Large retroperitoneal hematoma following vaginal delivery: a case report

Abstract Background Retroperitoneal hematoma after vaginal delivery is rare but can lead to maternal morbidity and mortality. Diagnosis of this condition is challenging due to its complexity and its nonspecific signs and symptoms. To date, studies and case reports regarding retroperitoneal hematoma are few, particularly in low-income countries where risk factors for this condition may be more prevalent and the prognosis poorer. Case presentation We report the case of a 37-year-old multiparous african (Congolese) woman who presented to the emergency department of a large referral hospital in Bukavu, Democratic Republic of the Congo (DRC), 2 weeks after a spontaneous nontraumatic vaginal delivery. She had abdominal pain that began immediately after delivery and progressed throughout the postpartum period. The patient had anemia, hypotension, tachycardia, and a left costo-lumbar arch distorting the body shape on a soft and depressed abdomen. She had visited a private clinic on days 3 and 7 postpartum; however, signs and symptoms of retroperitoneal hematoma went unrecognized. Using abdominal ultrasound, we diagnosed an extensive hematoma in the retroperitoneal space from the left iliac fossa to the left flank. Laparotomy was performed to evacuate the hematoma, and the patient recovered. Conclusion Retroperitoneal hematoma following a nontraumatic vaginal delivery is an unusual situation in general obstetrical practice. The knowledge of this potentially life-threatening condition in resource-limited settings enables effective diagnosis and management by ultrasound and laparotomy.

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Histoplasmosis caused by Histoplasma capsulatum var. duboisii: a comprehensive review of cases from 1993 to 2019

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1304 ◽

2020 ◽

Author(s):

M Develoux ◽

F M Amona ◽

C Hennequin

Keyword(s):

Low Income ◽

Endemic Area ◽

Histoplasma Capsulatum ◽

Case Reports ◽

Bone Infection ◽

Low Income Countries ◽

Diagnostic Tools ◽

Cutaneous Lesions ◽

Comprehensive Search ◽

Therapeutic Alternatives

Abstract Background Histoplasmosis caused by Histoplasma capsulatum var. duboisii (Hcd) is a rare, but probably underestimated, endemic infection described in intertropical Africa. Therefore, the epidemiology of the infection remains unclear, and there is no consensus on therapeutic management Methods Using a comprehensive search on different internet databases, we collected case reports of Hcd infection published from 1993 to 2019. Epidemiological, clinical charts and therapeutic strategies were analyzed Results We found 94 well-documented cases of Hcd infection, and 30.1% of the patients were under 18. Symptoms occurred in some patients several decades after leaving the endemic area. Cutaneous/sub-cutaneous lesions, bone infection, and lymphadenopathies, isolated or combined, were the most frequent presentations. The human immunodeficiency virus (HIV) co-infection rate was at 20.8% with fever, lymphadenopathies and absence of bone infection being the differentiating elements from HIV-negative patients. The rate of disseminated forms (60.6% in our review) significantly increased as compared to studies published before 1993 but without correlation with HIV infection. The global mortality rate was at 23.4% by the end of follow-up. The outcome was not correlated with the antifungal drug prescribed nor with the HIV serologic status but with the initiation of an antifungal therapy Conclusion Hcd histoplasmosis is a severe fungal infection for which the precise mode of acquisition remains to be determined. There is a need for affordable and more specific diagnostic tools. Itraconazole and amphotericin B are the best therapeutic alternatives and should be available in all low-income countries of the endemic area

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Medication Bezoars: A Literature Review and Report of a Case

Annals of Pharmacotherapy ◽

10.1345/aph.17420 ◽

1998 ◽

Vol 32 (9) ◽

pp. 940-946 ◽

Cited By ~ 55

Author(s):

James R Taylor ◽

Daniel S Streetman ◽

Sharon S Castle

Keyword(s):

