[Predictive factors of polysensitization to contact allergens: study conducted at the Dermato-Allergology Unit of the Farhat Hached University Hospital in Sousse, Tunisia]. / Facteurs prédictifs de la polysensibilisation aux allergènes de contact: étude comparative réalisée à l'Unité de Dermato-Allergologie du CHU Farhat Hached de Sousse, Tunisie.

Introduction: polysensitization is often defined as sensitization to three or more contact allergens. The objectives of our study were to determine the prevalence of polysensitization to allergens patch test and to analyze the factors associated with allergen polysensitization of the European Standard Battery in comparison with cases of oligosensitization. Methods: this is a retrospective descriptive cross-sectional study that included all patients who had undergone patch tests at the Department of Dermato-Allergology of the Department of Occupational Medicine of University Hospital Center Farhat Hached in Sousse spread over 10 years from January 1, 2009 to December 31, 2018. Results: in total, we collected 464 cases of contact dermatitis during the study period. The average age of patients was 38.93 ± 12.52 years with a slight female predominance (52.8% of cases). Among all the patients who consulted during the study period (832 patients), 133 patients had positive reactions to 3 or more allergens 16% of patients. Concerning, the associations of the most frequently noted allergens were those of triplet (chromium, cobalt, and nickel) in 15 patients and triplet (mercaptobenzothiazole, thiuram mix, and IPPD) in 7 cases. The predictive factors of polysensitivity were the personal history of leg ulcers; the site of the lesions in the thorax and the erythematous squamous and dyshidrotic appearance of the lesions. Conclusion: this phenomenon is frequent polysensitization, and close collaboration between dermatologists and occupational physicians to prevent this type of multiple allergies through better management of personal and also professional risk factors.

Weight excess among high-school students: Relation with mental health and sociodemographic factors.

INTRODUCTION: The escalating prevalence of adolescent obesity represents a complex public health challenge, influenced by interactions of environmental, socio-economic, and behavioral factors. Recent studies reveal a surge in addictive substance use among adolescents, with non-substance addictions. Overweight adolescents are particularly susceptible to risky behaviors. Tunisia is not exempt from this issue, facing a rapidly increasing prevalence. AIM: Our work aimed to assess the prevalence of obesity among adolescents and to explore the connections between sociodemographic factors, mental health, and overweight in this demographic group. METHODS: A cross-sectional study was led among sample of Tunisian high school adolescents from Sousse. We enrolled study participants through proportional stratified sampling. RESULTS: Our study included 1399students, predominantly female, with an average age of 17±1.5 years. The average BMI (Body Mass Index) was 22.7±4.1 kg/m². According to the International Obesity Task Force (IOTF), 20.4% were overweight, and 7% were obese, resulting in an overall weight excess prevalence of 27.4%. Girls exhibited a higher weight excess prevalence compared to boys. Multivariate analysis identified factors associated with overweight and obesity, including maternal self-employment(aOR=2.13,[1.35-3.35];p<0.001), regular physical activity (aOR=0.61,[0.47-0.8];p<0.001), internet usage ≥2 hours (aOR=0.70,[0.50-0.99];p=0.045), daily fruit-vegetable consumption (aOR=1.51,[1.15-1.97]; p=0.003), possible alexithymia (aOR=1.55,[1.07-2.22];p=0.018), probable anxiety (aOR=1.28,[0.87-1.89]; p=0.007), very probable anxiety (aOR=1.61,[1.14-2.2]; p=0.037), and problematic Facebook-use (aOR=0.67,[0.50-0.89]; p=0.006). CONCLUSION: Understanding factors tied to excess weight in our social and cultural context is crucial in shaping effective public health strategies. Interventions should adopt a multisectoral approach specifically targeting working mothers within the adolescent's socio-familial environment. It is fundamental also to address mental health concerns, with a particular focus on alexithymia and anxiety.

Effect of smoking on the clinical and allergological profile of contact dermatitis.

