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Introduction: Nosocomial infections (NI) are common conditions among hospitalized patients. This study aimed to evaluate healthcare workers' knowledge and practices regarding infection prevention measures in intensive care units. Method: This was a descriptive, cross-sectional study conducted from April 13to June 10, 2022, among 45 healthcare workers in three university teaching hospitals of Abidjan. The parameters studied were: the theoretical and practical knowledge of healthcare workers regarding the prevention of nosocomial infections. Results: 45 healthcare workers participated. 74.7% knew the definition of a nosocomial infection and 43% identified the main risk factors for its occurrence. Sixty-five percent identified staff hands as the main mode of cross-transmission of germs between patients. Sixty-four percent of staff reported using non-sterile gloves during urinary catheter insertion. Compliance with hand hygiene before patient contact was low (31.8%) while gloves changes between patients were observed in 87.2% of cases. Deficiencies were noted in adherence to aseptic techniques before performing invasive procedures. Non-compliance was mainly attributed to shortages of supplies and personnel, and insufficient knowledge of preventive measures. Conclusion: healthcare workers’ knowledge and adherence to hygiene practices in intensive care units were insufficient.

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Severe burns during pregnancy are rare but pose a danger to both the mother and the fetus. The management was multidisciplinary, involving an intensivist and an obstetrician. Maternal and fetal prognosis depends on the extent of body burns. We report the case of a 23-year-old woman, 28 weeks pregnant, hospitalized for a recent, severe, extensive burn, in order to demonstrate the prevalence and maternal and fetal outcomes of this combination.

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Introduction: The anesthetic strategy for esophageal surgery has evolved thanks to optimization of patient care from the preoperative phase to postoperative rehabilitation. The objective of this study was to describe the anesthetic management of esophagectomies for esophageal cancer at the Aristide Le Dantec University Hospital. Patients and Methods: We conducted a retrospective and descriptive study from January 2014 to December 2021. We included all patients who underwent anesthesia for esophagectomy for esophageal cancer. We studied the epidemiology, the anesthetic technique, analgesia and postoperative complications. Results: We collected data on 18 patients with a mean age of 45 years and a male-to-female ratio of 0.63. Patients were classified as ASA I (American Society of Anesthesiologists) in 27.77%, ASA II in 56.66% and ASA III in 16.66% of cases. General anesthesia was combined with epidural analgesia in 61.11% of cases. Intraoperative analgesia was maintained with fentanyl in 11 patients. The mean intraoperative blood loss was 150 ml. The mean duration of surgery was 3 hours and 40 minutes (range: 2 hours and 50 minutes to 6 hours and 30 minutes). The predominant postoperative analgesia protocol was a combination of paracetamol, nefopam and epidural analgesia. Postoperative morbidity was 50%, and postoperative mortality was 16.66%. Conclusion: Perioperative management of this surgical procedure through good preoperative assessment improves patient prognosis.

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Introduction: Effective postoperative analgesia is essential for early mobilization, rehabilitation, and patient satisfaction following total knee replacement (TKR). While continuous epidural analgesia remains a traditional technique, peripheral nerve blocks such as the continuous femoral triangle block and continuous adductor canal block have emerged as promising alternatives that may offer comparable analgesia with fewer side effects. Aim: To compare the efficacy, safety, opioid consumption, and functional outcomes of continuous epidural analgesia (CE), ultrasound-guided continuous femoral triangle block (CF), and continuous adductor canal block (AC) for postoperative analgesia after TKR. Materials and Methods: Sixty patients undergoing primary TKR were randomized into three equal groups: CE (n=20), CF (n=20), and AC (n=20). Baseline demographics, intraoperative variables, postoperative pain scores (VAS), opioid requirements, side effects, and functional outcomes were recorded and statistically analyzed. Results: Baseline characteristics and intraoperative variables were comparable among groups (p>0.05). CE provided marginally lower early pain scores, but this advantage diminished by 24–48 hours. Opioid consumption was significantly higher in the CF group, while the AC group required the least opioids (p<0.01). CE was associated with the highest incidence of hypotension (30%) and motor block (35%). Functional outcomes were superior in the AC group, with earlier ambulation (20 ± 4 hours) and lower quadriceps weakness (15%) (p<0.001). Patient satisfaction was highest in CE and AC groups, with clinically acceptable scores in all. Conclusion: All three modalities provided effective analgesia after TKR; however, the adductor canal block demonstrated the best balance between analgesia, safety, preserved motor function, and early mobilization. It appears to be a preferred option for enhanced recovery after TKR.

