Background The intensive care unit (ICU) is a health care delivery service for patients who are in critical condition with potentially recoverable diseases. Patients can benefit from more detailed observation, monitoring and advanced treatment than other wards or department. The care is advancing but in resource-limited settings, it is lagging far behind and mortality is still higher due to various reasons. Therefore, we aimed to determine the admission patterns, clinical outcomes and associated factors among patients admitted medical intensive care unit (MICU). Methods A retrospective cross-sectional study was conducted based on a record review of logbook and charts of patients admitted from September, 2015 to April, 2019. Data were entered and analysed using SPSS version 20. Both bivariate and multivariate logistic regression analyses were used and a P-value < 0.05 was considered statistically significant. Results A total of 738 patients were admitted to medical intensive care unit (MICU) during September, 2015 - April, 2019. Five hundred and four patients (68%) of all intensive care unit (ICU) admissions had complete data. Out of the 504 patients, 268 (53.2%) patients were females. Cardiovascular disease 182(36.1%) was the commonest categorical admission diagnosis. The overall mortality rate was 38.7%. In the multivariate analysis, mortality was associated with need for mechanical ventilation (AOR = 5.87, 95% CI: 3.24 - 10.65) and abnormal mental status at admission (AOR = 2.8, 95% CI: 1.83-4.29). Patients who had stay less than four days in MICU were 5 times more likely to die than those who has stay longer time (AOR= 5.58, 95% CI: 3.58- 8.69). Conclusions The overall mortality was considerably high and cardiovascular diseases were the most common cause of admission in MICU. Need for mechanical ventilator, length of intensive care unit stay and mental status at admission were strongly associated with clinical outcome of patients admitted to medical intensive care unit.

This systematic review was conducted according to the Preferred Reporting Items for Systematic review and meta-analysis (PRISMA) protocol. Search engines like PubMed through HINARI, Cochrane database, GoogleScholar and ScienceDirect were used to find high-level evidence that helps to draw appropriate conclusions. Potassium is a critical electrolyte for cellular functions and its serum concentration must be precisely maintained between 3.5 and 5.5 mEq/L. A multidisciplinary approach is crucial to identify and optimise high risk surgical patients prone to hyperkalemia during preoperative assessment. Elective surgery should be deferred in patients with serum potassium level >6 mEq/L during and appropriate management should be initiated. Given the variable presentation of hyperkalemia, clinicians should have high index of suspicion of potassium disorders among patients with chronic kidney disease, poorly controlled diabetes mellitus, burns, recent major trauma and blood transfusion. In high risk surgical patients with a normal range of serum potassium level drugs like suxamethonium and Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided. Goal direct fluid regimes with 0.9% normal saline, a high threshold for blood transfusion and tight glycemic controlled are recommended. IV calcium gluconate, insulin -dextrose regime and diuretics are the main therapeutic options in patients with severe hyperkalemia. Highlights:

BackgroundCesarean section (CS) has been one of the most frequently performed major surgical interventions and causes severe postoperative pain. Spinal opioid and abdominal field block have been investigated as effective analgesia for postoperative pain and reduce the need for systemic medications and associated side effects. The aim of the current study is to compare spinal morphine (SM) and bilateral landmark oriented transversus abdominis plane (TAP) block for postoperative pain management.MethodIn this randomized controlled trial, 114 pregnant mothers scheduled for CS under spinal anesthesia were allocated randomly to receive either SM 0.1 mg (group SM; n = 56) or bilateral landmark-oriented TAP block with 20 ml of 0.25% of bupivacaine (group TAP; n = 52). A comparison of numerical variables between study groups was done using unpaired student t-test and Mann–Whitney test for symmetric and asymmetric data, respectively. Time to event variable was analyzed by using Kaplan–Meir's survival function. A p-value of &lt; 0.05 was considered statistically significant.ResultA total of 114 patients were recruited and randomly assigned and received interventions. Among them, 108 patients completed this study. Time to first analgesic request was significantly shorter in the TAP block compared to SM. Twenty-four-hour median morphine consumption was reduced in the SM group compared to the TAP block (p &lt; 0.001). Median postoperative pain score during movement and rest shows statistically significant differences between groups (p &lt; 0.001).ConclusionThe addition of preservative-free 100 μg SM provides prolonged postoperative analgesia time, superior postoperative analgesia, and less postoperative opioid consumption compared to the TAP block.

Background: The prevalence of maternal obesity has increased globally and more than 70% of overweight pregnant women occurred in upper middle income and lower middle income countries. In Ethiopia, the proportion of overweight and obesity among women has increased from 3% in 2000 to 8% in 2016. This indicates that the prevalence of maternal obesity is increasing both globally and in our country. This review summarized recent findings on anesthetic implications of morbid obesity in pregnancy. Objectives: This study aimed to identify the clinical implication of morbid obesity during pregnancy on anesthesia management for pregnant women. Methodology: Literature was searched from electronic databases (including PubMed, Google Scholar, CINAHL, and Cochrane database of systematic reviews that are published in English language from 2010 to 2021. Conclusion: Obesity and pregnancy are both factors that complicate anesthesia management. Airway management is a challenge for all obese parturients because their short safe apnea time and altered anatomical changes. Apneic oxygenation and ramped position create better intubating condition by increasing safe apnea time and improved the laryngeal view. Use of a hierarchical, opioid-sparing pain management approach to provide effective analgesia in morbidly obese parturients as opioids has increased risk of respiratory complications and abdominal field blocks may technically difficult. Highlights

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