Height For Age Research Articles

The effect of high-dose vitamin D supplementation and an exercise program to lose weight on some biochemical variables of overweight women

Background and Study Aim. In recent years, there has been a technological revolution and development in all fields, particularly the sports field. This has imposed on man a lifestyle characterized by comfort at the expense of a significant portion of his movement and activities. The problem of obesity has expanded beyond the inconsistency of the body to include its direct effect of increasing the proportion of fat and the negative impact on the work of vital organs. This disruption alters the body's internal environment and causes numerous diseases. The purpose of this study is to determine the effect of a sports program on taking vitamin D to lose weight and on some biochemical variables in young adults aged 30 to 35 years old. Materials and Methods. The study involved 10 overweight women aged 30-35 years, selected through intentional sampling. Inclusion criteria required consent, good health, and no ongoing vitamin D or exercise programs. The research employed a Randomized Controlled Trial (RCT) design. Primary outcome measures encompassed body weight, body composition, lipid profile, and vitamin D status. Anthropometric measurements included age, height, weight, and training age. Biochemical measurements involved blood tests for cholesterol, triglycerides, and vitamin D levels. The experimental group received vitamin D tablets and a proposed aerobic exercise program for 12 weeks. Results. The proposed aerobic sports program with vitamin D intake improved biochemical variables, such as total fat, total cholesterol, triglyceride, high-density cholesterol, low-density cholesterol, OH, and Vitamin D-025 for the sample under investigation. The application of the aerobic program with vitamin D led to weight loss among the study's female participants. The aerobic program with vitamin D intake has a positive effect on the general health status of the sample. Conclusions. Based on the study's findings, it is recommended to consider the positive effects of Vitamin D on the overall functional state of the body, making it essential to incorporate an aerobic sports program across various age groups. Regular medical tests are crucial for monitoring and maintaining overall health. Emphasizing the importance of regular exercise is vital in preventing weight gain and reducing the risk of certain chronic diseases. By implementing these recommendations, individuals can enhance their overall well-being and lead a healthier lifestyle. To further validate these outcomes, similar studies should be conducted on different age groups and diverse samples.

Comparison of Nutritional Status of Healthy Under-Five Indian Children Using Composite Index of Anthropometric Failure on WHO 2006 versus 2019 Indian Synthetic Growth Charts.

To assess nutritional status of apparently-healthy under-five Indian children using Composite Index of Anthropometric Failure (CIAF) and to compare anthropometric failure prevalence using conventional indices and CIAF on World Health Organization (WHO) vs. synthetic Indian growth charts. This observational study was conducted over 2 y. The inclusion criteria was apparently-healthy children (0-60 mo) and the exclusion criteria were acute/chronic illness and small for gestational age. A total of 1557 children (762 girls) were included in the study. The mean age of the subjects was 21 mo. The Z-scores for height, weight, body mass index (BMI) for age and weight for height in children were lower on WHO vs. synthetic charts (p=0.0001). Significantly higher proportion of children were moderately and severely underweight, stunted and wasted on WHO charts. Synthetic charts identified significantly higher proportion as normal for weight, height, BMI for age, weight for height, overweight (overall), and ahigher prevalence of severe stunting, and severe acute malnutrition (SAM) was notedamong girlscompared to boys. Using CIAF, 54.1% children were normal on WHO charts vs. 78.0% on synthetic (p=0.0001). Larger proportion of girls (8.8%) were stunted+underweight (category-E) vs. boys (4.3%) on synthetic charts (p=0.0003). Significantly higher proportion of children demonstrated failure (single/dual/multiple) on WHO charts except category-Y (higher proportion of underweight on synthetic charts). Maximum difference in CIAF (WHO vs. synthetic) was observed between 0-24 mo age. Of 1215 children normal on synthetic charts, 837 (68.9%) were normal on WHO charts. Of 116 underweight children (category-Y) on synthetic charts, 20 (17.2%) were underweight on WHO charts; remaining had compound failure (wasting+underweight = 49.1%, wasting+stunting+underweight = 14.7%, stunting+underweight = 12.1%) on WHO charts. Among those stunted+underweight (category-E) on synthetic charts, WHO charts classified 1/4th as wasted+stunted+underweight (category-D). Synthetic references are more representative of Indian growth patterns, and seem more appropriate for monitoring growth of Indian children to avoid mislabelling as malnourished.

Development of weight and height age z-score after total cavopulmonary connection.

