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La maladie à virus corona (COVID-19) peut provoquer de nombreuses manifestations oculaires. Nous rapportons un cas rare de choriorétinopathie séreuse centrale bilatérale, post-infection au COVID-19, chez une femme âgée de 38 ans qui s’est présentée pour un flou visuel bilatéral, 1 mois après l’infection au COVID-19. Elle avait de la fièvre, des frissons, une toux et un essoufflement avec fatigue et elle était positive au COVID-PCR. Pendant son séjour de 10 jours à l’hôpital, elle a reçu une oxygénothérapie, des antibiotiques, de l’héparine et des corticoïdes par voie intraveineuse puis relais par voie orale en ambulatoire. Après sa guérison du COVID-19, la patiente a développé une baisse progressive de l’acuité visuelle des 2 yeux : son acuité visuelle de loin corrigée était de 3/10 dans les 2 yeux, le segment antérieur était normal et le vitré était clair. L’examen du fond d’œil, complété par la tomographie en cohérence optique et l’angiographie à la fluorescéine a montré des décollements séreux rétiniens bilatéraux. L’évolution a été marquée par une amélioration de l’acuité visuelle et une régression des décollements séreux rétiniens. La choriorétinopathie séreuse centrale peut survenir après une infection au COVID-19 en raison de l’administration des corticoïdes et un contrôle ophtalmologique précoce est indispensable pour dépister au plus tôt une atteinte oculaire.

Resume Introduction Le syndrome de blepharophimosis ptosis epicanthus inversus (SBPE) est une anomalie congenitale et hereditaire rare. Il associe des malformations orbito- palpebrales complexes, generant une gene esthetique et fonctionnelle. La prise en charge du SBPE passe par deux etapes : diagnostique et therapeutique. Patients et methodes Nous avons realise une etude descriptive retrospective sur 44 patients (88 paupieres) presentant un syndrome de blepharophimosis-ptosis-epicanthus (SBPE). Dans notre serie, nous avons opte pour une chirurgie en deux temps operatoires dans 28 cas : chirurgie de l’epicanthus- telecanthus suivie de la chirurgie de la ptose palpebrale. Une chirurgie simultanee a ete realisee dans 5 cas. Resultats L’âge moyen lors de la premiere consultation etait de 6 ans (6,1 ± 6,4). L’âge moyen de nos patients au moment de la premiere chirurgie etait de 6,6 ans. La chirurgie de l’epicanthus a ete realisee dans 35 cas. Les deux techniques utilisees pour corriger l’epicanthus etaient une plastie YV dans 30 cas (85,7 %, n = 35) et une plastie YV + double Z dans 5 cas (14,3 %, n = 35). La correction du telecanthus a ete realisee dans le meme temps operatoire par une plicature du TCM dans 31 cas (88,6 %, n = 35) ou une canthopexie transnasale dans 4 cas (11,4 %, n = 35). L’âge moyen de la chirurgie du ptosis etait de 7,23 ans (±6,25) avec des extremes de 8 mois a 27 ans. La chirurgie du ptosis a ete realisee dans 41 cas, dont 3 ont ete operes d’un seul œil (ptosis asymetrique), soit 79 paupieres. La technique utilisee etait une resection du RPS pour 64 paupieres et une suspension au frontal pour 15 paupieres. Conclusion Le SBPE est souvent de diagnostic clinique. La difficulte de prise en charge reside dans sa chirurgie complexe. Il n’y a pas de consensus etabli concernant les techniques chirurgicales ni la sequence operatoire.

