Genetic Diversity, Population Structure, and Linkage Disequilibrium in Bread Wheat (Triticum aestivum L.).

Bread wheat (Triticum aestivum L.) gene pool was analyzed with 117 microsatellite markers scattered throughout A, B, and D genomes. Ninety microsatellite markers were giving 1620 polymorphic alleles in 55 different bread wheat genotypes. These genotypes were found to be divided into three subgroups based on Bayesian model and Principal component analysis. The highest polymorphism information content value for the markers resides on A genome was estimated for wmc262 marker located on 4A chromosome with the polymorphism information content value of 0.960. The highest polymorphism information content value (0.954) among the markers known to be located on B genome was realized for wmc44 marker located on 1B chromosome. The highest polymorphism information content value for the markers specific to D genome was found in gwm174 marker located on 5D chromosome with the polymorphism information content value of 0.948. The presence of linkage disequilibrium between 81 pairwise SSR markers reside on the same chromosome was tested and very limited linkage disequilibrium was observed. The results confirmed that the most distant genotype pairs were as follows Ceyhan-99-Behoth 6, Gerek 79-Douma 40989, and Karahan-99-Douma 48114.

Neurobrucellosis in children: Case series from Turkey.

BACKGROUND: Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations and complications. Neurobrucellosis is an uncommon and serious complication of pediatric brucellosis. METHODS: We describe seven cases of neurobrucellosis. RESULTS: Ataxia (one patient), diplopia (one patient) and hearing loss (one patient) were among the neurological signs and symptoms. The most common diagnoses were acute meningitis and meningoencephalitis. Five of the patients fully recovered, one was lost to follow up and the other had hearing loss as a sequela. CONCLUSION: Neurobrucellosis should be kept in mind in patients with any neurological or neuropsychiatric diseases who live in endemic areas of brucellosis.

[Evaluation of 44 pediatric measles cases detected in Ankara, Turkey during 2012-2013 epidemic and molecular characterization of the viruses obtained from two cases]. / 2012-2013 kizamik salgini sürecinde Ankara'da saptanan 44 çocuk olgunun degerlendirilmesi ve iki olgudan elde edilen viruslarin moleküler analizi.

Elimination of measles and rubella until the end of 2015 in parallel with the "World Health Organization (WHO) Europe Region's Measles Elimination" work-up has been targetted and "Measles Elimination Program'' has been carried out since 2002 in Turkey. Due to the routine vaccination programmes the number of the vaccinated children have increased and epidemic incidences have been falling. However, imported measles cases from Europe and other neighboring countries have been observed in Turkey in the recent two years. Patients who applied to Dr. Sami Ulus Maternity and Children's Training and Research Hospital with a pre-diagnosis of measles between December 2012 and April 2013 were screened in this study. Seventy-eight patients who match the clinical definition of the disease (> 38°C fever and maculopapular rash and cough or nasal discharge or conjunctivitis) were evaluated. Forty-four children (25 male, 19 female; age range: 4-191 months, mean age: 58.6 ± 59.5 months) with a positive measles IgM test result were taken into consideration and the epidemiological and clinical features of these children were evaluated. In addition to fever and rash, cough, nasal discharge and conjunctivitis were seen in 36 (82%), 24 (55%), and 18 (41%) patients, respectively. Thirty five (80%) patients were diagnosed in December, 6 (14%) in January, 2 (4%) in February, and 1 (2%) in March. All patients included in the study were unvaccinated or too young to be vaccinated according to the routine vaccination calendar. The index case was a three-year old unvaccinated girl who had a history of contact with the Syrian neighborhoods. During the study period; following contact with the index case, two doctors (born in 1986 with a history of single dose of vaccination at ninth month) and three children (without vaccination) were also diagnosed as measles. Eight (18%) patients were hospitalized because of complications. Four (50%) of them had pneumonia and the other four (50%) had lack of oral feeding and dehydration. Average duration of hospitalization for patients was 4 ± 1.7 (range: 2-6) days and all patients were discharged with full recovery. For molecular typing, viral RNAs were isolated from urine samples of two of the measles IgM positive patients, subjected to sequence analysis of 450 nucleotides comprising the most variable C-terminal region of the nucleoprotein (N) gene. Phylogenetic analysis revealed that those two strains belonged to genotype D8. This study represented the involvement of measles virus genotype D8 in an outbreak in Turkey for the first time. During a measles epidemic, following the index case; medical personnel should be informed about possible, probable, and definite case definitions and should apply for appropriate triage or fast-track (rapidly examination) if necessary, and routine announcements should be made precisely and accurately at proper times and unvaccinated medical personnel and any people in touch with the patient should be vaccinated. In order to reach the elimination goal declared by European WHO for 2015, susceptible populations should be identified and vaccinated in Turkey to obtain sufficient herd immunity for preventing outbreaks.

