Occupational skin diseases in Czech healthcare workers from 1997 to 2009.

BACKGROUND: The healthcare sector ranked in second place among economic sectors in the Czech Republic, with about 11.4 % of all occupational diseases in 2009. Skin diseases constituted about 20 % of all occupational diseases. OBJECTIVES: The aim of this study was to analyze the causes and trends in allergic and irritant-induced skin diseases in the healthcare sector. METHODS: The data concerning occupational skin diseases (Chapter IV of the Czech List of Occupational Diseases, non-infectious skin illnesses) in the healthcare sector were analyzed from the Czech National Registry of Occupational Diseases from 1997 until 2009. The trends in the total counts and most frequent causes were evaluated. RESULTS: During the past 13 years, a total of 545 skin diseases were acknowledged in healthcare workers. Allergic contact dermatitis was diagnosed in 464 (85 %), irritant contact dermatitis in 71 (13 %) and contact urticaria in 10 subjects (2 %). Ninety-five percent of the patients were females. The overall incidence in individual years varied between 1.0 and 2.9 cases per 10,000 full-time employees per year. Disinfectants were the most frequent chemical agents causing more than one third of all allergic skin diseases (38 %), followed by rubber components (32 %) and cleaning agents (10 %). CONCLUSION: A general downward trend of diagnosed cases of occupational skin diseases in heath care workers in the Czech Republic over the past 13 years was demonstrated.

Mercury intoxication from skin ointment containing mercuric ammonium chloride.

OBJECTIVE: A one-year follow-up was performed of a 21-year-old man with a 16-year history of diabetes mellitus type I, who had been using ointment containing 10% mercuric ammonium chloride (hydrargyrum amidochloratum; HgNH(2)Cl) for eczema for approximately 3 weeks. Tiredness, fasciculations on the extremities and poor control of diabetes appeared after the end of the ointment treatment. Nephrotic syndrome and hypertension were diagnosed 1 month later. Two months after the ointment application the patient was very weak with tremors of the hands, almost unable to walk, and had lost 20 kg of body weight. He had severe neurasthenic symptoms and his behaviour suggested acute psychosis. METHODS: Internal, neurological and neuropsychological examinations were performed. Mercury in urine was determined by flameless atomic absorption spectrometry. RESULTS: The urine mercury level on admission was 252.0 microg/l. He was treated with Dimaval, sodium (2,3)-dimercaptopropane(-1)-sulphonate capsules for 12 days (total dose 6.3 g). The highest urine mercury excretion during antidote treatment was 2336.0 microg/24 h. The patient had proteinuria of up to 11.10 g/24 h, and renal biopsy revealed diffuse membranous glomerulonephritis of the 1st stage without apparent diabetic nephropathy. Similarly, neuropathy did not have typical signs of diabetic neuropathy. His clinical condition started to improve during the first 2 weeks. Further follow-up has shown slow normalisation of renal functions. After 1 year, proteinuria decreased to 0.62 g/24 h and body weight normalised. Neuropsychological and electromyographic findings became almost normal. CONCLUSION: Severe intoxication developed after a short period of ointment application. Most signs of damage disappeared in the course of 1 year, except mild proteinuria and neuropathy. The evolution was favourable and confirmed the primary role of mercury intoxication in the severe deterioration of the clinical status of the patient.

Lipid metabolism and neuropsychological follow-up study of workers exposed to 2,3,7,8- tetrachlordibenzo- p-dioxin.

