1
|
Calabrese F, Montero-Fernandez MA, Kern I, Pezzuto F, Lunardi F, Hofman P, Berezowska S, Attanoos R, Burke L, Mason P, Balestro E, Molina Molina M, Giraudo C, Prosch H, Brcic L, Galateau-Salle F. The role of pathologists in the diagnosis of occupational lung diseases: an expert opinion of the European Society of Pathology Pulmonary Pathology Working Group. Virchows Arch 2024:10.1007/s00428-024-03845-1. [PMID: 39030439 DOI: 10.1007/s00428-024-03845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 07/21/2024]
Abstract
Occupational lung/thoracic diseases are a major global public health issue. They comprise a diverse spectrum of health conditions with complex pathology, most of which arise following chronic heavy workplace exposures to various mineral dusts, metal fumes, or following inhaled organic particulate reactions. Many occupational lung diseases could become irreversible; thus accurate diagnosis is mandatory to minimize dust exposure and consequently reduce damage to the respiratory system. Lung biopsy is usually required when exposure history is inconsistent with imaging, in case of unusual or new exposures, in case of unexpected malignancy, and in cases in which there are claims for personal injury and legal compensation. In this paper, we provide an overview of the most frequent occupational lung diseases with a focus on pathological diagnosis. This is a paper that summarizes the expert opinion from a group of European pathologists, together with contributions from other specialists who are crucial for the diagnosis and management of these diseases. Indeed, tight collaboration of all specialists involved in the workup is mandatory as many occupational lung diseases are misdiagnosed or go unrecognized. This document provides a guide for pathologists in practice to facilitate the accurate diagnosis of occupational lung disease. The review article reports relevant topics discussed during an educational course held by expert pathologists, active members of the Pulmonary Pathology Working Group of the European Society of Pathology. The course was endorsed by the University of Padova as a "winter school" (selected project in the call for "Shaping a World-class University" 2022).
Collapse
Affiliation(s)
- Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy.
| | | | - Izidor Kern
- Cytology and Pathology Laboratory, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Federica Pezzuto
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Francesca Lunardi
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, IHU RespirERA, Nice Hospital, University Côte d'Azur, Nice, France
| | - Sabina Berezowska
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Richard Attanoos
- Department of Cellular Pathology, Cardiff University, Cardiff, UK
| | - Louise Burke
- Department of Histopathology, Cork University Hospital, Cork, Ireland
| | - Paola Mason
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | | | - Maria Molina Molina
- Respiratory Department, University Hospital of Bellvitge, IDIBELL, CIBERES, L'Hospitalet de Llobregat, Spain
| | - Chiara Giraudo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Helmut Prosch
- Division of Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Luka Brcic
- Diagnostic and Research Centre for Molecular BioMedicine, Diagnostic & Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | | |
Collapse
|
2
|
Larson AJS, Cartwright MM, Jones WD, Luce K, Chen MY, Petersen K, Nelson SV, Michaelis DJ, Madsen MD. Slow Release of GA 3 Hormone from Polymer Coating Overcomes Seed Dormancy and Improves Germination. PLANTS (BASEL, SWITZERLAND) 2023; 12:4139. [PMID: 38140466 PMCID: PMC10748187 DOI: 10.3390/plants12244139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
Seed dormancy often hinders direct seeding efforts that are attempting to restore degraded landscapes. Gibberellic acid (GA3) can be applied to physiologically dormant seeds to induce germination, but this hormone is rarely effective, as it can degrade or be leached from the seed. We tested different polymer matrixes (polylactic acid, polyvinylpyrrolidone, and ethylcellulose) to apply and slowly release GA3 to the seed. These polymers were tested as seed coatings in either a powder, liquid, or a combination of powder and liquid forms. We found that a liquid ethylcellulose/GA3 coating generally outperformed the other polymers and applications methods using our test species Penstemon palmeri. With this top-performing treatment, seed germination was 3.0- and 3.9-fold higher at 15 °C and 25 °C, respectively. We also evaluated the liquid ethylcellulose/GA3 coating on P. comharrenus, P. strictus, P. pachyphyllus, and P. eatonii. Again, the coating had a strong treatment response, with the degree of difference related to the relative level of dormancy of the species. Growth studies were also performed in pots to ensure that the side effects of GA3 overdosing were not present. Here, we found minimal differences in root length, shoot length, or biomass between plants grown from untreated and GA3-coated seeds.
