Review: The Chemical and Biological Medical Treatment Symposium - Middle East I Science and Medicine Building Bridges

Cairo, Egypt, 7 -11 December 1997

by Barbara Price, Co-chair

Summary of Sessions
The CBMTS Middle East I brought together over 115 scientists from 31 countries to discuss chemical poisoning and biological infections and diseases and their treatment, highlighting the Middle East perspective. Previous CBMTSs had been held in Europe and this was the first effort at a regional perspective. 

Some of the technical talks emphasized the agricultural and pesticide workers and their environment. From these we developed an appreciation of the effects dust levels in the Middle East, the prevalence of hepatitis, bilharzia, and other conditions endemic to the Middle East. It became apparent that typical clinical measures of intoxication, such as profiling liver and pulmonary functions, were of limited usefulness. These could also be very different when compared to typical European or American populations. Both conditions reminded the attendees of the importance of both baseline measurements and monitoring that could be more unique and specific to the particular toxic chemicals.

Most papers dealt with different manifestations of intoxication and fewer dealt with their treatment. Several papers discussed monitoring methods that could be extrapolated to measure or predict human intoxication. The use of brine shrimp as a general toxicity measure has been correlated with over 43 different chemicals. Cultured pulmonary cells can be used to relate exposure to pulmonary toxicants. Several papers discussed various clinical measures of intoxication, including detailed discussions of cholinesterase measurements. It is apparent from the wide range of manifestations studied that there are no agreed standards for measuring intoxications in general. Even among chemicals with similar initial modes of attack, i.e., OPs and carbamates, there are questions as to the appropriate monitors. We were reminded that while BuChE measurements with the less toxic insecticides may give us a measure of the intoxication, the utility of same measurement with chemical warfare agents was dubious because other clinical manifestations were more sensitive.

Of particular interest to most ASA readers were the papers dealing with chemical warfare agents. Although the study of health of OP pesticide workers has direct correlation with OPs used as chemical weapons, there are enough differences in clinical symptoms and conventional means of assessing the level of intoxication to hinder the exchange of information, unless the scientists and medical doctors could personally compare notes and discuss approaches. And this was one of the very useful and practical outcomes of this CBMTS. Many of the Middle East participants expressed their thanks for a symposium that brought scientists and doctors from the international community to their region for detailed discussions. 

With regard to OPs, one session chair offered these recommendations for continued work in the area :

1. Undertake more studies on the pathophysiology of OP poisoning and expand such studies to cover all internal organs.

2. It is essential to follow up patients exposed to OPs and determine the reversibility of the damages produced. 

3. It is essential to look at the regulation of OP usage, as well as training the user on the proper usage and to initiate health educations programs on the dangers of OP.

4. Further studies should be initiated aimed at the use of drugs to attack various points in the biochemical and physiological chain reactions caused by OPs.

5. More studies should be conducted to investigate OP effect on fetal development and possible fetal damage.

6. There is a definite need to look in details into the metabolism and excretion of toxic chemicals in order to determine the best way to counteract their toxic effects

A pair of presentations from Kuwait provided a vividly illustrated account of the environmental catastrophe and human suffering caused during the Iraqi occupation of Kuwait. The many questions, comments, and expressions of sympathy and appreciation showed the extent to which this audience is concerned that our efforts, in the end, are aimed at improving human life. These final talks also illustrated the important requirement for cooperation between military medical personnel and civilian medical and epidemiological experts to document and quantify the health impact of conflict. Data being collected in Kuwait show measurable health effects, which can be related to a range of factors, including oil fire pollution, psychological/social disruption, disruption of health services, and trauma (e.g., from land mines). Effects are shown not only in specific disease patterns, but also in broader measures such as life expectancy.

In the biological area, the two papers from Vector addressed the need for improved diagnostic tests for Ebola virus and the involvement of the immune system in Ebola and Marburg infections (see also ASA 97-6). A third paper from Egypt discussed how the use of PCR diagnostic markers for hepatitis B, used in a general study of hospital patients, indicated an amazing 20 percent of
the general population was infected, albeit at levels below any clinical manifestations.

Biological toxins from various plants and animals have been considered threat agents. Some of these will be controlled under the CWC and even more under the BTWC. An excellent presentation gave a balance between the good and bad of toxins, emphasizing their utility as specific molecular probes and as drugs to relieve or ameliorate symptoms of a large variety of diseases. Rather than restrict or eliminate research programs, researchers in the field were encouraged to develop detection techniques along with their other research programs.

98-1, issue no. 64
For the Professional in Government and Industry with an interest in Nuclear, Biological and Chemical Defense, Disarmament and Verification; Emergency and Disaster Medical Planning; Industrial Health and Safety; and Environmental Protection