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1.
Pneumologie ; 74(9): 603-610, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32643765

RESUMO

Occupational diseases are certain diseases designated as such by law. Whereas the medical conditions are described in guidelines, their recognition is based on judicial administrative procedures. Establishing causality is based on requirements of social law. The basic socio-legal concepts are mentioned and the principles of causality in asbestos-related occupational diseases are listed. Exemplary social court judgments are cited. Judgements may not infrequently differ from the medical point of view. The aim of this article is to describe the correct use of social medical understanding in order to carry out adequate assessment of occupational diseases, which implements the legal requirements.


Assuntos
Asbestos/efeitos adversos , Asbestose , Dermatologia/legislação & jurisprudência , Doenças Profissionais , Medicina do Trabalho/legislação & jurisprudência , Justiça Social/legislação & jurisprudência , Asbestose/diagnóstico , Asbestose/terapia , Humanos , Doenças Profissionais/diagnóstico , Doenças Profissionais/terapia
2.
Pneumologie ; 74(4): 201-209, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32053838

RESUMO

BACKGROUND: The aim of this study was to evaluate the effects of an outpatient medical rehabilitation (OMR) mainly composed of exercise therapy and sports for patients with asbestosis and focused on keeping up sustainability effects. METHODS: 157 male patients aged 65.2 ±â€Š5.7 years suffering from asbestosis carried out over a period of three weeks 5 times weekly 6 h at a time phase 1 of the OMR consisting of evidence-based contents of the pulmonary rehabilitation. In the immediately following phase 2, the patients completed once a week for 3 hours over 12 weeks further therapeutic applications with the main focus on exercise therapy and sports and were subsequently transferred to health sports groups near to residence (phase 3). The effects of the OMR were evaluated at the beginning (T1), at the end of phase 1 (T2) and phase 2 (T3) as well as 6 (T4) and 20 months (T5) after T3. 61 patients (73.5 years ±â€Š5.6) were re-examined 6 years after T5 (T6) without any interim care. RESULTS: 72.1 % of the 61 patients (n = 44) carried out health sports twice a week in T5 as well as in T6 eight years after T1 and were able to maintain their physical performance (6-minute walk test, hand force, PWC test) as well as the perceived quality of life (SF-36, baseline/transition dyspnea index) according to age, while the rehab effects of the 17 patients breaking off any sporting activities after T3 fell significantly (p < .01) below the starting condition in T1. CONCLUSIONS: In spite of a restrictive pulmonary disease specific exercise therapy and sports are able to mobilize physical reserves of performance and induce an increasing quality of life as well as a higher resilience in activities of daily living. These positive effects could be stabilized in the long term by a regular training. The results underline the necessity of integrating aftercare strategies into the concept of rehabilitation with special consideration of perceived self-efficacy.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Asbestose/reabilitação , Terapia por Exercício/métodos , Atividades Cotidianas , Idoso , Asbestose/diagnóstico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Qualidade de Vida , Resultado do Tratamento
3.
Med Lav ; 110(5): 353-362, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31659992

RESUMO

BACKGROUND: The relationship between pleural plaques and cumulative asbestos exposure is controversial. OBJECTIVES: To evaluate the relationship between lung asbestos bodies (AB) and fibres (AF) and plaques presence and extension. METHODS: In a necropsy series of shipyard workers with asbestos-related diseases, we measured counts (per g of dry lung tissue) of AB (thousands) and AF>1 µm (millions). Pleural plaques were classified into three extension grades. We fitted univariate and multivariable linear (dependent variables: AB and AF, log10 transformed) and multinomial (dependent variable: plaques grade) regression models. RESULTS: We analysed 124 subjects, 13 without plaques 20 with grade 1, 69 with grade 2, and 22 with grade 3 plaques. Geometric means (GM) of AB were 10.6, 23.3, 126, and 140 in the four groups respectively (P=0.0001). GMs for AF (mostly amphiboles) were 1.2, 1.4, 7.3, and 12.9 (P=0.0001). AB and AF were strongly correlated (r=0.81). The likelihood of no plaques and grade 1 plaques decreased with increasing AB and AF doses, with a corresponding increase of grade 2 and 3 plaques. Plaque presence and extension was also associated with histologically verified asbestosis (P<0.001). CONCLUSIONS: Our study showed a strong positive relationship between pleural plaque presence and extension and both lung asbestos burden and asbestosis.


