[A Case Report of Monkeypox Disease in an Adolescent]. / Adölesan Bir Olguda Maymun Çiçegi Hastaligi.

Monkeypox virus (MPXV) infection is a zoonotic disease characterized by smallpox-like rashes. It is endemic in Central and West Africa. The World Health Organization (WHO) declared the disease as an epidemic due to a significant increase in the number of reported cases, starting from Europe and spreading to other regions, particularly in certain areas, in May 2022. On July 23, 2022, it was recognized as a public health problem of international importance. Our country has also been affected by this epidemic, and the official number of reported cases is twelve. In this case report, an adolescent case diagnosed with MPXV infection was presented. A 17-year-old male patient admitted with the complaints of sores around the mouth and genital area, fever and headache. The patient had a history of sexual contact with three different males in the last six months. Honey-colored crusted papules and plaques were observed in the perioral area, as well as crusted papules on the penile and gluteal areas. Ulcerative sores were present in the oral cavity. Laboratory tests for sexually transmitted diseases confirmed the patient's HIV-positive status and MPXV infection through PCR (polymerase chain reaction) testing. Antiviral treatment for human immunodeficiency virus (HIV) was initiated after the HIV RNA level resulted in 263000 copies/mL. Additionally, a glycopeptide was added to the treatment regimen when methicillin-resistant Staphylococcus aureus growth was detected in the swab culture taken from the wounds on the patient's face. No specific treatment was administered for MPXV due to the patient's uncomplicated clinical course and overall well-being. This case report aims to raise awareness about monkeypox disease in children by highlighting the clinical findings and potential risk factors.

The Evaluation of the Genetic Variation Types of the Uridine Diphosphate Glucuronosyl Transferase 1A1 Gene by Next-Generation Sequencing and Their Effects on Bilirubin Levels in Obese Children.

Background and Objectives: Obesity is a major nutritional problem with an increasing prevalence among children and adolescents. The uridine-diphosphate-glucuronosyl-transferase1A1 (UGT1A1) gene encodes the UDP-glucuronosyl transferase enzyme, converting the toxic form of bilirubin to a soluble, nontoxic form. There are yet to be studies on the evaluation of the UGT1A1 variant types detected by next-generation sequencing (NGS) and their effects on bilirubin levels in nonsyndromic obese children. Methods: Forty-five children with body mass index (BMI) >95 percentile (p) constituted the obesity group and fourteen healthy children with BMI <85p constituted the control group. Anthropometric, clinical features, and biochemical parameters were evaluated. Furthermore, the UGT1A1 gene was sequenced by NGS. Results: The obese patients had lower total, direct, and indirect bilirubin levels (p = 0.422, 0.026, and 0.568, respectively). In addition, obese patients had more genetic variations in the UGT1A1 gene compared with the control group (62.2% and 50%, respectively). We found that children with variations had higher total direct and indirect bilirubin levels compared with those without variation (p = 0.016, 0.028, and 0.015, respectively). Children diagnosed with obesity in the first two years of their life had fewer genetic variations and lower total bilirubin levels (p = 0.000 and 0.013, respectively). Conclusions: It is assumed that bilirubin can be protective against many chronic diseases. Although bilirubin levels are found to be lower in obese children compared with the control group, some variations in the UGT1A1 gene may be supported by raising bilirubin. We suggest that high bilirubin levels caused by those UGT1A1 variations may be protective against obesity and its many negative effects.

Adolescents With Breakthrough COVID-19 Infections Requiring Hospitalization: A Multicenter Retrospective Study.

Background Vaccines have the most important role in the battle against the COVID-19 pandemic. With the widespread use of vaccines, COVID-19 has remarkably declined. Adolescents were vaccinated after approvals for this age group, which was later than adults, and a nationwide vaccination program was implemented in August 2021 in Turkey for adolescents ≥12 years of age. Therefore, we aimed to determine the effects of the COVID-19 nationwide adolescent vaccination program on adolescent hospitalizations due to COVID-19 and multisystem inflammatory syndrome in children (MIS-C) by comparing two periods, including the vaccination period (VP) and the pre-VP (PVP). The second aim of this study is to compare the clinical features and disease severity of vaccine-breakthrough COVID-19 hospitalizations with unvaccinated individuals in the VP. Methods A retrospective multicenter study was conducted to determine and compare the number of hospitalizations due to COVID-19 and MIS-C between the VP (September 1, 2021, to August 31, 2022) and PVP (September 1, 2020, to August 31, 2021). We also compared the characteristics, risk factors, and outcomes of breakthrough infections of adolescents aged 12-18, which required hospitalization with the same age group of unvaccinated hospitalized individuals during the VP. Results During the study period, 3967 children (0-18 years) were hospitalized in the PVP and 5143 (0-18 years) in the VP. Of them, 35.4% were adolescents (12-18 years) in the PVP, and this rate was 18.6% in the VP; relative risk was 0.6467 (95% confidence interval [CI]: 0.6058-0.6904; p < 0.001). Patients with breakthrough COVID-19 were older (201 vs. 175 months, p < 0.001) and less commonly hospitalized for COVID-19 (81.5% vs. 60.4%, p < 0.001, odds ratio [OR]: 0.347 [95% CI: 0.184-0.654]). The majority of these infections were asymptomatic and mild (32% vs.72.9%: p < 0.001, OR: 5.718 [95% CI: 2.920-11.200]), and PICU admission was less frequently required (p = 0.011, OR: 0.188 [95% CI: 0.045-0.793]). Most breakthrough COVID-19 infections occurred within three months after the last vaccine dose (54.2%). Conclusions This study demonstrated a significant decrease in adolescent hospitalizations due to COVID-19 and MIS-C after implementing COVID-19 vaccines in Turkey. Breakthrough cases were less severe and mostly occurred three months after the last dose. This study emphasizes the importance of COVID-19 vaccines and that parents' decisions may be changed, particularly those who hesitate to or refuse vaccination.

