Reported occupational respiratory diseases in Catalonia

OBJECTIVES

A voluntary surveillance system was implemented in Catalonia (Spain) to ascertain the feasibility, incidence, and characteristics of occupational respiratory diseases and compare them with those of the compulsory official system.

METHODS

In 2002, in collaboration with the Occupational and Thoracic Societies of Catalonia, occupational and chest physicians and other specialists were invited to report, on a bimonthly basis, newly diagnosed cases of occupational respiratory diseases. Information requested on each case included diagnosis, age, sex, place of residence, occupation, suspected agent, and physician's opinion on the likelihood that the condition was work related. Compulsory official system data derived from statistics on work related diseases for possible disability benefits declared by insurance companies, which are responsible for declaring these diseases to the Autonomous Government of Catalonia.

RESULTS

Of 142 physicians seeing patients with occupational respiratory diseases approached, 102 (74%) participated. Three hundred and fifty nine cases were reported, of which asthma (48.5%), asbestos related diseases (14.5%), and acute inhalations (12.8%) were the most common. Physicians rated 63% of suspected cases as highly likely, 28% as likely, and 8% as low likelihood. The most frequent suspected agents reported for asthma were isocyanates (15.5%), persulphates (12.1%), and cleaning products (8.6%). Mesothelioma (5.9%) was the most frequent diagnosis among asbestos related diseases. The number of acute inhalations reported was high, with metal industries (26%), cleaning services (22%), and chemical industries (13%) being the most frequently involved. The frequency of occupational respiratory diseases recorded by this voluntary surveillance system was four times higher than that reported by the compulsory official system.

CONCLUSIONS

The compulsory scheme for reporting occupational lung diseases is seriously underreporting in Catalonia. A surveillance programme based on voluntary reporting by physicians may provide better understanding of the incidence and characteristics of these diseases. Persulphates and cleaning products, besides isocyanates, were the most reported causes of occupational asthma. Metal industries and cleaning services were the occupations most frequently involved in acute inhalations with a remarkably high incidence in our register.

Decline in cognitive and functional skills increases mortality risk in nondemented elderly

OBJECTIVE

To investigate the relation between rate of decline in cognitive and functional/physical abilities and risk of death in nondemented elderly.

METHODS

Data were included from individuals participating in a prospective study of aging and dementia in Medicare recipients, 65 years and older, residing in northern Manhattan. The authors included 878 members of the cohort who had measures of memory, cognitive, language, or functional scores over three study intervals, excluding all participants who were demented or had more than one problem in activity of daily living (ADL) skills at baseline. Participants were classified as showing no decline, slow, medium, or rapid rate of decline, based on the slope of change in cognitive and functional/physical factors. The authors used survival methods to examine the relation of rate of decline in cognitive and functional performance to subsequent mortality in younger and older nondemented elderly and across three ethnic groups, adjusting for potential confounders.

RESULTS

Nondemented elderly with preserved ADL skills who showed rapid rates of decline on measures of visuospatial reasoning/cognitive, language, ADL, and instrumental ADL functions were approximately twice as likely to die as nondemented elderly who showed no decline or slower rates of decline, while rate of decline in memory or in measures of extremity mobility was not related to risk of death. The association of the rate of decline to risk of death was stronger in relatively young (< or =75 years) than in older participants.

CONCLUSIONS

Rate of decline in cognitive and functional skills predicts mortality in nondemented elderly.

Interactions between Sla1p, Lsb5p and Arf3p in yeast endocytosis

Endocytosis is critical for controlling the protein-lipid composition of the plasma membrane, uptake of nutrients as well as pathogens, and also plays an important role in regulation of cell signalling. While a number of pathways for endocytosis have been characterized in different organisms, all of these require remodelling of the cell cortex. The importance of a dynamic actin cytoskeleton for facilitating endocytosis has been recognized for many years in budding yeast, and is increasingly supported by studies in mammalian cells. Our studies have focused on proteins that we have shown to act at the interface between the actin cytoskeleton and the endocytic machinery. In particular, we have studied interactions of Sla1p, which binds to both activators of actin dynamics, i.e. Abp1p, Las17p and Pan1p, and to cargo proteins such as the pheromone receptor Ste2p. More recently we have mapped the interaction of Sla1p with Lsb5p, a protein that has a similar structure to the GGA [Golgi-localizing, gamma-adaptin ear homology domain, Arf (ADP-ribosylation factor)-binding] family of proteins with an N-terminal VHS (Vps27p/Hrs/STAM)-domain and a GAT (GGAs and TOM1) domain. We show that Lsb5p can interact with yeast Arf3p (orthologous with mammalian Arf6) and we demonstrate a requirement for Arf3p expression in order to localize Lsb5p to the cell cortex.

