ABSTRACT
Critical illness is characterized by substantial hormone- and cytokine-mediated protein metabolism changes in various organs, leading to increased breakdown and decreased synthesis rates. Consequently, a considerable and life-threatening loss of muscle mass occurs. Medical therapeutic measures such as long-term sedation and mechanical ventilation during ICU stay can further enhance this muscle degradation (up to 2 % muscle mass per day leading to clinically relevant symptoms known as ICU-acquired weakness, a clinical symptom that is classified as a secondary disorder. If left unabated, these circumstances might strongly affect long-term patient outcomes. This study consists of 20 mechanically ventilated patients expected to stay in the intensive care unit (ICU) for at least 4 days. We used indirect calorimetry to determine energy expenditure and guide caloric provision to the patients randomized to the high protein and early exercise (HPE) group and the control group. Protein intakes were 1.48 g/kg/day and 1.19 g/kg/day medians respectively; while the former was submitted to two daily sessions of exercise, the latter received routine physiotherapy. We evaluated the primary outcome physical component summary (PCS) score at 3 and 6 months and the secondary outcomes (handgrip strength at ICU discharge and ICU and hospital mortality. In this prospective randomized controlled trial, we found that a high protein intake and resistance training led to an improvement in the physical quality of life of critically ill patients as measured by the PCS score after 3 and 6 months. We also found a reduction in mortality rate and a tendency to improvement in the ICU-acquired weakness measured through handgrip strength in the study group.

ABSTRACT
Guillain–Barre´ syndrome (GBS) is an acute demyelinating disease and the most common cause of acute flaccid paralysis (AFP). We report a case of Guillain-Barré syndrome associated with corona virus which is a novel virus. At presentation the patient was hypoxic and was intubated in view of high oxygen requirement. He was weaned off from ventilator but there was extubation failure. He was reintubated. Other causes of extubation failure were ruled out. His motor power was 1/5 in upper limb, 0/5 in lower limb along with autonomic involvement. He was diagnosed with GBS. He was tracheostomised and managed with dual session of IVIG (intravenous immunoglobulin) and 3 sessions of plasmapheresis. Patient’s motor power improved. He was weaned off from ventilator and decannulated. Motor power improved to 5/5 in upper limb and 3/5 in lower limb and he was discharged on room air.

ABSTRACT
Purpose: The use of antibiotic prophylaxis in surgery is to prevent infection of the surgical wound. Although its principles follow specific guidelines, inappropriate practice is often observed. The aim of this study is to evaluate the use of prophylactic antibiotics in the operating room of the RH of Maradi (Niger). Methodology: This was a prospective and descriptive study done over a period of 12 months; from the 1st of January to December 31, 2020. We studied patients admitted to the operating rooms for Surgical Wound Classification (SWC) I and II scheduled surgeries. Results: We collected 286 patients of which 68.53% were male with a mean age of 27.1 years. Patients were SWC I and II. Abdominal,genito-urinary and ortho-trauma surgeries were the most performed. 96.15% of patients received antibiotic prophylaxis. Six patients were already on antibiotics and five patients received none. Ceftriaxone was the most widely used drug. The delay between administration and incision was 30 min or more in only 6.18% of patients. More than half of our patients had received the antibiotic less than 30 min before the incision (57.81%). Postoperative complications were infectious in 60% of cases, 80% of which were surgical site infections. Infectious complications occurred in patients who received their 1st round of antibiotics after incision and the rest within 15 min which preceded the incision. Conclusion: Strict and rigorous respect of preoperative antibiotic prophylaxis protocols in the operating room is a daily challenge, while the fight against nosocomial infections and bacterial resistance remains a major concern.

ABSTRACT
Kidney infarction is a rare diagnostic condition because it is often underestimated. It occurs most often in patients with cardiovascular terrain. Most often, the clinical symptomatology of renal infarction initially simulates a picture of febrile renal colic or not, the radiological examinations of which requested are based on the first-line ultrasound. The abdominopelvic scanner without injection being used more and more in front of a painful abdominal symptomatology. In some cases, it is desirable to complete the scan by injecting contrast product, especially in the event of an unconfirmed lithiasis obstacle. Early management of renal infarction with thrombolysis or curative-dose anticoagulation (heparin therapy) may improve complete and permanent restoration of renal function. Indeed, the early diagnosis of a renal infarction is made in less than 30% of patients; it is a critical problem that requires rapid management to save the vital prognosis and the function of the kidney.

