Early Onset Research Articles

Juvenile idiopathic arthritis management: insights into the utilization of intra-articular corticosteroid injections

ABSTRACT Background Juvenile idiopathic arthritis (JIA) is a common chronic rheumatic disease in children, requiring careful management to reduce both short- and long-term morbidity. In this study, our objective was to assess the clinical features of patients diagnosed with JIA who received intra-articular corticosteroid injections (IACI). Methods In this retrospective study, we evaluated the clinical and laboratory characteristics of 225 JIA patients monitored from January 2012 to October 2023 at a tertiary care center. We focused on patients who underwent intra-articular corticosteroid injections (IACI) as part of their treatment. Triamcinolone hexacetonide (TH) was used due to its demonstrated safety and efficacy. Results Our analysis revealed that IACI, particularly utilizing TH, was a widely employed and effective adjunct therapy, contributing to rapid symptom relief and local disease control. Patients receiving IACI exhibited earlier symptom onset, younger age at diagnosis, longer follow-up durations, and higher cumulative treatment burden (p < 0.001, p < 0.001, p < 0.01, p < 0.001 respectively). Despite inconclusive acute-phase reactants, a higher frequency of ANA positivity and elevated initial lymphocyte counts were associated with increased IACI use (p < 0.001, p < 0.001 respectively). Importantly, on a joint basis, a high percentage of arthritis remission following IACI underscores its efficacy and favorable safety profile. Conclusions Notably, the high percentage of arthritis remission achieved with intra-articular corticosteroid injections (IACI) on a joint-specific basis highlights its efficacy and favorable safety profile. A lymphocyte count exceeding 5000/mm3 at the time of diagnosis may serve as an early indicator for considering intra-articular steroid administration. These findings emphasize the need for nuanced and individualized treatment strategies in JIA management to optimize outcomes for affected children.

Exploring the impact of baseline platelet count on linezolid-induced thrombocytopenia: a retrospective single-center observation study.

Patients treated with linezolid (LZD) frequently develop thrombocytopenia, and previous studies have identified the risk factors for this condition. However, the relationship between the development of LZD-induced thrombocytopenia and baseline platelet count has varied according to different reports. To explore the relationship between platelet count and the development of LZD-induced thrombocytopenia. Patients who underwent LZD at Hokkaido University Hospital in Japan from September 2008 to March 2023 were included. We collected data on patient characteristics and platelet counts at baseline and during LZD therapy from the electronic medical records. Thrombocytopenia was defined as a decrease in platelet count by 30% or more from baseline, or a platelet level < 100,000/µL. Two hundred and ninety-five patients who received LZD were included in this study, of whom 34.9% developed thrombocytopenia. In the early days of LZD treatment, the thrombocytopenia group showed a nearly 5% decrease in platelet count, while the non-thrombocytopenia group exhibited an increase of over 5%. Additionally, focusing on early onset thrombocytopenia (within 5 days), a baseline platelet count of < 150,000/µL was identified as a risk factor for early thrombocytopenia. Conversely, it was also observed that 24.7% of patients with a baseline platelet count ≥ 150,000/µL still developed early thrombocytopenia. Our findings suggest that while a baseline platelet count of < 150,000/µL is a risk factor for the early onset of thrombocytopenia, vigilant monitoring of platelet counts by clinical pharmacists in the early stages of LZD treatment is essential, regardless of baseline platelet levels.

Alternate-day fasting delays pubertal development in normal-weight mice but prevents high-fat diet-induced obesity and precocious puberty.

