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PubMed1990

Nuclear, biological and chemical warfare. Part I: Medical aspects of nuclear warfare.

Casualties in earlier wars were due much more to diseases than to weapons. Mention has been made in history of the use of biological agents in warfare, to deny the enemy food and water and to cause disease. In the first world war chemical agents were used to cause mass casualties. Nuclear weapons were introduced in the second world war. Several countries are now involved in developing nuclear, biological and chemical weapon systems, for the mass annihilation of human beings, animals and plants, and to destroy the economy of their enemies. Recently, natural calamities and accidents in nuclear, chemical and biological laboratories and industries have caused mass instantaneous deaths in civilian population. The effects of future wars will not be restricted to uniformed persons. It is time that physicians become aware of the destructive potential of these weapons. Awareness, immediate protective measures and first aid will save a large number of persons. This series of articles will outline the medical aspects of nuclear, biological and chemical weapon systems in three parts. Part I will deal with the biological effects of a nuclear explosion. The short and long term effects due to blast, heat and associated radiation are highlighted. In Part II, the role of biological agents which cause commoner or new disease patterns is mentioned. Some of the accidents from biological warfare laboratories are a testimony to its potential deleterious effects. Part III deals with medical aspects of chemical warfare agents, which in view of their mass effects can overwhelm the existing medical resources, both civilian and military.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed2001

Toxins as weapons of mass destruction. A comparison and contrast with biological-warfare and chemical-warfare agents.

Toxins are toxic chemical compounds synthesized in nature by living organisms. Classifiable by molecular weight, source, preferred targets in the body, and mechanism of action, they include the most potent poisons on the planet, although considerations of production, weaponization, delivery, environmental stability, and host factors place practical limits on their use as WMD. The two most important toxin threats on the battlefield or in bioterrorism are probably botulinum toxin (a series of seven serotypes, of which botulinum toxin A is the most toxic for humans) and SEB, an incapacitating toxin. Ricin and the trichothecene mycotoxins, including T-2 mycotoxin, are of lesser concern but are still potential threats. Botulinum toxin is a neurotoxin, ricin and trichothecene mycotoxins are membrane-damaging proteins, and SEB is a superantigen capable of massive nonspecific activation of the immune system. The clinical intoxications resulting from exposure to and absorption (usually by inhalation) of these agents reflect their underlying pathophysiology. Because of the hybrid nature of toxins, they have sometimes been considered CW agents and sometimes BW agents. The current trend seems to be to emphasize their similarities to living organisms and their differences from CW agents, but examination of all three groups relative to a number of factors reveals both similarities and differences between toxins and each of the other two categories of non-nuclear unconventional WMD. The perspective that groups toxins with BW agents is logical and very useful for research and development and for administrative and treaty applications, but for medical education and casualty assessment, there are real advantages in clinician use of assessment techniques that emphasize the physicochemical behavior of these nonliving, nonreplicating, intransmissible chemical poisons.

Biological Warfare↗
PubMed2006

Anxiety, depression, and posttraumatic stress in Iranian survivors of chemical warfare.

