Background: In recent decades, the incidence of children’s hematological malignancies has been increasing worldwide including Tunisia. Their severity is reflected in the importance of the medical, social and economic...Background: In recent decades, the incidence of children’s hematological malignancies has been increasing worldwide including Tunisia. Their severity is reflected in the importance of the medical, social and economic impact. This increase remains fully unexplained, and the involvement of genetic, environmental and occupational factors is strongly suspected. Materials and methods: Our study was a cross-sectional survey of the type case-control conducted in the University Hospital of Farhat Hached of Sousse during the period ranging between 1 July 2011 and 30 June 2012, and which included children with acute leukemia compared to children unharmed by neoplastic disease. Cases and controls were matched by age and gender. Our objective was to describe the socio-occupational characteristics of the parents of children with acute leukemia and to identify potential occupational factors implicated in the genesis of acute leukemia. Results: The number of acute leukemia cases in the Hematology Service and day hospital of the University Hospital of Farhat Hached during the study period was 66 cases divided into in 40 boys and 26 girls with a sex ratio of 1.53. Our cases and controls were matched by age and gender. The risk of incidence of leukemia in children from smoking fathers was higher (p = 0.02, OR = 2.24, IC = [1.11 - 4.52]). The risk of incidence of leukemia in children from alcoholic fathers was higher with p = 0.009, OR = 3.9;CI = [1.33 - 11.39]. After adjusting different variables, the difference persisted significantly with pa = 0.03 and ORa = 3.5, ICa = [1.09 - 11.6]. 25.7% of cases had a family history of blood disease and neoplasia, whereas no control presented that. The difference was statistically significant (p = 0.006, OR = 1.46, IC = [1.38 - 1.56]). The parental occupational exposures associated to the occurrence of acute leukemia in children were pesticides with a statistically significant difference (p = 0.03, OR = 2.94, IC = [1.06 - 8.13]). This difference persisted after adjustment with different var展开更多
Tarlov cysts are often asymptomatic and incidentally discovered. However, in few cases, these cysts can be symptomatic and may manifest as chronic low back pain. We report a case of a Tarlov cyst incidentally diagnose...Tarlov cysts are often asymptomatic and incidentally discovered. However, in few cases, these cysts can be symptomatic and may manifest as chronic low back pain. We report a case of a Tarlov cyst incidentally diagnosed by MRI in a wiring factory worker complaining of chronic low back pain exacerbated with the carrying of heavy loads and the hyper solicitation of the lumbar spine during his professional activity. The clinical manifestations of symptomatic Tarlov cysts can influence the life quality of patients and have enormous repercussions on their work ability, which in some cases can lead to job loss. Thus, the socio-professional aspects of symptomatic Tarlov cysts should not be underestimated and maintaining these patients in employment should be considered from the outset as an objective in its own right in the management.展开更多
Introduction: Apart from its increasingly important frequency, occupational asthma (OA) has become the most important cause of occupational respiratory disorders in developed countries. The number of etiological agent...Introduction: Apart from its increasingly important frequency, occupational asthma (OA) has become the most important cause of occupational respiratory disorders in developed countries. The number of etiological agents continues to grow following the constant introduction of new harmful substances in industry. Objectives: Determine the prevalence and incidence of OA in our country, the socio-occupational characteristics of asthmatics, and study the forensic and social impact of such pathology. Material and Methods: An exhaustive retrospective epidemiological study was conducted in Tunisia about charts of occupational asthma cases recognized by the competent commissions of the National Medical Care Fund (CNAM) during the period ranging from January 1<sup>st</sup> 2000 to December 31<sup>st</sup> 2008. Results: 361 occupational asthma cases, accounting for a prevalence of 7.17% of all occupational diseases, were recognized during the period of the study. Occupational asthma annual incidence was estimated to be 24.42 cases per 1000000 workers. Our study population was mainly women with a sex ratio of 0.86. More than a half (57.6%) of recognized OA cases were working in the textile industry sector. Concerning the asthmatics’ professional career, most of recognized OA cases (n = 225 i.e. 70.6% of cases) kept their jobs, whereas 58 patients did not. The professional career was linked to gender with a job loss that is 1.79 time more important in asthmatic women. Conclusion: The incidence of occupational asthma in Tunisia is comparable with that found in other Mediterranean countries. A rigorous and adequate prevention is necessary and allows reducing the importance of this occupational pathology and its serious consequences.展开更多
The random amplified mirosatellite polymorphism method was performed in a set of Tunisian fig landraces using eighteen primer combinations. A total of sixty three random amplified microsatellite polymorphism （RAMPO）...The random amplified mirosatellite polymorphism method was performed in a set of Tunisian fig landraces using eighteen primer combinations. A total of sixty three random amplified microsatellite polymorphism （RAMPO） markers were scored and used either to assess the genetic diversity in these cultivars or to detect cases of mislabeling. Opportunely, data proved that the designed procedure constitutes an attractive and fast method with low costs and prevents radio exposure. As a result, we have identified the primer combinations that are the most efficient to detect genetic polymorphism in this crop. Therefore, the derived unweighted pair-group method with arithmetic averages （UPGMA） dendrogram illustrates the genetic divergence among the landraces studied and exhibits a typically continuous variation. Moreover, no evident correlation between the sexes of trees was observed. In addition, using these markers, discrimination between landraces has been achieved. Thus, random amplified mirosatellite polymor- phism is proved to be powerful for characterizing the local fig germplasm.展开更多
