[Dizziness and hearing loss in healthcare workers with COVID-19]. / Les vertiges et la perte auditive chez le personnel de santé atteint de COVID-19.

Coronavirus disease 2019 (COVID-19) affects the respiratory system. Studying the clinical characteristics of this infection has revealed its tropism to the nervous system, which is responsible for neurological and sensory damage, in particular, dizziness and hearing loss. To determine the frequency and characteristics of the neurological impairment represented by dizziness and hearing loss in healthcare professionals (HCP) with COVID-19. Cross-sectional descriptive study conducted among HCP at Charles Nicolle Hospital (CNH) in Tunis affected by COVID-19 during the period from September 2020 to December 2020. Data collection was carried out by regular telephone follow-up of COVID-19 symptoms in these HCPs during the period of sanitary isolation. A total of 482 HCPs with COVID-19 were collected. The average age of the population was 41 ± 10 years, of which 111 were men (23%) and 371 were women (77%). The main neurological manifestations were: headache (71.2%), anosmia (60%), dizziness (21.8%), and hearing loss (1.5%). Patients with vertigo were significantly older (P=0.035), female (P=0.003), obese (P=0.014), suffering from more comorbidities (P=0.004), and having greater professional seniority (P=0.009). Dizziness was significantly associated with fever (P=0.001), abdominal pain (P=0.001), and desaturation (P=0.039). Neurological symptoms including dizziness and hearing loss may be the only sign with which a case of COVID-19 could be recognized. Raising awareness of such a presentation of COVID-19 patients is crucial during this pandemic period to prevent infectious spread, especially in hospitals.

Work ability and mental health at return to work after COVID-19: A descriptive study among healthcare workers.

BACKGROUND: Healthcare workers (HCW) may experience anxiety and prolonged work schedules during pandemics. The mental health status after a COVID-19 infection and the work ability of HCW are interesting criteria in assessing their fitness to work at the return to work (RTW) medical visit. OBJECTIVES: To assess mental health and work ability after a COVID-19 infection among HCW at the RTW medical visit. METHODS: An observational cross-sectional and descriptive study was carried out among HCW of Charles Nicolle Hospital of Tunisia infected with COVID-19 from September to December 2020. Anxiety and depression were screened using the Hospital Anxiety and Depression Scale (HAD). The perceived ability to work at RTW was measured using the Work Ability Index (WAI). RESULTS: We included 531 HCW. The median age was 40 years. HCW belonged to surgical departments (36.9%) and were nurses (32.4%). The median delay to RTW was 15 days (IQR: 13-18). At the RTW medical visit, certain anxiety and depression were found in 36.5% and 33.3% of the patients respectively. The perceived work ability was evaluated as good to very good in 37.8% of cases. The delay to RTW increased proportionally with a better-perceived work ability (p = 0.007). CONCLUSION: Our study described the perceived work ability and the prevalence of anxiety and depression among the HCW at the RTW medical visit after COVID-19 infection in the early stages of the pandemic. Specific strategies for RTW after COVID-19 should take into consideration the mental health and work ability of HCW.

The Professional Future in Operated Carpal Tunnel Syndrome: A Cross-Sectional Study of Recognized Occupational Cases.

BACKGROUND: Carpal tunnel syndrome (CTS) is frequently present among workers. This syndrome's professional and economic impact makes it a priority in occupational health. We aimed to describe the professional future of workers suffering from occupational CTS after surgery and the factors that could influence their retention at the job. -Methods: A retrospective descriptive study of workers operated on occupational CTS was conducted from 2014 to 2019. The data was collected using pre-established and phone questionnaires to determine their professional future after surgery. RESULTS: We included 99 workers with operated CTS. They had a mean age of 45±6.5 years, were predominantly female (97%), and had two dependent children in 72.7% of cases. They worked as a seamstress in 44.4% of patients with a mean professional seniority of 18±7.2 years. The professional future was a return to work with a job transfer at 44.4% and job maintenance with ergonomic adjustments at 39.4%. A job loss was noticed in 12.2% of cases. Early retirement was noticed in 8.2%, dismissal in 3%, and resignation in 1% of cases. The factors influencing the professional future were age 50 to 59 years (p=0.01) and dependent children (p=0.02). CONCLUSIONS: In our survey, most operated-CTS workers benefited from a job transfer and kept their job with ergonomic adjustments to their work conditions. Therefore, interventions aiming to improve the professional future of workers operated on CTS by ensuring sufficient staff and adjusting workplaces are needed.