CONTEXT: In the 1980-1988 Iran-Iraq War, extensive use of chemical weapons resulted in high rates of morbidity and mortality. While much is known about the physical consequences of chemical warfare, there is a paucity of information about the long-term effects of chemical attacks on mental health. OBJECTIVE: To assess the long-term psychological impact of chemical warfare on a civilian population. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional randomized survey conducted in July 2004 of 153 civilians in 3 towns exposed to warfare in northwestern Iran: Oshnaviyeh (low-intensity conventional warfare), Rabat (high-intensity conventional warfare), and Sardasht (both high-intensity conventional warfare and chemical weapons). MAIN OUTCOME MEASURES: Full or partial posttraumatic stress disorder (PTSD) diagnosis, anxiety symptoms, and depressive symptoms were assessed using Farsi versions of the Clinician-Administered PTSD Scale, Hamilton Scale for Anxiety, and Beck Depression Inventory, respectively. RESULTS: Overall participation rate was 93%. Respondents had a mean age of 45 years and were all of Kurdish ethnicity. Among individuals exposed to both high-intensity warfare and chemical weapons, prevalence rates for lifetime PTSD, current PTSD, major anxiety symptoms, and severe depressive symptoms were 59%, 33%, 65%, and 41%, respectively. Among the low-intensity warfare group, the corresponding rates were 8%, 2%, 18%, and 6%, respectively, while intermediate rates were found among those exposed to high-intensity warfare but not to chemical weapons (31%, 8%, 26%, and 12%, respectively). Compared with individuals exposed to low-intensity warfare, those exposed to both high-intensity warfare and chemical weapons were at higher risk for lifetime PTSD (odds ratio [OR], 18.6; 95% confidence interval [CI], 5.8-59.4), current PTSD (OR, 27.4; 95% CI, 3.4-218.2), increased anxiety symptoms (OR, 14.6; 95% CI, 6.0-35.6), and increased depressive symptoms (OR, 7.2; 95% CI, 3.3-15.9). Exposure to high-intensity warfare but not to chemical weapons was also significantly associated with lifetime PTSD (OR, 5.4; 95% CI, 1.7-17.6), compared with those in the low-intensity warfare group. Further, compared with individuals exposed to high-intensity warfare alone, those exposed to both high-intensity warfare and chemical weapons were at higher risk for lifetime PTSD (OR, 3.4; 95% CI, 1.5-7.4), current PTSD (OR, 6.2; 95% CI, 2.0-20.1), increased anxiety symptoms (OR, 5.6; 95% CI, 2.5-12.6), and increased depressive symptoms (OR, 3.7; 95% CI, 1.8-7.2). CONCLUSION: Exposure to chemical warfare is an extreme traumatic event that has long-lasting adverse consequences on mental health.

Adult↗
PubMed1995

Biological warfare in the twentieth century: lessons from the past, challenges for the future.

Biological warfare and fear of biological warfare have affected our wars, our peace, and our research throughout this century. During World War I, animals were deliberately infected with glanders. During World War II, biowarfare research was carried out by Japan, Germany, England, and the United States. Japan carried out biological warfare attacks in China. England used biological warfare for the assassination of Reinhard Heydrich. In the 1950s and 1960s, Army researchers released bacteria over U.S. cities in biological warfare tests. The most frequent biological warfare terrorist episodes have been contamination of food and water. Although biological warfare can be very low tech, genetic engineering is capable of making biowarfare agents available in vast quantities. Biowarfare research should continue, but the National Institutes of Health should oversee human biological warfare research.

Biological Warfare↗
PubMed2000

The role of the sand in chemical warfare agent exposure among Persian Gulf War veterans: Al Eskan disease and "dirty dust".

The purpose of this paper is to inquire into the relationship between Al Eskan disease and the probable exposure to chemical warfare agents by Persian Gulf War veterans. Al Eskan disease, first reported in 1991, compromises the body's immunological defense and is a result of the pathogenic properties of the extremely fine, dusty sand located in the central and eastern region of the Arabian peninsula. The disease manifests with localized expression of multisystem disorder. Signs and symptoms of Al Eskan disease have been termed by the news media "Persian Gulf syndrome." The dust becomes a warfare agent when toxic chemicals are microimpregnated into inert particles. The "dirty dust" concept, that the toxicity of an agent could be enhanced by absorption into inactive particles, dates from World War I. A growing body of evidence shows that coalition forces have encountered Iraqi chemical warfare in the theater of operation/Persian Gulf War to a much greater extent than early U.S. Department of Defense information had indicated. Veterans of that war were exposed to chemical warfare agents in the form of direct (deliberate) attacks by chemical weapons, such as missiles and mines, and indirect (accidental) contamination from demolished munition production plants and storage areas, or otherwise. We conclude that the microimpregnated sand particles in the theater of operation/Persian Gulf War depleted the immune system and simultaneously acted as vehicles for low-intensity exposure to chemical warfare agents and had a modifying-intensifying effect on the toxicity of exposed individuals. We recommend recognition of a new term, "dirty sand," as a subcategory of dirty dust/dusty chemical warfare agents. Our ongoing research efforts to investigate the health impact of chemical warfare agent exposure among Persian Gulf War veterans suggest that Al Eskan disease is a plausible and preeminent explanation for the preponderance of Persian Gulf War illnesses.

