Issue 3-The occupational burden of respiratory diseases, an update.

INTRODUCTION AND AIMS: Workplace exposures are widely known to cause specific occupational diseases such as silicosis and asbestosis, but they also can contribute substantially to causation of common respiratory diseases. In 2019, the American Thoracic Society (ATS) and the European Respiratory Society (ERS) published a joint statement on the occupational burden of respiratory diseases. Our aim on this narrative review is to summarise the most recent evidence published after the ATS/ERS statement as well as to provide information on traditional occupational lung diseases that can be useful for clinicians and researchers. RESULTS: Newer publications confirm the findings of the ATS/ERS statement on the role of workplace exposure in contributing to the aetiology of the respiratory diseases considered in this review (asthma, COPD, chronic bronchitis, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, infectious pneumonia). Except for COPD, chronic bronchitis and infectious pneumonia, the number of publications in the last 5 years for the other diseases is limited. For traditional occupational lung diseases such as silicosis and asbestosis, there are old as well as novel sources of exposure and their burden continues to be relevant, especially in developing countries. CONCLUSIONS: Occupational exposure remains an important risk factor for airways and interstitial lung diseases, causing occupational lung diseases and contributing substantially in the aetiology of common respiratory diseases. This information is critical for public health professionals formulating effective preventive strategies but also for clinicians in patient care. Effective action requires shared knowledge among clinicians, researchers, public health professionals, and policy makers.

Invasion and high-elevation acclimation of the red imported fire ant, Solenopsis invicta, in the southern Blue Ridge Escarpment region of North America.

The red imported fire ant (Solenopsis invicta) is a non-native invasive species that rapidly spread northward in the United States after its introduction from South America in the 1930s. Researchers predicted that the northward spread of this invasive ant would be limited by cold temperatures with increased latitude and greater elevation in the Blue Ridge Escarpment region of the United States. The presence of S. invicta at relatively high elevations north of their projected limits suggests greater cold tolerance than previously predicted; however, these populations might be ephemeral indications of strong dispersal abilities. In this study, we investigated potential physiological adaptations of S. invicta that would indicate acclimation to high elevation environments. We hypothesized that if S. invicta colonies can persist in colder climates than where they originated, we would find gradients in S. invicta worker cold tolerance along a montane elevational gradient. We also predicted that higher elevation S. invicta ants might incur greater physiological costs to persist in the colder climate, so we measured colony lipid content to assess health status. For comparison, we also collected physiological temperature tolerance data for the co-occurring dominant native woodland ant Aphaenogaster picea. We found that S. invicta occurring at higher elevations exhibited greater physiological tolerance for cold temperatures as compared to lower-elevation conspecifics-a cold tolerance pattern that paralleled of the native A. picea ants along the same gradient. Both S. invicta and A. picea similarly exhibited lower thermal tolerances for colder temperatures when moving up the elevational gradient, with A. picea consistently exhibiting a lower thermal tolerance overall. There was no change in S. invicta colony lipid content with elevation, suggesting that greater metabolic rates were not needed to sustain these ants at high elevations.

Engaging with Lyell: Alfred Russel Wallace's Sarawak Law and Ternate papers as reactions to Charles Lyell's Principles of Geology.

Alfred Russel Wallace (1823-1913) and Charles Darwin (1809-1882) are honored as the founders of modern evolutionary biology. Accordingly, much attention has focused on their relationship, from their independent development of the principle of natural selection to the receipt by Darwin of Wallace's essay from Ternate in the spring of 1858, and the subsequent reading of the Wallace and Darwin papers at the Linnean Society on 1 July 1858. In the events of 1858 Wallace and Darwin are typically seen as central players, with Darwin's friends Charles Lyell (1797-1875) and Joseph Dalton Hooker (1817-1911) playing supporting roles. This narrative has resulted in an under-appreciation of a more central role for Charles Lyell as both Wallace's inspiration and foil. The extensive anti-transmutation arguments in Lyell's landmark Principles of Geology were taken as the definitive statement on the subject. Wallace, in his quest to solve the mystery of species origins, engaged with Lyell's arguments in his private field notebooks in a way that is concordant with his engagement with Lyell in the 1855 and 1858 papers. I show that Lyell was the object of Wallace's Sarawak Law and Ternate papers through a consideration of the circumstances that led Wallace to send his Ternate paper to Darwin, together with an analysis of the material that Wallace drew upon from the Principles. In this view Darwin was, ironically, intended for a supporting role in mediating Wallace's attempted dialog with Lyell.