Impact of atypical working hours on sleep and mood among healthcare workers.

BACKGROUND: Atypical working hours have raised serious concerns about health effects, such as sleep disorders and psychological repercussions. These schedules are frequent among health professionals having the obligation to ensure the permanence of health services. OBJECTIVE: To assess the impact of atypical working hours on sleep, sleepiness, and mood among health personnel (HP). METHODS: Comparative descriptive cross-sectional study was carried out among HP of a regional hospital in Southern Tunisia from December 2019 to May 2020. Two groups were defined according to their work schedule: group A had a fixed-day work and group B had atypical working hours. The assessment of sleep, sleepiness, and mood was based respectively on the Spiegel questionnaire, the Epworth Sleepiness Scale, and the Hospital Anxiety and Disorder scale. RESULTS: A total of 101 HP in group A and 135 in group B were included. We found signs of pathological sleep in group B: greater delay in falling asleep (78.1% Vs 53.5%; p = 0.002), altered sleep quality (88.1% Vs 56.4%; p = 0.039), and more frequent occurrence of dreams (37% Vs 31.7%; p = 0.033). The quality of sleep was associated with the professional seniority (p = 0.01), the workplace (p = 0.02), and having dependent children (p = 0.04). The mean score of depression was higher in group B (p = 0.02). Depression was associated with the workplace (p = 0.04) and the quality of sleep (p = 0.01). CONCLUSION: The results of this study indicate that atypical working hours generate both sleep and mood disorders in HP. It is vital to encourage the occupational physicians to estimate sleep and mood disorders in HP.

Occupational diseases compensated in the Tunisian public sector.

AIM: Describe the epidemiological characteristics of occupational diseases (OD) recognized by the Central Medical Commission (CMC) of the first ministry during the period from 2012 to 2019. METHODS: It was a descriptive and retrospective study covering all cases of diseases declared and recognized as occupational diseases by the CMC of the first ministry in the public sector and their repair during the period from the first of January 2012 to December 31, 2019. RESULTS: During the study period, 294 OD were declared, of which, 213 were recognized by the CMC (72.4%). The average age of the population was 45.8 ± 10.9 years. A female predominance was noted (61%). Most employees (56%) were part of the health sector. Tuberculosis was the most common occupational disease (21.1%). Cancers were present in 5.6% of cases. In this series, 99 workers had a temporary total disability (TTD) (46.5%). A partial permanent disability rate (PPD) was attributed to 20 victims of OD (9.4%) with an average rate of 29% and extremes ranging from 8% to 70%. CONCLUSION: The OD recognized in the public sector seemed to be low. This encourages better information for workers on occupational risks and better awareness of attending physicians to report the professional nature of PD.

Cutaneous manifestations of COVID-19 among healthcare workers: A Case report and literature review.

