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The aim was to describe the profile of workers with occupational multi-site musculoskeletal disorders (MSMSD) and study the relationship between these lesions and socio-professional factors. This is a cross-sectional study involving 254 subjects with occupational musculoskeletal disorders (MSD), identified in the Department of Occupational Medicine at the University Hospital of Mahdia, in Tunisia, over a period of 10 years from 2005 to 2014. The study population was subdivided into two groups; mono-site MSD and multi-site (≥2 sites) groups. Data collection was based on a questionnaire prepared beforehand and covered the description of sociodemographic and professional characteristics. To study psychosocial constraints at work, we have used the Karasek questionnaire. MS-MSD was correlated to the number of dependent children (p=0.02), job/place of work (p=0.00), qualification (p=0.02), taking a rest period (p=0.03), decision latitude (p=0.00), mental demands (p=0.002), social support (p=0.00) and job stress (p=0.04). After binary logistic regression, MS-MSD depended significantly on the number of dependent children (p=0.013; OR=0,33; IC=0,17-0,83), working spouse (p=0.05; OR=0.35; IC=0.12-0.99), job/place of work (p=0.00; OR=4.16; IC=1.95-8.88), qualification (p=0.008; OR=0.28; IC=0.11-0.72), taking a break during work (p=0.04; OR=3.10; IC=1.04-9.22) and social support (p=0.00; OR=7,1; IC=1,9-25,3). When individual risk factors are fixed, the prevention of MS-MSD must target modifiable levers, related to the professional environment of the employees.

We aimed to determine whether diminished cardiorespiratory capacity in patients with coronary artery disease (CAD) is accompanied by impaired skeletal muscle function as measured by isokinetic dynamometry. We also evaluated the correlation between isokinetic strength and aerobic capacity in these patients.Fifteen CAD patients and 15 age-matched healthy subjects (mean age 60+/-6 vs. 57+/-3.5 years) underwent maximal laboratory exercise testing, a 6-min walking test and an assessment of peripheral skeletal muscle function by use of an isokinetic apparatus. Quadricep and hamstring function was tested at two angular velocities, 150 and 180 degrees s(-1) with simultaneous electrocardiography monitoring. The cardiorespiratory and mechanical parameters (VO(2), ventilatory threshold [VT], heart rate [HR], and power) were measured at VT and at maximal effort.Quadricep and hamstring peak torque was impaired in CAD patients, with quadriceps peak torque at 180 degrees being 71.13 +/- 14 vs. 91.13 +/- 23 Nm (P0.01) and hamstring peak torque 46.50+/-10 vs. 59.86+/-12 Nm (P0.01). CAD subjects presented a deficient aerobic capacity as compared with the healthy subjects at maximal effort. At VT, the VO(2), ventilation, and HR were significantly lower in CAD patients, at 13.77+/-2.33 vs. 17.08+/-3.59 ml min(-1) kg(-1) (P0.05), 29.64 +/- 664 vs. 37.76 +/- 7.2 ml min(-1) (P0.05), and 86+/-14 vs. 111+/-15 beats min(-1) (P=0.001), respectively. The 6-min walking distance was significantly shorter for CAD patients than healthy subjects (425.93+/-52.77 vs. 551.46 +/- 57.94 m; P0.01). In CAD patients quadriceps and hamstring strength was not correlated with VO(2) at maximal effort and at VT. Total distance walked during the 6-min walk and VO(2)max were correlated (r=0.869; P0.001) but not at VT.CAD patients showed impaired cardiorespiratory capacity accompanied by increased muscle fatigability as compared with healthy subjects. An isokinetic muscle assessment in these patients must be achieved systematically and seems to have value in cardiovascular rehabilitation.

Objective: The aim of this study was to determine if the diminished aerobic capacity of coronary artery disease (CAD) in male patients is accompanied by a peripheral impaired skeletal muscle function and to assess the correlation between the isokinetic strength and aerobic aptitude of these patients. Materials and methods: Fifteen CAD patients and 15 healthy subjects (age: 60 ± 6 vs 57 ± 3.5 years old) performed both maximal exercise testing, an isokinetic assessment of knee muscles and a 6-minute walking test. The quadriceps and hamstrings were tested at 150 and 180°/s while being monitored with ECG. The cardio-respiratory and mechanical parameters (V02, VT, HR, and power) were measured at ventilatory threshold and at maximal effort during a maximal exercise testing. Results: Isokinetic assessment was conducted successfully with all patients. No rhythm irregularity or hemodynamic anomalies were observed in the 2 groups. Muscle testing revealed significant strength impairment. Quadriceps peak torque, at 150°/s was 77 ± 16 Nm in patients vs. 99 ± 23 Nm in controls, (p < 0.01) while at 180°/s the values were 71 ± 14 vs. 91 ± 23 Nm, (p < 0.01), respectively. For the hamstrings the values were respectively 49 ± 16 vs. 66 ± 14 Nm, (p < 0.01) and 47 ± 10 vs. 60 ± 12Nm,(p

