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This study aimed to assess the levels of depression in children with type 1 diabetes mellitus (T1DM) and evaluate the quality of life as well as levels of depression and anxiety of their mothers. 30 children with T1DM (mean age: 12.9 ± 2.9 years) and their mothers (mean age: 40.0 ± 7.5 years) were included in the study. Control group consisted of 30 healthy children (mean age: 12.7 ± 2.7 years) and their mothers (mean age: 39.8 ± 7.2 years). The presence and severity of depressive symptoms in the children were evaluated using the Children's Depression Inventory (CDI). The short form 36-health survey (SF-36), the Beck Depression Inventory (BDI), and Spielberg's State-Trait Anxiety Inventory (STAI) were administered to all mothers. The children with T1DM had higher scores of depression compared to healthy children in the control group. The mothers of children with T1DM had significantly lower scores on all subscales of SF-36 except the bodily pain subscale. We observed a significant difference between groups in their BDI scores; the mean BDI score was higher in mothers of children with T1DM (p = 0.004). There was a significant difference in STAI scores between groups. CDI scores positively correlated with the ages of and HgA1C levels in the children with T1DM. There was a positive correlation between CDI scores of children with T1DM and BDI scores of their mothers. In addition, CDI sores negatively correlated with the scores of vitality and social functioning subscales of SF-36. Our findings suggest screening for mental health issues and quality of life in diabetic children and their mothers. [ABSTRACT FROM AUTHOR]

Sydenham's chorea is often encountered in pure form, but it may also occur in association with carditis. Recently, it has been reported that silent, mild valvular regurgitation has been encountered in patients with rheumatic fever manifested by isolated polyarthritis and pure chorea. We studied 22 children with Sydenham's chorea to determine clinical and subclinical heart involvement at the time of the initial diagnosis. Ages of the patients ranged from 6-19 y (mean 13.14 ± 3.0), and the female/male ratio was 3.4:1. All patients were evaluated by clinical and echocardiographic examination with respect to heart involvement. Carditis was detected in only 5 of 22 patients (23%) by auscultation. Clinical valvular involvement was determined: mitral regurgitation in three and combined mitral and aortic regurgitation in two. The frequency of valvular involvement increased significantly to 63% (14/22) after adding silent mitral regurgitation detected by colour Doppler echocardiography (χ[sup 2] = 7.50, p = 0.0062). We found that clinically inaudible, but echocardiographically significant, mild valvular regurgitation was frequent in patients with pure chorea. It is concluded that colour Doppler echocardiography may be useful in detecting silent valvular regurgitation and in deciding the duration of prophylaxis. [ABSTRACT FROM AUTHOR]

The presence of a foreign body in the heart have been reported, mostly in adults. Deaths and injuries can result from the breakage or rupture of angiography catheters. We present a case in which an angiocath tip was identified in the right ventricle of a pediatric patient, and the patient died as a result thereof. As no similar cases have been reported, we would like to draw attention to this subject. A 4.5-month-old female patient who was hospitalized 3 times during her life had a history of peripheral venous access establishment in the extremities with angiocatheters. During these hospital admissions, a central catheter was not inserted, and no additional problems were identified. Emergency personnel responded and found the patient at home, experiencing bradycardia and arrhythmia. She was resuscitated and taken to the hospital, where she died. The autopsy revealed, the tip of a 1.5 cm long, 1 mm wide lumen catheter had penetrated the right ventricular wall (Fig. 1) (Fig. 2), thus her death was attributed to complications that developed as a result of the peripheral vascular access catheter tip breaking and migrating to the right ventricle. Although the patient did not have an ECG, physical examination by the emergency ambulance personnel revealed an irregular and bradycardic heartbeat, suggesting that the child may have developed arrhythmia and atrioventricular conduction block. Health care professionals must check upon removal of peripheral intravenous access, and record whether the integrity of the peripheral catheter tip was compromised to prevent similar events in future. Fig. 1 Angiocath tip piercing the right ventricular wall and exiting the heart Fig. 2 a A 1.5 cm long, b 1 mm wide lumen catheter tip penetrating the right ventricular wall., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Evaluating predictors of coronavirus disease 2019 (COVID-19) and severity among children may help clinicians manage the high rate of hospital admissions for suspected cases., Objectives: This study aimed to evaluate the demographic, clinical and laboratory characteristics of children during the pandemic, and determine the predictors of COVID-19 and moderate-to-severe disease., Material and Methods: This retrospective cohort study included all consecutive COVID-19 cases in patients aged <18 years who presented to the Pediatric Emergency Department at Haseki Training and Research Hospital (Istanbul, Turkey) between March 15 and May 1, 2020, and underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) analysis of oro-nasopharyngeal swabs (n = 1137)., Results: The frequency of SARS-CoV-2 PCR positivity was 28.6%. The COVID-19 (+) group presented with sore throat, headache and myalgia significantly more frequently than the COVID-19 (-) group. Multivariate logistic regression models showed independent predictors of SARS-CoV-2 positivity as follows: age, contact history, lymphocyte count <1500/mm3, and neutrophil count <4000/mm3. In addition, higher age, neutrophil count and fibrinogen levels were independent predictors of severity. The diagnostic cutoff value for fibrinogen (370.5 mg/dL) had a sensitivity of 53.12, specificity of 83.95, positive predictive value (PPV) of 39.53, and negative predictive value (NPV) of 90.07 for predicting severity., Conclusions: Symptomatology, whether alone or in combination with other approaches, may be an appropriate strategy to guide the diagnosis and management of COVID-19.

Background: Migraine is the most common primary headache in children. Neuromediators and deterioration in circadian rhythm and sleep disorders can play a role in the etiology of migraines., Aim: To determine the serum melatonin levels of children with migraine and the relationship between melatonin and childhood migraine., Materials and Methods: Thirty-five children aged between 10 and 18 years with migraine as the case group and 35 healthy children of similar age and sex as the control group were included in the study. Venous blood samples were taken at 09.00 AM and melatonin analysis was performed using enzyme-linked immunosorbent assay (ELISA)., Results: The mean serum melatonin levels of the case group and control group were found to be 300.1 ± 67.3 pg/mL and 314.9 ± 64.0 pg/mL, respectively. There was no statistically significant difference between the groups (P = 0.351). Comparison of the melatonin levels in the case group according to the clinical characteristics was not significantly different., Conclusion: An association between sleep and migraine is predictable, but its pathophysiology is not yet known. Etiological studies continue and the relationship between melatonin and migraine remains unclear., (Copyright © 2024 Copyright: © 2024 Neurology India, Neurological Society of India.)

