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.

ABSTRACT
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.

ABSTRACT
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.

ABSTRACT
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.

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.