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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

ABSTRACT
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.

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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.

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Introduction: The objective was to assess the knowledge of intensive care staff at Abidjan University Hospitals on the preventive and curative management of pressure ulcers. Method: This is a descriptive and multicenter cross-sectional study, carried out on126 members of medical staff (senior and junior anesthesiologists and resuscitators) and paramedical staff (nurses) from the intensive care units of the university hospitals of Yopougon, Treichville, Cocody and Angré, from October to December 2024. Results: The staff was relatively young with a mean age of 36.7 years with a sex ratio of 1.21. The staff had insufficient knowledge on the assessment and monitoring of pressure ulcers (61.90%). Knowledge on pressure ulcer risk factors was acceptable (50.70%). Knowledge on preventive measures was acceptable (93.65%). Knowledge on pressure ulcer treatment was insufficient (61.90%). Knowledge on psychosocial feelings, information and education of patients was insufficient (53.17%). No specific training had been received by the entire sample. Conclusion: The majority of staff have insufficient knowledge regarding the preventive and therapeutic management of pressure ulcers.

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Objective: To assess the incidence and nature of perioperative complications in pediatric anesthesia at the University Hospital Center (CHU) of Conakry. Material and Methods: This was a prospective, descriptive study conducted over a period of eight (8) months, from June 1, 2024, to January 31, 2025, at the CHU of Conakry. Included were children under 18 years of age who underwent elective or emergency surgical procedures and experienced intraoperative or postoperative complications within 15 days of surgery, with obtained consent. Results: Out of 452 surgical procedures, 124 intraoperative complications (27.4%) and 176 postoperative complications (38.9%) were recorded. The mean age of the children was 6 ± 5 years, with the majority classified as ASA I (71.68%) and a sex ratio of 1.22. Visceral surgery was the most common (79.65%), followed by orthopedics (10.62%), neurosurgery (4.42%), otolaryngology and urology (2.66% each). Procedures were elective in 65.5% of cases. Appendicitis (25.66%), peritonitis (16.81%), and intestinal obstruction (9.73%) were the main indications. The most frequent complications were infectious (45.65%), hemorrhagic (36.96%), and cardiovascular (17.39%). Conclusion: This study highlights the need to improve perioperative safety in pediatric anesthesia, particularly in resource-limited countries. Optimizing anesthetic and surgical practices is essential to reduce pediatric morbidity and mortality and to improve postoperative outcomes.

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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.