Risk Factors ◽

English Language ◽

Case Reports ◽

Relevant Literature ◽

Significant Risk ◽

Signs And Symptoms ◽

The Body ◽

Surgical Removal ◽

Diagnostic Challenge ◽

Medline Search

OBJECTIVE: To describe a case of a medication bezoar and to review the clinical presentation, diagnosis, risk factors, pathogenesis, complications, and treatment of medication bezoars. DATA SOURCES AND STUDY SELECTION: A MEDLINE search (January 1966–December 1997) of the English-language literature pertaining to bezoars was performed. These articles were scanned, and literature specifically discussing medication bezoars was selected. Additionally, the reference sections of pertinent review and case reports were scanned for additional relevant literature. DATA SYNTHESIS: Bezoars are concretions of foreign material within the body. In the case of medication bezoars, these concretions occur within the digestive tract and are composed of medications and/or medication vehicles. Rarely, however, is bezoar formation solely due to a medication. In nearly all reported cases the patient had one or more significant risk factors that contributed to bezoar formation. The exact method by which medication bezoars form is dependent on the particular type or combination of medications involved. Bezoar formation may be associated with significant complications for the patient due to the presence of the bezoar and because of the effects of the medication within the bezoar. Treatment of medication bezoars depends largely on the location and the cause of the bezoar. CONCLUSIONS: Medication bezoars are a rare but potentially serious complication of medication use in certain patients. These patients often present with signs and symptoms consistent with an obstruction of the gastrointestinal tract and represent an even greater diagnostic challenge due to the rarity of this complication. These patients also face significant complications from both the bezoar and the medication within the bezoar. To date, treatment of medication bezoars involves mainly physical manipulation of the bezoar through lavage, endoscopic removal, or, in most cases, surgical removal.

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Rumor surveillance in support of minimally invasive tissue sampling for diagnosing the cause of child death in low-income countries: A qualitative study

PLoS ONE ◽

10.1371/journal.pone.0244552 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244552

Author(s):

Md Saiful Islam ◽

Abdullah Al-Masud ◽

Maria Maixenchs ◽

Saquina Cossa ◽

Rui Guilaze ◽

...

Keyword(s):

Minimally Invasive ◽

Cause Of Death ◽

Low Income ◽

Child Death ◽

The Body ◽

Low Income Countries ◽

Tissue Sampling ◽

Middle Income ◽

Additional Information ◽

Tissue Specimens

In low-and middle-income countries, determining the cause of death of any given individual is impaired by poor access to healthcare systems, resource-poor diagnostic facilities, and limited acceptance of complete diagnostic autopsies. Minimally invasive tissue sampling (MITS), an innovative post-mortem procedure based on obtaining tissue specimens using fine needle biopsies suitable for laboratory analysis, is an acceptable proxy of the complete diagnostic autopsy, and thus could reduce the uncertainty of cause of death. This study describes rumor surveillance activities developed and implemented in Bangladesh, Mali, and Mozambique to identify, track and understand rumors about the MITS procedure. Our surveillance activities included observations and interviews with stakeholders to understand how rumors are developed and spread and to anticipate rumors in the program areas. We also engaged young volunteers, local stakeholders, community leaders, and study staff to report rumors being spread in the community after MITS launch. Through community meetings, we also managed and responded to rumors. When a rumor was reported, the field team purposively conducted interviews and group discussions to track, verify and understand the rumor. From July 2016 through April 2018, the surveillance identified several rumors including suspicions of organs being harvested or transplanted; MITS having been performed on a living child, and concerns related to disrespecting the body and mistrust related to the study purpose. These rumors, concerns, and cues of mistrust were passed by word of mouth. We managed the rumors by modifying the consent protocol and giving additional information and support to the bereaved family and to the community members. Rumor surveillance was critical for anticipating and readily identifying rumors and managing them. Setting up rumor surveillance by engaging community residents, stakeholders, and volunteers could be an essential part of any public health program where there is a need to identify and react in real-time to public concern.

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A comprehensive review on clinical and mechanistic pathophysiological aspects of COVID-19 Malady: How far have we come?

Virology Journal ◽

10.1186/s12985-021-01578-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Baila Shakaib ◽

Tanzeel Zohra ◽

Aamer Ikram ◽

Muhammad Bin Shakaib ◽

Amna Ali ◽

...

