Dengue fever is a significant mosquito-borne viral disease in tropical and subtropical areas that causes a significant burden to public health systems and the affected communities. There is no definite antiviral treatment that can be used routinely in clinical practice, though there is growing interest in natural management, especially in endemic countries where home-based care, traditional medicine, and plant-derived adjuncts are widely used. The objective of this review is to critically evaluate evidence for natural and supportive management strategies in dengue fever, including oral hydration, nutritional support, rest, non-pharmacological symptom relief, and selected herbal interventions. A focused narrative review of clinical, preclinical, systematic-review, and guideline-based literature was conducted. Evidence supports oral hydration as the most established supportive measure in uncomplicated dengue, while nutritional support and rest may aid recovery. Carica papaya leaf extract may improve platelet counts, but this has not consistently translated into better clinical outcomes such as reduced bleeding, shock, hospitalization, or mortality. Evidence for other ethnomedicinal plants remains limited and largely preclinical. Overall, natural approaches may be useful only as adjuncts to standard supportive care and should not replace clinical monitoring or timely referral. Further well-designed trials are needed to clarify efficacy, safety, dosing, and standardization.

Objective: To analyze the nonlinear relationship between meteorological predictors and dengue hemorrhagic fever, and to quantify the meteorologically attributable fraction of dengue hemorrhagic fever (DHF) during 2021-2025 in Cilacap Regency.

Methods: This ecological time series design used sequential three-stage analytical tools, including a cross-correlation function (CCF) analysis applied to identify lag structures, Granger causality within a vector autoregression (VAR) framework used to confirm directional temporal precedence, and a quasi-Poisson Distributed Lag Nonlinear Model (DLNM) with natural cubic spline crossbases over a 28-day lag window used to estimate the exposure-response relationship. Autoregressive terms alongside long-term trends and seasonal splines were incorporated to account for autocorrelation and potential confounding.

Results: Granger causality testing confirmed unidirectional of DHF relationships across all four predictors, including mean temperature, rainfall, relative humidity, and wind speed (all P<0.05). Among these, daily rainfall emerged as the dominant predictor [relative risk (RR) 4.23; 95% CI 2.10-8.52)], a peak CCF lag of 7 days, and an attributable fraction of 27.58%. The mean temperature displayed a J-shaped exposure-response curve, with a protective nadir at 26.5°C, and markedly elevated risk above 28 °C [RR 2.13; 95% CI 1.43-3.19; Attributable Fraction (AF) = 6.22%]. Relative humidity (AF= -14.40%) and wind speed (AF= -3.37%) demonstrated complex nonlinear patterns contributing net protective attributable fractions. Overall, the model explained 52.26% of the null deviance (QAIC= 3 984.23).

Conclusions: Rainfall and temperature were the meteorological predictors most strongly associated with DHF incidence in Cilacap Regency. This finding provides evidence for actionable vector control program and early warning system of DHF to consider the utilization of meteorological predictor to prevent DHF outbreak in Cilacap.

Objective: To identify factors associated with the therapeutic effectiveness of albendazole in children with Toxocara canis infection in Ho Chi Minh City, Vietnam.

Methods: The study was conducted from April 2022 to December 2023 and consisted of two phases. Phase 1 was a cross-sectional study involving 986 children aged 3-15 years in Ho Chi Minh City, Vietnam, to determine the seroprevalence of Toxocara spp. using ELISA IgG testing. Phase 2 was an interventional study conducted in children with compatible clinical manifestations and positive ELISA results. Patients received albendazole at a dose of 15 mg/kg/day for 5 days. Clinical and laboratory reassessments were performed 6 months after treatment.

Results: Of 986 school children included in the cross-sectional study, 140 (14.2%) had positive Toxocara ELISA results and 107 completed follow-up after treatment. At 6 months, 96.3% showed complete resolution of clinical symptoms, 71.0% had normalized eosinophil counts, and 57.9% had total IgE levels returned to the normal range. The treatment failure rate was 72.0%. Multivariable analysis identified place of residence and inappropriate disposal of dog and cat feces as independent factors associated with treatment failure (P<0.05).

Conclusions: Environmental and hygiene-related factors, particularly improper disposal of dog and cat feces, were independently associated with treatment failure.

Objective: To investigate the heterogeneous effects of polyene phosphatidylcholine (PPC) on different liver diseases.

Methods: This multicenter retrospective study used the Cooperative Registry of Hospital Prescription from 264 Grade-A hospitals in 16 provinces in China. Eligible patients had abnormal baseline liver functions and follow-up liver function tests. We used linear mixed-effects growth curve analysis to analyze the change of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT) and total bilirubin after adjusting for age and sex. Statistical significance was set at P<0.05.

Results: Among 1 454 patients (median age 52 years; 63.8% male), PPC significantly controlled abnormal ALT, AST, GGT and total bilirubin (P<0.05). Patients with drug-induced liver injury exhibited higher baseline ALT levels and more rapid ALT decline. Cirrhotic patients had lower baseline ALT/AST and slower recovery. Patients with alcoholic liver disease had a sharp GGT decline (P<0.001). ALT/AST recovery was not impacted by autoimmune hepatitis. Patients with higher baseline ALT received higher PPC doses, resulting in an adequate ALT/AST normalization time.

Conclusions: PPC’s hepatoprotective effects differed by liver disease subtypes. Higher doses suited patients with elevated baseline ALT/AST.

Rationale: In dengue- and typhoid-endemic regions, a reactive IgM often anchors the diagnosis, yet severe sepsis can drive polyclonal B-cell activation and low-specificity antibodies that yield false-positive results.

Patient concerns: A 57-year-old previously healthy male patient presented with six days of fever, crampy abdominal pain, and mucoid diarrhea, followed by progressive weakness and circulatory collapse.

Diagnosis: Septic shock with multiple organ dysfunction (SOFA 10), thrombocytopenia, markedly raised procalcitonin, acute kidney injury, conjugated hyperbilirubinemia, and pancreatic edema. Dengue IgM was positive and Salmonella TUBEX was borderline positive, but both reverted to negative on repeat testing. The final diagnosis was culture-negative septic shock of presumed gastrointestinal origin with secondary acute pancreatitis.

Interventions: Fluid resuscitation, norepinephrine and vasopressin, empirical ceftriaxone, nutritional support, and conservative pancreatitis care.

Outcomes: Cultures obtained after antibiotics were sterile; procalcitonin fell from 7.95 to 0.15 ng/mL by day 7, and the patient recovered and was discharged on day 13.

Lessons: In septic shock, an isolated reactive IgM should be interpreted cautiously and integrated with biomarker trends, cultures, and organ-dysfunction patterns.