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Toxicokinetics of Nerve Agents 107 guinea pigs arteria thoracica interna discount micardis 40mg overnight delivery, and marmosets blood pressure danger zone chart buy generic micardis 40mg line, are much smaller than that for phosphonofluoridates heart attack 22 years old micardis 20mg generic. Some in vitro experiments with plasma and liver homogenates from hairless guinea pigs confirmed that the sequestration of the enantiomers is lower than that observed with the G-agents blood pressure causes purchase micardis 40mg without a prescription. Unfortunately, it was not possible to take blood samples for a longer period of time for technical reasons. Presumably, this spread is caused by the variation in thickness and permeability of the skin in the various animals. Moreover, these time periods are considerably longer than those observed with G-agents, that is, at most 2 h for an i. This difference in combination with the gradual build-up of the blood levels after p. Presumably, this period is too short to judge whether the treatment has been truly effective because it is possible that animals would have died after that period of time. Interestingly, the paper mentioned also a positive effect of pyridostigmine in treatment. It should be mentioned that a treatment with scavengers such as BuChE would be more effective in this respect, since these scavengers have a longer half-life time than oximes. Next, the animals were euthanized at different time points and the amount of regenerable sarin in the tissues was determined. Toxicokinetics of Nerve Agents 113 that could be regenerated from the tissues after subcutaneous administration of doses corresponding with 0. The figures show that after subcutaneous administration of sarin corresponding with 0. The amount of regenerable sarin seems to correlate with the flow of blood through that organ. Intact sarin is supplied by the blood stream and reacts with the available binding sites. The lungs are the only organ where 100% of the cardiac output flows through, which may be an explanation for the high amount of regenerable sarin in that particular organ. The liver is an organ with an extremely high number of binding sites, but the limited blood flow through that organ causes a moderate amount of bonded sarin. It is obvious that the amount of regenerable sarin in the eyes is relatively high, because the uptake of sarin takes place directly from the air into the eyes. It cannot be excluded that the amount of measured sarin partly consists of intact sarin that is not necessarily regenerated from binding sites. At a higher exposure level, the amount of regenerable sarin is highest in the lungs. It is remarkable that the amounts of regenerable sarin in the lungs after whole-body exposure or subcutaneous administration at comparable dosages (0. It might be expected that the amount of bonded sarin upon whole-body exposure is higher because sarin is inhaled. However, the absorption of sarin does not occur in the lungs but proceeds most likely in the upper airways rather than in the lungs. In this way, intact sarin has to be transported by blood to the lungs, where it can react with the binding sites in that organ. The difference in lethality of various nerve agents in rats, guinea pigs, and marmosets is a result of the presence of different amounts of CaE, which reacts as a scavenger in blood of these species. Therefore, attention has been paid to pretreatment with highly reactive scavengers, which would intercept or destroy the nerve agent before it could reach its target site, when entering the blood stream. It is anticipated that effective scavengers offer protection against both lethal and incapacitating effects of an acutely toxic dose. In addition, if a scavenger remains in circulation at an effective concentration during a relatively long period of time, the pretreatment will, a fortiori, protect against a long-term exposure to low doses of a nerve agent. As early as 1957, Cohen and Warringa53 achieved some protection in rats against a lethal subcutaneous dose of diisopropyl phosphorofluoridate and sarin by pretreatment with an enzyme capable of hydrolyzing organophosphates. The enzyme is rapidly distributed in laboratory animals, such as mice, rats, guinea pigs, and rhesus monkeys, after i. Pretreatment with the enzyme resulted not only in an increase in survival of mice, rats, and rhesus monkeys intoxicated. An effective protection of guinea pigs against respiratory exposure to C(+)P(+)-soman has been reported. The ultimate goal is to use these scavengers as pretreatment to protect humans against nerve agent intoxication. Toxicokinetic studies can be an adequate tool for the quantitative description