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Competing Interests: The authors have no funding or conflicts of interest to disclose.

Competing Interests: The authors have no funding or conflicts of interest to disclose.

Background: In the first half of 2022, the increase in cases of severe acute hepatitis in children with no epidemiological link and unknown cause has aroused concern worldwide. In this study, we aimed to determine the frequency of adenovirus in children with hepatitis of unknown origin in Turkey., Methods: In this study, which was conducted with the participation of 16 centers from Turkey, between July 2022 and January 2023, 36 pediatric patients under the age of 18 who met the definition of acute hepatitis were included., Results: Twenty (55,6%) of patients were female and 16 (44,4%) were male, with a mean age of 41.55 ± 39.22 (3-192) months. The most common symptoms were fever (66.7%), weakness (66.7%), loss of appetite (66.7%), fatigue (61.1%), vomiting (61.1%), and diarrhea (47.2%). Six (16 %) children had acute hepatic failure. Eight of the 15 children (46%) had respiratory viral infections (rhinovirus/enterovirus, n = 4; rhinovirus + parainfluenza, n = 1; parainfluenza, n = 1, SARS-CoV-2 n = 2). Adenovirus was detected in 16 (44%) patients. Adenovirus and coinfections were detected in 7 patients. History of diarrhea and fatigue in the last month was significantly higher in the adenovirus group ( P = 0.023 and 0.018). One child who had both adenovirus and rhinovirus infection required liver transplantation; all others recovered with supportive care., Conclusion: There were no deaths in our series; however, the number of cases, etiology, and severity of the clinical course may have differed between countries owing to differences in case definitions, laboratory facilities, or regional genetic differences., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Migraine is a complex neurogenic inflammatory disorder. There are strong neuronal, endocrine, and immunologic connections between the brain and gastrointestinal system. Damage to the intestinal barrier is thought to cause systemic immune dysregulation. Zonulin is a protein produced by the small intestine epithelium in humans that regulates intestinal permeability through intracellular tight junctions and is a potential marker for inflammation. Zonulin increases in positive correlation with permeability. In our study, we aimed to research the correlation between serum zonulin levels in the period between attacks in pediatric patients with migraine., Methods: The study included 30 patients with migraine and 24 healthy controls, matched in terms of sex and age. Demographic and clinical characteristics were recorded. Serum zonulin levels were studied with the enzyme-linked immunosorbent assay method., Results: Patients had a mean of 5.6 ± 3.5 attacks per month. The mean serum zonulin was 5.68 ± 1.21 ng/mL in the migraine group and 5.72 ± 2.1 ng/mL in the control group with no significant difference found (P = 0.084). In the migraine group, no correlations were identified between serum zonulin levels and age, body mass index, pain frequency, pain duration, onset time, visual analog scale score, and presence of gastrointestinal systems apart from nausea-vomiting., Conclusions: More than 50 proteins were identified to affect the intestinal permeability apart from zonulin. There is a need for prospective studies encompassing the time of attack, but our study is important as it is the first study about zonulin levels in pediatric migraine., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Antibiotic-associated diarrhea is one of the most frequent side effects of antimicrobial therapy. We assessed the epidemiological data of antibiotic-associated diarrhea in pediatric patients in our region., Methods: The prospective multi-center study included pediatric patients who were initiated an oral antibiotic course in outpatient clinics and followed in a well-established surveillance system. This follow-up system constituded inclusion of patient by the primary physician, supply of family follow-up charts to the family, passing the demographics and clinical information of patient to the Primary Investigator Centre, and a close telephone follow-up of patients for a period of eight weeks by the Primary Investigator Centre., Results: A result of 758 cases were recruited in the analysis which had a frequency of 10.4% antibiotic-associated diarrhea. Among the cases treated with amoxicillin-clavulanate 10.4%, and cephalosporins 14.4% presented with antibiotic-associated diarrhea. In the analysis of antibiotic-associated diarrhea occurrence according to different geographical regions of Turkey, antibiotic-associated diarrhea episodes differed significantly (p = 0.014), particularly higher in The Eastern Anatolia and Southeastern Anatolia. Though most commonly encountered with cephalosporin use, antibiotic-associated diarrhea is not a frequent side effect., Conclusion: This study on pediatric antibiotic-associated diarrhea displayed epidemiological data and the differences geographically in our region., (© 2023. The Author(s).)

