Emerging and reemerging respiratory viral infections up to Covid-19

Infectious diseases remain as the significant causes of human and animal morbidity and mortality, leading to extensive outbreaks and epidemics. Acute respiratory viral diseases claim over 4 million deaths and cause millions of hospitalizations in developing countries every year. Emerging viruses, especially the RNA viruses, are more pathogenic since most people have no herd immunity. The RNA viruses can adapt to the rapidly changing global and local environment due to the high error rate of their polymerases that replicate their genomes. Currently, coronavirus disease 2019 (COVID-19) is determined as an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first identified in 2019 in Wuhan. Herein we discuss emerging and reemerging respiratory viral infections till to SARS-CoV-2.

Choking agents and chlorine gas - History, pathophysiology, clinical effects and treatment.

INTRODUCTION: Choking agent exposure, among them chlorine gas, occurs in household or industrial accidents, chemical warfare and terrorist attacks. AIMS: Review of published animal and human data regarding the history, pathophysiology, clinical effects and management of chlorine exposure. PATHOPHYSIOLOGY: Highly soluble agents cause quick upper respiratory tract symptoms. Chlorine gas has a medium solubility, also causing delayed lower airway symptoms, mainly due to its oxidizing potential by releasing hypochlorous and hydrochloric acid, but also by interacting with Transient Receptor Potential channels. SYMPTOMS: Eyes may show conjunctival injection, abrasions and corrosions. Burns of the oronasal mucosa and trachea can occur. Dyspnea, bronchospasm and possible retrosternal pain occur frequently. Glottis edema or laryngospasm are acute life-threatening emergencies. Chlorine gas can cause toxic pneumonitis, lung edema and acute respiratory distress syndrome (ARDS). MANAGEMENT: General management includes physical examination, pulse oximetry and arterial blood gases. Eyes should be irrigated, humidified oxygen and inhalative bronchodilators administered. An EKG, cardiac enzymes and complete-blood-count should be obtained if there is retrosternal pain. Routine chest x-ray is not recommended - except if pulmonary edema is suspected. Laryngoscopy should be performed if glottis edema is suspected. Sodium bicarbonate inhalation after chlorine gas inhalation is discussed controversially. Mechanical ventilation with continuous-positive-airway-pressure or intubation/tracheotomy with high positive-end-expiratory-pressure may be necessary. Glucocorticoids for prevention of pulmonary edema should be applied restrictively. Prophylactic antibiotics are not recommended. In severe ARDS, extracorporeal membrane oxygenation (ECMO) can be considered. CONCLUSION: Treatment is mainly symptom oriented. New and promising therapies are in development.

20 años en enfermería respiratoria / 20 years in respiratory nursing

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20 años en neumología pediátrica / 20 years in pediatric pneumonology

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The Dust Bowl in the US: An Analysis Based on Current Environmental and Clinical Studies.

The Dust Bowl occurred in the Central Plains states in the United States between 1930 and 1940. Prolonged drought, intense recurrent dust storms and economic depression had profound effects on human welfare. The causes included increased farming on marginal land, poor land management, and prolonged drought. There was a significant increase in the number of cases of measles, increased hospitalization for respiratory disorders and increased infant and overall mortality in Kansas during the Dust Bowl. Recent scientific studies have demonstrated that dust transmits measles virus, influenza virus and Coccidioides immitis, and that mortality in the United States increases following dust storms with 2-3-day lag periods. Advances in technology have provided information about the composition of dust and the transfer of microbial pathogens in dust and provided the framework for reducing the economic and health consequences of the next prolonged drought in the United States.

Progress in Vaccine-Preventable and Respiratory Infectious Diseases-First 10 Years of the CDC National Center for Immunization and Respiratory Diseases, 2006-2015.

The need for closer linkages between scientific and programmatic areas focused on addressing vaccine-preventable and acute respiratory infections led to establishment of the National Center for Immunization and Respiratory Diseases (NCIRD) at the Centers for Disease Control and Prevention. During its first 10 years (2006-2015), NCIRD worked with partners to improve preparedness and response to pandemic influenza and other emergent respiratory infections, provide an evidence base for addition of 7 newly recommended vaccines, and modernize vaccine distribution. Clinical tools were developed for improved conversations with parents, which helped sustain childhood immunization as a social norm. Coverage increased for vaccines to protect adolescents against pertussis, meningococcal meningitis, and human papillomavirus-associated cancers. NCIRD programs supported outbreak response for new respiratory pathogens and oversaw response of the Centers for Disease Control and Prevention to the 2009 influenza A(H1N1) pandemic. Other national public health institutes might also find closer linkages between epidemiology, laboratory, and immunization programs useful.

Historic air pollution exposure and long-term mortality risks in England and Wales: prospective longitudinal cohort study.