Evaluation of Mitochondrial Copy Number in Thyroid Disorders.

OBJECTIVE: The purpose of this study was to determine whether the mitochondrial DNA (mitDNA) copy number in blood samples of patients with thyroiditis, benign nodules or malignant nodules is different from that in healthy individuals, and to examine whether mtDNAcn has the ability to distinguish between different thyroid diseases. MATERIALS AND METHOD: This study consists of principal groups as thyroid patients and control group. The thyroid patient group comprised 30 patients with malignant nodules, 33 with benign nodules and 31 with thyroiditis, whereas the control group was composed of 21 healthy individuals. Blood samples were collected from the patients before treatment. Results were evaluated between groups. RESULTS: We could not find an adequate number of participants for inclusion to match the groups. Similarly, since there is a gender difference in terms of disease prevalence, it was not possible to pair the populations in terms of gender. Instead, the results were analyzed with an adjusted model, including man characteristics as cofounders. We found that the mtDNAcn of the thyroid patients was significantly lower than that measured for the control group (p = 0.01). Furthermore the mtDNAcn of the benign group was significantly lower than that measured in the control group (p = 0.0001). A similar significant difference was found between the thyroiditis group and the control group (p = 0.005). CONCLUSION: It was observed that mtDNAcn in the malignant group was significantly higher than that measured in the benign group (p = 0.004), which would indicate that it may be used as a diagnostic and therapeutic marker in thyroid diseases.

Role of calcium metabolism in ADHD: The relationship between parathyroid hormone and ADHD symptom severity.

Background: Vitamin D has been found to be associated with the pathogenesis of attention deficit hyperactivity disorder (ADHD). However, the potential role of parathyroid hormone (PTH) is still unclear. Aim: We aimed to investigate the association between calcium metabolism and ADHD symptomatology. Methods: We included 106 participants aged between 7 and 13 years old (51 ADHD patients, mean age: 9.54 ± 1.77, 55 healthy controls mean age: 9.97 ± 0.94) to this study. K-SADS-PL and Conners' Parent/Teacher Rating Scales, Stroop Test were performed. Blood samples to measure serum levels of Vitamin D, PTH, calcium (Ca), magnesium (Mg), phosphorus (P), and alkaline phosphatase (ALP) were collected in the spring (March-April-May) to prevent seasonal variability. Results: PTH, P, and ALP values were significantly lower and Vitamin D, Ca, and Mg values were significantly higher in the ADHD group (P < 0.05, for all). Both groups had Vitamin D deficiency. Control group has lower Vitamin D levels than the ADHD group (respectively; 17.66 ± 9.07, 21.99 ± 10.99, P < 0.05). There was a negative correlation between PTH and CTRS hyperactivity, CGI-RI and CGI-EL sub-scores, CGI-Total, DSM-IV-Inattention, DSM-IV Hyperactivity/Impulsivity, DSM-IV-Total scores (P < 0.05, for all). Conclusions: We found lower PTH levels in ADHD patients and a strong and negative correlation between PTH and symptom severity. Future studies are needed to clarify if these findings are due to the key role of PTH in ADHD pathology or PTH's function in activating vitamin D.

[Pulmonary artery sling as a cause of recurrent wheezing in children]. / Çocuklarda tekrarlayan hisiltinin bir nedeni olarak pulmoner arter sling.

