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Presentation – Dr. James Baraniuk - IOM Gulf War Illness "CMI" Panel.

Presentation – Dr. James Baraniuk - IOM Gulf War Illness "CMI" Panel.

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Published by Anthony Hardie
Presentation by Dr. James Baraniuk, Meeting 1, June 26, 2013. Institute of Medicine (IOM) panel, "Development of a Case Definition for Chronic Multisymptom Illness" in 1990-91 Gulf War veterans.
Presentation by Dr. James Baraniuk, Meeting 1, June 26, 2013. Institute of Medicine (IOM) panel, "Development of a Case Definition for Chronic Multisymptom Illness" in 1990-91 Gulf War veterans.

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Published by: Anthony Hardie on Jun 27, 2013
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The Gulf War and its Diseases
IOM Subjective GWI Case Designation CriteriaIX, X, or XI
22 Years of Subjective Symptomatologyvs.A Toxicological Approach for Objective Markers
James N. Baraniuk, MDGeorgetown UniversityWashington, DC
 
Table 1. Overlap of SUBJECTIVE case designations & potential mechanistic outcomes
CMI
 
≥1 “severe” symptom in 2
or 3 categories(Fukuda 1998)
Kansas” GWI
 
definition
 3 moderate or severe
FM 2010
 
FM 1990
 
CFS
 Fatigue plus4 of 8 others(Fukuda 1994)
Potential
 
MechanisticOutcomes
fatigue
fatigue / sleep
fatigue
fatigue
fatigue
mood /cognition
sleep
cognitive
anxiety
depressive
moody
cognitive /neurological /mood
wakingunrefreshed
cognitivesymptoms
sleepdisturbance
memory or concentration
workingmemory
attentionnetworks
sleep
affect
anxiety
myalgia/ arthralgia
arthralgia
stiffness
myalgia
pain
 widespreadpain index(WPI)
widespreadpain
myalgia
arthralgia
nociceptive,interoceptive &somatosensorycentralsensitization
migraine
GI
airways
skin
somaticsymptoms
sore throat
lymph node
headacheExtensive exclusion criteria includingpregnancy, depression, HIV, chronic viral,autoimmune, neoplastic or medical disease.
manualtenderness
systemichyperalgesia
 
exertional exhaustionexercise-induced dysfunction
N
ociceptive,
I
nteroceptive and
F
a
T
iguing
I
llnesses (
NIFTI
)
 
 
I disagree: Use a “Toxicological Approach”
 
Prevalence
DeployedNotDeployed
Cohort
CMICMIViet Nam(AgentOrange?)CMICMI1980to1989CMICMI
1990to1991
CMICMI1992to2001CMICMI2002to2012CMICMI
Prospective2013
 
CMICMI
FutureExposures
HYPOTHESIS:
CMI in 1990-1991 cohort (GWI) is a unique syndrome.
Null Hypothesis:
CMI is an occupational consequence of military service.1. Military service is a risk factor for CMI [1998] with increased odds ratio vs. civilians.a. ORs for CMI are equivalent for deployed vs. nondeployed from each era.b. Patterns of claims data reveal consistent comorbid conditions and mortality.2. 1990-
1991 cohort had a “toxicological exposure”.
 a. Odds ratio for CMI is significantly higher in GWI than other cohorts.b. OR for nondeployed GWI from 1990-1991 is significant higher than other cohorts.3. Viet Nam era deployment exposure cohort provides a model of natural history
IF 
CMI is related tomilitary service alone (LaCoste Syndrome model)4. GWI provides a predictive model for 2002-
2012 “exposures” and syndromes
 
5. These patterns identify risk factors and allow risk reduction to future “exposures”
 
No CMINo CMI

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