Peripubertal Age Research Articles

Pediatric sex estimation using AI-enabled ECG analysis: influence of pubertal development

AI-enabled ECGs have previously been shown to accurately predict patient sex in adults and correlate with sex hormone levels. We aimed to test the ability of AI-enabled ECGs to predict sex in the pediatric population and study the influence of pubertal development. AI-enabled ECG models were created using a convolutional neural network trained on pediatric 10-second, 12-lead ECGs. The first model was trained de novo using pediatric data. The second model used transfer learning from a previously validated adult data-derived algorithm. We analyzed the first ECG from 90,133 unique pediatric patients (aged ≤18 years) recorded between 1987–2022, and divided the cohort into training, validation, and testing datasets. Subgroup analysis was performed on prepubertal (0–7 years), peripubertal (8–14 years), and postpubertal (15–18 years) patients. The cohort was 46.7% male, with 21,678 prepubertal, 26,740 peripubertal, and 41,715 postpubertal children. The de novo pediatric model demonstrated 81% accuracy and an area under the curve (AUC) of 0.91. Model sensitivity was 0.79, specificity was 0.83, positive predicted value was 0.84, and the negative predicted value was 0.78, for the entire test cohort. The model’s discriminatory ability was highest in postpubertal (AUC = 0.98), lower in the peripubertal age group (AUC = 0.91), and poor in the prepubertal age group (AUC = 0.67). There was no significant performance difference observed between the transfer learning and de novo models. AI-enabled interpretation of ECG can estimate sex in peripubertal and postpubertal children with high accuracy.

Estimation of cAMP binding in hippocampus CA1 field by a fluorescent probe.

The hippocampus is an allocortex structure involved in many complex processes, from memory formation to spatial navigation. It starts developing during prenatal life but acquires its adult functional properties around the peripubertal age, in both humans and mice. Such prolonged maturation is accompanied by structural changes in microcircuitry and functional changes involving biochemical and electrophysiological events. Moreover, hippocampus undergoes plasticity phenomena throughout life. In murine rodents, the most relevant maturation steps in Cornu Ammonis 1 (CA1) hippocampal subfield occur during the third-fourth weeks of life. During this period, also the expression and localization of cAMP-dependent protein kinases (PKA) refines: many regulatory (R1A) PKA clusters appear, bound to the cytoskeleton. Here the binding characteristics of R1A are determined in CA1 by using confocal microscopy. Apparently, two binding sites are present with no evidence of cooperativity. Equilibrium dissociation constant is estimated around 22.9nM. This value is lower from that estimated for R1A in soluble form, suggesting a different binding site conformation or accessibility in the tissue. The method described here may be useful to track the developmental changes in binding activity, which affects cAMP availability at selected intracellular microzones. Possible relations with functional consequences are discussed.

Human immature testicular tissue organ culture: a step towards fertility preservation and restoration.

Cryopreservation of immature testicular tissue (ITT) is currently the only option to preserve fertility of prepubertal patients. Autologous transplantation of ITT may not be safe or appropriate for all patients. Therefore, methods to mature ITT ex vivo are needed. Aim to investigate the feasibility of inducing in vitro spermatogenesis from ITT cryopreserved for pediatric patients prior to initiation of gonadotoxic therapy. Cryopreserved-thawed ITT from prepubertal and peripubertal patients were cultured for 7, 16, and 32 days in medium with no hormones or supplemented with 5 IU/L FSH, 1 IU/L hCG, or 5IU/L FSH+1 IU/L hCG. Samples were evaluated histologically to assess tissue integrity, and immunofluorescence staining was performed to identify VASA (DDX4)+ germ cells, UCHL1+ spermatogonia, SYCP3+ spermatocytes, CREM+ spermatids, SOX9+ Sertoli cells. Proliferation (KI67) and apoptosis (CASPASE3) of germ cells and Sertoli cells were also analyzed. Sertoli and Leydig cell maturation was evaluated by AR and INSL3 expression as well as expression of the blood testis barrier protein, CLAUDIN11, and testosterone secretion in the culture medium. Integrity of seminiferous tubules, VASA+ germ cells and SOX9+ Sertoli cells were maintained up to 32 days. The number of VASA+ germ cells was consistently higher in the peripubertal groups. UCHL1+ undifferentiated spermatogonia and SOX9+ Sertoli cell proliferation was confirmed in most samples. SYCP3+ primary spermatocytes began to appear by day 16 in both age groups. Sertoli cell maturation was demonstrated by AR expression but the expression of CLAUDIN11 was disorganized. Presence of mature and functional Leydig cells was verified by INSL3 expression and secretion of testosterone. Gonadotropin treatments did not consistently impact the number or proliferation of germ cells or somatic cells, but FSH was necessary to increase testosterone secretion over time in prepubertal samples. ITT were maintained in organotypic culture for up to 32 days and spermatogonia differentiated to produce primary spermatocytes in both pre- and peripubertal age groups. However, complete spermatogenesis was not observed in either group.

