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

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Open Journal of Nephrology 2024年第2期14卷 157-175页

作者： Kessy Shija Hindu Ibrahim Sylvia Jumbe Bushi Lugoba Stephen Mathew Kibusi Alphonce Chandika Department of Nephrology and Urology Benjamin Mkapa Hospital Dodoma Tanzania clinical Research and Innovation Benjamin Mkapa Hospital Dodoma Tanzania Outreach Services and clinical Coordination Benjamin Mkapa Hospital Dodoma Tanzania clinical Audit and Quality Assurance Benjamin Mkapa Hospital Dodoma Tanzania School of Nursing and Public Health University of Dodoma Dodoma Tanzania Executive Director Benjamin Mkapa Hospital Dodoma 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.

关键词： clinical presentation Treatment Outcomes Pregnancy-Related Acute Kidney Injury

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Incidence and clinical presentation of portal vein thrombosis in cirrhotic patients

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Hepatobiliary & Pancreatic Diseases International 2016年第5期15卷 499-503页

作者： Yasir Furkan Cagin Yahya Atayan Mehmet Ali Erdogan Firat Dagtekin Cemil Colak Division of Gastroenterology Medical Faculty Inonu University Malatya 44280 Turkey Division of Internal Medicine Medical Faculty Inonu University Malatya 44280 Turkey Division of Biostatistics and Medical Informatics Colak C Medical Faculty Inonu University Malatya 44280 Turkey

BACKGROUND: Portal vein thrombosis (PVT) is due to many risk factors, but its pathogenesis is still not clearly understood. To identify the risk factors for PVT, we analyzed the clinical characteristics and complications associated with PVT in cir-rhotic patients. METHODS: We studied patients with liver cirrhosis who were admitted to our unit from April 2009 to December 2014. The patients were divided into the PVT and non-PVT groups, and were compared by variables including gender, age, the etiology of cirrhosis, stage of cirrhosis, complications, imaging, and treatment. RESULTS: PVT was found in 45 (9.8%) of 461 cirrhotic pa-tients admitted to our hospital. Most patients (45.9%) had hepatitis B virus (HBV)-related cirrhosis, with a similar dis-tribution of etiologies between the groups. However, there was no positive relationship between PVT and etiologies of cirrhosis. Most patients (71.5%) were in the stage of hepatic decompensation. No statistically signiifcant differences were found in complications including esophageal varices, ascites, and hepatic encephalopathy between the groups. However, there was a signiifcant positive correlation between hepatocel-lular carcinoma (HCC) and PVT (P CONCLUSIONS: The incidence of PVT was 9.8%, mainly in patients with HBV-related cirrhosis. The development of PVT was associated with the severity of liver disease and HCC.

关键词： portal vein thrombosis cirrhosis clinical presentation

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

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Open Journal of Obstetrics and Gynecology 2023年第8期13卷 1432-1451页

作者： Nzometia Crysantus Yimlefack Foumane Pascal Dohbit Julius Sama Kenn Chi Ndi Daniel Tarh Ketchen Claude Hector Mbia Robinson Enow Mbu Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaoundé Cameroon

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. Conclusi

关键词： HELLP Syndrome clinical presentation Management Maternal and Fetal Outcomes

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clinical presentation of Ovarian Tumors

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Open Journal of Obstetrics and Gynecology 2016年第4期6卷 205-209页

作者： Qamarunissa Muhabat Fakharunissa Waheed Waqarunissa Nigar Jabeen Department of Obstetrics & Gynecology Aga Khan Maternity & Child Care Hospital Hyderabad Sindh Pakistan Department of Obstetrics & Gynecology Indus Tando M. Khan Hyderabad Sindh Pakistan Department of Obstetrics &Gynecology Isra University Hospital Hyderabad Sindh Pakistan Department of Obstetrics & Gynecology Aga khan Maternity & Child Care Hospital Hyderabad Sindh Pakistan

Ovarian malignancy is a serious disease affecting women of all ages, more so above 50 years, and they are still difficult to treat, partly because no truly effective therapy has yet been developed although presentation is often vague and non-specific, the symptoms are definitely present. It is important to recognize the symptoms so far, there is no test yet available, which is truly specific and suitable for screening and early detection of epithelial ovarian carcinoma. So, it is concluded that for prognosis and patient survival, early detection and treatment is mandatory.

