Children vaccinated against HBV during infancy may show low levels of antibody during adolescence. Our data suggest that a booster dose of vaccine may be required in low HBV endemic areas.

Introduction: Renal vein entrapment, named nutcracker phenomenon, is a contraction of renal vein between abdominal aorta and superior mesenteric artery. Patients can be asymptomatic or clinically manifested, called nutcracker syndrome. Proteinuria, hematuria, flank pain, varicocele in males and pelvic congestion in females are reported in such patients. Case Presentation: The current report presented an eight-year-old girl with microscopic hematuria and chronic abdominal pain along with short review of anatomy, pathophysiology, clinical significance and management of this syndrome. Conclusions:The nutcracker syndrome should be differentiated from unexplained chronic abdominal pain.

Background: Information about renal involvement in pediatric patients with COVID-19 is limited, and there is not enough data about renal and urinary tract involvement in children infected with this novel virus. Objectives: This study aimed to determine the spectrum of kidney diseases in pediatric patients with COVID-19, admitted to a tertiary children’s hospital. Methods: This cross-sectional study was conducted on 71 pediatric patients with COVID-19 infection. Diagnosis of COVID-19 was established based on the guidelines by the Iranian Ministry of Health. The patients’ demographic characteristics, clinical symptoms, laboratory results, and renal ultrasonography findings were extracted from the hospital medical records. Results: On admission, 10% of patients had oliguria, 7.7% had edema, and 3% had hypertension. The first urinalysis indicated proteinuria, leukocyturia, and hematuria in 46%, 24%, and 23% of the patients, respectively. Overall, 40.7% of the patients showed some degree of renal involvement. During hospitalization, acute kidney injury (AKI) occurred in 34.5% of the patients. Based on the pediatric risk, injury, failure, loss of kidney function, and end-stage kidney disease (pRIFLE) classification, stage I (risk group) was found in 20% of patients, stage II (injury group) in 25% of patients, and stage III (failure group) in 55% of patients with AKI. The total mortality rate was estimated at 12.67%, and the incidence of in-hospital death was 30% in pediatric patients with severe COVID-19 infection associated with AKI. Conclusions: The prevalence of AKI was high in patients with COVID-19 infection hospitalized in our tertiary hospital. We also found that a decrease in renal function was associated with a higher risk of mortality. Overall, early detection of AKI and effective treatment may help reduce mortality in patients with COVID-19.

Urinary tract infections (UTIs) are among the most common infectious diseases diagnosed especially in pediatric patients 1,2. UTIs are liable for more than 1.5 million hospitalization and 300,000 cases of severe disease in the United States annually 3. Among all infectious agents causing UTIs, the Staphylococcus aureus (S. aureus) is one of those who have recently received considerable attention because its high abilities to resistance against commonly used antibiotics 4, 5 .

: Multiple inflammatory syndrome in children (MIS-C) is a multisystem inflammatory disease following COVID-19 in children. This disease occurs a few weeks after COVID-19. A child with this condition develops a cytokine release cascade that results in organ damage. The involved organs include the heart, lungs, brain, gastrointestinal tract, and central nervous system. Fever is present in all patients and Kawasaki-like symptoms are one of the common features in these children. In this article, we introduce a child with MIS-C who has skin, gastrointestinal, neurological, and renal symptoms and has been hospitalized in the PICU.

Purpose:Hepatitis B virus (HBV) vaccination is recommended for all human immunodeficiency virus (HIV)-infected patients without HBV immunity. However, serological response to standard HBV vaccination is frequently suboptimal in this population and the appropriate strategy for revaccination of HIV-infected nonresponders remained controversial. We aimed to determine the serological response to one booster dose of HBV vaccine given by intradermal (ID) or intramuscular (IM) route in HIV-positive nonresponders to standard HBV vaccination.Materials and Methods:In this study, 42 HIV-infected nonresponders were enrolled. We randomized them to receive either 10 μg (0.5 mL) for ID (20 cases) or 20 μg (1 mL) for IM (22 cases) administration of HBV vaccine as a one booster dose. After 1 month, anti-HBs titer was checked in all cases. A protective antibody response (seroconversion) defined as an anti-HBs titer ≥10 IU/L.Results:Seroconversion was observed in 47.6% of subjects after 1 ID dose. A total of 30% showed antibody titers above 100 IU/L. Except one case, all responders had CD4+ >200 cells/mm3. Mean anti-HBs titer was 146.5 ± 246 IU/L. After the one IM booster dose, seroconversion was observed in 50% of cases. A total of 36.3% of subjects had anti-HBs ≥100 IU/L. All responders had CD4+ >200 cells/mm3, except one case. Mean anti-HBs titer was 416.4 ± 765.6 IU/L. Responders showed significantly higher CD4+ cell counts, in comparison to nonresponders (P < 0.001).Conclusions:One booster dose administered IM or ID to HIV-infected nonresponders resulted in similar rates of seroconversion, overall response rate 50%. However, higher anti-HBs titers observed more frequently in IM group.

Staphylococcal cassette chromosome mec (SCCmec) is a mobile genetic element of Staphylococcus aureus which includes the mecA gene coding for resistance to t h e methicillin and other types of     -lactam antibiotics. The present study was carried out to investigate the distribution of SCCmec t y p e s i n S. aureus strains isolated from the urine samples of pediatrics suffered from UTIs. Totally, 162 urine samples were collected from hospitalized pediatrics suffered from UTIs. Samples were cultured and those that were S. aureus-positive were analyzed for the presence of SCCmec types I, II, III, IVa, IVb, IVc, IVd and V. Of 162 studied samples, 56 samples (34.56%) were S. aureus positive. Total prevalence of S. aureus in boy and girl patients were 29.16% and 38.88%, respectively (P= 0.048). the prevalence of S. aureus in the cases of pyelonephritis and cystitis were 38.82% and 29.87%, respectively (P= 0.045). Total prevalence of SCCmec types I, II, III, Iva, IVb, IVc, IVd and V in the S. aureus isolates were 26.78%, 17.85%, 35.71%, 19.64%, 30.35%, 14.28%, 10.71% and 46.42%, respectively. Higher prevalence of SCCmec types was reported in the cases of pyelonephritis and also in girl patients. As far as we know, the present study was the first prevalence report of SCCmec types of S. aureus isolated from Iranian pediatric patients. Our data showed that researchers should tried to find a proper replacement for methicillin.

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