Search

Background: In Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics., Objective: The study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention., Methods: The Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite)., Results: The study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60%) patients were from the public sector, while 600 (40%) patients were from the private sector. A total of 1298 (86.3%) patients received a conventional pacemaker and 75 (5%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5%) patients. Of these patients, 45 (3%) underwent CRT-D implantation., Conclusions: This study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care., Trial Registration: ClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759., International Registered Report Identifier (irrid): RR1-10.2196/47525., (©Sonia Chabrak, Abdeddayem Haggui, Emna Allouche, Sana Ouali, Afef Ben Halima, Slim Kacem, Salma Krichen, Sonia Marrakchi, Wafa Fehri, Mohamed Sami Mourali, Zeineb Jabbari, Manel Ben Halima, Elyes Neffati, Aymen  Heraiech, Mehdi Slim, Salem Kachboura, Habib Gamra, Majed Hassine, Sondes Kraiem, Sofien Kammoun, Leila Bezdah, Gouider Jridi, Hatem Bouraoui, Samir Kammoun, Rania Hammami, Rafik Chettaoui, Youssef Ben Ameur, Fares Azaiez, Rami Tlili, Kais Battikh, Hedi Ben Slima, Rim Chrigui, Samia Fazaa, Islem Sanaa, Yassine Ellouz, Mohamed Mosrati, Sami Milouchi, Soumaya Jarmouni, Wacef Ayadi, Malek Akrout, Rabie Razgallah, Wissal Neffati, Meriem Drissa, Selma Charfeddine, Salem Abdessalem, Leila Abid, Lilia Zakhama. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 08.04.2024.)

The large language models GPT-4 Vision and Large Language and Vision Assistant are capable of understanding and accurately differentiating between benign lesions and melanoma, indicating potential incorporation into dermatologic care, medical research, and education., (©Katrina Cirone, Mohamed Akrout, Latif Abid, Amanda Oakley. Originally published in JMIR Dermatology (http://derma.jmir.org), 13.03.2024.)

The purpose of this work was to investigate the structural, thermal, micromechanical and tribological properties of novel polymer/metal composite materials for bearing applications. Copper (Cu)-filled Acrylonitrile Butadiene Styrene (ABS) composites were mixed in a laboratory scale by an internal mixer with two blade impellers, and then injection-molded. Neat ABS, ABS+5wt% Cu, ABS+10wt% Cu, and ABS+15wt% Cu were the four materials that were tested. The dispersion of Cu particles in the ABS matrix was investigated using Scanning Electron Microscopy (SEM) and a micro-tomography scan. The filler particles have a uniform distribution in the matrix, according to the observations. The incorporation of Cu filler also refined an increase in the glass transition temperature from Differential Scanning Calorimetry (DSC) and less intensity in the amorphous phase by X-ray diffraction (XRD). Nanoindentation tests were carried out to characterize the micro-mechanical behavior of the composites. Friction and wear analysis were also examined using a pin-on-disk tribometer. Compared with neat ABS, all the micro-composites showed much higher indentation hardness, Vickers hardness, and indentation elastic modulus. It was also concluded that the incorporation of Cu filler into ABS simultaneously improved the friction and wear properties of the composites, which contributed to the suitability of the micro-filled composites with hard metallic particles for a wider range of mechanical components for bearing applications.

Competing Interests: None disclosed.

Objective. This study aimed to examine the association of the different dimensions and forms of work-family conflict with the occurrence of neck and lower back pain (LBP) in Tunisian nurses. Methods. We conducted a cross-sectional study on nurses assigned to a district hospital in Tunisia. The work-family interface was assessed with the work-family conflict scale of Carlson et al. Psychosocial and organizational constraints at work were assessed through the nursing work index - extended organization in its specific version designed for nurses. Assessment of neck and lumbar pain was carried out with the standardized Nordic musculoskeletal questionnaire. Results. Seventy-two nurses participated in the present study (participation rate = 100%) with a mean age of 42.38 ± 10.85 years. Binary logistic regression analyses retained strain-based work-to-family conflict as a significant determinant of both LBP ( p  < 10 -3 ; odds ratio [ OR ] = 5.07; 95% confidence interval [CI] [2.1, 11.7]) and neck pain ( p  = 0.001; OR  = 6.8; 95% CI [2.13, 22]). Conclusions. Strain-based work-to-family conflict was found to predict lumbar and cervical pain more than the other types of conflict in nursing staff. Thus, reducing strain in health-care settings should be a central component of the preventive approach of musculoskeletal disorders in nursing staff.

