Occupational asthma follow-up — which markers are elevated in exhaled breath condensate and plasma?

Objectives: To search for optimal markers in the exhaled breath condensate (EBC), plasma and urine that would reflect the activity/ severity of occupational asthma (OA) after the withdrawal from the exposure to the allergen. Material and Methods: Markers of oxidative stress: 8-iso-prostaglandin F2α (8-isoprostane, 8-ISO), malondialdehyde (MDA), 4-hydroxy-trans-2-nonenale (HNE), cysteinyl leukotrienes (LT) and LTB4 were determined using liquid chromatography and mass spectrometry in 43 subjects with immunological OA (49.3±11.8 years), removed from the exposure to the sensitizing agent 10.5±6.5 years ago; and in 20 healthy subjects (49.0±14.9 years). EBC was harvested both before and after the methacholine challenge test. In parallel, identical markers were collected in plasma and urine. The results were analyzed together with forced expiratory volume in one second (FEV1), blood eosinophils, immunoglobulin E (IgE) and eosinophilic cationic protein (ECP) and statistically evaluated (Spearman rank correlation rS, two- or one-sample t tests and alternatively Kruskal Wallis or pair Wilcoxon tests). Results: Several parameters of lung functions were lower in the patients (FEV1% predicted, MEF25% and MEF50%, Rtot%, p < 0.001). Shorter time interval since the removal from the allergen exposure correlated with higher ECP (rS = 0.375) and lower FEV1%, MEF25% and MEF50% after methacholine challenge (rS = -0.404, -0.425 and -0.532, respectively). In the patients, IgE (p < 0.001) and ECP (p = 0.009) was increased compared to controls. In EBC, 8-ISO and cysteinyl LTs were elevated in the asthmatics initially and after the challenge. Initial 8-ISO in plasma correlated negatively with FEV1 (rS = -0.409) and with methacholine PD20 (rS = -0.474). 8-ISO in plasma after the challenge correlated with IgE (rS = 0.396). Conclusions: The improvement in OA is very slow and objective impairments persist years after removal from the exposure. Cysteinyl LTs and 8-ISO in EBC and 8-ISO in plasma might enrich the spectrum of useful objective tests for the follow-up of OA

Occupational contamination with americium and Ca-DTPA treatment


Dismantling and decommissioning operation of three glove boxes contaminated by 241Am was conducted in summer 2001. During the first two terms of the decommissioning project no hesitation appeared about the adequacy of the protective regime. After measuring of filters from ventilation during the third term the volume activity was assessed as 1.5 Bq/m3 with the volume of filtered air of 69.2 m3 at a flow rate of 1 m3 per hour and all the working activities were stopped. On the basis of first results, six workers were treated with calcium trisodium diethylene-triamine-pentaacetate (Ca-DTPA) in infusions. The check of urine proved the increased excretion of contaminating radionuclide. The tolerance of the treatment was good. Final evaluation based on complex excretion data in the workers pointed to the committed effective dose of 35–185 mSv. This extraordinary event was caused first of all by the considerable underestimation of the hazard of the dismantling of dry glove boxes.

The practical application of clinical criteria for the recognition of the disease of the lumbar spine from overloading as an occupational disease

