Alert Sounds for the VA Gulf War Task Force to Get it Right This Time and Alert for the Veterans of the Gulf War 1990-91 with Respiratory Complaints

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Gulf War Veterans that have had extensive respiratory changes in basic measurement on lung functions and vital capacity need to remember to assess data gather in the early 90’s during the Comprehensive Clinical Evaluation Examination Program(CCEEP) and their medical records since those examinations. The veterans might also want to assess any of the DOD required physicals for documentation of respiratory functions.

Again the VA needs to look to the past records of WWI veterans with Mustard gas exposures and to the two landmark Gulf War illness Reports ie Senator Reigle and Senator Rockfeller in 1994. We are encouraged by the new spirit that appears to be at VA Headquarters in DC. The 2 reports mentioned approve may still have classified versions of the reports. In addition the Senate Select Committee had a report that was done on Gulf War Exposures that needs to be dusted off and reviewed.

Gulf War Veterans 90-91 that have had significant respiratory problems need to have a look at the following two Research articles that relate Respiratory problems with Mustard Gas.

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Hum Exp Toxicol. 2009 Dec;28(12):739-45. http://www.ncbi.nlm.nih.gov/pubmed/19919970

Highly sensitive C-reactive protein levels in Iranian patients with pulmonary complication of sulfur mustard poisoning and its correlation with severity of airway diseases.
Attaran D, Lari SM, Khajehdaluee M, Ayatollahi H, Towhidi M, Asnaashari A, Marallu HG, Mazloomi M, Mood MB.

Lung disease and tuberculosis research center, Mashhad University of Medical Sciences, Iran.

BACKGROUND: Sulfur mustard (SM) is a chemical warfare agent that can cause serious pulmonary complications. This study was designed to determine serum highly sensitive C-reactive protein (hs-CRP) and evaluate its correlation with lung function parameters in patients with chronic obstructive pulmonary disease (COPD) due to SM poisoning. METHODS: Fifty consecutive SM patients with stable COPD and a mean age 46.3 +/- 9.18 years were enrolled in this cross sectional study. Thirty healthy men were selected as controls. Lung function parameters were evaluated. Serum hs-CRP by immunoturbidometry assay was measured in both the patients and controls. RESULTS: In the case group, the mean forced expiratory volume in one second (FEV1) was 2.14 +/- 0.76 L (58.98% +/- 17.51% predicted). The mean serum hs-CRP was 9.4 +/- 6.78 SD and 3.9 +/- 1.92 SD mg/L in the cases and controls, respectively, with significant statistical differences (p < .001). There was negative correlation between the serum hs-CRP and FEV1 levels (p = .01). The serum hs-CRP levels were also correlated with Global Initiative for Chronic Obstructive Lung disease (GOLD) stages (r = .45, p < .001).

CONCLUSIONS: Our findings suggest that the serum hs-CRP level is increased in SM patients with COPD and may have a direct correlation with disease severity. It may then be used as a marker for the severity of COPD in patients with SM poisoning. PMID: 19919970 [PubMed – indexed for MEDLINE]

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http://www.ncbi.nlm.nih.gov/pubmed/19876850

 J Med Toxicol. 2009 Dec;5(4):191-5. Long-term complications of sulphur mustard poisoning in intoxicated Iranian veterans. Namazi S, Niknahad H, Razmkhah H. Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Science, Shiraz, Iran.

INTRODUCTION: Sulphur mustard (SM) is an alkylating chemical warfare agent that was widely used during the Iran-Iraq conflict(1980-1988). Delayed complications of SM in different organs were evaluated in this study. METHODS: This cross-sectional study was performed from March 2005 to June 2006. The Veterans Foundation provided us with the files of all chemical warfare-poisoned patients in the province of Fars, Iran. Clinical manifestations, laboratory data, and demographic characteristics of the patients were recorded from their files and a face-to-face interviews. Data analysis was performed by student t test statistical method. RESULTS: A total of 134 patients were enrolled in the study. The age range of the patients was 32-45 (37.2+/-9) years. SM poisoning was confirmed 19.5+/-1.6 (17-22) years after initial exposure. The duration of exposure in patients was 13.35+/-8.7 (1.5-48) hours. The most common complication was found in the lungs (100%), skin (82.84%), and eyes (77.61%). The most frequent medications used for the treatment of these complications were: bronchodilators, drugs used for dermatological problems, and drugs used for ocular complications. Analytical study showed no association between the age of exposed patients and the severity of toxic complications (p>.05), but there was a significant association between the duration of exposure and the number of complications (p<.05).

CONCLUSION: Results of this study indicate that respiratory complications generally increase over time. Therefore, follow-up of veterans exposed to SM is recommended. This may lead to early diagnosis of SM complications and help prevent the late manifestations of this toxicity.

PMID: 19876850 [PubMed – indexed for MEDLINE]

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