Summary: Aims. To assess the influence of socio-professional factors on mental health of teachers at primary and secondary schools. Materials and Methods. It's a cross-sectional study, lasted 3 months of the year 2014. This study involved a representative sample of teachers working in public schools. Data collection was based on a survey sheet prepared beforehand and describing socio-demographic and occupational characteristics of the participants. Mental health was assessed by the GHQ 30 score in its validated version in Arabic. Results. Study population was composed of 255 teachers with a participation rate of 78.43%. This population was characterized by a slight female predominance (57.5%) with a sex ratio of 0.73. The mean age was 43.54 ± 8.9 years. Of the responding teachers, 17% felt that their profession was poorly perceived by the society. More than half of participants were satisfied with their profession (68.8%). Relational constraints with parents were reported by 50.5% of teachers. Seventy-one teachers reported having problem of indiscipline in class. The mean GHQ score was 7.21 ± 6.24. Teachers' psychological health deterioration was significantly correlated with smoking (p = 0.03, OR = 0.2, IC = [0.05-0.9]) , pathological antecedents (p = 0.02, OR = 3.6, IC = [1.1-10]), feeling guilty toward pupils passivity (p = 0.01, OR = 3.8, IC = [1.3-10]), to professional seniority (p = 0.008, OR = 0.2, IC = [0.06-0.6], to the image referred back by the society (p = 0.005, OR = 4.9, IC = [1.6-15]), to emotional exhaustion and personal satisfaction (p = 0.00, OR = 12.7, IC = [3.4-47] ). Conclusion. Acting on these factors through a collective preventive approach headed by the Ministry of Education is necessary to reduce the rate of psychological distress among teachers and therefore improve the quality of teaching., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by Aracne Editrice, Roma, Italy.)

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.

Cardiac metastases are rare. They are found in one to 10% of autopsies of patients withmalignant neoplasm. Adenocarcinoma represents the most common histologicaltype. The most common neoplasms that metastasize to the heart are lung andbreast cancers, melanoma, mesothelioma and lymphoma. However, Cardiacinvolvement is unusual in Hepatic, cutaneous and gastric cancer. We reportedthese three primary localizations in our cases.

Introduction: Career dissatisfaction among occupational physicians (OP) may affect their performance and the quality of healthcare services provided. Our study aims to assess the job satisfaction of OP serving on the Institutes for Occupational Safety and Health(IOSH) in Tunisia and to identify the determinant factors., Methodology: We conducted a national cross-sectional validated SAPHORA JOB survey among all the OP serving on 22 IOSH., Results: 58% of OP serving on the IOSH were dissatisfied with their career. Career satisfaction was statistically influenced by the number of healthcare facilities for which they were responsible (p=0.016), the work organisation (p=0.010), the work impact (p=0.011), the salary (p‹10-3) and knowledge on current regulation (p=0.047)., Conclusion: The standardisation of pay scale and career ladders for OP serving on the IOSH based on a revision of legislative texts is recommended. Improving organization and working conditions may allow success in the workplace and benefit enhancement.

Introduction: This study has been performed to determine the influence of rotating shift work on physical working capacity of Tunisian nurses and to design recommendations to managers so that they implement effective preventive measures., Methods: It is a cross-sectional design using a standardized questionnaire and many physical capacity tests on a representative sample of 1181 nurses and nursing assistants from two university hospital centers of the school of Medicine of Monastir located in the Tunisian Sahel. 293 participants have been recruited by stratified random sampling according to gender and departments. Maximum Grip strength, 30s sit-to-stand test, one leg test, Fingertip-to-Floor test, Saltsa test and peak expiratory flow were used to assess physical capacity. Work ability was assessed through the workability index., Results: Mental and physical loads were heavily perceived in shift healthcare workers (p=0.01; p=0.02). The maximum grip force was stronger in rotating shift work nurses (p=0.0001). Regarding to the seniority subgroups in each kind of work schedule, the Body Mass Index was increasing with seniority in both schedules. All the physical tests, were better in less-than-ten-year groups. Peak Flow and grip strength were significantly better in less-than-ten-year seniority in shift work group., Conclusion: There is a need to improve the design of the existing shift systems and to reduce as much as possible shift schedule as well as to avoid shift schedule for over-10-year-seniority nurses., Competing Interests: The authors declare no competing interests.

