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obstetric References in Disadvantaged Environments: Case of References to the University Hospital Center of Kara, in Northern Togo

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Open Journal of obstetrics and gynecology 2024年第2期14卷 267-277页

作者： Kossi Edem Logbo-Akey Bassowa Akila Kofi Mawoulé Améwouho Ketevi Tina Yendoubé Pierre Kambote Dédé Régine Diane Ajavon Baguilane Djoauguibe Abdoul-Samadou Aboubakari Koffi Akpadza service de gynécologie-obstétrique CHU Kara Togo service de gynécologie-obstétrique CHU Campus Lomé Togo service de gynécologie-obstétrique CHU Sylvanus Olympio Lomé Togo service de gynécologie-obstétrique CHR Tomdé Kara Togo

Introduction: References are frequent and most often carried out in emergency situations. The objective of this study was to describe the epidemiological and clinical profile of obstetric referrals to the CHU-Kara. Methodology: This was a retrospective cross-sectional descriptive study conducted from September 1, 2022, to February 28, 2023, at CHU-Kara, focusing on obstetric referrals to the gynecology-obstetrics department. Result: 828 patients were referred for obstetric reasons out of 1295 admissions, representing a frequency of 63.9%. The average age was 25.04 years. They were primigravida (38.3%), unemployed (62.7%). Motorcycles were the main means of transportation, accounting for 53.1% of cases. The average distance to reach the referral center was 31.6 km, covered in an average of 71 minutes. In 40.7% of cases, patients had less than 4 prenatal consultations and were referred in peripartum (56.6%) for pre-eclampsia (14%), post-term pregnancy (11.8%), dystocia (10.5%). Eighty-six point nine percent (86.9%) of the referred patients were able to deliver during their stay in the department, of which 61.7% had vaginal deliveries. The maternal and perinatal mortality rates were 0.7% and 14.9%, respectively. conclusion: obstetric referrals to Kara University Hospital are frequent during the perpartum period and are often carried out by motorbike.

关键词： obstetric Referral Epidemiology Prognosis CHU-Kara

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obstetric Emergencies at the Kara University Hospital Maternity Ward: Sociodemographic, Etiological and Prognostic Aspects

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Open Journal of obstetrics and gynecology 2024年第1期14卷 69-76页

作者： Logbo-Akey Kossi Edem Bassowa Akila Ketevi Tina Kambote Yendoubé Patchidi Kibandou Amewouho Kofi Ajavon Dédé Régina Aboubakari Abdoul-Samadou service de gynécologie-obstétrique CHU Kara Université de Kara Kara Togo service de gynécologie-obstétrique CHU Campus Université de Lomé Lomé Togo service de gynécologie-obstétrique CHU Sylvanus Olympio Université de Lomé Togo Faculté des sciences de la santé Université de Lomé Lomé Togo service de gynécologie-obstétrique CHR Tomdé Université de Kara Togo

Introduction: obstetric emergencies are common throughout the world and more particularly in developing countries where they are responsible for high maternal-fetal mortality and morbidity. Objective: Study obstetric emergencies in the maternity ward of Kara University Hospital. Method: Retrospective and descriptive study from April 1, 2022 to March 30, 2023, carried out in the obstetrics and gynecology department of Kara University Hospital. Results: Eight hundred and thirty-five (835) obstetric emergencies were recorded out of 2215 admissions, i.e. a frequency of 37.7%. The average age of the patients was 26.7 with a range of 14 and 45 years. They were primigravidas (36.7%) and nulliparous (38.7%), referred (84.7%) and came from rural areas (72%). Emergencies occurred in the 3rd trimester in 74.1% and in parturients (54.1%). Preeclampsia (27%), cessation of progression of labor due to feto-pelvic disproportion (12.4%), postpartum hemorrhage (7.5%) constituted the main obstetric emergencies. In 44.8%, the delivery was carried out vaginally. Magnesium sulfate was the most used drug, i.e. 30.1%;followed by antihypertensive medications in 28.1%. Blood transfusion was performed in 24.3%. The evolution was simple in 90.9%. The maternal fatality rate was 1.6%. The perinatal case fatality rate was 12.3%. conclusion: obstetric emergencies are common, dominated by preeclampsia, stopping progress of labor and postpartum hemorrhages. They are responsible for high morbidity and mortality.

