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.     

Changes in growth rate and thyroid- and sex-hormones blood levels in rats under sub-chronic lithium treatment

Lithium therapy, mainly used in curing some psychiatric diseases, is responsible for numerous undesirable side effects. The present study is a contribution to the understanding of the pathophysiological mechanisms underlying lithium toxicity. Male and female mature rats were divided into three batches and fed commercial pellets: one batch was the control and the second and third batches were given 2 g (Li1) and 4 g (Li2) of lithium carbonate/kg of food/day, respectively. After 7, 14, 21 and 28 days, serum levels of free tri-iodothyronine (FT3), thyroxine (FT4), testosterone and estradiol were measured. Attention was also paid to growth rate and a histological examination of testes or vaginal mucosa was carried out. In treated rats, a dose-dependent loss of appetite and a decrease in growth rate were observed, together with symptoms of polydypsia, polyuria and diarrhea. Lithium serum concentrations increased from 0.44 mM (day 7) to 1.34 mM (day 28) in Li1 rats and from 0.66 to 1.45 mM (day 14) in Li2 rats. Li2 treatment induced a high mortality after 14 days, reaching 50-60% in female and male animals. From these data, the LD50 (14 days Li2 chronic treatment) was calculated to be about 0.3 g/day per kilogram of animal, leading to Li serum concentrations of about 1.4 mM. A significant decrease of FT3 and FT4 was observed in treated rats. This effect appeared immediately for the highest dose and was more pronounced for FT3, resulting in an increase of the FT4/FT3 ratio. In males, testosterone decreased and spermatogenesis was stopped. Conversely, in females, estradiol increased in a dose-dependent manner as the animals were blocked in the diestrus phase at day 28. This finding supports a possible antagonistic effect of lithium on the estradiol receptors.     

Retrobulbar anesthesia during keratolplasty

AIM: A restrospective study was carried in order to evaluate the efficacy and safety of retrobulbar anaesthesia during keratoplasty. METHODS: Of 250 consecutive keratoplasty, 30 (12%) were performed under retrobulbar anaesthesia. Patients received a mean volume of 12 ml, composed of etidocaine (2/3), bupicaine (1/3) and hyaluronidase. Ocular compression duration was at least 20 minutes. RESULTS: Surgery was found painless by 90% of patients. Akinesia was complete in 80% of cases. CONCLUSION: Theses results demonstrate that retrobulbar anaesthesia may be recommended to this type of surgery.     

Gliomatosis cerebri

The Gliomatosis Cerebri (GC) is an infiltrating and rare primitive tumour of the brain. It is characterized by diffuse neoplastic proliferation of glial cells involving of at least two lobes of the brain, without a distinct tumor mass and with the preservation of the anatomical and neuronal architecture. According to the WHO classification, GC is categorized as a high-grade neuroepithelial tumor of uncertain origin (GradelV). Now the diagnosis is facilitated via stereotactic biopsies of the representative lesion identified in magnetic resonance. Our objective is to present 4 new cases, and recall the clinical and radiological features and the prognosis.     

Unusual localization of spinal hydatid cyst

We report one case of uncommon spinal hydatid cysts particular by its localization. It is intradural, localized with predilection in the big cistem cerebello-medullar. There is no involvement of adjacent vertebral discs and ligaments. We specify characteristic imaging features and polymorphism of this affection who can affect all anatomical structures. We emphasize MRI for diagnosis and follow-up in search for residual or recurrent lesions.     

Effects of intra-session concurrent endurance and strength training sequence on aerobic performance and capacity

Aim: To examine the effects of the sequencing order of individualised intermittent endurance training combined with muscular strengthening on aerobic performance and capacity. Methods: Forty eight male sport students (mean (SD) age 21.4 (1.3) years) were divided into five homogeneous groups according to their maximal aerobic speeds (vV^·O₂MAX). Four groups participated in various training programmes for 12 weeks (two sessions a week) as follows: E (n = 10), running endurance training; S (n = 9), strength circuit training; E+S (n = 10) and S+E (n = 10) combined the two programmes in a different order during the same training session. Group C (n = 9) served as a control. All the subjects were evaluated before (T0) and after (T1) the training period using four tests: (1) a 4 km time trial running test; (2) an incremental track test to estimate vV^·O₂MAX; (3) a time to exhaustion test (t_lim) at 100% vV^·O₂MAX; (4) a maximal cycling laboratory test to assess V^·O₂MAX. Results: Training produced significant improvements in performance and aerobic capacity in the 4 km time trial with interaction effect (p<0.001). The improvements were significantly higher for the E+S group than for the E, S+E, and S groups: 8.6%, 5.7%, 4.7%, and 2.5% for the 4 km test (p<0.05); 10.4%, 8.3%, 8.2%, and 1.6% for vV^·O₂MAX (p<0.01); 13.7%, 10.1%, 11.0%, and 6.4% for V^·O₂MAX (ml/kg^0.75/min) (p<0.05) respectively. Similar significant results were observed for t_lim and the second ventilatory threshold (%V^·O₂MAX). Conclusions: Circuit training immediately after individualised endurance training in the same session (E+S) produced greater improvement in the 4 km time trial and aerobic capacity than the opposite order or each of the training programmes performed separately.     

