ABSTRACT
Background: Intubation with a cuffed endotracheal tube is the gold standard for securing a definitive airway. Bucking over the tube during extubation can result in a potentially dangerous hemodynamic response. Tracheal tube cuff can be used as a reservoir for drugs to blunt this response. Lidocaine, a local anesthetic can achieve this by anesthetizing the airway. Dexamethasone has been known to potentiate the effect of lidocaine and has an intrinsic anti-inflammatory property. Methods: A prospective double-blind randomized control trial was conducted in a tertiary hospital for patients undergoing elective surgeries under general anesthesia requiring endotracheal intubation. Sixty patients were randomized equally into one of three groups. Cuff was inflated with saline (Group-S), 40 mg alkalinized lidocaine (Group-L), 40 mg alkalinized lidocaine with 8 mg dexamethasone (Group-LD). Heart rate, blood pressure and bucking were recorded during extubation, and post-operative sore throat were assessed. Results: All groups were comparable with regard to demographics, quantity of drug instilled in the cuff, duration of extubation and baseline hemodynamics. Group-L had the lowest incidence of hemodynamic changes during extubation, even lower than Group-LD. (p=0.020). Group-L and Group-LD had a lower incidence of bucking when compared to placebo (p<0.001). Both Group-L and Group-LD revealed a lower grade of sore throat in the early post-operative period. Conclusion: Instilling endotracheal tube cuff with 40 mg alkalinized significantly blunts hemodynamic response and bucking during extubation, and sore throat in the early post-operative period compared to placebo. Addition of 8 mg dexamethasone does not improve hemodynamic extubation response.

ABSTRACT
Objective: To study the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of post-intubation tracheal stenosis occurring in patients admitted to intensive care units. Patients and methods: This is a multicenter, retrospective and descriptive study conducted from November 1, 2010 to June 1, 2022 in 7 intensive care units and 3 ENT departments. From medical records, we collected epidemiological data (frequency, age, sex), medical history, data relating to tracheal intubation (indication, duration, inflation pressure of the intubation tube balloon), data on post-intubation (PI) tracheal stenosis (symptoms and time to onset), paraclinical data, treatment and evolution modalities. The data collected were expressed as averages with their standard deviation. Results: During the study period, 19 patients presented with PI tracheal stenosis. The frequency ranged from 0.03% to 0.1%. The average age of the patients was 25.7 years 11.07 14-38 years. Patients had been intubated in a traumatic context in 47.37% of cases. The average duration of ventilatory support was 10.37 days  03.03 4-15 days No intubation tube cuff pressure monitoring was done for any patient. Dyspnea was the main telltale sign. Its average time to onset was 33.21  days 12.07 1h-3months. Endoscopically, the average degree of tracheal stenosis was 72.63% 50-99% . Therapeutically, in intensive care, 5 patients (26.31%) who presented with acute respiratory failure underwent a life-saving surgical tracheostomy. Curative surgery resulted in a tracheal resection-anastomosis (73.68%) and enlargement tracheoplasty (26.32%). The outcome was favorable for 9 patients (47.37%). The recurrence of the stenosis after curative surgery was observed in 31.58% of cases. Death occured in 3 patients (15.79%). Conclusion: Over-inflation of the intubation tube cuff is the leading cause of PI tracheal stenosis. Prevention is based on the systematic monitoring of its inflation pressure.

ABSTRACT
The Kupang Regency in East Nusa Tenggara, Indonesia, experiences 8-9 dry months annually and relies heavily on agricultural and livestock activities, integral to its population. Moringa cultivation for livestock feed is interconnected with these activities. To assess the spatial suitability of moringa plantations, a descriptive study utilized GIS software and overlay methods, incorporating elevation, slope, annual rainfall, temperature data, and land use maps. After excluding forested, residential, and other areas, Kupang Regency's total land area was 288,497 ha. Of this, 114,239 ha were found highly suitable, 138,040 ha moderately suitable, and 36,218 ha unsuitable for moringa cultivation. East Kupang Subdistrict ranked highest in suitable land (16,232 ha), followed by Takari (11,932 ha), Sulamu (9,281 ha), and West Kupang (8,208 ha). Conversely, Fatuleu Tengah (27 ha), Amfoang Tengah (96 ha), and Amfoang Selatan (409 ha) had the least very suitable land. Similarly, Takari (18,279 ha), West Fatuleu (15,784 ha), Fatuleu (14,194 ha), West Amarasi (10,620 ha), and South Amfoang (10,130 ha) excelled in moderately suitable land. In contrast, South Semau (246 ha), East Kupang (434 ha), and Central Kupang (960 ha) had the smallest moderately suitable areas. Unsuitable land for moringa, like South Amfoang (10,270 ha) and Amfoang Tengah (8,932 ha), were prominent. This research aids in identifying optimal locations for moringa cultivation, aligning farming practices with the region's agricultural needs.