The present study reports on population structure analysis of the marbled crab Pachygrapsus marmoratus （Fabricius, 1787） from the Tunisian coast, an appropriate location to study biogeographical processes because of...The present study reports on population structure analysis of the marbled crab Pachygrapsus marmoratus （Fabricius, 1787） from the Tunisian coast, an appropriate location to study biogeographical processes because of the presence of a well-known discontinuous biogeographic area （the Siculo-Tunisian Strait）. Patterns of morphological and genetic variation of this highly dispersive and continuously distributed decapod species were assessed among its geographically close populations which cover almost the entire Tunisian coastline. A total of 386 specimens from nine sites were collected and examined for morphometric variability at 14 morphometric traits. The results of multivariate analyses of linear morphometric traits showed the existence of sexual dimorphism in this species by PERMANOVA （Permutational multivariate analysis of variance）. In addition, both CDA （Canonical discriminant analysis） and NPMANOVA （Non parametric MANOVA test） analyses revealed statistically significant differences among the studied locations for both sexes. Overall, the outcome of CDA analysis showed that over 87% of individuals could be assigned correctly to three regional groups in both sexes （North, Center and South）. Specifically, SIMPER （Similarity Percentages） analysis showed that carapace length, carapace width and merus length were major contributors to the morphometric separation between populations. The pattern of phenotypic variation suggested by morphometric analyses was found to be highly discordant with that suggested by the analysis of a mitochondrial marker （cytochrome oxidase I, COI）. Indeed, the results inferred from restriction fragment analysis of the COI in 180 crabs, suggested high genetic homogeneity. Very low levels of haplotype diversity （h） were found in almost all the studied populations, associated with non significant genetic distances for nearly all population comparisons. Explanations to these morphometric and mtDNA patterns as well as the discrepancy between them are discus展开更多
Objectives: Low back pain is a major occupational problem especially among nursing staff. The objectives of our study are to evaluate the prevalence of low back pain among nurses and to look for physical and psychosoc...Objectives: Low back pain is a major occupational problem especially among nursing staff. The objectives of our study are to evaluate the prevalence of low back pain among nurses and to look for physical and psychosocial risk factors. Methods: It is a cross-sectional study based on a self-administered questionnaire destined for all nurses working in Farhat Hached Teaching hospital of Sousse (Tunisia). Results: Our study included 203 nurses with an average age of 39.8 years. The prevalence of low back pain over the last twelve months was 58.1%. The factors that are significantly associated to low back pain were: high BMI, number of pregnancies, arthritis, poor physical condition, daily frequency of inappropriate posture for the activity being performed, and the layout of materials in the workplace. Conclusion: Our study evidenced the high prevalence of LBP among nurses and allowed bringing to light the role of individual and ergonomic physical factors in the genesis of LBP. Such identification permits to undertake targeted preventive actions. The association between psychosocial factors and LBP was not emphasized.展开更多
Background: Occupational allergic contact dermatitis (ACD) is one of the most frequent diseases on the workplace worldwide. Its national incidence and prevalence were not previously studied in Tunisia. Objective: To a...Background: Occupational allergic contact dermatitis (ACD) is one of the most frequent diseases on the workplace worldwide. Its national incidence and prevalence were not previously studied in Tunisia. Objective: To assess incidence of occupational allergic contact dermatitis and its occupational outcome in Tunisia. Methods: Descriptive epidemiological study of all cases of occupational allergic contact dermatitis reported from 2002 to 2012 in Tunisia and recognized by the medical commissions of the National Health Insurance Fund. Results: 315 cases of occupational ACD were collected representing an annual incidence of 31.65 cases/100.000 workers in the private sector in Tunisia. The mean age of our population was 42.70 ± 9.02 years with a male predominance (sex ratio 3.03). The most affected sectors were the clothing sector (14.3% of cases) and the cement industry (13.7% of cases). Patch tests were positive in 188 patients (59.67%). The most frequently positive allergen was potassium dichromate in 27.3% of the cases. Overall, 25.4% of patients had lost their jobs. After multiple binary logistic regression, job loss had a statistically significant relationship with localization of lesions on the face and on dominant hand. Conclusion: Occupational ACD is frequent in Tunisia and is responsible for an important rate of job loss. Preventive measures must be reinforced, especially the wearing of protective gloves.展开更多
Colorectal cancers （CRC） account for frequent and serious cancers which result from the interaction between individual genetic factors and environmental factors, and in particular widely studied nutritional ones. Th...Colorectal cancers （CRC） account for frequent and serious cancers which result from the interaction between individual genetic factors and environmental factors, and in particular widely studied nutritional ones. The role of other occupational factors remains a controversial subject. The objective of this study is to evaluate the possible impact of occupational factors on the risk of developing CRC. Materials and Methods： This is a retrospective case-control study. The cases and the control group were enlisted in the general surgical ward of Farhat Hached Teaching Hospital of Sousse （Tunisia） during the period extending from 2004 to 2008, and they were age and gender-matched. The data were analyzed using SPSS 11.0 software with a signification threshold fixed at 5%. A univariate analysis was carried out as well as a multiple binary logistical regression. Results： During the period of the study, 40 cases of colorectal cancers have been colligated including 28 men and 12 women with a sex ratio of 0.43. The average age of the cases was 61.55 ± 13.3 years and 60.40 ± 12.84 years for the control group, with a non significant difference （P = 0.69）. The univariate analysis has objectivized significant associations between colorectal cancer and the housing conditions, the neoplastic and digestive family history, the occupational activity sector, exposure to pesticides, and lack of periodic medical supervision. After logistical regression, the occurrence risk of CRC was significantly associated with： alcohol and smoking （ORa = 3.43; Pa = 0.05）, meat consumption （ORa = 3.34; Pa = 0.03）, exposure to pesticides （ORa = 20.44; Pa = 0.012） and lack of periodic medical supervision （OR = 7.45; P = 0.004）. Conclusion： The occupational risk factors might play a role in the etiopathogenesis of colorectal cancers. With regard to our study, pesticides seem to be most implicated and necessitate suitable preventive measures. Nevertheless, it seems useful to multiply the studies to a much larger scal展开更多
