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Patients presenting with a post-invasive procedure hematoma can be treated with medicinal leeches to evacuate the hematoma. Our patient, a postmenopausal woman in her 60s, with a past medical history of hypothyroidism, presented to the outpatient clinic with pain, redness, warmth, and swelling on her right thigh. Ten days prior, the patient had undergone a subcutaneous pellet implant procedure in the right thigh for hormonal replacement therapy. The patient developed post-procedure cellulitis and soft tissue infection and was treated with antibiotics. The patient developed a progressively enlarged hematoma at the implant site. The hematoma was treated with medicinal leeches. Two weeks after treatment, the implant area healed. The patient had a family history of von Willebrand disease and a history of prolonged bleeding during childbirth, menstruation, and dental procedures. A von Willebrand panel was obtained, and the results were consistent with a new diagnosis of von Willebrand disease., Competing Interests: The patient in the case study is a family member of one of the authors., (Copyright © 2023, Marquez-Gil et al.)

Niger is a Sahelian country of 1,267,000 km2 and 11 M inhabitants (84% living in rural area). The national seroprevalence of the HIV infection is low (2.08% in urban area and 0. 64% in rural area). Because of limited resources, laboratories and qualified personnel are scarce, so the classical strategy using ELISA methods to diagnose HIV is available only in the capital Niamey. In order to define a strategy suitable to the Nigerian field conditions, we have determined the diagnostic value of five commercialised rapid assays (Génie II, InoCheck, Determine, Capillus and Doublecheck). A panel of plasma, whole blood and dried blood spot from 42 positive and 160 negative control individuals was tested and the sensitivity and specificity of each assay were calculated. The two best algorithms using two tests were selected: a algorithm discriminating HIV1 & 2 combining Determine and Genie II showing an excellent sensitivity and specificity (100%) but with many practical constraints; and a non discriminative algorithm combining Determine and Double-check less specific but workable on capillary blood and fully compatible with the field conditions. Its negative predictive value was 100% and its positive predictive value was > 97% for urban population and > 91% for rural population. Dried blood spots on filter paper proved to be very practical and efficient to use by the reference laboratory for the quality control of the peripheral diagnostic centres.

A case of Gilles de la Tourette's syndrome in a Kuwaiti woman is described, and the possibility of antecedent head injury as the organic etiological factor is discussed.