Vascular rings are a group of aortic arch anomalies and usually presents with dispnea, stridor and feeding difficulties after birth. Pulmonary artery sling is created by anomalous origin of the left pulmonary artery from the posterior aspect of the right pulmonary artery. The anomalous left pulmonary artery compresses the lower trachea and right mainstem bronchus, producing upper airway symptoms. We presented a seven-month-old male patient who admitted to our clinic because of recurrent wheezing, stridor, and frequent lower respiratory tract infections.

Technological addictions in attention deficit hyperactivity disorder: Are they associated with emotional intelligence?

BACKGROUND: The impaired regulation of emotional responses has significant social consequences for patients with attention deficit hyperactivity disorder (ADHD) and can be thought to increase the risk for technological addictions. AIM: Ditto objective of the present research is to investigate the relationship between technological addictions and trait emotional intelligence (EI) in adolescents with ADHD. METHODS: This cross-sectional study was conducted in 150 treatment-naïve adolescents with ADHD, aged 12-18 years. The sociodemographic information form, the Emotional Quotient-Inventory: Youth Version (EQ-i: YV), Internet Addiction Test, Smartphone Addiction Scale, and Conners' Parent Rating Scales were used for data collection. RESULTS: The findings revealed that ADHD-C and female patients have lower mean stress management scores on EQ-i: YV. Patients who have smartphone addiction (SA)/problematic internet usage have lower total EI and stress management scores. The oppositional, hyperactivity, and DSM-total scores were negatively correlated with stress management scores. Intrapersonal and stress management scores were negatively correlated to SA symptoms. CONCLUSION: The stress management dimension was the strongest factor related to ADHD and technological addictions. In adolescents with ADHD, stress management may be the key factor to cope with daily problems. Therefore, the interventions to develop EI can be a therapeutic option in ADHD and technological addictions.

The Effectiveness of Melatonin in Head Banging: A case report.

Head banging is one of the three typical subtypes of rhythmic movement disorder. It typically involves anteroposterior movements of the head. Rhythmic movement disorder usually resolves in early childhood but less commonly persists into adolescence and adulthood. Although benzodiazepines commonly used, the universal effectiveness of any pharmacologic agent has not been approved. Herein, we present an 8-year-old girl patient suffered from head banging who responded to melatonin after in failure to imipramine treatment. Although nocomplete remission has been obtained, this is the first melatonin trial in a child patient with headbanging.

Characteristics, diagnosis, and treatment modality of pediatric patients with cystic echinococcosis: a single centre experience.

Kaman A, Tanir G, Çakmakçi E, Demir P, Öz FN, Aydin Teke T, Metin Ö, Gayretli Aydin ZG, Karaman A. Characteristics, diagnosis, and treatment modality of pediatric patients with cystic echinococcosis: a single centre experience. Turk J Pediatr 2019; 61: 704-713. Cystic echinococcosis (CE) is among the most common zoonotic infections worldwide. Studies about CE are limited in childhood. The aim of this study was to evaluate clinical, radiological and laboratory characteristics of childhood CE at a tertiary care pediatric hospital. Medical records of children with CE were analyzed between January 2005 and January 2015. A total of 130 patients with a median age of 10.4 years (IQR= 7.2-years-13.2 years) were evaluated. The anatomic locations of cysts were as follows; liver (76.9%), lung (36.9%), spleen (6.2%), pelvic region (3.8%) and kidney (2.3%). The most common symptoms were abdominal pain and cough in the patients with liver cysts and lung cysts, respectively. The indirect hemagglutination (IHA) test positivity was 58%. Elevated serum total immunoglobulin E levels were detected in 59% of the patients. Fourty-four patients with liver CE, 33 patients with lung CE were treated surgically and 23 patients with liver CE were treated with percutaneous aspiration, injection and re-aspiration (PAIR) along with medical treatment. The recurrence was observed in five patients with liver CE. It was demonstrated that CE mainly involves liver but lung cysts are more frequently symptomatic and prone to be complicated than liver cysts in children. IHA test positivity together with abdominal ultrasonography are useful to diagnose liver CE but thorax CT is usually needed to diagnose lung CE. Liver cysts that are sized greater than 5 cm are more frequently treated with PAIR or surgery but smaller liver cysts can be treated medically.

