ACh: Acetylcholine; AChE: Acetylcholinesterase; AChEI: Acetylcholinesterase inhibitors; ACTH: Adrenocorticotropic hormone; AIDS: Acquired immune deficiency syndrome; CBT: Cognitive-behavioral therapy; CDC: Centers for Disease Control and Prevention; CDMRP: Congressionally Directed Medical Research Programs; CFS: Chronic fatigue syndrome; CHF: Chronic heart failure; CMI: Chronic multisymptom illness; CoQ10: Coenzyme Q10; DoD: Department of Defense; FDA: Food and Drug Administration; FM: Fibromyalgia; GW: Gulf War; GWI: Gulf War illness; GWIRP: Gulf War Illness Research Program; GWV: Gulf War veteran; IBS: Irritable bowel syndrome; IOM: Institute of Medicine; ME: Myalgic encephalomyelitis; NCBI: National Center for Biotechnology Institute; NIH: National Institute of Medicine; ORD: Office of Research & Development; PB: Pyridostigmine bromide; PTSD: Posttraumatic stress disorder; QuERI: Quality Enhancement Research Initiative; RNS: Reactive nitrogen species; ROS: Reactive oxygen species; TCM: Traditional Chinese medicine; VA: Veterans Affairs; VHA: Veterans Health Administration; WRIISC: War Related Illness and Injury Study Center
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The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Gulf War Illness Inflam- mation Reduction Trial (Department of Defense, Congressionally-Directed Medical Research Program, GW130025) and Biomarkers of Gulf War Veterans’ Illnesses: Tissue Factor, Chronic Coagulopathy, and Inflammation (Department of Defense, Congressionally-Directed Medical Research Program, GW080080) to RRB. Dietary Fat Effect on Brain Immune Response and Inflammation (VA Merit Review, BX004146), Rodent model of systemic immune activation to study cognitive impairment in Gulf War illness (Center for Veterans Research and Education) and VA Shared Equipment Evaluation Program Request for a multi-array electrochemiluminescence biomarker assay reader (VA Merit Review, 1IS1BX004808-01) to TAB. VA Merit Review, I01 BX000760 to LHS.
Gulf War Illness (GWI) is a chronic debilitating disease of unknown etiology that affects the brain and has afflicted many veterans of the 1990-91 Gulf War (GW). Here we tested the hypothesis that brain damage may be caused by circulating harmful substances to which GW veterans were exposed but which could not be eliminated due to lack of specific immunity. We assessed the effects of serum from GWI patients on function and morphology of brain cultures in vitro, including cultures of embryonic mouse brain and neuroblastoma N2A line. Blood serum from GWI and healthy GW veterans was added, alone and in combination, to the culture and its effects on the function and morphology of the culture assessed. Neural network function was assessed using electrophysiological recordings from multielectrode arrays in mouse brain cultures, whereas morphological assessments (neural growth and cell apoptosis) were done in neuroblastoma cultures. In contrast to healthy serum, the addition of GWI serum disrupted neural network communication and caused reduced cell growth and increased apoptosis. All of these detrimental effects were prevented or ameliorated by the concomitant addition of serum from healthy GW veterans. These findings indicate that GWI serum contains neuropathogenic factors that can be neutralized by healthy serum. We hypothesize that these factors are persistent antigens circulating in GWI blood that can be neutralized, possibly by specific antibodies present in the healthy serum, as proposed earlier 1 .
