Nerve attacks

Rotenberg, J.S., Newmark, J. (2003). Nerve attacks on children diagnosis and management. Pediatrics 112 648-58. 

To further exemplify the importance of cultural diversity and minority concerns, Leon and Dziegielewski (1999) identify two culture-bound syndromes that are of particular importance when working with Hispanics. These two conditions are ataque de nervios (nerve attacks) (p. 847) and susto (fright or soul loss) (p. 848) and are listed as culture-bound syndromes in the DSM-IV. These conditions often exist within the culture and can resemble certain mental disorders but they may be interpreted as dysfunctional in mainstream society by the professional who is unaware (American Psychiatric Association, 1994). Yet these syndromes are not considered mental disorders (although they may resemble the signs and symptoms of certain mental disorders) and are commonly accepted among many Hispanic cultures. 

The modem history of the military use of toxic chemical agents (1,3—5) dates from the first full-scale (chlorine) gas attack on April 22, 1915, near Ypres, Belgium in World War I. There were a few reports of the limited use of toxic chemicals since that time. The Italians employed mustard, a bUster agent, during the Ethiopian war in 1935 and 1936 the Japanese used toxic chemicals in a number of small-scale engagements in the early years of their war with China and Iraq purportedly employed both mustard and nerve gases in the 1980s. 

Not all toxic organophosphoms compounds have uses beneficial to humans. Sarin is an extremely toxic nerve gas that is lethal to humans. In March 1995 this substance was released in a terrorist attack on a Japanese subway, resulting in several deaths and many serious injuries. Sarin and related nerve gases bind an amino acid in the enzyme responsible for muscle action. When this enzyme is deactivated, muscles contract but cannot relax. Even a small dose can be lethal if the nerve gas reaches the muscles of the heart. 

The interplay between the chemical and biological properties of the threat agent, on the one hand, and the specific attack scenario, on the other, can influence the lethality of the attack. Table 2-2 shows the relative respiratory toxicities (expressed as the lethal concentration of toxin at which 50 percent of test animals are killed, or LCT50, in milligrams per minute per cubic meter) of a variety of toxic gases compared with chlorine gas, which was used as a chemical weapon in World War I. According to Table 2-2, the nerve agent sarin (GB) has a respiratory toxicity approximately 100 times that of chlorine, while sulfur mustard (HD) is about 7 times more toxic. However, the lethality of an attack... 

There are as many incidents of poisoning by OPPs as there are by OCPs [12, 40, 46, A8]. All OPPs are polytropic poisons. Changes are observed in the brain nerve cells of victims of acute OPP poisoning. Acute poisoning accompanied by diffuse damage to the central nervous system causes attacks similar to epileptic fits when symptoms of clinical poisoning have already... 

Stroke A transient ischaemic attack or cerebrovascular accident due to occlusion (blockage) of blood vessels supplying an area of the brain. The subsequent nerve cell death may result in major disability. 

CX is very different from other blister agents in that it attacks whatever tissue it contacts, such as skin, muscle, and nerves. Its impact on nerves is intense unremitting pain. When CX comes in contact with skin, it leaves a blanched area (bleached appearance) within 30 seconds where it has been absorbed into the skin. A red rash-like ring immediately forms around the affected area. Within a day, the blanched area and rash will turn dark as broken-down skin pigment pools near the surface. A scab will form over the area in about a week. This scab will fall off approximately 3 weeks later. Immediate death from systemic shock or trauma is possible. Healing may take as long as 1 year in severe cases. 

Any rational approach to the study of antidotes for nerve-gas poisoning must take this firm attachment into account. It has been observed that, in experiments in vitro, the D.F.P.-poisoned heart recovers to an appreciable extent in the presence of hydroxylamine. With this experiment in mind I. B. Wilson1 has examined the action of hydroxylamine derivatives and has had considerable success with nictonic hydroxamic acid meth-iodide (IV). The reaction envisaged here is a nucleophilic attack... 

Hopkins replied to their letter on March 14, 1913- (33) He apologized for the tone of the Biochemical Journal note "The fact is I have done so much work in this (not very successful) endeavour to separate the unknown substances which affect growth, that when your paper. ..came out I suffered from an attack of nerves." (3 0 Hopkins went on to discuss his success with feeding small quantities of milk to growing rats, and said that the story was clear under his experimental conditions. Furthermore, he commented that the organic constituents which he labeled, exogenous... 

In 1976, another vaccine case illustrated how dangerous a mistake involving vaccines can be. Between October 1,1976 and December 14,1976, more than 40 million people were vaccinated against swine flu (a virus similar to fhe 1918 Spanish flu virus fhaf killed so many during World War I). The feared epidemic never manifested, buf fhere was a tenfold increase in CBS (in which fhe body s immune system attacks its peripheral nerves), which thousands of people confracfed. 

Certain organic forms of mercury can elicit specific damage in the main cell body of peripheral neurons. Similar responses are associated with certain natural products called vincristine and vinblastine, both of which have been used as antileukemic medicines. The deadly botulinum toxins, mentioned earlier in this chapter, block transmission of nerve impulses at the synapses of motor neurons. This blockage results in muscular paralysis which, if sufficiently severe, can lead to death, usually because respiration is impaired. The once widely used pesticide, DDT, is an organic chemical that also acts on the nervous system at this site, although it can also mount an attack on areas of the CNS. 

In Japan, a number of years ago, a terrorist attack with sarin killed a dozen individuals confined to a subway car out of roughly a thousand people in the nearby vicinity. Sarin has little effect on the skin, due to rapid evaporation. It is true that the Iraqis killed many Kurds with nerve gas, but the victims were unprepared, had no training, no detection devices, no masks or other protection, no antidote and no practical way to avoid the gas. None of these vulnerabilities would be the case in a conflict with American troops. 

Why have there been no terrorist attacks with nerve agents in the many months since 9-11 The answer seems obvious chemical weapons are not particularly effective At best, they cause deaths in a circumscribed area where there is no protection and no escape. Two hundred kilograms of conventional high explosive, (the capacity of a SCUD missile) can cause more deaths than the same amount of "nerve gas." Any statement that such agents will cause tens of thousand of casualties is gross hyperbole. What is worse, it unnecessarily fans the flames of panic. 

I am puzzled by the failure of the Department of Defense and/or the Secretary of Homeland Security to issue more realistic guidance concerning the actual likelihood (or lack thereof) of Americans becoming victims of a "nerve gas" attack. Perhaps the Times can have some beneficial influence in this regard. 

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