Rejected

In 2005, the National Immunisation Program implemented a varicella vaccine for children aged 18 months, and in 2016, a herpes zoster (HZ) vaccine for adults aged 70-79 years. This epidemiological review analyses national trends in varicella and HZ for the years 1998-2015 to examine the impact of a funded varicella vaccine and provide a baseline for monitoring the impact of a funded HZ vaccine.

Low levels of agreement between caregiver and child reports of acute pain are well documented.

Approximately 25% of all deliveries in Denmark are medically induced, typically characterized by more intense uterine contractions. The aim of this paper is to investigate the differences in the administration of epidural analgesia and pain experience between spontaneous and medically induced labor in nulliparous and multiparous women.

Cystic echinococcosis is a chronic parasitic zoonosis of high prevalence in Chile. We report a clinical case of a 66-year-old man, domiciled in an urban area of the Maule Region, who presents skeletal muscle cystic echinococcosis. Consultation for pain, volume increase and left thigh fistula that gives out crystalline fluid. In the study with imaging techniques, multiple cystic lesions are identified in the sacral wing, iliac bone, soft tissues of the groin and left thigh. No cysts were evident in other organs. Serology Elisa IgG was positive Echinococcus granulosus. Surgical resection of soft tissue injuries. Combined antiparasitic therapy with albendazole and praziquantel was started, with good clinical response. Upon discontinuation of antiparasitic therapy at the initiative of the patient, symptoms are reinitiated.

The use of quantitative sensory testing (QST) in multicenter studies has been quite limited, due in part to lack of standardized procedures among centers.

Osteonecrosis of the jaw (ONJ) and atypical femoral fracture (AFF) are rare potential adverse effects of bisphosphonates and RANKL antibody therapy. The pathogenic mechanisms of both conditions are known to be independent of each other. Here, we report both conditions sequentially occurring in the same patient. An 81-year-old, obese, diabetic, female was admitted due to hypertensive urgency and persistent jaw pain after tooth extraction. The patient has postmenopausal osteoporosis for fourteen years and was on intermittent, unsupervised treatment with alendronate, denosumab and ibandronate. Upon presentation, the patient was noted with tenderness intraorally of tooth number 35 periapical region. This was associated with elevated erythrocyte sedimentation rate and C-reactive protein. Imaging study showed presence of bony sclerosis which represent a sequestrum in the molar area of the left hemi-mandible. Antibiotic infusion and excision and debridement of left posterior mandible were done. Histopathologic finding was consistent with a diagnosis of osteonecrosis of the jaw. The same patient, upon review, had suffered sequential fracture of both femurs during the eighth and eleventh year of treatment with antiresorptive agents. The fractures were transverse, non-comminuted, at the proximal femoral shaft. Each occurred after a minor trauma and was managed with open reduction and internal fixation. Both fractures were consistent with atypical femoral fractures. ONJ and AFF can occur both in the same patient during prolonged treatment with bisphosphonates and denosumab and may suggest a common pathogenic mechanism.

Scrub typhus, caused by Orientia tsutsugamushi and transmitted by larvae of trombiculid mites, is an endemic rickettsiosis in the Asia Pacific region. After the first identification of a case in Chile in 2006, more than 30 cases have been diagnosed by our group since 2015. Cases were detected predominantly during the Chilean summer months. Patients presented with fever, rash, and a typical eschar at the inoculation site; other frequent findings were intense headache, night sweats, increased laboratory markers of inflammation and transaminases. The vast majority of cases have been diagnosed in southern Chile (mainly Chiloé Island), although recently some cases were also identified in the central Metropolitan Region in patients returning from trips to southern Chile. Physicians attending Chilean patients should be aware of this emerging infection to be able to initiate empirical therapy with doxycycline. The confirmation of cases by the diagnostic methods available in Chile will contribute to a better understanding of the epidemiological and clinical relevance of this emerging infection in South America.

The perioperative period provides a critical window to address opioid use, particularly in patients with a history of chronic pain and presurgical opioid use. The Toronto General Hospital Transitional Pain Service (TPS) was developed to address the issues of pain and opioid use after surgery.

A 58-year-old male presented with persistent severe headache, lethargy, decline libido and no neurological deficits. Besides quadruple anterior pituitary hormonal deficiencies, magnetic resonance imaging (MRI) demonstrated an enlarged ring-enhanced non-homogenous pituitary. Following hormonal replacement, these symptoms improved but empty sella evolved. The challenges of diagnosis and management were discussed. Awareness of the unclear etiology and uncertain clinical course of autoimmune hypophysitis in a man in this age group is essential for prompt and appropriate management.

Besli GE, Yıldırım S, Akalın İ, Ayhan Yİ, Kısıoğlu M, Berdeli A. Fever-induced Brugada syndrome in a 9-year-old boy presenting with acute chest pain. Turk J Pediatr 2018; 60: 571-575. Brugada syndrome, an arrhythmogenic disease, occurs due to mutations involving cardiac sodium channels. It is characterized by persistent or transient ST-segment elevation in the right precordial electrocardiogram leads that could be unmasked by several circumstances, with fever particularly. Molecular and cellular mechanisms leading to Brugada syndrome have not been completely elucidated. Mutations of the SCN5A gene encoding the pore-forming α-subunit of the cardiac sodium channel protein have been attributed in the molecular diagnosis. Although this syndrome is well-known in adults, it is less frequently reported in infants and children. We describe a 9-year-old Turkish boy with a family history of sudden cardiac death, who presented with chest pain and fever-induced expression of the Brugada syndrome phenotype that might be associated with a mutation in SCN5A gene.