Automobile mechanics have been exposed to asbestos in the past, mainly due to the presence of chrysotile asbestos in brakes and clutches. Despite the large number of automobile mechanics, little is known about the non-malignant respiratory diseases observed in this population. The aim of this retrospective multicenter study was to analyze the frequency of pleural and parenchymal abnormalities on HRCT in a population of automobile mechanics.
The study population consisted of 103 automobile mechanics with no other source of occupational exposure to asbestos, referred to three occupational health departments in the Paris area for systematic screening of asbestos–related diseases. All subjects were examined by HRCT and all images were reviewed separately by two independent readers, with further consensus in the case of disagreement. Multiple logistic regression models were constructed to investigate factors associated with pleural plaques.
Pleural plaques were observed in 5 cases (4.9%) and interstitial abnormalities consistent with asbestosis were observed in 1 case. After adjustment for age, smoking status, and a history of non-asbestos-related respiratory diseases, multiple logistic regression models showed a significant association between the duration of exposure to asbestos and pleural plaques.
The asbestos exposure experienced by automobile mechanics may lead to pleural plaques. The low prevalence of non-malignant asbestos-related diseases, using a very sensitive diagnostic tool, is in favor of a low cumulative exposure to asbestos in this population of workers.
Adult; Asbestos; toxicity; Automobiles; Female; Humans; Logistic Models; Lung Diseases; epidemiology; radiography; Male; Mechanics; Middle Aged; Occupational Diseases; epidemiology; radiography; Occupational Exposure; adverse effects; Paris; Pleural Diseases; epidemiology; radiography; Prevalence; Retrospective Studies; Time Factors; Tomography, X-Ray Computed; methods; Young Adult; asbestos; pleural plaques; automobile mechanics; HRCT
Acute allergic reactions often occur in out-of-hospital settings, and
some of these reactions may cause death in the short term. However, initial
diagnosis, management and processing of acute allergic reactions by Medical
Emergency Dispatch Centres are not documented. We sought to describe acute
allergic reactions and their management by a Medical Emergency Dispatch
A prospective study was conducted from 20th August 2006 to 5th
November 2006 on incoming calls for acute allergic reactions to the Medical
Emergency Dispatch Centre for the Hauts de Seine (Paris
West suburb, France). The agreement between initial diagnosis (made by
dispatching physician) and final diagnosis (made by the physician who later
examined the patient), and between initial and final severity, were
evaluated using Cohen’s weighted Kappa coefficient.
210 calls were included. The diagnoses made by the dispatching
physician were: in 58.1% of cases urticaria, in 23.8%
angioedema, in 13.3% laryngeal edema, and in 1.9%
anaphylactic shock. The agreement between initial and final diagnoses was
evaluated by a kappa coefficient at 0.44 (CI 95%: 0.26–0.61)
and the agreement between initial and final severity was evaluated using a
kappa coefficient at 0.37 (CI 95%: 0.24–0.50).
We have highlighted only moderate agreement between the initial
severity assessed by the dispatching physician and the final severity
assessed by the physician later examining the patient. This demonstrates the
need to develop a tool for assessing severity of acute allergic reactions
for dispatching physicians in Medical Emergency Dispatch Centres.
Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Emergency Medical Services; organization & administration; Female; France; Humans; Hypersensitivity; diagnosis; Infant; Male; Middle Aged; Physician's Role; Prospective Studies; Severity of Illness Index; Young Adult; allergy; pre-hospital; clinical assessment; severity (other)
Physical examination is often used to screen workers for carpal tunnel syndrome (CTS). In a population of newly-hired workers, we evaluated the yield of such screening.
Our study population included 1108 newly-hired workers in diverse industries. Baseline data included a symptom questionnaire, physical exam, and bilateral nerve conduction testing of the median and ulnar nerves; individual results were not shared with the employer. We tested three outcomes: symptoms of CTS, abnormal median nerve conduction, and a case definition of CTS that required both symptoms and median neuropathy.
