Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disorder, while multiple sclerosis (MS) is a prevalent chronic inflammatory demyelinating disease of the central nervous system. The coexistence of these two conditions is rare. Thus, patients with NF1 may exhibit signal abnormalities on brain imaging, referred to as focal areas of signal intensity (FASI), which can mimic lesions seen in MS and complicate the differential diagnosis. We present the case of a female patient suffering from progressive paraparesis, accompanied by urinary disorders and coordination disorders of the upper limbs. Neurological examination revealed a pyramidal syndrome and a cerebellar syndrome, with an Expanded Disability Status Scale (EDSS) score of 7.5. Additionally, the skin examination showed multiple café-au-lait spots larger than 15 mm and numerous diffuse neurofibromas. Brain magnetic resonance imaging showed white matter lesions typical of MS, and isoelectrofocalization of cerebrospinal fluid proteins revealed positive oligoclonal bands. The diagnosis was primary progressive multiple sclerosis associated with neurofibromatosis type 1. The aim of this case report is to document the association of these two conditions and discuss the challenges in differential diagnosis and treatment, as early diagnosis of MS is crucial to prevent further disability in patients with NF1.

Breast cancer is a common disease worldwide, with over two million cases reported in 2018. Various therapy modalities use biological characteristics that influence treatment and outcomes to provide individualized care. Some biomarker advancements, such as hormone receptors, vascular endothelial growth factors, and HER2/neu receptors, have significantly contributed to the biological characterization of breast cancer. Triple-negative breast cancer is defined as malignancies that do not express hormone responsiveness or HER-2. Approximately 12% of women with breast cancer will have triple-negative illness, which is more common among non-Hispanic black women regardless of age, but is detected at a younger age than other subtypes. Women with triple-negative illness are more likely to be diagnosed at a later stage (stage III or IV). The pathogenesis of breast cancer is complex and poorly understood, however many risk factors are known. This cross-sectional study spanned from 2010 to 2022. In this study, the prevalence of triple-negative breast cancer in archived breast cancer cases at Federal Medical Centre Yenagoa, Bayelsa State, was analyzed using the Haematoxylin and Eosin Staining Technique on breast cancer samples collected over the study period. This study, done at Bayelsa State's Federal Medical Centre Yenagoa, analyzed 178 breast specimens. Ninety-six percent (96%) of the patients were IDC, and 5% were TNBC. The average age at presentation was 48.21 years, with 59.1% of patients being under 50 years. 40% of the patients exhibited HER-2/neu positive, and 65% had estrogen receptor (ER) positivity. The study was conducted in a single medical institution, and specific types of lesions were not included. Other potential limitations include comparing findings with various techniques and diagnostic protocols.

In the month of February 2024, India lost a budding actor in the name of Suhani Bhatnagar who was a part of the popular movie ‘Dangal’. She was only 19 years of age. Unfortunately, she had ‘Dermatomyositis’, a rare inflammatory disease. She was treated with steroids but in vain. It is here that the article focuses on the use of homoeopathy of AYUSH in this rare disease. Homoeopathy has already proved its efficacy during the COVID 19 pandemic where it subdued the inflammation in the body. Thereafter, the disease could not progress to the lungs. Applying the concept of anti inflammatory approach, homoeopathy can deal with the issue of ‘Dermatomyositis’. It is to be noted that along with the homoeopathic medicines, all other supportive therapies like fluid management, temperature management & blood circulation management. At the end of the article, a homoeopathic protocol is mentioned that can be used in this rare disease.

