ABSTRACT
α2-antiplasmin (α2-AP) deficiency is a rare but serious hemorrhagic disorder caused by excessive fibrinolysis due to insufficient inhibition of plasmin. It can be congenital, resulting from mutations in the SERPINF2 gene, or acquired, often associated with liver disease, malignancies, or fibrinolytic therapy. Clinically, it manifests as spontaneous or prolonged bleeding, including postoperative hemorrhages, gastrointestinal bleeding, and intracranial hemorrhages, often with normal standard coagulation tests, making diagnosis challenging. The gold standard for diagnosis includes specific α2-antiplasmin assays and genetic testing for SERPINF2 mutations. Treatment involves fresh frozen plasma (FFP) and tranexamic acid, with recombinant Factor VII (rFVIIa) as an alternative for severe cases. Recent advances in gene therapy offer promising future perspectives. Early recognition and appropriate management are critical to prevent life-threatening bleeding complications.

ABSTRACT
Background: Perioperative Respiratory complications are usually encountered by most patients undergoing surgical procedures by using endotracheal tube or laryngeal mask airway under general anaesthesia. They are the major cause of morbidity, mortality, prolonged hospital stay and increased cost of care. The objective of the present study was to determine the perioperative respiratory of laryngeal mask airway and endotracheal intubation at Muhimbili National Hospital. Methods: This was a hospital based prospective comparative study. The minimum sample of 137 patients who met the inclusion criteria were recruited into the study. Target populations were patients admitted for elective surgery at Muhimbili national Hospital. A structured questionnaire was used to collect variables being measured. The Data entry and analysis was handled using SPSS version 20.0. Proportion was calculated for all categorical variables. Categorical data were analysed using Chi-square test, values <0.05 was considered statistically significant. Results: Out of 137 patients who had elective surgery by anaesthesia with ETT or LMA 70 (51.1%) were put on ETT while 67 (48.9%) were put on LMA. Desaturation was observed in more than half (53%) of patients who were put in ETT group as compared to those under LMA (14%) with P <0.001, Similarly cough was observed in more than half of patients who received ETT (53%) compared to 29% patients who received LMA with P =0.004. Conclusion: There were lesser proportions of cough and desaturation among LMA patients when compared to ETT patients. LMA should be used as alternative to ETT in patients undergoing surgeries under general anaesthesia. Furthermore further studies should be delpoyed inlarger sample and other study sites to explore factors associated with periopertive complications.

ABSTRACT
Introduction: Complications such as postherpetic neuralgia (PHN) are the most common in herpes zoster infection. The pain is often severe and can lead to impact the quality of life whereas the treatment of this kind of pain is challenging. We performed ultrasound guided nerve block for pain relief. Patients and methods: During the period from March 2023 to May 2024, we conducted a single-center, prospective and descriptive study covering all patients who had post-herpetic neuralgia (PHN)with a DN 4 score ≥ 5/10. The nerve blocks were performed under ultrasound regarding the metamere involved. The analgesic solution was ropivacaine 0,2% and dexamethasone 4mg. Results: The average age of our patients was 64.38 years and the sex ratio was 1.16. The majority had a score of more than 7/10, or 46% of the workforce. In 38% of cases the EVA was 7/10. The pain was accompanied by sensory disturbances such as cutaneous hyperesthesia in 62% of cases. Regarding the impact, a deterioration in general condition WHO stage 2 was noted in 61.6% of cases. In 23% of cases, pregabalin 75 mg was added to the paracetamol and tramadol combination. Haloperidol 5mg and amitriptyline 125mg were associated with these treatments in 1 case each, 7% of the total. Ultrasound guided paravertebral nerve block was mostly performed in 54% of cases. After 3 months of monitoring, 12 patients noticed their VAS score drop to 1/10. Only one needed a perineural catheter placement for pain relief. Conclusion: Peripheral nerve blocks is a good option in severe PHN where systemic analgesic failed.