Background : Estimation of food portion sizes has always been a challenge in dietary studies on free-living individuals. The aim of this work was to develop and validate a food photography manual to improve the accuracy of the estimated size of consumed food portions. Methods : A manual was compiled from digital photos of foods commonly consumed by the Tunisian population. The food was cooked and weighed before taking digital photographs of three portion sizes. The manual was validated by comparing the method of 24-hour recall (using photos) to the reference method [food weighing (FW)]. In both the methods, the comparison focused on food intake amounts as well as nutritional issues. Validity was assessed by Bland–Altman limits of agreement. In total, 31 male and female volunteers aged 9–89 participated in the study. Results : We focused on eight food categories and compared their estimated amounts (using the 24-hour recall method) to those actually consumed (using FW). Animal products and sweets were underestimated, whereas pasta, bread, vegetables, fruits, and dairy products were overestimated. However, the difference between the two methods is not statistically significant except for pasta ( p

Fat and muscle areas can be calculated from equations on the basis of upper arm circumference (C) and triceps skinfold thickness (TS). These equations assume a circular limb and muscle compartment and a symmetrically distributed fat rim: total upper arm area (TUA) = C2/(4 pi), upper arm muscle area (UMA) = [C - (TS x pi)2]/(4 pi), and upper arm fat area (UFA) = TUA - UMA. This traditional method underestimates the degree of adiposity. We propose that the unrolled fat rim is a rectangle whose length = C and width = TS/2. The following new indexes are based on this assumption: upper arm fat area estimate (UFE) = C x (TS/2), and upper arm muscle area estimate (UME) = TUA - UFE. To validate these equations, areas were measured with magnetic resonance imaging (MRI) in 28 children aged 9-15 y (17 control subjects and 11 obese subjects). Correlations between MRI and UFA and MRI and UFE were similar (r = 0.96 for both correlations in the control group and r = 0.84 and 0.82, respectively, in the obese group), but the areas assessed by MRI (13.8 cm2) were closer to UFE (12.4 cm2) than to UFA (11.2 cm2) in the control group as well as in the obese group (MRI = 48.7 cm2, UFE = 46.6 cm2, and UFA = 38.5 cm2). The limits of agreement between MRI and anthropometry were 5.7 +/- 5.8 cm2 for UFA and 0.6 +/- 5.0 cm2 for UFE, showing that UFA is not acceptable in most cases, whereas UFE measurements are close to MRI measurements. In conclusion, UFE and UME are simple and accurate indexes to assess body composition. French reference values are available from 1 mo to 17 y of age.

Background: Pregnancy in women with mechanical prosthetic heart valves carried an increased risk of thromboembolic complications due to changes in haemostasis. Prosthetic valve thrombosis is a serious complication resulting in high mortality. We reviewed the incidence, risk factors, and treatment strategies of this rare complication. Methods: In the present study 86 pregnancies in 57 women with prosthetic mechanical heart valve replacement were identified in our institution between 1985 and 2011. After careful review of the records, the most likely preditors of prosthetic valve thrombosis was assigned. Results: Seven patients from 23 to 38 years of age (mean age was 30 years) had 7 thromboses of mechanical heart prostheses during pregnancy. The prosthesis was mitral in all cases. The prosthesis was a ball valve in 3 cases and bi-leaflet in 4 cases. The most frequent clinical presentation was severe congestive heart failure. Initial emergency treatment was surgical in 3 cases and medical in 4 cases (simple heparin therapy). Secondary surgery was carried out in one patient after failure of heparin therapy. There was one death in the surgical group and 33% foetal mortality in the surviving women. In univariate analysis, predictors of prosthetic valve thrombosis were: inadequate level of anticoagulation and dilation of the left atrium Conclusion: Thrombosis is the most life-threatening complication for women with prosthetic heart valve during pregnancy. Inadequate level of anticoagulation and dilation of the left atrium are the two factors involved in the pathogenesis of prosthetic valve thrombosis. The overall mortality rate despite surgical treatment remains high. This study underscores the importance of meticulous surveillance of anticoagulation therapy in pregnant women with prosthetic valves.