INTRODUCTION: Long-term air pollution exposure contributes to mortality but there are few studies examining effects of very long-term (>25 years) exposures. METHODS: This study investigated modelled air pollution concentrations at residence for 1971, 1981, 1991 (black smoke (BS) and SO2) and 2001 (PM10) in relation to mortality up to 2009 in 367,658 members of the longitudinal survey, a 1% sample of the English Census. Outcomes were all-cause (excluding accidents), cardiovascular (CV) and respiratory mortality. RESULTS: BS and SO2 exposures remained associated with mortality decades after exposure-BS exposure in 1971 was significantly associated with all-cause (OR 1.02 (95% CI 1.01 to 1.04)) and respiratory (OR 1.05 (95% CI 1.01 to 1.09)) mortality in 2002-2009 (ORs expressed per 10 µg/m(3)). Largest effect sizes were seen for more recent exposures and for respiratory disease. PM10 exposure in 2001 was associated with all outcomes in 2002-2009 with stronger associations for respiratory (OR 1.22 (95% CI 1.04 to 1.44)) than CV mortality (OR 1.12 (95% CI 1.01 to 1.25)). Adjusting PM10 for past BS and SO2 exposures in 1971, 1981 and 1991 reduced the all-cause OR to 1.16 (95% CI 1.07 to 1.26) while CV and respiratory associations lost significance, suggesting confounding by past air pollution exposure, but there was no evidence for effect modification. Limitations include limited information on confounding by smoking and exposure misclassification of historic exposures. CONCLUSIONS: This large national study suggests that air pollution exposure has long-term effects on mortality that persist decades after exposure, and that historic air pollution exposures influence current estimates of associations between air pollution and mortality.

Miners, silica and disability: The bi-national interplay between South Africa and the United Kingdom, c1900-1930s.

This paper investigates silicosis as a disabling disease in underground mining in the United Kingdom (UK) before Second World War, exploring the important connections between South Africa and the UK and examining some of the issues raised at the 1930 International Labour Office Conference on silicosis in Johannesburg in a British context. The evidence suggests there were significant paradoxes and much contestation in medical knowledge creation, advocacy, and policy-making relating to this occupational disease. It is argued here that whilst there was an international exchange of scientific knowledge on silicosis in the early decades of the twentieth century, it was insufficient to challenge the traditional defense adopted by the British government of proven beyond all scientific doubt before effective intervention in coal mining. This circumspect approach reflected dominant business interests and despite relatively robust trade union campaigning and eventual reform, the outcome was an accumulative legacy of respiratory disease and disability that blighted coalfield communities.

Development of the clinic of pulmonology and allergy.

University Pulmology and Allergy Clinic was founded in 1975 when the Depertment of Internal Medicine, directed by Prof. Dr. Dimitar Arsov, later member of the Macedonian Academy of Sciencies and Arts, was divided into eight separate and independent clinics. The first head of the Pulmonology and Allergy Clinic was Prof. Dr. Ljubomir Kotevski. He had a very difficult goal: to establish and further develop the newly formed clinic. The Clinic flourished and became one of the leading Clinics in the Clinical Centre during the directorship of Prof. dr. Dejan Dokic.. He completely rebuilt and refurbished the Clinic, which became a modern Clinic providing excellent working conditions for the employees and, most importantly, provided a first class service to the patients. During his mandate he obtained a grant from the Japanese Government worth $1,000,000 which was used to obtain a new, modern and sophisticated medical equipment. Since the establishment of the clinic, many national and international scientific projects were carried out and many scientific papers were published as well as many monographs, and chapters in scientific books. As a result of continuous education, of the total number of 24 doctors there are 16 subspecialists in respiratory medicine and 4 specialists in internal medicine. There are 9 professors in internal medicine at the University of Pulmonology and Allergy Clinic lecturing at the Medical Faculty in Skopje. The University Pulmonology and Allergy Clinic has an international reputation due to many contacts with famous European Institutions. All these international interrelations have resulted in honouring 3 professors: Prof. Dr. Gert Kunkel from Berlin, Germany, Prof. Dr. Robert Loddenkemper from Berlin, Germany and Prof. Dr. Peter Howard from Southampton, UK.

Cuando el arte duele pero salva. Los casos de Modigliani, Matisse, Portinari y Rebecca Horn / When art hurts but it saves. The cases of Modigliani, Matisse, Portinari and Rebecca Horn

Se analizan los datos patobiográficos de 4 geniales artistas del siglo xx −Modigliani, Matisse, Portinari y Rebeca Horn− que vieron truncadas sus carreras artísticas en algún momento debido a enfermedades profesionales ocasionadas por los materiales que utilizaban. En el caso de Matisse, por manipulación debido a su propio temperamento de las cicatrices de una intervención quirúrgica. Sin embargo, lucharon contra tal contratiempo y su superación les permitió hallar nuevas vías de expresión artística para encauzar su creatividad(AU)

The patobiographic data of 4 great xx century artists −Modigliani, Matisse, Portinari and Rebecca Horn− are reviewed. Their artistic careers were cut short at some moment due to the professional diseases they suffered in relation with the materials used in their works. In the case of Matisse, this was due to his own temperament by manipulation of the scars from surgery. However, they fought against such impediments and when they overcame them, they were able to find new ways of artistic expression to channel their creativity(AU)