Collapse
Affiliation(s)
- Alexandra J. S. Larson
- Department of Plant and Wildlife Sciences, Brigham Young University, Provo, UT 84602, USA; (A.J.S.L.); (W.D.J.); (K.L.); (M.-Y.C.); (S.V.N.)
| | - Maureen M. Cartwright
- Department of Plant and Wildlife Sciences, Brigham Young University, Provo, UT 84602, USA; (A.J.S.L.); (W.D.J.); (K.L.); (M.-Y.C.); (S.V.N.)
| | - Whitney D. Jones
- Department of Plant and Wildlife Sciences, Brigham Young University, Provo, UT 84602, USA; (A.J.S.L.); (W.D.J.); (K.L.); (M.-Y.C.); (S.V.N.)
| | - Katrina Luce
- Department of Plant and Wildlife Sciences, Brigham Young University, Provo, UT 84602, USA; (A.J.S.L.); (W.D.J.); (K.L.); (M.-Y.C.); (S.V.N.)
| | - Mei-Yu Chen
- Department of Plant and Wildlife Sciences, Brigham Young University, Provo, UT 84602, USA; (A.J.S.L.); (W.D.J.); (K.L.); (M.-Y.C.); (S.V.N.)
| | - Kate Petersen
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT 84602, USA; (K.P.); (D.J.M.)
| | - Shannon V. Nelson
- Department of Plant and Wildlife Sciences, Brigham Young University, Provo, UT 84602, USA; (A.J.S.L.); (W.D.J.); (K.L.); (M.-Y.C.); (S.V.N.)
| | - David J. Michaelis
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT 84602, USA; (K.P.); (D.J.M.)
| | - Matthew D. Madsen
- Department of Plant and Wildlife Sciences, Brigham Young University, Provo, UT 84602, USA; (A.J.S.L.); (W.D.J.); (K.L.); (M.-Y.C.); (S.V.N.)
| |
Collapse
|
3
|
Samynathan A, Saardi K, Akiska YM, Sadur A, Johnson S, Nasseri M. "Skin Popping" and "Shooter's Patch" As Manifestations of Intradermal Drug Abuse. Cureus 2023; 15:e45251. [PMID: 37842500 PMCID: PMC10576613 DOI: 10.7759/cureus.45251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Talc, a common adulterant in injectable opioids and filler in oral tablets, is frequently abused as crushed suspensions in injections. This review aims to recognize intradermal drug injection referred to colloquially as "skin popping" or "shooter's patch" as a cause of granulomatous disease and prevention of systemic complications from cutaneous cues.
Collapse
Affiliation(s)
- Archana Samynathan
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
- Department of Dermatology, Bangalore Medical College and Research Institute, Bangalore, IND
| | - Kaarl Saardi
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Yagiz M Akiska
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Alana Sadur
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Skylar Johnson
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Mana Nasseri
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| |
Collapse
|
4
|
Basilar Predominant Emphysema: Thinking beyond Alpha-1-Antitrypsin Deficiency. Case Rep Med 2022; 2022:9840085. [DOI: 10.1155/2022/9840085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
Basilar predominant emphysema, or disproportionate emphysematous involvement of the lung bases compared to the apices, is an uncommon radiographic pattern of emphysema traditionally associated with alpha-1-antitrypsin deficiency (AATD). We present a case of a 59-year-old female with 41 pack-year tobacco use, Stage IV COPD with supplemental oxygen, and bibasilar predominant emphysema who successfully underwent bronchoscopic lung volume reduction. She presented with recurrent hospitalizations for frequent exacerbations. After lung reduction, the patient displayed improvement in functional status without hospitalizations at the 15-month follow-up. Careful history taking is essential for any patients diagnosed with lower lobe emphysema to elucidate the underlying etiology. This case challenges the notion that basilar emphysema is sensitive or specific for AATD and emphasizes that this pattern of emphysema has a broad differential diagnosis and alternative etiologies should be considered. Our patient was ultimately diagnosed with smoking-related emphysema, with atypical bibasilar involvement. Furthermore, basilar predominant emphysema should be considered a separate entity from its apical predominant counterpart.
