Computer-assisted evaluation of small airway disease in CT scans of Iran-Iraq war victims of chemical warfare by a locally developed software: comparison between different quantitative methods.

OBJECTIVE: Diagnosis of small airway disease on computed tomography (CT) scans is challenging in patients with a history of chemical warfare exposure. We developed a software package based on different methodologies to identify and quantify small airway disease in CT images. The primary aim was to identify the best automatic methodology for detecting small airway disease in CT scans of Iran-Iraq War victims of chemical warfare. METHODS: This retrospective case-control study enrolled 46 patients with a history of chemical warfare exposure and 27 controls with inspiratory/expiratory (I/E) CT scans and spirometry tests. Image data were automatically segmented, and inspiratory images were registered into the expiratory images' frame using the locally developed software. Parametric response mapping (PRM) and air trapping index (ATI) mapping were performed on the CT images. Conventional QCT methods, including expiratory/inspiratory mean lung attenuation (E/I MLA) ratio, normal density E/I (ND E/I) MLA ratio, attenuation volume Index (AVI), %low attenuation areas (LAA) < -856 in exhale scans, and %LAA < -950 in inhale scans were also computed. QCT measurements were correlated with spirometry results and compared across the two study groups. RESULTS: The correlation analysis showed a significant negative relationship between three air trapping (AT) measurements (PRM, ATI, and %LAAExp < -856) and spirometry parameters (Fev1, Fvc, Fev1/Fvc, and MMEF). Moreover, %LAAExp < -856 had the highest significant negative correlation with Fev1/Fvc (r = -0.643, P-value < 0.001). Three AT measurements demonstrated a significant difference between the study groups. The E/I ratio was also significantly different between the two groups (P-value < 0.001). Binary logistic regression models showed PRMFsad, %LAAExp < -856, and ATI as significant and strong predictors of the study outcome. Optimal cut-points for PRMFsad = 19%, %LAAExp < -856 = 23%, and ATI = 27% were identified to classify the participants into two groups with high accuracy. CONCLUSION: QCT methods, including PRM, ATI, and %LAAExp < -856 can greatly advance the identification and quantification of SAD in chemical warfare victims. The results should be verified in well-designed prospective studies involving a large population.

Chemical Warfare in Ancient Greek Ionia: Mass Intoxication With Hecate's Deleterium.

The rich land of Erythrae in the coast of Asia Minor attracted the attention of the Ionian king Codrus. An oracle demanded the presence of the murky deity Hecate for him to conquer the city. Priestess Chrysame was sent by Thessalians to set the strategy of the clash. The young sorceress poisoned a sacred bull who turned mad, later to be released toward the camp of Erythraeans. The beast was captured and sacrificed. In the feast that followed, all ate a piece of his flesh and went crazy, stimulated by the poison, an easy prey for the army of Codrus. The deleterium used by Chrysame is unknown, but her strategy shaped the origin of biowarfare.

Warning system for potential releases of chemical warfare agents from dumped munition in the Baltic Sea.

The research aimed to determine the scale of the potential contamination of the southern Baltic by substances from dumped chemical weapons, in the context of applying a strategy for detecting the potential releases of toxic materials. The research included the analysis of total arsenic in sediments, macrophytobenthos, fish, and yperite with derivatives and arsenoorganic compounds in sediments and as an integral part of the warning system the threshold values for arsenic in these matrices were set. Arsenic concentrations in sediments ranged from 11 to 18 mg kg-1 with an increase to 30 mg kg-1 in layers dated to 1940-1960, what was accompanied by the detection of triphenylarsine (600 mg kg-1). The presence of yperite or arsenoorganic-related chemical warfare agents was not confirmed in other areas. Arsenic ranged from 0.14 to 1.46 mg kg-1 in fish and from 0.8 to 3 mg kg-1 in macrophytobenthos.

A Hidden Gem: Highlighting the Indispensable Capabilities and History of the DoD Cholinesterase Monitoring Program and DoD Cholinesterase Reference Laboratory.

The DoD Cholinesterase Monitoring Program and Cholinesterase Reference Laboratory have safeguarded U.S. government employees in chemical defense for over five decades. Considering Russia's potential deployment of chemical warfare nerve agents in Ukraine, it is critical to maintain a robust cholinesterase testing program and its efficiency presently and in future.

Acute care for patients exposed to a chemical attack: protocol for an international multicentric observational study.

