Mohamed Akrout

Assessment of Chromosomal Aberrations and Micronuclei in Peripheral Lymphocytes from Tunisian Hospital Workers Exposed to Ionizing Radiation

Epidemiological studies suggest that cytogenetic biomarkers, such as micronuclei (MN) in peripheral blood lymphocytes may predict cancer risk because they indicate genomic instability. The objective of the present study was to evaluate the frequencies of MN and chromosome aberrations (CA) in peripheral blood lymphocytes of hospital workers exposed to ionizing radiation and healthy subjects. The study was conducted using peripheral blood lymphocytes from 30 workers from the radiology department and 30 from the cardiology department. This study included 27 healthy age- and sex-matched individuals as the control group. The assessment of chromosomal damage was carried out by the use of CA and micronucleus assays in peripheral lymphocytes. Our results show that CA and micronucleus frequencies were significantly higher among the exposed groups when compared to controls. Our finding of significant increase of CA and MN frequencies in peripheral lymphocytes in exposed workers indicates a potential cytogenetic hazard due to this exposure. The enhanced chromosomal damage of subjects exposed to genotoxic agents emphasizes the need to develop safety programs.

Adverse effects of pesticides on biochemical and haematological parameters in Tunisian agricultural workers.

Biomonitoring of effects in agricultural workers is necessary to assess the individual risk of handling pesticides. In this study, biochemical and haematological parameters were measured to evaluate the effects of exposure to these compounds in agricultural workers. The study was carried out in 110 workers and 97 control subjects. Several haematological and biochemical parameters were analysed. Assessment of haematological parameters revealed that the mean cell volume and haematocrit levels were significantly lower in workers than in controls (P=0.002 and 0.013, respectively), while mean corpuscular haemoglobin concentrations were higher in workers (P<0.001). There was also a significant inhibition of butyrylcholinesterase activity in workers compared with that in controls (P<0.001). Assessment of biochemical parameters further showed significantly higher activities of transferases, lactate dehydrogenase (P<0.001), alkaline phosphatase (ALP) (P=0.006) and creatine kinase (CK) (P<0.015), as well as higher levels of proteins (P<0.001), creatinine (P=0.001) and urea (P=0.001) in workers compared with controls, along with significantly higher uric acid levels (P=0.012). Furthermore, the number of years exposed to pesticides predicted higher activities of alanine aminotransferase, CK, ALP, as well as uric acid levels. Overall, chronic exposure to pesticides appeared to affect several biochemical parameters. These biomarkers seem to be indicative of adverse effects of pesticides in agricultural workers, confirming their use for routine monitoring of effects.

Occupational allergy in healthcare workers.

Occupational healthcare may expose to various allergens and irritants. Thus, the allergic manifestations in nursing staff are frequent and their prevalence is increasing all over the world. In fact, many new substances continuously appear in the medical practices. These allergic manifestations include a wide spectrum of clinical symptoms such as ocular, nasal and especially bronchial symptoms, which can be isolated or associated. These diseases can be a source of many problems related to the occupational aptitude. All these conditions justify prevention procedure strengthening, which mainly consist in substituting the sensitizing agents, and applying collective and individual prevention measures. This article also refers to some patents on the treatment of allergy.

Évaluation de l’irradiation ionisante des opérateurs en cardiologie interventionnelle

Resume Les rayonnements ionisants (RI) sont largement utilises en pratique medicale aussi bien a des fins diagnostiques que therapeutiques. Toutefois, ils ne sont pas denues d’effets indesirables sur la sante des operateurs exposes. De ce fait, nous nous proposons d’evaluer l’exposition du personnel hospitalier en cardiologie interventionnelle. Pour cela, nous avons effectue une etude transversale descriptive au cours du premier trimestre 2003 a l’aide des dosimetres electroniques de type L36, Dosicard et DMC100 a l’unite de cardiologie interventionnelle du CHU de Monastir. L’analyse des temps de scopies a permis de noter une variabilite en fonction de l’acte et de l’operateur soit 6,06 min pour la coronarographie et 21,41 min pour l’angioplastie. Le calcul des doses equivalentes par acte a note que l’exposition des mains etait superieure a celle des autres parties du corps. En effet, le niveau d’irradiation des mains etait pres de 99,5 μSv contre 14 μSv au niveau du cou et 34 μSv au niveau des pieds. Nous avons note aussi que le niveau d’exposition de la main gauche etait correle a la technique abordee. Le calcul des doses equivalentes annuelles a permis de constater que le niveau d’exposition chez tous les operateurs etait largement en deca des normes de radioprotection. En effet, l’exposition du cristallin et des membres superieurs etait respectivement de l’ordre de 1,93 mSv/an et de 14,02 mSv/an. De meme, l’estimation de la dose efficace annuelle nous a permis de constater un bas niveau d’exposition chez tous les operateurs avec une dose maximale de 2,5 mSv. En conclusion, meme si le niveau d’exposition des operateurs en cardiologie interventionnelle en temps reel reste largement en deca des normes preconisees, une radioprotection efficace reste toujours indispensable.

