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Biomedical subjects

Eran Rotman

Publications and source records attributed to Eran Rotman.

9 recordsLinked to original sources
PubMed2006

Civilian adult self injections of atropine-trimedoxime (TMB4) auto-injectors.

INTRODUCTION: The clinical effects of self injections of atropine-trimedoxime auto-injectors distributed to the civilian population as a field antidote for nerve agent attack were assessed. METHODS: Data on self injections by adults (> or = 18 years) were collected from the Israel Poison Information Center and a hospital Emergency Department's records during a 2-year period. The data included demographics, time interval from injection, type of auto-injector, clinical manifestations and atropinization score. RESULTS: Sixty-five patients, all with unintentional self injections, were reported. Systemic atropine effects were observed in 24 patients, but no severe atropinization. The atropinization score was significantly higher in the 2 mg atropine dose group than in the two lower dose groups, which were in the normal range. No specific adverse effects attributable to trimedoxime were observed. Intravenous fluids and physostigmine were not required. CONCLUSION: Only mild reactions were observed following self-injection of atropine trimedoxime auto-injectors in adults, attesting to their relative safety under these conditions.

Accidents↗
PubMed2005

Pharmacologic prophylaxis against nerve agent poisoning.

Nerve agent poisoning is characterized by the rapid progression of toxic signs, including hypersecretions, tremor, convulsions and profound brain damage. In the political arena of today's world, the threat of nerve agent use against military troops has prompted armies to search for prophylactic protection. The two main strategies for prophylaxis include biological scavengers that can bind or cleave nerve agents before they react with acetylcholinesterase, and antidotes as prophylactic treatment. Pyridostigmine is the current pretreatment for nerve agent poisoning and is in use by most of the armed forces in Western countries. However, since pyridostigmine barely crosses the blood-brain barrier it provides no protection against nerve agent-induced central injury. Pyridostigmine is ineffective when administered without post-exposure treatment adjuncts. Therefore, other directions for prophylactic treatment should be explored. These include combinations of carbamates (reversible AChE inhibitors) and central anticholinergics or NMDA receptor antagonists, benzodiazepines or partial agonists for benzodiazepine receptor, and other central AChE inhibitors approved for Alzheimer's disease. The transdermal route is an alternative way for delivering the prophylactic agent. Administration of prophylaxis can be extended also for civilian use during wartime.

Antidotes↗
PubMed2005

[Medical management in the chemical terrorism scene].

The Tokyo subway sarin attack in March 1995 demonstrated the importance of preparedness toward a chemical terrorist attack. Emergency medical teams on the scene are valuable, beside the medical treatment of casualties, in the cognition of toxicant involvement and later in the recognition of the specific toxidrome involved. The chemical terrorism scene is a contaminated area; therefore, first responders have to be protected from both percutaneous and inhalational exposure to toxic materials. This protection is also against secondary evaporation (gas-off) from contaminated casualty, hence the importance of disrobing casualties on the scene as soon as possible. Once the recognition of toxicological involvement have been made, the next crucial decision is whether the clinical toxidrome is of cholinergic toxicity (e.g. organophosphate or carbamate intoxication) in which there are automatic injectors for treatment available on the scene, or any other toxidrome (such as irritation or vesicants) in which, beside general measures, like oxygen delivery and airway support, there is not a specific antidotal treatment on the scene. The clinical detection and identification of the chemical toxidrome involved is of utmost importance since it promotes the antidotal treatment quickly and efficiently. The key to the medical management of such events is based on decisions that have to be taken as soon as possible according to the clinical judgment of medical teams on the scene.

Bioterrorism↗
PubMed2005

[Political poisoning with dioxins--a weapon of chemical "disgracefulness"].

The recent attempt to poison Ukrainian President, Viktor Yuschenko with dioxins, raised public concern regarding this toxic chemical. In industrial countries, there is a constitutive exposure of humans to dioxin compounds, which are formed as by-products in manufacturing processes of various chlorinated organic chemicals and in waste incinerators. Dioxins are extremely stable in the environment and have a low turnover rate in the body--sometimes they are detected years after the original exposure. Of the dioxins, the most notoriously famous is the TCDD (2,3,7,8 tetrachlorodibenzo-p-dioxin). Dioxins exhibit high acute toxicity in various animal species. Humans, however, are considered less susceptible and so far there were no reported deaths following acute dioxin poisoning. Nevertheless, numerous adverse health effects are attributed to dioxin exposure. The most prominent is the chloracne--an acute acneiform eruption, usually appearing on facial skin. There is a solid evidence base that some dioxins are carcinogens. Other long-term deleterious effects of dioxin include: immunosuppression, effects on reproduction, impairments in developmental, neurological and cognitive functions in infants, increased risk for diabetes and cardiovascular diseases and various hormonal alterations. The action of dioxins resembles that of hormones, since their toxicity is mostly receptor-mediated. Dioxins manifest their toxicity in extremely low concentrations. Although there are compounds that exhibit their biological activity at even lower dose range (e.g. nerve gases), this potency of dioxins is considered extraordinary, since there is an every-day exposure to dioxins through environmental vectors mostly via the food chain. Until now, there is no antidotal cure for dioxins, but only symptomatic treatment combined with techniques that accelerate its excretion rate from the body.

Animals↗
PubMed2002

[Biological agents turning into weapons].

