Although the use of cyanides as warfare agents has not been documented since the Iran-Iraq war in... more Although the use of cyanides as warfare agents has not been documented since the Iran-Iraq war in the 1980s, there are rising fears of cyanide being used by terrorists. An Al-Qaeda terror plot to use cyanide gas in the London Underground was foiled in 2002. The threat of similar events becomes more imminent in light of the terror attacks in our country and worldwide, accompanied by statements and threats by fundamentalist leaders to employ chemical weapons. Therefore, mass-intoxication with cyanides is not merely a hypothetical scenario. The treatment of cyanide poisoning is under constant evaluation and there is no international consensus on the subject. The medical treatment of victims at the scene and in hospitals should be rapid and efficient. Current treatment dictates establishing an intravenous line and a slow rate of administration of antidotes. Both demands are not feasible in this specific mass casualty event. The clinical signs of cyanide poisoning are complex, variable a...
The recent attempt to poison Ukrainian President, Viktor Yuschenko with dioxins, raised public co... more 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 ...
The Israel Medical Association journal : IMAJ, 2007
OsO4 is a powerful oxidizer. It affects mainly the skin and mucous membranes. Although unsuitable... more OsO4 is a powerful oxidizer. It affects mainly the skin and mucous membranes. Although unsuitable for a large-scale terrorist attack, mainly due to its scarcity, it could be used in small-scale attacks. The small quantity contained in a vial would cause irritation to the eyes, nose, throat and skin. Combining the agent with an explosive material will probably destroy most of it, chemically. Thus, releasing the chemical without using explosives may be considerably more dangerous. Medical management is mainly symptomatic. As soon as the chemical enters the body, it rapidly reacts with the tissues in contact. Medical personnel should be aware of its poisonous effects and be equally familiar with the necessary self-protection measures and the treatment protocols.
On March 20, 1995, sarin gas was used in Tokyo by members of the Japanese "Uhm-Shinrikiu&quo... more On March 20, 1995, sarin gas was used in Tokyo by members of the Japanese "Uhm-Shinrikiu" cult, killing 12 and injuring >5,500 innocent people. Most of the casualties were mildly injured. This article reviews the neurological follow-up data for some of the victims over the past decade. We reviewed the published literature regarding neurological follow-up of the victims, dividing the data according to the time elapsed after the attack. The digit span test, finger-tapping test, and computerized posturography were the only performance tests that showed statistically significant differences between the victims and the control groups in some of the surveys. The main sequela 7 years after the attack was post-traumatic stress disorder. The results emphasize the need for a national preparedness program for such mass casualty events, led by national health systems. This should include long-term, neurological, follow-up monitoring with performance tests and a post-traumatic stres...
Mutations in the TP63 gene have been associated with a variety of ectodermal dysplasia syndromes,... more Mutations in the TP63 gene have been associated with a variety of ectodermal dysplasia syndromes, among which the clinically overlapping Ankyloblepharon-Ectodermal defects-Cleft lip/palate (AEC) and the Rapp-Hodgkin syndromes. We report a multiplex nonconsanguineous family of Ashkenazi-Jewish descent, in which the index patient presented with a persistent scalp skin lesion, dystrophic nails and light thin hair. Further evaluation revealed over 10 affected individuals in the kindred, over four generations, exhibiting varying degrees of ectodermal involvement. Analysis of the TP63 gene from four of the patients and from two healthy individuals of the same family was performed. Gene sequencing of the patients revealed a nonsense mutation leading to a premature termination codon (PTC) (p.Gln16X). The same mutation was found in all tested affected individuals in the family, but gave rise to marked phenotypic variability with minor clinical manifestations in some individuals, underscoring...
