ABSTRACT
Reversible posterior encephalopathy syndrome is a rare acute or subacute clinic-radiological syndrome whose topography most often affects the posterior territories, which are more vulnerable to variations in systemic pressure. Due to the rarity of this syndrome, we report the case of a 31-year-old patient with no known pathological history admitted to the emergency department of Maternité Issaka Gazobi (MIG) in Niamey, where the diagnosis of reversible posterior encephalopathy was made, and her evolution was favorable.

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Introduction: Operating room safety is a major imperative. The surgical safety checklist (CL), developed by the World Health Organization (WHO), is an essential tool to reduce surgical risks and improve patient safety. Objective: This study aimed to assess the level of knowledge and use of the checklist among healthcare professionals in operating rooms in Senegal. Methods: This was a multicenter cross-sectional study conducted over three months, from September to December 2024. Data were collected using an anonymous questionnaire, available in both paper and digital formats. Data analysis was performed with SPSS v.29 and Excel 2021. Results: The study included 110 professionals, with 56% based in Dakar and 44% in other regions. Participants were mainly surgeons (45%), anesthesiologists (35%), and paramedical staff (25%), with an average professional experience of 6.7 years. Although 94% of professionals were aware of the checklist, only 36% used it systematically. The main barriers identified were lack of training (53%), workload (31%), and resistance related to work habits (16%). Furthermore, 92.7% of participants emphasized that training initiatives (workshops, online sessions, or a combination) could facilitate adoption and implementation of the checklist. Finally, 98.5% of participants perceived a positive impact of the checklist on patient safety. Conclusion: The checklist is an essential tool to improve patient safety in the operating room. Its integration must be part of a broader quality improvement strategy. However, adoption in Senegal is hindered by lack of training, organizational constraints, and entrenched work habits. To optimize its use, it is crucial to strengthen training, improve working conditions, and promote a systemic approach centered on safety.

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Background: Postoperative nausea and vomiting (PONV) remain common complications following gynecological surgeries, often leading to patient discomfort and prolonged recovery. This study aimed to evaluate the impact of dexamethasone in preventing PONV in women undergoing gynecological surgery at a tertiary care hospital. Methods: This was a prospective observational study conducted in the Department of Anaesthesiology, Square Hospital and Bangladesh Medical College Hospital, Dhaka, Bangladesh, from April 2014 to March 2015. This study included 100 women who underwent elective gynecological surgery under general anesthesia. They were randomly allocated into two groups: Group A (n=50) - Patients received intravenous dexamethasone, and Group B (n=50) - Patients received intravenous granisetron. Results: Baseline characteristics were comparable between groups, with a mean age of 44.45 ± 9.74 years in the Dexamethasone group and 44.26 ± 9.89 years in the Granisetron group. The mean BMI was similar (24.7 ± 1.69 vs 24.56 ± 2.27). Adnexectomy was the most common surgery in both groups. Duration of surgery (70.21 ± 19.62 vs 72.11 ± 16.60 min, p = 0.602) and anesthesia (93.22 ± 18.58 vs 95.23 ± 21.94 min, p = 0.622) did not differ significantly. A history of PONV was reported in 4.0% of patients in the Dexamethasone group and 6.0% in the Granisetron group (p = 0.660). Postoperatively, nausea occurred in 14.0% vs 12.0% (p = 0.587), vomiting in 6.0% vs 8.0% (p = 0.750), and metoclopramide use in 6.0% vs 8.0% (p = 0.750), with no significant differences. Side effects were minimal and comparable between groups. Conclusion: Dexamethasone was as effective as granisetron in preventing postoperative nausea and vomiting in women undergoing gynecological surgery, with no significant difference in efficacy or side effects. Both agents appear to be safe options for PONV prophylaxis in this patient population.

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Tracheo-esophageal fistula (TEF) is a rare and complex surgical condition, often resulting from trauma or previous thoracic interventions. We present a case of a 20-year-old male with a history of bamboo injury in 2019, complicated by right lobectomy and pericardial effusion treated with anti-tuberculosis therapy. The patient underwent esophageal fistula closure in February 2023 and feeding jejunostomy in April 2023. He subsequently developed inability to swallow even saliva, necessitating surgical repair of TEF. Anesthetic management was challenging due to the difficult airway and proximity of the fistula to the carina. A flexometallic endotracheal tube (ETT) was placed via fiber-optic bronchoscope, and anesthesia was maintained with oxygen, air, sevoflurane, and atracurium infusion. Postoperatively, the ETT was converted to nasal intubation to facilitate airway hygiene and prevent complications. This case highlights the anesthetic and surgical challenges in TEF repair and underscores the importance of meticulous preoperative planning, intraoperative management, and postoperative care.

