Clinical Presentation and Treatment Outcomes of Pregnancy-Related Acute Kidney Injury among Pregnant Women Admitted at the Benjamin Mkapa Hospital in Tanzania

Background: Globally, PRAKI is among the leading causes of death in pregnant women. The prevalence, causes and outcome of this condition vary among countries due to differences in environmental, socioeconomic, and health delivery systems. The common causes that have been reported in several studies are PIH, Haemorrhages and Sepsis while the outcomes may be either complete renal recovery, progression to CKD and hence dialysis dependency or death. This study aimed at determining clinical presentation and treatment outcomes of Pregnancy-Related Acute Kidney Injury in Pregnant women admitted at the Benjamin Mkapa Hospital, Dodoma, Tanzania. Results: Out of 4007 pregnant women who were admitted to the maternity ward 51 pregnant women were found to have PRAKI. Of those with PRAKI, 74.5% were between 21 to 25 years. The leading causes of PRAKI were PPH 12 (23.53%), Eclampsia 12 (23.53%), and pre-eclampsia 12 (23.5%). Hemodialysis therapy was provided to 22 (43.1%) patients, 15 (29.4%) individuals recovered spontaneously with medical management and 14 (27.5%) missed haemodialysis therapy due to various reasons. The mortality due to PRAKI was 17 (33.3%). Conclusion and Recommendation: Pre-eclampsia/eclampsia and post-partum haemorrhage were found to be the main causes of PRAKI. The mortality related to PRAKI is high and Hemodialysis therapy is vital help to prevent deaths for pregnant women with PRAKI. Pregnant women who develop acute kidney injury should be followed closely and a nephrologist should be consulted early. Early referral should be done by the lower level facilities for all at-risk pregnant women to a specialized multidisciplinary health facility.

Clinical Presentation, Management and Materno-Fetal Outcome of Patients with HELLP Syndrome at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital

Background: HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome is a common complication of severe preeclampsia, with a high maternal and perinatal mortality rate. Data on HELLP syndrome is scanty in our setting. We sought to study the clinical presentation, management, and materno-fetal outcome of patients with HELLP syndrome at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital (YGOPH). Methods: This was a cross-sectional, analytical study with a retrospective data collection of patients, diagnosed with HELLP syndrome at the YGOPH between 1st January 2020 and 31st July 2021. Data were analyzed using the software R version 4.0.2. Results are presented as mean ± standard deviation, frequencies and percentages. P values < 0.05 were considered statistically significant. Results: Of 254 cases of severe preeclampsia, 17 developed HELLP syndrome, giving us a frequency of 6.7%. One patient who presented with hepatitis B was excluded. The mean age was 27.19 ± 6.44 years. Most patients (56.3%) had poor follow up during antenatal contacts. The most common symptom was headache (93.8%). Most cases (56.3%) were diagnosed during post-partum, prepartum (25.0%), and per partum (18.8%). Obstetrical management was done by cesarean section (62.5%) and vaginal delivery (37.5%). Post-partum management of HELLP syndrome consisted of antihypertensive medication, anticonvulsants, sedatives, transfusion of blood and blood products, and fluid resuscitation. Of the 50% of patients who presented with acute kidney injury, only 12.5% (1) were referred for dialysis. Over 50% of our study participants presented severe complications after delivery, but 43.8% recovered, while 56.2% finally died. The fetal outcome was: still birth (31.2%), intra-uterine growth restriction/low birth weight (12.5%), term delivery (≥37 weeks) (31.3%), and preterm deliveries (<37 weeks) (68.7%). Three (18.8%) of the neonates delivered alive presented with a poor Apgar score at the 5th minute. Conclusion: Although rare, HELLP syndrome exists in our setting. Proper management in appropriate centers is key to improving maternal and fetal outcomes.

The Present Situation of Chattel Guarantee System and Its Improvements—Taking the Angle of American Uniform Commercial Code(UCC)

Although there are appropriate stipulations for the chattel guarantees in the law of China, this guarantee system could not adapt to the request of economy's development because of the following reasons: the scope of chattel guarantees is narrow according to relevant stipulations; the transaction cost of the chattel is high; mortgage registration of chattel is in a mess; lack of efficiently executive guarantee system, etc. To counter the problems existing in the present Chinese chattel guarantee system, in this article, the author proposed some corresponding suggestions and countermeasures, hoping to perfect the chattel guarantee system in China.