Purpose Ocular toxoplasmosis is the most common cause of infectious uveitis worldwide. The diagnosis of ocular toxoplasmosis is primarily clinical when it is a typical presentation.With an atypical presentation in the fundus, parasitological diagnosis is a decisive contribution, as well as multimodal imaging. The aim of this study was to investigate vitreal, retinal, and choroidal morphologic changes in active and scarred toxoplasmosis lesions using swept source optical coherence tomography. To our knowledge, it is the first study in Tunisia which describes with precision the retinochoroidal lesions caused by Toxoplasma Gondi by means of the optical coherence tomography (OCT). Methods A retrospective analysis of fifteen patients diagnosed with ocular toxoplasmosis was conducted. The patients were examined at ophthalmology service of Farhat Hached Hospital in Sousse Tunisia between January 2002 and December 2019. Complete ophthalmologic examination including best-corrected visual acuity, slit lamp biomicroscopy, dilated biomicroscopic and fundus examinations, colour fundus photography as well as fluorescein angiography and OCT were done at the initial visit and during follow-up. Result In the acute phase, thickening, hyper-reflectivity of the neurosensory retina, posterior shading, bumping of the RPE, hyporeflectivity and thickening of choroid were found in 86,6% of patients. During follow-up, neurosensory retinal layers thinning and disorganization, interrupting ofthe ellipsoid zone (EZ), and RPE hyper reflective were noticed in 73% of patients. The choroid became thin and more hyperreflective in 73% of patients. Multiple hyperreflective dots in the vitreous cavity and posterior hyaloid thickening were demonstrated in the acute phase in 60% of patients, with complete resolution and detachment of the posterior hyaloid in the scarred lesions. Conclusion The SS-OCT is an important adjunctive imaging modality in the diagnosis and follow-up of patients with ocular toxoplasmosis., Highlights • Ocular toxoplasmosis is the most common cause of infectious uveitis worldwide. • The introduction of SD-OCT has enabled imaging with greater resolution, wider sampling area, and improved image registration. • The active retinochoroiditis lesion shows thickening with hyper reflectivity of the internal layers of the retina. • The retinochoroidal scar shows retinal atrophy, interruption of the IS/OS line, sometimes subretinal fibrosis.

Introduction Diabetic retinopathy (DR) increases the risk of blindness by 25 times. Advanced researchs are justified for better management, leading to the role of Optical Coherence Tomography-Angiography (OCT-A), a new non-invasive imaging technique exploring retinal vascularization. Our purpose is to identify microvascular macular anomalies of DR on OCT-A with qualitative and quantitative evaluation of their impact on retinal vascularization. Patients and methods This is a descriptive cross-sectional study where 120 eyes of 66 diabetic patients were enrolled. All patients were diabetic and went through OCT-A imaging. Results Microanevrysms were identified in both superficial capillary plexus (SCP) and deep capillary plexus (DCP) where they were more frequently visualized. Macular edema was present in 16,7% of cases in the SCP, and in 30% in DCP. Edema spaces were more frequently present in DCP (p, Highlights • Retinal microvascular abnormalities on OCT-A are observed in diabetic retinopathy and are proportional to its severity. • Deep capillary plexus was more severely affected than superficial capillary plexus. • The assessment of macular ischemia could be based on the identification of areas of vascular rarefaction. • Quantitative assessment of vascular density and the study of the foveal avascular zone can assess the macular ischemia

Background Many studies suggest the existence of an alteration of the retinal hemoperfusion in primary open-angle glaucoma. The OCT-A is a novel technique that allows to provide information on retinal microcirculation in a non-invasive way, thus it represents a possible imaging target for the early diagnosis and follow-up of glaucoma. The aim of our work is to evaluate the contribution of vascular parameters provided by OCT-A and their diagnostic abilities in the different stages of primary open-angle glaucoma. Method This is a prospective cross-sectional study involving 200 eyes of control subjects and 250 eyes of glaucomatous subjects divided into early glaucoma, moderate glaucoma and advanced glaucoma subgroups. They were assessed for MD, LV by visual field, RNFL and GCC thickness by SS-OCT papillary and macular vascular densities by SS-OCT A. Results OCT-A vessel densities determined in the optic nerve head, in the peripapillary and in the macular regions were significantly lower in glaucomatous eyes. Among the vascular parameters studied the whole image vascular density showed the best diagnostic ability in the discrimination between glaucomatous eyes and healthy eyes with an AUC of 0.949. Nevertheless, the diagnostic ability of vascular parameters remains lower than of the structural parameters RNFL (AUC: 0.981). A significant correlation was found between structural, functional and vascular parameters with r, Highlights • OCT-A vascular density parameters exploring the macular and papillary regions are decreased in primary open-angle glaucoma. • Disc and macular vessel density parameters have excellent diagnostic abilities in diagnosing glaucomatous eyes. • A correlation is shown between functional, structural, and vascular parameters. • The non-linear quadratic model better describes the relationship between structural, functional, and vascular parameters.

