The role of pathologists in the diagnosis of occupational lung diseases: an expert opinion of the European Society of Pathology Pulmonary Pathology Working Group.

Occupational lung/thoracic diseases are a major global public health issue. They comprise a diverse spectrum of health conditions with complex pathology, most of which arise following chronic heavy workplace exposures to various mineral dusts, metal fumes, or following inhaled organic particulate reactions. Many occupational lung diseases could become irreversible; thus accurate diagnosis is mandatory to minimize dust exposure and consequently reduce damage to the respiratory system. Lung biopsy is usually required when exposure history is inconsistent with imaging, in case of unusual or new exposures, in case of unexpected malignancy, and in cases in which there are claims for personal injury and legal compensation. In this paper, we provide an overview of the most frequent occupational lung diseases with a focus on pathological diagnosis. This is a paper that summarizes the expert opinion from a group of European pathologists, together with contributions from other specialists who are crucial for the diagnosis and management of these diseases. Indeed, tight collaboration of all specialists involved in the workup is mandatory as many occupational lung diseases are misdiagnosed or go unrecognized. This document provides a guide for pathologists in practice to facilitate the accurate diagnosis of occupational lung disease. The review article reports relevant topics discussed during an educational course held by expert pathologists, active members of the Pulmonary Pathology Working Group of the European Society of Pathology. The course was endorsed by the University of Padova as a "winter school" (selected project in the call for "Shaping a World-class University" 2022).

Making an accurate diagnosis of anterior mediastinal lesions: a proposal for a new diagnostic algorithm from the BTOG Thymic Malignancies Special Interest Group.

Due to the rising demand in cross-sectional thoracic imaging, anterior mediastinal lesions are being identified with increasing frequency. Following iterative and multidisciplinary discussions, the BTOG Thymic Malignancies Special Interest Group have developed an algorithm to standardise the diagnostic approach for these relatively uncommon but important conditions which span from benign (thymic remnant, thymic hyperplasia and thymic cysts) to suspected localised thymomas to suspected more aggressive malignancy (thymic carcinoma, lymphoma and germ cell tumours). For each condition, we provide a brief description, an overview of the key radiological findings and a description of the proposed algorithm including the rationale behind the recommendations. We also highlight the role of magnetic resonance (MR) imaging for the characterisation of anterior mediastinal masses in specific indications when the necessary local resources and expertise exist. In addition, we hope this provides the rationale for service development in MR of the anterior mediastinum where current resource and expertise requires development. Through this standardised pathway, we hope to drive improvements in patient care by rationalising surveillance schedules, avoiding unnecessary resections of benign entities with their associated morbidity and optimising the diagnostic work-up prior to the appropriate treatment of anterior mediastinal malignancies.

Histopathology features of the lung in COVID-19 patients.

COVID-19 is the infectious disease caused by the recently discovered coronavirus, SARS-CoV-2, unknown before the outbreak in Wuhan, China, in December 2019. COVID-19 is a pandemic, infectious disease that has simultaneously affected many countries globally. The leading cause of dead in patients with COVID-19 is hypoxic respiratory failure from acute respiratory distress syndrome (ARDS). Diffuse alveolar damage (DAD) is the histopathological pattern commonly described in all the postmortem series up to date. DAD is divided into two phases, and depending on the length of the disease, the morphological features seen in the specimens vary. There is an acute/exudative phase, which occurs during the first week after the pulmonary injury, following by the organizing/proliferative phase. Additional features detailed include vascular thrombosis, endothelialitis and angiogenesis. Interestingly, there is an ongoing discussion about the specificity of these changes, as diffuse alveolar damage seen in other viral infections show similar features.

Effects of corticosteroids on COPD lung macrophage phenotype and function.

