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Introduction: polysensitization is often defined as sensitization to three or more contact allergens. The objectives of our study were to determine the prevalence of polysensitization to allergens patch test and to analyze the factors associated with allergen polysensitization of the European Standard Battery in comparison with cases of oligosensitization., Methods: this is a retrospective descriptive cross-sectional study that included all patients who had undergone patch tests at the Department of Dermato-Allergology of the Department of Occupational Medicine of University Hospital Center Farhat Hached in Sousse spread over 10 years from January 1, 2009 to December 31, 2018., Results: in total, we collected 464 cases of contact dermatitis during the study period. The average age of patients was 38.93 ± 12.52 years with a slight female predominance (52.8% of cases). Among all the patients who consulted during the study period (832 patients), 133 patients had positive reactions to 3 or more allergens 16% of patients. Concerning, the associations of the most frequently noted allergens were those of triplet (chromium, cobalt, and nickel) in 15 patients and triplet (mercaptobenzothiazole, thiuram mix, and IPPD) in 7 cases. The predictive factors of polysensitivity were the personal history of leg ulcers; the site of the lesions in the thorax and the erythematous squamous and dyshidrotic appearance of the lesions., Conclusion: this phenomenon is frequent polysensitization, and close collaboration between dermatologists and occupational physicians to prevent this type of multiple allergies through better management of personal and also professional risk factors., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (Copyright: Noura Belhadj et al.)

Introduction: Several clinical and epidemiological data point to a possible link between smoking exposure and contact dermatitis (CD)., Aims: To identify the clinical and epidemiological differences of CD in smoking and non-smoking subjects, and to determine the influence of smoking on the allergological profile of CD., Methods: Retrospective descriptive study who consulted the Department of Occupational Medicine and Occupational Pathology of the Farhat Hached University Hospital of Sousse (Tunisia) during a period of 8 years for exploration of CD and who were tested with the European Standard Battery (ESB)., Results: A total of 767 patients were enrolled during the study period, 40% of whom were smokers. The group of smokers was characterized by a male predominance (p=10-3) and a greater professional seniority compared to non-smokers (p=0.01). Personal history of atopy was predominant in non-smokers (p=0.02). Among the ESB allergens, there was a significant association between smoking and CD due to metals (chromium, cobalt) and conservatives. After binary logistic regression, the variables associated with smoking exposure were male gender (OR=12.12 ; 95% CI=[6.07 - 24.21]; p=10-3), Kathon CG allergy (OR=3.69 ; 95% CI=[1.24 - 10.81]; p=0.018), and right hand involvement (OR= 2.83; 95% CI=[1.29 - 6.17]; p=0.005)., Conclusion: Our study revealed an effect of smoking on the clinical and allergological characteristics of CD.