Objective: To identify the factors influencing the quality of life and professional future of patients suffering from occupational asthma., Method: A cross-sectional study of patients compensated for occupational asthma in Tunisian center during 2004-2011. The study of quality of life was based on the Asthma Quality of Life Questionnaires (AQLQ). Some related patents were also discussed., Results: One hundred twenty-nine patients were compensated and the mean age was 40.8 ± 7.6 years. The global score of quality of life was 3.65 ± 0.75. The group of employees having a "bad quality of life" included 82 patients (77.3%), 73 patients kept the same job (56.6%), 20.9% had an occupational reclassification, 13.9% were dismissed, 6.2% abandoned their job and 2.3% were put in disability. The analytical study of the quality of life showed that: - The global score was correlated with the fact of keeping the same job and the application of preventive measures. - The score in the "symptoms" area was correlated with working in the textile sector and the association with an occupational rhinitis. - The score in the "activity limitation" area was correlated with age. The analytical study of the professional future revealed that maintaining the same job was correlated with low rates of permanent partial disability., Conclusion: Our study revealed the need to implement early preventive measures and to establish a systematic review of the permanent partial disability rate attributed to workers suffering from occupational asthma before the end of the legal period of five years., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Background: Major effects of shift schedule are related to sleep alertness and performance, but also to long term health outcomes. For nurses, these negative effects have consequences not only on the individual, but also on the workplace, as decreased alertness and reduced job performance could endanger human lives., Objective: The specific aim of our study is to assess the influence of shift schedule on nurses´ cognitive ability and rapidity of execution., Method: Our survey is a cross sectional study which had been conducted for 15 months; it involved a sample of 293 participants representative of 1118 nurses working in two Tunisian university hospitals. It included an evaluation of the rapidity of execution performance through the manual dexterity test and the reaction time test. The study was completed by an assessment of the workability Index through a 7- item survey., Results: No association was found between the groups of work schedules and the cognitive ability of execution speed. However, we found a significant decrease in cognitive performance in the nurses exceeding 10 years of job seniority for both schedules., Conclusion: We concluded to an impaired cognitive performance speed in the over 10-year seniority groups in both schedules. Recommendations should be focused on implementing periodic assessment of cognitive performance based on O'Connor finger dexterity test and time reaction test and on implementing effective preventive measures in hospitals after ten years of seniority at work., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

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<0.05) and dairy products (p<0.05). The coefficient of correlation between the two methods is highly significant, ranging from 0.876 for pasta to 0.989 for dairy products. Nutrient intake calculated for both methods showed insignificant differences except for fat (p<0.001) and dietary fiber (p<0.05). A highly significant correlation was observed between the two methods for all micronutrients. The test agreement highlights the lack of difference between the two methods., Conclusion: The difference between the 24-hour recall method using digital photos and the weighing method is acceptable. Our findings indicate that the food photography manual can be a useful tool for quantifying food portion sizes in epidemiological dietary surveys.

Background - Neonatal lupus erythematosus is an uncommon acquired autoimmune disease caused by transplacental passage of maternal antibodies SSA/Ro, SSB/La or U1 ribonucleoproteins. The most common clinical manifestations are skin rash, cardiac lesions, thrombocytopenia, anemia and hepatosplenomegaly. Complete congenital heart block is usually irreversible needing a pacemaker implantation in two-thirds of cases. Cases report - We report neonatal lupus erythematosus with complete congenital heart block in twins. Newborns were delivered by caesarean section at week 38 of gestation with a heart rate regular at 70 beats per minute. Both twins and mother were positive for antinuclear, anti-SSA, and anti-SSB antibodies. Twins received single-chamber pacemaker implants at day 12 of life. The evolution was immediately favorable with a heart rate around 110 beats per minute. The follow-up was 2 years. The twins are currently asymptomatic. Conclusion - Complete congenital heart block is the most serious manifestation of the neonatal lupus erythematosus associated with significant morbidity and mortality.

There is increasing evidence that environmental factors in early life predict later health. The early adiposity rebound recorded in most obese subjects suggests that factors promoting body fat development have operated in the first years of life. Birth weight, growth velocity and body mass index (BMI) trajectories seem to be highly sensitive to the environmental conditions present during pregnancy and in early life ("The first 1000 days"). Particularly, nutritional exposure can have a long-term effect on health in adulthood. The high protein-low fat diet often recorded in young children may have contributed to the rapid rise of childhood obesity prevalence during the last decades. Metabolic programming by early nutrition could explain the development of later obesity and adult diseases.