Retinal Nerve Fiber Layer Thickness in Children With ADHD.

OBJECTIVES: The current study aims to compare retinal nerve fiber layer (RNFL) thickness, macular thickness, and macular volume between children with ADHD and a control group. METHOD: The study group included children with ADHD and the control group consisted of age- and gender-matched participants without any psychiatric disorder. In all participants, RNFL thickness, macular thickness, and macular volume were measured by using spectral domain-optical coherence tomography (SD-OCT). ADHD symptom severity was evaluated by using parent-report measures, including Conners' Parent Rating Scale-Revised: Short Form (CPRS-R: S) and the Strengths and Difficulties Questionnaire: Parent Form (SDQ: P). RESULTS: We compared 90 eyes of 45 children with ADHD and 90 eyes of 45 controls. ADHD group had significantly lower RNFL thickness only in nasal quadrant than the controls. The remaining RNFL quadrants, macular thickness, and volume were not significantly different between groups. There was a reverse correlation between RNFL thickness and ADHD symptom severity. CONCLUSION: This is the first study examining the RNFL thickness in ADHD. Our findings showed that nasal RNFL thickness was lower, indicating reduced unmyelinated axons in the retina of children with ADHD. The results of this study support the evidence that ADHD involves a lag in cortical maturation and this is measurable in the retina.

Time Series Analysis of the Microbiota of Children Suffering From Acute Infectious Diarrhea and Their Recovery After Treatment.

Gut microbiota is closely related to acute infectious diarrhea, one of the leading causes of mortality and morbidity in children worldwide. Understanding the dynamics of the recovery from this disease is of clinical interest. This work aims to correlate the dynamics of gut microbiota with the evolution of children who were suffering from acute infectious diarrhea caused by a rotavirus, and their recovery after the administration of a probiotic, Saccharomyces boulardii CNCM I-745. The experiment involved 10 children with acute infectious diarrhea caused by a rotavirus, and six healthy children, all aged between 3 and 4 years. The children who suffered the rotavirus infection received S. boulardii CNCM I-745 twice daily for the first 5 days of the experiment. Fecal samples were collected from each participant at 0, 3, 5, 10, and 30 days after probiotic administration. Microbial composition was characterized by 16S rRNA gene sequencing. Alpha and beta diversity were calculated, along with dynamical analysis based on Taylor's law to assess the temporal stability of the microbiota. All children infected with the rotavirus stopped having diarrhea at day 3 after the intervention. We observed low alpha diversities in the first 5 days (p-value < 0.05, Wilcoxon test), larger at 10 and 30 days after probiotic treatment. Canonical correspondence analysis (CCA) showed differences in the gut microbiota of healthy children and of those who suffered from acute diarrhea in the first days (p-value < 0.05, ADONIS test), but not in the last days of the experiment. Temporal variability was larger in children infected with the rotavirus than in healthy ones. In particular, Gammaproteobacteria class was found to be abundant in children with acute diarrhea. We identified the microbiota transition from a diseased state to a healthy one with time, whose characterization may lead to relevant clinical data. This work highlights the importance of using time series for the study of dysbiosis related to diarrhea.

Pediatricians' attitudes in management of acute otitis media and ear pain in Turkey.