The use of biological agents as weapons is a well-known and established fact in the modern world. Biological warfare can be used both in terrorist events and in war and they pose a real threat and a formidable challenge to the defender. Biological weapons, in their various forms such as germs, viruses or toxins, can harm both living creatures and their surroundings. The relative simplicity of their production and use, compared to other non-conventional weapons, renders them to be a highly accessible system that can cause numerous casualties. Therefore, it is extremely important to study the threat and learn its characteristics, so as to be appropriately prepared in order to minimize potential damage. This review summarizes the characteristics of biological weapons (physical and biological), the means of use in bioterrorism and war, the advantages and disadvantages, comparisons to other non-conventional weapons and both tactical and strategical uses.

Biological Warfare↗
PubMed2002

[Anthrax--an overview at 2002].

BACKGROUND: Bacillus anthracis, the causative agent of anthrax, is well known in human history as a major cause of disease in domestic and wild animals and as a rare condition in humans. For the last seventy years, anthrax was developed and occasionally stored as an agent of biological weapon arsenal in numerous countries. The incubation period in humans is 1-6 days and the disease may be present as three distinct clinical syndromes: cutaneous, inhalational, and gastrointestinal disease. The major concern in regard of biological warfare is the inhalational form of anthrax, which starts as a febrile flu-like disease. The development of malaise, fatigue, cough and mild chest discomfort is followed by severe respiratory distress with dyspnea, diaphoresis, stridor, and cyanosis. Shock and death occur within 24-36 hours after onset of severe symptoms. Physical findings are non-specific, but a widened mediastinum is usually seen on chest x-ray. A positive blood culture, immunohistochemical methods and the use of the polymerase chain reaction method confirm the diagnosis. Although effectiveness may be limited after severe symptoms are present, a high dose of antibiotic treatment should be administered and aggressive supportive therapy may be necessary. In the situation of an anthrax attack, as was recently seen in the United States, penicillin is no longer recommended as an acceptable first line therapy. In this case, ciprofloxacin or doxycycline is the recommended drug of choice since penicillin-resistant strains may be used, as well as the possibility of the emergence of an inducible beta-lactamase positive bacterium. Since a high infecting dose may exacerbate the clinical course of the disease, a combination antibiotic regimen should be considered. The disease is not contagious and standard precautions are sufficient. Pre-exposure prophylaxis is based on a vaccine administration, while post-exposure prophylaxis is feasible by the initial use of oral ciprofloxacin or doxycycline. In this article we reviewed the literature with emphasis on the recent medical reports from the United States analyzing the eleven cases of inhalational anthrax as well as the new guidelines for diagnosis and treatment that resulted from the bioterrorism attack in October 2001. Although physical findings were non-specific, abnormal findings on chest x-rays were present in all the eleven cases. A positive blood culture, immunohistochemical methods and the use of the polymerase chain reaction method were highly valuable in revealing and confirming the diagnosis of anthrax. In the case of an attack with anthrax spores, the likelihood of exposure to a large infective dose of high quality spores, may require a prolonged period of treatment as well as prolonged post-exposure therapy.

Animals↗
PubMed2002

[The history of biological warfare].

Selected events in the history of biological weapons are highlighted to increase the physician's awareness of this crucial threat. The deliberate use of biological substances originated in antiquity and has pervaded the history of human wars throughout time until the 21th century. The history of biological warfare is difficult to assess because of a number of confounding factors. These include the difficulty in verification of allegation, the use of the threat of this weapon for propaganda purposes, the lack of microbiological or epidemiological data, and the incidence of natural occurring endemic or epidemic diseases during hostilities. Although it may be problematic to verify at times, the use of such weapons has not been limited to national armies or militia. Frustrated civilians, terrorists and even physicians have used biological substances to promote their interests. Today, the biological threat has become more serious. It's potency, cost-effectiveness, and the ability to manufacture and deploy it with little sophistication, or under the semblance of legitimate commercial endeavors, will ensure that biological weapons remain a constant threat to human health.

Biological Warfare↗
PubMedDate not supplied

OP or not OP: the medical challenge at the chemical terrorism scene.

Since the 1995 Tokyo subway sarin attack, terrorist attacks involving weapons of mass destruction or other industrial chemicals present worldwide security and health concerns. On-scene medical triage and treatment in such events is crucial to save as many lives as possible and minimize the deleterious effects of the toxic agent involved. Since there are many chemicals that can be used as potential terrorist weapons, the medical challenge for the emergency medical services (EMS) is a combination of: (1) recognizing that a chemical terrorist attack (non-conventional) has occurred; and (2) identifying the toxic agent followed by proper antidotal treatment. The latter must be done as quickly as possible, preferably on-scene. The most valuable decision at this stage should be whether the agent is organophosphate (OP) or not OP, based on clinical findings observed by pre-trained, first responders. This decision is crucial, since only OP intoxication has readily available, rapidly acting, onscene, specific agents such as atropine and one of the oximes, preferably administered using autoinjectors. Due to the lack of a specific antidote, exposure to other agents (such as industrial chemicals, e.g., chlorine, bromide, or ammonia) should be treated on-scene symptomatically with non-specific measures, such as decontamination and supportive treatment. This paper proposes an algorithm as a cognitive framework for the medical teams on-scene. This algorithm should be part of the medical team's training for preparedness for chemical terrorist attacks, and the team should be trained to use it in drills. Implementing this path of thinking should improve the medical outcome of such an event.

Chemical Warfare↗