We aimed to analyze somatic growth of patients after total cavopulmonary connection (TCPC) as well as to identify factors influencing postoperative catch-up growth. A total of 309 patients undergoing TCPC at 4 years old or less between 1994 and 2021 were included. Weight-for-age z-score (WAZ) and height-for-age-z-score (HAZ) at TCPC and at postoperative time between 1 to 3 years were calculated. Factors influencing somatic growth were analyzed. Most frequent diagnosis and initial palliation were hypoplastic left heart syndrome (HLHS) (34%) and the Norwood procedure (51%), respectively. Median age and weight at TCPC was 2.0 (IQR: 1.7-2.5) years and 11.3 (10.5-12.7) kg, respectively. Median 519 days after TCPC, significant increase in WAZ (-0.4 to -0.2, p<0.001) was observed, but not in HAZ (-0.6 to -0.6, p=0.38). Older age at TCPC (p<0.001, OR: 2.6) and HLHS (p=0.007, OR: 2.2) were risks for low WAZ after TCPC. Older age at TCPC (p=0.009. OR: 1.9) and previous Norwood procedure (p=0.021, OR: 2.0) were risks for low HAZ after TCPC. Previous bidirectional cavopulmonary shunt (BCPS) was a protective factor for both WAZ (p=0.012, OR: 0.06) and HAZ (p=0.028, OR: 0.30) at TCPC. In patients undergoing TCPC at the age of 4 years or less, a significant catch-up growth was observed in weight-for-age z-score after TCPC, but not in height-for-age-z-score. Previous BCPS resulted to be a protective factor for a better somatic development at TCPC. HLHS undergoing Norwood were considered as risks for somatic development after TCPC.

THU237 A Case Of Primary Hypothyroidism, Dysglycemia And Epilepsy With PAX8 And SETD1A Mutation

Abstract Disclosure: S.K. Singh: None. KEYWORDS: PAX8, SETD1A, DYSGLYCEMIA INTRODUCTION: Hypothyroidism is associated with dysglycemia linked with insulin resistance and shared common genetic determinants.PAX 8 gene regulates the development of thyroid gland as well as the expression of TG,TPO and NIS genes.It impacts glucose homeostasis by favoring beta-cell survival and through thyroid hormones.Epilepsy in hypothyroid patients can be idiopathic or due to Hashimoto’s Encephalopathy (HE). Thyroid hormones can impact epileptogenesis through mitochondrial dysfunction, oxidative-stress and GABAergic transmission. THE INDEX PATIENT: A 13 year old female(weight and height age 1.5 years below her chronological age by Indian growth chart and a further lag of 18 months and 6 months, respectively by CDC chart)was diagnosed as a case of thyroprivic hypothyroidism with TSH - 100 mIU/L and positive anti-TPO antibody. She was euthyroid on 112 ug/d L-T4.She is on anticonvulsant since 12 years of age for tonic-clonic epilepsy. The MRI of brain showed focal gliosis with few small encephalomalacic streaks in right occipital lobe. On evaluation at 12.5 years of age, her fasting plasma glucose was 80 mg/dl and her HbA1c was 4.8% but 2-h post glucose was 233 mg/dl with another value of 270 mg/dl. Her father has T2DM and Hypothyroidism. Her mother is Hypothyroid. Her genetic study showed SETDIA and PAX8(-) mutations. DISCUSSION: PAX8 regulates development of thyroid gland and biosynthesis of thyroid hormones. It can impact glucose homeostasis by enhancing beta-cell survival by inhibiting apoptosis, immunomodulation, maintaining local anti-inflammatory milieu in pancreas, ensuring systemic levels of thyroid hormone to stimulate insulin secretion and protect beta-cells from environmental stressors.PAX8 mutation in a family has been shown to be associated with a spectrum of disorders encompassing Gestational Thyroid Dysfunction(GTD),Gestational Diabetes Mellitus(GDM) and T2DM.[1] Although mutation analysis was done only in the index patient, Hypothyroidism and Dysglycemia (post- glucose&amp;gt;200 mg/dl)in the patient and family history of Hypothyroidism and T2DM could be linked with PAX8 mutation.SETD1A mutation has been linked with early-onset epilepsy with or without developmental delay. The mutation study can aid in deciding appropriate therapy including steroids for HE. CONCLUSION: This case highlights the significance of evaluation for PAX8 mutation in hypothyroid patients, even if anti-TPO positive, particularly when there is family history of thyroid dysfunction, GDM, T2DM. It also underlies the importance of SETD1A mutation analysis in hypothyroid patients with epilepsy. Presentation: Thursday, June 15, 2023

SAT348 Changes In BMI Z-score After Presentation For Early Breast Budding Is Associated With Rapidly Progressive Puberty And Treatment With GnRH Analogues