OBJECTIVES: Acute otitis media (AOM) is predominantly a disease of childhood and one of the common reasons for prescribing antibiotics. Ear pain is the main symptom of AOM, with the result that parents frequently seek immediate medical assistance for their children. Antibiotic therapy for AOM does not provide symptomatic relief in the first 24 hours, and analgesics are commonly recommended for relieving the pain associated with AOM. The aims of the present study were to assess pediatricians' attitudes toward AOM and ear pain management in Turkey. METHODS: This multicenter descriptive questionnaire study was conducted in 20 centers from different geographic locations in Turkey, with 977 pediatricians, between June 2015 and December 2016. The questionnaire comprised 20 questions focusing on the pediatricians' sociodemographic variables, experiences, and treatment related to AOM and ear pain. RESULTS: Of the pediatricians, 58.2% were residents, 36.5% were specialists, and 4.3% were lecturers. Most participants were working in a university hospital (54.8%) or education and research hospital (32.2%). In general daily practice, the AOM diagnosis rates were between 6% and 20% in outpatient clinics, and 52.3% of the participants stated the patients complained about ear pain in pediatric clinics. The watchful waiting (WW) rate, as opposed to immediate antibiotic treatment, was 39.8% for all the pediatricians. The pediatric residents used the WW strategy less than the specialists and lecturers did (p = 0.004). The rates of the WW strategy were higher in outpatient clinics where AOM was commonly diagnosed (p < 0.001). The most common antibiotic prescribed for AOM was amoxicillin clavulanate (76.7%). The mean recommended treatment period for AOM was 9.3 ± 2.2 days. The choices for systemic ear pain treatment were acetaminophen (26.8%), ibuprofen (29.4%), and alternating between ibuprofen and acetaminophen (43.9%). Moreover, 34.6% of the participants recommended topical agents for otalgia. Topical agents were more commonly recommended by the pediatric residents than specialists or lecturers (p < 0.001). Finally, 58.3% of pediatricians had experiences of the parents' usage of a variety of herbal and folk remedies, such as breast milk or olive oil, for their children's ear pain. CONCLUSION: Amoxicillin clavulanate was the most frequently prescribed antibiotic for AOM. WW was approved by the pediatricians, and having more AOM patients was a significant factor in the physicians' choice of WW; nevertheless, the WW rate was poor. Implementation of educational intervention strategies will help pediatricians in improving their compliance with evidence-based guidelines for AOM treatment. Otalgia is taken seriously by parents and pediatricians, and otalgia treatment seems to be well accepted in Turkey for providing symptomatic relief and enhancing the patients' quality of life.

[Executive Functions in Frontal Lob Syndrome: A Case Report]. / Frontal Lob Sendromunda Yönetici Islevler: Bir Olgu Sunumu.

Prefrontal cortex in frontal lobe (FL) is the center of executive functions (EF). FL damage can lead to executive dysfunction by influencing frontal-subcortical circuits (dorsolateral, orbitofrontal, ventromedial). Damage to the dorsolateral prefrontal cortex (DLPFC) can lead to deterioration in EF, whereas damage to the orbitofrontal cortex (OFC) can lead to personality changes with the characteristic of disinhibition and irritability. In addition, damage to the anterior cingulate cortex/medial prefrontal cortex (ACC/MPFC) can result in decreased spontaneity. Neuropsychological tests are important components in the assessment of EF including goal-directed behavior, decision-making, risk assessment, making plans for the future, setting of priorities and order of our actions. Clinical conditions affecting frontal-subcortical connections outside of the FL can also lead to executive dysfunctions and frontal lobe syndrome (FLS). This case report is about an adolescent patient diagnosed as FLS. The clinical symptoms, assessment and treatment processes of this case are discussed in this report. The case is a 15-year-old boy that was admitted to our clinic with behavioral problems, which began after a car accident three years ago. Magnetic resonance imaging (MRI) of the brain indicated hyperintense signal increase in periventricular deep white matter that is associated with traumatic brain damage. Neuropsychological tests results (Stroop, Wisconsin Card Sorting Test, Serial Digit Learning Test, Line Orientation Test, Verbal Memory Processes Scale) have demonstrated impairment in cognitive flexibility, verbal fluency, setting priority, inappropriate response inhibition, sustained attention, planning, problem solving, organization skills and subcortical memory functions. We thought that cognitive and behavioral symptoms of this case were associated with the dysfunctions of frontal-subcortical circuits, independent of an obvious frontal lesion. FLS for the patients with sudden-onset behavioral and cognitive problems after head traumas should be kept in mind in differential diagnosis, even in the absence of an obvious frontal lesion.

Cutaneous Leishmaniasis in Pediatric Patients in a Single Tertiary Hospital in Ankara.