The effects of measures taken during the COVID-19 pandemic on the seasonal dynamics of respiratory viruses in children.

BACKGROUND: We aimed to evaluate the effects of public health measures taken during the COVID-19 pandemic on respiratory viruses. METHODS: The study was conducted between February 1, 2021 and December 1, 2022. Patients aged 1 month to 18 years hospitalized for infectious diseases were tested for SARS-CoV-2 and respiratory viruses by multiplex PCR. RESULTS: Of the total 1173 patients, 56.2% were male and 43.8% were female, and 47.5% of the patients were under 24 months of age. The viruses detected were SARS-CoV-2 31.9%, human rhinovirus/enterovirus 19.4%, respiratory syncytial virus (RSV) 9.3%, parainfluenza virus 7%, adenovirus 6%, seasonal coronavirus 5.2%, bocavirus 3.8%, influenza 3.1%, and metapneumovirus 2.8%. Among the patients, 386 were hospitalized with lower respiratory tract infections, 238 with upper respiratory tract infections, 202 to evaluate fever etiology, 111 with acute gastroenteritis and 236 with other diagnoses. Of these patients, 113 were admitted to the intensive care unit. Intensive care unit admission rates were statistically significantly higher for bocavirus and RSV, in those hospitalized between July 1, 2021 and July 1, 2022 (first period when schools were held full-time face-toface at all grades) and in children aged 1-24 months. CONCLUSIONS: Public health measures taken during the COVID-19 pandemic have affected the seasonal distribution of respiratory viruses and the severity of illness in children.

A case of bradycardia during SARS CoV-2 infection in a 14-year-old child.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) has caused an infectious disease that affects multiple organs. Recently, the cardiological effects of the virus have also been striking. To the best of our knowledge, there are no SARS CoV-2 positive paediatric cases reported with sinus bradycardia in the literature. CASE PRESENTATION: A 14-year-old male patient presented with complaints of abdominal pain and fatigue. The heart rate of the patient, whose grandmother was found to be positive for SARS CoV-2 test, ranged between 43 and 60/min, the heart sounds were normal. There was no known history of cardiological disorder in the patient and his family. His laboratory findings were; normal Troponin I, elevated C Reactive protein, normal Haemoglobin, normal CK-MB, mildly elevated D-Dimer. Electrocardiography of the patient was evaluated as sinus bradycardia. There was no pathological finding in his echocardiography. The SARS CoV-2 PCR test was positive. In his follow-up, the heart rate decreased to 50 beats per minute while awake and 43 beats per minute while sleeping. The patient had a bradycardic course until the 4th day of hospitalisation. Control SARS CoV-2 PCR test was negative. He was discharged on the 8th day. CONCLUSION: It's understood that SARS-CoV-2 is responsible for multiple cardiac manifestations. The most common bradyarrhythmia associated with SARS CoV-2 reported worldwide is sinus bradycardia and complete heart block. In order to contribute to the literature, we present a 14-year-old paediatric patient with positive SARS CoV-2 PCR test who has normal cardiac tests and sinus bradycardia.

Alpha-lipoic acid intoxication in an adolescent girl: Case report and review of the literature.

Alpha-lipoic acid is a widely used medication that does not need a prescription. Although it is safely used in adults, hitherto no safe dose for children has been reported, and there is no known antidote. The medical literature provides four reports of alpha-lipoic acid intoxication in the pediatric population to date. This case-report is the lowest known dose of alpha-lipoic acid intake leading to poisoning in a teenager.

