Aleksandar P.S. Milovanović

Screening commercial drivers for obstructive sleep apnea: translation and validation of Serbian version of Berlin Questionnaire

PurposeObstructive sleep apnea (OSA) can lead to severe health consequences. Drivers of motor vehicles with untreated or undiagnosed OSA have a greater risk of traffic accidents. Use of self-reported questionnaires is the first step in OSA diagnosis. The main aim of this study was to perform the translation and validation of Berlin Questionnaire in a sample of commercial drivers.MethodsAfter formal translation, validation was performed on a sample of commercial drivers and included evaluation of internal consistency, test–retest reliability, construct and criterion validity. Full-night attended polysomnography or cardiorespiratory polygraphy was used for OSA diagnosis.ResultsOne hundred male participants, 24–62xa0years old, were included. Berlin Questionnaire classified 35xa0% subjects as potential OSA patients. Polysomnography confirmed OSA in 58xa0% of the subjects. Berlin Questionnaire showed good internal consistency (Cronbach’s alpha 0.82—first category, 0.73–0.95—second category). Test–retest reliability (Cohen’s kappa 0.78) was adequate. Berlin score was significantly correlated with OSA category and apnea–hypopnea index (AHI). Sensitivity of Berlin Questionnaire was from 50.9 (AHIxa0≥xa05) to 75xa0% (AHIxa0≥xa030), while specificity ranged from 86 to 70.5xa0%.ConclusionsBerlin Questionnaire (Serbian version) showed good measurement properties, creating basis for further research of its usefulness as OSA screening tool in populations of interest.

Magnesium sulfate reduces formalin-induced orofacial pain in rats with normal magnesium serum levels

BACKGROUNDnIn humans, orofacial pain has a high prevalence and is often difficult to treat. Magnesium is an essential element in biological a system which controls the activity of many ion channels, neurotransmitters and enzymes. Magnesium produces an antinociceptive effect in neuropathic pain, while in inflammatory pain results are not consistent. We examined the effects of magnesium sulfate using the rat orofacial formalin test, a model of trigeminal pain.nnnMETHODSnMale Wistar rats were injected with 1.5% formalin into the perinasal area, and the total time spent in pain-related behavior (face rubbing) was quantified. We also spectrophotometrically determined the concentration of magnesium and creatine kinase activity in blood serum.nnnRESULTSnMagnesium sulfate administered subcutaneously (0.005-45mg/kg) produced significant antinociception in the second phase of the orofacial formalin test in rats at physiological serum concentration of magnesium. The effect was not dose-dependent. The maximum antinociceptive effect of magnesium sulfate was about 50% and was achieved at doses of 15 and 45mg/kg. Magnesium did not affect increase the levels of serum creatine kinase activity.nnnCONCLUSIONSnPreemptive systemic administration of magnesium sulfate as the only drug can be used to prevent inflammatory pain in the orofacial region. Its analgesic effect is not associated with magnesium deficiency.

Screening commercial drivers for obstructive sleep apnea: Validation of STOP-Bang questionnaire

OBJECTIVESnThe main aim has been to examine psychometric properties of STOP-Bang (snoring, tiredness, observed apnea, high blood pressure, body mass index (BMI), age, neck circumference, male gender) scoring model (Serbian translation), an obstructive sleep apnea (OSA) screening tool, in a sample of commercial drivers.nnnMATERIAL AND METHODSnAfter formal translation, validation was performed on a sample of bus and truck drivers evaluating test-retest reliability, construct and criterion validity. Overnight polysomnography or cardiorespiratory polygraphy were used for OSA diagnosis purposes.nnnRESULTSnOne hundred male participants, 24-62 years old, were included. STOP-Bang classified 69% as potential OSA patients. Polysomnography identified OSA in 57% of the sample. Test-retest reliability (Cohens κ = 0.89) was adequate. STOP-Bang score was significantly correlated to apnea-hypopnea index (AHI) and OSA severity. Sensitivity was 100% for AHI ≥ 15, highest specificity was 53.5% (AHI ≥ 5).nnnCONCLUSIONSnSTOP-Bang showed good measurement properties, supporting its further use in OSA screening of commercial drivers. Int J Occup Med Environ Health 2016;30(5):751-761.

Reliability and Validity of the Pittsburgh Sleep Quality Index-Serbian Translation.

