ABSTRACT
Background: Nutritional support in critically-ill patients is one of the most important parameters guarding the prognosis and influencing morbidity and mortality in these patients, owing to that fact, accurate measurement of the resting energy expenditure using Indirect calorimetry is recommended by guidelines as a gold standard. But due to lack of resources and other technicalities predictive equations are conveniently used as surrogates. Aims: This study was intended to examine the extent of malnutrition, poor nutrition support practices and to validate the common used predictive equations in critically-ill patients in our setting. Methodology: A hospital-based descriptive cross-sectional study was conducted on consecutively sampled 110 mechanically ventilated ICU patients at Muhimbili National Hospital Mloganzila. Anthropometric measurements, duration of stay in ICU, Temperature and Minute Volumes were recorded so as to estimate resting energy expenditure, REE from different predictive equations. Using Indirect Calorimetry Module patient’s REE was measured and recorded then a statistical data analyzed using SPSS software version 23. Results: The prevalence of poor nutritional support was 69%; underfeeding and overfeeding were observed in 41.8% and 27.3% of all participants respectively. Prevalence of malnutrition was 51.8%; underweight and overweight were found to be in 29.1% and 22.7% of all participants respectively. The accuracy of predictive equation in ±10% difference was 30%, 45.5%, 46.4% and 68.2% in HB, MSJ, ESPEN and PENN respectively. Conclusion and Recommendation: Malnutrition and Poor Nutritional support are common problems in ICU. Predictive equations have poor accuracy and validity in comparison to indirect calorimetry. Penn State Equation was the most accurate and with the highest agreement with IC.

ABSTRACT
With the availability of modern workstations and heightened awareness of the Health services cost and environmental effects of waste anaesthesia gases, anaesthesia providers worldwide are practicing low flow anaesthesia. In most developing countries Low Flow Anaesthesia is still underutilized due to lack of monitoring equipments and sufficient knowledge. Tanzania appears to have a paucity of studies on the prevailing practice pattern of fresh gas flow. Objective; The study aimed at assessing the practice of low flow anaesthesia and volatile agents choices among anaesthesia providers at Muhimbili national hospital and Muhimbili orthopaedic institute. Methods: A descriptive cross-sectional study was carried out for a period of 8 months involving 158 anaesthesia providers. A Structured questionnaire was used to collect data which included demographic, practice setting of Low Flow Anaesthesia, Workstations, scavenging, monitoring equipments, Volatile agents routinely used and preferred Agent. Data were analysed using the IBM Statistical package for social science’s version 23.0. Result: Prevalence of Low flow anaesthesia was 27.2%, however, only 6% used the fresh gas flow of 1l/min – 500mls/min. All anaesthesia providers had workstations and only 2.3% displayed Minimum Alveolar concentration (MAC), 79.1% worked in theatre with functioning scavenging systems, 55.8% used capnography, 6.9% monitored inspiratory Oxygen and none of anaesthesia providers used Bispectral and Agent Analyzers. Isoflurane was the most routinely used inhalational agents (100%) followed by Sevoflurane (69%), then Halothane (32%). Desflurane still not available in these hospitals. Conclusion: Low flow anaesthesia is seldom practiced in our locality despite having strong evidence of attractive advantages in medical practice and ergonomics.

ABSTRACT
Background: Postoperative period is a time of significant physiological flux, patient recover from the acute derangements resulting from anaesthesia and surgery. On arrival at PACU, the patient is re-evaluated by the anaesthesia provider gives a handover to the responsible PAC provider. Incomplete handover increase risk of morbidity and mortality to patients. Objective: Study assessed the handover practice of postoperative patient from operating room to post-anaesthesia care unit in Muhimbili Orthopedic Institute operating theatre recovery room. Methodology: This was a hospital based cross-sectional observational study which was conducted at Muhimbili Orthopedic Institute Hospital located at Upanga. Handover conducted by Anaesthetic Provider to PACU nurse in the Recovery rooms were Observed and information communicated were marked using SBAR handover checklist. Then anaesthetic providers and PACU nurse were surveyed to know which item in the checklist was relevant to be communicated during handover. Data collected was analyzed using Statistical Package for Social Scientists (SPSS version 23). Results: 319 PACU handover were observed. 17.5% of the handover were completed and rated as Good, 50.8% were satisfactory and 31.7% poorly completed. Most communicated items were Vital Sign 90.6%, Operation Underwent 86.8% and Type of anaesthesia 85.9% and the least was ASA 24.5%. Items providers thought should be communicated were Name of the patient (0.954), Age and Gender (0.938), Type of Anaesthesia (0.925). Among the Anaesthetic Provider Cadre Physician Providers provided Good and Satisfactory handover compared to Nurse Provider. Conclusion: Majority of the handover were satisfactorily completed, with Vital Sign, type of anaesthesia and Operation underwent being the most communicated items in checklist.