Assuntos
Asbestos , Asbestose , Exposição Ocupacional , Doenças Pleurais , Asbestos/farmacocinética , Amiantos Anfibólicos , Asbestose/diagnóstico , Biomarcadores , Humanos , Doenças Pleurais/etiologia
4.
Rev Mal Respir ; 36(8): 924-936, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31522950

RESUMO

INTRODUCTION: In France, long-term follow-up after occupational exposure to asbestos is recommended. This study looked at the psychological consequences in the longer term following a CT-scan, in particular the impact of having received compensation for an occupational disease. METHODS: As part of an asbestos post-exposure survey study (APExS), volunteers from Normandy were asked to complete self-assessment questionnaires about their psychological condition at different points during follow-up, including a psychological questionnaire before, then 6 months, and finally 18 to 24 months after their chest CT-scan. Information collected from 622 individuals were analyzed based on information provided as to the result of the screening and whether they had received compensation for having an occupational disease. RESULTS: The identification of an occupational disease eligible for compensation is associated with a long term increase in psychological distress. The impact of psychological state during follow-up is greater in men who reported receiving occupational disease compensation. The discovery of an asbestos-related disease during the screening is associated with a negative perception of general health and an increase in psychological distress. CONCLUSION: The receipt of compensation of an occupational disease does not seem to compensate for the negative psychological impact related to the discovery of a disease during the asbestos post-exposure follow-up.


Assuntos
Asbestos/toxicidade , Asbestose/psicologia , Exposição Ocupacional/efeitos adversos , Estresse Psicológico/etiologia , Indenização aos Trabalhadores , Adulto , Idoso , Idoso de 80 Anos ou mais , Asbestose/diagnóstico , Estudos de Coortes , Feminino , França , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Inquéritos e Questionários
5.
Tuberk Toraks ; 67(1): 8-14, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31130130

RESUMO

Introduction: Pleural plaques have the possibility of bearing malignancy thus investigation of this entity is important and the most important indicator of malignancy in general is fluorodeoxyglucose (FDG) accumulation in radiological appearance. However there is discrepancy between results of previous studies in the literature about this subject. The aim of this study is to analyze the standardized uptake value of pleural plaques and the cut off levels for malignancy in comparison with computed tomography (CT). Materials and Methods: Seventy one patients were included in the study (27F, 44M; mean: 59.9 ± 13.1 years). Oncologic F-18 FDG positron emission tomography/computed tomography (PET/CT) was performed to all the subjects for a different primary tumor. Pleural plaques were identified in all patients in CT component of PET/CT examination. Contrast enhanced and nonenhanced CT images were evaluated by a Radiology Physician independently according to the gold standard pathology. Result: The diagnostic sensitivity, specificity of CT was; 39%, 79% respectively and if the cut-off SUVmax level was accepted "4.8" the diagnostic sensitivity and specificity of PET was 71%, and 63% respectively. Conclusions: According to the results and ROC curves determined in the study the cut-off level for evaluation of pleural plaques in PET examination was "4.8". The sensitivity and accuracy of PET was higher compared to CT with this cut-off value.


Assuntos
Asbestose/diagnóstico , Fluordesoxiglucose F18/farmacologia , Doenças Pleurais/diagnóstico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Compostos Radiofarmacêuticos/farmacologia
7.
Ugeskr Laeger ; 180(25)2018 Jun 18.
Artigo em Dinamarquês | MEDLINE | ID: mdl-29938630

RESUMO

Asbestos was used in numerous products until its total ban in Denmark in 1988. The prevalence of asbestosis and pleural plaques does not yet appear to be falling. Unfortunately the statistics are unreliable due to errors in the Danish translation of the ICD-10 codes of the disease. In this review, clinical and radiologic diagnostic criteria of asbestosis and pleural plaques and recommendations for follow-up of patients are described. Typical changes on a high-resolution CT scan combined with relevant asbestos exposure is essential for the diagnosis. Asbestosis and pleural plaques are both notifiable in Denmark.


