Farewell, king coal!

Coal mining provided the power for the industrial development of the West, at great cost to the health of the workforce and, from industrial pollution, of the population. Medical appreciation of the diseases of miners was slow to develop and has been marked by controversy relating to the roles of coal and quartz and the causation of emphysema. Research by the MRC and the British coal industry resolved these issues as the industry itself declined. However, from the research has come an understanding of the influence of inhalation of different inhaled pollutants on human health that has been applied to predicting and preventing possible hazards of developing nanotechnologies.

[Silicotuberculosis]. / La silicotuberculose.

OBJECTIVE: Tuberculosis is a serious and common complication of silicosis. The aim of this study is to describe the epidemiological, clinical, radiological and progressive aspects of this pathological entity. PATIENTS AND METHODS: The study concerns 23 cases of silicotuberculosis which were collected at the service of respiratory diseases at CHU Ibn Rochd of Casablanca, Morocco during 12years (2003-2015). RESULTS: All patients were men. They were 7 diggers, 5 rock crushers, 7 miners and 4 masons. The mean duration of silica exposure was 11years. The symptomatology was dominated by dyspnea and persistent bronchial syndrome. Imagery showed tumor-like opacities in all cases, associated with mediastinal calcified lymphadenopathy in 9 cases, with micronodules in 8 cases and an excavated opacity in 2 cases. The diagnosis of tuberculosis was confirmed by isolation of the Koch's bacillus in sputum in 13% of cases in the bronchial aspirate in 52% and culture in sputum post-bronchoscopy in 13%. The bronchial biopsies confirmed the diagnosis in 2 cases. Tuberculosis had complicated silicosis 9years on average after the cessation of exposure to silica in 65% of cases. The antituberculous treatment was started in all patients with good clinical outcome in 22 cases. We had deplored a case of death by acute respiratory failure. CONCLUSION: Silicosis increases the risk of tuberculosis, hence the importance of TB screening in all patients with silicosis.

Conspicuous disease: The surveillance of silicosis in South Africa, 1910-1970.

Scholarly understanding of the nature of the science around silicosis has been strongly influenced, in recent years, by the idea that the mine doctors were responsible for hiding an epidemic, on the mines and in the countryside. In this paper, I try to show that the opposite was in fact the case, and that the science and government institutions for the regulation of silicosis and tuberculosis in white and black male workers were distinctively elaborated, and very largely successful in tracking and controlling the disease. This singular visibility, funded by the mines, stands in marked contrast with disease in general in South Africa, and forms a major part of the explanation for the very strong association of silicosis with mine work.

[Erasmus' syndrome with pseudo-tumour masses]. / Un syndrome d'Erasmus avec des masses pseudo-tumorales.

INTRODUCTION: Erasmus' syndrome involves the association of systemic scleroderma (SS) and exposure to silica. Silicosis may precede the SS but the latter may be the presentation, in which case a history of exposure to silica should be sought as part of the diagnosis. CASE REPORT: A 46-year-old man with history of pulmonary tuberculosis presented with dyspnoea and dysphagea. Clinical examination revealed thickening of the facial skin with a pointed nose, erythema and telangiectasia, Raynaud's syndrome and sclerodactyly. A thoracic CT scan revealed bilateral, fibrotic, pseudo-tumoural masses. Antinuclear antibodies, anti-topoisomerase 1 and antihistone were positive. CONCLUSION: The clinical presentation of Erasmus' syndrome associating systemic scleroderma and pulmonary pseudo-tumours may pose a problem of differential diagnosis from lung cancer. This condition requires regular clinical and radiological monitoring, particularly as both scleroderma and silicosis increase the risk of lung cancer.

[Prospective analysis of clinical course and outcomes in silicosis patients].

The authors revealed features of clinical course and outcomes in patients with silicosis and silicotuberculosis, who worked on iron industry enterprise. The article covers comparative analysis of survival rate and mortality among silicosis patients over 14 years of observation.

Tuberculosis and silicosis: epidemiology, diagnosis and chemoprophylaxis.