The numbers of macrophages are increased in the lungs of chronic obstructive pulmonary disease (COPD) patients. COPD lung macrophages have reduced ability to phagocytose microbes and efferocytose apoptotic cells. Inhaled corticosteroids (ICSs) are widely used anti-inflammatory drugs in COPD; however, their role beyond suppression of cytokine release has not been explored in COPD macrophages. We have examined the effects of corticosteroids on COPD lung macrophage phenotype and function. Lung macrophages from controls and COPD patients were treated with corticosteroids; effects on gene and protein expression of CD163, CD164, CD206, MERTK, CD64, CD80 and CD86 were studied. We also examined the effect of corticosteroids on the function of CD163, MERTK and cluster of differentiation 64 (CD64). Corticosteroid increased CD163, CD164, CD206 and MERTK expression and reduced CD64, CD80 and CD86 expression. We also observed an increase in the uptake of the haemoglobin-haptoglobin complex (CD163) from 59 up to 81% and an increase in efferocytosis of apoptotic neutrophils (MERTK) from 15 up to 28% following corticosteroid treatment. We observed no effect on bacterial phagocytosis. Corticosteroids alter the phenotype and function of COPD lung macrophages. Our findings suggest mechanisms by which corticosteroids exert therapeutic benefit in COPD, reducing iron available for bacterial growth and enhancing efferocytosis.

La criobiopsia transbronquial en la enfermedad pulmonar intersticial: excelente relación coste/beneficio / No disponible

No disponible

Tumor fibroso solitario intrapulmonar asociado a hemoptisis: a propósito de un caso / Intrapulmonary solitary fibrous tumor associated with hemoptysis: a case report

El tumor fibroso solitario intrapulmonar es una neoplasia mesenquimal extremadamente rara sobre la que existen muy pocas referencias en la literatura. Presentamos el caso de una mujer joven con hemoptisis que en la radiografía simple de tórax presentó una masa pulmonar, efectuándose a continuación una TCMD con contraste que mostró una tumoración pulmonar sólida, bien definida y con realce heterogéneo. Se realizó resección quirúrgica de dicha lesión y el estudio histológico reveló un tumor fibroso solitario intrapulmonar con un área de degeneración mixoide. A propósito de este caso realizamos una descripción de los hallazgos clínicos, radiológicos e histológicos de esta rara entidad, así como una revisión de la bibliografía (AU)

Intrapulmonary solitary fibrous tumor is an extremely rare mesenchymal neoplasm about which very few references can be found in the literature. We present the case of a young woman with hemoptysis in whom plain-film chest radiographs showed a pulmonary mass. Contrast-enhanced MDCT showed a solid lung tumor with well-defined margins and heterogeneous enhancement. Histological study after surgical resection of the lesion revealed an intrapulmonary solitary fibrous tumor with an area of myxoid degeneration. We describe the clinical, radiological, and histological findings for this rare entity and review the relevant literature (AU)

[Intrapulmonary solitary fibrous tumor associated with hemoptysis: a case report]. / Tumor fibroso solitario intrapulmonar asociado a hemoptisis: a propósito de un caso.

Intrapulmonary solitary fibrous tumor is an extremely rare mesenchymal neoplasm about which very few references can be found in the literature. We present the case of a young woman with hemoptysis in whom plain-film chest radiographs showed a pulmonary mass. Contrast-enhanced MDCT showed a solid lung tumor with well-defined margins and heterogeneous enhancement. Histological study after surgical resection of the lesion revealed an intrapulmonary solitary fibrous tumor with an area of myxoid degeneration. We describe the clinical, radiological, and histological findings for this rare entity and review the relevant literature.

Identificación de las prácticas seguras simples en un área de atención primaria / Identification of simple safe practices in a primary care area

Objetivos. Valorar las prácticas seguras (PS) elaboradas por la Unidad Funcional de Gestión de Riesgos Sanitarios (UFGRS), según su complejidad de implantación y el impacto en la seguridad del paciente (SP) e identificar PS simples (PSS). Material y métodos. Desde la UFGRS del Área 4 de Atención Primaria (AP) de Madrid, se han elaborado un número importante de PS, posteriormente se valoraron según su complejidad de implantación e impacto potencial en la SP, identificándose las PSS: contra eventos adversos (EA), de baja complejidad de implantación y de alto impacto en la SP. Por último, se identificaron las barreras para su implantación efectiva y se diseñaron acciones para superar dichas barreras. Resultados. Se han elaborado 50 PS, de ellas 42 se han generalizado a todo el área. Se han identificado como PSS: 7 de nivel 1, que cumplen las condiciones ideales. Las principales barreras tienen que ver con la falta de formación, cultura, liderazgo de los equipos directivos y profesionales de los centros y escasa difusión de las PS. Conclusiones. Desde la UFGRS se ha elaborado un número importante de PS, identificándose PSS para AP. La mayoría de estas tienen que ver con el uso seguro de medicamentos y con las vacunas(AU)

