Occupational hazards in Asansol, West bengal

The city of Asansol has many major industries which could pose occupational hazards and health risks. Asansol is close to the Raniganj Coal Fields and Sitarampur coal mines, making coal mining a significant industry. This is considered one of the most hazardous industries, where miners suffer directly from unhygienic working conditions in underground mines and pose a high risk for anthracosis. There are also other industries such as Steel and Iron manufacturing industries, cement and ceramic industries 

Light’s classification of Parapneumonic effusion

 CLASSIFICATION OF PARAPNEUMONIC EFFUSION

EMPYEMA LIGHT'S CLASSIFICATION - BASED ON

1) AMOUNT OF FLUID

2) GROSS CHARACTERISTICS OF PLEURAL FLUID

3) BIOCHEMICAL CHARACTERISTICS OF PLEURAL FLUID

4) LOCULATIONS

CLASS 1 – NON SIGNIFICANT PARAPNEUMONIC EFFUSION

•        Free flowing fluid

•        Less than 10mm on lateral decubitus chest radiograph

•        Treatment – antibiotics

CLASS 2 – TYPICAL PARAPNEUMONIC EFFUSION

•        Pleural fluid is free flowing

•        Thickness >10 mm

•        Pleural fluid Glucose > 40mg/dl

                          pH > 7.20

                          LDH < 3times the upper limit normal for serum

•        Bacterial smear and culture – negative

•        Rx – antibiotics alone

CLASS 3 – BORDERLINE COMPLICATED PARAPNEUMONIC EFFUSION

•        Bacterial smear and culture – negative

•        Glucose > 40mg/dl

•        pH between 7.00 to 7.20

•        LDH > 3 times the upper limit normal for serum (or)

•        Pleural fluid is loculated

•        Rx – antibiotics + serial thoracentesis

CLASS 4 – SIMPLE COMPLICATED PARAPNEUMONIC EFFUSION

•        Ph < 7.00

•        Glucose < 40mg/dl

•        LDH > 3 times the upper limit normal for serum

•        Positive gram stain or culture

•        Fluid does not look like pus and it is not loculated

•        Rx – tube thoracostomy + antibiotics

CLASS 5 – COMPLEX COMPLICATED PARAPNEUMONIC EFFUSION

•         class 4 + Loculations

•        Tube thoracostomy + fibrinolytics (or) thoracotomy with decortication (rarely)

CLASS 6 – SIMPLE EMPYEMA

•        Frank pus – either free flowing or single loculus

•        Have a thick peel over the visceral fluid that prevents the underlying lung from expanding

•        Rx – tube thoracostomy + decortication

•        If empyema cavity remains after several days of chest tube drainage - then decortication is considered

CLASS 7 – COMPLEX EMPYEMA

•        Frank pus – multiloculated

•        Initially – tube thoracostomy + fibrinolytics

•        Often requires – thoracoscopy with breakdown of adhesions or thoracotomy and decortication

Right minor fissure

 

   Surface anatomy of Right minor fissure

•   Anteriorly: It begins at the level of the 4th costal cartilage at the sternum.
•   Laterally:   It runs horizontally across the chest wall.
•   Posteriorly: It meets the oblique fissure around the level of the mid-axillary line, at the level of the 5th rib.

Zoonotic pneumonias

 Chlamydia psittaci- Psittacosis- Inhalation of bird feces or respiratory secretions

Francisella tularensis- Tularemia- Contact with wild and pet animals, birds or arthropods ( ticks, deer, fly)

Pasteurella multocida - Pasteurellosis-  Feline and dog contact; chronic lung disease

Rhodococcus equi-  Rhodococcus pneumonia- Airborne droplets; contact with soil contaminated with horse, cow, or swine excrement

Yersinia pestis- Plague-  Contact with rodents, fleas; contact with plague pneumonia case

Bacillus anthracis Inhalation anthrax or woolsorter’s disease- Industrial; use of or contact with animal products in hobbies. 