Introduction: The mycosis fungoides (MF) is the most common cutaneous T-cell lymphomas representing about 50% of all cutaneous lymphomas. Its pathogenesis remains poorly understood. Thus, its rising incidence rates ca...Introduction: The mycosis fungoides (MF) is the most common cutaneous T-cell lymphomas representing about 50% of all cutaneous lymphomas. Its pathogenesis remains poorly understood. Thus, its rising incidence rates call for an explanation. Several environmental and occupational factors have been implicated in the pathogenesis of this disease. Objective: To determine the potential occupational factors correlated in the occurrence of MF. Methods: Case-control study was carried out at the teaching Hospital Farhat Hached of Sousse (Tunisia) to investigate associations of MF and occupational risk factors. A questionnaire on lifetime job history was administered to 24 cases and controls. Cases were patients with MF and whose diagnosis was suspected by a dermatologist and confirmed by pathological examination. Controls were patients consulting in the occupational medicine department and matched to cases by age and gender. Bivariate analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: The average age of onset of the disease was 55.41 ± 17.4 years with a sex ratio of 2.42. We found an increased risk of MF associated with tobacco consumption higher than 40 Pack-year (OR = 6.6;95% CI = 1.22 to 35.4), exercise in the textile sector (OR = 9.4;CI = 1.06 to 84.3) and exposure to diesel exhaust (OR = 9.47;95% CI = 1.06 to 84.3). Conclusion: Occupational factors could play a role in the pathogenesis of MF. Regarding our study, smoking, working in the textile industry and exposure to diesel exhaust appear to be involved in the pathogenesis of MF. Further investigation is needed to confirm these findings.展开更多
Background. Cutaneous extraskeletal Ewing s sarcoma is rare, being seen principally in children. We report a case of cutaneous sarcoma in the sole of the foot in a child. Case report. A 9-yearold child with no medic...Background. Cutaneous extraskeletal Ewing s sarcoma is rare, being seen principally in children. We report a case of cutaneous sarcoma in the sole of the foot in a child. Case report. A 9-yearold child with no medical history of note was presenting a skin tumor for 3months on the heel of the right foot. This tumor was burgeoning and painful and measured 3.5cm in diameter; it was ulcerative at the surface and covered with a crust. Histological and immunohistochemical examinations confirmed the diagnosis of Ewing s sarcoma. Staging examinations proved negative and the patient underwent polychemotherapy, resulting in complete regression of the tumor. Comments. Until 1998, 37 cases of cutaneous and subcutaneous Ewing s sarcoma were reported, being seen in 21 girls and 16 boys. Mean age at diagnosis was 15 years and mean tumor size was 3 cm (range: 1 to 12 cm). The tumors were observed throughout the body, being seen in the sole of the foot in 2 cases. Confirmation of the diagnosis was made by histological examination (malignant proliferation of small round cells in the dermis), immunohistochemical examination (CD99+ ) and cytogenetic analysis (translocation between chromosomes 22 and 11). The prognosis for cutaneous Ewing s sarcoma appears more favorable than that of Ewing s sarcoma in bone. Of the 37 patients treated, 7 had metastases and 2 presented relapse. Treatment for cutaneous Ewing s sarcoma, though not codified, consists of polychemotherapy associated with surgery and/or radiotherapy.展开更多
The present investigation focuses on population structure analysis of the purple sea urchin Paracentrotus lividus across the African Mediterranean coast, with the main aim of assessing the influence of the Siculo-Tuni...The present investigation focuses on population structure analysis of the purple sea urchin Paracentrotus lividus across the African Mediterranean coast, with the main aim of assessing the influence of the Siculo-Tunisian Strait on gene flow disruption in this highly dispersive echinoid species. For this purpose, patterns of morphological and genetic variation were assessed among its populations from the western and eastern Mediterranean coasts. A total of 302 specimens from seven Tunisian sites were collected and examined for morphometric variability at twelve morphometric traits. Concordant results, inferred from CDA（canonical discriminant analyses）, pairwise NPMANOVA（non parametric multivariate analysis of variance） comparisons and MDS（multidimensional scaling） plot, unveiled significant inter-population differences in the measured traits among the studied populations. Furthermore, the combined use of the one way ANOSIM（analysis of similarities） and the Discriminant/Hotelling analysis allowed unravelling two morphologically differentiated groups assigned to both western and eastern Mediterranean basins. The SIMPER（similarity percentages） routine analysis showed that total dry weight, test diameter and spine length were major contributors to the morphometric separation between locations and between groups. Pattern of phenotypic divergence discerned in P. lividus across the Siculo-Tunisian Strait is interestingly in congruence with that inferred from the genetic investigation of the purple sea urchin populations from the same region based on the analysis of the mt DNA COI（cytochrome oxidase I） gene in 314 specimens from nineteen locations covering a wider geographic transect, streching westward to the Algerian coast and eastward to the Libyan littoral. The specific haplotypic composition characterizing each Mediterranean basin,as inferred from the minimum spanning network, confirmed the geographic partioning of genetic variation, as revealed by F-statistics and AMOVA（analysis of molecul展开更多