Assuntos
Asbestose , Doenças Pleurais , Asbestos/efeitos adversos , Asbestose/diagnóstico , Asbestose/etiologia , Asbestose/fisiopatologia , Asbestose/terapia , Dinamarca , Humanos , Classificação Internacional de Doenças , Doenças Profissionais/diagnóstico , Doenças Profissionais/etiologia , Doenças Profissionais/fisiopatologia , Doenças Profissionais/terapia , Exposição Ocupacional/efeitos adversos , Doenças Pleurais/diagnóstico , Doenças Pleurais/etiologia , Doenças Pleurais/fisiopatologia , Doenças Pleurais/terapia , Radiografia , Tomografia Computadorizada por Raios X , Traduções
8.
Epidemiol Prev ; 42(2): 171-177, 2018.
Artigo em Italiano | MEDLINE | ID: mdl-29774715

RESUMO

Asbestos-related diseases are characterized by a long latency time since exposure. This accounts for a health surveillance programme addressed to asbestos workers to be performed for decades after the cessation of occupational exposure. We describe the health surveillance programme for former asbestos-exposed workers in Tuscany Region (Central Italy), with particular attention to organization and related critical issues. The Deliberation of the Regional Administration of Tuscany (No. 396/2016) supports the programme, defined by a regional group of experts, and defines the public health services where the programme has to be implemented. The programme activities are classified in two levels: a first level for a basic health evaluation and a second level for in-depth analyses. The former asbestos workers, aged less than 80 years and with cessation of occupational asbestos exposure in the last 30 years, that might be included free of charge in the programme are about 5.600. The funds assigned to develop the programme from 2016 to 2024 were 2,044,808 euros. The Regional Administration of Tuscany decided to offer and guarantee a homogeneous programme in the whole region. The identification of a specific public health programme and the cooperation of social stakeholders, defined with specific regional agreements, might facilitate to overcome the problems which are still open, such as a broaden invitation to adhere to the programme, an extended knowledge on the service, and the application of a similar health programme for still-working former asbestos workers.


Assuntos
Poluentes Ocupacionais do Ar/toxicidade , Asbestos/toxicidade , Asbestose/epidemiologia , Mesotelioma/epidemiologia , Neoplasias Pleurais/epidemiologia , Vigilância da População , Idoso , Idoso de 80 Anos ou mais , Asbestose/complicações , Asbestose/diagnóstico , Programas de Triagem Diagnóstica , Feminino , Humanos , Itália/epidemiologia , Masculino , Mesotelioma/diagnóstico , Mesotelioma/etiologia , Pessoa de Meia-Idade , Exposição Ocupacional , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/etiologia , Avaliação de Programas e Projetos de Saúde , Participação dos Interessados
9.
Artigo em Inglês | MEDLINE | ID: mdl-29772681