Common clinical features of COVID-19 are increasingly known but cutaneous manifestations are rarely described among healthcare workers. A review of cutaneous manifestations of COVID-19 especially among healthcare workers (HCW) is thus required. The aim of our current study was to provide a comprehensive review of cutaneous manifestations of COVID-19 among HCW through six case reports and a literature review. We conducted a literature search for cases reports, original and review articles using PubMed and the Google search engines. We included the written English studies that mentioned cutaneous symptoms during COVID-19 infection. In addition to the review, 6 cases were collected among the HCW working at the Charles Nicolle Hospital of Tunis from September 2020 to January 2021. In our review, we included 17 articles in addition to our six cases. The type of papers was case series and case reports in respectively 8 and 9 studies. Skin manifestations were reported in two studies including two HCW, in addition to our series of six HCW. Skin manifestations were chilblain-like lesions (44.5%), a generalized macular or maculopapular exanthem (32.1%), a papulovesicular rash and chicken pox-like vesicles (11.5%), painful acral red-purple papules (4.6%), urticaria (2.8%), purpuric or petechial lesions (2.3%), and livedo reticularis lesions (0.45%). Of the 218 cases, 203 cases have reported the location of lesions. The very great majority of lesions were found on the trunk, hands, and feet. Fifty-one patients (23.4%) experienced lesions on the trunk. The time of onset of cutaneous lesions was variable. At the diagnosis or the onset of COVID-19 symptoms, 8.3% (18/218) of patients presented with cutaneous lesions. After the onset of respiratory symptoms or COVID-19 diagnosis, 36.7% (80/218) of patients presented with cutaneous lesions. Of the 197 cases with reported healing times, healing times were up to 24 days. COVID-19 has been associated with different cutaneous manifestations, likely of varying pathophysiology and severity, some preceding COVID-19 symptomatology and others occurring during active disease or later in the course. Thus, heightened awareness and timely recognition of cutaneous manifestations in COVID-19 are important for occupational physicians treating HCW with COVID-19.

Perception of mental health and professional quality of life in Tunisian doctors during the COVID-19 pandemic: a descriptive cross-sectional study.

INTRODUCTION: few research studies about mental health problems in medical staff during the first wave of the COVID-19 pandemic have been reported. The Aim of the study is to assess the prevalence of anxiety and insomnia, affecting the professional quality of life of physicians during COVID-19 pandemic. METHODS: doctors answered an online questionnaire regarding their perception of insomnia, anxiety and professional quality of life during COVID-19 pandemic with psychological parameters including the Generalized Anxiety Disorder (GAD-7), Insomnia Severity Index (ISI) and Professional quality of life version 5 (ProQOL5). RESULTS: anxiety was found in 64.8% of the participants. This disorder was respectively moderate and severe in 12.4% and 6.7% of cases. Insomnia was found in 51.4% of respondents, 29.5% of whom worked in the COVID circuit (p=0.17). Insomnia was assessed as mild, moderate and severe in respectively 38.1%, 11.4% and 1.9% of cases. Compassion satisfaction was moderate in 72.4 of cases and high in 24.8% of cases. The entire population with low CS belonged to the 20-29 age group (p=0.019). Compassion satisfaction was statistically higher in married people (32.7%) (p=0.004). This entity varied significantly with occupational grade (p=0.003), seniority in grade (p=0.011) and working in the private health sector (p=0.046). Burnout was moderate in 73.3% and low in 26.7% of cases. Burnout was significantly higher among single people (p=0.03) and statistically altered in the staff working in the COVID unit (p=0.028). Secondary traumatic disorder was above moderate in 69.6%. CONCLUSION: a high prevalence of psychological symptoms was found among doctors during COVID-19. Medical health workers are in need of health protection and adequate working conditions.

Peritoneal mesothelioma associated with bladder cancer and occupational exposure to asbestos: A case report.

Mesothelioma is a rare tumor usually located on the pleura. In this typical location, it is closely linked to asbestos exposure. However, in other locations such as in peritoneal mesothelioma, the association to asbestos remains unusual.

Visual disorders and fitness for professional driving.

