Corps étrangers laryngo-trachéo-bronchiques : à propos de 130 cas

Objectifs : Les objectifs de notre étude étaient de décrire les aspects épidémiologiques, diagnostiques et thérapeutiques des corps étrangers des voies respiratoires inférieures à la clinique d'ORL et de chirurgie cervico-faciale du centre Hospitalier National et Universitaire de Fann. Patients et méthodes : Il s'agit d'une étude rétrospective, couvrant la période du 1er janvier 2011 au 31 décembre 2013. Nous avons colligé, durant cette période, 130 dossiers de patients âgés de moins de 18 ans qui étaient reçus pour inhalation de corps étrangers. Les endoscopies blanches étaient exclues. Les paramètres étudiés étaient : l'âge, le sexe, la présence ou non d'un syndrome de pénétration, les signes fonctionnels, le délai de consultation, le traitement effectué, la localisation endoscopique, la nature du corps étranger, les données de l'imagerie, l'indication de la trachéotomie et les complications. L'analyse des données était effectuée avec le logiciel Sphinx Lexica V 4.5 2003. Résultats : L'âge moyen de nos patients était de 3,84 ans avec des extrêmes allant de 4 mois à 17 ans. Une prédominance féminine était notée avec un sex-ratio de 0,91. Les patients évacués d'autres pays représen- taient 6,9% des cas. Le délai moyen de consultation était de 8,05 jours. Le syndrome de pénétration était retrouvé dans 78,5% des cas. La radiographie standard mettait en évidence un corps étranger radio-opaque dans 33,1% des cas. La localisation laryngée était la plus fréquente, elle représentait 26,7% des cas. La graine d'arachide était le corps étranger le plus fréquemment retrouvé soit 39,2%. Onze patients étaient trachéotomisés. Quatre cas de décès ont été rapportés soit 3% des cas.Conclusion : L'inhalation d'un corps étranger est un problème de santé publique. L'augmentation de l'incidence de cet accident et la transition épidémiologique impose une meilleure prévention

Work-related asthma: current concepts and management approaches to various phenotypes

"Introduction: Asthma is a heterogeneous disease and within its spectrum there are several phenotypes and sub-phenotypes that are important for both clinical evaluation and management. The disease may further be complicated by workplace exposures resulting in a number of conditions under the umbrella term ""work-related asthma"". Understanding and making the distinction between the various forms of work-related asthma is pertinent for the prognosis and obtaining adequate compensation of the affected worker. Methodology: A systematic review of relevant publications from 1998 to 2008 on the topic work-related asthma and occupational asthma was conducted. Results: This article focuses on the issue that work-related asthma is not a homogenous disease; but in fact can be caused by various exposures most notably allergens and irritants which may cause reversible airflow obstruction with different underlying inflammatory responses. It outlines current concepts and provides a range of examples of high risk occupational environments and exposures typically sociated with different phenotypes of asthma. It also aims to promote some understanding of the main inflammatory mechanisms involved in allergen and irritant-induced work-related asthma. Conclusion: Understanding the phenotypic and pathophysiologic characteristics of work-related asthma may alleviate some of the constraints regarding the diagnosis and management of work-related asthma which may account for up to one third of adult asthma cases."

Evaluation of Peak Expiratory Flow rates (PEFR) of Workers in a Cerment Factory in Port Harcout South-South; Nigeria

Occupational lung diseases (OLD) remain one of the most common workplace health challenges since the industrial revolution. One of the risks for OLD is the exposure to cement dust which is associated with varying degrees of respiratory symptoms and reduction in lung function. This study aimed to measure the peak expiratory flow rates (PEFR) of workers in a cement manufacturing company in Port Harcourt and estimate the determinants of the measured rates.Method: In this descriptive cross-sectional study; 105 workers of a cement company who presented for the annual fitness to work exercise were sampled and had their peak expiratory flow rates measured using a spirometer. Data were also collected using structured interviewer-administered questionnaires and a walk through survey carried out to examine workplace situation. The results were analyzed using descriptive and inferential statistics.Results: The study showed that 13.3 of the workers had abnormal (i.e low) PEFR. The lowest mean PEFR of 327.5L/min was found among workers who had worked for 21 23 years and worked mainly at the production and bagging area. Most of the workers (81.9) made effective use of some form of personal protective equipment (PPE).Conclusion: Reduction in the PEFR implied that prolonged exposure to cement dust may result in decreased lung function and by extension pulmonary disease. The high percentage of normal PEFR found among the workers; irrespective of their duration of work; could be attributed to the effective use of the PPE