Mental health symptoms in partial epilepsy

We evaluated the potential clinical value of the Symptom Checklist-90-Revised (SCL-90-R) as a multidimensional self-report measure to identify the expected higher rates of clinically significant mental health symptoms in adults with partial/complex partial epilepsy (PE), as compared to a representative sample of adult non-patients. As expected, adults with PE had significantly higher rates of elevated SCL-90-R scale scores than did adult non-patients. The SCL-90-R may serve as both a screening measure to identify patients who could benefit from further mental health services as well as a measure of clinical response to epilepsy- and mental health-related interventions.

NIV treatment for acute exacerbation in COPD patients

The authors review the clinical applications of non invasive ventilation (NIV) in patients with chronic obstructive pulmonary disease (COPD), mostly focusing on NIV issues and possible solutions. After briefly reviewing the respiratory mechanics modification during an episode of COPD exacerbation, the authors describe the two crucial technical aspects (choice of the interface and leaks control) that are mostly involved in patient-ventilator interaction. Finally, they briefly review the most important clinical trials on NIV.

Hypoalbuminaemia does not impair Diprifusor performance during sedation with propofol

BACKGROUND

About 98% of plasma propofol is bound to albumin. We investigated if severe hypoalbuminaemia may affect the accuracy of a target-controlled infusion (TCI) device, the Diprifusor, during sedation in critically ill patients.

METHODS

Ten critically ill hypoalbuminaemic patients (<24 g litre(-1)) and 10 critically ill normoalbuminaemic patients (>32 g litre(-1)) were included in this study. They underwent sedation with propofol, aimed at a Ramsey sedation score of 4-5. The Diprifusor was used to achieve target propofol plasma concentrations that ranged between 0.6 and 1.5 mg litre(-1). Propofol concentration was measured by high-performance liquid chromatography 5 min, 15 min, 30 min, 1 h, 2 h, 4 h, 6 h and 8 h after starting TCI. The accuracy of TCI was evaluated by calculating performance errors [PE=100x(measured concentration-predicted concentration)/predicted concentration], absolute and relative individual median performance errors (MDAPE and MDPE) and divergence (the slope of individual regression lines between PEs and time).

RESULTS

PEs [median (range)] were -7 (-65, 79) in hypoalbuminaemic patients and -2 (-53, 188) in normoalbuminaemic patients; absolute PEs were 21 (1, 79) and 22 (0, 188). No significant difference was observed between the two groups. MDPE, MDAPE and divergence values were also similar. In most patients the accuracy of TCI increased with time because higher PE values were observed during the first 30 min.

CONCLUSIONS

Hypoalbuminaemia does not affect the accuracy of Diprifusor during sedation with propofol in critically ill patients.

[Reactive airways dysfunction syndrome]

Reactive airways dysfunction syndrome, better known as RADS, was described as a clinical entity consisting in the appearance of bronchial asthma due to massive toxic inhalation. The term was coined and recognised for the first time in 1985. Since then different publications have verified new cases as well as different causal agents. It usually arises from an accident at the work place and in closed or poorly ventilated spaces, where high concentrations of irritant products are inhaled in the form of gas, smoke or vapour. In the following minutes or hours symptoms of bronchial obstruction appear in an acute form, with bronchial hyperresponsiveness persisting for months or years. The affected patients do not show a recurrence of symptoms following exposure to non-toxic doses of the same agent that started the symptoms. This is why diagnosis is based on clinical manifestations as it is not reproducible through a provocation test.

Docetaxel em administração semanal como quimioterapia de primeira linha para câncer de pulmão de não-pequenas células em estádio IV: tratamento eficaz com toxicidade baixa

O estudo avaliou a segurança e eficácia do docetaxel como terapia de primeira linha em pacientes com câncer de pulmão de não-pequenas células avançado (CPNPC). Trinta e seis pacientes com CPNPC de estádio IV receberam docetaxel 36 mg/m2/ semana X 6 com 2 semanas de descanso em um total de seis ciclos programados. Os ciclos foram repetidos a cada 8 semanas. O status tumoral foi avaliado por exame clínico e radiológico. Neutropenia foi a toxicidade hematológica mais comum (14% dos pacientes). A taxa de resposta global foi de 14% (5 respostas parciais), 9 (25%) pacientes apresentaram respostas menores ou doença estável por ≥17 semanas. Tempo mediano para progressão e sobrevida mediana foram de 3,4 meses e 7,0 meses, respectivamente. Sobrevida em 1 ano foi de 32%. Esses dados sugerem que o docetaxel em administração semanal é bem-tolerado, com uma taxa de resposta compatível com agentes únicos usados em CPNPC avançado, representando uma opção adicional para pacientes com dificuldade de tolerar o esquema padrão a cada 3 semanas, com uma toxicidade bastante aceitável.