Thrombosis risk of Alport syndrome patients: evaluation of cardiological, clinical, biochemical, genetic and possible causes of inherited thrombophilia and identification of a novel COL4A3 variant.

: To evaluate cases with Alport syndrome for laboratory, radiological, ophthalmological, auditory tests, cardiological and inherited thrombophilia risk. Laboratory findings, abdominal and urinary ultrasonography, ophthalmological and auditory tests and cardiological examination of 21 Alport syndrome suspicious cases were performed. Also, collagen type IV alpha three chain (COL4A3) gene, four chain (COL4A4) gene and five chain (COL4A5) genes were sequenced by next-generation sequencing system. In addition, possible causes of inherited thrombophilia were evaluated. A novel (c.2806C>T/p.Gln936Ter) variation in COL4A3 gene was detected in three cases. Also c.221G>A/p.Arg74Gln variation in COL4A5 gene of two cases, c.4421C>T/p.Thr1474Met variation in COL4A4 gene of one case, c.665C>T/p.Pro222Leu variation in COL4A4 gene of one case and compound heterozygous c.4421C>T/(p.Thr1474Met) and c.665C>T/p.Pro222Leu variation in COL4A4 gene of one case were detected. Although 10 (47.6%) cases had microscopic hematuria, six (28.6%) cases had macroscopic hematuria, but there were not hematuria in five (23.8%) of cases. Three cases with variation carrier in COL4A genes and one case without variation carrier had vision problem. Also, one case with variation carrier in COL4A gene had hearing loss. All cases with variation carrier in COL4A genes exclude one had at least one cardiac problems. Also, all cases with variation carrier in COL4A genes had possible causes of inherited thrombophilia risk. In addition to developing risk of progressive kidney failure, sensorineural hearing loss and ocular abnormalities, Alport syndrome cases may have increasing cardiac problems and possible causes of inherited thrombophilia risk. Therefore, these cases should be regularly evaluated and followed for cardiac problems and inherited thrombophilia risk.

Thrombotic thrombocytopenic purpura as a rare cause of anemia with thrombocytopenia in childhood: report of 2 cases.

Köker O, Yildirmak ZY, Genç DB, Kiliçaslan Ö. Thrombotic thrombocytopenic purpura as a rare cause of anemia with thrombocytopenia in childhood: report of 2 cases. Turk J Pediatr 2019; 61: 418-423. Thrombotic thrombocytopenic purpura (TTP) is a rare multisystem disorder characterized by single or recurrent episodes of thrombocytopenia, microangiopathic hemolytic anemia and widespread microvascular thrombosis, which causes significant morbidity and mortality unless promptly recognized and treated. The underlying pathogenesis is a defect in von Willebrand factor (vWF) cleaving protease, called `A Disintegrin and Metalloproteinase with Thrombospondin Type 1 Repeats 13 (ADAMTS-13)`. There are 2 forms: congenital TTP (ADAMTS-13 gene mutations) and acquired TTP (autoantibodies and ADAMTS-13 deficiency). We presented two patients who initially presented with thrombotic microangiopathy and were later diagnosed with TTP upon demonstration of the deficiency in ADAMTS-13 activity.

Short Term Unscheduled Revisits to Paediatric Emergency Department - A Six Year Data.

INTRODUCTION: Reviewing the reasons for return visits within 24 hours is a very important method of determining possible problems of emergency health care. Several causes stay behind unscheduled emergency return visits. Therefore, identifying these factors is crucial to set strategies in order to decrease the number of unnecessary visits. AIM: To define the characteristics of the patients returning to the Paediatric Emergency Department (PED) within 24 hours via determining rate, number and demographic data of patients. MATERIALS AND METHODS: The present study design involves retrospective data collection of patients who returned to PED within 24 hours after being discharged. Data was included over six year period and was collected from July 1, 2010 to June 30, 2016. The data was analysed with SPSS17.0 statistical package for windows. RESULTS: A total of 1994 patients returned to PED within 24 hours from July 1, 2010 to June 30, 2016. The most common group of revisiting patients were toddlers (aged 0-2-year old), n=1168 (58.5%), and the least number represented young adolescents (aged 15-18-year old), n=82 (4.1%). Number of patients returning to PED in 24 hours has significantly increased within years from approximately 90 patients to 720 (p<0.05). This increase in number was observed in all and each age group (from 0-18 years of age) without any exception. Seasonal distribution of the patients showed no significant difference (p>0.05) for each age, but again, presented definite negative correlation with age (the older is the patient group, the less is the number of revisits). The most common time for revisits was 17-24 hours after first discharge from PED, n=1277 (64.04%). CONCLUSION: The number of return visits is increasing over the years. The younger the patient is, more likely is the risk of unscheduled revisit to PED. Most of the patients returned to PED in 17 to 24 hours after discharge.