Objectives: Coeliac disease is an autoimmune intestinal disease that develops with permanent intolerance to gluten and similar cereal proteins. It can damage to many tissues, including myocardium, by autoimmune mechanisms. In our study, we aimed to investigate the effect of coeliac disease on cardiac electrical activity by comparing the Tp-e interval and Qt dispersion values of coeliac patients with healthy children., Methods: Fifty-seven coeliac patients and 57 healthy children were included in the study. Sociodemographic findings, physical examinations, symptoms, laboratory values, dietary compliance, endoscopy, and pathological findings were recorded into a standardised form. Electrocardiogram parameters were calculated, and echocardiography findings were noted., Results: No statistically significant difference was found between the two groups in terms of age, gender, heart rate, electrocardiogram parameters such as p wave, PR interval, QRS complex, QT interval, and QTc values. Tp-e interval, Tp-e / QT ratio, and Tp-e / QTc ratio were statistically significantly higher in the patient group compared to the control group. Ejection fraction and fractional shortening values were significantly lower in the patient group compared to the control group. In the patient group, Tp-e interval, Tp-e / QT ratio, Tp-e / QTc ratio, and QTc dispersion were statistically significantly higher in patients with tissue transglutaminase IgA positive compared to patients with tissue transglutaminase IgA negative., Conclusion: Our study gives important findings in terms of detecting early signs of future cardiovascular events in childhood age group coeliac patients.

Objective: Functional constipation is the most common form of constipation, and its exact aetiology is still unclear. However, it is known that deficiencies in hormonal factors cause constipation by changing physiological mechanisms. Motilin, ghrelin, serotonin acetylcholine, nitric oxide, and vasoactive intestinal polypeptide are factors that play a role in colon motility. There are a limited number of studies in the literature where hormone levels and gene polymorphisms of serotonin and motilin are examined. Our study aimed to investigate the role of motilin, ghrelin, and serotonin gene/receptor/transporter polymorphisms in constipation pathogenesis in patients diagnosed with functional constipation according to the Rome 4 criteria., Methods: Sociodemographic data, symptom duration, accompanying findings, the presence of constipation in the family, Rome 4 criteria, and clinical findings according to Bristol scale of 200 cases (100 constipated patients and 100 healthy control) who applied to Istanbul Haseki Training and Research Hospital, Pediatric Gastroenterology Outpatient Clinic, between March and September 2019 (6-month period) were recorded. Polymorphisms of motilin-MLN (rs2281820), serotonin receptor-HTR3A (rs1062613), serotonin transporter-5-HTT (rs1042173), ghrelin-GHRL (rs27647), and ghrelin receptor-GHSR (rs572169) were detected by real-time PCR., Results: There was no difference between the two groups in terms of sociodemographic characteristics. Notably, 40% of the constipated group had a family history of constipation. The number of patients who started to have constipation under 24 months was 78, and the number of patients who started to have constipation after 24 months was 22. There was no significant difference between constipation and control groups in terms of genotype and allele frequencies in MLN, HTR3A, 5-HTT, GHRL, and GHSR polymorphisms (p<0.05). Considering only the constipated group, the rates of gene polymorphism were similar among those with/without a positive family history of constipation, constipation onset age, those with/without fissures, those with/without skin tag, and those with type 1/type 2 stool types according to the Bristol stool scale., Conclusion: Our study results showed that gene polymorphisms of these three hormones may not be related to constipation in children.

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 kidney is the second most commonly affected organ by severe acute respiratory syndrome coronavirus-2, characterized by hematuria, proteinuria, and acute kidney injury. There are few studies describing renal involvement in pediatric cases., Materials and Methods: This retrospective study evaluated the prevalence of hematuria, proteinuria, and acute kidney injury in severe acute respiratory syndrome coronavirus-2-positive pediatric cases (1-18 years old) who visited emergency department between March and November 2020. Patients with urinary tract infections were excluded. An age-specific upper limit of reference interval was used to define "elevated serum creatinine" (greater than upper limit of reference interval) and acute kidney injury (>1.5 times upper limit of reference interval)., Results: A total of 228 patients were evaluated, median age was 12.7 years (interquartile range: 7.5; 16.1), and 51.3% were male. The prevalence of asymptomatic, mild, and moderate-to-severe disease was 12.7% (29/228), 77.2% (176/228), and 10.1% (23/228), respectively. The prevalence of hematuria, proteinuria, and elevated serum creatinine was 15.8% (36/228), 6% (14/228), and 3% (7/228), respectively. Kidney involvement (i.e., at least 1 of these findings) was 23.2% (53/228) and significantly higher in the moderate-to-severe disease (43.5%). None of the patients met the acute kidney injury criterion. In logistic regression analysis, female sex (odds ratio: 1.97, 95 CI%: 1.03; 3.70, P = .040) and fever (odds ratio: 2.28, 95% CI: 1.19; 4.36, P = .012) were independent predictors of kidney involvement. Three patients demonstrated a kidney presentation (macroscopic hematuria) on admission, and another patient was diagnosed with C3 glomerulonephritis during hospitalization., Conclusion: Kidney involvement was found about in 1 quarter of children with coronavirus disease 2019. Awareness and recognition of kidney involvement and follow-up are important in the management.

