Riccardo Romeo

Asbestos exposure assessment by mineralogical analysis of bronchoalveolar lavage fluid.

Mineralogical analysis of bronchoalveolar lavage fluid (BALF) by electron microscopy can represent the most suitable method for assessing asbestos exposure. However, it has been claimed that no standardized or systematic approach to the subject of mineralogical analysis exists. This study aimed to evaluate BALF mineralogical analysis by transmission electron microscopy as biomarker of asbestos fiber load. BALF was examined in 108 exposed workers and 57 patients who underwent diagnostic fiberoptic bronchoscopy for various clinical purposes. Asbestos bodies in BALF were counted with a phase-contrast microscope. Fibers were counted and analyzed by transmission electron microscopy, which showed a significant difference between the two populations and positive results for all exposed subjects. Only 82.2% of the exposed population tested positive for asbestos bodies. Subjects with long-term exposure had higher concentrations of fibers than did those with more recent exposure, probably because of the higher workplace exposure levels in the past. The results of the study confirm that fiber concentration in BALF can be considered as a reliable biomarker of past asbestos exposure, even many years after the end of exposure.

Serum erythropoietin and blood lead concentrations

The aim of the study was to test the hypothesis that high blood lead levels are associated with depressed serum erythropoietin concentrations in workers occupationally exposed to lead. The results in exposed workers and in a control group of unexposed subjects were compared. Blood lead values were ≤20 μg/dl in unexposed subjects and ≥30 μg/dl in exposed subjects. The two groups of exposed workers and the control population were matched for sex and age. Hemoglobin levels were not affected by blood lead values and did not differ significantly between the three groups. The two-tailed, nonparametric Mann-Whitney U-test was used to compare unpaired groups. The Spearman rank correlation test was used to evaluate the dose-effect relationship between Pb and EPO. The analysis of the data indicate that erythropoietin values are significantly lower in exposed subjects than in controls. However no correlation was demonstrated between blood lead concentrations and erythropoietin in any group.

Respiratory disease as a result of talc inhalation

Three cases of respiratory disease in workers with occupational exposure to talc containing asbestos fibers are reported. Standard chest roentgenographs, high-resolution computed tomography, respiratory function tests, morphologic study of bronchoalveolar lavage fluid (BAL), light microscopic examination, and mineralogical analysis by transmission electron microscopy (TEM) of BAL was performed. All subjects showed bilateral pleural plaques, and in two subjects the study of BAL revealed lymphocytic alveolitis with an increased T4/T8 ratio. Mineralogical analysis of BAL detected asbestos-fiber concentrations of 510, 2039, and 3392 fibers/mL and many asbestos bodies. In one patient, mineralogical analysis of lung tissue was also performed; a concentration of 3,659,000 fibers/g dry tissue was found. Simultaneously, we performed a mineralogical study of 12 commercial talc samples, including those used by the patients during the last phase of their working lives. TEM revealed asbestos fibers in five samples. Two subjects used two of these talc powders. The study presented here confirms the need to perform all relevant clinical tests together with the study of BAL and mineralogical analysis of the materials to which the patients are or were exposed to determine occupational exposure to fibers, including those associated with talc, which are often misidentified.

Silicosis en trabajadores expuestos a conglomerados artificiales de cuarzo: ¿es distinta a la silicosis crónica simple?

Recently, a number of reports have been published on silicosis in workers exposed to artificial quartz conglomerates containing high levels of crystalline silica particles (70-90%) used in the construction of kitchen and bathroom surfaces. Three cases of silicosis in workers exposed to artificial quartz conglomerates are reported. The diagnosis was derived from both the International Labour Office and the International Classification of HRCT for Occupational and Environmental Respiratory Diseases (ICOERD) classifications and cytological analysis of bronchoalveolar lavage fluid. In 2 cases, levels of respirable silica greatly in excess of recommended standards were measured in the workplace, and cytological analysis of bronchoalveolar lavage fluid highlighted a prevalence of lymphocytes, meeting criteria for the diagnosis of accelerated silicosis. The prevention of pneumoconiosis caused by the use of innovative materials, such as artificial conglomerates with high crystalline silica content must be addressed.