BACKGROUND: The professional driver's post is a security post that requires a careful assessment of the visual functions influencing the medical fitness decision. Professional driving benefits from a codified regulation regarding vision disorders. However, it suffers from several shortfalls making the task of the occupational doctor sometimes difficult. AIM: To identify the ophthalmological pathologies that have influenced the fitness decision for professional driving and develop a fitness approach for professional driving according to the different ophthalmological pathologies encountered. METHODS: We conducted a retrospective, descriptive study from the files of professional drivers with visual impairment who consulted the department of occupational health at Charles-Nicolle Hospital of Tunis for medical fitness decision, during the period from January 1, 2008 to December 31, 2016. RESULTS: Sixty drivers were included in the study. The population gender was exclusively male. Mean age was 48 ± 8.43 years. A pathological medical history was found in 70% of patients, mainly represented by: Diabetes (37%) and high blood pressure (28%). Truck drivers were the most represented (45%) and the average of professional experience was 14 years with extremes ranging from zero to 33 years. In 75% of cases, patients had one or more functional complaints. The decrease in visual acuity was the common reason for consultation (55% of cases). Diabetic retinopathy was the ophthalmological diagnosis most commonly found in our study (18% of cases). Diabetic retinopathy was the leading cause of definitive disability in our study (32% of cases). Other ophthalmologic causes of definitive disability were: Glaucoma, amblyopia, homonymous haemianopia, age-related macular degeneration, blindness or functional loss of one eye, diplopia, retinal detachment and uveitis complicating Behcet's disease. CONCLUSION: At the end of this study, we showed regulatory deficiencies for which we suggested recommendations that could help the occupational physician to take medical fitness decisions.

Effets du travail en horaires alternés sur la qualité de vie et la vigilance en Tunisie.

INTRODUCTION: Alternate work is known to cause physical and mental health disorders for employees that can alter their quality of life and sleep. OBJECTIVE: The purpose of this research was to evaluate workers quality of life and sleep in situations of alternate work. RESULTS: In total, 391 workers answered the questionnaire. According to the type of schedule, 320 employees worked alternately on a 2×8 shift schedule and 71 worked on a permanent night shift schedule. The group of employees working at night had a better quality of life than the group of employees working in 2×8 in terms of both their physical and mental scores (P < 10-3). Type 2×8 workers were found to have excessive daytime sleepiness as compared to those on fixed night schedules. CONCLUSIONS: Shortly, we can deduce from this study that alternating day shift work causes a deterioration of workers' quality of life of and generates sleep disorders..

A national survey of occupational exposures in Tunisia.

INTRODUCTION: The evaluation of occupational exposures allows to guide preventive strategies and to suggest adequate solutions. AIM: Identify occupational exposures and constrains among workers of private sector in Tunisia. METHODS: A descriptive study including all companies of the private sector who are adhering to a service of occupational health of 17 Tunisian governorates. The survey was exhaustive for the services having less than 500 companies and by sampling for the services with more than 500.The data collection was based on data sheet completed by the occupational physician. RESULTS: This investigation concerned 1653 companies employing 161 517 employees. The industrial sector represented 52.8 %.Small and medium-sized enterprises represented 92.6 % of the studied companies. Companies having a committee of Health and Safety at work represented 16.82 % and 22.14 % had a safety officer. Posturales constraints are the most represented exposures (56%) followed by gestural constraints (27%). Heavy lifting concerned 17% of workers. Exposure to noise represented the third professional nuisance, 23% of employees are exposed. The employees exposed to organic solvents were among 16695 (10.34 %), distributed on 685 companies. CONCLUSION: This study allowed us to identify and to rank the professional exposures and constrains in the Tunisian private sector. This could lead to improving targeted strategies of prevention occupational risks.

[Evaluation of psychosocial constraints among grocery stores workers in Tunisia] / Évaluation des risques psychosociaux dans le secteur de la grande distribution en Tunisie.

