Background: Chronic inducible urticaria (CIndU) is a subtype of chronic urticaria induced by a physical stimulus. Objective: To evaluate the clinical features, prognostic factors, and natural course of childhood CIndU subtypes. Methods: Patients (1-18 years old, n = 117) diagnosed with CIndU between March 2011 and March 2019 were analyzed. Patients (n = 101) were re-evaluated for the status of their CIndU at least 6 months after the initial evaluation. Results: The study population comprised of 117 children with a median (inter-quartile range) age of 10.3 (6-14.8) years at admission and a male predominance (53%). Symptomatic dermographism was the most common type of CIndU, affecting 65% of the group, followed by cold urticaria and cholinergic urticaria, which affected 17% and 15.4%, respectively. Baseline serum tryptase levels in cholinergic urticaria and cold urticaria were higher than those in symptomatic dermographism [7.0 (3.3-10.7) μg/L, 4.2 (2.8-9.3) μg/L, and 2.7 μg/L (1.8-5.9), respectively; P = .020]. Recovery was observed in 9.6%, 25.3%, and 34.7% of the CIndU children after 12, 36, and 60 months, respectively. Of the patients with symptomatic dermographism, 40% had remission in 5 years, whereas this rate was only one-fifth in patients with cold urticaria. The worst prognosis was observed in patients with cholinergic urticaria. Conclusion: This study concluded that nearly one-third of children with CIndU recovered within 5 years and symptomatic dermographism has the best prognosis. Cholinergic urticaria is the CIndU type with the worst prognosis, male dominance, and highest baseline serum tryptase levels. K E Y W O R D S baseline serum tryptase, children, chronic inducible urticaria, chronic urticaria, prognosis | 147 BAL et AL. 1 | INTRODUC TI ON Chronic urticaria (CU) is characterized as the appearance of pruritic migratory wheals, angioedema, or both on most days of the week for more than 6 weeks. 1 The estimated prevalence of CU is 0.5%-5% and may affect up to 3% of children. 2,3 CU is classified into two subgroups: chronic inducible urticaria (CIndU) and chronic spontaneous urticaria (CSU). Recurrent pruritic wheals and/or angioedema occur after exposure to a specific stimulus in CIndU that includes symptomatic dermographism, cold urticaria, cholinergic urticaria (ChU), solar urticaria, heat urticaria, delayed pressure urticaria, vibratory angioedema, aquagenic urticaria, and contact urticaria. 1 CIndU is observed in approximately 20%-30% of adults with CU. 4 In a meta-analysis including children and adults, 14.9% of patients with CU were reported as having CIndU. 5 There are few studies in the literature about CIndU in children, with most adult studies providing guidance. A retrospective study by Silpa-archa et al. noted that CIndU was diagnosed in 7.2% of patients with CU, and the most common form was symptomatic dermographism, followed by cold urticaria, delayed pressure urticaria, and ChU. 6 In the literature, it was reported that nearly 13-16% of adult CU patients were in remission within 1 ye...

Severity of disease caused by influenza virus and the influencing factors that may be different. Moreover, the disease course actually may not be determined specifically in children because of lower seroprotection rates of children. Herein, the results clinic and outcome data of children with influenza from Turkey were reported. We present here the results from 2013 to 2017. Nasopharyngeal swab samples of the children with influenza were investigated via multiplex polymerase chain reaction. A total of 348 children were diagnosed with influenza; 143 (41.1%) were influenza A, 85 (24.4%) were influenza B, and 120 (34.5%) were mixt infection with other respiratory viruses. Fifty‐four percent of children admitted to intensive care unit (ICU) were under 2 years of age ( p = .001). Having an underlying disease was detected as the main predictor for both hospitalization and ICU stay according to multiple logistic regression analysis (odds ratio [OR], 11.784: 95% confidence interval [CI], 5.212–26.643; p = .001 and OR, 4.972: 95% CI, 2.331–10.605; p = .001, respectively). Neurological symptoms most frequently seen in cases who died (44.4%; p = .02). Lymphopenia was relatively higher (55.6%) and thrombocytopenia was most frequently seen in cases who died (77.8%) with a significant ratio ( p = .001). Underlying diseases was found a risk factor for influenza being hospitalized and being admitted to ICU. Children under 2 years of age and with underlying diseases should be vaccinated particularly in countries where the influenza vaccination is still not routinely implemented in the immunization schedule. Highlights Underlying diseases is a risk factor for influenza to be hospitalized and admitted to ICU. Influenza vaccination is of great importance to prevent life‐threatening complications of influenza, particularly in children require ICU admission. The possibility to reduce the outpatient visit number by vaccination has a great impact on disease burden in addition to the underestimated crucial social benefits, as well.