Childhood obesity, particularly in girls, is linked to early puberty onset, heightening risks for adult-onset diseases. Addressing childhood obesity and precocious puberty is vital to mitigate societal burdens. Despite existing costly and invasive medical interventions, introducing lifestyle-based alternatives is essential. Our study investigates alternate-day fasting's (ADF) impact on pubertal development in normal-weight and high-fat diet (HFD)-induced obese female mice. Four groups of female mice were utilized, with dams initially fed control chow during and before pregnancy. Post-parturition, two groups continued on control chow, while two switched to an HFD. Offspring diets mirrored maternal exposure. One control and one HFD group were subjected to ADF. Morphometry and hormone analyses at various time points were performed. Our findings demonstrate that ADF in normal-weight mice led to reduced body length, weight, uterine, and ovarian weights, accompanied by delayed puberty and lower levels of sex hormones and growth hormone (GH). Remarkably, GH treatment effectively prevented ADF-induced growth reduction but did not prevent delayed puberty. Conversely, an HFD increased body length, induced obesity and precocious puberty, and altered sex hormones and leptin levels, which were counteracted by ADF regimen. Our data indicate ADF's potential in managing childhood obesity and precocious puberty. ADF reduced GH and sex hormone levels, contributing to reduced growth and delayed puberty, respectively. Therefore, parents of normal-weight children should be cautious about prolonged overnight fasting. ADF prevented HFD-induced obesity and precocious puberty, offering an alternative to medical approaches; nevertheless, further studies are needed for translation into clinical practice.

Development of non-invasive biomarkers for pre-eclampsia through data-driven cardiovascular network models.

Computational models can be at the basis of new powerful technologies for studying and classifying disorders like pre-eclampsia, where it is difficult to distinguish pre-eclamptic patients from non-pre-eclamptic based on pressure when patients have a track record of hypertension. Computational models now enable a detailed analysis of how pregnancy affects the cardiovascular system. Therefore, new non-invasive biomarkers were developed that can aid the classification of pre-eclampsia through the integration of six different measured non-invasive cardiovascular signals. Datasets of 21 pregnant women (no early onset pre-eclampsia, n = 12; early onset pre-eclampsia, n = 9) were used to create personalised cardiovascular models through computational modelling resulting in predictions of blood pressure and flow waveforms in all major and minor vessels of the utero-ovarian system. The analysis performed revealed that the new predictors PPI (pressure pulsatility index) and RI (resistance index) calculated in arcuate and radial/spiral arteries are able to differentiate between the 2 groups of women (t-test scores of p < .001) better than PI (pulsatility index) and RI (Doppler calculated in the uterine artery) for both supervised and unsupervised classification. In conclusion, two novel high-performing biomarkers for the classification of pre-eclampsia have been identified based on blood velocity and pressure predictions in the smaller placental vasculatures where non-invasive measurements are not feasible.

How Much Better is Faster? Empirical Tests of QALY Assumptions in Health-Outcome Sequences.

This study was designed to test hypotheses regarding the path dependence of health-outcome values in the form of linear additivity of health-state utilities and diminishing marginal utility of health outcomes. We employed a discrete-choice experiment to quantify patient treatment preferences for major depressive disorder. In a series of choice questions, participants evaluated seven symptom-improvement sequences and out-of-pocket costs over 6-week durations. Money-equivalent values were derived from a deductive latent-class mixed-logit analysis. The discrete-choice experiment was completed by 751 respondents with self-reported major depressive disorder recruited from an online commercial panel. The class-membership probability was 0.83 for latent-class preferences consistent with supporting relative importance weights for all symptom-improvement sequences in the study design. First, we found strong support for diminishing marginal utility in symptom-improvement sequences. The money-equivalent value of an initial week of normal mood was $147 (95% confidence interval: $128, $166) and a second week of normal mood was $70 ($49, $91). Furthermore, for short treatment durations where conventional discounting was not a factor, equivalent changes in health status were valued more highly for an earlier onset of effect: holding subsequent symptom patterns constant, $338 (211, 454) versus $70 (49, 91) for improvements starting in week 2 versus week 3 and $147 ($128, $166) versus $29 (-$4, $64) for improvements starting in week 3 versus week 4. Our findings imply that conventional quality-adjusted life-year calculations in which health values are assumed to be path independent can understate the value of health improvements that appear earlier in a sequence.