Objectives. To assess the safe practices (SP) prepared by the Health Risk Management Functional Unit (UFGRS), according to their complexity of introduction and the impact on patient safety, and to identify simple SP. Material and methods. A number of important SP have been prepared by the UFGRS of Madrid Health Area 4 Primary Care (PC). They were subsequently assessed according to their complexity of introduction and their potential impact on patient safety, simple SP (SSP) for the prevention of adverse events, low complexity of introduction and impact on patient safety. Lastly, the barriers to their effective introduction were identified, and actions were designed to overcome these barriers. Results. Of the 50 PS prepared, 42 have been applied in the whole Area. Seven Level 1 SP (which fulfil the ideal conditions) were identified as simple SP. The main barriers were due to lack of training, culture, leadership of the management teams and professionals of the centre and lack of knowledge of the SPs. Conclusions. A large number of SP has been prepared by the UFGRS, with simple SP being identified for PC. The majority of these have to do with the safe use of drugs and vaccines(AU)

[Identification of simple safe practices in a primary care area]. / Identificación de las prácticas seguras simples en un área de atención primaria.

OBJECTIVES: To assess the safe practices (SP) prepared by the Health Risk Management Functional Unit (UFGRS), according to their complexity of introduction and the impact on patient safety, and to identify simple SP. MATERIAL AND METHODS: A number of important SP have been prepared by the UFGRS of Madrid Health Area 4 Primary Care (PC). They were subsequently assessed according to their complexity of introduction and their potential impact on patient safety, simple SP (SSP) for the prevention of adverse events, low complexity of introduction and impact on patient safety. Lastly, the barriers to their effective introduction were identified, and actions were designed to overcome these barriers. RESULTS: Of the 50 PS prepared, 42 have been applied in the whole Area. Seven Level 1 SP (which fulfil the ideal conditions) were identified as simple SP. The main barriers were due to lack of training, culture, leadership of the management teams and professionals of the centre and lack of knowledge of the SPs. CONCLUSIONS: A large number of SP has been prepared by the UFGRS, with simple SP being identified for PC. The majority of these have to do with the safe use of drugs and vaccines.

Variabilidad en la prescripción farmacéutica de atención primaria de castilla la mancha durante 2003 / Variability in primary care drug prescription in 2003 in Castile-la Mancha, Spain

Fundamento: Detectar la variabilidad en la práctica clínica esimportante, ya que puede implicar infra o sobreutilización de recursos.El objetivo del estudio fue estudiar en Castilla la Mancha lavariabilidad de la prescripción farmacéutica en Atención Primaria,en función de determinadas características sociosanitarias de cadazona de salud.Métodos: Se revisó en 180 zonas de salud la prescripción en2003 de varios grupos terapéuticos, recogiendo las siguientes variables:número de envases prescritos por 100 habitantes, porcentaje demayores de 65 años en la zona, frecuentación (consultas/1.000 habitantes),médicos/1.000 habitantes y distancia al hospital de referencia.Resultados: La mayor variabilidad en la prescripción se encontróen los fibratos (coeficiente de variación de 42,95%) y antiH2(38,61%). El grupo con mejor correlación entre su tasa de prescripcióny las variables analizadas fue el de los inhibidores de la enzimade conversión de la angiotensina (r de Spearman promedio 0,719);por contra, los antidepresivos tuvieron una correlación débil(0,324). El porcentaje de mayores de 65 años y la frecuentación sonlas variables que más aparecen de forma significativa en los modelosde regresión múltiple construidos para cada grupo terapéutico.El mayor coeficiente de determinación se encontró en el modelo delos inhibidores de la enzima de conversión de la angiotensina(R2=0,761). El coeficiente de determinación promedio de todos losgrupos, ponderado en base al volumen de prescripción, fue de0,492.Conclusiones: Se observa gran variabilidad en la prescripciónfarmacéutica según las distintas zonas. En general, las variables analizadasexplican en parte dicha variabilidad