Background: Grip muscle force has always been used to assess functional limitations in elderly. Its use as a tool to assess work capacity has never been described in the literature., Objective: To describe the patent determinants of grip strength and the usefulness of its measurement in assessing workability index in the healthcare sector., Methods: This is a cross-sectional study conducted in a sample of 293 healthcare workers representative of 1181 based on a comprehensive questionnaire about socio-professional characteristics and on an 8-item work capacity evaluation (WAI). Besides, Body mass index was measured and muscle strength was assessed by JAMAR hydraulic dynamometer., Results: Handgrip Strength was stronger in male nurses (p < 0.001), with low perceived physical load (p = 0.0001) and working on a night shift (p = 0.001). It decreased with a greater duration of household work (p < 0.0001) and increased with a greater BMI (p = 0.015) and a better workability index (p < 0.0001). After removal of all the variables that were not independently associated with the muscle strength force, factors accounting for 52.6% of the variance in nurses handgrip strength were gender (p < 0.001), workability index (p < 0.001), duration of household work (p = 0.021), BMI (p = 0.002), perceived physical load (p < 0.001) and work schedule (p = 0.002)., Conclusion: Grip Strength Test is a useful tool to assess strength and functional capacity at work in healthcare workers. Further longitudinal studies are required to confirm this hypothesis.

Aims: The aim of this study is to assess the neuropsychological manifestations of mercury exposure in dentists., Methods: A cross-sectional study was carried out including 64 dentists matched to a control group according to age and gender. This study protocol included a neurological evaluation, a questionnaire assessing the study groups' general characteristics and personal factors that may affect mercury urinary excretion in both groups. EUROQUEST questionnaire and Hospital Anxiety and Depression scale (HADS) were used to evaluate the neuropsychological symptoms reported during the last 12 months. In both groups, mercury impregnation was assessed by monitoring urinary mercury., Results: In the exposed group, scores of neurological symptoms, memory disturbances and anxiety were found to be significantly higher than those in controls (p < 0.01). Mean scores of HAD Depression's scale were higher in the exposed group than in controls. Most of the neurotoxic manifestations were correlated to the levels of urinary mercury excretion in the exposed group. Mean levels of urinary mercury were significantly higher in the dentists group than in controls, with respective values of 21.1 ± 19.6 µg/g of creatinine and 0.05 ± 0.9 µg/g of creatinine. In nine dentists having urinary mercury levels higher than 35 µg/g of creatinine, neurological examination showed a bilateral and symmetric intentional tremor in both upper limbs. In the exposed group, the neuropsychological manifestations and levels of urinary mercury were found to be significantly correlated., Conclusion: Increased levels of urinary mercury observed in dentists suggest that exposure to mercury vapour emissions adversely affects dental professionals, therefore prevention measures should be strengthened, with a special medical supervision program of dentists exposed to mercury vapours should be implemented. We have also outlined some relevant patents in this article.

Epidemiological studies suggest that cytogenetic biomarkers, such as micronuclei (MN) in peripheral blood lymphocytes may predict cancer risk because they indicate genomic instability. The objective of the present study was to evaluate the frequencies of MN and chromosome aberrations (CA) in peripheral blood lymphocytes of hospital workers exposed to ionizing radiation and healthy subjects. The study was conducted using peripheral blood lymphocytes from 30 workers from the radiology department and 30 from the cardiology department. This study included 27 healthy age- and sex-matched individuals as the control group. The assessment of chromosomal damage was carried out by the use of CA and micronucleus assays in peripheral lymphocytes. Our results show that CA and micronucleus frequencies were significantly higher among the exposed groups when compared to controls. Our finding of significant increase of CA and MN frequencies in peripheral lymphocytes in exposed workers indicates a potential cytogenetic hazard due to this exposure. The enhanced chromosomal damage of subjects exposed to genotoxic agents emphasizes the need to develop safety programs.

Aim: To report our clinical experience with transcatheter closure of ostium secundum atrial septal defects (OS ASDs) using Amplatzer septal occluder., Methods: It's a retrospective study conducted between October 2005 and April 2010 and involving 34 patients. The procedures were conducted in the hemodynamic laboratory under general anesthesia with transthoracic (TTE) and transoesophageal echocardiographic (TEE) monitoring. Clinical and echocardiography assessments of the patients were conducted within 24 hours post procedure and several months after the procedure., Results: From the 34 patients, 28 (82%) were females. The middle age was 27.5 years. The mean ASD diameter was 19.4 mm by TTE; 18.1 mm [12-38] by TEE, and 23.4 by angiography. The average size of the implanted devices was 23.2 mm ranging from 10 to 34 mm.The final success rate of the procedure was 90.9% (30/33). One patient was excluded from transcatheter occlusion and three patients (8,6%) had complications including two prosthesis migrations and one large residual shunting. A total of 4 patients (11,7%) underwent surgery. No major complication (thromboembolic events, obstruction of intracardiac structures, cardiac perforation, device embolization and endocarditis) or death has occurred during follow-up and all devices were securely anchored without any persistent residual shunts., Conclusion: Compared to previous data of the literature, percutaneous closure of OS ASDs using Amplatzer device appears safe and effective according to our experience of the cardiology department of Hedi Chaker Hospital.

