ABSTRACT
The coronavirus disease 2019 (COVID‐19) pandemic, caused by severe acute respiratory corona virus-2 (SARS CoV-2) that started in late December 2019, lead to millions of infections and mortalities and disruption in routine clinical services, including surgical procedures. Such delay in routine; surgical procedures leads to a backlog of patients, including cardiac, planned for surgical interventions. The pandemic has presented healthcare workers with the unprecedented challenge of maintaining patient and personal safety dealing with patients, including surgical ones. The healthcare personnel in general and nurses caring confirmed SARS-CoV-2 infected patients in specific have a high risk of patients and self-safety concerns, especially under peri-operative care where aerosol-producing procedures are key components of care. Herein, we present the peri-operative nursing approach to a SARS CoV-2 infected patient, confirmed with reverse transcriptase-polymerase chain reaction (rt-PCR), and remained positive as repeated four times in nearly four weeks, who underwent an essential coronary artery bypass graft (CABG), with specific focus to standard recommendations and protocols. Adherence by nursing staff to these recommended peri-operative protocols will mandate; both patient and nursing safety.

ABSTRACT
Background: Melasma is a common chronic acquired hyper pigmentary disorder of skin, particularly among Asian and Hispanics. Females are more affected than men. It has a significant impact on appearance, causing psychosocial and emotional distress and reducing the quality of life of the affected individual. Tranexamic acid (TA) can be used to treat melasma. Objectives: To compare the efficacy of oral Tranexamic acid and Hydroquinone (HQ) plus sunscreen in the treatment of melasma. Methods: It was prospective, interventional clinical trial conducted among 150 Bangladeshi melasma patients visiting the Dermatology and Venereology OPD of DMCH between January 2016 and June 2017. Patients were divided randomly into two groups, 75 in each, by lottery method. First group (Group A) was treated with 4% Hydroquinone plus sunscreen (regular) daily for 12 weeks and second group (Group B) was treated with Tranexamic acid 250mg twice a day for 12 weeks. Response was evaluated on the basis of Melasma Area and Severity Index (MASI) and Melasma Quality of Life (MELASQoL) Questionnaire. The mean scores of both variables were compared between both groups. Results: Epidermal melasma was comparatively quicker and better responded to the treatment than dermal or mixed variants. The mean MASI and mean MELASQoL scores between both groups were not significantly different at 4 weeks (p>0.05) but was significantly effective in Group B at 8 and 12 weeks (p<0.05). The mean MASI scores of Group A (HQ & sunscreen) were 11.43±1.82, 9.98±1.99 and 8.94±2.16 at 4, 8 and 12 weeks respectively. The mean MASI scores of Group B (TA) were 11.34±1.92, 9.30+2.07 and 7.19±2.16 at 4, 8 and 12 weeks respectively. Similarly, the mean MELASQoL scores of Group A (HQ & sunscreen) were 34.95±6.61, 29.40±6.60 and 25.87±7.19 at 4, 8 and 12 weeks respectively. The mean MELASQoL scores of Group B (TA) were 33.12±6.40, 26.19±6.43 and 20.63±6.70 at 4, 8 and 12 weeks respectively. Conclusion: Oral Tranexamic acid is more ..

ABSTRACT
The authors report a case of papilledema revealing a subdural hematoma in a 24-year-old male subject with known SS homozygous sickle cell disease. The patient presented with a sudden unilateral visual acuity loss on the right side and violent headaches that were resistant to level 1 analgesics. The discovery of unilateral papilledema on fundus examination led to a CT scan which revealed a subdural hematoma. The evolution was favorable under corticoid and hypotonizing treatment with the total resorption of the papillary edema, a significant regression of the subdural hematoma after 10 days of treatment and a recovery of the visual acuity. The authors insist on the necessity of performing a fundus examination accompanied by a CT scan in all sickle cell patients in the context of intractable headaches.

ABSTRACT
For several years, the surgical treatment of post-traumatic osteoarthritis of the ankle was essentially based on arthrodesis. Currently, ankle arthroplasty has become a reliable alternative with the development of new prostheses. However, the total ankle prosthesis cannot be offered to all patients and it is often a source of medium and long-term complications. The management of these complications, in particular that of the loosening of the prosthesis, is generally done by a definitive treatment by arthrodesis after removal of the prosthesis. It is necessary to combine it with a bone graft in order to fill the gaps left after the removal of the prosthesis and thus allow consolidation with fixation of the joint.

ABSTRACT
Introduction: The pyelo-ureteral junction syndrome is defined by a dilation of the renal pelvis and the calyxes with a downstream ureter of normal caliber. It is a fairly frequent pathology often of congenital cause whose diagnosis can be ante-natal or post-natal thanks to ultrasound. The treatment is surgical especially if there are clinical manifestations. The objective of this work is to study in general the pyelo-ureteral junction syndrome in the pediatric surgery department of the Mali hospital. Material and Methods: This was a prospective study which took place at the Mali hospital from May 2018 to April 2021. This study included all patients aged 0 to 15 who were operated on for pyelo-ureteral junction. Results: During the 3-year study period, we collected 12 cases of pyelo-ureteral junction syndrome. The average age was 3 years with extremes of 20 days and 14 years. All patients had an abdominal mass accompanied by abdominal pain in 83.3% of cases. Dehydration was present in 66.66% of patients. The attack of the left kidney was predominant is 66.66% of the patients, in only one patient the expectation was bilateral. Serum creatinine was normal in all patients. Cytobacteriological examination of urine found 2 cases of Echerichia coli infections. 10 pyeloplasties and 2 nephrectomies were performed with simple postoperative course. Conclusion: The pyeloureteral junction syndrome is a frequent pathology in the literature but not very frequent in our daily practice. Most of our diagnoses are made post natally. It is not very symptomatic, mainly affecting male infants. Ultrasound and Uro scanner have a very important role in the exploration of this pathology. Open-air surgery is the technique of choice in our context.

ABSTRACT
Retroperitoneal sarcomas are rare tumors that develop in the mesenchymal tissue, where liposarcoma is the most frequently encountered subtype. The symptoms they induce are often vague and nonspecific, thus requiring thorough evaluation. Their diagnosis primarily relies on imaging techniques such as CT scans and MRI, and is confirmed by biopsy. Despite excision surgery, which remains the main treatment aiming for total resection, local recurrences remain a frequent challenge. Although radiotherapy and chemotherapy in the perioperative period are sometimes considered, their effectiveness remains subject to debate. The histological type of the tumor is of paramount importance in prognosis, with well-differentiated liposarcomas being associated with better outcomes than myxoid or dedifferentiated forms. Optimal management of these tumors requires a multidisciplinary approach, involving close collaboration between surgeons, oncologists, radiologists, and pathologists to ensure adequate and personalized treatment. Hence, the interest of a case of giant retroperitoneal liposarcoma in a 65-year-old man that we managed and report here.