Introduction Optic nerve avulsion is a traumatic disinsertion of optic nerve fibres from the globe at the level of the lamina cribrosa. It is an uncommon and severe complication of blunt ocular trauma. Case presentation We report the case of a 15 years old male presented to the emergency department after being kicked by a horse. Initial ophthalmologic examination of the left eye (LE), exhibited eyelid hematoma, subconjunctival hemorrhage, VA was limited to light perception and there was a left relative afferent pupillary defect. Dilated fundus examination of the LE revealed an extensive vitreous and preretinal hemorrhage overlaying the optic disc and retina edema.The diagnosis of LE optic nerve head avulsion (ONA) was made. Five years after the accident, VA of LE detecting hand motion, fundus examination revealed a superior dragging of the optic disc, fibroglial scarring, retinal vessel narrowing and retinal epithelium hyperplasia. Clinical discussion In case of ONA, the avulsion can be missed initially due to vitreous and retinal hemorrhage overlaying the optic nerve, in such cases multimodal imaging can be a useful tool to the diagnosis and to evaluate associated ocular damage. Healing process of the avulsed optic nerve is characterized by the development of fibroglial proliferation. Visual outcome is poor and the final visual acuity range from light perception or no light perception in total ONA. Conclusion Optic head nerve avulsion is a rare and severe disease and initial diagnosis is challenging due to associated media opacities. The prognosis is poor and the injury leads to permanent visual impairment., Highlights • Optic nerve avulsion is rare and serious complication of blunt ocular trauma. • Domestic, work related and sport related accidents are incriminated. • Diagnosis is challenging because of media opacities associated. • The prognosis is poor. • To date, there is no efficient treatment.

Introduction Retinal vasoproliférative tumors (VPTs) have been reported as uncommon complications of intermediate Uveitis. Case description A patient consulted for a gradually decreased vision in the right eye (RE). The examination of the RE found a corrected visual acuity at 20/100 with normal eye pressure measured. The anterior segment was deep and quiet and 2+ vitreous haze was found. Funduscopy showed a VPT. Retinal fluorescein angiography of the RE revealed macular cystoid edema also objectified by the Optical Coherence Tomography (OCT). Intermediate Uveitis was considered idiopathic. The patient received a cryoapplication and was put on oral corticosteroid therapy with improvement of visual acuity and a regress of both vitreous inflammation and cystoid macular edema. Conclusion The association of a VPT with intermediate uveitis represents a real diagnostic and therapeutic challenge and imposes rigorous care and monitoring strategy combining internist and ophthalmologist., Highlights • Retinal vasoproliferative tumors (VPTs) have been reported as uncommon complications of intermediate Uveitis. • The presence of active intermediate uveitis accompanied by VPTs suggests the need for an aggressive uveitis treatment. • The causative process underlying the development of VPT in eyes with intermediate Uveitis remains unknown. • We speculate in this case report a pathogenic relationship of this long-standing inflammation to the vascular tumor.