Of the exam measures used, only Semmes-Weinstein sensory testing had a sensitivity value above 31%. Positive predictive values were low, and likelihood ratios were all under 5.0 for positive testing and over 0.2 for negative testing.
Physical examination maneuvers have a low yield for the diagnosis of CTS in workplace surveillance programs and in post-offer, pre-placement screening programs.
Carpal Tunnel Syndrome; Post-offer pre-placement examinations; physical examination; screening; clinical epidemiology
Katz et al have published a standardized scoring system of hand diagrams for carpal tunnel syndrome. The purpose of this study was to quantitatively evaluate alternative scoring of the hand diagram for detection of carpal tunnel syndrome.
In a prospective study of 1107 workers, 221 workers with hand symptoms completed hand diagrams and electrodiagnostic testing for carpal tunnel syndrome. Scoring algorithms for the hand diagrams included the Katz rating; a median nerve digit score (0–2) with a maximum of 2 symptomatic digits of thumb, index, and long; and isolated digit scores (0–1) of thumb, index, or long. Intraclass correlation coefficients quantified inter-rater reliability. Sensitivity, specificity, and logistic regression analyses evaluated scoring systems performances ability to predict abnormal median nerve conduction.
One hundred ten (50%) subjects illustrated symptoms within the median nerve distribution. All scoring systems demonstrated substantial inter-rater reliability. “Classic” or “probable” Katz scores, median nerve digit score of 2, and positive long finger scores were significantly associated with abnormal median nerve distal sensory latency and median-ulnar difference. Abnormal distal motor latency was significantly associated with the median nerve digit score of 2 and positive long finger scores. Increasing Katz scores from “possible” to “probable” and “classic” were not associated with greater odds of electrodiagnostic abnormality. Positive long finger scores performed at least as well as the most rigorous scoring by Katz.
Symptoms diagramed within the median nerve distribution are associated with abnormal nerve conduction among workers. The median nerve digit score and the long finger score offer increased ease of use compared to the Katz method while maintaining similar performance characteristics. The long finger appears best suited for isolated digit scoring to predict abnormal median nerve conduction in a working population.
Carpal tunnel syndrome; Hand diagram; screening; scoring
Thoracic outlet syndrome is a controversial cause of neck and shoulder pain due to complex mechanisms involving muscular dysfunction and nerve compression. Although management of thoracic outlet syndrome must be based on a multidisciplinary approach, physicians and occupational therapist should be familiar with the principles of diagnosis and treatment.
Method, results and conclusion
The purpose of this article is to review the definitions, diagnosis and management of this syndrome. A particular emphasis was described on the links between the workplace and the individual in the pathogenesis, prevalence in the workforce and the course of this disease.
Diagnosis, Differential; Humans; Occupational Diseases; diagnosis; etiology; therapy; Prevalence; Risk Factors; Thoracic Outlet Syndrome; diagnosis; etiology; therapy; Thoracic outlet syndrome; rehabilitation; diagnosis; occupational disease
Attitude of Health Personnel; Cooperative Behavior; Disaster Planning; organization & administration; Hospital Administration; Humans; Paris; Snow
The musculoskeletal disorders in working population represent one of the most worrying work-related health issues at the present time and although the very great majority of available data on the subject focus on musculoskeletal disorders defined by anatomical site, a growing number of studies indicate the low prevalence of disorders strictly confined to a specific anatomical site. The objective of this study was to describe the prevalence and characteristics of multisite musculoskeletal symptoms (multisite MS) in a large French working population.
This study was performed on surveillance data of the cross-sectional survey (2002–2005) conducted by a network of occupational physicians in the working population of the Loire Valley region (from 20 to 59 years old). Data concerning MS were collected in the waiting room of the occupational physicians by means of the self-administrated standardized NORDIC questionnaire.