INTRODUCTION: The use of weapons of mass destruction against civilian populations is of serious concern to public health authorities. Chemical weapons are of particular concern. A few studies have investigated medical responses in prehospital settings in the immediate aftermath of a chemical attack, and they were limited by the paucity of clinical data. This study aims to describe the acute management of patients exposed to a chemical attack from the incident site until their transfer to a medical facility. METHODS AND ANALYSIS: This international multicentric observational study addresses the period from 1970 to 2036. An online electronic case report form was created to collect data; it will be hosted on the Biomedical Telematics Laboratory Platform of the Quebec Respiratory Health Research Network. Participating medical centres and their clinicians are being asked to provide contextual and clinical information, including the use of protective equipment and decontamination capabilities for the medical evacuation of the patient from the incident site of the chemical attack to the moment of admission at the medical facility. In brief, variables are categorised as follows: (1) chemical exposure (threat); (2) prehospital and hospital/medical facility capabilities (staffing, first aid, protection, decontamination, disaster plans and medical guidelines); (3) clinical interventions before hospital admission, including the use of protection and decontamination and (4) outcomes (survivability vs mortality rates). Judgement criteria focus on decontamination drills applied to any of the patient's conditions. ETHICS AND DISSEMINATION: The Sainte-Justine Research Centre Ethics Committee approved this multicentric study and is acting as the main evaluating centre. Study results will be disseminated through various means, including conferences, indexed publications in medical databases and social media. TRIAL REGISTRATION NUMBER: NCT05026645.

Healthcare Utilization and Expenditures among Iranian Chemical Warfare Survivors Exposed to Sulfur Mustard.

BACKGROUND: This study aims to explore the healthcare utilization (HCU) and expenditures from complementary health insurance among Iranian people who survived sulfur mustard (SM) exposure during the Iran-Iraq war. METHODS: This study was conducted between March 21, 2018 and March 21, 2019 using secondary data. Data on the HCU and expenditure of war survivors after their exposure to SM were obtained from the Iran Veterans and Martyr Affair Foundation (VMAF) database and the national complementary insurance organization that covers their medical expenses. Multiple linear and zero-inflated poison regression (ZIP) models were used to estimate the costs and HCU. Analyses were performed in R software version 3.6.3. RESULTS: Among 58880 survivors who were included in study, 36383 (61.7%) used at least one service during a year. The total frequency of HCU was 15.6 services per person per year. The annual mean medical cost of each survivor was US$807.6 (±2901.2). The highest number of utilizations was related to medicine and physician visits. The highest median cost was related to rehabilitation (US$151.7), medical equipment (US$84.5), medicine (US$83.3) and inpatient services (US$ 48.8). With increasing age, disability, weight, severity of injury in lung or eye injuries, the rate of health service utilization rose significantly. CONCLUSION: Over 30 years after the Iran-Iraq war, Iranian people who were exposed to SM and survived still suffer from injuries and pose a significant drain on healthcare resources.

Implications of Neurological Directed-Energy Weapons for Military Medicine.

Since 2016, there has been an increase in reported cases of intelligence officers and diplomats hearing pulsing sounds and experiencing neurophysiologic and cognitive symptoms. These varied and often intense symptoms manifest in ways similar to a traumatic brain injury (TBI) but without inciting trauma. Known formerly as "unconventionally acquired brain injury" (UBI), these events are now labeled "anomalous health incidents" (AHIs). Investigations of these incidents suggest reasons to be concerned that a specific type of neuroweapon may be the cause-a directed energy weapon (DEW). Neuroweapons that target the brain to influence cognition and behavior are leading to a new domain of warfare-neurowarfare. The implications and resultant stakes, especially for the Special Operations community, are significant. This article focuses specifically on the implications of DEWs as a neuroweapon causing UBIs/AHIs for military medical practitioners and suggests using a comprehensive strategy, analogous to that of chemical warfare or other weapons of mass destruction (WMD), to improve our preparedness for the medical repercussions of neurowarfare.

CTAB-functionalized δ-FeOOH for the simultaneous removal of arsenate and phenylarsonic acid in phenylarsenic chemical warfare.

This study prepared a cetyltrimethylammonium bromide (CTAB) functionalized δ-FeOOH using the coprecipitation method to remove arsenate and phenylarsonic acid in water polluted by phenylarsonic chemical warfare agents. Under neutral conditions, the adsorption capacity for arsenate and phenylarsonic acid was 45.7 and 85.3 mg g-1, respectively. The adsorption process conformed to the pseudo-second-order kinetics and Freundlich isothermal adsorption model, and the adsorption was spontaneous and endothermic. The CTAB-functionalized δ-FeOOH could effectively resist the interference of coexisting anions except for CO32-, SiO32- and PO43-. Furthermore, the adsorption mechanism was proposed by combining the adsorption experimental results, Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, and density functional theory analyses. The results showed that the adsorption of arsenate by the CTAB-functionalized δ-FeOOH was mainly through the formation of bidentate-dinuclear inner-sphere complexes and electrostatic interactions. While for phenylarsonic acid, the formation of monodentate-mononuclear inner-sphere complexes on (100) and (110) crystal facets, and the formation of bidentate-dinuclear inner-sphere complexes on the (002) crystal facet, as well as hydrogen bonding, electrostatic interaction, and π-hydrophobic interaction between organic compounds were the primary mechanism. Moreover, the CTAB-functionalized δ-FeOOH could maintain about 60% of the adsorption capacity for the two pollutants after five cycles. Overall, CTAB-functionalized δ-FeOOH has good potential for the remediation of inorganic and organic arsenic-contaminated water bodies.