Introduction: Health care workers (HCWs) are disproportionately exposed to infectious diseases and play a role in nosocomial transmission, making them a key demographic for vaccination. HCW vaccination rates are not optimal in many countries; hence, compulsory vaccination policies have been implemented in some countries. Although these policies are effective and necessary under certain conditions, resolving HCWs' hesitancies and misconceptions about vaccines is crucial. HCWs have the advantage of direct contact with patients; hence, they can respond to safety concerns, explain the benefits of vaccination, and counter antivaccine campaigns that escalate during pandemics, as has been observed with COVID-19., Method: A short survey was carried out in May-June 2020 on the vaccination status of HCWs working with pediatric patients with COVID-19. The survey inquired about their vaccination status (mumps/measles/rubella [MMR], varicella, influenza, and diphtheria/tetanus [dT]) and willingness to receive hypothetical future COVID-19 vaccines. The respondents were grouped according to gender, age, occupation, and region., Results: In total, 4927 HCWs responded to the survey. Most were young, healthy adults. The overall vaccination rates were 57.8% for dT in the past 10 years, 44.5% for MMR, 33.2% for varicella, and 13.5% for influenza. Vaccination rates were the highest among physicians. The majority of HCWs (81%) stated that they would be willing to receive COVID-19 vaccines., Conclusion: Although vaccination rates for well-established vaccines were low, a majority of HCWs were willing to receive COVID-19 vaccines when available. Education and administrative trust should be enhanced to increase vaccination rates among HCWs.

Objective: The first articles about the impact of COVID-19 infection focused on the physical health and existing well-being of children and adolescents. However, little is known about the long-term effects of the disease itself, especially being infected with the virus and even the possibility of the infection on their mental health. Therefore, this study aimed to examine the long-term psychological effects of the disease., Method: The study was designed as cross-sectional quantitative research. For this, the medical records of all 8-18-year-old children who presented to a university pandemic clinic in 2020 with possible COVID-19 symptoms were scanned. One hundred 62 children, with the first presentation date of 6 months ago and earlier, were divided into three groups. Group 1 consisted of children with chronic diseases who were hospitalized at the time of admission and continued to be hospitalized in the follow-up after they were PCR( +; polymerase chain reaction +). Group 2 comprised children without chronic diseases and continued outpatient follow-up after they were PCR(+). Finally, Group 3 was constituted by children with chronic diseases who were hospitalized at the time of admission but were discharged after their test was negative. A control group was also included., Results: It was found that presenting to a pandemic clinic with possible COVID-19 symptoms, being PCR-positive for COVID-19, and being hospitalized with a verified disease posed a significant risk to children for the development of mental disorders, including anxiety, depression, posttraumatic stress disorder (PTSD), and sleep disorders., Conclusion: Thus, prompt identification of at-risk populations, early intervention, and effective management of diagnosed disorders is necessary. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective: This study aimed to evaluate presentations of new-onset type 1 diabetes mellitus in a pediatric cohort during the coronavirus disease 2019 pandemic., Materials and Methods: This study was designed as a single-center, descriptive, cross-sectional retrospective study. The patients diagnosed with new-onset type 1 diabetes mellitus between April 1, 2020, and April 1, 2021, were included in the study. The rate of severe acute respiratory syndrome coronavirus 2 polymerase chain reactivity-positivity was investigated. The pandemic period was compared with the same period of the pre-pandemic 2 years in terms of number of new-onset type 1 diabetes mellitus patients, rate of presentation with diabetic ketoacidosis, and degree of diabetic ketoacidosis severity., Results: In total, 56 patients were diagnosed with type 1 diabetes mellitus during the pandemic and 2 (3.57%) of them tested positive for severe acute respiratory syndrome coronavirus 2 polymerase chain reaction. The number of new-onset type 1 diabetes mellitus patients was 39 in 2019 and 39 in 2018. The rate of presentation with diabetic ketoacidosis was similar in the pandemic period compared to the pre-pandemic periods (53.5% in 2020 vs. 56.4% in 2019 and 53.8% in 2018; P = .94). The proportion of severe diabetic ketoacidosis was also similar in all years, respectively (43.3% in 2020 vs. 45.4% in 2019 and 47.6% in 2018; P = .95)., Conclusion: We reported only 2 cases that tested positive for severe acute respiratory syndrome coronavirus 2among the new-onset type 1 diabetes mellitus patients during the pandemic. Although we found an increase in the number of new-onset type 1 diabetes mellitus cases by comparing with prepandemic period, rates of diabetic ketoacidosis and severe diabetic ketoacidosis were similar. There was no finding to suggest that severe acute respiratory syndrome coronavirus 2taking a part in type 1 diabetes mellitus pathogenesis. Since the development of type 1 diabetes mellitus is a long process, prospective studies are needed to investigate the long-term effects of severe acute respiratory syndrome coronavirus 2.