The aim of this study was translating and exploring psychometric properties of Serbian Pittsburgh Sleep Quality Index (PSQI) in a sample of “good” and “bad” sleepers suffering from depression or obstructive sleep apnea (OSA). Formal translation and validation were performed on a sample of healthy controls, patients with untreated OSA, and with diagnosed major depressive disorder with evaluation of internal consistency, test–retest reliability, and construct and criterion validity. Controls and OSA subgroups were recruited from a larger sample of commercial drivers. One hundred and forty subjects, 84.3% male, 22–67 years old, were included. OSA subgroup had 59 subjects and depression subgroup had 40 subjects (22 females). Mean ± SD total PSQI was 3.5 ± 2.2 in controls, 4.9 ± 3.6 in OSA subjects, and 9.0 ± 4.9 in patients with depression. Cronbach’s α for total PSQI was 0.791. Subscale scores were significantly correlated to global PSQI in all subgroups. Intraclass correlation coefficient for global PSQI was 0.997 (p < .001). Epworth Sleepiness Scale score was significantly correlated to global PSQI (ρ = 0.333, p < .001). Three subgroups differed significantly in total PSQI and PSQI ≥ 5, even after adjustments for age and gender (p < .001). OSA patients had higher mean PSQI than controls but not significantly (p = .272). PSQI-reported sleep latency did not correlate with PSG-measured sleep latency (r = .130, p = .204). Total PSQI was significantly correlated to OSA severity (ρ = 0.261, p < .05). Serbian PSQI showed good internal consistency, test–retest reproducibility, and adequate construct and criterion validity, which supports further exploration of its use as a sleep quality screening tool in different target populations.

Micronuclei As A Marker For Medical Screening Of Subjects Continuously Occupationally Exposed To Low Doses Of Ionizing Radiation

Abstract Context: Genotoxicity assays are widely employed in human biomonitoring studies to assess genetic damage inflicted by genotoxic agents. Objective: Evaluation of micronuclei (MN) as a screening marker of occupational ionizing radiation (IR) exposure. Materials and methods: Using micronucleus test, peripheral blood lymphocytes (PBL) of 402 control and exposed subjects were screened for genetic damage. Results: The mean frequencies of micronucleus test parameters were significantly higher in exposed persons. Increase of micronucleus yield with duration of exposure (DOE) by 0.303MN/year was revealed. Discussion and conclusion: The obtained data encourage us to consider MN as valuable markers for preventive medical screening of occupationally exposed groups.

The influence of redox status on inter-individual variability in the response of human peripheral blood lymphocytes to ionizing radiation

Abstract Purpose: Ionizing radiation (IR) can act on atomic structures, producing damage to biomolecules. Earlier investigations evaluating individual radiosensitivity in vitro were focused on cytogenetic biomarkers (chromosomal aberrations – CA and micronuclei – MN). Since IR can also cause oxidative damage by producing reactive oxygen species, the main goal of this investigation was to establish the influence of redox status on CA and MN frequency in human peripheral blood lymphocytes. Materials and methods: Blood samples from 56 healthy donors were irradiated at doses of 0, 0.75, 1.5 and 3u2009Gy and then analyzed cytogenetically and biochemically. Results: The results showed inter-individual variability in all analyzed parameters, as well as dose-dependent increases in almost all of them. Correlation analysis indicated no association between CA, MN and oxidative stress parameters. However, findings for overall response (HRR) parameters showed that donors with lower values for parameters of antioxidant status had increased levels of cytogenetic damage and higher responses to irradiation and vice versa. Conclusion: Besides well-established cytogenetic biomarkers of radiation exposure, our results indicated promising future use for biochemical oxidative status parameters in routine radiation protection practice, since together they can provide a complete radiation response profile in cases of continuous low-dose exposure, as well as in a radiation emergency.

Authors’ response (November 28, 2017) to the letter to the Editor (November 15, 2017) concerning the paper “Screening commercial drivers for obstructive sleep apnea: Validation of STOP-Bang questionnaire”

Dear Editor, We would like to thank the author of the letter to the Editor [1] for his interest in our manuscript entitled “Screening commercial drivers for obstructive sleep apnea: Validation of STOP-Bang questionnaire” published in the “International Journal of Occupational Medicine and Environmental Health” in 2017 [2]. We appreciate the constructive criticism of the author of the letter. We have addressed each of his concerns as outlined below. The initial concern is about the response to the item 1 and 3 of the STOP-Bang (snoring, tiredness, observed apnea, high blood pressure, body mass index (BMI), age, neck circumference, male gender), which relate to snoring and breathing cessation during sleep, and in respect of which the author of the letter has taken the stand that answers to both questions are difficult to obtain using a self-administered questionnaire, citing a similar letter to the editor [3]. In that letter, Kawada has raised the issue of possible underestimation or overestimation of obstructive sleep apnea (OSA) in case answers to questions on snoring and breathing cessation in the STOPBang are missing. We agree with the author that this could be a significant issue. In our manuscript we reported the results of the STOPBang translation and validation study in the sample of commercial drivers. Our subjects had been tested and retested after several months, and on both occasions we had not experienced any issues of missing responses to the items in the subjective (STOP) part of the STOP-Bang screening model. We had only seen a somewhat lower level of the test–retest agreement on questions about snoring (Cohen’s κ = 0.8), which was reported in the manuscript. We are aware that the items 1 and 3 are based on the information that subjects obtain from their partners, spouses or family members, but almost all self-reported questionnaires for OSA screening include similar if not identical items, which have proven their validity through many studies [4]. The second concern is that the diagnosis of OSA is based on the apnea-hypopnea index (AHI) ≥ 15 and AHI ≥ 30 events/h of sleep. We respectfully have to disagree. In the Material and Methods (Polysomnography) section as well as in the Results section of the manuscript, we clearly identified that OSA was diagnosed if the AHI was equal or greater than 5 events/h of