Background: Detecting variability in clinical practice isimportant, given that it may entail the underuse or overuse ofresources. This study was aimed at studying the variability of drugprescription in Primary Care in Castile-La Mancha in terms of certainsociosanitary characteristics of each health district.Methods: The prescribing of various therapeutic groups in 2003was reviewed in 180 health districts, the following variables havingbeen gathered: number of packages having been prescribed per 100inhabitants, percentage of inhabitants over age 65 in the district, visitrate (visits/1,000 inhabitants), physicians/1,000 inhabitants and distanceto the reference hospital.Results: The greatest degree of drug-prescribing variability wasfound regarding fibrates (42.95% variance factor) and H2-blockers(38.61%). The group showing the closest correlation between itsprescription rate and the variables analyzed was that of the angiotensin-converting enzyme inhibitors (mean Spearman r: 0.719);antidepressants however showing a weak correlation (0.324).Thepercentage of inhabitants over age 65 and the visit rate are thevariables arising more significantly in the multiple regressionmodels constructed for each treatment group. The highest determinationcoefficient was found in the angiotensin enzyme-convertinginhibitors (R2=0.761). The mean determination coefficient for all ofthe groups, weighted on the basis of the prescribing volume, was0.492.Conclusions: A high degree of drug-prescribing variability wasfound to exist according to the different districts. Generally speaking,the variables analyzed explain part of this variability

Variabilidad en la prescripción de antidepresivos en Atención Primaria de la provincia de Toledo / Variability in the prescription of antidepressants at the Primary Care level in the Toledo province

Objetivos. Describir la prescripción de antidepresivos en Atención Primaria (AP) de la provinciade Toledo, y analizar posibles factores explicativos de la variabilidad existente.Diseño. Estudio descriptivo transversal.Emplazamiento. Áreas de Toledo y Talavera (32 y 16 Centros de Salud).Sujetos. Prescripciones de antidepresivos realizadas en 2004 por los 342 médicos de familia dela provincia de Toledo.Mediciones Principales. Mediante el sistema de información Digitalis se obtuvieron los envasesfacturados al SESCAM durante 2004 de cada médico. Como unidad de medida se utilizó la Dosis Diaria Definida (DDD) y la DDD por 1.000 habitantes/día (DHD). Como posibles factores explicativos de la variabilidad se estudiaron: sexo, edad, formación MIR, ubicación (rural/urbana), Área de Salud, población asignada (TIS) y porcentaje de mayores de 65 años. Se calculó un modelo de regresión lineal múltiple.Resultados. En 2004, en la provincia, se prescribieron 7.768.998,03 DDD de antidepresivos, equivalentes a 43,2 DHD. Por facultativos, la media de DHD fue 45,8, con un coeficiente de variación de 35,2%. No se hallaron diferencias por sexo del médico ni formación MIR. La prescripción fue inferior en el Área de Toledo (40,0 vs 58,1 DHD). Se encontró relación significativa entre DHD y edad del médico (rho de Spearman= -0,233), TIS (-0,408) y porcentaje de mayores de 65 años en el cupo (+0,407). En el análisis multivariante resultaron asociadas a la prescripción las variables “Área”, “edad del médico” y “porcentaje de mayores de 65 años en el cupo”. El coeficiente de determinación R2 del modelo fue de 0,435.Conclusiones: Constatamos una importante variabilidad en la prescripción de antidepresivos. La edad del médico, el porcentaje de mayores de 65 años y el Área sanitaria pueden explicar parte de la variabilidad

Objetives: to describe the prescription of antidepressants in Primary Care in the province of Toledo,and to analyze possible explanatory factors of the existing variability.Design: descriptive transversal study.Setting: Areas of Toledo and Talavera (32 and 16 Primary Health Centers).Subjects: Prescriptions of antidepressants generated during 2004 by 342 general practicioners ofthe province of Toledo.Principal measurements: the number of packets of antidepressants prescribed by each physicianand paid by SESCAM during 2004 were offered by the Digitalis information system. The DefinedDaily Dose (DDD) and the DDD by 1000 head of population per day (DHD) were used as units of measurement. The next variables were studied as possible explanatory factors of the variability: sex, age, MIR training, location (rural / urban), Primary Health Area, assigned population (TIS) and percentage of patients older than 65 years. It was calculated as a model of linear multiple regression.Results: 7.768.998 DDD of antidepressants were prescribed during 2004 in the province of Toledo,which is equivalent to 43,2 DHD. The mean of DHD prescribed by physician was 45,8 , with a 35,2% coefficient of variation. There were no differences found in the matter of sex or MIR training. The prescription was lower in the Area of Toledo (40,0 vs 58,1 DHD). We found a significant relationship between DHD and the age of the doctor (Spearman´s rho= -0,233), TIS (-0,408) and the percentage of older than 65 years in the quota (+0,407). The multivariant analysis showed an association between the prescription and the variables “area”, “age of the doctor” and “percentageof patients older than 65 years in assigned population”. The coefficient of determination R2 of themodel was 0,435.Conclusions: we have confirmed an important variability in the prescription of antidepressants. The age of the doctor, the percentage of patients older than 65 years and the Primary Health Area can explain part of the variability (AU)