Abstract Disclosure: H. Jung: None. J. Cho: None. K. Shim: None. Introduction: Childhood overweight and obesity are associated with earlier pubertal timing, especially in girls. We aimed to identify different body mass index (BMI) trajectories in patients presenting for breast budding between 5 and 7 years of age, and investigated whether the change in BMI z-scores during follow up is associated with rapid progression of puberty and eventual treatment with gonadotropin-releasing hormone (GnRH) analogues. Methods: We retrospectively reviewed girls who presented with breast budding at 5 to 7 years of age, between March 2016 and May 2021 at a single center. Those 206 girls, who had more than 3 follow up BMI measurements to more than 9 years of age were included in the study. The girls were grouped according to whether BMI z-scores increased or decreased/remain unchanged overall during follow-up. The BMI z-score changes over time (age) were also assessed for latent class trajectories. The risk of progression to rapid progressive puberty requiring treatment with GnRH analogues was analyzed according to overall changes in BMI z-scores and the different BMI trajectory groups, with adjustment for birthweight, gestational age, maternal menarche, maternal height, as well as the initial age, height, and bone age at presentation. Results: The mean age at presentation for breast budding was 7.1±0.7 years. A greater proportion of girls whose BMI z-scores increased during follow up, required treatment with GnRH analogues (n=53, 64%) compared to those whose BMI z-scores decreased or remained unchanged (n=54, 44%). Girls with increases in BMI z-scores during follow up (n=83) had increased risk (OR 4.68, 95% CI 1.88-11.63, p = 0.001) for rapid progressive puberty and treatment with GnRH analogues compared to those girls with decreases/no changes (n=123) in BMI z-scores, even after adjustment for covariates. Further analysis showed that increases in BMI z-scores even in those of normal weight status, were associated with increased OR (4.88) for treatment. Through latent class mixed modelling analysis, we identified 2 different trajectories (high and increasing BMI z-scores, n=72; and decreasing BMI z-scores, n=134). Risk for rapid progression of puberty and eventual treatment with GnRH analogues did not differ significantly between the different latent class trajectories. Conclusions: Increases in BMI z-scores during the follow up period after presentation for early breast budding may be associated with increased risk for rapid progression of puberty and treatment with GnRH analogues. Analysis of a larger group of patients may allow for better assessment of latent class BMI z-score trajectories. Presentation: Saturday, June 17, 2023

THU227 Isosexual Peudo-precocious Puberty Due To Leydig Cell Tumor In A Prepubertal Child

Abstract Disclosure: M. Baby: None. A. Xu: None. N. Shacham: None. E. Shapiro: None. B.C. Shah: None. Background: Testicular tumors account for 2-4% of all childhood cancers. Leydig cell tumors are the most common form of sex cord stromal tumors and represent 1-3% of all testicular tumors. In the pediatric population, testicular Leydig cell tumors present with signs of precocious puberty. Workup reveals low gonadotropins with elevated testosterone and testicular mass on ultrasound. Treatment involves surgical enucleation (partial orchiectomy) in most cases. Clinical case: We present the case of a 4 year 10 month old male who presented to endocrine clinic for precocious puberty. He developed pubic hair three months prior with body odor. He did not have any CNS symptoms including headaches or visual changes. There was no use of exogenous androgens at home. He was born full term, small for gestational age with an uncomplicated postnatal course. There was no family history of precocious puberty. Height was at the 99th percentile (z-score 2.7), weight 98th percentile (z-score 2.07), and BMI 86th percentile (z-score 1.09). On exam, he was lean and appeared muscular. His testes were asymmetrical with the right testicle measuring 3 ml and the left testicle 2 ml. Scrotal hair was curly and sparse, Tanner III. Stretched penile length was 7 cm (90th percentile), width was 3.2 cm. Results: Bone age was advanced to 10 year 0 months with height age of 7 year 3 months. Serum gonadotropins were low, testosterone was pubertal at 115 ng/dl (Electrochemiluminescence Immunoassay). Serum 17-hydroxyprogesterone (221 ng/dl, ref range 0-90 ng/dl) androstenedione (163 ng/dl, ref range = &amp;lt; 51 ng/dl), and IGF-1 (368 ng/ml, ref range 108 – 293 ng/ml) were elevated. ACTH, cortisol, thyroid profile, and prolactin were normal. Beta-HCG and AFP were negative. ACTH stimulation test showed normal response. Testicular ultrasound with doppler was performed; right testicle measured 1.82 x 1.06 x 1.36 cm, volume of 1.4 ml, while left measured 1.27 x 0.72 x 0.87 cm, 0.4 ml. Within the right testicle, there was a mass that was hypoechoic, vascular (with a testicular artery feeding branch in the periphery), multinodular and measured 1.2 x 0.8 x 1.10 cm (0.53 ml). He was referred to urology and underwent enucleation of the right testicular mass through an inguinal approach. Grossly, the mass appeared tan and lobulated and surgical pathology confirmed a benign Leydig cell tumor. The patient recovered well and post-operative serum testosterone level at 2 weeks was &amp;lt;2.5 ng/dl. Conclusion: We present a case of a testicular Leydig cell tumor that presented as peripheral precocious puberty marked by low gonadotropins and elevated testosterone with ultrasound findings of a vascular mass with testicular artery feeding branch in the periphery. Early detection of a Leydig cell tumor is crucial as it can be treated by enucleation thus salvaging the testes. Presentation: Thursday, June 15, 2023

Functional Outcomes of Knee Arthrodesis for Infected Total Knee Arthroplasty.

