Immunotherapies application in active stage of systemic lupus erythematosus in pregnancy:A case report and review of literature

BACKGROUND Pregnancy in the setting of systemic lupus erythematosus can worsen thecondition from the stable to active stage, with quality of life and fertility desirebeing particular concerns. Pregnancy in the active stage of systemic lupuserythematosus (ASLE), although rare and complicated to manage, can be treatedfavorably with immunotherapies ifs used properly. Here we report such a successcase.CASE SUMMARY A 31-year-old primigravida patient, diagnosed with SLE seven years ago, wasinduced ASLE after a cold at 21 + weeks. The patient’s vital signs on presentationwere normal. Her laboratory exam was remarkable for significant proteinuria,liver and renal dysfunction, and low C3 and C4 levels. Infectious work-up wasnegative. The patient was diagnosed with ASLE. She was given immunosuppressiveagents (methylprednisolone, gamma globulin and azathioprine etc.)and plasma adsorption therapy, monitoring blood pressure every 8 h, fetal heartrate twice a day, and liver and renal function at least twice a week. Successfulmaternal and fetal outcomes are presented here.CONCLUSION Child-bearing in ASLE has become more promising, even for this difficult case ofASLE with multiple organ damage. Thorough antepartum counseling, cautiousmaternal-fetal monitoring, and multi-organ function monitoring bymultidisciplinary specialties are keys to favorable pregnancy outcomes.

Active Management of the Third Stage of Labour: Knowledge and Challenges of Obstetric Caregivers in Selected Health Facilities in Fako Division, Cameroon

Background: In Cameroon, the decrease in MMR (Maternal Mortality Ratio) from PPH (Postpartum Haemorrhage) despite the reported use of the Active Management of the Third Stage of Labour (AMTSL) is slower than what is required to achieve the Third Sustainable Development Goal (SDG3) hence the need to question obstetric caregivers’ competence in AMTSL, as well as the factors hindering its proper use. We therefore aimed to assess obstetric caregivers’ knowledge about AMTSL, as well as the determinants and barriers of AMTSL in selected hospitals in Fako Division, Cameroon. Methods: This was a hospital-based cross-sectional study of 150 participants recruited in 27 health facilities in Buea, Limbe and Tiko health districts from January 15, 2020, to March 31, 2020. Participants’ socio-demographic and qualification characteristics, knowledge and challenges, and the references guiding their practice of AMTSL were collected using a structured questionnaire. AMTSL knowledge was categorized as poor or good and the determinants of good AMTSL knowledge were evaluated. The data was analyzed in SPSS version 25.0. Results: Of the 150 caregivers interviewed, only 48.7% had good knowledge of AMTSL. In logistic models, participants’ use of AMTSL increased Good knowledge of AMTSL (AOR: 12.96, CI: 1.12 - 150.3, p = 0.04). Unavailability of drugs and/or equipment, insufficient staff coverage and lack of knowledge and training of the staff were the major challenges reported. Conclusion: Obstetric caregivers in Fako division have knowledge gaps and face numerous challenges in AMTSL use, which could account for the consistently high MMR from PPH. Filling this knowledge gap and mitigating the challenges of these caregivers would certainly accelerate progress towards the achievement of SDG3.

Biological Removal of Nitrogen Compounds at a Coke-Oven Effluent Stream

The steel company SSAB in Oxel?sund, Sweden operates a coke-oven plant and has since a long time operated an activated sludge plant for treatment of effluent water. Along with more stringent requirements on discharge quality, especially focusing on nitrogen compounds and a new consent value for total nitrogen discharge (< 30 ppm of total N) the company decided to operate a pilot plant facility to investigate two major issues: 1) To define the conditions and restrictions for nitrification of ammonia nitrogen in the water;2) To find out how efficiently a denitrification would perform. In order to find answers to these questions SSAB hired a pilot plant for testing. The test facility is based on a single sludge activated sludge reactor system for biological nutrient removal, with a reactor volume of 3.8 m3. After a test period of 5 months it was possible to draw reliable conclusions regarding the performance. The untreated wastewater has a high content of total nitrogen, around 240 ppm. The major nitrogen part is ammonia nitrogen, but an important fraction is found as thiocyanate nitrogen. The following main conclusions were drawn from the test operation: · It was found to be crucial that the solids retention time (SRT) was kept at a sufficiently high level. During the successful operation the SRT was in the range of 40 - 50 days;· It is desirable to have an equalization basin upstream the main biological reactor to meet short time peak loads, defined as both flow and pollution;· The major toxic risks for the biological process were high thiocyanate and ammonia concentrations in the raw wastewater;· The system showed however a good microbiological capacity to acclimatize to the prevailing conditions after the needed time;· The tests did not include an optimization of the oxygen supply with respect to nitrification;however it was evident that the oxygen level was sufficient to maintain a complete nitrification at normal operating conditions;· Once the nitrification was established it was also possible to reach a high degree of denitrification—as long as an external carbon source was applied;· It was found that both the cyanide nitrogen and especially the thiocyanate nitrogen were reduced by the process. The cyanide reduction is probably related both to precipitation by ferrous ions and biological transformation.

Scholar Plays an Active Role on International Diplomatic Stage

ON more than one occasion, Professor Yuan Ming has been mistaken for a man. It isn’t her appearance, but her high status in academe that confuses people. Yuan, 48, is president of the International Relations Research Institute of Beijing University, managing council member of the China Institute for Study of the United States, council member of the International Strategic Foundation of China and vice-director of the AsianPacific Research Center of Beijing University. Many people who had only heard of Yuan took it for granted that she was