Buerger’s disease, also called thromboangiitis obliterans (TAO), is an inflammatory disease affecting small and medium size blood vessels of the limbs. Several risk factors are strongly associated with this disease. ...Buerger’s disease, also called thromboangiitis obliterans (TAO), is an inflammatory disease affecting small and medium size blood vessels of the limbs. Several risk factors are strongly associated with this disease. In fact, heavy smokers represent 99% of patients diagnosed with Buerger’s disease and smoking cessation can slow down the progression of the pathology. Ulcers and gangrene are very common complications and TAO may also cause a vasculitis as well as ischemic damage to the distal part of the limbs that can eventually lead to limb amputation. Here, we report the case of a 43 years old patient, a flight personnel working in a Tunisian airline company who consults for a lesion of the left toe that appeared 2 weeks ago. He is a chronic inveterate smoker with 36 pack-years. The diagnosis of TAO was made based on the clinical presentation and the results of the Doppler Ultrasound of the left toe. This disease has a major impact on the quality of life due to the risk of necrotic ulcers and amputation. Navigation is a profession that requires a high level of physical and mental fitness. According to the international and Tunisian standards, the applicant or the holder of medical certificate must not have a cardiovascular condition that may affect the safety of the exercise.展开更多
Objective: To identify the importance of using humor in patient/nurse relationship, its factors, its conditions and the barriers that might limit its use. Methods: We systematically searched PubMed, Science Direct and...Objective: To identify the importance of using humor in patient/nurse relationship, its factors, its conditions and the barriers that might limit its use. Methods: We systematically searched PubMed, Science Direct and Google Scholar, for relevant articles published in English between 2010 and 2019. We included the studies that investigated humor between nurses and their patient’s relationship. Results: From the initial 287 articles found, 15 were included for final revision. Data allowed retrieving information on humor definition;its applicability as a nursing intervention;humor as a tool to improve nurse-patient communication and relationship;influencing factors;humor benefits in health care context and the limits that come against its use. Conclusion: Humor is considered a powerful communication tool, it promotes well-being, relieves anxiety and stress, helps deal with stressful situations but it should be used cautiously in order to prevent undesired consequences.展开更多
N-doped mesoporous alumina has been synthesized using chitosan as the biopolymer template. The adsorbent has been thoroughly investigated for the adsorption of CO2 from a simulated flue gas stream （15% CO2 balanced w...N-doped mesoporous alumina has been synthesized using chitosan as the biopolymer template. The adsorbent has been thoroughly investigated for the adsorption of CO2 from a simulated flue gas stream （15% CO2 balanced with N2） and compared with commercially available mesoporous alumina procured from SASOL, Germany. CO2 adsorption was studied under different conditions of pre- treatment and adsorption temperature, inlet CO2 concentration and in the presence of oxygen and moisture. The adsorption capacity was determined to be 29.4 nag CO2/g of adsorbent at 55℃. This value was observed to be 4 times higher in comparison to that of commercial mesoporous alumina at a temperature of 55℃. Basicity of alumina surface coupled with the presence of nitrogen in template in synthesized sample is responsible for this enhanced CO2 adsorption. Adsorption capacity for CO2 was retained in the presence of oxygen; however moisture had a deteriorating effect on the adsorption capacity reducing it to nearly half the value.展开更多
Introduction: The exposure to shift works, and especially to night shift, goes against the circadian rythmicity of the social man, which brings about a multitude of disruptive effects on health. In a hospital environm...Introduction: The exposure to shift works, and especially to night shift, goes against the circadian rythmicity of the social man, which brings about a multitude of disruptive effects on health. In a hospital environment, such night shift is necessary so as to ensure the continuity of care. Sleep and vigilance disorders related to this work mode are frequent and often pose adaptation problems. The objective of this study is to detect the harmful effects of night shift on sleep, vigilance and the quality of life of nurses in Farhat Hached Teaching Hospital in Sousse. Material and Methods: It is a cross-sectional study carried out among two groups of nurses: one group performing a fixed night work and the other one working permanently during the day at Farhat Hached Teaching Hospital in Sousse. Data collection is mainly based on validated questionnaires evaluating sleep quality (Pittsburg sleep quality index), daytime sleepiness (Epworth sleepiness scale), sleep typology (Horne and Ostberg questionnaire), and the quality of life (SF-12). An objective evaluation of vigilance was realized by the study of reaction time and error rates to different tasks of “Super lab” software. Results: 50 night and 50 day nurses have been colligated. Both groups were age- and gender-matched. Sleep quality mean index was significantly higher among night nurses in comparison with day nurses (10.2 ± 5.9 versus 6.76 ± 5.16). After multivariate analysis, sleep quality was significantly correlated to age, department, schedule and the choice of schedule. Night shift was not related to daytime sleepiness. The objective analysis of vigilance showed that the reaction time to different tasks exploring the attentional mechanisms, as well as errors rate, were significantly more important among the night group. The mental score of the quality of life was significantly higher among day nurses. However, such difference was not significant with regard to physical score. Conclusion: The findings of our study highlight not only the alteration of 展开更多