RESUMO

Introduction: Asbestos has been used for thousands of years but only at a large industrial scale for about 100⁻150 years. The first identified disease was asbestosis, a type of incurable pneumoconiosis caused by asbestos dust and fibres. The latest estimate of global number of asbestosis deaths from the Global Burden of Disease estimate 2016 is 3495. Asbestos-caused cancer was identified in the late 1930's but despite today's overwhelming evidence of the strong carcinogenicity of all asbestos types, including chrysotile, it is still widely used globally. Various estimates have been made over time including those of World Health Organization and International Labour Organization: 107,000⁻112,000 deaths. Present estimates are much higher. Objective: This article summarizes the special edition of this Journal related to asbestos and key aspects of the past and present of the asbestos problem globally. The objective is to collect and provide the latest evidence of the magnitude of asbestos-related diseases and to provide the present best data for revitalizing the International Labor Organization/World Health Organization Joint Program on Asbestos-related Diseases. Methods: Documentation on asbestos-related diseases, their recognition, reporting, compensation and prevention efforts were examined, in particular from the regulatory and prevention point of view. Estimated global numbers of incidence and mortality of asbestos-related diseases were examined. Results: Asbestos causes an estimated 255,000 deaths (243,223⁻260,029) annually according to latest knowledge, of which work-related exposures are responsible for 233,000 deaths (222,322⁻242,802). In the European Union, United States of America and in other high income economies (World Health Organization regional classification) the direct costs for sickness, early retirement and death, including production losses, have been estimated to be very high; in the Western European countries and European Union, and equivalent of 0.70% of the Gross Domestic Product or 114 × 108 United States Dollars. Intangible costs could be much higher. When applying the Value of Statistical Life of 4 million EUR per cancer death used by the European Commission, we arrived at 410 × 108 United States Dollars loss related to occupational cancer and 340 × 108 related to asbestos exposure at work, while the human suffering and loss of life is impossible to quantify. The numbers and costs are increasing practically in every country and region in the world. Asbestos has been banned in 55 countries but is used widely today; some 2,030,000 tons consumed annually according to the latest available consumption data. Every 20 tons of asbestos produced and consumed kills a person somewhere in the world. Buying 1 kg of asbestos powder, e.g., in Asia, costs 0.38 United States Dollars, and 20 tons would cost in such retail market 7600 United States Dollars. Conclusions: Present efforts to eliminate this man-made problem, in fact an epidemiological disaster, and preventing exposures leading to it are insufficient in most countries in the world. Applying programs and policies, such as those for the elimination of all kind of asbestos use-that is banning of new asbestos use and tight control and management of existing structures containing asbestos-need revision and resources. The International Labor Organization/World Health Organization Joint Program for the Elimination of Asbestos-Related Diseases needs to be revitalized. Exposure limits do not protect properly against cancer but for asbestos removal and equivalent exposure elimination work, we propose a limit value of 1000 fibres/m³.


Assuntos
Asbestose/epidemiologia , Saúde Global/estatística & dados numéricos , Mesotelioma/epidemiologia , Asbestose/diagnóstico , Asbestose/etiologia , Asbestose/prevenção & controle , Efeitos Psicossociais da Doença , Humanos , Mesotelioma/diagnóstico , Mesotelioma/etiologia , Mesotelioma/prevenção & controle
10.
Ugeskr Laeger ; 180(22)2018 May 28.
Artigo em Dinamarquês | MEDLINE | ID: mdl-29808815

RESUMO

Asbestosis is interstitial lung fibrosis due to inhalation of asbestos fibres. Up to the ban of import in 1986, 0.7 mil tons had been used in Denmark. The diagnosis of asbestosis is a challenge because of long latency time and very few national occupational asbestos measurements. The cornerstone of exposure assessment is a thorough occupational history, investigation of asbestos content in products used, search for possible and relevant measurements of asbestos fibres in the air, and results of lung biopsies, if present. Although no definite lower limit of exposure can be defined, a cumulated exposure of > 10 fibre-years is a relevant measure for exposure defining the disease, as one fibre-year equals one asbestos fibre/cm3 air/occupational year.


Assuntos
Asbestos/análise , Asbestose/diagnóstico , Doenças Profissionais/diagnóstico , Exposição Ocupacional/análise , Asbestos/efeitos adversos , Materiais de Construção/análise , Guias como Assunto , Humanos
11.
NPJ Prim Care Respir Med ; 28(1): 11, 2018 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-29615629

RESUMO

A diagnosis of asbestosis, which is a long-latency, fibrotic lung disease, has implications for the patient in terms of prognosis, treatment and compensation. Identifying and quantifying asbestos exposure is difficult without a detailed occupational history, and the threshold dose of asbestos required to cause asbestosis is not well understood. We reviewed all cases of asbestosis diagnosed between 2001 and 2016 at the Birmingham Regional NHS Occupational Lung Disease Service to determine the industries and occupations most frequently implicated in causation, in order to help clinicians identify where asbestosis might enter the differential diagnosis for a patient with chronic respiratory symptoms. A variety of construction trades were frequently reported including carpenters and joiners, pipe fitters, laggers, labourers, painters and shop fitters. Traditionally heavily exposed occupations such as shipbuilding were not commonly seen.