Toxoplasmosis- Toxoplasma gondii- Contact with feline species

Hantavirus infectionx- Infected rodents mainly inhaling airborne virus particles from urine, droppings or saliva. 

CARDINAL SYMPTOMS OF CVS:

 1) Chest pain

2) Brreathlessness

3) Palpitation 

4) Syncope

5) Edema

6) Fatigue

CAUSES OF PLEURITIC CHEST PAIN

CAUSES OF PLEURITIC CHEST PAIN

Pleuritic chest pain is a sharp, stabbing in the chest that worsens with respiratory movements such as deep breathing, coughing, sneezing, or laughing.

CAUSES:

1. Infectious Causes: These are among the most common reasons for pleuritic chest pain.

Viral Infections 

Bacterial Infections: Pneumonia, Tuberculosis

Fungal Infections: Though less common, fungal infections can also inflame the pleura, especially in individuals with weakened immune systems.

Parasitic Infections

2. Inflammatory and Autoimmune Conditions:

Pleuritis due to inflammation caused by conditions such as SLE, Rheumatoid arthritis, Sarcoidosis

Pleural Effusion

3. Cardiovascular Causes:

Pulmonary Embolism

Pericarditis

4. Neoplastic Causes (Cancers):

Lung Cancer invading or irritating the pleura.

I Mesothelioma

Pleural Metastatic Cancers

5. Traumatic Causes:

Rib Fractures or Chest Injury

Thoracic surgery or other procedures involving the chest can lead to temporary pleuritic pain.

ILD with family history - differential diagnosis

 Differential diagnosis of ILD with family history:

1. Idiopathic pulmonary fibrosis - most common form of familial ILD presenting as UIP pattern
2. Other idiopathic interstitial pneumonia - NSIP, cryptogenic organizing pneumonia
3. Connective tissue disorder associated ILD - rheumatoid arthritis, scleroderma associated ILD
4. Hypersensitivity pneumonitis - due to shared environmental exposure
5. Genetic mutations - Surfactant protein mutations (SFTPA2, SFTPC, ABCA3), telomeropathies (TERT, TERC), Hermansky pudlak syndrome, MUC5B polymorphism
6. Sarcoidosis

Health effects of dyes and chemicals used in Printing press

Process: Adhesive laminating 

Risk: Isocyanate prepolymers can cause an irritation of the airways and lungs leading to occupational asthma.

Process: Digital (ink-jet) printing

 Risk: Carbon present in black ink can cause lung irritation. Methyl ethyl ketone and propanol can cause abnormal heart rhythm and rate and can affect the liver and kidneys on long term exposure.

Process: UV lamps for photo processing, UV curing and high speed printing – ink misting 

Risk: Acrylates and methcrylates in  fumes can cause irritation of respiratory tracts with the potential for occupational asthma as well as severe headaches and nausea.

Health Effects Of Chemicals Used In Printing

Process: Etching, Engraving, Platemaking, Photographic Reproduction 

Risk: Nitric, sulphuric and hydrofluoric acids can cause skin burns, eye damage and blisters.

Process: Concentrated photographic developer or fixer solutions 

Risk: Acidic salt solutions and Hydroquinone can irritate eyes and even cause dermatitis

Process: UV and infra red curable inks, varnishes and lacquers 

Risk: Reactive acrylates or methacrylate’s can cause corrosion of the skin, eyes and mucous membranes.

Process: Lithographic platemaking, Gravure cylinder preparation and photoengraving. 

Risk: Ammonium, potassium and sodium dichromate’s are all very corrosive and can cause deep ulcers as well as a risk of cancer.

Process: Lithographic fount solution, blanket restorers, cleaning solvents, Gravure and flexographic Risk: Alcohol, Esters and Ketones can cause dermatitis, dizziness and other effects of the central nervous system.

Process: Flexographic, Dyeline Printing and Screen Inks Risk: Perchloroethylene, Ammonium hydroxide and Ketones can cause dizziness, drowsiness and other effects on the central nervous system via inhalation.