Collapse
|
5
|
Babalola OF, Salawu AI, Okunlola AI, Abdullahi YO. Thumb talc granuloma mimicking squamous cell carcinoma: A case report. Niger J Clin Pract 2021; 24:1565-1568. [PMID: 34657027 DOI: 10.4103/njcp.njcp_148_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Application of topical powdery substances to the wound is an age old practice. Talc containing powdery substances are however commonplace and predominant in our environment. This insoluble mineral has been linked to chronic granulomatous reaction particularly in the lungs. We present a case report of a fifty-year-old man with prolonged application of talc containing powdery substances to the left thumb wound and excitation of exuberant granuloma mimicking squamous cell carcinoma. He had complete excision of the mass and satisfactory first dorsal metacarpal artery flap coverage of the soft tissue defect.
Collapse
Affiliation(s)
- O F Babalola
- Department of Surgery, Federal Teaching Hospital, Ido-Ekiti/Afe Babalola University, Ado-Ekiti, Ekiti-State, Nigeria
| | - A I Salawu
- Department of Surgery, Federal Teaching Hospital, Ido-Ekiti/Afe Babalola University, Ado-Ekiti, Ekiti-State, Nigeria
| | - A I Okunlola
- Department of Surgery, Federal Teaching Hospital, Ido-Ekiti/Afe Babalola University, Ado-Ekiti, Ekiti-State, Nigeria
| | - Y O Abdullahi
- Department of Surgery, Federal Teaching Hospital, Ido-Ekiti/Afe Babalola University, Ado-Ekiti, Ekiti-State, Nigeria
| |
Collapse
|
6
|
Micronodular lung disease on high-resolution CT: patterns and differential diagnosis. Clin Radiol 2021; 76:399-406. [PMID: 33563413 DOI: 10.1016/j.crad.2020.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
With the advent of high-resolution computed tomography (HRCT), micronodular lung disease is a routinely encountered pathology in thoracic imaging. This article will review how to differentiate the three main micronodular patterns and review the differential diagnosis for each. Differential diagnosis of micronodular lung disease may be extensive, but by identifying the pattern and using additional clues, such as distribution, additional imaging findings, and clinical history, a radiologist can make an accurate diagnosis. First, three micronodular patterns - centrilobular, peri-lymphatic, and random - can be identified by using a simple algorithm based on the location of nodules. This algorithm requires understanding of the anatomy and function of the secondary pulmonary lobule. Each micronodular pattern offers a unique differential diagnosis. Centrilobular nodules can be seen with inflammatory, infectious, or vascular aetiologies; peri-lymphatic nodules with sarcoidosis and lymphangitic carcinomatosis; and random nodules with haematogenous metastases or infections.
Collapse
|
7
|
Leung SS, Lee P, Most JE, Sundaram B. Images in COPD: Idiopathic Emphysema in a Never Smoker. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2020; 7:130-133. [PMID: 32324984 DOI: 10.15326/jcopdf.7.2.2020.0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Stephan S Leung
- Division of Cardiothoracic Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Patrick Lee
- Division of Cardiothoracic Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jessica E Most
- Division of Pulmonology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Baskaran Sundaram
- Division of Cardiothoracic Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
8
|
Olds K, Gilbert J, Langlois NE, Byard RW. Systemic Dissemination of Injected Foreign Material. J Forensic Sci 2018; 64:1245-1247. [DOI: 10.1111/1556-4029.13970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kelly Olds
- School of Medicine University of Notre Dame Henry St Perth 6160
| | | | - Neil E.I. Langlois
- Forensic Science SA GPO Box 2790 Adelaide 5001
- School of Medicine University of Adelaide Frome Rd Adelaide 5005 Australia
| | - Roger W. Byard
- Forensic Science SA GPO Box 2790 Adelaide 5001
- School of Medicine University of Adelaide Frome Rd Adelaide 5005 Australia
| |
Collapse
|
9
|
Lafferty L, Treloar C, van Breda N, Steele M, Hiley S, Flaherty I, Salmon A. ‘It's Fast, It's Quick, It Stops Me Being Sick’: How to influence preparation of opioid tablets for injection. Drug Alcohol Rev 2017; 36:651-657. [DOI: 10.1111/dar.12562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/19/2017] [Accepted: 04/04/2017] [Indexed: 12/20/2022]
Affiliation(s)
| | - Carla Treloar
- Centre for Social Research in Health; UNSW Sydney; Sydney Australia
| | - Nick van Breda
- Uniting Medically Supervised Injecting Centre; Sydney Australia
| | - Maureen Steele
- Uniting Medically Supervised Injecting Centre; Sydney Australia
| | - Sarah Hiley
- Uniting Medically Supervised Injecting Centre; Sydney Australia
| | - Ian Flaherty
- Uniting Medically Supervised Injecting Centre; Sydney Australia
| | - Allison Salmon
