Environmental surveys conducted in the Gulf region following the Gulf War to identify possible neurobehavioral consequences

Vitamin D deficiency in women with fibromyalgia in Saudi Arabia

BACKGROUND

The relation between low levels of 25-hydroxyvitamin D and nonspecific musculoskeletal pain, including fibromyalgia syndrome, is debatable. Many studies have reported "a positive relation" and others "found no relation."

OBJECTIVES

To determine the prevalence of vitamin D deficiency among patients with fibromyalgia in a neurology clinic in the Kingdom of Saudi Arabia (KSA).

METHODS

This study was done at a neurology clinic of Bugshan Hospital, Jeddah, KSA, from January to April 2011. Thirty female patients were diagnosed with fibromyalgia according to new clinical fibromyalgia diagnostic criteria; their serum vitamin D levels were screened. Vitamin D deficiency is defined as <20 ng/mL, vitamin D insufficiency is defined as 21-29 ng/mL, and vitamin D sufficiency is equal to or >30 ng/mL.

RESULT

Thirty female patients were included in the study. The mean age was 34.56 ± 8.1 years. Mean vitamin D level was 4.76 ± 1.46 ng/mL. A significant negative correlation between vitamin D level and widespread pain index was found. Thirty percent of the patients were Saudi Arabian of whom 100% were veiled; 70% were non-Saudi Arabian of whom 47.6% were veiled and 52.4% wore long pants and/or full sleeved clothes. Vitamin D deficiency was equally prevalent among veiled (4.77 ± 1.37 ng/mL) and nonveiled (4.75 ± 1.68 ng/mL). Treatment with high-dose vitamin D resulted in clinical improvement in all patients.

CONCLUSION

Vitamin D deficiency is often seen in patients diagnosed with fibromyalgia in our population. This was equally true in veiled and nonveiled, but conservatively dressed populations. Effective treatment with high-dose vitamin D could lead to resolution of almost all symptoms. Further study of these populations and fortification of foods with vitamin D may be essential.

Gulf War syndrome: an emerging threat or a piece of history?

‘Gulf War syndrome’ is a phrase coined after the 1991 Gulf War to group together disparate, unexplained health symptoms in Gulf veterans. This paper examines the many hypotheses that have been put forward about the origins of the concept and gives an overview of the studies that have attempted to explain the lasting health effects associated with Gulf service. Our review finds that although in the UK there has not yet been evidence of a new Gulf War syndrome as a result of the current conflicts in Iraq and Afghanistan, there is a rise in post-conflict psychiatric disorders now being reported in the USA. We postulate that after conflicts military personnel will always face some form of post-conflict syndrome and the nature of the threats experienced is likely to dictate the form the syndrome might take. We also postulate that media reporting is likely to have influenced and to continue unhelpfully to influence the health of service personnel.

Major lymphocyte populations and T-cell expression of ICAM-1 and L-selectin adhesion molecules in Kuwaitis with asthma and rhinitis

The authors evaluate major immunologic features of asthma and allergies in a Kuwaiti population. They analyzed peripheral venous blood from 17 asthmatic and 17 healthy long-term residents of Kuwait by using two-color flow cytometry for major lymphocyte subpopulations; they also evaluated 10 healthy individuals who had recently arrived in Kuwait. Relative to healthy subjects, asthmatics exhibited increased percentages of T+ NK cells (p < .01), T-helper cells (p < .05), T-cytotoxic and NK cells for both total numbers (p < .01-.001) and percentages (p < .05-.01), and increased percentages of T cells expressing CD54 (ICAM-1; p < .001) and CD62 (L-selectin; p < .01). However, B cells were present at significantly lower levels in asthmatics, both in total numbers (p < .05) and percentages (p < .01). In comparison with healthy individuals who had recently arrived in Kuwait, healthy long-term residents exhibited elevated numbers of pan-T cells (p < .01) and T-helper cells (p < .05). These results help establish immunological parameters for asthma and allergies in Kuwaiti populations.

Is Gulf War Syndrome really a mystery?

Since the end of the 1991 Gulf War about 20,000 United States veterans and similar proportions of troops from other allied contingents have been affected by a variety of symptoms which have collectively become known as 'Gulf War Syndrome'. Similar symptoms have been reported in Iraqi civilians including children. Despite extensive investigations no agreement has been reached on whether there is an underlying cause or causes. In this article, the principal features of the illness are summarised and some of the proposed causes discussed. It is proposed that the common cause is the toxic smoke from incomplete combustion of oil from burning wells, and this hypothesis is related to the known toxicology of two likely combustion products, nitric oxide and carbon monoxide. The effect of this proposal on possible investigations and treatment is considered.

Respiratory health status of Australian veterans of the 1991 Gulf War and the effects of exposure to oil fire smoke and dust storms

BACKGROUND

Since the 1991 Gulf War concerns have been raised about the effects on veterans' health of exposures to Kuwaiti oil fire smoke and to dust storms.