As the occurrence of total knee arthroplasties (TKAs) is forecasted to continue rising, so too will the frequency of prosthetic joint infections (PJIs) and revision TKAs. Multiple revisions can result in an unreconstructible knee. In such instances, the knee may be salvaged through arthrodesis. We evaluated whether height, BMI, and age impacted patient-reported outcome measures (PROMs) in patients who underwent knee arthrodesis after revision TKA due to PJI. We conducted a retrospective review of patients undergoing arthrodesis for an infected TKA at a dedicated orthopedic infection service from 2014 to 2022. Patient demographics and PROMs from 36-Item Short Form Survey (SF-36) and Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaires were collected. Correlation analysis was performed to determine if any association between height, BMI, and age was present with the various PROMsand sub-scores. Forty-four patients (19 males, 25 females) were included, with a mean follow-up of 48 months. Increases in height (>166 cm), BMI (>30), and age (>62 years) had a statistically significant negative impact on three SF-36 components: health changes (P = 0.016), physical functioning ability (P = 0.0096), and general health components (P = 0.0075). Our results suggest that a knee arthrodesis is an acceptable option in patients with a persistent knee PJI with good functional PROMs and ambulatory status. Patients with shorter height, lower BMI, and younger age showed overall better outcomes. Knee arthrodesis can be an alternative option for amputationin patients with an infected TKA and provide good functional outcomes in selected patients.

Urban-rural differences in the association between long-term exposure to ambient particulate matter (PM) and malnutrition status among children under five years old: A cross-sectional study in China.

The evidence regarding the relationship between postnatal exposure of air pollution and child malnutrition indicators, as well as the corresponding urban-rural disparities, is limited, especially in low-pollution area of low- and middle-income countries (LMICs). Therefore, our aim was to contrast the effect estimates of varying ambient particulate matter (PM) on malnutrition indicators between urban and rural areas in Tibet, China. Six malnutrition indicators were evaluated in this study, namely, Z-scores of height for age (HFA), Z-scores of weight for age (WFA), Z-scores of weight for height (WFH), stunting, underweight, and wasting. Exposure to particles with an aerodynamic diameter ≤2.5 micron (μm) (PM2.5), particles with an aerodynamic diameter ≤10 μm (PM10) and particles with an aerodynamic diameter between 2.5 and 10 μm (PMc) was estimated using satellite-based random forest models. Linear regression and logistic regression models were used to assess the associations between PM and the above malnutrition indicators. Furthermore, the effect estimates of different PM were contrasted between urban and rural areas. A total of 2511 children under five years old were included in this study. We found long-term exposure to PM2.5, PMc, and PM10 was associated with an increased risk of stunting and a decreased risk of underweight. Of these air pollutants, PMc had the strongest association for Z-scores of HFA and stunting, while PM2.5 had the strongest association for underweight. The results showed that the odds ratio (OR) for stunting were 1.36 (95% confidence interval (CI) = 1.06 to 1.75) per interquartile range (IQR) microgrammes per cubic metre (μg/m3) increase in PM2.5, 1.80 (95% CI = 1.30 to 2.50) per IQR μg/m3 increase in PMc and 1.55 (95% CI = 1.17 to 2.05) per IQR μg/m3 increase in PM10. The concentrations of PM were higher in urban areas, and the effects of PM on malnutrition indicators among urban children were higher than those of rural children. Our results suggested that PM exposure might be an important trigger of child malnutrition. Further prospective researches are needed to provide important scientific literature for understanding child malnutrition risk concerning postnatal exposure of air pollutants and formulating synthetically social and environmental policies for malnutrition prevention.

Non-Surgical Respiratory Management in Relation to Feeding and Growth in Patients with Robin Sequence; a Prospective Longitudinal Study.

To reflect upon our non-surgical respiratory management by evaluating clinical outcomes regarding airway, feeding, and growth during the first year of life in patients with Robin Sequence. Prospective study. Sophia Children's Hospital, Rotterdam, the Netherlands. 36 patients with Robin Sequence who were treated between 2011 and 2021. Positional therapy and respiratory support. Data on respiratory outcomes included polysomnography characteristics and capillary blood gas values. Feeding outcomes were based on the requirement of additional tube feeding. Outcomes on growth were expressed as standard-deviation-scores (SDS) for weight-for-age (WFA) and height-for-age (HFA). Twenty patients were treated with positional therapy (PT), whilst the other 16 patients required respiratory support. Twenty-two patients presented with non-isolated Robin Sequence (RS). During the first year of life, obstructive apnea hypopnea index decreased, oxygen levels enhanced, and capillary blood gas values improved. Eighty-six percent (31/36) experienced feeding difficulties, which completely resolved in 71% (22/31) during their first year of life. From start treatment, to stop treatment, to the age of 1 year, the SDS WFA worsened from -0.40 to -0.33 to -1.03, respectively. Non-surgical respiratory treatment resulted in an improvement of respiratory outcomes to near normal during the first year of life in patients with RS. These patients often experience feeding difficulties and endure impaired weight gain up to 1 year of age, despite near normalization of breathing. The high prevalence of feeding difficulties and impaired weight for age indicate the urgency for early recognition and adequate treatment to support optimal growth.

