[Acute silicosis. An infrequent pneumoconiosis]. / Silicosis aguda, una neumoconiosis rara.

BACKGROUND: Acute Silicosis was first described in 1900 by Betts. It's also denominated as silicoproteinosis. It's an infrequent way of pneumoconiosis which is produced when sandblasting. CLINICAL CASE: 27 year old male who has been working for four years in a glass shop, etching them through sandblasting. Four years before with dyspnea on exertion rapidly progressing. Coughing spell, emetic and wheezing, with daily hyaline expectoration of 50 cc, yearly weight loss of 44 lbs and intense chest pain. Breathing rates 36X'. He was polypneic, with basal bilateral crackling rales. Thorax X-rays shows Mengeaux Festoon, right lung apex, rounded opacities between 3 and 10 mm in diameter, type 2/2 r/r in the ILO 2000 Classification. Opacities in the left lung flux to mix into a honeycomb shape type B silicoma. Cardiac silhouette frayed and Grade 1 Cardiomegaly. Dies five years after his condition started. CONCLUSIONS: This kind of operations should be prohibited unless an industrial safety program using a Self-Contained Breathing Apparatus (SCBA) is applied.

Introducción: la silicosis aguda fue descrita inicialmente en 1900 por Betts. Se le denomina también silicoproteinosis alveolar. Es una forma infrecuente de neumoconiosis producida al utilizar chorro de arena (sandblast) para pulir. Caso clínico: masculino de 27 años, trabajó 4 años en un expendio de vidrios, esmerilándolos por medio de chorro de arena. Padecimiento de 4 años con disnea de esfuerzos rápidamente progresiva hasta mínimos esfuerzos, tos seca, emetizante y disneizante, con expectoración hialina 50 ml diarios, pérdida de 20 kg de peso en 1 año y dolor torácico generalizado de tipo pungitivo intenso. Frecuencia respiratoria 36X´ frecuencia cardiaca 120X´, estertores crepitantes basales bilaterales. En la telerradiografía de tórax se observa festón de Mengeaux en hemidiafragma derecho y en el vértice derecho, opacidades redondeadas entre 3 y 10 mm de diámetro tipo 2/2 r/r de la Clasificación de la OIT, 2000. En el pulmón izquierdo las opacidades confluyen formando un silicoma tipo B e imágenes en panal de abeja. Silueta cardiaca deshilachada y cardiomegalia grado 1. Fallece a los 5 años de iniciado su padecimiento. Conclusiones: se deben prohibir estas operaciones o aplicar programa de higiene industrial con uso de respirador autónomo.

Cement dust exposition and bronchioalveolitis. A case report.

The goal of the current investigation was to report an unusual case of a worker acutely exposed to big amounts of cement dust. This exposure caused chemical bronchioalveolitis and dermatitis due to chromium contact. This person suffered the exposure when a cement deposit exploded at work. This exposed the worker to big amounts of cement dust. After the accident, the individual suffered dyspnea and bilateral basal pulmonary crackles. The subject also presented an atypical restrictive pattern, which could also be seen on X-rays as 1/1 q/q images of the classification of 2000 of the International Labour Organization (ILO), and a bulging of a pulmonary artery. A restrictive pattern pure atypical was observed, and arterial blood gas with hipoxemia. A treatment with steroids was prescribed and the worker showed some improvement. There is high risk of developing pulmonary fibrosis with the progressive evolution in stages of the bronchioalveolitis, even when the subject is isolated. Therefore, it would be very convenient to create a specialized medical center where workers that have this kind of accidents can have the proper care by qualified personnel.

El objetivo de esta publicación es informar del caso poco habitual de un trabajador expuesto de forma aguda a grandes cantidades de cemento, lo cual le produjo un cuadro de broncoalveolitis química industrial y dermatitis de contacto por cromo. El trabajador sufrió un accidente de trabajo cuando se rompió un depósito de cemento y lo expuso a cantidades muy elevadas del polvo de cemento. Presentó disnea de grandes esfuerzos, con estertores crepitantes basales bilaterales. Tuvo, asimismo, una frecuencia respiratoria de 32 por minuto y rash cutáneo. La espirometría mostró un patrón restrictivo atípico incipiente que se correlacionó radiográficamente con imágenes 1/1 q/q de la Clasificación del 2000 de la Organización Internacional del Trabajo (OIT) y abombamiento de la arteria pulmonar. En la gasometría arterial efectuada al trabajador se encontró hipoxemia en posición de decúbito supino. Se prescribió tratamiento esteroideo con mejoría del padecimiento. Dado que hay un alto riesgo de que la fase aguda de las broncoalveolitis termine en fibrosis pulmonar por su evolución en etapas (pues son progresivas aunque se suspenda la exposición), se sugiere crear un servicio especializado, atendido por personal calificado, para el manejo médico de este tipo de accidentes.