- Uniting Medically Supervised Injecting Centre; Sydney Australia
| |
Collapse
|
10
|
Steele M, Silins E, Flaherty I, Hiley S, van Breda N, Jauncey M. Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work? Drug Alcohol Rev 2017; 37:116-120. [PMID: 28317315 DOI: 10.1111/dar.12481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/28/2016] [Accepted: 08/07/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Wheel-filtration of pharmaceutical opioid tablets is a recognised harm reduction strategy, but uptake of the practice among people who inject drugs is low. The study aimed to: (i) examine perceptions of filtration practices; (ii) provide structured education on wheel-filtration; and (iii) assess uptake of the practice. DESIGN AND METHODS Frequent opioid tablet injectors (n = 30) attending a supervised injecting facility in Sydney, Australia, received hands-on instruction on wheel-filtration based on recommended practice. Pre-education, post-education and follow-up questionnaires were administered. RESULTS Wheel-filtration was generally regarded as better than cotton-filtration (the typical method) in terms of perceived effects on health, ease of use and overall drug effect. Sixty-eight percent of those who said they would try wheel-filtration after the education had actually done so. Of those who usually used cotton-filtration, over half (60%) had used wheel-filtration two weeks later. DISCUSSION AND CONCLUSIONS Uptake of safer preparation methods for pharmaceutical opioid tablets increases after structured education in wheel-filtration. Findings suggest that SIFs are an effective site for this kind of education. Supervised injecting facility workers are uniquely positioned to provide harm reduction education at the time of injection. [Steele M, Silins E, Flaherty I, Hiley S, van Breda N, Jauncey M. Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work? Drug Alcohol Rev 2018;37:116-120].
Collapse
Affiliation(s)
- Maureen Steele
- Sydney Medically Supervised Injecting Centre, Sydney, Australia
| | - Edmund Silins
- Sydney Medically Supervised Injecting Centre, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Ian Flaherty
- Sydney Medically Supervised Injecting Centre, Sydney, Australia
| | - Sarah Hiley
- Sydney Medically Supervised Injecting Centre, Sydney, Australia
| | - Nick van Breda
- Sydney Medically Supervised Injecting Centre, Sydney, Australia
| | | |
Collapse
|
11
|
Matrosovich E, Brodmann R, Lampert S, Lehnert G, Hartmann A, Ficker J. Dyspnea following intravenous drug use. Respir Med Case Rep 2017; 20:192-194. [PMID: 28316931 PMCID: PMC5344321 DOI: 10.1016/j.rmcr.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- E. Matrosovich
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg General Hospital, Nuremberg, Germany
- Paracelsus Medical University, Nuremberg, Germany
- Corresponding author. Department of Respiratory Medicine, Allergology, Sleep Medicine, Nuremberg General Hospital/Paracelsus Medical University, Prof.-Ernst-Nathan Str.1, 90419 Nuremberg, Germany.Department of Respiratory Medicine, Allergology, Sleep MedicineNuremberg General Hospital/Paracelsus Medical UniversityProf.-Ernst-Nathan Str.1Nuremberg90419Germany
| | - R. Brodmann
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg General Hospital, Nuremberg, Germany
- Paracelsus Medical University, Nuremberg, Germany
| | - S. Lampert
- Respiratory Medical Practice, Uttenreuth, Germany
| | - G. Lehnert
- Respiratory Medical Practice, Uttenreuth, Germany
| | - A. Hartmann
- Institute of Pathology, Friedrich-Alexander-University of Erlangen-Nuremberg, Germany
| | - J.H. Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg General Hospital, Nuremberg, Germany
- Paracelsus Medical University, Nuremberg, Germany
| |
Collapse
|
12
|
Holl-Ulrich K, Rose C. [Non-infectious granulomatous inflammation: Focus on the lungs and skin]. DER PATHOLOGE 2017; 37:172-82. [PMID: 26670175 DOI: 10.1007/s00292-015-0119-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Whereas a granulomatous reaction represents a physiologically useful immune defense mechanism against many infections, in autoimmune diseases granuloma formation and the concomitant inflammatory mechanisms may provoke a potentially organ-threatening reaction. Morphologically, several defined sub-types of granuloma have long been known, e.g. foreign body granuloma, tuberculous granuloma,sarcoid, pseudosarcoid, rheumatoid and rheumatic fever granulomas. However, in practice, assigning granulomas to a certain etiology from a biopsy or resection specimen can be a challenging diagnostic process. This article gives a practically oriented overview of the clinically most relevant non-infectious granulomatous diseases. The etiology, epidemiology, clinical correlation and morphology of granulomatous diseases are discussed, focussing on the lungs and skin.
