Rasch Honore (okrabank73)

spitalization or mortality rate. 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. 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), 2weeks after a spontaneous nontraumatic vaginal delivery. TAE226 cost 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. 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. 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. The stem-group of Ephemeroptera is phylogenetically important for understanding key steps in evolutionary history of early pterygote insects. However, these taxa have been mostly studied from the taxonomy point of view focused on the pattern of wing venation and often using only classical optical microscopy devices. In-depth studies on detailed morphology of the different body structures are scarcely performed, although the results are critical for elucidation of life history traits and their evolutionary pattern among the basal pterygotes. New information is presented on the morphology of two species of Misthodotes, which are stem-mayflies from the Early Permian. Based on new results obtained from a re-examination of the type specimens and supplementary material, we infer the life history traits of both the adult and larval stages of these Palaeozoic insects and reconsider previous interpretations. For the first time, we report the structure of the thoracic pleura and the articulation at the base of the otorism) in modern taxa. There is no evidence for swarming behaviour and mating in the air as occurs in modern mayflies as they had none of the associated morphological adaptations. Putative larvae of Misthodotes can not be unambiguously associated with the adults. They also exhibit some morphological specializations of Protereismatidae like 9 pairs of abdominal tracheal gills supporting their benthic lifestyle with legs adapted to burrowing. The vital signs of trauma patients are complex and changeable, and the prediction of blood transfusion demand mainly depends on doctors' experience and trauma scoring system; therefore, it cannot be accurately predicted. In this study, a machine learning decision tree algorithm [classification and regression tree (CRT) and eXtreme gradient boosting (XGBoost)] was proposed for the demand prediction of traumatic blood transfusion to provide technical support for doctors. A total of 1371 trauma patients who were diverted to the Emergency Department of the First Medical C