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
Background: Pathogenic resistance against antibiotics is substantially mounting in the developing countries including Bangladesh. Antimicrobial resistance is a rising concern specially among the critically ill patients who are often treated by multiple antibiotics. Objective: To observe the pattern of antimicrobial resistance among the patients diagnosed with sepsis admitted into the intensive care unit (ICU). Method: This observational study took place in the ICU of Bangabandhu Sheikh Mujib Medical University for 1 year. Samples of blood, urine, tracheal aspirate were obtained from 192 patients admitted in ICU with clinically diagnosed sepsis which were cultured and analyzed. Result: Mean age of the patients were 54.29 ± 19.443 years and 60.4% were males. The most common sample yielding positive culture was tracheal aspirate [94 (51.6%)]. Out of 530 samples, organisms were isolated from 158 samples. The most frequently isolated microorganisms were Klebsiella spp. 54 (35.29%), followed by Acinetobacter spp. 38 (24.83%), Pseudomonas spp. 19 (12.42%) and Candida spp. 15 (9.80%). Regarding antimicrobials, a range of drugs classified as Penicillins, Cephalosporins, Carbapenems, Fluroquinolones, Macrolides and others such as Trimethoprim/Sulfamethoxazole and Nitrofurantoin were found to be 100.0% resistant to Pseudomonas spp., Klebsiella spp., Acinetobacter spp. and E. coli. Conclusion: A high prevalence of resistance to most antibiotics was detected. Overall, such a revelation of increased antibiotic resistance demands for restrictive and appropriate antibiotic usage in accordance with the updated antibiotic prescribing policy in Bangladesh.

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.

ABSTRACT
Background: Early aggressive fluid resuscitation is beneficial in the management of septic shock (SS). Recent studies show that more positive or higher fluid balances after initial resuscitation in septic shock are associated with adverse outcomes. This study aimed to determine the impact of fluid balance on intensive care unit (ICU) mortality, and length of stay (LOS). Methods: A 4-year longitudinal retrospective study was conducted at the ICU of the Douala General Hospital (DGH). We reviewed file records of patients ≥ 18 years old, and with an ICU LOS of > 12 hours, admitted with a diagnosis of SS. We recorded the sociodemographic data, comorbidities, severity of illness as measured by the Sequential Organ Failure Assessment (SOFA), and modified Acute Physiologic and Chronic Health Evaluation (mAPACHE) II scores, treatment details, and patient’s outcome. We followed the fluid intake and balance during the first 3 days. Data were analyzed using a the software SPSS version 26. Survival analysis was done for different fluid balance quartiles. Multivariate logistic regression was used to control for confounders. Statistical significance was set at a p-value < 0.05. Results: 99 patients with an ICU mortality rate of 60.6% were recruited. Survivors had a significantly higher mean cumulative fluid intake within 48h (4.76 vs 3.64 L, p = 0.007) and 72 h (6.45 vs 4.53 L, p = 0.002). Non-survivors had a significantly higher mean fluid balance within 24 h (1.81 vs 0.64 L, p < 0.001) and cumulative fluid balance within 72 h (3.00 vs 1.45 L, p = 0.005). In multivariate logistic regression, mean cumulative fluid intake and fluid balance within 72 h were independently associated with ICU mortality (p = 0.016 (OR: 0.999) and 0.005 (OR; 1.001) respectively). There was no significant association between fluid balance and ICU LOS. Conclusions: Aggressive fluid resuscitation in septic shock is beneficial; however, a more positive fluid balance cumulatively over 3 days is associated ..