ABSTRACT
Introduction: Leptospirosis is a bacterial zoonosis of worldwide distribution. Its clinical presentation is highly variable in terms of signs and severity. Weil's disease is characterized by the association of conjugated hyperbilirubinemia, sometimes severe, with hemorrhagic manifestations including hemoptysis and gastrointestinal bleeding. Case presentation: We report the case of a 27-year-old woman admitted to the intensive care unit for management of a hemorrhagic syndrome. She initially presented with an influenza-like illness treated by self-medication with paracetamol. On admission, the patient presented with febrile hepatonephritis associated with multiorgan failure, together with the classic triad of Weil's disease: conjugated hyperbilirubinemia, and hemorrhagic manifestations including hemoptysis and gastrointestinal bleeding. Leptospira IgM serology was positive, confirming the diagnosis. She was treated with ceftriaxone and supportive care. The clinical course was favorable, with discharge from the intensive care unit after 10 days of hospitalization. Conclusion: The presence of a hemorrhagic syndrome in the setting of febrile hepatonephritis should raise suspicion of human leptospirosis. Patient history-taking is essential and may reveal exposure to animals capable of transmitting the pathogen to humans. Definitive diagnosis relies on isolation of the organism or rapid IgM serological testing.

ABSTRACT
Fascia iliaca compartment block (FICB) can be performed using anatomical landmarks or ultrasound guidance for analgesia after femoral fractures. This prospective, parallel-group, randomised controlled trial at Irrua Specialist Teaching Hospital, Nigeria, enrolled adults with femoral neck or shaft fractures and pain between 15 November 2021 and 14 January 2023. Participants were randomised 1:1 to landmark-guided or ultrasound-guided FICB, with 30 mL of plain 0.25% bupivacaine administered in each group. Co-primary outcomes were needle-tip precision and block effectiveness at 1 h; secondary outcomes included Numerical Rating Scale (NRS) pain scores, procedural time, time to block onset, time to first rescue analgesia, complications and satisfaction. Ninety participants were randomised and 89 were analysed. Needle-tip placement was confirmed in 44/44 participants (100.00%) with ultrasound and 29/45 (64.44%) with landmarks; the reported Fisher’s exact test statistic was 19.073 (P = 0.050). Effective block at 1 h occurred in 41/44 (93.18%) and 41/45 (91.11%), respectively. Median NRS scores were lower with ultrasound at 30 min (2 vs. 3; P = 0.009) and 1 h (1 vs. 2; P = 0.001). Landmark-guided FICB was faster to perform (901 vs. 2,414 s; P = 0.050), while time to first rescue analgesia did not differ (P = 0.608). No clinically apparent complications were observed. Ultrasound guidance improved needle-tip localisation and was associated with lower early pain scores, whereas landmark-guided FICB remained a feasible and efficient alternative. The aggregate data do not establish universal differences in overall analgesic effectiveness or safety.

ABSTRACT
Background: Anterior mediastinal masses in children pose significant anesthetic challenges because of the potential for airway compression, cardiovascular compromise, and acute cardiorespiratory collapse during induction of anesthesia. Careful preoperative assessment, appropriate planning of airway and vascular access, and maintenance of spontaneous ventilation are important considerations in these patients. Case Presentation: We report the perioperative anesthetic management of a 8 years old pediatric patient with a large anterior mediastinal mass who presented for thoracotomy and surgical resection. Preoperative evaluation included clinical assessment, imaging, and evaluation for evidence of airway and cardiovascular compression. Appropriate preparation was made for difficult airway management and emergency cardiopulmonary support. Anesthesia was induced intravenously, with continuous monitoring of respiratory and cardiovascular status. After securing the airway and confirming adequate manual ventilation, there was difficulty in controlled ventilation due to compression of the airway, so the patient was immediately reversed with sugammadex and the rest of case done under spontaneous ventilation with sevoflurane with oxygen-air mixture, and thoracic epidural was placed for adequate analgesia. The mass was successfully resected through thoracotomy without major intraoperative cardiorespiratory complications. Postoperative care included close respiratory and hemodynamic monitoring, with appropriate analgesia and subsequent recovery. Conclusion: Anesthetic management of children with anterior mediastinal masses requires meticulous preoperative risk stratification and preparation for sudden airway or cardiovascular compromise. Maintaining spontaneous ventilation during the critical phase of induction, minimizing factors that can worsen airway compression, and ensuring immediate availability of advanced airway and cardiopulmonary rescue strategies are important principl