Meltem Dinleyici

Adrenal insufficiency associated with cytomegalovirus infection in two infants

Adrenal insufficiency associated with cytomegalovirus (CMV) is a well-described condition in adults with AIDS, however there is little information about CMV-associated adrenal insufficiency in childhood. The cases of two infants with negative HIV serology, presenting with CMV-associated adrenal insufficiency, are described. Clinical findings and therapeutic interventions are discussed with reference to the affinity of CMV infection for the adrenal gland. The differential diagnosis of adrenal insufficiency in newborns and infants should include CMV infection, and clinical suspicion of CMV-associated adrenal insufficiency should lead to early initiation of appropriate adrenal substitution therapy and ganciclovir antiviral therapy. Timely therapy for CMV-associated adrenal insufficiency can be lifesaving.

Giant Condyloma Acuminate Due to Human Papillomavirus Type 16 in an Infant Successfully Treated with Topical Imiquimod Therapy.

Anogenital warts related to human papillomavirus (HPV) have been observed in children. Definition of the transmission mode, therapy, and follow-up for long term potential complications is important. A 27-month old girl was admitted with multiple pedunculated red-purple colored cauliflower-like lesions of 1.5 years duration. Clinical/histopathological and microbiological diagnosis was condyloma acuminate due to HPV type 16. After 12 weeks of imiquimod 5% cream application (pea-sized) overnight three times per week, the perianal warts had completely disappeared. The mode of transmission of HPV 16 in our case was probably horizontal, related to the sharing of common personal hygiene items in the women’s shelter. We report herein the case of an infant living in a women’s shelter with giant condyloma acuminata due to HPV 16, which was successfully treated with topical imiquimod therapy. This patient should be followed up for recurrence and potential malignant lesions related to HPV type 16.

Severe fatal course of axial mesodermal dysplasia spectrum associated with complex cardiac defect in an infant of a mother with insulin dependent diabetes

Axial mesodermal dysplasia spectrum (AMDS) includes the features of other malformation complexes or sequences, such as oculo‐auriculo‐vertebral spectrum (OAVS) and sacral dysgenesis. We describe a new patient, an infant born to a type 1 diabetic mother, with the phenotype of AMDS as well as severe congenital cardiac anomalies including transposition of the great arteries and an atrioventricular septal defect. Congenital heart defects had been reported with OAVS, sacral dysgenesis, and in an infant born to a diabetic mother and combinations of these findings have been reported in the same patient. To our knowledge, this is the first patient with AMDS with transposition of great arteries and an atrioventricular septal defect and the second patient with AMDS who had history of parental consanguinity. The mechanism through which maternal diabetes mellitus leads to malformations is not entirely clear, but the glycemic control is essential in the care of mothers.

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

ABSTRACT 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.

The immunization status of children with chronic neurological disease and serological assessment of vaccine-preventable diseases

ABSTRACT The aim of this study was to evaluate the age-appropriate immunization coverage in 366 children with chronic neurological disease (CND), to evaluate the use of vaccines not included in routine program, to evaluate serological tests for vaccine-preventable diseases and to describe the related factors in unvaccinated children. 95.6% of all children with had received age-appropriate vaccinations according to the actual National Immunization Program (NIP) during childhood. 12 children (3.6%) had not received vaccines; only two had true contraindications. Because most of the vaccines have been implemented through the NIP for 10 years in Turkey, 88% of children required these new vaccines or booster doses. Moreover, 86.6% of the children and 92.6% of household contacts had no prior history of influenza vaccine. Furthermore, 88% of the patients had not received the varicella vaccine, and the anti-varicella IgG levels were only negative in 27.9%. In addition, 18.6% of the children were negative for anti-mumps IgG, 23.7% for anti-measles IgG, and 6.3% for anti-rubella IgG. Anti-HBs IgG level was 0–10 IU/L in 45.6% of the patients (most of them previously vaccinated) and 79.8% were negative for hepatitis A IgG antibodies. For pertussis infection, the antibody titers of 54.1% of patients were below the protective level, and 10% of patients had a prior acute pertussis infection. Therefore, it is suggested that children with CND should be evaluated for their vaccination status during their first and follow-up visits at certain intervals, and their primary immunization should be completed; moreover, many will need revaccination or booster doses.

Media Use by Children, and Parents’ Views on Children's Media Usage

Background New (mobile phones, smartphones, tablets, and social media) and traditional media (television) have come to dominate the lives of many children and adolescents. Despite all of this media time and new technology, many parents seem to have few rules regarding the use of media by their children and adolescents. Objectives The aim of this study was to evaluate media access/use of children and to evaluate beliefs and attitudes of parents concerning the use of old and new media in Turkey. Methods This is a cross-sectional electronic survey of a national convenience sample in Turkey via SurveyMonkey, including 41 questions regarding topics relevant to television, computers, mobile phones, iPad/tablet use, and social media accounts. Results The responses of the 333 participants (238 women, 95 men; 27-63 years) were evaluated. The average daily watching alone time was 0 to 2 hours among 53.4% (46/86), and daily coviewing time with parents of children was 0 to 2 hours among 62.7% (54/86) of children below 2 years of age. Regarding parents’ monitoring their children’s computer use (n=178), 35.4% (63/178) of the parents prefer coviewing, 13.5% of the parents use a family filter (24/178), and 33.1% (59/178) of the parents prefer to check Web history. Approximately 71.2% (237/333) of the participants had an iPad/tablet in the house, 84.3% (200/333) of the parents give their children permission to use the iPad/tablet. Of the parents, 22.5% (45/200) noted that their children used the iPad/tablet at the table during lunch/dinner and 57.9% (26/45) of these children were aged 5 years and below. Of parents, 27.3% (91/333) agreed that the optimal age for owning a mobile phone was 12 years, and 18.0% (60/333) of the parents noted that their children (one-third was below 2 years) used the mobile phone at the table during meals. A total of 33.3% (111/333) children/adolescents have a Facebook profile, and 54.0% (60/111) were below 13 years of age. Approximately 89.2% (297/333) of the parents emphasized that the Internet is essential for their child’s education. Discussion According to our study results, knowledge regarding the use of old and new media is limited among the parents in Turkey. Our study showed that screen time and mobile device use (including during meals) are common in children below 2 years of age, whereas no screen time was recommended for children below 2 years of age. We concluded that there is need for evidence-based guidelines regarding the use of the Internet and social media for parents and parents should ensure that there is a plan in place for the use of children’s media.