Background: Invasive Trichosporon infections are rarely seen opportunistic fungal infections in children and mainly affect immunocompromised patients. This multicenter retrospective study has rewieved the characteristics, risk factors, treatment modalities and outcomes of bloodstream infections caused by Trichosporon species in children diagnosed over the past ten years in Turkey., Methods: The study was performed with the participation of 12 of 55 hospitals invited from Turkey. In each center, the patients with bloodstream infections caused by Trichosporon spp. between January 2010 and December 2020 were retrospectively ascertained and the results were reported to the study coordinator by means of a simple case report. Data were collected on patient demographics, underlying condition(s), treatment of.infections caused by Trichosporon spp, and 7 and 30- day mortality rates., Results: A total of 28 cases with fungemia caused by Trichosporon spp. were included in the study. The most common underlying disease was paediatric cancers (39.3%). T. asahii infections were detected in 78.5 % (n=22) of patients. A various spectrum of antifungal treatment regimens were used including intravenous amphotericin B monotherapy in 35.7%, intravenous amphotericin B and voriconazole combination in 32.1% and intravenous voriconazole monotherapy in 28.6% of the patients. The overall mortality rate was 28.5 %. The mortality rates were 12.5% in the voricanozole, 30% in the amphotericin B and 33.3% in combined voriconazole -amphotericin B arms CONCLUSIONS: Invasive Trichosporon infections with an important impact of patients quality of life are almost related to underlying diseases with an overall mortality rate of 28.5%. Voriconazole was found to be associated with lower mortality rates when compared with other treatment regimens., Competing Interests: Declaration of Conflict of Interest No potential conflict of interest has been declared by the author(s). All authors have reviewed and approved the finalized version of the manuscript, and contributed significantly to the survey. No financial support was provided relevant to this article. The manuscript has not been previously published nor is it being considered for publication elsewhere, (Copyright © 2021 SFMM. Published by Elsevier Masson SAS. All rights reserved.)