Introduction: Gallbladder disease is one of the most common conditions affecting the digestive tract. Autopsy reports have shown a prevalence of gallstones ranging from 11-36%, with cholecystitis being one of the most prevalent complications. Although cholecystoenteric fistulas are rare, with an incidence of 0.15-0.5% among patients undergoing cholecystectomy, they can present significant diagnostic and therapeutic challenges. The transverse colon is the second most common site for these fistulas after the duodenum. A high degree of suspicion is required to diagnose it preoperatively. Here, we present a noteworthy case of a 65-year-old male patient with a fistula between the gallbladder and transverse colon, complicated by severe adhesions and a large stone, underscoring the complexities associated with this condition. Case Presentation: The patient had a history of hypertension and gallbladder stones when he was admitted during the COVID-19 pandemic with acute cholecystitis. Two years later, he had an elective laparoscopic cholecystectomy and, during surgery, the surgical team noticed significant adhesions around the gallbladder. Further inspection during dissection of the gallbladder bed revealed a fistula between the transverse colon and the gallbladder, and a single large stone was identified. The patient’s surgical procedure was successful, and his postoperative recovery was uncomplicated. Conclusion: A fistula between the gallbladder and transverse colon is a rare complication of gallbladder disease, and the transverse colon is the second most common cholecystoenteric fistula after the duodenum. The presence of a fistula is usually a late sequence of chronic gallstone disease that requires appropriate diagnosis and correct treatment. In this case, the surgery was complicated by extensive adhesions around the gallbladder with an adjacent colon and a large stone with a fistula noted between the transverse colon and the gallbladder. However, through careful planning, correct surgical procedures, and skilled surgical expertise, the patient’s condition after surgery lacked complications. This case focuses on the importance of addressing all possible complications of gallbladder disease and adjusting surgical procedures accordingly.

Background: The outpatient parenteral antibiotic therapy (OPAT) service is becoming increasingly popular worldwide due to its efficacy, safety, and cost-effectiveness. It is considered as an alternative to hospital treatment. However, these services have not yet become an integral part of the healthcare system in Saudi Arabia. The present study is intended to estimate the 30-day readmission rate of OPAT patients, estimate healthcare costs in OPAT services, evaluate patient and family satisfaction, and evaluate catheter-related complications. Methods: In this retrospective study, at the Prince Sultan Military Medical City (PSMMC), 80 patients aged ≥3 months to <14 years, stable and kept only for the completion of IV antibiotics were recruited between the period of November 2020 to October 2023. Data on demographic characteristics, antibiotics used, improvement rate, patient satisfaction and cost-effectiveness were collected. Results: Significant variations in medical cases are observed, with notable fluctuations in UTI cases and consistent reporting of other medical conditions across the years. Antibiotic usage patterns also vary, with some antibiotics increasing in usage over time. Cost-saving analyses reveal substantial saving associated with outpatient parenteral antibiotic therapy (OPAT) compared to inpatient care, highlighting OPAT's cost-effectiveness. Inferential findings confirm significant differences in the distribution of medical cases and antibiotic usage across the years. The study highlighted the importance of OPAT in providing patient-centered care and managing healthcare expenses efficiently. Conclusions: Our study demonstrates that OPAT is a reliable and cost-effective service. It can reduce the direct cost of life-threatening infections compared to completing the course as an in-patient case. We have saved 93.48% of the overall estimated hospital expense through providing OPAT service.

Background: While the transfusion of blood products does come with inherent risks, it should only be considered if it has the potential to improve the patient's outcome. The aim of this study was to evaluate the reasons for blood transfusion and the results in a group of pregnant women from Sudan. Methodology: This study was a retrospective descriptive analysis of 138 pregnant women residing in El-Obeid, a city located in the northern Kordofan province of Sudan. Results: Most patients underwent blood transfusions primarily due to anemia, accounting for 59% of cases. Antepartum hemorrhage (APH), miscarriage, and ectopic pregnancy accounted for 21%, 10%, and 7% of the cases, respectively. Out of the 138 women, 33% were primigravida, 53% were multipara, and 14% were grand multipara. Grandmultipara women predominantly showed anemia, with a prevalence rate of 68%. Primigravida women, with a prevalence rate of 61%, and multipara women, with a prevalence rate of 55%, came next. Miscarriage is most common among women who are pregnant for the first time, with a rate of 15%. Out of the 138 patients, a mere 1.4% of them died, while 5.7% encountered various problems. However, the remaining 92.7% of patients have demonstrated improvement and received their release. Conclusion: Anemia is a crucial factor in determining the need for blood transfusion in pregnant women, particularly after childbirth when postpartum hemorrhage may occur. Despite the ongoing conflict in Sudan posing challenges, the health system can still achieve positive results.

