Caplan’s syndrome, known as rheumatoid pneumoconiosis, was first described by Anthony Caplan in 1953, who identified a rare lung disorder found in coal mine workers with rheumatoid arthritis. Although Caplan’s syndrome was found in patients with a variety of pneumoconioses, it mostly affects individuals with long exposure to crystalline silica. We present a case of Caplan’s syndrome in a patient with advanced stage of rheumatoid arthritis and silicosis.
Entrapment syndromes of the upper limb are common neuro-muscular-skeletal pathology in musician instrumentists. From this group of morbid entities, the most prevalent worldwide is carpal tunnel syndrome closely followed by the cubital tunnel syndrome and de Quervain stenosing tenosynovitis. Due to their distinctive etiopathogenic correlation with exposure to specific occupational factors linked to instrument interpretation and professional environment, these diseases raise a medical challenge and constitute a socioeconomic and professional burden with legal branchings and implications for individuals and society. These syndromes develop isolated or more often in various associations with each other in a clinical pattern that has been described under the model of “double crush” syndrome by Upton and McComas. From its inception in 1973 until the present time, this clinical model has been a point of interesting debate between various specialists worldwide. This model underlines an already lesioned neuron’s susceptibility and vulnerability for further neural damage at a different level from the initial lesion. The sophisticated clinical presentation of this “double or multiple crush” syndrome is due not only to overlapping symptomatology from each contributing neuro-muscular-skeletal pathology or lesional site but also to other local or systemic conditions such as trauma, diabetes, osteoarthritis, thyroid disease, obesity, etc. The occupational factors such as repetitive movements, strain and overload, vibrations, ergonomics, and others all contribute to the creation and progression of the morbid process. We cannot overstate the implications of understanding these complex relations and interdependencies between the factors mentioned above as they are essential not only for the diagnosis of these neuropathies but also for the treatment, rehabilitation, and occupational reinsertion of the patients. The studies support the fact that both lesional sites need to be medically addressed for an optimal outcome and resolution. We present the case of a female violinist with bilateral multiple neuro-muscular-skeletal pathologies of the upper limb treated previously invasively and conservatively over several years by various specialists without a satisfactory clinical resolution of the symptomatology or any professional and legal measures taken.
The definition of COVID-19 as occupational disease follows the investigation of any other occupational disease caused by an infectious agent. The risk is not equal for all occupations and the occupational physician has to assess the working conditions to conclude a diagnosis of occupational COVID-19. In the pandemic context, employees face also other occupational hazards. The high level of work load and the scarce resources lead to stress, physical and mental exhaustion and irregular sleep. The protection measures, of undisputable benefit, increase the risk for contact dermatitis. There is a high probability for medium and possible long term effects of COVID-19, such as the post-traumatic stress disorder or the respiratory sequelae. These consequences need to be acknowledged and properly manged by the medical team taking care of the patient. This review presents the main characteristics of the occupational related disorders during and after the current pandemia.
Occupational asthma, the most common occupational respiratory disease in industrialized societies, accounts for 5-10% of all cases of asthma diagnosed in the world. The number of cases is increasing given the development of the “consumer society”. We aim to discuss a case of occupational asthma that we have confirmed using internationally validated methods.
Currently, the question is no longer if the climate is changing because the magnitude and speed of climate change, but it is a fact confirmed by many teams of specialists. It has become a hotly debated topic for politicians, businessmen, environmentalists, society and media. We designed a pilot study using a questionnaire in order to identify the level of knowledge, skills and practices of family physicians regarding the impact of their work on the environment and climate change. The questionnaire included 42 items regarding socio-demographic data, doctors’ knowledge regarding climate change, global warming, heatwave, thermal stress, the activity performed by doctors during the heat wave and the information received by doctors about heatwave periods. The research results confirm the hypothesis that doctors have some knowledge about the phenomenon of climate change, but there are some gaps and misunderstandings of the cause and effect of the phenomenon, as well as the methods to combat them. There is a need for additional training and guidance of physicians on the relationship between climate change, global warming and population health.
Impulse oscillometry (IOS) is a variant of forced oscillation technique described by Dubois 50 years ago, which allows us to measure the reactance of the airways and the resistance of the small and large airways during tidal breathing. It requires minimal patient cooperation from subjects who are unable to perform spirometry, like elders, children and patients with neurologic disorders. IOS can outline the diagnosis of obstructive airway disease, differentiate small airway obstruction from large airway obstruction. It is more sensitive than spirometry for peripheral airway disease in determining the severity of the disease, the exacerbations and evaluate the therapeutic response. Other applications include early evaluation of transplant rejection, cystic fibrosis, vocal cord disorder, bronchiectasis, hypersensitivity pneumonitis, obstructive sleep apnea.