An Unusual Clinical and Radiological Presentation of Ovotesticular Disorders of Sex Development with Male and Female External Genitalia: A Case Report

Background: Ovotesticular disorders of sex development (ODSD), previously known as true hermaphroditism, is a rare disorder of sexual differentiation that causes ambiguity in external genitalia and the presence of both ovarian and testicular elements in the gonads. The condition is characterised by the existence of testicular tissue with distinctive tubules and ovarian tissue in the same gonad (ovotestis), or separately in an individual. The most common cytogenetic karyotype is 46,XX. The age and presentation of symptoms vary, but typically include hypospadias, urogenital sinus, inguinal hernia, cryptorchidism, and gynaecomastia during the peripubertal age, as well as lower abdominal mass. Case Presentation: A 15-year-old female exhibited typical male genitalia, including a normal penile shaft, scrotal sac, palpable testes, and a urethral opening, with a separate vaginal opening located between the penile shaft and scrotum. Pelvic MRI confirmed the presence of both testes within the scrotal sac and an infantile-sized uterus with a central endometrium, as well as a left-sided ovary in the pelvic region. The right ovary was not seen. Correlative ultrasound confirmed these findings and indicated that the testes had a normal echo texture and vascularity. The patient was diagnosed with ODSD, and further hormonal testing was recommended. Conclusions: ODSD is a rare cause of genital ambiguity. Typically, both paramesonephric and mesonephric duct derivatives are seen, and most of the affected individuals present as neonates or infants with ambiguous external genitalia. At peripubertal age, the symptoms typically include hypospadias, urogenital sinus, inguinal hernia, unilateral or bilateral cryptorchidism, and gynaecomastia. Fertility is not uncommon and has been reported in female-reared patients. The ovotestis is the commonest gonad in people with ODSD and are known to be predisposed to germ cell tumours. Over 500 cases of ODSD have been reported in the literature. Ultrasound is the first line of investigation used to see the pelvic organs. The non-invasive test of choice for detecting paramesonephric and mesonephric duct derivatives is an MRI pelvis. The purpose of this paper is to describe various clinical and radiological features associated with ODSD.

Diminished ovarian reserve in adolescent cancer survivors treated with heavy metal chemotherapy.

The extent to which heavy metal chemotherapy results in treatment-related ovarian damage is controversial. Anti-Mullerian hormone (AMH) levels measured more than 1year after cancer therapy completion were abstracted from the medical records of 39 female survivors of childhood cancer aged 11years and older, whose only gonadotoxic exposure was heavy metal chemotherapy. One-fifth of survivors who received cisplatin had AMH levels indicative of diminished ovarian reserve at last measurement. There was an observed clustering of low AMH in patients diagnosed in the peripubertal age range (i.e., 10-12years). These findings may support a small, but present, risk of gonadal damage after heavy metal chemotherapy.

HIGH-FAT DIET IN THE PERI-PUBERTAL PERIOD PROGRAMS CARDIOVASCULAR DYSFUNCTION IN ADULT MALE WISTAR RATS

Stress during peri-pubertal period can determine no communicable disease in adulthood. Thisstudy aims to evaluate whether high fat diet exposure during adolescence induces long-termcardiovascular dysfunctions. The ethic committee approved the animal protocol nº1527130815. Wistar rats, 30-days-old, were feed to a high fat diet (HFD, 35% lard w/w) until60-days-old, then fed a normal fat diet for a further 60 days dietary recovery. Control animalsate normal fat diet throughout life. Body weight and food intake were evaluated weekly. AtPN120, cardiovascular and histological analysis were done. Student´s T test were applied.PN120, feed by HFD during adolescence increase systolic and diastolic blood pressure (upper10% and 4%, respectively; p <0.05 and p <0.005). Using ganglionic blocker, hexamethonium(30 mg/kg, iv), blood pressure was greater in the HFD rats (26%; p <0,01). Increasedperivascular and interstitial fibrosis (42% and 62% respectively; p<0,01 and p<0,001) wereobserved in the HFD rats, accompanied by a left ventricular hypertrophy (29%; p<0,001).Rats who were fed with HFD during peri-pubertal age present hypertension, hyperactivity ofthe vascular sympathetic nervous system and morphological cardiac alterations in adulthood.Current study remarks that adolescence is a plastic phase which permit to programs diseaseslater in life.

Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how.