The study population comprised 3,710 workers (2,162 men (58%) and 1,548 women (42%)) with a mean age of 38.4 years (standard deviation: 10.4 years). The prevalence of MS during the past 12 months was 83.8% with 95% confidence interval of [82.8-85.3] for men and 83.9% [82.0-85.7] for women. The prevalence of subacute MS (lasting at least 30 days) over the past 12 months was 32.8% [30.9-34.8] for men and 37.3% [34.9-39.7] for women. Two-thirds of workers reported MS in more than one anatomical site and about 20% reported MS lasting at least 30 days in more than one anatomical site. The anatomical sites most frequently associated with other MS were the upper back, hip, elbow and neck. The majority of these multisite MS were widespread, involving at least two of the three anatomical regions (upper limb, axial region and lower limb).
The frequency and extent of multisite MS reported by workers are considerable. Further research must be conducted in this field in order to provide a better understanding of the characteristics and determinants of these multisite MS.
The underlying purpose of this commentary and position paper is to achieve evidence-based recommendations on prevention of work-related musculoskeletal disorders (MSDs). Such prevention can take different forms (primary, secondary and tertiary), occur at different levels (i.e. in a clinical setting, at the workplace, at national level) and involve several types of activities. Members of the Scientific Committee (SC) on MSDs of the International Commission on Occupational Health (ICOH) and other interested scientists and members of the public recently discussed the scientific and clinical future of prevention of (work-related) MSDs during five round-table sessions at two ICOH conferences (in Cape Town, South Africa, in 2009, and in Angers, France, in 2010). Approximately 50 researchers participated in each of the sessions. More specifically, the sessions aimed to discuss new developments since 1996 in measures and classification systems used both in research and in practice, and agree on future needs in the field.
The discussion focused on three questions: At what degree of severity does musculoskeletal ill health, and do health problems related to MSDs, in an individual worker or in a group of workers justify preventive action in occupational health? What reliable and valid instruments do we have in research to distinguish ‘normal musculoskeletal symptoms’ from ‘serious musculoskeletal symptoms’ in workers? What measures or classification system of musculoskeletal health will we need in the near future to address musculoskeletal health and related work ability?
Four new, agreed-upon statements were extrapolated from the discussions: 1. Musculoskeletal discomfort that is at risk of worsening with work activities, and that affects work ability or quality of life, needs to be identified. 2. We need to know our options of actions before identifying workers at risk (providing evidence-based medicine and applying the principle of best practice). 3. Classification systems and measures must include aspects such as the severity, frequency, and intensity of pain, as well as measures of impairment of functioning, which can help in prevention, treatment and prognosis. 4. We need to be aware of economic and/or socio-cultural consequences of classification systems and measures.
Occupation; Epidemiology; Prevention; Aetiology; Expert opinion; Occupational health; Public health; Rheumatology; Rehabilitation; Orthopaedics
The etiological work-up of a disease with an occupational component, such as renal failure associated with exposure to organic solvents, may include several complementary investigations. We discussed certain elements of the aetiological work-up in the light of a clinical case, particularly the individual and collective advantages and disadvantages of this work-up. Further investigations would not have provided the patient with any individual or collective benefit and were therefore not performed, while other investigations (environmental studies, screening of fellow workers) may provide collective rather than individual benefits, but must be decided by a multidisciplinary approach. A multidisciplinary study (general practitioner, nephrologist, occupational health physician and specialist in toxicology) is necessary to discuss the appropriate aetiological work-up, taking into account the individual and collective benefit-risk balance.
Occupational disease; Kidney disease (Failure); (Organic)Solvent; (Etiologic diagnosis)
The aim of our study was to assess agreement between different case definitions of carpal tunnel syndrome (CTS) for epidemiological studies.
We performed a literature search for papers suggesting case definitions for use in epidemiological studies of CTS. Using data elements based on symptom questionnaires, hand diagrams, physical examinations and nerve conduction studies collected from 1107 newly-hired workers, each subject in the study was classified according to each of the case definitions selected from the literature. We compared each case definition to every other case definition, using the Kappa statistic to measure pairwise agreement on whether each subject met the case definition.
