Commentary: Silica-A Multisystem Hazard

Systemic lupus erythematosus: latest insight into etiopathogenesis

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder of unknown etiology. Multifactorial interaction among various susceptible factors such as environmental, hormonal, and genetic factors makes it more heterogeneous and complex. Genetic and epigenetic modifications have been realized to regulate the immunobiology of lupus through environmental modifications such as diet and nutrition. Although these interactions may vary from population to population, the understanding of these risk factors can enhance the perception of the mechanistic basis of lupus etiology. To recognize the recent advances in lupus, an electronic search was conducted among search engines such as Google Scholar and PubMed, where we found about 30.4% publications of total studies related to genetics and epigenetics, 33.5% publications related to immunobiology and 34% related to environmental factors. These outcomes suggested that management of diet and lifestyle have a direct relationship with the severity of lupus that influence via modulating the complex interaction among genetics and immunobiology. The present review emphasizes the knowledge about the multifactorial interactions between various susceptible factors based on recent advances that will further update the understanding of mechanisms involved in disease pathoetiology. Knowledge of these mechanisms will further assist in the creation of novel diagnostic and therapeutic options.

Difficulties in distinguishing silicosis and pulmonary tuberculosis in silica-exposed gold miners: A report of four cases

Silicosis and tuberculosis (TB) are both global health concerns, with high prevalence among miners from the South African gold mines. Although knowledge has accumulated about these two conditions as distinct diseases since the early 20th century, and despite progress in technology with multiple diagnostic tools and treatment options available for TB, the challenge of distinguishing and therefore efficiently managing these two conditions in this population remains as current as it was 100 years ago. To illustrate the diagnostic and health service problems of distinguishing TB and silicosis clinically and radiologically in former gold miners from the South African mines living in resource-poor areas, we discuss four cases reviewed for this report by a panel of experts. For each case, occupational history, past and current medical history, physical examination, radiological and laboratory findings are described. Common themes are: (1) poor agreement between radiological and clinical presentation; (2) poor agreement between radiology findings and detection of active TB on sputum Xpert MTB/RIF testing; and (3) difficulty in distinguishing the clinical and radiological presentations of silicosis and tuberculosis. Possible consequences at the population level are undertreatment or overtreatment of TB, and underdiagnosis or overdiagnosis of silicosis. There is a need for training of practitioners who are screening or attending to former gold miners in the clinical and radiological features of combined disease, using a curated database of miners' chest X-ray images. Investment in protocols for management of both acute and chronic silicotuberculosis in ex-miners is needed, as is clinical, epidemiologic, and operations research.

Occupational exposure to respirable crystalline silica in municipal household waste collection and road cleaning workers

Despite the increase in the number of cases among South Korean sanitation workers, lung cancer as a result of exposure to occupational carcinogen has not been sufficiently investigated. This study aimed to identify exposure levels of sanitation workers to respirable crystalline silica (RCS) for various tasks and factors that affect individual RCS exposure. Exposure to RCS was assessed for 90 sanitation workers from seven companies. The obtained geometric mean value of the RCS was 2.6 µg m^–3, which is a similar level to recommendations set by California’s Office of Environmental Health Hazard Assessment's Recommended Exposure Limit. Meanwhile, coal briquette ash (CBA) collectors exhibited the highest RCS concentration (24 µg m^–3), followed by road cleaning workers who used a blower, municipal household waste collectors, sweepers, and drivers (p < 0.05). Additionally, when the ANOVA was conducted, statistically significant differences were observed in RCS concentrations among various factors such as job task, season, employment type and city scale. Our study confirmed that sanitation workers who work outdoors could be exposed to RCS. Due to the possibility of exposure to high RCS concentrations, special attention should be paid to the collection of used CBA and road cleaning involving the use of a blower.