Objective: Lower respiratory tract infections (LRTIs) are responsible for significant morbidity and mortality in children. Viral pathogens are responsible for 50-70% of LRTIs. The real-time multiplex polymerase chain reaction (RT-MPCR) tests allow the simultaneous detection of several different viruses along with some bacterial pathogens and give faster and more reliable results than viral culture. We aimed to describe the disease etiology and the clinical, laboratory, and radiological characteristics of children aged under 5 years who were hospitalized in a tertiary care medical center with LRTIs assayed using an RT-MPCR respiratory pathogen panel, and evaluate the effects of the detection of etiology on treatment and outcome., Methods: This retrospective study was conducted in the tertiary medical health center. The study group comprised all pediatric cases aged under five who were hospitalized due to LRTIs in the pediatric wards and pediatric intensive care unit (ICU) and undergone RT-MPCR analyses between January 2019 and February 2020. RT-MPCR analyses of samples from nasopharyngeal swabs were consecutively evaluated., Results: A total of 65 samples were collected from aged under 5 years who were hospitalized with LRTIs and screened for respiratory viruses. Specimens were collected from pediatric ICU (18.5%) and pediatric wards (81.5%). The overall positive rate was 89.2% (58/65). Forty of the patients (61.5%) were positive for a single pathogen, 15 (23.6%) for two, and three (4.6%) for three pathogens. The most common virus was respiratory syncytial virus (RSV) (32.3%), followed by human rhinovirus (HRV) (30.8%). In HRV-positive patients, eosinophil count was higher than that in Influenza A/B- and Human metapneumovirus-positive patients (respectively p=0.014, 0.005). In RSV-positive patients, hospitalization duration and neutrophil, lymphocyte, C-reactive protein level had moderate correlation (respectively; r=0.587; p=0.005, r=-0.436; p=0.038, r=0.498; p=0.022)., Conclusion: Despite the limited number of participants from a single center, a wide range of causative pathogens were detected in our study. In addition, we found that viral pathogens are common etiologies of LRTIs. To describe the disease etiology in LRTIs, assays using an RT-MPCR respiratory pathogen panel, would be beneficial to the detection of etiology and treatment., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study has received no financial support. Authorship Contributions: Concept – GA; Design – GA, SB; Supervision – KS, ME; Materials – CD; Data collection and/or processing – CD, SB; Analysis and/or interpretation – GA, CD; Literature review – GA, SB; Writing – GA, CD; Critical review – ME, KS., (Copyright © 2022 by Istanbul Provincial Directorate of Health - Available online at www.northclinist.com.)

Predictors of early diagnosis and severe infection in children with coronavirus disease 2019 (COVID-19), which has killed more than 4 million people worldwide, have not been identified. However, some biomarkers, including cytokines and chemokines, are associated with the diagnosis, pathogenesis and severity of COVID-19 in adults. We examined whether such biomarkers can be used to predict the diagnosis and prognosis of COVID-19 in pediatric patients. Eighty-nine children were included in the study, comprising three patient groups of 69 patients (6 severe, 36 moderate and 27 mild) diagnosed with COVID-19 by real-time polymerase chain reaction observed for 2-216 months and clinical findings and 20 healthy children in the same age group. Hemogram, coagulation, inflammatory parameters and serum levels of 16 cytokines and chemokines were measured in blood samples and were analyzed and compared with clinical data. Interleukin 1-beta (IL-1β), interleukin-12 (IL-12) and interferon gamma-induced protein 10 (IP-10) levels were significantly higher in the COVID-19 patients (p = 0.035, p = 0.006 and p < 0.001). Additionally, D-dimer and IP-10 levels were higher in the severe group (p = 0.043 for D-dimer, area under the curve = 0.743, p = 0.027 for IP-10). Lymphocytes, C-reactive protein and procalcitonin levels were not diagnostic or prognostic factors in pediatric patients (p = 0.304, p = 0.144 and p = 0.67). Increased IL-1β, IL-12 and IP-10 levels in children with COVID-19 are indicators for early diagnosis, and D-dimer and IP-10 levels are predictive of disease severity. In children with COVID-19, these biomarkers can provide information on prognosis and enable early treatment., (© The Author(s) [2022]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: Epileptic discharges occurring during seizure may affect many systems in the ictal, postictal, and interictal periods. Autonomic dysfunction and its negative impacts on the heart may cause life-threatening clinical manifestations, cardiac arrhythmias, and sudden cardiac death in epileptic patients. This study investigated the impact of levetiracetam (LEV) therapy on cardiac electrical activity in children with epilepsy., Material and Methods: Our study included a total of 120 cases, comprising 40 newly diagnosed epilepsy patients, 40 epilepsy patients who had been receiving LEV therapy for at least 6 months, and 40 healthy individuals. Age at diagnosis, duration of LEV treatment, and familial history of cardiac disease were recorded in a standardized form. Electrocardiogram (ECG) parameters were calculated for all cases, echocardiography (ECHO) findings were noted, and the obtained data were compared using statistical methods., Results: A comparison of the ECG parameters showed that the Tpeak-Tend (Tp-e) interval, and the Tp-e/QT dispersion (QTd) and Tp-e/QTc dispersion (QTcd) ratios, of the newly diagnosed epilepsy patients were statistically significantly increased compared with the other two groups (p = <0.001, p = 0.001, and p = 0.007, respectively). There were no statistically significant differences between the three groups in terms of QTd and QTcd., Discussion: The repolarization differences in children with newly diagnosed epilepsy may have reflected early subclinical findings associated with the disease. We concluded that LEV monotherapy may make a positive contribution to early repolarization differences., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Cardiomyopathies account for 1% of cardiac diseases that mainly originate from myocarditis in the form of dilated cardiomyopathy in the neonatal period. Viruses are the main cause of myocarditis resulting in dilated cardiomyopathy. Rhinovirus is the leading cause of viral respiratory infections though it is rarely severe., Case: We report a 17 day old newborn with acute onset dilated cardiomyopathy due to myocarditis that developed after a viral respiratory infection caused by Rhinovirus who was admitted to the emergency ward with shock due to heart failure and recovered without any complications. This is the first case reporting the causal role of rhinovirus and myocarditis in the neonatal period., Conclusions: A comprehensive approach is needed for the diagnosis of myocarditis in the case of unknown etiology and an extensive respiratory panel may be taken into consideration if there is a history or clinical symptoms of respiratory infection.

