Hard metal lung disease: a case series / Doença pulmonar por metal duro: uma série de casos

ABSTRACT Objective: To describe diagnostic and treatment aspects of hard metal lung disease (HMLD) and to review the current literature on the topic. Methods: This was a retrospective study based on the medical records of patients treated at the Occupational Respiratory Diseases Clinic of the Instituto do Coração, in the city of São Paulo, Brazil, between 2010 and 2013. Results: Of 320 patients treated during the study period, 5 (1.56%) were diagnosed with HMLD. All of those 5 patients were male (mean age, 42.0 ± 13.6 years; mean duration of exposure to hard metals, 11.4 ± 8.0 years). Occupational histories were taken, after which the patients underwent clinical evaluation, chest HRCT, pulmonary function tests, bronchoscopy, BAL, and lung biopsy. Restrictive lung disease was found in all subjects. The most common chest HRCT finding was ground glass opacities (in 80%). In 4 patients, BALF revealed multinucleated giant cells. In 3 patients, lung biopsy revealed giant cell interstitial pneumonia. One patient was diagnosed with desquamative interstitial pneumonia associated with cellular bronchiolitis, and another was diagnosed with a hypersensitivity pneumonitis pattern. All patients were withdrawn from exposure and treated with corticosteroid. Clinical improvement occurred in 2 patients, whereas the disease progressed in 3. Conclusions: Although HMLD is a rare entity, it should always be included in the differential diagnosis of respiratory dysfunction in workers with a high occupational risk of exposure to hard metal particles. A relevant history (clinical and occupational) accompanied by chest HRCT and BAL findings suggestive of the disease might be sufficient for the diagnosis.

RESUMO Objetivo: Descrever aspectos relacionados ao diagnóstico e tratamento de pacientes com doença pulmonar por metal duro (DPMD) e realizar uma revisão da literatura. Métodos: Estudo retrospectivo dos prontuários médicos de pacientes atendidos no Serviço de Doenças Respiratórias Ocupacionais do Instituto do Coração, localizado na cidade de São Paulo, entre 2010 e 2013. Resultados: Entre 320 pacientes atendidos no período do estudo, 5 (1,56%) foram diagnosticados com DPMD. Todos os pacientes eram do sexo masculino, com média de idade de 42,0 ± 13,6 anos e média de tempo de exposição a metal duro de 11,4 ± 8,0 anos. Os pacientes foram submetidos a avaliação clinica, história ocupacional, TCAR de tórax, prova de função pulmonar, broncoscopia com LBA e biópsia pulmonar. Todos apresentaram distúrbio ventilatório restritivo. O achado de imagem à TCAR de tórax mais frequente foi de opacidades em vidro fosco (em 80%). Em 4 pacientes, o LBA revelou presença de células gigantes multinucleadas. Em 3, foi diagnosticada pneumonia intersticial por células gigantes na biópsia pulmonar. Houve o diagnóstico de pneumonia intersticial descamativa associada à bronquiolite celular em 1 paciente e de pneumonite de hipersensibilidade em 1. Todos foram afastados da exposição e tratados com corticoide. Houve melhora em 2 pacientes e progressão da doença em 3. Conclusões: Apesar de ser uma entidade rara, a DPMD deve ser sempre considerada em trabalhadores com risco ocupacional elevado de exposição a metais duros. A história clínica e ocupacional associada a achados em TCAR de tórax e LBA sugestivos da doença podem ser suficientes para o diagnóstico.

Hospital Qualities Related to Return to Work from Occupational Injury after Controlling for Injury Severity as Well as Occupational Characteristics

