ABSTRACT
Introduction: Meningoencephalitis (ME) represents a serious neuroinfectious emergency, particularly in resource-limited countries where etiological diagnosis is often delayed or impossible. In sub-Saharan Africa, specific data in resuscitation are few. The objective was to describe the clinical profile, diagnostic and therapeutic challenges of ME in intensive care at the University Hospital of Angré. Methods: We conducted a 24-month retrospective observational study on patients admitted for ME, defined according to recognized clinical criteria, and who had received a lumbar puncture. Clinical data and standard analyses of the CSF were collected. The data was analyzed in a descriptive and univariate way with Epi Info TM. Results: The cohort included young patients (median age 13 years), with high severity at admission and significant mortality (70%). The lumbar puncture, performed in 63% of cases, showed an inflammatory CSF, but without etiological agent identification, notably due to the lack of advanced molecular tools. Co-infections and comorbidities, including HIV, complicated management. Conclusion: This study highlights the major diagnostic limitations and a high mortality rate, highlighting the urgency of improving diagnostic capabilities and therapeutic protocols in resource-limited settings to reduce morbidity and mortality associated with EM.

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Single atrium is a rare congenital heart disease defined by a complete absence of the interventricular septum and endocardial cushion, an absence of ventricular septal defect, and an absence of atrioventricular valve malformations. Given the epidemiological, diagnostic, and therapeutic interest, and more specifically, anesthesiological management, we report a clinical case of a 9-month-old infant admitted for the treatment of stomal prolapse. The infant has several congenital malformations: a single atrium, an anorectal malformation, and hexadactyly of both thoracic and pelvic limbs. The paraclinical biological and biochemical assessments were normal. One intraoperative incident involving constant desaturation followed by cardiac arrest was reported, which progressed favorably without neurological sequelae.

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Background: Anaesthesia is essential for successful surgical interventions to achieve complete immobilization, analgesia, muscle relaxation and unconsciousness. It facilitates pain-free surgical. Ketamine and lignocaine are examples of anaesthetic agents, often administered alone or in combination, for instance with anticholinergics or adrenaline, respectively. However, their effects on hemostatic and biochemical parameters are still subject of ongoing research. In this study, hemostatic parameters such as bleeding time, prothrombin time, activated partial thromboplastin time of male wistar rats treated with ketamine and different kinds of lignocaine were explored. Methodology: 35 male wistar rats were used for the study. These animals were housed for one week for them to acclimatized before being sacrificed. Blood samples were collected using sample bottles and appropriate laboratory techniques were employed for laboratory investigations. Data obtained from this study was analysed using one way ANOVA. Discussion: Ketamine and lidocaine when used both alone and in combination caused substantial variations in the haematological and biochemical parameters with the decrease in haemoglobin, level increase in erythropoietin and potassium, and an increase in plasma viscosity. Nevertheless, haemostatic parameters and erythrocyte integrity did not change, which means that there was low risk of coagulation. These implications present the possibility of renal and cardiovascular consequences that need a careful clinical application. Conclusion: It is concluded that two different kinds of anaesthesia does not alter hemostatic cell lines and hence cannot cause hypercoagulation and hypocoagulation in users. Use of anaesthesia for surgical intervention is encouraged.

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Background: Anesthesia in children carries unique risks and potential complications due to their distinct physiological and pharmacological responses. Understanding these complications is crucial for improving perioperative care in pediatric patients. Objective: To evaluate the incidence and types of anesthesia-related complications in children at a tertiary care hospital in Bangladesh. Methods: A prospective observational study was conducted at Community Based Medical College Bangladesh, from January 2023 to December 2024. A purposive sampling technique was used to enroll 183 pediatric patients (aged ≤12 years) undergoing various surgical procedures under anesthesia. Data on demographic characteristics, type of anesthesia, surgical procedure, and perioperative complications (respiratory, cardiovascular, neurological, or others) were collected and analyzed using MS Office tools. Results: The study found respiratory complications (23.5%) most prevalent, primarily desaturation (12.6%) and laryngospasm (6.6%). Cardiovascular events occurred in 8.7% of cases. Children <3 years had higher complication rates (31.2%) versus older children (16.4%). Emergency surgeries showed 28.9% complications compared to 13.8% in elective cases. Postoperative nausea & vomiting (14.2%) and emergence agitation (9.8%) were notable postoperative issues. No mortality was observed in this cohort. Conclusion: This study confirms respiratory complications as the primary anesthesia risk in Bangladeshi children, especially under age 3. Findings highlight the critical need for improved monitoring and tailored protocols to enhance pediatric perioperative safety. No mortality cases were observed.