Chemical Warfare Agents↗
PubMed2006

Liquid chromatography electrospray tandem mass spectrometric and desorption electrospray ionization tandem mass spectrometric analysis of chemical warfare agents in office media typically collected during a forensic investigation.

Most prior analytical studies have dealt with the determination of chemical warfare agents in environmental or biological matrices that would typically be collected following battlefield use or in support of the Chemical Weapons Convention. These methods may be useful for some investigations, but may not be practical for indoor forensic investigations where chemical warfare agent use is suspected. There is a need for analytical methods for chemical warfare agent identification in office media, including flooring, wall surfaces, office fabrics and paper products, which would typically be collected in an office environment during forensic investigations. During this study, typical office environment media were spiked at the 4-20microg/g level with either a complex munitions grade sample of tabun (GA) or with a standard containing the three nerve agents, sarin (GB), cyclohexyl methylphosphonofluoridate (GF), soman (GD) and the nerve agent simulant, triethyl phosphate (TEP), to evaluate the potentials of liquid chromatography electrospray ionization mass spectrometry (LC-ESI-MS) and liquid chromatography electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) for forensic purposes. An emerging technique, desorption electrospray ionization (DESI-MS/MS), was also investigated for the direct determination of TEP, GB and GD sampled onto solid phase microextraction (SPME) fibers exposed to spiked office media. The spiked chemical warfare agents were recovered with varying efficiencies during this study, but in all cases sufficient chemical warfare agent was recovered for mass spectrometric identification purposes. Full high resolution mass spectra were acquired for all the chemical warfare agents in the continuum mode, which typically resulted in mass measurement errors of 0.001Da or less.

Central Nervous System Agents↗
PubMedDate not supplied

Airway hyperresponsiveness to methacholine in chemical warfare victims.

BACKGROUND: The lung is one of the most exposable organs to chemical warfare agents such as sulfur mustard gas. Pulmonary complications as a result of this gas range from severe bronchial stenosis to mild or no symptoms. Airway hyperresponsiveness (AHR) which is usually assessed as response to inhaled methacholine is the most characteristic feature of asthma. AHR is reported in chronic obstructive pulmonary disease patients and smokers, and may also show in chemical warfare victims. However, there are little reports regarding AHR in chemical warfare victims. OBJECTIVE: Therefore, in this study, airway responsiveness to methacholine in victims of chemical warfare was examined. METHODS: The threshold concentrations of inhaled methacholine required for a 20% change in forced expiratory flow in 1 s (FEV1; PC20) or a 35% change in specific airway conductance (PC35) were measured in 15 chemical war victims and 15 normal control subjects. RESULTS: In 10 out of 15 chemical warfare victims (two thirds), PC20 and PC35 methacholine could be measured and subjects were called responders. AHR to methacholine in responder chemical war victims (PC20 = 0.41 and PC35 = 0.82 g/l) was significantly lower than in normal subjects (PC20 = 5.69 and PC35 = 4.60 g/l, p < 0.001 for both cases). There was a significant correlation between FEV1 and PC20 methacholine (r = 0.688, p < 0.001). The correlations between PC20 and PC35 were statistically significant as well (r = 0.856, p < 0.001). CONCLUSION: Results showed increased airway responsiveness of most chemical warfare victims to methacholine which correlated with the FEV1 value and which may be related to chronic airway inflammation or irreversible airway changes.

Adult↗
PubMed2003

Mass spectrometric analysis of chemical warfare agents and their degradation products in soil and synthetic samples.