Development and validation of a web-based nomogram for acute kidney injury in acute non-variceal upper gastrointestinal bleeding patients

BackgroundAcute kidney injury (AKI) is a common and serious complication in patients with acute non-variceal upper gastrointestinal bleeding (NVUGIB). Early prediction and intervention are crucial for improving patient outcomes.MethodsData for patients presenting with acute NVUGIB in this retrospective study were sourced from the MIMC-IV database. Patients were randomly allocated into training and validation cohorts for further analysis. Independent predictors for AKI were identified using least absolute shrinkage and selection operator regression and multivariable logistic regression analyses in the training cohort. Based on the logistic regression results, a nomogram was developed to predict early AKI onset in acute NVUGIB patients, and implemented as a web-based calculator for clinical application. The nomogram’s performance was evaluated through discrimination, using the C-index, calibration curves, and decision curve analysis (DCA) to assess its clinical value.ResultsThe study involved 1082 acute NVUGIB patients, with 406 developing AKI. A multivariable logistic regression identified five key AKI predictors: CKD, use of human albumin, chronic liver disease, glucose, and blood urea nitrogen. The nomogram was constructed based on independent predictors. The nomogram exhibited robust accuracy, evidenced by a C-index of 0.73 in the training cohort and 0.72 in the validation cohort. Calibration curves demonstrated satisfactory concordance between predicted and observed AKI occurrences. DCA revealed that the nomogram offered considerable clinical benefit within a threshold probability range of 7% to 54%.ConclusionOur nomogram is a valuable tool for predicting AKI risk in patients with acute NVUGIB, offering potential for early intervention and improved clinical outcomes.

Altered dNTP pools accelerate tumor formation in mice.

Alterations in deoxyribonucleoside triphosphate (dNTP) pools have been linked to increased mutation rates and genome instability in unicellular organisms and cell cultures. However, the role of dNTP poolchanges in tumor development in mammals remains unclear. In this study, we present a mouse model with a point mutation at the allosteric specificity site of ribonucleotide reductase, RRM1-Y285A. This mutation reduced ribonucleotide reductase activity, impairing the synthesis of deoxyadenosine triphosphate (dATP) and deoxyguanosinetriphosphate (dGTP). Heterozygous Rrm1+/Y285A mice exhibited distinct alterations in dNTP pools across various organs, shorter lifespans and earlier tumor onset compared with wild-type controls. Mutational spectrum analysis of tumors revealed two distinct signatures, one resembling a signature extracted from a human cancer harboring a mutation of the same amino acid residue in ribonucleotide reductase, RRM1Y285C. Our findings suggest that mutations in enzymes involved in dNTP metabolism can serve as drivers of cancer development.

Case report: A novel HNF1A variant linked to gestational diabetes, congenital hyperinsulinism, and diazoxide hypersensitivity

Diazoxide (DZX) remains the first-line medication for the treatment of prolonged and persistent forms of hyperinsulinemic hypoglycemia (HH). In nearly 40%–50% of cases of HH, the genetic mechanism is unidentified. Almost half of the infants with permanent or genetic causes are DZX sensitive, but hypersensitivity to DZX is extremely rare, and the mechanism is poorly understood. Here, we report for the first time a case of DZX hypersensitivity in a neonate with HH who inherited a novel HNF1A variant from the mother. A term, male large-for-gestational-age infant of a diabetic mother presented with early onset of severe, recurrent hypoglycemia. Critical blood samples when hypoglycemic confirmed HH. Diazoxide was initiated at conventional doses of 5 mg/kg/day, which resulted in hyperglycemia (blood glucose, 16.6 mmol/L) within 48 h. Glucose infusion was rapidly weaned off. DZX was withheld and eventually stopped. Following 3 days of milk feeds alone with a normal glucose profile, suspecting a resolution of HH, he underwent a 6-h fasting study and passed. While on glucose monitoring in the hospital, he again developed hypoglycemic episodes, and the critical blood samples confirmed HH. DZX was restarted at a lower dose of 3 mg/kg/day, which required further down-titration to 0.7 mg/kg/day before steady euglycemia was obtained. No more episodes of hypo- or hyperglycemia occurred, and he passed a safety fasting study before discharge. Molecular genetic testing identified a novel HNF1A mutation in the mother–child dyad, whereas the father tested negative. We concluded that the HH phenotype due to this novel HNF1A mutation can be mutation specific and require a very low dose of DZX. Clinicians should observe closely for the risk of diabetic ketoacidosis and hyperglycemic hyperosmolar state while initiating DZX therapy.