Incidental and Underreported Pleural Plaques at Chest CT: Do Not Miss Them—Asbestos Exposure Still Exists

Pleural plaques (PPs) may be a risk factor for mortality from lung cancer in asbestos-exposed workers and are considered to be a marker of exposure. Diagnosing PPs is also important because asbestos-exposed patients should be offered a health surveillance that is mandatory in many countries. On the other hand PPs are useful for compensation purposes. In this study we aimed to evaluate the prevalence, as incidental findings, and the underreporting rate of PPs in chest CT scans (CTs) performed in a cohort of patients (1512) who underwent chest CT with a slice thickness no more than 1.25 mm. PPs were found in 76 out of 1482 patients (5.1%); in 13 out of 76 (17,1%) CTs were performed because of clinical suspicion of asbestos exposure and 5 of them (38%) were underreported by radiologist. In the remaining 63 cases (82.9%) there was no clinical suspicion of asbestos exposure at the time of CTs (incidental findings) and in 38 of these 63 patients (60.3%) PPs were underreported. Reaching a correct diagnosis of PPs requires a good knowledge of normal locoregional anatomy and rigorous technical approach in chest CT execution. However the job history of the patient should always be kept in mind.

Gardening in greenhouses as a risk factor for silicosis

Silicosis is a typical occupational disease, although some cases caused by non-industrial exposure have also been reported. We saw a 53-year-old male gardener with recurrent non-productive cough. A routine radiograph of the chest showed bilateral pulmonary nodules and subsequent computed tomography suggested that the infiltrates could be metastases. Open lung biopsy revealed nodules consisting of fibrotic tissue while the presence of birefringent silica particles was observed by polarised light microscopy. Mineralogical analysis of the substrata from the patient’s workplace revealed an SiO2 concentration of 31%. This case indicates that the inhalation of siliceous particles in a closed environment such as a greenhouse is a risk factor for silicosis.

1113 Pleural plaques: markers of asbestos exposure or indipendent risk factor for pleural mesothelioma? a case report

Pleural plaques (PPs) represent the most common non malignant asbestos-related disease. Currently PPs are widely referred as a marker of asbestos exposure and not as an independent risk factor for the development of asbestos-related neoplastic diseases (1). However, the association between PPs and pleural mesothelioma (PM) remains controversial, as some studies on cohorts of asbestos exposed workers have shown correlation between PPs and PM. Despite this, scientific literature is poor. Research has been focused on the relationship between PPs and lung cancer, while there is a lack of studies on the possible relationship between PPs and the development of PM. Case presentation A clinical case of a patient affected by asbestosis and PPs with a history of occupational asbestos exposure is presented. During the follow up a PM was diagnosed at a PP. Conclusions The widespread belief that there is no relationship between PPs and PM is not supported by a vast literature as it happens for the absence of association between PPs and lung cancer. In the patient described it is not possible to determine whether the localization of the PM at a PP is incidental or not and whether the PM can be attributed only to intense exposure or even to the presence of PPs. Similar cases may not be uncommon even if not reported in the literature. References . Maxim LD, Niebo R, Utell MJ. Are pleural plaques an appropriate endpoint for risk analyses?Inhalation Toxicology2015;27:321–334. . Pairon JC, Laurent F, Rinaldo M, Clin B, Andujar P, et al. Pleural plaques and the risk of pleural mesothelioma. JNCI2013;105:293–301. doi:10.1093/jnci/djs513Abstract 334 Table 1 All apps are free of charge Encyclopaedia of prevention The electronic encyclopaedia of prevention is designed to help the user obtain information regarding essential aspects of occupational health and safety in Austria in a concise, comprehensible and well-organised form. Health and safety management The ‘health and safety management’ app was designed as an app to support the gradual introduction to the company´s own health and safety management, for assessing the completeness of health and safety management, for carrying out internal audits and for carrying out health and safety inspections using standardised questionaries’. First Aid – Hand Injuries The app provides an overview of the different types of hand injuries. The user obtains important information regarding what to do in the event of emergency. Illustrations accompany you step-by-step through the first aid procedure. Computer workstation The tablet app ‘Computer workstation’ is based on the field of ergonomics. It is aimed at anybody who works at a computer workstation. The app offers support in setting up this computer workstation in the most ergonomic way possible and provides assistance in detecting any shortcomings. Lifting and carrying This app lets you analyse a person´s lifting and carrying technique. Take a photograph of a person lifting an object with the camera on the smartphone, place a few points on certain parts of the body and then enter the weight of the load and the person´s sex and age. The app will calculate the strain on the intervertebral discs based on this information. This will be shown on a scale and explained. Safety signs The app provides information regarding signs related to health and safety, such signs illustrating hazards, orders, prohibitions and information in the workplace and on the roads. If you are not familiar with a sign, you can simply enter specific criteria in order to find the signs you are searching for with the corresponding description.