ABSTRACT
Total hip replacement (THR) surgery is an operation with a high bleeding potential. It is performed regularly at the University Hospital Center (CHU) of N'Djamena. To overcome the difficulties of blood supply and minimize the infectious risks that can result from blood transfusion. We paid particular attention to carrying out a prospective epidemiological study of the blood-sparing strategy, using drugs such as tranexamic acid (ATX) and iron. We enrolled 44 patients during our 13-month study period from November 1, 2022 to December 31, 2023. 47.73% (n=21) of patients received a dose of 1g of ATX in 30 min before incision and 500mg at the end of the procedure, 25% (n=11) received a dose of 500mg before incision and 500mg/6h/24h and 11.36% received 1g only at incision. Blood loss was greater in the non-ATX group, with P-value above the confidence level (0.32 > 0.05). Thus, through this study and the various studies carried out on the subject [4, 6-10], we were able to observe that the use of the combination of tranexamic acid and iron proves effective for the blood-sparing strategy during THP surgery.

ABSTRACT
Introduction: Ionic disorders are an imbalance between the ions entering and leaving the body. We studied dysnatremia and dyskaliaemia in patients admitted in resuscitation department. Patients and Method: This is a retrospective, descriptive and analytical study of dysnatremias and dyskaliaemias in patients hospitalized in the resuscitation department Peace Hospital of Ziguinchor from January 1st, 2021 to December 31th, 2021. The objectives were to assess the prevalence of these ionic disorders in resuscitation, to clarify the epidemiological profile, to identify clinical and paraclinical signs, to evaluate management and to monitor the evolution of patients. Results: During the study period, the Peace Hospital resuscitation service recorded 287 hospitalizations, among which we identified 66 cases of ionic disorders (dysnatremias and dyskaliaemias) at admission. We found a frequency of 22.9% of hospitalized patients. The average age was 40.71 ± 23.83 years. Males were the most represented in 53%. The majority of patients, 62.1%, came from outside the city of Ziguinchor. Diabetes was the most common medical history in 50% of patients. Patients were from 53% of emergency department. Stroke was the most common cause in 16.7%. Dysnatremias were found in 57 patients, or 86.4%. Dyskaliaemias were found in 32 patients or 48.5%. Clinical signs were marked by the disorder of consciousness in 37.9%. Electrical signals were more marked by the flattened/negative T wave and ST depression in 60%. We reported a 53% mortality rate. Deaths occurred in 60% within 72 hours of hospitalization. Severe malaria and hyperkalemia were factors of poor prognosis. Conclusion: The ionic disorders, frequent in resuscitation, are of multifactorial origin. They are associated with significant morbidity and mortality and require early and accurate management.

ABSTRACT
Introduction: Anesthesia allows surgery to proceed smoothly, with pain suppression, patient immobility and neurovegetative protection. The aim of this study is to describe anesthetic practice in adults at Zinder National Hospital. Patients and Method: it was a prospective cross-sectional study including patients aged at least 16 undergoing surgery at the Zinder national hospital from December 4, 2023 to March 3, 2024 (3 months). Results: During the study period, 560 anaesthetic procedures were performed in the operating theatre, of which 329 (58.8%) involved patients aged 16 or over. The mean age was 38.7±17.8, with extremes of 16 and 85 years. Past history was present in 30% of patients, dominated by hypertension. The types of surgery were: visceral surgery 48.9% followed by traumatology 27.1%, all patients were evaluated before anesthesia. General anesthesia (GA) was used in 61.4% of cases. In 55.3% of cases, patients were classified as ASA I. The drug regimen most commonly used for GA was: fentanyl, suxamethonium and ketamine in 38.4% of cases, and for spinal anesthesia, the bupivacaine-fentanyl combination. Anesthesia was provided by 2 anesthesiologists and 10 anesthesia technicians. More than half the patients developed adverse events in the operating room, and one (1) patient died (0.3%). Conclusion: This study provides us with information on the socio-demographic characteristics of patients, the types of surgery and the characteristics of adult anaesthesia at Zinder National Hospital. A number of aspects remain to be improved, including the number of anaesthetists and the availability of equipment such as respirators and capnographs.

ABSTRACT
Anesthesia for surgical separation of conjoined-twin is not an unusual situation. The occurrence of birth of these babies is 1:50,000 to 250,000 live births. Their surgical separation remains a great challenge, especially in our low-settings context. The success of the intervention depends largely on the organization and planning of the surgical procedure. The medical simulation of the procedure and the distribution of roles between different actors interacting collegially is a fundamental issue for surgical success as we describe it through the experience drawn from these clinical cases.