ABSTRACT
Children may be at increased risk of pulmonary aspiration because of retention of gastric contents caused by pain or inadequate fasting. We performed this study to analyze the use of ultrasound for evaluation of gastric ultrasound in children less than 12 years. Two hundred children, 1-12 years of age belonging to ASA physical status I to II, scheduled to undergo elective surgery were included in the study. Patients were scanned in supine position followed by right lateral decubitus position (RLD). In qualitative assessment, the antrum was judged to contain fluid if it appeared to have an endocavitary lumen with hypoechoic content and distended walls. All measurements were taken with antrum at rest (between contraction) to avoid underestimating volume. It was observed that majority of the children were in Perlas grade 0, 116(58%) followed by 75 children in grade 1 and 9 children in grade 2. Using Karl Pearson’s Correlation coefficient, low positive correlation was found between gastric volume and fasting status solid (in hours) and the variation (correlation) was found to be statistically non-significant (r=0.139; p>0.05). There is no proportionate decline in gastric volume with increased duration of preoperative fasting. Ultrasonographic measurement of antral area can be of interest to anesthesiologist for accurate qualitative and quantitative estimation of preoperative gastric contents and volume. However, gastric ultrasonography has to be validated in further trials involving a larger patient population before it can become a routine standard of care in perioperative period.

ABSTRACT
Introduction: Encephalic death (ED) is one of the consequences of severe head trauma (TBI), and the donor in a state of encephalic death is an unavoidable solution to the shortage of transplants. The aim of our study was to detect the transition to ME in MCT and to assess the possibility of performing multi-organ retrieval from the deceased donor. Material and Method: prospective study of TCGs admitted to the Salim Zemirli health hospital who had progressed to ME, it began in February 2017 over a period of three years. We collected the following data, incidence of ME, age, sex, medical history, Glasgow score on admission, pupil status of donors in ME, mean time to onset of ME, mean duration of graft resuscitation, availability of monitoring, paraclinical investigations and treatment necessary for the management of a donor in ME. The results: A total of 175 MCTs were included, 16% of these MCTs were found to be in the ME state, the diagnosis of ME was clinical with paraclinical confirmation by transcranial doppler, these donors benefited from therapeutic management without limitation of care. The average age was 35 ± 12 years, medical history was present in 35.71% of cases. The average Glasgow score was 5.63 ± 0.324, with pupillary anomalies such as anisocoria in 28.57% and mydriasis in 21.42%. The average time to onset of ME was 3 ± 1.23 days; the average resuscitation time was 44.06 ±8.79 hours; EEG was not available in our department. For the treatment of diabetes insipidus, we noted the absence of desmopressin. Conclusion: Organ harvesting from a deceased donor is technically possible in our establishments.

ABSTRACT
Introduction: Caesarean section (CS) is a commonly performed major surgical procedure that causes significant postoperative pain. The objective of this study was to evaluate the efficacy of the transverse abdominal plane block (TAPB) in the management of post-caesarean pain at the Souro Sanou Teaching Hospital (CHUSS) of Bobo Dioulasso. Methodology: This was a single blind randomised clinical trial. One hundred patients admitted for CS under spinal anaesthesia were randomised into two groups using the sealed envelope method. The intrathecal morphine (ITM) group received 100 µg morphine intrathecally at induction and the TAPB group a bilateral TAPB at the end of the caesarean section with 20 ml of 0.25% bupivacaine and 4 mg dexamethasone in the same syringe on each side. The proportion of mild pain, numeric rating scale (NRS) < 3 on mobilisation at 24 hours post-caesarean was the primary outcome. Results: The 2 groups were comparable for socio-demographic and clinical characteristics. The mean age of the patients was 28.14 ± 6.34 years and 29.08 ± 5.58 years (p=0.43). At rest at 24 hours post-op, the proportion of NRS < 3 was 100% for the TAPB group and 88% for the ITM group (p=0.49). On mobilisation at 24 hours post-op, 96% of patients in the TAPB group and 74% in the ITM group (p=0.002) had a NRS < 3. At rest at 48 hours post-op, it was 100% for the TAPB group and 88% for the ITM group (p=0.027). On mobilisation at 48 hours post-op, it was 94% for the TAPB group and 70% for the ITM group (p=0.002). Postoperative nausea and vomiting (PONV) were present in 50% of patients in the ITM group and 6% in the TAPB group (p<0.001). Conclusion: TAPB significantly reduced pain scores on mobilisation in the post-caesarean period with a significant reduction in PONV.

