely used the world war I and in the Iran-Iraq war It acts as an alkylating agent with long-term toxic effects on skin, eyes, respiratory system, bone marrow tissues, and the mucosal cells of the gastrointestinal tract resulting in several early and long-term effects on human health, many of them cannot be defined clinically or pathologically. regarding the fact that no study has been performed on dental therapeutic needs of these patients in Iran, this study was conducted to determine the frequency of oral soft tissue lesions of toxic veterans referred to medical toxicology Center of Imam Reza hospital to oral medicine department, Mashhad Dental School of Mashhad University. The aim of this study was to determine the dental conditions and therapeutic needs in sulfur mustard veterans which referred from Medical Toxicology Research Center (MTRC) to Mashhad Dental School in 2009. Methods &Material: This is a descriptive (cross-sectional) study. Following coordination and obtaining the informed consent, the veterans of Khorassan Razavi with delayed complications of sulfur mustard (SM) poisoning were referred from MTRC of Mashhad University of Medical Sciences to oral medicine clinic of Mashhad faculty of dentistry. The teeth of the patients were examined by an oral medicine specialist using dental mirror and other required tools. The information obtained by WHO Questionnaire. The collected data were as follow: Demography information, abnormalities of teeth and oral cavity and the dental therapeutic needs. The statistical analysis was performed bySPSS (version11.5Using appropriate statistical tests. This study was carried out on 40 male SM veterans with a mean age of 50.7 years (minimum 39 and maximum 71 years) the patients had oral soft tissue lesions and were edentulous.. Majority (75%) of patients need to be treated dentally, including oral hygiene instruction (60%), fixed prosthetic (40%), root canal therapy (12.5%), tooth extraction (12.5), restorative treatment)5.25%(and follow up for denture adjacent(5.0%).The most common therapeutic needs were OHI and partial or fixed prosthesis. Most patients needed oral hygiene instruction and treatment for the oral lesions. It is thus recommend considering routine oral dental examination and treatment at regular intervals for the patients with delayed complications of SM poisoning.

Mindfulness and emotion regulation have important effects on the variables related to mental health in chemical weapons victims. The purpose of this study was to examine the effectiveness of mindfulness-based stress reduction and emotion regulation training on the affect and mood in chemical weapons victims.

This interventional study was conducted with two experimental groups and a control group including 47 male chemical weapons victims with high scores on the General Health Questionnaire in Sardasht city, Iran, randomly selected and then assigned to mindfulness training, emotion regulation training, and control groups. Mindfulness-based stress reduction (MBSR) training was used with experimental group 1, emotion regulation (ER) training was implemented with experimental group 2, and the control group received no training. Data were gathered using the General Health Questionnaire, Positive and Negative Affect and Depression-Happiness scales. Analysis of variance with repeated measure was used for analyzing the data.

The results indicated that mindfulness-based stress reduction and emotion regulation training significantly increased positive affect and mood and decreased negative affect in chemical weapons victims.

The results supported the effectiveness of mindfulness and emotion regulation training on affect and mood in chemical victims. Therefore, attention to the effectiveness of mindfulness and emotion regulation on variables related to mental health is important in chemical weapon victims.

Increased fat in the body of one of the most common risk factors for major diseases and nutritional problems importantly, as an independent factor increasing the risk of mortality. Body mass index (BMI), percentage of body fat (% PBF) and waist to hip ratio (WHR) is also a tool for indicating weight status in adults as a simple indicator of body fat or obesity is used in public. Today, lack of exercise can cause many diseases in which people have been injured in the Chemical ventures the fear of respiratory problems and diseases associated with physical activity, less likely that this increase is associated with obesity. Given the special circumstances of chemical ventures, this study aimed to evaluate body mass index (BMI), percent body fat(% PBF) and the waist to the waist to hip ratio WHR) Chemical ventures of Razav i Khorasan, and the current state of health of the afrd about be investigated. Methods & Materials: This cross sectional study - were descriptive. Therefore, the 88 Chemical ventures of Razav i Khorasan with an average age of 28.8 ± 45.48 years, a group of veterans who were considered severe, were studied. About the composition of body weight, fat percentage, body mass index and waist- hip ratio, the subjects were assessed using the body composition (Body composition) analysis and output data were presented in specific forms of this device, using spss software was analyzed. Mean body mass index, fat percentage and waist to hip ratio in all subjects, respectively, 4.10 ± 25.5, 7.1 ± 28.2, 5.14 ± 0.922 Moreover, body mass index, fat percentage and waist to hip ratio Thus, in 9 cases (10.2%), 0 (0%), 7 (7.95%) below normal in 29 patients (32.9%), 6 (2.38%), 35 (39.77%) in normal and 50 (56.8%), 82 (97.61%), 46 (52.27%) were in the very obese. This study showed high rates of obesity in veterans of the importance of these complications seem to excessive weight gain the adjusted body mass index, waist- hip ratio and percent body fat in certain groups should be considered department of Physical Education in the Foundation of Martyrs and Veterans of the physical activity and sports programs and special programs is recommended.

