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: 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
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 ..

ABSTRACT
Introduction: Diabetes mellitus (DM) is a chronic multisystemic disorders that causes complications that include long-term damage, dysfunction and failure of various organs in the body. Objective: The study aimed at determining the awareness of the chronic complication of DM that included ocular disorders, stroke, heart attack/heart failure, foot ulcer, skin rashes, sexual organs dysfunction and pregnancy losses by the subjects with DM at Onitsha, South Eastern Nigeria. Materials and Methods: This was a cross-sectional, descriptive hospital-based study involving 128 consenting DM subjects at St Charles Boromeo Specialist Hospital, Onitsha. The study-subjects were recruited using a convenient sampling method. Data collection was done with a pre-tested researcher-structured questionnaire. Laboratory tests that included fasting plasma glucose and glycated haemoglobin were done. Also, blood pressure and anthropometric measurements were done. Data was analysed using SPSS version 25. The mean values and the standard deviation of the continuous variables were calculated. Categorical variables were presented in tables as frequencies and percentages and compared using Chi-Square test. The level of significance was set at p ˂ 0.05. Result: A total of 128 DM subjects were studied comprising 98.4% type 2 DM subjects and 1.6% subjects with gestational DM respectively. The mean age of the subjects was 59.41 ± 12.32 years. 40.6% and 59.4% of the subjects were male and female subjects respectively. The most commonly known chronic complications of DM among the subjects were poor vision/blindness (87.5%), foot ulcer (75.0%), stroke (55.5%), renal failure (38.3%), heart attack/heart failure (35.9%) and skin rashes (26.6%) respectively. The least commonly known complications were sexual organ dysfunction (16.4%) and miscarriage/pregnancy loss (8.6%) respectively. The sources of information on the chronic complications of DM among the subjects included, friends/family members ...

ABSTRACT
Digestive ischemia is rare among all acute ischemias. It is even rarer when its origin is a paradoxical embolism. Paradoxical embolism is an important clinical entity in patients with venous thromboembolism and the presence of cardiac or pulmonary shunts. The clinical manifestations are serious but diverse and sometimes make the diagnosis difficult. The advent of transesophageal ultrasound (TEE) has greatly facilitated the detection of patent foramen ovale (PFO). Given the diagnostic and therapeutic interest of this apparently rare manifestation, we report the observation of a young patient aged 20, with the initials AB, recently delivered one month, admitted to the surgical emergency department of the national hospital of Niamey (HNN) for diffuse abdominal pain. The clinical evaluation allowed the diagnosis of acute generalized peritonitis. The anesthesiological evaluation classified her as ASA 1 U. In the operating room, after rapid sequence induction followed by orotracheal intubation, opening the abdominal cavity allowed the aspiration of approximately 300 cc of peritoneal fluid and the discovery of a mesenteric infarction involving the loops from 10 cm from the ileocecal junction to 90 cm from the ileocecal junction. Elsewhere, the exploration was unremarkable. The procedure performed was a segmental resection, end-to-end small intestine anastomosis and the patient was transferred to the continuing care services for continued care. Given this atypical picture, hypotheses were raised as part of an etiological search. Thus, we thought of a paradoxical embolism given the notion of recent childbirth, which is a risk factor for venous thromboembolic disease, and familial dyslipidemia. The lipid profile was normal but cardiac Doppler ultrasound revealed a 4mm diameter interatrial communication with right-to-left shunt (PFO). The final diagnosis was that of a paradoxical embolism through a patent foramen ovale leading to mesenteric ischemia. The outcome ....

ABSTRACT
Introduction: Hemorrhagic cerebrovascular accident (HCVA) is a medical or medico- surgical emergency requiring treatment in neurovascular or intensive care units. The aim of this work was to determine the prognostic factors of hemorrhagic stroke in young subjects in intensive care in the 3 university hospitals of Abidjan. Method: This is a descriptive and analytical retrospective study covering, which extends from January 2018 to December 2022, taking into account All patients aged 18 to 50 admitted to intensive care for a hemorrhagic stroke during the study period. Results: 146 patients including 100 men were included. The average age was 43 years old. High blood pressure was the main modifiable risk factor. The average Glasgow score was 8.2 and 98% of cases presented with impaired consciousness. Grade 3 hypertension was found in 73 patients on admission. The main location of the hemorrhage on imaging was parenchymal and 45% of subjects had an ICH score greater than or equal to 3 in almost 50% of cases. Nicardipine was the antihypertensive of choice. 103 patients were intubated and ventilated. 52% underwent neurosedation 13% underwent neurosurgery. The average length of hospitalization was 8.3 days during which 72.6% of patients presented complications, mostly infectious. Mortality remains high at 66.44% of cases. We listed as prognostic factors, inaugural deep coma, inaugural grade 3 arterial hypertension, ICH severity score greater than or equal to 3, renal failure and length of stay less than 7 days. Conclusion: Hemorrhagic strokes in young subjects remain a common condition in our country. Mortality in intensive care is high and is linked to clinical and neurological severity, biological disorders, the occurrence of complications and the length of stay in intensive care.

ABSTRACT
Aim of the study: To describe the management of patients with chest trauma in the ICU of National Hospital of Niamey (HNN). Patients and Method: It was a retrospective descriptive analytical study carried out from February 1st, 2017 to February 28th, 2021, ie 4years. Were included in the study, all the patients with chest trauma admitted in the ICU of National Hospital of Niamey. The studied variables included: age, gender, medical history, the circumstances of occurrence, the mecanism involved, transport, time to admission, type of the trauma, associated lesions, clinical signs, complementary signs, medical care of the patient, surgical care of the patient, evolution and length of stay in hospital. The collected data were entered and analized with the following software : EPI Info v3.5.4, Office 2019. Results: During the time of our study we have registered 34 patients over 982 patients who were hospitalized ; ie a frequency of 3.46%. We’ve noted a male predominance with 73.52% (n=25) ; ie a sex ratio of 2.77. The average age of our patients was 32.14 years with extremes ranging from 1 to 70 years. The age group of 31 to 45 years was the most affected with 64.70% (n=22). Twenty six (26) patients, ie 76.5% had no medical history, 5 had hypertension, 2 were diabetics and 1 was a chronic smoker. The etiologies were dominated by road accidents with 61.76% (n=21) followed up by ballistic trauma with 17.64% (n=6). We noted close chest trauma in 76.47% (n=26) of the cases and open chest trauma in 23.53% (n=8) of the cases. The patients benefited from medical transport (SAMU) in 35.29% (n=12) of cases. The average time to admission was 3.8 hours. Hemothorax was the most frequent lesion with 26.47% (n=9), followed up by pneumothorax with 20.58% (n=7) and ribs fracture with 17.64% (n=6). The most frequent associated lesions were limbs fracture with 26.47% (n=9), abdominal trauma with 23.52% (n=8) and head trauma with 20.58% (n=7). Fifty percent (50%) of our patients had ...