[Sleep disorders and psycho-affective problems in paramedical personnel working an atypical schedule]. / Troubles du sommeil et troubles psychoaffectifs chez le personnel paramédical travaillant à horaire atypique.

INTRODUCTION: Shift work can cause health problems and sleep disorders and therefore affect mental health. These psycho-affective disorders can, in return, worsen sleep disorders and thus establish a vicious circle. The aims of our study were to assess the frequency of sleep and psycho-affective disorders among paramedical personnel doing shift work and to screen them for obstructive sleep apnoea-hypopnoea syndrome (OSA). METHODS: It was a cross-sectional study carried out among paramedical staff at the University Hospital Center Mongi Slim La Marsa in Tunis. Three questionnaires translated into Arabic (the Berlin questionnaire, the Spiegel questionnaire and the Hospital Anxiety and Depression Scale [HAD]) were presented by the same investigator during the survey. RESULTS: One hundred and fifty-eight paramedics were interviewed (46.2% were nurses, 23.4% were blue-collar workers, 19% were senior technicians and 11.4% were health care aides, midwives and physiotherapists). The average duration of shift work was 10.27 years, the average age was 36.48 years and there was a female prevalence of 70.9%. Sleep disorders were detected in 40.5% of the cases, OSA in 24%, anxiety in 53.2% and depression in 17.1%. CONCLUSION: Sleep and psycho-affective disorders are frequent among paramedical personnel undertaking shift work in hospitals. Screening consultations in occupational medicine are necessary in order to detect these disorders at an early stage.

[Graded classification of acute chloralose poisoning. 509 cases]. / Classification en grades des intoxications aiguës par le chloralose. 509 cas.

OBJECTIVE: The annual incidence of chloralose poisoning has exceeded 3 cases per 100,000 inhabitants in Tunisia since 1997. The purpose of this study was to analyze clinical features of chloralose poisoning. METHODS: We reviewed patients admitted to the intensive care unit during the last 5 years to search for chloralose poisoning. The identified cases were classed into 5 grades by clinical features: depth of coma, characteristics of the myoclonia, and cerebral trunk reflex response. RESULTS: We identified 509 cases of chloralose poisoning over the last 5 years. Seventy-five patients (14.7%) were in grade 1: drowsiness alone. Four hundred ten patients (80.8%) were in grades 2 and 3: hypertonic coma and myoclonus. The clinical course was favorable after sedation, tracheal intubation and mechanical ventilation. Twenty-three patients (4.6%) were in grades 4 and 5: hypertonic coma (Glasgow coma score = 3). Three of them died. CONCLUSION: The clinical features of chloralose poisoning depend on the ingested dose. Despite the gravity of the initial clinical presentation, prognosis is excellent if symptomatic treatment is given early, even in grade 5 cases which simulate brain death.