A packed capillary liquid chromatography-electrospray ionization mass spectrometry (LC-ESI-MS) method was developed for the identification of chemical warfare agents, their degradation products and related compounds in synthetic tabun samples and in soil samples collected from a former mustard storage site. A number of organophosphorus and organosulfur compounds that had not been previously characterized were identified, based on acquired high-resolution ESI-MS data. At lower sampling cone voltages, the ESI mass spectra were dominated by protonated, sodiated and protonated acetonitrile adducts and/or their dimers that could be used to confirm the molecular mass of each compound. Structural information was obtained by inducing product ion formation in the ESI interface at higher sampling cone voltages. Representative ESI-MS mass spectra for previously uncharacterized compounds were incorporated into a database as part of an on-going effort in chemical warfare agent detection and identification. The same samples were also analyzed by capillary column gas chromatography (GC)-MS in order to compare an established method with LC-ESI-MS for chemical warfare agent identification. Analysis times and full-scanning sensitivities were similar for both methods, with differences being associated with sample matrix, ease of ionization and compound volatility. GC-MS would be preferred for organic extracts and must be used for the determination of mustard and relatively non-polar organosulfur degradation products, including 1,4- thioxane and 1,4-dithiane, as these compounds do not ionize during ESI-MS. Diols, formed following hydrolysis of mustard and longer-chain sulfur vesicants, may be analyzed using both methods with LC-ESI-MS providing improved chromatographic peak shape. Aqueous samples and extracts would, typically, be analyzed by LC-ESI-MS, since these analyses may be conducted directly without the need for additional sample handling and/or derivatization associated with GC-MS determinations. Organophosphorus compounds, including chemical warfare agents, related compounds and lower volatility hydrolysis products may all be determined during a single LC-ESI- MS analysis. Derivatization of chemical warfare agent hydrolysis products and other compounds with hydroxyl substitution would be required prior to GC-MS analysis, giving LC-ESI-MS a definite advantage over GC-MS for the analysis of samples containing chemical warfare agents and/or their hydrolysis products.

Biodegradation, Environmental↗
PubMed2002

[The spectrum of symptoms associated with biological warfare].

BACKGROUND: There are hundreds of potential agents that could be used in biological warfare or bioterrorism: bacteria, viruses and toxins. There are no similarities between clinical presentations of organisms or toxins belonging to specific microbial families. Therefore, it is important for the physician, required to cope with an unusual disease or outbreak among his patients, to become familiar with the various symptoms that victims of biological warfare or bioterrorism may present. METHODS: To describe the six most common groups of symptoms expected in the above setting. The most common symptoms will be described as they appear in nature, because of a fortunate lack of experience with the majority of these agents in biological warfare. Hence, variations of these presentations may be possible. RESULTS: The six most common presentations reviewed are: 1) respiratory tract symptoms; 2) hemorrhagic fevers; 3) meningitis and encephalitis; 4) flaccid paralyses; 5) fever syndromes with rash; and 6) diarrheal syndromes. Additional presentations may be possible due to alterations made in these organisms or development of new agents and mixtures. A list is provided of features that may alert a physician of the possibility of biological warfare or bioterrorism. CONCLUSION: Knowledge of the principal clinical presentations of victims of biological warfare or bioterrorism is essential to all physicians. This knowledge may contribute to the early recognition of a cluster of patients, an epidemic, an unusual disease, or biological warfare; quick referral to the emergency department, leading to early microbiological diagnosis; and rapid notification of the Ministry of Health. All these, and the institution of appropriate measures, will ultimately contribute to the survival of individual patients and at-risk populations.

Biological Warfare↗
PubMed2003

Chemical warfare and the Gulf War: a review of the impact on Gulf veterans' health.

It is unlikely that Gulf War veterans are suffering chronic effects from illnesses caused by chemical warfare nerve agent exposure. Extensive investigation and review by several expert panels have determined that no evidence exists that chemical warfare nerve agents were used during the Gulf War. At no time before, during, or after the war was there confirmation of symptoms among anyone, military or civilian, caused by chemical warfare nerve agent exposure. However, studies of Gulf War veterans have found belief that chemical weapons were used, significantly associated with both severe and mild-moderate illnesses. The psychological impact of a chemical warfare attack, either actual or perceived, can result in immediate and long-term health consequences. The deployment or war-related health impact from life-threatening experiences of the Gulf War, including the perceived exposure to chemical warfare agents, should be considered as an important cause of morbidity among Gulf War veterans.