Background: Understanding SARS-CoV-2 seroprevalence among health care personnel is important to explore risk factors for transmission, develop elimination strategies and form a view on the necessity and frequency of surveillance in the future., Methods: We enrolled 4927 health care personnel working in pediatric units at 32 hospitals from 7 different regions of Turkey in a study to determine SARS Co-V-2 seroprevalence after the first peak of the COVID-19 pandemic. A point of care serologic lateral flow rapid test kit for immunoglobulin (Ig)M/IgG was used. Seroprevalence and its association with demographic characteristics and possible risk factors were analyzed., Results: SARS-CoV-2 seropositivity prevalence in health care personnel tested was 6.1%. Seropositivity was more common among those who did not universally wear protective masks (10.6% vs 6.1%). Having a COVID-19-positive co-worker increased the likelihood of infection. The least and the most experienced personnel were more likely to be infected. Most of the seropositive health care personnel (68.0%) did not suspect that they had previously had COVID-19., Conclusions: Health surveillance for health care personnel involving routine point-of-care nucleic acid testing and monitoring personal protective equipment adherence are suggested as important strategies to protect health care personnel from COVID-19 and reduce nosocomial SARS-CoV-2 transmission., Competing Interests: Conflict of interest All contributing authors declare no conflict of interest. The study is not funded by any organization. The study is approved by Hacettepe University Ethics Committee (Approval No: 2020/11-57)., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Malpractice in medicine refers to the failure of a physician to meet a standard of diagnosis and treatment, damages/injuries caused by reprehensible ignorance, or negligence of a doctor., Methods: Allegedly malpractice cases of pediatricians and the cases in which causal link between malpractice and death was confirmed by the decision of the First Board of Specialization of the Council of Forensic Medicine between the dates of Januray 1, 2012 and December 31, 2014 were analyzed retrospectively., Results: The study revealed that in the majority of 286 cases, the infants were 0-28 days old (n = 115; 40.2%) and were hospitalized due to respiratory problems (n = 111; 38.8%). The allegations of malpractice cases were most frequently seen in private hospitals (n = 120; 42%). Malpractice was found in 17.5% of the cases (n = 50), in which the majority of cased were proved to be diagnostic errors (n = 24; 48%). The most common diagnostic error was the misdiagnosis of "healthy child" in medical malpractice cases (n = 11, 22%)., Conclusions: In conclusion, it is considered to be important for the pediatricians to maintain prope communication with the relatives of the patients while monitoring their health condition, and pediatricians are expected to be more careful-especially in the diagnostic phase-in the cases involving 0-1 age group as children are most likely to be diagnosed as healthy in this age group.

This study aimed to determine the prevalence of infantile functional gastrointestinal disorders (FGIDs) based on Rome IV diagnostic criteria, and to determine the associated patient demographic and nutritional characteristics. A total of 2383 infants aged 1-12 months which were evaluated by 28 general pediatricians and pediatric gastroenterologists on the same day at nine tertiary care hospitals around Istanbul, Turkey, between November 2017 and March 2018, were included in the study. Patients included consulted the pediatric outpatient clinics because of any complaints, but not for vaccines and/or routine well child follow-ups as this is not part of the activities in the tertiary care hospitals. The patients were diagnosed with FGIDs based on Rome IV diagnostic criteria. The patients were divided into a FGID group and non-FGID group, and anthropometric measurements, physical examination findings, nutritional status, risk factors, and symptoms related to FGIDs were evaluated using questionnaires. Among the 2383 infants included, 837 (35.1%) had ≥1 FGIDs, of which 260 (31%) had already presented to hospital with symptoms of FGIDs and 577 (69%) presented to hospital with other symptoms, but were diagnosed with FGIDs by a pediatrician. Infant colic (19.2%), infant regurgitation (13.4%), and infant dyschezia (9.8%) were the most common FGIDs. One FGID was present in 76%, and ≥2 FGIDs were diagnosed in 24%. The frequency of early supplementary feeding was higher in the infants in the FGID group aged ≤6 months than in the non-FGID group (P = 0.039).Conclusion: FGIDs occur quite common in infants. Since early diversification was associated with the presence of FGIDs, nutritional guidance and intervention should be part of the first-line treatment. Only 31% of the infants diagnosed with a FGID were presented because of symptoms indicating a FGID. What is Known: • The functional gastrointestinal disorders (FGIDs) are a very common disorder and affect almost half of all infants. • In infants, the frequency of FGIDs increases with mistakes made in feeding. When FGIDs are diagnosed in infants, nutritional support should be the first-line treatment. What is New: • This study shows that only a third of children presented to hospital because of the symptoms of FGIDs, but pediatricians were able to make the diagnosis in suspected infants after appropriate evaluation. • The early starting of complementary feeding (<6 months) is a risk factor for the development of FGIDs., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Vitamin D has an immunomodulating property that regulates the inflammatory response. In this study, the aim was to evaluate the relationship between vitamin D levels and clinical severity and inflammation markers in children and adolescents with COVID-19. The clinical and laboratory records of 103 pediatric cases with COVID-19, whose vitamin D levels had been measured, were retrospectively reviewed. The cases were divided into groups according to their clinical severity (asymptomatic, mild, and moderate-to-severe) and vitamin D levels. The moderate-to-severe clinical group had significantly higher inflammation markers (CRP, procalcitonin, fibrinogen, D-dimer) and a lower lymphocyte count compared to both the mild and asymptomatic groups. The 25 OH vitamin D levels were also significantly lower (p < 0.001), and the ratio of vitamin D deficiency was 70.6% in the moderate-to-severe group. The vitamin D-deficient group had a significantly higher age and fibrinogen levels while also having a lower lymphocyte count compared to the insufficient and normal groups. The 25 OH vitamin D level was correlated positively with the lymphocyte count (r = 0.375, p = <0.001), and negatively with age (r = -0.496, p = <0.001), CRP (r = -0.309, p = 0.002) and fibrinogen levels (r = -0.381, p = <0.001). In a logistic regression analysis, vitamin D deficiency, D-dimer, and fibrinogen levels on admission were independent predictors of severe clinical course.Conclusion: This study revealed an association between vitamin D deficiency and clinical severity, in addition to inflammation markers in pediatric COVID-19 cases. Prophylactic vitamin D supplementation may be considered, especially in the adolescent age group. What is Known: • • The pathology of COVID-19 involves a complex interaction between the SARS-CoV-2 and the immune system. Hyperinflammation/cytokine storm is held responsible for the severity of the disease. • Vitamin D has multiple roles in the immune system that can modulate the body reaction to an infection. What is New: • • Clinically more severe group had significantly lower vit D levels and significantly higher inflammation markers. • Lower 25 OH vit D levels were associated with higher inflammation markers, suggesting an important role of vitamin D in the clinical course of COVID-19 in children and adolescents probably by regulating the systemic inflammatory response., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Environmental tobacco smoke (ETS) exposure is associated with many diseases, including lower respiratory tract infections, in pediatric age groups. In this study, we aimed to assess the effect of household ETS exposure on symptom frequency and clinical severity in children and adolescents with COVID-19., Materials and Methods: This retrospective study included pediatric cases (<18 years old) with a positive SARS-CoV-2 test, who were admitted to our hospital between 20.03.2020 and 01.05.2020. Patients with respiratory diseases and active smokers were excluded. Demographic characteristics, symptoms, and clinical severity of COVID-19 were obtained from parents and children using a questionnaire and from patients' files. Household ETS exposure was assessed by questionnaire., Results: A total of 167 patients (median age 145 months, 50.7 % male) were included in the study. The frequency of household ETS exposure was 50.9%, and the frequency of cough was significantly higher in exposed children than non-exposed children (71.4% vs 50.8% respectively, p=0.02). The frequency of both fever and cough was significantly higher ETS-exposed in the subgroup of cases with a mild clinical course (69.5% vs 48.1% respectively, p= 0.02 for fever and 67.8% vs 44.4% respectively, p=0.01 for cough). There was no relationship between clinical severity and household ETS exposure., Conclusion: Household ETS exposure may impact COVID-19 pediatric cases as demonstrated by the increased frequency of cough and fever in ETS-exposed children. As new lockdown measures are implemented, increasing public awareness about the effect of household ETS exposure on COVID-19as well as encouraging a decrease in ETS exposure are essential., Competing Interests: Conflict of Interest: The authors have no conflict of interest to declare., (© Copyright 2021 by The Turkish Archives of Pediatrics.)