Cardiac syndrome X.

This article describes: 1) situations that can cause angina pectoris in the absence of formal atherosclerotic obstructive lesions: a) those that cause non-atherosclerotic coronary obstructions and b) those with normal coronary angiography, among them cardiac syndrome X (CSX); 2) the various definitions of CSX, particularly the definition of true CSX by Bertrand et al.: effort anginal pain plus positive exercise test, plus a second demonstration of myocardial ischemia (e.g. abnormal myocardial scintigraphy), plus normal coronary angiography; 3) the different pathogenic mechanisms that have been proposed for CSX, which suggest that the problem is mainly at the microvascular level; 4) the excellent survival prognosis of CSX; 5) the lack of any standard therapeutic protocol.

[Juvenile cutaneous polyarteritis nodosa associated with streptococcal infection]. / Poliarterite nodosa cutânea infantil associada a infecção estreptocócica.

Polyarteritis nodosa is a rare vasculitis of small and medium arteries. It can occur in a systemic form with multi-organ involvement, or as a limited form confined to the skin, muscles, joints and peripheral nerves called cutaneous polyarteritis nodosa. Both forms are rare in adults and even more in children. The caues of this vasculitis remain unknown but some viruses and bacteria have been implicated, specially, Streptococcus. We present the case of a 6-year-old child who developed cutaneous polyarteritis nodosa following a probable streptococcal infection.

Cross-sectional study of 50 patients with calcium pyrophosphate dihydrate crystal arthropathy.

Calcium pyrophosphate dihydrate crystal arthropathy (CPPA) is a well known but heterogeneous disease with a variable presentation and course. We present a cross-sectional study undertaken in a Portuguese rheumatology unit with the aim of analysing clinical and radiological patterns of CPPA in our population. The study population included 50 patients, 34 (68%) women and 16 (32%) men. The mean age was 69.8 +/- 8.8 years. The onset features were acute arthritis in 19 (38%) patients and chronic joint complaints in 26 (52%); five (10%) patients were asymptomatic at the time of diagnosis, which was based only on radiological findings. The diagnosis was established in 37 (74%) cases by clinical and radiographic features, in eight (16%) by clinical, X-ray and synovial fluid analysis, and in five (10%) by clinical features and fluid analysis. The disease course was characterised by acute episodic arthritis in 16 (32%) patients and by persistent symptoms (with or without synovitis) in 34 (68%). The pattern of CPPA in 20 (40%) patients was pseudo-osteoarthritis with synovitis, pseudo-osteoarthritis without synovitis in nine (18%), pseudogout in nine (18%), monoarthropathy in eight (16%) and pseudorheumatoid arthritis in four (8%). The phosphocalcium balance was altered in nine (18%) cases: six patients had hypercalciuria two hyperphosphaturia, two hypocalciuria, one hypophosphaturia and one hypercalcemia. Five patients had abnormal thyroid hormone levels, but only one presented with clinical hypothyroidism. Four patients showed increased parathormone levels, but only one presented with clinical hyperparathyroidism. Radiographic findings showed that 43 (86%) patients had meniscus calcifications, 20 (40%) radiocarpal and 16 (32%) calcification of the symphysis pubis. The study confirms the clinical variability of the disease in a population of Portuguese patients. The knee meniscus calcifications were the most sensitive single finding for establishing the diagnosis of CPPA. Almost all our patients had sporadic idiopathic CPPA without associated pathological conditions.

[The variability of the heart rate in the first 24 hours after fibrinolytic therapy in acute myocardial infarct]. / Variabilidade da frequência cardíaca nas primeiras 24 horas após a terapêutica fibrinolítica no enfarte agudo do miocárdio.