Resume Objectifs Evaluer l’impact du traitement antiglaucomateux et de la pathologie de surface oculaire (PSO) sur la qualite de vie (QdV) chez les patients glaucomateux suivis au CHU Farhat Hached de Sousse (Tunisie). Materiel et methodes Etude transversale incluant 120 patients suivis pour Glaucome primitif a angle ouvert (GPAO). Tous les patients ont repondu a la version arabe du National Eye Institut-Visual Field Questionnaire 25 (NEI-VFQ 25). La qualite de vie etait quantifiee en termes de scores et correlee aux caracteristiques du traitement antiglaucomateux et a l’etat de la surface oculaire. Resultats Nous avons etudie 120 patients. Le nombre moyen de molecules et de gouttes instillees etait respectivement de 1,95 (1–4) et de 2,69 (1–7). Au total, 66,7 % des patients rapportaient des effets indesirables du traitement. A l’examen, un syndrome sec modere ou severe etait releve chez 90 % des patients. Au total, 16,7 % des patients avaient une keratite ponctuee superficielle. Le nombre de gouttes instillees par jour, l’utilisation de la brimonidine ou des inhibiteurs de l’anhydrase carbonique (IAC) per os et la presence d’une PSO avaient un impact negatif sur les scores du NEI-VFQ 25. Conclusions Le traitement antiglaucomateux et l’atteinte de la surface oculaire sont deux facteurs influencant la QDV des patients glaucomateux et sur lesquels l’ophtalmologiste peut agir en optimisant le traitement et en examinant regulierement la surface oculaire des patients glaucomateux.

Devant une entorse laterale de la cheville, le clinicien doit evaluer la gravite des lesions afin de proposer le traitement le plus adapte. L’apport de l’echographie dans notre serie determine le type et le nombre de faisceaux rompus ou infiltres. Elle renseigne aussi sur l’epanchement articulaire et contribue ainsi au diagnostic de lesions moins frequentes des articulations tibiofibulaires distales, mediotarsiennes ou du sinus du tarse. Le but de ce travail prospectif et randomise est de comparer a trois mois les resultats cliniques du traitement fonctionnel vs le traitement orthopedique relaye par un traitement fonctionnel. Une echographie est pratiquee au stade initial, en milieu et en fin de traitement pour le suivi de la cicatrisation ligamentaire. Au troisieme mois aucune recidive de l’entorse n’a ete rapportee. Il n’a pas ete mis en evidence de difference significative en ce qui concerne la douleur au site initial, la sensibilite anterolaterale, l’instabilite et l’insecurite a la course. Nous proposons pour toute suspicion d’entorse laterale grave de la cheville de confirmer le bilan lesionnel par une echographie qui, selon les lesions ligamentaires isolees ou associees, permettra d’adapter le traitement. Le suivi de la cicatrisation ligamentaire est assure par des echographies repetitives.

Resume Objectifs Evaluer la qualite de vie chez les patients glaucomateux suivis au CHU Farhat Hached de Sousse et identifier les facteurs sociodemographiques et cliniques affectant potentiellement la qualite de vie. Materiel et methodes Etude transversale incluant 120 patients suivis pour glaucome primitif a angle ouvert (GPAO). Tous les patients ont repondu a la version arabe du National Eye Institute-Visual Field Questionnaire 25 (NEI-VFQ 25). La qualite de vie etait quantifiee en termes de scores et correlee aux facteurs sociodemographiques et cliniques. Resultats Nous avons etudie 120 patients. L’âge moyen etait de 62,38 ± 10,68 ans. Le score moyen global (SMG) de la qualite de vie de nos patients allait de 23,71 a 98 %, avec une moyenne de 70,11 ± 18,45 %. La residence urbaine etait associee a un meilleur SMG de la qualite de vie ( p = 0,01). Le niveau d’education etait correle aux dimensions de la vision de loin ( p = 0,01), du fonctionnement social ( p = 0,03), de la limitation des activites physiques ( p = 0,01) et de la vision peripherique ( p = 0,01). Le score de qualite de vie global etait inversement correle, et de facon tres significative, a l’anciennete du glaucome ( p = 0,002), aux excavations papillaires du meilleur et du mauvais œil ( p −4 ), a la meilleure acuite visuelle corrigee du meilleur et du mauvais œil ( p −4 ), mais pas a la pression intraoculaire. Une association inverse entre le nombre de traitements et la qualite de vie a ete objectivee, et ce, pour le SMG ( p = 0,03) et les SMD de la limitation des activites physiques ( p = 0,04) et de la conduite ( p = 0,002). Conclusions La qualite de vie des patients glaucomateux, mesuree par le NEI-VFQ questionnaire, est correlee a plusieurs elements sociodemographiques et cliniques. L’evaluation de la qualite de vie est un facteur essentiel a considerer pour la prise en charge des glaucomateux. Dans notre contexte, les recherches doivent s’orienter d’abord vers la validation d’un questionnaire en dialecte local.