Biomonitoring of effects in agricultural workers is necessary to assess the individual risk of handling pesticides. In this study, biochemical and haematological parameters were measured to evaluate the effects of exposure to these compounds in agricultural workers. The study was carried out in 110 workers and 97 control subjects. Several haematological and biochemical parameters were analysed. Assessment of haematological parameters revealed that the mean cell volume and haematocrit levels were significantly lower in workers than in controls (P=0.002 and 0.013, respectively), while mean corpuscular haemoglobin concentrations were higher in workers (P<0.001). There was also a significant inhibition of butyrylcholinesterase activity in workers compared with that in controls (P<0.001). Assessment of biochemical parameters further showed significantly higher activities of transferases, lactate dehydrogenase (P<0.001), alkaline phosphatase (ALP) (P=0.006) and creatine kinase (CK) (P<0.015), as well as higher levels of proteins (P<0.001), creatinine (P=0.001) and urea (P=0.001) in workers compared with controls, along with significantly higher uric acid levels (P=0.012). Furthermore, the number of years exposed to pesticides predicted higher activities of alanine aminotransferase, CK, ALP, as well as uric acid levels. Overall, chronic exposure to pesticides appeared to affect several biochemical parameters. These biomarkers seem to be indicative of adverse effects of pesticides in agricultural workers, confirming their use for routine monitoring of effects.

Objective: The purpose of the present study is to describe our experience with patients who have a transmural myocardial infarction (MI) in the presence of a normal coronary artery. The clinical profile, demographic characteristics and outcomes of these patients are discussed., Methods: Between January 2006 and August 2011, 21 patients who presented with a Q-wave myocardial infarction were found to have normal coronary arteries. The prevalence rate of this entity was 1.5% (21 out of 1,400 Q wave MI patients). These patients were characterized by their young age (the mean age=44.95±14.86), male dominance (90.47%), and a high prevalence of smoking (85.71%). In this study, 4 patients have an evident spontaneous spasm shown on coronary angiography which disappeared after intracoronary injection of nitrates. Coagulation Disorders, such as activated protein C resistance (APC) resistance, protein C deficiency and antiphospholipid antibody syndrome were found in 4 of 12 patients who underwent systematic examination. One patient had a history of lung cancer which may be associated with a hypercoagulable state and may explain the occurrence of myocardial infarction with a normal coronary artery. The mean left ventricle ejection was 56. 5±12. The mean follow-up was 24±10 months. Six patients developed residual chest pain which was generally easily controlled by anti-spastic therapy and no patient had a major cardiovascular event., Conclusion: Patients with Q-wave MI and with normal coronary arteries seem to have a good short and long-term prognosis especially when they are treated with an exclusive medical strategy.

We present the case of a 49-year-old male patient with prosthetic mitral valve endocarditis associated with QT prolongation and torsades de pointes. He was asymptomatic until the end of January 2012, when he was admitted to our hospital emergency unit because of syncope, fever, and suspicion of endocarditis. Cardiologic evaluation was requested and the transthoracic (TTE) and transesophageal (TEE) echocardiograms revealed vegetations on the prosthetic mitral valve. All cultures were positive for methicillin-sensitive Staphylococcus aureus. The corrected QT (QTc) interval was markedly prolonged upon admission (QTc 540 ms). He experienced torsades de pointes (TdP) several times and he was recovered after bystander cardiopulmonary resuscitation. The clinical course and the long QTc interval with deep inverted T wave were completely normalized 4 weeks after. He continued on triple antibiotic therapy for 45 days with a good revolution. The clinical features and the possible mechanisms of QT prolongation (inflammation, infection) of this patient are discussed.

This case report represents the difficulties in diagnosing brucellosis, which is an enigma with unusual cardiovascular complications. A 32-year-old Caucasian man with acute chest pain was examined at Sfax Hedi Chaker's Hospital. He had a night fever, although his cardiac examination was normal. Further laboratory analyses showed an elevated C-reactive protein of 20.8 mg/dL and troponine I of 1.469 IU/L. A cardiac MRI using delayed enhancement was then performed. The T2-weighted short-axis showed a subepicardial delaying enhancement of infero-lateral and the basal walls of the left ventricle. Accordingly, a diagnosis of Brucella-related myocarditis was made.

