Scabies surrepticius represents the non-classic atypical presentation of scabies and diagnosing scabies in these individuals could be difficult. We present a clinical case of a 71-year-old woman with intense body pruritus for about 2 years, unresponsive to oral and topical antibiotics, corticosteroid creams, topical calcineurin inhibitors, as well as antiallergic agents, due to a suspected allergic reaction.

Introduction: An anal fissure manifests as a painful longitudinal tear in the anoderm distal to the dentate line with symptoms of pain during defecation, rectal bleeding, tremendous emotional stress, and declined quality of life. Anal fissures are found more frequently in women. Several treatment options are available with or without medication and/or surgery. This paper presents 4 cases of patients affected by anal fissures healed by one healer and cured successfully by the application of Yoga Prana Vidya (YPV) healing protocols as alternative medicine. Method: This paper uses the case study method by collecting medical data from the 4 patients (3 female and 1 male), YPV healer’s records, and patient feedback. Results: Patient in case 1 became normal after 37 healing sessions of 20 minutes each in 1 ½ months of YPV healing. The patient in case 2 became normal after 25 sessions of 20 minutes of YPV healing conducted in 17 days. The patient in case 3 became normal after 35 sessions of 20 minutes each within a period of about 7 weeks of healing. The patient in case 4 became normal after 10 sessions of 20 minutes of healing within 11 days. Conclusions: This paper presented multiple cases of anal fissures suffered by patients over many years that have been cured successfully by the application of the integrated and holistic system of Yoga Prana Vidya (YPV) healing protocols. Further research is recommended. Recommendations include training Healthcare workers for applying YPV techniques complementary to their respective professions for treating patients holistically and as a preventive modality boosting immunity.

Background and aim: Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths worldwide. It is curable in the early stages but has a poor prognosis when advanced. Current diagnostic protocols for the early stages of HCC are inefficient. Serum Glypican-3 (GPC-3) is a promising serum tumour marker in diagnosing HCC, and its diagnostic value has been explored in various studies. The outcomes, however, continue to be inconsistent and controversial. This systematic review and meta-analysis aimed to investigate the diagnostic accuracy of serum GPC-3 in hepatocellular carcinoma. This study included recent papers not captured in previous meta-analyses. Method: PUBMED, MEDLINE, Cochrane Library, and CINAHL databases were systematically searched according to preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies guidelines. Studies on the diagnostic accuracy of serum GPC-3 in HCC were selected. The Quality assessment of diagnostic accuracy studies 2 (QUADAS-2) tools were used to assess the quality of selected studies. Sensitivity, specificity, and other diagnostic parameters were pooled using the random effect model. The Summary receiver operating characteristic (sROC) was used to summarise the diagnostic accuracy of Serum GPC-3. Results: Eleven studies were included in this systematic review. The pooled sensitivity, specificity, and 95% confidence intervals (CIs) were 0.60 (0.57-0.62) and 0.67(0.64-0.70), respectively. The pooled positive and negative likelihood ratios and 95% CIs were 2.11 (1.51-2.93) and 0.59 (0.51-0.68), respectively; the pooled diagnostic odds ratio and the 95% CI were 4.07 (2.37-6.98), the area under the sROC curve was 0.7194. Conclusion: This meta-analysis has shown that Serum GPC-3 has an acceptable diagnostic value in diagnosing HCC compared to benign chronic liver diseases. A higher-quality study with a larger sample size is necessary to thoroughly assess the diagnostic utility of serum GPC-3.

Linear IgA bullous dermatosis is a rare subepidermal bullous disease that can occur idiopathically or to be drug-induced. The disease affects both the skin and mucous membranes in children and adults. Drug-induced linear Ig A bullous dermatosis occurs more often in elderly patients who suffer from various chronic and systemic diseases. Among the most frequently reported medications causing the disease are non-steroidal anti-inflammatory drugs, antibiotics, anticoagulants, statins, ACE-inhibitors. In this report, we present a case of etoricoxib-induced linear Ig A bullous dermatosis in a woman with no known comorbidities at the time of hospitalization.

