Immunoglobulin A (IgA) vasculitis is a common systemic vasculitis in children, involving the skin, joint, gastrointestinal tract and kidneys. Scrotal involvement is a less common manifestation in the course of IgA vasculitis, which alters disease management. The purpose of this study was to present the characteristics of patients with IgA vasculitis with scrotal involvement and to compare patients with and without scrotal involvement. We also aimed to investigate the relationship between scrotal involvement and disease activity and inflammatory markers. This medical record review study was conducted in 234 male patients under the age of 18 years who were diagnosed with IgA vasculitis and followed for at least 6 months in the Pediatric Rheumatology Clinic. Demographic characteristics, clinical findings, laboratory findings, and pediatric vasculitis activity score (PVAS) of IgA vasculitis patients were recorded. CRP to albumin ratio (CAR), platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) were calculated using the patients’ complete blood count parameters and C reactive protein (CRP) levels. Two hundred thirty four male patients with IgA vasculitis were included in the study. Scrotum involvement was detected in 34 (14.5%) of patients. The mean age at diagnosis of 34 patients with scrotal involvement was 7.37 (4.41–8.43) years. Of the 34 patients, 15 had scrotal pain, swelling and rash, 12 had scrotal pain and swelling, and 2 had only scrotal swelling. Two (5.9%) patients had penile involvement with scrotal involvement. Patients were divided into two groups as those with scrotal involvement (n = 34, 10.2%) and those without (n = 200, 89.8%). Local edema, widespread skin involvement, hematuria, penile involvement, PVAS and CAR were significantly higher in IgA patients with scrotal involvement than in those without (p < 0.001, p < 0.001, p = 0.019, p = 0.001, p < 0.001, and p = 0.004, respectively). Conclusion: Widespread purpura, local edema, penile involvement and hematuria are more common in patients with scrotal involvement than those without. PVAS and some systemic inflammatory markers such as CAR may be helpful in predicting scrotal involvement. What is known: • IgA vasculitis is the most common type of vasculitis in childhood and scrotal involvement is very rare during the course of the disease.• PVAS is a scoring system used to measure the severity of childhood vasculitis. What is new: • PVAS might be promising surrogate tool for predicting scrotal involvement in patients with IgA vasculitis.

Objective: Atropa belladonna, known as the deadly nightshade, is one of the most poisonous plants in the world. Deadly nightshade poisoning in both children and adults has been rarely reported and is mostly in the form of case reports. The aim of this study was to illuminate the findings of weed poisoning in childhood. Materials and Methods: Clinical and laboratory findings of 54 children with acute deadly nightshade and other weed poisoning followed in our center between January 2010 and January 2022, were retrospectively reviewed. Results: In the study analyzing 54 children admitted to the pediatric intensive care unit for poisoning, 24 cases (44.4%) were attributed to deadly nightshade, with the remaining cases involving other weed poisonings. The most common symptoms were flushing, vomiting, mydriasis, gibberish, dry mouth, and tachycardia. Three patients required mechanical ventilation. No patient was dead. Patients were categorized into 2 groups: mild/moderate (no encephalopathy, n : 46) and severe poisoning (with encephalopathy, n : 8). The severe poisoning group had a higher incidence of urinary retention, incoherent speech, dry mouth, agitation, lethargy, convulsions, and coma, which led to longer intensive care unit (ICU) stays and an increased need for respiratory support (P < .05). Furthermore, a statistically significant difference was observed between deadly nightshade poisoning and other weed poisonings, particularly in the presence of symptoms such as headache, flushing, mydriasis, incoherent speech, encephalopathy, convulsions, and coma, all of which contributed to extended ICU stays and elevated respiratory support requirements (P < .05). Notably, neostigmine was administered in all cases of deadly nightshade poisoning due to the unavailability of physostigmine. Our findings showed that the first signs and symptoms of acute deadly nightshade and other weed poisoning may be severe in some children, but no death was observed. Meaningless speech, mydriasis, coma, and lachrymation were negative prognostic signs in childhood weed poisoning. We believe that neostigmine may be an alternative for deadly nightshade poisoning in cases when physostigmine is unavailable. Conclusions: Our study highlights the severity of poisonings involving deadly nightshade and other weeds in pediatric patients. Despite the significant clinical manifestations observed, no fatalities were recorded. The findings underscore the importance of early recognition and appropriate management, emphasizing the need for heightened awareness among healthcare professionals and caregivers. Cite this article as: Botan E, Boyraz M, Yüce S, Erdem Torun Ş. Deadly nightshade (Atropa belladonna) and other weed poisonings in the pediatric intensive care unit: Analysis of 54 children. Turk Arch Pediatr. 2024;59(6):580-585.