OBJECTIVE: Leishmaniasis is an infectious disease that is caused by a protozoan parasite of the Leishmania genus and that occurs worldwide. Leishmaniasis is endemic in southeastern Turkey and the neighboring Middle Eastern countries. The purpose of this study was to describe the clinical characteristics of patients admitted to our hospital with a diagnosis of cutaneous leishmaniasis (CL). METHODS: A total of 16 CL patients [11 (69%) boys and five (31%) girls] were admitted between January 2014 and December 2015. The data of the patients were retrospectively recorded from their medical records. RESULTS: Their mean age was 74.3±32.3 months (range: 1-10.5 years). Double lesions were most commonly seen in eight (50%) patients. The face and neck was the most commonly involved site (87.5% of the patients). Skin smears for a parasitological examination were positive in nine (56%) patients. Two patients (12.5%) with limb lesions were treated with intralesional meglumine antimoniate. Fourteen patients were treated with systemic agents. CONCLUSION: We felt that the increase in human movement that include travels and forced migration due to the war might make it possible for CL to appear in non-endemic provinces such as Ankara. In particular, in patients with painless cutaneous lesion(s) who came from endemic areas such as Syria, CL should be kept in mind by the clinicians that residing in even non-endemic areas .

Clinical and microbiological features of resistant gram-negative bloodstream infections in children.

BACKGROUND: Bloodstream infections (BSIs) caused by Gram-negative (GN) bacteria cause significant morbidity and mortality. There is a worldwide increase in the reported incidence of resistant microorganisms; therefore, surveillance programs are important to define resistance patterns of GN microorganisms causing BSIs. The objective of this study was to describe the clinical and microbiological features of resistant GN BSIs in a tertiary pediatric hospital in Turkey. METHODS: Patients between 1 month and 18 years of age hospitalized between January 2005 and December 2012 were included in this study. The presence of ESBL and AmpC type beta-lactamase activity were evaluated using the Clinical and Laboratory Standards Institute (CLSI) disk diffusion and double-disk synergy tests. RESULTS: A total of 209 resistant GN bacterial BSI episodes were identified in 192 patients. Of 192 children, 133 (69.2%) were aged ≤48 months of age. Sixty-six (31.6%) of the BSIs were considered community-acquired and 143 (68.4%) were hospital-acquired infections. The most common isolates were non-fermenting GN bacteria (n=117, 55.9%). The major causative pathogens were Pseudomonas spp. in non-fermenting GN bacteria. The resistance rates to imipenem for Pseudomonas spp. and Acinetobacter spp. were 40.5% and 41.6%, respectively. The most common isolates in fatal patients were Pseudomonas spp. followed by Escherichia coli. The overall 28-day mortality rate was 16.3%. CONCLUSIONS: Although our study was performed at a single center and represents a local population, based on this study, it is concluded that surveillance programs and studies of novel antibiotics for resistant GN bacteria focusing on pediatric patients are required.

The prevalence, serogroup distribution and risk factors of meningococcal carriage in adolescents and young adults in Turkey.

