scholarly journals Case Report: Flavoring-Related Lung Disease in a Coffee Roasting and Packaging Facility Worker With Unique Lung Histopathology Compared With Previously Described Cases of Obliterative Bronchiolitis

2021 ◽  
Vol 9 ◽  
Author(s):  
R. Reid Harvey ◽  
Brie H. Blackley ◽  
Eric J. Korbach ◽  
Ajay X. Rawal ◽  
Victor L. Roggli ◽  
...  
Keyword(s):  
Lung Disease ◽  
Prolonged Exposure ◽  
Airflow Obstruction ◽  
Giant Cells ◽  
Obliterative Bronchiolitis ◽  
Lung Pathology ◽  
Exertional Dyspnea ◽  
Work Related ◽  
Luminal Narrowing ◽  
Mixed Pattern

Occupational exposure to diacetyl, a butter flavor chemical, can result in obliterative bronchiolitis. Obliterative bronchiolitis is characterized by exertional dyspnea, fixed airflow obstruction, and histopathologic constrictive bronchiolitis, with bronchiolar wall fibrosis leading to luminal narrowing and obliteration. We describe a case of advanced lung disease with histopathology distinct from obliterative bronchiolitis in a 37-year-old male coffee worker following prolonged exposure to high levels of diacetyl and the related compound 2,3-pentanedione, who had no other medical, avocational, or occupational history that could account for his illness. He began working at a coffee facility in the flavoring room and grinding area in 2009. Four years later he moved to the packaging area but continued to flavor and grind coffee at least 1 full day per week. He reported chest tightness and mucous membrane irritation when working in the flavoring room and grinding area in 2010. Beginning in 2014, he developed dyspnea, intermittent cough, and a reduced sense of smell without a work-related pattern. In 2016, spirometry revealed a moderate mixed pattern that did not improve with bronchodilator. Thoracoscopic lung biopsy results demonstrated focal mild cellular bronchiolitis and pleuritis, and focal peribronchiolar giant cells/granulomas, but no evidence of constrictive bronchiolitis. Full-shift personal air-samples collected in the flavoring and grinding areas during 2016 measured diacetyl concentrations up to 84-fold higher than the recommended exposure limit. Medical evaluations indicate this worker developed work-related, airway-centric lung disease, most likely attributable to inhalational exposure to flavorings, with biopsy findings not usual for obliterative bronchiolitis. Clinicians should be aware that lung pathology could vary considerably in workers with suspected flavoring-related lung disease.

scholarly journals POS0331 LUNG TARGETED DELIVERY OF EVEROLIMUS AS A NEW TREATMENT OF SCLERODERMA-RELATED INTERSTITIAL LUNG DISEASE (SSc-ILD) DEVELOPED BY PSGL-1 KO MICE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 393.1-393
Author(s):  
E. González Sánchez ◽  
J. Gómez-Román ◽  
A. Muñoz-Callejas ◽  
A. Marengo ◽  
N. Tsapis ◽  
...  
Keyword(s):  
T Cells ◽  
Hyaluronic Acid ◽  
Interstitial Lung Disease ◽  
Observational Study ◽  
Lung Disease ◽  
High Dose ◽  
Lung Pathology ◽  
Intratracheal Administration ◽  
Interstitial Inflammation ◽  
Autoimmune Syndrome

