Vaccine dilemma for children at risk: Recently approved malaria vaccine versus ongoing COVID-19 vaccination campaign.

Recently, the World Health Organization (WHO) approved RTS, S/AS01 (RTS, S) as the world's first malaria vaccine for partial malaria protection in young children at risk. While this immunization drive begins during the unprecedented pandemic of the SARS-CoV-2 Virus, the WHO has also approved 7 Vaccines in 2021 for the vaccination of children at risk. This article explores the quandary that would occur to the officials in charge of carrying out large vaccination campaigns against these two deadly infectious illnesses in several regions including the continent of Africa. The article also outlines the priorities for resolving this dilemma, offers evidence-based solutions, and provides a summary of recent significant events and their consequences. While providing the latest data, a discussion on the causation of the dilemma with clear recommendations for possible solutions has been explored as well.

Diagnostic Value of Dynamic High-frequency Ultrasound for the Slipping Rib and Twelfth Rib Syndrome: A Case Series with Review.

BACKGROUND: High-frequency ultrasound (HFUS) is a mobile, radiation-free imaging tool for the diagnosis of musculoskeletal disorders. We aim to demonstrate the diagnostic value of dynamic HFUS for undiagnosed lower chest, upper abdomen, and loin pain with this case series. CASE SERIES: A cricketer presented with long-standing left-sided dull ache lower chest and upper abdominal pain, aggravated on exertion and leaning forward. His previous laboratory and previous imaging tests were unrevealing. Dynamic HFUS of his left ribs during hooking maneuver demonstrated slipping of the eighth rib over the seventh rib associated with clicking. He also reported tenderness over this region. He was diagnosed with slipping rib syndrome (SRS), and was treated with the eighth nerve block under the HFUS guidance. The second and third cases presented with chronic undiagnosed waxing and waning loin pain despite extensive laboratory and radiological workup. Both patients demonstrated twelfth rib HFUS probe tenderness in a sitting position with a specific movement that reproduced the pain during the dynamic HFUS study. The diagnosis of twelfth rib syndrome (TRS) was confirmed and treated successfully with a local intercostal nerve block. REVIEW OF THE LITERATURE: HFUS is the most underutilized imaging tool for the diagnosis of unexplained upper abdominal and lower chest pain syndromes. We identified only a few such reported cases managed with the help of HFUS. CONCLUSION: The dynamic HFUS is a valuable imaging modality for the undiagnosed lower chest, upper abdominal, or loin pain.

Adrenocortical Crisis Triggered by Levothyroxine in an Unrecognized Autoimmune Polyglandular Syndrome Type-2: A Case Report with Review of the Literature.

BACKGROUND: Autoimmune polyglandular syndrometype-2 (APS-2) is an uncommon endocrine disorder of Addison's disease with an autoimmune thyroid disorder and/or type 1 diabetes mellitus. The diagnosis is more challenging when a patient presents with nonspecific neuropsychiatric features with hypothyroidism in the setting of unrecognized Addison's disease. CASE REPORT: We report a case of subclinical autoimmune hypothyroidism presented with nonspecific neuropsychiatric symptoms precipitated by stress. Despite levothyroxine treatment, her symptoms deteriorated and she was admitted with persistent vomiting and hypovolemic shock. Clinical features and laboratory parameters were suggestive of underlying adrenocortical insufficiency. Preexisting autoimmune hypothyroidism combined with Addison's disease confirmed the diagnosis of unrecognized APS-2. She remarkably improved and her thyroid function tests also normalized with the treatment of corticosteroids only. REVIEW OF THE LITERATURE: We identified only five published case reports of our title by searching the database. Neufeld and Betterle have reported their data of APS-2 and concluded that a full- blown clinical picture of two or more components of the syndrome is like the tip of the iceberg. CONCLUSION: The patients of one major component of APS-2 should be screened for other components of the disease to pick up latent cases. Addison's disease should be ruled out in patients of hypothyroidism who are intolerant to levothyroxine.