We found six unique papers in a twenty year period suggesting a case definition of CTS for use in population-based studies. We extracted seven case definitions. Definitions included different parameters: symptoms only, symptoms and physical examination, symptoms and either physical examination or median nerve conduction study, symptoms and nerve conduction study. When applied to our study population, the prevalence of CTS using different case definitions ranged from 2.5% to 11.0%. The percentage of misclassification was between 1 to 10%, with generally acceptable levels of agreement (Kappa values ranged from 0.30 to 0.85).
Different case definitions resulted in widely varying prevalences of CTS. Agreement between case definitions was generally good, particularly between those that required very specific symptoms or the combination of symptoms and physical examination or nerve conduction. The agreement observed between different case definitions suggests that the results can be compared across different research studies of risk factors for CTS.
median neuropathy; population study; nerve conduction studies; screening
An epidemiological surveillance network for carpal tunnel syndrome (CTS) was set up in the general population of a French region to assess the attributable fraction of CTS according to work in high risk industries and occupations.
Cases of CTS occurring among patients aged 20 to 59 living in the Maine and Loire region were included prospectively from 2002 to 2004. Medical and occupation history was gathered by mailed questionnaire for 815 women and 20 men. Age-adjusted relative risks of CTS and the attributable fractions of CTS to work among exposed persons (AFE) were computed in relation to industry sectors and occupation categories.
Twenty-one industry sectors and eight occupational categories for women, and ten sectors and six occupational categories for men were characterized by a significant excess risk of CTS. High values of AFE were observed in the manufacturing (from 42 to 93% for both genders), construction (66 for men) and personal service industries (66 for women), and trade and commerce (49% for women) sectors. High values of AFE were observed in female lower grade white-collar occupations (from 43 to 67%), and male (from 60 to 74%) and female (from 48 to 88%) blue-collar occupations.
The attributable fractions of CTS among workers employed in industry sectors and occupation categories identified at high risk of CTS varied between 36 and 93%
Adult; Carpal Tunnel Syndrome; epidemiology; Employment; statistics & numerical data; Female; France; epidemiology; Humans; Incidence; Male; Middle Aged; Occupational Diseases; epidemiology; Odds Ratio; Questionnaires; Risk Factors; Attributable risk fraction; Carpal tunnel syndrome; Industry; Occupation; Work; Work-related.
The study aimed to assess the relative importance of personal and occupational risk factors for upper-extremity musculoskeletal disorders (UEMSDs) in the working population.
A total of 3,710 workers (58% of men) participating in a surveillance program of MSDs in a French region in 2002–2005 were included. UEMSDs were diagnosed by 83 trained occupational physicians performing a standardized physical examination. Personal factors and work exposure were assessed by a self-administered questionnaire. Statistical associations between MSDs, personal and occupational factors were analyzed using logistic regression modeling.
A total of 472 workers suffered from at least one UEMSD. The risk of UEMSDs increased with age for both genders (P<0.001) (O.R. up to 4.9 in men and 5.0 and in women) and in cases of prior history of UEMSDs (OR 3.1 and 5.0, P<0.001). In men, UEMSDs were associated with obesity (OR 2.2, P=0.014), high level of physical demand (OR 2.0, P<0.001), high repetitiveness of the task (OR 1.5, P=0.027), postures with the arms at or above shoulder level (OR 1.7, P=0.009) or with full elbow flexion (OR 1.6, P=0.006), and high psychological demand (O.R. 1.5, P=0.005). In women, UEMSDs were associated with diabetes mellitus (O.R. 4.9, P=0.001), postures with extreme wrist bending (OR 2.0, P<0.001), use of vibrating hand tools (O.R. 2.2, P=0.025) and low level of decision authority (OR 1.4, P=0.042).
The study showed that personal and work-related physical and psychosocial factors were strongly associated with clinically-diagnosed UEMSDs.