Work Related Asthma in the Textile Industry

Nowadays, occupational asthma is the most common form of occupational lung disease in the world. In some countries the textile industry remains an important source of potential agents causing occupational asthma. In the textile industry several agents such as cotton dust and dyes may cause occupational asthma. In this review, we discuss the epidemiology, pathogenesis/mechanisms, clinical presentations, management and prevention specific to occupational asthma in the textile industry.Work-related asthma risk is considerable. Current understanding of the mechanisms by which many textile agents cause occupational asthma is limited, especially for low molecular-weight sensitizers and irritants. The diagnosis is generally established on the basis of a suggestive history of a temporal association between exposure and the onset of symptoms and objective evidence that these symptoms are related to airflow limitation. Early diagnosis, elimination or reduction of exposure to the offending agent and early use of convenient therapy according to disease severity may play an important role in the prevention of long-term persistence of asthma. Its prevention in the textile industry should be both technical and medical. It depends on the difficulties to reduce dust level, the limits in arranging work station or in occupational rehabilitation. These difficulties are increased in small textile industry companies. Persistent occupational asthma in this sector is often associated with substantial disability and consequent impacts on income and quality of life. Prevention of new cases is the best approach to reduce the burden of asthma attributable to occupational exposures. This review also outlines different patents on the diagnosis and treatment of asthma.

Préoccupations de carrière chez les médecins de travail des groupements de Médecine de travail en Tunisie

INTRODUCTION Career dissatisfaction among occupational physicians (OP) may affect their performance and the quality of healthcare services provided. Our study aims to assess the job satisfaction of OP serving on the Institutes for Occupational Safety and Health(IOSH) in Tunisia and to identify the determinant factors. METHODOLOGY We conducted a national cross-sectional validated SAPHORA JOB survey among all the OP serving on 22 IOSH. RESULTS 58% of OP serving on the IOSH were dissatisfied with their career. Career satisfaction was statistically influenced by the number of healthcare facilities for which they were responsible (p=0.016), the work organisation (p=0.010), the work impact (p=0.011), the salary (p‹10-3) and knowledge on current regulation (p=0.047). CONCLUSION The standardisation of pay scale and career ladders for OP serving on the IOSH based on a revision of legislative texts is recommended. Improving organization and working conditions may allow success in the workplace and benefit enhancement.

Determinants of Grip Strength in Tunisian Nurses: A Bicentric Study

Background Grip muscle force has always been used to assess functional limitations in elderly. Its use as a tool to assess work capacity has never been described in the literature. Objective To describe the patent determinants of grip strength and the usefulness of its measurement in assessing workability index in the healthcare sector. Methods This is a cross-sectional study conducted in a sample of 293 healthcare workers representative of 1181 based on a comprehensive questionnaire about socio-professional characteristics and on an 8-item work capacity evaluation (WAI). Besides, Body mass index was measured and muscle strength was assessed by JAMAR hydraulic dynamometer. Results Handgrip Strength was stronger in male nurses (p < 0.001), with low perceived physical load (p = 0.0001) and working on a night shift (p = 0.001). It decreased with a greater duration of household work (p < 0.0001) and increased with a greater BMI (p = 0.015) and a better workability index (p < 0.0001). After removal of all the variables that were not independently associated with the muscle strength force, factors accounting for 52.6% of the variance in nurses handgrip strength were gender (p < 0.001), workability index (p < 0.001), duration of household work (p = 0.021), BMI (p = 0.002), perceived physical load (p < 0.001) and work schedule (p = 0.002). Conclusion Grip Strength Test is a useful tool to assess strength and functional capacity at work in healthcare workers. Further longitudinal studies are required to confirm this hypothesis.