Background:Interstitial lung disease (ILD), the main cause of mortality in scleroderma (SSc) patients (1), has no treatment (2). P-selectin glycoprotein ligand 1 (PSGL-1), the main ligand for P-Selectin, is expressed on leukocytes and responsible for the initial steps of extravasation (3). The absence of PSGL-1 in mice spontaneously develops an autoimmune syndrome similar to human SSc with fibrosis, vascular damage, autoantibodies and pulmonary arterial hypertension in females, and almost 60% of animals older than 12 months develop ILD with aging (4). In this work, the therapeutic action of everolimus-loaded nanomedicine given by local administration as a treatment for ILD was evaluated. The intratracheal administration of everolimus loaded into in liposomes decorated with hyaluronic acid (HA) is studied as an administration strategy to reach the inflammatory and fibrotic cells, targeting these cells and avoiding systemic effects and possible toxicity on epithelial cellsObjectives:1) To study the effect of everolimus on bronchoalveolar lavage (BAL) cell populations and in lung pathology in SSc-ILD PSGL-1 KO mice2) To analyze the intratracheal application of everolimus included in empty liposomes (Lip+Ev) vs. liposomes decorated with hyaluronic acid (Lip-HA+Ev) as an administration strategy to decrease drug toxicity and increase drug effectivityMethods:In an observational study, PSGL-1−/− C57BL/6 males older than 12 months (n=4) were treated intratracheally with 4 doses of Lip or Lip-HA (with or without everolimus included), once a week (Lip+Ev 295.67µg/mL; Lip+Ev 82.73µg/mL; Lip-HA+Ev 82.73µg/mL). Then, animals were euthanatized and BAL and lungs were obtained. BAL cells were stained for flow cytometry analysis. Lungs were embedded in paraffin blocks for blind histological analysis by a pathologist and evaluated for interstitial inflammation and fibrosis degree. Lip-HA was selected as the treatment of choice for a second experiment (n=8) following the same experimental design (86.22µg/mL)Results:The observational study showed an increase in CD45+, alveolar macrophages (AM), eosinophils (Eos), granulocytes (Gr1+) and T cells in the BAL of untreated PSGL-1-/- mice compared with WT mice. Everolimus reduced these populations to WT levels in all casesLip-HA+Ev administration was chosen for further experiments because a lower dose of the drug gave a better result than the high dose in undecorated liposomes. Reduction of CD45+, AM, eosinophils, and CD45- cells populations by Lip-HA+Ev was confirmed. Lip-HA treatment increased the number of neutrophils and T cells, but this effect is controlled by the everolimus administrationHistological lung analysis showed an increase in interstitial inflammation and fibrosis in untreated PSGL-1-/- and empty Lip-HA experimental groups. Treatment with everolimus included in Lip-HA reduced the fibrotic and inflammatory interstitial lung lesions, reaching values similar to those observed in WT miceConclusion:PSGL-1 KO mice present ILD associated with scleroderma (SSc-ILD) with an increase of CD45+, Gr1+, Eos, T cells and AM populations in the BAL. Intratracheal treatment with everolimus included in liposomes decorated with hyaluronic acid reduces immune cell infiltration and fibrosis once SSc-ILD is establishedReferences:[1]Solomon JJ, Olson AL, Fischer A, Bull T, Brown KK, Raghu G (2013). Scleroderma lung disease[2]Singh D, Parihar AK, Patel S, Srivastava S, Diwan P, Singh MR (2019). Scleroderma: An insight into causes, pathogenesis and treatment strategies. Pathophysiology, 26(2)[3]Zarbock A, McEver RP, Hidalgo A (2011). Leukocyte Ligands for Endothelial Selectins: Specialized Glycoconjugates That Mediate Rolling and Signaling Under Flow. BLOOD[4]Pérez-Frías A, Núñez-Andrade N, et al. (2014). Development of an autoimmune syndrome affecting the skin and internal organs in P-selectin glycoprotein ligand 1 leukocyte receptor-deficient mice. Arthritis RheumatolDisclosure of Interests:None declared

scholarly journals Prevalence and burden of chronic bronchitis symptoms: results from the BOLD study

2017 ◽  
Vol 50 (5) ◽  
pp. 1700621 ◽  
Author(s):  
Filip Mejza ◽  
Louisa Gnatiuc ◽  
A. Sonia Buist ◽  
William M. Vollmer ◽  
Bernd Lamprecht ◽  
...  
Keyword(s):  
Lung Function ◽  
Lung Disease ◽  
Chronic Bronchitis ◽  
Airflow Obstruction ◽  
Population Based ◽  
Normal Lung ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Definition Of ◽  
Disease Study

We studied the prevalence, burden and potential risk factors for chronic bronchitis symptoms in the Burden of Obstructive Lung Disease study.Representative population-based samples of adults aged ≥40 years were selected in participating sites. Participants completed questionnaires and spirometry. Chronic bronchitis symptoms were defined as chronic cough and phlegm on most days for ≥3 months each year for ≥2 years.Data from 24 855 subjects from 33 sites in 29 countries were analysed. There were significant differences in the prevalence of self-reported symptoms meeting our definition of chronic bronchitis across sites, from 10.8% in Lexington (KY, USA), to 0% in Ile-Ife (Nigeria) and Blantyre (Malawi). Older age, less education, current smoking, occupational exposure to fumes, self-reported diagnosis of asthma or lung cancer and family history of chronic lung disease were all associated with increased risk of chronic bronchitis. Chronic bronchitis symptoms were associated with worse lung function, more dyspnoea, increased risk of respiratory exacerbations and reduced quality of life, independent of the presence of other lung diseases.The prevalence of chronic bronchitis symptoms varied widely across the studied sites. Chronic bronchitis symptoms were associated with significant burden both in individuals with chronic airflow obstruction and those with normal lung function.

scholarly journals Exertional dyspnea associated with chest wall strapping is reduced when external dead space substitutes for part of the exercise stimulus to ventilation