of the protective mechanism, which is needed for registration of the enzyme as pretreatment drug for application in humans. The toxicokinetics of soman in anesthetized, atropinized, and artificially ventilated naive and HuBuChE-pretreated guinea pigs was studied. The ratio of the dose of HuBuChE relative to the dose of the nerve agent was chosen on the basis of results reported by Ashani et al. In order to study the effect of the scavenger we compared the toxicokinetic data of the HuBuChE-pretreated and nonpretreated animals. The period of time that acutely toxic levels of soman exist is reduced from 40 to 1 min. Addition of fast binding sites to soman will only increase the number of multiple fast binding sites. It is therefore explicable that the scavenger will not be consumed completely by soman, which means that the effect of the scavenger on the toxicokinetics of soman is less in this case. HuBuChE acts as a stoichiometric scavenger for nerve agents, which means that the efficacy of the protection by HuBuChE depends on the balance between the amount of nerve agent and the amount of scavenger. This capability allowed to measure the toxicokinetics of nerve agents after a variety of exposure routes at several doses, and to determine the time period for which 118 Chemical Warfare Agents: Chemistry, Pharmacology, Toxicology, and Therapeutics acutely toxic levels exist. It is evident that these studies can be used for the development of strategies for timely administration of antidotes in case of nerve agent intoxication. For example, the efficacy of HuBuChE as a scavenger for nerve agents was demonstrated by toxicokinetic studies. Analysis of regenerated sarin from binding sites has provided more insight into the elimination pathways of nerve agents. This is especially true for the lungs and the eyes, which appeared to contain many binding sites for nerve agents following whole-body exposure. Exposure studies at lower levels (occupational exposure) are near the lower limit of what can be reached with regard to toxicokinetics based on in vivo measurement of the intact nerve agent. Ultra low level exposure can only be studied after analysis of fluoride-regenerated nerve agents. The inhibition of acetylcholinesterase and butyrylcholinesterase by enantiomeric forms of sarin, Biochem. Microarray Analysis of Sulfur Mustard Exposure Reveals Potential Therapeutic Targets Confirmed by Protein Analysis. Microarray Analysis of Phosgene Exposure Reveals Mechanisms of Toxicity that Correlate with Biochemical Data. Later technology used more sensitive chemical dyes in other formats such as paper tickets. Nerve agent exposure is detected in the field by the use of a fieldable Ellman assay to determine cholinesterase inhibition in the blood (Ellman et al. Oxime was added to the treatment regimen after the development of oxime therapy in the 1950s (Maynard, 2000).
Patients with goiter or following thyroid diseases and also patients with a particular predisposition for disturbances of the thyroid function (especially elderly patients) are at risk of developing thyroid hyperfunction (hyperthyroidism) heart attack 5 year survival rate 20mg micardis fast delivery. Betadine antiseptic solution should therefore not be applied over a long period and to large area of the skin blood pressure normal unit discount micardis 40 mg without prescription. Even after the end of the treatment (up to 3 months) one should look for the early symptoms of possible hyperthyroidism and if necessary the thyroid function should be monitored prehypertension high blood pressure order micardis 40 mg free shipping. In patients undergoing concomitant lithium therapy exo heart attack buy micardis 80mg cheap, regular use of Betadine antispetic solution is to be avoided. During pregnancy and lactation, Betadine antiseptic solution should only be used if strictly prescribed by the doctor and its use should be kept to the absolute minimum. Povidone-Iodine use may induce transient hypothyroidism in the fetus or in the newborn. Also, any possible ingestion of the solution by the infant must be absolutely avoided. Date: 7 January 2003 1 Note: Due to the oxidative effect of Betadine antiseptic solution various diagnostic agents can show false-positive results. After the end of the treatment, an interval of at least 1-2 weeks should be allowed before a new scintigram is carried out. The long-term use of Betadine Antiseptic Solution for the treatment of wounds and burns over extensive areas of the skin can lead to a notable uptake of iodine. In isolated cases, patients with a history of thyroid disease can develop hyperfunction of the thyroid (iodine induced hyperthyroidism), sometimes with symptoms such as racing pulse or a feeling of unrest (see under Contraindications). If you experience any of these symptoms, you should immediately consult your doctor. It has to be expected that the complex will react with protein and other unsaturated organic compounds, leading to impairment of its effectiveness. The concomitant use of wound-treatment preparations containing a so-called enzymatic component leads to a weakening of the effects of both substances. The same thing can happen if disinfectants containing silver, hydrogen peroxide or taurolidine are concomitantly used. The use of mercury-containing wound-treatment products at the same time or shortly after Betadine Antispeci Solution can, under certain circumstances, lead to the formation of a substance (from iodine and mercury) which can damage the skin. Dosage instructions and mode and duration of application Spread the solution, undiluted, onto the parts to be treated. After drying, an air-permeable film is formed, which can be easily washed off with water. Date: 7 January 2003 2 For disinfection of the hands the procedure is as follows: 1) Hygienic disinfection of the hands: 3 ml undiluted - allow to work for one minute. For disinfection fthe skin the proceudre is as follows: Application on skin with few sebaceous glands Before injections, punctures and surgical operations, allow the solution to act for at least 1 minutes. Application on skin with many sebaceous glands Before all operations allow the solution to act for at least 10 minutes, keeping the skin constantly moist. If there is no improvement of the symptoms after several days (2-5 days) regular applications, you should consult your doctor. Note: Do not use after the expiry date (see printed on the packagine) Keep medicine out of the reach of children. Pharmaceutical forms and packing sizes 30 ml solution, 120 ml solution, 500 ml, hospital packs. Licenced by Mundipharma Medical Company, Bermuda 8349-0003 Date: 7 January 2003 3. Hypovolemia, which is common in oedematous disorders, particularly during diuretic therapy, stimulates the renin-angiotensin mechanism with hypersecretion of aldosterone. Adrenal Function Testing Protocols the following protocols are listed along with brief summaries of the utility, methods and interpretations of the tests. If a cat is being tested it may be worthwhile contacting a pathologist if guidance is desired. In addition, once hyperadrenocorticism is diagnosed and localized, additional periodic testing for the purposes of monitoring will be indicated. If you have a question regarding a particular case, please feel free to contact the duty clinical pathologist. Low-dose dexamethasone suppression test: this test is used to differentiate between normal adrenal function and hyperadrenocorticism. The test is typically performed on dogs that have clinical signs, physical exam findings and/or laboratory findings that already allow suspicion of hyperadrenocorticism. This test is infrequently used in the few suspected cases of feline hyperadrenocorticism and the dosage is listed in brackets below. Dexamethasone will not be measured as cortisol by the test method and one-time doses should not interfere with test results. Suppression is defined by a >50% decrease of cortisol output from the baseline or a cortisol value of <40 nmol/L at the 3 hour mark. Collect 1ml of blood in a red top tube at 4 and 8 hours post injection - label as "4 hr post" and "8 hr post" respectively. The test can also be used to monitor response to therapy for a previously diagnosed hyperadrenocorticism patient. If glucocorticoid administration must be given (perhaps due to current unavailability of Cortrosyn in the clinic) then it is recommended that dexamethasone be used for a short period (1-2 days) as this drug will not directly interfere with the cortisol assay and it has a short half-life. As it is a glucocorticoid, dexamethasone supplementation can affect the pituitary-adrenal axis and for this reason if longer periods of supplementation happens to have been the case. If the test is being used to diagnose hyperadrenocorticism, the typical positive response is characterized by an exaggerated response where cortisol levels are higher than the normal reference interval (values can vary widely). If the test is being used for monitoring response to therapy for a previously diagnosed hyperadrenocorticism patient the target ranges vary depending on the medication being used. The text above lists a suggested target range of >1 ug/dL and <5 ug/dL (translating into >27. Urine cortisol:creatinine ratio: this test has been used as an early screening test for hyperadrenocorticism where the true value of the test is a "negative" value where the ratio is <10x10-6. Frequently asked questions: Does the serum have to be separated from