Objectives: The aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children. Methods: A retrospective study was conducted by pediatric infectious disease specialists from 32 different hospitals from all over Turkey by case record forms. Pediatric cases who were diagnosed as COVID-19 between March 16, 2020, and June 15, 2020 were included. Case characteristics including age, sex, dates of disease onset and diagnosis, family, and contact information were recorded. Clinical data, including the duration and severity of symptoms, were also collected. Laboratory parameters like biochemical tests and complete blood count, chest X-ray, and chest computed tomography (CT) were determined. Results: There were 1,156 confirmed pediatric COVID-19 cases. In total, male cases constituted 50.3% ( n = 582) and females constituted 49.7% ( n = 574). The median age of the confirmed cases was 10.75 years (4.5-14.6). Of the total cases, 90 were younger than 1 year of age (7.8%), 108 were 1-3 years of age (9.3%), 148 were 3-6 years of age (12.8%), 298 were 6-12 years of age (25.8%), 233 were 12-15 years of age (20.2%), and 268 cases were older than 15 years of age (23.2%). The most common symptom of the patients at the first visit was fever (50.4%) ( n = 583) for a median of 2 days (IQR: 1-3 days). Fever was median at 38.4°C (38.0-38.7°C). The second most common symptom was cough ( n = 543, 46.9%). The other common symptoms were sore throat ( n = 143, 12.4%), myalgia ( n = 141, 12.2%), dyspnea ( n = 118, 10.2%), diarrhea ( n = 112, 9.7%), stomachache ( n = 71, 6.1%), and nasal discharge ( n = 63, 5.4%). When patients were classified according to disease severity, 263 (22.7%) patients were asymptomatic, 668 (57.7%) patients had mild disease, 209 (18.1%) had moderate disease, and 16 (1.5%) cases had severe disease. One hundred and forty-nine (12.9%) cases had underlying diseases among the total cases; 56% of the patients who had severe disease had an underlying condition ( p < 0.01). The need for hospitalization did not differ between patients who had an underlying condition and those who do not have ( p = 0.38), but the need for intensive care was higher in patients who had an underlying condition ( p < 0.01). Forty-seven (31.5%) of the cases having underlying conditions had asthma or lung disease (38 of them had asthma). Conclusions: To the best of our knowledge, this is one of the largest pediatric data about confirmed COVID-19 cases. Children from all ages appear to be susceptible to COVID-19, and there is a significant difference in symptomatology and laboratory findings by means of age distribution., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Karbuz, Akkoc, Bedir Demirdag, Yilmaz Ciftdogan, Ozer, Cakir, Hancerli Torun, Kepenekli, Erat, Dalgic, Ilbay, Karaaslan, Erdeniz, Aygun, Bozdemir, Hatipoglu, Emiroglu, Sahbudak Bal, Ciftci, Bayhan, Gayretli Aydin, Ocal Demir, Kilic, Hacimustafaoglu, Sener Okur, Sen, Yahsi, Akturk, Cetin, Sutcu, Kara, Uygun, Tural Kara, Korukluoglu, Akgun, Üstündağ, Demir Mis, Sali, Kaba, Yakut, Kılıc, Kanik, Cetin, Dursun, Cicek, Kockuzu, Sevketoglu, Alkan, Guner Ozenen, İnce, Baydar, Ozkaya, Ovali, Tekeli, Celebi, Cubukcu, Bal, Khalilova, Kose, Hatipoglu, Dalkiran, Turgut, Basak Altas, Selcuk Duru, Aksay, Saglam, Sari Yanartas, Ergenc, Akin, Duzenli Kar, Sahin, Tuteroz, Bilen, Ozdemir, Senoglu, Pariltan Kucukalioglu, Besli, Kara, Turan, Selbest Demirtas, Celikyurt, Cosgun, Elevli, Sahin, Bahtiyar Oguz, Somer, Karadag, Demirhan, Turk Dagi, Kurugol, Taskin, Sahiner, Yesil, Ekemen Keles, Sarikaya, Erdem Eralp, Ozkinay, Konca, Yilmaz, Gokdemir, Arga, Ozen, Coksuer, Vatansever, Tezer and Kara.)