Keyword(s):

Case Reports ◽

Case Series ◽

Signs And Symptoms ◽

Organ Damage ◽

Underlying Disease ◽

The Body ◽

Host Cells ◽

Irreversible Damage ◽

Organ Systems ◽

Wide Range

AbstractSince its outbreak in 2019, the coronavirus disease (COVID-19) has become a pandemic, affecting more than 52 million people and causing more than 1 million mortalities globally till date. Current research reveals a wide array of disease manifestations and behaviors encompassing multiple organ systems in body and immense systemic inflammation, which have been summarized in this review. Data from a number of scientific reviews, research articles, case series, observational studies, and case reports were retrieved by utilizing online search engines such as Cochrane, PubMed, and Scopus from December 2019 to November 2020. The data for prevalence of signs and symptoms, underlying disease mechanisms and comorbidities were analyzed using SPSS version 25. This review will discuss a wide range of COVID-19 clinical presentations recorded till date, and the current understanding of both the underlying general as well as system specific pathophysiologic, and pathogenetic pathways. These include direct viral penetration into host cells through ACE2 receptors, induction of inflammosomes and immune response through viral proteins, and the initiation of system-wide inflammation and cytokine production. Moreover, peripheral organ damage and underlying comorbid diseases which can lead to short term and long term, reversible and irreversible damage to the body have also been studied. We concluded that underlying comorbidities and their pathological effects on the body contributed immensely and determine the resultant disease severity and mortality of the patients. Presently there is no drug approved for treatment of COVID-19, however multiple vaccines are now in use and research for more is underway.

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How is magnetic resonance imaging used in Iran?

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462308080598 ◽

2008 ◽

Vol 24 (04) ◽

pp. 452-458 ◽

Cited By ~ 7

Author(s):

Mohammad Palesh ◽

Sten Fredrikson ◽

Hamidreza Jamshidi ◽

Goran Tomson ◽

Max Petzold

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Low Income ◽

Spinal Column ◽

The Body ◽

Low Income Countries ◽

Resonance Imaging ◽

Utilization Patterns ◽

Magnetic Resonance Imaging Mri ◽

Almost All

Objectives:Analysis of and understanding the utilization patterns of diagnostic imaging technologies is important for planning health systems especially in middle- and low-income countries. Almost all published studies have been focused on utilization trends or utilization rates of magnetic resonance imaging (MRI) over time and little has been published about utilization patterns of MRI. This study aims to identify and describe the utilization pattern of MRI in Iran.Methods:Data was collected from referrals and MRI reports of the population covered by one of the largest insurance organizations (Social Security Organization [SSO]) with more than 27 million beneficiaries in the Country. We focused on patients who had undergone an MRI examination during 1 month (October 13 to November 12), 2005. The data collected consisted of 1,656 referrals for MR imaging and 1,547 MRI reports.Results:No clear association was found between the number of referrals per 100,000 population and the number of MRI machines per 100,000 population (r = 0.30;p= .13). Neurosurgeons, orthopedists, and neurologists contributed to more than 88 percent of MRI utilization. The Spinal column (55 percent), brain (25.5 percent), and knee (11.0 percent) were the most common parts of the body scanned by MRI.Conclusions:Having identified some of the most frequent users of MRI technology, any plan for modifying or improving MRI use should focus mainly on these specialties. International evidence on using the technology for examining brain and spine indicate that MRI is mainly used in diagnosing the central nervous system (CNS) diseases.