Introduction: This study aims to identify the epidemiological and occupational characteristics of patients with occupational asthma (OA) and to assess their clinical evolution and occupational outcomes., Methods: We carried out a descriptive epidemiological study over a period of five years (from 2012 to 2016) about the OA cases in the private sector reported in the Tunisian region of Zaghouan., Results: All in all, 165 OA cases were reported during the study period, representing an annual incidence of 733.3 cases per 1,000,000 workers in the private sector. Our study population was composed predominantly (85.5%) of women, whose mean age was 41.5±6.8years. More than three quarters of the affected persons were working in the automobile industry, and most illnesses (77%) were attributable to isocyanates. The mean time to onset of the respiratory symptoms was longer for low molecular weight agents (13.6±3.1years) compared to high molecular weight agents (12.0±3.9years) (P=0.0006). The majority of OA cases (66.7%) lost their jobs. Job loss was significantly more frequent among asthmatic women and workers with OA due to isocyanates. Among the 62 cases of OA for whom risk factors were eliminated, 45 nonetheless remained symptomatic., Conclusion: Effective prevention strategies involving the various actors need to be implemented in work environments so as to reduce the frequency and the medico-legal repercussions of a disabling condition., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: The COVID-19 pandemic is a real global health crisis. Its clinical presentation has evolved over time with an increasing number of symptoms. Olfactory dysfunction (OD) has recently been recognized as a frequent symptom relevant to screening for COVID-19, especially in pauci-asymptomatic forms. However, the underlying mechanisms of OD are not yet fully understood., Aim: To determine the prevalence of OD in healthcare workers with SARS-CoV-2 and to identify its associated factors., Methods: This is a cross-sectional, analytical study, carried out during a period of six months and including all healthcare workers at Farhat Hached Academic Hospital (Tunisia) who were diagnosed with SARS-CoV-2 by PCR, RAT, or chest CT scan., Results: A total of 474 healthcare workers were included, representing a participation rate of 85.4%. The mean age was 41.02±10.67 years with a sex ratio of 0.2. The distribution of this population by department noted that it was mainly maternity (13.9%). The most presented workstation was nursing (31.4%). OD represented 39.2% of the reasons for consultation. Hospitalization was indicated in 16 patients (3.4%). The average duration of hospitalization was 8.87 ± 7.8 days. The average time off work was 17.04 ± 11.6 days. OD persisted for more than 90 days in 35 patients (7.4%). After multiple binary logistic regression, OD was statistically associated with female gender (p =0.001; OR 95% CI: 2.46 [1.4-4.2]) and blue-collar occupational category (p =0.002; OR IC95%:3.1 [1.5-6.5]). A significant association was also noted between OD and professional seniority and absence from work duration (p =0.019; OR 95% CI: 0.97 [0.95-0.99] and p =0.03; OR 95% CI: 0.97 [0.95-0.99]) respectively., Conclusion: OD is common in COVID-19 patients. The identification of its associated factors may contribute to enhancing the understanding of its mechanism and drive therapeutic options., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Tobacco use and alcohol consumption are the primary risk factors for laryngeal cancer (LC). In most populations, occupational exposures are likely to play a minor role in laryngeal carcinogenesis. We aimed to investigate the association between occupational exposure and laryngeal cancer., Methods: It is a case-control study that included 140 cases diagnosed between January 2013 and December 2016 and 140 controls matched by sex, age, alcohol consumption, and tobacco consumption., Results: Significantly increased risks were found amongst workers of the building sector (OR=4.621; 95% CI [1.826-11.693]) and the mechanical industry sector (OR=5.074; 95% CI [1.425-18.072]). Significant association of laryngeal cancer with various carcinogens was observed such as asbestos (p=0.009; OR=3.68; 95% CI [1.29-10.46]), paint vapors (p=0.005; OR=3.35; 95% CI [1.37-8.16]), solvents (p=0.001; OR=3.29: 95% CI [1.61-6.68]) and cement dust (p=0.003; OR=3.19: 95% CI [1.43-7.12]). After binary logistic regression, cement dust was independently correlated with LC (p=0.042; OR=3.93; 95% CI [1.04-14.78]. The administration sector was associated with decreased risk (p=0.001; OR=0.07; 95% CI [0.03-0.15]) as well as the health sector (p=0.001; OR=0.098; 95% CI [0.02-0.43])., Conclusions: Our results supported the role of occupational factors in developing LC. Further studies enabling an in-depth analysis of occupational exposures are necessary to provide a clearer definition of the etiological associations between single agents and circumstances of exposure and the genesis of LC.

Background: Risk factors for the severity of occupational asthma (OA) are often attributed to occupational exposure. However, some recent epidemiological data suggest a link with obesity. The study aimed to analyze the relationship between obesity and the severity of (OA) assessed by non-specific bronchial provocation., Materials and Methods: We conducted an epidemiological descriptive retrospective study including patients who were referred to the Occupational Medicine Department of Farhat Hached University Hospital of Sousse, for (OA) and who have completed a non-specific bronchoprovocation test to metacholine., Results: Our population consisted of 131 cases of (OA) with a female predominance. The average BMI was 27.34 ±5.30 kg. Obesity was observed in 29.8% of cases. The non-specific metacholine bronchial provocation test revealed an average dose of PD20 at 750.4 ±656.3 μg. Severe (OA) was observed in (35.1%). After univariate analysis, obesity in asthmatics had a significant association with age (p<0.001), marital status (p=0.005), average professional seniority (p<0.001), the evolution of complaints (p=0.035) and abnormal initial spirometry (p=0.044). As for the severity of (OA), the univariate analytical study did not show a significant link with obesity (p=0.68)., Conclusion: The association between obesity and OA is not an easy task and should be made using more accurate tools to measure body fat percentage. The preventive role of the occupational physician is essential in factories in order to make more prudent decisions when employing workers with a high BMI in high-risk occupations. Hence the importance of regular monitoring of weight in workers exposed to asthmatics during periodic examinations., Competing Interests: Conflict of Interest There is no conflict of interest to declare., (Copyright© 2023 National Research Institute of Tuberculosis and Lung Disease.)