Comparison non-linear growth models to reflect body weight and body measurements of pre-weaning Kejobong goat

This study aimed to compare two growth models that reflect body weight and body measurement of pre-weaning Kejobong goat. A total data records of 35 heads of Kejobong goat observed for 14 weeks in five variables were used in this study. Two non-linear growth models (Gompertz and Logistic model) were applied for analysis of growth to compare growth performance by Non-Linear Mixed Model. Result showed Gompertz models has smaller AIC, BIC and σ2e value than those Logistic models. The growth curve models based on Gompertz were: y = 23.94 exp (-1.43 exp−0.01764*age) for body weight; y = 61.72 exp (-0.5 exp–0.01805*age) for wither weight; y = 13.12 exp (-0.35 exp−0.026*age) for chest width; y = 55.72 exp (-0.50 exp −0.01805*age) for hip height and y = 52.30 exp (-0.50 exp-0.01805*age) for hearth girth. It conclude that Based AIC, BIC and σ2e value, Gompertz model is the most fitted growth model for reflecting body weight and body measurement of pre-weaning Kejobong goat than those Logistic model.

The Length of Incision in Unicondylar Knee Arthroplasty Is More Affected by the Patient's Height Than Their Weight.

Objective Obesity leads to osteoarthritis due to increased loading forces on joint cartilage and inflammatory agents released from adipose tissue. In patients with a high body mass index (BMI), during hip and total knee arthroplasty, surgical technical challenges such as longer incisions and wider exposure are encountered, resulting in increased postoperative complications (wound healing problems and infection, venous thromboembolism (VTE)- pulmonary embolism (PE), dislocation, early implant failure) and ultimately decreased patient satisfaction and implant survival. This study investigates whether BMI, height, weight, and patient age are associated with longer incisions in patients undergoing unicondylar knee prosthesis (UKP) placement. Method Between January 2017 and December 2018, 30 patients (29 females and 1 male) who underwent UKP surgery due to medial gonarthrosis were included in the study. The UKP used in the procedures was the Oxford Knee Phase III by Biomet Ltd., UK. The study comprised 43 knees, 13 being bilateral cases, 8 on the right, and 9 on the left. Data regarding the patient's height, weight, BMI, age, and the operated side were collected and compiled. The relationships between these variables and the surgical incision length were statistically analyzed. Results The average age of the patients was 66.3 years, with an average weight and height of 77.6 kg (ranging from 62 to 98 kg) and 167 cm (ranging from 150 to 184 cm), respectively. The lengths of the surgical incisions ranged from 70 mm to 160 mm, with an average length of 124.5 mm. When comparing the incision lengths between the right and left sides, it was observed that the incisions on the left side were longer. The average incision length on the right side was 122.09 mm, while on the left, it was 126.86 mm. Moreover, in the 13 patients who underwent bilateral surgery, this difference in incision length was even more pronounced. The average incision length on the right side was 117.15 mm, whereas on the left, it was 124.23 mm. Bivariate correlation analyses were performed to examine the relationship between the length of the incision and BMI and age. However, no significant relationship was found between the incision length and BMI or age. On the other hand, there was a correlation between the patient's weight values and the incision length (p < 0.05, correlation 0.335). Furthermore, a higher correlation was observed between the patient's height and the incision length (p < 0.01, correlation 0.595). Conclusion The latest advances in surgical techniques and instrumentation have enabled surgeons to perform the procedure using a reliable mini-incision approach. Mid-term evaluation of UKP with mini-incision shows faster recovery and lower morbidity. The findings show that in UKP, the length of the surgical incision is more strongly related to the patient's height than their weight.

Advantages and limitations of estrogen replacement therapy on hypogonadal survivors of childhood cancer.

Hypogonadism is a significant late complication in childhood cancer survivors (CCS). The aim of this study was to elucidate the advantages and limitations of estrogen replacement therapy (ERT) for CCS with hypogonadism. Seventeen CCS were divided into two groups: gonadal hypogonadism (GH) group (n = 8) and central hypogonadism (CH) group (n = 9). Pearson correlation coefficients were used to investigate the impact of cancer management on final height, bone density, and uterine development. Seven of GH group had hematologic malignancies, and all of them underwent total body irradiation before bone marrow transplantation. The GH group showed significant positive correlations between the onset age of disease treatment and final height (p < 0.05, R = 0.712) and uterine size following ERT (p < 0.05, R = 0.775). All CCS in the CH group had brain tumors, and seven of them received chemotherapy. There were trends towards positive and negative correlations between the onset age of disease treatment and final height (p = 0.09, R = 0.598) or uterine size (p = 0.07, R = -0.669), respectively. A negative correlation trend was observed between the age at ERT initiation and final height (p = 0.07, R =-0.769) or bone density (p = 0.18, R = -0.626) in six CH patients who received growth hormone therapy. Five CCS in both groups experienced osteoporosis, despite receiving ERT. Individualized management strategies beyond ERT are essential to reduce long-term complications in CCS with hypogonadism, considering the type and timing of cancer treatment.