Aim: This study aims to compare changes in rates of suicidal ideation (SI) and attempts (SA) among adolescents during pre, mid and later periods of the pandemic. Material and Method: This study included adolescents who presented to the adolescent medicine clinic in Turkey between March-May 2019 (prepandemic = T0), March-May 2021(mid period of the pandemic = T1) and March-May 2022 (late period year of the pandemic = T2). SI and SA data were assessed through the electronic hospital records of the “HEEADSSS” inventory. Results: The charts of 2113 adolescents were evaluated. The rates of both SI ( p = .015) and SA ( p = .026) were determined to be higher during the pandemic (T1+T2) compared to the pre-pandemic period, with a 1.4-fold increase in SI and a 1.5-fold increase in SA. The rates of SI did not differ according to gender, ( p = .090). In contrast, SA rate was significantly higher in females (7.3%) than males (3.6%) ( p = .001). Conclusion: This study reveals an increase in SI and SA among adolescents during the first 2 years of the pandemic. In challenging times, health professionals should prioritize the identification and treatment of mental health issues, including screening for depression and suicide risk.

Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory disease affecting the bone in which, diagnostic delays are common due to lack of physician awareness. The aim of this study was to evaluate the knowledge of orthopedic surgeons and pediatricians about CNO and to investigate the effect of professional experience on this process. This study was conducted between January-February 2025 using a 13-item online questionnaire comprising multiple-choice questions with clearly defined correct and incorrect answers. The questionnaire consisted of two main categories. The first category included questions regarding the clinicians' areas of specialization, professional experience, and training needs. The second category aimed to assess clinicians' knowledge levels about CNO. For each participant, the number and rate of correct and incorrect responses were calculated. The questionnaire was sent to a total of 551 clinicians and 244 of them (44.2%) (130 orthopedic surgeons, 114 pediatricians) completed the questionnaire. Of the 61 items, orthopedic surgeons had a median of 30 correct responses (26-35), while pediatricians had a median of 32 (28-36) (p = 0.023). The rate of giving the correct answers to the questions increased with the professional experience of the clinicians (p = 0.02). 116 (47.5%) clinicians stated that they didn't think to have sufficient knowledge about CNO and 212 (86.8%) clinicians stated that they'd like to participate in a training about CNO. This study demonstrates that both orthopedic surgeons and pediatricians still have significant knowledge gaps regarding CNO. Although the current level of awareness remains limited in both groups, they appear willing to acquire further knowledge. These findings highlight the need for focused educational programs to improve patient care.

Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease for which colchicine is regularly used every day. Health literacy (HL) is the ability of individuals to acquire, understand and use health information. The aim of this study was to evaluate medication adherence and HL levels in adolescents with FMF and to investigate the impact of HL on colchicine adherence. A cross-sectional, prospective study was conducted with FMF patients aged 12-18 years at the Pediatric Rheumatology Department. Medication adherence was measured using the Medication Adherence Scale in FMF Patients, with scores ≥60 indicating adherence. HL was assessed using the Health Literacy Scale for School-Age Children, categorizing scores as low (10-25), moderate (26-35), or high (36-40). Among 87 FMF patients, 53 (60.9%) were female. The mean age of the patients was 14.89 ± 1.69 years. HL levels were moderate in 64 (73.6%), high in 17 (19.5%) and low in 6 (6.9%) patients. Patients were divided into 2 groups according to medication adherence. Nineteen (21.8%) patients were colchicine adherent and 68 (78.2%) were colchicine non-adherent. A significant difference was observed between the groups in terms of HL levels (p < 0.05). None of the patients with low HL were adherent to colchicine treatment. Higher HL levels were associated with increased medication adherence (p < 0.05). There was no statistically significant difference between adherent and non-adherent patients in terms of gender, age, educational status, reminder methods, school absenteeism, frequency attacks at the last year, colchicine dose, number of colchicine tablets per day (p > 0.05). Adolescents with FMF were generally found to have moderate levels of HL. Colchicine adherence was found to be higher as HL levels increased.

Background. At the onset of the pandemic, we conducted a study on adolescents with eating disorders (EDs) and found no deterioration in ED symptoms. The objective of this subsequent study was to conduct a follow-up evaluation of the same cohort and investigate the consequences of the prolonged pandemic. Methods. This longitudinal study was conducted one year after the first study between May 2021 and June 2021 with 37 adolescents aged 12-18 years (pre-existing EDs). The reassessment included an evaluation of sociodemographic and clinical characteristics, the impact of pandemic-related restrictions on ED behaviors, well-being, and quality of life. All the participants underwent a re-administration of the ED examination questionnaire (EDE-Q), Beck Depression Inventory, the State Anxiety Inventory for Children, and the Maudsley Obsessive Compulsive Inventory. Results. No significant difference was observed in the EDE-Q scores or the ED examination questionnaire scores between the initial (T1) and subsequent (T2) study. The ED-related quality of life was seen to have slightly improved in the later stage. While depression (T1: 18, T2: 15, p=0.883) and obsession scores (T1: 11, T2: 14, p: 0.536) showed no disparity between the studies, anxiety scores (T1: 38, T2: 43, p:0.011) exhibited a significant increase. Conclusions. Consistent with the early phase, no exacerbation of ED symptoms in adolescents was observed during the later stages of the pandemic. Close clinical monitoring during the pandemic might have been protective against the deteriorating effects of the pandemic. During social isolation, it is important to monitor adolescents with EDs continously for depression and anxiety.