[Pulmonary disease due to asbestos in steel industry workers]. / Enfermedad pulmonar por amianto en trabajadores de acería.

Asbestos-related diseases are caused by the inhalation of asbestos fibers in their variety chrysotile or white asbestos. Although the ban in Argentina dates from 2003, there are numerous industries where work continues with this mineral, including iron and steel industries. It is currently known the high pathogenicity of this material, so that in many countries there are programs to monitoring the exposed workers. Here we describe the general characteristics and pulmonary manifestations in 27 patients who had worked in a very huge steel factory in South America. The diagnosis of asbestos-related diseases was made by a medical-occupational record, history of asbestos exposure, additional studies of lung function and chest images. Then the sources of exposure (occupational, domestic and environmental), exposure time and latency period were analyzed, in those patients in whom a related disease was detected. Smoking history was also taken into account. Twenty-two patients had benigns pathologies (81.4%), sixteen of them with lesions localyzed in pleura, and other six pulmonary asbestosis. The malignant pathologies occurred in five patients (18.5%), in four of them mesothelioma and in other one lung cancer. The problem of asbestos exposure has contemporary relevance. Hence the need for a surveillance program in workers exposed to asbestos in the past or currently, to detect, report, record and investigate the characteristics of these pathologies.

Enfermedad pulmonar por amianto en trabajadores de acería / Pulmonary disease due to asbestos in steel industry workers

Las enfermedades relacionadas al amianto se producen por la inhalación de fibras de asbestos en su variedad crisotilo o amianto blanco. A pesar de que en la Argentina la prohibición data del año 2003, existen numerosas industrias donde se sigue trabajando con este mineral, entre ellas las metalúrgicas y acerías. Actualmente se conoce la alta patogenicidad de este material, por lo que en muchos países existen programas de seguimiento de los trabajadores expuestos. Se describen las características generales y manifestaciones clínicas pulmonares de 27 pacientes que trabajaron en una gran acería de América del Sur. El diagnóstico de amiantopatías se realizó mediante historia clínica laboral, antecedente de exposición al amianto, estudios complementarios de función pulmonar e imágenes del tórax. Se analizaron la fuente de exposición (laboral, doméstica y ambiental), tiempo de exposición y período de latencia en los pacientes de los cuales se detectó enfermedad relacionada. Los antecedentes de tabaquismo fueron tenidos en cuenta para el análisis. En 22 pacientes se presentaron patologías benignas (81.4%), 16 de ellos tenían lesiones exclusivamente pleurales y otros 6 asbestosis. Las patologías malignas se presentaron en 5 pacientes (18.5%), en 4 fueron mesoteliomas y en uno carcinoma pulmonar. El problema de la exposición al amianto tiene vigencia actual. De ahí la necesidad de un programa de vigilancia en trabajadores expuestos al amianto actualmente o en el pasado, para detectar, notificar, registrar e investigar las características de estas patologías.

Asbestos-related diseases are caused by the inhalation of asbestos fibers in their variety chrysotile or white asbestos. Although the ban in Argentina dates from 2003, there are numerous industries where work continues with this mineral, including iron and steel industries. It is currently known the high pathogenicity of this material, so that in many countries there are programs to monitoring the exposed workers. Here we describe the general characteristics and pulmonary manifestations in 27 patients who had worked in a very huge steel factory in South America. The diagnosis of asbestos-related diseases was made by a medical-occupational record, history of asbestos exposure, additional studies of lung function and chest images. Then the sources of exposure (occupational, domestic and environmental), exposure time and latency period were analyzed, in those patients in whom a related disease was detected. Smoking history was also taken into account. Twenty-two patients had benigns pathologies (81.4%), sixteen of them with lesions localyzed in pleura, and other six pulmonary asbestosis. The malignant pathologies occurred in five patients (18.5%), in four of them mesothelioma and in other one lung cancer. The problem of asbestos exposure has contemporary relevance. Hence the need for a surveillance program in workers exposed to asbestos in the past or currently, to detect, report, record and investigate the characteristics of these pathologies.

Enfermedad intersticial grave de difícil caracterización / Severe difficult interstitial disease characterization

Se presenta una mujer de 62 años de edad, comienza un mes previo al ingreso con progresión de su disnea habitual de grado 3 a 4 MRC. Una semana previa agrega tos, inicialmente seca y luego productiva, motivo por el cual asiste a nuestro hospital (FSG) donde se detecta hipoxemia marcada e infiltrados bilaterales en radiografía de tórax y se decide su internación. No presentó fiebre ni otra sintomatología asociada

Multidrug-resistant tuberculosis in HIV-negative patients, Buenos Aires, Argentina.

Initial multidrug-resistant (MDR) tuberculosis (TB) in HIV-negative patients treated at a Buenos Aires referral hospital from 1991 to 2000 was examined by using molecular clustering of available isolates. Of 291 HIV-negative MDRTB patients, 79 were initially MDR. We observed an ascending trend of initial MDRTB during this decade (p=0.0033). The M strain, which was responsible for an institutional AIDS-associated outbreak that peaked in 1995 to 1997, caused 24 of the 49 initial MDRTB cases available for restriction fragment length polymorphism. Of those, 21 were diagnosed in 1997 or later. Hospital exposure increased the risk of acquiring M strain-associated MDRTB by approximately two and a half times. The emergence of initial MDRTB among HIV-negative patients after 1997 was apparently a sequel of the AIDS-related outbreak. Because the prevalence of M strain-associated disease in the study population did not level out by the end of the decade, further expansion of this disease is possible.

Asma ocupacional / Occupational asthma

En la cátedra de Neumonología (UBA) se estudiaron 31 pacientes con diagnóstico de asma ocupacional. Ellos se desempeñaron en 9 diferentes oficios principales, y otros secundarios; se hallaron expuestos a: polvos de algodón, lino, colorantes, isocianatos, harina de trigo, sílice y otros. Se registró un período de latencia promedio de 3,9 años. Todos tuvieron episodios de broncoespasmos; 38,7 por ciento revelaron eosinofilia periférica; de 15 en que se midíó IgE suérica se observaron elevaciones en el 66 por ciento. Doce hicieron pruebas de provocación inespecífica con MTC y fueron positivas en el 58,3 por ciento de los casos a dosis muy pequeñas, que correlataron con enfermos más graves. De los 31, 77,4 por ciento tuvieron espirometrías obstructivas, y del conjunto de ellos, 80 por ciento mejoraron con broncodilatadores. En 3 de ellos se hicieron pruebas serológicas de contrainmunoelectroforesis, que fueron positivas. Todos mejoraron cuando no inhalaban el ambiente laboral, durante las vacaciones, licencia médica prolongada, o cuando abandonaban el trabajo.