Úvod: Vertebrogenní algický syndrom bederní páteře je velmi častým steskem pacientů v ordinacích praktických lékařů i specialistů. Jedná se o onemocnění s multifaktoriální etiologií, přičemž jednou z prokázaných příčin je i přetěžování bederní páteře v rámci výkonu zaměstnání. Proto bylo v rámci navrhované pravidelné aktualizace českého seznamu nemocí z povolání rozhodnuto vytvořit dosud chybějící kritéria, na základě kterých by bylo možné toto onemocnění uznávat jako nemoc z povolání. V letech 2012–2015 byl realizován projekt, jehož výstupem je metodický návod k zajištění jednotného postupu při posuzování a uznávání chronického onemocnění bederní páteře z přetěžování jako nemoci z povolání. Předkládané sdělení podává informace o obecných a klinických podmínkách pro uznání profesionality onemocnění a prezentuje jejich praktickou aplikaci. Metodika: Soubor tvořilo 55 probandů, 30 žen, 25 mužů, průměrného věku 44,9 roků (SD 6,4, medián 46) s průměrnou dobou expozice potenciálně rizikové práci 15,6 roků (SD 9,5), medián 26. Do souboru byly zařazeny osoby s chronickým lumbagem trvajícím nejméně rok, s kořenovým syndromem, nebo bez něj, s nejméně tříletou anamnézou potenciálně rizikové práce. Na tomto souboru je prezentována aplikace navrhovaných klinických kritérií. Výsledky: Klinické kritéria, tzn. střední tíže závažnosti jak v neurologickém, tak v radiologickém nálezu, byla splněna u 16 z 55 osob. Jednalo o dva lesní dělníky, čtyři operátory výroby, dvě zdravotní sestry (oddělení geriatrie a ortopedie), dva skladové dělníky, zedníka, truhláře, přadlenu, automechanika, dělníka na poště – manipulace s balíky a dělnici při výrobě a instalaci billboardů. Závěr: Z výsledků vyplývá, že kritéria pro uznávání onemocnění bederní páteře z přetěžování jako nemoci z povolání jsou nastavena tak, aby v odůvodněných případech mohla být nemoc z povolání uznána, zároveň, aby nebylo možné zneužití titulu nemoci z povolání u onemocnění, jehož prevalence je v obecné populaci vysoká.Introduction:Low back pain is a very common complaint of patients visiting both general practitioners and specialists.The etiology is multifactorial,with one of the demonstrated causes being occupational lumbar spine overload.Therefore,a decision was made to establish criteria for recognition of the disease as occupational so that it may be included in the regularly revised Czech list of occupational diseases.In 2012–2015,a project was completed to provide recommendations for assessment of chronic low back due to overload and its recognition as an occupational disease.Presented is information about both general and clinical criteria for recognition of the occupational nature of a disease and their practical application. Methods:The sample comprised 55 participants (30 females, 25 males) with a mean age of 44.9 years (SD 6.4; median 46) and a mean exposure to potentially high-risk work tasks of 15.6 years (SD 9.5; median 26). Included in the study were individuals with chronic low back pain lasting for at least one year, with or without nerve root syndrome and three or more years of performing potentially high-risk work tasks. In this sample, the proposed clinical criteria were applied. Results:The clinical criteria, that is, moderate severity confirmed by both neurological and radiological findings, were met by 16 of the 55 individuals.Those were 2 forest workers, 4 production operators, 2 nurses (geriatric and orthopedic departments), 2 warehouse operators, a bricklayer, cabinetmaker,spinning machine operator,auto mechanic,post office worker handling packages and workers making and installing billboards.Conclusion:The results suggest that the criteria for recognition of lumber spine overload as an occupational disease have been adequately set so that in justifiable cases, the condition may be recognized as occupational.At the same time,owever,misuse is prevented and conditions highly prevalent in the general population cannot be identified as occupational diseases

Low-back Pain Disorders as Occupational Diseases in the Czech Republic and 22 European Countries: Comparison of National Systems, Related Diagnoses and Evaluation Criteria

International audienceAim: Low-back pain diseases (LBPD) belong to the most frequent diagnoses determined by general practitioners, and constitute one of the most common reasons for sick leave and permanent disability pension in the Czech Republic and other European countries. Epidemiological studies have shown a statistically significant association between LBPD and certain types of occupational burden. However, in the Czech Republic, LBPD caused by overload and/or whole-body vibrations have not yet been included in the list of occupational diseases. The aim of this study was to collect and compare the systems, criteria and diagnoses used to recognize LBPD as occupational diseases in other European countries.Methods: A questionnaire focused on LBPD was distributed and answered by specialists in occupational diseases in European countries. It included items concerning LBPD in the national list of occupational diseases, and work-related and diagnostic criteria that need to be fulfilled for recognizing LBPD as occupational diseases and possible awarding compensations to the patients.Results: In 13 countries out of the 23 countries studied, LBPD caused by overload can be recognized as occupational, providing that the diagnosis is sufficiently proven and exposure criteria and/or listed occupation are met and duration of exposure is confirmed (Belgium, Denmark, France, Germany, Hungary, Italy, Lithuania, Macedonia, Netherlands, Romania, Slovakia, Sweden, and Switzerland). LBPD due to vibrations can be also recognized as occupational in 14 countries. In 8 countries LBPD are not accepted as occupational unless they are caused by an injury at work. Specific criteria to evaluate occupational exposure of patients with LBPD were set in Belgium, Denmark, France, Germany, Lithuania, Macedonia, Netherlands, and Slovakia. In other countries, the evaluation is done at an individual basis.Conclusions: In practice, the assessment of occupational overload and its contribution to the development of LBPD as well as its inclusion in the compensation system are important for several reasons. Firstly, it may be considered essentially preventable. Secondly, cases with a significant contribution of occupational aetiology may be viewed as occupational diseases for which compensation may be claimed, as it is the case in many European countries. Importantly, inclusion of LBPD in the list of occupational diseases or another system of compensation may be viewed as a preventive measure as it increases the visibility of this problem not only for the workers, but especially for the employers