Assuntos
Asbestos/efeitos adversos , Asbestose/epidemiologia , Indústria da Construção/estatística & dados numéricos , Exposição Ocupacional/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Asbestose/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Reino Unido/epidemiologia
12.
Int J Occup Med Environ Health ; 31(3): 293-305, 2018 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-29099505

RESUMO

OBJECTIVES: This study has researched the significance of histologically raised findings and lung dust analyses in the context of claiming the recognition of and thus compensation for an asbestos-associated occupational disease. MATERIAL AND METHODS: For this approach, all findings from the German Mesothelioma Register in 2015 that included lung dust analyses were evaluated and were compared with information on asbestos fiber exposure at work based on fiber years, and with the results of radiological findings. RESULTS: For 68 insured persons, recognition of an asbestos-induced lung disease according to Section 4104 of the German Ordinance on Occupational Diseases (Berufskrankheitenverordnung - BKV) could be recommended solely on the basis of the histological examinations of lung tissues and complementary lung dust analyses. Neither did the calculation of the cumulative asbestos dust exposure at work yield 25 fiber years, nor could bridge findings (e.g., plaques) be identified. In addition, the autopsies of 12 patients revealed plaques that had not been diagnosed during radiological examinations. These results show that - irrespective of the prescribed working techniques and radiological diagnosis - pathological/anatomical and histological diagnostics are often the only way for the insureds to demonstrate the causal connection between asbestos and their disease. Even after long intervals of up to 40 years post last exposure, the asbestos fibers would still be easily detectable in the lung tissues evaluated. CONCLUSIONS: Whenever suitable tissue is available, it should be examined for mild asbestosis with the aid of a lung dust analysis. Otherwise there is a risk that an occupational disease is wrongfully rejected. In the context of health insurance, the lung dust analysis and the resulting proof of the presence of asbestosis often constitute one option of providing evidence of an occupational disease. Int J Occup Med Environ Health 2018;31(3):293-305.


Assuntos
Asbestos/análise , Asbestose/diagnóstico , Pneumopatias/diagnóstico , Doenças Profissionais/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Asbestose/diagnóstico por imagem , Asbestose/patologia , Poeira/análise , Alemanha , Técnicas Histológicas , Humanos , Pneumopatias/patologia , Pessoa de Meia-Idade , Doenças Profissionais/patologia , Exposição Ocupacional/estatística & dados numéricos , Doenças Pleurais/diagnóstico , Doenças Pleurais/patologia , Indenização aos Trabalhadores
13.
Clin Respir J ; 12(4): 1676-1684, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29087047

RESUMO

BACKGROUND: Asbestos exposure may cause asbestos-related lung diseases including asbestosis, pleural abnormalities and malignancies. The role of asbestos exposure in the development of small airway obstruction remains controversial. Anatomic and physiologic small airway abnormalities may develop as part of the pathophysiologic process of asbestosis. We hypothesized that inhalation of asbestos may induce small airway defects in addition to asbestosis and pleural abnormalities. METHODS: In total, 281 patients with newly diagnosed asbestosis were evaluated. Clinical data were collected from the patients' medical charts. The patients were classified into various stages according to their chest X-ray findings using the International Labour Organization classification. Pulmonary function was evaluated by plethysmography and the forced oscillation technique. RESULTS: Expiratory flow, including the predicted values of the maximum expiratory flow between 25% and 50% of the forced vital capacity (MEF25-50 ), was significantly lower in the different stages of asbestosis. Accordingly, the predicted percentage of R5 -R20 was significantly higher with increasing stages of asbestosis. Furthermore, the duration of exposure to asbestos was significantly associated with the forced expiratory volume in the first second (FEV1 )/forced vital capacity (FVC) ratio and the predicted percentage of MEF25 or MEF50 according to the regression analysis in non-smoking patients with asbestosis. The predicted percentage of FEV1 or the FEV1 /FVC ratio was significantly lower and the predicted percentage of R5 -R20 was significantly higher in smokers than non-smokers. CONCLUSIONS: The patients with asbestosis have small airway obstructive defects that are significantly associated with asbestos exposure.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Asbestos/efeitos adversos , Asbestose/complicações , Pulmão/fisiopatologia , Exposição Ocupacional/efeitos adversos , Idoso , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/fisiopatologia , Asbestose/diagnóstico , Asbestose/fisiopatologia , Progressão da Doença , Feminino , Seguimentos , Volume Expiratório Forçado , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pletismografia , Radiografia Torácica , Estudos Retrospectivos , Espirometria , Fatores de Tempo , Tomografia Computadorizada por Raios X , Capacidade Pulmonar Total , Capacidade Vital
14.
J Occup Environ Med ; 60(2): e90-e97, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29111984