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Acute Ethanol Intoxication in a Child

PEDIATRICS ◽

10.1542/peds.42.5.837 ◽

1968 ◽

Vol 42 (5) ◽

pp. 837-840

Author(s):

Joseph D. Dickerman ◽

William Bishop ◽

James F. Marks

Keyword(s):

Young Children ◽

Case Reports ◽

Signs And Symptoms ◽

Acute Poisoning ◽

The Body ◽

Ethanol Intoxication ◽

Metabolic Fate ◽

Acute Ethanol ◽

Acute Ethanol Intoxication ◽

Acute Alcoholism

Acute alcoholism is an important cause of morbidity and mortality in adults. The signs and symptoms of acute ethanol intoxication and the metabolic fate of ethanol in the body are well known.1 There are a few case reports of alcohol-induced hypoglycemia in young children2 and also case reports of withdrawal symptoms in infants of alcoholic mothers.3 Yet there is very little in the literature on the course, treatment, and prognosis of children with acute poisoning due to accidental alcohol ingestion. This report is designed to call attention to this entity, to describe a case whose blood alcoholic level was, as far as we know, the highest recorded in the pediatric literature in a survivor, to Suggest a mode of therapy, and, hopefully, to awaken pediatricians to thew possibility of ethanol intoxication in young children.

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Probing for stomach using the Focused Impedance Method (FIM)

Journal of Electrical Bioimpedance ◽

10.2478/joeb-2019-0011 ◽

2019 ◽

Vol 10 (1) ◽

pp. 73-82

Author(s):

Rashida Haque ◽

Muhammad Abdul Kadir ◽

K Siddique-e Rabbani

Keyword(s):

Low Income ◽

Electrical Impedance ◽

Impedance Measurement ◽

The Body ◽

Low Income Countries ◽

Impedance Method ◽

Impedance Tomography ◽

Cross Sectional ◽

Sensitivity Equations ◽

Element Simulation

Abstract For probing deep organs of the body using electrical impedance, the conventional method is to use Electrical Impedance Tomography (EIT). However, this would be a sophisticated machine and will be very expensive when a full 3D EIT is developed in the future. Furthermore, for most low income countries such expensive devices may not deliver the benefits to a large number of people. Therefore, this paper suggests the use of simpler techniques like Tetrapolar Impedance Measurement (TPIM) or Focused Impedance Method (FIM) in probing deeper organs. Following a method suggested earlier by one of the authors, this paper studies the possibility of using TPIM and FIM for the stomach. Using a simplified model of the human trunk with an embedded stomach, a finite element simulation package, COMSOL, was used to obtain transfer impedance values and percentage contribution of the stomach region in the total impedance. For this work, judicious placement of electrodes through qualitative visualizations based on point sensitivity equations and equipotential concepts were made, which showed that reasonable contribution of the stomach region is possible through the use of TPIM and FIM. The contributions were a little over 20% which is of similar order of the cross-sectional area percentage of the stomach with respect to that of the trunk. For the case where the conductivity of the stomach region was assumed about 4 times higher, the contributions increased to about 38%. Through further studies this proposed methods may contribute greatly in the study of deeper organs of the body.

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Microcredit Impact on Socio-Economic Development and Women Empowerment in Low-Income Countries: Evidence from Yemen

Sustainability ◽

10.3390/su13169326 ◽

2021 ◽

Vol 13 (16) ◽

pp. 9326

Author(s):

Samer Ali Al-shami ◽

Abdullah Al Mamun ◽

Nurulizwa Rashid ◽

Mohammed Al-shami

Keyword(s):

Low Income ◽

Financial Services ◽

Middle Eastern ◽

The Body ◽

Low Income Countries ◽

Positive Zero ◽

Women Empowerment ◽

Family Rituals ◽

Empowerment Theory ◽

Household Incomes

Microcredit financing is extensively considered as an effective development method for poverty mitigation and women empowerment. Nevertheless, relevant studies reflected opposing outcomes on microfinance effects consisting of positive, zero, and negative impacts. Thus, this research investigated Al-Amal Bank’s microcredit impacts on women empowerment in Yemen, one of the poorest Middle Eastern nations. A panel dataset and primary and secondary data were gathered through household surveys and propensity score matching to restrict intangible variables’ possible effects. The empirical results revealed that microcredit had a significant positive effect on monthly household incomes and accumulated asset values. Although microcredit facilitated female entrepreneurship and income generation for improved household incomes and expenditure, no influence was found on female household decisions and mobility following the patriarchal system practised in many Arabian nations, including Yemen. Hence, the study finding has theoretically and practically contributed to the body of knowledge in three ways. First, a novel proof of how microcredit interactions affected several Yemeni women empowerment elements was identified. This study also provides new insight into the empowerment theory by explaining how access to microcredit influences numerous features of women’s economic and social empowerment. Lastly, social and family traditions significantly influenced female attributes and lifestyles by reflecting how communal and family rituals affected microcredit impacts on women empowerment and vice versa. Conversely, this study guides Yemeni policymakers and those from other nations on extending financial services for self-development to reduce poverty and drive women empowerment rather than relying on government and international agencies.