Musculoskeletal disorders; upper extremity; risk factors; personal factors; physical exposure; psychosocial factors; work; Adult; Employment; Female; Humans; Male; Middle Aged; Musculoskeletal Diseases; diagnosis; epidemiology; etiology; Occupational Diseases; diagnosis; epidemiology; etiology; Risk Factors; Safety Management; Upper Extremity; pathology; physiopathology
Arthralgia; etiology; radiography; Dancing; Female; Foot Joints; radiography; Humans; Metatarsal Bones; radiography; Middle Aged; Occupational Diseases; etiology; radiography; Osteoarthritis; etiology; radiography; Tomography, X-Ray Computed
Little is known about the long-term effect of occupational determinants on knee pain. We aimed to assess whether the risk factors for severe knee pain, observed with a cross-sectional approach, were still relevant after retirement, 12 years later.
All men participating in the ARPEGE side study of the GAZEL cohort (employees of the French national utility for energy production and distribution, recruited in 1989) and who answered the 1994 or 1995 general GAZEL self-administered questionnaire, were included. Weight and self-reported exposures over the entire working life were collected at baseline. Knee pain and its intensity were recorded in 1994–1995 and again in 2006. Moderate and severe knee pain, defined from an intensity or discomfort scale (threshold 3 on a 6-level scale in 1994–1995, and 4 on an 8-level scale in 2006), were the main outcomes. Results At baseline, 1786 men were included. In 1994–1995, moderate knee pain was observed among 10.3% and severe pain in 12.8% of men. In 2006, 1482 men (83%) answered the questionnaire. Moderate and severe knee pain were observed in 18.6% and 16.3% of respondents, respectively. Working in a kneeling or squatting position was significantly associated with severe knee pain at baseline, taking into account age, sports, smoking habits, and body mass index [adjusted odds ratio (ORadj) 1.4, 95% confidence interval (95% CI) 1.1–1.9 for “ever exposed” and ORadj 2.0, 95% CI 1.3–3.1 for >25 years of exposure]. In 2006, when most subjects were retired, the association between working in a kneeling or squatting position and severe pain was weaker but still significant (ORadj 1.4, 95% CI 1.04–1.85).
The effect of high knee exposure in the working life on severe knee pain remains even after retirement, although decreased. An extended surveillance and prevention program for these workers could be proposed.
Carpal tunnel syndrome (CTS) represents one of the most significant and costly health problems occurring in the working population. Estimation of the potential impact of prevention programs for CTS in the workplace would be useful for public policy. The aim of this study was to assess the population attributable fraction (PAF) of CTS to work according to the main industry sectors and occupation categories at high risk of CTS in a general population.
All cases of CTS occurring among patients living in a French region were included prospectively from 2002 to 2004. Medical and occupation history was gathered from 815 women and 320 men by mailed questionnaire. Age-adjusted relative risks and PAFs of CTS were computed in relation to industry sectors and occupation categories.
The PAF for women was higher in lower-grade white-collar workers (24% [19–29]) than in blue-collar workers (19% [15–22]). PAF was higher for the service industries sector (16% [8–22]) than for manufacturing (10% [7–13]) or agriculture (5% [3–7]) sectors. For men, the PAF was high in male blue-collar workers (50% [41–57]) and in the construction (13% [9–18]) and manufacturing industries (17% [10–23]).
The study suggested that in theory up to 5 to 50% of cases of CTS might be avoided in the whole population if totally effective intervention programs were implemented in specific occupational categories or industry sectors.
burden of disease; carpal tunnel syndrome; population attributable risk; prevention; work; work-related; Adult; Carpal Tunnel Syndrome; epidemiology; prevention & control; Female; Humans; Incidence; Male; Middle Aged; Occupational Diseases; epidemiology; prevention & control; Occupational Health; statistics & numerical data; Occupations; statistics & numerical data; Risk Assessment
In view of the conflicting opinions published, a meta-analysis was undertaken on epidemiological studies in order to assess any association between Dupuytren's contracture and work exposure.