Blepharophimosis ptosis epicanthus inversus syndrome (BPES) is a rare congenital hereditary abnormality. It includes complex orbital-palpebral malformations, causing aesthetic and functional ramifications. Management of BPES requires two steps : diagnosis and treatment.We performed a retrospective descriptive study of 44 patients (88 eyelids) with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). In our series, we opted for two-stage surgery in 28 cases : epicanthus-telecanthus surgery followed by ptosis surgery. Simultaneous surgery was performed in 5 cases.The mean age at the first visit was 6 years (6.1±6.4). The mean age of our patients at the time of the first surgery was 6.6 years. Epicanthus surgery was performed in 35 cases. The two techniques used to correct epicanthus were Y-V plasty in 30 cases (85.7%, n=35) and Y-V+double Z plasty in 5 cases (14.3%, n=35). Correction of the telecanthus was performed at the same time by a medial canthal tendon plication in 31 cases (88.6%, n=35) or transnasal canthopexy in 4 cases (11.4%, n=35). The mean age at the time of ptosis surgery was 7.23 years (±6.25), ranging from 8 months to 27 years. Ptosis surgery was performed in 41 cases (79 eyelids), of which 3 patients underwent unilateral ptosis surgery due to asymmetrical ptosis. The techniques used were levator resection in 64 eyelids and frontal suspension in 15 eyelids.BPES is often clinically diagnosed. The difficulty in management lies in the complex surgery required. There is no established consensus regarding surgical techniques or the timing of the surgeries.

To assess the impact of glaucoma treatment and ocular surface disease (OSD) on the vision-specific quality-of-life (VS-QoL) of glaucoma patients attending Farhat Hached university hospital Sousse-Tunisia.This was a cross-sectional study enrolling one-hundred-twenty patients followed for primary open angle glaucoma. All patients successfully responded to the Arabic version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ 25). QoL was quantified in terms of scores (0-100) and correlated with the characteristics of glaucoma treatment and status of the ocular surface.One hundred and twenty patients were studied. The mean number of medications and instilled drops was 1.95 (1-4) and 2.69 (1-7) respectively. A total of 66.7% patients reported side effects of treatment. On examination, moderate or severe dry eye syndrome was identified in 90% of cases. A total of 16.7% of patients had superficial punctate keratopathy. The number of instilled drops per day, the use of brimonidine or oral carbonic anhydrase inhibitors, and the presence of OSD had a negative impact on the NEI-VFQ 25 scores.Glaucoma treatment and OSD are 2 factors potentially reducing the QoL of glaucoma patients, on which the ophthalmologist can act by optimizing treatment and regularly examining the ocular surface of glaucoma patients.

Our study aimed to describe the therapeutic management of moderate and severe dysthyroid orbitopathies and to evaluate the factors associated with optic neuropathy as well as the prognostic factors of poor visual outcome using a statistical analysis. We conducted a retrospective study of 22 patients presenting with moderate to severe dysthyroid orbitopathy in at least one eye and hospitalized in the Department of Ophthalmology at the University Hospital Farhat Hached, Sousse over the period from 1998 to 2015. Therapeutic indications were based on activity and severity criteria of the Eugogo (European Group On Graves' Orbitopathy) as well as on the assessment of prognostic factors of poor visual outcome. The average age of our patients was 40 years, with a slight male predominance (54.5%). 68.2% of patients were euthyroid, 18.2% had a history of smoking. The most significantly associated factor with neuropathy was a compression in the orbital apex (p = 0.03). Treatment was based on intravenous corticosteroid therapy and/or orbital decompression based on disease activity and severity. Overall evolution after treatment was marked by an improvement in inflammatory signs and by the reduction of exophthalmia. Visual prognosis was worse in elderly patients (p = 0.0001), male sex (p = 0.03) and treated by iratherapy (p = 0.04). Given the limits of a retrospective study, our results were generally consistent with the literature. The assessment and the management of dysthyroid orbitopathy are not well understood. Cohort, probably multicenter studies should be conducted to improve its management.

