Occupational Exposure and Co-Occurrence of Work-Related Skin and Respiratory Disorder in Cleaner: A Case Report

BACKGROUND: Despite the connection between skin and respiratory system in occupational disease is growing area of research interest, there is still a limited evidence for the effects of both airborne and skin exposures together with skin and respiratory outcomes.CASE PRESENTATION: This report describes a 32-years old female with no previous history of atopy, asthma or skin disorders working as an office cleaner for three years. About two years after entering the actual workplace she developed episodic wheezing, shortening of breath and chest tightness. At the same time, she noticed eczematous lesions on the skin of both hands. She reported work-relatedness of both respiratory and skin symptoms, i.e. the symptoms improved during weekends and holidays and worsened when she returned to work. The patient was referred to Institute for Occupational Health of R. Macedonia for assessment of possible occupational asthma (OA) and occupational contact dermatitis (OCD). Diagnosis of asthma was confirmed by standard diagnostic procedure, while the diagnosis of sensitizer-induced OA was established by positive result of serial peak expiratory flow rate (PEFR) measurements at and away from work. Diagnosis of allergic OCD was confirmed by positive patch test to formaldehyde. The management of both diseases included complete removal from the harmful workplace exposure, as well as pharmacological treatment according to the actual recommendations.CONCLUSIONS: This case report represents a description of a co-occurrence of work-related skin and respiratory symptoms in a female working as an office cleaner. Formaldehyde is found to be a causative factor of allergic OCD, and it also may be a causative factor of sensitive-induced OA in the same patient, but other occupational sensitizers cannot be excluded

Health Promoting Workplaces

Workplace health promotion is a process of actively achieving health at workplace by changing working and living conditions. As a key concept it includes measures aimed both at individual and at environmental level from different areas. Good practice in workplace health promotion demands statutory requirements and strong motivation. Increasing consciousness and responsibility for health, identification and dissemination of models of good practice, development and incorporating adequate policies are priorities in workplace health promotion. The basic principles on which workplace health promotion has to be developed are: awareness raising, setting up infrastructure and service management. Beneficial effects can be achieved on individual, enterprise and society levels. The Institute of Occupational Health, WHO Collaborating Center, plays a major role in launching the first workplace health promotion activities in the Republic of Macedonia (education programs for stress managing at workplace, tobacco free workplaces), but the strongest impulse for workplace health promotion in the country is created by the implementation of the WHO’s Health, Environment and Safety Management in Enterprises (HESME) program

Complications of Coronavirus Disease-19 in a Hospitalized Patient: A Case Report

BACKGROUND: Coronavirus (CoV) disease (COVID)-19 infection is a major public health issue worldwide with no specific therapy or vaccine. CASE REPORT: COVID-19-positive patient was hospitalized due to a dry irritating cough that has persisted for 3 days. The polymerase chain reaction test to severe acute respiratory syndrome-CoV-2 was positive. Computed tomography (CT) scan of the lungs showed massive bilateral consolidation. The patient was set to oxygen support (6 L/min). Two hours after referring the patient’s condition worsened with shortness of breath, suffocation, wheezing, and decreased saturation (77%). The patient was given mechanical support with continuous positive airway pressure mask. Therapy included azithromycin 500 mg and ceftriaxone 2 g. On the 3rd day of hospitalization, there was a sharp deterioration of the condition and a decrease in saturation (40%). The patient was intubated and immediately placed on intermittent positive pressure ventilation. Azithromycin was now combined with meropenem 3 × 1 g. The next morning patient’s condition further worsened with decrease in saturation and heart rate. The resuscitation was unsuccessful. CONCLUSION: COVID-19 is primary a respiratory infection, but the virus also affects other organs with poor outcome

Case Study of Analysis and Targets Setting in Workplace Health Promotion: Pilot Implementation of Health Environment and Safety Management in Enterprises (HESME) Program in the Republic of Macedonia