Background and Objectives: Following the initial management, some patients with differentiated thyroid cancer (DTC) develop a state of high thyroglobulin (Tg) and Negative Iodine Scintigraphy. The predisposing factors...Background and Objectives: Following the initial management, some patients with differentiated thyroid cancer (DTC) develop a state of high thyroglobulin (Tg) and Negative Iodine Scintigraphy. The predisposing factors and outcome of this condition are unclear. In this study, our objectives were to analyze the characteristics of patients with high Tg level and negative Iodine scintigraphy and to determine the predictive factors for development of high Tg and negative scintigraphy. Patients and Methods: Retrospective study of 34 patients undergoing treatment for DTC, followed in the Nuclear Medicine department of the University Hospital—Sahloul Sousse between 1990 and 2006 and having a high Tg and negative Iodine scintigraphy. Fourteen patients had Tg between 2 and 10 ng/ml, 16 had Tg between 11 and 100 ng/ml and 4 patients had Tg more than 100 ng/ml. Results: There were 25 women and 9 men. The mean age was 51.65 years. In 94.1% of cases, the tumor was papillary carcinoma. Follicular tumors accounted for only 5.9%. The mean nodule size was3.26 cm. Capsular invasion was seen in 47.1% cases. The locoregional invasion was found in 35.3%. The lymph node extension was found in 84.8% of patients having lymph node surgery. Lymph node involvement was observed in 92.8% of patients with papillary cancer but it was found in 7.2% of patients with follicular cancers. Lymph node invasion was unilateral in 28.6% (N1a) and bilateral, contralateral or mediastinal in 71.4% (N1b). Initial level of Tg was as follows: 7 patients had Tg between 2 and 10 ng/ml, 14 patients had Tg between 11 and 100 ng/ml and 12 had Tg more than 100 ng/ml. The mean number of radioactive Iodine cure was 11.08 for patients with Tg more than 100 ng/ml with a significant difference (P = 0.001). Conclusion: Among epidemiological, pathological and clinical characteristics, lymph node invasion is the most frequent parameter found in patients with a DTC with high Tg level and negative Iodine scintigraphy.展开更多
文摘Background: In recent decades, the incidence of children’s hematological malignancies has been increasing worldwide including Tunisia. Their severity is reflected in the importance of the medical, social and economic impact. This increase remains fully unexplained, and the involvement of genetic, environmental and occupational factors is strongly suspected. Materials and methods: Our study was a cross-sectional survey of the type case-control conducted in the University Hospital of Farhat Hached of Sousse during the period ranging between 1 July 2011 and 30 June 2012, and which included children with acute leukemia compared to children unharmed by neoplastic disease. Cases and controls were matched by age and gender. Our objective was to describe the socio-occupational characteristics of the parents of children with acute leukemia and to identify potential occupational factors implicated in the genesis of acute leukemia. Results: The number of acute leukemia cases in the Hematology Service and day hospital of the University Hospital of Farhat Hached during the study period was 66 cases divided into in 40 boys and 26 girls with a sex ratio of 1.53. Our cases and controls were matched by age and gender. The risk of incidence of leukemia in children from smoking fathers was higher (p = 0.02, OR = 2.24, IC = [1.11 - 4.52]). The risk of incidence of leukemia in children from alcoholic fathers was higher with p = 0.009, OR = 3.9;CI = [1.33 - 11.39]. After adjusting different variables, the difference persisted significantly with pa = 0.03 and ORa = 3.5, ICa = [1.09 - 11.6]. 25.7% of cases had a family history of blood disease and neoplasia, whereas no control presented that. The difference was statistically significant (p = 0.006, OR = 1.46, IC = [1.38 - 1.56]). The parental occupational exposures associated to the occurrence of acute leukemia in children were pesticides with a statistically significant difference (p = 0.03, OR = 2.94, IC = [1.06 - 8.13]). This difference persisted after adjustment with different var
文摘Tarlov cysts are often asymptomatic and incidentally discovered. However, in few cases, these cysts can be symptomatic and may manifest as chronic low back pain. We report a case of a Tarlov cyst incidentally diagnosed by MRI in a wiring factory worker complaining of chronic low back pain exacerbated with the carrying of heavy loads and the hyper solicitation of the lumbar spine during his professional activity. The clinical manifestations of symptomatic Tarlov cysts can influence the life quality of patients and have enormous repercussions on their work ability, which in some cases can lead to job loss. Thus, the socio-professional aspects of symptomatic Tarlov cysts should not be underestimated and maintaining these patients in employment should be considered from the outset as an objective in its own right in the management.
文摘Introduction: Apart from its increasingly important frequency, occupational asthma (OA) has become the most important cause of occupational respiratory disorders in developed countries. The number of etiological agents continues to grow following the constant introduction of new harmful substances in industry. Objectives: Determine the prevalence and incidence of OA in our country, the socio-occupational characteristics of asthmatics, and study the forensic and social impact of such pathology. Material and Methods: An exhaustive retrospective epidemiological study was conducted in Tunisia about charts of occupational asthma cases recognized by the competent commissions of the National Medical Care Fund (CNAM) during the period ranging from January 1<sup>st</sup> 2000 to December 31<sup>st</sup> 2008. Results: 361 occupational asthma cases, accounting for a prevalence of 7.17% of all occupational diseases, were recognized during the period of the study. Occupational asthma annual incidence was estimated to be 24.42 cases per 1000000 workers. Our study population was mainly women with a sex ratio of 0.86. More than a half (57.6%) of recognized OA cases were working in the textile industry sector. Concerning the asthmatics’ professional career, most of recognized OA cases (n = 225 i.e. 70.6% of cases) kept their jobs, whereas 58 patients did not. The professional career was linked to gender with a job loss that is 1.79 time more important in asthmatic women. Conclusion: The incidence of occupational asthma in Tunisia is comparable with that found in other Mediterranean countries. A rigorous and adequate prevention is necessary and allows reducing the importance of this occupational pathology and its serious consequences.
基金Supported by the Tunisian Ministry of Scientic Research, Technology and Development of Competences. Publication of this paper is supported by the National Natural Science Foundation of China （30624808） and Science Publication Foundation of the Chinese Academy of Sciences.
