Pulmonary infections due to nontuberculous mycobacteria (NTM) are increasingly recognized worldwide. Although over 150 different species of NTM have been described, pulmonary infections are most commonly due to Mycobacterium avium complex (MAC), Mycobacterium kansasii, and Mycobacterium abscessus. The identification of these organisms in pulmonary specimens does not always equate with active infection; supportive radiographic and clinical findings are needed to establish the diagnosis. It is difficult to eradicate NTM infections. A prolonged course of therapy with a combination of drugs is required. Unfortunately, recurrent infection with new strains of mycobacteria or a relapse of infection caused by the original organism is not uncommon. Surgical resection is appropriate in selected cases of localized disease or in cases in which the infecting organism is resistant to medical therapy. Additionally, surgery may be required for infections complicated by hemoptysis or abscess formation. This review will summarize the practical aspects of the diagnosis and management of NTM thoracic infections, with emphasis on the indications for surgery and the results of surgical intervention. The management of NTM disease in patients with human immunodeficiency virus (HIV) infections is beyond the scope of this article and, unless otherwise noted, comments apply to hosts without HIV infection

/pdf/nontuberculous-mycobacterial-pulmonary-infections-4nqntofrty.pdf

Nontuberculous mycobacterial pulmonary infections

Wheat is one of the major crops grown, processed and consumed by humankind and is associated with both intolerances (notably coeliac disease) and allergies. Two types of allergy are particularly well characterized. The first is bakers' asthma, which results from the inhalation of flour and dust during grain processing. Although a number of wheat proteins have been shown to bind IgE from patients with bakers' asthma, there is no doubt a well-characterized group of inhibitors of alpha-amylase (also called chloroform methanol soluble, or CM, proteins) are the major components responsible for this syndrome. The second well-characterized form of allergy to wheat proteins is wheat-dependent exercise-induced anaphylaxis (WDEIA), with the omega(5)-gliadins (part of the gluten protein fraction) being the major group of proteins which are responsible. Other forms of food allergy have also been reported, with the proteins responsible including gluten proteins, CM proteins and non-specific lipid transfer proteins. Processing of wheat and of related cereals (barley and rye, which may contain related allergens) may lead to decreased allergenicity while genetic engineering technology offers opportunities to eliminate allergens by suppressing gene expression.

Allergens to wheat and related cereals

https://purehost.bath.ac.uk/ws/files/144337654/A_Shokrani_JMP_Authors.pdf

Investigation of the effects of cryogenic machining on surface integrity in CNC end milling of Ti-6Al-4V titanium alloy

any of the myriad problems in the u.s. mortgage market could have been contained, but together they caused a crisis that spread across the globe T HE causes of the crisis in subprime mortgages have become clear. They started with poor underwriting practices, which became legion. But damage was propagated at each stage of the complicated process in which a risky home loan was originated, then became an asset-backed security that then formed part of a collateralized debt obligation (CDO) that was rated and sold to investors. What is not so clear, though, is how these losses could spread to other parts of the global financial system. Like an epidemic in which an invisible virus infects many people and communities, the financial crisis spread when losses to intermediaries in one nontransparent market raised concerns about liquidity and solvency elsewhere. Just as diseases are passed on by close human contact, pests, and contaminated food, so this financial crisis has been transmitted through connected markets and institutions while leaving others largely untouched. We examine the origins of the subprime crisis and the various places, some of them surprising, where the effects of the crisis have been found—such as markets in which banks make loans to one another, short-term commercial paper, and even municipal bonds.

An outbreak; of what?

Purpose of reviewSarcoidosis, the multiorgan granulomatous disease of unknown cause, remains mysterious Several important investigations in the past 2 years add to the accumulating evidence for both occupational and environmental causes of granulomatous inflammationRecent findingsThis review consi

Occupational causes of sarcoidosis.

Introduction Potential demographic risk factors for outbreaks of respiratory disease due to water-based metalworking fluids (MWFs) were investigated through systematic review of published outbreak investigations. Methods Search terms were selected by a multidisciplinary team, assisted by an experienced library information service. Several computerized literature databases were searched for articles published between January 1990 and October 2011, relating to ill health outbreaks due to MWFs. Papers meeting the search criteria were reviewed in detail, and their references checked for additional articles. Study design and demographic details of the outbreak were extracted from the selected articles and entered into standardized evidence tables. Results Thirty-five articles relating to investigations of 27 outbreaks of respiratory ill health attributed to MWF exposure were identified. The majority of reports were case series of disease or observational cross-sectional studies of symptoms and hygiene measurements. Eight of the outbreak investigations included an element of case-control analysis. Most outbreaks were from the USA, had occurred in large car- or aeronautical-manufacturing plants, and were associated with the use of central shared sumps. Hygiene studies have not demonstrated consistent risk factors for respiratory outbreaks, in terms of the type of MWF utilized, degree of microbial contamination, or levels of personal exposure. Six studies were identified that found workers with MWF exposure during outbreaks were more likely to report respiratory or systemic symptoms than unexposed control workers. Six case-control analyses were also identified that found workers with extrinsic allergic alveolitis (EAA) were more likely to demonstrate certain immune responses to microbial contaminants and/or used MWFs than workers without EAA. Conclusion Despite a number of detailed workplace and immunological studies of asthma and alveolitis outbreaks in MWF-exposed workforces, our understanding of their aetiology remains limited.

