Microbiological, biological, and chemical weapons of warfare and terrorism.

Microbiological, biological, and chemical toxins have been employed in warfare and in terrorist attacks. In this era, it is imperative that health care providers are familiar with illnesses caused by these agents. Botulinum toxin produces a descending flaccid paralysis. Staphylococcal enterotoxin B produces a syndrome of fever, nausea, and diarrhea and may produce a pulmonary syndrome if aerosolized. Clostridium perfringens epsilon-toxin could possibly be aerosolized to produce acute pulmonary edema. Ricin intoxication can manifest as gastrointestinal hemorrhage after ingestion, severe muscle necrosis after intramuscular injection, and acute pulmonary disease after inhalation. Nerve agents inhibit acetylcholinesterase and thus produce symptoms of increased cholinergic activity. Ammonia, chlorine, vinyl chloride, phosgene, sulfur dioxide, and nitrogen dioxide, tear gas, and zinc chloride primarily injure the upper respiratory tract and the lungs. Sulfur mustard (and nitrogen mustard) are vesicant and alkylating agents. Cyanide poisoning ranges from sudden-onset headache and drowsiness to severe hypoxemia, cardiovascular collapse, and death. Health care providers should be familiar with the medical consequences of toxin exposure, and understand the pathophysiology and management of resulting illness.

Medical neurobiology: do we teach neurobiology in a format that is relevant to the clinical setting?

During a period of unprecedented growth in technology that allows imaging of the body in elegant detail, anatomy as a discipline has, in some instances, become marginalized. This may be seen in a reduction of time allotted to anatomy, reduction or elimination of laboratory experiences, or shifting of anatomy teaching to clinical departments. One potential cause of this marginalization is the fact that anatomy is frequently taught in a format that is not useful in, or even applicable to, the clinical setting. At the University of Mississippi Medical Center, the Medical Neurobiology course stresses the functional anatomy of the brain, especially the brainstem, in a format that is directly transferable to the clinical setting. These approaches include (1) using a small neurology book as one of the required texts in the course; (2) extensive use of magnetic resonance imaging (MRI) and computed tomography (CT) as an integral part of the instructional approach; (3) teaching external and internal anatomy of the brain, particularly the brainstem and spinal cord, in a "clinical orientation" that reflects how these central nervous system (CNS) regions are viewed in the clinical setting; (4) teaching nuclei and tracts in images of stained sections and correlating this information with comparable MRI and CT images; and (5) using a large series (75 images) of vascular drawings and clinical cases, all in clinical orientation. The clinical applicability of the basic science information, therefore, is continuously reinforced and extended. It is suggested that teaching anatomy and anatomical concepts in formats that are more obviously useful in, and applicable to, the clinical setting will enhance the value of this basic science in the medical curriculum.