[Silicosis and industrial bronchitis by exposure to silica powders and cement].

OBJECTIVE: to identify the association between the exposure of workers to inorganic dust in a quarry and a cement factory and pulmonary diseases. METHODS: a transverse study on data from 32 quarry workers (QWs) and 57 cement production line workers (CFWs) to inorganic-dust exposure was performed. Pulmonary function tests and chest X ray were done in both groups. RESULTS: there were differences between QWs and the CFWs; QWs were younger, shorter and thinner. The number of sick individuals might be considered significantly different, showing a smaller proportion on the cement production line. The quarry workers have been on the company for a shorter period of time and, in the end, they present more serious pulmonary problems with an average of 3 years working. CONCLUSIONS: the amount of free-silica that is managed on the quarry affects the workers in some way, even when literature states that the evolution of industrial bronchitis and silicosis have a period development of approximately 10 years.

Objetivo: asociar la exposición a polvos inorgánicos en trabajadores de una cantera y una cementera y la generación de alteraciones pulmonares. Métodos: estudio transversal con 32 trabajadores expuestos a polvos inorgánicos en una cantera y 57 en una cementera. Se les realizaron pruebas de función respiratoria y telerradiografías de tórax. Se midieron polvos totales. Resultados: existieron diferencias demográficas significativas entre las dos líneas de producción: los empleados de la cantera fueron más jóvenes, menos altos y ligeramente más delgados. La proporción de enfermos fue significativamente diferente entre las dos áreas: en la cementera fue menor que en la cantera. Aun cuando los trabajadores de la cantera tuvieron una antigüedad menor, presentaron problemas pulmonares más graves. Conclusiones: la cantidad de sílice libre que se maneja en la cantera afecta gravemente la salud de los trabajadores, ya que con un promedio de tres años de antigüedad laboral presentaban silicosis. Por ello, deben establecerse mejores programas de higiene industrial para el control de los polvos.

[The influence of preventive programs on laboral injuries]. / Impacto de los programas preventivos de accidentes de trabajo.

OBJECTIVE: To evaluate the impact of preventive programs at enterprises affiliated to the Instituto Mexicano del Seguro Social (IMSS) during 2004. METHODS: Transversal study in 987 enterprises. VARIABLES: labor injuries (LI) of temporal disability, permanent disability and death. ANALYSIS: simple and relative frequencies, rates and Anova application to differences. RESULTS: 64.4% of the enterprises decrease LI (p < 0.04), with a decrement of 2602 LI (16%); the rate of LI per 100 workers declined from 4.19 to 3.60 (p < 0.08), with a decrease of 43,369 disability days (10.93%), which represents $8,456,955 MXP. States with larger decreases were: Queretaro (80%) p < 0.05; Sinaloa (63%) p < 0.05, and Morelos (61%) p < 0.05. Permanent incapacities diminished at 12.1%, p < 0.09; the rate of permanent disability per 1000 workers diminished from 1.37 to 1.32 and death cases increased from 42 to 49. CONCLUSIONS: the expenses on consultancy by IMSS was estimated as $9,341,955 MXP. The savings on temporal and permanent incapacities was $33,691,255 MXP with a cost containment of $19,701,310 MXP. Preventive programs are profitable, because they generate benefits to the workers, the IMSS and the enterprises.

Pleural mesothelioma in paraoccupational, environmental and occupational patients exposed to asbestos.

