Background: Emerging of anesthetics opens a new era to medical discipline in relieving patients' pain and stress when undergoing surgery but simultaneously exposes the healthcare personnel working in areas of anesthetics exposure to many adverse health effects including reproductive outcomes effects. Thus, this study aimed to assess the effect of inhalational anesthetics exposure on reproductive outcomes and its predictors among health care personnel in hospitals of Jimma zone public hospitals. Methods: A comparative cross-sectional study was conducted from May 01 to 30, 2021. We approached 483 healthcare personnel in Jimma zone public hospitals to partake in this study. Of this number, we recruited 292 healthcare personnel, comprising 146 exposed healthcare personnel and 146 unexposed healthcare personnel. Structured questionnaires were used to assess the reproductive outcomes. Data were entered into EPI-data version 4.6.1 and exported to SPSS version 24 for analysis. Binary logistic regressions were carried out to identify associated factors with reproductive outcomes. Statistical significance was declared using a p value <0.05. Results: The overall prevalence of bad reproductive outcome status was high (30.8%) and the prevalence was much higher among exposed HCPs (20.9%) when compared to unexposed HCPs (9.9%). Among a total of 292 HCPs the likelihood of occurred bad reproductive outcomes was higher among an exposed group (AOR=3.17, 95% CI: 1.40-7.16) and those who smoke cigarettes (AOR=8.44, 95% CI: 1.93-36.91). The occurrence rate of bad reproductive outcome was higher among 30-45h/week exposure (AOR=11.94, 95% CI: 1.25-24.95) if separately analyzed among exposed and age of couple above 41 years among unexposed (AOR=5.87, 95% CI: 1.56-22.06) were significantly associated with bad reproductive outcomes. Conclusion: Prevalence of bad reproductive outcomes was higher among exposed HCPs. Hence, it requires attention to create awareness about the danger of anesthetics exposure in the study setting, suggesting the need to further minimize the exposure.

Many developing economies have seen a rise in e-commerce activity within their borders, and a decline in income from traditional industries as a result of COVID-19, meaning the digital economy offers a potentially unexploited source of tax revenue. . As a result, more developing countries may soon begin adopting some sort of digital tax. The economic activities which may be subject to the Digital Services Tax (DST) may vary from country to country. It will, therefore, be necessary for businesses operating in multiple jurisdictions across developing countries to keep up with the changes in digital taxes. Before implementing a DST scheme, developing countries are advised to perform an in-depth cost-benefit analysis and due considerations. Some developing (and several developed) countries have already unilaterally implemented a “provisional” DST system. Other developing countries are on the process of implementing DST or have simply announced that they will implement a DST soon. Although most of the countries so far actively working on DST (are rich countries, a growing list of developing countries are joining the process. Some examples include the following: Malaysia, Indonesia, Kenya, Nigeria, Argentina and, Chile. It is important to mention that the literature on DST is very limited – although growing, and the evidence base around the economic impacts is particularly scarce. This is partly due to the quite recent nature of DST implementation. The evidence is even scarcer for developing countries – Due to these limitations, this rapid evidence review looks at different types of available literature – including reports and blogs issued by international financial institutions and development agencies. The rest of the report will give an overview of key proposed approaches to tax the digital economy, provide a very brief account of the economic impact of DST, provide a brief mapping of the implementation of digital service taxes in developing countries, provide a brief description of each DST system and about the economic impact of the DST, finally a brief account or attributes of a “good” DST system.

Background. Emergence delirium is a common and serious postoperative complication in older surgical patients. It occurs at any time in the perioperative period, during or immediately following emergence from general anesthesia. Unfortunately, it is highly associated with postoperative complications such as a decrease in functional capacity, prolonged hospital stay, an increase in health care costs, and morbidity and mortality. The goal of this study was to determine the prevalence of emergence delirium and associated factors among older patients who underwent elective surgery in the teaching hospitals of Ethiopia at the postanesthesia care unit in 2021. Methods. A multicenter prospective observational study was conducted at the postanesthetic care unit in the four teaching hospitals of Ethiopia. Older surgical patients admitted to the postanesthesia care unit who underwent elective surgery in the four teaching hospitals of Ethiopia were selected by using simple random sampling. Pretested structured questionnaire was used to collect data. Data were entered into EpiData (version 4.6) and exported to the SPSS (version 25.0). Binary logistic regression was used to identify factors independently associated with the emergence delirium. Results. Out of 384 older patients included in the study, the prevalence of emergence delirium was 27.6%. Preoperative low hemoglobin levels (AOR: 2.0, 95% CI; 1.77–3.46), opioid (AOR: 8.0, 95% CI; 3.22–27.8), anticholinergic premedications (AOR: 8.5, 95% CI; 6.85–17.35), and postoperative pain (AOR: 3.10, 95 CI; 2.07–9.84) at PACU were independently associated with emergence delirium. Conclusion. The prevalence of emergence delirium was high among older patients who underwent elective surgery. Opioid and anticholinergic premedication, low preoperative hemoglobin, and the presence of postoperative pain were independently associated with the emergence delirium. Adequate preoperative optimization and postoperative analgesia may reduce the prevalence of emergence delirium.

