[Allergy to latex gloves among healthcare workers in Dakar]. / Allergie aux gants en latex chez les professionnels de la santé à Dakar.

BACKGROUND: The prevalence of latex allergy is high (to 17%) among groups at risk such healthcare workers. Our aim was to determine the prevalence and severity of allergy to latex gloves among health workers in Dakar. PATIENTS AND METHODS: The study was conducted in three of the five hospitals in Dakar (Senegal). A randomized sample was constituted. All healthcare workers required to use latex gloves in their work were included. A questionnaire was administered. The analysis was performed using the Epi-info software package (6.0). RESULTS: One hundred and forty cases were included. The median age was 39 years and the sex-ratio was 0.57. Sixty-six (47%) cases had familial atopic dermatitis, 13 (9.6%) had atopic dermatitis, and 4 (2.9%) indicated food allergy (banana, avocado). Irritant dermatitis was found in 40.7% of cases, 112 healthcare workers (81.2%) used bleach and water to clean their hands. Antiseptics were used frequently: 75.5% of those interviewed used them more than three times a day. None of the healthcare workers indicated any allergy to latex condoms. Otherwise surgical procedures and bladder/rectal catheters were noted respectively in 24% and 18% cases. Fifteen healthcare workers (10.7%), of whom 12 were women, indicated appearance of clinical signs when using latex gloves. The clinical manifestations were: contact urticaria or immediate pruritus (8 cases), combined contact dermatitis and contact urticaria (2 cases), allergic conjunctivitis (1 case), allergic rhinitis (2 cases) and asthma (2 cases). We also noted 6 cases of contact dermatitis. Rechallenge tests were performed in 7 cases and were positive, 2/3 prick-tests and 1/4 patch-tests (standard European battery). The statistical analysis shows that allergy to latex gloves was significantly associated with atopy and irritant dermatitis (p<0.03). DISCUSSION: We found a prevalence of allergy to latex gloves of 11% among healthcare workers in Dakar, reflecting reports in the literature. The classical risk factors such atopic dermatitis and irritant dermatitis were found. The correlation between irritant dermatitis and frequent use of bleach and water mean that these practices should be eradicated since they play an important role in the development of contact urticaria and anaphylactic reactions.

[Permanent disability and the insurance estimation process]. / Estimation de l'incapacite partielle permanente et du pretium doloris dans le cadre judiciaire et dans le cadre des procedures conseil d'assurances.

INTRODUCTION: The casualties are indemnified according to two processes. First by transaction on rate proposition of insurance physicians, and the second process on rate proposition by a medical expert assigned by law-court. Indemnification scale failure justifies the Interafrican Conference of insurance Markets code adoption. MATERIAL AND METHOD: Six insurance societies and the Automotive Guarantee Fund were debtors. Only 627 victims had been indemnified between 1986 and 2003. Expert valuations done at forensic medicine service were the support of the investigation. Inquired parameters were insurance societies, regulation type, aftermaths and the retained prejudices. The data collected on computer card have been analyzed by software Epi Info. RESULTS: The partial permanent inabilities fixed since its adoption differ to inabilities fixed before this adoption. Transaction process concerned 567 victims (90.4%). Sixty victims were indemnified by judicial way. According to process type, the rates fixed in judicial process were 61.6% middle permanent partial inabilities. After 1997, there have observed a decrease in the high and middle permanent partial inabilities in the two processes. The appreciation of the pretium doloris is more subjective but must repair the aftermaths. The middle pretium was majority in the two processes, before and after 1997 with a high decrease of the middle pretium in the transaction process (-15.07) and a small pretium increase of 10.98 points. CONCLUSION: A common scale code has decreased the judicial litigation concerning casualties in spite of scales' limits. Only the patients with important aftermaths arrive in the judicial process since 1997.

[Sexual child abuse: correlation between medical certificates' conclusions and judiciary sanctions]. / Sevices sexuels sur les enfants: correlations entre les conclusions medicales et les peines prononcees.

Sexual child abuse, comprises of indecency attitudes and physical misbehaviours, directed towards children are dominated by rape. The objective of our study was to assess in sexual child abuse the relation between the conclusion of medical certificates and court decision. It is a retrospective study carried out from 1994 to 1998 on the clerk's office correctional repertories in Dakar regional court. An overall number of 79 cases of child abuse were collected in 5 years period. Children under 18 years old of of both sex, were concerned. Data found were correlated with a review of requisition cases received by the of gynaecology and obstetrics clinic of Aristide Dantec Hospital. This facilitates the establishement of the relationship between the offences and the pronounced sanctions, as well as the initial medical certificate and these sanctions. The sanctions were severe whenever rape had been retained. Some cases were disqualified in indecent assault and were judged as such. The judge decision, which follow the medical certificate conclusions in 11 cases out of 14 shows the importance and reliability of this medical document. All files reviewed at the medical and legal level were incomplete. The difficulty of the materiality of the rape and the psychological consequences in the long run and especially HIV infection should invite to a multidisciplinary, specialized and organized management of sexual child abuse. This study has shown the importance of a correct and complete drafting of the medical certificate, to enable the establishment by the judge the materiality of the facts.