To assess the vision-specific quality-of-life (VS-QoL) of glaucoma patients followed at Farhat Hached university hospital, Sousse-Tunisia, and identify clinical and sociodemographic factors potentially affecting it.This was a cross-sectional study enrolling one-hundred twenty patients followed for primary open angle glaucoma (POAG). All the patients successfully responded to the Arabic version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ 25). Quality of life was quantified in terms of scores (0-100) and correlated with sociodemographic and clinical factors.One hundred and twenty patients were studied. The mean age was 62.38±10.68years. The global mean score (GMS) score was 70.11±18.45% ranging from 23.71 to 98%. Urban residence was associated with a better total score (P=0.01). Educational background was correlated with the subscale scores of distant activities (P=0.01), social functioning (P=0.03), physical activity limitations (P=0.01) and peripheral vision (P=0.01). The total NEI-VFQ 25 had a statistically significantly negative correlation with the duration of the glaucoma (P=0.002), the cup to disc ratio of the better and the worse eye (P10Vision-specific quality of life of glaucoma patients, as measured by the NEI-VFQ 25, is correlated to many sociodemographic and clinical elements. QoL evaluation is an essential factor to be considered in the management of glaucoma patients. In our context, research should be directed first to the validation of a questionnaire in the local dialect.

Resume Quatre patients, deux femmes âgees de 50 et de 67 ans, un homme de 36 ans et un enfant de cinq ans, ont presente une necrose cutanee suite a une anesthesie locale par la xylocaine adrenalinee a 2 %. Dans trois cas, l’anesthesie etait pratiquee avant la suture d’une plaie palpebrale et la necrose interessait la paupiere superieure. Dans un cas, l’anesthesie etait pratiquee avant une biopsie de l’artere temporale. Une necrose cutanee de toute la peau temporale etait observee. Dans tous les cas, une excision chirurgicale de la necrose etait realisee. Deux patients ont presente une surinfection bacterienne, traitee par des antibiotiques par voie generale avec une bonne evolution. La necrose des extremites secondaire a une injection d’une solution adrenalinee est une complication rare. Longuement decrite au niveau des doigts et bien connue des dermatologues, elle est due a un spasme vasculaire prolonge. Elle se voit surtout apres injection d’une trop grande quantite chez des sujets a risque (arterite, syndrome de Raynaud). Au niveau des paupieres, peu de cas ont ete rapportes.

Synkinetic movements of the upper eyelids may be noted in association with movements of either extraocular muscles or other muscles of the face. Patients with oculopalpebral or facial-palpebral synkinesis may also have ptosis of the involved eyelid. The clinical and therapeutic features of this association are specific. We mainly distinguish two forms of synkinetic movements, characterized either by the elevation of the ptotic eyelid such as in Marcus Gunn phenomenon and in the Fuchs sign or by the falling of the upper lid such as in Marin Amat syndrome. Many surgical techniques have been used to correct the blepharoptosis and the synkinetic movement. Levator resection is often advocated for correction of blepharoptosis with a mild degree of synkinesis. However, when the ptosis is major, eyelid lag is a possible outcome. For moderate or major synkinesis, bilateral frontalis suspension with disinsertion of the levator has been suggested. This procedure generally provides satisfactory cosmetic results.

The most common cause of aortic stenosis is degenerative and progression of the disease is slow. Deciding to proceed to aortic valve replacement in an asymptomatic patient is always difficult. Only a minority will require valve replacement after repeated work-ups including stress testing and serial echographic examinations. In the future, stress echocardiography and BNP measurements may prove helpful in decision making.

