BACKGROUND: The prescribed maximum dose of allopurinol is 300 mg/day to maintain a serum uric acid (sUA) concentration of < 6.0 mg/dl. However, increasing evidence shows that 300 mg dose is ineffective in achieving the target sUA level, limiting allopurinol's use in certain subsets of patients who are intolerant to allopurinol such as patients with chronic kidney disease, with multiple comorbidities and elderly patients.
OBJECTIVE: To determine the efficacy and safety of febuxostat compared with allopurinol in lowering sUA level in patients with hyperuricemia in gout with a baseline sUA ? 8 mg/ dl.
DATA SOURCES: Electronic searches through COCHRANE, EMBASE, PUBMED, and Manual Search. Search terms included the following: febuxostat, allopurinol, hyperuricemia, gout.
STUDY SELECTION: Randomized, double-blinded, parallel-group clinical trials with meta-analysis quality scale of A-B were included. Intervention included administration of febuxostat and allopurinol in determined dosages
and duration in    each study.
ANALYSIS: All outcomes were examined using the random effects model. Dichotomous data were analyzed by calculating the odds ratio, with 95% confidence interval and a significant p value of 0.1 was used.
RESULTS: Pooled data showed significant decrease in sUA level from baseline with febuxostat 80 mg than with allopurinol with OR 0.31 (95% CI, 0.24-0.39, p = 0.00001). The risk of developing any adverse event with allopurinol is greater compared to febuxostat with RR 0.90 (95% CI, 0.84-0.96, p = 0.002).
CONCLUSION: Febuxostat has significant urate lowering efficacy than allopurinol, and in patients with renal impairment without requiring dose adjustment, with lower incidence of any adverse events. However, elevated liver enzymes brought about by febuxostat were noted.

Hyperuricemia ; Allopurinol ; Uric Acid ; Febuxostat ; Comorbidity ; Gout ; Thiazoles ; Renal Insufficiency, Chronic ; Information Storage And Retrieval ; Liver

Carcinosarcoma is a rare neoplasm that most commonly affects the uterus. In the pancreas, fewer than thirty cases are reported worldwide. We present a 47-year-old female with epigastric pain, and jaundice. Histopathology revealed a pancreatic head mass showing a biphasic tumor composed of seventy percent Pancreatic Ductal Adenocarcinoma, and thirty percent High Grade Sarcoma with immunohistochemistry using Pancytokeratin, Vimentin, Desmin, S-100, Smooth Muscle Actin, CD34, and Ki-67.
Pancreas ; Carcinosarcoma ; Immunohistochemistry ; Pathology, Surgical ; Diagnosis

INTRODUCTION: This study compared the effectiveness and safety of neem (Azadirachta indica) seed oil methanolic extract shampoo against permethrin shampoo in reducing head lice infestation among children. METHODS: A single-blind, non-inferiority, randomized clinical trial was conducted on children aged 6-14 years with pediculosis. Using block randomization, the participants were assigned to receive either 10% neem seed oil methanolic shampoo, 1% permethrin shampoo, or pure shampoo for three treatment applications at 10-day intervals. The presence of head lice after each application was determined by standard quadrant counting and compared with the baseline count within and among treatment groups. RESULTS: There was a statistically significant difference in lice count after treatment for both neem and permethrin, with mean reductions of 17.8 ± 23.97 (p = 0.043) and 22.5 ± 23.47 (p = 0.014), respectively. Repeated Measures ANOVA showed a summary p-value of 0.041 for neem, 0.013 for permethrin, and 0.193 for the shampoo alone with a linear trend indicating a significant decrease in the lice counts from the baseline to the third application of neem and permethrin shampoo, but not in the shampoo group. There was no significant difference in the mean decrease in lice count from baseline to the third application between the neem and permethrin shampoo groups. CONCLUSION Neem seed oil methanolic extract shampoo is non-inferior and comparable to permethrin in the reduction of head lice count. There were no reported dermatologic adverse effects such as burning sensations, redness, skin irritation, and allergic reactions.

Introduction: Literature shows that infant distress and care-giving can be sources of stress of primary care givers, especially for first-time mothers. This study aimed to determine the efficacy of Dunstan baby Language in decreasing parenting stress among first time mothers compared with those receiving standard newborn care alone. Methods: This research utilized a quasi-experimental approach, where 18 first-time mothers with babies 0-2 months old were allocated to receive standard care plus Dunstan baby language training or standard care alone. Maternal stress was measured at baseline and after the intervention period with the Parental Stress Scale. The scores were compared within and between the two study arms. A repeated measures mixed model was used for the Parental Stress Scale (PSS) results. Results: A total of 27 participants were enrolled in the study. The Dunstan baby language group had 18 participants, while the control group had 9 participants. An apparent decrease was noted in the week 1 to week 2 and the week 2 to week 3 Parental Stress Scale scores in the Dunstan baby language group compared with the control group which had minimal changes in their mean scores. The mean difference between the two groups was not significant. Conclusion The use of Dunstan baby language in addition to standard care may decrease stress among first time mothers with 0-2 month old babies.
Parenting

Data collected through routine syndromic surveillance for influenza-like illness in the Micronesian United States-affiliated Pacific Islands highlighted out-of-season influenza outbreaks in the spring of 2019. This report describes the data collected through the World Health Organization’s Pacific Syndromic Surveillance System for the Commonwealth of the Northern Mariana Islands (CNMI), Guam, the Federated States of Micronesia (FSM) and the Republic of the Marshall Islands (RMI). Compared with historical data, more cases of influenza-like illness were observed in all four islands described here, with the highest number reported in Guam in week 9, CNMI and FSM in week 15, and RMI in week 19. The outbreaks predominantly affected those aged <20 years, with evidence from CNMI and RMI suggesting higher attack rates among those who were unvaccinated. Cases confirmed by laboratory testing suggested that influenza B was predominant, with 83% (99/120) of subtyped specimens classified as influenza B/Victoria during January–May 2019. These outbreaks occurred after the usual influenza season and were consistent with transmission patterns in Eastern Asia rather than those in Oceania or the United States of America, the areas typically associated with the United States-affiliated Pacific Islands due to their geographical proximity to Oceania and political affiliation with the United States of America. A plausible epidemiological route of introduction may be the high levels of international tourism from Eastern Asian countries recorded during these periods of increased influenza B/Victoria circulation. This report demonstrates the value of year-round surveillance for communicable diseases and underscores the importance of seasonal influenza vaccination, particularly among younger age groups.