Frequency of the association between non-Hodgkin's lymphoma (NHL) and the hepatitis C virus (HCV) infection is variable according to previous studies. Besides, direct and/or indirect implication of the HCV infection in the development of NHL is probable but, its pathophysiological mechanisms remain unclear. In this report, we described the case of a 49-year-old patient with a B-cell NHL of the sacrum complicating a chronic HCV related to a blood exposure, and we report the recent data of this association.

We studied the influence of some factors on plasma butyrylcholinesterase activity (BChE) and we assessed the health status of agricultural workers and looked for the effects of chronic exposure to pesticides, in the aim to determinate factors that must be considered for interpretation of BChE, for occupational monitoring of workers exposed to pesticides. The study was carried out in 110 workers from the Sahel region of Tunisia exposed to pesticides and in 97 controls. All individuals have undergone clinical examination. BChE activity was measured by spectrophotometric method. The mean of BChE activity of workers was significantly lower than that of control group (P < 0.001). Among the 44% of farmworkers with at least one neurologic or neuropsychic symptom, 29% had BChE activity lower than 6000 IU/L. Headache was observed in 20% of workers. Ancientness of exposure equal to 10 years or more, last exposure dates back to 60 days or less, exposure for 2 days or more per week, exposure exceeding 150 h per year and to organophosphorus-carbamates mixture were implicated in significant decreases of BChE activity and can be considered as risk factors of cholinergic toxic effects. Thus, BChE activity is a useful indicator to monitor workers chronically exposed to pesticides. However, it should be accompanied by periodical health examination, taking into account risk factors, for an early identification of workers at increased risk.

Nowadays, occupational asthma is the most common form of occupational lung disease in the world. In some countries the textile industry remains an important source of potential agents causing occupational asthma. In the textile industry several agents such as cotton dust and dyes may cause occupational asthma. In this review, we discuss the epidemiology, pathogenesis/mechanisms, clinical presentations, management and prevention specific to occupational asthma in the textile industry.Work-related asthma risk is considerable. Current understanding of the mechanisms by which many textile agents cause occupational asthma is limited, especially for low molecular-weight sensitizers and irritants. The diagnosis is generally established on the basis of a suggestive history of a temporal association between exposure and the onset of symptoms and objective evidence that these symptoms are related to airflow limitation. Early diagnosis, elimination or reduction of exposure to the offending agent and early use of convenient therapy according to disease severity may play an important role in the prevention of long-term persistence of asthma. Its prevention in the textile industry should be both technical and medical. It depends on the difficulties to reduce dust level, the limits in arranging work station or in occupational rehabilitation. These difficulties are increased in small textile industry companies. Persistent occupational asthma in this sector is often associated with substantial disability and consequent impacts on income and quality of life. Prevention of new cases is the best approach to reduce the burden of asthma attributable to occupational exposures. This review also outlines different patents on the diagnosis and treatment of asthma.

Occupational healthcare may expose to various allergens and irritants. Thus, the allergic manifestations in nursing staff are frequent and their prevalence is increasing all over the world. In fact, many new substances continuously appear in the medical practices. These allergic manifestations include a wide spectrum of clinical symptoms such as ocular, nasal and especially bronchial symptoms, which can be isolated or associated. These diseases can be a source of many problems related to the occupational aptitude. All these conditions justify prevention procedure strengthening, which mainly consist in substituting the sensitizing agents, and applying collective and individual prevention measures. This article also refers to some patents on the treatment of allergy.

Introduction: The property of mercury to amalgamate with other metals is used to create a material for filling teeth. This material remains the cheapest and most efficient in tooth restoration. Mercurial toxicity has been documented since Antiquity but the metal remains widely used in some countries. This study compared mercury impregnation in dentists and dental assistants in Monastir (Tunisia) to another population not exposed professionally., Subjects and Methods: A cross-sectional study was made on 52 dentists and dental assistants working in private offices and in the stomatology unit of the Monastir teaching hospital, with a control group of 52 physicians and nurses working in the Monastir Fattouma Bourguiba hospital. The groups were paired according to age and gender. The study lasted three months. A questionnaire investigated the socioprofessional features of the study population, non professional mercury exposure, work environment, the various amalgam handling and preparation techniques, and preventive hygiene measures. Urinary and salivary sampling was performed so as to prevent any accidental mercurial contamination. Mercury level was assessed by atomic absorption spectroscopy in an automatic sampler, urine creatinine with Jaffé's colorimetric reaction. The results of mercury level assessment were expressed in microg/g of creatinine, salivary mercury in mug/l. The statistical analysis was made with the Epi.info 6 software. Khi(2) and Fisher tests were used to compare qualitative variables. The ANOVA test was used to compare averages with a statistic significance threshold at 0.05., Results: Sixty-one percent of individuals with risk exposure worked in a dental clinic. Bruxism and onychophagia were more important in the control group with a significant statistical difference (respectively, p=0.01 and p<0.0001). The urinary and salivary mercury levels were significantly increased in the exposed group, with respective values of 20.4+/-42.4microg/g of creatinine and 10.6+/-13.02microg/l versus 0.04+/-0.3microg/g of creatinine and 0microg/l in the control group. Disposing of amalgam waste was inadequate in 94% of the cases. The variation of mercury in urine was significantly influenced by the presence of fabric curtains (p=0.04). Eating lunch at meals at the work place was also linked to a significant increase of mercury levels in urine (p=0.04). The storage mode of mercury in open containers was a significant factor for variation of mercury level (p=0.03)., Discussion: Most dentists' private offices in Monastir do not comply or comply weakly with prevention measures linked to risk of mercury poisoning. Awareness campaigns were launched as well as actions for the improvement of work conditions: efficient aspiration of offices containing fixed sources of mercury, adequate storage of mercury and waste, and compliance to occupational hygiene rules.