/pdf/systematic-review-of-respiratory-outbreaks-associated-with-6lch681asu.pdf

Systematic review of respiratory outbreaks associated with exposure to water-based metalworking fluids

Aim A random sample of general practitioners (GPs), practice nurses (PNs) and practice managers (PMs) in Sheffield and Manchester was recruited into a study to evaluate the perceptions of occupational health (OH) in primary care. Methods Qualitative data were collected using focus groups with three groups of primary care sector professionals. Quantitative data were collected nationally from 295 GPs using a postal questionnaire. Results GPs and PNs had minimal OH training, and 60% of GPs reported constraints in addressing OH matters with patients. The lack of referral routes (63 and 67%, respectively) was also seen as a barrier. OH was regarded as a speciality, and primary care professionals preferred to refer patients with OH problems to specialist centres because they perceived barriers to their dealing with the issues. A total of 74% of GPs surveyed thought that speedier access to secondary care would help them to address OH problems. Conclusions This study has identified some of the problems associated with delivering OH through primary care. It also demonstrated a need for greater emphasis on OH education in medical and nurse training, and a need for better advice for GPs, PNs and PMs regarding support services for OH.

The perceptions of occupational health in primary care

BACKGROUND Wood dust is a common cause of occupational asthma. There is potential for high exposure to wood dust during furniture and wood manufacturing processes. AIMS To evaluate the evidence for non-neoplastic respiratory ill health associated with work in the furniture and wood manufacturing sector. METHODS A systematic review was performed according to PRISMA guidelines. Articles were graded using SIGN (Scottish Intercollegiate Guideline Network) and MERGE (Methods for Evaluating Research Guidelines and Evidence) criteria, with data grouped by study outcome. RESULTS Initial searches identified 1328 references, from which 55 articles were included in the review. Fourteen studies were graded A using MERGE or >2++ using SIGN. All but one paper describing airway symptoms reported an increased risk in higher wood dust exposed workers in comparison to lower or non-exposed groups. Five studies reporting asthma examined dose response; three found a positive effect. The relative risk for asthma in exposed workers in the single meta-analysis was 1.5 (95% CI 1.25-1.87). Two studies reported more obstructive lung function (forced expiratory volume in 1 s [FEV1]/forced vital capacity < 0.7) in exposed populations. Excess longitudinal FEV1 decline was reported in female smokers with high wood dust exposures in one study population. Where measured, work-related respiratory symptoms did not clearly relate to specific wood immunoglobulin E positivity. CONCLUSIONS Work in this sector was associated with a significantly increased risk of respiratory symptoms and asthma. The evidence for wood dust exposure causing impaired lung function is less clearly established. Further study is required to better understand the prevalence, and causes, of respiratory problems within this sector.

Asthma in furniture and wood processing workers: a systematic review

To the Editors:

We read with interest the article published by Tillie-Leblond et al. [1] relating to hypersensitivity pneumonitis (HP) in French automobile workers exposed to metalworking fluids (MWFs). Our group was involved in the UK outbreak investigation referenced in their article [2, 3], and have a clinical and research interest in this area.

Whilst Tillie-Leblond et al. [1] are correct in stating that the majority of MWF-HP outbreaks have occurred in the USA, the UK Powertrain and French outbreaks are not the only ones to have occurred in Europe. We have provided scientific support to three other similar outbreaks in the UK, all with confirmed cases of MWF-HP [4, 5]. In addition, we have diagnosed single cases of MWF-HP or asthma in workers from at least five other workplaces close to our occupational lung disease clinic. We are also aware of a published respiratory outbreak from Croatia [ …

https://erj.ersjournals.com/content/erj/38/2/486.full.pdf

Hypersensitivity pneumonitis and metalworking fluids contaminated by mycobacteria

Objectives: Enzymes are commonly used in the baking industry, as they can improve dough quality and texture and lengthen the shelf life of the final product. There is little published information highlighting exposure to enzymes (other than fungal alpha-amylase) in the baking industry, therefore the purpose of this study was to identify antibodies and develop assays for the measurement of a variety of such enzymes in samples of airborne flour dust. Methods: Polyclonal antibodies to bacterial amylase, glucose oxidase and amyloglucosidase were identified and developed into ELISA assays. The assays showed limited cross-reactivity with other enzymes commonly used in the baking industry. Results: We measured levels of airborne enzymes in 195 personal air samples taken from a sample of 55 craft baking establishments. We were able to detect amyloglucosidase in 9% (16/184)ofthesamples,fungalalpha-amylasein6%(11/171),bacterialalpha-amylasein7%(13/ 195). However, we were unable to detect glucose oxidase in any of the samples. Measurements for protease enzymes were not carried out. Median levels in detectable samples of amyloglucosidase, fungal alpha-amylase and bacterial amylase were similar at 10.3, 5.3 and 5.9 ng/m 3 , respectively. These figures represent the total enzyme protein (active and inactive) measured. Conclusions: There are few data in the literature regarding sensitization and exposure– response relationships to these enzymes, and indeed there is often a lack of information within the industry as to the precise enzyme content of particular baking ingredients. As a precautionary measure, all enzymes are regarded as having the potential to cause respiratory sensitization. Consequently, exposures need to be controlled to as low a level as reasonably practicable, and future investigation may highlight the importance of measuring a variety of enzyme exposures and standardizing these methodologies to inform approaches to adequate control.

Enzyme exposure in the British baking industry

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