Chlorfenapyr poisoning:mechanisms,clinical presentations,and treatment strategies

BACKGROUND:Chlorfenapyr is used to kill insects that are resistant to organophosphorus insecticides.Chlorfenapyr poisoning has a high mortality rate and is difficult to treat.This article aims to review the mechanisms,clinical presentations,and treatment strategies for chlorfenapyr poisoning.DATA RESOURCES:We conducted a review of the literature using PubMed,Web of Science,and SpringerLink from their beginnings to the end of October 2023.The inclusion criteria were systematic reviews,clinical guidelines,retrospective studies,and case reports on chlorfenapyr poisoning that focused on its mechanisms,clinical presentations,and treatment strategies.The references in the included studies were also examined to identify additional sources.RESULTS:We included 57 studies in this review.Chlorfenapyr can be degraded into tralopyril,which is more toxic and reduces energy production by inhibiting the conversion of adenosine diphosphate to adenosine triphosphate.High fever and altered mental status are characteristic clinical presentations of chlorfenapyr poisoning.Once it occurs,respiratory failure occurs immediately,ultimately leading to cardiac arrest and death.Chlorfenapyr poisoning is diflcult to treat,and there is no specific antidote.CONCLUSION:Chlorfenapyr is a new pyrrole pesticide.Although it has been identified as a moderately toxic pesticide by the World Health Organization(WHO),the mortality rate of poisoned patients is extremely high.There is no specific antidote for chlorfenapyr poisoning.Therefore,based on the literature review,future efforts to explore rapid and effective detoxification methods,reconstitute intracellular oxidative phosphorylation couplings,identify early biomarkers of chlorfenapyr poisoning,and block the conversion of chlorfenapyr to tralopyril may be helpful for emergency physicians in the diagnosis and treatment of this disease.

Recent Advances for Global Perspectives on Etiology, Pathophysiology, Clinical Presentations, and Management of Moyamoya Disease

Moyamoya disease (MMD) is a condition characterized by the gradual narrowing and blockage of blood vessels in the brain, specifically those in the circle of Willis and the arteries that supply it. This results in reduced blood flow and oxygen to the brain, leading to progressive symptoms and potential complications. The underlying pathophysiological mechanism remains elucidated. However, recent studies have highlighted numerous etiologic factors: abnormal immune complex responses, susceptibility genes, branched-chain amino acids, antibodies, heritable diseases, and acquired diseases, which may be the great potential triggers for the development of moyamoya disease. Its clinical presentation has varying degrees from transient asymptomatic events to significant neurological deficits. Moyamoya disease (MMD) shows different patterns in children and adults. Children with MMD are more susceptible to ischemic events due to decreased blood flow to the brain. Conversely, adults with MMD are more prone to hemorrhagic events involving brain bleeding. Children with MMD may experience a range of symptoms including motor impairments, sensory issues, seizures, headaches, dizziness, cognitive delays, or ongoing neurological problems. Although adults may present with similar clinical symptoms as children, they are more prone to experiencing sudden onset intraventricular, subarachnoid, or intracerebral hemorrhages. One of the challenges in moyamoya disease is the potential for misdiagnosis or delayed diagnosis, particularly when physicians fail to consider MMD as a possible cause in stroke patients. This review aims to provide a comprehensive overview of recent global studies on the pathophysiology of MMD, along with advancements in its management. Additionally, the review will delve into various surgical treatment options for MMD, as well as its rare occurrence alongside atrioventricular malformations. Exciting prospects include the use of autologous bone marrow transplant and the potential role of Connexin 43 protein treatment in the development of moyamoya disease.

Evaluating the role of large language models in inflammatory bowel disease patient information

This letter evaluates the article by Gravina et al on ChatGPT’s potential in providing medical information for inflammatory bowel disease patients.While promising,it highlights the need for advanced techniques like reasoning+action and retrieval-augmented generation to improve accuracy and reliability.Emphasizing that simple question and answer testing is insufficient,it calls for more nuanced evaluation methods to truly gauge large language models’capabilities in clinical applications.

DYNAMIC CHARACTERISTICS OF PRESENT PRODUCTIVITY FOR CULTIVATED LAND IN THE FARNMING-PASTORAL ZONE OF INNER MONGOLIA

In this article, the distribution of cultivated land, the changes ofcultivated land productivity, and regional differentiation of the Change forpresent productivity in the Farming-Pastoral Zone, Inner Mongolia arediscussed. Then, the close relationship between dynamic characterlsticsdivision and atmospheric circulation systems is revealed. Finally, based ondynamic characteristics, four regions are divided, including thenortheastem area, the eastern area, the western area, and the middle area.

Research on Strategies for Enhancing the Ability of Chinese German Learners to Tell Chinese Stories Through Short Videos

In the age of new media,short videos play an increasingly important role in international cultural exchange.However,German learners often encounter challenges when producing and sharing short videos due to factors such as technology and language proficiency.Such challenges can affect the professionalism and attractiveness of the videos.This study focuses on German learners at the University of Shanghai for Science and Technology.The aim of this study is to investigate students’experiences in producing short videos,identify issues through surveys and interviews,and concentrate on editing skills,language proficiency,and intercultural communication abilities.It proposes strategies for developing these skills and aims to provide insights for German and other foreign language learners in telling Chinese stories using short videos.