Hyperprolactinemia in systemic lupus erythematosus. A prospective study of 38 cases

OBJECTIVE: To study prospectively the serum prolactin concentrations among patients with systemic lupus erythematosus and their possible relationship to disease activity and manifestations. METHODS: Serum prolactin levels were measured by radioimmunoassay in 38 patients with systemic lupus erythematosus and 22 age matched controls. Patients with known secondary causes for hyperprolactinaemia, such as pregnancy, lactation, prolactinoma and taking medications known to induce prolactin secretion, were excluded from the study. Demographic, clinical and laboratory features of the patients were obtained. Patients were divided into two subgroups according to their disease activity. Mean prolactin levels from both groups were compared using student test, and prolactin from patients with systemic lupus erythematosus was correlated with variables of disease activity, including the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). RESULTS: Mean prolactin levels were higher in patients with systemic lupus erythematosus (15.4) than healthy controls (9.83); however, the difference did not reach statistical significance (p=). Hyperprolactinemia was found in 24 patients with systemic lupus erythematosus and 5 controls. The frequency of hyperprolactinaemia in systemic lupus erythematosus group was higher than healthy controls. No significant difference in mean prolactin levels was found between patients with active versus inactive disease (18.9 vs 18.5). CONCLUSION: Hyperprolactinaemia occurred significantly in patients with systemic lupus erythematosus, but did not correlate with disease activity.     

Frequency of the DYT1 mutation in primary torsion dystonia without family history

BACKGROUND: Idiopathic torsion dystonia is a clinically and genetically heterogeneous movement disorder. A GAG deletion at position 946 of the DYT1 gene was the first mutation found, in early-onset dystonia, with an autosomal dominant transmission and reduced penetrance. OBJECTIVE: To evaluate the frequency of the DYT1 mutation in patients with idiopathic torsion dystonia but without a family history. DESIGN: Prospective cohort study. SETTING: Four botulinum toxin clinics in the Paris, France, area. PATIENTS: A French population of 100 patients with dystonia. MAIN OUTCOME: Frequency of the DYT1 mutation tested by polymerase chain reaction and enzyme restriction analysis for the 946 GAG deletion, and genotype-to-phenotype correlation. RESULTS: Only 5 mutation carriers were identified, 4 of whom were part of a group of 10 patients with generalized dystonia. Onset was between ages 5 and 12 years as in typical early-onset dystonia. All 4 patients had cranial muscle involvement, which is atypical for DYT1 mutation carriers. One had segmental dystonia. Molecular analysis of relatives in 2 families demonstrated that the lack of family history was due to reduced penetrance. CONCLUSIONS: For accurate diagnosis and genetic counseling, screening for the DYT1 deletion is of great interest in cases with generalized dystonia without a family history. In other cases, positive results are rare.     

Mycosis fungoides. Study of a series of 11 Tunisian cases

Mycosis fungoides is an epidermotropic cutaneous T lymphoma. It's a non Hodgkinian lymphoma. We report the results of a retrospective review of 11 mycosis fungoide seen during 22 years. The frequency of MF was about 39.3% among all cutaneous lymphoma. Six patients were male and 5 were female; the mean age was about 56 years. Mean delay between diagnostic and the first manifestation was about 25 months. All patients had the progressive form: 4 had infiltrate plaques and 7 were at the tumoral phase. Lymph nodes and medullar metastases were noted respectively in 1 and 2 cases. Treatment was mono or polychemotherapy associated in 6 cases with topical drug. Three patients died of their diseases According to our experience and after reviewed the literature, we notice that our patients are slightly younger without male predominance. The diagnostic was done tardily and this may explain the pejorative prognostic.