Menstruation‐related headache in adolescents: Point prevalence and associated factors

The aim of this study was to investigate the prevalence of menstruation‐related headache and the impact of associated factors in adolescents.

The attitudes, behaviors, and knowledge of healthcare professionals towards the diagnosis, treatment, and prevention of bacterial meningitis in Turkey

ABSTRACT Introduction: Bacterial meningitis is one of the leading causes of morbidity and mortality among children and adults. Better understanding of the seroepidemiology of meningitis is critical for both the selection and implementation of an effective meningitis vaccine for the national immunization program. Because physicians play a crucial role in the implementation of this vaccine, the aim of this study was to evaluate the attitudes, behaviors, and knowledge of healthcare professionals in Turkey regarding the diagnosis, treatment and prevention of bacterial meningitis, especially pneumococcal and meningococcal meningitis. Methods: This study used a cross-sectional electronic survey with a national convenience sample of 339 physicians (171 pediatric age specialists [PAS] and 168 adult patient specialists [APS]) in Turkey. A web-based questionnaire which consisted 28 questions about the definition, diagnosis, and treatment of bacterial as well as knowledge and/or attitudes about meningococcal vaccines, was designed. Results: Approximately 72.9% (n = 247) of the respondents followed a patient with meningitis in the last year. A 49.5% of participants preferred to perform computerized cranial tomography (CCT) for suspected meningitis cases before lumbar puncture (LP) at 75–100% frequency (27.5% PAS; 72% APS, p < .01). In addition 27.1% of the respondents reported using a routine steroid as an adjunctive treatment (19% PAS; 35% APS, p < .01). For meningococcal meningitis, 72.5% of the participants preferred to use third-generation cephalosporins (63.1% PAS; 82.1% APS, p < .05). For pneumococcal meningitis, approximately 50% of the participants preferred to use a third-generation cephalosporin plus glycopeptide (41.5% PAS; 58.9% APS, p < .05). While 32.7% of the sample preferred to administer a 7-day course of antibiotics for meningococcal meningitis, 40.9% preferred a course of 14 days or more. For pneumococcal meningitis, 88.4% of the sample preferred a 10–14 day course of antibiotics. In addition, 67% of the PAS group and 50% (p < .001) of the APS group thought that a conjugated meningococcal vaccine should be a part of the National Immunization Program. The top five groups recommended for routine immunization included all children, asplenia/splenectomy patients, immunodeficient patients, those who planned to travel to endemic areas, including Hajj, and military personnel. Conclusion: In this large convenient sample of physicians in Turkey, we showed that there are heterogenous approaches to the diagnosis and treatment of bacterial meningitis, also differences between pediatricians and non-pediatricians regarding their beliefs and attitudes, which may be due to differences in the epidemiology and clinical presentation between children and adults. We observed appropriate but unnecessary extended courses of antibiotics for meningitis. Most of the participants thought that children are a vulnerable risk group that should potentially be immunized and that meningococcal vaccines should be included in the National Immunization Program. Our results imply that more awareness is needed regarding diagnosis, treatment, and further recommendations for meningitis at the country level in Turkey.

Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study)

ABSTRACT Background: Febrile seizure is the most common childhood neurological disorder, is an important health problem with potential short- and long-term complications, also leading to economic burden and increased parental anxiety about fevers and seizures occurring in their children. There are no routine recommendation to detect etiological causes of FS for neurological perspective, further knowledge about the etiological causes of FS in children will support preventive measures and follow-up strategies. The aim of this study is to evaluate the percentage of respiratory viruses in children with FS. Methods: This prospective multicenter study, entitled “Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study)” examined representative populations in eight different cities in Turkey between March 1, 2016 and April 1, 2017. Nasopharyngeal swabs were taken from all children at presentation. A respiratory multiplex array was performed to detect for influenza A and B; respiratory syncytial virus A and B; human parainfluenza virus 1-2-3 and 4; human coronavirus 229E and OC43; human rhinovirus; human enterovirus; human adenovirus; human bocavirus; human metapneumovirus. Results: During the study period, at least one virus was detected in 82.7% (144/174) of children with FS. The most frequently detected virus was adenovirus, followed by influenza A and influenza B. Detection of more than one virus was present in 58.3% of the children with FS, and the most common co-existence was the presence of adenovirus and influenza B. In children younger than 12 months, Coronavirus OC43 was the most common, while influenza A was most frequently observed in children older than 48 months (p < 0.05). Human bocavirus was common in children who experienced complex FS, while respiratory syncytial virus (RSV) A was more common in children who experienced simple FS. Influenza B virus was the most common virus identified in children who were experiencing their first incidence of FS (p < 0.05). Conclusions: This study indicates that respiratory viruses are important in the etiology of FS in children. The results show that antibiotics must be prescribed carefully in children with FS since the majority of cases are related to viral causes. Widespread use of the existing quadrivalent influenza vaccine might be useful for the prevention of FS related to the flu. Further vaccine candidates for potential respiratory pathogens, including RSV, might be helpful for the prevention of FS.