BACKGROUND: The identification of psychosocial constraints in the sector of mass retail is necessary to set up and guide preventive strategies. AIM OF THE STUDY: To evaluate the prevalence of psychosocial constraints among employees working in a large supermarket chains. METHODS: A descriptive cross-sectional survey conducted in employees of grocery stores. The study was based on a questionnaire exploring their socio-professional characteristics and on the Karasek questionnaire. RESULTS: 245 workers participated in the study. The average age was 32.4±6.4 years. Sex-ratio was 0.84. Occupational seniority was 6.3 years (min=1 year; max=18 years). The category of employees was the most represented (56%); the cashiers and the executives represented respectively 24.5 and 19.5%. A job strain situation was observed in 28.2 % of cases. It varied significantly with occupational seniority (p=0.03). The employees and the cashiers represented the most exposed posts. A high job demands was observed in 48,2% of the cases. The employees working in a supermarket are more exposed than those working in a minimarket (p<0,001). A low job control was found in 61.2 % of cases. It was more important among the employees having a permanent employment contract (p=0.01). A low job suport was found in 65,3% of cases. A situation of isostrain was observed in 20%. CONCLUSION: According our results, workers in grocery stores are exposed to psychosocial risk factor. The implementation of strategies to reduce stress factors at work is required.

Epileptic seizures and occupational exposure to solvents: a cases series.

INTRODUCTION: Organic solvents (OS) are substances with well-known nervous system tropism. Long-term exposure can cause several neurological and neuropsychic manifestations (mainly toxic encephalopathy). A potential causal relation between epileptic seizures and exposure to OS remains controversial. METHODS: We report seven cases of patients with no neurological history who had been professionally exposed to OS and who had at least one epileptic seizure after exposure. Selection of these cases was based on medical records of patients who were referred to the occupational health department of Charles Nicolle Hospital of Tunis during the period from January 1, 2010 to December 31, 2014. RESULTS: Cases studies concerned five men and two women aged between 29 and 46. Professional seniority ranged from 2 to 31 years. In all cases, epileptic seizures occurred after exposure to a mixture of solvents. It was concluded, according to workplace inspections, that there was an important daily and direct OS exposure. Working conditions were considered as defective. Six cases had generalized seizures, one patient presented with status epilepticus. Illness onset occurred between one and nine years after the beginning of exposure to OS. CONCLUSION: These cases suggest a possible relationship between OS exposure and onset of epilepsy.

[Effects of day shift work on quality of life and vigilance in Tunisia]. / Effets du travail en horaires alternés sur la qualité de vie et la vigilance en Tunisie.

INTRODUCTION: Alternate work is known to cause physical and mental health disorders for employees that can alter their quality of life and sleep. OBJECTIVE: The purpose of this research was to evaluate workers quality of life and sleep in situations of alternate work. RESULTS: In total, 391 workers answered the questionnaire. According to the type of schedule, 320 employees worked alternately on a 2×8 shift schedule and 71 worked on a permanent night shift schedule. The group of employees working at night had a better quality of life than the group of employees working in 2×8 in terms of both their physical and mental scores (P < 10-3). Type 2×8 workers were found to have excessive daytime sleepiness as compared to those on fixed night schedules. CONCLUSIONS: Shortly, we can deduce from this study that alternating day shift work causes a deterioration of workers' quality of life of and generates sleep disorders..

Fitness for work of hospital personnel in sickness absence.

INTRODUCTION: The evaluation of fitness for work can be conducted upon the employer's request even during the employee's sickness absence. AIM: Determine the contribution of conducting medical examinations to assess the working ability of Charles Nicolle hospital's workers who are on sick leave. METHODS: A descriptive and retrospective study included all the medical records, completed over a two-year period (2013-2014), of Charles Nicolle hospital's personnel who were on sick leave and who consulted the service of occupational medicine and professional pathology to undergo a fitness for work evaluation requested by the employer. RESULTS: Our study was based on a total of 170 cases of sickness absenteeism reported from a population of 133 employees. The average age of the study population was 39 years (+/- 9.5) with a sex ratio of 0.51. The category of nurses was the most represented (44.4 %). The average work seniority was 10.6 years (+/- 8.4). It is worth notifying that in 65.3% of the cases (111/170), medical examinations were conducted on the employees during the time they were off work. However, in the remaining 34.7 % of the cases (59/170), medical examinations were conducted on the employees after they go back to work. Our study showed that among the 111 employees who were subject to a medical examination during their sickness absence, 88 of them, which is the equivalent of 79.3 %, were found to be fit for work. Among those, 8 cases were fit for work but with some restrictions. A temporary unfitness for work was indicated in only 20.7% of the cases (23/111). CONCLUSION: Our study unveiled a discrepancy between sickness absenteeism and fitness for work in Charles Nicolle hospital. Employees on sick leave had the physical and the mental abilities that would allow them to work with some individualized accommodations based on their health-related needs.