INTRODUCTION: Several clinical and epidemiological data point to a possible link between smoking exposure and contact dermatitis (CD). AIMS: To identify the clinical and epidemiological differences of CD in smoking and non-smoking subjects, and to determine the influence of smoking on the allergological profile of CD. METHODS: Retrospective descriptive study who consulted the Department of Occupational Medicine and Occupational Pathology of the Farhat Hached University Hospital of Sousse (Tunisia) during a period of 8 years for exploration of CD and who were tested with the European Standard Battery (ESB). RESULTS: A total of 767 patients were enrolled during the study period, 40% of whom were smokers. The group of smokers was characterized by a male predominance (p=10-3) and a greater professional seniority compared to non-smokers (p=0.01). Personal history of atopy was predominant in non-smokers (p=0.02). Among the ESB allergens, there was a significant association between smoking and CD due to metals (chromium, cobalt) and conservatives. After binary logistic regression, the variables associated with smoking exposure were male gender (OR=12.12 ; 95% CI=[6.07 - 24.21]; p=10-3), Kathon CG allergy (OR=3.69 ; 95% CI=[1.24 - 10.81]; p=0.018), and right hand involvement (OR= 2.83; 95% CI=[1.29 - 6.17]; p=0.005). CONCLUSION: Our study revealed an effect of smoking on the clinical and allergological characteristics of CD.

Occupational Risk Factors for Laryngeal Cancer in Tunisia: A Case Control Study.

BACKGROUND: Tobacco use and alcohol consumption are the primary risk factors for laryngeal cancer (LC). In most populations, occupational exposures are likely to play a minor role in laryngeal carcinogenesis. We aimed to investigate the association between occupational exposure and laryngeal cancer. METHODS: It is a case-control study that included 140 cases diagnosed between January 2013 and December 2016 and 140 controls matched by sex, age, alcohol consumption, and tobacco consumption. RESULTS: Significantly increased risks were found amongst workers of the building sector (OR=4.621; 95% CI [1.826-11.693]) and the mechanical industry sector (OR=5.074; 95% CI [1.425-18.072]). Significant association of laryngeal cancer with various carcinogens was observed such as asbestos (p=0.009; OR=3.68; 95% CI [1.29-10.46]), paint vapors (p=0.005; OR=3.35; 95% CI [1.37-8.16]), solvents (p=0.001; OR=3.29: 95% CI [1.61-6.68]) and cement dust (p=0.003; OR=3.19: 95% CI [1.43-7.12]). After binary logistic regression, cement dust was independently correlated with LC (p=0.042; OR=3.93; 95% CI [1.04-14.78]. The administration sector was associated with decreased risk (p=0.001; OR=0.07; 95% CI [0.03-0.15]) as well as the health sector (p=0.001; OR=0.098; 95% CI [0.02-0.43]). CONCLUSIONS: Our results supported the role of occupational factors in developing LC. Further studies enabling an in-depth analysis of occupational exposures are necessary to provide a clearer definition of the etiological associations between single agents and circumstances of exposure and the genesis of LC.

Associations between Occupational Asthma and Obesity in the Central Region of Tunisia.

Background: Risk factors for the severity of occupational asthma (OA) are often attributed to occupational exposure. However, some recent epidemiological data suggest a link with obesity. The study aimed to analyze the relationship between obesity and the severity of (OA) assessed by non-specific bronchial provocation. Materials and Methods: We conducted an epidemiological descriptive retrospective study including patients who were referred to the Occupational Medicine Department of Farhat Hached University Hospital of Sousse, for (OA) and who have completed a non-specific bronchoprovocation test to metacholine. Results: Our population consisted of 131 cases of (OA) with a female predominance. The average BMI was 27.34 ±5.30 kg. Obesity was observed in 29.8% of cases. The non-specific metacholine bronchial provocation test revealed an average dose of PD20 at 750.4 ±656.3 µg. Severe (OA) was observed in (35.1%). After univariate analysis, obesity in asthmatics had a significant association with age (p<0.001), marital status (p=0.005), average professional seniority (p<0.001), the evolution of complaints (p=0.035) and abnormal initial spirometry (p=0.044). As for the severity of (OA), the univariate analytical study did not show a significant link with obesity (p=0.68). Conclusion: The association between obesity and OA is not an easy task and should be made using more accurate tools to measure body fat percentage. The preventive role of the occupational physician is essential in factories in order to make more prudent decisions when employing workers with a high BMI in high-risk occupations. Hence the importance of regular monitoring of weight in workers exposed to asthmatics during periodic examinations.

Studying SARS-CoV-2 vaccine hesitancy among health professionals in Tunisia.