ABSTRACT
Background: The milieu of intensive care units (ICU), the meticulous management of critically ill patients, especially in terms of nutrition, is paramount. Malnutrition poses a serious threat, emphasizing the necessity to assess and enhance current nutritional care practices. Objective: This cross-sectional study aimed to evaluate the adequacy of nutritional care for ICU patients at Rajshahi Medical College Hospital and multiple multi-central base hospitals between 2020 and 2022. Methods: Data were collected from patient records, ICU nursing documentation, and direct patient or family interviews. A total of 100 ICU patients were included through a multistage cluster sampling design. Patient demographics, including age and gender, were analyzed concerning nutritional care practices. Results: The study found that the mean patient age was 54.8 ± 19.97 years, with 45.3% over 60. Male patients predominated, but females were notably older. Nutritional care practices in the ICU varied, with initial feeding starting on the second ICU Day for 66% of patients, mainly via enteral (57.2%) or oral (37%) routes. Patients achieved only 59.2% ± 37.78 of prescribed calories and 55.5% ± 30.04 of required protein, with adequate intake for only 16.2% and 10.7% of patients, respectively. Nutritional care practices varied, with most patients receiving nutrition support, yet inadequate energy and protein intake were common. This underscores the need for personalized ICU nutrition care. Conclusion: This study emphasizes the need for tailored nutritional care in the ICU, considering the diverse age groups and gender differences among patients. Further research and targeted interventions are warranted to optimize nutritional support for critically ill patients.

ABSTRACT
Creutzfeldt Jakob Disease is a rare and fatal neurodegenerative disorder characterized by rapidly worsening dementia, myoclonic jerks and akinetic mutism. It accounts for more than 90% of all human prion diseases. Over 90% of patients progress from normal function to death in under a year. There is no definitive treatment and it must be distinguished from other causes of rapidly progressive dementia such as viral encephalitis, autoimmune and paraneoplastic encephalitis which will respond to appropriate therapy. In the following 2 cases, we describe patients with presentation of rapidly progressive dementia which was finally diagnosed as Probable sporadic CJD. It is essential to make early diagnosis as it will allow patient and family to understand the course of disease and prognosis.

ABSTRACT
IgG4 Related Disease (IgG4 RD) is a comparatively new multisystem disorder associated with elevated levels of IgG4. It includes a number of disorders which were previously thought to be idiopathic or autoimmune. This is a rare condition and can affect any organ system in the body with IgG4 Related pachymeningitis having even lesser incidence. In this case report we present a patient who had chronic low back ache, who on evaluation was found to have a mass compressing on the spinal cord at the thoracic level, requiring surgical decompression. Biopsy and immunological testing were suggestive of IgG4 related pachymeningitis. We describe the diagnosis, medical management, and follow up of this patient, with discussion on how timely diagnosis and management will help in preventing further episodes and help in recovery. This case reiterates about medical conditions presenting as tumor mimics.

ABSTRACT
Introduction: The transverse abdominal plane block or TAP block consists of injecting a local anaesthetic between the internal oblique and transverse muscles. Its contribution to muscle relaxation during laparoscopic surgery has been little studied. Material and Method: We carried out a 2-years prospective, descriptive and analytical randomised study blinded to the surgeon conducted in the operating theatre of the Saint Louis Regional Hospital Centre. Patients were randomised into two groups: those who received vecuronium after rapid sequence induction (group V) and those who received bilateral TAP block without curares (group T). Anamnestic, clinical, anaesthetic, surgical and evolutionary aspects were collected and analysed. The main evaluation criteria were: pneumoperitoneum pressure, exhaled CO2, respiratory motor pressure and surgeon satisfaction scale. Results: We collected 61 patients admitted for laparoscopic abdominal surgery. The mean age was 32.9 years with a standard deviation of 14.5. Appendicitis was the indication in 55% of cases. The Propofol-celocurine-TAP-block anaesthetic protocol was used in 25 patients, i.e. in 41% of cases, and 59% of patients had undergone a conventional induction using vecuronium. The mean pressure of the pneumoperitoneum was 11.3 mmHg for the conventional induction group and 12.6 mmHg for the TAP-block group. The mean respiratory motor pressures were 12 cmH2O for the conventional induction group and 13.7 cmH2O for the TAP-block group. The mean value of exhaled CO2 was 37.5 mmHg. Fentanyl reinjections were more frequent in the conventional induction group in 55.6% of cases. The mean VAS at 6 hours post-op was 4.5 for the conventional induction group and 3 for the TAP-block group. Discussion/Conclusion: The ultrasound-guided trans-abdominal-pelvic block remains an effective, durable and reproducible technique. Its advantages in terms of postoperative analgesia are well known. In addition, its selective effects on muscle ......