RESUMO

OBJECTIVE: The aim of this study was to evaluate environmental asbestos sources, mesothelioma incidence and mortality, and awareness on asbestos-related diseases (ARDs) by general practitioners (GPs) in Molise Region. METHODS: The contaminated sites in three towns were identified by census; mesothelioma incidence (2000 to 2012) and mortality (2003 to 2013) was achieved from local registries; GPs were interviewed on practiced population's exposures and ARDs diagnosis. RESULTS: About 54.3% of visited sites were contaminated (71.2% by friable asbestos) and 38.8% was extremely damaged. Over above time-periods, 32 mesothelioma cases (62.5% males, 25% in people aged 70 to 75 years) and 27 deaths (90% males, 69 ±â€Š10 years, 70.4% pleural mesothelioma) have been reported. A total of 122 GPs were interviewed who had diagnosed 40 mesothelioma and 28 asbestosis cases. CONCLUSION: There is the need of remediation/removal interventions for contaminated sites and of strategies to increase GPs awareness on asbestos risks for better patients' management.


Assuntos
Exposição Ambiental , Clínicos Gerais , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias Pulmonares/epidemiologia , Mesotelioma/epidemiologia , Neoplasias Pleurais/epidemiologia , Adulto , Fatores Etários , Idoso , Asbestose/diagnóstico , Asbestose/epidemiologia , Competência Clínica , Feminino , Humanos , Incidência , Itália/epidemiologia , Neoplasias Pulmonares/mortalidade , Masculino , Mesotelioma/diagnóstico , Mesotelioma/mortalidade , Pessoa de Meia-Idade , Neoplasias Pleurais/mortalidade , Sistema de Registros
15.
BMC Pulm Med ; 17(1): 144, 2017 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-29149883

RESUMO

BACKGROUND: Asbestosis and silicosis are progressive pneumoconioses characterized by interstitial fibrosis following exposure to asbestos or silica dust. We evaluated the potential diagnostic biomarkers for these diseases. METHODS: The serum concentrations of Krebs von den Lungen-6 (KL-6), surfactant protein D (SP-D), and matrix metalloproteinase-2 (MMP-2), MMP-7, and MMP-9 were measured in 43 patients with asbestosis, 45 patients with silicosis, 40 dust-exposed workers (DEWs) without pneumoconiosis, and 45 healthy controls (HCs). Chest high-resolution computed tomography (HRCT) images were reviewed by experts blinded to the clinical data. According to the receiver operating characteristic (ROC) curve, the ideal level of each biomarker and its diagnostic sensitivity were obtained. RESULTS: The serum KL-6 and MMP-2 concentrations were highest in patients with asbestosis, particularly in comparison with those in DEWs and HCs (P<0.05). The serum SP-D concentration was significantly higher in patients with asbestosis than in patients with silicosis, DEWs, and HCs (P<0.01), whereas no significant difference was noted among patients with silicosis, DEWs, and HCs. No significant difference in the serum MMP-7 or -9 concentration was found among patients with asbestosis, patients with silicosis, DEWs, or HCs. Among patients with asbestosis, the serum KL-6 concentration was significantly correlated with the lung fibrosis scores on HRCT and negatively correlated with the forced vital capacity (FVC) % predicted and diffusing capacity of the lung for carbon monoxide (DLCO) % predicted. The serum SP-D and MMP-2 concentrations were negatively correlated with the DLCO % predicted (all P<0.05). The order of diagnostic accuracy according to the ROC curve was KL-6, SP-D, and MMP-2 in patients with asbestosis alone and in the combination of both patients with asbestosis and those with silicosis. The combination of all three biomarkers may increase the possibility of diagnosing asbestosis (sensitivity, 93%; specificity, 57%) and both asbestosis and silicosis (sensitivity, 83%; specificity, 62%). CONCLUSIONS: KL-6, SP-D, and MMP-2 are available biomarkers for the adjuvant diagnosis of asbestosis and silicosis. The combination of all three biomarkers may improve the diagnostic sensitivity for asbestosis and silicosis.


