Musculoskeletal disorders among Tunisian hospital staff: Prevalence and risk factors

Aim of the workMusculoskeletal disorders (MSD) represent a significant occupational problem among hospital staff; however, data on musculoskeletal health of hospital staff are sparse. This study sought to determine the prevalence of MSD, their epidemiologic data and the associated risk factors.MethodsA previously self administered questionnaire sought information on demographics, prevalence and pattern of MSD, associated risk factors was employed as the survey instrument. A total of 520 questionnaires were distributed to hospital staff but only 433 questionnaires was valid. Eighty-seven of the returned questionnaires were excluded because of incomplete data.ResultsThe prevalence of MSD among hospital staff was 65.4%. Musculoskeletal disorders occurred mostly in low back (74.5%), neck (38.1%), and knees (31.1%).Factors associated to MSD were age (P < 0.001), female gender (P < 0.001), years of service (P < 0.001) as well as prolonged standing or sitting (P = 0.016 and 0.023, respectively). No significant association was found between repetitive movement, uncomfortable postures, heavy load handling, working on night shifts, stress and the presence of MSD.ConclusionA high proportion of hospital staff reported MSD at some body site with the low back being injured most often. Education programs on prevention and coping strategies for musculoskeletal disorders are recommended for hospital staff in order to reduce the rate of occupational hazards and also promote efficiency in patient care.     

Movement disorders in neuro-metabolic diseases

Inborn errors of metabolism (IEM) are a group of genetic disorders characterized by dysfunction of an enzyme or other protein involved in cellular metabolism.¹ Most IEMs involve the nervous system (neuro-metabolic diseases or NMD). NMD often present with a complex clinical picture: psychomotor retardation and/or regression, pyramidal signs, ataxia, hypotonia and epilepsy and movement disorders.¹ Movement disorders are more frequently part of this complex picture than a predominant symptom, however in some instances the clinical picture may be summarized in an invalidating movement disorder.²On a phenomenology basis, one can distinguish eight main types of movement disorders: dystonia and athetosis, chorea, tremor with or without parkinsonism, ballismus, myoclonus, tics and stereotypies. Most of these abnormal involuntary movements generate from a dysfunction or a lesion in the basal ganglia, excepting myoclonus, the origin of which can vary (cortical, brainstem, basal ganglia, spinal and even peripheral nervous system).³Classically the most frequently observed movement disorders in NMD are: dystonia, myoclonus, chorea, tremor and parkinsonism (Fig. 1). The primary goal of this article is, departing from the literature and a large personal series, to describe the types of movement disorders most frequently observed in NMD and to discuss their clinical value in the setting of specific types of NMD.     

The managment of serious pregnant disease in the intensive care unit

We report a retrospective study over a period of 4 years and half and bearing on 59 patients that require an intensive care. The number of childbirth during this period was 22237 with 8.97% of Caesareans. The main obstetrical diseases was: gravidic toxaemia 75.5%, uterine inertia 7%, cardiopathy 5% of the cases. The reasons for the transfer were: eclamptic state in 27% of the cases, hémostasis disorder 22% of the cases, and acute pulmonary oedema 18.6% of the cases. Average duration of hospitalization was 3.18 days. Five cases of death were noted.     

Primary pachydermoperiostosis associated with pigmented villonodular synovitis: An unknown association?

Primary pachydermoperiostosis is a rare genetic disease affecting the skin and musculoskeletal system. In contrast to secondary hypertrophic osteoarthropathy, primary pachydermoperiostosis is considered a benign condition. While a variety of associated abnormalities have been described in this form, any association with tumors was previously reported in the literature. We hereby describe the first case of a 20-year-old man with primary pachydermoperiostosis revealed by a knee synovial tumor.     

Pharmacology of carbon nanotubes: Toxicokinetics,excretion and tissue accumulation

Carbon nanotubes (CNT) are increasingly being investigated for their use in biomedical applications and nanomedicine. An emergent need for the understanding of their in vivo biodistribution and pharmacokinetics is therefore needed to establish the essential properties and criteria for their further development as targeted CNT delivery systems to specific tissues for diagnostics and therapeutic purposes. Until their biodistribution and toxicoketic profiles are fully understood, their translation into the clinic will be hindered. This review will highlight the important factors affecting the biodistribution and pharmacokinetic profile of CNT and address their toxicokinetics following systemic, pulmonary and dermal exposure.     

