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Gulf War Illness-relatred Medical Research & Publications:
Defining Illnesses

A Guide to Gulf War Veterans Health

War Syndromes and Their Evaluation: From the U.S. Civil War to the Persian Gulf War

De Meirleir D, et al. A 37 kDa 2-5A Binding Protein as a Potential Biochemical Marker for Chronic Fatigue Syndrome. American Journal of Medicine 2000; 108: 99-105. The hypothesis of this study done in Belgium and France is that there develops a problem with the regulation of the antiviral response, resulting in chronic fatigue syndrome (CFS).

Smith TC, Gray GC, and Knoke JD. Is Systemic Lupus Erythematosis, Amyotrophic Lateral Sclerosis, or Fibromyalgia Associated with Persian Gulf War Service? An Examination of Department of Defense Hospitalization Data. American Journal of Epidemiology 2000; 151: 1053-9. The authors studied military hospitalizations of active duty personnel, comparing Gulf War veterans (GWV) (551,841) to non-deployed veterans (NDV) (1,478,704) who remained on active duty as of July 31, 1991.

Persian Gulf Veterans Coordinating Board. Unexplained Illnesses Among Desert Storm Veterans. Arch Int Med 1995; 155: 262-268. Summarizes the frequency of unexplained illnesses among veterans evaluated by the DVA, the case assessment protocol being used by DVA and DoD for GW veterans, and the possible health risks unique to the GW.

Stretch, R.H. et al. Physical Health Symptomatology of Gulf War-Era Service Personnel from the States of Pennsylvania and Hawaii. Military Medicine 1995; 160: 131-136. Congressionally-mandated questionnaire survey of veterans (active, reserve, Guard) in Pennsylvania and Hawaii. Response rate was 31%. Deployed veterans reported significantly more physical health symptoms and more physician visits during the previous two weeks than non-deployers.

Southwick, S.M. et al. Trauma-Related Symptoms in Veterans of Operation Desert Storm: A 2-Year Follow-Up. Am J Psychiatry 1995; 152: 1150-1155. This paper reports on the continuation of a study of 84 soldiers from two National Guard units who had served in the GW. Sixty two completed evaluations at 2 years. Depending upon the diagnostic criterion used, six or eight veterans met the criteria for PTSD at 2 years.

The Iowa Persian Gulf Study Group. Self-reported Illness and Health Status Among Gulf War Veterans. A Population-Based Study. JAMA 1997; 277: 238-245. In this study of Iowans from the National Guard, Reserve, or active component who were on active duty during the Gulf War, a stratified random sample selected 4,886 subjects of whom 3,695 (76%) completed a structured telephone interview. Personnel deployed to the Gulf reported significantly higher prevalence rates of symptoms of depression, PTSD, chronic fatigue, cognitive dysfunction, bronchitis, asthma, fibromyalgia, alcohol abuse, anxiety, and sexual discomfort. Most of the self-reported GW exposures were significantly related to many of the medical and psychiatric conditions.

Hyams, K.C. et al. The Impact of Infectious Diseases on the Health of U.S. Troops Deployed to the Persian Gulf During Operations Desert Shield and Desert Storm. Clinical Infectious Diseases 1995; 20: 1497-1504. This paper assesses the impact of infectious diseases (ID) on operations in the Persian Gulf based upon published reports and data on the surveillance of 40,000 Marine Corps personnel in northeastern Saudi Arabia. Leading ID were diarrheal disease and acute upper respiratory infections. 19 cases of cutaneous leishmaniasis (expected) and 12 cases of viscerotropic leishmaniasis (unexpected) occurred. The anticipated serious threat from sandfly fever never materialized. There were one case of West Nile fever, seven cases of malaria (Plasmodium vivax), three cases of Coxiella burnetii infection (Q fever), and two cases of meningococcal disease. The favorable experience with infectious diseases is discussed.