Laurus nobilis is known in the field of herbal medicine and in vitro studies for its antibacterial, antifungal, anti- diabetes, and anti-inflammatory beneficial effects. Laurus nobilis tea consumption was investigated with regard to its effects on anxiety and stress in healthy individuals, measured by subjective tools and by plasmatic cortisol levels. The study included thirty healthy Tunisian volunteers aged between 20 and 57 years consuming Laurus nobilis infusion, prepared from 5g of dried Laurus nobilis leaves in 100 ml boiled water, once a day during 10 days. Plasma concentrations of serum cortisol were measured before Laurus nobilis consumption and at the end of the experiment. Laurus nobilis tea consumption significantly decreased the concentration of plasmatic cortisol ([cortisol] D0= 93.5± 43.01ng/mL, D11=72.23± 25.37, p=0.001). A statistically significant decrease in PSS and STAI scores (p=0.006 and p=0.002 respectively) was also noted.These findings highlight the decrease in blood cortisol levels, which means a possible positive effect on reducing the risk of stress related-diseases in healthy volunteers consuming Laurus nobilis tea. However, more powerful studies with extended treatment periods are required.

Background: Healthcare workers are at a high risk of developing Occupational Dermatitis (OD). Affected workers often experience severe impairment of their Quality of Life (QoL). This study aimed to assess the skin-related QoL of healthcare workers with OD and to explore its related factors., Methods: A cross-sectional and exhaustive study was conducted among healthcare personnel of four public hospitals in the central region of Tunisia. All the cases of OD declared were included. Skin-related QoL was assessed using the validated Tunisian version of the "Dermatology Life Quality Index" (DLQI). Some related patents have also been discussed., Results: A total of 37 cases of OD were collected with an annual incidence of 4.2 cases per 10000 workers. The population was predominantly female (73%) and the mean age was 44.7±9.4 years. Nurses were the most represented occupational category (38%). Allergic contact dermatitis was the most frequent diagnosis (96%). The use of gloves was the most frequently reported occupational hazard (86%). The most frequently affected sites were hands (97%). The median score of DLQI was five. Multivariate analysis showed an association between the impairment of skin-related QoL and female gender (p = 0.04; OR = 19.3,84), exposure to disinfecting chemicals in the workplace (p = 0.01; OR = 17,306) and the absence of occupational reclassification (p = 0.01; OR = 21,567)., Conclusion: About one-third of the population had an impaired quality of life. The score impairment was significantly related to the female gender, exposure to disinfecting chemicals and the absence of occupational reclassification., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

The drafting of the initial medical certificate (IMC) is an innocuous act that can engage the responsibility of the certifier., Aim: To evaluate the quality of the IMC and their compliance with the legal provisions and to develop good practice recommendations for the drafting of the occupational accident certificate., Method: An epidemiological, descriptive and retrospective study was conducted in the University Hospital Center Farhat Hached (Tunisia) based on the occupational accident certificates completed by physicians during a period of 12 months., Results: In our study, 241 certificates were collected. The number of the patient's ID card was mentioned in 12% of cases. The date of the accident was noted in almost all cases (99.6%). The date of certification was indicated in all the cases. The average number of days of permanent work incapacity was significantly higher among male patients (p = 0.015), married patients (p≤10⁻³), and night workers (p = 0.05) and significantly lower among doctors (p ≤ 10⁻³)., Conclusion: Our study showed that the quality of the initial medical certificate drafting suffered from several inadequacies. This may be related to the lack of training of doctors in forensic practice, hence the importance of reminding the rules of good practice.

Aim: To study the influence of season on patch tests results., Methods: We conducted a retrospective epidemiological study which concerned all the patients of the Tunisian center, who consulted in the Dermato-Allergology Unit of Occupational Medicine Department of Farhat Hached University Hospital-Sousse (Tunisia) over a period of 07 years. All the patients were tested by the European Standard Battery allergens (BSE)., Results: The data of 1000 patch tests were analyzed during the study period. More than half of the patch tests (58.6%) was positive. In winter, 63% of patch tests showed a positive reaction versus 52% of patch tests in summer without a statistically significant association. However, results of lanolin alcohols, epoxy resin, and Sesquiterpene lactone mix varied significantly with season. Atopy was significantly associated with 18.8% of positive reactions in winter and only with 5.2% of positive reactions in summer ( p = 0.015)., Conclusion: Seasonal variations in patch tests results were more significant with some allergens of European Standard Battery and in atopic patients., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Aïcha Brahem et al.)