[At what care level are cyclo-oxygenase-2 inhibitors prescribed?]. / Desde qué nivel asistencial se prescriben los inhibidores de la ciclooxigenasa 2?

OBJECTIVES: To find the evolution in the billing of prescriptions for selective cyclooxygenase-2 (COX-2) inhibitors since they came on the market and to compare this evolution in primary care (PC) and specialist care (SC).Design. Cross-sectional, descriptive study. SETTING: Toledo Health Area. Main measurements. Data were obtained from the System of Drug Information (SIFAR) to analyse the monthly turnover of NSAID prescriptions (M01A group in the official classification of medicines, including rofecoxib and celecoxib) issued by doctors in PC and SC between January 2000 and June 2001. RESULTS: In our area during the study period, 583,558 NSAID packages were prescribed; 6.61% were COX-2 inhibitors, which represented 29.08% of NSAID expenditure. 98.23% of NSAID packages and 94.61% of COX-2 inhibitors were prescribed in PC. The use of COX-2 inhibitors in SC rose from 10.03% of the total NSAIDs in February 2000 to 29.79% in June 2001; whilst in PC it rose from 1.52% to 10.78%. Rofecoxib and celecoxib were third and fifth in the lists of most prescribed NSAIDs (number of packages) in SC, and ninth and twelfth in PC. In terms of cost of prescription, they were first and second in SC, and first and fourth in PC. CONCLUSIONS: COX-2 inhibitors have become the main NSAIDs prescribed. The appearance of these drugs had a different impact on SC and PC doctors, with greater use of them and a more rapid introduction in SC.

¿Desde qué nivel asistencial se prescriben los inhibidores de la ciclooxigenasa 2? / At what care level are cyclooxygenase-2 inhibitors prescribed?

Objetivo. Conocer la evolución en la facturación de recetas de los inhibidores selectivos de la ciclooxigenasa 2 (ICOX-2) desde su comercialización y comparar dicha evolución en los niveles asistenciales primario (AP) y secundario (AE).Diseño. Estudio descriptivo transversal. Emplazamiento. Área de Salud de Toledo. Mediciones principales. Se obtuvieron del Sistema de Información Farmacéutica (SIFAR) datos para analizar la facturación mensual de las recetas de antiinflamatorios no esteroides (AINE) (grupo M01A de la clasificación oficial de medicamentos, que incluye rofecoxib y celecoxib) prescritas por los médicos de AP y AE entre enero de 2000 y junio de 2001.Resultados. Durante el período de estudio, en nuestra área se prescribieron 583.558 envases de AINE; el 6,61 per cent era ICOX-2, representando el 29,08 per cent del gasto en AINE. El 98,23 per cent de los envases de AINE y el 94,61 per cent de ICOX-2 se prescribieron desde AP. El uso de ICOX-2 en AE pasó del 10,03 per cent del total de AINE (febrero de 2000) al 29,79 per cent (junio de 2001); mientras que en AP pasó del 1,52 per cent al 10,78 per cent. Rofecoxib y celecoxib ocupan el tercero y quinto puestos, respectivamente, en la lista de AINE más prescritos (número de envases) en AE, y el noveno y duodécimo en AP. En cuanto al coste de la prescripción, ocupan el primero y segundo puestos en AE y el primero y cuarto en AP. Conclusiones. Los ICOX-2 han pasado a ocupar los primeros lugares en la prescripción de AINE. La aparición de estos fármacos ha tenido un impacto diferente entre los facultativos de AE y los de AP, observándose un mayor uso y una incorporación más rápida en AE (AU)