We examined associations between hospital quality in the workers' compensation system and injured patients' return to work after controlling for injury severity, occupational factors, and demographic factors. Return to work data of injured workers were constructed from 2 datasets: 23,392 patients injured in 2009-2011 from the Korea Workers' Compensation & Welfare Service and return to work data from Korea Employment Information Services. After de-identifying the data, quality scores were matched for each hospital that cared for injured patients. Injury severity was measured by Abbreviated Injury Scales. Relative risk and 95% confidence interval were calculated using log binomial regression models. After adjusting for age, sex, injury severity, occupation, factory size, city, and hospital type, the relative risk (95% confidence interval) for the total score was 1.04 (1.02-1.06), 1.06 (1.04-1.09), and 1.07 (1.05-1.10) in the 2nd, 3rd, and 4th quartiles, respectively, compared to the 1st quartile. The RR (95% CI) in the 2nd, 3rd, and 4th quartiles was 1.05 (1.02-1.07), 1.05 (1.02-1.08), and 1.06 (1.04-1.09) for the process score; and 1.02 (1.01-1.04), 1.05 (1.03-1.07), and 1.06 (1.04-1.09) for the outcome score compared to the 1st quartile score, respectively. In conclusion, our study design with blinded merge methods shows that total, process, and outcome qualities are related to the return to work of injured workers after controlling for other factors.

Milker's nodule - Case report

Abstract Milker's nodule is an occupational viral skin disease of universal distribution, caused by the Paravaccinia virus and that occurs in individuals who deal with dairy cattle herds. We describe a case acquired due to lack of use of PPE (Personal Protective Equipment) and perform a literature review.

Patologías frecuentes que presentan los trabajadores de la fábrica de cemento COBOCE Irpa Irpa con relación a las condiciones de trabajo, primer trimestre del año 2011 / Frequent pathologies workers have cement Irpa Irpa Coboce regarding working conditions, first quarter of 2011

La salud de los trabajadores es un derecho universal, como también lo es para el desarrollo económico. Tanto a nivel global como regional, las enfermedades laborales han ido en aumento, el riesgo de contraerlas es el peligro más frecuente que enfrentan los trabajadores en su fuente de trabajo.Un problema muy importante es la ausencia de datos reales y exactos sobre las enfermedades laborales relacionadas al trabajo. Es necesario que las empresas velen por la salud de los trabajadores, brindándoles condiciones adecuadas de trabajo. El presente trabajo busca identificar las enfermedades más frecuentes de los trabajadores de la fábrica de cemento COBOCE Irpa Irpa, la muestra fue representada por 120 trabajadores, a los cuales se les aplicó una entrevista. Los resultados del estudio reflejan que las patologías más frecuentes son: estrés, miopía y astigmatismo, lumbago, depresión, resfríos frecuentes y en porcentajes menores, hipoacusia y dermatitis entre otras, éstas están precedidas por sintomatología como ser: irritación de los ojos, disminución de la agudeza visual y auditiva, dolor de espalda, dificultad para respirar, tos e irritación en la piel

Fenómeno de Raynaud por exposición a cloruro de vinilo / Raynaud's phenomenon secondary to vinyl chloride exposure

El policloruro de vinilo (PVC) es el polímero que ocupa el tercer puesto en el mercado de producción de plásticos a nivel mundial. Como consecuencia de la exposición crónica, los operarios pueden desarrollar cambios óseos degenerativos, Raynaud, trastornos circulatorios en extremidades, trombocitopenia y lesiones cutáneas semejantes a esclerodermia; esto se conoce como “enfermedad por cloruro de vinilo”. Presentamos un paciente masculino de 24 años de edad que presenta fenómeno de Raynaud, cefaleas, malestar en manos y pies, sensación de frío, fatiga y pérdida de apetito asociado a exposición a policloruro de vinilo. El estudio de la microcirculación cutánea periungueal por videocapilaroscopía muestra alteraciones estructurales y funcionales características. Se recomienda un seguimiento multidisciplinario estricto de los trabajadores expuestos a PVC.

Doença pulmonar por metal duro em trabalhador da indústria petrolífera / Hard metal lung disease in an oil industry worker

A doença pulmonar por metal duro é uma pneumonia intersticial por células gigantes relacionada com a exposição à poeira composta por metais duros. Neste artigo é relatado o caso de um profissional da indústria petrolífera, diagnosticado com doença pulmonar por metal duro com base na documentação clínica, radiológica, funcional pulmonar e anatomopatológica.

Hard metal lung disease, which manifests as giant cell interstitial pneumonia, is caused by exposure to hard metal dust. We report the case of an oil industry worker diagnosed with hard metal lung disease. The diagnosis was based on the clinical, radiological and anatomopathological analysis, as well as on pulmonary function testing.

