Rejected

 We reported an outbreak of human parainfluenza virus type 1 (HPIV1) in a kindergarten and explored the genetic characteristics of HPIV1 (HN) and (F) genes to provide more evidence about HPIV1 outbreaks.  Suspected cases were the children with an influenza-like illness during June 20 to 26, 2018. Nasopharyngeal swabs were collected and screened to determine the presence of respiratory pathogens by real-time fluorescent quantitative polymerase chain reaction. The HN and F gene sequences of HPIV-positive samples were further amplified and sequenced to confirm the HPIV genotype and identify genetic characteristics. A phylogenetic tree, based on the HN and F genes, was reconstructed by maximum likelihood method.  Fourteen children in the outbreak were diagnosed as upper respiratory tract infection. The most common symptom was cough (10/14), followed by rhinorrhea (5/14), sore throat (4/14), headache (1/14), and abdominal pain (1/14). Eight patients were positive for HPIV1 and negative for other pathogens. Phylogenetic tree demonstrated that the eight strains from the year 2018 in our study located in the clade 2.3. Two specific substitutions (N333S and I509M) in the amino acids of the F protein and two substitutions (V19A and L436I) in the HN protein were different from other strains in the clade 2.  HPIV1 was attributed to the outbreak, which may be related to the genetic variations of HPIV1.

Described in the article is a clinical case report regarding diagnosis and treatment of pelvic varicose veins in a 34-year-old male patient presenting with compressive stenosis of the left common iliac vein (May-Thurner syndrome). The man had developed clinical symptoms of the disease as varicocele when he was 17 years old. Multiple surgical interventions on the veins of the spermatic cord failed to result in significant success. The diagnosis was verified by means of ultrasound examination and contrast X-ray phlebography. The patient was subjected to balloon angioplasty and stenting of the compressive stenosis of the left common iliac vein. The endovascular treatment performed was followed by the patient's improved condition, confirmed by methods of instrumental diagnosis, as well as by regression of clinical symptomatology.

species are divided into three groups depending on the induced disease and the tick vector. is a relapsing fever but can induce symptoms related to Lyme disease. Discovered in 1995, it is found in ticks around the world. In France, this species of has been isolated in ticks and rodents, but was not yet observed in humans. The aim of the study was to look for in symptomatic patients. Real-time PCR was performed on 824 blood samples from patients presenting symptoms of persistent polymorphic syndrome possibly due to tick bite, a syndrome recognized by the French Authority for Health, which is close to the post-treatment Lyme disease syndrome. PCR was also performed on 24 healthy control persons. The primers were specifically designed for this particular species of . The sequence of interest of 94 bp is located on the gene. Sequencing of amplification products, randomly chosen, confirmed the amplification specificity. To better investigate cases, a clinical questionnaire was sent to the patients PCR-positive for and to their physician. This search revealed a positive PCR for in the blood from 43 patients out of 824 (5.22%). PCR was negative in all control persons. A clinical chart was obtained from 31 of the 43 patients. A history of erythema migrans was reported in five of these 31 patients (16%). All patients complained about fatigue, joint pain and neuro-cognitive disorders. Some patients complained about respiratory problems (chest tightness and/or lack of air in 41.9%). Episodes of relapsing fever were reported by 11 of the 31 patients (35.5%). Chilliness, hot flushes and/or sweats were reported by around half of the patients. may not cross-react with serology. This study is the first to detect in human blood in France. This series of human infection is the largest in patients with long term persistent syndrome. Our data suggest that this infection may be persistent, even on the long term.

A 49-year-old man with chronic hepatitis B receiving treatment with entecavir visited a hospital with a complaint of abdominal pain. Computed tomography (CT) showed 2 liver tumors, each measuring 1cm in diameter, 1 in segment 7 and 1 in segment 4. Magnetic resonance imaging (MRI) showed a hypervascular tumor in segment 7 that appeared in a site different from that seen on CT. The liver tumor in segment 4 was not detected by MRI. Two months later, MRI showed a new liver tumor in segment 7/6 and that the liver tumor in segment 7 had increased to 2cm in diameter;blood tests showed eosinophilia. Enzyme-linked immunosorbent assay showed a high serum Toxocara antibody. The patient was diagnosed as having hepatic toxocariasis and was treated with albendazole for 8 weeks. After treatment, MRI showed that the liver tumors disappeared. Eosinophilia, multiple lesions, and the disappearance of the tumors were characteristic findings of visceral larva migrans.

X-linked hypophosphatemia (XLH) causes significant burden in pediatric patients in spite of maintained treatment with phosphate supplements and vitamin D derivatives. Administration of burosumab has shown promising results in clinical trial but studies assessing its effect in the everyday practice are missing. With this aim, we analyzed the response to one-year treatment with burosumab, injected subcutaneously at 0.8 mg/kg every 2 weeks, in five children (three females) aged from 6 to 16 years, with genetically confirmed XLH. Patients were being treated with phosphate and vitamin D analogs until the beginning of burosumab treatment. In all children, burosumab administration led to normalization of serum phosphate in association with marked increase of tubular reabsorption of phosphate and reduction of elevated serum alkaline phosphatase levels. Baseline height of patients, from -3.56 to -0.46 SD, increased in the three prepubertal children (+0.84, +0.89, and +0.16 SD) during burosumab treatment. Growth improvement was associated with reduction in body mass index (-1.75, -1.47, and -0.17 SD, respectively), suggesting a salutary effect of burosumab on physical activity and body composition. Burosumab was well-tolerated, mild local pain at the injection site and transient and mild headache following the initial doses of burosumab being the only reported undesirable side effects. No patient exhibited hyperphosphatemia, progression of nephrocalcinosis, worsening of metabolic control or developed hyperparathyroidism. Mild elevation of serum PTH present at the beginning of treatment in one patient 4 was not modified by burosumab administration. These results indicate that in the clinical setting, beyond the strict conditions and follow-up of clinical trials, burosumab treatment for 1 year exerts positive effects in pediatric patients with XLH without major adverse events.