A systematic review on the impact of SARS-CoV-2 viral infection on precocious puberty

Precocious puberty is defined as the onset of sexual characteristics before age 8 in girls and 9 in boys, with serious physical and psychological implications, including advanced bone maturation, early growth cessation, and increased behavioral issues. As per the studies done by Gupta et al precocious puberty cases have risen during the pandemic, prompting inquiries into the potential link between SARS-CoV-2 and early pubertal onset. PubMed, Scopus Web of Science, Google Scholar, and other electronic databases were used for the literature search. The search was restricted to studies published between January 2020 and July 2024. The study has shown a concerning increase in precocious puberty cases during the pandemic, with reports of a significant rise ranging from 9.8% to 93%. The increase clearly shows the concern of having a massive impact on the puberty timing in girls. The data reveal a consistent increase in the incidence of precocious puberty during the pandemic, with relative increases ranging from 0.2 average incidence per month pre-pandemic to 5.9 average per month pandemic incidence. These findings underscore the need for localized public health strategies and further research to fully understand the long-term implications of early puberty in the context of the COVID-19 pandemic. This review emphasizes the importance of continued monitoring and research to mitigate the potential long-term health risks associated with precocious puberty, including metabolic, cardiovascular, and psychological disorders.

Is early-onset colorectal cancer an evolving pandemic? Real-world data from a tertiary cancer center.

Early onset Colorectal Cancer (EOCRC), defined as those diagnosed under the age of 50, has been increasing rapidly since 1970. UK data on EOCRC are currently limited and better understanding of the condition is needed. A single-center retrospective study of patients with EOCRC treated over 9 years (2013-2021) at a large UK cancer center was performed. Clinicopathological features, risk factors, molecular drivers, treatment, and survival were analyzed. In total, 203 patients were included. A significant increase in cases was reported from 2018-2019 (n = 33) to 2020-2021 (n = 118). Sporadic EOCRC accounted for 70% of cases and left-sided tumors represented 70.9% (n = 144). Median duration of symptoms was 3 months, while 52.7% of the patients had de-novo metastatic disease. Progression-free survival after first-line chemotherapy was 6 months (95% CI, 4.85-7.15) and median overall survival (OS) was 38 months (95% CI, 32.86-43.14). In the advanced setting, left-sided primary tumors were associated with a median OS benefit of 14 months over right-sided primaries (28 vs 14 months, P = .009). Finally, primary tumor resection was associated with median OS benefit of 21 months compared with in situ tumors (38 vs 17 months, P < .001). The incidence of EOCRC is increasing, and survival outcomes remain modest. Raising public awareness and lowering the age for colorectal cancer screening are directions that could improve EOCRC clinical outcomes. There is also a need for large prospective studies to improve the understanding of the nature of EOCRC and the best therapeutic approaches.

Financial burden within first year of diagnosis for privately-insured patients with early-onset breast or colorectal cancer.

9 Background: Rising incidence of early-onset (E-O) cancers has been observed globally. E-O breast cancer (BC) are patients (pts) diagnosed ages 18 to 44 and E-O colorectal cancer (CRC) are aged 18 to 49. Because many E-O cancers are among pts who do not meet screening eligibility criteria by age, they are often diagnosed at advanced stage, which is also more expensive to treat. Younger pts may also have lower incomes and fewer assets, increasing risk of financial burden for pts with E-O cancers. We estimated the financial burden for pts and private payors for E-O BC and CRC, compared to non-elderly pts with BC and CRC diagnosed between the age of 45 to 64 and 50 to 64 (older-onset), respectively. Methods: We applied a claims-based algorithm to identify pts with incident BC and CRC diagnosed between 2014 and 2021 from MarketScan Commercial Claims and Encounters Data and required 12-month continuous enrollment before and after the index diagnosis for completeness of claims. Financial burden was quantified as total and out-of-pocket (OOP) payments, calculated as the sum of deductibles, copayments, and coinsurance. We used generalized linear models and quantile regressions to compare differences in mean and median costs, respectively, between pts with E-O vs. older onset cancer, adjusting for comorbidity, region, insurance plan type, sex (for CRC) and year. Results: Study cohort included 58,419 pts with BC and 11,251 pts with CRC. The proportion of E-O increased from 15% in 2014 to 17% in 2022 (Ptrend&lt;0.01) in BC and from 23% to 30% (Ptrend&lt;0.01) in CRC. Higher percentage of E-O pts were enrolled in high-deductible plans (BC: 25% v22%; CRC: 24% vs. 21%) and received systemic therapy (BC: 61% v 49%; CRC: 57% vs. 43%). Higher percent of surgery (93% v 89%) was observed in E-O BC and radiation (21% v 16%) in E-O CRC. Pts with E-O BC and CRC had significantly higher adjusted mean and median total and OOP payments (Table). Conclusions: E-O BC and CRC result in substantial costs to payors and moderately higher OOP payments. OOP maximums in private insurance may offer some financial protection for pts. E-O Older onset Difference 95% CIBC: BC: Mean total pay $182,770 $128,640 $54,130 $50445, $57817 Median total pay 143,351 93,317 50,034 47691, 52377 Mean OOP 6,014 5,063 951 817, 1085 Median OOP 5,142 4,258 884 791, 978 CRC: Mean total pay $153,446 $123,449 $29,998 $24244, $35752 Median total pay 119,747 89,340 30,406 25216, 35597 Mean OOP 5,429 4,791 638 428, 848 Median OOP 4,452 4,015 437 266, 607