HESME program concept is based on building and strengthening existing national structures and practices for health promotion at workplace, occupational health and safety, and environmental health. As part of the global HESME program, which includes different activities in the Republic of Macedonia, HESME pilot projects in two enterprises in 2003/2004 were aimed at analysis and setting targets of workplace health promotion. The analysis was made by the Institute of Occupational Health, WHO Collaborating Center and conclusions and recommendations to all stakeholders were presented. Workplace health promotion needs and priorities were defined: control of work environment hazards, smoking and alcohol consuming, encouragement of sport activities. Dealing with health problems (specific indications on stress, muscle pains, injuries at work, respiratory and allergy problems) and addiction problems (alcohol consuming, smoking), application of self-protection measures, education of managerial team on workplace hazards and ergonomics. HESME pilot implementation in both enterprises is centered on encouraging the integration of workplace health promotion issues at enterprise level as preparation for further steps

Effects of Pleuran (β-glucan from Pleurotus ostreatus) Supplementation on Incidence and Duration of Bronchiectasis Exacerbations

BACKGROUND: Patients with non-cystic fibrosis bronchiectasis (BE) have frequent exacerbations that are causes of significant morbidity and sometimes mortality, and which it is desirable to prevent. AIM: We aimed to assess the effects of pleuran on the incidence and duration of exacerbations in patients with BE. METHODS: A prospective, observational, open-label, and active-controlled study was realized as a comparison of the frequency and duration of exacerbations between a group of patients with BE (30 patients, 14 males and 16 females, aged 44–72 years) who received a combination supplement containing pleuran 100 mg, Vitamin C 60 mg and zinc 5 mg over a 3-month period and a group of patients with BE (31 patients, 15 males and 16 females, aged 45–74 years) treated over a 3-month period with a combination supplement containing Vitamin C 60 mg and zinc 5 mg. RESULTS: Over the study period, altogether 46 exacerbations were documented (19 in the patients receiving pleuran and 27 in the patients who did not receive pleuran), nine of which required hospital treatment (four in the patients receiving pleuran [21.5%] and five in the patients who did not receive pleuran [18.6%]). The mean number of exacerbations over the study period was significantly lower in the patients receiving pleuran (0.6 ± 0.4) as compared to the mean number in the patients who did not receive pleuran (0.8 ± 0.3) (p = 0.0297). The mean duration of exacerbations, expressed in days, needed for cure or clinical improvement in the patients receiving pleuran (11.2 ± 1.7 days) was significantly shorter than that of exacerbations in the patients who did not receive pleuran (12.4 ± 1.3 days) (p = 0.0029). We found significantly lower incidence and significantly shorter duration of exacerbations in the patients with BE who received pleuran as compared to their incidence and duration in the patients with BE who did not receive pleuran. CONCLUSION: Our findings indicated a need for further investigations in this domain to define the possible role of pleuran in the prevention of BE exacerbations

Are the Obese Patients and Patients with Severe Malnutrition at Increased Risk of Severe Coronavirus Disease 2019 during Hospital Admission?

BACKGROUND: Recently, authorities highlighted the need for nutritional management of individuals with severe acute respiratory syndrome coronavirus 2 infection. AIM: The aim of the study was to evaluate the use of body mass index (BMI) and nutrition risk index (NRI) on hospital admission for detecting patients at risk for malnutrition and obesity and their association with patients’ outcomes (disease type, length of hospital and home stay, and inflammatory markers). METHODS: The study of 100 patients with confirmed diagnosis Coronavirus Disease-19 (COVID-19). Assessment of patients took place at City General Hospital 8th September, Skopje, transformed into main COVID-19 Center during pandemic. Primary outcomes were NRI and BMI scores, while secondary ones: length of home and hospital stay, number of symptoms, presence of co-morbidities, type of disease, serum albumin, and C-reactive protein (CRP). RESULTS: Patients were classified according to BMI and NRI scores. Increased BMI and NRI were associated with a severe type of disease. Most of the patients with severe disease were: obese (83.3%) and patients with risk for malnutrition (53.3%). Obese patients had a longer length of home stay and higher CRP levels, but the level of albumin was lower in a group with a risk for malnutrition. CONCLUSION: Future studies are needed to identify and quantify specific screening tool for nutrition deficiency in patients with COVID-19 infection

Exercise-Induced Bronchoconstriction and Exercise-Induced Respiratory Symptoms in Nurses