Collapse
Affiliation(s)
- K Holl-Ulrich
- Konsultations- und Referenzzentrum für Vaskulitis-Diagnostik, Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. .,Gemeinschaftspraxis für Pathologie am Lademannbogen, Hamburg, Deutschland.
| | - C Rose
- Dermatopathologie Lübeck, Lübeck, Deutschland
| |
Collapse
|
13
|
Iversen J, Dertadian G, Geddes L, Maher L. High risk injecting behaviour among people who inject pharmaceutical opioids in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 42:1-6. [PMID: 28104570 DOI: 10.1016/j.drugpo.2016.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 11/30/2016] [Accepted: 12/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Use of opioid analgesic medicines has doubled globally over the past decade, with a concomitant increase in prevalence of injection of pharmaceutical opioids (PO), including in Australia. This study investigates types of PO injected, methods used to prepare PO for injection and correlates of recent (last 6 months) PO injection among a large national sample of people who inject drugs (PWID). METHODS The Australian NSP Survey (ANSPS), conducted annually at ∼50 NSP services across Australia, consists of a brief self-administered questionnaire and provision of a capillary dried blood spot for HIV and hepatitis C antibody testing. Data from 2014 were used to conduct univariable and multivariable logistic regression analysis to determine factors independently associated with recent injection of PO. RESULTS Among 1488 ANSPS respondents who were identified as opioid injectors, 57% (n=848) reported injection of PO in the previous six months. The majority of PO injectors (85%) reported filtering PO prior to injection, although use of efficacious wheel filters was relatively rare (11%). Correlates of POs injection included daily injection (AOR=1.65, 95% CI 1.31-2.08), receptive sharing of syringes (AOR=2.00, 95% CI 1.43-2.78), receptive sharing of drug preparation equipment (AOR=1.55, 95% CI 1.19-2.01), drug overdose in the previous year (AOR=1.81, 95% CI 1.36-2.42) and residence in inner regional (AOR=3.27, 95% CI 2.21-5.23) or outer regional/remote (AOR=5.50, 95% CI 3.42-8.84) areas of Australia. CONCLUSION PO injection is geographically widespread among Australian PWID and takes place in the context of poly-drug use. People who inject POs are at high risk of overdose, injection related injury and disease and blood borne viral infections. Harm reduction services that target this group, including in non-urban areas, should deliver health education regarding PO-specific overdose risks, the requirement to adequately filter PO before injection and to ensure that both naloxone and specialist pill filters are readily accessible.