ABSTRACT
Introduction: Propofol, a popular intravenous anesthetic, is now on the trade. It's a common tool for both starting and keeping anesthesia going. Antiemetic and anticonvulsant properties and the speed of induction and recovery are its primary benefits. Intubation without a muscle relaxant, day surgery, and the installation of a laryngeal mask airway has all been effective using this technique. Injection discomfort, dosage-dependent hypotension, and severe bradycardia are the primary drawbacks of the drug's use. Objectives: Researchers set out to see how much of a difference complete intravenous anesthesia with Propofol made in mean systolic function roughly equivalent to balanced anesthesia (Thiopentone; Isoflurane; Nitrousoxide). Results: Multicentered based randomized quasi-experimental prospective study was performed in Kushtia Medical College Hospital, Kushtia, Bangladesh, from January 2019 to December 2020. In our study, out of 60 cases (30 in each group), 70 %(n=21) in Group-A and 63.33%(n=19) in Group-B were between 12-30 years of age while 30%(n=9) in Group-A and 36.67%(n=11) in Group-B were between 31-60 years of age, mean±SD was calculated as 27.90±8.91 and 29.8±8.49 years respectively. 60 %(n=18) in Group-A and 53.33%(n=16) in Group-B were male while 40%(n=12) in Group-A and 46.67%(n=14) in Group-B were females. Comparison of mean hemodynamic changes using Propofol as total intravenous anesthesia with balanced anesthesia technique (thiopentone isoflurane-nitrous oxide) shows that heart rate after intubation in Group-A was 83.4±2.36 and 90.36±1.95 in Group-B, the p-value was 0.001 while meaning arterial pressure in Group-A was recorded as 78.6±2.25 and in Group-B 89.43±1.73, the p-value was 0.000. Conclusion: A substantial improvement in supportive care is seen in surgical interventions when using Propofol as a complete intravenous anesthetic vs. balanced anesthesia (thiopentone-isoflurane-nitrous oxide).

ABSTRACT
Background: Spinal anaesthesia consists of inserting a spinal needle into the subarachnoid space and, when a free flow of cerebrospinal fluid (CSF) is obtained, injection of a solution of local anaesthetic directly into the CSF. In Paediatric Patients Spinal Anaesthesia is used for subumbilical surgeries but still there is a concern about its safety & feasibility. Objective: To assess the spinal anaesthesia in paediatric patients of district level hospital, Tangail, Bangladesh. Materials and Methods: In this prospective study was conducted in the Dept. of Anaesthesia, Sheikh Hasina Medical College Hospital, Tangail, Bangladesh from January to June 2021. 32 paediatric patients of aged 2-10 years were included undergoing sub umbilical surgery. Under all aseptic precautions and sedation, subarachnoid block was given with 27g quineke needle through L3-L4 or L4-L5 subarachnoid space & hyperbaric 0.5%. Bupivacaine was administered according to the weight of children. The dose of Bupivacaine used was 0.1ml\kg for child (<5kg), 0.08ml\kg (5-15kg), 0.06ml\kg (>15kg). Demographic data, vital parameters, sensory –motor block characteristics & complications were noted. Results: The mean and standard deviation of age is 5.17+2.83 (2-10) years and Mean Weight (Kg) 15.23+7.43 (7.8-23). Out of the 32 cases, 24 were males whereas the remaining 8 were females. In this study indication of high perception RIH 10 (31.25%), Fracture shaft of femur 4 (12.5%), LIH 4 (12.5%), Umbilical Polyp 2 (6.25%), Distal Hypospadias 5 (15.62%), Re-Circumcision 2 (6.25%), Undescended testicle 3 (9.37%), Appendicitis 1 (3.12%) and Mucous Cyst 1 (3.12%). In our study common SA Herniotomy 14 (43.75%), Circumcision 2 (6.25%), Urethroplasty 5(15.62%), Excision polyp 2(6.25%), Orchiopexy 3(9.37%), Ortho surgery 4 (12.5%), Mucous Cyst Excision 1 (3.12%). There was no significant change in vital parameters. Mean peak sensory level was T 6.20 ±1.20 (T4- T8). Mean sensory level at the end of surgery was T8.11±1.4

ABSTRACT
Introduction: The study of mortality makes it possible to control and revise therapeutic measures in a health facility. Maternal death is a major concern in the world, it is a social tragedy. We present a study on maternal death at the Mother Child Health Center in the Zinder region. Methodology: The study was a retrospective, descriptive study covering eleven months from January 1st to November 30th, 2017. Study conducted at the mother and child health center in the Zinder region, the main regional reference point for obstetric gynecology. The objective was to determine the epidemiological profile of deceased parturients. Patients admitted directly or evacuated from other health facilities and who died as a result of maternity were included. Patients who died outside the gestational setting were excluded. Data was collected from the admission register, the maternal death audit report and the patient record. The variables studied were epidemiological data, type of anesthesia, ASA class, cause of death, mode of transport. Results: A total of 10090 patients admitted were studied, one hundred and sixteen (116) women died (1.14%) and 3030 deliveries was conducted, of which 2635 were live births. The average age was 26.28 years with extremes of 15 years and 42 years. The 21 to 30 age group was the most affected with 31.89% (n = 37). Large multiparas (5 to 13 parities) were in the majority with 46.55% (n = 54). Transportation was unsafe at 86.20% (n = 100) and 68.96% (n = 80) was more than 50 km from the site of care. Almost all, 99.13% (n = 115) were uneducated and unprofessional. NPC was not achieved in 98.27% (n = 114) of the cases. Anesthesia was performed in 23.27% (n = 27) of the patients including 19.82% general anesthesia and 03.44% spinal anesthesia. The ASA I class represented 14.81% (n = 04), ASA II 74.07% (n = 20) and 11.11% for the other classes. The midwife was the caregiver in 87.93% (n = 103) of the cases. Delayed treatment was the leading cause of .......