Krivda, S.J. et al. Cutaneous Findings in Gulf War Veterans. Arch Dermatol 1996; 132: 846-847. Studied were 111 patients with dermatologic complaints between June 1994 and June 1995. Sixty-two different disorders were found. Authors comment that all problems were diagnosable and not unusual.

Hyams, K.C. et al. War Syndromes and Their Evaluation: From the U.S. Civil War to the Persian Gulf War. Ann Intern Med 1996; 125: 398-405. Authors reviewed and reported on articles and books about war-related illnesses published since 1863. Poorly understood war syndromes have been associated with armed conflicts since the Civil War. No single recurring illness is apparent.

Haley, R.W. et al. Is There a Gulf War Syndrome ? Searching for Syndromes by Factor Analysis of Symptoms. JAMA 1997; 277:215-222. Authors attempted to study 606 GW veterans from the 24th Reserve Naval Mobile Construction Battalion (RNMCB-24). Through factor analysis, the authors derived 6 different groups of symptoms which they termed "Syndromes" in 63 (25%) of the participants. The authors conclude that the reported symptom Syndromes may represent generalized neurologic injuries possibly due to exposures to neurotoxins occurring during the GW.

Haley, R.W. et al. Evaluation of Neurologic Function in Gulf War Veterans. JAMA 1997; 277:223-230. Building upon the above study, the authors compared 23 GW veterans with the most severe symptoms of Syndromes 1, 2, and 3 (cases) with two groups of veterans with no serious health problems. The 23 cases had more evidence of brain dysfunction by several neuropsychological tests. Neurophysiological and audiovestibular tests among cases generally did not exceed normal limits for the testing laboratory, but the results were significantly more in the abnormal direction in the cases than in the controls. The authors conclude that the cases' scores "more in the abnormal direction on objective tests of neurologic function" support their hypothesis that "a subset of veterans with Gulf War-related illnesses appears to have a subtle neurologic injury or illness contracted in the war."

Haley, R.W. and Kurt, T.L. Self-reported Exposure to Neurotoxic Chemical Combinations in the Gulf War. JAMA 1997; 277: 231-237. The authors administered surveys to the 249 participants in the study above. The authors conclude that they have demonstrated associations between specific risk factors (especially cholinesterase-inhibiting compounds) and systematically defined syndromes in GW veterans. They liken the syndromes to variants of organophosphate-induced delayed polyneuropathy (OPIDP). The article's discussion elaborates on the mechanism of OPIDP and the related scientific evidence which is compatible with their hypothesis. They discuss at length the controversy about whether or not chemical agents which do not cause acute symptoms can cause delayed neurological effects.

Unwin, C. et al. Health of UK Servicemen Who Served in Persian Gulf War. Lancet (1999) 353: 169-178. British servicemen who served in the Gulf War (GWV) were compared to those who did not deploy to the Gulf and to others who deployed to the Bosnia conflict. GWV reported all symptoms and conditions more frequently than the comparison groups. Among servicemen in all three groups, perceptions of poorer health were associated with virtually all potential risk factors or exposures, regardless of deployment status. Patterns of symptoms were the same in all three groups, suggesting that there is no specific "Gulf War Syndrome." The authors plan further studies which will include detailed examinations of symptomatic veterans and controls.

Ismail, K. et al. Is There a Gulf War Syndrome ? Lancet (1999) 353: 179-182. The authors used factor analysis to analyze the symptoms reported by British Gulf War veterans and other veterans. Three factors (or groups of symptoms) were identified and labeled mood-cognition, respiratory system, and peripheral nervous system. Although Gulf War veterans reported a higher frequency of symptoms than veterans who did not deploy to the Gulf and veterans of the Bosnia deployment, the similarity in the patterns of symptoms among all three study groups did not support the existence of a syndrome unique to Gulf War veterans. The discussion compares this study with the two previously published studies of Gulf War veterans which used factor analysis (Haley, R. et al. and Fukuda, K. et al.).

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