ABSTRACT
Aim and background: Pulmonary embolism (PE) is a life-threatening medical emergency where a blood clot travels from somewhere else in body, usually from deep vein thrombosis of legs to pulmonary artery and blocks it, leading to high mortality and morbidity. If not treated on time, it can lead to death. Case Description: In the following two cases, we describe patients with presentation of pain abdomen which was finally diagnosed as acute pulmonary embolism. Conclusion: Pulmonary embolism has a varied clinical symptomatology and can cause frequent diagnostic dilemma and challenge, which can delay timely diagnosis. Clinical Significance: It is essential for the critical care physician to be aware of varied symptoms and to have a high index of suspicion.

ABSTRACT
Background: Regional anesthesia is defined as loss of sensation in a body produced by administration of anaesthetic agent to the nerves supplying that region. Regional anesthesia whether by spinal, epidural, peripheral nerve blocks offer a number of advantages. Bupivacaine has become standard agent for intrathecal anesthesia. A number of adjuvants can be added to prolong the duration of analgesia. In our study we are comparing fentanyl & dexamedetomidine as an epidural adjuvant to spinal bupivacaine in abdominal hysterectomies. Materials and Methods: A total of 60 patients scheduled for abdominal hysterectomy under CSE were enrolled for this prospective randomized study which was conducted in hospital from November 2019 to October 2020. This work has been granted ethical committee approval. Results: Two groups comprising of 30 patients each were taken randomly. Haemodynamic parameters of heart rate, blood pressure, spo2, were monitored and recorded every 5 min for first 20 minutes and then every 10 minutes till the end of surgery and thereafter postoperatively. The sensory block was assessed by bilateral pin prick method and motor blockade according to Modified Bromage Scale. Duration of anesthesia was taken as time period till VAS of 4 was recorded. Conclusion: In our study we concluded that dexmedetomidine is better adjuvant as compared to fentanyl in combined spinal epidural anaesthesia with intrathecal bupivacaine.

ABSTRACT
The Kupang Regency in East Nusa Tenggara, Indonesia, experiences 8-9 dry months annually and relies heavily on agricultural and livestock activities, integral to its population. Moringa cultivation for livestock feed is interconnected with these activities. To assess the spatial suitability of moringa plantations, a descriptive study utilized GIS software and overlay methods, incorporating elevation, slope, annual rainfall, temperature data, and land use maps. After excluding forested, residential, and other areas, Kupang Regency's total land area was 288,497 ha. Of this, 114,239 ha were found highly suitable, 138,040 ha moderately suitable, and 36,218 ha unsuitable for moringa cultivation. East Kupang Subdistrict ranked highest in suitable land (16,232 ha), followed by Takari (11,932 ha), Sulamu (9,281 ha), and West Kupang (8,208 ha). Conversely, Fatuleu Tengah (27 ha), Amfoang Tengah (96 ha), and Amfoang Selatan (409 ha) had the least very suitable land. Similarly, Takari (18,279 ha), West Fatuleu (15,784 ha), Fatuleu (14,194 ha), West Amarasi (10,620 ha), and South Amfoang (10,130 ha) excelled in moderately suitable land. In contrast, South Semau (246 ha), East Kupang (434 ha), and Central Kupang (960 ha) had the smallest moderately suitable areas. Unsuitable land for moringa, like South Amfoang (10,270 ha) and Amfoang Tengah (8,932 ha), were prominent. This research aids in identifying optimal locations for moringa cultivation, aligning farming practices with the region's agricultural needs.