2017 ◽  
Vol 122 (5) ◽  
pp. 1179-1187
Author(s):  
Luke A. Garske ◽  
Ravin Lal ◽  
Ian B. Stewart ◽  
Norman R. Morris ◽  
Troy J. Cross ◽  
...  
Keyword(s):  
Lung Disease ◽  
Chest Wall ◽  
Dead Space ◽  
Exercise Intensity ◽  
Rating Scale ◽  
Exertional Dyspnea ◽  
Restrictive Lung Disease ◽  
Muscle Work ◽  
Leg Muscle ◽  
Exercise Stimulus

Chest wall strapping has been used to assess mechanisms of dyspnea with restrictive lung disease. This study examined the hypothesis that dyspnea with restriction depends principally on the degree of reflex ventilatory stimulation. We compared dyspnea at the same (iso)ventilation when added dead space provided a component of the ventilatory stimulus during exercise. Eleven healthy men undertook a randomized controlled crossover trial that compared four constant work exercise conditions: 1) control (CTRL): unrestricted breathing at 90% gas exchange threshold (GET); 2) CTRL+dead space (DS): unrestricted breathing with 0.6-l dead space, at isoventilation to CTRL due to reduced exercise intensity; 3) CWS: chest wall strapping at 90% GET; and 4) CWS+DS: chest strapping with 0.6-l dead space, at isoventilation to CWS with reduced exercise intensity. Chest strapping reduced forced vital capacity by 30.4 ± 2.2% (mean ± SE). Dyspnea at isoventilation was unchanged with CTRL+DS compared with CTRL (1.93 ± 0.49 and 2.17 ± 0.43, 0–10 numeric rating scale, respectively; P = 0.244). Dyspnea was lower with CWS+DS compared with CWS (3.40 ± 0.52 and 4.51 ± 0.53, respectively; P = 0.003). Perceived leg fatigue was reduced with CTRL+DS compared with CTRL (2.36 ± 0.48 and 2.86 ± 0.59, respectively; P = 0.049) and lower with CWS+DS compared with CWS (1.86 ± 0.30 and 4.00 ± 0.79, respectively; P = 0.006). With unrestricted breathing, dead space did not change dyspnea at isoventilation, suggesting that dyspnea does not depend on the mode of reflex ventilatory stimulation in healthy individuals. With chest strapping, dead space presented a less potent stimulus to dyspnea, raising the possibility that leg muscle work contributes to dyspnea perception independent of the ventilatory stimulus. NEW & NOTEWORTHY Chest wall strapping was applied to healthy humans to simulate restrictive lung disease. With chest wall strapping, dyspnea was reduced when dead space substituted for part of a constant exercise stimulus to ventilation. Dyspnea associated with chest wall strapping depended on the contribution of leg muscle work to ventilatory stimulation. Chest wall strapping might not be a clinically relevant model to determine whether an alternative reflex ventilatory stimulus mimics the intensity of exertional dyspnea.

scholarly journals Pulmonary Pathology of Early Phase SARS-COV-2 Pneumonia

2020 ◽  
Author(s):  
Sufang Tian ◽  
Weidong Hu ◽  
Li Niu ◽  
Huan Liu ◽  
Haibo Xu ◽  
...  
Keyword(s):  
Early Phase ◽  
Giant Cells ◽  
Lung Pathology ◽  
Cellular Infiltration ◽  
Multinucleated Giant Cells ◽  
Time Of Surgery ◽  
Hyaline Membranes ◽  
Pulmonary Pathology

There is currently a lack of pathologic data on the SARS-CoV-2 pneumonia, or COVID-19, from autopsy or biopsy. Two patients who recently underwent lung lobectomies for adenocarcinoma were retrospectively found to have had COVID-19 at the time of surgery. These two cases thus provide important first opportunities to study the pathology of COVID-19. Pathologic examinations revealed that, apart from the tumors, the lungs of both patients exhibited edema, proteinaceous exudate with globules, focal hyperplasia of pneumocytes with only patchy inflammatory cellular infiltration, and multinucleated giant cells. Hyaline membranes were not prominent. Since both patients did not exhibit symptoms of pneumonia at the time of surgery, these changes likely represent an early phase of the lung pathology of COVID-19 pneumonia.