OBJECTIVE: To identify the characteristics of pleural mesothelioma in patients exposed to asbestos. METHODS: A transverse study in 3700 cases of lung cancer was conducted. There were identified 21 cases with mesothelioma. Age, gender, smoking history, cancer development, dissemination, cytohistochemistry, lethality and total lung capacity were studied. ANOVA test was used. RESULTS: The incidence was of 0.45/100,000 patients. Four (19%) corresponded to occupational exposure (OE), seven (33%) para-occupational (PE) and ten (48%) environmental (EE). The mean age at detection was 50 years for PE, 55 years for EE and 64 years for OE. Twenty cases were male. Thirteen patients (62%) were active cigarette smokers. The latency time in PE mesothelioma was 34.5 years, in OE 40 years, and in EE more than 40 years. In 19 (90%) cases the tumor was disseminated. Diagnosis was confirmed by cytohistochemistry. Malignant mesothelioma was reported in 19 (90%) cases. The survival period was 5 months for OE patients, 10 in PE and 16 in EE. CONCLUSIONS: There is a low incidence of malignant mesothelioma in our population. Male was the predominant group. Occupational and paraoccupational exposure predominated in patients.

[Laboral talc pneumoconiosis as a low frequency disease]. / Talcosilicosis, enfermedad laboral poco frecuente.

OBJECTIVE: To identify the association between exposition to talcum powder and talcosilicosis in a cosmetic factory. METHODS: A descriptive and prospective survey including 24 workers from the bottling and grinding areas was performed. All patients had chest roentgenography. They were separated into two groups: the first patients exposed up to a period of five years and the second with more than five years exposure. Environmental monitoring of high flow polyvinyl chloride filters and galvimetric analysis was performed. The dust analysis was performed in 12 inhaling powders, eight environmental and four in workers. A Fisher exact test was applied. RESULTS: All of the exposed workers displayed radiographic findings compatible with talcosis; 18 (75%) patients had light talcosis and 6 (25%) moderate. The Fisher test was 13.7 with a p value of 0.004. Dust analysis showed: five were reported over the maximum allowed levels corresponding to the areas of compact cosmetics grinders, powder grinders, powder dispensers and the talcum final line. The analyzed talcum powder contained more than 95% of free silica. CONCLUSIONS: The association was confirmed between the exposure and the presence of talcosis.

[Pneumoconiosis in affiliated workers have irreversible sequelae]. / Neumoconiosis en trabajadores expuestos a polvos inorgánicos.

OBJECTIVE: to analyze the frequency and importance of pneumoconiosis in affiliated workers to Instituto Mexicano del Seguro Social. MATERIAL AND METHODS: it was carried out a transverse, observational and comparative study; the behavior of the qualified pneumoconiosis was revised 1994-2004. The analyzed variables were sex, age, occupation, permanent disability and economic activity. It was carried out the analysis of absolute frequencies and rates. RESULTS: it was registered 14,827 cases; the rate for 10,000 workers oscillated from 0.48 to 2.39. The 99 % were presented in males, with 14,262 cases with permanent disability (rate: 96.89 per 100 cases of pneumoconiosis); employments with more frequency were miners, quarry workers and bricklayers. The average of permanent disability for pneumoconiosis in the period was of 11.09 to 15 %. States with a higher number of cases were Coahuila, Zacatecas and Hidalgo. Economic activities with a greater incidence were the extraction and benefit of mineral coal, graphite and metallic and non-metallic minerals. CONCLUSION: cases of pneumoconiosis have been decreasing, but even the determination of diagnosis is delayed, and due to this most workers have irreversible sequelae.

[Industrial bronchitis in workers exposed to hydroalcohol]. / Bronquitis industrial en trabajadores expuestos a hidroalcoholes.

OBJECTIVE: To identify the association between industrial bronchitis and exposure to hydroalcohol. METHODS: In a prospective study, 80 workers exposed to hydroalcohol answered a standardized questionnaire and had two spirometry tests based on the American Thorax Society (ATS) criteria, to evaluate functional capacity and predominant spirometric patterns. The test included the parameters: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), the ratio FEV1/FVC, the peak expiratory flow (PEF), the forced expiratory flow 25-50 (FEF50) and the forced expiratory flow 25-75% (FEF 25%-75%). Fisher exact test was used to identify differences. An environmental sampling of hydroalcohols was done as well. RESULTS: 85 % Of workers were women and 15 % men, with respiratory symptoms as follows: 25 % with cough and expectoration, 14 % thoracic pressure feeling, 23 % dyspnea; 36 % eye, nose or throat irritation. The spirometry results were: 25 % for pulmonary normal pattern; 66 % had obstructive pattern; 3 % had restrictive patterns and 6 % mixed pattern. 25 % of workers with obstructive pattern and 10 % of normal pattern had symptoms. It was obtained an OR = 1.9 (95 % CI = 1.135-3.195; p = 0.021) for the time of exposure to hydroalcohols and the presence of industrial bronchitis. The monitoring of hydroalcohols reported: 131.1 mg/m3 for isopropyl alcohol and 438.3 mg/m3; 49 workers (61 %) had bronchitis symptoms and 58 (72 %) showed obstructive or mixed patterns in the spirometry tests. The exposure to hydroalcohols was below the limits established by the Mexican Official Norm.

