Effect of smoking on the clinical and allergological profile of contact dermatitis.

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.

Olfactory Dysfunction in Healthcare Workers with COVID-19: Prevalence and Associated Factors.

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. AIMS: 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.

Occupational Noise Exposure and Diabetes Risk.

Introduction: Noise is one of the most common worldwide environmental pollutants, especially in occupational fields. As a stressor, it affects not only the ear but also the entire body. Its physiological and psychological impacts have been well established in many conditions such as cardiovascular diseases. However, there is a dearth of evidence regarding diabetes risk related to noises. Aim: To evaluate the relationship between occupational exposure to noise and the risk of developing diabetes. Methods: This is a cross-sectional analytical study enrolling two groups of 151 workers each. The first group (noise exposed group: EG) included the employees of a Tunisian power plant, who worked during the day shift and had a permanent position. The second group (unexposed to noise group: NEG) included workers assigned to two academic institutions, who were randomly selected in the Occupational Medicine Department of the Farhat Hached University Hospital in Sousse, during periodical fitness to work visits. Both populations (exposed and unexposed) were matched by age and gender. Data collection was based on a preestablished questionnaire, a physical examination, a biological assessment, and a sonometric study. Results: The mean equivalent continuous sound level was 89 dB for the EG and 44.6 dB for the NEG. Diabetes was diagnosed in 24 workers from EG (15.9%) and 14 workers from NEG (9.3%), with no statistically significant difference (p=0.08). After multiple binary logistic regression, including variables of interest, noise did not appear to be associated with diabetes. Conclusion: Our results did not reveal a higher risk of developing diabetes in workers exposed to noise. Further studies assessing both level and duration of noise exposure are needed before any definitive conclusion.

Influence of weather and air pollution on the occurrence of idiopathic pulmonary embolism in the region of Sousse (Tunisia).

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 PM10 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.

Chronic Pain following Chest Trauma: Prevalence, Associated Factors, and Psychosocial Impact.

Background: Chronic pain (CP) is a real public health concern. It is a common cause of poor quality of life and workplace absenteeism. It is well studied in many medical and surgical fields. However, only few data are available as regards to its occurrence in trauma patients. Purpose: To assess the prevalence, associated factors, and psychosocial impact of CP following chest trauma. Methods: This is an observational, descriptive, and analytic cross-sectional study performed in a Tunisian department of anesthesia and intensive care over a two-month period. Adult patients admitted one year ago for isolated chest trauma were enrolled. Data were collected by a phone interview. Studied variables were sociodemographic characteristics, traumatic injuries and their management, the occurrence of CP, and its psychosocial impact. CP was diagnosed by the Brief Pain Inventory (BPI) considering an evolution period of at least 3 months. Its impact was assessed by the BPI and the Posttraumatic stress disorder Checklist Scale (PCLS). Results: Fifty-four patients were included in the study. The prevalence of CP was 79.6%. The average CP intensity was 3.18 ± 1.4. It was neuropathic in 90.7%. Its main associated factors were pleural effusion (p=0.016), time to ICU admission (p=0.016), time to ICU admission (p=0.016), time to ICU admission (p=0.016), time to ICU admission (. Conclusion: CP following chest trauma is frequent and severe requiring preventive measures such as high risk patients screening, better management of acute pain, and a multidisciplinary approach for patients with diagnosed CP.

Relationship between Hand Eczema Severity and Occupational Stress: A Cross-Sectional Study.

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.

Evaluation of the risk of metabolic syndrome among shift workers in Tunisia.

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.

Quality of Life and Work Productivity Impairment of Patients with Allergic Occupational Rhinitis.

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.

Occupational lumbar back accidents in the private sector: prevalence and factors associated with their severity and sequelae in central Tunisia.

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.

Prévalence et déterminants des troubles musculosquelettiques des membres supérieurs chez les artisans tunisiens.

Musculoskeletal disorders (MSDs) of the upper limbs are a major occupational health problem. We report the results of a cross-sectional survey of 334 craftsmen from the governorate of Monastir in Tunisia. The objectives of this study were to assess the prevalence of MSDs among these workers and determine their risk factors. A pre-established questionnaire based on the Nordic MSD questionnaires, Karassik and the one developed by Malchaire in 2000 was used. In the 12 months prior to the survey, the prevalence of MSDs was 92.0%. The risk factors identified were related to individual characteristics, psychosocial factors and work organization. Appropriate preventive measures seem necessary in this sector.

First evidence of okadaic acid in Mytilus galloprovincialis mussels, collected in a Mediterranean Lagoon, Tunisia.

Evidence of the presence of okadaic acid (OA) and its monthly fluctuations are reported for the first time in Mytilus galloprovincialis samples collected from June 2005 to May 2006 in the Bizerte Lagoon. All of the samples with the exception of those taken in August 2005 were found to be contaminated. The level of OA in mussels exceeded the regulatory limit of DSP toxins (16 microg OA/100 g mussel meat) within the European Union (2002) in only two cases: in January and February, 2006 with 31.85 +/- 3.06, and 18.86 +/- 1.88 microg OA/100 g mussel meat respectively. During the investigative period, potentially toxic dinoflagellates were observed. The results reported here, although based on limited sampling, demonstrate for the first time the existence of a risk to public health from diarrheic shellfish poisoning in cultivated bivalve mollusc in Tunisia.