Collapse
Affiliation(s)
- Jenny Iversen
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia.
| | - George Dertadian
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia
| | - Louise Geddes
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia
| | - Lisa Maher
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia
| |
Collapse
|
14
|
Roy É, Arruda N, Bertrand K, Dufour M, Laverdière É, Jutras-Aswad D, Perreault M, Berbiche D, Bruneau J. Prevalence and correlates of prescription opioid residue injection. Drug Alcohol Depend 2016; 166:69-74. [PMID: 27397582 DOI: 10.1016/j.drugalcdep.2016.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/17/2016] [Accepted: 06/23/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is growing evidence of intravenous administration of prescription opioids (POs) in several countries. Preparation of POs for injection may leave residues in containers and filters used by people who inject drugs and may lead to adverse health outcomes if they are injected. METHODS This exploratory study used cross-sectional data from the COSMO study, a prospective cohort of out-of-treatment cocaine users carried out in Montréal (Canada) between October 2010 and August 2015. For this analysis, only one visit per participant was selected, that is, the first time the participant reported PO injection during the study. The outcome of interest, "injection of PO residues", was defined as having injected PO residues from a filter and/or a container in the last month. Correlates of this outcome were identified using logistic regression analyses. RESULTS Of the 122 participants who reported PO injection during the study period, 41.8% had injected PO residues. Reporting an unstable source of income (AOR=4.26; 95% CI: 1.03-17.69), a recent overdose (AOR=5.45; 95% CI: 1.50-19.88) and a preponderant use of opiates (mostly opiate use versus other drugs excluding alcohol and cannabis) (AOR=2.46; 95% CI: 1.08-5.63) increased the risk of PO residue injection. The odds of reporting PO residue injection rose by 7% per unit increase in the score of psychological distress (AOR=1.07 per unit increase; 95% CI: 1.01-1.12). CONCLUSIONS The findings of this study suggest that PO residue injection is associated with markers of vulnerability. Further investigation is needed in order to better understand this understudied drug injection practice.
Collapse
Affiliation(s)
- Élise Roy
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada; Institut national de santé publique du Québec, Montréal, Québec, Canada.
| | - Nelson Arruda
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Karine Bertrand
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Magali Dufour
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Émélie Laverdière
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
| | - Michel Perreault
- Douglas Mental Health Institute, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Djamal Berbiche
- Faculty of Medecine and Health Sciences, Charles-Le Moyne Hospital Research Centre, Longueuil, Québec, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Family Medecine, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
15
|
Pulmonary Talcosis in an Immunocompromised Patient. Case Rep Med 2016; 2016:4678637. [PMID: 27446215 PMCID: PMC4944058 DOI: 10.1155/2016/4678637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/12/2016] [Indexed: 11/18/2022] Open
Abstract
The first case of pulmonary talcosis or talc pneumoconiosis related to inhalation of talc during its extraction and processing in mines was described by Thorel in 1896. Pulmonary talcosis is most commonly seen secondary to occupational exposure or intravenous (IV) drug abuse and, occasionally, in excessive use of cosmetic talc. Based on literature review, there has been an increase in reported incidents of pulmonary talcosis due to various forms of exposure to the mineral. We report an 82-year-old man who is diagnosed with Philadelphia chromosome positive pre-B cell acute lymphoblastic leukemia (ALL) treated with palliative imatinib who presented with chronic hemoptysis and dyspnea shortly after his diagnosis. His symptoms were initially thought to be due to an infectious etiology due to his malignancy, immunocompromised state, and radiographic findings until high-resolution computerized tomographic (HRCT) findings showed a diffuse pulmonary fibrosis picture that prompted further questioning and a more thorough history inquiry on his exposure to causative agents of interstitial lung disease. Very often, patients do not recognize their exposure, especially in those whose exposure is unrelated to their occupation. Our case emphasizes the need for thorough and careful history taking of occupational and nonoccupational exposure to known causative agents of interstitial lung disease.
