Silicotuberculosis and silicosis as occupational diseases: report of two cases.

INTRODUCTION: Silicosis, the most prevalent of the pneumoconioses, is caused by inhalation of crystalline silica particles. Silica-exposed workers are at increased risk for tuberculosis and other mycobacterium-related diseases. The risk of a patient with silicosis developing tuberculosis is higher (2.8 to 39 fold higher, depending on the severity of silicosis) than that found in healthy controls. OUTLINE OF CASES: The first patient was a 52-year-old male who was admitted in 2002 for the second time with dyspnoea, wheezing and fatigue over the last 11 years. He had worked in an iron smelting factory and was exposed to silica dust for 20 years. First hospitalization chest radiography showed bilateral pleural adhesions, diffuse lung fibrosis with signs of a specific lung process. Second hospitalization chest radiography showed bilateral massive irregular, non-homogenous calcified changes in the upper and middle parts of lungs. The patient died due to respiratory failure and chronic pulmonary heart in 2007. The main causes of his death were silicotuberculosis and chronic obstructive pulmonary disease. The second patient was a 50-year-old male who was admitted in 2005 for the second time with chest tightness, dyspnoea, wheezing and fatigue over the last 10 years. He had worked in an iron smelting factory and was exposed to silica dust for 30 years. First hospitalization chest radiography showed diffuse lung fibrosis and small nodular opacities. The patient was diagnosed with silicosis, small opacities sized level p/q, and profusion level 2/3. Second hospitalization chest radiography and CT showed diffuse lung fibrosis and small nodular opacities predominantly in the upper lobes. The patient was recognized as having an occupational disease, and received early retirement due to disability. CONCLUSION: In low-income countries, new cases of silicosis and associated lung cancer, chronic obstructive pulmonary disease and tuberculosis are likely to be seen for decades because necessary reduction of silica use will take time to be achieved.

Neuropsychiatric effects in workers with occupational exposure to carbon disulfide.

In a cross-sectional study, prevalence of dysfunctions of the central nervous system was assessed in 134 male workers exposed to different levels of carbon disulfide (CS2) in a rayon viscose plant and compared to 38 non-exposed workers. In three groups of workers from the same plant with different levels of CS2 (heavy, intermediate, none) estimated by personal samplers, disorders in the central nervous system were examined by means of psychiatric examination and questionnaire 16 (Q16). Unconditional logistic regression was calculated adjusted for age, alcohol consumption and education. Psychoorganic syndrome was diagnosed significantly more often in workers with heavy CS2 exposure, with adjusted OR of 17.9 (95% CI 2.18-146.73), and insignificantly in workers with intermediate exposure. Prevalence of workers with more than 6 positive answers on the Q16 was higher in the heavily exposed workers (OR=4.76; 95% CI 1.80-12.60). A similar result was found for almost all the questions in the Q16, and the most pronounced psychological symptom was of less interest in sex (adjusted OR=8.14; 95% CI 2.19-30.22). High correlation was found between symptoms recorded on neuropsychiatric examination and on Q16. Both neuropsychiatric exams and Q16 indicated disturbances in the central nervous system due to the long-term heavy exposure to CS2. Disorders of the central nervous system were found more often in workers with heavy exposure to CS2. Questionnaire Q16 is a valuable means for selecting workers for further neuropsychiatric testing.

Occupational health in Yugoslavia.

Occupational health in Yugoslavia was once well organized in accordance with WHO declarations and ILO conventions and recommendations. Since the 1990s, the system has been disrupted by destruction of the former Yugoslavia, wars, refugees, changes in the economy, and NATO bombardment. Economic trends, main industries, and employment and unemployment conditions in Yugoslavia are presented. The organization of occupational health services, their tasks, and prevailing problems are discussed. Occupational diseases and relevant research and educational opportunities are described. The authors conclude by suggesting approaches to improving worker's health in the future.