Background Assessement of the pattern of admission and treatment outcomes of critically ill pediatrics admitted to pediatric intensive care units (PICU) in developing countries is crucial. In these countries with resource limitations, it may help to identify priorities for resource mobilization that may improve patient service quality. The PICU mortality rate varies globally, depending on the facilities of the intensive care unit, availability of experties, and admission patterns. This study assessed the admission pattern, treatment outcomes, and associated factors for children admitted to the PICU. Methods A retrospective cross-sectional study was implemented on 406 randomly selected pediatrics patients admitted to the PICU of Tikur Anbessa Specialized Hospital from 1-Oct-2018 to 30-Sept-2020. The data were collected with a pretested questionnaire. A normality curve was used to check for data the distribution. Both bivariable and multivariable analyses were used to see association of variables. A variable with a p-value of < 0.2 in the bivariable model was a candidate for multivariate analysis. The strength of association was shown by an adjusted odds ratio (AOR) with a 95% Confidence interval (CI), and a p-value of < 0.05 was considered statistically significant. Frequency, percentage,and tables were used to present the data. Results A total of 361 (89% response rate) patient charts were studied, 197 (54.6%) were male, and 164(45.4%) were female. The most common pattern for admission was a septic shock (27.14%), whereas the least common pattern was Asthma 9(2.50%). The mortality rate at the pediatric intensive care unit was 43.8%. Moreover, mechanical ventilation need (AOR = 11.2, 95%CI (4.3–28.9), P < 0.001), need for inotropic agents (AOR = 10.7, 95%CI (4.1–27.8), P < 0.001), comorbidity (AOR =8.4, 95%CI (3.5–20.5), P < 0.001), length of PICU stay from 2 to 7 days (AOR = 7.3, 95%CI (1.7–30.6), P = 0.007) and severe GCS (< 8) (AOR = 10.5, 95%CI (3.8–29.1), P < 0.001) were independent clinical outcome predictors (mortality). Conclusion The mortality rate at the PICU was 43.8%. Septic shock, and meningitis were the common cause of death and the largest death has happened in less than 7 days of admission.

Background During transverses abdominal plane block (TAP) procedure to provide analgesia in cesarean section (CS) operation, the use of perineural dexamethasone as an additive agent may improve pain relief and may cause a prolonged block duration. This study aims to investigate whether perineural dexamethasone, when added to bupivacaine local anesthetic agent during a TAP block, may provide adequate pain relief without adverse events. Methods This is a prospective cohort study of fifty-eight patients undergoing elective CS with spinal anesthesia. We hypothesized to perform bilateral TAP block using perineural dexamethasone as an additive agent. The patients were randomly divided into two groups using a systematic random sampling method. While one group of patients received perineural dexamethasone of 8 mg additive agent together with bupivacaine 0.25% 40 ml (Group TAPD), the other group received only bupivacaine 0.25% 40 ml in TAP block (Group TAPA). The primary outcomes are the period for the first request of postoperative pain relief medication and the numerical rating scale (NRS) pain intensity scores at 2, 6, 12, and 24 h after surgery. The secondary outcomes are comparing the 24-h tramadol and diclofenac analgesic requirements and the incidences of side effects on postoperative day one. A p-value of < 0.05 is statistically significant. Results The time to first analgesic request was 8.5 h (8.39–9.79) in the TAPD group versus 5.3 h (5.23–5.59) in the TAPA group, respectively. (p < 0.001) The median NRS scores were significantly reduced in the TAPD group compared to the TAPA group at 6, 12, and 24 h after surgery (p-values < 0.001). The total analgesics consumption over 24 h postoperatively was lower in Group TAPD compared to Group TAPA (p < 0.05). Conclusion An additive agent of perineural dexamethasone at a dose of 8 mg during bilateral TAP block for elective CS operation under spinal anesthesia provided better pain relief on postoperative day 1.

Background: Most of the time propofol and ketamine have been used as an induction agent in adult surgical patients but propofol may cause cardiorespiratory depression while ketamine increases heart rate and arterial blood pressure. On the other hand, the clinical effects of propofol and ketamine seem to be complementary. Ketofol is most commonly used for procedural sedation hence exploring its effectiveness for induction will be paramount for the clinical care of surgical patients. Objective: This study aims to compare the hemodynamic changes between ketofol and propofol within 30 min after induction of general anesthesia for elective surgical patients. Methodology: A Double-blind Randomized Controlled Trial was done on 62 patients aged between 18 and 65 years and the American Society of Anesthesiologist class I & II those have been allocated randomly into ketofol and propofol groups. A change in systolic blood pressure, mean arterial pressure, and heart rate within 30mins was followed for both groups. After the normal distribution of data was tested analytic statistics were calculated for variables in the study using Mixed ANOVA, Independent samples T-test, and Mann Whitney U test as appropriate, and for categorical data Chi-square test or fisher's exact test was used for analysis. P-value < 0.05 is considered statistically significant with a power of 90%. Results: Both the mean systolic blood pressure and mean arterial pressure were significantly decreased in the propofol group immediately after induction, at 5th minute, 10th minute, and 15th minute compared to the baseline value with a statistically significant value of (p < 0.05). There was a significant increase in mean heart rate in the ketofol group immediately after induction and on the 5th minute after induction compared to the baseline value (p = 0.001 and p = 0.022 respectively). Conclusion and recommendations: We conclude the administration of ketofol (0.75 mg/kg of ketamine and 1.5 mg/kg of propofol) for induction of general anesthesia has better hemodynamic stability than propofol during the first 30 min after induction. We recommend to researchers to do further randomize controlled trials, with invasive blood pressure measurement and multicenter study. Highlights