packed cells prior to shipping The Adrenal Glands the aim of this presentation is to: 1) highlight some of the fundamentals thought in the basic sciences modules to 2) facilitate a better understanding of the strategies adopted in clinical medicine when investigating the functions of the adrenal glands. Discuss - based on the normal physiology - the rationale behind the investigations of the functions of the Adrenal Glands. Each gland is supplied by the superior, middle and inferior suprarenal arteries, which arise from the inferior phrenic artery, abdominal aorta and renal artery respectively. The blood reaches the outer surface of the gland before entering and supplying each layer. The medullary veins emerge from the hilum of each gland before forming the suprarenal veins, which join the inferior vena cava on the right side and the left renal vein on the left. Each symbol is unique and the committee ensures that each gene is only given one approved gene symbol. This allows for clear and unambiguous reference to genes, and facilitates electronic data retrieval from databases and publications. The rest is bound to albumin and only a minor fraction circulating as free, unbound hormone. Cortisol-binding globulin is important in the interpretation of dynamic tests of the hypothalamic-pituitary-adrenal axis. Cushing Disease It will be increased production of glucocorticoids from the adrenal gland. Why is the symptoms at the bottom different in primary and secondary insufficiency Pheochromocytoma has been termed the "the great masquerade" the classic triad: episodes of palpitations, headaches and profuse sweating accompanied with hypertension makes pheochromocytoma likely. The diagnosis of histoplasmosis was only made post operatively as the constitutional manifestations, besides being partially masked by hypercortisolism also resemble those of tuberculosis. Pigmented multinodular adrenocortical dysplasia, the second subtype, is less common than the macroscopic form. It is often familial, occurs in children and young adults, and is non-corticotropin dependent.
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A test for sensory response to temperature is done by instilling 30 mL of room-temperature sterile water followed by 30 mL of warm sterile water heart attack proove my heart radio cut micardis 40mg without prescription. Fluid is removed from the bladder hypertension in dogs order micardis 40 mg on-line, and the catheter is connected to a cystometer that measures the pressure heart attack grill dallas buy 20mg micardis. Sterile normal saline pulse pressure quizlet discount 20 mg micardis visa, distilled water, or carbon dioxide gas is instilled in controlled amounts into the bladder. The patient is instructed to void, and urination amounts as well as start and stop times are then recorded. Pressure and volume readings are recorded and graphed for response to heat, full bladder, urge to void, and ability to inhibit voiding. The patient is requested to void without straining, and pressures are taken and recorded during this activity. After completion of voiding, the bladder is emptied of any other fluid, and the catheter is withdrawn, unless further testing is planned. Further testing may be done to determine if abnormal bladder function is being caused by muscle incompetence or interruption in innervation; anticholinergic medication. Inform the patient that he or she may experience burning or discomfort on urination for a few voidings after the procedure. Depending on the results of this procedure, additional testing may be needed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Refer to the Genitourinary and Renal System tables in the back of the book for related tests by body system. This procedure is also used to obtain specimens and treat pathology associated with the aforementioned structures. Cystoscopy is accomplished by transurethral insertion of a cystoscope into the bladder. Rigid cystoscopes contain an obturator and a telescope with a lens and light system; there are also flexible cystoscopes, which use fiberoptic technology. The procedure may be performed during or after ultrasonography or radiography, or during urethroscopy or retrograde pyelography. Restrict food and fluids for 8 hr if the patient is having general or spinal anesthesia. If general or spinal anesthesia is to be used, it is administered before positioning the patient on the table. If local anesthetic is used, it is instilled into the urethra and retained for 5 to 10 min. The urethroscope has a sheath that may be left in place, and the cystoscope is inserted through it, avoiding multiple instrumentations. After insertion of the cystoscope, a sample of residual urine may be obtained for culture or other