Background: Smoking cessation continues to be an issue of public health concern in Bangladesh, with a high prevalence of male smoking and exposure to second-hand smoke. It is for this reason that it is pertinent to know the socio-demographic characteristics, knowledge attitudes, and health risks and impacts of active and passive smoking. Objective: The objectives of this study include assessing the health risks of passive smoking on Bangladeshi adults, understanding the role of socio-demographic characteristics in tobacco use, and determining the awareness of health risks by tobacco users and people exposed to second-hand smoke. Methods: The current cross-sectional study was carried out at the Community Based Medical College Hospital in Bangladesh during July 2021 to June 2022. In total, one hundred participants with an age of 18 years and above were selected using the convenience sampling technique. Data was collected by administering a structured questionnaire and interviewing the participants face-to-face. The data was analyzed using descriptive statistics, and chi-square tests were also conducted. Results: The sample possessed a mean age of 32 years. 85 years, with male participants being 60%. Understanding about these smoking-related health consequences differed with gender and level of education achieved. 69% of them were aware that smoking causes environmental pollution, and 73% knew that smoking posed danger to pregnant women. As for the negative health consequences of smoking, only 5% of the respondents mentioned that it causes respiratory problems. Self-identified health complaints included cancer, hypertension, and abdominal pain/vomiting in 19%, 18%, and 16% of respondents, respectively. Conclusion: There is a lack of adequate information as regards the dangers of active and passive smoking to the studied population. These findings further stress the importance of intensification of tobacco control because of the high burden of severe diseases. Considering these gaps in knowledge, gender disparities, and protection from SHS exposure, appropriate interventions need to be applied to minimize morbidity and mortality from tobacco use in Bangladesh.

Background: The primary acute outcome of sickle cell disease (SCD) is a vaso-occlusive crisis (VOC) with extreme pain. More than three vaso-occlusive crisis (VOC) hospitalizations in a year increase the risk of early death. The objective of the study was to evaluate the hematological alterations in complete blood count (hemoglobin, red blood cell indices, white blood cell count, and platelets) and C-reactive protein levels during vaso-occlusive crises in patients with sickle cell anemia (HbSS) compared to a stable symptomatic state. Methodology: This study is a prospective descriptive study conducted in a hospital setting. During the period from February to June 2015, a Sudan Sickle Cell Anemia Center (SSCAC) in North Kordofan State, Sudan, treated a total of 100 patients with sickle cell anemia. Out of these patients, 74 had a vaso-occlusive crisis and 26 had a steady-state condition. All patients had measurements of their complete blood count (CBC) and C-reactive protein (CRP) levels. We calculated the average values of CBC and CRP level counts during vaso-occlusive crises and compared them to the values during steady state using independent t-tests. We analyzed the collected data using the Statistical Tool for Social Sciences (SPSS) software tool, specifically version 13. Results: The statistical analysis of the patient sample during vaso-occlusive crisis and steady state revealed that the concentration of hemoglobin (Hb) was 6.55 g/dl ± 1.3 and 9.8 g/dl ± 2.4, respectively, with a p-value of 0.000. The packed cell volume (PCV) was 20.4% ± 3.9 and 30.7% ± 7.1, respectively, with a p-value of 0.000. The red blood cell (RBC) count was 2.5×106/µl ± 0.57 and 3.9×106/µl ± 1.1, respectively, with a p-value of 0.000. A lot more white blood cells (WBC) were present in vasoocclusive than in steady state, with numbers 19.36 x 109/l ± 10.645 and 76.76 x 109/l ± 20.19, respectively, and a P-value of ≤0.000. There was a notable statistical disparity in the platelet count, with values of (357.108109/l ± 162.838) and (290.4610×9/l ± 124.40), with a P value of 0.05. In vaso-occlusive crises, the amounts of hemoglobin, packed cell volume (PCV), and red blood cells (RBCs) are lower than they are in the steady-state phase. Conversely, white blood cell (WBC) and platelet levels are much greater in patients experiencing vaso-occlusive crises compared to those in a steady state. The levels of C-reactive protein (CRP) were significantly different between patients experiencing vaso-occlusive crises and those in a stable condition.