Asbestos exposure biomarkers in the follow-up of asbestos-exposed workers

Health surveillance of asbestos exposed workers should be stratified according to the exposure level. Unfortunately there is a lack of information regarding asbestos exposure in many working places and markers of asbestos exposure are often needed. The aim of the study was to assess the reliability of different dose and effect biomarkers in the follow up of asbestos-exposed workers. Mineralogical analysis of bronchoalveolar lavage fluid (BALF) as a biomarker of asbestos fibre burden was performed in a population of 307 male subjects occupationally exposed to asbestos. Using nonparametric statistical methods 8 variables were analyzed with respect to asbestos-related diseases and working sectors. The existence of a relationship between serum soluble mesothelin-related peptides (SMRP) and asbestos exposure levels was also investigated. Concentrations of amphiboles, chrysotile and asbestos bodies in BALF were higher in patients with asbestosis as well as in railway industry workers. A correlation between the onset of non malignant asbestos-related diseases and the levels of SMRP concentration was not found. This study confirms that fibre concentration in BALF may be considered as a reliable biomarker of previous asbestos exposure, whereas SMRP does not appear to be influenced by asbestos exposure levels.

Pleural plaques: markers of asbestos exposure or independent risk factor for pleural mesothelioma? A case report of mesothelioma developed on a pleural plaque in a worker with occupational asbestos exposure

Pleural plaques are considered as a markers of asbestos exposure and not as an independent risk factor for the development of asbestos-related neoplastic diseases. However isolated studies showed an association between pleural plaques and malignat pleural mesothelioma. A clinical case of a patient with an history of occupational asbestos exposure affected by asbestosis, pleural plaques and pleural mesothelioma is presented. Correspondence to: Pietro Sartorelli, Department of Medical Biotechnology, Unit of Occupational Medicine, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy, Tel: 0577-235510; E-mail: pietro.sartorelli@ unisi.it

Angora Wool Asthma in Textile Industry

Up to now the exposures to hair and skin derivatives of animals have not yet been the subject of systematic studies. The observation of a clinical case has provided the opportunity for a review of the literature. The inpatient was a 49-year-old man, a carder in a textile factory, exposed to angora wool. He noticed the appearance of dyspnea during working hours. There was no eosinophilia in blood, and the results of pulmonary function tests were normal. The nonspecific bronchial provocation test with methacholine demonstrated an abnormal bronchial reactivity. The challenge test with angora wool was positive (decrease in FEV1 of more than 40%) as well as total IGE and specific IgE to rabbit epithelium (433 KU/l and 12.1 KUA/l, resp.). Several sources of allergens were found in the rabbit, and the main allergen was represented by proteins from epithelia, urine, and saliva. Most of these proteins belong to the family of lipocalin, they function as carriers for small hydrophobic molecules (vitamins and pheromones). If the diagnosis of occupational asthma caused by animal hair and skin derivatives may be relatively easy by means of the challenge test, defining etiology is complicated because of the lack of in vitro tests.