Background: Dengue hemorrhagic fever is a notable vector-borne viral disease, currently becoming the most dreaded worldwide health problem in terms of the number of people affected. The objective of this study is to investigate spatial clustering of dengue hemorrhagic fever incidence in the first 9-months of 2023 in Ho Chi Minh city, Vietnam. Methods: the global Moran’s I statistic, Moran’s I scatterplot and local statistic were employed to spatial clusters (high-high and low-low) and spatial outliers (low-high and high-low) in the study area of Ho Chi Minh city. The first and third order of contiguity were used to constructe spatial weight matrix. Results: it was found from a case study of the first 9-months of 2023 in Ho Chi Minh city, a total of four high-high clusters, two low-low spatial clusters were detected in urban area and rural areas in the north and south of the Ho Chi Minh city, respectively when using the first order contiguity (statistically significance at the 0.05 level). For the case of using the third order of contiguity, a total of six high-low, two low-high spatial clusters and one low-low spatial cluster were successfully identified. Conclusions: the study results has proven the effective use of the global Moran’s I statistic, Moran’s I scatterplot and local Moran’s I statistic in the identification of spatial clustering of dengue hemorrhagic fever incidence.

Background and aim: Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths worldwide. It is curable in the early stages but has a poor prognosis when advanced. Current diagnostic protocols for the early stages of HCC are inefficient. Serum Glypican-3 (GPC-3) is a promising serum tumour marker in diagnosing HCC, and its diagnostic value has been explored in various studies. The outcomes, however, continue to be inconsistent and controversial. This systematic review and meta-analysis aimed to investigate the diagnostic accuracy of serum GPC-3 in hepatocellular carcinoma. This study included recent papers not captured in previous meta-analyses. Method: PUBMED, MEDLINE, Cochrane Library, and CINAHL databases were systematically searched according to preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies guidelines. Studies on the diagnostic accuracy of serum GPC-3 in HCC were selected. The Quality assessment of diagnostic accuracy studies 2 (QUADAS-2) tools were used to assess the quality of selected studies. Sensitivity, specificity, and other diagnostic parameters were pooled using the random effect model. The Summary receiver operating characteristic (sROC) was used to summarise the diagnostic accuracy of Serum GPC-3. Results: Eleven studies were included in this systematic review. The pooled sensitivity, specificity, and 95% confidence intervals (CIs) were 0.60 (0.57-0.62) and 0.67(0.64-0.70), respectively. The pooled positive and negative likelihood ratios and 95% CIs were 2.11 (1.51-2.93) and 0.59 (0.51-0.68), respectively; the pooled diagnostic odds ratio and the 95% CI were 4.07 (2.37-6.98), the area under the sROC curve was 0.7194. Conclusion: This meta-analysis has shown that Serum GPC-3 has an acceptable diagnostic value in diagnosing HCC compared to benign chronic liver diseases. A higher-quality study with a larger sample size is necessary to thoroughly assess the diagnostic utility of serum GPC-3.

Background: Hand-Foot-and-Mouth Disease (HFMD) is most frequently caused by Enterovirus71 (EV-A71) or Coxsackie virus A16 (CV-A16), infants and young children are at greatest risk. Describing the spatial patterns of HFMD can help develop and better target interventions. The objective of this study is to identify spatial patterns of HFMD in the first 8-months of 2023 in Ho Chi Minh city, Vietnam. Methods: The global Moran’s I statistic, Moran’s I scatterplot and local Moran’s I statistic and Boxplot will be applied to study spatial patterns of HFMD. Spatial patterns including spatial clusters (high-high and low-low) and spatial outliers (low-high and high-low) will be identified for HFMD cases and HFMD infection rates. Results: three high-high spatial clusters were mainly distributed in districts in the western region of the city such as Binh Tan, Binh Chanh, and Tan Phu. These high-high spatial clusters belonged to districts having the highest rates of HFMD infections in the city with their corresponding rates of 289, 283 and 281 cases/100,000 inhabitants, respectively. On the other hand, two low-low spatial clusters were detected in Districts 1 and 5 in the city center with their HFMD infection rates of 190 and 209 cases/100,000 inhabitants, respectively. Conclusions : findings in this study support the usefulness of boxplots, local and global Moran’s I statistics, and Moran’s I scatterplots in the identification of spatial clusters and spatial outliers of HFMD.