关键词： obstetric Emergency Kara University Hospital

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Female contraception: comparative Study of Biometrics and Vascularization of the Uterus at Sylvanus Olympio University Hospital (Togo)

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Open Journal of obstetrics and gynecology 2024年第1期14卷 162-174页

作者： Dédé Régine Diane Ajavon Metoukam Andrée Josiane Douaguibe Baguilane Ketevi Améyo Ayoko Logbo Akey Kossi Edem Kambote Yendoube M’bortche Bingo Amadou Abdoulatif Aboubakari Abdoul Samadou Faculty of Health Sciences University of Kara Kara Togo Faculty of Health Sciences University of Lomé Lomé Togo service de gynécologie obstétrique du CHU Sylvanus Olympio Lomé Togo

Female contraception uses both hormonal and non-hormonal methods. The aim of the study is to determine the impact of female contraception on uterine vascularisation and the endometrium. Method: It was a descriptive comparative study with an analytical aim. It took place at the University Clinic of obstetrics gynaecology and the Radiology and Medical imaging department of Sylvanus Olympio University Hospital in Lomé over a two-month period from May 15, 2023 to July 15, 2023. Group 1 included women using a modern contraceptive method and group 2 women not using a modern contraceptive method. Epidata 3.1 and R 4.0.4 software were used to process the data. Results: Each group included 50 women. There were no significant differences in uterine and endometrial biometrics. All women on contraception had their zone 1 vascularized, without vascularisation of zone 2, without significant difference with women without contraception The pulsatility index was greater than 3 in 51% (n = 51) of women, including 62.7% (n = 32) of women without contraception and 37.3% (n = 19) of women on contraception, with a statistically significant difference (p = 0.009). conclusion: contraceptive methods do not influence the biometry of the uterus. However, uterine artery Doppler indices can predict abnormal uterine bleeding.

关键词： contraception Endometrium Uterine Artery Doppler

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Massive abdominal muscle atrophy during prolonged mechanical ventilation: Implications for tracheostomy removal

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Journal of Intensive Medicine 2024年第1期4卷 133-135页

作者： Pascal Beuret Florian Michelin Audrey Tientcheu Laurane Chalvet Benedicte Philippon-Jouve Jean-Charles Chakarian Xavier Fabre service de Réanimation et Soins continus Centre Hospitalier de RoanneRoanneFrance

Introduction Maintaining the functional integrity of respiratory muscles is crucial for critically ill patients to be weaned from mechanical ventilation and decannulated if *** of the diaphragm is frequent in patients under mechanical ventilation and has been associated with a longer duration of weaning.[1,2]Studies on expiratory muscles are *** recent studies demonstrated the feasibility and reproducibility of ultrasound in measuring the thickness of abdominal muscles,[3,4]with one study showing abdominal muscle atrophy in 22%of mechanically ventilated critically ill patients during the first week of mechanical ventilation.[4]

关键词： critically mechanical abdominal

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Feasibility of smart intraocular lens

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International Journal of Ophthalmology(English edition) 2024年第7期17卷 1379-1380页

作者： Francisco Gonzalez CIMUS University of Santiago de CompostelaSantiago de Compostela 15782Spain service of Ophthalmology and IDIS Complejo Hospitalario Universitario de Santiago de CompostelaSantiago de Compostela 15706Spain

dear Editor,Wearable biosensors are monitoring implantable devices that provide real-time detection of biomarkers by means of non-invasive measurements[1].There is a high demand for novel sensors that can be comfortably used by the patients for clinical monitoring of ocular *** implanted into eyes have been improved and they have the capacity to monitor parameters such as intraocular pressure(IOP),and also have the possibility of recording lactic acid,glucose or cortisol levels[2-3].

关键词： intraocular clinical ocular

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QoS Routing Optimization Based on deep Reinforcement Learning in SDN

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computers, Materials & continua 2024年第5期79卷 3007-3021页

作者： Yu Song Xusheng Qian Nan Zhang Wei Wang Ao Xiong State Key Laboratory of Networking and Switching Technology Beijing University of Posts and TelecommunicationsBeijing100876China Marketing service Center State Grid Jiangsu Electric Power Co.Ltd.Nanjing220000China Customer service Center State Grid Co.Ltd.Nanjing211161China