AIM OF THE STUDY: The role of heart rate variability changes in the appraisal of reperfusion after fibrinolytic therapy in acute myocardial infarction is still controversial. The aim of this study was to analyze the influence of reperfusion and infarct site on heart rate variability within 24 hours after infarction. PATIENTS AND METHODS: We studied 45 patients with a mean age = 56.3 +/- 12.4 years, 25 with anterior infarction and 20 with inferior infarction. The reperfusion was defined by the simultaneous presence of three classic noninvasive criteria (fast relief of pain, fast regression of ST segment elevation and early peak of CK). We studied heart rate variability parameters in time-domain and frequency-domain on a 24-hour Holter ECG started at the same time as fibrinolytic therapy. RESULTS: Thirty-three patients showed reperfusion. We did not find significant differences in the several parameters of heart rate variability between patients with reperfusion and patients without reperfusion, but the patients with anterior wall infarction showed a significant reduction in SDNN in comparison with patients with inferior wall infarction (84 +/- 28 ms vs 102 +/- 30 ms; p = 0.05). pNN50 (5.3 +/- 7.2 ms vs 10.5 +/- 9.8 ms; p = 0.04), LF (618 +/- 591 ms2 vs 1374 +/- 1761 ms2; p = 0.05) and TP (1415 +/- 1199 ms2/Hz vs 3015 +/- 4243 ms2/Hz). CONCLUSION: These data suggest a relationship between infarct severity and sympathetic activation and/or reduction of vagal modulation, but a potential beneficial effect of reperfusion on autonomic nervous system alterations was not evident in the first day of acute myocardial infarction.

[Prevalence of respiratory diseases in the textile industry. Relation with dust levels]. / Prevalência de doença respiratória na indústria têxtil. Relação com os níveis de empoeiramento.

Many workers in the textile industry have respiratory symptoms that are related to their work environment. In this study we observed the dust level conditions of eleven textile industries of the North of Portugal. The dust levels determined were between 0.1 mg/m3 and 1.25 mg/m3, in many cases above the Portuguese standard levels of exposure (VLE). For these dust levels we found a prevalence of 23% of workers with respiratory symptoms with occupational characteristics in 10.8%, and 5.7% presenting byssinosis. Workers exposed to cotton fibres in spinning areas have the highest prevalence of symptoms, and reduction of the FEV1. These characteristics were related to dust levels and were higher in the initial phases of the spinning processes. We found no cases of byssinosis in workers exposed to synthetic fibres, or in workers from weaving areas. Smoking habits were related to the reduction of the FEV1, and severity of respiratory illness but not to the presence of byssinosis.

[Thrombolytic treatment of acute myocardial infarct. 1]. / Tratamento trombolítico do enfarte agudo do miocárdio. Primeira de três partes.

I-Rationale of thrombolytic therapy in acute myocardial infarction (AMI). II-Thrombolytic drugs. III-Effects of thrombolytic therapy on mortality. IV-Studies comparing the effects of various thrombolytic agents on mortality.

[Thrombolytic treatment of acute myocardial infarct. 2]. / Tratamento trombolítico do enfarte agudo do miocárdio. Segunda de três partes.

V-Effects of thrombolytic therapy on coronary reperfusion and left ventricular function VI-Noninvasive markers of reperfusion. VII-Timing of thrombolysis. VIII-Side effects and adverse outcomes.

[The physiopathology of angina pectoris]. / Fisiopatologia da angina de peito.

The author reviews the pathophysiology of angina pectoris. The first part concerns to the regulation of coronary blood flow: 1. Determinants of myocardial oxygen consumption (preload, afterload,contractility, heart rate); 2. Factors that control the myocardial oxygen supply (perfusion pressure, coronary vascular resistance). The second part concerns the coronary insufficiency and its clinical consequences (angina pectoris, myocardium infarction, heart failure, arrhythmias, primary cardiac arrest. The third part concerns the principal pathophysiologic mechanisms of the stable angina and of the unstable angina (progression of atherosclerosis, platelet aggregation, thrombosis and/or alterations in vasomotor tone).

[Respiratory symptoms in the textile industry. Their prevalence in the Vale do Ave]. / Sintomas respiratórios na indústria têxtil. Prevalência no Vale do Ave.