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Introduction: “Burnout” or professional exhaustion syndrome is characterised by physical, emotional and mental exhaustion. The aim of this work was to determine the factors associated with the occurrence of this syndrome. Material and Methods: this was a prospective, cross-sectional and analytical study which took place over four months (September 2019 - December 2019) in the emergency departments, intensive care units and operating rooms of seven hospitals in Abidjan. All doctors and nurses working in these services were included. Data collection was carried out using a pre-established questionnaire based on the “Maslach Burnout Inventory” (MBI). The variables studied were: sociodemographic and professional characteristics, as well as MBI scores. All data were processed and analyzed using statistical software. Differences were considered statistically significant at p < 0.05. Results: we identified 188 participants. The average age was 41 years. The majority of respondents (78%) worked more than 40 hours per week. The prevalence of burnout was 60.1%. The factors associated with burnout were: male sex, age > 40 years, unmarried status, work experience < 20 years, nursing profession, more than 40 hours of work per week and professionals working in university hospitals and operating rooms. Conclusion: the factors associated to this syndrome are sociodemographic and professional.

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Introduction: Anesthesia outside the operating room develops in various areas requiring a calm, relaxed and painless patient. The anesthetist-resuscitator intervenes thus outside the block to ensure appropriate care. The main objective of this work is to analyze anesthetic practices performed outside the operating room over a period of 30 months. Methodology: This is an observational, prospective and cross-sectional study with analytical aim, conducted over 30 months (from June 4, 2018 to November 30, 2020) in the Anesthesia-Intensive Care department of the University Hospital of Angré. It includes all patients, regardless of age or gender, who required sedation for an imaging or endoscopy procedure. Results: The majority of out-of-block sedations involved infants, children and young adults. The sex ratio of 1.15 in favor of women. Medical imaging examinations were the main indication for sedation (60.62%). Propofol was the most used induction agent in 57.03% of cases (n = 223). Anesthetic maintenance was required in 172 patients (43.99%), with propofol also predominantly used (n = 157; 40,15 %). The majority of patients (97.67%) were able to return home after the procedure, while 0.51% (n = 2) required a transfer to intensive care. Conclusion: Out-of-block sedation is mainly performed in children, using imaging, with propofol as the main induction agent.

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Tuberculosis (TB) remains a pressing global health issue, requiring timely and accurate diagnosis to prevent its spread and ensure effective treatment. In this study, we explore the po- tential of deep learning and computer vision to enhance TB detection using readily accessible tools like smartphone cameras. Specifically, we leverage the YOLOv8 object detection algo- rithm to analyze images of microscopic slides stained for TB, captured via smartphones. The dataset used in this study consists of 1,224 annotated images sourced from Roboflow, divided into training (861 images), validation (244 images), and test (119 images) sets. Our YOLOv8 model was trained to identify TB bacteria within these images, employing various data augmentation techniques to improve generalization. The model was trained over 100 epochs, and we applied hyperparameter tuning to optimize performance. The training process took approximately 0.826 hours. After training, the model achieved a precision of 72.7%, a recall of 78.7%, and a mean average precision (mAP) of 82.7% at an IoU threshold of 0.5. Additionally, the overall mAP (IoU from 0.5 to 0.95) was 41.5%. The final model size, after stripping the optimizer, was reduced to 22.5MB. These results demonstrate that YOLOv8 is well-suited for TB detection, offering reliable performance with potential real-world applications, especially in remote areas where access to specialized diagnostic equipment is limited. By incorporating YOLOv8 into a smartphone- based diagnostic tool, we propose a more accessible solution for TB detection that could as- sist healthcare workers in resource-constrained settings. This approach not only increases the speed of TB diagnosis but also helps address the challenges associated with traditional meth- ods, which are often time-consuming and require trained personnel. Our findings suggest that YOLOv8, combined with the ubiquity of smartphones, can play a crucial role in advancing TB diagnostics globally.