Approche préventive de la violence au travail chez le personnel de la consultation

Objectifs La maitrise des risques professionnels et l’amelioration des conditions de travail afin de promouvoir la sante au travail constituent un veritable facteur de performance d’un etablissement de sante. L’agression subie par le personnel de soin mettant en peril son bienetre et la stabilite de son travail constitue un de ces risques majeurs. Suite a des actes repetes d’agression du personnel du bureau d’accueil et d’enregistrement des consultations externes du CHU de Monastir, une demande d’intervention ergonomique a ete formulee aupres du service de Medecine du travail. Methodologie L’intervention menee est une etude exploratoire des conditions potentielles d’agression survenues aux bureaux d’inscription, elle s’est basee sur l’etude de l’activite a travers une observation du terrain. Resultats L’observation de l’activite au bureau d’inscription des consultations externes a montre l’existence d’une combinaison de facteurs generateurs a l’origine de declenchement des actes agressifs. La majorite des facteurs declencheurs constates etaient secondaires au dysfonctionnement organisationnel existant. Ainsi, les bureaux d’inscription etaient negliges et non pris en compte dans les projets d’amenagement menes par la direction de l’hopital. Cette activite professionnelle n’a jamais fait l’objet d’etude malgre l’augmentation considerable du nombre des consultants. Les conditions actuelles de travail dans ce milieu sont la cause d’une insatisfaction chez le personnel et sources de stress au travail. Des difficultes majeures de communication sont a l’origine de conduites agressives documentees au cours de cette etude. Par ailleurs, ce milieu qui accueille des gens souffrant de diverses maladies et dont le nombre ne cesse d’augmenter, ne dispose pas d’un systeme d’accueil et d’information adequats. Dans un autre volet, nous avons constate l’absence de developpement des competences du personnel en matiere d’habilites de communication et d’accueil et en matiere de gestion des conflits afin de les empecher a se transformer en agressions. Conclusion Des mesures preventives visant une meilleure organisation du travail a travers la mise en service d’une application informatisee de gestion des rendez-vous, l’avancement de l’heure de debut des consultations pour eviter la file d’attente ont ete proposes. Dans un autre registre, une meilleure prise en charge des victimes des actes agressifs et l’utilisation de l’arbre des causes de ces agressions afin d’identifier les causes directes et de les eviter ulterieurement ont ete proposes. De meme que la creation d’un comite de securite au travail et le recrutement d’un psychologue de travail.

Signes cliniques et variations de l’activité de la cholinestérase plasmatique chez des travailleurs agricoles exposés aux pesticides

L’objectif de cette etude est de contribuer a l’evaluation et l’appreciation des risques reels lies a l’exposition chronique aux pesticides, a partir des variations de l’activite de la cholinesterase plasmatique (PChE), et des manifestations cliniques susceptibles d’etre dues a l’exposition professionnelle aux pesticides. L’etude a concerne 110 travailleurs agricoles et 97 individus temoins, vivant dans le Sahel tunisien. Chaque individu a beneficie d’un examen clinique, afin de rechercher des symptomes fonctionnels en relation avec une intoxication chronique aux pesticides. La determination de l’activite de la PChE a ete realisee par une methode cinetique adaptee sur konelab 30 (Thermo Clinical Labsystems™). Les signes neurologiques sont les plus frequemment retrouves chez les travailleurs, suivis des atteintes osteomusculaires et des signes dermatologiques. Une association significative a ete retrouvee entre les signes neurologiques mentionnes par les travailleurs et l’exposition a des organophosphores (OP) et/ou des carbamates (CB) (p = 0,013). L’activite moyenne de la PChE est significativement plus basse chez les travailleurs par rapport aux temoins (p < 0,001). Elle est diminuee chez les travailleurs exposes a des melanges de pesticides OP-CB par rapport a ceux n’ayant utilises que des OP (p = 0,030) ou des CB (p = 0,031). Une association significative a ete notee entre la diminution de la PChE et l’exposition aux OP et/ou CB (p < 0,001). La variation de la PChE est egalement liee a la duree d’epandage et l’anciennete d’exposition. Ainsi, l’activite de la PChE constitue un important biomarqueur d’effet de l’exposition aux pesticides. Cependant, l’interpretation de l’activite de cette enzyme chez les travailleurs doit prendre en consideration certains facteurs, notamment la nature des pesticides utilises ainsi que la duree et l’anciennete de l’exposition.

Lymphome B non hodgkinien du sacrum compliquant une hépatite virale C chronique liée à un accident d’exposition au sang : à propos d’une observation

Frequency of the association between non-Hodgkins lymphoma (NHL) and the hepatitis C virus (HCV) infection is variable according to previous studies. Besides, direct and/or indirect implication of the HCV infection in the development of NHL is probable but, its pathophysiological mechanisms remain unclear. In this report, we described the case of a 49-year-old patient with a B-cell NHL of the sacrum complicating a chronic HCV related to a blood exposure, and we report the recent data of this association.