Some workers in the textile industry have respiratory symptoms related to their occupation. This study is aimed at evaluating the frequency of respiratory symptoms in textile industries in the North of Portugal. We evaluated 3529 workers from 20 factories (19 deal with synthetic fibres and cotton and the other deals with sisal.) Among the workers, there were 34.5% with respiratory symptoms - 24,5% referred nasal symptoms, 22,6% with bronchial symptoms and 12,6% associated both. The workers who dealt with cotton presented a higher frequency of bronchial symptoms (25,0%) than the ones dealing with synthetic fibres (12,7% p < 0,000001). The same was noticed among the workers in the opening and spinning areas, who showed a higher frequency of bronchial symptoms (28,3%) than the ones in weaving areas (12,7% p < 0,000001). We did not find any differences concerning the frequency of symptoms among the workers handling both natural fibres (cotton and sisal). Individually all the symptoms were more frequent among the workers handling natural fibres. The most frequent symptom depended on the fibre. Cough was more frequently mentioned among the workers handling synthetic fibres (9.6%) and cotton (15.7%). Among the workers who handle sisal, dyspnea was the most frequently mentioned (16.9%). Productive cough was the most frequent association (7.2% sisal; 2.8% synthetic; 8.0% cotton), and the association between dyspnea and wheezing the least mentioned (6.4% sisal; 0.5% synthetic; 5.9% cotton). The workers with bronchial symptoms (synthetic fibre and cotton) have more years of exposure and greater smoking habits. In a covariance adjusted for age and smoking habits, the workers with bronchial symptoms, exposed to cotton have more years of exposure.

[Coronary disease in the postmenopausal woman. The experience of an intensive care unit over 10 years]. / Doença das coronárias na mulher pós-menopáusica. Experiência de uma unidade de cuidados intensivos durante 10 anos.

OBJECTIVES: Analysis of the characteristics of acute myocardial infarction in female patients admitted to a coronary care unit during a 10 year period. DESIGN: Retrospective analysis of computerized data collected during a 10-year period in every patient with acute myocardial infarction admitted between 1986 and 1995. SETTING: A coronary care unit of a central hospital. PATIENTS AND METHODS: Data on 2439 patients were analyzed in what concerns gender, age and hospital mortality. In the restricted group of 655 patients admitted between 1993 and 1995 the prevalence of the following risk factors was assessed: arterial hypertension, dyslipidemia, smoking and diabetes mellitus. RESULTS: During a 10-year period, 1918 male (M) and 521 female (F) patients were admitted, originating a 3.5 to 1 M:F ratio. The M:F relation decreased from decade to decade from 11:1 in patients under 50 years old to 1.8:1 in patients over 70 years old. Hospital mortality was 25.9% in female patients and 12.0% in male patients (p < 0.001). Mortality was similar in males and females until 60 years of age; significant differences were found only in the seventh decade of life (25% in females vs. 12% in males, p < 0.001) and in patients over 70 years old (36% in females vs. 24% in males, p < 0.005). Hypertension was significantly move prevalent in females (66% in females vs 46% in males, p < 0.001) as well as diabetes mellitus (31% in females vs. 20% in males). Similarly, a previous history of dyslipidemia was more frequently found in females than in males, but the difference was not significant (24% vs. 19%, respectively). On the contrary, smoking was significantly less frequent in female patients (11% in female patients vs. 44% in male patients, p < 0.001). CONCLUSIONS: The probability of the occurrence of acute myocardial infarction is very low in premenopausal women. The M:F ratio decreases with aging. The risk of death progressively increases with age, and it is significantly higher in females in relation to males after the age of 60 years. Women, besides being older, have a higher prevalence of coronary artery disease risk factors, namely hypertension, diabetes mellitus and dyslipidemia.

Developments in social terminology: semantic battles in a conceptual war.

The problems posed by the evolution of the diverse forms of animal sociality are among the most important and fascinating in evolutionary biology. The conceptual and terminological framework guiding studies of social evolution has been based on a particular insect model, namely, that of highly derived family-structured societies. Virtually all other social systems have been categorized as 'less social' relative to these societies. Recently, the ambiguities and constraints inherent in this hierarchical classification have led to numerous proposals to amend social terminology. What is the best framework for studying social evolution? Should the traditional classification be expanded, narrowed or abandoned altogether? In an important respect, most recent proposals present the same wine in a different bottle by retaining and recasting key terms of the traditional social-evolutionary classification.