Collapse
|
16
|
Ng H, Patel RP, Bruno R, Latham R, Wanandy T, McLean S. Filtration of crushed tablet suspensions has potential to reduce infection incidence in people who inject drugs. Drug Alcohol Rev 2014; 34:67-73. [DOI: 10.1111/dar.12196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Huei Ng
- Division of Pharmacy; School of Medicine; University of Tasmania; Hobart Australia
| | - Rahul P. Patel
- Division of Pharmacy; School of Medicine; University of Tasmania; Hobart Australia
| | - Raimondo Bruno
- Division of Psychology; School of Medicine; University of Tasmania; Hobart Australia
| | - Roger Latham
- School of Medicine; University of Tasmania; Hobart Australia
| | - Troy Wanandy
- Division of Pharmacy; School of Medicine; University of Tasmania; Hobart Australia
- Pharmacy Department; Royal Hobart Hospital; Hobart Australia
| | - Stuart McLean
- Division of Pharmacy; School of Medicine; University of Tasmania; Hobart Australia
| |
Collapse
|
17
|
Fiorelli A, Accardo M, Rossi F, Santini M. Spontaneous pneumothorax associated with talc pulmonary granulomatosis after cocaine inhalation. Gen Thorac Cardiovasc Surg 2014; 64:174-6. [DOI: 10.1007/s11748-014-0439-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
|
18
|
Altraja A, Jürgenson K, Roosipuu R, Laisaar T. Pulmonary intravascular talcosis mimicking miliary tuberculosis in an intravenous drug addict. BMJ Case Rep 2014; 2014:bcr-2014-203908. [PMID: 24713715 DOI: 10.1136/bcr-2014-203908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pulmonary foreign body granulomatosis following intravenous administration of medications meant for oral use among drug addicts has been occasionally reported. This condition is often misdiagnosed because of its rarity, but rather due to its similarity to other pulmonary diseases that are more common. Here we report a case of pulmonary intravascular talcosis mimicking miliary tuberculosis in a young male intravenous drug addict from North-Eastern Estonia, known as a hotspot for tuberculosis and drug misuse. The condition was caused by intravenous administration of crushed tablets of diphenhydramine, but miliary tuberculosis was misdiagnosed on patient's demographical, clinical and radiological grounds and a decision to start treatment with four first-line antituberculosis drugs followed. The current report refers to the importance of considering rare causes of pulmonary disseminations with attempts to identify the causative agent and warns against the use of antituberculosis treatment without confirmation of microbiological diagnosis of tuberculosis.
Collapse
Affiliation(s)
- Alan Altraja
- Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia
| | | | | | | |
Collapse
|
19
|
Arboe DK, Tomashefski JF. Pulmonary Foreign Body Embolism and Granulomatosis in Intravenous Substance Abuse. Acad Forensic Pathol 2013. [DOI: 10.23907/2013.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Prescription drug abuse has increased in the United States in part because of the relative ease of acquisition. Some drug abusers resort to the injection of crushed tablets for rapid onset and increased euphoria. Adolescents and young adults with chronic pain disorders and intravenous access ports are particularly susceptible to this practice. Clinically, those who inject tablets may develop dyspnea, hypoxemia, pulmonary hypertension, and are at an increased risk of sudden death. In addition to the active ingredient(s), pharmaceutical tablets contain inert excipients such as talc, starch, microcrystalline cellulose and crospovidone. Angiothrombosis and foreign body granulomatosis induced by particulate emboli are the major pathological findings identified. Tablet excipients can be discerned by their morphological and histochemical attributes. Microanalytic techniques may be required for definitive identification. Inhalational exposures, aspiration, endogenously formed crystals, and hyperalimentation are potential mimickers of tablet-induced foreign body emboli and granulomatosis.
Collapse
Affiliation(s)
- David K. Arboe
- Case Western Reserve University School of Medicine in Cleveland, OH
- MetroHealth Medical Center and Case Western Reserve University School of Medicine - Pathology, Cleveland, OH (JT)
| | - Joseph F. Tomashefski
- MetroHealth Medical Center and Case Western Reserve University School of Medicine - Pathology, Cleveland, OH (JT)
| |
Collapse
|
20
|
Intravascular Talcosis due to Intravenous Drug Use Is an Underrecognized Cause of Pulmonary Hypertension. Pulm Med 2012; 2012:617531. [PMID: 22645680 PMCID: PMC3356979 DOI: 10.1155/2012/617531] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 02/14/2012] [Accepted: 02/15/2012] [Indexed: 11/17/2022] Open
Abstract
Intravenous injection of illegal drugs or medications meant for oral administration can cause granulomatous disease of the lung. This intravascular talcosis results in pulmonary fibrosis and pulmonary hypertension. Nine cases of histologically confirmed intravascular talcosis were reviewed with specific attention given to the clinical histories in these patients. Five autopsy cases were included in this series with detailed investigation in the anatomic features associated with intravascular talcosis and pulmonary hypertension. All nine patients showed perivascular and/or intravascular deposition of polarizable foreign material in their lungs. Intravascular talcosis as a result of previous intravenous drug use was not clinically suspected in any patient despite clinically diagnosed pulmonary hypertension in five. All patients showed dilatation of the right and left heart, but none had dilatation of the aortic valve. Congestive heart failure with hepatosplenomegaly was also common. We conclude that intravascular talcosis is an underdiagnosed cause of pulmonary hypertension in patients with known history of intravenous drug use.