74P Update on GNE-myopathy: introduction of tissue and blood biomarkers and a novel homozygous missense variant associated with early disease onset and proximal involvement

74P Update on GNE-myopathy: introduction of tissue and blood biomarkers and a novel homozygous missense variant associated with early disease onset and proximal involvement

Impact of early onset colorectal cancer on mental and physical health: A comparative analysis of self-reported mental and physical health outcomes using the PROMIS framework in the NIH All of Us Research Program.

241 Background: Patients with early-onset colorectal cancer (EOCRC) have complex psycho-social needs that can impact their overall health and well-being. With the increasing incidence of EOCRC, it is essential to investigate the effects of this diagnosis on patients' mental and physical health. This study uses the Patient-Reported Outcomes Measurement Information System (PROMIS) framework to compare patients' self-reported mental and physical health perceptions with EOCRC and those with late-onset colorectal cancer (LOCRC). Methods: We utilized the National Institutes of Health's (NIH) All of Us database Registered Tier Dataset v7, which includes 266,520 participants who agreed to share their EHR information, for analysis. Participants completed PROMIS surveys for physical health (PROMIS-PH) and mental health (PROMIS-MH). We categorized patients with colorectal cancer into EOCRC (age at diagnosis &lt;50) and LOCRC (age at diagnosis &gt;=50) using ICD 9/10 codes. We calculated the raw summed scores for PROMIS-PH and PROMIS-MH for each group. We transformed the raw summed score into a T-score. The study compared scores in EOCRC and LOCRC using the Mann-Whitney U test with a significance level of P&lt;0.05. We used the R programming language in the web-based Jupyter Notebook platform for data analysis. Results: Our study revealed 1764 colorectal cancer patients, with 408 cases of EOCRC (mean age of onset: 42.13 years, SD: 7.0) and 1356 cases of LOCRC (mean age: 63.72 years, SD: 8.35). Analysis of PROMIS Global scores showed that EOCRC patients had a mean PROMIS-MH score of 13.90 (SD: 3.42, T-score: 45.8, 95% CI: 38.74-52.86) and mean PROMIS-PH score of 13.95 (SD: 3.38, T-score: 42.3, 95% CI: 34.07-50.53). In contrast, LOCRC patients had mean PROMIS-MH and PROMIS-PH scores of 14.47 (SD: 3.37, T-score: 48.3, 95% CI: 41.05-55.55) and 14.24 (SD: 3.35, T-score: 44.9, 95% CI: 36.47-53.33), respectively. The PROMIS-MH scores were significantly higher in LOCRC than in EOCRC (p-value &lt;0.001). However, there was no significant difference between the PROMIS-PH scores in both groups (p-value= 0.191). Conclusions: The study suggests that patients with EOCRC have a lower level of perceived mental health compared to LOCRC. Also, the EOCRC had a lower level of perceived physical health, although not statistically significant. These findings emphasize the significance of age-specific approaches in cancer research and underscore the importance of focused interventions to meet the unique mental and physical health needs of patients with EOCRC.

Temporal Trends in Racial and Gender Disparities of Early Onset Colorectal Cancer in the United States: An Analysis of the CDC WONDER Database.