Chemical Warfare↗
PubMed1990

Chromatographic analysis of chemical warfare agents.

The usefulness and applications of the particular types of chromatography in the analysis of chemical warfare agents have been reviewed. A major problem in the chromatographic analysis of chemical warfare agents is the collection and preparation of the samples. The importance of this problem differs for the various types of chromatography. Significant differences occur in the way in which samples are collected from air, water, soil, vegetables or animal organisms. The analyses are characterized by the main groups of chemical warfare agents, e.g., organophosphorus, vesicants, irritants, etc. Account has been taken of the relationships between their properties and the possibilities of their chromatographic analysis. The advantages and disadvantages of particular types of chromatography in the analysis of the particular groups and individual agents have been considered. The detectability of particular chemical warfare agents has been assessed, together with the separating efficiency for their mixtures. Examples of applications of chromatographic systems and conditions of chromatographing are summarized in tables. It is concluded that chromatography is a very useful tool in the analysis of chemical warfare agents; GC and TLC have the most advantageous properties, HPLC being slightly inferior.

Animals↗
PubMed2004

Intraosseous vascular access in the treatment of chemical warfare casualties assessed by advanced simulation: proposed alteration of treatment protocol.

UNLABELLED: Current treatment protocols for chemical warfare casualties assume no IV access during the early treatment stages. Time constraints in mass casualty scenarios, impaired manual dexterity of medical personnel wearing protective gear, and victims' complex clinical presentations render standard IV access techniques impractical. A newly developed spring-driven, trigger-operated intraosseous infusion device may offer an effective solution. Sophisticated simulators were developed and used to mimic scenarios of chemical warfare casualties for assessing the feasibility of intraosseous infusion delivery. We evaluated the clinical performance of medical teams in full protective gear. The success rate in intraosseous insertion, time to completion of treatment goals, and outcome were measured in a simulated setting. Medical teams from major hospitals in Israel, designated for emergency response in a real chemical warfare mass casualty scenario, were trained in a simulated setting. All 94 participating physicians were supplied with conventional treatment modalities: only the 64 study group physicians received intraosseous devices. The simulated survival rate was 73.4% for the study group and 3.3% for the controls (P < 0.001). Treatment goals were achieved within 3.5 min (range, 1-9 min) in the study group and within >10 min for controls (P < 0.001), and the complication rate for intraosseous use was 13.8%. Personnel satisfaction with the intraosseous device was unanimous and high. New-generation intraosseous infusions have great potential value in the early treatment stages of chemical warfare casualties. IMPLICATIONS: In a chemical warfare mass casualty scenario, the protective gear worn by medical personnel, the time constraints, and the casualties' medical condition impose limitations on the establishment of IV access during early treatment of the victims. A spring-driven, trigger-operated intraosseous infusion delivery system may offer an effective solution.

Chemical Warfare↗
PubMed2004

Biological warfare--an emerging threat.

As we approach the 21st century, there is an increasing worldwide awareness and threat regarding the use of biological warfare agents both for war and terrorist attack. Biological agents include microorganisms or biological toxins that are used to produce death in humans, animals and plants. They are characterized by low visibility, high potency, substantial accessibility and relatively easy delivery. Biological warfare agents are unconventional weapons that can be delivered by unconventional means like aerosol sprays, food and water contamination, conventional explosive munitions or by covert injections. Because of their concealed delivery, easy transportation and difficult identification they are readily adaptable for terrorist operations or to gain political advantages. The detection of such attack requires recognition of the clinical syndromes associated with various biological warfare agents. Diagnosis can be made on clinical grounds and on investigations. Protective measures can be taken against biological warfare agents. These should be implemented early (if warning is received) or later (once suspicion of agent use is made). After the confirmation of diagnosis emergency medical treatment and decontamination are performed in rapid sequence. Patients are then evacuated and specific therapy is given according to the agent involved. Appropriate emergency department and hospital response could significantly limit the morbidity and mortality of biological warfare agents.

Biological Warfare↗