BACKGROUND: People's lives were seriously affected by the emergence and the spread of the COVID-19 disease. Several vaccines were developed in record time to overcome this pandemic. However, putting an end to this public health problem requires substantial vaccination coverage rate. This latter depends on the acceptance of these vaccines especially by health professionals; the leaders of the current war against COVID-19. In fact, they have a central role in promoting vaccination against the SARS-CoV-2. In the developed countries, hesitancy rates towards these vaccines among health professionals vary from 4.3% to 72%. In the developing countries, few studies focused on this issue. OBJECTIVE: To estimate the prevalence and the predictors of SARS-CoV-2 vaccine hesitancy among the Tunisian health professionals. METHODS: A cross-sectional study was led online between the 7th and the 21th of January 2021 among Tunisian health professionals. At least 460 participants were required. Snowball sampling method served to recruit participants. Data were collected using a pre-established and pre-tested questionnaire recorded in a free Google form. The link of the questionnaire was disseminated online to be self-administered anonymously to the participants. The generated online Google Sheet was uploaded and exported to SPSS software for analysis. RESULTS: Of the 546 responses, 493 were retained. The mean age of participants was 37.4 (± 9.5) years. Females represented 70.2% of participants. Social media represented the most frequently used source of information about COVID-19. The prevalence of SARS-CoV-2 vaccine hesitancy among participants was 51.9% (95% CI: 47.5-56.3)). Female sex, working far from the capital and having concerns about the vaccines components predicted more hesitancy among participants. In contrast, the use of the national COVID-19 information website predicted less hesitancy among them. CONCLUSIONS: The current Tunisian communication plan about COVID-19 vaccines must be reinforced. Social media represent a cost effective communication channel that can serve to reassure Tunisian health professionals regarding the safety of COVID-19 vaccines. Special interest should be paid to females, paramedical professionals and those working far from the capital.

Critical study of the initial medical certificates of occupational accident declaration.

The drafting of the initial medical certificate (IMC) is an innocuous act that can engage the responsibility of the certifier. AIM: To evaluate the quality of the IMC and their compliance with the legal provisions and to develop good practice recommendations for the drafting of the occupational accident certificate. METHOD: An epidemiological, descriptive and retrospective study was conducted in the University Hospital Center Farhat Hached (Tunisia) based on the occupational accident certificates completed by physicians during a period of 12 months. RESULTS: In our study, 241 certificates were collected. The number of the patient's ID card was mentioned in 12% of cases. The date of the accident was noted in almost all cases (99.6%). The date of certification was indicated in all the cases. The average number of days of permanent work incapacity was significantly higher among male patients (p = 0.015), married patients (p≤10⁻³), and night workers (p = 0.05) and significantly lower among doctors (p ≤ 10⁻³). CONCLUSION: Our study showed that the quality of the initial medical certificate drafting suffered from several inadequacies. This may be related to the lack of training of doctors in forensic practice, hence the importance of reminding the rules of good practice.

Seasonal Variation in Patch Test Results with European Baseline Series.

AIM: To study the influence of season on patch tests results. METHODS: We conducted a retrospective epidemiological study which concerned all the patients of the Tunisian center, who consulted in the Dermato-Allergology Unit of Occupational Medicine Department of Farhat Hached University Hospital-Sousse (Tunisia) over a period of 07 years. All the patients were tested by the European Standard Battery allergens (BSE). RESULTS: The data of 1000 patch tests were analyzed during the study period. More than half of the patch tests (58.6%) was positive. In winter, 63% of patch tests showed a positive reaction versus 52% of patch tests in summer without a statistically significant association. However, results of lanolin alcohols, epoxy resin, and Sesquiterpene lactone mix varied significantly with season. Atopy was significantly associated with 18.8% of positive reactions in winter and only with 5.2% of positive reactions in summer (p = 0.015). CONCLUSION: Seasonal variations in patch tests results were more significant with some allergens of European Standard Battery and in atopic patients.

Relationship between Hand Eczema Severity and Occupational Stress: A Cross-Sectional Study.

BACKGROUND: Stress has been recently implicated as a contributing factor of hand eczema (HE) severity. However, published data are both rare and contradictory justifying the need of further research. The purpose of this study was to evaluate the relation between stress and HE severity. METHODS: This is a cross-sectional study enrolling all patients who have been attending the Dermato-allergology unit of Farhat Hached University Hospital of Sousse over a period of one year. The HE severity was assessed by the Osnabrück Hand Eczema Severity Index (OHSI). The stress level was assessed by the Perceived Stress Scale-10 (PSS-10) in its validated Arabic version. RESULTS: During the study period, 109 participants meeting the inclusion criteria were identified. The mean age was 40 ± 9.9 years with a sex-ratio of 0.8. Severe eczema was found in 76 participants (69.7%). A high level of perceived stress was found in 18.3% of cases. A statistically significant association was noted between HE severity and the high level of perceived stress (p=0.039, OR = 4.46, 95% CI [0.96-20.59]) and the number of dependent children ≥3 (p=0.0039, OR = 1.92, 95% CI [0.51-7.22]). Leisure activity was found to be a protective factor against HE severity (p=0.031, OR = 0.27, 95% CI [0.09-0.80]). CONCLUSION: Although the link between the severity of eczema and atopy, wet work, and contact with irritants and allergens is well known, the relation remains questionable for other factors including stress.