Objective: Familial Mediterranean fever is the most common auto-inflammatory disease in childhood. The aim of present study is to assess whether familial Mediterranean fever increases the risk of premature atherosclerosis., Materials and Methods: It is a case-control prospective study. The study included 32 patients in attack-free period and 22 healthy children who did not have any chronic disease. Demographic features, clinical findings, response to colchicine therapy, Mediterranean Fever gene mutations were recorded in familial Mediterranean fever group. Mean platelet volume and intima-media thickness were evaluated as a possible marker of early onset atherosclerosis. Intima media thickness of abdominal aorta and common carotid arteries with color Doppler ultrasound, mean platelet volume and acute phase reactants were measured in both groups., Results: No significant difference was documented between the patient and control groups regarding the intima-media thickness (p>0, 05). Familial Mediterranean fever patients had significantly higher mean platelet volume values compared with the controls (8.35±1.0 vs. 7.79±0.78 fl, p=0.026). Intima media thickness and mean platelet volume values of familial Mediterranean fever patients were not correlated with lipid profiles, inflammatory markers., Conclusions: The present study found out no evidence that intima media thickness of abdominal aorta and common carotid arteries in familial Mediterranean fever patients could predict early atherosclerosis. However, mean platelet volume value was found higher in children with familial Mediterranean fever. Mean platelet volume may be useful marker to show premature atherosclerosis in familial Mediterranean fever.

Objectives: This study was designed to determine the prevalence of metabolic syndrome (MS) in Turkish children and to examine the relationship between MS components in this age group., Methods: A total of 395 students in Istanbul aged 10 to 14 years in the 2004-2005 school year were enrolled in the study. Body weight, height, waist circumference, hip circumference, and systolic-diastolic blood pressure were measured. Of the total, 353 provided blood samples for analysis of fasting glucose level, basal insulin, total cholesterol, triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL) levels. Modified World Health Organization criteria were used for the diagnosis of MS., Results: In this study, 44.5% of the children were female and 55.5% were male. The mean body mass index (BMI) was 20.57±3.48 kg/m², 10.4% (n=41) were overweight, and 12.7% (n=50) were obese. MS was diagnosed in 0.85% of the entire study group and in 6% of the obese children. There was a positive correlation between BMI and waist circumference (p<0.001), waist/hip ratio (p<0.001), systolic blood pressure (p<0.001), diastolic blood pressure (p<0.001), basal insulin level (p<0.001), homeostasis model assessment of insulin resistance (p<0.001), triglyceride value (p<0.001), total cholesterol level (p<0.05), LDL (p<0.001), and VLDL level (p<0.001), and a negative correlation with HDL level (p<0.001)., Conclusion: The study results confirmed that MS is present in children and not limited to adults, and this is an important health problem. The prevalence of MS is more common in obese children. Therefore, early diagnosis of obese children and examination of cardiovascular risk factors and metabolic syndrome criteria is very important., Competing Interests: Conflict of Interest: None declared., (Copyright: © 2019 by The Medical Bulletin of Sisli Etfal Hospital.)

Üstyol A, Takahashi S, Hatipoğlu HU, Duman MA, Elevli M, Selçuk Duru HN. A novel mutation in SLC2A1 gene causing GLUT-1 deficiency syndrome in a young adult patient. Turk J Pediatr 2019; 61: 946-948. GLUT-1 deficiency syndrome is a rare, frequently unrecognized metabolic encephalopathy that is probably underdiagnosed. Although developmental delay, acquired microcephaly, spasticity, and impaired coordination were initially described as the classic findings, mild cases with no pronounced neuromotor compromise have since been included in the broad clinical spectrum with new mutations being identified more recently. We report a case of myoclonic seizures not responding to anti-epileptics since the age of one year in a 17-year-old patient with a normal phenotype and neuromotor development. Previously unreported p.Phe389Leu mutation was determined in the SLC2A1 gene in our patient. This case will be useful in clarifying the phenotype of GLUT-1 deficiency and reveals a new pathogenic mutation.

Background: Diabetes mellitus type 1 is the most common endocrine metabolic disorder occurring in childhood and adolescence due to the autoimmune destruction of pancreatic beta cells as a result of various environmental factors interacting with an underlying genetic predisposition. Diabetes is a risk factor for early onset atherosclerosis, and the high mortality rate seen in these patients is partially related to cardiovascular diseases., Objectives: This study was conducted to compare mean platelet volume as a marker of early atherosclerosis with aortic intima-media thickness in children with type 1 diabetes and to identify its correlation with known cardiovascular risk factors., Patients and Methods: The study included 27 patients between age range of 6 and 17 years that were diagnosed with type 1 diabetes and 30 healthy children of the same age range who did not have any chronic disease. In both groups, we used the color Doppler ultrasound to measure children's aortic intima-media thickness and identify their mean platelet volumes., Results: There was no significant difference between the groups regarding gender distribution, age, High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL) cholesterol levels (P > 0.05). Also no significant difference could be documented between the patient and control groups regarding the aortic intima-media thickness and mean platelet volume (P > 0.05). However, there was a significant correlation between aortic intima-media thickness and mean platelet volume (r = 0.351; P < 0.05)., Conclusions: In the present study, there was no evidence of early atherosclerosis in children with type 1 diabetes. However, mean platelet volume having a significant correlation with aortic intima-media thickness may be useful as an early marker of atherosclerosis.

Background/aim: The mechanism of edema formation in nephrotic syndrome is still poorly understood. We aimed to evaluate the volume status in children with steroid-sensitive nephrotic syndrome (SSNS) and to emphasize the importance of echocardiography in demonstrating of volume changes., Materials and Methods: Thirty-two SSNS patients and 30 healthy children were enrolled in this study. The volume statuses of patients were evaluated by clinical and laboratory features, including fractional sodium excretion (FENa) and distal sodium/potassium exchange (UK/UNa+K ratio). Inferior vena cava collapsibility index (IVCCI), left atrial diameter (LAD), aortic diameter (AD), and left ventricular mass index (LVMI) were measured using conventional echocardiographic methods., Results: FENa was lower in children with NS; however, the distal K/Na ratio of the patient and control groups did not differ. In addition, IVCCI, LAD, AD, and LVMI were not different among groups. When evaluating the volume status of patients, 8 patients (25%) were hypovolemic while 24 patients (75%) were nonhypovolemic (normovolemic or hypervolemic). LAD was significantly lower in hypovolemic patients., Conclusion: The majority of children with SSNS are normovolemic or hypervolemic and echocardiography is an easy and valuable method for the evaluation of volume status in these patients.