Introduction: Laurus nobilis is known in the field of herbal medicine and in vitro studies that it has beneficial effects such as antibacterial, antifungal, antidiabetes, and anti-inflammatory properties. Objective: We investigated whether L. nobilis tea consumption affects the plasma levels of lipid biomarkers in healthy volunteers. Methods: Thirty healthy Tunisian volunteers aged between 20 and 57 years old consumed L. nobilis infusion, prepared from 5 g of dried L. nobilis leaves in 100 ml boiled water, once a day during 10 days. Plasma concentrations of serum low-density lipoprotein (LDL) cholesterol, triglycerides and HDL (high-density lipoprotein) cholesterol were measured by Beckman Coulter D × 600 analyzer before L. nobilis consumption and at the end of the experiment. Results: L. nobilis tea consumption significantly increased the concentration of HDL cholesterol ([HDL cholesterol] D 0 = 1.34 ± 0.25 pg/mL, D 11 =1.42 ± 0.29, p  = 0.01). However, a slight decrease that was statistically non-significant in LDL cholesterol and triglycerides levels was observed ( p  < 0.05). Conclusions: These findings highlight the improving blood lipidic profiles, which means a possible positive effect on reducing the risk of cardiovascular disease of L. nobilis tea consumption in healthy volunteers. However, more powerful studies with an extended treatment period are required.

Pulmonary embolism (PE) is the most serious manifestation of thromboembolic conditions. Its incidence varies considerably between countries, suggesting its interaction with the external environment. To analyze the influence of climate and air pollution on the occurrence of idiopathic PE in the region of Sousse (Tunisia). A total of 142 patients with idiopathic PE at two academic hospitals in Sousse (Tunisia) were enrolled in the study over a 7-year period. An analysis of two time series (environmental data and PE cases) was performed. Climatic data were collected from the National Institute of Meteorology. Air pollution data were obtained from the modeling platform of the National Agency for Protection of the Environment. The year 2015 was marked by the occurrence of the highest number of cases (24.6%). A statistically significant decrease in PE risk of 41.9% was observed during the summer with an OR of 0.59 (95% CI [0.36-0.94] and p = 0.026), compared with other seasons. Poisson GLM regression showed a significant increased risk of PE of 3.3% for each 1 °C temperature drop. After multiple binary logistic regression, the elevation of PM 10 concentration was independently associated with an increased risk of PE (p < 10 -3 , OR 79.55, 95% CI [42.28-149.6]). Some environmental parameters may predispose to the onset of idiopathic PE. Understanding their accurate influence may have preventive and curative implications.

Background: Shift work is a source of health problems for workers around the world. The metabolic syndrome is one of the pathologies that can occur because of this work pattern., Aims: Investigate possible association between shift work and the development risk of the metabolic syndrome (MS)., Methods: A cross-sectional study was conducted among male gender agents of company of electricity production in the Center of Tunisia. This population was divided into two groups according to the organization of their work: a group of shift workers and a group of non-shift workers. Data collection was based on a questionnaire, a clinical examination and a biological assessment. The definition of International Diabetes Federation 2005 (IDF) was adopted to retain the diagnosis of the MS., Results: A total of 263 agents responded to our invitation with a participation rate of 65.5%. The shift workers group accounted for 48.3% of the participants and the fixed workers group accounted for 51.7% of the participants. The diagnosis of MS was retained in 51.2% of shift workers and 27.2% of non-posted workers, with a statistically significant difference (p <10 -3 ). This association persisted after adjusting for the confounding variables with an OR of 2.64 [1.38-5.04]., Conclusion: Our study underlined a higher risk of MS development among shift workers. These findings highlight the importance of taking specific preventive measures. This prevention is based not only on hygieno-dietetic measures and regular physical activity, but also the improvement of working conditions., (Copyright © World Health Organization (WHO) 2019. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: Stress has been recently implicated as a contributing factor of hand eczema (HE) severity. However, published data are both rare and contradictory justifying the need of further research. The purpose of this study was to evaluate the relation between stress and HE severity., Methods: This is a cross-sectional study enrolling all patients who have been attending the Dermato-allergology unit of Farhat Hached University Hospital of Sousse over a period of one year. The HE severity was assessed by the Osnabrück Hand Eczema Severity Index (OHSI). The stress level was assessed by the Perceived Stress Scale-10 (PSS-10) in its validated Arabic version., Results: During the study period, 109 participants meeting the inclusion criteria were identified. The mean age was 40 ± 9.9 years with a sex-ratio of 0.8. Severe eczema was found in 76 participants (69.7%). A high level of perceived stress was found in 18.3% of cases. A statistically significant association was noted between HE severity and the high level of perceived stress ( p =0.039, OR = 4.46, 95% CI [0.96-20.59]) and the number of dependent children ≥3 ( p =0.0039, OR = 1.92, 95% CI [0.51-7.22]). Leisure activity was found to be a protective factor against HE severity ( p =0.031, OR = 0.27, 95% CI [0.09-0.80])., Conclusion: Although the link between the severity of eczema and atopy, wet work, and contact with irritants and allergens is well known, the relation remains questionable for other factors including stress., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2019 Meriam Hafsia et al.)