Background: Infective endocarditis is a lethal infection affecting the endocardium of the heart and the valves.The causes are varied with staphylococcus aureus and streptococcus as the major causative agents.The triad of fever exceeding 38oc,vegetation in the heart and blood culture of the causative agents are the hallmarks of the diagnosis .The disease is known to be affect all ages with the very young age group, those with congenital heart disease and those on cardiac prosthesis as the most vulnerable. Septic emboli from the septic vegetation can spread to the brain, kidney, spleen, and lungs resulting in massive metastatic infections.It therefore has multisystemic manifestations and complications. Though neurological complications are common, brain abcess is known to be rare constituting only 1.0% of neurological complications. Objective: The study aimed at reporting occurrence of both cerebral and cerebellar micro- and macro-abscesses in a 3 year boy with infective endocarditis; a rare occurrence in the literature. Methods: This case report was carried out at University College Hospital Ibadan. Results: The boy presented with fever of 38oc for five weeks, convulsions and altered state of consciousness for ten days..In course of treatment patient however developed irritability and aggressive behaviour, which attracted the use of largactil to which he reacted with extrapyramidal signs and convulsions. Within the week he developed yellowness of the eyes and increase in abdominal girth. Patient had cranial computed tomography (CT) after plain skull X-rays and was referred to University College Hospital Ibadan as a result of the radiologically diagnosed brain abscess seen on CT images. child had grunting respiration with dyspnea, and the respiratory rate was 50/mm. However, the chest was clinically clear. In the cardiovascular system (CVS); the pulse was 140/mm, with moderate volume. The blood pressure (BP) was l60/110 mmHg. The first and second heart sounds were heard with a gallop rhythm. Cranial CT scan showed multiple ring enhancing hypodense lesions with surrounding hypodensity measuring 1cm in diameter and above with only a few measuring less than 1.0cm in both cerebral hemispheres and cerebelli in keeping with multiple cerebral and cerebellar abscesses. An echocardiography showed a brightly echogenic spot attached to the papillary muscle in the left ventricle suggesting vegetation consistent with an infective endocarditis. Retroviral test was negative for both type I and II.Blood culture — was negative, however urine culture yielded klebsiella sp. Serum urea, creatinine, Ca2+ and P04 were all elevated.The abdominal ultrasound scan confirmed the hepatosplenomegaly with decreased echogenicity but both kidneys appeared normal.There was no demonstrable ascitis. The boy was placed on antimicrobials; and had craniotomy for the drainage of the macroabscesses. He improved significantly. His renal and cardiac condition equally improved; he was subsequently discharged to continue treatment in the the paediaric outpatient. The infective endorcarditis still poses enormous challenge in management and the condition calls for multi disciplinary approach. It requires high index of suspicion for early detection; as well deployment of multiple imaging modalities by the cardiologists and radiologists to arrive at a more accurate diagnosis for effective patient management. This may save financial and material resources on part of the patients, care givers, the facility managers and the society at large.

Background: Malignant Small round Cell Tumor (MSRCT) is very rare group of tumors. Malignant cells have similar histologic appearance making it difficult to distinguish one from another, and poses a diagnostic challenge with needs for a multimodal approach. Immunohistochemistry and immunophenotyping by flow cytometry, reverse transcriptase polymer chain reaction (RT-PCR) and fluorescence in situ hybridization are needed to confirm. The appropriate and best treatment in early stages of MSRCT is early surgical excision with chemoradiotherapy based on patient specification. Inspite of all these, tumors have poor prognosis and chance of recurrence are high. Method: Case study of a 27-year-old male who presented with a non-productive cough for 4 weeks, with feverish feeling with weight loss and shortness of breath and a new onset precordial chest pain non radiating and worse on exertion. On examination his vitals were: BP 121/91 mm of hg, pulse rate 114bpm, temperature 36.3 degrees Celsius, respiratory rate 24/per min, SPO2 96%.On examination, Elevated Jugular Venous Pressure, hyperactive precordium, displaced apex beat to 6th intercostal space anterior axillary line, muffled heart sounds and bilateral lower limb edema. Respiratory exam was unremarkable. Sputum gene expert was negative for mycobacterium tuberculosis and covid 19 rapid test was negative. Chest X Ray showed cardiomegaly and a transthoracic echocardiography revealed moderate-large pericardial effusion, with mild collapse of right atrium in diastole. Pericardiocentesis done showed hemorrhagic effusion with lymphocytes cell component, patient was initiated on treatment for TB pericarditis empirically. Three months later a chest CT scan done revealed extensive mediastinal/pericardial mass with lung nodules. An ultrasound guided mediastinal/Pericardial biopsy was done, revealed a poorly differentiated small round cell carcinoma. Results: Patient expired 14 weeks from the initial onset of symptoms while awaiting immunohistochemistry studies for specific diagnosis of the tumor and oncology review. Discussion: This demonstrates the complexity of establishing differential diagnosis of MSRCT in a resource limited setting with subsequent delay in treatment initiation, heralds poor prognosis. This also confirms difficulties in establishing differential diagnosis in poorly differentiated tumor.