Silicosis, the most prevalent of the pneumoconioses, is caused by inhalation of crystalline silica particles. Silica-exposed workers, with or without silicosis, are at increased risk for tuberculosis and nontuberculous mycobacteria-related diseases. The risk of a patient with silicosis developing tuberculosis is higher (2.8 to 39 times higher, depending on the severity of the silicosis) than that found for healthy controls. Various regimens for tuberculosis chemoprophylaxis in patients with silicosis have been studied, all of which present similar efficacy and overall risk reduction to about one half of that obtained with placebo. Long-term regimens have potential side effects (particularly hepatotoxicity). In addition, the use of such regimens can jeopardize adherence to treatment. The current guidelines recommend that tuberculin skin tests be performed, and, if positive, that chemoprophylaxis be instituted. There are several possible regimens, varying in terms of the drugs prescribed, as well as in terms of treatment duration. We recommend the use of isoniazid at 300 mg/day (or 10 mg/kg/day) for six months for patients with silicosis, as well as for healthy patients with periods of exposure to silica longer than 10 years and strongly positive tuberculin skin test results (induration > or = 10 mm). Nevertheless, further studies are necessary so that indications, drugs, doses and duration of chemoprophylaxis regimens can be more properly defined.

Respiratory health of female stone grinders with free silica dust exposure in Gujarat, India.

Eighty-five female quartz mill stone-grinding workers belonging to the Naika, Rathwa and Damor tribes of Chhotaudepur village of the Godhra region of Gujarat, Western India were surveyed and examined to assess health effects related to free silica dust exposure. The mean age for the subjects was 28.2 +/- 9.2 years, while the mean duration of exposure was 2.04 +/- 1.7 years. Chest radiographs showed findings suggestive of silicosis in 14%, silico-tuberculosis in 11.6% and tuberculosis in 8.1% of the study subjects. Respiratory morbidity was significantly associated with duration of exposure (X2 = 9.9, df = 2, p<0.007). On spirometry, obstructive, restrictive and combined (restrictive as well as obstructive) changes were found in 12.8%, 10.5% and 3.5% of the subjects, respectively. Overall, about one-third of subjects displayed abnormal pulmonary function and respiratory morbidity on chest radiographs.

Tuberculose e silicose: epidemiologia, diagnóstico e quimioprofilaxia / Tuberculosis and silicosis: epidemiology, diagnosis and chemoprophylaxis

A silicose, a mais prevalente das pneumoconioses, é provocada pela inalação de partículas de sílica cristalina. Indivíduos expostos à sílica, com ou sem silicose, apresentam risco aumentado de tuberculose e de micobacterioses não-tuberculosas. O risco de silicóticos desenvolverem tuberculose em relação a controles sadios varia de 2,8 a 39 vezes, em conformidade com a gravidade da doença de base. Têm sido estudados diferentes esquemas de quimioprofilaxia para tuberculose em silicóticos, todos com eficácia semelhante e com redução final de risco para cerca da metade em relação ao uso de placebo. São, no entanto, esquemas de longa duração, o que, acrescido dos possíveis efeitos colaterais (particularmente hepatotoxicidade), podem prejudicar a aderência. As diretrizes atuais recomendam a realização de prova tuberculínica e, se positiva, a instituição de quimioprofilaxia. São vários os esquemas possíveis, tanto em termos de drogas quanto de duração. Nossa recomendação é de que se use isoniazida na dose de 300 mg/dia (ou 10 mg/kg/dia) por seis meses para os indivíduos com silicose ou sadios com exposição superior a 10 anos, se forem reatores fortes à prova tuberculínica (induração > 10 mm). São necessários, no entanto, novos estudos para que indicações, drogas, doses e duração da profilaxia sejam definidas mais apropriadamente.

Silicosis, the most prevalent of the pneumoconioses, is caused by inhalation of crystalline silica particles. Silica-exposed workers, with or without silicosis, are at increased risk for tuberculosis and nontuberculous mycobacteria-related diseases. The risk of a patient with silicosis developing tuberculosis is higher (2.8 to 39 times higher, depending on the severity of the silicosis) than that found for healthy controls. Various regimens for tuberculosis chemoprophylaxis in patients with silicosis have been studied, all of which present similar efficacy and overall risk reduction to about one half of that obtained with placebo. Long-term regimens have potential side effects (particularly hepatotoxicity). In addition, the use of such regimens can jeopardize adherence to treatment. The current guidelines recommend that tuberculin skin tests be performed, and, if positive, that chemoprophylaxis be instituted. There are several possible regimens, varying in terms of the drugs prescribed, as well as in terms of treatment duration. We recommend the use of isoniazid at 300 mg/day (or 10 mg/kg/day) for six months for patients with silicosis, as well as for healthy patients with periods of exposure to silica longer than 10 years and strongly positive tuberculin skin test results (induration > 10 mm). Nevertheless, further studies are necessary so that indications, drugs, doses and duration of chemoprophylaxis regimens can be more properly defined.

