ABSTRACT
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the alimentary tract. Now a day GISTs represents 0.1-3% of all gastrointestinal malignancies, making it a diagnostic challenge. Lesions are frequently located in stomach and proximal small intestine but rarely elsewhere in the abdomen. They are believed to result from mutations of protooncogenes c-Kit or platelet-derived growth factor receptor alpha polypeptide, this increase tyrosine kinase receptor activity, leading to uncontrolled proliferation of stem cells that differentiate into cells of Cajal. They can occur at any age but predominantly in middle-aged people and in elderly. We reported the cases presented to our hospital with progressively distension of the abdomen, finding in diagnostic image suggested GIST without evidence of metastasis disease, total excision was done, Cytologic and immunohistochemistry analysis confirm diagnosis of GISTs.

ABSTRACT
Background: Most patients admitted to the surgical ward undergo laparotomy for various reasons, despite the use of analgesics pain control could remain inadequate. Inadequate postoperative pain management can lead to undesired post-operative complications which increases the risk of morbidity and increased hospital stay. This study aimed to determine the prescription pattern of analgesics, inadequacy of postoperative pain management and its associated factors in the first three days among patients undergoing laparotomy at Bugando Medical Centre. Method: Prospective longitudinal study was conducted at Bugando Medical Centre from April to July 2022, involving 106 adult postoperative patients undergone laparotomy and were admitted to the general surgery wards. Structured questionnaires were used to obtain post-operative information. Postoperative pain severity scores were assessed by using a Numerical Rating Scale (NRS). Data were analysed using STATA v.15. Bivariate analysis and multivariate logistic regression were done. A P-value of <0.05 was considered significant. Results: The types of analgesics commonly prescribed postoperatively were a combination of Pethidine and Paracetamol (67.8%), followed by combinations of Pethidine and Paracetamol with Diclofenac (25.2%) and lastly Pethidine, Paracetamol and Tramadol (7.0%). The prevalence of moderate to severe postoperative pain within 12, 24, 48 and 72 hours were 97.7%, 92.2%, 47% and 21.8% respectively. There was a significant association between sex with the severity of pain. Conclusions: Postoperative pain management was inadequately managed at Bugando Medical Centre. The proportion of postoperative pain in the first twenty-four hours post-operative was the highest. There was no uniformity in the postoperative pain management in our setting and a suboptimal prescription of pethidine was noted. The frequency of pethidine prescription was eight hours instead of four to six hours. Male sex was associated .........

ABSTRACT
Background: Fibromyalgia (FM) is characterized by widespread musculoskeletal chronic pain, which compromises the patient’s quality of life and is a Somatic symptom disorder. A typical symptom seen in the patients is the lack of acceptance of the disease, since its pathophysiology is not clear. This work aims to clear few new treatment methods at a holistic level, that is, cognitive, physical, and pharmacological therapies. Methodology: A literature review was carried out form researchgate, google scholar, pubmed, scopus etc. that discusses treatment methods that relieves the pain and manage the symptoms of the disease. Results: Fibromyalgia symptoms can be managed by various treatment protocols that include a response to the mind through pain management, response to the body through physical activity, and response to the pain through pharmacological treatment. Conclusions: Treatment for fibromyalgia often involves medications along with complementary treatments, such as exercise, acupuncture, and life style modification.

ABSTRACT
Aneurysmal bone cyst are uncommon lesions of long tubular bone. It is benign and nonneoplastic. Aneurysmal bone cyst is unusual in temporal bone that may extend intracranially. We report here a patient of 6 years old boy presented with swelling over left temporal region for 2 months. CT and MRI findings and histopathology revealed aneurysmal bone cyst. Total surgical resection was ensured though lesion was extended intracranially. Prognosis is excellent after total removal as total surgical excision is curative. Good surgical result of this uncommon lesion prompted our report.

ABSTRACT
Nosocomial infections, particularly bacteremias, are a significant concern in intensive care units (ICUs) due to their invasive nature and the severity of patient’s conditions. This retrospective study aimed to investigate the epidemiological and resistance profile of bacteria isolated from blood cultures in patients admitted to the intensive care units of Ibn Sina University Hospital in Rabat. The study spanned over 24 months, from January 2021 to December 2022. Data from 725 positive blood cultures were analyzed, and 423 cases met the criteria for bacteremia. Gram-negative bacilli were more frequently isolated than gram-positive cocci, with Klebsiella pneumoniae and Acinetobacter baumannii being the most prevalent species. The resistance profile of the isolated bacteria was assessed using various techniques, including automated systems and disk diffusion. The findings underscore the importance of identifying the responsible bacterial species and their resistance patterns in ICU settings to guide appropriate treatment strategies and improve patient outcomes. Further research and interventions are needed to address the challenges posed by nosocomial infections in ICUs and reduce their associated morbidity and mortality rates.

ABSTRACT
Sigmoid volvulus is the third most common cause of colonic obstruction. Men and women are not affected equally and some cases have been reported to occur during pregnancy [1, 2]. The current literatures are still devoid of the cases that occur soon after delivery in the early puerperal period. We present a 37 years’ old female who was brought to St. Francis Regional Referral Hospital (SFRRH) as a referral from nearby health Centre with absolute intestinal obstruction that had an acute onset just one day after her non-eventful spontaneous vertex delivery, she was brought to us on the second day course. On examination she was ill looking with a nasogastric tube insitu that was draining bilious fluid. Her abdomen was grossly distended, hyper-tympanic with an empty rectum on digital rectal examination. She had hypokalemia that was corrected prior surgery and the plane abdominal x-ray showed a gaseous distended colon with a typical coffee bean sign. Intraoperatively a mega distended and a gangrenous sigmoid colon was laying on the rest of the visceral – twisting in a 3600 clockwise direction. A whole of the sigmoid colon was gangrenous of which a total sigmoidectomy was done followed by closure of the rectal stamp and its attachment to the anterior abdominal wall. The lateral to medial descending colon mobilization was done that culminated into placement of the end colostomy. Though noticed and reported during pregnancy, an attention should also be paid to those patients presenting with such obstruction soon after delivery on the early puerperium, this will facilitate early diagnosis and intervention so as to prevent undesirable complications as in the case of this patient.

ABSTRACT
Introduction: Respiratory distress in children is a frequent emergency in daily practice. The aim was to describe the clinical and therapeutic characteristics of respiratory distress in young children aged 6 to 59 months admitted to the paediatric emergency department of CSREF CV. Methods: This was a prospective cross-sectional study conducted over a 12-month period from 01 August 2022 to 31 July 2023. Data were collected using an individual survey form. S0PSS 23.0 software was used for data entry and analysis. Results: During the study period, 881 hospital admissions were recorded, including 82 cases of respiratory distress, i.e. a frequency of 9.31%. Females were more prevalent (57.3%). The most common age group was 6-12 months (46.34%). The month with the highest number of admissions was September (15.85%). Dyspnoea was the most common reason for consultation (31.06%) and hospitalisation (68.29%). Intercostal indrawing was the most common sign of respiratory difficulty (49.02%). Pneumonia was the most common pulmonary cause (54.88%). The majority of patients were hospitalised for 1 to 5 days (47.56%). Almost a third of patients received antibiotic treatment (27.80%). Conclusion : Early management of respiratory distress can reduce the length of hospital stay and improve vital prognosis.