Working with argan cake: a new etiology for hypersensitivity pneumonitis

International audienceAbstractBackgroundArgan is now used worldwide in numerous cosmetic products. Nine workers from a cosmetic factory were examined in our occupational medicine department, following the diagnosis of a case of hypersensitivity pneumonitis (HP) related to handling of argan cakes.MethodsOperators were exposed to three forms of argan (crude granulates, powder or liquid) depending on the step of the process. All workers systematically completed standardized questionnaires on occupational and medical history, followed by medical investigations, comprising, in particular, physical examination and chest X-rays, total IgE and a systematic screening for specific serum antibodies directed against the usual microbial agents of domestic and farmer’s HP and antigens derived from microbiological culture and extracts of various argan products. Subjects with episodes of flu-like syndrome several hours after handling argan cakes, were submitted to a one-hour challenge to argan cakes followed by physical examination, determination of Carbon Monoxide Diffusing Capacity (DLCO) and chest CT-scan on day 2, and, when necessary, bronchoalveolar lavage on day 4.ResultsSix of the nine workers experienced flu-like symptoms within 8 hours after argan handling. After challenge, two subjects presented a significant decrease of DLCO and alveolitis with mild lymphocytosis, and one presented ground glass opacities. These two patients and another patient presented significant arcs to both granulates and non-sterile powder. No reactivity was observed to sterile argan finished product, antigens derived from argan cultures (various species of Bacillus) and Streptomyces marokkonensis (reported in the literature to contaminate argan roots).ConclusionsWe report the first evidence of hypersensitivity pneumonitis related to argan powder in two patients. This implies preventive measures to reduce their exposure and clinical survey to diagnose early symptoms. As exposure routes are different and antibodies were observed against argan powder and not the sterile form, consumers using argan-based cosmetics should not be concerned

Development of a Questionnaire for the Search for Occupational Causes in Patients with Non-Hodgkin Lymphoma: The RHELYPRO Study

Non-Hodgkin lymphoma (NHL), multiple myeloma and chronic lymphocytic leukemia are possibly related to environmental and/or occupational exposure. The primary objective of this study was to develop a questionnaire for screening patients with these blood disorders who might benefit from a specialized consultation for possible recognition of the disease as an occupational disease. The study included 205 subjects (male gender, 67.3%; mean age, 60 years; NHL, 78.5%). The questionnaire performed very satisfactorily in identifying the exposures most frequently retained by experts for their potential involvement in the occurrence of NHL. Its sensitivity and specificity in relation to the final expertise were 96% and 96% for trichloroethylene, 85% and 82% for benzene, 78% and 87% for solvents other than trichloroethylene and dichloromethane, 87% and 95% for pesticides, respectively. Overall, 15% of the subjects were invited to ask National Social Insurance for compensation as occupational disease. These declarations concerned exposure to pesticides (64%), solvents (trichloroethylene: 29%; benzene: 18%; other than chlorinated solvents: 18%) and sometimes multiple exposures. In conclusion, this questionnaire appears as a useful tool to identify NHL patients for a specialized consultation, in order to ask for compensation for occupational disease

DNA damage in B and T lymphocytes of farmers during one pesticide spraying season

Purpose The effect of one pesticide spraying seasonon DNA damage was measured on B and T lymphocytesamong open-field farmers and controls.Methods At least two peripheral blood samples were collectedfrom each individual: one in a period without anypesticide application, several weeks after the last use (January,at period P0), and another in the intensive pesticidespraying period (May or June, at period P4). DNA damagewas studied by alkaline comet assay on isolated B or Tlymphocytes.Results Longitudinal comparison of DNA damageobserved at both P0 and P4 periods revealed a statisticallysignificant genotoxic effect of the pesticide spraying seasonin both B (P = 0.02) and T lymphocytes (P = 0.02) in exposed farmers. In contrast, non-farmers did not showany significant modifications. DNA damage levels in Band T lymphocytes were significantly higher in farmersthan in non-farmers during the P4 period (P = 0.003 andP = 0.001 for B and T lymphocytes, respectively) but notduring the P0 period. The seasonal effect observed amongfarmers was not correlated with either total farm area, farmarea devoted to crops or recent solar exposure. On average,farmers used pesticides for 21 days between P0 and P4.Between the two time points studied, there was a tendencyfor a potential effect of the number of days of fungicidetreatments (r2 = 0.43; P = 0.11) on T lymphocyte DNAdamage.Conclusions A genotoxic effect was found in lymphocytesof farmers exposed to pesticides, suggesting in particularthe possible implication of fungicides

Approche des facteurs psychosociaux et organisationnels dans les douleurs d'origine musculo-squelettique, en particulier les aspects longitudinaux (caractère prédictif)