The mortality rates of early-onset colorectal cancer (EOCRC) have surged globally over the past two decades. While the underlying reasons remain largely unknown, understanding its epidemiology is crucial to address this escalating trend. This study aimed to identify disparities potentially influencing these rates, enhancing risk assessment tools, and highlighting areas necessitating further research. Using the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) database, this study assessed EOCRC mortality data from 2012 to 2020. Individuals under 50years who succumbed to EOCRC were identified through the International Classification of Diseases, Tenth Revision (ICD-10) codes. Data interpretation and representation were performed using R 4.2.2 software. Between 2012 and 2020, EOCRC mortality rates fluctuated marginally between 1.7 and 1.8 per 100,000. Male mortality rates increased from 1.9 to 2.0 per 100,000, while female rates varied between 1.5 and 1.6 per 100,000. Significant variations were observed across age groups, with the 40-49years category experiencing an increase from 6.34 (2012) to 6.94 (2020) per 100,000. Racial category-based data revealed the highest mortality rates among African Americans. Geographically, Mississippi and Alabama exhibited elevated mortality rates. Age-adjusted mortality rate (AAMR) assessments indicated a marked decline for both genders from 2012 to 2020, with consistently higher rates for men. The findings highlight the evolving landscape of EOCRC mortality, revealing significant gender, age, and racial disparities. These results underscore the urgent need for tailored health strategies and intensified research efforts targeting these disparities.

150P Patient, caregiver and healthcare professionals’ perspective on spinal bracing in early onset spinal muscular atrophy in the UK: a national survey

150P Patient, caregiver and healthcare professionals’ perspective on spinal bracing in early onset spinal muscular atrophy in the UK: a national survey

Persons Who Have Undergone ACL Reconstruction Exhibit Altered Patellofemoral Joint Contact Area: Implications For Early Onset Patellofemoral Joint Arthritis

Persons Who Have Undergone ACL Reconstruction Exhibit Altered Patellofemoral Joint Contact Area: Implications For Early Onset Patellofemoral Joint Arthritis

Chronic low-grade inflammation associated with higher risk and earlier onset of cardiometabolic multimorbidity in middle-aged and older adults: a population-based cohort study.

Evidence regarding the role of chronic low-grade inflammation in the progression of cardiometabolic diseases (CMDs) and cardiometabolic multimorbidity (CMM) is currently limited. This prospective cohort study, utilising data from the UK Biobank, included 273,804 adults aged 40-69years initially free of CMD at baseline. CMM was defined as the coexistence of two or more CMDs, such as coronary artery disease, type 2 diabetes mellitus, hypertension and stroke. The aggregated inflammation score (INFLA-score), incorporating C-reactive protein, white blood cell count, platelet count and granulocyte-to-lymphocyte ratio, quantified chronic low-grade inflammation. Absolute risks (ARs), hazard ratios (HRs) and 95% confidence intervals (CIs) assessed the association of increased INFLA-score with the risk of CMMs and CMDs. The accelerated failure time model explored the effect of INFLA-score on the time to CMM onset, and a restricted cubic spline characterised the dose-dependent relationship between INFLA-score and CMM risk. After a median follow-up of 166.37months, 13,755 cases of CMM were identified. In quartiles with increasing INFLA-score levels, CMM ARs were 4.41%, 4.49%, 5.04% and 6.01%, respectively; HR increased by 2%, 15% and 36%, respectively, compared to the lowest quartile. The INFLA-score and CMM risk relationship was nonlinear (P for nonlinear < 0.001), exhibiting a significant risk trend change at a score of 9. For INFLA-score < 9, CMM risk increased by 1.9% for each 1-point increase; for INFLA-score ≥ 9, the risk increased by 5.9% for each 1-point increase. Additionally, a higher INFLA-score was associated with an earlier onset of CMM (P < 0.001). Compared to the first INFLA-score quartile, the AFT model revealed adjusted median times to CMM occurrence were 2.92, 6.10 and 13.19months earlier in the second, third and fourth quartile groups, respectively. Chronic low-grade inflammation is associated with a higher risk of cardiometabolic multimorbidity and earlier onset among middle-aged and older adults. Monitoring and screening the INFLA-score in adults without CMDs may improve early prevention of CMM.