Background/aim: To evaluate the efficacy of entecavir (ETV) among chronic hepatitis B (CHB) nucleos(t)ide-naïve and -experienced patients in clinical practice. Materials and methods:In this retrospective study 85 CHB patients who had been receiving ETV and who attended our clinic since 2007 were included. Fifty patients were nucleos(t)ide analogue (NA)-naïve. Factors including sex, positive HBeAg, baseline HBV DNA level, baseline alanine aminotransferase level, and prior lamivudine (LAM) resistance were evaluated in terms of their predictive role in treatment response, which was defined as a serum HBV DNA decrease of <31.4 copies/mL. Results:Resistance was detected in 18 (51.4%) of 35 lamivudine-experienced patients. Virological response (VR) was achieved in 48 (96.0%) of NA-naïve patients, while 16 (45.7%) of NA-experienced patients achieved VR. LAM-resistant patients had significantly lower response rates (P < 0.001). More responders with a low initial viral load achieved VR at the end of the 12-month follow-up period compared to those with a high initial viral load (91.7% vs. 70.0%, P = 0.004). Conclusion:ETV has greater efficacy in NA-naïve patients and in NA-experienced patients without prior LAM resistance. The rate of VR achievement at 12 months was higher in patients who initially had a low viral load with ETV treatment.

Systemic juvenile idiopathic arthritis (sJIA) presents with prolonged fever and systemic features such as arthritis, rash, lymphadenopathy, hepatosplenomegaly and serositis. In this study, we aimed to evaluate the clinical and laboratory findings, and outcomes of sJIA patients from a tertiary rheumatology center. Between 2010-2017, patients who had been diagnosed with sJIA, participated in the study. The demographics, clinical and laboratory features, and outcomes, were evaluated retrospectively. Seventy-five sJIA (%56 male) patients were enrolled. The mean age at diagnosis was 6,45±4,80 years. At the time of diagnosis, the most common findings were fever (%100) followed by arthritis (78,7%), and rash (66,2%). Twenty-four percent of the patients present with macrophage activation syndrome (MAS) at the time of diagnosis. Totally, 36% of the patients had at least one MAS attack during the course of the disease. 46% of the patients had polyphasic course while 54% had one attack (26% monophasic, 28% persistant). All of the patients were treated with non-steroid anti-inflammatory drugs (NSAID) and/or corticosteroids at the beginning of the disease. Twenty percent of the patients reached remission with corticosteroid or disease-modifying anti-rheumatic drugs (DMARDs) however the rest of the patients needed at least one biologic agent. Anakinra was the most common first-line biologic treatment choice (n=45). Fourteen (18,7%) of the patients had polyarticular joint involvement during the disease course, and 5 of them achieved remission with tocilizumab. Systemic JIA is an important disease with high risk of morbidity and mortality. As our center is one of the most important tertiary referral rheumatology centers in the country, we had a high MAS incidence. Eighty percent of the patients achieved remission with a biological agent. Anti-IL1 drugs are mostly preferred for ongoing systemic inflammation. Anti-IL-6 agents are very efficient in patients with a polyarticular course.

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