[Night work, shift work: Breast cancer risk factor?]

OBJECTIVE

The aim of this review was to determine the link between night/shift work and breast cancer.

METHODS

The analysed articles were taken from the PUBMED database between 1996 and 2015. The keywords used were "breast cancer risk", "night work" and "shift work". In total, 25 articles were selected.

RESULTS

Night/shift workers are more at risk to develop a breast cancer (relative risk (RR) between 1.09; 95% CI: 1.02-1.20 and 1.48; 95% CI: 1.36-1.61 in the meta-analyses). However, this risk is not found by some cohort and case-control studies. The circadian rhythm disruption, responsible of disorderliness of melatonin secretion, could be one of the mechanisms involved in the increase of that risk. Hormonal status of night/shift workers, their geographic origin, their lifestyle and their vitamin D deficiency appear as other mechanisms potentially responsible for increased risk of cancer in this professional population. Moreover, a dose-effect connection may exist, with an increase of the risk with the number of years of night/shift work.

CONCLUSION

Night/shift work is associated with a moderate increased risk of breast cancer, especially among women who worked over 20 years. Recommendations concerning the breast monitoring in this population could be diffused. The benefit of melatonin supplementation remains to be assessed.

Prognosis of status epilepticus (SE): Relationship between SE duration and subsequent development of epilepsy

In animal models, SE duration is related to epileptogenesis. Data in humans are scarce, mainly in NCSE; therefore, we aimed to study the prognosis of SE de novo and which factors may influence subsequent development of epilepsy.

METHODS

We evaluated patients with SE without previous epilepsy at our hospital (February 2011-February 2014), including demographics, etiology, number of AEDs, duration of SE, mortality, and occurrence of seizures during follow-up.

RESULTS

Eighty-nine patients were evaluated. Median age was 69 (19-95) years old. Among them, 33.7% were convulsive. Regarding etiology, 59 were considered acute symptomatic (41 lesions, 18 toxic-metabolic), 17 remote or progressive symptomatic, and 13 cryptogenic. The median recovery time was 24h (30 min-360 h). In-hospital mortality was 29% (n = 26). After a median follow-up of 10 months, 58.7% of survivors (n = 37) showed seizures. Subsequently, we analyzed which factors might be related to the development of epilepsy, and we found that epilepsy development was more frequent with longer SE duration (37 vs. 23 h, p = 0.004); furthermore, patients with a toxic-metabolic etiology developed epilepsy less frequently (33% vs. 67%; p = 0.022). Epilepsy was also correlated (tendency) with focal SE (p = 0.073), a lesion in neuroimaging (p = 0.091), and the use of 2 or more AEDs (p = 0.098). Regarding SE duration, a cutoff of above 24h was clearly related to chronic seizures (p = 0.014); however, combining etiology and duration, the association of longer SE and epilepsy was significant in acute lesional SE (p = 0.034), but not in epilepsy with cryptogenic or remote/progressive etiology. After a logistic regression, only a duration longer than 24h (OR = 3.800 (1.277-11.312), p = 0.016) was found to be an independent predictor of the development of epilepsy.

CONCLUSION

In patients with SE, the longer duration is associated with an increased risk of subsequent epilepsy at follow-up, mainly in symptomatic SE due to an acute lesion. It is unclear if it might be the result of a more severe injury causing both prolonged seizures and subsequent epilepsy, and therefore whether more aggressive treatment in this group might avoid this possibility. Most of the patients with cryptogenic or remote/progressive SE developed epilepsy regardless of SE duration. This article is part of a Special Issue entitled "Status Epilepticus".