Transient ischemia leads to tolerance to subsequent protracted ischemia. This &am... more Transient ischemia leads to tolerance to subsequent protracted ischemia. This "ischemia preconditioning" results from the induction of numerous protective genes, involved in cell metabolism, proliferation and survival, in antioxidant capacity, angiogenesis, vascular tone and erythropoiesis. Hypoxia inducible factors (HIF) play a pivotal role in this transcriptional adaptive response. HIF prolyl hydroxylases (PHDs), serving as oxygen sensors control HIFα degradation. HIF-mediated ischemic preconditioning can be achieved with the administration of PHD inhibitors, with the attenuation of organ injury under various hypoxic and toxic insults. Clinical trials are currently under way, evaluating PHD inhibitors as inducers of erythropoietin. Once their safety is established, their potential use might be further tested in clinical trials in various forms of acute ischemic and toxic organ damage. Repeated transient limb ischemia was also found to attenuate ischemic injury in remote organs. This "remote ischemic preconditioning" phenomenon (RIP) has been extensively studied recently in small clinical trials, preceding, or in parallel with an abrupt insult, such as myocardial infarction, cardiac surgery or radiocontrast administration. Initial results are promising, suggesting organ protection. Large scale multi-center studies are currently under way, evaluating the protective potential of RIP in cardiac surgery, in the management of myocardial infarction and in organ transplantation. The mechanisms of organ protection provided by RIP are poorly understood, but HIF seemingly play a role as well. Thus, Inhibition of HIF degradation with PHD inhibitors, as well as RIP (in part through HIF) might develop into novel clinical interventions in organ protection in the near future. This article is protected by copyright. All rights reserved.
Ammonia is a common household and industrial chemical. In the medical literature and the electron... more Ammonia is a common household and industrial chemical. In the medical literature and the electronic press there are many descriptions of accidental spills of anhydrous ammonia, but apart from the Chechen war, there is no evidence of its intentional use by a terrorist to date. When considering its characteristics, ammonia tankers may pose an imminent threat for a civilian population nearby. This short review attempts to highlight the main health issues and basic principles of medical management after exposure to ammonia. Ammonia can directly cause damage due to its irritating as well as alkaline properties. The management of toxic exposure to ammonia is largely supportive and there is no specific antidote. Emergency medical response on site includes rapid evacuation, life-saving procedures and decontamination if necessary and if possible. Major clinical manifestations include respiratory symptoms, such as hypoxia, bronchospasm and pulmonary edema, as well as hypovolemia and burns to ...
Infant botulism is a paralytic syndrome which manifests as a result of ingesting spores of the to... more Infant botulism is a paralytic syndrome which manifests as a result of ingesting spores of the toxin secreting bacterium Clostridium botulinum by infants. As opposed to botulism in adults, treating infant botulism with horse antiserum was not approved due to several safety issues. This restriction has led to the development of Human Botulism Immune Globulin Intravenous (BIG-IV; sells under BabyBIG). In this article we review infant botulism and the advantages of treating it with BIG-IV.
Vesicants and some nerve agents penetrate exposed skin, mainly through the sensitive integration ... more Vesicants and some nerve agents penetrate exposed skin, mainly through the sensitive integration areas of the personal protective equipment. Therefore, improving dermal barrier with a topical agent should reduce the threat of exposure. A topical skin protectant lotion (IB1) was developed to improve protection against chemical warfare agents. Preclinical studies in several animal models have proven the protective efficacy of IB1. Here we present the results of a randomized placebo-controlled, double-blind phase I clinical study, performed with 34 healthy volunteers. The study tested the safety of repeated applications, including ruling out transdermal permeation of magnesium, which may lead to a dangerous blood magnesium level, since the lotion contains magnesium sulfate. Other objectives included detection of dermatological adverse effects, assessment of application convenience, and effect on daily activities. Importantly, no serious adverse effects were recorded and the lotion did ...
Many viruses may cause encephalitis. Three such viruses of the Alpha genus (Venezuelan equine enc... more Many viruses may cause encephalitis. Three such viruses of the Alpha genus (Venezuelan equine encephalitis (VEE), Western equine encephalitis (WEE) and Eastern equine encephalitis (EEE)) may be used as biological warfare agents. The clinical course of the diseases caused by these viruses is not specific, and resembles a broad range of bacterial and viral diseases. Several attenuated and inactivated vaccines were developed, but their efficacy in the biological warfare scenario is questionable. There is no effective drug therapy for the treatment of these diseases, and treatment is mainly supportive. Several VEE outbreaks were reported in humans and horses in South America and southern United States. This virus usually causes a febrile illness, which might be complicated with encephalitis, mainly in the cases of children and elderly patients. The EEE virus causes the most severe form of disease, with severe encephalitis and high proportion of sequel. It is prevalent mainly in the east...
