Case-report of Mycosis fungoides in a patient with occupational asbestos exposure
Alexandra Maria Rașcu, Maria-Gabriela Neicu, Agripina Rașcu and Marina Ruxandra Oțelea
Mycosis fungoides is one of the most common forms of cutaneous T-cell lymphoma. Its diagnosis is sometimes challenging and quite difficult for the physician, because its onset clinical appearance is similar to other skin diseases. Although there are a few hypotheses about mycosis fungoides’ etiology, they aren’t fully understood and still need confirmation. We report the case of a 68 years old patient diagnosed with mycosis fungoides, who has been exposed to asbestos fibers. This case is one of the few reported cases of association between asbestos and mycosis fungoides. There is no data exploring the causal relation between asbestos exposure and mycosis fungoides but common biological mechanisms could represent an argument. If occupational exposure to asbestos will be confirmed in larger studies, a new research-field of asbestos-related diseases needs to be opened.
Ionizing radiation are classified as Class I carcinogens. The exposure to this factor increases the risk of developing cancer, and researchers aim to establish the relationship between the exposure and the risk levels, as well as guidelines which would limit exposure to it. The risks were assessed through studies related to the atomic bomb survivors, to the populations exposed to radiation for the purpose of diagnosis or therapy and to the professionally exposed populations – radiologists, radiotherapists, workers in uranium mines, operatives in the nuclear industry. The population of Japanese survivors of the atomic bombs is the largest population exposed and studied with an extremely wide age range (from the irradiation in utero to old people). This population, made up of 93.000 people, represents a major source of information used to determine the potential risk of low dose radiation exposure. Health professionals working with ionizing radiation have been studied ever since the 1890’s. After the implementation of a radiation protection system, the doses received decreased only to increase again with the technical development and its use in a wide variety of specialties. Two recent studies on large cohorts and during long periods of time brought information about the cancer risk due to occupational exposure to ionizing radiation and shed light on the need to monitor exposed staff and re-evaluate radiological safety standards. This review is focused on recent literature concerning the radiation exposure of medical professionals.
Context. It has been decades since the circadian variation of the secretion of the thyroid stimulating hormone (TSH) was proven in humans. Even so, there are few studies on human beings that explored the relationship existing between night shift circadian rhythm deregulation and thyroid disorders.
Methods. We have revised the occupational medicine files of all employees in a single speciality hospital to conduct an observational study on the prevalence of thyroid disorders in night shift compared to day shift workers. Age, gender, occupational history, body mass index and specialist diagnosed thyroid disorders were recorded. Numerical variables were compared with ANOVA test, and categorical ones with chi test (StatPlus for Mac version v6).
Results. Obesity was slightly more prevalent in night shift workers, but not statistically significant. Instead, we found a significant increase in the prevalence of thyroid disorders in night shift workers (X= 7.424, p = 0.006). As this is a mere observational study, our results only contribute to the pool of data concerning the relationship between thyroid dysfunction and night shifts.
Conclusions: These results should raise awareness, particularly among occupational physicians and endocrinologists, about the influence of sleep and circadian rhythm deregulation on the raising incidence of thyroid disorders.
Case presentation and literature review of the TB diagnosis in silicosis
Patricia Petculescu, Andrei Năstase, Ana-Maria Mănescu and Marina Ruxandra Oțelea
Romania is recognized as the European country with the highest tuberculosis rate in Europe. The association of tuberculosis with silicosis determines synergistic immunosuppression of the alveolar macrophages resulting in a higher grade of pulmonary parenchymal destruction and consequently respiratory failure. The case report approaches a patient with third stage of silicosis and associated active secondary pulmonary tuberculosis disease with positive smears. The impact of the Mycobacterium tuberculosis (MTB) infection’s activation is known to be severe, worsening the prognosis of silicosis and reducing the patient’s quality of life. Regarding the high morbidity rate of tuberculosis, an early diagnosis of tuberculosis in patients with silicosis is paramount, and sometimes cannot be achieved by usual bacteriological tests. Therefore, a better strategy is to be considered in silicotuberculosis, namely to prevent the progression of the latent tuberculosis foci by testing the positive predictive value of up-to-date tests such as IFN-γ inducible protein 10 biomarker, which may allow early detection and treatment.