Sulfur mustard and biological ageing: A multisystem biological health score approach as an extension of the allostatic load in Sardasht chemical veterans.

BACKGROUND: Mustard gas as a chemical weapon has been used in wars and its long-term side effects are substantial in the human body. This study was aimed to apply an extension of allostatic load, known as synthetic biological health score (BHS), including the wear-and-tear of four physiological systems (endocrine, inflammatory, cardiovascular and metabolic systems) and two organs (liver and kidney) to estimate biological aging caused by sulfur mustard (SM) gas poisoning. METHODS: The plasma samples were prepared from two following groups of people; 1) 446 individuals exposed to SM gas in 1987. 2) 115 healthy members, at the same range of age and residence, as the non-exposed group. These people were chosen from the same patients' families and have not had any exposure to SM or pulmonary dysfunction. To estimate BHS, 18 blood-derived biomarkers of the mentioned systems and organs were measured and the relative contribution of many social and body parameters across the age groups was explored. RESULTS: It was revealed, in BHS calculation, the cardiovascular system had the most effect. Also, in the SM group, BHS was significantly higher than in the control group. This feature has a positive correlation with physical parameter (BMI) and a negative correlation with social parameters (salary and educational levels). CONCLUSION: The multisystem BHS could be useful in the evaluation of biological aging due to SM exposure. Social (education, good-paying job) and physical (BMI) parameters could influence BHS and the higher BHS indicates the progress of biological aging due to mustard gas.

A randomized controlled trial of a forgiveness intervention program with female acid attack survivors in Pakistan.

Despite the traumatic effects of acid violence on its victims, treatment options are very limited. The present study was aimed at examining the efficacy of a forgiveness intervention with female survivors of acid attack violence in Pakistan. Female acid attack victims in Pakistan were randomized to either a forgiveness group (n = 8) or a treatment-as-usual (TAU; n = 8) control group. The forgiveness group received twice-a-week forgiveness sessions for 4 months, whereas the TAU group either received typical psychological treatment sessions for acid attack victims or no treatment. All participants were assessed on their levels of forgiveness, anger, anxiety, depression, and hope four times prior to the 4-month intervention period, twice after the intervention period, and once at the 1-year follow-up. Posttreatment, the forgiveness intervention group showed greater improvement in hope, anger, anxiety, and depression when compared with the TAU group. Upon further examinations, both groups improved on forgiveness from pretreatment to posttreatment, but the forgiveness group had a higher baseline. From pretreatment to the 12-month follow-up, the forgiveness group, when compared with the TAU group, showed greater improvement in all areas except for depression. This is the first study that examined the effects of a forgiveness intervention for acid attack victims in Pakistan. Results showing the improvement posttreatment as well as over a 1-year period posttreatment are encouraging.

Follicular pathway role in chemical warfare simulants percutaneous penetration.

Chemical warfare (CW) exposure could be fatal to military and civilians through skin contamination. Our work and others focus on investigating stratum corneum reservoir with less regards to skin appendageal routes including hair follicles. Here, C-14 CW simulants (CWS) with specific activity of 0.1 mCi/ml were tested on abdominal and scalp human cadaver skin using flow-through diffusion system. Quantitative analysis of simulants in skin compartments were performed using scintillation counter. Scalp permeation of dipropylene glycol monomethyl ether (DPGME), diisopropyl methylphosphonate (DIMP) and methyl salicylate (MeS) exceed abdominal skin by 8%, 15%, and 6% (p value < 0.05) of applied dose, respectively. DPGME and DIMP (most hydrophilic) showed earlier permeation peak time (Tmax) through scalp skin at 2 and 4 h, respectively, comparing with 6 h with abdominal skin. The percentage of applied dose of DPGME and DIMP retained in human skin membrane (SC, epidermis, and viable dermis) showed no statistically significant difference between tested abdominal and scalp skin samples (p value >0.05). The percentage of applied dose of MeS in scalp showed higher partitioning in stratum corneum and viable epidermis than abdominal skin (p value <0.05). In conclusion, human scalp showed greater total skin absorption than abdominal skin. This work points to a qualitative importance of high follicular density body regions in percutaneous penetration and suggests that transfollicular pathway might have a significant role in early stage permeation of chemical warfare simulants. However, the difference noticed here between scalp and abdominal skin could be attributed to regional variability in anatomy, physiology, and barrier characteristics.