To enhance the efficiency and expediency of issuing e-licenses within the power sector, we must confront thechallenge of managing the surging demand for data traffic. Within this realm, the network imposes stringentQuality of service (QoS) requirements, revealing the inadequacies of traditional routing allocation mechanismsin accommodating such extensive data flows. In response to the imperative of handling a substantial influx of datarequests promptly and alleviating the constraints of existing technologies and network congestion, we present anarchitecture forQoS routing optimizationwith in SoftwaredefinedNetwork (SDN), leveraging deep reinforcementlearning. This innovative approach entails the separation of SDN control and transmission functionalities, centralizingcontrol over data forwardingwhile integrating deep reinforcement learning for informed routing decisions. Byfactoring in considerations such as delay, bandwidth, jitter rate, and packet loss rate, we design a reward function toguide thedeepdeterministic PolicyGradient (DDPG) algorithmin learning the optimal routing strategy to furnishsuperior QoS provision. In our empirical investigations, we juxtapose the performance of deep ReinforcementLearning (DRL) against that of Shortest Path (SP) algorithms in terms of data packet transmission delay. Theexperimental simulation results show that our proposed algorithm has significant efficacy in reducing networkdelay and improving the overall transmission efficiency, which is superior to the traditional methods.

关键词： deep reinforcement learning SDN route optimization QoS

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Factors associated with decreased compliance after on-site extracorporeal membrane oxygenation cannulation for acute respiratory distress syndrome:A retrospective,observational cohort study

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Journal of Intensive Medicine 2024年第2期4卷 194-201页

作者： Sylvain Le Pape Florent Joly François Arrivé Jean-Pierre Frat Maeva Rodriguez Maïa Joos Laura Marchasson Mathilde Wairy Arnaud WThille Rémi coudroy Centre Hospitalier Universitaire de Poitiers Service de Médecine Intensive RéanimationPoitiersFrance INSERM Centre d'Investigation Clinique 1402 IS-ALIVE Research GroupUniversitéde PoitiersPoitiersFrance

Background Extracorporeal membrane oxygenation(ECMO)for acute respiratory distress syndrome(ARDS)is systematically associated with decreased respiratory system compliance(CRS).It remains unclear whether transportation to the referral ECMO center,changes in ventilatory mode or settings to achieve ultra-protective ventilation,or the natural evolution of ARDS drives this change in respiratory ***,we assessed the precise moment when CRS decreases after ECMO cannulation and identified factors associated with decreased *** To rule out the effect of transportation and the different modes of ventilation on CRS,we conducted a retrospective,single-center,observational cohort study from January 2013 to May 2020,on 22 patients with severe ARDS requiring on-site ECMO and ventilated in pressure-controlled mode to achieve ultra-protective *** was assessed at different time points ranging from 12 h before ECMO cannulation to 72 h after ECMO *** primary outcome was the relative change in CRS between 3 h before and 3 h after ECMO *** secondary outcomes included variables associated with the relative changes in CRS within the first 3 h after ECMO cannulation and the relative changes in CRS at each time *** CRS decreased within the first 3 h after ECMO cannulation(−28.3%,95%confidence interval[CI]:−38.8 to−17.9,Pdecrease was mild before and after these first 3 h after ECMO *** achieve ultra-protective ventilation,respiratory rate decreased in the mean by–13 breaths/min(95%CI:−15 to−11)and driving pressure by−8.3 cmH2O(95%CI:−11.2 to−5.3),resulting in decreased tidal volume by−3.3 mL/kg of predicted body weight(95%CI:−3.9 to−2.6)as compared to before ECMO cannulation(Pdecreased CRS after ECMO cannulation,whereas neither respiratory rate,positive end-expiratory pr

关键词： Acute respiratory distress syndrome Extracorporeal membrane oxygenation Driving pressure Respiratory compliance

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A comprehensive look at the psychoneuroimmunoendocrinology of spinal cord injury and its progression: mechanisms and clinical opportunities

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Military Medical Research 2024年第2期11卷 228-267页

作者： Miguel A.Ortega Oscar Fraile-Martinez Cielo García-Montero Sergio Haro Miguel Ángel Álvarez-Mon Diego de Leon-Oliva Ana M.Gomez-Lahoz Jorge Monserrat Mar Atienza-Pérez David Díaz Elisa Lopez-Dolado Melchor Álvarez-Mon department of Medicine and Medical Specialities University of Alcala28801 Alcala de HenaresSpain Ramón y Cajal Institute of Sanitary Research(IRYCIS) 28034 MadridSpain department of Psychiatry and Mental Health Hospital Universitario Infanta Leonor28031 MadridSpain service of Rehabilitation National Hospital for Paraplegic PatientsCarr.de la PeraledaS/N45004 ToledoSpain Immune System Diseases‑Rheumatology service and Internal Medicine University Hospital Príncipe de Asturias(CIBEREHD)28806 Alcala de HenaresSpain