文摘The random amplified mirosatellite polymorphism method was performed in a set of Tunisian fig landraces using eighteen primer combinations. A total of sixty three random amplified microsatellite polymorphism （RAMPO） markers were scored and used either to assess the genetic diversity in these cultivars or to detect cases of mislabeling. Opportunely, data proved that the designed procedure constitutes an attractive and fast method with low costs and prevents radio exposure. As a result, we have identified the primer combinations that are the most efficient to detect genetic polymorphism in this crop. Therefore, the derived unweighted pair-group method with arithmetic averages （UPGMA） dendrogram illustrates the genetic divergence among the landraces studied and exhibits a typically continuous variation. Moreover, no evident correlation between the sexes of trees was observed. In addition, using these markers, discrimination between landraces has been achieved. Thus, random amplified mirosatellite polymor- phism is proved to be powerful for characterizing the local fig germplasm.
文摘The present study reports on population structure analysis of the marbled crab Pachygrapsus marmoratus （Fabricius, 1787） from the Tunisian coast, an appropriate location to study biogeographical processes because of the presence of a well-known discontinuous biogeographic area （the Siculo-Tunisian Strait）. Patterns of morphological and genetic variation of this highly dispersive and continuously distributed decapod species were assessed among its geographically close populations which cover almost the entire Tunisian coastline. A total of 386 specimens from nine sites were collected and examined for morphometric variability at 14 morphometric traits. The results of multivariate analyses of linear morphometric traits showed the existence of sexual dimorphism in this species by PERMANOVA （Permutational multivariate analysis of variance）. In addition, both CDA （Canonical discriminant analysis） and NPMANOVA （Non parametric MANOVA test） analyses revealed statistically significant differences among the studied locations for both sexes. Overall, the outcome of CDA analysis showed that over 87% of individuals could be assigned correctly to three regional groups in both sexes （North, Center and South）. Specifically, SIMPER （Similarity Percentages） analysis showed that carapace length, carapace width and merus length were major contributors to the morphometric separation between populations. The pattern of phenotypic variation suggested by morphometric analyses was found to be highly discordant with that suggested by the analysis of a mitochondrial marker （cytochrome oxidase I, COI）. Indeed, the results inferred from restriction fragment analysis of the COI in 180 crabs, suggested high genetic homogeneity. Very low levels of haplotype diversity （h） were found in almost all the studied populations, associated with non significant genetic distances for nearly all population comparisons. Explanations to these morphometric and mtDNA patterns as well as the discrepancy between them are discus
文摘Objectives: Low back pain is a major occupational problem especially among nursing staff. The objectives of our study are to evaluate the prevalence of low back pain among nurses and to look for physical and psychosocial risk factors. Methods: It is a cross-sectional study based on a self-administered questionnaire destined for all nurses working in Farhat Hached Teaching hospital of Sousse (Tunisia). Results: Our study included 203 nurses with an average age of 39.8 years. The prevalence of low back pain over the last twelve months was 58.1%. The factors that are significantly associated to low back pain were: high BMI, number of pregnancies, arthritis, poor physical condition, daily frequency of inappropriate posture for the activity being performed, and the layout of materials in the workplace. Conclusion: Our study evidenced the high prevalence of LBP among nurses and allowed bringing to light the role of individual and ergonomic physical factors in the genesis of LBP. Such identification permits to undertake targeted preventive actions. The association between psychosocial factors and LBP was not emphasized.
文摘Background: Occupational allergic contact dermatitis (ACD) is one of the most frequent diseases on the workplace worldwide. Its national incidence and prevalence were not previously studied in Tunisia. Objective: To assess incidence of occupational allergic contact dermatitis and its occupational outcome in Tunisia. Methods: Descriptive epidemiological study of all cases of occupational allergic contact dermatitis reported from 2002 to 2012 in Tunisia and recognized by the medical commissions of the National Health Insurance Fund. Results: 315 cases of occupational ACD were collected representing an annual incidence of 31.65 cases/100.000 workers in the private sector in Tunisia. The mean age of our population was 42.70 ± 9.02 years with a male predominance (sex ratio 3.03). The most affected sectors were the clothing sector (14.3% of cases) and the cement industry (13.7% of cases). Patch tests were positive in 188 patients (59.67%). The most frequently positive allergen was potassium dichromate in 27.3% of the cases. Overall, 25.4% of patients had lost their jobs. After multiple binary logistic regression, job loss had a statistically significant relationship with localization of lesions on the face and on dominant hand. Conclusion: Occupational ACD is frequent in Tunisia and is responsible for an important rate of job loss. Preventive measures must be reinforced, especially the wearing of protective gloves.
