Background:
What kind of HVNC (Home-visit nursing care) is necessary for a home-alone patient with atopic dermatitis, alcoholic cirrhosis, and alcoholism?
Case: A 53-year-old Japanese man lived by himself because of a divorce. He had atopic dermatitis, alcoholic liver cirrhosis, and alcoholism. He was admitted to the hospital for treatment of alcoholism, and then, he participated in the alcoholics anonymous meetings and demonstrated leadership. He had MSSA bacteremia and pyogenic discitis of the spines. The antimicrobial therapy with cefazolin 2.0 g every 8 hours for 8 weeks was done. After the discharge, we planned psychiatric HVNC twice a week and internal medicine HVNC twice a week for him.

Results:
After adopting HVNC for him to check vital signs, help taking medicines regularly, support defecation, and assist in continuing to quit alcohol, he did well everything, preventing hepatic encephalopathy, reducing ascites, and edema of foot. He did quit alcohol. HVNC needs for preventing infectious diseases with comorbidities in an alcoholic patient living alone and he succeeded in quitting drinking because he received emotional support, such as sharing his experiences with the members of the self-help group and encouraging each other. And he was entrusted with counseling and guidance for other alcoholic patients from an alcohol treatment hospital and was admired as a teacher. In other words, he became proud that he was recognized and that he was useful to others. Conclusion: Finding a new interest for the patient, encouraging each other with buddies and the support of medical staff led to be a temperance.

1. Home-visit nursing care(HVNC) to prevent infectious diseases
2. Home-visit nursing care(HVNC) for an alcoholic patient living alone
3. The tips for the successful temperance

This study investigated effects of tFUS on BBB opening, regional cerebral metabolic rate of glucose (rCMRglu), and cognitive function in AD patients. Eight patients with AD received image-guided tFUS stimulation to the right hippocampus with intravenous injection of microbubble ultrasound contrast agents. Patients underwent brain MRI, FDG-PET, and europsychological assessments before and after the sonication. No evidence of transient BBB opening was found on T1 dynamic contrast-enhanced MRI. However, immediate recall (p = 0.03) and recognition memory (p = 0.02) were significantly improved on the verbal learning test. PET image analysis demonstrated increased rCMRglu in the right hippocampus (p = 0.001). In addition, increases of hippocampal rCMRglu was correlated with better performance in recognition memory (Spearman's ρ = 0.77, p = 0.02). No adverse events were observed. Our results suggest that tFUS may have beneficial effects on brain function and cognition in AD patients, even without BBB opening. Limitations, first, the study participants consisted of patients with early stage of AD. To generalize our findings, additional studies with patients with varying AD severity are required. Second, multiple comparison correction methods were not applied in the analyses. A previous positron emission tomography study also used the liberal threshold of uncorrected p < 0.01 for the voxel-wise multiple regression analysis to examine correlations between cerebral glucose metabolism and NPS domain scores in early-onset AD.

1. Alzheimer's disease
2. Focused Ultrasound
3. FDG-PET

Background
Neonatal health outcomes remain a major contributor to any population's well-being and reflect the quality of healthcare systems. Prematurity, low birth weight, perinatal asphyxia, and neonatal jaundice are identifiable reasons for neonatal admissions as well as mortalities. This study aimed to review the pattern of neonatal morbidity and mortality in our setting as reflecting on these may help in appropriate policymaking and improve newborn care.

Methodology
This cross-sectional study was conducted at a faith-based secondary health facility in Nigeria, Sub-Saharan Africa. All babies admitted during the seven-month study period whose parent(s) consented to the study were recruited. The data was analysed using SPSS version 26.

Results
During the study period, 405 babies were admitted; 254 (62.7%) were males with a M:F ratio of 1.7:1, and 324 (80%) were admitted within 72 hours of birth. In-born babies accounted for 61.5% (249) of admission and over 50% of these babies were delivered per vaginam. The diagnosis was multiple in about a quarter of the babies. The overall commonest diagnoses were perinatal asphyxia (39.5%), neonatal jaundice (22.5%) and prematurity (21.7%) and these were more prevalent in out-born babies. Forty-one (10.1%) of the babies died, of which 27 (66%) were out-born and perinatal asphyxia accounted for the highest mortality recorded (61%); while 52 (13.1%) left against medical advice (LAMA).

