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.

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.

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.

Late presentation of dural tears:Two case reports and review of literature

BACKGROUND The late presentation of dural tears(LPDT)has a low incidence rate and hidden symptoms and is easily ignored in clinical practice.If the disease is not treated in time,a series of complications may occur,including low intracranial pressure headache,infection,pseudodural cyst formation,and sinus formation.Here,we describe two cases of LPDT.CASE SUMMARY Two patients had sudden fever 1 wk after lumbar surgery.Physical examination showed obvious tenderness in the operation area.The patients were confirmed as having LPDT by lumbar magnetic resonance imaging and surgical exploration.One case was caused by continuous negative pressure suction and malnutrition,and the other was caused by decreased dural ductility and low postoperative nutritional status.The first symptom of both patients was fever,with occasional headache.Both patients underwent secondary surgery to treat the LPDT.Dural defects were observed and dural sealants were used to seal the dural defects,then drainage tubes were retained for drainage.After the operation,the patients were treated with antibiotics and the patients’surgical incisions healed well,without fever or incision tenderness.Both recovered and were discharged 1 wk after the operation.CONCLUSION LPDT is a rare complication of spinal surgery or neurosurgery that has hidden symptoms and can easily be overlooked.Since it may cause a series of complic-ations,LPDT needs to be actively addressed in clinical practice.

Unusual Presentation of a Large Multi-Septated Cystic Hygroma: A Case Report and Comprehensive Literature Review

Background: Cystic hygromas are primarily found in the cervicofacial, thoracic, and abdominal regions, with limited occurrences in other areas. Despite existing literature on this condition, comprehensive descriptions and MRI findings of cystic hygromas in the extremities are rare. Aim: This case report aims to present a unique instance of a cystic hygroma in the left thigh. The objective is to provide detailed insights into the characteristics of this atypical presentation. Case Presentation: The case involves a 2-year-10 month-old girl with a cystic hygroma in her left thigh. The report includes a comprehensive description of the lesion’s clinical features and diagnostic evaluation, emphasizing the MRI findings to enhance understanding of this rare occurrence. Conclusion: This case report highlights the rarity of cystic hygromas outside the cervicofacial, thoracic, and abdominal regions, explicitly focusing on the occurrence in the left thigh. By presenting detailed insights into the clinical features, MRI findings, histopathological findings, and the surgical approach employed, this report contributes to the existing knowledge on this condition in atypical locations and informs future treatment strategies.

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.

An Incidental Finding and Unusual Presentation of Atypical Coccidioidomycosis in a 72-Year-Old Man: A Case Report

This case report presents an unusual and challenging diagnostic scenario involving a 72-year-old man who recently returned from a trip to Maui, Hawaii. While in Maui, the patient presented with a fever and fatigue that resolved spontaneously. However, he had an observable rash on his head and was given a steroid injection to resolve the rash. Later on his trip, the patient experienced a dry, nonproductive cough which resolved with a five-day course of prednisone. While visiting Michigan, the patient began to experience neck pain and visited Troy Beaumont Hospital for further treatment. Meningitis tests were negative. Vancomycin was given due to the detection of gram positive coccidioidomycosis in the culture, but this was later proven to be a contaminant. Coccidiomycosis does not initially have specific symptoms. Despite negative coccidioidomycosis antigen tests, the patient exhibited features more consistent with blastomycosis and cryptococcus, highlighting the complexities of diagnosing fungal infections with atypical presentations. The case emphasizes the importance of considering alternative fungal pathogens native to endemic regions and pursuing comprehensive diagnostic measures to establish an accurate diagnosis. Lastly, the discussion about recommendations for antifungal therapy and preventative measures for individuals at risk of respiratory fungal infections is critically important for the advancement of early detection of fungal infections.