关键词： Ovaries Ovarian Tumor clinical presentation

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Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome

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World Journal of Gastroenterology 2007年第3期13卷 432-437页

作者： Haridimos Markogiannakis Evangelos Messaris Dimitrios Dardamanis Nikolaos Pararas Dimitrios Tzertzemelis Panagiotis Giannopoulos Andreas Larentzakis Emmanuel Lagoudianakis Andreas Manouras Ioannis Bramis 1~(st) Department of Propaedeutic Surgery Hippokration Hospital Athens Medical School University of Athens Vasilissis Sofias 114 Avenue Athens 11527 Greece

AIM: To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of bowel ischemia, necrosis, and perforation. METHODS: This is a prospective observational study of all adult patients admitted with acute mechanical bowel obstruction between 2001 and 2002. RESULTS: Of the 150 consecutive patients included in the study, 114 (76%) presented with small bowel and 36 (24%) with large bowel obstruction. Absence of passage of flatus (90%) and/or feces (80.6%) and abdominal distension (65.3%) were the most common symptoms and physical finding, respectively. Adhesions (64.8%), incarcerated hernias (14.8%), and large bowel cancer (13.4%) were the most frequent causes of obstruction. Eighty-eight patients (58.7%) were treated conservatively and 62 (41.3%) were operated (29 on the first day). Bowel ischemia was found in 21 cases (14%), necrosis in 14 (9.3%), and perforation in 8 (5.3%). Hernias, large bowel cancer, and adhesions were the most frequent causes of bowel ischemia (57.2%, 19.1%, 14.3%), necrosis (42.8%, 21.4%, 21.4%), and perforation (50%, 25%, 25%). A significantly higher risk of strangulation was noticed in incarcerated hernias than all the other obstruction causes. CONCLUSION: Absence of passage of flatus and/or feces and abdominal distension are the most common symptoms and physical finding of patients with acute mechanical bowel obstruction, respectively. Adhesions, hernias, and large bowel cancer are the most commoncauses of obstruction, as well as of bowel ischemia, necrosis, and perforation. Although an important proportion of these patients can be nonoperatively treated, a substantial portion requires immediate operation. Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia, necrosis, and perforation is significantly high.

关键词： Acute mechanical bowel obstruction clinical presentation Etiology Management Outcome

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Wernicke encephalopathy clinical presentation and MR images in two nonalcoholic patients

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Neural Regeneration Research 2008年第4期3卷 461-464页

作者： He Zhang Jun Wu Zhiping Hu Bo Xiao Guoliang Li Department of Neurology Xiangya Second Hospital Central South University Changsha 410011 Hunan Province China Department of Neurology Xiangya Hospital Central South University Changsha 410011 Hunan Province China

The aim of the present study was to investigate the importance of and correlation between clinical presentations and magnetic resonance imaging （MRI） of two different cases of nonalcoholic Wernicke encephalopathy. Case l ： A 63-year-old man with a diagnosis of incomplete mechanical intestinal obstruction. His abdominal symptoms were improved by gastrointestinal decompression, but blurred vision, hypoacusis, dizziness, and unsteady gait were noted. His illness deteriorated to confusion on day seven. MRI showed hyperintense lesions in the medial thalami, tectum of the midbrain, and the periaqueduct region on T2- and diffusion-weighted images. Thiamine therapy was commenced immediately with good results. Case 2： A 22-year-old woman was admitted for sudden-onset confabulation and unsteady gait after hyperemesis gravidarum. She had no history of alcohol or any medication. Brain MRI was normal. The patient experienced relief after Vitamin B1 treatment. These results suggest that brain MRI can define characteristic abnormalities in Wernicke encephalopathy, and that diffusion-weighted imaging may improve the diagnosis sensitivity. In addition, the MRI images may be correlated to the clinical stage and severity of the disease. Nevertheless, the clinical features are essential for correct diagnosis.

关键词： wernicke encephalopathy magnetic resonance imaging clinical presentation

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Chlorfenapyr poisoning:mechanisms,clinical presentations,and treatment strategies

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World Journal of Emergency Medicine 2024年第3期15卷 214-219页

作者： Ji Cheng Yulu Chen Weidong Wang Xueqi Zhu Zhenluo Jiang Peng Liu Liwen Du Emergency Department Ningbo No.2 HospitalNingbo 315010China

BACKGROUND:Chlorfenapyr is used to kill insects that are resistant to organophosphorus *** poisoning has a high mortality rate and is difficult to *** article aims to review the mechanisms,clinical presentations,and treatment strategies for chlorfenapyr *** RESOURCES:We conducted a review of the literature using PubMed,Web of Science,and SpringerLink from their beginnings to the end of October *** inclusion criteria were systematic reviews,clinical guidelines,retrospective studies,and case reports on chlorfenapyr poisoning that focused on its mechanisms,clinical presentations,and treatment *** references in the included studies were also examined to identify additional ***:We included 57 studies in this *** can be degraded into tralopyril,which is more toxic and reduces energy production by inhibiting the conversion of adenosine diphosphate to adenosine *** fever and altered mental status are characteristic clinical presentations of chlorfenapyr *** it occurs,respiratory failure occurs immediately,ultimately leading to cardiac arrest and *** poisoning is diflcult to treat,and there is no specific ***:Chlorfenapyr is a new pyrrole *** it has been identified as a moderately toxic pesticide by the World Health Organization(WHO),the mortality rate of poisoned patients is extremely *** is no specific antidote for chlorfenapyr ***,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.