Background/aim: Bloodstream infections are the major cause of morbidity, increased cost, prolonged hospitalization, and mortality in pediatric patients. Identifying the predominant microorganisms and antimicrobial susceptibilities in centers helps to select effective empirical antimicrobials which leads to positive clinical outcomes. We aimed to identify the causative microorganisms and their antimicrobial susceptibilities in patients with bloodstream infections., Materials and Methods: Data belonging to patients with hematological and/or oncological diseases admitted to our hospital with fever between January 2010 and November 2015 were analyzed., Results: In total, 71 patients who had 111 bloodstream infection episodes were included. Responsible pathogens were detected as follows: 35.1% gram-positive microorganisms, 60.5% gram-negative bacteria, and 4.4% fungi. The most common causative gram-negative pathogen was Escherichia coli and the most commonly isolated gram-positive microorganism was coagulase-negative staphylococci., Conclusion: Gram-negative microorganisms were predominant pathogens in bloodstream infections. Escherichia coli and coagulase-negative staphylococci were the most commonly isolated responsible pathogens. Beta-lactam/lactamase inhibitors were suitable for empirical treatment. However, in critical cases, colistin could have been used for empirical treatment until the culture results were available. Routine glycopeptide use was not required. By identifying the causative microorganisms and their antimicrobial resistance patterns, it will be possible to obtain positive clinical results., (This work is licensed under a Creative Commons Attribution 4.0 International License)

Hydatid disease is a parasitic disease. Although the disease causes many organ involvement, intracranial involvement is rarely seen. Clinical findings vary according to the number, size, localization of the cyst and the immune status of the patient. We aimed to present a rare case with intracranial hydatid cyst. A 8-year-old male patient presented with headache and vomiting. Physical examination revealed papillary edema. Brain computerized tomography imaging revealed a 13x13 cm cystic formation in the brain. The patient’s echinococcal indirect hemagglutination test result was positive. The patient was started on oral albendazole therapy for intracranial hydatid cyst and was operated by brain surgery. Pathologic examination of the cyst was compatible with hydatid cyst. Although cysts are detected in the liver and lungs, cysts may be seen in atypically located areas. It should be kept in mind in clinically suspected patients that the disease can develop in rare organs, especially in patients with endemic areas. In patients with hydatid disease, advanced radiological examinations such as lung X-ray, abdominal ultrasonography and brain magnetic resonance imaging and echocardiographic examination should be performed for other organ involvement.

Pneumonia is a significant cause of death for children, particularly those in developing countries. The records of children who were hospitalized because of pneumonia between January 2003 and December 2015 were retrospectively reviewed, and patients who met the recurrent pneumonia criteria were included in this study. During this 13-year period, 1395 patients were hospitalized with pneumonia; of these, 129 (9.2%) met the criteria for recurrent pneumonia. Underlying diseases were detected in 95 (73.6%) patients, with aspiration syndrome (21.7%) being the most common. Rhinovirus (30.5%), adenovirus (17.2%) and respiratory syncytial virus (13.9%) were the most frequent infectious agents. These results demonstrate that underlying diseases can cause recurrent pneumonia in children. Viruses are also commonly seen in recurrent pneumonia. Appropriate treatments should be chosen based on an analysis of the underlying disease, the patient's clinical condition and the laboratory and radiological data., (© The Author(s) [2018]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: The aim of this prospective single-center study was to determine the changings in incidence of invasive pneumococcal disease (IPD), serotype distribution and the antimicrobial resistance patterns of S. pneumoniae in children with IPD after the period (1 to 7 years) of vaccination with PCV7 (2008) and PCV13 (2011)., Population and Methods: The study was conducted on 39 Turkish children with IPD between ages 1 month and 18 years in Ankara, Turkey. Streptococcus pneumoniae was identified using standard laboratory procedures from blood, cerebrospinal fluid (CSF), pleural fluid, and other sterile body fluids and tissues. S. pneumoniae isolates were tested for resistance to penicilin and ceftriaxone using the E-test methodology. Serotypes of the isolates were determined by Quellung reaction., Results: The overall annual incidence rate of IPD decreased significantly from 7.71 (95% CI, 1.99-13.4) to 1.58 (95% CI, 0.6-3.77; RRR=-79.5; p=0.006) per 100 000 population among ≤5 years of age without underlying disease. During the overall study period, the PCV7-serotypes and PCV13-serotypes represented 27.8% and 63.8% of isolates, respectively. PCV13-serotypes made up 81.8% of cases of IPD in the pre-PCV13 era and decreased to 56% in the 4 years after PCV13. The penicillin and ceftriaxone (for meningitis) resistance rates were 48.5% and 9.1%, respectively., Conclusions: This is the first study about the changing pattern of the incidence of IPD in Turkish children after the implementation of the PCV7 and PCV13 in Turkish national vaccine schedule and a prominent decrease in incidence of IPD has seen after the implementation of PCV13., (Sociedad Argentina de Pediatría)