Prevalencia de enfermedades en trabajadores académicos de una universidad pública según seguro de gastos médicos / Prevalence of disease among academic workers at a Public University in Mexico City: health insurance data

La salud de los trabajadores académicos sin lugar a dudas es uno de los objetivos primordiales de numerosas investigaciones no sólo en nuestro país sino en España, Venezuela, Perú, Costa Rica, por mencionar algunos. En esos países se han estudiado principalmente entidades nosológicas desde el punto de vista médico, las investigaciones publicadas dan cuenta de la problemática y abordan enfermedades generales y estrés. El objetivo de este estudio fue conocer y reportar la prevalencia de enfermedades de los trabajadores académicos de una universidad pública, en la Ciudad de México, según el seguro de gastos médicos mayores y cuyos hallazgos demuestran que en relación al género, los más afectados son del sexo masculino, la edad de mayor presentación de enfermedades fue de 51 años, incrementándose el riesgo al ser casado con hijos menores de 18 años. Asimismo, la población objeto de estudio manifiestó no disponer de tiempo libre para recreación familiar o personal. El grupo más afectado son los profesores con mayor antigüedad laboral y que se desempeñan en las áreas de ciencias biológicas y de la salud. Otro factor observado como predisposición para enfermedad fue la exigencia laboral del propio individuo ya que invierten tiempo de sus días de descanso y vacaciones para mejorar su desempeño académico a fin de incrementar los estímulos que les otorga la universidad, lo cual se traduce en desgaste físico y emocional. Las enfermedades psicosomáticas mayormente encontradas fueron en primer lugar colitis, seguida por gastritis e hipertensión arterial y no existe diferencia estadísticamente significativa para la presentación de estas enfermedades psicosomáticas entre hombres y mujeres, por lo que se concluye que todos los profesores académicos están expuestos a los mismos riesgos para enfermarse

The health of academic workers has been the subject of numerous studies not only in our country, but also in Spain, Venezuela, Peru, Costa Rica, etc. This research has focused mostly on nosologic entities from a medical point of view, with general descriptions of the nature of the problem, diseases encountered, and stress. The objective of this study was to measure disease prevalence of diseases among academic workers at a Public University in Mexico City, using data from the largest health insurance company. Most affected were males, age greater than 51 years, and being married with children under 18 years of age. The study population also reported having little time for personal or family recreation. Also at risk were faculty with greater seniority, and working in the biological and health sciences. Another predisposing factor was self-imposed work demands, including working on weekends and holidays in order to obtain incentives provided by the University, resulting in physical and emotional fatigue. Psychosomatic illnesses included colitis, followed by gastritis and hypertension, without regard to gender, suggesting that all academic workers are exposed to similar health risks in this environment

Para não calar a voz dos nossos professores: um estudo das desordens vocais apresentadas pelos professores da rede pública municipal do Rio de Janeiro / Not to silence the voice of our teachers: a study of vocal disorders presented by the municipal public school teachers in Rio de Janeiro

Introdução: A freqüência, a gravidade e as repercussões sociais dos problemas de voz o transformaram em uma questão relevante para a Saúde Pública e para a Saúde do Trabalhador. A análise dos fatores de risco relacionados à voz profissional deve incluir tanto questões individuais como aspectos ambientais e organizacionais. Seu uso incorreto, originando ajustes inapropriados no modo de produção vocal, e a grande demanda vocal são fatores importantes para o desencadeamento de alterações no aparelho fonador dos professores. Uma parcela significativa deles desenvolve sintomas laríngeos, faríngeos e/ou cervicais de diferentes tipos e graus de severidade, afetando seu desempenho vocal. O absenteísmo e freqüentes pedidos de licença médica, além das incapacidades permanentes neste grupo, sobrecarregam os serviços de saúde e de perícia médica. A Lista Brasileira de Doenças Relacionadas ao Trabalho, produzida pelo Ministério da Saúde e adotada pelo Ministério da Previdência, não incluiu os transtornos da voz relacionados ao trabalho e a legislação vigente sobre aptidão e inaptidão vocal para o trabalho é ainda insuficiente e imprecisa. Objetivos: Avaliar diagnósticos, causas e critérios de readaptação funcional por problemas de voz de professores da rede pública municipal de ensino da cidade do Rio de Janeiro durante o ano de 2007...

