ABSTRACT
Introduction: Nosocomial infections (NI) are common conditions among hospitalized patients. This study aimed to evaluate healthcare workers' knowledge and practices regarding infection prevention measures in intensive care units. Method: This was a descriptive, cross-sectional study conducted from April 13to June 10, 2022, among 45 healthcare workers in three university teaching hospitals of Abidjan. The parameters studied were: the theoretical and practical knowledge of healthcare workers regarding the prevention of nosocomial infections. Results: 45 healthcare workers participated. 74.7% knew the definition of a nosocomial infection and 43% identified the main risk factors for its occurrence. Sixty-five percent identified staff hands as the main mode of cross-transmission of germs between patients. Sixty-four percent of staff reported using non-sterile gloves during urinary catheter insertion. Compliance with hand hygiene before patient contact was low (31.8%) while gloves changes between patients were observed in 87.2% of cases. Deficiencies were noted in adherence to aseptic techniques before performing invasive procedures. Non-compliance was mainly attributed to shortages of supplies and personnel, and insufficient knowledge of preventive measures. Conclusion: healthcare workers’ knowledge and adherence to hygiene practices in intensive care units were insufficient.

ABSTRACT
Background: Delays in the administration of analgesia remain common in emergency departments, with more than 75% of patients experiencing treatment delays exceeding 60 minutes. This persistent undertreatment contributes to oligoanalgesia and avoidable patient suffering. Objective: To evaluate the effect of implementing an early analgesia protocol on time to pain management in the emergency department of Essos Hospital Center over a 3-month period. Methods: We performed a quasi-experimental before-and-after study including 180 consecutive adult patients presenting with moderate to severe acute pain (visual analogue scale [VAS] ≥4). The intervention consisted of a standardised, protocol-driven analgesia algorithm combined with focused staff training. The primary outcome was the proportion of patients receiving analgesia within 30 minutes of triage. Secondary outcomes included median time to analgesic administration, pain intensity at 60 minutes (VAS), and patient satisfaction at 24 hours. Results: Following implementation of the protocol, the proportion of patients receiving analgesia within 30 minutes increased significantly from 21% to 66% (p<0.001). The median time to analgesic administration was reduced from 76 minutes (IQR, not reported) to 29 minutes, and mean pain scores at 60 minutes decreased from 6.2±1.3 to 3.3±1.0 (p<0.001). Patient satisfaction at 24 hours improved markedly, rising from 48% to 79% (p<0.001). Conclusion: The introduction of an early, protocol-driven analgesia strategy in the emergency department was associated with a substantial reduction in treatment delays and a clinically meaningful improvement in pain relief and patient satisfaction. These findings support the routine implementation of structured analgesia pathways to optimise the timely management of acute pain in resource-limited emergency care settings.

ABSTRACT
EME is classically defined as a "fixed and lasting epileptic condition" and, more precisely, as continuous seizures or a succession of seizures without improvement in consciousness over a period of 30 minutes. The aim of this study was to assess the status epilepticus in the intensive care unit of CHNDJ. This was a single-center, observational, retrospective, descriptive, and analytical study. We included all patients hospitalized in the intensive care unit of the CHNDJ between January 1, 2022, and December 31, 2024, who presented with status epilepticus. Clinical and paraclinical data were collected. The prevalence was 3.37%. The mean age was 34.57 years. The sex ratio was 0.78. 33% were being treated for epilepsy, and 21 patients (66%) came from the emergency department. Refractory status epilepticus was found in 49% of patients, and 15% had super-refractory status epilepticus. Hemodynamic instability was the most frequent abnormality on admission, present in 28.125% of patients. EEG was performed in 3 patients (9.37%), and a brain CT scan was performed in all patients. Anemia, hypocalcemia, and hypokalemia were the most common laboratory abnormalities, present in 34% of patients. Lumbar puncture was performed in 16 patients (50%). Hypoproteinorachia and hypoglycorachia were predominant, each occurring in 22% of cases. The cerebrospinal fluid (CSF) was clear in 34% of patients. Discontinuation of treatment was the most frequent cause (31.25%), followed by ischemic stroke (18.75%). Anticonvulsant therapy was initiated in all patients to prevent seizures. The mean duration of sedation was 8.21 ± 8.12 days, ranging from 1 to 35 days. The combination of midazolam and fentanyl was the most commonly used sedative. 72% of patients developed a nosocomial infection during their hospitalization. Ventilator-associated pneumonia (VAP) was the most frequent nosocomial infection, occurring in 22% of cases. Hyperthermia was the most common adverse event occurring in the acute ph