Supervised classification approach of biometric measures for automatic fetal defect screening in head ultrasound images

Abstract

This paper presents an advanced approach for foetal brain abnormalities diagnostic by integrating significant biometric features in the identification process. In foetal anomaly diagnosis, manual evaluation of foetal behaviour in ultrasound images is a subjective, slow and error-prone task, especially in the preliminary treatment phases. The effectiveness of this appearance is strictly subject to the attention and the experience of gynaecologists. In this case, automatic methods of image analysis offer the possibility of obtaining a homogeneous, objective and above all fast diagnosis of the foetal head in order to identify pregnancy behaviour. Indeed, we propose a computerised diagnostic method based on morphological characteristics and a supervised classification method to categorise subjects into two groups: normal and affected cases. The presented method is validated on a real integrated microcephaly and dolichocephaly cases. The studied database contains the same gestational age of both normal and abnormal foetuses. The results show that the use of a support vector machine (SVM) classifier is an effective way to enhance recognition and detection for rapid and accurate foetal head diagnostic.     

Population pharmacokinetics of bupivacaine in combined lumbar and sciatic nerve block

Objectives:

The primary aim of this study was to establish the population pharmacokinetic (PPK) model of bupivacaine after combined lumbar plexus and sciatic nerve blocks and secondary aim is to assess the effect of patient''s characteristics including age, body weight and sex on pharmacokinetic parameters.

Materials and Methods:

A total of 31 patients scheduled for elective lower extremity surgery with combined lumbar and sciatic nerve block using plain bupivacaine 0.5% were included. The total bupivacaine plasma concentrations were measured before injection and after two blocks placement and at selected time points. Monitoring of bupivacaine was made by high performance liquid chromatography (HPLC) with ultraviolet detection. Non-linear mixed effects modeling was used to analyze the PPK of bupivacaine.

Results:

One compartment model with first order absorption, two input compartments and a central elimination was selected. The Shapiro-Wilks test of normality for normalized prediction distribution errors for this model (P = 0.156) showed this as a valid model. The selected model predicts a population clearance of 930 ml/min (residual standard error [RSE] = 15.48%, IC 95% = 930 ± 282.24) with inter individual variability of 75.29%. The central volume of distribution was 134 l (RSE = 12.76%, IC = 134 ± 33.51 L) with inter individual variability of 63.40%. The absorption of bupivacaine in two sites Ka1 and Ka2 were 0.00462/min for the lumbar site and 0.292/min for the sciatic site. Age, body weight and sex have no effect on the bupivacaine pharmacokinetics in this studied population.

Conclusion:

The developed model helps us to assess the systemic absorption of bupivacaine at two injections sites.KEY WORDS: Bupivacaine, lumbar plexus block, non-linear mixed effects modeling, pharmacokinetics parameters, sciatic nerve blocks     

Clinicopathological significance of cancer stem cell markers CD44 and ALDH1 expression in breast cancer

Background

CD44 and aldehyde dehydrogenase 1 (ALDH1) has been reputed to be cancer stem cell (CSC) markers in breast cancer. Yet, the clinicopathologic and prognostic significance of these markers remain unclear. In this study, we have investigated the expression of these markers and their relation with conventional clinicopathologic tumor characteristic including molecular subtype.

Methods

CD44 and ALDH1 expression were investigated by immunohistochemistry in a series of 157 formalin-fixed paraffin-embedded breast cancer tissues.

Results

Overall, CD44 and ALDH1 are, respectively, detected in 33% (52 of 157) and 7% (10 of 157) of breast cancer cases. We also observed that CD44 expression was associated with histological grade (p?=?0.005). For ALDH1, we found that its expression is more frequent with elderly women (>?50 years, p?=?0.03). The investigation of relationship between the stem cell phenotype and breast cancer molecular subtype, revealed that CD44 and ALDH1 expression was more frequent in basal-like tumors (p?=?0.005). Among the two cancer stem cell markers tested, ALDH1 showed a strong association with the basal marker EGFR (p?=?0.05).

Conclusions

These findings suggest that CD44 and ALDH1 play a role in the clinical behavior in breast cancer and might be interesting biomarkers and therapeutic targets.

     

Short coupled variant of "torsades de pointes" and sudden death

A case report of 38 year old man who experienced syncope and torsade de pointes is presented with the short coupled variant. The patient had a normal QT interval (QTC: 0.37 seconds) and multiform ventricular premature beats on the resting electrocardiogram. Under antiarrhythmic treatment (intravenous xylocaine), torsades de pointes suddenly appeared and cardiac arrest was followed. After cardioversion, sinus rhythm was restored. A cardiovascular disease was excluded, the echocardiography, the left and right ventricular angiography and coronarography were normal. Three months after, the patient presented at home a sudden cardiac death.