Conclusion
Neonatal mortality and LAMA were unacceptably high in our setting with perinatal asphyxia contributing significantly to neonatal morbidity and mortality. More effort should be geared towards improving the skills of birth attendants in neonatal resuscitation and improving funding for neonatal healthcare; as out-of-pocket payment has been attributed to the high LAMA rate.

1. There is a high neonatal mortality rate in our setting
2. The high proportion of out-of-pocket payment is linked to many parents leaving the hospital against medical advice (LAMA)
3. The high prevalence of perinatal asphyxia reiterates the need for training and retraining of birth attendants including early intrauterine referrals.

A constantly increasing proportion of the population in the world will acquire two or more chronic diseases or functional disabilities during their lifetime, with ageing being one of the most imminent risk factors. Multimorbidity is often accompanied by polypharmacy. Polypharmacy has been defined both as the regular use of multiple medications or as the use of unnecessary amounts of medications with overlapping or missing clinical indications. The aim of this study is to explore the prevalence of multimorbidity and polypharmacy among older people, and to be able to identify individuals at risk of functional decline by using clinical risk factors.

The subjects of the study are 75-year-old community-dwelling clients of the Turku Senior Health Clinic (TSHeC) in Southwestern Finland. Clinic protocol includes pre-visit blood tests, questionnaires to be completed prior to visits, interviews and clinical examinations carried out by clinic nurses and physiotherapists. Data on participants’ health status (e.g. diagnosed diseases and medication), health behaviour, psychosocial and physical functional ability have been widely gathered. Results will be analyzed with a statistical analysis program where the studied population will receive risk ranking scores defining the odds for continued independent living in the future. Risk factors are mental and/or physical illnesses, polypharmacy, difficulties in everyday life, gerastenia, that is fatigue combined with frailty, and multimorbidity.

The goals for this study are increased awareness regarding the prevalence of multimorbidity and polypharmacy in society. Furthermore, the results can be used by healthcare professionals to create individual treatment plans especially for multimorbid patients at risk of functional decline. A proactively working health care system can help multimorbid patients to experience less ill health, live at home longer, and improve their quality of life.

1. The prevalence of multimorbidity was 85% and of polypharmacy 52%
2. Risk factors associated with polypharmacy and multimorbidity
3. Risk factors associated with functional decline in the elderly citizens

Posterior fossa malformations are rare cyst-like pathologies of the central nervous system which include Dandy-Walker Malformation, Dandy-Walker Variant and Mega Cisterna Magna. Outcomes of patients with these conditions are seen limitedly in fetal or early childhood studies, with patients reaching their adult years as rare occurrences. This is a case of a 26-year-old female who presented with recurrent headache and seizure episodes of 2-year duration. Obstetric history showed that she gave birth to a term male infant diagnosed with Patau’s Syndrome. Family history revealed she has a maternal uncle with intellectual disability. Physical examination exhibited a bulging occiput, hypertelorism, antimongoloid palpebral fissures, large globular nose, large ear lobules, high arched palate and clinodactyly. She was assessed to have non-isolated Mega Cisterna Magna having extra-cranial features of Dandy-Walker Malformation. The mixed presentation could further strengthen the Dandy-Walker Complex classification. The pivotal role of family physicians in dealing with such rare diseases by coordinating patients’ care is also highlighted.

1. Learn about a rare case of non-isolated MCM in an adult which demonstrated the classification of Dandy Walker Malformation and Mega Cisterna Magna, as members of a continuum called the Dandy Walker Complex.
2. Appreciate the central role of family physicians in diagnosing and coordinating care of patients with rare diseases.
3. Learn that the role of family physician is never-ending i.e. does not stop after referring the patient to a specialist.