Introduction: Seasonal variation of Pulmonary tuberculosis (TB) has attracted the attention in several regions of the world., Aim: To explore the relationship between variations of mean meteorological parameters (temperature, atmospheric pressure, relative humidity and duration of sunshine) and the occurrence of cases of pulmonary TB., Methods: This is a retrospective descriptive study of two-time series (meteorological data, case of pulmonary TB) from 1th January 2010 to 31th December 2014.Meteorological data were collected throughout the 5-year period., Results: We collected 180 cases confirmed by direct examination. The relationship between seasonality and the occurrence of TB cases was addressed in two ways considering either the date of the bacteriological diagnosis or the date date of onset of symptoms of TB as the date of the census of cases. Taking into account the date of bacteriological diagnosis, it appeared that spring (33.7%) and summer (25.9%) had the most days with positive diagnosis (p = 0.012). However, considering the date of onset of symptoms of TB , it appeared that winter (34.2%) and spring (28%) had the most days with positive diagnosis with a significant difference. The comparison of the mean of meteorological parameters between days with and without bacteriological diagnosis showed that only the mean duration of sunshine was significatively associated with more cases(p=0.002). This same comparison between the days with and without TB according to the date of onset of symptoms of TB showed significant difference only for mean temperatures which were lower  during the days when patients présented symptoms of TB (p=0.013)., Conclusion: Our results have highlighted the possible implication of meteorological parameters in the occurrence of pulmonary TB cases.

Introduction: Weather conditions were implicated in the onset of spontaneous pneumothorax (SP)., Aim: Investigate the influence of weather conditions on the onset of SP., Methods: A total of 200 patients with SP in Sousse (Tunisia) were enrolled in the study between January 2010 and December 2014. An analysis of two time series (meteorological data and pneumothorax cases) was performed. Data on weather conditions were collected daily throughout the 5-year period., Results: A comparison of the mean temperature between days with and without SP showed significantly higher temperatures during the days with SP. A decrease of 1% in the relative humidity one day lag (D-1) was associated with an increase in the risk of SP by 1.6% (p=0,02). The occurrence of clusters was associated significantly with higher temperature averages on the same days. This same observation was made regarding the mean duration of sunshine two days before the cluster onset (p = 0.05). The occurrence of storms two days before clusters was also significantly associated with a risk multiplied by 1.96., Conclusion: There was a correlation between clusters of spontaneous pneumothorax and weather conditions in the region of Sousse-Tunisia.

Background: Several studies demonstrated the negative impact of allergic rhinitis on Quality of Life (QOL) and occupational activities. Similar studies on allergic Occupational Rhinitis (OR) are rare. The aim of this study was to evaluate the QOL and work productivity of patients diagnosed with allergic occupational rhinitis., Materials and Methods: We conducted a cross-sectional study from January 2005 to December 2015 at the Department of Occupational Medicine in Farhat Hached Teaching Hospital-Tunisia including patients diagnosed with allergic OR. QOL was assessed by the Mini-RQLQ (Rhinitis quality of life questionnaire) and Work impairment was measured by WPAI (Work Productivity and Activity Impairment) questionnaire., Results: a total of 414 patients was enrolled in the study with a mean age of 37.82±8.08 years and a sex ratio = 0.33. Textile and clothing industry was the most represented sector (65.7%). The mean percent work time missed (absenteeism) due to allergic OR was 9.98±20.86% with a median of 0% and the mean presenteeism score was 46.7±32.67%. Overall QOL was 2.71±1.31. The most affected domains were practical problems and activity limitations. Absenteeism was positively correlated with age and eye symptoms scores. Both presenteeism and percent overall activity impairment were positively correlated with severe nasal obstruction and activity limitations score., Conclusion: Allergic OR impairs QOL and work productivity. Although it doesn't seem to be associated with an important absenteeism, work productivity is reduced by an important rate of presenteeism. QOL and work productivity seem to interact significantly.