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Clinical assessment of micronutrient deficiencies among children (1- 5 years) enrolled in anganwadis of old Hubli slums, Karnataka, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20170297 ◽

2017 ◽

Vol 4 (2) ◽

pp. 598 ◽

Cited By ~ 1

Author(s):

Rana Sarvar ◽

D. D. Bant

Keyword(s):

Vitamin A ◽

Low Income ◽

Signs And Symptoms ◽

Cross Sectional Study ◽

Childhood Mortality ◽

Low Income Countries ◽

Micronutrient Deficiencies ◽

Global Public Health ◽

Cross Sectional ◽

Mortality And Morbidity

Background: Micronutrients are vitamins and minerals required in small amounts that are essential to our health, development, and growth. As tiny as the amounts are, however, the consequences of their absence are severe. Iodine, vitamin A and iron are most important in global public health terms; their lack represents a major threat to the health and development, particularly children and pregnant women in low-income countries. The objectives were to clinically evaluate micronutrient deficiencies among children aged 1-5 years enrolled in anganwadi’s of old Hubli.Methods:A community-based cross-sectional study was carried out on 100 children enrolled in the anganwadis of Hubli slums for signs and symptoms of micronutrient deficiency.Results: Pallor was found in 78% children and delayed developmental milestones in 20% followed by delayed eruption of teeth in 17%. Among the studied group 37% had dry hair and dry skin. Vitamin A, B, C, D deficiency was seen in 1%, 29%, 14%, 38% respectively.Conclusions:The study concludes micronutrient deficiencies are prevalent among preschool children more so in with higher birth order having partial immunization. This appeals effective implementation of national health programmes, which can play a crucial role in addressing the hidden hunger. Correcting micronutrient deficiencies can significantly reduce childhood mortality and morbidity.

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Heat-Stable Carbetocin Could Replace Oxytocin To Prevent Postpartum Haemorrhage Following Vaginal Delivery

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v18i1.21063 ◽

2019 ◽

Vol 18 (1) ◽

pp. 75-77

Author(s):

Bikram Thapa

Keyword(s):

Vaginal Delivery ◽

Low Income ◽

Postpartum Haemorrhage ◽

Active Management ◽

World Health ◽

Low Income Countries ◽

Maternal Deaths ◽

Heat Stable ◽

Third Stage Of Labor ◽

Third Stage

Postpartum haemorrhage (PPH) is the most common type of obstetric haemorrhage and accounts for 35% of all maternal deaths. World Health Organisation (WHO) defines PPH as: blood loss of 500 mL or more within 24 hours following vaginal delivery. PPH is the leading cause of maternal mortality in low-income countries, and the primary cause of nearly one quarter of all maternal deaths globally. Uterine atony is the most common cause of PPH accounting for more than 80% of causes. Thus, to prevent PPH, WHO has recommended active management of third stage of labor. All women giving birth should be offered uterotonics during the third stage of labor (as a part of third stage management) for the prevention of PPH; oxytocin (IM/IV, 10 IU) is recommended as the uterotonic drug of choice. Conclusion: Heat stable carbetocin can be a breakthrough drug for overcoming heat degradation of oxytocin. Cold chain for storage or transportation of uterotonic drug is thus now not an issue. This single advantage can remarkably reduce the morbidity and mortality in low-income countries due to PPH as this drug can be made available even in most remote part of the country. Heat-stable carbetocin was studied aiming the developing countries. We can hope to see this drug in the new update in WHO recommendation for prevention of postpartum hemorrhage; that undoubtedly would be a very remarkable change, especially for resource limited countries like ours.

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