Le terme de trouble musculo-squelettique (TMS) est une application générique utilisée pour désigner les atteintes de l'appareil ostéo-articulaire attribuées au travail (muscles, tendons, nerfs...), principalement des membres supérieurs et du rachis. L'étiologie des TMS repose sur la combinaison des éléments liés à la personne, des facteurs psychosociaux, des sollicitations biomécaniques et de l'organisation du travail. La douleur d'origine musculo-squelettique a des conséquences sociales importantes notamment professionnelles. Notre travail de thèse avait pour objectif d'analyser le rôle joué par les facteurs psychosociaux et organisationnels professionnels dans les douleurs d'origine musculo-squelettique. Notre travail a porté sur deux études nationales longitudinales, l'une en milieu soignant (ORSOSA) avec deux recueils 2600-2008 et l'autre en population générale de travailleurs (ESTEV) avec deux recueils également 1990 et 1995. Nous avons rapporté des associations statistiquement significatives et indépendantes entre les facteurs psychosociaux mesurés par le modèle généraliste de Siegrist et des facteurs psycho-organisationnels spécifiques de l'environnement professionnel des soignants (infirmières) mesurées par un nouvel outil (Nursing Work Index - Extended Organisation ou NWI-EO) avec les douleurs de l'appareil musculo-squelettique des membres supérieurs présentées au cours des 7 derniers jours par des infirmières en exercice (Herin et al. Pain 2011). De plus, nous avons confirmé le fait que certains facteurs psychosociaux liés au travail sont associés à la douleur chronique de l'épaule indépendamment des facteurs biomécaniques d'origine professionnels et des facteurs individuels reconnus dans la littérature comme facteurs de risque de TMS de l'épaule. Nos résultats explicitent fortement le rôle prédictif majeur joué par les facteurs psychosociaux, notamment la dimension psychosociale " faible latitude décisionnelle au travail " et la perception d'un travail monotone dans les douleurs chroniques de l'épaule après un suivi de 5 années (Herin et al. Pain 2012). La plupart des études dans la littérature ayant pour objet les TMS ont concerné l'atteinte d'une seule région anatomique et ont déterminé les facteurs de risque comme spécifiques à chaque site. En conséquence, nous nous sommes intéressés au rôle joué par les facteurs psychosociaux liés au travail sur la douleur chronique musculo-squelettique dans quatre régions anatomiques distinctes et sur la douleur chronique diffuse (atteintes plurifocales ou multisites). Ainsi, les facteurs psychosociaux (faible latitude décisionnelle et forte demande psychologique) semblent être des facteurs prédictifs d'atteinte musculo-squelettique plurifocale ou multisite sous la forme de douleur chronique, mais uniquement chez les femmes (Herin et al. Pain 2014). Au total, ce travail de thèse a permis de préciser le rôle joué par les facteurs psychosociaux et organisationnels sur les douleurs d'origine musculo-squelettique.Work-related musculoskeletal disorders (MSDs) have a multifactorial aetiology that includes not only physical stressors, but also psychosocial and organizational factors. But it is unclear whether these factors contribute to specific regional musculoskeletal pain or to multisite pain. Musculoskeletal pain is a leading cause of disability among people of working age and has a substantial social and economic impact. The objective of this thesis was to assess the impact of work-related psychosocial and organizational factors according to the musculoskeletal pain. The data for two prospective cohort studies (ORSOSA and ESTEV) on general population of workers) were analyzed. We identified and assessed specific healthcare organisational factors by the self-rated Nursing Work Index - Extended Organisation (NWI-EO) that have an impact on nurses' upper limb symptoms, sometimes independently of ERI perception (Herin et al. Pain 2011). Shoulder pain is the third most common type of musculoskeletal pain, and can have a major impact on health-related quality of life. This work emphasises the multifactorial nature of chronic shoulder pain during a prospective 5-year follow-up in a large representative sample of workers. Our results suggest that psychosocial work-related factors (job demand and decision control) are predictors of chronic shoulder pain at work. (Herin et al. Pain 2012). The role of psychosocial and physical factors in the development of musculoskeletal pain has now been clearly demonstrated, but it is unclear whether these factors contribute to specific regional musculoskeletal pain or to multisite pain. This work emphasises the multifactorial nature of regional body site pain and multisite pain in a large representative sample of female and male workers. Our results support the hypothesis that some psychological work-related factors are predictive of regional or multisite musculoskeletal pain but differ according to gender (Herin et al. Pain 2014). Finally, we have clarified the role of psychosocial and organizational work-related factors on musculoskeletal pain

L'échelle visuelle analogique comme moyen d'évaluation du stress professionnel en consultation de médecine du travail (à partir d'une enquête transversale)