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Objective: To study the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of post-intubation tracheal stenosis occurring in patients admitted to intensive care units. Patients and methods: This is a multicenter, retrospective and descriptive study conducted from November 1, 2010 to June 1, 2022 in 7 intensive care units and 3 ENT departments. From medical records, we collected epidemiological data (frequency, age, sex), medical history, data relating to tracheal intubation (indication, duration, inflation pressure of the intubation tube balloon), data on post-intubation (PI) tracheal stenosis (symptoms and time to onset), paraclinical data, treatment and evolution modalities. The data collected were expressed as averages with their standard deviation. Results: During the study period, 19 patients presented with PI tracheal stenosis. The frequency ranged from 0.03% to 0.1%. The average age of the patients was 25.7 years 11.07 14-38 years. Patients had been intubated in a traumatic context in 47.37% of cases. The average duration of ventilatory support was 10.37 days  03.03 4-15 days No intubation tube cuff pressure monitoring was done for any patient. Dyspnea was the main telltale sign. Its average time to onset was 33.21  days 12.07 1h-3months. Endoscopically, the average degree of tracheal stenosis was 72.63% 50-99% . Therapeutically, in intensive care, 5 patients (26.31%) who presented with acute respiratory failure underwent a life-saving surgical tracheostomy. Curative surgery resulted in a tracheal resection-anastomosis (73.68%) and enlargement tracheoplasty (26.32%). The outcome was favorable for 9 patients (47.37%). The recurrence of the stenosis after curative surgery was observed in 31.58% of cases. Death occured in 3 patients (15.79%). Conclusion: Over-inflation of the intubation tube cuff is the leading cause of PI tracheal stenosis. Prevention is based on the systematic monitoring of its inflation pressure.

ABSTRACT
Background: Intubation with a cuffed endotracheal tube is the gold standard for securing a definitive airway. Bucking over the tube during extubation can result in a potentially dangerous hemodynamic response. Tracheal tube cuff can be used as a reservoir for drugs to blunt this response. Lidocaine, a local anesthetic can achieve this by anesthetizing the airway. Dexamethasone has been known to potentiate the effect of lidocaine and has an intrinsic anti-inflammatory property. Methods: A prospective double-blind randomized control trial was conducted in a tertiary hospital for patients undergoing elective surgeries under general anesthesia requiring endotracheal intubation. Sixty patients were randomized equally into one of three groups. Cuff was inflated with saline (Group-S), 40 mg alkalinized lidocaine (Group-L), 40 mg alkalinized lidocaine with 8 mg dexamethasone (Group-LD). Heart rate, blood pressure and bucking were recorded during extubation, and post-operative sore throat were assessed. Results: All groups were comparable with regard to demographics, quantity of drug instilled in the cuff, duration of extubation and baseline hemodynamics. Group-L had the lowest incidence of hemodynamic changes during extubation, even lower than Group-LD. (p=0.020). Group-L and Group-LD had a lower incidence of bucking when compared to placebo (p<0.001). Both Group-L and Group-LD revealed a lower grade of sore throat in the early post-operative period. Conclusion: Instilling endotracheal tube cuff with 40 mg alkalinized significantly blunts hemodynamic response and bucking during extubation, and sore throat in the early post-operative period compared to placebo. Addition of 8 mg dexamethasone does not improve hemodynamic extubation response.

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The placenta can invade the myometrium up to varied levels leading to morbid adhesions of the placenta. This can present as acute abdomen and rarely with hemoperitoneum which is highlighted in this case.

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Background: Obesity is defined as an abnormal or excessive accumulation of body fat that may impair health. Body mass index expressed (BMI) in kg/m2 is a simple measure of weight for height used to estimate obesity in adults. For adults, the World Health Organization defines obesity when the body mass index is greater than or equal to 30. Africa is faced with the growing problem of obesity and overweight, due to new habits food and new lifestyles. Obesity surgery has come to impose itself in our environment as a mechanical and metabolic aid to fight against this scourge which has become a public health problem. It is in this perspective that we proposed to study the intraoperative complications Related to Anesthesia for laparoscopic sleeve gastrectomy at Essos Hospital Center. Patients and Methods: This was a descriptive, retrospective and analytical study that took place over a period of 3 years, from January 2017 to December 2019, in the anesthesiology department of the Essos hospital center. All the files of the obese patients who underwent laparoscopic sleeve gastrectomy during the above-mentioned period were included in the study. The variables studied were: socio-demographic data, intraoperative anesthetic complications. The results obtained were subjected to univariate and bivariate analysis using the CSPRO and SPSS software. Results: A non-probability convenience sampling allowed us to obtain 16 patients. The age group that was mostly represented was those 36 to 55 years (81%). The sex ratio was 0.1. A body mass index > 40 kg/m2 of body surface area was found in 38% of cases (morbid obesity). Arterial hypertension was the comorbidity frequently associated with obesity (37.5%). The surgery was long, > 6 hours in all cases. The main anesthetic intraoperative complications were difficult intubation (62.5%), arterial hypotension (43.7%) and hypothermia (75%). Conclusion: Obesity is a public health problem in sub-Saharan Africa, which remains neglected. ........