Objective: The aim of this study was to measure the 24 h urinary calcium content in children with monosymptomatic nocturnal enuresis (MNE) and compare with those in healthy children to investigate whether there is any relation with enuresis and hypercalciuria., Material and Methods: This study included 120 children and adolescents with MNE aged between 7 and 14 years. Eighty age- and sex-matched healthy children served as a control group. To determine urinary calcium excretion, 24 h urine samples were collected. The children with enuresis were divided into two sub-groups as hypercalciuric and normocalciuric groups according to the amount of urinary calcium excretion., Results: Hypercalciuria was found in 27 (23%) of the MNE patients compared with two (4%) of continent children (p<0.001). In addition, the mean 24 h urine calcium/body weight ratio was higher in the enuresis group than in the control group, 2.94±2.42 versus 1.59±1.72, respectively (p=0.002). When the children with enuresis were divided into two groups as normokalsiuric and hypercalciuric, the hypercalciuric children were younger and the majority of this group were boys.., Conclusions: Our study showed that hypercalciuria is common in children with MNE, so we suggested measuring urine calcium levels in NE patients. However, further studies are needed to clarify the relationship between hypercalciuria and NE in larger series.., (Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: The metabolic syndrome (MS) has reached epidemic proportions worldwide. This syndrome is associated with cardiovascular risk factors, including functional and structural cardiac and vascular changes. The aim of our study was to evaluate subclinical atherosclerosis and its associated risk factors in children with MS., Methods: The study cohort comprised 52 children with MS and 38 age- and sex-matched healthy children. The diagnosis of MS was made according to criteria adopted by the World Health Organization. Blood pressure based on 24-h ambulatory blood pressure monitoring (ABPM), carotid intima-media thickness (cIMT), carotid distensibility coefficient (DC) and flow-mediated endothelium-dependent dilation (EDD) were assessed in all children., Results: We found a significantly higher cIMT in children with MS than in healthy children, but carotid DC and flow-mediated EDD were lower in the former. Multivariate analysis revealed that a higher cIMT was independently associated with a higher nighttime systolic blood pressure (SBP) and lower high-density lipoprotein-cholesterol (β = 0.386, p = 0.011 and β = 0.248, p = 0.042, respectively). Also, higher nighttime SBP remained an independent predictor of lower DC (β = 0.495, p = 0.009), and higher 24-h SBP was the only independent predictor for a lower EDD (β = 0.532, p = 0.004)., Conclusions: Atherosclerotic vascular changes were common among our pediatric patients with MS and easily determined by high-resolution ultrasound imaging. In particular, subclinical atherosclerosis was clearly associated with nocturnal or 24-h systolic hypertension as measured by ABPM. We therefore recommend that subclinical vascular changes and AMBP measurements should be used as diagnostic markers to predict atherosclerotic risks in this pediatric patient group.

Spina bifida (SB) is a common birth defect associated with significant lifelong morbidity. The objective of this study was to assess the quality of life and psychological status of mothers of children with SB. In this study, we included 30 mothers with children with SB and 30 mothers of healthy children. The groups were similar for background variables (child's age, sex, and number of siblings; mother's age, marital status; economic status of the families, and presence of health insurance). The 36-item short-form health survey (SF-36), State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI) were administered to all mothers. Except for social functioning and mental health, all SF-36 subscale scores were significantly lower and the mean STAI and BDI scores were higher for mothers of children with SB (P<0.001). SF-36, STAI, and BDI scores were not associated significantly with the child's age, sex, number of siblings, and mother's age. This study shows that the quality of life is affected negatively for mothers of children with SB. The clinician should pay close attention to the psychosocial status of mothers of these children within the scope of disease management.

Paraphenylene daimine (PPD) is a kind of aromatic amine that is widely used in several industrial products. Women also use PPD added to henna (Lawasonia alba) as a hair dye. Though rare in Western countries, PPD poisoning is quite common in East Africa, India and Middle Eastern countries because it is a traditional product at these countries. Different pathologies were described as caused by PPD ingestion including angioedema of head and neck, rhabdomyolysis, and acute renal failure. The authors report a case of systemic poisoning with PPD that lead to angioedema resulting in tracheostomy and rhabdomyolysis.

Background: The metabolic syndrome (MS), a cluster of potent risk factors for cardiovascular disease, is composed of insulin resistance, obesity, hypertension and hyperlipidemia. The aim of our study was to investigated the relationships between MS and left ventricular mass index (LVMI) in childhood MS. This study included 50 children and adolescents with MS aged between 7-18 years., Methods: Thirty age- and sex-matched healthy children served as a control group. The diagnosis of MS was made according to the criteria adapted from the World Health Organization. They underwent clinical examination with causal blood pressure (BP) measurements, 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiogram. Patients underwent echocardiography to detect left ventricular hypertrophy (LVH). LVMI was calculated as left ventricular mass/height(2.7)., Results: The mean age of MS group was 12.0 ± 3.1 years. The mean value of LVMI was 46.5 ± 11.5 g/m(2.7) in the MS group and it was significantly higher than those in the healthy children. The prevalence of severe LVH was 12 % using adult criteria (LVM > 51 g/m(2.7)) and 44 % using pediatric criteria (LVM > 95th percentile). The mean daytime systolic BP load (β = 0.315, p = 0.003) and HOMA-IR (β = 0.368, p = 0.006) were found as the independent predictors of LVMI., Conclusions: In conclusion, LVH occurs commonly in pediatric MS and is associated with systolic hypertension and insulin resistance. LVMI should be measured routinely for the predicting of cardiovascular risks in these patients.

Background: The purpose of this study was to assess the effect of monosymptomatic nocturnal enuresis (MNE) on the quality of life of the mothers., Methods: Mothers who have a child with MNE (n = 60) and mothers who have a child without any health problems (n = 90) were included in the study. Groups were similar for background variables (child's age, gender, and number of siblings; mother's age and marital status; and economic status of families and presence of health insurance). The key question was to determine whether or not the difference between the two groups in terms of the quality of life. All mothers underwent Short-Form Health Survey (SF-36) Questionnaire, Spielberg's State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI)., Results: All SF-36 subscales except social functioning were significantly lower in mothers of enuretic children. The trait-anxiety score, the subcomponent of the STAI, was higher in mothers who have a child with enuresis nocturna (P < 0.001). The mean BDI score was higher in enuretic group (P < 0.001). There was no significant correlation between SF-36, STAI, and BDI scores and child's age, gender, number of siblings, and mother's age., Conclusion: This study shows that the quality of life of the mothers was negatively affected by having a child with MNE.