Neurotrophic factor therapy for Parkinson's disease: past, present and future

One of the greatest unmet needs in the treatment of Parkinson’s disease（PD）is a disease-modifying therapy,which can halt the ongoing degeneration of dopaminergic neurons that is characteristic of this disorder.Current therapies focus on managing symptoms,rather than on addressing their cause.Promising candidates for disease-modifying therapies are the dopaminergic neurotrophic factors（NTFs）.

The ChatGPT After: Building Knowledge Factories for Knowledge Workers with Knowledge Automation

Briefing: This perspective introduces the concept and framework of knowledge factories with knowledge machines for knowledge workers to achieve knowledge automation for Industry 5.0 and intelligent industries.Introduction The big hit of Chat GPT makes it imperative to contemplate the practical applications of big or foundation models [1]-[5]. However, as compared to conventional models, there is now an increasingly urgent need for foundation intelligence of foundation models for real-world industrial applications.

The Prevention of Blindness-Past, Present and Future

Prevention of blindness is the most important aim of ophthalmology. Prevention of blindness is related to many factors. It is related to many factors, such as science and technology, economy and social behavior. There are worldwide activities by WHO, NGOs and other functions to promote the prevention of blindness in the world. More than 90% of blind population lives in developing world. Cataract is the top causes of blindness which is curable. Onchocerciasis is an endemic disease in west Africa and cent...

Celebrating the 70th Anniversary--National University of Defense Technology,1953-2023 Special Section on Complex Systems Theory and Practice

In the 21st century,a new round of scientifi c and technological revolution represented by digitalization,networking and intelligence has caused a change in the scientific research paradigm,and the research of complex systems has become the main driving force for the change of the scientific research paradigm.

Old Geographical Materialities. Recover the Past and the Heritage in the Present of Pheripherical European Rural Spaces: A Research Proposal

The past has had a minor consideration in geographic studies the transformation of rural areas,usually dominated by socioeconomic analysis.Incorporating the old and in many cases,the materialities of the past through a reconsideration of heritage to the future of rural space requires an adequate conceptualization and reconsideration of rural materialities and especially of popular housing.In this way,it is intended to decentralize the human and functionalist point of view to give a life of their own to rural cultural and natural materialities in the context of more-than-human-geographies.The renewed study of heritage and the historical past acquires a notable value in the present and future of rural areas through:(1)the interpretation of dissymmetrical realities where the old confronts new activities;(2)for adequate and realistic management of rural heritage and the processes of selective recovery of heritage in certain historical places.

Stroke care in the ChatGPT era:Potential use in early symptom recognition

Dear editor,Generative Pre-trained Transformer-based Chatbot(ChatGPT)[1]or similar natural language processing[2]and large language models[3]are artificial intelligence systems designed to understand and respond to human languages,allowing them to provide information,answer questions,and provide guidance on a wide range of topics.One of their key benefits is immediate access to information in a conversational format,as if a hotline call,which is essential in acute medical conditions.Currently,medical utilization of ChatGPT is a hot research topic.Because its intrinsic difference from search engines,ChatGPT has the potential to revolutionize our mode of information access.

Expert Perception of ChatGPT in the Field of Education

问题1:您是如何得知Chat GPT的?您使用它的原因是什么?回答:大概在一两个月前,我通过媒体和朋友得知了Chat GPT,并且从那之后开始关注Chat GPT相关方面的一些信息。因为我身边有许多朋友都在从研究的角度探求如何更好地使用Chat GPT,所以我很好奇这个最新出现的人工智能会给我们的生活、对各级各类学校的教师、对学术工作者,甚至对未来的社会带来怎样的改变。

What to do when it is breech? A state-of-the-art review on management of breech presentation

Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.

Nanluoguxiang Alley A Blend of the Past and Present

TOURISTS traveling to Beijing always have the Great Wall,Tiananmen Square and the Forbidden City on their must-see list.But what if you have already seen the sights?Then it’s time to explore the ancient capital’s hutongs.Featured this issue is Nanluoguxiang Alley,one of downtown Beijing’s best preserved hutongs.With its grey-walled courtyard homes,it offers a real taste of traditional city life. Located several kilometers north of the Forbidden City and east of Houhai Lake, Nanluoguxiang Alley is a 786-meter-long and 8-meter-wide lane.It stretches northsouth from Gulou East Street to Di’anmen East Street.

ChinAfrica presents selected Chinese cities with a brief introduction about what makes them interesting,and what makes them tick

YichangTHE city of Yichang can attest that not all excit- ing sports are modern. Each year, it hosts the China Dragon Boat Rally, which draws teams from all over the country to compete in traditional dragon boat races.

ChinAfrica presents selected Chinese cities with a brief introduction about what makes them interesting,and what makes them tick

LOCATED in the northwest of southwest China＇s Yunnan Province, Lijiang has two faces - one scenic, and the other urban. Its multifaceted nature makes it a perfect Valentine＇s Day destination for sun-seeking couples and singles alike.