[Pachydermodactyly: a report of two cases]

Pachydermodactyly is a superficial benign, symmetrical and painless fibromatosis, characterized by a swelling of the proximal interphalangeal joints of the fingers. Histological examination shows epidermal hyperplasia increase of dermal collagen bundles and an increased number of fibroblasts. We report two cases of pachydermodactyly in male teenagers. The aetiology remains unknown. Pachydermodactyly has to be distinguished from knuckle pads.

A mutation in Drosophila simulans that lengthens the circadian period of locomotor activity

The length of the Thr-Gly repeat within the period gene of Drosophilids, coevolves with its immediate flanking region to maintain the temperature compensation of the fly circadian clock. In Drosophila simulans, balancing selection appears to maintain a polymorphism in this region, with three repeat lengths carrying 23, 24 or 25 Thr-Gly pairs, each in complete linkage disequilibrium with a distinctive flanking region amino acid moiety. We wondered whether separating a specific length repeat from its associated flanking haplotype might have functional implications for the circadian clock. We fortuitously discovered a population of flies collected in Kenya, in which a chimeric Thr-Gly haplotype was segregating that carried the (Thr-Gly)24 repeat, but the flanking region of a (Thr-Gly)23 allele. One of the five isofemale lines that carried this 'mutant' Thr-Gly sequence showed a dramatically long and temperature-sensitive free-running circadian period. This phenotype was mapped to the X chromosome, close to the D. simulans per gene, but there was also a significant effect of a modifying autosomal locus or loci. It seems remarkable that such a mutant phenotype should be discovered in a screen of chimeric Thr-Gly regions.

Impact of tuberculosis on the course of HIV-infected patients with a high initial CD4 lymphocyte count

OBJECTIVE

To assess the influence of tuberculosis (TB) on the progression of human immunodeficiency virus (HIV) infection in patients without immunological impairment.

MATERIAL AND METHODS

In an observational study of retrospective cohorts, the evolution of 28 HIV-infected patients with TB and a CD4 lymphocyte count >500 x 10(6) cells/l was compared with 56 HIV-infected patients without TB. Each case was paired with two controls by CD4 lymphocyte count (+/-50 x 10(6)/l) and date of starting follow-up (+/-6 months). The progression of HIV infection was evaluated as: 1) immunological progression: time to CD4 lymphocyte count <200 x 10(6)/l; 2) clinical progression: time to development of acquired immune-deficiency syndrome (AIDS), excluding TB; 3) survival; and 4) global disease progression: time to the first defined event in 1, 2 and/or 3. The times to these events were estimated using Kaplan Meier curves.

RESULTS

There were no significant differences between the cohorts for age, sex and risk group. Faster immunological impairment (RR 2.94; 95%CI 1.46-8.6; P < 0.01), greater progression to AIDS (RR 4.01; 95%CI 1.66-9.69; P < 0.01), lower survival (RR 3.89; 95%CI 1.53-9.87; P < 0.05) and higher global disease progression (RR 2.82; 95%CI 1.57-5.09; P < 0.01) were found in the cohort of TB patients. These associations were still significant after adjustment for CD4 lymphocyte counts.

CONCLUSION

The diagnosis of TB in HIV-infected patients with a high initial CD4 lymphocyte count (>500 x 10(6)/l) was related to greater progression to AIDS and shorter survival.

Non-invasive ventilation in COPD patients

The authors briefly review the clinical applications of non-invasive ventilation (NIV) in patients with chronic obstructive pulmonary disease (COPD), mostly focusing on the application of NIV in the intensive care setting. After a short discussion of the main pathophysiologic aspects of NIV administration in patients with acute exacerbation of COPD, the most relevant clinical trials are shortly reviewed, particularly focussing on prospective randomised trials. NIV application is analysed both in its early administration, as a tool to prevent endotracheal intubation and its main complication, and as a technique alternative to endotracheal intubation in patients requiring mechanical ventilation. Finally, the main contraindications for NIV are reviewed and discussed.