Like medicine, ethics is a practical discipline, which they acquire the knowledge of the general principles and skills to solve problems. Long term care involves both clinical and ethical issues in medicine. Effective medical education of long-suffering patients has to be focusing on increasing their adherence to treatment. The occurrence of AIDS pandemic has changed the physician’s way of thinking in terms of ethics in general, and in medicine in particular. HIV/AIDS has focused attention on deficiencies in the field of therapy, long care issues, medical training and education of the patients, as well as in deontology. The treatment of HIV infected patients with all new drugs discovered is not yet completely curative and the association of opportunistic infections, as tuberculosis (TB), is representing a permanent challenge for therapist.
Both ethical and medical training in general as regards AIDS and TB, should focus mainly on exposed people and learning through experience, to form skills that would make doctors to work with sensitivity in regard to sexuality, substance abuse, lack of treatment, relapses of disease and even death. In the same time, any ethical or cultural environment can enrich and support the real moral education of medical staff.
Medical ethics and ethics relating specifically to TB and HIV/AIDS, often meet highly complex problems. Alternative possibilities and decisions to take of what is right or wrong may create a real ethical, clinical and therapeutic dilemma.
Given the occupational exposure to substances contained in petroleum heated to high temperature, cholestatic liver disease, neurological signs and symptoms can occur. We present a case report of a male patient with no tobacco exposure or alcohol use, but with prolonged occupational exposure to petroleum vapours and natural gases like methane, propane butane who developed liver and neurologic disease, in the absence of protective equipment. Delayed diagnosis was established after 9 years of the first symptoms occurrence. Differential diagnosis with alcoholic etiology was considered and biological biomarkers were useful.
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 is a case report of a pulmonary silicotuberculosis in a former smoker, male, 43 years old, having 21 years of occupational exposure to particulate coniotic-free crystalline-silicon dioxide as an electrician, developing symptoms as fever higher than 38°C, dry cough and diffuse chest pain, being diagnosed with miliary of the lung in 2002. Silicosis was confirmed later by histological exam obtained through an exploratory thoracotomy and it was included in the transient first to second stage of pneumoconiosis. Three years later, in July 2005, Pulmonary Tuberculosis was diagnosed by acid-fast stains positive smears. The evolution of the case was to a progressive deterioration till 2008, leading to silicosis stage III. Silicosis is a pulmonary fibrosis which must be always suspected in persons working in conditions of occupational exposure to dust of silicon dioxide, having suggestive radiological changes including micronodular radiological pattern or pseudotumoral one. Once the diagnosis of silicosis is confirmed, tuberculosis may be frequently associated. The more advanced silicosis is, the more the combination of the two diseases is commonly revealing and, often, the TB morbidity among workers in the silica industry exceeds that of general population. A hint orientation for the silicotuberculosis’ diagnosis, in this reported case, was represented by the radiological dynamic of the lesions. Tuberculosis lesions are less dense and imprecisely defined, located in upper lobes and develop necrotic centers.
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.
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.
A 74 year old Caucasian man, presents with a 6 week history of right sided chest pain including traumatic related painful right shoulder. Shoulder minor contusion was diagnosed and partial managed by symptomatic treatment associated to rehabilitation. The pain was initially eased with nonsteroidal anti-inflammatory drug (NSAID) use and finally changed worsening. He has evidence of moderate COPD on spirometry and has been commenced on inhalers. An invasive primitive adenocarcinoma lung cancer was confirmed by chest CT scan and lymphnode biopsy through mediastinoscopy
The Metabolic syndrome (MetS) is considered as an association of the abdominal obesity, abnormal metabolism of the lipids and glucose (high level of triglycerides, low level of HDL-cholesterol and high level of glycemia) and high values of blood pressure, determined by an underlying mechanism of insulin resistance. As a result of environmental-gene interaction, MetS is associated with unhealthy nutrition, smoking, alcohol abuse, lack of physical activity, shorter sleep duration and desynchronization of the circadian rhytm caused by working in shifts. The aim of this article is to review the effects of working in shifts on the MetS through the epidemiological evidence and the perspective of the physiopathological mechanisms.
Lung cancer remains one of the most frequent pathologies in Pulmonology Departments. Tumor extension, histopathological types, and treatment influence the prognosis and survival in lung cancer. Five years survival dramatically decreases for the 4th-stage of the disease. Non-small cell lung cancer (NSCLC) represents the vast majority of lung cancers. In the last decades, important findings have been made on identifying standardized molecular biomarkers that control tumor growth in lung adenocarcinoma. The discovery of new drugs led to the increased survival, even in extensive forms of the disease. The greatest advances could be obtained by targeting EGFR genetic mutations or EML4-ALK translocate in patients diagnosed with adenocarcinoma lung cancer