Evaluation of the risk of metabolic syndrome among shift workers in Tunisia.

BACKGROUND: Shift work is a source of health problems for workers around the world. The metabolic syndrome is one of the pathologies that can occur because of this work pattern. AIMS: Investigate possible association between shift work and the development risk of the metabolic syndrome (MS). METHODS: A cross-sectional study was conducted among male gender agents of company of electricity production in the Center of Tunisia. This population was divided into two groups according to the organization of their work: a group of shift workers and a group of non-shift workers. Data collection was based on a questionnaire, a clinical examination and a biological assessment. The definition of International Diabetes Federation 2005 (IDF) was adopted to retain the diagnosis of the MS. RESULTS: A total of 263 agents responded to our invitation with a participation rate of 65.5%. The shift workers group accounted for 48.3% of the participants and the fixed workers group accounted for 51.7% of the participants. The diagnosis of MS was retained in 51.2% of shift workers and 27.2% of non-posted workers, with a statistically significant difference (p <10-3). This association persisted after adjusting for the confounding variables with an OR of 2.64 [1.38-5.04]. CONCLUSION: Our study underlined a higher risk of MS development among shift workers. These findings highlight the importance of taking specific preventive measures. This prevention is based not only on hygieno-dietetic measures and regular physical activity, but also the improvement of working conditions.

Quality of Life and Work Productivity Impairment of Patients with Allergic Occupational Rhinitis.

BACKGROUND: Several studies demonstrated the negative impact of allergic rhinitis on Quality of Life (QOL) and occupational activities. Similar studies on allergic Occupational Rhinitis (OR) are rare. The aim of this study was to evaluate the QOL and work productivity of patients diagnosed with allergic occupational rhinitis. MATERIALS AND METHODS: We conducted a cross-sectional study from January 2005 to December 2015 at the Department of Occupational Medicine in Farhat Hached Teaching Hospital-Tunisia including patients diagnosed with allergic OR. QOL was assessed by the Mini-RQLQ (Rhinitis quality of life questionnaire) and Work impairment was measured by WPAI (Work Productivity and Activity Impairment) questionnaire. RESULTS: a total of 414 patients was enrolled in the study with a mean age of 37.82±8.08 years and a sex ratio = 0.33. Textile and clothing industry was the most represented sector (65.7%). The mean percent work time missed (absenteeism) due to allergic OR was 9.98±20.86% with a median of 0% and the mean presenteeism score was 46.7±32.67%. Overall QOL was 2.71±1.31. The most affected domains were practical problems and activity limitations. Absenteeism was positively correlated with age and eye symptoms scores. Both presenteeism and percent overall activity impairment were positively correlated with severe nasal obstruction and activity limitations score. CONCLUSION: Allergic OR impairs QOL and work productivity. Although it doesn't seem to be associated with an important absenteeism, work productivity is reduced by an important rate of presenteeism. QOL and work productivity seem to interact significantly.

A case of Caplan syndrome in a recently diagnosed patient with silicosis: A case report.

Rheumatoid pneumoconiosis, also known as Caplan's syndrome is defined as the association between silicosis and rheumatoid arthritis (RA). It is a rare and usually diagnosed in an advanced stage of RA course. It affects generally patients with long exposure to silica. In this article, we report a case of Caplan's syndrome.

[Silica-associated systemic sclerosis occurring after an occupational exposure to arc welding]. / Sclérodermie systémique associée à l'exposition à la silice survenant après une exposition professionnelle à la soudure à l'arc.

Crystalline silica-associated systemic sclerosis can occur in people operating arc welding. Diffuse scleroderma was diagnosed in a 57-year old plumber-welder suffering from inflammatory polyarthralgias, Raynaud's phenomenon, sclerodactyly, diffuse cutaneous scleroderma, telangiectasias, esophageal damage, pulmonary arterial hypertension and pulmonary fibrosis associated with the presence of anti-nucleosome antibodies. During his professional activity the patient was frequently exposed to high atmospheric concentrations of crystalline silica generated by arc-welding. The diagnosis of Erasmus syndrome associated with systemic sclerosis and pulmonary silicosis was retained. A report of work-related illness (table 17 in Tunisia) was made.