Secondhand Smoke Exposure among Nonsmoking Adults in two Nigerian Cities

Background: Tobacco control policy can only succeed if the burdens of smoking are known. The objective of this study was to determine the prevalence and correlates of secondhand smoke (SHS) exposure among nonsmoking adults in two Nigerian cities. Materials and Methods: We carried out a cross-sectional study from October 2009 to April 2010 among adult population of two Nigerian cities: Enugu and Ilorin. A semi-structured questionnaire was administered by interviewers to obtain socio-demographic information; and information regarding pattern of SHS exposure; wareness of tobacco control policy and the harmful effects of SHS. SHS exposure was defined as regular exposure to tobacco smoke in the previous 30 days in a nonsmoking adult. Results: Of the 585 nonsmoking adults that completed the study; 38.8had regular exposure to SHS; mostly; in public places (24.4). More men were exposed at public places when compared with women (27.0vs. 19.5). The strongest factor associated with exposure to SHS in women was having a smoking spouse [prevalence rate (PR) ratio-7.76; 95confidence interval (CI); 3.08-9.42]; and in men; it was lack of home smoking restriction (PR ratio-6.35; 95CI; 4.51-8.93). Among men; SHS exposure at any location was associated with lack of secondary school education; residing in slum apartment (house with many households); living with a smoking family member (non-spouse); lack of home smoking restriction; and alcohol intake. Among women; SHS exposure at any location was associated with having a smoking spouse; residing in slum apartment and lack of home smoking restriction. Seventy-two percent of respondents were aware of the harmful effects of SHS on their health. Lack of awareness of the harmful effects was significantly associated with increasing age (r= +0.45; P = 0.01); lack of secondary school education (rof the employees reported availability of outdoor smoking area at their workplaces. Conclusion: Our results show that prevalence of SHS exposure was the highest in public places. These findings underscore the need for enactment of comprehensive smoke-free legislation and implementation of educational strategies to reduce SHS exposure in homes

Exposure to secondhand smoke in health institutions and sources of knowledge: a cross-sectional study from the city of Bulawayo, Zimbabwe

Introduction: annually, many people die due to being exposed to secondhand smoke (SHS) which they experience at a number of premises that include health institutions. Scientists agree that there is no safe exposure level to SHS, however, in the City of Bulawayo many people are exposed to SHS. There are great expectations from communities for health professionals to reduce SHS exposure-related morbidity and mortality. This study sought to establish exposure to SHS in health institutions and sources of knowledge on SHS.Methods: a cross-sectional study, with participants randomly selected from residents visiting the 13 municipal revenue halls in the City of Bulawayo, was conducted. Data were collected through a structured questionnaire and were analyzed by performing descriptive and multivariate logistic regression. Results: 26.3% (N = 419) of respondents who had been to health institutions in the previous 30 days had been exposed to SHS within those institutions. Almost all the respondents (85.4%) had never received a lesson on SHS from a health professional or had last received one three months before the survey. Furthermore, 74% of respondents had not seen posters on SHS or had last seen one more than three months before the survey.Conclusion: health professional should collaborate with other professionals in the fight against exposure to SHS as evidenced by the high prevalence of exposure in the health institutions and low health education given on SHS exposure in the City of Bulawayo

Elimination of silicosis: to eliminate which silica?

International and national programmes to eliminate silicosis have been initiated with the inference that exposure to quartz is associated with silicosis. Experimental evidence is presented by numerous investigators to indicate that pathogenicity of the polymorphs of silica is related to their crystalline structure; origin; and various surface properties. As a result; in the risk assessment process; silica cannot be dealt with as a single hazard entity. Accordingly; if elimination of silicosis is to be achieved in South Africa; standard values for quartz; the main crystalline form of silica polymorphs; should be adopted which will be protective enough against the species with the greatest adverse activity existing in the South African working environment