Luminescent Europium(III) "Turn-On" Sensor for G-Series Chemical Warfare Simulants: A Mechanistic Investigation.

A thermodynamically stable terpyridine-dicarboxylate based emissive Eu(III) probe, [Eu(OH-TPDC)] (1), was designed as a time-resolved "turn-on" luminescent probe for the selective sensing of diethyl chlorophosphate (DCP), a G-series nerve agent simulant through modulation of sensitization of 5D0 → 7FJ transitions from Eu(III) via quenching of nonradiative vibrational energy transfer.

Acetylcholinesterase: The "Hub" for Neurodegenerative Diseases and Chemical Weapons Convention.

This article describes acetylcholinesterase (AChE), an enzyme involved in parasympathetic neurotransmission, its activity, and how its inhibition can be pharmacologically useful for treating dementia, caused by Alzheimer's disease, or as a warfare method due to the action of nerve agents. The chemical concepts related to the irreversible inhibition of AChE, its reactivation, and aging are discussed, along with a relationship to the current international legislation on chemical weapons.

Counteracting poisoning with chemical warfare nerve agents.

Phosphylation of the pivotal enzyme acetylcholinesterase (AChE) by nerve agents (NAs) leads to irreversible inhibition of the enzyme and accumulation of neurotransmitter acetylcholine, which induces cholinergic crisis, that is, overstimulation of muscarinic and nicotinic membrane receptors in the central and peripheral nervous system. In severe cases, subsequent desensitisation of the receptors results in hypoxia, vasodepression, and respiratory arrest, followed by death. Prompt action is therefore critical to improve the chances of victim's survival and recovery. Standard therapy of NA poisoning generally involves administration of anticholinergic atropine and an oxime reactivator of phosphylated AChE. Anticholinesterase compounds or NA bioscavengers can also be applied to preserve native AChE from inhibition. With this review of 70 years of research we aim to present current and potential approaches to counteracting NA poisoning.

[Chemical warfare agents].

This review presents an overview of the different classes of chemical warfare agents and the toxidromes associated with these agents. An increasing terrorist threat to Denmark and the Danish armed forces operating internationally mandates increased awareness of chemical warfare agents in clinicians working with emergency and military medicine. Rapid recognition of the classical toxidromes produced by different classes of chemical warfare agents aids in providing the medical support necessary for reducing mortality and morbidity.

Biodegradation of Organophosphorus Compounds Predicted by Enzymatic Process Using Molecular Modelling and Observed in Soil Samples Through Analytical Techniques and Microbiological Analysis: A Comparison.

Organophosphorus compounds (OP) are chemicals widely used as pesticides in different applications such as agriculture and public health (vector control), and some of the highly toxic forms have been used as chemical weapons. After application of OPs in an environment, they persist for a period, suffering a degradation process where the biotic factors are considered the most relevant forms. However, to date, the biodegradation of OP compounds is not well understood. There are a plenty of structure-based biodegradation estimation methods, but none of them consider enzymatic interaction in predicting and better comprehending the differences in the fate of OPs in the environment. It is well known that enzymatic processes are the most relevant processes in biodegradation, and that hydrolysis is the main pathway in the natural elimination of OPs in soil samples. Due to this, we carried out theoretical studies in order to investigate the interactions of these OPs with a chosen enzyme-the phosphotriesterase. This one is characteristic of some soils' microorganisms, and has been identified as a key player in many biodegradation processes, thanks to its capability for fast hydrolyzing of different OPs. In parallel, we conducted an experiment using native soil in two conditions, sterilized and not sterilized, spiked with specific amounts of two OPs with similar structure-paraoxon-ethyl (PXN) and O-(4-nitrophenyl) O-ethyl methylphosphonate (NEMP). The amount of OP present in the samples and the appearance of characteristic hydrolysis products were periodically monitored for 40 days using analytical techniques. Moreover, the number of microorganisms present was obtained with plate cell count. Our theoretical results were similar to what was achieved in experimental analysis. Parameters calculated by enzymatic hydrolysis were better for PXN than for NEMP. In soil, PXN suffered a faster hydrolysis than NEMP, and the cell count for PXN was higher than for NEMP, highlighting the higher microbiological toxicity of the latter. All these results pointed out that theoretical study can offer a better comprehension of the possible mechanisms involved in real biodegradation processes, showing potential in exploring how biodegradation of OPs relates with enzymatic interactions.