Introduction: The frequency, severity and impact of social problems due to voice problems turned into an issue for Public and Occupational Health. The analysis of risk factors related to professional voice use should include not only individual issues but also organizational and environmental aspects. Inappropriate settings for the mode of voice production due to incorrect use of the voice, and high vocal demand are important factors for the triggering of changes in teachers' vocal apparatus. Laryngeal, pharyngealand/or cervical symptoms of different types and degrees and changes in vocalperformance are developed by a significant amount of them. The absences and frequent requests for medical leave, in addition to permanent disability in this group, overwhelmthe health services and medical expertise. The List of Brazilian Diseases Related to Work, produced by the Ministry of Health and adopted by the Ministry of Welfare, does not include work related voice disorders and legislation about vocal ability and inability to work are still insufficient and imprecise. Objectives: To assess diagnosis, causes and criteria for functional readaptation of teachers with voice problems in the public schoolsof Rio de Janeiro City during the year of 2007...

Scrotal neoplasia: would truck drivers be at greater risk?

OBJECTIVE: To analyze how scrotal neoplasias have been managed during the past decade and to question possible factors or professions associated to its presence. MATERIALS AND METHODS: We retrospectively evaluated every case reported from 1995 to 2005 at our hospital. We described the clinical scenario, complementary exams, treatments and outcomes. We also tried to verify if there was any risk, predisposing factors or professions that would explain the cancer origin. RESULTS: Six cases were reviewed. Out of these, three patients were truck drivers. Five of them showed restricted lesions without inguinal lymph nodes enlargement. Histologically, six patients presented squamous carcinoma, with two of them having the verrucous type. The median age of patients was 52 years old (31 to 89). The five patients who are still alive had their lesions completely removed with safety margin and primary closure. CONCLUSIONS: We have noticed that the scrotal carcinoma behavior is similar to that of the penis, where removal of the lesion and study of the regional lymph nodes help to increase the patient survival rate. The outstanding fact was that three out of six patients were truck drivers, raising the hypothesis that such profession, maybe due to the contact or attrition with the diesel exhaust expelled by the engine or to sexual promiscuity, would imply in a larger risk of developing this rare neoplasia.

Doenças granulomatosas ocupacionais / Granulomatous diseases of occupational etiology

Por apresentarem achados comuns caracterizados pela formação de granulomas; manisfestações sistêmicas e respiratórias; exposição ambiental e ocupacional a agentes orgânicos e inorgânicos; envolvimento de linfócitos T em sua patogênese e aspectos clínicos similares, a pneumonite por hipersensibilidade, as micobacterioses, a sarcoidose e as doenças pulmonares por exposição ao berílio e aos metais duros, foram englobadas numa denominação didática como doenças granulomatosas de provável etiologia ocupacional. Com o intuito de destacar a possibilidade da exposição ambiental e ocupacional como desencadeadora dessas doenças, algumas considerações sobre os aspectos epidemiológicos, da avaliação da exposição, da patogênese, dos critérios diagnósticos e da prevenção e controle dessas doenças foram abordados. Foram destacados, também, grupos de indivíduos considerados como de maior risco de acometimento e a necessidade dos profissionais da área da saúde estarem atentos em relação a eventual etiologia ocupacional dessas doenças, fator decisivo para a elaboração de medidas efetivas de prevenção e de vigilância epidemiológica.

A variety of diseases are encompassed in the didactic denomination of "granulomatous diseases of probable occupational etiology". As well as presenting similar clinical aspects, such diseases are characterized by certain common traits: formation of granulomas; systemic and respiratory manifestations; environmental or occupational exposure to organic or inorganic agents; and T lymphocyte involvement in the pathogenesis. Included in this category are hypersensitivity pneumonitis, mycobacteriosis (all forms) and sarcoidosis, as well as beryllium disease and other lung diseases caused by exposure to heavy metals. In order to highlight the risk of developing one of these diseases as a result of environmental or occupational exposure to etiologic agents, we address aspects related to epidemiology, pathogenesis and evaluation of exposure of these diseases, as well as those related to diagnostic criteria, prevention and control. We have given special emphasis to groups of individuals considered to be at high risk for developing these diseases, as well as to the need for health care professionals to remain aware of the potential occupational etiology of such diseases, a decisive factor in devising effective measures of prevention and epidemiological surveillance.