Some veterans returning from the first Persian Gulf War, Operations Desert Shield and Desert Storm (1990–1991), reported a variety of symptoms including fatigue, muscu- loskeletal discomfort, skin rashes, and cognitive dysfunc- tion [1-3]. Because many of these veterans potentially experienced various hazards such as physical and psycho- logical stressors, multiple vaccinations, prophylactic med- ications, infectious agents, pesticides, depleted uranium, oil well fires and smoke, and chemical and biological war- fare agents, many hypotheses as to the cause of the syn- drome, now called Gulf War Illness (GWI), have ensued . As yet there are no diagnostic clinical signs or labora- tory abnormalities that distinguish GWI and the patho- physiology remains inchoate. Thus, there is no specific pharmacological treatment and many of the veterans affected continue to be unwell some 18 years after their return from combat. Perhaps more important, the current deployment of larger numbers of military personnel back to this region, for considerably longer tours of duty, will likely cause considerable morbidity through GWI and similar poorly explained illnesses. Now it is even more important that additional studies are pursued to further our understanding of the illness in order that better treat- ments are developed. To date, the effects of the numerous different exposures on the veterans are still unclear, but it is likely that many would result in immune function alter- ations. These have been demonstrated in GWI by several groups [5-7], although the results have not been uniform. We hypothesize that there is a possible heterogeneity to GWI similar to that seen in Chronic Fatigue Syndrome (CFS), and the functional impairment oscillates over the many years of the illness. This makes it difficult to identify the biochemical and physiological measures that are dis- turbed, as it changes with the symptoms experienced. Along with this, GWI veterans exhibit a post-exertional fatigue that exacerbates clinical symptoms such as pain and cognitive impairment. In an attempt to measure the changing functionality within subjects, we used an exer- cise challenge paradigm. We believe this would amplify the immune cell dysfunction, allowing us to monitor pos-
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A common issue in pathway analysis is that genes shared between overlapping functional modules and pathways may cause an inflated or biased p-value of statistical significance for some annotations. In such situations highly influential genes that are shared across multiple pathways may bias the identification of some pathways unfairly. The current analysis is not immune to this problem. As such it is pertin- ent to examine the results in the context of the specific ill- ness in question, and the individual genes highlighted by the analysis. Pathway annotation of the drug treatable GWI affected modules revealed two major pathway clusters. The first is dominated by the Netpath (1.1.2015)  annotated pathway for Tumor Necrosis Factor (TNF) alpha and the Reactome (51)  Immune System pathway. Overall, this cluster of pathways suggest that immune signaling, particu- larly TNF-α signaling, are prime targets for repurposed drug treatment in GWI. Projecting this onto known ill- nesses with similar pathway involvement pointed to com- monalities with RA. The relation between GWI and RA in the Netpath (1.1.2015) : Tumor Necrosis Factor (TNF) alpha pathway identifies the gene encoding TRAF1 in con- junction with several TNF-α inhibitors. Suppressed activity of TNF receptor and apoptotic pathways , and higher responsiveness of TNF-α [43, 45] have previously been identified in GWI subjects by our group, consistent with the current findings, suggesting an autoimmune compo- nent to this illness. TNF-α blockers, such as infliximab, ada- limumab and etanercept, are currently approved by the FDA for the treatment of chronic inflammatory diseases such as RA, Crohn’ s disease and ankylosing spondylitis. While, such treatments may affect immune function, indu- cing autoantibodies leading to conditions such as drug- induced lupus, there is low risk of infliximab, etanercept, and adalimumab in association with drug-induced lupus despite the higher incidence of autoantibodies with its use . As chronic inflammation is a suggested component of GWI pathophysiology , these compounds may provide
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square the fact that only one-third of U.S. Gulf War veterans developed GWI when all were administered routine vaccines in preparation (and during) deployment. HLA composition appears to be a determining factor in the vaccine-GWI association. The present study documents varying affinity between 6 alleles that have been shown to protect against GWI and antigens from vaccines administered to Gulf War veterans. Protective effects of these six alleles appear to be linked to the successful elimination of potentially harmful persistent antigens contained in those vaccines.
The study utilized a case–control design to evaluate BChE activity and genotype in relation to GWI and de- ployment characteristics in a population-based sample of 304 Gulf War veterans. Detailed information on the study sample and data collection have previously been described . Study participants included 144 GWI cases and 160 controls, with cases defined according to Kansas GWI criteria . Briefly, the Kansas GWI case definition requires that veterans endorse moderately se- vere or multiple chronic symptoms in at least three of six defined symptom domains. Veterans are excluded as GWI cases if they report being diagnosed with any from a list of chronic medical conditions that might account for their symptoms, or severe psychiatric conditions that might preclude their ability to accurately report symp- toms. Veteran controls had insufficient symptoms to meet GWI case criteria, and reported no exclusionary medical or psychiatric diagnoses. The study questionnaire also in- cluded symptom questions that allowed identification of veterans who met case criteria for “chronic multisymptom illness (CMI),” as defined by Fukuda et al.  at the U.S. Centers for Disease Control and Prevention, sometimes referred to as the “CDC” case definition.
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measures, namely GWI symptom severity and SNI distribution parameters. The weighted sums of these measures, based on the coefficients yielded by the logistic regression, form the horizontal axes in Figures 8 and 15, respectively. The question is whether these separate measures are associated, given that they both predict, independently, the presence of mental health disorder. For that purpose, we performed a correlation analysis between the two weighted sums above. The parametric Pearson correlation coefficient was 0.216 (P = 0.004, N = 174) and the nonparametric Spearman correlation coefficient was 0.302 (P = 0.00005, N = 174). (The higher value of the nonparametric correlation is due to the fact the distributions of the weighted GWI and SNI sums were slightly skewed, thus deviating from the normal distribution and resulting in loss of power.) This highly significant positive correlation between the weighted GWI and SNI measures provides a key link between GWI symptom severity and synchronous neural interactions in the context of mental illness.