Objectif : Comparer les dimensions stress et satisfaction au travail d'une double Echelle Visuelle Analogique aux dimensions des modèles de Karasek et de Siegrist. Méthode : Exploitation du fichier de l'enquête Vécu au travail , étude transversale réalisée sur plus de 18000 sujets de la région Midi-Pyrénées en 2004. Résultats : La double Echelle Visuelle Analogique de stress et de satisfaction au travail est mal corrélée aux modèles de Karasek et de Siegrist. Conclusion : Le Risque Psycho-Organisationnel est une préoccupation majeure en santé au travail. Il existe une difficulté importante de mesure de ce risque et de ses conséquences en termes de stress perçu. Il faut tendre vers un moyen rapide d'évaluation adapté à la visite médicale. L'Echelle Visuelle Analogique est un instrument potentiellement intéressant.TOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Antibody titers and protection against a SARS-CoV-2 infection

International audienceRecent studies indicate that binding and neutralizing SARS-CoV-2 antibodies elicited by natural infection or vaccination persist for more than 6 months although their concentration decreases over time. The passive transfer of neutralizing antibodies (NAb) and protection are correlated in non-human primates. While such a link has not yet been defined in humans, individuals with a high NAb titer could well be better protected against SARS-CoV-2. A re-cent letter in Journal of Infection indicated that indeed neutralizing antibodies are considered linked to protective immunity due to their ability to block the viruses from entering the host cells. The authors discussed the decrease in neutralizing antibodies after vaccination without being able to provide a threshold below which protection against SARS-CoV-2 infection is no longer guaranteed. We measured the antibody titers in 8758 healthcare workers (HCWs), vaccinated and unvaccinated, soon after the first epidemic wave had occurred in France (10 June–10 July, 2020)

DNA damage in B and T lymphocytes of farmers during onepesticide spraying season

Purpose The effect of one pesticide spraying seasonon DNA damage was measured on B and T lymphocytesamong open-field farmers and controls.Methods At least two peripheral blood samples were collectedfrom each individual: one in a period without anypesticide application, several weeks after the last use (January,at period P0), and another in the intensive pesticidespraying period (May or June, at period P4). DNA damagewas studied by alkaline comet assay on isolated B or Tlymphocytes.Results Longitudinal comparison of DNA damageobserved at both P0 and P4 periods revealed a statisticallysignificant genotoxic effect of the pesticide spraying seasonin both B (P = 0.02) and T lymphocytes (P = 0.02) in exposed farmers. In contrast, non-farmers did not showany significant modifications. DNA damage levels in Band T lymphocytes were significantly higher in farmersthan in non-farmers during the P4 period (P = 0.003 andP = 0.001 for B and T lymphocytes, respectively) but notduring the P0 period. The seasonal effect observed amongfarmers was not correlated with either total farm area, farmarea devoted to crops or recent solar exposure. On average,farmers used pesticides for 21 days between P0 and P4.Between the two time points studied, there was a tendencyfor a potential effect of the number of days of fungicidetreatments (r2 = 0.43; P = 0.11) on T lymphocyte DNAdamage.Conclusions A genotoxic effect was found in lymphocytesof farmers exposed to pesticides, suggesting in particularthe possible implication of fungicides

The real seroprevalence of SARS-CoV-2 in France and its consequences for virus dynamics

Abstract The SARS-CoV-2 virus has spread world-wide since December 2019, killing more than 2.9 million of people. We have adapted a statistical model from the SIR epidemiological models to predict the spread of SARS-CoV-2 in France. Our model is based on several parameters and assumed a 4.2% seroprevalence in Occitania after the first lockdown. The recent use of serological tests to measure the effective seroprevalence of SARS-CoV-2 in the population of Occitania has led to a seroprevalence around 2.4%. This implies to review the parameters of our model to conclude at a lower than expected virus transmission rate, which may be due to infectivity varying with the patient’s symptoms or to a constraint due to an uneven population geographical distribution

Protection of Healthcare Workers Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Reinfection

International audienceRecent reports of SARS-CoV-2 reinfection have raised questions as to whether and to what degree a first infection protects against reinfection. This is particularly important for healthcare workers (HCW) as they are always in the front line combatting both the present epidemic and any new waves of SARS-CoV-2 infection. These workers can also transmit the virus to co-workers and hospitalized susceptible patients. In their recent study, Lumley et al presented 6 months of data from a longitudinal seroprevalence study of UK HCW and showed that SARS-CoV-2 anti-nucleocapsid antibodies wane within months

Post-Vaccination Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibody Kinetics and Protection Duration

International audienceDear Editor,It will be difficult to mount an effective response to the SARS-CoV-2 pandemic without a clear understanding of the kinetics of the immune response to the virus. A recent study looked at the kinetics of antibody avidity maturation in COVID-19 patients and showed that IgG avidity increased form 1-90 days associated with disease severity. In a complementary way, another study in healthcare workers (HCWs) showed that a total antibody concentration greater than 141 BAU/ml provides 89.3% protection against SARS-CoV-2 infection. In this study we determined the duration of protection conferred by the total antibodies taking into account the pre-vaccination infectious status and the waninghumoral immunity