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Dyspnoea remains a common cause of emergency admissions in sub-Saharan Africa, where diagnostic delays are compounded by limited access to advanced imaging modalities. Point-of-care ultrasound (POCUS) is increasingly recognised as an essential tool for the rapid bedside evaluation of cardio-pulmonary disorders. We report the case of a 71-year-old man admitted to the Essos Hospital Centre emergency department with acute dyspnoea, fever, and hypoxaemia. Cardiac POCUS revealed right ventricular dilatation with paradoxical interventricular septal motion, while lung ultrasound demonstrated bilateral pleural effusions and a B-profile, immediately suggesting a dual pathology: acute pulmonary embolism and bilateral pleuro-pneumonia. Thoracic CT angiography confirmed a segmental embolus in the left lower lobe associated with a pleuro-pneumonia. Early initiation of anticoagulation and targeted antibiotic therapy, guided by POCUS findings, resulted in rapid clinical improvement. This case highlights the major diagnostic value of integrating cardiac and lung POCUS into emergency assessment, particularly in resource-limited African settings where imaging delays may compromise outcomes.

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Background and Aim: Dexmedetomidine, a selective alpha-2 adrenergic agonist, has been used to blunt various stress responses during general anaesthesia including that of pneumoperitoneum. It also has synergistic effects when used as an adjuvant with anaesthetic agents. Our study aimed to assess the efficacy of dexmedetomidine without any initial bolus at an infusion dose of 0.5 mcg/kg/hour, in attenuating the haemodynamic stress response to pneumoperitoneum in laparoscopic surgeries and evaluate the efficacy of its synergistic effects at this dose. Methods: 60 American Society of Anaesthesiologists physical status I/II patients, 18-60 years, undergoing elective laparoscopic surgery were randomized into 2 groups: Group I received dexmedetomidine and group II normal saline @ 0.5 mcg/kg/hour intravenously, started before premedication till the end of pneumoperitoneum. Heart rate and blood-pressure were monitored continuously. Anaesthetic agents and analgesics were titrated to maintain entropy of 40-60. Results: Compared to group II, group I showed significant blunting of HR and BP rise during entire duration of pneumoperitoneum (p<0.05). There was reduced requirement for propofol, fentanyl and isoflurane, showing significant MAC sparing effect (p<0.0001) in group I vs group II. Patients in group I also exhibited earlier emergence, without residual sedation (p<0.0001). Conclusion: Without any initial bolus, Dexmedetomidine infusion @0.5 mcg/kg/hour, when started timely before induction of pneumoperitoneum, effectively attenuated the hemodynamic stress response to pneumoperitoneum, significantly reduced anaesthetic/analgesic requirements exhibiting good synergistic effect, while maintaining depth of anaesthesia, resulting in early and smooth emergence. This dose achieves maximum efficacy with minimal side effects.

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Introduction: The perioperative management of an elderly patient is significantly particular due to age-related physiological and pharmacological changes. Emergency surgery in the elderly patient corresponds to a major and disturbing life event for the patient. Objective: To evaluate the perioperative management of abdominal surgical emergencies in elderly patients. Methodology: This is a retrospective, descriptive and analytical study conducted over 3 years from January 1st, 2022 to December 31th, 2024. We included in the study all patients aged 60 years and older who were operated on for a non-traumatic abdominal surgical emergency. Results: We collected and included 74 medical recording, representing a frequency of 2.5%. The sex ratio was 1.04. The average age was 71.5 years with extremes of 60 to 91 years. Patients were classified as ASA 2u in 59.4% and ASA 1u in 32.4%. Charlson’s index was on average 3.1 with extremes from 2 to 6. Surgeries were rated Altemeier 4 in 39.2%. The preoperative indications were dominated by acute bowel occlusions in 43.2%, strangulated abdominal wall hernias in 25.6%, acute peritonitis in 12.1% and acute appendicitis in 12.1%. Preoperative acute kidney injury was found in 27%. In the postoperative phase, 36.4% of patients were admitted to intensive care unit. The reasons for admission to intensive care unit were delayed awakening (64%), hypovolemic shock (9.5%) and respiratory distress (5.4%). The state of hypovolemic shock (12.1%), postoperative acute kidney injury (5.4%) and acute respiratory distress syndrome (5.4%) were the main postoperative complications. The evolution was favorable in 78.4% and the mortality was 21.6%. The causes of death were septic shock in 68.7% and cardiogenic shock in 31.3%. Factors associated with mortality were age, ASAu score, Charlson index, preoperative acute kidney injury (AKI), perioperative anuria, pulmonary inhalation, admission to intensive care unit, septic shock, postoperative AKI,