Mortality from silicosis in Brazil: Temporal trends in the period 1980-2017.

BACKGROUND: Silicosis is the most prevalent pneumoconiosis in Brazil. We aimed to estimate mortality rates and temporal trends for silicosis, and to identify areas of highest mortality. METHODS: Records of silicosis as the underlying (1980-2017) or contributory (2000-2017) cause of death in adults aged 20 years and older were retrieved from the Brazilian Mortality Database. Age-standardized mortality rates (ASMR) were calculated. The annual trend in ASMR was analyzed by joinpoint regression. Mortality rates per 100,000 person-years were calculated for each municipality. We analyzed temporal trends in municipalities where similar activities with exposure to silica were performed. RESULTS: There were 3164 death records (96.6% men) distributed over 14% of the municipalities. Mean age of death was 59.2 (SD 15.1) and mean ASMR was 0.085/100,000 (confidence interval 0.080-0.091). Joinpoint regression showed a significant increase in ASMR from 1980 to 2006 and a significant decrease after 2006 driven by a decline in deaths of individuals younger than 70 years. The highest mortality rate was 21.83/100,000 person-years, in a municipality with small mining operations for gems. Gold mining municipalities showed the highest composite death rate, 4.0/100,000 person-years. Tuberculosis was the main cause of death when silicosis was a contributing cause. CONCLUSIONS: In contrast with developed countries, silicosis mortality in Brazil increased to 2006 and subsequently started to drop, mostly from a plateau or decrease in deaths occurring in municipalities which regulated economic activities. However, this decrease did not occur in the older age group nor in the unregulated sector, the latter being the main challenge for exposure control and surveillance.

What is expected in lung function after lung transplantation due to end-stage pulmonary silicosis?

In this study, we aimed to determine the impact of lung transplantation (LTx) on pulmonary function tests (PFTs) and survival among patients with end-stage silicosis. We included patients with end-stage silicosis on the wait list for LTx, between January 1989 and July 2015 (N = 26). Sixteen of these patients received LTx; 10 were eligible, but did not undergo LTx (non-LTx) during the study period. Retrospective information on PFTs (spirometry [volumes and flows], 6-minute walking test [6MWT], and DLCO) was retrieved from patients' medical charts, including baseline information for all patients and follow-up information for the LTx. At baseline, most patients presented with spirometric and 6MWT values that were suggestive of severe disease (FEV1 /FVC 76.5 ± 29.7; 6MWT 267.4 ± 104.5 m). Significant increases in these values were observed at follow-up in the LTx (P = .036 and .151, respectively). The overall median survival of patients in the LTx and non-LTx was 3.35 years (95% CI: 0.16-14.38) and 0.78 years (95% confidence interval [CI]: 0.12-3.65) (P = 0.002), respectively. For patients with end-stage silicosis, LTx offers significant benefits regarding pulmonary function and survival when compared to non-LTx, and is a reliable tool to help this critical population of patients, whose only treatment option is LTx.

Las silicosis aceleradas / The accelerated silicosis

Se revisaron las historias clínicas de 67 pacientes con diagnóstico de silicosis. Los 37 primeros tienen el tipo de silicosis acelerada (grupo A) y los segundos, silicosis crónica (grupo C). De los del primer grupo fallecieron 9, con los que se conformó otro que se estudió aparte (grupo B). Todos fueron objeto de estudios clínicos, radiológicos, funcionales y broncoscópicos. El conjunto de ellos, considerados en promedio, demostraron que la enfermedad era más grave en el grupo B que en el grupo A, a pesar de su juventud y menor exposición. Los del grupo A tenían una situación de gravedad importante, aunque menor que los del B. El grupo C tenía lesiones irreversibles y autoevolutivas de tal naturaleza que sugieren cronicidad y agravamientos a plazos más prolongados. De los de la enfermedad acelerada falleció el 25 por ciento. Desde el punto de vista epidemiológico se destaca el predominio de oficios como arenador y minero. Se verificó asociación estadísticamente significativa entre: 1) el oficio de arenador y el diagnóstico de silicosis acelerada; Odd Ratio 149.8, IC 95 por ciento (16.4 < OR < 6303.0). 2) diagnóstico de silicosis crónica con el oficio de minero, OR 26.4, IC 95 por ciento (5.7 < OR 158.3). 3) la posibilidad de morir y el antecedente de arenado (concentración de sílice en el medio ambiente laboral)...(AU)