Impact of BMI on childhood growth, pubertal timing, and bone maturation: A comprehensive review and clinical implications

Introduction: Childhood obesity and undernutrition significantly affect growth patterns, pubertal timing, and bone maturation, leading to long-term health implications. Materials and Methods: A comprehensive literature review was conducted using databases such as PubMed, Google Scholar, and Scopus. Twenty-four studies, including a total of 40,732 patients, were analyzed from two tables examining the impact of BMI, growth patterns, pubertal timing, and bone maturation. Results: Children with high BMI exhibit accelerated linear growth during early childhood, that may be driven by elevated leptin levels, which stimulate growth before puberty. Despite early growth advantages, these children experience reduced height gain during adolescence due to advanced bone maturation and earlier closure of growth plates. High BMI is strongly linked to early puberty, especially in girls, as increased adipose tissue raises leptin levels, triggering early pubertal onset. Boys, however, show variability in pubertal timing, with severe obesity sometimes delaying puberty. In contrast, children with low BMI or undernutrition demonstrate delayed linear growth and delayed puberty. Nutritional deficits lead to reduced growth velocity, delayed pubertal onset, and extended pubertal periods due to a lack of adipose tissue and hormonal deficiencies in leptin and kisspeptin. Nutritional rehabilitation promotes catch-up growth, allowing for extended growth potential by delaying growth plate closure. However, full recovery may not occur in cases of prolonged or severe undernutrition. Advanced bone age in high BMI children shortens the pubertal growth spurt, while delayed bone maturation in undernourished children offers a prolonged period for potential growth, contingent on timely nutritional support. Conclusion: Timely interventions for childhood obesity and undernutrition are critical to improving growth outcomes and preventing long-term developmental delays. Early identification, nutritional rehabilitation, and lifestyle modifications can help optimize growth and pubertal development by addressing both advanced and delayed growth trajectories.

CHILDHOOD SEXUAL ABUSE IMPACT ON ADULTHOOD

Introduction – Child sexual abuse (CSA) occurs when a kid or younger person is forced or persuaded to engage in sexual activity, whether the child is conscious of what is taking place. According to global databases, in one-third of countries in the world, at least 5% of young women reported experiences of sexual abuse in childhood. Mental health issues, behavioral manifestations, and interpersonal outcomes are a few impacts of CSA. This study aims to discuss the CSA's impact on adulthood. Methods – The researcher used a total of 13 works of literature, articles, and journals that discuss CSA and its correlation with some mental health issues impact on an adult. Results – Adults with a history of CSA are more likely to suffer from early onset depression, borderline personality disorder, and suicidal tendencies than someone without a history, that is why emotional support seems very important to the CSA survivors. Discuss – As children are sexually abused, it may lead to a variety of difficulties with relationships in general, as well as a host of poor intimate relationship consequences such as adult sexual assault, intimate partner violence, and reduced happiness in romantic relationships. Conclusion – Childhood sexual abuse is still a major problem among children and has several psychological impacts on adulthood, and emotional support is one of the great therapies. Keywords: childhood, sexual, abuse.

Airborne Alternaria Spores: 70 Annual Records in Northwestern Spain

This study presents data on the concentration of Alternaria spores in the atmosphere of the northwestern Iberian Peninsula. A non-viable volumetric method was used to collect the samples, resulting in a database of 70 annual. When the annual averages for each locality are calculated, Ourense stands out with 2152 spores/m3, followed by Vigo and Lugo, while Santiago de Compostela recorded the lowest concentrations. Focusing on the total data for each locality, the main sporulation period started in May and ended in October in all localities, centered on a single phase, with an earlier onset and longer duration in Ourense and Vigo. The number of days with concentrations in excess of 100 spores/m3 was very low in Santiago de Compostela, Ourense, and Vigo and null in Lugo. Temperature was the meteorological parameter for which the highest statistical correlation was obtained in all locations, being favorable to the concentration of spores in the air. Temperature ranges favorable to the presence of airborne spores in the study area ranged from 25.5 to 31.2 °C. Based on the analysis of the data collected, it is concluded that Alternaria spore concentrations are low throughout most of the year.