The median time to first rescue analgesia was significantly shorter in the R group 8h [7-12] than RD group 21 h [18-24]. The median (interquartile range) opioid use was 3 [3-6] morphine mg equivalents in the R group and 0 [0-2] morphine mg equivalents in the RD group. The first time to mobilization was significantly shorter in RD group (22±03 h) than R group (27±06 h).INTRODUCTION The loss of correct relationships between the sesamoid and the first metatarsal is one of the architectural consequences of the hallux valgus (HV). The reduction of this dislocation by lateral soft tissue release (LSTR) is one of the objectives of surgery. AIM To study the relationship between postoperative position of sesamoid and clinical outcome at one-year postoperative follow-up. METHODS It’s a retrospective study including patients operated for evolved HV performed in la Rabta orthopedic department in Tunis. These patients had a Scarf osteotomy associated with at least one Weil osteotomy. The functional evaluation was based on the AOFAS score (American-orthopedic-foot-and-ankle-society). We classified the sesamoid position according to 3 scores Hardy & Clapham , RCAOFAS and the Agrawal. We compared each score of the sesamoid position to the clinical outcome. RESULTS We collected 46 cases of HV in 45 patients. The mean AOFAS score increased from 60,9 to 85,5/100 postoperatively. Our patients were divided into 2 groups group A whose result was excellent and group B whose result was good, fair and poor. The analytical study of this work concluded that there was no relationship between the postoperative sesamoid position and the clinical outcome, regardless of the radiological classification used (p=0,361, p=0,222, p=0,260). CONCLUSION Sesamoids that remain in postoperative dislocation are not necessarily predictive of a poor clinical outcome at one year of the surgical cure.INTRODUCTION Atrial septal defects (ASD) constitute the most frequent congenital heart disease in adults and ostium secundum (OS) the most common type. Benefit of its closure in adulthood has long been controversial. AIM To evaluate outcomes of OS-ASD closure in adults. METHODS Retrospective cohort study, over a ten-year period from 2008 to 2018. All adults (≥20 years old) who benefited from OS-ASD closure were included. Study endpoints were closure success rate, functional status evolution and incidence of new arrhythmias at 12 months. RESULTS Fifty patients were recruited. Dyspnea (≥ NYHA II) was noted in 58% and arrhythmia in 18% of patients. Feasibility of a percutaneous closure was 50%. Myrcludex B clinical trial Closure success rate was 100%. Surgery was associated with high postoperative morbidity with longer hospitalization stay (20 vs. 4 days, p less then 0.001). At 12 months, an improvement in functional status was observed in 79%. Incidence of new arrhythmias was 5%. A significant decrease in right cavities dilation as well as pulmonary arterial pressure has been reported. CONCLUSIONS Immediate results of OS-ASD closure in adults are satisfactory. Percutaneous closure is associated with reduced hospital morbidity. At 12 months, a significant improvement in functional status was observed however the possible occurrence of new arrhythmias imposes a close follow-up.BACKGROUND Trauma is a leading cause of death in young people and hemorrhagic shock is a leading mechanism of this mortality. Hypoperfusion can be difficult to diagnose clinically, especially in younger patients. Arterial Base Excess (BE) has been used as an early indicator of hypoperfusion. AIM To evaluate the prognostic value of admission BE in severe trauma patients admitted to the emergency department (ED). METHODS In this prospective study, severe trauma patients meeting high velocity criteria admitted to the ED during the study period were included. BE was calculated from arterial blood gas samples. Multivariate analysis was performed for Day-1 and Day-7 post trauma mortality. ROC characteristics and survival curves were used. RESULTS We included 479 patients. Median age was 37 (18-90). Eighty-one per cent were male. Clinical characteristics n(%) GCS -6.5mmol/l. CONCLUSION in this study, a high BE above 6.5mmol/L showed a significant prognostic value in immediate and early mortality and is proposed as a marker of injury severity in trauma patients admitted to the ED. Prediction was better for the immediate mortality and thus could be proposed as a triage tool in the ED.BACKGROUND A negative association between serum vitamin D levels and obesity has been reported by several studies. Data on vitamin D status in Tunisian obese children and its relationship with metabolic syndrome remain rare. AIM We aimed to study the prevalence of vitamin D deficiency in Tunisian obese children and to examine the correlation between vitamin D levels and metabolic syndrome. METHODS Thirty obese children matched to 30 non-overweight volunteer controls by age, gender and pubertal stage were included in a prospective study. Anthropometric parameters and blood pressure were measured.  Vitamin D level, fasting glucose and lipid profile were performed in all subjects. RESULTS Vitamin D deficiency was more common in obese children (94% vs 80 %, p=0.002). Vitamin D level was negatively correlated with BMI (p= 0.001, r= -0.51). Six obese children were diagnosed with metabolic syndrome. Vitamin D levels were negatively correlated with waist circumference (p=0.019, r=-0.13), systolic Blood pressure (p=0.04, r=-0.26), triglyceride level (p=0.025, r= -0.3), insulin (p=0.01, r=-0.34) and HOMA-IR (p=0.035, r=-0.29). CONCLUSIONS despite the sunny climate, the deficiency in vitalmine D is common in Tunisia. Vitamin D levels are inversely correlated with BMI and the risk of metabolic syndrome.INTRODUCTION Obstructive sleep apnea (OSA) is a risk factor for type 2 diabetes that adversely impacts glycemic control. However, there is little evidence about the effect of continuous positive airway pressure (CPAP) on glycemic control in patients with diabetes. AIM Assess the effect of CPAP on glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes and OSA. METHODS it was a prospective study including type 2 diabetic patients with OSA and a CPAP therapy indication. All participants had HbA1c measurement at baseline (T0) and 2 months after the onset of CPAP (T1) with a compliance ≥ 4 hours / night. Patients who changed anti-diabetic treatment during follow-up were excluded. The HbA1c level goal was ≤ 7%. RESULTS Thirty patients were included (4 men and 26 women) with a mean age of 61.3 ± 8.8 years. The mean diabetes duration was 5.8 ± 3.7 years. Twenty-four patients had poorly controlled diabetes. Associated comorbidities were dominated by hypertension (n=22) and obesity (n=22). The mean apnea hypopnea index was 38.