Although the use of cyanides as warfare agents has not been documented since the Iran-Iraq war in... more Although the use of cyanides as warfare agents has not been documented since the Iran-Iraq war in the 1980s, there are rising fears of cyanide being used by terrorists. An Al-Qaeda terror plot to use cyanide gas in the London Underground was foiled in 2002. The threat of similar events becomes more imminent in light of the terror attacks in our country and worldwide, accompanied by statements and threats by fundamentalist leaders to employ chemical weapons. Therefore, mass-intoxication with cyanides is not merely a hypothetical scenario. The treatment of cyanide poisoning is under constant evaluation and there is no international consensus on the subject. The medical treatment of victims at the scene and in hospitals should be rapid and efficient. Current treatment dictates establishing an intravenous line and a slow rate of administration of antidotes. Both demands are not feasible in this specific mass casualty event. The clinical signs of cyanide poisoning are complex, variable a...
The recent attempt to poison Ukrainian President, Viktor Yuschenko with dioxins, raised public co... more 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 ...
The Israel Medical Association journal : IMAJ, 2007
OsO4 is a powerful oxidizer. It affects mainly the skin and mucous membranes. Although unsuitable... more OsO4 is a powerful oxidizer. It affects mainly the skin and mucous membranes. Although unsuitable for a large-scale terrorist attack, mainly due to its scarcity, it could be used in small-scale attacks. The small quantity contained in a vial would cause irritation to the eyes, nose, throat and skin. Combining the agent with an explosive material will probably destroy most of it, chemically. Thus, releasing the chemical without using explosives may be considerably more dangerous. Medical management is mainly symptomatic. As soon as the chemical enters the body, it rapidly reacts with the tissues in contact. Medical personnel should be aware of its poisonous effects and be equally familiar with the necessary self-protection measures and the treatment protocols.
On March 20, 1995, sarin gas was used in Tokyo by members of the Japanese "Uhm-Shinrikiu&quo... more On March 20, 1995, sarin gas was used in Tokyo by members of the Japanese "Uhm-Shinrikiu" cult, killing 12 and injuring >5,500 innocent people. Most of the casualties were mildly injured. This article reviews the neurological follow-up data for some of the victims over the past decade. We reviewed the published literature regarding neurological follow-up of the victims, dividing the data according to the time elapsed after the attack. The digit span test, finger-tapping test, and computerized posturography were the only performance tests that showed statistically significant differences between the victims and the control groups in some of the surveys. The main sequela 7 years after the attack was post-traumatic stress disorder. The results emphasize the need for a national preparedness program for such mass casualty events, led by national health systems. This should include long-term, neurological, follow-up monitoring with performance tests and a post-traumatic stres...
Mutations in the TP63 gene have been associated with a variety of ectodermal dysplasia syndromes,... more Mutations in the TP63 gene have been associated with a variety of ectodermal dysplasia syndromes, among which the clinically overlapping Ankyloblepharon-Ectodermal defects-Cleft lip/palate (AEC) and the Rapp-Hodgkin syndromes. We report a multiplex nonconsanguineous family of Ashkenazi-Jewish descent, in which the index patient presented with a persistent scalp skin lesion, dystrophic nails and light thin hair. Further evaluation revealed over 10 affected individuals in the kindred, over four generations, exhibiting varying degrees of ectodermal involvement. Analysis of the TP63 gene from four of the patients and from two healthy individuals of the same family was performed. Gene sequencing of the patients revealed a nonsense mutation leading to a premature termination codon (PTC) (p.Gln16X). The same mutation was found in all tested affected individuals in the family, but gave rise to marked phenotypic variability with minor clinical manifestations in some individuals, underscoring...