Organochlorine pesticides and PCBs in Southern Right Whales (Eubalaena australis) breeding at Península Valdés, Argentina

Organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) were assessed in blubber from 35 dead Southern Right Whales (SRW - Eubalaena australis) stranded at Península Valdés, Argentina. The life cycle includes a feeding period in high productivity areas of the South West Atlantic and a reproductive period in coastal template waters of Argentina. Organochlorine pesticides showed higher concentrations (22.6±13.8 ng·g(-1)ww) than PCBs (7.5±10 ng·g(-1)ww). Among pesticides, HCHs, DDTs, endosulfans, dieldrin, chlordans, heptachlor epoxide, and trans-nonachlor were detected. p,p'-DDE and p,p'-DDT were present in 69% and 26% of samples, respectively. p,p'-DDT/p,p'-DDE ratio showed low values (<0.33) as a result of aged DDT inputs. However, the occurrence of only p,p'-DDT in some samples suggests a recent pesticide input. α-HCH/γ-HCH ratio (<DL-0.37) indicated no recent contribution of technical HCH mixture and/or current use of lindane. Dieldrin was present in 77% of the samples and endosulfan was detected in all samples with predominance of α- (75%) over β-endosulfan (19%) and scarce contribution of endosulfan sulphate (7%), suggesting a recent input of this insecticide to the environment in the SRW foraging area. A predominance of pentachlorobiphenyls was observed. In 21 samples at least one PCB indicator was found and PCB #118, highly toxic, contributed in 5% to total PCBs. Although all these organochlorine compounds are forbidden they were bioaccumulated in the blubber of SRW with a predominance of endosulfans, the more recently used pesticide. The absence of data on chemical pollutants in stranded dead whales is highlighted as a priority for research. This is the first study on levels, compositional patterns, and organochlorine sources in SRW. Moreover, more research including milk, and other tissues/organs is recommended considered that in the studied specimens, mostly calves, pollutants are likely transferred from the mother during pregnancy and nursing.

Asthma among workers in healthcare settings: role of disinfection with quaternary ammonium compounds

INTRODUCTION

An increased incidence of asthma has been reported among healthcare workers. The role of quaternary ammonium compounds (QACs), commonly used in cleaning/disinfection products, has not been clearly defined. The aim of this study was to analyse associations between asthma and occupational exposure to disinfectants, especially QACs.

METHODS

The study was performed on a stratified random sample of the various healthcare departments of 7 healthcare settings. The study included: questionnaire, physical examination and specific IgE assays. Occupational exposure assessment was performed by means of a work questionnaire, workplace studies and a review of products ingredients. Data were analysed by logistic regression.

RESULTS

Response rate was 77%; 543 workers (89% female) participated; 37.1% were registered nurses (RNs), 16.4% auxiliary nurses (ANs), 17.3% cleaners; 32.8% were atopic. 335 participants were exposed to QACs. Nursing professionals reported a significantly higher risk of reported physician-diagnosed asthma and, for RNs, of nasal symptoms at work than administrative staff working in healthcare sector. This risk was particularly marked during disinfection tasks and when exposure to QACs. Exposure to QACs increased significantly the risk of reported physician-diagnosed asthma and nasal symptoms at work (adjusted OR = 7.5 and 3.2, respectively). No significant association was found with other exposures such as latex glove use, chlorinated products/bleach or glutaraldehyde.

CONCLUSION

RNs and ANs presented a higher risk of reported asthma than administrative staff. The highest risk was associated with tasks involving dilution of disinfection products by manual mixing, suggesting possible exposure to repeated peaks of concentrated products known to be strong respiratory irritants. Workplace interventions should be conducted to more clearly determine QAC exposure and improve disinfection procedures.

Multimatrix measurement of persistent organic pollutants in Mar Chiquita, a continental saline shallow lake