Objective: Respiratory allergies are the most common occupational diseases in the world. The aim of this study was to determine the prevalence of rhinitis and asthma among apprentices exposed to cotton dust in the clothing industry and to describe their epidemiologic and clinical profiles., Subjects and Methods: We carried out a descriptive study of 600 apprentices in a textile and clothing vocational training centre in the Monastir area. The investigation comprised a questionnaire exploring risk factors and symptoms appearing during their training. Subjects who developed allergic respiratory symptoms at the work-place underwent a clinical examination, rhinomanometry and investigation of their allergic status and respiratory function., Results: One hundred twenty apprentices (20%) developed allergic respiratory reactions due to exposure to textile dust (exclusively cotton) during their training, with a positive withdrawal-re-exposure test. Conjunctivitis (14.3%) and rhinitis (8.5%) were the most frequent allergic symptoms. Twenty eight apprentices (4.6%) presented symptoms of asthma. Rhinitis was associated with asthma in 45% of cases. Two cases of asthma were diagnosed clinically at the work-place following their exposure to textile dust. The prick test performed in 120 symptomatic apprentices was positive in 41.6% of cases. There was sensitization to pollens in 29 cases and to dermatophagoides in 13 cases. Cotton and wool allergy was noted in two cases. Allergic symptoms developing during the training were significantly more frequent in the atopic group, and they varied according to the intensity of textile dust exposure., Conclusion: In the textile and clothing industry the frequency of respiratory disorders caused by allergens remains high, especially in atopic apprentices who constitute a population at high risk.

Objective: 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., Materials and Methods: 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., Results: 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 (P<0.01) and hamstring peak torque 46.50+/-10 vs. 59.86+/-12 Nm (P<0.01). 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) (P<0.05), 29.64 +/- 664 vs. 37.76 +/- 7.2 ml min(-1) (P<0.05), 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; P<0.01). 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; P<0.001) but not at VT., Conclusion: 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.

The objective of this study was to determine the efficacy of systemic colistin therapy in the treatment of nosocomial infections caused by multidrug-resistant Acinetobacter baumannii or Pseudomonas aeruginosa and to study related adverse events. We prospectively studied 78 infections caused by multidrug-resistant A. baumannii or P. aeruginosa that were treated with colistin. The sites of infection were pulmonary infection (78.2%), urinary tract infection (7.7%), primary bloodstream infection (11.5%) and meningitis (2.6%). The mean daily dose of colistin was 5.5+/-1.1 MU/day (range 2-9 MU/day) and the mean duration of colistin therapy was 9.3+/-3.8 days (range 5-21 days). A favourable clinical response to colistin occurred in 60 cases (76.9%). Renal failure occurred in only seven cases. We conclude that colistin can be a safe and effective salvage therapeutic option for nosocomial infections caused by multidrug-resistant A. baumannii or P. aeruginosa.

Objectives: Because of its frequency and consequences on professional life, low back pain (LBP) represents a real health care problem. Our study is aimed at determining the prevalence of LBP among hospital staff, analyzing the medical and professional consequences as well as investigating into the factors associated to this health problem., Methods: We have conducted an inquiry among 350 employees at Fattouma Bourguiba teaching hospital. The employees have answered a pre-established questionnaire including 51 items., Results: The cumulative life-prevalence was 57.7% of the cases. The annual prevalence was 51.1% of the cases. Chronic LBP prevalence was 12.8% of the cases. Medical care was required in 61.9% of the cases. Radiological explorations were performed in 45% of the cases. Sick leave was observed in 26.1% of the cases and an occupational change was necessary in two cases. Factors associated to LBP were age (P <0.01), female gender (P = 0.024), high BMI (P = 0.01), the fact of being married or divorced (P < 0.01), smoking (P = 0.016), past medical LBP history (P < 0.0001), extra professional activity (P < 0.01), migraine (P < 0.001), years' service (P = 0.007) as well as heavy weight lifting (P = 0.008). Exercise is rather a protecting factor against LBP (P = 0.019)., Conclusion: The prevalence of LBP among hospital staff as well as the socio-professional drawbacks is important. Many factors are associated to LBP urging medical teams to take some preventive measures to reduce this affliction.