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The objective of this report was to identify and compare syndromes among 4 samples collected from UK [11,17- 19] and US  studies of Gulf War illness by using factor analysis. We used dichotomous factor analysis models because symptoms were measured on a nominal scale (Yes/No), either during the past month (UK study) or currently (US study). UK data included Gulf War service- men, individuals deployed to Bosnia on a U.N. peace- keeping operation, and active duty military that had not been deployed. US data included only Gulf War veterans. We identified and confirmed at most 4 correlated factors in each of the samples. Three of the four constructs (Res- piratory, Mood-Cognition, Peripheral Nervous) over- lapped considerably across the UK cohorts. These factors were identical to those derived in a linear factor analysis of these data . However, the current study identified one factor including gastrointestinal and urogenital symp- toms in the UK Gulf cohort that was noticeably different from the gastrointestinal factor identified from the Bosnia and Era cohorts. One possible explanation is that Gulf War veterans were more stressed than Bosnia or Era veter- ans, and this fact maybe associated with multi-system symptom reporting. More needs to be investigated in this area.
Next, an embargo can be an effective reactive measure to unwanted behavior, but it is limited in that regard. Embargoes serve as a punishment, in this case to admonish a country for blatantly attacking reporters in war zones. Carla Anne Robbins argues in Bloomberg Business, “In a world bristling with bad actors, and especially at a time when the country is wary of another war, sanctions have an obvious appeal—and limited impact” (Robbins, 2013, para. 2). Because an embargo is reactionary, it can never be proactive. An embargo does not prevent journalist deaths, but rather reprimands after-the-fact. Robbins insinuates that the U.S. has never had an effective embargo, citing failures in North Korea, Iran, and Syria (Robbins, 2013). She describes embargoes as having a “limited impact,” an impossible be-all and end-all. Once an embargo is placed, if a country decides to target more journalists, a second embargo cannot be placed, hence the impracticality. Furthermore, an embargo doesn’t always limit a country’s access to goods. According to Andrea Ovans with the Harvard Business Review, it often opens up more contraband channels and underground routes to obtain products illegally, which can hurt the rural people of a country (Ovans, 2014).
time, to have warm, close relations with the Soviet Uni o n was the best o ption for co u n t e r i n g any threat e n d a n g e r i n g its national interests and security. Such close relations lay in the fact that, apart from bei n g plunged into m i l i tary confrontation with Israel in the A r ab-Israeli theater and border dispute over Shatt al-Arab wat e r w a y w ith the T eheran regime, the Ba'athist leaders in Baghdad were, moreover, p o l i t i c a l l y isolated by the conservative, m o n a r chical, and m oderate Gulf sheikhdoms spearheaded by the Riyadh regime.
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The methods employed in the systematic review have been described in another paper  and are summarised here. 5387 studies from the period January 1990 to May 2001 were identified for possible inclusion by searching through databases (EMBASE, Medline, ASSIA, SIGLE, Psy- cINFO, CancerLit, HealthSTAR, Dissertation Abstracts, Current Contents, Health and Psychosocial Instruments, CINAHL and Biological Abstracts) and websites and by contacting researchers in the field. Studies were eligible for inclusion if they contained data on military, medical or peace-keeping personnel who were deployed to the Gulf War together with a comparison group which dif- fered in its level of exposure. Abstracts of 2296 references that remained eligible were examined by two members of the research team. Studies were excluded if they measured simulated exposures, if they measured non-health related outcomes or if the subjects were inhabitants of the Persian Gulf rather than deployed military personnel. Studies that examined pain within groups of Gulf veterans that had experienced differential exposures whilst in the Gulf, e.g. exposure to the smoke from oil-well fires, were also excluded from this review.