RAMSAR sites are determined by specific characteristics of the environment in terms of ecological productivity as well services for human development, but they are also one of the most threatened ecosystems. Thus, the objective of this work was to evaluate the dynamic of Persistent Organic Pollutants (POPs) in different biotic and abiotic matrixes of the RAMSAR site (wetlands with international importance), Mar Chiquita Lake. Sampling was performed according to land use (agricultural, urban, and industrial) at two stations: Laguna del Plata and Campo Mare. POPs were analyzed in superficial water (Sw), suspended particulate material (SPM), bottom sediment (Bs) and fish tissues (Odontesthes bonariensis). Organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) were analyzed by GC-ECD. HCHs, Endosulfans, DDTs, PCBs and PBDEs were found in all matrixes at both stations. The high persistence and transport processes are responsible for the occurrence of HCHs, DDTs and PCBs in Bs, SPM and fish tissues, even many years after their prohibition. PBDEs showed lower levels according to the scarcity of punctual sources in the area. Endosulfan showed variable amounts in agreement with application periods since this pesticide was used until a few years ago in this area. Finally, PCB levels overpassed the acceptable daily intake for human consumption being a risk for human health Thus, the present report confirms the occurrence of POPs in Mar Chiquita lake, alerting on the contribution of agricultural and urban pollutants in a RAMSAR site. Current results also raise concerns on biomagnification processes through the food web.

Y155H amino acid substitution in influenza A(H1N1)pdm09 viruses does not confer a phenotype of reduced susceptibility to neuraminidase inhibitors

The Y155H amino acid substitution in the neuraminidase gene (NA) has previously been associated with highly reduced inhibition by neuraminidase inhibitors in the seasonal H1N1 influenza A virus which circulated in humans before the 2009 pandemic. During the 2012/13 epidemic season in Spain, two A(H1N1)pdm09 viruses bearing the specific Y155H substitution in the NA were detected and isolated from two patients diagnosed with severe respiratory syndrome and pneumonia requiring admission to the intensive care unit. Contrary to what was observed in the seasonal A(H1N1) viruses, neither of the Y155H A(H1N1)pdm09 viruses described here showed a phenotype of reduced inhibition by NAIs as determined by the neuraminidase enzyme inhibition assay (MUNANA). High-throughput sequencing of the NA of both Y155H viruses showed that they were composed to >99% of H155 variants. We believe that this report can contribute to a better understanding of the biological significance of amino acid substitutions in the neuraminidase protein with regard to susceptibility of influenza viruses to neuraminidase inhibitors. This is of critical importance for optimal management of influenza disease patients.

Y155H amino acid substitution in influenza A(H1N1)pdm09 viruses does not confer a phenotype of reduced susceptibility to neuraminidase inhibitors

The Y155H amino acid substitution in the neuraminidase gene (NA) has previously been associated with highly reduced inhibition by neuraminidase inhibitors in the seasonal H1N1 influenza A virus which circulated in humans before the 2009 pandemic. During the 2012/13 epidemic season in Spain, two A(H1N1) pdm09 viruses bearing the specific Y155H substitution in the NA were detected and isolated from two patients diagnosed with severe respiratory syndrome and pneumonia requiring admission to the intensive care unit. Contrary to what was observed in the seasonal A(H1N1) viruses, neither of the Y155H A(H1N1) pdm09 viruses described here showed a phenotype of reduced inhibition by NAIs as determined by the neuraminidase enzyme inhibition assay (MUNANA). High-throughput sequencing of the NA of both Y155H viruses showed that they were composed to >99% of H155 variants. We believe that this report can contribute to a better understanding of the biological significance of amino acid substitutions in the neuraminidase protein with regard to susceptibility of influenza viruses to neuraminidase inhibitors. This is of critical importance for optimal management of influenza disease patients.

[Lung volume reduction (LVR) in severe emphysema: a multidisciplinary approach]

Most cases of emphysema are managed conservatively. However, in severe symptomatic emphysema associated with hyperinflation, lung volume reduction (LVR) may be proposed to improve dyspnea, exercice capacity, pulmonary functions, walk distance and to decrease long-term mortality. LVR may be achieved either surgically (LVRS) or endoscopically (EVLR by valves or coils) according to specific clinical criteria. Currently, the optimal approach is discussed in a multidisciplinary setting. The latter permits a personalized evaluation the patient's clinical status and allows the best possible therapeutic intervention to be proposed to the patient.