The serogroup epidemiology of invasive meningococcal disease (IMD), which varies considerably by geographic region and immunization schedule, changes continuously. Meningococcal carriage data are crucial for assessing IMD epidemiology and designing f potential vaccination strategies. Meningococcal seroepidemiology in Turkey differs from that in other countries: serogroups W and B are the predominant strains for IMD during childhood, whereas no serogroup C cases were identified over the last 10 y and no adolescent peak for IMD was found. There is a lack of data on meningococcal carriage that represents the whole population. The aims of this multicenter study (12 cities in Turkey) were to evaluate the prevalence of Neisseria meningitidis carriage, the serogroup distribution and the related risk factors (educational status, living in a dormitory or student house, being a household contact with Hajj pilgrims, smoking, completion of military service, attending bars/clubs) in 1518 adolescents and young adults aged 10-24 y. The presence of N. meningitidis DNA was tested, and a serogroup analysis was performed using polymerase chain reaction. The overall meningococcal carriage rate was 6.3% (n = 96) in the study population. A serogroup distribution of the 96 N. meningitidis strains isolated from the nasopharyngeal specimens revealed serogroup A in 5 specimens (5.2%), serogroup B in 9 specimens (9.4%), serogroup W in 64 specimens (66.6%), and serogroup Y in 4 specimens (4.2%); 14 were classified as non-grouped (14.4%). No serogroup C cases were detected. The nasopharyngeal meningococcal carriage rate was 5% in the 10-14 age group, 6.4% in the 15-17 age-group, and 4.7% in the 18-20 age group; the highest carriage rate was found in the 21-24 age group (9.1%), which was significantly higher than those of the other age groups (p < 0.05). The highest carriage rate was found in 17-year-old adolescents (11%). The carriage rate was higher among the participants who had had close contact with Hajj/Umrah pilgrims (p < 0.01) or a history of upper respiratory tract infections over the past 3 months (p < 0.05). The nasopharyngeal carriage rate was 6.3% among adolescents and young adults in Turkey and was similar to the recent rates observed in the same age groups in other countries. The most prevalent serogroup was W, and no serogroup C cases were found. In conclusion, the present study found that meningococcal carriage reaches its peak level by age 17, the highest carriage rate was found in 21 - to 24 - year-olds and the majority of the carriage cases were due to serogroup W. Adolescents and young adult carriers seem to be a potential reservoir for the disease, and further immunization strategies, including adolescent immunization, may play a role in the control of IMD.

An interesting fistula tract presenting with recurrent gluteal abscess: instructive case.

A fistula extending from the gluteus to penis is an extremely rare entity. In this paper, we have highlighted novel variant of congenital penile to gluteal fistula complicated with gluteal and penoscrotal abscess in a previously healthy boy. A fistulous tract extending from the gluteus to penis has been shown by fistulogram. Bleomycin has been used in fistula tract with successful results in our patient.

An Unusual Manifestation of Q Fever: Peritonitis.

Q fever has rarely been reported and can be difficult to diagnose, especially in immunocompromised patients. In the present report, we describe an unusual case of Q fever that presented as peritonitis and was treated with long-term combination therapy with doxycycline, ciprofloxacin and rifampicin for five weeks in a patient who had been on peritoneal dialysis for six years due to hypertensive nephropathy.

A pediatric case of acute meningitis due to Streptococcus pneumoniae serotype 33D.

Streptococcus pneumoniae is a leading cause of bacterial meningitis in children. It is also responsible for bacteremia, sepsis, pneumonia, sinusitis and acute otitis media in young children worldwide. The serotypes included in the 7-valent conjugated pneumococcal vaccine (PCV7)-1, 5, 6A, 6B, 14, 19F, 23F-are those most commonly responsible for invasive pneumococcal disease (IPD) globally. Unvaccinated children are at greater risk for meningitis. The rate of non-vaccine serotypes as causes of invasive disease has increased. Although the incidence rate of IPD is highest in children aged <2 years, the rare, non-vaccine serotypes of S. pneumoniae may be responsible for acute meningitis in older, unvaccinated children. In this report, we present a pediatric case of meningitis due to S. pneumoniae serotype 33D, which has not been previously identified as a cause of IPD in those countries where PCV7 is routinely administered, including Turkey.

Pediatric Tuberculosis in Turkey: A Review of 8-Years Period in a Tertiary Care Hospital.

The purpose of this study was to evaluate the clinical, radiological, microbiological characteristics, side effects of anti-TB drugs and treatment outcome of childhood definite or probable TB. The medical records of all childhood TB patients were investigated in the department of pediatric infectious disease of a tertiary care hospital between January 2005 and December 2012. Patients who followed-up until the anti-TB treatment was completed were included in the study. One hundred forty four pediatric cases with active TB were included in the study (27 definite, 117 probable). Twenty-four (16.7 %) patients were asymptomatic at admission. Pulmonary TB was the most common type. The most common localizations for extrapulmonary TB were superficial lymphadenitis. An index case was detected in 39.6% of the patients. In conclusion, the absence of constitutional symptoms does not exclude TB. Household contact screening plays an important role in the diagnosis of childhood TB especially in asymptomatic patients.