Pulmonary fibrosis in a steel mill worker

We report a case of pulmonary fibrosis in a 32-year-old man, who had worked at a steel mill and who died of respiratory failure due to interstitial fibrosis despite vigorous treatment. He showed SLE-associated symptoms, such as pleural effusion, malar rashes, discoid rashes, arthritis, leukopenia, and positive antinuclear antibody and anti-histone antibody. However, he did not present anti-DNA antibody. A thoracoscopic lung biopsy showed interstitial fibrosis, chronic inflammation and a small non-caseating granuloma in lung tissues, which could be induced by external agents such as metals. The manganese concentration in the lung tissue was 4.64 microg/g compared to 0.42-0.7 microg/g in the controls. The levels of other metals, such as iron, nickel, cobalt and zinc in patient's lung tissue were higher than those in the controls. The patient was probably exposed to Si and various metal dusts, and the lung fibrosis was related to these exposures. Exposure to Si and metal dusts should be sought in the history of any patient with SLE, especially in a male with pulmonary signs, and if present, exposure should be stopped. In the meantime, steps should be taken to ensure that workers exposure to Si and metal dusts in all environments have adequate protection.

Estudio descriptivo sobre la disfonia como enfermedad profesional en docentes primarios en el periodo octubre-noviembre 1999 / Description study about the dysphonia how professional disease in primary teachers in the peirod october-november 1999

El principal objetivo del presente trabajo de investigación de tipo dewscriptivo, es reflexionar acerca del conocimiento que poseen los docentes primarios sobre la disfonía como enfermedad profesional como así también la responsabilidad que tienen sobre su salud vocal. La población estuvo conformada por 105 docentes primarios pertenecientes a escuelas de las zonas centro y sur de la ciudad de Rosario encuestados en el período Octubre-Noviembre de 1999. Analizando las variables "conocimiento de la disfonía como enfermedad profesional" y "la responsabilidad de la salud vocal", surge que la mayor parte de la población posee un conocimiento medianamente satisfactorio (41,9 por ciento) y una responsabilidad moderada (42,9 por ciento). Esta población tiene una antigüedad en la docencia entre 10 y 19 años, con una carga horaria de un turno

Polineuropatia devido ao óxido de etileno: registro de caso com estudo clínico, eletrofisiológico e histopatológico / Polyneuropathy caused by ethylene oxide: report of a case with clinical, electrophysiological and histopathological studies

Os autores referem-se a caso de um jovem que, trabalhando em fábrica de esterilizaçäo de artigos médicos e em contato diário com o óxido de etileno, desenvolveu leve polineuropatia sensitivo-motora. Os estudos eletrofisiológicos evidenciaram neuropatia por degeneraçäo axonal. A biópsia do nervo sural mostrou discreta perda de fibras mielínicas e sinais de degeneraçäo e regeneraçäo axonal. Este é o primeiro caso desta afecçäo descrita em nosso meio

Clinical and immunological responses to cotton dust exposure among workers in cotton industry

This study was carried out on 206 workers, selected randomly from workers of ESCO Company in Kaliubia governorate, to reveal the effect of exposure to cotton dust on health of workers and to investigate the role of cotton antigen in the etiology of cotton related symptoms or diseases. The examined workers were divided into an exposed and a control group comprising 150 and 81 workers respectively. The results showed higher prevalence of chest symptoms among exposed workers than controls. Workers in dusty operations showed more chest symptoms than in less dusty ones. The longer the duration of exposure the more prevalent were the chest symptoms. Exposure to cotton dust can lead to acute and chronic reduction in FEV which was directly proportional to duration and level of exposure and prevalence of respiratory symptoms. The titre of total IgE and specific IgE antibodies to cotton antigen in the serum of exposed workers was not significantly different from that of controls