METHODS

A cross sectional study compared 1456 Australian Gulf War veterans with a randomly sampled military comparison group (n = 1588). A postal questionnaire asked about respiratory conditions, exposures, medications, tobacco use, demographic characteristics, and military service details. During a medical assessment, spirometric tests and a physical examination were performed and a respiratory questionnaire was administered.

RESULTS

The response rate for the Gulf War veteran group was 80.5% and for the comparison group 56.8%. Australian Gulf War veterans had a higher than expected prevalence of respiratory symptoms and respiratory conditions suggesting asthma (OR 1.4; 95% CI 1.1 to 1.9) and bronchitis first diagnosed since the Gulf War (OR 1.9; 95% CI 1.2 to 3.1) but did not have poorer lung function or more ventilatory abnormalities than the comparison group. Veterans who reported exposure to oil fire smoke had slightly poorer forced vital capacity (difference between means -0.10 l; 95% CI -0.18 to -0.03) and those exposed to dust storms had a slightly better peak expiratory flow rate (difference between means 12.0 l/min; 95% CI 0.6 to 23.4) than veterans who did not report exposure. Veterans who were in the Gulf at or after the start of the oil fires had more respiratory conditions suggesting asthma (OR 1.7; 95% CI 1.0 to 2.9) than those who completed their deployment before this time.

CONCLUSIONS

Increased self-reporting of respiratory symptoms, asthma, and bronchitis by veterans was not reflected in poorer lung function. The findings do not suggest major long term sequelae of exposure to oil fire smoke or dust storms.

Sulfur: its clinical and toxicologic aspects

Although there is no known dietary requirement for inorganic sulfur, it is an essential element for all animal species in as much as they all require the sulfur-containing amino acid methionine. There are three predominate forms of organic sulfur in animals and humans: 1). the thiomethyl of methionine residues in protein; 2). the sulfhydryl disulfides of protein; and 3). the compounds containing ester or amide bound sulfates of glycosaminoglycans, steroids, and many xenobiotic metabolites. Thus, sulfur becomes an important constituent of amino acids, proteins, enzymes, vitamins and other biomolecules. Unlike mammalian species, plants can use inorganic sulfur and synthesize methionine from which are synthesized all the other important sulfur compounds. Hence, sulfur deficiency occurs mainly when plants are grown in sulfur-depleted soils and when humans and animals consume low-protein diets. In recent times, however, the increasing prevalence of refining petroleum and smelting sulfur compounds of metallic minerals into free metals are having a large impact on the balance of sulfur in the environment. Sulfur toxicity is associated mainly with high levels of the element and its toxic volatile substances in the environment. Sulfur dioxide (SO(2)), a major air pollutant, may adversely affect animal and human health by causing bronchitis, bronchoconstriction, and increased pulmonary resistance.

Controversies in neurotoxicology: current status

Several controversial neurotoxic syndromes have received notoriety in the past several decades. For each, the controversy involves the most fundamental question about the existence of the disorder as a clinically diagnosable entity. Interestingly, the most controversial of these syndromes share several features, including argument about the existence of each syndrome in the courtroom. The authors focus their discussion on three problems (painter's encephalopathy, silicone breast implant neurotoxicity, and the Gulf War syndrome) for which no scientific consensus has been reached that would establish them as diagnosable disorders. These syndromes do not meet traditional disease criteria, and until a clear set of symptoms and objective signs can be defined, a definite course and clear cause demonstrated, and specific tests and treatments identified, these syndromes are likely to remain highly controversial.

Incidence of spontaneous abortion in Bahrain before and after the Gulf War of 1991

OBJECTIVES

To determine the incidence of spontaneous abortions in the 5 years before and 5 years after the Gulf War of 1991 and to explore the possible causes that may have affected these changes. To analyze the clinical types, associated medical problems, morbidity, length of hospital stay and mortality rate of abortions.

DESIGN

Retrospective study for the period starting on 1 January 1987-31 December 1996.

SUBJECTS

The study involved 14,850 cases of abortions admitted into Salmaniya Medical complex during this period.

SETTING

The Salmaniya Medical Complex (SMC) is the main referral hospital in Bahrain.

METHODS

Analysis of medical records of patients admitted with diagnosis of abortion during this period.

RESULTS

By comparing the incidence of abortions in the 5 years before (1 January 1987-31 December 1991) and the 5 years after (1 January 1992-31 December 1996) the Gulf War a significant rise was observed--starting from 1992, reaching a peak in 1994, which then began to decline in 1996.

CONCLUSION

Several published reports from Iraq, Kuwait and now from Bahrain are suggestive of an increase in the incidence of abortion and adverse outcome of pregnancy after the Gulf War of 1991. The mechanism is not clear, i.e. whether this is affected by toxicity acquired through the food chain, the oil spillage, smoke pollution resulting from the burning of the Kuwaiti oil fields or stress and anxiety caused by the war.