Introduction: Behcet's disease is an inflammatory disorder of unknown origin, with mucocutaneous, ocular, articular, vascular, gastrointestinal and central nervous system manifestations. About 28 cases of myocardial infarction associated with Behcet's disease have been reported previously. Although coronary involvement is rare in Behcet's disease, it is especially important because it affects young individuals and often presents as acute coronary syndromes. Case presentation: A 22-year-old Tunisian man was admitted to our emergency department for retrosternal pain of two and a half hours duration. His detailed medical history revealed that he had no risk factors for coronary artery disease. His electrocardiogram showed anterior myocardial infarction. He underwent coronary angiography that showed constriction by 50% of the left anterior descending artery. When he was hospitalized one month later to evaluate this recent event, he developed clinical findings consistent with the diagnosis of Behcet's syndrome. Three months later, he experienced another episode of inferior myocardial infarction. Conclusion: This case highlights the importance of careful diagnostic work-up in the evaluation of myocardial infarction in patients. Although coronary involvement is rare in Behcet's disease, it is especially important because it affects young individuals and often presents as acute coronary syndromes.

Hyperthyroidism has many characteristic manifestations of various organ systems. Cardiovascular effects are frequent in these patients. A less known complication of hyperthyroidism is reversible right-sided heart failure and pulmonary hypertension. In the patient presented, the symptoms of atrial fibrillation and right-sided heart failure were the first manifestations of hyperthyroidism. Doppler echocardiography confirmed pulmonary hypertension. Other secondary reasons for pulmonary hypertension were excluded. Graves' disease was the only reasonable choice. The treatment of hyperthyroidism resulted in conversion in sinus rhythm, withdrawal of symptoms and signs of right-sided heart failure, and normalization of pulmonary artery pressure.

Facing a world undergoing fundamental and rapid change, healthcare organizations are seeking ways to increase innovation, quality, productivity, and patient value, keys to more effective care. Individual clinics acting alone can respond in only a limited way, so re- engineering the process key which services are delivered demands real-time collaborative technology that provides immediate information sharing, improving the management and coordination of information in cross-functional teams. StreamWorks is a development stage architecture that uses a distribution technique to deliver an advanced information management system for telemedicine. The challenge of StreamWorks in telemedicine is to enable equity of the quality of Health Care of Telecommunications and Information Technology also to patients in less favored regions, like India or China, where the quality of medical care varies greatly by region, but where there are some very current communications facilities.© (1996) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Individual patterns of food intake development have been investigated on the basis of a longitudinal study of nutrition and growth carried out in 112 children at the ages of 10 months, and 2, 4, 6, and 8 years. On the average, energy intake increased steadily with age. However, individual subjects sometimes followed a different pattern. Approximately 1 out of 5 subjects decreased their intake between two examinations. Besides, less than half the children (43%) were in the same category of energy intake (defined as tertiles) at 10 months and 8 years of age. Similarly, 47% of the children were in the same weight/height (BMI) category at 10 months and 8 years. Correlations computed between early intakes (10 months, and 2, 4, and 6 years) and intakes at 8 years were better for energy and protein intake than for fat and carbohydrates (CHO), showing that intake of energy or protein early in life has a better predictive value of intake at later ages. Energy intake development has been examined in those children who were found to be lean, medium, and fat at the age of 8 years; it increased more between the ages of 4 and 6 years, in children who were fat at 8 years. Individual variations of anthropometric measurements during growth are well documented. The present study points out that similar individual variations of intake also exists. These variations could reflect regulatory processes acting during growth and should be taken into account in investigating the child's appetite.

Regions of Interest of analog Mammograms with and without Microcalcifications (95 Clinical Cases Randomly selected) were Digitized and then compressed by a factor 10:1 using a block subband coding technique. Detectability of Microcalcifications was compared before and after compression by a R.O.C (Receiver Operating Characterstic) Pocedure involving 7 graduated radiologists. No significant difference was found between the area under the two R.O.C. curves (z=0.658 p=0.05).