Chemical weapon victims are suffering from physical difficulties and psychological trainings may help to decrease these problems. The purpose of this research was to examine the effectiveness of mindfulness and emotion regulation training on physical and psychological well-being in chemical weapon victims.

An experimental, pre-post and follow-up study designed. Forty seven chemical weapon victims men with low mental health in Sardasht city (North-Western Iran) randomly selected and assigned into three groups: 1-Mindfulness training group 2- Emotion regulation training group and 3- Control group. The first two groups were received mindfulness-based stress eduction training and emotion regulation training respectively, while no training provided for control group. Data was collected using the General Health Questionnaire, and Physical Syndromes Scale. Analysis of variance with repeated measure was used for analyzing the data.

Results indicated that mindfulness and emotion regulation were significantly improved physical syndromes and mental health in chemical weapon victims. Also, the effectiveness of mindfulness in follow-up scores of physical syndromes and in post-test and follow-up scores of mental health was higher than the base line scores (P

Chemical warfare agents especially sulfur mustard has been widely used in Iraq-Iran conflict. Long-term complications of the respiratory system, eyes and skin that are most common involved organs in victims, proposed possible involvement of immune and inflammatory reactions. IL-19 is a novel member of IL-10 superfamily that has ascribed to be a pro-inflammatory cytokine in the most studies and anti-inflammatory in some studies. According to the importance of IL-19 as a member of IL-10 family, we decided to evaluate serum level of this cytokine in the sera of chemical victims. This case-control study was conducted on 144 severe lung injured sulfur mustard war victims, 57 mild to moderate lung injured sulfur mustard war victims and 55 unexposed participants as control group. The serum concentration of IL-19 was measured by a sandwich ELISA technique (R &D system Eliza kit) and read by ELISA reader instrument. The present study showed that although the serum level of IL-19 in the unexposed control group is more than the exposed group and also is increased in the mild to moderate exposed group compared to the severe exposed group, but these increases are not statistically significant. Median and mean of the serum IL-19 level in the exposed group increase with the increasing FEV1, FVC and decrease with the increasing FEV1/FVC but it was not statistically significant. There were significant correlation between serum level of IL-19 and FEV1/FVC in the exposed group (P=0.022). Although there is no significant difference in serum level of IL-19 between exposed and non exposed groups, but the role of this cytokine as an inflammatory factor in local inflammation and inflammatory processes is not completely rejected.

The purpose of this investigation was to study the respiratory parameters in different body positions (standing, chair-sitting, supine and side-lying) in chemical veterans. 10 chemical veterans (age 42.7±5 yrs; height 174.8±5.4 cm; weight 80.8±6 kg) participated in this study. Respiratory parameters such as Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), Tidal Volume (TV), Peak Expiratory Flow (PEF), Minute Ventilation (VE), Breathing Frequency (fb) and FEV1/FVC ratio were measured by spirometer in different body positions. ANOVA with repeated measure was used to show the mean difference in each parameter between body positions. The results showed no significant difference in any respiratory parameters between different body positions. Educating chemical veterans and they putting in proper body position can have a positive effect on pulmonary function and also, putting in improper body positions lead to occur variety of musculoskeletal problems that can have more effect on pulmonary system in chemical veterans.

Fatigue as a usual symptom in respiratory chronic symptom can affect the some dimensions daily living aspects of patient. The aim of this study was fatigue measurement and correlation determination between fatigue and spirometery parameters in war chemical victims who suffer from respiratory disorders. According to a descriptive cross sectional design and purposeful sampling the number of 140 victims selected. After Spirometery parameters measurement, the fatigue was estimated by using of Persian version of Multidimensional Fatigue Inventory -20 (MFI-20). According to spirometery parameters severity, the sample was classified. The fatigue score in total and each dimensions analyzed for presence of correlation between fatigue and spirometery parameters values. The average of physical fatigue dimension was 17.3±2.8. It was higher average score in comparison to other dimensions; meanwhile, the score of mental fatigue dimension (14.1±4.5) was the lower score of dimensions. Correlation coefficients between the MFI-20 dimensions and spirometry's parameters, there was a positive significant relation between dimensions of fatigue and spirometery parameters (p<.01). There is experience of fatigue more than medium level in daily living of chemical war victims, which has positive correlation with severity of respiratory disease status. In daily care and treatment program of them, it is necessary to have attention to fatigue state of chemical war victims