Simultaneous effects of noise exposure and smoking on OAEs.

Noise is one of the most pervasive hazardous factors in the workplace. Noise-induced hearing loss (NIHL) is the most common disorder related to noise exposure. Smoking is probably associated with hearing loss. The simultaneous effect of noise and smoking on hearing is a recent concern. In this study, we assessed the simultaneous effect of noise and smoking on standard pure tone audiometry (PTA) and distortion product otoacoustic emissions (DP-OAEs). This was an historical cohort study on 224 workers exposed to noise who were divided into two groups: Smokers and nonsmokers. DP-OAE response amplitudes were assessed. Data were analyzed by SPSS software (version 19) using Student's t-test and Mann-Whitney U test. One hundred and five subjects were smokers (case group) and 119 individuals were nonsmokers (control group). All the subjects were exposed to 91.08 + 2.29 dBA [time-weighted average (TWA) for an 8 h work shift]. Mean DP-OAE response amplitude at frequencies higher than 1,000 Hz was significantly higher in the smokers than the nonsmokers. This study showed that smoking can aggravate the effect of noise on hearing in DP-OAEs.

Concurrent effect of noise exposure and smoking on extended high-frequency pure-tone thresholds.

OBJECTIVE: Concurrent effect of noise and smoking on hearing loss is a recent concern. In this study, the concurrent effect of noise and smoking on hearing loss in conventional frequencies and frequencies higher than 8 kHz was assessed. DESIGN: This was a cross-sectional study on workers exposed to noise who were divided into two groups: smokers and non-smokers. Hearing thresholds were assessed by conventional audiometry, and HFA. Data were analysed using non-parametric tests and Student's t-test. STUDY SAMPLE: There were 212 workers. RESULTS: Ninety-seven subjects were smokers and 115 individuals were non-smokers. All subjects were exposed to 92.1 ± 2.4 dBA (Leq8h). The highest threshold in conventional and high-frequency audiometry was observed at 6 kHz and 16 kHz, respectively. Hearing threshold at frequencies above 1 kHz was significantly higher in the smokers than non-smokers. There was no correlation between hearing thresholds and pack-years of smoking. CONCLUSIONS: Concurrent exposure to noise and smoking may be associated with more hearing loss than exposure to noise alone in the conventional and high frequencies. However, other differences between smokers and non-smokers may explain these differences as well.

Spirometry values for detecting a restrictive pattern in occupational health settings.

BACKGROUND: Pulmonary function tests are valuable measures for diagnosis and management of respiratory diseases. In the field of occupational medicine, spirometry is commonly performed, and in a considerable number of spirometries during occupational health evaluations, restrictive pattern is observed without any respiratory symptoms and may necessitate referral of the subject for body plethysmography, which is an expensive test. In this study, we evaluated the diagnostic accuracy of spirometry for detection of restrictive lung pattern in an occupational setting. MATERIALS AND METHODS: In a cross-sectional study from 2008 to 2012, 1224 subjects were selected and entered in the study out of 1,486 individuals referred for annual spirometry. Selected subjects underwent spirometry and body plethysmography. Subjects were divided into two groups of restrictive and non-restrictive patterns and then sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of spirometry for detection of restrictive lung pattern were calculated using total lung capacity measured by plethysmography as the gold standard. Receiver operating characteristic (ROC) curves were used as well. RESULTS: Spirometry showed sensitivity, specificity, PPV and NPV of 97.75%, 73.04%, 73.72% and 97.67% for FVC< lower limit of normal (LLN) and 98.68%, 78.00%, 77.31% and 98.83% for FVC< LLN along with FEV1/FVC≥ LLN, respectively. According to the ROC curve, the best cut-off point for FVC for detection of restrictive lung pattern was 70%. CONCLUSION: This study showed that spirometry is a useful method in occupational health evaluations to rule out restrictive lung patterns with acceptable accuracy; however, it is not an accurate tool for detection of restrictive lung pattern in an occupational setting. Simultaneous use of FVC and FEV1/FVC for detection of restriction increases the predictive value of spirometry.

Bronchodilator Response of FEV6 and FEV3 as Surrogates of Forced Vital Capacity.