Spirometric measurements among quartz stone ex-workers of Gujarat, India.

The present cross sectional study was carried out among 134 ex-workers from quartz stone crushing units. Using the interview technique as a tool for data collection, demographic and occupational details of the subjects were recorded on the predesigned proforma. Standard diagnostic criteria were used for diagnosing silicosis and silico-tuberculosis. The pulmonary functions of the subjects were measured with Spirovit SP-10. The mean age of the males was found to be 33.18 +/- 10.39 yr and that of the females was 30.10 +/- 9.3 yr and for the whole group was 31.77 +/- 9.99 yr. Mean duration of exposure was 2.74 +/- 1.65 yr. The study variables included age, sex, duration of exposure, smoking and respiratory morbidity. Forced Vital Capacity (FVC) which suggests lung parenchymal disorders was found to be significantly reduced with female sex, presence of smoking, increasing duration of exposure and presence of pneumoconiosis, whereas the lung function parameters indicating the status of airways were found to be significantly reduced with all the factors. Therefore, it was concluded that quartz stone workers exposed to approximately 100% free silica had deteriorated lung function which can be attributed mainly to respiratory disorders along with other epidemiological factors such as age, sex, duration of exposure and smoking.

Uranium mining in Germany: incidence of occupational diseases 1946-1999.

OBJECTIVES: In East Germany, uranium mining was performed on a large scale for approximately 45 years (1946-1990). In particular, the poor working conditions during the post-war years until 1955 led to a high level of occupational diseases. The present study gives an overview of the occurrence of occupational diseases during the mining period as well as after uranium mining was stopped in 1990. METHODS: The number of occupational diseases which occurred during the mining period was calculated from the files of the former Wismut SDAG. Although exposure to uranium ceased after 1990, new cases of occupational diseases were recognized after that date. These were recorded by the German Federation Of Institutions For Statutory Accident Insurance And Prevention (HVBG). RESULTS AND CONCLUSIONS: Today, more than 35,000 cases of occupational diseases are known, and many more are expected. About two-thirds of them are lung diseases: 16,376 cases of silicosis/silicotuberculosis and 7,695 cases of bronchial carcinomas. The increase in the number of recognized occupational diseases is shown and discussed against the background of changes in criteria for recognition and in working conditions as well as the duration of the latency period.

[Aspects of silicotuberculosis course in workers of highly aluminous mullite refractories]. / Osobennosti techeniia silikotuberkuleza u rabochikh na proizvodstve vysokoglinozemistykh mullitovykh ogneupornykh izdelii.

The article covers differential diagnostic features of pulmonary tuberculosis and pneumoconiosis in workers engaged into mullite refractories production. The authors suggest that the disease courses as a new form of lung disorder--mullitosis.

Dustiness, silicosis & tuberculosis in small scale pottery workers.

Studies were carried out in eight small scale potteries to find out the airborne dust concentrations and the prevalence of dust related diseases like silicosis and tuberculosis in 292 workers. Chest radiography revealed that 44 (15.1%) pottery workers were suffering from silicosis and an equal number showed radiological evidence of tuberculosis. The environmental study showed that the concentrations of airborne dust, containing free silica, in the work environment of all departments (except packing department) of potteries were higher than threshold limit values (TLVs). The prevalence of silicosis and tuberculosis correlated with the levels of airborne dust. The prevalence of tuberculosis increased with radiological severity of silicosis. Dust control measures combined with pre-employment and periodical medical examinations are recommended for the control of silicosis and tuberculosis in the pottery industry.

Pneumoconioses in Bulgaria--prevalence, development, prognosis and prevention.

Prevalence of the basis types of pneumoconioses (silicosis, silicotuberculosis, asbestosis) in Bulgaria was studied during a 7-year period (1985-1991). Information was taken from reports of the Department for silicosis and other pneumoconioses control in the country. As a basis of the investigation serves the total number of workers endangered by dust exposure in different risk branches. The more rarely encountered pneumoconioses are referred to in absolute numbers. Trends in the development and prognosis of the most frequently encountered pneumoconiosis in Bulgaria could be followed. Recommendations are given for future preventive activity.