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Introduction: Pediatric anesthesia requires, however, both a material and human environment adapted to very varied situations. Objective: Evaluate the anesthetic management of pediatric surgical emergencies. Patients and Methods: This is a retrospective, descriptive and analytical study conducted from January 2022 to June 2024. We included patients aged from 0 to 15 years who were admitted for a surgical emergency. Results: We collected a sample of 154 operated patients, representing a prevalence of 6.7%. The sex ratio is 2.85. The age group of 10–15 years was the most represented in 37.7% of cases. The average age was 6.96 years with extremes of 4 days and 15 years. The main diagnoses were traumatic in 29.2% followed by skin infections in 18.2% and foreign bodies in 16.2%. The children were classified ASA 1U in 98.7%. General anesthesia was performed in 85.8%. Anesthetic induction was mostly performed by IV route in 98% of the patients and sevoflurane was the only halogen used. The administration of paracetamol alone was most used for post-operative analgesia in 76.7% of patients followed by the combination of paracetamol and tramadol in 18.9%. Laryngospasm was the only complication found intraoperatively in 0.64%. We deplored a peroperative death, which is a mortality rate of 0.64%. Conclusion: The practice of pediatric emergency anesthesia poses organizational difficulties in most of our hospitals.

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Objective: To evaluate the practice of RAAC at the Dalal Jamm National Hospital Center (CHNDJ). Patients and Methods: Prospective randomized single-center study over a 12-month period (January-December 2023) in the intensive care and general surgery departments of Dalal Jamm Hospital. Data analysis was performed using Excel and SPSS software. Results: During the study period, 107 patients were included, divided into two groups: an RAAC group (n=64) and a control group (n=43). The average age was 46.03 years, with a predominance of females and a sex ratio of 0.79. Hepatobiliary surgery was the most common type of surgery performed (45%), followed by colorectal surgery (23%) and pancreatic surgery (13%). Gallstones were the main indication (33%), followed by colorectal tumors (21%) and duodenopancreatic tumors (13%). For the RAAC group, postoperative pain was controlled at H2 vs. H12 for the control group. The average time to ambulation was at H3 vs. H5 for the control group, and feeding was resumed at H8 vs. D1 for the control group. In our series, four cases of postoperative ileus were noted in the control group. The outcome was favorable in 98% of the RAAC group vs. 86% of the control group. Anastomotic leakage was the main surgical complication (n=3). Mortality was 7% in the control group and zero in the RAAC group. The average length of stay was 6 days (2-21 days) for the RAAC group vs. 8 days (2-13 days) for the control group. Conclusion: The implementation of ERAS has reduced postoperative morbidity and mortality, shortened the average length of stay, and improved recovery in patients undergoing digestive surgery.

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Objective: To evaluate the epidemiological, clinical, paraclinical, therapeutic, and evolutionary aspects of severe traumatic brain injuries (TBI) admitted to the intensive care unit at Dalal Jamm National Hospital. Methodology: This is a retrospective, descriptive, and analytical study conducted over a period of 30 months (January 2022–June 2024) on patients with severe TBI, Glasgow ≤ 8, admitted to the intensive care unit at Dalal Jamm Hospital. Results: The incidence of severe TBI was 5.1% with a mean age of 21.98 years (range 18 months to 67 years). Males predominated with a sex ratio of 5. The 15-30 age group was the most affected. Road traffic accidents were the most common cause (63% of cases), followed by falls due to work-related or recreational accidents (26%). Medical transport was used for 17% of patients. The average time to admission to intensive care was 2.39 hours. A Glasgow Coma Scale score between 3 and 4 was noted in 10% of patients, 30% had a score between 5 and 6, and 60% between 7 and 8. Brain CT scans were performed in 90% of cases. Severe TBI was part of multiple trauma in 60% of cases. Edematous-hemorrhagic contusion was the most frequently found lesion (33%). The secondary systemic cerebral injuries (SSCI) noted were arterial hypotension (46.67%), acute anemia (40%), and arterial hypertension (23.33%). All patients were intubated, ventilated, and sedated. Surgical indications were established in 36.6% of patients, and surgery was performed in 17% of patients. The outcome was favorable in 36.67% of cases and unfavorable in 63.34% of cases. Complications included VAP (33%), pressure ulcers (30%), and urinary tract infections (23%). Overall mortality was 63.34%, with septic shock (52.6%) as the main cause. The average length of stay was 9.77 ± 12.02 days, ranging from 1 hour to 58 days. The factors for poor prognosis were a Glasgow score between 3 and 6 and a pupillary abnormality on admission. Conclusion: Severe TBI mainly affects young adult