Transient ischemia leads to tolerance to subsequent protracted ischemia. This &am... more Transient ischemia leads to tolerance to subsequent protracted ischemia. This "ischemia preconditioning" results from the induction of numerous protective genes, involved in cell metabolism, proliferation and survival, in antioxidant capacity, angiogenesis, vascular tone and erythropoiesis. Hypoxia inducible factors (HIF) play a pivotal role in this transcriptional adaptive response. HIF prolyl hydroxylases (PHDs), serving as oxygen sensors control HIFα degradation. HIF-mediated ischemic preconditioning can be achieved with the administration of PHD inhibitors, with the attenuation of organ injury under various hypoxic and toxic insults. Clinical trials are currently under way, evaluating PHD inhibitors as inducers of erythropoietin. Once their safety is established, their potential use might be further tested in clinical trials in various forms of acute ischemic and toxic organ damage. Repeated transient limb ischemia was also found to attenuate ischemic injury in remote organs. This "remote ischemic preconditioning" phenomenon (RIP) has been extensively studied recently in small clinical trials, preceding, or in parallel with an abrupt insult, such as myocardial infarction, cardiac surgery or radiocontrast administration. Initial results are promising, suggesting organ protection. Large scale multi-center studies are currently under way, evaluating the protective potential of RIP in cardiac surgery, in the management of myocardial infarction and in organ transplantation. The mechanisms of organ protection provided by RIP are poorly understood, but HIF seemingly play a role as well. Thus, Inhibition of HIF degradation with PHD inhibitors, as well as RIP (in part through HIF) might develop into novel clinical interventions in organ protection in the near future. This article is protected by copyright. All rights reserved.
Ammonia is a common household and industrial chemical. In the medical literature and the electron... more Ammonia is a common household and industrial chemical. In the medical literature and the electronic press there are many descriptions of accidental spills of anhydrous ammonia, but apart from the Chechen war, there is no evidence of its intentional use by a terrorist to date. When considering its characteristics, ammonia tankers may pose an imminent threat for a civilian population nearby. This short review attempts to highlight the main health issues and basic principles of medical management after exposure to ammonia. Ammonia can directly cause damage due to its irritating as well as alkaline properties. The management of toxic exposure to ammonia is largely supportive and there is no specific antidote. Emergency medical response on site includes rapid evacuation, life-saving procedures and decontamination if necessary and if possible. Major clinical manifestations include respiratory symptoms, such as hypoxia, bronchospasm and pulmonary edema, as well as hypovolemia and burns to ...
Infant botulism is a paralytic syndrome which manifests as a result of ingesting spores of the to... more Infant botulism is a paralytic syndrome which manifests as a result of ingesting spores of the toxin secreting bacterium Clostridium botulinum by infants. As opposed to botulism in adults, treating infant botulism with horse antiserum was not approved due to several safety issues. This restriction has led to the development of Human Botulism Immune Globulin Intravenous (BIG-IV; sells under BabyBIG). In this article we review infant botulism and the advantages of treating it with BIG-IV.
Vesicants and some nerve agents penetrate exposed skin, mainly through the sensitive integration ... more Vesicants and some nerve agents penetrate exposed skin, mainly through the sensitive integration areas of the personal protective equipment. Therefore, improving dermal barrier with a topical agent should reduce the threat of exposure. A topical skin protectant lotion (IB1) was developed to improve protection against chemical warfare agents. Preclinical studies in several animal models have proven the protective efficacy of IB1. Here we present the results of a randomized placebo-controlled, double-blind phase I clinical study, performed with 34 healthy volunteers. The study tested the safety of repeated applications, including ruling out transdermal permeation of magnesium, which may lead to a dangerous blood magnesium level, since the lotion contains magnesium sulfate. Other objectives included detection of dermatological adverse effects, assessment of application convenience, and effect on daily activities. Importantly, no serious adverse effects were recorded and the lotion did ...
Many viruses may cause encephalitis. Three such viruses of the Alpha genus (Venezuelan equine enc... more Many viruses may cause encephalitis. Three such viruses of the Alpha genus (Venezuelan equine encephalitis (VEE), Western equine encephalitis (WEE) and Eastern equine encephalitis (EEE)) may be used as biological warfare agents. The clinical course of the diseases caused by these viruses is not specific, and resembles a broad range of bacterial and viral diseases. Several attenuated and inactivated vaccines were developed, but their efficacy in the biological warfare scenario is questionable. There is no effective drug therapy for the treatment of these diseases, and treatment is mainly supportive. Several VEE outbreaks were reported in humans and horses in South America and southern United States. This virus usually causes a febrile illness, which might be complicated with encephalitis, mainly in the cases of children and elderly patients. The EEE virus causes the most severe form of disease, with severe encephalitis and high proportion of sequel. It is prevalent mainly in the east...
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Papers by Arik Eisenkraft