Introduction: Time restraint, heavy workload, limitation of diagnostic procedures and Urgency in selecting treatment Method are among the remarkable features of working in emergency units. These points, along with other particular problems in a selected emergency largest referral unit in Glean/province were our driving force to document the weaknessess by using statisties and information and propose a strategy to improve the quality of health care rendered to patients. Methods: In a cross-sectional study conducted within a month period, the quality health of services rendered to all referrals in emergency units expect, infant emergency unit, gyneochological and obsterics (O.B.G), and psychiatric cases were studied, Acriterian based questionnaire was designed to be completed by the observer, then data were tallied statistically by computer. Finbings: The number of referrals to the emergency department whilst the study was being conducted amounted to 2815.Or on the average (84 daily).59.2 percent personally referred, 40.8 percent were referrals from other centers or offices, 42.3 percent were hospitalized and 57.7 percent were treated as outpatients. The mean time spent for each diagnostic and treatment procedurals was as follows: The average time spent by trainers was 29 minutes, the time patient entered the unit until he was actually admitted took 55 minutes, record filling was 16 minutes, prescripitonal procedures 16 minutes, transfer time to the other departments 18 minutes, the time the emergency patient entered the ward (after diagnosis and treatment procedurals) till he got the prescription 118 minutes, lab results took 97 minutes. EKG results 11 minutes, sonography results 48 minutes, C.T scan from reqursting to return the result took 27 minutes. During Shahrrivar month in 1381, orthopedic and surgical wards had the most admissions (39.1and 28.8 respectably). Resident aids in the screening room at the emergency department were mostly anesthesists an surgeon aids all inal only 10.2 percent of the sceener's field of specialty matched the referees' cases. The average CPR and death cases in emergency unit was 2.5 and 2 respectably. Early diagnosis in 34% of the cases were correct and 5.4 percent were wrong. 42.8% of cases the final dignosis was determined by only one sign or indication. In 15.1% of the cases, there existed an ambiguity in the patient's diagnosis. The most crowded referral time estimated to have between 4 to 12p.m (49.4%). Results: considering the results, the procedures which hinderd the work flow in the selected center include: diagnositic tests, making decisions on admission, orders, filing procedures. Other shortcomings of the selected center are; lack of adequate space and great number of emergency referrals, inconsistency of the aid's major field of study to the referrals actual medical complaint, and the absence of documentation of final diagosis in some cases.

Resume Objectif Le travail de nuit impose a l’individu de travailler en periode de desactivation et de dormir en phase d’activation. Cette perception d’informations conflictuelles aboutit a des perturbations des rythmes biologiques. La presente etude a pour objectif d’evaluer les repercussions du travail de nuit sur le plan physique, psychologique et social du personnel des services de reanimation et des urgences. Methode Le travail de nuit a l’hopital, et ses repercussions sur la sante et la vie sociale, ont ete etudies chez 118 membres du personnel hospitalier des deux CHU de Sousse. Une etude transversale de type expose - non expose a ete conduite de janvier a avril 1999 et a ete basee sur un questionnaire standardise. Resultats Les troubles du sommeil observes sont constitues de difficultes a l’endormissement et de sommeil agite qui sont significativement plus eleves chez le personnel de nuit par rapport a celui de jour. Les plaintes portant sur l’appareil digestif ont ete revelees respectivement chez 38,2 % et 23,8 % du personnel de nuit et de jour. Une prise de poids a ete observee chez 32,7 % chez le personnel de nuit, il a ete de 7,9 % dans l’autre groupe. Les principales perturbations neuropsychiques retrouvees chez 76,3 % des travailleurs de nuit contre 31,7 % des travailleurs de jour sont dominees par les troubles de la memoire, l’anxiete, l’angoisse pendant le travail et la fatigue mentale. Conclusions Ce travail confirme, d’une part le retentissement du travail de nuit sur la sante, et, d’autre part, le risque des consequences de la privation chronique du sommeil sur la vie sociale et la qualite des soins.