Eduardo Algranti

Destaques das diretrizes de doenças pulmonares intersticiais da Sociedade Brasileira de Pneumologia e Tisiologia

Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.

The next mesothelioma wave: mortality trends and forecast to 2030 in Brazil.

BACKGROUND There are limited data on mesothelioma mortality in industrializing countries, where, at present, most of the asbestos consumption occurs. OBJECTIVES To analyze temporal trends and to calculate mortality rates from mesothelioma and cancer of the pleura in Brazil from 2000 to 2012 and to estimate future mortality rates. METHODS We retrieved records of deaths from mesothelioma (ICD-10C45) and cancer of the pleura (ICD-10C38.4) from 2000 to 2012 in adults aged 30 years and over. Crude and age-standardized mortality rates (ASMR) were calculated. Rate ratios of mean crude mortality for selected municipalities were compared to the Brazilian rate. A regression was carried out of the annual number of deaths against asbestos consumption using a Generalized Additive Model (GAM). The best model was chosen to estimate the future burden and peak period of deaths. RESULTS There were 929C45 and 1379 C38.4 deaths. The ratio of men to women for C45 was 1.4. A positive trend in C45 numbers was observed in Brazil (p=0.0012), particularly in São Paulo (p=0.0004) where ASMRs presented an increasing linear trend (p=0.0344). Selected municipalities harboring asbestos manipulation presented 3.7-11 fold rate ratios of C45 compared to Brazil. GAM presented best fits for latencies of 34 years or more. It is estimated that the peak incidence of C45 mortality will occur between 2021 and 2026. CONCLUSIONS The observed ASMRs and the gender ratio close to 1 suggest underreporting. Even so, deaths are increasing and mesothelioma clusters were identified. Compared to industrialized countries Brazil displays a 15-20 year lag in estimated peak mesothelioma mortality which is consistent with the lag of asbestos peak consumption in the country.

Longitudinal decline in lung function in former asbestos exposed workers

Background This study was designed to assess the effect of asbestos exposure on longitudinal lung function decline. Methods A group of 502 former asbestos-cement workers with at least two spirometry tests 4 years apart. Repeated evaluations included respiratory symptoms questionnaire, spirometry and chest imaging. Asbestos exposure was ascertained as years of exposure, an index of cumulative exposure and latency time. The mixed effects model was used to evaluate the effect of exposure on the level and rate of change in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Results Mean age at entry was 51 (SD 9.9) years, mean latency time 25.6 (SD 10.0) years, mean follow-up time 9.1 (SD 2.8) years and mean number of spirometry tests 3.5. The FEV1 level was significantly related to pack-years of smoking at entry and during the follow-up, the index of cumulative asbestos exposure at entry, and the presence of asbestosis at follow-up. The FVC level was significantly related to pack-years of smoking during the follow-up, cumulative asbestos exposure at entry, asbestosis and pleural thickening at follow-up, and body mass index at entry. Asbestos exposure was not associated with increasing rates of FEV1 and FVC decline. However, FEV1 regression slopes with age, estimated by terciles of cumulative exposure, showed significant differences. Combined effects of smoking and exposure conferred further acceleration in lung function decline. Conclusions Occupational exposure in asbestos-cement industry was a risk factor for increased lung function decline. The effect seems to be mostly concentrated during the working period. Smoking and exposure had synergic effects.

Câncer de pulmão ocupacional

Lung cancer is a multifactorial disease. Hereditary, genetic, and environmental factors interact in its genesis. The principal risk factor for lung cancer is smoking. However, the workplace provides an environment in which there is a risk of exposure to carcinogens. The International Agency for Research on Cancer currently lists 19 substances/work situations/occupations that have been proven to be associated with lung cancer (group 1). Thorough occupational history taking is not widely practiced in patients with lung cancer, which has a negative impact on the investigation of causality and, consequently, on the identification of cases of occupational cancer. The objectives of this review were to list the agents that are recognized as causes of lung cancer, to discuss the contribution of occupation to the development of the disease, to cite national studies on the subject, and to propose a list of procedures that are essential to the appropriate investigation of causality between lung cancer and occupation.

Estudos de prevalência na RBSO: Como separar o joio do trigo?

Objective: to describe the fatal accident victims’ work and the circumstances of work-related deaths in Salvador, Bahia state, Brazil, in 2004. Methods : ...

