Mounira Hajjaji

Influence of Ramadan Observance on Sleep Pattern and Wakefulness at Workamong Medical Trainer in Tunisia

Introduction: Muslims practice intermittent Islamic fasting all over the globe each year during Ramadan. This practice induces several changes that may affect work performance. The aim of this study is to evaluate the impact of fast during Ramadan on eating behaviors, sleep habits, daytime sleepiness, and professional life. Methods: Target population was medical trainees who were working since at least 4 months at the beginning of the study. They were invited to complete an anonymous self-administered questionnaire during and apart from Ramadan. Results: Two hundred forty-three subjects (243) had correctly completed the questionnaire (mean age = 26.81 ± 2.17 years and sex-ratio = 0.69). During Ramadan, all Alcohol drinkers had stopped drinking (p<0.001), and daily tobacco consumption had significantly dropped from 14.82 ± 8.26 to 11.67 ± 8.64 cigarettes during Ramadan (0.002). Consumption of both coffee and tea was significantly reduced from 2.44 ± 1.3 to 1.03 ± 0.71 and from 1.06 ± 0.59 to 0.77 ± 0.66 cups a day, respectively (p<0.0001). The average number of meals per day dropped from 2.92 ± 0.49 before Ramadan to 1.79 ± 0.58 during Ramadan (p = 0.032). The average bedtime was significantly delayed until to 3.80 ± 5.37 am, while it was at 9.7 ± 10.93 pm during the previous month (p<0.0001). The percentage of subjects who went to bed after midnight also had significantly increased from 57.1% to 93.1% (p<0.001). The degree of dissatisfaction about sleep quality had substantially increased from 18.9% at baseline to 54.7% during Ramadan (p<0.0001). Fasted Trainees found more difficult getting up in the mornings (74.1% versus 79% respectively, p<0.0001). The percentage of trainees who often arrived late for work or missed it increased significantly, from 3.7% at baseline to 11.9% during Ramadan (p<0.0001). The majority (81.1%) reported feeling extra sleepy during the daytime of Ramadan month as compared to 60.1% during the previous month (p<0.0001). It was also noted a higher frequency of digestive disorders (46.9% versus 29.6%, <0.001), morning headaches (15.2% versus 6.6%), excessive nervousness (65% versus 57.6%, p<0.001) and concentration and memory disturbances (88.9% versus 77%, p<0.001). Both daily and weekly working hours had significantly decreased during the month of Ramadan (p<0.001). Trainees started their daily work 15 minutes later and left 20 minutes earlier, which results in 35 less minutes worked per day, and around 3 and half hours less per week. Most of participants (88.1%) thought that Ramadan had a negative effect on their sleeping pattern and affected their daytime functioning. Although, the percentage of those who took sedative-hypnotics for sleep disorders had significantly dropped from 7% at baseline to 3.3% during this month (p = 0.0001). Conclusion: The present study showed that Ramadan is associated with several changes in eating behaviors and sleep habits. These changes resulted in sleep pattern impairment, increased daytime sleepiness and reduced work performance. Healthy sleep and eating habits with a suitable work rhythm should be recommended to Fasted medical trainees to minimize the impact of Ramadan on their wellbeing and professional life.

Oxidative stress and glutathione S-transferase genetic polymorphisms in medical staff professionally exposed to ionizing radiation

Abstract Purpose: Ionizing radiation (IR) is considered as a diagnostic and therapeutic tool in medicine. However, chronic occupational exposure of medical staff to IR may affect the antioxidant status and, as a result, DNA damage and cancers as well. The objective of our study was to evaluate the oxidative stress profile caused by IR in 29 Tunisian medical staff from radiology and radiotherapy departments, and to find an association between the GSTM1 null, GSTT1 null, and GSTP1 Ile105Val polymorphisms and oxidative stress biomarkers. Materials and methods: The oxidant biomarkers malondialdehyde (MDA) and advanced oxidation protein product (AOPP) and the activities of the antioxidant superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) enzymes were spectrophotometrically determined in erythrocytes hemolysates. The analysis of GSTT1 null, GSTM1 null, and GSTP1 Ile105Val polymorphisms was determined for each participant using PCR methods. Results: A significant increase of white blood cell (WBC) numbers (p < .05) and a significant decrease by 11% of hemoglobin (Hb) (p < .01) were noted in the exposed subjects in our study. Moreover, we report a significant increase of MDA level and the activities of SOD and CAT enzymes of the IR-exposed group compared to controls (p < .001). Interestingly, a close association was noted between the genotypes GSTP1 low active, GSTT1 null, GSTM1 null, and both GSTT1/GSTM1 null and oxidative stress biomarkers, especially with MDA level, SOD, and CAT activities. Conclusions: Our findings indicate that the medical staff exposed to low IR levels were under risk of significant oxidative stress that was enhanced by their glutathione S-transferase (GST) polymorphisms.