BACKGROUND: Spirometry as a non-invasive and inexpensive test is widely used for occupational health evaluations. Bronchodilator test is used for the assessment of airflow limitation and increase in forced expiratory volume in 1 second (FEV1) or forced vital capacity (FVC) is considered as a positive response. This study was performed to assess the response of forced expiratory volume in 6 seconds (FEV6), forced expiratory volume in 3 seconds (FEV3), and forced expiratory time (FET) to bronchodilator administration. MATERIALS AND METHODS: In this cross-sectional study, the response of FEV3, FEV6, FEV1/FEV3, FEV1/FEV6 and FET to bronchodilator administration was assessed in subjects referred to Yazd occupational medicine clinic regardless of their diagnosis. The average increase in spirometric parameters (i.e. FVC, FEV1, FEV1/FVC, FEV3, FEV6, FEV1/FEV3, FEV1/FEV6 and FET) was measured. The difference between baseline and post-bronchodilator spirometries was assessed by calculating absolute change and change from baseline as well. Data analysis was done by Student's t test, chi square test and Pearson's correlation test. RESULTS: Totally 104 subjects were entered in the study. FEV1 showed the highest response to bronchodilator. FVC response to bronchodilator was correlated with FET, but such correlation was not observed for FEV6 and FEV3. The mean increase in FEV6, FEV3, and FET after bronchodilator administration was 50.90 ml (2.23%), 110.51 ml (3.08%) and -1.85 s, respectively. CONCLUSION: FVE6 can be used as a substitute for FVC for the assessment of bronchodilator response without the need for FET adjustment.

Lifestyle changes for prevention of breast cancer.

Breast cancer is the second most common cause of death from cancer among women. Lifestyle changes are shown to be important in the prevention of breast cancer. Diet, physical activity, smoking, alcohol use, and vitamin and mineral use are key factors influencing the risk of breast cancer among women. Because these factors are related to each other, it is difficult to assess their individual roles in breast cancer. Some of these factors are alterable, meaning that women can decrease their risk for breast cancer by changing their behavior. Breast cancer is associated with a high rate of mortality and morbidity among women. Therefore, it is logical to try to find ways to decrease the risk of developing breast cancer. Lifestyle changes seem to be an easy, effective, and economical way to help prevention breast cancer. In women with a confirmed breast cancer diagnosis who are under radiotherapy treatment after undergoing a mastectomy, lifestyle changes are still very important. Some factors, such as smoking cessation and prevention of weight gain, may improve the long-term survival chances of these patients. Therefore, ways to increase women's knowledge about the role of lifestyle changes in the prevention of breast cancer and in the survival of patients with diagnosed breast cancer should be considered and studied.

Bird Fancier's Disease Due to Exposure to Birds Via a Desert Cooler.

Hypersensitivity pneumonitis (HP) is an immunologically mediated pulmonary disease caused by various organic particles and some non-organic chemicals. HP is mostly associated with some occupations such as farming and bird breeding. We report a case of hypersensitivity pneumonitis in a housewife without any prior history of occupational exposures. The disease was developed due to indirect exposure of the patient to doves antigens via a desert cooler ducts.

Assessment of bronchodilator response in various spirometric patterns.

BACKGROUND: Spirometry is a physiologic test that measures the volume of air an individual inhales or exhales and the rate at which the volume is changed as a function of time. Bronchodilator response, as a beneficial test for diagnosis of bronchial responsiveness is measured using the percent change from baseline and absolute changes in forced expiratory volume in 1 second and/or forced vital capacity. In this study we aimed to assess the increase in spirometric parameters in patients with symptoms of asthma regardless of spirometric pattern. MATERIALS AND METHODS: In this cross-sectional study bronchodilator test was performed in individuals with dyspnea, cough or wheezing and the mean increase in various spirometric parameters was measured and compared among individuals with different spirometric patterns. RESULTS: Among all individuals 24.5% responded to bronchodilator. Forced expiratory volume in 1 second was the parameter with the most frequent response to bronchodilator. Patients with mixed pattern had the highest frequency of response to bronchodilator. Response to bronchodilator was more than 50% in most mid flow volumes. CONCLUSION: Some patients with symptoms of asthma may show restrictive or mixed pattern in spirometry which may respond to bronchodilator administration.