Analysis of children with familial short stature: who should be indicated for genetic testing?

Familial short stature (FSS) describes vertically transmitted growth disorders. Traditionally, polygenic inheritance is presumed, but monogenic inheritance seems to occur more frequently than expected. Clinical predictors of monogenic FSS have not been elucidated. The aim of the study was to identify the monogenic etiology and its clinical predictors in FSS children. Of 747 patients treated with growth hormone (GH) in our center, 95 with FSS met the inclusion criteria (pretreatment height ≤-2 SD in child and his/her shorter parent, excluded secondary short stature, excluded Turner/Prader-Willi syndrome). Genetic etiology was known in 11/95 children before the study, remaining 84 were examined by next-generation sequencing. The results were evaluated by ACMG guidelines. Nonparametric tests evaluated differences between monogenic and non-monogenic FSS, an ROC curve estimated quantitative cutoffs for the predictors. Monogenic FSS was confirmed in 36/95 (38%) children. Of these, 29 (81%) carried a causative genetic variant affecting the growth plate, four (11%) a variant affecting GH-IGF1 axis, and three (8%) a variant in miscellaneous genes. Lower shorter parent's height (p=0.015) and less delayed bone age (BA) before GH treatment (p=0.026) predicted monogenic FSS. In children with BA delayed less than 0.4 years and with shorter parent heights <-2.4 SD, monogenic FSS was revealed in 13/16 (81%) cases. To conclude, in FSS children treated with GH, a monogenic etiology is frequent, gene variants affecting the growth plate are the most common. Shorter parent's height and bone age are clinical predictors of monogenic FSS.

Screening for protein energy wasting in children with chronic kidney disease using dual energy x-ray absorptiometry as an additional tool.

The current diagnosis of protein energy wasting (PEW) is based on scoring systems that lack precision in measuring muscle deficits. We undertook this cross-sectional study to determine the prevalence of PEW in children with chronic kidney disease (CKD) using a scoring system that included dual energy x-ray absorptiometry (DEXA) for measuring lean body mass (LBM) and to determine the prevalence of selected markers in PEW. Thirty CKD and 20 healthy children (1-18years) were evaluated for (1) reduced dietary protein intake (DPI); (2) BMI < fifth centile for height age (BMI/HA); (3) serum albumin < 3.8g/dl, cholesterol < 100mg/dl, or CRP > 3mg/L; (4) LBM < fifth centile for height age [LBMr] on DEXA. PEW was scored as minimal-one parameter positive in 2/4 categories; standard-one parameter positive in 3/4 categories; or modified-standard plus height < 2 SD. Twenty childrenwith CKD (66.7%) had PEW, (5/9) 55% in CKD 3, and (15/21) 71% in advanced CKD; minimal 12, standard 1, and modified 7. LBMr was seen in 20 (100%), reduced DPI in 16 (80%), and BMI/HA in 6 (30%) childrenwith PEW. LBMr had 100% sensitivity and BMI/HA 100% specificity. LBMr was seen in 8 who had no other criteria for PEW. None of the parameters were positive in controls (p < 0.01). PEW prevalence in CKD was high. Both prevalence and severity were higher in advanced CKD. LBMr was a highly sensitive marker to detect PEW. LBMr seen in some children with CKDwho were negative for other markers could represent subclinical PEW.

PENGARUH KONSENTRASI DAN JENIS ZAT PENGATUR TUMBUH TERHADAP PERTUMBUHAN STEK PUCUK JERUK NIPIS (Citrus aurantifolia)

The purpose of this research is to ascertain how growth regulator concentration and type affect lime shoot cuttings (Citrus aurantifolia) growth. From November 2022 to February 2023, this study was carried out in Dusun III Pandanan Dukuh Biru RT 03/RW 01, Wonosari District, Klaten Regency, Central Java. At an elevation of about 118 meters above sea level, the research site is located. This study employed a CRD (completely randomized design) with two factors, namely three ZPT types at (Z1: extract of onions, Z2: coconut water, and Z3: IBA Chemical Hormones) and growth regulator concentrations (K1: 25%, K2: 50% , K3 : 75%). There were 108 experimental units totaling 36 with four replications and three sample plants each. The percentage of living cuttings, the age at which shoots appeared, the height of shoots, the number of leaves, the number of shoots, and root length were the parameters that were observed. used the One-Way ANOVA test of variance (Test F) at the levels of 5% and 1% to analyze the data. at a level of 5%, continued the Duncan Multiple Range Test (DMRT) examination. According to the findings of the research, the treatment of various types of PGR significantly affects the age of shoot emergence, plant height, and number of leaves. ZPT concentration had a significant impact on plant height and root length, but there was no significant interaction between the two in any of the observed parameters.