Interstitial pneumonia following exposure to fluorocarbon polymers

Perfluoroalkyl resins are compounds containing hydrophobic alkyl chains, which are partially or fully fluorinated. These resins are heat-resistant (up to 260°C) thermoplastics used as coatings in the metallurgical industry (because of their mechanical and anti-adhesive resistance), as waterproofing agents for coating fabric, in papers used in the food industry, and in surface-active products, waxes, and insecticide formulations. As waterproofing agents, these resins are applied by manually-compressed or motorized spraying systems or by sprays. Reports of respiratory symptoms or epidemics in countries in Europe, Asia, and North America, totaling a few hundred cases, are summarized in a 2009 document by the Public Health Agency of Switzerland.

0217 Mesothelioma and cancer of the pleura deaths – recovering missing cases from hospital records

Background Mesothelioma is a rare cancer of high lethality associated with asbestos exposure. In several studies mesothelioma and cancer of the pleura (MCP) are analysed together because misdiagnoses or coding errors between them are common. Undercounting and underreporting of these diseases have been demonstrated, particularly where access to diagnostic resources is poor as for developing countries. Objective To examine the performance of a probabilistic linkage used to match data from death certificates (Mortality Information System) to deaths reported in hospital records (Authorisation of Hospital Admissions of the National Health System). Methods Cases with diagnosis coded as C45.0 - C45.9 and C38.4 (International Classification of Diseases 10thRevision) were selected from each anonymous database from 2002 to 2012, Brazil. After probabilistic linkage, matched and unmatched cases were combined in a single individual database. Linkage performance was examined by confirming matched cases based on similar datasets which includes full names, available only for the São Paulo state. Results A total of 1059 MPC cases were found, 718 (71.7%) with records only in the Mortality Information System, 277 (23.6%) registered exclusively in the hospital database, and 57 (5.7%) matched with data in both databases. The majority of hospital unmatched cases had other cancer diagnosis as the underlying cause of death (87.4%). Linkage failed to match only five cases due to inconsistencies in birth dates or gender records. Conclusions Probabilistic linkage can be a tool to recover missing cases of MCP in death certificates using hospital admissions records in Brazil.

Silica exposure and disease in semi-precious stone craftsmen, Minas Gerais, Brazil

BACKGROUND Brazil is an exporter of precious stones and craftsmen often work in poor conditions. We assessed silica-related diseases among crystal craftsmen and the complexity of its control. METHODS Case-series including 118 subjects evaluated from 2006 to 2015, based on medical interviews, chest X-rays, spirometry, and respirable silica samples. RESULTS Median age and length of exposure were 32 and 13 years, respectively. Silicosis, with 1/0 as a threshold, was diagnosed radiologically in 57 individuals (48.3%). Respirable silica concentrations were 0.9-29.3 times greater than the Brazilian occupational exposure limit. A Receiver Operating Characteristic (ROC) curve with the same diagnosis threshold showed best discrimination at a cut point of 12.5 years of exposure, corresponding to 4.85 mg-y/m3 of cumulative silica exposure. There was a significant decline in FEV1 across radiological and cumulative silica exposure categories. Eleven individuals (9.3%) had mycobacterial diseases at baseline or follow-up. CONCLUSION Crystal craftsmen continue to suffer from silicosis, lung function impairment, comorbidity, and death due to silicosis. To date collective protection in some work sheds has not diminished silica levels. Long-term follow-up is needed to evaluate further improvements in preventive measures. Am. J. Ind. Med. 60:239-247, 2017.

Identificação, prevenção e notificação de riscos biológicos no trabalho: ainda há muito que melhorar

2 Editora associada Este numero da RBSO apresenta oito artigos, um relato de experiencia, duas comunicacoes breves e uma resenha. Embora nao inclua um dossie tematico, coincidentemente tres trabalhos sao relacionados a riscos biologicos no ambiente de trabalho. Dois referem-se a acidentes com perfurocortantes, porem com objetivos de analise distintos: o trabalho de Machado e Machado (p. 274-281), voltado para a ocorrencia de acidentes e sua notificacao em um hospital publico do Centro-Oeste, e o trabalho de Silva, Machado, Santos e Marziale (p. 265-273), abordando a falta de padronizacao de notificacao de acidentes ocorridos em unidades pertencentes a uma mesma fundacao publica, com propostas concretas de melhoria desta situacao. O terceiro trabalho, de Silva, Santos, Reis e Lima, enfoca o conhecimento dos profissionais de saude acerca da hepatite B (VHB) e o estado vacinal contra esse virus em um hospital publico do Nordeste (p. 258-264).