Regular review: Chemical weapons

Evison, Demetrius; Hinsley, D E; Rice, Paul

doi:10.1136/bmj.324.7333.332

Cited by 165 publications

(56 citation statements)

References 12 publications

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“…Mustard is a poisonous chemical agent that exerts a local action on the eyes, skin and respiratory tissue, with subsequent systemic action on the nervous, cardiac and digestive systems in humans and laboratory animals [1]. Consequently, this agent can have serious side effects in humans [2]. The lung is one of the most exposable organs to chemical warfare agents.…”

Section: Introductionmentioning

confidence: 99%

Airway Hyperresponsiveness to Methacholine in Chemical Warfare Victims

Mirsadraee

Attaran²,

Boskabady³

et al. 2005

Respiration

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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.

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Section: Introductionmentioning

confidence: 99%

Airway Hyperresponsiveness to Methacholine in Chemical Warfare Victims

Mirsadraee

Attaran²,

Boskabady³

et al. 2005

Respiration

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“…The next attack by this group was performed in the subway with the toxic gas Sarin. Nineteen persons were killed and nearly a thousand others required medical assistance (Klietman and Ruoff 2001;Lathrop and Mann 2001;Evison et al 2002) 1998 Mail items suspected of containing of Bacillus anthracis were found in several hospitals performing abortions in the USA. The FBI announced the arrests of microbiologist Larry Wayne Harris Larry and William Job Leavitt, Jr., in the USA, who threatened the government with a Bacillus anthracis attack 2001 An unknown person or persons sent mail infected with Bacillus anthracis from New Jersey, USA (Klietman and Ruoff 2001;Budowle et al 2007;Friedman et al 2008;Brower 2003;Olson 1999;Guarner et al 2003) microbiology, biochemistry, defense, and others, procedures are prepared for the protection of science and the community against the dual use of biological research (Sandhu et al 2003).…”

Section: Terrorism and Bioterrorismmentioning

confidence: 99%

The Potential Dual Use of Online Pharmacies

Letkiewicz

Górski

2009

Sci Eng Ethics

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The technological advances of the 20th century resulted in the creation of the Internet and its introduction into everyday life on a global scale. The Internet provides access to information and the sale and purchase of goods. Medications are also subject to trade. Their sale is conducted by online pharmacies and their global turnover amounts to hundreds of billions of dollars. Medications ordered over the Internet are sent by mail all over the world. Considering the events of recent years, we cannot exclude the risk of a terrorist attack through online pharmacies. Terrorists can establish such companies, legally or illegally, or acquire ones already existing. Parcels, which are highly trusted by the customers of online pharmacies, can, for example, be contaminated with dangerous materials. The sale of online medications in the international system is potentially dangerous and requires international regulation.

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“…Chemical warfare (CW) has been widely condemned since it was first used on a massive scale during World War 1 (WW1) [2]. Chlorine (Cl 2 ) was the first lethal chemical to be released and continues to present a threat, most recently being employed in attacks with vehicle-borne improvised explosive devices in Iraq [3].…”

Section: The Issuementioning

confidence: 99%

“…The psychological impact of CW agents on society makes them ideal for terrorism [2], as shown by the coordinated release of the nerve gas sarin in the Tokyo subway system in 1995 by Aum Shinrikyo. The attack was directed against trains passing through Kasumigaseki and Nagatachō stations, close to the seat of the Japanese Government.…”

Section: The Issuementioning

confidence: 99%

The injured lung: clinical issues and experimental models

Jugg

Smith

Rudall

et al. 2011

Phil. Trans. R. Soc. B

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Exposure of military and civilian populations to inhaled toxic chemicals can take place as a result of deliberate release (warfare, terrorism) or following accidental releases from industrial concerns or transported chemicals. Exposure to inhaled toxic chemicals can result in an acute lung injury, and in severe cases acute respiratory distress syndrome, for which there is currently no specific medical therapy, treatment remaining largely supportive. This treatment often requires intensive care facilities that may become overwhelmed in mass casualty events and may be of limited benefit in severe cases. There remains, therefore, a need for evidence-based treatment to inform both military and civilian medical response teams on the most appropriate treatment for chemically induced lung injury. This article reviews data used to derive potential clinical management strategies for chemically induced lung injury.

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Regular review: Chemical weapons

Cited by 165 publications

References 12 publications

Airway Hyperresponsiveness to Methacholine in Chemical Warfare Victims

Airway Hyperresponsiveness to Methacholine in Chemical Warfare Victims

The Potential Dual Use of Online Pharmacies

The injured lung: clinical issues and experimental models

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