Assuntos
Asbestose/sangue , Asbestose/diagnóstico , Metaloproteinase 2 da Matriz/sangue , Mucina-1/sangue , Proteína D Associada a Surfactante Pulmonar/sangue , Silicose/sangue , Silicose/diagnóstico , Idoso , Asbestose/fisiopatologia , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Metaloproteinase 7 da Matriz/sangue , Metaloproteinase 9 da Matriz/sangue , Pessoa de Meia-Idade , Capacidade de Difusão Pulmonar , Curva ROC , Silicose/fisiopatologia , Tomografia Computadorizada por Raios X , Capacidade Vital
16.
Med J Aust ; 207(10): 443-448, 2017 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-29129163

RESUMO

Occupational exposures are an important determinant of respiratory health. International estimates note that about 15% of adult-onset asthma, 15% of chronic obstructive pulmonary disease and 10-30% of lung cancer may be attributable to hazardous occupational exposures. One-quarter of working asthmatics either have had their asthma caused by work or adversely affected by workplace conditions. Recently, cases of historical occupational lung diseases have been noted to occur with new exposures, such as cases of silicosis in workers fabricating kitchen benchtops from artificial stone products. Identification of an occupational cause of a lung disease can be difficult and requires maintaining a high index of suspicion. When an occupational lung disease is identified, this may facilitate a cure and help to protect coworkers. Currently, very little information is collected regarding actual cases of occupational lung diseases in Australia. Most assumptions about many occupational lung diseases are based on extrapolation from overseas data. This lack of information is a major impediment to development of targeted interventions and timely identification of new hazardous exposures. All employers, governments and health care providers in Australia have a responsibility to ensure that the highest possible standards are in place to protect workers' respiratory health.


Assuntos
Pneumopatias/epidemiologia , Doenças Profissionais/epidemiologia , Asbestose/diagnóstico , Asbestose/epidemiologia , Asbestose/terapia , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Asma Ocupacional/terapia , Austrália/epidemiologia , Bronquiolite Obliterante/diagnóstico , Bronquiolite Obliterante/epidemiologia , Bronquiolite Obliterante/terapia , Humanos , Pneumopatias/diagnóstico , Pneumopatias/terapia , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/epidemiologia , Doenças Pulmonares Intersticiais/terapia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/terapia , Doenças Profissionais/diagnóstico , Doenças Profissionais/terapia , Exposição Ocupacional/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Silicose/diagnóstico , Silicose/epidemiologia , Silicose/terapia
18.
BMJ Case Rep ; 20172017 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-29102973

RESUMO

We report for the first time asbestosis among ship-breaking workers of Sitakunda in Bangladesh who were exposed to asbestos during ship-based and beach-based operations for at least 10 years. Asbestosis was present among 35% of workers. Years of work (>20) and forced vital capacity (<80% of predicted) were significantly associated with the disease. Currently, global ship-breaking operations are mainly concentrated in the Indian subcontinent, and Bangladesh has the majority share. Ninety per cent of domestic steel is produced in the ship-breaking operations in Bangladesh and is an important contributor to the economy. It also gives employment to more than 100 000 people. It is imperative to medically check up all the workers for benign and malignant diseases causally related to asbestos among these vulnerable population of workers.