[Comparative review of the Senegalese and French deontology codes]. / Revue comparative des codes de déontologie sénégalais et français.

The medical deontology regroups duties of the physicians and regulate the exercise of medicine. The code of medical deontology of Senegal inspired of the French medical deontology code, has not been revised since its institution whereas the French deontology code knew three revisions. Comparing the two codes of deontology titles by title and article by article, this work beyond a parallel between the two codes puts in inscription the progress in bioethics that are to the basis of the revisions of the French medical deontology code. This article will permit an advocacy of the health professionals, in favor of a setting to level of the of Senegalese medical deontology code. Because legal litigation, that is important in the developed countries, intensify in our developing countries. It is inherent to the technological progress and to the awareness of the patients of their rights.

[Ethical problems faced by in managing HIV in workplace]. / Problèmes ethiques rencontrés par les médecins dans la gestion de l'infection VIH en milieu de travail.

This study which was conducted between September 1999 and June 2000 among occupational physicians aimed to appreciate ethical problems faced by physicians in managing HIV infection in workplace. A questionnaire was administrated by telephone to physicians included in the list of Occupational Physicians Association. Thirty eight physicians responded among the fourty four contacted. Thirty two ie 84.21% did face HIV infection in their workplace. The frequency of meeting cases was in between 1 to 5 for 68.75%. Thirty two did order the test either to depist or to conduct eatiologic diagnosis. Informed consent were asked by twenty one physicians. Six physicians ie 18.75% did inform the employer of serologic status, among them four said having obtain employee's consent to reveal status. For them, such revalation was the basis for financial involvment of employer in the treatment, and facilitates his tolerance of absenteeism. Four physicians signaled facing dilemma when a patient did not want to inform his or her partner of his (her) serologic status. They suggested a legal authorization to reveal patients status in such circumtances.

[Obstacles in the management of pesticides intoxication in Senegal: about a case of malathion autolysis]. / Difficultes du traitement des intoxications aux pesticides au Sénégal: a propos d'un cas d'autolyse au malathion.

Pesticides are widely used inSenegal as in others africans countries. This situation facilitate occurrence of intoxications, whose management is limited by unavailability of antidotes. We report a case of acute pesticide intoxication in a suicide attempt by a girl of thirteen. The clinical evaluation showed a coma with advanced muscarinic and nicotinic syndrome. The absence of antidotes in the country limited the care management to atropine administration and reanimation measures. The evolution was positive in few days and the patient referred to pediatrics in order to be clinically and psychologically managed. The positive evolution should not hide the necessity for the country to make available all antidotes of toxic substances and to implement Poison Control Centre in order to improve medical management of poisoned people.

[Medico-legal conditions of recognition and compensation of occupational asthma in Sénégal]. / Conditions médico-légales de reconnaissance et d'indemnisation de l'asthme professionnel au Sénégal.

The aims of this study were to appreciate how frequent asthma was named in the legal list of worker's compensation, state hazards and occupations involved and appreciate conditions required for a legal recognition of the disease. The study consisted of a review of the legal list of occupational diseases of all tables where asthma was stated. Medical, technical and administrative criteria allowing compensation were looked for. Asthma was listed in 12 among the 67 tables; causal substances listed were known as sensitizers and included mainly organic and metallic compounds. Numerous occupations were concerned in all primary, secondary and tertiary sectors. Medical conditions refered to "all asthma confirmed by functionally respiratory tests or regenerated by a new exposure". Time length of declaration was seven days. Variety of occupations concerned and numerous substances involved should invite to look for occupations in all patients with asthma. Physicians should be aware of theses legal conditions in order to recognize better occupational asthma and ease it legal compensation.

[Acute hydrogen sulfite intoxication: report of three lethal cases occurred at a Senegalese chemical plant]. / Intoxication à l'hydrogène sulfuré: à propos de trois cas mortels survenus dans une entreprise chimique sénégalaise.

We report an hydrogen sulfite intoxication which occurred in a Senegalese chemical plant and which lead to the death of three temporary workers in charge of cleaning up the pumping basin of seawater. Hydogen sulfite was generated by the decomposition of seaweeds and other inorganic compounds. Agitation of water due to human presence increased the air concentration at very high levels. The death of workers trying to rescue their colleagues was due to their ignorance of key elementary prevention rules. Diagnosis was based upon microbiologic analysis and air sampling. The ignorance of toxicologic effects of this widespread substance invite to inform people working in industries where the risk of hydrogen sulfite intoxication is high.

[HIV in workplace: knowledges and attitudes of workers in three Senegaleses manufactures]. / Infection a VIH en milieu de travail: enquête sur les connaissances et attitudes dans trois entreprises sénégalaises.