Site Index Curves for Abies borisii-regis Mattf. and Fagus sylvatica L. Mixed Stands in Central Greece

Despite their productivity, fir and beech forests in Greece lack site index curves. In this work, site index curves for Fagus sylvatica and Abies borisii-regis in central Greece were developed. Thirty plots were randomly established in the mixed stands of F. sylvatica–A. borisii-regis in Aspropotamos, central Greece, and two dominant trees, one from each species, were randomly selected and cut. Height–age measurements were collected through stem analysis. These data were used to develop site index curves for each species. The site index curves illustrate a growth rate difference between the two species, specifically in the worst sites, with fir growing faster than beech. Additionally, as trees age, the growth difference between the two species in the best sites decreases. Based on these results, F. sylvatica is found to be more site-sensitive than A. borisii-regis. In the new adverse conditions of global warming, an increased knowledge of the site sensitivity of the two species will help to develop appropriate treatments for the conservation of the studied mixed stands, or at least to minimize negative impacts.

P-447 Gestational weight gain in relation to time-to-pregnancy and conception by assisted reproductive technology

Abstract Study question Does the gestational weight gain trajectory differ across levels of time-to-pregnancy (TTP) for spontaneously conceived pregnancies and pregnancies conceived by assisted reproductive technology (ART)? Summary answer Women with ART pregnancies had lower weekly weight gain during the third trimester compared with women with spontaneous conceptions with TTP ≤3. What is known already Studies suggest that both prolonged TTP and conception by ART may increase the risk of pregnancy complications and affect perinatal outcomes such as birthweight. Suboptimal gestational weight gain might further increase the risk of adverse pregnancy outcomes. However, it remains unclear whether there may be differences in gestational weight gain according to TTP and ART, which contribute to the subsequent risk of adverse pregnancy outcomes. Study design, size, duration We studied 69,121 singleton planned pregnancies contributed by 60,847 women participating in the Norwegian Mother, Father and Child Cohort Study. Participants completed questionnaires at 15 weeks’ gestation (study entry), 30 weeks’ gestation, and six months postpartum on sociodemographic, reproductive, and behavioral factors. Participants reported their TTP, and up to four weight measurements and corresponding gestational age from preconception through delivery. We identified use of ART in the Medical Birth Registry of Norway. Participants/materials, setting, methods We fitted gestational weight gain trajectories using mixed-effects linear regression models and included an interaction term between time (gestational weeks) and the exposure groups, TTP ≤3 (reference); TTP 4-6; TTP 7-11, TTP ≥12 months, and ART, to assess differences across levels of TTP and conception by ART. The analyses were adjusted for maternal age at start of pregnancy, pre-pregnancy height, educational attainment, pre-pregnancy smoking, parity, and gestational age at birth. Main results and the role of chance The adjusted average weekly weight gain was -15g (95% CI: −19; −12) during the first trimester, 620g (95% CI: 615; 624) during the second trimester, and 491g (95% CI: 489; 494) during the third trimester. When we compared differences in average weekly weight change during the first trimester, we observed little difference between the exposure groups. During the second trimester, compared with TTP≤3 months women with TTP 4-6 months, TTP 7-11 months or TTP ≥12 months gained on average 7g (95% CI: −18; 3), 19g (95% CI: −33; −5) and 15g (95% CI: −29; −1) less per week, respectively, whereas women with ART pregnancies gained 11g more per week (95% CI: −13; 34). However, the results for TTP 4-6 and ART pregnancies were imprecise. During the third trimester, average weekly weight gain did not differ according to TTP for spontaneous conceptions, while women who conceived after ART gained 35g (95% CI: −49; −22) less than women with TTP≤3 each week. Limitations, reasons for caution Because TTP and gestational weight gain were self-reported, non-differential misclassification may have influenced our results. Wider implications of the findings Decelerated weight gain during the third trimester in ART pregnancies compared with women who conceived spontaneously within 3 months might be associated with adverse pregnancy outcomes. Although our findings are imprecise and need to be replicated, monitoring gestational weight gain trajectories might support identification of pregnancies at increased risk. Trial registration number Not applicable

Undernutrition and 60-day mortality in critically ill children with respiratory failure: a prospective cohort study