Using the key words: "occupational disease", "work" and "Dupuytren contracture" without limitation on language or year of publication, epidemiological studies were selected from four databases (Pub-Med, Embase, Web of science, BDSP) after two rounds (valid control group, valid work exposure). A quality assessment list was constructed and used to isolate papers with high quality methodological criteria (scores of 13 or above, HQMC). Relevant associations between manual work, vibration exposure (at work) and Dupuytren's contracture were extracted from the articles and a metarisk calculated using the generic variance approach (meta-odds ratios, meta-OR).
From 1951 to 2007, 14 epidemiological studies (including 2 cohort studies, 3 case-control studies, and 9 cross-sectional studies/population surveys) were included. Two different results could be extracted from five studies (based on different types of exposure), leading to 19 results, 12 for manual work (9 studies), and 7 for vibration exposure (5 studies). Six studies met the HQMC, yielding 9 results, 5 for manual work and 4 for vibration exposure. Five studies found a dose-response relationship. The meta-OR for manual work was 2.02[1.57;2.60] (HQMC studies only: 2.01[1.51;2.66]), and the meta-OR for vibration exposure was 2.88 [1.36;6.07] (HQMC studies only: 2.14[1.59;2.88]).
These results support the hypothesis of an association between high levels of work exposure (manual work and vibration exposure) and Dupuytren's contracture in certain cases.
Dupuytren contracture; meta-analysis; observational studies; occupational
Aged; Body Height; physiology; Cohort Studies; Female; Humans; Low Back Pain; physiopathology; surgery; Male; Middle Aged; Predictive Value of Tests; Questionnaires; Risk Factors
We evaluated the utility of physical examination maneuvers in the prediction of carpal tunnel syndrome (CTS) in a population-based research study.
We studied a cohort of 1108 newly employed workers in several industries. Each worker completed a symptom questionnaire, a structured physical examination, and nerve conduction study. For each hand, our CTS case definition required both median nerve conduction abnormality and symptoms classified as “classic” or “probable” on a hand diagram. We calculated the positive predictive values and likelihood ratios for physical examination maneuvers, in subjects with and without symptoms.
The prevalence of CTS in our cohort was 1.2% for the right hand and 1.0% for the left hand. The likelihood ratios of a positive test for physical provocative tests ranged from 2.0 to 3.3, and those of a negative test from 0.3 to 0.9. The post-test probability of positive testing was less than 50% for all strategies tested.
Our study found that physical examination, alone or in combination with symptoms, was not predictive of CTS in a working population. We suggest using specific symptoms as a first level screening tool, and nerve conduction study as a confirmatory test, as a case definition strategy in research settings.
carpal tunnel syndrome; epidemiology; case definition; musculoskeletal; likelihood ratio
Despite the high frequency of work-related musculoskeletal disorders (WRMD), the relations between working conditions and ulnar nerve entrapment at the elbow (UNEE) has not been the object of much study. We studied the predictive factors for UNEE in a three-year prospective survey of upper-limb WRMD in repetitive work.
In 1993–1994 and three years later, 598 workers whose jobs involve repetitive work were examined by their occupational health physicians and completed a self-administered questionnaire. Predictive factors associated with the onset of UNEE were studied with bivariate and multivariate analysis.
Annual incidence was estimated at 0.8% per person year, based on 15 new cases during this three-year period. Holding a tool in position was the only predictive biomechanical factor (OR = 4.1, CI 1.4–12.0). Obesity increased the risk of UNEE (OR = 4.3, CI 1.2–16.2), as did presence of medial epicondylitis, carpal tunnel syndrome, radial tunnel syndrome, and cervicobrachial neuralgia. The associations with “holding a tool in position” and obesity were unchanged when the presence of other diagnoses was taken into account.
Despite the limitations of the study, the results suggest that UNEE incidence is associated with one biomechanical risk factor (holding a tool in position, repetitively), with overweight, and with other upper-limb WRMD, especially medial epicondylitis and other nerve entrapment disorders (cervicobrachial neuralgia, carpal and radial tunnel syndromes).