Lead and its compounds are hazardous chemical agents; some lead compounds, are classified as carcinogens in humans. In Romania, the occupational exposure to inorganic lead and its compounds occurs in many sectors: production of lead, manufacture of batteries, manufacture of thermal ceramic products (terracotta), production of electric and electronic components, manufacture of articles of metal wire, production of dyes and additives for plastics, recovery of lead from waste batteries, waste collection and treatment of electrical and electronic equipment, etc. The binding occupational limit value for inorganic lead compounds established under the national regulations is 0.15 mg/m3 in the air (measured in relation to a reference period of eight hours, time-weighted average, TWA). The binding biological limit value is 70 μg Pb/100 ml blood. We have summarized lead occupational exposure data collected from the regional public health authorities in Romania, for the period 2011-2019. The concentrations of lead recorded in the workplaces air varied between “not detected” and 0.22 mg/m3. The lead concentrations in the blood had high values (over the alert value of 40 μg/100 ml blood) in several activities (production of lead, recovery-recycling of lead from waste batteries, manufacture of batteries, and manufacture of articles of metal wire) leading to the need of continuous surveillance of health status for the exposed workers.
Hypersensitivity pneumonitis is a group of inflammatory interstitial lung diseases caused by hypersensitivity immune reactions to the inhalation of various antigens: fungal, bacterial, animal protein, or chemical sources, finely dispersed, with aerodynamic diameter <5μ, representing the respirable fraction. The national register for interstitial lung diseases records very few cases of hypersensitivity pneumonitis (extrinsec allergic alveolitis), a well defined occupational disease. Although not an eminently of occupational origin, the extrinsec allergic alveolitis can occur secondary to occupational exposure to organic substances (animal or insect proteins, bacteria, fungi) or inorganic (low molecular weight chemical compounds) and the occupational doctor is a key actor in the diagnosys. The disease has chronic evolution and exposure avoidance, as early as possible, has major prognostic influence. The occupational anamnesis remains the most important step and the occupational physician is the one in charge for monitoring and detection of the presence of respiratory symptoms in all employees with risk exposure. Next, we present the case of a farmer, without other comorbidities, who develops various respiratory and systemic diseases and manifestations due to repeated exposure to animal proteins and molds, in order to review the risk factors and the consequences of exposure in poultry farms.
This study aimed to provide a brief historical overview of occupational medicine in Sibiu County combined with epidemiological evidence and trends in occupational diseases useful to design an agenda for future research and development of other components. Methods: to depict a model of circumstances, correlations, and trends, we applied to the local employee population a semi-structured narrative review method combined with the analysis of occupational diseases. The search strategy relied on literature and document review to create a timeline. We used a statistic chart histogram to highlight the most significant factors. Results: since 1950, concerning the industrial profile and the significant health effects on workers, we identified six stages of developing an occupational health network. The coverage was both for medical and hazard surveillance through a centralized system in the communist regime and recovery in the unique Sanatorium for occupational diseases established in the area. Occupational medicine private health services and the Faculty of Medicine from Sibiu appeared in the 1990s. Sibiu’s occupational disease model was a particular one in the 20th century, given the burden of lead poisoning from local industries. Infectious diseases in medical staff related to sporadic epidemics and the ongoing COVID-19 pandemic as an emergent professional risk pose new current challenges for occupational medicine. Conclusion: unique challenges increase the need for occupational epidemiologic research and the need for advances in other components of occupational health, but lessons from the past and traditional methods are well documented and still valuable.
The study was performed in seven medical units in Bucharest with the intention to offer a comprehensive analysis of the nurses’ current prevention practices for hospital-acquired pressure ulcers and also to determine: (1) the main risks that can negatively affect the prevention activities for this type of injury, and (2) if there is a correlation between the nurses’ knowledge and the clinical approach to the current hospital-acquired pressure ulcer prevention practices. The statistical analysis was based on data collected from 713 questionnaires from subjects who met the inclusion criteria of the study. The results showed that nurses considered protocols for hospital-acquired pressure ulcer prevention and its management to be important, but both were not always fully implemented into practice due to the lack of resources, time allocation and staff shortages. The regression analysis method we used was focused to assess the predictive capacity for the combined clinical knowledge and professional approaches to hospital-acquired pressure ulcer prevention and management. The conclusion was that a simultaneous improvement in the clinical approaches and professional knowledge on the topic of pressure-ulcer prevention and management may lead to an improvement of up to 6% of the practices in this field according to the results of the statistical analysis performed.