Analysis of Role Stress in the Indian IT Industry

2018 ◽  
pp. 1-23
Author(s):  
Shubhangini Rathore
Keyword(s):  
Prolonged Exposure ◽  
Service Industry ◽  
Demographic Factors ◽  
Role Stress ◽  
It Industry ◽  
Work Related ◽  
Mind And Body ◽  
Related Stress ◽  
The Mind

Contemporary industries face new competition requiring employees to work for longer hours under competitive time-bound deadlines. Prolonged exposure to such stressful situations leads to a depletion and exhaustion of resources in the mind and body with dysfunctional effects on job performance and overall organizational effectiveness. The Indian IT industry is a fast-paced service industry that is characterized by such stressful work situations and related outcomes. This chapter analyses the various factors that contribute to organizational stress and the role of demographic factors on role stress among the professionals of the Indian IT industry. A sample of 250 employees has been collected from the Delhi NCR region. Role stress has been measured by using the ORS scale which comprises of 10 dimensions of the role of stress that are measured by 50 items. The results show that there is a considerable amount of work related stress along with a significant impact of demographic factors on the role of stress amongst the IT professionals.

scholarly journals Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound

2020 ◽  
Vol 180 (1) ◽  
pp. 137-146
Author(s):  
Nora Tusor ◽  
Angela De Cunto ◽  
Yousef Basma ◽  
John L. Klein ◽  
Virginie Meau-Petit
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Lung Ultrasound ◽  
Clinical Laboratory ◽  
Control Group ◽  
Ventilator Associated Pneumonia ◽  
Lung Pathology ◽  
Rater Agreement ◽  
X Ray ◽  
Chest X Ray

AbstractNo consensus exists regarding the definition of ventilator-associated pneumonia (VAP) in neonates and reliability of chest X-ray (CXR) is low. Lung ultrasound (LU) is a potential alternative diagnostic tool. The aim was to define characteristics of VAP in our patient population and propose a multiparameter score, incorporating LU, for VAP diagnosis. Between March 25, 2018, and May 25, 2019, infants with VAP were identified. Clinical, laboratory and microbiology data were collected. CXRs and LU scans were reviewed. A multiparameter VAP score, including LU, was calculated on Day 1 and Day 3 for infants with VAP and for a control group and compared with CXR. VAP incidence was 10.47 episodes/1000 ventilator days. LU and CXR were available for 31 episodes in 21 infants with VAP, and for six episodes in five patients without VAP. On Day 1, a VAP score of > 4, and on Day 3 a score of > 5 showed sensitivity of 0.94, and area under the curve of 0.91 and 0.97, respectively. AUC for clinical information only was 0.88 and for clinical and CXR 0.85.Conclusion: The multiparameter VAP score including LU could be useful in diagnosing VAP in neonates with underlying lung pathology. What is Known:• Ventilator associated pneumonia (VAP) is common in infants on the neonatal unit and is associated with increased use of antibiotics, prolonged ventilation and higher incidence of chronic lung disease.• Commonly used definitions of VAP are difficult to apply in neonates and interpretation of chest X-ray is challenging with poor inter-rater agreement in patients with underlying chronic lung disease. What is New:• The multiparameter VAP score combining clinical, microbiology and lung ultrasound (LU) data is predictive for VAP diagnosis in preterm infants with chronic lung disease.• LU findings of VAP in neonates showed high inter-rater agreement and included consolidated lung areas, dynamic bronchograms and pleural effusion.

scholarly journals Work-Related Tuberculosis among Health Workers Employed in a Tertiary Hospital in Northeastern Thailand: A Report of Nine Cases

2020 ◽  
Vol 17 (14) ◽  
pp. 5156
Author(s):  
Thanthun Sangphoo ◽  
Naesinee Chaiear ◽  
Patimaporn Chanpho
Keyword(s):  
Prolonged Exposure ◽  
Health Workers ◽  
Tertiary Hospital ◽  
International Standards ◽  
Respiratory Protection ◽  
Effective Work ◽  
Work Related ◽  
Investigation Methods ◽  
Epidemiological Information ◽  
Northeastern Thailand

Between October 2016 and September 2018, fifteen health workers were diagnosed with tuberculosis (TB) at a tertiary hospital in northeastern Thailand. However, the cases could not be diagnosed as occupational TB according to international standards because of hospital limitations. The use of occupational epidemiological information provides a more effective work-related TB diagnosis. This study aims to provide a report of work-related TB using individual case investigation methods. We collected secondary data from the Occupational Health and Safety Office of the hospital in question, including baseline characteristics for the health workers, occupational history, source of TB infection and occupational exposure, and working environmental measurements. We found that nine of the fifteen cases were diagnosable as work-related TB due to two important factors: daily prolonged exposure time to an infected TB patient, and aerosol-generating procedures without adequate respiratory protection. The other six cases were not diagnosable as work-related TB because of inadequate evidence of activities related to the TB infection. The diagnosis of work-related TB thus requires occupational epidemiological information in order to complete the differentiation process.

Sign in / Sign up

Export Citation Format

Share Document