Assuntos
Asbestose/epidemiologia , Doenças Profissionais/epidemiologia , Doenças Pleurais/epidemiologia , Navios , Adulto , Asbestose/diagnóstico , Asbestose/diagnóstico por imagem , Bangladesh/epidemiologia , Dispneia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Doenças Profissionais/diagnóstico por imagem , Exposição Ocupacional/estatística & dados numéricos , Doenças Pleurais/diagnóstico , Doenças Pleurais/diagnóstico por imagem , Inquéritos e Questionários , Capacidade Vital
19.
Rev Mal Respir ; 34(9): 1011-1015, 2017 Nov.
Artigo em Francês | MEDLINE | ID: mdl-29033202

RESUMO

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the joints but which frequently includes extra articular effects, including pulmonary nodules, which grow faster under immunosuppressive treatment. CASE REPORT: A 74 years old man, with mild asbestosis, underwent treatment with methotrexate then leflunomide (LEF) for seropositive RA. In February 2014, during monitoring of his asbestosis, chest CT scan showed the appearance of thick-walled cavitating lung nodules, with a central and sub pleural distribution. The patient was asymptomatic. Bronchoalveolar lavage excluded infection and tumor. LEF was stopped but in May 2014, the patient was admitted with respiratory infection and a pyopneumothorax which required surgical management. The postoperative course was complicated with a persistent pneumothorax. CONCLUSIONS: We describe a case of RA complicated by a pyopneumothorax after treatment with LEF. The risk of this complication could be reduced by regular chest imaging.


Assuntos
Artrite Reumatoide/complicações , Pneumotórax/etiologia , Idoso , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/cirurgia , Asbestose/complicações , Asbestose/diagnóstico , Asbestose/cirurgia , Diagnóstico Diferencial , Empiema Pleural/diagnóstico , Empiema Pleural/etiologia , Empiema Pleural/cirurgia , Humanos , Masculino , Nódulos Pulmonares Múltiplos/diagnóstico , Nódulos Pulmonares Múltiplos/cirurgia , Pneumotórax/diagnóstico , Pneumotórax/cirurgia
20.
Ultrastruct Pathol ; 41(5): 309-311, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28805487

RESUMO

The nanopathological diagnostics (ND) is an ultra-specialized branch of pathological anatomy aimed to identify the nanoparticles of metallic, semimetallic, or nonmetallic elements in the inorganic particulate matter present inside pathological tissues, even on the nanometer scale. ND exploits an environmental scanning electron microscope, connected to an X-ray microprobe mounted on an energy-dispersive spectrometer. The searching of nanoparticles can be performed on paraffin-embedded material, omitting emissions of black overlay and plating procedures. The technique is highly sensitive and specific, reproducible and rapid, covering an entire operating cycle in few hours. Nowadays, ND finds many applications: (I) intratumor detection of heavy metals and endocrine metal disruptors; (II) identification of pathogenic nanoparticles in medical or veterinary drugs and devices, cosmetics, household products, and foodstuffs; (III) differential diagnosis of sarcoid-type granulomas (berylliosis, baritosis) and foreign body granulomas (prosthetic, iatrogenic); (IV) attestation of occupational disease correlating the datum with the occupational risk (anthracosis, asbestosis, bauxite fibrosis, byssinosis, chalicosis, siderosis, silicosis, stannosis, talcosis); and (V) forensic investigations to ascertain a causal link between disease and environmental, military, or work exposure. In addition to filling a knowledge gap, ND offers to the pathologist a current research field, with particular reference to the impact of occupational and environmental pollution on the human health and cancer.


Assuntos
Asbestose/patologia , Pulmão/patologia , Microscopia Eletrônica de Varredura , Neoplasias/diagnóstico , Neoplasias/patologia , Animais , Asbestose/diagnóstico , Humanos , Microscopia Eletrônica de Varredura/métodos , Pneumoconiose/diagnóstico , Pneumoconiose/patologia , Espectrometria por Raios X/métodos
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