Collapse
|
21
|
McLean S, Bruno R, Brandon S, de Graaff B. Effect of filtration on morphine and particle content of injections prepared from slow-release oral morphine tablets. Harm Reduct J 2009; 6:37. [PMID: 20025779 PMCID: PMC2803777 DOI: 10.1186/1477-7517-6-37] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 12/22/2009] [Indexed: 11/25/2022] Open
Abstract
Background Injections of mixtures prepared from crushed tablets contain insoluble particles which can cause embolisms and other complications. Although many particles can be removed by filtration, many injecting drug users do not filter due to availability, cost or performance of filters, and also due to concerns that some of the dose will be lost. Methods Injection solutions were prepared from slow-release morphine tablets (MS Contin®) replicating methods used by injecting drug users. Contaminating particles were counted by microscopy and morphine content analysed by liquid chromatography before and after filtration. Results Unfiltered tablet extracts contained tens of millions of particles with a range in sizes from < 5 μm to > 400 μm. Cigarette filters removed most of the larger particles (> 50 μm) but the smaller particles remained. Commercial syringe filters (0.45 and 0.22 μm) produced a dramatic reduction in particles but tended to block unless used after a cigarette filter. Morphine was retained by all filters but could be recovered by following the filtration with one or two 1 ml washes. The combined use of a cigarette filter then 0.22 μm filter, with rinses, enabled recovery of 90% of the extracted morphine in a solution which was essentially free of tablet-derived particles. Conclusions Apart from overdose and addiction itself, the harmful consequences of injecting morphine tablets come from the insoluble particles from the tablets and microbial contamination. These harmful components can be substantially reduced by passing the injection through a sterilizing (0.22 μm) filter. To prevent the filter from blocking, a preliminary coarse filter (such as a cigarette filter) should be used first. The filters retain some of the dose, but this can be recovered by following filtration with one or two rinses with 1 ml water. Although filtration can reduce the non-pharmacological harmful consequences of injecting tablets, this remains an unsafe practice due to skin and environmental contamination by particles and microorganisms, and the risks of blood-borne infections from sharing injecting equipment.
Collapse
Affiliation(s)
- Stuart McLean
- School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia.
| | | | | | | |
Collapse
|
22
|
Krimsky WS, Dhand S. Pulmonary talc granulomatosis mimicking malignant disease 30 years after last exposure: a case report. J Med Case Rep 2008; 2:225. [PMID: 18598367 PMCID: PMC2491654 DOI: 10.1186/1752-1947-2-225] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2007] [Accepted: 07/03/2008] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pulmonary talc granulomatosis is a rare disorder characterized by the development of foreign body granuloma secondary to talc exposure. Previous case reports have documented the illness in current intravenous drug users who inject medications intended for oral use. We present a rare case of the disease in a patient with a distant history of heroin abuse who presented initially with history and imaging findings highly suggestive of malignancy. CASE PRESENTATION A 53-year-old man reported a 4-month history of increasing dyspnea and weight loss. He had a long history of smoking and admission chest X-ray revealed a density in the right hemithorax. Computed tomography confirmed a probable mass with further speculated opacities in both lung fields suspicious for malignant spread. Biopsies obtained using endobronchial ultrasound-guided aspiration returned negative for malignancy and showed bronchial epithelial cells with foreign body giant cell reaction and polarizable birefringent talc crystals. CONCLUSION This case demonstrates a rare presentation of talc granulomatosis three decades after the last likely exposure. The history and imaging findings in a chronic smoker were initially strongly suggestive of malignant disease, and we recommend that talc-induced lung disease is considered in any patient with multiple scattered pulmonary lesions and a history of intravenous drug use. Confirmation of the disease by biopsy is essential, but unfortunately there are few successful proven management options for patients with worsening disease.
Collapse
|