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The articles included in this review add important, contextually-relevant data to our understanding of men- tal illness in the region. However, despite nearly 40 years of research addressing the impact of sociocultural factors on people’s experiences of mental illness, a limited un- derstanding of these issues remain. For example, the Arab extended family is widely acknowledged in having a key supportive role for those with mental illness. How- ever, it has also been reported as a source of stress and conflict. Religion influences all aspects of life in Arab society and provides a source of strength and support for people with mental illness. However, forbidden acts, such as alcohol and substance abuse and suicide, still occur, and cause guilt and worry for patients and their families. Widespread belief in the influence of the super- natural on mental illness has been documented. These beliefs fall within the scope of modern mental health practice, but there is little evidence of how they can be incorporated successfully into a contextually-relevant model of psychiatric care and recovery. Research into the interplay between psychiatry and traditional healing is also lacking; service users place value on consultation with faith healers, but it is unclear how these services might be incorporated into a cohesive system of mental health service in the region, or even if they should be incorporated. The concept of stigma is conspicuously absent from the articles and little effort has gone into measuring or describing stigma towards mental illness in the GCC. Also absent from the literature are investi- gations into service users’ self-management of their
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According to the Indonesian Embassy database, as of the end of June 2017, the number of Indonesian citizens who had reported and recorded was around 29,988 people with the following distribution of Indonesian citizens: Troubled Indonesian Workers (TKIB) at the Indonesian Embassy in shelters (91 people / 3 children); domestic workers (9,613 people); semi-skilled (1,718 people); skilled (2,994 people); nurses (59 people); pilots (43 people); cabin crew (84 people); Indonesian Embassy staff (30 people); students (15 people); crew / sailors (103 people); children (6,725 people); housewives 1,653 people); others / not including jobs (6,860 people). (Sidehabi, 2018). Based on domicile, Indonesian Citizens domiciled in the city of Doha are around 13,460 people, Wakrah 1,595 people, Al Khor 1,437 people, Messaieed 784 people; Dukhan 319 people, and about 12,393 people did not include the address. Of the registered number, the number of Indonesian citizens reached almost 30,000 (Sidehabi, 2018). The author's observations, since June 2017 Qatar has experienced diplomatic relations termination by 4 neighboring countries namely Saudi Arabia, Bahrain, United Arab Emirates and Egypt. Since then, Qatar has been blocked by land, sea and air transportation routes. This condition does not affect the daily lives of the population of Qatar, including the people of Indonesia. However, in the midst of safe conditions, as a migrant population must always be aware of the worst possible horizontal conflict, in this case the war. Both inside Qatar and if the war took place in countries around Qatar in the bay area. The Indonesian Embassy in Doha as a representative of the Indonesian government in Qatar since 2014 has several times provided education and socialization to Indonesian citizens regarding emergency preparedness. The preparedness in question is an important role of citizen preparedness in the event of conditions that require the evacuation of Indonesian citizens. The activity was carried out in several areas including Doha, Messaeed, Alkhor and Dukhan. Even though, this program does not conduct as regular basis. The results of these observations are taken into consideration to produce strategy assumptions. The assumptions of the strategy aim to increase public awareness in the mitigation of the Gulf War disaster, specifically related to the readiness of citizens when facing conditions that require the evacuation of Indonesian citizens from Qatar. This assumption was obtained by the SAST method.
Clinton's new policy was aimed at implementing the strategy of NATO airstrike over Bosnian Serbs if they continue to attack the Croatian and Muslim population. In this way, the UN officials had first to identify the targets before any air attack. The bombing by NATO coincided with sending new diplomatic support in order to conclude a peace treaty. A key figure in this diplomatic support was Richard Holbrooke, tireless negotiator who understood the connection between military force and diplomacy. In November 1995, a delegation of Holbrooke managed to bring the warring parties to negotiate in Dayton, Ohio. Twenty-one day the representatives of the international community and the representatives of the warring sides in Bosnia, negotiated to reach an agreement in order to stop the war. At the end of 1995, sixty thousands NATO troops, including twenty thousands Americans were present on the territory of Bosnia in order to begin the process of implementation of the agreement (Warren 1998).
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Saudi Arabia's role in production of cheap oil has become absolutely transparent since the end of the war. The Saudi monarchy, producing 5.4bn barrels of oil per day before the war, increased production during the hostilities to 8.6bn barrels and plans to install extra capacity to produce up to lObn barrels per day, nearly a fifth of the world's production, by the mid-1990s. The result will be that whatever other OPEC members may decide, it will be in Saudi Arabia's gift to determine the world price of oil. At the 11-13 March OPEC meeting this was already clear as the Saudis refused, in the middle of a world recession which has seen a 13-15 per cent fall in oil demand, to countenance an output reduction of more than 5 per cent. The same meeting confirmed Saudi Arabia's wartime production share on a permanent basis.
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The decision for limb amputation is more difficult than it seems. We tried at the early period of the war to save as much limbs as we could but we learned later that this cannot be achieved all the time. Sometimes, early amputation can be the best option for some patients that saves their lives. Amputation rate depends on many factors including the severity of limb injury, mechanism of injury, ischaemia time, presence of associated injur- ies, and disaster situations when treating mass causali- ties .
The Clinton administration and other U.S. policy makers have vested interest in demonising Iran, Islam and the governments and political movements which challenge the U.S. and pro-Western muslim regimes in its name. For nearly fifty years America was politically, economically, militarily and ideologically geared towards fighting a Cold War with the USSR. The United States seems to be attempting to fill the post-Cold war vacuum with another threat against which to test its bravado and power, and to provide a new justification for committing a large proportion of its budget to the defence sector - preserving jobs and serving vested interests associated with the military-industrial complex. The United States may be seeking a leading military role in world affairs to alleviate a feeling of insecurity associated with its gradual decline as a world power, severe internal socio economic problems, and the loss of economic ground to Europe and Japan. The U.S. is also anxious for a justification for foreign intervention to protect its interests in the Third World, especially the Persian Gulf oil. During the Cold War the policy of containment provided this. Now, in the post-Cold war era, the U.S. is in need of a new enemy in the region to continue its policy, an "Islamic fundamentalist" Iran is an ideal excuse.26
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