Background:The nature of COVID-19 transmission creates significant risks in surgical departments owing to the close contact of medical staff with patients, the limited physical environment of the operating room and recovery room, the possibility of shared surgical equipment and challenges in the delivery of surgical care in all surgical departments. Globally, studies have reported that the effects of the pandemic on surgical departments are profound, potentially long-lasting and extensive. To manage these effects, different local guidelines and recommendations have been developed, with potential differences in their effectiveness and implementation. Therefore, harmonized and effective national/international guidelines for specific surgical departments during perioperative periods are pertinent to curtail the infection, and will inevitably need to be adapted for consistent and sustainable implementation by all medical staff. The pattern of surgical patient care during the COVID-19 pandemic at Jimma Medical Center (JMC), Ethiopia, has not been explored yet. The present study aimed to describe the pattern of perioperative surgical patient care, equipment handling and operating room management during the COVID-19 pandemic at JMC. Methods: A cross-sectional study was conducted to describe the pattern of perioperative surgical patient care, equipment handling and operating room management during the COVID-19 pandemic at JMC, using five-point Likert scales (0, not at all; 1, rarely; 2, sometimes; 3, most of the time; 4, frequently). A total of 90 respondents [35 patients (five patients from each of seven surgical departments) and 55 healthcare providers (six professionals from each of nine units, including the center of sterility room and anesthesia)] who were available during the study period, selected by a convenience sampling technique with multistage clustering, participated in the study. Data were collected using a structured questionnaire via direct observation and face-to-face interviews with patients undergoing surgery, healthcare providers and hospital administrators, against the standard surgical patient care guidelines. The collected data were manually checked for missing values and outliers, cleared, entered into EpiData (v4.3.1) and exported to SPSS (v22) for analysis. The mean score of practice was compared among different disciplines by applying the unpaired t-test. The findings of the study were reported using tables and narration. A p-value of less than 0.05 was declared as statistically significant. Results: Despite the surgical care practice having changed during the COVID-19 pandemic in all service domains, it is not implemented consistently among different surgical departments owing to different barriers (lack of training on the updated guidelines and financial constraints). The majority of surgical staff were implementing the use of preventive measures against COVID-19, while they were practiced less among patients. The guidelines for surgical practice during the preoperative phase were well applie...

Background: A retropharyngeal abscess is a bacterial infection of the back of the throat. It rarely results in deadly complications such as mediastinitis and thoracic empyema from deep neck infections involving soft tissues of the face, arising from oropharyngeal infections, particularly dental caries. Thus, complicating retropharyngeal abscess extending to mediastinitis poses an increased risk of high mortality rate as a result of its significant invasive potential and the fact that the recognition and diagnosis must be made early, as this is usually delayed. Complicating retropharyngeal abscess increases airway compromise and difficult airway management during anesthesia. We present a 40-year-old, male patient who transferred from another primary hospital to our institution's surgical emergency outpatient department with a complaint of neck swelling of 10 days secondary to tooth extraction. He had a complaint of dull-itching pain, localized initially to the submandibular area and subsequently involving the oropharyngeal, neck, and descending to the chest and mediastinum. He was diagnosed with a complicated retropharyngeal abscess extending to the mediastinum (mediastinitis) and thoracic empyema as a complication of odontogenic infection in origin. Besides intravenous antimicrobial therapy, deep neck incision and drainage, and thoracotomy was done under general anesthesia. After adequate venous access and the patient positioned in head-up position, premedication was given. General anesthesia with an endotracheal tube was provided with a ready tracheostomy set. Inhalational induction was conducted and laryngoscopy was performed after the adequate depth of anesthesia was achieved. We experienced anticipated difficult intubation after induction. After multiple attempts, the tracheal tube was placed correctly by using a bougie. Halothane was used for maintenance anesthesia with intermediate-acting muscle relaxant under controlled ventilation. Conclusion: On top of a detailed review of the patient's history, physical examination, laboratory investigations, and imaging profiles; early recognition of the airway compromise from the complicated retropharyngeal abscess, and proper readiness to manage potentially challenging airway compromise, and difficult airway management during the perioperative period.