Taoufik Khalfallah

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.

983 Thermal stress and constrain in a tunisian steel industry

Introduction The hardship at work in the steel industry is linked to the important thermal constraints related to production processes. This study aims to identify the heat strain at work in the steel industry in Tunisia through the assessed metabolism by cardiovascular heart rate recording and to evaluate the thermal stress based on the various of measurable parameters. Methods A cross-sectional exhaustive study was conducted among the 80 workers in a steel company. The recommendation of the ‘analysis’ level of the international standard ISO 8996 ‘ Ergonomics of the thermal environment -- Determination of metabolic rate was adopted for the evaluation of the thermal strain. The international standard ISO 7933 ‘ Ergonomics of the thermal environment -- Analytical determination and interpretation of heat stress using calculation of the predicted heat strain’ was adopted for the assessment of the thermal stress. Thus, metabolism was evaluated based on the recording of heart rate during work withen steel workers. Moreover, physical parameters of thermal stress (air temperature, relative humidity, air velocity, globe temperature, clothing isolation, working metabolism) were assessed. Results The equivalent metabolism was equal to 292.7 W±59.8 W. Thus, workload was ‘acceptable’ for the majority of workers (84.8%). Concerning the thermal stress level, 68.18% of the subjects were at risk of a long-term constraint (discomfort and risk of dehydration after several hours of exposure) and 30,3% of them faced a short term constraint (risk for Health after 30 to 120 min of exposure). Discussion The present study objectively quantified the physical workload in the steel sector. For most workers, the workload was light to moderate. The long-term and short-term thermal stress objectified in this study was the source of a workstation layout and a prevention strategy.

Ergonomic Evaluation of Physical Workload Among Steelworkers

Our study aims, to assess the physical workload among steel workers through heart rate recordings and to develop a preventive strategy. Methods: A Cross-sectional study conducted within 65 steelworkers. The physical load was evaluated by the estimation of occupational metabolism based on recording the heart rate during a representative period of the working day as recommended by ISO 8996 (level 3). Results: The study population was exclusively male. The mean age was 37.8 years ± 9.5 years The equivalent metabolism was estimated at 282.4 ± W 80,6 W. Interpretation of the workload has concluded that this charge was “Acceptable” for the entire population study except 3 workers for which the workload was considered as “Inadmissible”. Conclusion: Urgent preventive actions have been proposed, associated to general recommendations to increase automation of production processes, improvement of work conditions, and tasks organization and strengthening the medical supervision of these workers.

Influence of Age on Patch Tests Results

Amaç: Yama test sonuçları üzerinde yaşın etkisini incelemek ve yaş gruplarına göre deri duyarlaştırıcılarının profillerini karşılaştırmaktır. Yöntemler: Bu sekiz yıllık retrospektif çalışma, Tunus, Sousse Üniversite Hastanesi, Meslek Hekimliği Bölümü, Dermatoloji ve Alergoloji Ünitesi’nde alerjik kontakt dermatit hastalarının tüm tıbbi kayıtlarını içermektedir. Çalışma popülasyonu iki yaş grubuna ayrıldı (grup 1: <40 yaş hastalar; grup 2: >40 yaş hastalar). İstatistiksel anlamlılık derecesi p<0,05 olarak kabul edildi. Bulgular: Beş yüz altmış sekiz hasta en az bir yama testine pozitif reaksiyon vermiştir. Yaşlı bireylerin en az bir yama testine pozitif yanıt vermeleri gençlere göre 1,1 kat daha muhtemeldir. İki grupta da görülen en yaygın alerjenler: potasyum dikromat (%34,2, %38), tiuram karışımı (%6, %11), kobalt klorür (%27, %28,8), Peru balsamı (%6, %11,3) ve nikel sülfattır (%41, %27,3). Potasyum dikromat ile deri reaksiyonlarının intansitelerinde belirgin bir varyasyon not edildi (p=0,00). Sonuç: Yama test sonuçları üzerinde yaş etkisinin fizyolojik mekanizmasının aydınlığa kavuşturulması ve European Standard Battery’yi alerji tipi ve uygun konsantrasyonlar açısından her yaş grubuna uyarlamak için daha fazla çalışmaya gereksinim vardır. Anahtar kelimeler: Yama testleri, alerjen, dermatit, yaş, deri reaksiyonları, deri Öz Abstract

Evaluation of Student’s Competencies on Social Medicine Internship with the Objective Structured Clinical Examination Method