analysis. If a prostatic tumor is found, a biopsy specimen may be obtained by means of a cytology brush or biopsy forceps inserted through the scope. Ureteral catheters can be inserted via the scope to obtain urine samples from each kidney for comparative analysis and radiographic studies. Upon completion of the examination and related procedures, the cystoscope is withdrawn. Place obtained specimens in proper containers, label them properly, and immediately transport them to the laboratory. Encourage the patient to drink increased amounts of fluids (125 mL/hr for 24 hr) after the procedure. Monitor vital signs and neurologic status every 15 min for 1 hr, then every Access additional resources at davisplus. Decreased urine output may indicate bladder edema or perforation caused by forceful advancement of instrumentation. Inform the patient that burning or discomfort on urination can be experienced for a few voidings after the procedure and that the urine may be blood-tinged for the first and second voidings after the procedure. Refer to the Genitourinary System table in the back of the book for related tests by body system. Excretion or micturition is recorded electronically or on videotape for confirmation or exclusion of ureteral reflux and evaluation of the urethra. Fluoroscopic or plain images may also be taken to record bladder filling and emptying. Sensitivity to social and cultural issues, as well as concern for modesty, is C important in providing psychological support before, during, and after the procedure. Inform the patient that he or she may receive a laxative the night before the test or an enema or a cathartic the morning of the test, as ordered. Instruct the patient to increase fluid intake the day before the test, and to have only clear fluids 8 hr before the test. Inform the patient that he or she may feel some pressure when the catheter is inserted and when the contrast medium is instilled through the catheter. A kidney, ureter, and bladder film or plain radiograph is taken to ensure that no barium or stool obscures visualization of the urinary system. A catheter is filled with contrast medium to eliminate air pockets and is inserted until the balloon reaches the meatus if not previously inserted in the patient. When the patient is able to void, the catheter is removed and the patient is asked to urinate while images of the bladder and urethra are recorded. Monitor for reaction to iodinated contrast medium, including rash, urticaria, tachycardia, hyperpnea, hypertension, palpitations, nausea, or vomiting. Encourage the patient to drink increased amounts of fluids (125 mL/hr for 24 hr) after the procedure to prevent stasis and bacterial buildup. Decreased urinary output may indicate impending renal failure or edema caused by instrumentation. In clinical practice, cytological examinations are generally performed to detect cell changes resulting from neoplastic or inflammatory conditions. Sputum specimens for cytological examinations may be collected by expectoration alone, by suctioning, by lung biopsy, during bronchoscopy, or by expectoration after bronchoscopy. A description of the method of specimen collection by bronchoscopy and biopsy is found in the monograph titled "Biopsy, Lung. Terms used to report results may include negative (no abnormal cells seen), inflammatory, benign atypical, suspect for neoplasm, and positive for neoplasm. If patient has asthma or chronic bronchitis, watch for aggravated bronchospasms with use of normal saline or acetylcysteine in an aerosol. Inform the patient that the test helps identify cellular changes associated with neoplasms or organisms that result in respiratory tract infections. When the actual infectious organisms are identified by cytology, inform the patient that the findings will be confirmed by culture. If the laboratory has provided a container with fixative, instruct the patient that the fixative contents of the specimen collection container should not be ingested or otherwise removed. Instruct the patient not to touch the edge or inside of the specimen container with the hands or mouth. Inform the patient that three samples may be required, on three separate mornings, either by passing a small tube (tracheal catheter) and adding suction or by expectoration. The time it takes to collect a proper specimen varies according to the level of cooperation of the patient and the specimen collection procedure. Atropine is usually given before bronchoscopy examinations to reduce bronchial secretions and to prevent vagally induced bradycardia. Reassure the patient that he or she will be able to breathe during the procedure if specimen collected is accomplished via suction method. Assist in providing extra fluids, unless contraindicated, and