文摘Colorectal cancers （CRC） account for frequent and serious cancers which result from the interaction between individual genetic factors and environmental factors, and in particular widely studied nutritional ones. The role of other occupational factors remains a controversial subject. The objective of this study is to evaluate the possible impact of occupational factors on the risk of developing CRC. Materials and Methods： This is a retrospective case-control study. The cases and the control group were enlisted in the general surgical ward of Farhat Hached Teaching Hospital of Sousse （Tunisia） during the period extending from 2004 to 2008, and they were age and gender-matched. The data were analyzed using SPSS 11.0 software with a signification threshold fixed at 5%. A univariate analysis was carried out as well as a multiple binary logistical regression. Results： During the period of the study, 40 cases of colorectal cancers have been colligated including 28 men and 12 women with a sex ratio of 0.43. The average age of the cases was 61.55 ± 13.3 years and 60.40 ± 12.84 years for the control group, with a non significant difference （P = 0.69）. The univariate analysis has objectivized significant associations between colorectal cancer and the housing conditions, the neoplastic and digestive family history, the occupational activity sector, exposure to pesticides, and lack of periodic medical supervision. After logistical regression, the occurrence risk of CRC was significantly associated with： alcohol and smoking （ORa = 3.43; Pa = 0.05）, meat consumption （ORa = 3.34; Pa = 0.03）, exposure to pesticides （ORa = 20.44; Pa = 0.012） and lack of periodic medical supervision （OR = 7.45; P = 0.004）. Conclusion： The occupational risk factors might play a role in the etiopathogenesis of colorectal cancers. With regard to our study, pesticides seem to be most implicated and necessitate suitable preventive measures. Nevertheless, it seems useful to multiply the studies to a much larger scal
文摘Introduction: The mycosis fungoides (MF) is the most common cutaneous T-cell lymphomas representing about 50% of all cutaneous lymphomas. Its pathogenesis remains poorly understood. Thus, its rising incidence rates call for an explanation. Several environmental and occupational factors have been implicated in the pathogenesis of this disease. Objective: To determine the potential occupational factors correlated in the occurrence of MF. Methods: Case-control study was carried out at the teaching Hospital Farhat Hached of Sousse (Tunisia) to investigate associations of MF and occupational risk factors. A questionnaire on lifetime job history was administered to 24 cases and controls. Cases were patients with MF and whose diagnosis was suspected by a dermatologist and confirmed by pathological examination. Controls were patients consulting in the occupational medicine department and matched to cases by age and gender. Bivariate analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: The average age of onset of the disease was 55.41 ± 17.4 years with a sex ratio of 2.42. We found an increased risk of MF associated with tobacco consumption higher than 40 Pack-year (OR = 6.6;95% CI = 1.22 to 35.4), exercise in the textile sector (OR = 9.4;CI = 1.06 to 84.3) and exposure to diesel exhaust (OR = 9.47;95% CI = 1.06 to 84.3). Conclusion: Occupational factors could play a role in the pathogenesis of MF. Regarding our study, smoking, working in the textile industry and exposure to diesel exhaust appear to be involved in the pathogenesis of MF. Further investigation is needed to confirm these findings.
文摘Background. Cutaneous extraskeletal Ewing s sarcoma is rare, being seen principally in children. We report a case of cutaneous sarcoma in the sole of the foot in a child. Case report. A 9-yearold child with no medical history of note was presenting a skin tumor for 3months on the heel of the right foot. This tumor was burgeoning and painful and measured 3.5cm in diameter; it was ulcerative at the surface and covered with a crust. Histological and immunohistochemical examinations confirmed the diagnosis of Ewing s sarcoma. Staging examinations proved negative and the patient underwent polychemotherapy, resulting in complete regression of the tumor. Comments. Until 1998, 37 cases of cutaneous and subcutaneous Ewing s sarcoma were reported, being seen in 21 girls and 16 boys. Mean age at diagnosis was 15 years and mean tumor size was 3 cm (range: 1 to 12 cm). The tumors were observed throughout the body, being seen in the sole of the foot in 2 cases. Confirmation of the diagnosis was made by histological examination (malignant proliferation of small round cells in the dermis), immunohistochemical examination (CD99+ ) and cytogenetic analysis (translocation between chromosomes 22 and 11). The prognosis for cutaneous Ewing s sarcoma appears more favorable than that of Ewing s sarcoma in bone. Of the 37 patients treated, 7 had metastases and 2 presented relapse. Treatment for cutaneous Ewing s sarcoma, though not codified, consists of polychemotherapy associated with surgery and/or radiotherapy.
文摘The present investigation focuses on population structure analysis of the purple sea urchin Paracentrotus lividus across the African Mediterranean coast, with the main aim of assessing the influence of the Siculo-Tunisian Strait on gene flow disruption in this highly dispersive echinoid species. For this purpose, patterns of morphological and genetic variation were assessed among its populations from the western and eastern Mediterranean coasts. A total of 302 specimens from seven Tunisian sites were collected and examined for morphometric variability at twelve morphometric traits. Concordant results, inferred from CDA（canonical discriminant analyses）, pairwise NPMANOVA（non parametric multivariate analysis of variance） comparisons and MDS（multidimensional scaling） plot, unveiled significant inter-population differences in the measured traits among the studied populations. Furthermore, the combined use of the one way ANOSIM（analysis of similarities） and the Discriminant/Hotelling analysis allowed unravelling two morphologically differentiated groups assigned to both western and eastern Mediterranean basins. The SIMPER（similarity percentages） routine analysis showed that total dry weight, test diameter and spine length were major contributors to the morphometric separation between locations and between groups. Pattern of phenotypic divergence discerned in P. lividus across the Siculo-Tunisian Strait is interestingly in congruence with that inferred from the genetic investigation of the purple sea urchin populations from the same region based on the analysis of the mt DNA COI（cytochrome oxidase I） gene in 314 specimens from nineteen locations covering a wider geographic transect, streching westward to the Algerian coast and eastward to the Libyan littoral. The specific haplotypic composition characterizing each Mediterranean basin,as inferred from the minimum spanning network, confirmed the geographic partioning of genetic variation, as revealed by F-statistics and AMOVA（analysis of molecul
文摘Buerger’s disease, also called thromboangiitis obliterans (TAO), is an inflammatory disease affecting small and medium size blood vessels of the limbs. Several risk factors are strongly associated with this disease. In fact, heavy smokers represent 99% of patients diagnosed with Buerger’s disease and smoking cessation can slow down the progression of the pathology. Ulcers and gangrene are very common complications and TAO may also cause a vasculitis as well as ischemic damage to the distal part of the limbs that can eventually lead to limb amputation. Here, we report the case of a 43 years old patient, a flight personnel working in a Tunisian airline company who consults for a lesion of the left toe that appeared 2 weeks ago. He is a chronic inveterate smoker with 36 pack-years. The diagnosis of TAO was made based on the clinical presentation and the results of the Doppler Ultrasound of the left toe. This disease has a major impact on the quality of life due to the risk of necrotic ulcers and amputation. Navigation is a profession that requires a high level of physical and mental fitness. According to the international and Tunisian standards, the applicant or the holder of medical certificate must not have a cardiovascular condition that may affect the safety of the exercise.