关键词： Chlorfenapyr poisoning Mechanism clinical presentation Treatment

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clinical presentations of gastric small gastrointestinal stromal tumors mimics functional dyspepsia symptoms

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World Journal of Gastroenterology 2014年第33期20卷 11800-11807页

作者： Qing-Xiang Yu Zhan-Kun He Jiang Wang Chao Sun Wei Zhao Bang-Mao Wang Department of Gastroenterology Tianjin Medical University General Hospital

AIM: To explore whether clinical presentations of gastric small gastrointestinal tumors (GISTs) mimics gastrointestinal dyspepsia symptoms.

关键词： Gastric small gastrointestinal stromal tumor Gastric leiomyoma clinical presentation Endoscopic ultrasonography

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Characteristics and clinical presentations of pediatric 0retinoblastoma in North-western Iran

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International Journal of Ophthalmology(English edition) 2012年第4期5卷 510-512页

作者： Reza Nabie Nazli Taheri Ali Mahdavi Fard Rohollah Fadaei Fouladi Department of Ophthalmology Nikookari Eye Hospital Tabriz University of Medical SciencesTabriz Iran Department of Ophthalmology Alavi Eye Hospital Tabriz University of Medical SciencesTabriz Iran Imam Reza Hospital Tabriz University of Medical SciencesTabriz Iran

·AIM:To report the characteristics and clinical presentations of retinoblastoma in a series of pediatric patients from Iran. ·METHODS:In this retrospective study, profiles of pediatric patients with retinoblastoma archived in a referral eye hospital in north-west of Iran during 7 years (n =40 patients with 57 eyes) were reviewed. Demographics, as well as the laterality, clinical manifestations and the types of treatment were the major endpoints. The Student’s t test, Mann-Whitney U -test, Chi-square or Fishers’ Exact test was used for analysis where appropriate. ·RESULTS:There were 23 cases (57.7%) with unilateral and 17 cases (42.5%) with bilateral involvement. The male to female ratio was 1 to 1.4 with a mean admitting age of 24.0±11.3 (range:5-62) months. The mean diagnosis delay was (7.4±9.6) months (range:10 days to 13 months). The most common presenting sign was leukocoria (97.5%) followed by proptosis (7.5%), strabismus (7.5%), hyphema (5%), orbital cellulitis (5%) and glaucoma (2.5%). Enucleation was performed in 95.7% of the cases with unilateral involvement and at least one eye of the patients with bilateral disease. A second enucleation was performed in other 3 patients (17.6%) of the latter group. ·CONCLUSION:This is the first study evaluating a series of Iranian children with retinoblastoma.

关键词： retinoblastoma epidemiology clinical presentation

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Celiac disease:diagnostic criteria in progress

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Cellular & Molecular Immunology 2011年第2期8卷 96-102页

作者： U Volta V Villanacci Department of clinical Medicine St Orsola-Malpighi University HospitalBolognaItaly Department of Pathology Spedali CiviliBresciaItaly

Until a few years ago,celiac disease(CD)was thought to be a rare food intolerance that was confined to childhood and characterized by severe malabsorption and flat intestinal ***,CD is regarded as an autoimmune disorder that is common in the general population(affecting 1 in 100 individuals),with possible onset at any age and with many possible *** identification of CD is challenging because it can begin not only with diarrhea and weight loss but also with atypical gastrointestinal(constipation and recurrent abdominal pain)and extra-intestinal symptoms(anemia,raised transaminases,osteoporosis,recurrent miscarriages,aphthous stomatitis and associated autoimmune disorders),or it could be completely *** the last 20 years,the diagnostic accuracy of serology for CD has progressively increased with the development of highly reliable tests,such as the detection of IgA tissue transglutaminase and antiendomysial and IgG antideamidated gliadin peptide *** routine use of antibody markers has allowed researchers to discover a very high number of‘borderline’cases,characterized by positive serology and mild intestinal lesions or normal small intestine architecture,which can be classified as potential ***,it is evident that the‘old celiac disease’with flat mucosa is only a part of the spectrum of *** is possible that serology could identify CD in its early stages,before the appearance of severe intestinal *** cases with a positive serology but with mild or absent intestinal lesions,the detection of HLA-DQ2 and HLA-DQ8 can help reinforce or exclude the diagnosis of gluten sensitivity.

关键词： celiac disease clinical presentation diagnostic criteria histology,genetics serology

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