Las silicosis aceleradas / The accelerated silicosis

Se revisaron las historias clínicas de 67 pacientes con diagnóstico de silicosis. Los 37 primeros tienen el tipo de silicosis acelerada (grupo A) y los segundos, silicosis crónica (grupo C). De los del primer grupo fallecieron 9, con los que se conformó otro que se estudió aparte (grupo B). Todos fueron objeto de estudios clínicos, radiológicos, funcionales y broncoscópicos. El conjunto de ellos, considerados en promedio, demostraron que la enfermedad era más grave en el grupo B que en el grupo A, a pesar de su juventud y menor exposición. Los del grupo A tenían una situación de gravedad importante, aunque menor que los del B. El grupo C tenía lesiones irreversibles y autoevolutivas de tal naturaleza que sugieren cronicidad y agravamientos a plazos más prolongados. De los de la enfermedad acelerada falleció el 25 por ciento. Desde el punto de vista epidemiológico se destaca el predominio de oficios como arenador y minero. Se verificó asociación estadísticamente significativa entre: 1) el oficio de arenador y el diagnóstico de silicosis acelerada; Odd Ratio 149.8, IC 95 por ciento (16.4 < OR < 6303.0). 2) diagnóstico de silicosis crónica con el oficio de minero, OR 26.4, IC 95 por ciento (5.7 < OR 158.3). 3) la posibilidad de morir y el antecedente de arenado (concentración de sílice en el medio ambiente laboral)...

Silicosis in Brazilian pit diggers: relationship between dust exposure and radiologic findings.

The incidental diagnosis of two cases of silicosis at Messejana Hospital, Fortaleza, capital of Ceará state, triggered a field research conducted with the objective of investigating the incidence of silicosis in pit diggers in four towns in the Ibiapaba Mountain Range, at the state's northwestern area, northeastern Brazil. Out of a universe of 1,050 pit diggers in the area, 366 participated in the study; they were all males ranging in age between 16 and 76 years old (average 39 years). The excavation and the sickening process were described and a dust exposure index in pit diggers (DEIPD) was defined. The study sample indicated a rate of 121 (33.06%) silicotics and possibly silicotics. The radiologic findings were related to the DEIPD and indicated significant prevalence of disease. Furthermore, during the research period, from 1986 to 1989, 30 (34.9%) silicotics died of respiratory failure and wasting of body tissues. The data suggested that these men were afflicted with a severe occupational health problem, possibly scattered throughout a large area in northeastern Brazil, where manual pit excavations occur during the whole year and increase during drought periods.

[The heart-lung transplant. Initial clinical experience]. / Transplante cardiopulmonar. Experiência clínica inicial.

PURPOSE: To assess this initial clinical experience with heart-lung transplantation in Brazil. METHODS: Four patients underwent heart-lung transplantation from December 1988 to March 1990, one patient with cardiomyopathy and high pulmonary resistance, two patients with primary pulmonary hypertension and another with pulmonary silicosis. The heart lung blocks were harvested from the donor using cardiopulmonary bypass and deep hypothermia. They were transplanted to the recipient by anastomosing the trachea, right atrium or venae cavae, and the ascending aorta. RESULTS: The second patient died on the 5th postoperative day due to respiratory insufficiency with consequent brain lesions. The first and third patients had survived nine months and 42 days respectively. The 4th patients is asymptomatic eight months after the operation. The main complications were bleeding in two patients, acute pulmonary rejection in three of them and obliterans bronchiolitis in one patients. CONCLUSION: The heart lung transplantation is a challenging procedure which results are progressively improving with the development of better surgical technique and clinical concepts.

Enfermedades renales asociadas a silicosis: revisión de necropsias 1979-1990

El sílice produce lesiones a nivel torácico y también en bazo, médula ósea, ganglios linfáticos extratorácicos, hígado y riñon. El daño renal puede ser directo por la partícula o mediado inmunológicamente. Las lesiones encontradas son glomerulonefritis rápidamente progresiva, necrosante, proliferativa mesangial, proliferativa local y segmentaria, y nefritis intersticial. La nefropatía por IgA ocurre en individuos HLAA29. Se busca establecer asociación de sílice con lesión renal y por ello revisamos 33 protocolos de necropsia con silicosis pulmonar, excluyendo enfermedades concurrentes cuyo órgano blanco fuese riñon, para el presente estudio se tomaron 28 casos en clos cuales realizamos nuevas coloraciones especiales (PAS, Jones y Tricromo) y examen conluz polarizada. En 21se demostró la presencia de sílice en riñon (75 por ciento), 14 había lesión histológica (50 por ciento) y de estos había sílice en 10 (71 por ciento). En 3 casos no había sílice ni lesiones (10 por ciento) y 11 casos con sílice pero sin lesiones. El coeficiente de correlación r (r=0.71) corresponde a una relación moderadamente buena entre la presencia de sílice y cambios histopatológicos. La presente es una revisión de una serie de casos cuyo propósito es plantear la hipótesis de asociación de sílice con lesión renal y concebir la silicosis como enfermedad sistémca.

Silicose pulmonar: lesão tumoral solitária

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