文摘Objective: To identify the importance of using humor in patient/nurse relationship, its factors, its conditions and the barriers that might limit its use. Methods: We systematically searched PubMed, Science Direct and Google Scholar, for relevant articles published in English between 2010 and 2019. We included the studies that investigated humor between nurses and their patient’s relationship. Results: From the initial 287 articles found, 15 were included for final revision. Data allowed retrieving information on humor definition;its applicability as a nursing intervention;humor as a tool to improve nurse-patient communication and relationship;influencing factors;humor benefits in health care context and the limits that come against its use. Conclusion: Humor is considered a powerful communication tool, it promotes well-being, relieves anxiety and stress, helps deal with stressful situations but it should be used cautiously in order to prevent undesired consequences.
基金the National Thermal Power Corporation (NTPC) sponsored project S-3-1392
文摘N-doped mesoporous alumina has been synthesized using chitosan as the biopolymer template. The adsorbent has been thoroughly investigated for the adsorption of CO2 from a simulated flue gas stream （15% CO2 balanced with N2） and compared with commercially available mesoporous alumina procured from SASOL, Germany. CO2 adsorption was studied under different conditions of pre- treatment and adsorption temperature, inlet CO2 concentration and in the presence of oxygen and moisture. The adsorption capacity was determined to be 29.4 nag CO2/g of adsorbent at 55℃. This value was observed to be 4 times higher in comparison to that of commercial mesoporous alumina at a temperature of 55℃. Basicity of alumina surface coupled with the presence of nitrogen in template in synthesized sample is responsible for this enhanced CO2 adsorption. Adsorption capacity for CO2 was retained in the presence of oxygen; however moisture had a deteriorating effect on the adsorption capacity reducing it to nearly half the value.
文摘Introduction: The exposure to shift works, and especially to night shift, goes against the circadian rythmicity of the social man, which brings about a multitude of disruptive effects on health. In a hospital environment, such night shift is necessary so as to ensure the continuity of care. Sleep and vigilance disorders related to this work mode are frequent and often pose adaptation problems. The objective of this study is to detect the harmful effects of night shift on sleep, vigilance and the quality of life of nurses in Farhat Hached Teaching Hospital in Sousse. Material and Methods: It is a cross-sectional study carried out among two groups of nurses: one group performing a fixed night work and the other one working permanently during the day at Farhat Hached Teaching Hospital in Sousse. Data collection is mainly based on validated questionnaires evaluating sleep quality (Pittsburg sleep quality index), daytime sleepiness (Epworth sleepiness scale), sleep typology (Horne and Ostberg questionnaire), and the quality of life (SF-12). An objective evaluation of vigilance was realized by the study of reaction time and error rates to different tasks of “Super lab” software. Results: 50 night and 50 day nurses have been colligated. Both groups were age- and gender-matched. Sleep quality mean index was significantly higher among night nurses in comparison with day nurses (10.2 ± 5.9 versus 6.76 ± 5.16). After multivariate analysis, sleep quality was significantly correlated to age, department, schedule and the choice of schedule. Night shift was not related to daytime sleepiness. The objective analysis of vigilance showed that the reaction time to different tasks exploring the attentional mechanisms, as well as errors rate, were significantly more important among the night group. The mental score of the quality of life was significantly higher among day nurses. However, such difference was not significant with regard to physical score. Conclusion: The findings of our study highlight not only the alteration of
文摘Background and Objectives: Following the initial management, some patients with differentiated thyroid cancer (DTC) develop a state of high thyroglobulin (Tg) and Negative Iodine Scintigraphy. The predisposing factors and outcome of this condition are unclear. In this study, our objectives were to analyze the characteristics of patients with high Tg level and negative Iodine scintigraphy and to determine the predictive factors for development of high Tg and negative scintigraphy. Patients and Methods: Retrospective study of 34 patients undergoing treatment for DTC, followed in the Nuclear Medicine department of the University Hospital—Sahloul Sousse between 1990 and 2006 and having a high Tg and negative Iodine scintigraphy. Fourteen patients had Tg between 2 and 10 ng/ml, 16 had Tg between 11 and 100 ng/ml and 4 patients had Tg more than 100 ng/ml. Results: There were 25 women and 9 men. The mean age was 51.65 years. In 94.1% of cases, the tumor was papillary carcinoma. Follicular tumors accounted for only 5.9%. The mean nodule size was3.26 cm. Capsular invasion was seen in 47.1% cases. The locoregional invasion was found in 35.3%. The lymph node extension was found in 84.8% of patients having lymph node surgery. Lymph node involvement was observed in 92.8% of patients with papillary cancer but it was found in 7.2% of patients with follicular cancers. Lymph node invasion was unilateral in 28.6% (N1a) and bilateral, contralateral or mediastinal in 71.4% (N1b). Initial level of Tg was as follows: 7 patients had Tg between 2 and 10 ng/ml, 14 patients had Tg between 11 and 100 ng/ml and 12 had Tg more than 100 ng/ml. The mean number of radioactive Iodine cure was 11.08 for patients with Tg more than 100 ng/ml with a significant difference (P = 0.001). Conclusion: Among epidemiological, pathological and clinical characteristics, lymph node invasion is the most frequent parameter found in patients with a DTC with high Tg level and negative Iodine scintigraphy.