Adult; Comorbidity; Cubital Tunnel Syndrome; epidemiology; etiology; Cumulative Trauma Disorders; complications; epidemiology; Female; France; epidemiology; Humans; Incidence; Logistic Models; Male; Middle Aged; Musculoskeletal Diseases; classification; epidemiology; Obesity; complications; Occupational Diseases; complications; epidemiology; Occupations; classification; Posture; physiology; Prospective Studies; Questionnaires; Risk Factors; Workplace; psychology; elbow; repetitive work; ulnar nerve entrapment; work-related musculoskeletal disorder
The study aimed to compare results of the standardized Nordic-style questionnaire to those of a clinical examination in two large surveys on upper-limb work-related musculoskeletal disorders (UWMSD).
The “Repetitive task” survey based on 1757 workers in 1993–1994 and 598 workers in 1996–1997 aimed at studying UWMSD risk factors in a population exposed to repetitive work. The “Pays de la Loire” survey, based on 2685 workers in 2002–2003, was part of a population-wide surveillance system. In both surveys, each worker completed a Nordic-style questionnaire and underwent a standardized clinical examination. Presence of at least one UWMSD was compared, with evaluation of sensitivity, specificity, and kappa value, considering clinical examination as the reference method. In the second survey, a score based on a numeric scale for severity of symptoms at the time of examination was evaluated in the same way (plus ROC curves).
Agreement between questionnaire and examination was different in the two surveys: from kappa=0.22 [0.19–0.23] in the “Pays de la Loire” survey to 0.77 [0.74–0.80] in 1993–1994 in the “Repetitive task” survey. Sensitivity was excellent in all situations (from 82.3% to 100%). Specificity was variable, from 51.1% in the “Pays de la Loire” survey to 82.4% for score ≥ 2 based on the severity of symptoms in the survey.
Nordic-style questionnaires exploring symptoms in the past year can be considered as useful tools for surveillance of UWMSD, especially if they include numerical scales on symptom severity. Physical examination remains essential for a medical or clinical diagnosis assessment.
Adult; Cumulative Trauma Disorders; diagnosis; Female; Humans; Male; Occupational Diseases; diagnosis; Physical Examination; Questionnaires; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Upper Extremity; epidemiological surveillance; predictive value; sensitivity; specificity
Accidents, Occupational; Computer Simulation; Disaster Planning; methods; Disasters; prevention & control; Emergency Medical Services; methods; Emergency Medical Technicians; Emergency Medicine; education; Female; Humans; Male; Occupational Medicine; education; Professional Competence
Combined glucocorticoids and cyclophosphamide pulse therapy showed promising results in moderate-to-severe paraquat poisonings to reduce life-threatening respiratory complications. Its benefit has been observed when given early in the course of poisoning; however, whether its delayed administration remains beneficial is unknown.
We describe a 23-year-old male who ingested 70 mL of a commercialized concentrate formulation with 20% weight/volume paraquat in a suicide attempt. Within 24 hours from paraquat ingestion, he presented most of the indicators of poor outcome, including gastritis, early renal dysfunction, dark blue urine colorimetric dithionite test, and marked plasma paraquat concentrations (0.56 μg/mL at 13 hours, and 0.41 μg/mL at 24 hours after ingestion). The patient received early gastrointestinal decontamination and aggressive supportive treatments. However, due to a rapidly progressive severe pulmonary infection, glucocorticoids and cyclophosphamide were delayed until day 14. Interestingly, our patient survived with mild respiratory sequelae despite poor initial prognosis.
This observation suggests the potential benefit of immunosuppressive pulse therapy, even if administered 14 days after paraquat ingestion, and highlights the role of paraquat-induced alveolitis in the development of fibrosis.
Combined glucocorticoids and cyclophosphamide should be considered in moderate-to-severe paraquat poisonings, even if delayed.
paraquat; acute poisoning; respiratory failure; prognosis; pulse therapy
musculoskeletal diseases; upper extremity; work; prognosis factor