Cytogenetic monitoring of hospital staff exposed to ionizing radiation: Optimize protocol considering DNA repair genes variability

Abstract Purpose: Chronic occupational exposure to ionizing radiation (IR) induces a wide spectrum of DNA damages. The aim of this study was to assess the frequencies of micronucleus (MN), sister chromatid exchanges (SCE) and to evaluate their association with XRCC1 399 Arg/Gln and XRCC3 241 Thr/Met polymorphisms in Hospital staff occupationally exposed to IR. Materials and methods: A questionnaire followed by a cytogenetic analysis was concluded for each subject in our study. The exposed subjects were classified into two groups based on duration of employment (Group I < 15 years; Group II ≥15years). The genotypes of all individuals (subjects and controls) were determined by the polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP). Results: DNA damage frequencies were significantly greater in IR workers compared with controls (p < .05). However, no association arised between XRCC1 399 Arg/Gln and XRCC3 241 Thr/Met polymorphisms, on one hand, and the severity of DNA damages in the studied cohort of Tunisian population, on the other hand. Conclusion: Our data provide evidence for an obvious genotoxic effect associated with IR exposure and reinforce the high sensitivity of cytogenetic assays for biomonitoring of occupationally exposed populations. These results indicate that workers exposed to IR should have periodic monitoring, along their exposure. The variants, rs25487 and rs861539, of XRCC1 and XRCC3 genes have obvious functional effects. Paradoxically, these variants are not associated with the severity of damages, according to used assays, in the studied cohort of Tunisian population, unlike other studies.

The Impact of Obstructive Sleep Apnea and Daytime Sleepiness on Work Performance: An Observational Cross-Sectional Study in a North African Population

Background: Obstructive sleep apnea hypopnea syndrome (OSAHS) has been shown to be associated with many serious health conditions. The impact on occupational health is still unclear as it was scarcely studied. Purpose: The aim of this study was to assess the association of work performance with OSAHS and daytime sleepiness. Methods: A cross-transversal study was conducted including Tunisian active adult subjects referred for suspected sleep disordered breathing. All subjects completed the Epworth Sleepiness Scale (ESS), the Work Productivity and Activity Impairment Questionnaire (WPAI), and the Patient Health Questionnaire 9 (PHQ9). They all underwent polygraph testing level 3. Result: One hundred thirty-nine subjects completed the survey, including 107 (77%) blue-collar workers, and 32 (23%) white-collar workers. Participants were classified as following: 50 patients with apnea hypopnea index (AHI) ≥ 30 and 89 with AHI <30. Among the four outcomes of the WPAI scale, only presenteeism was associated with AHI (p=0.012). A significant association has been found between daytime sleepiness and three outcomes of WPAI. Sleepy patients with ESS ≥ 11 had lower work performance in terms of presenteeism (42.46 ± 28.40 vs. 24.71 ± 24.77 p=0.0001), absenteeism (12.26 ± 25.51 vs. 6.05 ± 18.32, p=0.101), overall work productivity loss (47.43 ± 31.65 vs. 26.58 ± 28.47, p= 0.0001), and decline in activity (46.67 ± 30.75 vs. 32.14 ± 27.02, p=0.004) in comparison with non-sleepy participants. A strong correlation of presenteeism and overall work productivity loss scores with ESS was demonstrated among white-collar workers (r=0.624, p=0.0001; r=0.602, p=0.0001 respectively). PHQ9 score was significantly higher in sleepy subjects (p=0.0001). Near miss accidents in the workplace and work related accidents were significantly more frequent in those with ESS ≥ 11 (p=0.012, p=0.026; respectively). Conclusion: The most relevant finding of this study was the involvement of daytime sleepiness in performance impairment, while the impact of AHI was less clear.