ABSTRACT
TRALI is a post-transfusion acute respiratory distress syndrome that presents as acute non-cardiogenic pulmonary edema occurring within six hours after a transfusion. A 38-year-old female patient was hospitalized in intensive care for the management of postoperative complications following the resection of a parieto-occipital PEIC, complicated by intraoperative hemorrhagic shock requiring the transfusion of 2 units of red blood cells and 2 units of plasma. Preoperatively, the clinical and biological examination was unremarkable. Under general anesthesia, the estimated blood loss of 1000ml required transfusion of 2 units of packed red blood cells and 2 units of fresh frozen plasma. At 4 hours post-transfusion and 3 hours postoperatively, she developed respiratory distress associated with macroscopic hematuria. She exhibited diffuse bilateral crackles with fine wheezing. Oxygen saturation was 65% under mechanical ventilation. Blood gases showed hypoxemia with hypercapnia. Laboratory tests revealed anemia with Hb: 6.9 g/dl, thrombocytopenia at 59,000/mm³, AST 148.9, ALT 302.1. Transthoracic ultrasound was normal. Thoracic CT angiography showed findings consistent with acute lung injury edema. Furosemide 40 mg was administered every 6 hours for 3 days, in combination with nebulization sessions and corticosteroid therapy. After 24 hours of treatment, the progress was satisfactory with normal saturation. At 72 hours, the lung fields, CT scan, and laboratory results had returned to normal. TRALI is a syndrome whose clinical diagnosis involves identifying pulmonary edema without a hemodynamic or cardiac component

ABSTRACT
Introduction: Trauma is a major public health problem worldwide; the disability-adjusted life years (DALYs) attributable to it have been estimated at 248 million. A patient with severe trauma is a victim of violent trauma, regardless of the apparent injuries. Trauma accounts for 8% of global mortality. Methods: This was a one-year retrospective descriptive study conducted from January 1, 2024, to December 31, 2024. Results: Patients with severe trauma accounted for 41.8% of emergency department admissions during the study period. Young men were the most affected, with a mean age of 25.6 ± 16 years and a sex ratio of 7.7 in favor of males. The primary cause was acute abdominal trauma (81.9%). The mean time to admission was 88.9 ± 64.5 hours. The mean Glasgow Coma Scale score was 7.9 ± 1.9. The mean ISS score was 29.8 ± 7.5. Lesions on brain CT scans were predominantly edematous-hemorrhagic contusions in 66.7% of cases. Mortality was 26.7%, caused by severe hypoxemia in 50% of cases. Conclusion: Severe trauma is responsible for high morbidity and mortality. An effective care network could improve its impact on our society.

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Introduction: Treatment of locally advanced cervical cancer requires the use of radiotherapy. The tumour response rate measured midway through radiotherapy provides valuable prognostic information. This study sought to document the dose distribution and early tumor response in patients treated with cobalt teletherapy at Cancer Diseases Hospital (CDH). The objective was to determine the effectiveness of Cobalt Teletherapy in the treatment of cervical cancer patients at CDH with an anteroposterior separation of 21 cm and above using the four-field technique. Methodology: The study employed a cross-sectional design. Population was patient treatment files. All files fitting the criteria were included. Dose distribution and treatment response assessment data was retrieved and analysed. Descriptive and inferential statistics were run for the analysis. Results: There was a significant association between tumour size, the level of haemoglobin, and the number of fractions received during External Beam Radiotherapy (EBRT) (p<0.001), before and after treatment. An increase in the number of fractions received during EBRT and an increase in the level of haemoglobin resulted in the tumour size reduction. No significant association was seen between tumour size and Anterior Posterior (AP) separation, Age, Dose to the 95% isodose line (p>0.05). Other factors not significantly associated with tumour size reduction include Parity HIV status, Performance status, Average radiation dose, field size, number of chemotherapy circles, chemotherapy type. Conclusion: There is contextual evidence that tumour can reduce in size with an increase in number of fractions received during EBRT and level of haemoglobin. AP separation, Age, Parity, HIV status, Performance status, Average radiation dose, field size, number of chemotherapy circles, chemotherapy type, and Dose to the 95% isodose line did not show any effect on cervical tumour size (p>0.05).

ABSTRACT
Unilateral hypobaric spinal anesthesia is an anesthetic technique that provides hemodynamic stability, indicated for subumbilical surgery, especially in elderly subjects. The aim of this work was to demonstrate the effectiveness of this technique, which is very commonly practiced at the reference hospital in Maradi, through a descriptive and cross-sectional retrospective study over three years. Only patients who underwent surgery and had a complete file were included. A total of 56 patients were included, with a female predominance and a mean age of 78.03±5.4 years. The age group [60-70 years] represents 50%. The types of surgeries performed were traumatic and vascular. Surgical indications were dominated by pelvic limb trauma in 60.71% of cases. More than half of our patients (57.14%) had at least one comorbidity, with diabetes and hypertension at the forefront, accounting for 40.66% and 37.51%, respectively. At admission, patients presented a diverse hemodynamic state. Indeed, 10 had hypotension and 7 had hypertension. Bupivacaine was the only local anesthetic administered. Fentanyl and clonidine were the associated adjuvants. Osteosynthesis was the main surgical indication followed by amputation with respective rates of 51.78% and 28.57%. After anesthesia, patients were positioned in the lateral decubitus position, with the limb to be operated on positioned above, for 15 minutes. After this period, a failure rate of 8.20% was observed. Conversely, success was noted in 51 patients, 11 of whom had received a blood transfusion for intraoperative bleeding. However, no use of vasopressors was reported. The average duration of surgery was 64±11 minutes. No major incidents or conversions were reported intraoperatively. The average stay in the post-anesthesia recovery room was 43±12 minutes. The average anesthesia duration was 87±13 minutes. No incidents were reported postoperatively. This study allowed us to highlight the contribution of hypobaric unilateral spinal anes