Congenital lobar emphysema is a rare disease, which is characterized by pulmoner hyperinflation. Depending on the degree of bronchial obstruction, the clinical presentation may be variable. We report a rare case with congenital lobar emphysema in a 38-days-old male infant who presented with severe respiratory distress and hypertension. Air trapping in the left upper lung and significant mediastinal shift to the right were observed on the chest x-ray. Emphysematous changes were detected on the thorax computed tomography and considered as congenital lobar emphysema. The upper left lobectomy was successfully performed by pediatric surgeons. On postoperative follow up, no sign of respiratory distress occured and the patient was normotensive. In this report, a case with congenital lobar emphysema, which is a rare cause of respiratory distress and hypertension is discussed.

Rotavirus is an important morbidity and mortality agent among previously healthy infants. Rotavirus gastroenteritis (RG) causes severe fluid and electrolyte imbalance and development of fatal complications during course of the disease, if untreated. Although there are few case reports in the literature regarding septicemia after RG, it is one of the most important complications of the disease. The main reason of septicemia is unknown but it can be associated with severe consequences such as septic shock, endocarditis, and even death. If complications are taken into consideration on the course of disease, morbidity and mortality can be reduced. Herein, we evaluated the clinical characteristics, incidence and types of the complications during RG in this retrospective study. We evaluated a total of 276 patients (164 male, 112 female) diagnosed with RG between January 2006 and February 2013 at the department of Pediatric Infectious Disease. Male to female ratio was 1.5 and the median age at admission was 12 months (1-102 months). None of the patients had a history of Rotavirus immunization. While overall complication rate was 44.2%, the most common complication related RG was electrolyte imbalance and the second common complication was septicemia (32.6% and 6.5%, respectively). Klebsiella, E. coli and Candida species were the most common isolated microorganisms from the blood cultures. Rotavirus gastroenteritis is still an important cause of morbidity in children which can cause serious complications such as sepsis. Lack of rotavirus vaccine in our national immunization program might contribute to the related complications and prolonged hospitalization, health care expenses and family work loss, as well.

Dental lesions are commonly seen in children with malignancy. We report a child with acute lymphoblastic leukemia who had black-brown dental lesion during the febrile neutropenic episode. Histopathological examination of dental lesion showed fungal hyphae and conidia. F. pedrosoi that was isolated from the tissue culture. The patient was treated with intravenous liposomal amphotericin B therapy for 5 weeks and he was discharged on oral voriconazole. On follow-up, clinical symptoms recovered. Although F. pedrosoi may be an unusual causative agent of dental infection and maxillary osteomyelitis, it should be considered in patient with black-brown lesions which do not respond to antibacterial treatment.

After bone marrow aspiration procedure; some complications like pain and bleeding at the puncture site may be expected but some serious complications like osteomyelitis and soft tissue infections may also rarely occur. In this case we present a boy with recurrent fever. During etiologic investigation, familial Mediterranean fever (FMF) gene M694V mutation was +/+. Patient was treated with oral colchicine however fever persisted. The patient was considered as colchicine resistant FMF and steroid treatment was planned. Bone marrow aspiration procedure was executed to rule out malignancy. Three months after bone marrow aspiration, he was readmitted with complaint of left pelvic pain, difficulty in walking without support and standing on his left foot. Radiological imaging demonstrated left iliopsoas abscess and left sacroiliac osteomyelitis. Patient was successfully treated with intravenous ampicillin-sulbactam and clindamycin treatment for 6 weeks. Then oral amoxicillin-clavulanic acid treatment was continued for 2 weeks. Patient was discharged without any surgical procedure. On 1-year follow-up he could walk without any support.