Diagnóstico diferencial de nódulos pulmonares cavitados: a propósito de un caso clínico / Differential diagnosis of cavitary pulmonary nodules: a propos of a clinical case

El diagnóstico diferencial de nódulos pulmonares cavitados constituye un gran desafo en el cual, la clínica, la imagenología y los exámenes de laboratorio permiten una orientación etiológica en cutro grandes grupos: infecciosa, neoplásica, reumatológica y miscelánea. Presentamos el caso de una paciente gran fumadora y portadora de una diabetes mellitus descompensada, con nódulos pulmonares cavitados, en la cual el contexto clínico obligaba a plantear ciertas etiologías como las infecciosas y neoplásicas, pero cuya biopsia fue compatible con Granulomatosis con Poliangeítis (ex Granulomatosis de Wegener), sin una clínica ni exámenes de laboratorio concordantes con dicho hallazgo.

The differential diagnosis of cavitary pulmonary nodules is a great challenge, where the clinical context in addition to the image studies and laboratory tests are part of the key tools to guide the diagnostic process through 4 major etiological groups: infectious, neoplastic, rheumatologic and miscellaneous. We describe a case of a heavy smoker and complicated diabetic patient with cavitary pulmonary nodules, with a clinical context that induces certain etiologies such as infectious and neoplastic, but whose biopsy was compatible with Granulomatosis with polyangiitis (ex Wegener 's granulomatosis), without a clinical exam nor laboratory tests suggesting this finding.

Efectos de la exposición al humo de tabaco ambiental en no fumadores / Effects in passive smokers of environmental tobacco smoke exposure

National and international environmental tobacco smoke studies were reviewed regarding its effects on passive smokers' health. Environmental tobacco smoke is composed by more than 4,000 known substances, which are different if they are in the mainstream or sidestream. Studies with biomarkers like cotinine have concluded that exposed nonsmokers have an increased cardiovascular morbi-mortality. Passive smokers also have an increased risk of lung, nasal sinus and breast cancer. Children have more acute and chronic respiratory symptoms, low respiratory infections, otitis and sudden infant death syndrome. Environmental tobacco smoke induces asthma and causes exacerbations in both children and adults. In reproductive health, it decreases the age of menopause and produces menstrual disorders. Newborn infants of passive smoking mothers have a higher probability of low birth weight and to be small for gestational age. This international scientific evidence should lead countries to take measures in order to protect nonsmokers' health.

Se realizó una revisión de los estudios nacionales e internacionales sobre los efectos del humo de tabaco ambiental en la salud de los fumadores pasivos. El humo de tabaco ambiental está conformado por más de 4.000 sustancias químicas, las que difieren cuali y cuantitativamente al estar presentes en la corriente principal o en la lateral. Los no fumadores expuestos presentan un aumento de morbi-mortalidad por enfermedad cardiovascular, incluso con estudios con biomarcadores como cotinina. Además los fumadores pasivos tienen un riesgo aumentado de presentar cáncer de pulmón, de senos paranasales y mama. En niños existe un mayor número de síntomas respiratorios agudos y crónicos, infecciones respiratorias bajas, otitis media y síndrome de muerte súbita infantil. El humo de tabaco ambiental favorece la inducción y exacerbación de asma bronquial en niños y adultos. En la salud reproductiva, disminuye la edad de aparición de la menopausia y produce desórdenes menstruales. Los recién nacidos hijos de madres fumadoras pasivas tienen mayor probabilidad de nacer con bajo peso o de ser pequeños para la edad gestacional. La evidencia científica internacional debe contribuir a que los países tomen medidas para proteger la salud de los no fumadores.

Tabaquismo en funcionarios de educación / Smoking mong schhool teachers and other schoolworkers

A descriptive and transversal survey was carried out to know the prevalence of smoking and the attitudes of school teachers and other school workers. An anonymous self administered questionnaire was distributed in 235 educational establishments (132 basic schools, 14 high schools and 87 kindergartens) across the country. The analysis of 3,270 completed questionnaires showed a prevalence of smoking of 36.7%, women smoking more than men (37.3% versus 34.6%). The greatest prevalence was found between 20 and 44 years of age. Teacher auxiliaries and administrative staff showed the highest prevalece (57,6 and 48,6% respectively) while directive staff and teachers showed the lowest (22.2 and 32.6% respectively). Two thirds were daily smokers with an average consumption of 5.7 ± 4.3 (SD) cigarettes per day. Only 0.3% smoked more than 20 cigarettes per per day and 13.5% smoked one cigarette in the first 30 minutes after waking up in the morning. Seventy four percent do not allow smoking in their homes and 92.3% agree to limit smoking in their workplaces. The data from this survey suggest that school workers smoke less than the general population and than health workers. This may favour the development of smoke free environments in schools.

Se realizó un estudio descriptivo y transversal para conocer la prevalencia de tabaquismo y actitudes en funcionarios del sector educación. Para esto se distribuyó una encuesta autoaplicada y anónima en 235 establecimientos educacionales del país (132 escuelas, 14 liceos y 87 jardines infantiles). El análisis de 3.270 encuestas mostró una prevalencia de tabaquismo de 36,7%, siendo las mujeres más fumadoras que los hombres (37,3% vs 34,6%). La prevalencia de tabaquismo es mayor entre los 20 y 44 años. Los más fumadores son los paradocentes (57,6%) y administrativos (48,8%); mientras que los menos fumadores son los directivos (22,2%) y profesores (32,6%). Dos tercios de los fumadores son consumidores diarios, con un consumo promedio (± DE) 5,7 ± 4,3 cigarrillos/día. Sólo 0,3% fuma más de 20 cigarrillos/día y 13,5% consume el primer cigarrillo en los primeros 30 minutos luego de despertar. El 74,1% de los funcionarios no permite que se fume en su hogar y el 92,3% está de acuerdo en que se restringa fumar en sus lugares de trabajo. Los datos de esta encuesta sugieren que los funcionarios de educación son menos fumadores que la población general y que los funcionarios de salud, lo que favorece el desarrollo de políticas de ambientes libres del humo de tabaco.

Encuesta nacional de de tabaquismo en funcionarios de salud / A national survey on smoking habit among health care workers in Chile

Background: Worldwide, smoking is the main avoidable cause of death among adults. Aim: To study smoking habits among health care workers in Chile. Material and methods: A national survey about smoking among subjects working in the Chilean Ministry of Health. An anonymous and self administered enquiry was used. Results: The enquiry was answered by 20,848 employees, corresponding to 58 percent of the total universe of workers. There was an overall prevalence of smoking of 40.7 percent. Sixty four percent of smokers did it daily and their mean consumption was 7 cigarettes per day. Smoking was more common among men than women (43 and 39.6 percent, respectively). Also, nicotine addiction was also more common among men (16.5 and 11.7 percent, respectively). The prevalence of smoking decreased along with age. Journalists, guards, students and paramedics had the higher prevalence of smoking. Physicians, teachers and nutritionists had the lower prevalence. Although physicians had the lower frequency of smoking, they had the higher prevalence of nicotine addiction. Forty five percent of smokers were interested in therapies to quit, 69 percent did not allow smoking at home and 89 percent agreed with smoking restrictions in work places. Conclusions: The prevalence of smoking among health care workers is similar to that of the general population in Chile.