Spinal cord injury(SCI)is a devastating and disabling medical condition generally caused by a traumatic event(primary injury).This initial trauma is accompanied by a set of biological mechanisms directed to ameliorate neural damage but also exacerbate initial damage(secondary injury).The alterations that occur in the spinal cord have not only local but also systemic consequences and virtually all organs and tissues of the body incur important changes after SCI,explaining the progression and detrimental consequences related to this ***(PNIE)is a growing area of research aiming to integrate and explore the interactions among the different systems that compose the human organism,considering the mind and the body as a *** initial traumatic event and the consequent neurological disruption trigger immune,endocrine,and multisystem dysfunction,which in turn affect the patient's psyche and *** the present review,we will explore the most important local and systemic consequences of SCI from a PNIE perspective,defining the changes occurring in each system and how all these mechanisms are ***,potential clinical approaches derived from this knowledge will also be collectively presented with the aim to develop integrative therapies to maximize the clinical management of these patients.

关键词： Spinal cord injury(SCI) Psychoneuroimmunoendocrinology(PNIE) Secondary injury Immunoinflammatory dysfunction Gut microbiota Translational opportunities

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Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico

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World Journal of Transplantation 2024年第2期14卷 76-87页

作者： Andrés Gómez-de León Yesica A López-Mora Valeria García-Zárate Ana Varela-constantino Sergio U Villegas-de Leon Xitlaly J González-Leal Raúl del Toro-Mijares Anna C Rodríguez-Zúñiga Juan F Barrios-Ruiz Victor Mingura-Ledezma Perla R colunga-Pedraza Olga G Cantú-Rodríguez César H Gutiérrez-Aguirre Luz Tarín-Arzaga Elías E González-López David Gómez-Almaguer Hematology service Universidad Autónoma de Nuevo LeónFacultad de Medicina y Hospital Universitario Dr.JoséEleuterio GonzálezMonterrey 64460Nuevo LeónMexico Hemato-logy service Clínica Gómez AlmaguerMonterrey 64710Nuevo LeónMexico Hematology service Instituto Tecnológico de Estudios Superiores de MonterreyTec SaludEscuela de Medicina Ignacio SantosMonterrey 64710Nuevo LeónMexico

BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly *** observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHSCT)in two of Mexico's largest public and private *** To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in *** In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from *** were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in *** payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and *** outcomes included overall survival(OS),categorized by residence,referral,and payment *** outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and cox proportional hazard regression *** software included SPSS and R with tidycmprsk *** Our primary outcome was overall *** included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients dia

关键词： Hematopoietic cell transplant Social determinants of health Geography Haploidentical Out-of-pocket Financial toxicity Survival Health services and outcomes Hematopoietic malignancy Aplastic anemia

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Optimal Scheduling of Regional Integrated Energy Systems considering Hybrid demand Response

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CSEE Journal of Power and Energy Systems 2024年第3期10卷 1208-1219页

作者： Ganyun Lyu Bin Cao dexiang Jia Nan Wang Jun Li Guangyu Chen department of Electrical Engineering Nanjing Institute of TechnologyNanjing 211167China State Grid Energy Research Institute co. LTDBeijing 102209China State Grid Integrated Energy service Group co. LTDBeijing 100032China IEEE CSEE

Flexible load can optimize the load curve,which is an important means to promote renewable energy *** peculiarities of electricity,heat,cooling and gas loads are analyzed in this paper,considering the fuzzy degree of human perception for water temperature,and the characteristic model of hot water load is *** the fuzzy degree of human perception of ambient temperature,the characteristic model of cooling load is established by using PMV and PPD ***,considering four combinations of cut load,translatable load,transferable load and alternative load,and considering the coupling relationship of composite parts,different response models of load are established *** the minimum cost of the system,including operation and compensation costs as the objective function,the optimization scheduling model of the regional integrated energy system is established,and the Gurobi solver is used for simulation analysis to solve the optimal output and load response curve of each piece of *** results show that the load curve can be optimized,the flexible regulation ability of the regional integrated energy system can be enhanced,the energy loss of the system can be reduced,and the wind power consumption ability of the system can be increased by considering the integrated demand response.

关键词： Alternative load day ahead optimal scheduling integrated demand response PMV and PPD index regional integrated energy system

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