[Causes of mortality among workers exposed to inorganic dust containing crystalline silica]. / Przyczyny umieralnosci osób zawodowo narazonych na pyly nieorganiczne zawierajace krystaliczna krzemionke.

The authors briefly comment on the characteristics and results of recent epidemiological studies devoted to the reasons of mortality in persons exposed to dusts containing crystalline silica. The most important data concerning these studies are presented in the table accompanied by an author commentary which discusses results obtained by various authors and justification behind this subject in Poland.

Morbidity of pulmonary tuberculosis among silicotic and nonsilicotic foundry workers in Denmark.

Increased tuberculosis risk associated with silicosis is well described. The present study defines the incidence of pulmonary tuberculosis among 5424 nonsilicotic and 155 silicotic male foundry workers observed between 1967 and 1986. For the 18-year follow-up period, the following groups had statistically significant increased standard incidence rates (SIR) for pulmonary tuberculosis: silicotics, SIR = 1000 (95% CI = 272 to 2561, P less than .01); nonsilicotics employed at least 25 years, SIR = 353 (95% CI = 130 to 768, P less than .01); and for the entire cohort, SIR = 201 (95% CI = 125 to 397, P = .01). These results suggest that silica exposure may cause an increased pulmonary tuberculosis risk among nonsilicotic foundry workers.

[Dust levels and dust-induced diseases in the main dust-producing industries]. / Zaprashenost i prakhovi zaboliavaniia v osnovnite prakhoobrazuvashti proizvodstva.

The data on airborne dust and occupational disease in the main dust-related industries of the People's Republic of Bulgaria are generalized and analyzed for a period of 15 years. In the ore producing industry is established a stability in the concentration of total and respirable dust 1-2 TWA concentrations and decrease of silica content in dust. The highest occupational hazard is registered in diggers. The levels of TWA total and respirable dust and silica concentrations in the other underground mines as well as in the overground industries are strongly variable and high. Silicosis is still in the first place among dust-related diseases, but mainly among miners of advanced age. The newly detected other pneumoconiosis, asbestosis, mixed pneumoconiosis are already more than the cases of silicotuberculosis. An essential part is taken by the newly detected diffusive pneumosclerosis and dust bronchitis. The distribution of the newly detected occupational lung diseases is studied according to branches of industry.

[The morphological determination of immune reactivity in coniotuberculosis]. / Morfologicheskoe opredelenie immunnoi reaktivnosti pri koniotuberkuleze.

A study was performed on the immune reactivity of coniotuberculosis cases among iron-ore miners from initial to developed stages by means of a postmortem morphometric analysis of the pathologic changes. It was revealed that the disease was characterized by a marked decrease in immune reactivity which progressed along with the disease. It was established that the process was influenced by the age, the ferrum oxide (III) and cremnium dioxide content in the lungs, and the TB infection as such. Much influence was also caused by other sporadic environmental factors.

[Lung diseases associated with silicosis. Study of 618 cases]. / Pneumopatie associate a silicosi. Indagine su 618 casi.

Retrospective research has been carried out on the clinical reports of 618 cases of patients suffering from silicosis admitted to the S. Luigi Gonzaga Hospital in 1973-1987 (1.4% of all pneumopathy admittances). A comparative evaluation of the five-year periods 1973-77, 1978-82, 1983-87 showed a steady reduction in the percentage of silicosis to total cases (from 1.62% to 1.55% and 1.16%). Among the 618 cases assessed, the following pneumopathies were associated with silicosis either alone or in combination: chronic obstructive bronchopneumopathy (89.4%), pulmonary tuberculosis (22.2%), bronchogenic carcinoma (8.4%), acute aspecific infections (26.1%), mycosis (0.6%), sarcoidosis (0.3%), other pneumopathies (1.1%). Comparison between the three five-year periods shows an increase in the frequency of the silicosis-carcinoma association and a fall in the silicosis-tuberculosis and silicosis-COLD associations.

[Risk factors for the development of siderosilicotubeculosis]. / Faktory riska razvitiia siderosilikotuberkuleza.

The main risk factors on siderosilicotuberculosis developing in conditions of modern ore mining industry are high tuberculosis infestation of miners and patients with siderosilicosis, presence of residual changes in the lungs of pneumoconiosis and unspecific character. Siderosilicotuberculosis is diagnosed, as a rule, in miners and patients with siderosilicosis at the age of 45 years with 15 year length of work in the mine.