In Tunisia, few studies have been focused on occupational lumbar back accidents. We conducted a descriptive retrospective study of private sector employees in central Tunisia who were victims of lumbar back accidents, reported during a 5-year period from 2010 to 2014, to determine the prevalence and factors associated with their severity and sequelae. Data were collected from the regional centre of the National Health Insurance Fund of Sousse. We identified 293 cases, a prevalence of 14.2% in relation to all occupational accidents reported during this period. More than two thirds of the injured (69.2%) were victims of serious occupational lumbar back accidents and 33.8% of victims reported serious sequelae. After adjustment by binary logistic regression, the occupational category persisted as an associated factor with the severity of occupational lumbar back accidents (P = 0.001, OR = 2.86 [1.50-5.47]). Surgical treatment appeared as an associated factor of severity (P < 0.001, OR = 9.06 [3.09-26.56]) and prominent after effects resulting from these accidents (P < 0.001 OR = 54.72 [18.84-158.93]). Occupational lumbar back accidents are a real health problem. Thus, a preventive strategy should be implemented to reduce their socio-economic consequences., (Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: Acute appendicitis is the most common abdominal emergency. Its etiopathogenesis appears to be multifactorial. Several studies suggested a relationship between the development of acute appendicitis and some environmental factors. Air pollution predisposes some people to develop perforated appendicitis. However, data are relatively scarce and the results still controversial., Aim: Determine the seasonal variation of acute appendicitis and study the association between perforated appendicitis and short-term exposure to climatic factors and to air pollutants., Methods: A cross-sectional study was conducted including patients hospitalized in the general surgery department of Farhat Hached University Hospital in Sousse for acute appendicitis between January 1st and December 31st, 2014. Climatic conditions were collected from the National Institute of Meteorology. Data on air pollution were given by the National Agency for the Protection of the Environment and obtained by the modeling of the atmospheric pollution. For statistical analysis, we used mean concentrations of each environmental factor corresponding to the day of hospital admission and lagged by the 7 previous days. These factors were compared between the group of patients with perforated appendicitis and patients with nonperforated appendicitis., Results: We collected 246 cases of acute appendicitis. Perforated appendicitis was reported in 15.2% of the cases. The incidence of acute appendicitis was higher during summer. Compared to nonperforated appendicitis, perforated appendicitis was significantly associated with the mean relative humidity of the 5 day lag (p = 0.046), rainfall of the 7 day lag (p = 0.043), and consultation delay (p <10-3). Furthermore, perforated appendicitis was significantly associated with the daily mean concentration of carbon dioxide (p = 0.042), the 2- day lag mean concentration of particulate matter less than 10 μ (PM10 ) (p = 0.016), and the 2-day lag mean concentration of ozone (p = 0.048). After multivariate statistical analysis, predictive factors for perforated appendicitis were the consultation delay (OR: 1.621, 95% CI [1.288 - 2.039]; p<10-3) and the 2 day lag mean concentration of PM10 (OR: 1.066, 95% CI [1.007- 1.130]; p = 0.029)., Conclusion: Short-term exposure to particulate matter was associated with perforated appendicitis. Further large-scale studies are needed to support this conclusion., Key Words: Air pollution, Appendicitis, perforated appendicitis, Climateparticulate matter.

Objective: To study the etiologies of occupational asthma and determine its impact on the professional status of asthmatic subjects., Methods: The authors carried out a descriptive study on all of the cases of asthma recognized as an occupational disease and declared in the private sector over nine years (2000-2008) in the Tunisian central region., Results: Cases (219) of occupational asthma were listed, accounting for 16.8% of all of the occupational diseases recognized during the period studied. Occupational asthma concerned young adults (40±8.2 years), with a predominance of women (67.7%). The textile sector dominated (74.9%). The majority of the employees were exposed to high molecular weight allergens (82.3%) and cotton dust was the principal offending agent (75.3%). Involuntary unemployment was observed in about half of the cases (46.6%) and was associated with an age lower or equal to 35 years (p = 0.01) and under 15 years of professional seniority (p=0.03)., Conclusion: Occupational asthma in the Tunisian central region prevails in the textile sector thereby justifying the reinforcement of preventive measures in this branch of industry., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)