proper humidification to loosen tenacious secretions. Assist with mouth care (brushing teeth or rinsing mouth with water), if needed, before collection so as not to contaminate the specimen by oral secretions. For specimens collected by suctioning or expectoration without bronchoscopy, there are no food, fluid, or medication restrictions, unless by medical direction. Instruct the patient to fast and refrain from taking liquids from midnight the night before if bronchoscopy or biopsy is to be performed. Make sure a written and informed consent has been signed prior to the bronchoscopy or biopsy procedure and before administering any medications. Cytology specimens may also be expressed onto a glass slide and sprayed with a fixative or 95% alcohol.
Little dye was retained in the lungs heart attack song generic 80mg micardis overnight delivery, 490 Chemical Warfare Agents: Chemistry heart attack normal ekg buy micardis 80 mg without prescription, Pharmacology arrhythmia 1 micardis 20 mg mastercard, Toxicology heart attack mike d mixshow remix purchase micardis 80mg otc, and Therapeutics but that present was related to the exposure concentration. After exposure lung compliance, functional residual capacity, and forced vital capacity were significantly increased for the high exposure concentration group, indicating loss of elastic recoil without airflow obstruction. There were no biologically significant changes in serum biochemistry and no abnormal histology. At the end of the 13 week exposure period, the high-concentration group had body weights 5% lower than unexposed controls. Little dye was recovered from the lungs, but that detected did not increase linearly with increasing aerosol concentration, probably due to lower deposition efficiency for the larger sized particles. The macrophages accumulated in alveoli adjacent to terminal bronchioles and alveolar ducts, and the pigment was present as irregular masses ranging from <1 to >15 mm diameter. At this concentration, there were effects on body weights (reduction) and accumulation of vacuolated alveolar macrophages. Compared to unexposed controls, body weight was 7% lower for 4 weeks and 9% less after 13 weeks. Little Solvent Yellow 33 was retained in the lungs after 4 and 13 weeks, but a significantly larger proportion of Solvent Green 3 was still present in the lungs. In view of the higher lung retention of Solvent Green 3, the clearance of the dye was determined for the 13 week high-concentration exposure group. There was a dose-related increase in neutrophils, macrophages, and total proteins in the mid- and high-concentration exposure groups; the high-concentration exposure group had increased cytoplasmic enzymes (lactate dehydrogenase, glutathione reductase, and glutathione peroxidase) and the lysosomal enzyme b-D-glucuronidase. Cinnamic acid smoke is generated pyrotechnically from grenades and has a particular potential for use as an obscuring smoke with a reasonable degree of obscuration and low toxicity that can be used as a simulant in firefighting training. A typical pyrotechnic composition is lactose 26%, potassium chlorate 26%, aluminium silicate 15%, and cinnamic acid 33%. Renal lesions were seen, but these were specific to mice and not present in a clearly graded manner (Marrs et al. Pre- and postexposure chest radiographs were normal (Ballantyne and Clifford, 1978). During training and operational use, exercise will result in an increased respiratory minute volume (effect of tachypnea and increased tidal volume) and thus a greater inhalation exposure dose. Most of the more soluble inhaled material will tend to predominantly affect the upper airways, and the less soluble materials affect mainly the peripheral airways and alveoli. There may be chest discomfort, difficulty in breathing, dyspnea, retrosternal pain=discomfort, cough, and nausea. However, exposure to such smokes in a confined space, particularly if airflow is restricted, may lead to more severe respiratory inflammation and damage, including necrotizing bronchiolitis and pulmonary edema, with the possible development of cyanosis and hemoptysis. Arterial hypoxemia can result from obliterating bronchiolitis and by disturbed gas exchange due to alveolar and interstitial edema. Subjects with preexisting pulmonary disease, such as chronic bronchitis or asthma, may be at greater susceptibility, particularly for the production of bronchospasm and increased mucus. Ocular effects of overexposure to irritant smokes may include discomfort in the eyes, excess lacrimation, blepharospasm, and conjunctoblepharitis. With the exception of titanium tetrachloride, where water contact can lead to chemical burns, contaminated eyes should be copiously washed with water. Those exposed