ABSTRACT
Background: Conjoined twins (CTs) are rare and Anesthesia may be required for diagnostic imaging, invasive procedures and/or separation. This article described the anesthetics for CTs’ separation performed locally in West Africa from 2016 to 2022. Anesthetic management for the separation of conjoined twins performed from 2016 to 2022 in five West Africa countries, Benin, Burkina Faso, Guinea, Niger and Senegal, are reported on. Methods: Anesthetic management for the separation of conjoined twins performed from 2016 to 2022 in five West Africa countries, Benin, Burkina Faso, Guinea, Niger and Senegal, are reported on. The data collection was done retrospectively. Each country was sent their data to Burkina Faso for study. The parental consents were obtained for surgery and publication. Results: During the period, nine conjoined were reported. The cases were: 5 omphalopagus, 2 pygopagus, 1 xipho-omphalopagus and 1 thoraco-omphalopagus. Inhalation anesthesia or propofol combined with IV opioids were used. Monitoring relied heavily on pulse-oximetry. Manual ventilation was used in five separations. Separations were achieved in 1.5-4 hours. The death of a twin triggered surgery in one pair and three other babies died after the surgery. The fourteen remaining babies developed well. Peri-operative difficulties revealed widespread difficulties in Africa. Conclusion: CT separation surgery still constitutes an extraordinary challenge in low and middle income countries, but well-trained anesthesiologists, a multidisciplinary approach and international contacts can lead to safe performance of complex neonatal surgeries.

ABSTRACT
Background: Post-dural puncture headache (PDPH) is a complication of dura mater puncture. In order to reduce the burden and related morbidity, postpartum women who suffer from PDPH must be identified and treated as soon as possible utilizing highly effective, noninvasive approaches that are simple to apply in settings with limited resources. Objective: The aim of this study is to assess the causes, effects & management of post dural puncture headache among obstetric patients in a tertiary care hospital. Methods: The cross-sectional observational study was conducted in the department of Surgery, North Bengal Medical College Hospital, Sirajgonj, Bangladesh, from October 2022 to September 2023. A total of 300 patients were included in the study. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, most of the 104 (34.7%) patients were within the age group of 31 - 35 years. The mean±SD age of the patients was 32.6±1.3 years. BMI of most of the patients 137 (45.7%) were in the normal range (18.5 to <24.9), 103 (34.3%) had overweight (25-29.9), 37 (12.3%) were obese (≥30.0) and 23 (7.7%) had underweight (<18.5). Most of the patients 133 (44.3%) were multipara, among 300 patients 214 (71.3%) patients gestational age was >37 weeks and 86 (28.7%) patients gestational age was<37 weeks. About 49 (16.3%) had preexisting/ pregnancy-related medical conditions and emergency surgery was done in 217 (72.3%) patients. The majority of the participants 251 (83.7%) had only one attempt at the puncture, and all 300 (100.0%) were in a sitting position during the procedure, and a 25G-sized spinal needle was used in 296 (98.7%) of the patients. Most participants reported cerebrospinal fluid loss as minimal. Majority of the 231 (77.0%) patients had previous history of PDPH. All 300 (100.0%) ..

ABSTRACT
Diabetic ketoacidosis is a real public health problem in our context with an incidence of 12.67%. Diabetic ketoacidosis is a therapeutic emergency that requires rigorous management, especially in the acute phase, while respecting the therapeutic particularities of each patient and taking care to detect the etiologies. The etiological research of ketoacidotic decompensation has enabled us to determine, as the main triggering factors, therapeutic non-compliance and then infections, predominated by urinary infections and pneumonia. Initial treatment is based on rehydration, insulin therapy and correction of electrolyte and acid-base disorders, of course, with rigorous and essential monitoring combating possible complications, particularly iatrogenic, represented in our context mainly by the hypokalemia, hypoglycemia, cerebral edema and acute renal failure. The analytical statistical study allowed us to conclude that death was essentially linked to complications occurring during the hospital stay, notably septic shock, cerebral involvement, renal failure and the use of mechanical ventilation.

ABSTRACT
Anemia is one of the most common pathologies in the world, with major consequences on health, it is a common condition among patients Surgical, and its prevalence varies between 11% and 76%, depending on sex, age and the underlying pathology requiring surgical intervention, as well as the Hb threshold used for its definition. Our study concluded that anemic patients account for 22.99%. The 38 to 47 age group seemed to be the most affected with a prevalence of 35.48%. The sex ratio is 1.17 in favor of men. Among surgical patients, trauma patients were most affected by anemia (46.51%). Mild hypochromic microcytic anemia is the most common type of anemia in surgical patients. Only 26% of patients received anti-anemia treatment. Curative and above all preventive therapeutic care is essential. Strongly to understand the consequences of this scourge.

ABSTRACT
Colorectal cancer, by its frequency and severity, represents a serious public health problem worldwide. In Morocco, the incidence of colorectal cancer is constantly increasing. Post-operative morbidity and mortality is an event whose evaluation and analysis are necessary to improve surgical results and optimize patient care. Thus, knowledge of the causes and risk factors of morbidity and mortality will contribute not only to a better evaluation of patients candidates for colorectal surgery, but also to reveal new avenues of research to improve the post-operative prognosis of these patients. The objective of this retrospective work is to carry out an epidemiological study of the morbidity and mortality of patients admitted during the postoperative period of colorectal surgery to the surgical intensive care unit of the Ibn Rochd University Hospital in Casablanca; as well as the search for potential predictive factors associated with it.

ABSTRACT
Supraclavicular brachial plexus block is a common regional anesthesia technique used for upper extremity orthopedic surgeries. The addition of adjuvants to local anesthetics can prolong the duration of analgesia and improve the quality of the block. This prospective, randomized, double-blind study aimed to investigate the impact of dexamethasone on the efficacy of a lignocaine and ropivacaine mixture for ultrasound guided supraclavicular block. A total of 80 patients scheduled for major forearm orthopedic surgery were randomly assigned to receive either a mixture of lignocaine 2% and ropivacaine 0.5% (control group) Group A or the same local anesthetic mixture with the addition of dexamethasone 8 mg (dexamethasone group) Group B. The primary outcome was the duration of analgesia, defined as the time from block placement to the first request for rescue analgesia. Secondary outcomes included the onset time of sensory and motor block, the quality of the block, and the incidence of adverse events. The results showed that the addition of dexamethasone significantly prolonged the duration of analgesia compared to the local anesthetic mixture alone (135 ± 10 min vs. 170 ± 15 min, respectively, p < 0.001). Addition of dexamethasone to mixture of lidocaine and ropivacaine in supraclavicular block results in prolonged duration of sensory and motor block and also improves quality of analgesia without affecting its onset.

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.