We explored the effect of fasting in the month of Ramadan on the dietary pattern of a group of 130 healthy adults. During Ramadan, there was an increase in total energy intake, as a result of protein and lipid intake but not carbohydrate intake compared to the diet througout the rest of the year, in both students and parents. The meal eaten after sunset was an important contributor to calories (65%), lipids (74%), proteins (71%) and carbohydrates (56%). These findings show the eating behaviour during Ramadan may contribute to improved nutritional status of people at risk of nutritional deficiency.

Background: Prevalence of non-insulin-dependent diabetes mellitus was analyzed from a baseline survey of risk factors for cardiovascular disease in a random sample of the 35-50-year old population of the Gouvernorat of Nabeul, Tunisia., Methods: Diabetes was assessed on the basis of an interview and fasting blood glucose level among a sample of 692 men and women (35% aged 35-40 years, 30% aged 40-45 years, 35% aged 45-50 years). RESI;TS: Forty-six percent of the sample were men. The prevalence of diabetes was 7.2%; two-thirds of the identified cases of diabetes were known. The prevalence of diabetes was much higher in the urban area (9.3% in men and 10.4% in women) compared with the rural area (2.0% in men and 4.5% in women). Mean body mass index was significantly different (p<0.01) between normal and diabetic subjects. Hypertension was three times higher in diabetic subjects (33%) than in normal subjects (9%). Triglycerides level was higher in diabetic subjects (1.92+/-1.72mmol/l) compared with non-diabetic subjects (1.29+/-1.02mmol/l). There was a positive relation between blood glucose level and triglycerides level, independently of obesity in women, but dependently in men., Conclusion: In the Tunisian population, known to have a low level of cardiovascular risk factors, the relationships between diabetes, obesity, hypertension, and lipid abnormalities are similar to those observed in Western populations.

Background: An assessment of nutriment intake (protein, carbohydrates, fat) was collected from a baseline survey of risk factors for cardiovascular diseases from the urban and rural population of the North East of Tunisia (Cap-Bon)., Methods: 692 men and women, 35-50-year-old, were examined. The sample was randomly selected on the basis of the 1984 census from the population of Cap-Bon. A standardized 24-hour recall and a semi-quantitative food frequency questionnaire were used., Results: The amount of food consumed differed between men and women (expressed in absolute value), but no significant difference was shown between men and women when food intake was expressed in relative value (contribution to total energy intake). The living area (urban, rural) appears to be an important factor influencing nutritional intake., Conclusion: In the urban population, the increase of protein and fat intake (saturated fat and dietary cholesterol) and the decrease of carbohydrates and fiber intake schematize the trend of dietary habits in Tunisia.

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.

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.

Objective: To investigate the relationship between early nutrient intake and adiposity development., Design: A follow up study of nutrition and growth carried out in a sample of 112 French children from 10 months to 8 years of age., Measurements: Nutritional intakes at the age of 2 years and anthropometric measurements: Body Mass Index (BMI), subscapular and triceps skinfolds at the age of 8 years, and age at adiposity rebound assessed on the basis of BMI development., Results: The BMI at the age of 8 years is positively correlated with energy intake at the age of 2 years, but this correlation becomes non significant after adjustment for BMI at 2 years. Protein (% of energy) intake at the age of 2 years is positively correlated with BMI and subscapular skinfold at 8 years after adjustment for energy intake at 2 years and parental BMI. The percentage of protein at 2 years is negatively associated with age at adiposity rebound, i.e. the higher the protein intake at 2 years, the earlier the adiposity rebound and the higher the subsequent BMI level., Conclusion: Protein at the age of 2 years is the only nutrient intake associated with fatness development pattern. A high protein intake increases body fatness at 8 years of age, via an early adiposity rebound. The association between protein intake and obesity is consistent with the increased stature and accelerated growth of obese children. A high fat low protein diet (such as human milk) is adapted to high energy demand for growth in early childhood. Our results suggest that high protein diet early in life could increase the risk of obesity and other pathologies later in life.