to titanium tetrachloride should have dry wiping of eye and skin initially. Management of inhalation overexposure to irritant smokes, and depending on the clinical status of the patient, may necessitate the use of corticosteroids (aerosol inhalation and systemic therapy), oxygen, and prophylactic antibiotic and antimycotic cover. The appearance of pulmonary fibrosis may indicate the need for D-penicillamine (Ministry of Defence, 1972). In view of the latency to development of symptomatic lung injury with some inhaled chemicals, all exposed subjects should be kept under observation for a period of time even in the absence of normal objective evaluation of the patient. Some have suggested a postexposure period of 6 h may be sufficient (Meulenbelt, 2004); however, we consider a period of 24 h more appropriate for a postexposure observation period, and particularly with those individuals having increased susceptibility due to pre-existing disease. Investigation of those overexposed to screening smokes should include, at least, chest radiograph, pulmonary function tests, arterial oxygen tension measurement, blood clinical chemistry, sputum culture, ophthalmic examination with slit-lamp biomicroscopy, and possibly measurement of intraocular pressure. Biomedical and health aspects of the use of chemicals in civil disturbances, in Medical Annual, Scott, R. Identifying the exposed facilitates appropriate treatment, whereas identifying the nonexposed avoids unnecessary psychological stress on those who are worried and avoids burdening the medical system. Accurate, sensitive, and rapid analytical techniques enable the appropriate medical, political and military actions. Chemical warfare agent verification assays rarely target the intact agent due to its limited longevity in vivo. In living species, the body attempts to rapidly rid a foreign substance by metabolizing it to a more water-soluble state, in which it is then quickly excreted in the urine. However, the opportunity to identify them is limited by urine clearance time course (usually requiring timely urine collection within a few days). Afterward, a number of procedures for the verification of exposures to nerve agents and sulfur mustard using urinary markers were published. The publication was intended to provide the clinician with laboratory tests to detect exposure to chemical warfare agents in urine or blood samples. In these cases, the agent covalently binds to macromolecules, such as albumin, to form macromolecular adducts. As such, the protein acts as a depot for the adducted agent, and the residence time can be in terms of days to weeks. However, any sample derived from the exposed individual may be considered as a potential matrix to include blister fluid, tears, and saliva. The collection of urine is considered to be noninvasive and does not require highly trained medical personnel or specialized equipment. From an analytical standpoint, urine is more complex than aqueous solutions, but less problematic than blood, plasma, or tissues. Although biomarkers present in urine are usually short-lived metabolites (hours to days), they can be present in relatively high concentrations if the sample is obtained shortly after exposure. By comparison, collection of blood=plasma is more invasive and should be performed by trained medical personnel. These samples offer potential benefits in that both unbounded metabolites and the more long-lived macromolecular adducts can be assayed. Tissue sample collection is obviously the most invasive and usually limited to a deceased casualty. A variety of analytical methods have been developed to analyze biomedical samples. However, in general, the more sensitive the methods need to be, the more labor- and instrument-intensive the method becomes. The transition of analytical techniques developed in the laboratory to a field (incident) for forward setting has the potential to generate valuable information for the military or civilian clinician. The transition also has the potential for a vast array of problems, but the application of advanced digital telecommunication technologies could play a significant role in reducing or correcting these problems while in the field. These include, but are not limited to , data analysis, interpretation of complex spectra, and instrument troubleshooting and repair. As analytical methods are developed and refined and sent farther from the laboratory setting for which they were originally designed, the need for advanced telecommunication to provide a direct link between research scientists and field operators could become critical in the confirmation of patient exposure and for tracking patient recovery and treatment.
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