Iulia-Rahela Marcu, Ion Toma and Adrian Costin Bighea
Quality of life studies in patients with knee osteoarthritis (OA) attest to the significant impact of the disease on day-to-day activities and social interactions. The aim of this study was to assess the efficacy of a physical exercise program on functional status and quality of life in patients with work-related knee osteoarthritis. The present study included 144 participants with knee osteoarthritis, 72% women, mean age (SD) 47.2 (11.1) years. The patients were randomly assigned in two lots based on the type of kinetic treatment: lot A-with knee OA and medication (72 patients) and lot B- with knee OA, medication and exercise program (72 patients). They followed for 12 days ambulatory exercise programs based on increasing knee flexion, muscular strength and endurance, improving balance, coordination, and respiratory exercises. The patients in the control group continued their daily living activities. The evaluation was made at the beginning of the study (T0), after 2 weeks (T1) and 8 weeks after the 12 days of exercise program (T2) and was based on the following parameters: knee mobility (knee flexion), muscular strength, pain assessment on a Visual Analogue Scale (VAS), functional status (Western Ontario &McMaster Universities Osteoarthritis Index - WOMAC) and quality of life evaluation using SF-36 Questionnaire (36-Item Short Form Survey). Out of 144 participants who completed the initial evaluation, 138 also completed the 2 weeks and the 8 weeks follow-up assessments: 70 patients from the control lot and 68 patients from the exercise lot. The benefits of the kinetic programs were shown by a significant improvement in knee mobility and muscular strength for knee extensors (quadriceps muscle) and knee flexor muscles. Testing the linear correlations between the SF-36 score and the VAS (r=0.71, p<0.05) and WOMAC (r=0.83, p<0.05) indicators demonstrates a highly positive relationship between the quality of life expression, the pain assessment score and the functional status score in patients with knee OA. The physical exercise program improves both functional status and quality of life in patients with work-related knee osteoarthritis by increasing the range of motion and muscular strength and by reducing pain.
The analysis of Berezin and Kiselev’s concept assuming linear association of molecules in a localised adsorption monolayer on the homogeneous surface of a solid adsorbent was carried out. An inconsistency due to the lack of consideration of equilibrium concentration of free adsorption sites in the formulation of the expression for the association constant has been pointed out. It was shown that the correct form of this function leads to the final adsorption equation being identical to the specific case of the Fowler-Guggenheim equation. The obtained result has been generalised to cases of branched adsorbateadsorbate associations. A new adsorption equation limiting the association to at most the dimers has been introduced. Critical conditions for the two-dimensional condensation of the adsorption layer were determined. By applying the formalism of canonical ensemble, full equivalence of the phenomenological and statistical methods was demonstrated in the description of the intermolecular interactions in the localised adsorption monolayer.
Laura-Georgiana Moise, Bogdan-Alexandru Barbu and Agripina Rașcu
We report a case of subacute extrinsic allergic alveolitis due to occupational exposure to Penicillium spores in a 43-years old female working in a salami factory that developed a dry cough that gradually evolved to productive cough, shortness of breath, fatigue and body weight loss. Over time she complained of several episodes of flu-like symptoms that worsen around the periods in which she removed the excess mould from the surface of the salami a work. On admission, physical examination revealed crackles in both lungs on chest auscultation, pulmonary function tests showed a restrictive pattern with reduced diffusion capacity of carbon monoxide and imagistic tests identified centrilobular nodules of ground-glass opacity in both lung fields, particularly in the upper lobes. BAL showed lymphocytosis associated with neutrophilia, a pattern consistent with EAA. She was put on systemic corticosteroids and ceased exposure. The patient was compliant and after one year her medication was gradually withdrawn and in the absence of exposure, symptoms and pulmonary function normalized. The reported case had a favorable outcome due to relatively early detection and absence of exposure. Currently, the identification and removal of the causative agent remains the cornerstone of prevention, evolution and prognosis.
Mihaela Trenchea, Agripina Rașcu and Oana-Cristina Arghir
Over the last thirty years, the pathogenesis of obstructive sleep apnea syndrome (OSAS) has begun to be elucidated worldwide due to the presence of standardized diagnostic and treatment. In adults, the clinical diagnosis may be suggestive of OSAS when symptoms like fatigue, lack of concentration, poor work performance, absenteeism, daytime sleepiness, insomnia, snoring, nocturnal respiratory distress or apnea episodes witnessed by others are present. Some medical conditions found in employees’ personal history such as craniofacial abnormalities, some endocrine diseases, arterial hypertension, especially resistant arterial hypertension, coronary artery disease, atrial fibrillation, congestive heart failure, stroke, obesity, diabetes mellitus, cognitive dysfunction or mental disorders may be the alarm signal for OSAS. The assessment of all risk factors, clinical presentation and diagnosis must become an important part of occupational medical examinations and performed in all workers due to its major public health potential and impact on survival. The early identification of OSAS among workers performed by the occupational physician can potentially reduce the risk of work injuries and fatalities. In conclusion, OSAS is a complex entity and an important public health problem. The delay in diagnosis and treatment contributes to the increase of healthcare services demand and implicitly to general mortality.
This article addresses the practical aspects of the synthesis of an automatic control system for the thrust allocation strategy in the propulsion system of an unmanned underwater vehicle. The vehicle under consideration is a robot submarine equipped with a multi-propulsion system providing four degrees of freedom of movement. The power distribution algorithms are based on limited optimisation methods that allow the determination, on the basis of generalised torques and forces, of how much thrust is required to be produced by individual propulsors. Considering the issue of power distribution as a task of square and linear programming, two algorithms of thrust allocation were proposed and compared. The conducted model tests made it possible to evaluate their quality and efficiency in relation to speed and computational complexity.