OBJECTIVE: More than 35 years ago, during 1965-1968, in the former Czechoslovakia, approximately 80 persons became ill due to occupational exposure to 2,3,7,8-tetrachlordibenzo- p-dioxin (2,3,7,8-TCDD). The objective of this study was to investigate the incidence of disorders related to occupational exposure to 2,3,7,8-TCDD. METHODS: Most subjects in the group of 12 former 2,3,7,8-TCDD workers (mean age 56.8 years, exposure 10 days to 23 months) still suffer from disturbances of lipid metabolism, psychic disorders, chloracne, and/or nervous system lesions. All workers were given internal, neuropsychological and ophthalmological examinations. Blood cholesterol and triglycerides were measured, and the common carotid artery was examined by ultrasound (B-mode), with the intima-media thickness (IMT) also being measured. Findings were compared with the 2,3,7,8-TCDD level in 1996. RESULTS: Nine of the 12 previously exposed workers had elevated plasma lipids, and hyperlipidaemia was statistically more frequent in patients with higher 2,3,7,8-TCDD levels ( P=0.03). Subject 1, with the highest 2,3,7,8-TCDD plasma level, had 80% stenosis of the diameter of the carotid artery, which needed acute surgery. Besides him, seven persons had atherosclerotic plaques in the carotid arteries. The mean IMT in the group was 0.85 mm (SD+/-0.19); the normal value is 0.62 mm. Eight subjects had degenerative changes of the ocular fundus. Chloracne was still present in two persons. Neuropsychological findings were assessed as normal only in three persons with lower 2,3,7,8-TCDD plasma levels in 1996. Mean 2,3,7,8-TCDD plasma level in 1996 was 256 pg g(-1) fat (range 14-760). CONCLUSION: Hyperlipidaemia, atherosclerotic plaques, increased IMT, ischaemic heart disease and neuropsychological disturbances were frequent in this group of former 2,3,7,8-TCDD workers. Hyperlipidaemia might have played an important role in most of these disorders. The level of 2,3,7,8-TCDD correlated with the highest level of triglycerides ( P=0.02) and cholesterol ( P=0.01) that was found during the 35-year follow-up. This group belongs to the most heavily 2,3,7,8-TCDD-exposed groups of workers, because the mean estimated concentration at the time of intoxication was approximately 5000 pg g(-1) plasma fat.

Occupational diseases in the Czech Republic in the year 1998. The need for unifying European standards/criteria for all occupational diseases.

In the Czech Republic, the Clinics and Departments for Occupational Medicine according to the legislation have the right to recognise occupational diseases. The diagnosis must correspond to the Czech list of occupational diseases, which is similar to the European list of occupational diseases. The exposure, sufficient enough to cause certain occupational disease, must be confirmed by regional industrial hygienists, responsible for hygienic control of the workplace. It is evident that the number of diseases is very much dependent upon the standards/criteria used to recognise occupational diseases. In the Czech Republic, the patients suffering from occupational diseases are given considerable financial compensations, which creates a great motivation for them to apply for occupational diseases. The article presents the overview of occupational diseases in the Czech Republic in the year 1998. The total number of diseases was 2111, the incidence per 100,000 employees was 45.8. It is necessary to present and discuss unifying criteria for occupational diseases in European countries, as well as the minimum level of the damage, that could be called an occupational disease. The criteria should be co-ordinated, because in a unified Europe, there will be many more possibilities for change in the workplace.

[Risk factors for ischemic heart disease in healthy persons with hyperinsulinemia and normal glucose tolerance]. / Rizikové faktory pro ischemickou chorobu srdecní u zdravých osob s hyperinzulinémií a normální glukózovou tolerancí.

The authors investigated the relationship of plasma insulin to some risk factors of ischaemic heart disease (IHD). They examined 79 healthy men--drivers of international truck transport with a normal glucose tolerance. The group comprised 21 men with hyperinsulinaemia. This group was compared with 21 men from the same group with normal insulin levels. The two groups were comparable (matched pairs) for age, occupation, cigarette and alcohol consumption and education. Significantly higher values of the body mass index (BMI), systolic and diastolic blood pressure were found in the group with hyperinsulinaemia. The latter group had a significantly more frequent positive family-history as regards cardiovascular diseases. After 48 months all subjects were checked. Two men from the entire group had died (43 and 48 years) from fatal myocardial infarction, both had hyperinsulinaemia. Manifestations of cardiovascular diseases (IHD and hypertension) developed in 12 subjects from the group with hyperinsulinaemia, as compared with two subjects with hypertension but normal insulin levels. To conclude, it may be stated that healthy subjects with hyperinsulinaemia and a normal glucose tolerance have a higher level of some risk factors of coronary heart disease (hypertension, obesity, positive family-history), as compared with the normoinsulinaemic group, and a poorer prognosis as regards cardiovascular morbidity and mortality.