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Introduction: The occurrence of deaths among HIV-positive patients in the Medical Emergency Services (MES) is frequent but has been poorly studied in Côte d’Ivoire. This study aimed to determine the mortality rate among HIV patients and identify factors associated with early deaths of patients admitted to emergency services. Materials and Methods: This was a retrospective cohort study conducted from March 1, 2022, to February 29, 2023 (a 1-year period) at the MES of Treichville. Included in the study were patients admitted for HIV-related complications and those newly diagnosed with HIV at MES. Excluded were HIV-positive patients who died upon arrival (arrival time < 1 hour). The parameters studied included reasons for admission, sociodemographic variables (age, sex, HIV status), clinical variables (medical conditions, clinical stage according to WHO 2007, CD4 count), and the mortality rate. Data analysis was performed using Epi Info software. Results: Among 4,036 admissions to MES, 221 patients (prevalence 5.48%) were HIV-positive. The mean age was 35 (±0.9) years, with a sex ratio of 0.75 and an age range of 16 to 78 years. There was a predominance of females (n=126). Patients already diagnosed as HIV-positive prior to admission accounted for 79.60% of the sample, among whom 60.80% were non-adherent to antiretroviral treatment. The most common reasons for admission were altered consciousness (45.7%), respiratory distress (24.4%), and diarrhea (11.8%). Cerebral toxoplasmosis (26.7%) and pulmonary tuberculosis (15.8%) were the most frequently diagnosed conditions. Patients with CD4 counts < 200 (OR= 0.4003; CI= 0.1875-0.8135, p=0.007706) and WHO stage > 2 (OR= 0.38; CI= 0.1934-0.7611, p=0.0036) had poorer outcomes. The mortality rate was 26.7%. Conclusion: Early deaths occurred predominantly among young adults. The mortality rate was high, underscoring the need to establish voluntary testing centers nationwide and provide support for people living with HIV. Decrease

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Acute adrenal insufficiency (AAI) is a rare but potentially life-threatening endocrine emergency, particularly challenging in pregnancy due to overlapping symptoms with physiological changes and increased maternal-fetal risks. This report highlights the case of a 35-year-old woman with chronic adrenal insufficiency, presenting at 34 weeks of gestation with acute decompensation. Symptoms included severe abdominal pain and tonic-clonic seizures, confirmed by low cortisol levels and laboratory abnormalities. Prompt administration of hydrocortisone and emergency obstetric care ensured favorable maternal and fetal outcomes. The case underscores the importance of rapid diagnosis, appropriate glucocorticoid therapy, and a multidisciplinary approach to managing AAI in pregnancy. It also highlights the need for vigilant monitoring of pregnant women with chronic adrenal insufficiency to prevent decompensation. Early intervention is critical to reducing maternal and fetal morbidity and mortality.

ABSTRACT
Thyrotoxic crisis during pregnancy is a rare but life-threatening condition, most commonly associated with Graves’ disease. This case report details a 25-year-old primigravida at 16 weeks of gestation who presented with severe thyrotoxicosis. Symptoms included tachycardia, hyperthermia, and fatigue. Laboratory findings confirmed suppressed TSH and elevated free T4 levels. Immediate treatment with beta-blockers and antithyroid drugs stabilized the patient. Pregnancy alters thyroid physiology, increasing the risk of hyperthyroidism complications such as miscarriage, preterm birth, and preeclampsia. Treatment involves antithyroid medications, with PTU preferred in the first trimester due to MMI’s teratogenic risks. Close monitoring of thyroid hormone levels and fetal well-being is critical. Despite the severity of the initial presentation, the patient’s pregnancy progressed without complications, highlighting the importance of early and aggressive management.