Prediction equations for spirometric parameters in Mexican adult population.

BACKGROUND: Our objective was to develop prediction equations for spirometric parameters that included the following: forced vital capacity (FVC); 1st-sec forced expiratory volume (FEV1); FEV1/FVC ratio; peak expiratory flow (PEF); maximal expiratory flow 50% FVC (VF50) and maximal expiratory flow 75% FVC (VF75); maximal mid-expiratory flow (FEF25-75), and forced late expiratory flow rate (FEF75-85) in a sample of adult Mexican population of both sexes. Age and height variables were utilized. METHODS: Spirometric studies were carried out, observing the international recommendations and norms in force and effected under basal conditions and post-bronchodilator. Linear regression equations were generated based on gender, age, and height. For each spirometric parameter, we selected a linear model. Studies were carried out with spirometry that was in agreement with quality criteria recommended by the American Thoracic Society (ATS). Bronchodilatator administration allowed for elimination of subjects with subclinical bronchial hyperreactivity RESULTS: We studied 436 patients with normal clinical radiographic and pulmonary function, with negative smoking and age range between 17 and 63 years; 206 were females and 230, males. Linear regression equations obtained had direct linear correlation with height and inverse linear correlation with age; in addition, equations had a determination coefficient equal to or less than those reported by authors recommended by the ATS. CONCLUSIONS: Equations obtained in this study possessed the quality required for application in adult Mexican population exposed or not to occupational and environmental contaminants.

Radionúclidos en el diagnóstico de las neumoconiosis / Radionuclides imaging in the diagnosis of the pneumocononiosis

Se estudiaron 101 trabajadores con diagnóstico de neumoconiosis mixta por silice, asbesto y cemento, en los que se intento mejorar la precisión diagnóstica al valorar la incapacidad fisico-funcional producida por la enfermedad, para lo cual además de las radiografias de tórax, las pruebas de función pulmonar clásicas y el estudio clínico-que consta de exploración fisica e interrogatorio con énfasis en los antecedentes de trabajo-, se efectuaron estudios con isótopos radioactivos: xenón-133 para evidenciar las alteraciones ventilatorias y la zona pulmonar en que éstas se producen, tecnecio-99m macroagregados de albúmina (Te-99mMAA) para esclarecer el área de las alteraciones en la perfusión pulmonar, y gallo-67 para descubrir en qué sitio del pulmón existe inflamación intersticial. Con el xenón-133 se encontró correlación de 85 por ciento, con el Te-99m-MAA de 98 porciento y con el gallo-67 de 80 por ciento, en relación con el sistema tradicional utilizado para evaluar el grado de incapacidad fisico-funcional. Se realizó análisis bivariado con x², considerando significativo un valor de p<0.05

Bronconeumopatía del que trabaja en el cultivo de hongos comestibles / Bronchopneumopathy in the worker cultivating edible mushrooms

Se informa del caso de um trabajador al que se le diagnosticó con muchas dificuldades y después de mucho tiempo neumonitis por hipersensibilidad e incluso se trató con éxito de la misma, pero de la que no se pudo determinar al principio cuál era la forma, porque no se averiguó a qué tipo de riesgos se exponía en el desarrollo de su labor. Una vez interrogados los antecedentes personales de trabajo se pudo aclarar posteriormente que se expuso durante muchos años al medio ambiente contaminado con exporas de mohos que se producen donde se cultivan hongos comestibles, las que provocaron esta bronconeumopatía, excepcionalmente informada en al literatura médica, en este tipo de trabajadores, misma atribuida a actinomicetos, meso y termofílicos, y termotolerantes semejantes a los que producen, por ejemplo, las bagazosis y que generalmente pasa inadvertida, a causa de que se ignora su existencia por la baja frecuencia con que se desarrolla