PRESENTATION在ESL课堂上的应用

PRESENTATION作为第二外语教学课堂交际活动的一种形式,已经得到越来越广泛地应用。本文作者论述了PRESENTATION应用于第二外语课堂教学的理论依据,介绍了它的优势,并且谈到了教师的策划及组织工作。对于PRESENTATION的准备及内容编排也做了较为详尽的阐述。

提高高校文科课堂教学效能的实证研究——基于Presentation教学法

以Presentation为主的互动教学法的实证探索,对提高课堂教学效能的实践效果,特别是对学生挑战权威意识、批判性阅读和批判性思维学术研究能力和发现、分析、解决问题、团队合作能力的提高进行质与量的分析,说明以Presentation为主的互动教学法是提高高校文科课堂效能的有效方法,并对其教学的效能的提高提供可操作的保障性建议。

Presentation在“电磁场与电磁波”教学中的应用研究

本文探讨了Presentation教学法在专业基础课"电磁场与电磁波"课堂教学中的适用性和特点。教学实践结果表明:课堂中采用Presentation教学法,调动了学生学习的自主性和积极性,实现了良好的教学效果,为学生后续课程的学习奠定了良好基础。

Presentation在“摄影测量学”教学中的应用研究

以国家精品课程"摄影测量学"建设为契机,将美英等国普遍采用的Presentation教学法应用于"摄影测量学"课堂教学中,结合多年教学实践,探讨了Presentation教学法在专业教学中的适用性以及存在的优缺点。

美国课堂中Presentation的启示

本文通过对美国大学里教学活动的观察和对学生及教师的采访 ,分析了部分亚洲学生与美国学生对 presentation表现出巨大差异的原因。通过实践证明 ,积极地使用presentation这种教学手段会有效地培养学生的学习自主性、创造性和独立思考能力。

Presentation工具在大学英语口语教学中的应用

presentation作为大学英语教学的一种手段,有利于调动学生的学习兴趣,促进师生互动,活跃课堂气氛,更重要的是,学生参与或主导presentation过程,则可以有效地提高学生的口语能力,使大学英语口语教学成为真正的素质教育。本文介绍了presentation的几种常用工具,分析了各自的优缺点,以及应用中应该注意的问题。

学生Presentation在《英语国家概况》课程中的应用与思考——以宁波教育学院为例

《英语国家概况》是我校应用英语专业开设的一门专业必修课,针对这门课程自身内容的特点,结合我校英语专业人才培养目标,文章提出课程改革模式即学生Presentation在该课程中应用,并对改革实践中的问题提出相应的对策。

工业工程基础Presentation教学方法研究

结合"工业工程基础"的课程特征、教学对象和教学目标,探讨了Presentation教学法应用于"工业工程基础"课程本科教学中的具体实施步骤和方法。借助问卷调查和分析教学记录,对一个学期的教学实施效果进行了评估,结果表明,Presentation教学法能够激发学生的学习兴趣,锻炼学生发现、分析和解决问题的能力,提高学生自主学习与团队合作能力,是提高"工业工程基础"本科教学效能的有效方法。

Presentation教学方法在高职英语教学中的应用

在高职英语课堂教学过程中,Presentation是一种重要的教学方法,通过presentation课堂活动的展开,可以充分发挥学生主体作用,调动学习积极性、主动性,提高学生综合能力。本文对presentation的概念、理论依据、实施过程、教学注意事项和教学效果评价进行了分析。

Presentation教学法在护理专业英语教学中的应用

[目的]探讨Presentation教学法在护理专业英语教学中的应用效果。[方法]采用小组汇报的形式,引导学生收集相关英文资料,制作多媒体课件,并用英语进行课堂陈述。教学活动结束后应用自行设计的调查问卷对教学效果进行评价。[结果]94%的学生赞同这种教学方法,88%的学生提高了学习兴趣,84%的学生专业英语综合能力得到了提高。[结论]Presentation教学法能激发学生学习的兴趣,锻炼学生自主学习能力,引导学生学会分享与合作,取得良好的教学效果。

跨文化视角的Presentation在英语教学中的应用

Presentation作为一种交际教学法的手段,可有效地应用于英语教学中。乌克兰和中国高校英语课堂使用presentation进行教学存在共性和差异。在使用Presentation时,教师可根据课程特点设置不同的情境指导学生。

Presentation:高职中澳合作专业课程教学的有效方法

Presentation目前被广泛应用于高职中澳合作专业课程教学中,是培养学生综合能力的一种有效方法。本文旨在将教学理论与实践相结合,通过探讨Presentation的理论基础、Presentation在高职中澳合作专业课程教学中的具体应用以及Presentation的各项功能,来促进对该方法的深入研究,从而完善高职中澳合作专业课程教学。