In order to assess prevalence and characteristics of exercise-induced respiratory symptoms (EIRSs) and exercise-induced bronchoconstriction (EIB) in health care workers, we performed a cross-sectional study including 48 female nurses from primary care settings and an equal number of female office workers studied as a control group. The evaluation of examined groups included completion of a questionnaire, skin prick tests to common inhalant allergens, spirometry, and exercise and histamine challenge. We found a similar prevalence of EIRSs and EIB in both groups. EIB was closely related to asthma, atopy, family history of asthma, and positive histamine challenge in either group, while the association between EIB and daily smoking in nurses was of borderline statistical significance. Bronchial reaction to exercise was significantly higher in nurses than in controls with EIB. With the exception of exercise induced wheezing, EIRSs were weakly associated with EIB in both groups with a large proportion of false positive results

Effects of A Long-Term Use of Carbocysteine on Frequency and Duration of Exacerbations in Patients with Bronchiectasis

BACKGROUND: The failure of mucus clearance in bronchiectasis can be improved by chest physiotherapy or/and mucoactive agents. AIM: To assess the effects of long-term use of carbocysteine on frequency and duration of exacerbations in patients with bronchiectasis. METHODS: We performed an observational, non-randomized, open study (a real-life study) including 64 patients with bronchiectasis divided into two groups, examined group (EG) and control group (CG). All participants were treated with appropriate treatment for the stable disease, but in the study, subjects of EG two capsules 375 mg carbocysteine three times a day was added over three months. Daily diary cards realised collection of data regarding the occurrence and duration of exacerbation in all study subjects. RESULTS: Over the study period 43 exacerbations were documented, 17 in the EG and 26 in the CG, 10 (23.4%) of which required hospital treatment (four in the EG [23.5%] and six in the CG [23.1%]). A mean number of exacerbations over the study period was significantly lower in the EG (0.5 ± 0.1) as compared to their mean number in the CG (0.8 ± 0.2) (P = 0.0000). Mean duration of exacerbations expressed in days needed for complete resolution of symptoms or return of the symptoms to their baseline severity in the EG was significantly shorter than the mean duration of exacerbations in the CG (10.1 ± 2.6 vs 12.8 ± 2.1; P = 0.0000). The frequency of adverse effects, i.e. mild gastrointestinal manifestations and headache which did not require discontinuation of the treatment, in the EG during the study period was 15.6%. CONCLUSION: Our findings indicated positive effects of carbocysteine regarding the frequency and duration of exacerbations, as well as its good tolerability in the patients with bronchiectasis

Carbocysteine in the Management of Stable COPD: Are Its Antioxidant and Anti-Inflammatory Properties Clinically Relevant?

BACKGROUND: The recent epidemiological and experimental evidence suggest possible antioxidant effect of carbocysteine in patients with chronic obstructive pulmonary disease (COPD).AIM: To assess efficacy and tolerability of carbocysteine in the management of stable COPD.METHODS: We performed an observational, non-randomized, open study (a real life study) including 87 patients with stable COPD (group B and D by combined COPD assessment) divided in two groups, examined group (EG) and control group (CG). All participants were treated with the regular treatment of the stable disease, but in the participants of the EG carbocysteine 1,500 mg daily was added to their regular treatment during the period of two months. The study protocol included completion of the COPD Assessment Test (CAT) and spirometric measurements at initial visit and at the end of the mentioned period.RESULTS: We found significantly lower mean value of the overall CAT score in the EG at the end of the study as compared to its mean value registered at initial visit (26.9 vs. 24.3; P = 0.007). In regard to certain CAT items, we found significantly lower values of the mean scores related to cough phlegm and sleep disturbances as compared to their mean scores at initial visit. In addition, the mean values of the overall CAT scores at initial visit and at the end of the study in controls were similar. In EG we found significantly higher mean value of the MEF 25-75 at the end of the study as compared to its mean value registered at initial visit (59.3% vs. 67.2%; P = 0.003). There was no significant difference in the mean values of other spirometric parameters at the end of the study as compared to their mean values at initial visit. In controls we registered similar values of all measured spirometric parameters at the end of the study as compared to their values registered at initial visit. Mild gastrointestinal manifestations were registered in 13.3% of the participants of the EG during the examined period.CONCLUSION: Our findings indicate positive effects of carbocysteine regarding the symptoms and lung function, as well as its good tolerability in the patients with stable COPD