ABSTRACT
The death is a major accident of which the assessment and analysis are needed to improve the quality of care in an ICU. The aim of our work was to study mortality, analyze the main causes and assess avoidable and non-avoidable causes, in order to target possible preventive action. Prospective study carried out in the surgical intensive care unit, including all patients who died more than 48 hours after admission. Several severity scores were tested (Apache, SOFA, IGS), but none of them showed superiority over the others, and therefore represent only estimates of the severity of multivisceral failure. This high mortality rate can be explained by several factors: age, causal pathology and associated defects, but also by nosocomial infections, which remain a major cause and which can be reversed by preventive measures, in particular the correct prescription of antibiotics.

ABSTRACT
Myasthenia gravis (MG) is an autoimmune disorder affecting the neuromuscular junction caused by a B-cell-mediated, T-cell-dependent immunologic attack at the end plate of the postsynaptic membrane. Attack on muscle acetylcholine receptors (AChR) of the postsynaptic membrane due to the AChR, muscle-specific tyrosine kinase, or lipoprotein receptor-related peptide 4 antibodies lead to symptoms of painless, fluctuating weakness of muscle groups and often begins with ocular signs and symptoms. Coronavirus disease 2019 (COVID-19) is an acute respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus closely related to SARS-CoV. Serious neurologic complications are infrequent and diverse with reported cases of stroke, encephalitis/meningitis, Guillain-Barré syndrome, acute disseminated encephalomyelitis, ataxia, and unspecified limb weakness. MG is a rarely reported sequela of COVID-19 infection. To date, there are 15 reported cases of post-COVID-19 MG. In this article, we present a case of post-COVID-19 MG and a concise review of other reported cases. An 83-year-old Caucasian male with a medical history of atrial fibrillation status post-ablation and non-ischemic cardiomyopathy was initially admitted for COVID-19 pneumonia. He was treated with remdesivir, convalescent plasma, and supplemental oxygen therapy but did not require invasive mechanical intubation. One month after discharge, he started experiencing fatigue with muscle weakness and progressive dyspnea. He progressed to develop dysphonia, especially at the end of the day. After extensive workup, he was diagnosed with MG with a positive antibody against the AChR. The chronological events of developing slowly worsening muscular weakness after recovering from COVID-19 infection and positive AChR antibody led to the diagnosis of post-COVID-19 new-onset MG. Post-COVID-19 fatigue, long-term use of steroids, and intensive care unit-related physical deconditioning ....

ABSTRACT
Ex vacuo pulmonary edema is a rare but potentially severe event with a mortality of 15-20%. We report the case of a patient who presented with ex vacuo pulmonary edema after drainage of a right pneumothorax. The pathophysiology of ex vacuo pulmonary edema is not yet clearly established, with mechanical and inflammatory factors (production of interleukin 8 and leukotriene B4) being the most incriminating. Certain factors, such as the duration and extent of pulmonary collapse and the speed of lung re-expansion after drainage, appear to favour the onset of ex vacuo edema, justifying certain precautionary measures. Curative treatment relies essentially on oxygenation and reduction of pleural aspiration pressures, but the best treatment is prevention.

ABSTRACT
Background: Gas stations are areas that operate in the petroleum sector where repeated exposure to the products produced (butane, pentane, isopentane, benzene, alkylbenzene, toluene, and xylene) can have an impact in the form of health problems. The individuals with the greatest exposure to gas station products are the workers. According to data, during the period from 2016 to 2018 there were 120 cases of work accidents around gas stations. The use of Personal Protective Equipment (PPE) and training regarding the prevention for the worker and management of accidents and illnesses resulting from working at gas stations are important in ensuring worker safety. According to research that has been conducted, it was found that the use of Personal Protective Equipment (PPE) is still very low among Gas Station X workers, Maulafa District, Kupang City. Training and equipment that support Occupational Safety and Health programs are also not available to the majority of workers. This is the cause of health problems among Gas Station X workers, Maulafa District, Kupang City. Method: This research is a quantitative study with a cross sectional approach and involved 12 respondents. This study data collection techniques by interview dan physical examination directly to the samples at Gas Station X Maulafa District, Kupang City. Result: Based on the research results, it was found that the majority of Gas Station The health problems found were Peripheral Vertigo (16%), Tension Type Headache (TTH) (8%), Allergic Rhinitis (8%) and Irritant Contact Dermatitis (8%). Conclusion: An occupational risk factor that can affect the occupational safety and health of employees at GAS STATION X is exposure to fuel oil which contains volatile substances. It was found that 4 out of 12 workers at the gas station in Maulafa District, Kupang City experienced health problems, the health problems they experienced were Peripheral Vertigo, Tension Type Headache, Allergic Rhinitis and Irritant ...........