Objective: To document the various structural uterine abnormalities detected on transabdominal ultrasonography (TAUS) and hysterosalpingography (HSG) of premenopausal women with infertility and abnormal uterine bleeding (AUB) and determine whether the structural abnormalities correlate well with the clinical forms of AUB among the patients. Methodology: This is a prospective and analytical study of 98 infertile women with history of AUB, referred for HSG. Clinical history including the forms of AUB were obtained from the subjects. Subjects were evaluated with TAUS and HSG after obtaining both ethical clearance and informed consent. Statistical analysis was with the Statistical Package for Social Sciences (SPSS) version 21. Simple frequency, measures of central tendency and dispersion, crosstabulation as well as Pearson’s correlation tests were carried out. For correlation, p = 0.05 was considered significant. Result: Fibroids, followed by intrauterine adhesions (IUA) were the commonest structural uterine abnormalities. Fibroids were detected with both TAUS and HSG, while IUA were detected with HSG only. Shortened menstrual flow was the commonest form of AUB and occurred in 52 (53.1%) of the subjects, followed by light menstrual flow 41(41.8%). The menses were irregular in 33(33.7%), light and shortened in 32(32.7%), heavy in 21(21.4%), prolonged in 16(16.3%), and, heavy and prolonged in 9(9.2%). Fibroids occurred most frequently among those with heavy and prolonged menstrual bleeding while IUA occurred most frequently among those with scanty and reduced menstrual bleeding. On TAUS, HSG, or combined TAUS and HSG, there were significant correlations between fibroids and prolonged heavy menses, fibroids and heavy menses, and, fibroid and prolonged menses. On HSG, significant correlation existed between IUA and scanty short menses. Conclusion: Uterine fibroids and intrauterine adhesions were the commonest structural uterine abnormalities detected. There was significant correlation between fibroids and history of heavy menstrual flow as well as between fibroids and prolonged menses, and IUA and scanty short menses.

Total parenteral nutrition (TPN) is the treatment modality of providing intravenous nutrition for patients who cannot get oral feeding. Physicians use standard scales, such as NRS-2002 and NUTRIC, for TPN orders. The usage of NRS-2002 in public hospitals has been mandatory in Turkey since 2015. The quality management department of Izmir Tire Public Hospital recognized that TPN consumption increased dramatically since 2015. The orders, which increased in direct proportion to the number of patients, showed that it should be investigated by evaluating their necessity according to nutritional practice standards. The objective of this study is to research the effect of e-orders incorporated with a clinical decision support system on TPN consumption. We digitalized the NRS-2002 form and added a clinical decision support system to calculate the score and calorie requirements. We found that the total number of NRS-2002 forms completed by physicians increased by 95%, the number of TPN orders decreased by 41%, and the cost decreased by 38% in 2018. This study showed that e-ordering of TPN combined with a clinical decision support system is beneficial for decreasing costs.

This Point of View provides an overview of the integrated treatment framework for influenza and COVID-19 in the post-pandemic era. We discuss the available medications for influenza treatment and compare their efficacy. Additionally, we address the issue of antiviral resistance and the safety considerations associated with these medications. The research methods and findings supporting this treatment approach are discussed, highlighting its potential limitations and challenges. This work aims to contribute to the development of effective treatment strategies for influenza and COVID-19, considering the evolving landscape of infectious diseases in the aftermath of the pandemic.

Many unwanted pregnancies and its associated complications have resulted from refusal of some women of reproductive age to the use of contraceptives in general particularly the hormonal contraceptive in our environment. The fear of side effects, religious belief, ignorance and other myths surrounding the use of contraceptives had contributed to this. The main objective of the study was to find out if the reported side effects of hormonal contraceptives by women of reproductive age in Enugu, South Eastern Nigeria, are truth or myth. It was a combination of prospective and retrospective study with interviewer administered questionnaire to assess socio-demographic data, reasons why some women were not using hormonal contraceptives, side effects and benefits of hormonal contraceptives. From the 410 respondents, the study showed that 232 respondents (56.6%, X2=7.686) of respondents used hormonal contraceptive which was significant (p<0.05). 178respondents (43.4%) respondents did not use hormonal contraception. 76.0% of the hormonal contraceptives users had side effects while 24.0% did not. Irregular menses (44.4%) was the commonest side effect.130 respondents (73.0%) gave reasons such as religious belief, ignorance, fear of side effects etc as preventing factors to the use of contraceptives. The study showed that 69.8% of users were not discouraged by side effects and 81.1% agreed to recommend it to their friends and family relatives because of its numerous benefits. While it was true from the study that hormonal contraceptives was associated with some side effects of which some disappeared without intervention within 3-5 months of use (35.1%), and others were taken care of through medical interventions, some myths(religious belief, ignorance, husband approval, etc) were also limitations against hormonal contraceptives use.