Background: Post Spinal Anesthesia Shivering (PSAS) is common side effect during spinal anesthesia. Shivering could be treated with tramadol or meperidine. However, comparative effectiveness of the two drugs has not been assessed in our institution. Study objective: To evaluate effectiveness of meperidine versus tramadol on post spinal anesthesia shivering in mothers under go cesarean section. Methods: This prospective observational cohort study was conducted on74 ASA II and III obstetric mothers from December 20-March 20, 2017/18. Patients with PSAS received IV tramadol (0.5 mg/kg) or meperidine 0.5 mg/kg as independent decision of responsible anesthetist. Then they were followed for time of cessation of shivering, reoccurrence of shivering, hemodynamic changes, and occurrence of side effects such as sedation, nausea and vomiting. The collected data were entered Epi Info version 7.0 and exported to SPSS version 22. The mean difference of categorical data was analyzed with the Chi-Square test. Independent samples t-test or Mann-Whitney U test was used to evaluate numerical data -value less than 0.05 were considered statistical significance. Results: The mean time to ceased shivering was 4.45 ± 3.18 min and 3.08 ± 1.30 min in meperidine and tramadol groups, respectively (p = 0.021). The hemodynamic changes like mean arterial pressure (MAP), heart rate (HR), arterial saturation (SpO2) and body temperature changes were all comparable between the two groups. Recurrence of shivering after treatment was less in tramadol group 6 (16.2%) than meperidine group 9 (24.3%). Sedation, nausea and vomiting were reported as a side effect in both groups with no statistical significant (p > 0.05). Sedation was higher in Meperidine group 9 (24.3%) than tramadol group 3 (8.1%). Nausea and vomiting were found to be higher in tramadol group 9 (24.3%) than meperidine group 3 (8.1%). Conclusions: Both tramadol and meperidine effectively controlled shivering in clients during cesarean section under spinal anesthesia. Tramadol offered rapid onset, less recurrence and less sedation as a side effect when compared to meperidine. Highlights

Background Poorly controlled blood glucose is prevalent and contributes to the huge burden of diabetes related morbidity, and central obesity has a great role in the pathogenesis of diabetes and its adverse complications, which could predict such risks, yet evidence is lacking. Hence, this paper is to evaluate the predictive performance of central obesity indices for glycemic control among adult patients with diabetes in eastern Ethiopia. Methods A survey of 432 randomly chosen patients with diabetes was conducted using a pretested questionnaire supplemented by chart review, anthropometrics, and biomarkers by trained data collectors. The poor glycemic control was assessed using a fasting blood glucose (FBS) level of above 130 and/or an HgA1c level above 7%. Weight, height, waist circumference (WC), and hip circumference (HC) were measured under standard procedures and we calculated waist-to-hip circumference ratio (WHR) and waist-to-height ratio (WHtR). The receiver operating characteristics curve was used to assess the predictive performance of obesity indices for glycemic control using area under the curve (AUC) and corresponding validity measures. Results A total of 432 (92%) patients with diabetes were enrolled with a mean age of 49.6 (±12.4) years. The mean fasting blood glucose level was 189 (±72) mg dl-1 where 330 (76.4%) (95% CI: 74.4–78.4%) and 93.3% of them had poor glycemic control based on FBS and HgA1c, respectively. WC (AUC = 0.90; 95% CI: 0.85–0.95), WHR (AUC = 0.64; 95% CI: 0.43–0.84), and WHtR (AUC = 0.87; 95% CI: 0.83–0.94) have a higher predictive performance for poor glycemic control at cut-off points above 100 cm, 0.95, and 0.62, respectively. However, obesity indices showed a lower predictive performance for poor glycemic control based on FBS. Body mass index (BMI) had a poor predictive performance for poor glycemic control (AUC = 0.26; 95% CI: 0.13–0.40). Conclusions Poor glycemic control is a public health concern and obesity indicators, typically WC, WHR, and WHtR, have a better predictive performance for poor glycemic control than BMI.