The aim of the current study is to evaluate OSCE (Objective Structured Clinical Examination) stations elaborated to asses competencies of external students on the 5th year of Social Medicine internship at the Faculty of Medicine of Monastir, in Tunisia, carried out over a year. The total number of OSCE stations was 32 with an average of 5.3 ± 2.3 stations per session, each station lasting five minutes. More than half of OSCE stations were a clinical vignette type (68.7%), followed by photo-type stations in 8 cases (25%). The total number of tasks required was 76.The number of stations about a single task was 18.75%. Morethan two-thirds of tasks involved competencies of cognitive level type III (72.1%). The number of elements per correction grid varied between 4 and 10 with an average of 6.44 ± 1.8 elements. At the end of the different examination sessions, the success rate was low (15-19 / 30) for 61% of learners with a discrimination index -0.41 and a difficulty index of tests 66%. These results attest the feasibility of OSCE stations for evaluation of skills in medical specialty. However, a regular and more thorough evaluation of this method is necessary in order to promote skills of future general practitioner

Prevalence and determinants of musculoskeletal disorders upper limbs in the Tunisian craftsmen

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.

Impact socio professionnel de la libération chirurgicale du syndrome du canal carpien

L’objectif de notre travail était d’étudier les conséquences socioprofessionnelles d’une libération chirurgicale du SCC. Il s’agit d’une étude transversale portant sur les sujets opérés pour un SCC d’origine professionnelle ; recensés dans le Service de Médecine de Travail et de Pathologies Professionnelles au CHU Tahar Sfar de Mahdia en Tunisie sur une période de 8 ans allant du 1 Janvier 2006 au mois Décembre 2013. Le recueil des données s’est basé sur une fiche d’enquête, portant sur la description des caractéristiques socioprofessionnelles, médicales, et sur le devenir professionnel des participants. Pour étudier les contraintes psychosociales au travail, nous avons adopté le questionnaire de Karasek. La durée d’arrêt de travail après libération chirurgicale du SCC était significativement liée à l’existence d’autres troubles musculo-squelettiques autre que le SCC, la déclaration du SCC en maladie professionnelle et à l’ancienneté professionnelle des salariés. Quant au devenir professionnel des salariés opérés, 50,7% ont gardé le même poste, 15,3% ont bénéficié d’un aménagement de poste et 33,8% ont bénéficié d’un changement de poste dans la même entreprise. Le devenir professionnel de ces salariés était corrélé à leurs qualifications professionnelles et au type de l’atteinte sensitive et/ou motrice du nerf médian à l’EMG. Un certain nombre de facteurs non lésionnels déterminaient la durée de l’arrêt de travail, alors que le devenir professionnel des opérés pour SCC dépendait essentiellement de leurs qualifications professionnelles et des données de l’électromyogramme. Il est certain que des travaux beaucoup plus larges permettraient d’affiner encore ces résultats.

Ergonomic Intervention in the Sector of Waste Collection, with the Use of Deparis Guide Method: Case of the Municipality of Monastir in Tunisia

Despite the evolution of tools, equipment and work-organization, the collection of waste remains a difficult and dangerous sector. In the town of Monastir, in 2013, the number of operators assigned to the direction of cleanliness and environment was 63 and they ensured in average 1800–2000 tons of collected waste per month up to 3000 tons during the summer season. The current intervention had followed a request of the Mayor of the Municipality of Monastir which focused on the reorganization of the activity of collection of household and similar waste, with the objective to improve both the efficiency and the safety of work and the health of collectors and drivers of vehicles. We based our intervention on the 1st level of the Sobane Strategy: the Deparis guide on its initial version. The focus group was composed of ten actors in the business of waste collection, including key operators (drivers and garbage collectors) but also representatives of local of supervision and also of management (responsible for the municipal park district coordinator). The diagnosis had focused on physical work environments (buildings, equipment, tools, air hygiene, urban transport) but also on team organization and psychosocial factors. Consultation between the team work allowed to retain a number of proposed corrective actions focusing on machines and tools work, but also actions to re-design the work organization. Among these propositions we mention the design and development of new work spaces in the municipal park taking into consideration both the needs but also the activities of operators and the organization of collective work. Over 80 % of the actions proposed by the working group were retained and implemented. Other more complicated aspects of the work situation were chosen as subject of future ergonomic intervention (e.g. computerization of the organizational process of the park) or further reflection objects in budgeting (installation alarm systems).

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.