Aluminum chloride impacts dentate gyrus structure in male adult albino Wistar rats.

To get better insights into the aluminum neurotoxicity, rats were treated with AlCl3 for increasing doses and periods. Body and brain weights, plasma and brain AlCl3 levels were assayed. Light microscopy observation of brain was performed. AlCl3 exposure showed a significant decrease (p < 0.05) on body and brain weight with the highest dose at 18 months. Statistical analysis confirms no significant interaction during 6 months (ρ = 0.357; p > 0.05) while, significant correlation was observed during 12 (ρ = 0.836; p < 0.001) and 18 months (ρ = 0.769; p < 0.001) between body and brain weight. Plasma and brain AlCl3 concentration increased significantly (p < 0.05) with dose and period dependent manner. Statistical analysis confirms significant interaction between brain concentrations of AlCl3 and administrated doses during 6 (ρ = 0.969; p < 0.001), 12 (ρ = 0.971; p < 0.001) and 18 months (ρ = 0.965; p < 0.001). Similar relation was established between plasma AlCl3 concentration and administrated doses during 6 (ρ = 0.970; p < 0.001), 12 (ρ = 0.971; p < 0.001) and 18 months (ρ = 0.964; p < 0.001). Significant relation was confirmed between plasma and brain AlCl3 concentration during 6 (ρ = 0.926; p < 0.001), 12 (ρ = 0.983; p < 0.001) and 18 months (ρ = 0.906; p < 0.001). Morphological alterations mainly targeted the subgranular layer with modulation of the dentate gyrus appearance. This study highlights the toxic effect of AlCl3 on the brain which may affects learning and memory and seems to be different according to dose and duration of exposure.

[Occupational low back pain in Tunisia]. / La lombalgie post-traumatique professionnelle en Tunisie.

BACKGROUND: In Tunisia, eight researches works, dealing with low back trauma (LBT), have been achieved in some occupational sector activities and only 2 of them have been published. AIM: To synthesize data provided by these 8 works realized between 1998 and 2007, in order to estimate the disorder magnitude and to describe LBT victims profile in Tunisia. METHODS: The global population of study is made of 1357 LBT victims (977 belonging to the private sector and 380 to the public sector). The data collection was carried out according to an uniformed model for the 8 studies. RESULTS: In the public sector, Commission Médicale Centrale data show that LBT account for 4 to 5% of occupational accidents (OA) and that their annual incidence is from 32 to 36/100000. In the private sector, Caisse Nationale d'Assurance Maladie data reveal that LBT account for 7.7% to 9.5% of OA. LBT victim is a male (83%), with an age ranging between 36 and 43.5 years, married (84%), educated up to the secondary educational (91%) with a vertebral disorders history (34%). He belongs to the general-purpose workmen category in 1/2 of cases with an average seniority ranging between 7.8 and 16.2 years. LBT almost subjects, get at least of a sick leave. Work days lost is around 210 days for the private sector and 18 days for the public. The per annum amount versed for each LBT case, within the framework of the Total Temporary incapacity, is of 1449.319 DT and 45% of the subjects profit from a professional reclassification. CONCLUSION: Our results join those of international studies having dealt with LBD in professional environment. In spite of some limiting methodological issues, they allowed us to provide to professionals in occupational health useful data for this occupational risk management.