Cytogenetic Surveillance of Persons Occupationally Exposed to Genotoxic Chemicals

ABSTRACT Human genotoxic exposures can occur environmentally, occupationally, or medicinally. The aim of this study was to assess cytogenetic damage (chromosomal aberrations and micronuclei) in persons exposed to chemical agents in medical, agricultural, and industrial occupations. The results showed influences of age, gender, occurrence, and duration of exposure on the extent of cytogenetic damage, but no influence of smoking. Persons exposed to pesticides were allocated significantly higher values of most examined parameters. Among all tested parameters, logistic regression analysis marked tMN, CB, and iCB as the best predictors with high discrimination accuracy of separation between exposed and unexposed persons. The obtained data encourage us to consider certain cytogenetic parameters as valuable markers for preventive medical screening as the extent of cytogenetic damage reflects cumulative exposure events and possible health consequences related to chronic occupational genotoxic exposure.

Assessment of coarse and fine hand motor performance in asymptomatic subjects exposed to hand-arm vibration

Summary A frequently encountered exposure profile for hand-arm vibration in contemporary occupational setting comprises workers with a long history of intermittent exposure but without detectable signs of hand-arm vibration syndrome (HAVS). Yet, most of the published studies deal with developed HAVS cases, rarely discussing the biological processes that may be involved in degradation of manual dexterity and grip strength when it can be most beneficial - during the asymptomatic stage. In the present paper, a group of 31 male asymptomatic vibration-exposed workers (according to the Stockholm Workshop Scale) were compared against 30 male controls. They were tested using dynamometry and dexterimetry (modelling coarse and fine manual performance respectively) and cold provocation was done to detect possible differences in manual performance drop on these tests. The results showed reduced manual dexterity but no significant degradation in hand grip strength in the exposed subjects. This suggests that intermittent exposure profile and small cumulative vibration dose could only lead to a measurable deficit in manual dexterity but not hand grip strength even at non-negligible A(8) levels and long term exposures. Sažetak U suvremenim uvjetima profesionalne izloženosti vibracijama koje se prenose preko ruke i šake, često se mogu vidjeti radnici koji su, i pored dugotrajne povremene izloženosti, i dalje bez uočljivih simptoma vibracijske bolesti. U većini dosadašnjih istraživanja analizirani su ispitanici s razvijenom kliničkom slikom vibracijske bolesti, uz rijetka razmatranja bioloških procesa koji mogu biti uključeni u degradaciju ručne spretnosti i snage stiska šake, osobito u asimptomatskoj fazi, kada bi to bilo od najveće koristi. U ovom su istraživanju uspoređene dvije skupine ispitanika: izložena skupina - 31 radnik izložen lokalnim vibracijama koji prema Stockholmskoj klasifikaciji nema simptome vibracijske bolesti, i kontrolna skupina - 30 radnika koji nisu izloženi lokalnim vibracijama. Svaki je ispitanik bio podvrgnut dinamometrijskom i deksterimetrijskom testiranju (model za grubu i finu motoričku funkciju šake) te testu provokacije hladnoćom radi usporedbe pada motoričkih funkcija šake. U izloženoj skupini zabilježen je pad fine motoričke funkcije, ali ne i snage stiska šake. Rezultati upozoravaju na mjerljiv deficit grube ali ne i fine motoričke funkcije šake kod povremene izloženosti s malim kumulativnim dozama, čak i kada se radi o dugotrajnoj izloženosti nezanemarivim razinama A(8). Vibracijama inducirane lezije živčanih vlakana i/ ili mehanoreceptora, koji osiguravaju senzornu povratnu vezu za signale pokreta - čime kontroliraju zadatke koji iziskuju precizno kretanje prstiju - mogle bi biti odgovorne za uočeno smanjenje ručne spretnosti. Taj mehanizam, međutim, nije potreban za kontrolu grube sile stiska.

Work ability evaluation in neurosarcoidosis: A case report

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology which affects most frequently the hilar lymph nodes and lungs. Symptomatic involvement of the central nervous system may develop in patients diagnosed with sarcoidosis or it may be the initial manifestation of the disease. This is a case report of 48-year old female patient admitted to our clinic for evaluation of working ability. The patient had a total of 24 years of service and occupational exposure and she has been employed as supplies procurement officer. On admission, she complained of the following discomforts: eye-lid pain, intellectual fatigue, psychic uneasiness, forgetfulness, dyspnea and productive cough. Neurological findings indicated the presence of the right eye ophthalmoplegia, psychoorganic syndrome and neurosarcoidosis. Ophthalmological examination evidenced bilateral ptosis and presence of anisocoria. Magnetic resonance imaging revealed discrete focal lesions of the pons (paracentral left) and parietal corona radiata of the left hemisphere. Based on performed examinations and diagnostics procedures, final evaluation of patients working ability concluded that the patient was not capable of psychic strains and jobs associated with material accountability.