This study was conducted from may to august 2000 in three senegalese work sites randomly selected among seven which benefited from HIV preventive program. The aims were to evaluate knowledge, attitude and behavior related to HIV infection. A sample of 200 workers randomly chosen were asked about the ways of transmission and methods of protection as well as their risky attitudes and behaviors. Mean age was 41 years, 82.5% were male and 75.5% benefited from high school education; 75.75% had a good level of knowledge on HIV infection, 58% CI [51-65] stated having changed their sexual behavior into abstinence, fidelity to their partner (52.5%) and use of condom (46.5%). This good level of Knowledge and the positive changes in attitude are related to the high rate of alphabetization in our sample, information message diffused by media and preventive programs undertaken in workplace. Information campaigns via media should be maintained and strengthened and preventive programs diffused in all workplaces which will reduce diffusion of HIV in population.

[Chronic low back pain at a public transportation company in Senegal]. / Lombalgies chroniques dans une entreprise de transport public au Sénégal.

The aims of this study were to appreciate the prevalence of chronic low back pains in a public transport's company, to state characteristics and to identify categories of workers involved and medico-legal consequences. It is a cross sectional study. which used medical records of the occupational clinic. All workers who complained of low back pain in the past three years following the study were selected. Characteristics of workers, types of injuries, occupational and medico-legal consequences were looked out. Sixty nine cases were collected, they were exclusively males. 54 % of them were bus drivers, and 29% conductors. X rays abnormalities were found in 31.64%. Exposure to vibration due to damaged roads and decayed vehicles seems to be main etiologic factors. From a occupational and medico-legal standpoint, two patients were reported for workers compensation, three patients were reclassified in another job. Undamaged roads, ergonomic design of bus' seats, and medical screening during placement and routine medical examination are key issues in preventing low back pains.

[Bronchial hyperreactivity syndrome : a case report following exposure to sulfur dioxide]. / Syndrome d'hypereactivité bronchique: à propos d'un cas consécutif à une exposition à l'oxyde de soufre.

A variety of occupational asthma is induced by important exposure to irritants. A case is reported, where le patient developed asthma symptoms like, following huge exposure to sulfur dioxide. All Books criteria were met, except for the metachlorine challenge which was not performed. Nevertheless the bronchial reactivity in the work place, shown by a portable pick flow eased le diagnosis. General practitioners and occupational physicians should be aware of this new medical entity for a better management.

[Occupational carpal tunnel syndrome: the case of a secretary]. / Syndrome du canal carpien d'origine professionnelle à propos d'un cas survenu chez une secrétaire.

We report a case of carpal tunnel syndrome which occurred in a office secretary, whose job task was mainly type writing. Occupational origin of this disease was stressed based on unilateral lesion, absence of personal and familial risk factors. Working conditions seem to explain the occurrence of symptoms. The recognition of occupational origin is important for physicians, because it eases the implementation of ergonomic sound measures which supply medical treatment. It also allows to take into account medico-legal aspects.

[HIV infection at the work-place: beliefs and attitudes compliance to ethical standards]. / Infection VIH en milieu de travail: conformité des croyances et attitudes aux normes éthiques.

The aims of this study undertaken from May 2000 to August 2000, were to appreciate workers feelings about ethical questions arisen in workplaces. Three industries were randomly chosen among a total of seven which benefited from HIV preventive policy. Two hundred workers randomly chosen by a multistage sampling method, were interviewed by an occupational physician on their beliefs and attitudes about HIV infection. Mean age was 41 years, 82.5% were male and 75.5% did benefit from high school education. 76% of workers had a good level of knowledge about transmission and prevention methods about HIV. 76.5% were willing to take care of people infected. 73% believed that infected persons must continue their job in the workplace. For 63.5% infected patients should receive more care than the other sick persons no matter what disease is concerned. These positive attitudes are highly correlated with level of knowledge (p < 0.001). In contrary 73.5% did state that pathient status should be revealed. These findings are globally compliant with ethical issues except for confidentiality questions. They invite to enforce preventive measures in workplaces.

[Characteristics of occupational accidents in the building industry and public works in Senegal]. / Caracteristiques des Accidents du Travail dans une industrie des Bâtiments et Travaux Publics au Sénégal.

The objectives of this study were to appreciate the magnitude of work accidents in a building construction sector, to specify their type and characteristics. A retrospective study was undergone in a big building construction industry in Senegal. Data were collected from records of accidents reported to the Social Security Administration between 1994--1996. We looked for characteristics of accidents as well as workers involved in accident. 244 accidents were collected in a three years period, i e 81.5/year, 132 work injuries involved temporaryworkers. 55.73% occurred in chantiers, and 1/3 in working room. Moving and handle objects generated most accidents (36,47%). Wounds and contusions were the most frequent lesion (51,62.%). Arms and feets were concerned in 51.63%, and ocular lesions were noticed in 13.94%. These accidents generate an overall number of 3055 days lost. Work injuries in the building construction sector in Senegal are identical to those described in othercountries. Prevention measures requires improvement of working conditions, education of workers and availability of personal protective equipment's.