Acetilkolinesteraza u eritrocitima i butirilkolinesteraza u plazmi - Važni pokazatelji za liječenje osoba otrovanih organofosfornim spojevima

Inhibition of acetylcholinesterase (AChE) is regarded as the primary toxic mechanism of organophosphorus compounds (OP). Therapeutic strategies are directed to antagonise overstimulation of muscarinic receptors with atropine and to reactivate inhibited AChE with oximes. Reactivation is crucial within the neuromuscular synapse, where atropine is ineffective, since peripheral neuromuscular block eventually leads to respiratory failure. Patients with OP intoxication have to be identified as early as possible. During an international NBC-defence exercise anesthetised pigs were poisoned with sarin, followed by treatment with atropine and oxime. Blood samples were drawn and red blood cell (RBC)-AChE activity determined with a fielded test system on-site. Within a few minutes the poisoning was verified. After administration of HI-6, RBC-AChE activity increased rapidly. Blood samples were reanalysed in our laboratory in Munich. Almost identical course of the AChE activities was recorded by both systems. The more comprehensive cholinesterase status was determined in Munich. Oxime administration can be stopped when AChE is aged completely, but has to be continued as long as poison is present in the body and reactivation is possible. To aid the on-site physician in optimising diagnosis and treatment, a fielded test system should be available to allow rapid determination of the complete cholinesterase status.Inhibicija acetilkolinesteraze (AChE) smatra se primarnim mehanizmom toksičnoga djelovanja organofosfornih spojeva (OP). Strategije liječenja idu za zaustavljanjem prekomjerne stimulacije muskarinskih receptora atropinom i reaktiviranjem inhibiranog AChE oksimima. Ključna je reaktivacija u neuromuskularnoj sinapsi, u kojoj atropin nije djelotvoran, budući da neuromuskularna blokada u konačnici vodi do prestanka disanja. Važno je što ranije prepoznati otrovanje organofosfornim spojem. U jednoj međunarodnoj vježbi zaštite od nuklearnog, biološkog i kemijskog napada svinje pod anestezijom otrovane su sarinom te liječene atropinom i oksimom. Uzeti su im uzorci krvi te s pomoću terenskoga testa na licu mjesta određena aktivnost AChE u eritrocitima. Otrovanje je potvrđeno za nekoliko minuta. Nakon primjene HI-6, aktivnost AChE brzo je porasla. Isti su uzorci krvi ponovno analizirani u našem laboratoriju u Münchenu. Oba su testa zabilježila gotovo istovjetan tijek aktivnosti AChE. U Münchenu je međutim napravljen potpuniji nalaz kolinesteraza. Liječenje oksimima može se prekinuti kada AChE potpuno “ostari” (tj. dealkilira), ali ga valja nastaviti dokle god je otrov u tijelu, a reaktivacija moguća. Liječnici na terenu trebali bi raspolagati terenskim testovima radi brzoga i potpunog utvrđivanja statusa kolinesteraza, a time i kvalitetnije dijagnoze

Differences in Ethical Viewpoints among Civilian–Military Populations: A Survey among Practitioners in Two European Countries, Based on a Systematic Literature Review

Civilian–military collaboration in humanitarian crises has been encouraged globally; however, little is known about their diverse ethical viewpoints towards challenging and critical situations, which may cause difficulties in the partnership, and influence the outcomes of their mutual activities. The aim of this study was to identify the diversity of viewpoints and ethical decision-making during exceptional circumstances among civilian and military populations from two different countries, each with diverse background and healthcare organization structures. Possible scenarios, based on a systematic review of the literature, were introduced to Swedish and Polish civilian and military healthcare providers. Variations in the participants’ viewpoints and approaches to ethical decision-making were analyzed according to their characteristics, organizational belonging, and nationality. There were differences between both populations but also within the military and civilian groups, respectively. One significant factor influencing ethical viewpoints was participants’ nationality. Differences in ethical viewpoints between multiagency organizations should be considered in planning and implementation of future transdisciplinary and international collaboration in disaster and emergency management. Further studies and renewed educational initiatives are necessary to validate these differences and to navigate civilian–military as well as other multinational partnerships

Differences in Ethical Viewpoints among Civilian–Military Populations: A Survey among Practitioners in Two European Countries, Based on a Systematic Literature Review

Civilian–military collaboration in humanitarian crises has been encouraged globally; however, little is known about their diverse ethical viewpoints towards challenging and critical situations, which may cause difficulties in the partnership, and influence the outcomes of their mutual activities. The aim of this study was to identify the diversity of viewpoints and ethical decision-making during exceptional circumstances among civilian and military populations from two different countries, each with diverse background and healthcare organization structures. Possible scenarios, based on a systematic review of the literature, were introduced to Swedish and Polish civilian and military healthcare providers. Variations in the participants’ viewpoints and approaches to ethical decision-making were analyzed according to their characteristics, organizational belonging, and nationality. There were differences between both populations but also within the military and civilian groups, respectively. One significant factor influencing ethical viewpoints was participants’ nationality. Differences in ethical viewpoints between multiagency organizations should be considered in planning and implementation of future transdisciplinary and international collaboration in disaster and emergency management. Further studies and renewed educational initiatives are necessary to validate these differences and to navigate civilian–military as well as other multinational partnerships