Process: Screen Cleaning chemicals 

Risk: Strong alkalis such as concentrated sodium or potassium hydroxide, Oxidisers and sodium hypochlorite solvents can cause corrosion of the skin, eyes and mucous membrane as well as dizziness and drowsiness

Progressive Pulmonary Fibrosis

 

Diagnostic Criteria for PPF:

To diagnose PPF, all three of the following must be present:

Underlying fibrosing ILD (non-IPF), with imaging or histology showing fibrosis.

Evidence of progression within the past year, based on at least one of the following:

1.Worsening respiratory symptoms, such as increasing dyspnea or cough.

2.Decline in lung function, especially:

Absolute decline in FVC ≥ 5% predicted

Decline in DLCO (diffusing capacity for carbon monoxide) ≥ 10% predicted

3.Progressive fibrosis on imaging, shown by:

Increased reticulation

New ground-glass opacities with traction bronchiectasis

Increased honeycombing

No alternative explanation (e.g., infection, heart failure, pulmonary embolism).

Aggravating factors for chief complaints

 AGGRAVATING FACTORS OF CARDINAL SYMPTOMS- MNEMONICS

COUGH:

PDFCE 

Pollution, Pollen, Posture

Drugs, Diurnal, Dry air

Food

Cold weather, Common cold

Exercise

SPUTUM

 "DRIVE DUST"

 

D – Dust exposure

R – Respiratory infections

I – Irritants (e.g., smoke, fumes)

V – Viral infections

E – Exercise or exertion

D – Dry air

U – Upper respiratory tract conditions (e.g., postnasal drip)

S – Smoking

T – Temperature changes (cold air or sudden temperature drops)

Breathlessness: 

 "BREATHE HARD"

 

B – Body position (e.g., lying flat in orthopnea)

R – Respiratory infections

E – Exercise or exertion

A – Anxiety or emotional stress

T – Temperature extremes (cold or heat)

H – Hypoxia or high altitude

E – Environmental triggers (allergens, pollutants)

H – Heart failure or fluid overload

A – Anemia

R – Reflux (gastroesophageal reflux disease)

D – Drugs (e.g., beta-blockers, 

WHEEZE:

“BREATHE WHEEZE”

B – Bronchial irritants (smoke, pollution)

R – Respiratory infections (viral or bacterial)

E – Exercise

A – Allergens (pollen, dust mites, animal dander)

T – Temperature changes (cold air)

H – Hormonal changes (pregnancy, menstruation)

E – Emotions (stress, anxiety)

W – Workplace irritants (occupational exposures)

H – Household triggers (perfumes, cleaning agents)

E – Environmental changes (high altitude)

E – Exposure to drugs (NSAIDs, beta-blockers)

Z – Zzz… sleep (nocturnal asthma triggers)

E – Eating (GERD-induced wheeze)

CHEST PAIN:

“CHEST PAINS”

C – Coughing or deep breathing (pleuritic pain)

H – Heat or cold exposure (vasospastic angina)

E – Emotion or stress (psychogenic pain, angina)

S – Swallowing (esophageal causes like GERD or spasm)

T – Trauma or movement (musculoskeletal pain, costochondritis)

P – Physical exertion (angina, cardiac ischemia)

A – Alcohol or large meals (GERD or esophageal spasm)

I – Infections (pleuritis, pericarditis, pneumonia)

N – Nighttime (GERD-related pain due to supine position)

S – Specific postures (pericarditis, GERD, musculoskeletal pain)

HEMOPTYSIS:

“COUGH BLOOD”

C – Coughing (increases airway pressure, ruptures small vessels)

O – Overexertion (exacerbates vascular stress)

U – Upper respiratory tract infections

G – GERD or vomiting (irritation of airways)

H – High altitude (pulmonary hypertension)

B – Bronchial infections (bronchitis, bronchiectasis)

L – Lung malignancy (coughing or irritation)

O – Operations (post-procedural bleeding, e.g., bronchoscopy)

O – Oral anticoagulants (worsen bleeding)

D – Deep breaths or physical strain (ruptures fragile capillaries)