BackgroundTo determine whether undernutrition affects 60-day mortality in pediatric acute respiratory failure.MethodsSubjects with acute respiratory failure aged between two months and 13 years were included in the study. The Z-scores were calculated on admission and children were categorized into two groups of undernutrition and normal nutrition. The nutritional intake of the children was measured daily. The outcome was 60-day mortality.ResultsA total of 126 patients met the inclusion criteria; 41% were undernourished based on the Z-score of BMI and weight for height, 50% based on the Z-score of height and length for age and 45% based on the Z-score of weight for age. Overall, the 60-day mortality rate was 27.8%. The Cox regression analysis adjusted with PIM2, age and gender, showed that undernutrition has a significant relationship with 60-day mortality based on the weight for age Z-score (HR = 2.33; CI: 1.175–4.638). In addition, undernutrition has a significant relationship with 60-day mortality based on the BMI for age (HR = 3.04; CI:1.070–8.639) and weight for height (HR = 2.62; CI: 1.605–6.658) Z-scores. The mean calorie and protein intake of 72% of the children was less than 80% of their calorie needs. The time to start feeding in 63% of the children was more than 48 h. There was no relationship between the time of starting nutrition and nutritional intake during PICU admission and mortality.ConclusionUndernutrition is prevalent in mechanically ventilated children in the PICU and may be associated with 60-day mortality.

Comparison of Makorin Ring Finger Protein 3 Levels Between Obese and Normal Weight Patients with Central Precocious Puberty.

Genetic studies of familial central precocious puberty (CPP) have suggested that makorin ring finger protein 3 (MKRN3) is the primary inhibitor of gonadotropin-releasing hormone (GnRH) secretion. Obesity in girls can cause early puberty by affecting the hypothalamic-pituitary-gonadal (HPG) axis. This study evaluated the serum MKRN3 level of patients with CPP and its relationship with body mass index (BMI). The study included 92 CPP and 86 prepubertal healthy controls (HC) aged 6-10 years. The CPP and HC groups were divided into obese and non-obese subgroups to evaluate whether BMI affects MKRN3. Patients' presenting complaints, chronological age, height age, bone age, Tanner stage, standard deviation scores for weight, height, and BMI, levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and MKRN3, and pelvic ultrasonography findings were recorded. The serum MKRN3 levels were lower in the CPP group and lowest in the CPP-obese subgroup. There were significant differences in MKRN3 levels between the CPP-obese and CPP-normal weight (p=0.02), CPP-obese and HC-obese (p<0.001), and CPP-obese and HC-normal weight (p=0.03) groups. MKRN3 and BMI were negatively correlated in all cases (r=-0.326, p<0.001). The negative correlation between BMI and MKRN3, and lower MKRN3 levels in CPP-obese patients, suggests that adipose tissue has a role in the onset of puberty. More comprehensive studies are needed to determine the relationship between MKRN3 and adipose tissue.

Delayed puberty: How to approach?

Disorders of puberty can profoundly impact physical and psychosocial well-being. Delayed puberty is the absence of breast development in girls by 13 years of age and absence of testicular growth to at least 4 mL in volume or 2.5 cm in length in boys by 14 years of age. Hypogonadism occurs when there is a disruption in the hypothalamic-pituitary-gonadal axis. Two categories of delayed puberty are: hypergonadotropic (primary) hypogonadism and hypogonadotropic (secondary) hypogonadism. The etiology of delayed puberty varies from relatively benign to life threatening conditions, which may be either congenital or acquired. Constitutional delay of growth and puberty is the commonest cause of delayed puberty, which is a diagnosis of exclusion. There is a notable delay in puberty but eventually progress through normal stages of puberty. History concerns about stature are often present and a familial pattern of inheritance is usually present. Delayed bone age but corresponding to height age helps in diagnosis. Reversible hypogonadotropic hypogonadism may be observed due to associated conditions including chronic malnutrition, systemic disease, untreated hypothyroidism, hyperprolactinemia, anorexia nervosa. Permanent causes include structural damage either to hypothalamic-pituitary axis or linked to the sexual organs of the individual. Complete physical examination should include proper anthropometry, pubertal staging and assessment to look for any signs of chronic illness or stigmata of syndromes. In laboratory analysis, hypogonadotropichypogonadism (pHH) showing low serum testosterone or estradiol and blunted follicle-stimulating hormones (FSH) and luteinizing hormones (LH) levels may be due to abnormalities in the central nervous system. Magnetic resonance imaging is necessary to exclude morphological abnormalities and neoplasia. Low serum testosterone in male patients and low estradiol values in female patients, associated with high serum FSH and LH levels, suggest a diagnosis of hypergonadotropic hypogonadism due to dysfunction of peripheral sex organs. Abnormal growth velocity necessitates assessment of serum thyroid function, prolactin, and insulin like growth factor-1. Karyotyping can reveal a chromosomal abnormality like Turner syndrome or Klinefelter syndrome. Beside reassurance, in cases where the adolescent with CDGP is experiencing psychological difficulties, short courses of sex hormones may be used to allow individuals to catch up with their peers. Definitive treatment for underlying cause is worthy where possible. Long-term hormone replacement therapy is recommended for permanent causes of delayed puberty. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 192