Varicella can cause complications that are potentially serious and require hospitalization. Our current understanding of the causes and incidence of varicella-related hospitalization in Turkey is limited and sufficiently accurate epidemiological and economical information is lacking. The aim of this study was to estimate the annual incidence of varicella-related hospitalizations, describe the complications, and estimate the annual mortality and cost of varicella in children. VARICOMP is a multi-center study that was performed to provide epidemiological and economic data on hospitalization for varicella in children between 0 and 15 years of age from October 2008 to September 2010 in Turkey. According to medical records from 27 health care centers in 14 cities (representing 49.3% of the childhood population in Turkey), 824 children (73% previously healthy) were hospitalized for varicella over the 2-year period. Most cases occurred in the spring and early summer months. Most cases were in children under 5 years of age, and 29.5% were in children under 1 year of age. The estimated incidence of varicella-related hospitalization was 5.29-6.89 per 100,000 in all children between 0-15 years of age in Turkey, 21.7 to 28 per 100,000 children under 1 year of age, 9.8-13.8 per 100,000 children under 5 years of age, 3.96-6.52 per 100,000 children between 5 and 10 years of age and 0.42 to 0.71 per 100,000 children between 10 and 15 years of age. Among the 824 children, 212 (25.7%) were hospitalized because of primary varicella infection. The most common complications in children were secondary bacterial infection (23%), neurological (19.1%), and respiratory (17.5%) complications. Secondary bacterial infections (p < 0.001) and neurological complications (p < 0.001) were significantly more common in previously healthy children, whereas hematological complications (p < 0.001) were more commonly observed in children with underlying conditions. The median length of the hospital stay was 6 days, and it was longer in children with underlying conditions (<0.001). The median cost of hospitalization per patient was $338 and was significantly higher in children with underlying conditions (p < 0.001). The estimated direct annual cost (not including the loss of parental work time and school absence) of varicella-related hospitalization in children under the age of 15 years in Turkey was $856,190 to $1,407,006. According to our estimates, 882 to 1,450 children are hospitalized for varicella each year, reflecting a population-wide occurrence of 466-768 varicella cases per 100,000 children. In conclusion, this study confirms that varicella-related hospitalizations are not uncommon in children, and two thirds of these children are otherwise healthy. The annual cost of hospitalization for varicella reflects only a small part of the overall cost of this disease, as only a very few cases require hospital admission. The incidence of this disease was higher in children <1 year of age, and there are no prevention strategies for these children other than population-wide vaccination. Universal vaccination is therefore the only realistic option for the prevention of severe complications and deaths. The surveillance of varicella-associated complications is essential for monitoring of the impact of varicella immunization.

Henoch-Schonlein purpura (HSP) is a systemic vasculitis characterized by involvement of skin, joints, gastrointestinal tract (GIT), and kidney; its pathogenesis is still controversial. The aim of our study was to investigate the role of oxidative stress in the pathogenesis of HSP. Plasma advanced oxidation protein products (AOPP) level was measured in 29 children with HSP at the onset of the disease and during remission in comparison with 30 healthy subjects. Patients at the active stage had significantly higher AOPP levels than those at the remission stage of HSP and the controls (42.9 ± 25.7, 30.6 ± 11.8, 27.9 ± 11.2 mmol/l; P = 0.027 and P = 0.023 respectively). The mean AOPP levels of the patients with arthritis and/or arthralgia were significantly higher those than without joint involvement (48.3 ± 26.0 and 22.3 ± 9.3, P = 0.036 respectively). However, AOPP levels were similar in patients with and without gastrointestinal involvement. Plasma AOPP levels were positively correlated with leukocyte and thrombocyte count at disease onset, whereas they were found to be negatively correlated with serum glucose and sodium levels. The mean thrombocyte count was the only independent predictor of increased level of AOPP in regression analysis (β = 0.407; P = 0.029). In conclusion, this study showed that increased oxidative stress may play an important role in the pathogenesis of HSP. Also, we suggest that higher platelet count might be an indirect indicator of oxidative stress in these patients. Further research is required to identify the potential association between oxidative stress and increased thrombocyte count in children with HSP.

Background: Norovirus (NoV) is recognised as one of the most common causes of foodborne infections. Contaminated shellfish, food, water and hospitals are well documented sources of the virus., Objective: NoV in diarrheic children has not previously been investigated in Istanbul, Turkey, hence the aim of this study was to detect and investigate the frequency and phylogeny of human NoV genogroups I and II in children with acute gastroenteritis., Study Design: 238 stool samples were collected from diarrheic children from 2 hospitals (Cerrahpasa Medical School and Haseki) in Istanbul and analysed by ELISA, RT-PCR and real-time RT-PCR using both SYBR Green and probe-based assays for human NoV. Primers targeting the RNA-polymerase gene were used for RT-PCR to allow DNA sequencing of Turkish NoV strains and phylogenetic analysis to be performed., Results: NoV GII was detected in 36 (15.1%) of 238 samples by SYBR Green real-time RT-PCR, 10.9% by a probe-based real-time RT-PCR and 10.5% by ELISA (Ridascreen). Genogroup II (GII) the Turkish NoVs clustered with including GII4 (72.2%), GII16 (5.5%), GIIb (16.7%) and GIIe (5.5%). Two variants of GII4 (GII4-2006b and GII4-2008), GII16 and recombinant noroviruses (GIIb and GIIe) were identified., Conclusion: This study shows a high frequency and genetic diversity of NoV GII infections in children with acute gastroenteritis in Istanbul, Turkey., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Congenital afibrinogenemia, a very rare autosomal recessive coagulation disorder, is characterized by undetectable and extremely low antigen levels of fibrinogen in plasma. We report a male newborn with intracranial bleeding and diagnosed as congenital afibrinogenemia in the neonatal period. All members of the family were asymptomatic. Even though his sister and father showed extremely low fibrinogen levels, they did not have any symptoms. The most important finding of this case was a spontaneous intracranial hemorrhage at a very early stage of life. Another interesting point was the rapid resorption of this hemorrhage.