Pharmacological interventions remain the cornerstone of chronic pain treatment; however, nearly 40% of the prescription medicines are not taken as prescribed. The present study aims at understanding and describing non-adherence from the perspective of chronic pain patients during a 1-year follow-up study.

Hydatid disease (HD) is caused by Echinococcus granulosus and is endemic in many parts of the world. This parasitic tapeworm can produce cysts in almost every organ of the body, with the liver and lung being the most frequently targeted organs. The spleen and mesentery are unusual locations. We report a case of simultaneous huge splenic and mesenteric hydatid cyst in a 91-year-old male patient. The patient was presented with chronic abdominal pain, increased frequency of defecation, and typical history of animal contact (cattle, sheep, and dogs). After performing imaging studies, he was diagnosed with a simultaneous huge spleen and pelvic mesentery hydatid cyst that was managed surgically by splenectomy, pelvic mesenteric cyst deroofing, and partial cystectomy.

Currently, the only approved hepatitis C virus (HCV) treatment for children aged <12 years is pegylated-interferon plus ribavirin. In an open-label study, we evaluated the safety and efficacy of sofosbuvir plus ribavirin for 12 weeks in children aged 3 to <12 years chronically infected with genotype 2 or for 24 weeks in patients with genotype 3. Patients aged 3 to <6 years weighing <17 kg received sofosbuvir 150 mg, and patients aged 3 to <6 years weighing ≥17 kg and all patients aged 6 to <12 years received sofosbuvir 200 mg once daily. Intensive pharmacokinetic sampling conducted in each age group confirmed the appropriateness of sofosbuvir doses. For all patients, ribavirin dosing was determined by baseline weight (up to 1400 mg/day, two divided doses). The primary efficacy endpoint was sustained virologic response 12 weeks after therapy (SVR12). 54 patients were enrolled (41 aged 6 to <12 years and 13 aged 3 to <6 years). Most were treatment-naive (98%) and infected perinatally (94%). All but one patient achieved SVR12 (53/54, 98%, 95% CI 90-100%). The patient who did not achieve SVR12 was a 4 year-old who discontinued treatment after three days due to 'abnormal drug taste'. The most commonly reported adverse events in patients aged 6 to <12 years were vomiting (32%) and headache (29%) and in patients aged 3 to <6 years, vomiting (46%) and diarrhea (39%). One 3 year-old patient had a serious adverse event of accidental ribavirin overdose requiring hospitalization for monitoring; this patient completed treatment and achieved SVR12. CONCLUSION: Sofosbuvir plus ribavirin was well-tolerated and highly effective in children aged 3 to <12 years with chronic HCV genotype 2 or 3 infection. This article is protected by copyright. All rights reserved.

The peak prevalence of migraine occurs in women of reproductive age, and women experience a higher burden of migraine symptoms and disability compared to men. This increased burden of migraine in women is related to both developmental and temporally variable activational effects of female sex hormones. Changing levels of female sex hormones affect the expression of migraine during pregnancy, and, to a lesser degree, lactation, and are the mechanism underlying menstrual migraine. This review describes the evidence for sex differences in the expression of migraine across the reproductive epoch; reviews the epidemiology of migraine during pregnancy, lactation, and menses; and summarizes the available evidence for safety and efficacy of acute treatments during pregnancy and lactation and for menstrual migraine. Areas of controversy in treatment of migraine during pregnancy, including the use of magnesium, triptans vs butalbital combination medications, and onabotulinum toxin, are also explored.

The objective of this systematic review was to assess the analgesic efficacy of duloxetine (DLX) for fibromyalgia (FM) and find which dosage between 60mg/d DLX and 120mg/d DLX was more suitable for clinical application. A systematic search through multiple databases (Cochrane Central Register of Controlled Trials (CENTRAL), ProQuest, Pubmed) was conducted from 2000 until March 7, 2019. All steps were performed by two or more independent reviewers. A meta-analysis was performed to report the effects of DLX on pain reduction and its accompanied adverse events. This meta-analysis, including 7 studies with totaling 2642 FM patients, demonstrated that DLX could produce greater pain relief in FM than placebo (standardized mean difference (SMD) -0.26; 95% confidence interval (CI) -0.37 to -0.16). The Risk Ratio (RR) of at least 30% pain relief was 1.31(95%CI 1.19 to 1.44); The RR of at least 50% pain relief was 1.46 (95% CI 1.28 to 1.67). However, the adverse events were more common in patients with DLX than the ones with placebo (RR 1.17, 95%CI 1.12 to 1.23). The subgroup analyses of withdrawal effects demonstrated that 120mg/d DLX had a higher incidence (RR 0.96, 95% CI 0.80 to 1.15) than 60mg/d DLX (RR 0.77, 95% CI 0.63 to 0.93). In general, DLX was a great choice for pain relief in FM. Moreover, 60mg/d DLX produced less withdrawal effects than 120mg/d DLX. Highlight Fibromyalgia(FM) is a chronic condition of unknown etiology, characterized by widespread pain and often associated with other symptoms. Duloxetine (DLX), a serotonin-norepinephrine (noradrenaline) reuptake inhibitor(SNRI), is used to treat FM in many countries. DLX can produce greater pain relief in FM than placebo. DLX can bring about more adverse events than placebo. 60mg/d DLX produce less withdrawal than 120mg/d DLX for FM patients.