Despite decades of experience, the diagnosis of growth hormone deficiency (GHD) remains challenging, especially in peripubertal children. Failure to respond to GH stimulation tests (GHSTs) is needed to confirm GHD, but long-standing controversies regarding the number of tests needed and the interpretation of GH peaks are still a matter of debate worldwide. Diagnostic workup is even more problematic in short children with slow growth and delayed sexual development: they often exhibit low GH peaks under GHST, which often normalize as puberty progresses. Consequently, this transient suboptimal response to GHST may result in GH overtreatment, carrying both health and economic concerns. Considering the complex and bound link between GH axis and sex steroids, the use of sex steroid priming prior to GHST might be helpful in peripubertal setting. However, its use is still controversial. There is no consensus regarding patient selection, timing, dose, and preparation of sex steroids. In this review, we aim to overview the use of sex steroid priming in clinical practice, highlighting the need to develop appropriate guidelines in order to overcome diagnostic pitfalls in peripubertal age.

Rare presentations of ocular enterobiasis - Case reports.

Enterobius vermicularis, also known as pinworm or threadworm, is a large intestinal nematode which has a high prevalence among children and peripubertal age in our country. Transmission usually occurs by autoinfection like finger contamination of the embryonated eggs deposited by the gravid female worm on the perianal and perineal region. Globally, only a few reports are there regarding the isolation of the parasite from extra-intestinal sites. These are two rare case reports of ocular enterobiasis. The first case was a middle-aged female and the second one was a 14-year-old girl, both of whom were referred from other tertiary care hospitals to Calcutta School of Tropical Medicine and who presented with discharge of live motile worms from their eyes (conjunctiva). In both the cases, identification was done by saline wet mount and direct microscopy of a gravid female worm. Plano-convex embryonated eggs were also observed. The oval embryonated eggs, plano-convex in shape, and the gravid female, with its cervical alae near the anterior end and straight thin pointed tail, were identified under the microscope. Although E. vermicularis is a very common large intestinal parasitic infestation of children and adolescents, it can also rarely be isolated from unusual sites, which should be taken into account for effective diagnosis and treatment.

Systematic Isolation of Key Parameters for Estimating Skeletal Maturity on Anteroposterior Wrist Radiographs.

The ability to make a continuous skeletal maturity estimate from a wrist radiograph would be useful in the treatment of adolescent forearm fractures, scoliosis, and other conditions. We attempted to create a reliable, rapid, and accurate method to do this. Many anteroposterior wrist radiographic parameters from 3 skeletal maturity systems were simplified to 23 based on relevance to the peripubertal age range, univariate correlation with skeletal maturity, and reliability. These 23 parameters were evaluated on serial peripubertal anteroposterior hand-wrist radiographs. We determined the Greulich and Pyle (GP) skeletal age and Sanders hand system (SHS) stage. We used stepwise linear regression and generalized estimating equation (GEE) procedures to identify important radiographic and demographic parameters for estimating skeletal maturity, creating the "Modified Fels wrist skeletal maturity system." Its accuracy predicting skeletal maturity was evaluated and compared with that of 4 other systems: (1) GP system, (2) SHS, (3) GP parameters along with age and sex, and (4) SHS parameters along with age and sex. Three hundred and seventy-two radiographs of 42 girls (age range, 7 to 15 years) and 38 boys (age range, 9 to 16 years) were included. Fifteen radiographic parameters were excluded from the Modified Fels wrist system by stepwise regression and GEE analyses, leaving age, sex, and 8 radiographic parameters in the final model. Use of the Modified Fels wrist system resulted in more accurate skeletal maturity estimations (0.34-year mean discrepancy with actual skeletal maturity) than all other systems (p < 0.001 for all). The Modified Fels wrist system had a similar rate of outlier skeletal maturity estimations as the age, sex, and SHS model (1.9% versus 3.5%, p = 0.11) and fewer outliers than all other systems (p < 0.05 for all). A system that included demographic factors and 8 anteroposterior wrist radiographic parameters estimates skeletal maturity more accurately than the 2 most-used skeletal maturity systems in the United States. The Modified Fels wrist skeletal maturity system may allow for more accurate, reliable, and rapid skeletal maturity estimation than current systems, and also may be used when treating adolescent forearm fractures as it does not require imaging past the metacarpals. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

163 DNA Methylation Across Generation in Bovine

Abstract Scientists are starting to realize that some effects from the animal environment may affect their progeny’s phenotype. These epidemiological evidences of early life programming are very well described in humans and rodents but less documented in bovines, especially in relation to the peri-conceptual period. In fact, as other species the bovine gametes may carry non-genetic information that will impact the survival, the fitness and the phenotype of the embryo-fetus-offspring. Using a peri-pubertal age model we have compared the semen of bulls that we obtained at different ages just after puberty for whole genome DNA methylation, miRNA content and open DNA access regions to identify mechanistic relation to gene expression and DNA methylation in embryos created with the same bulls compared to themselves and mated by IVF to the same heifer several times. A similar experiment was also done with pre-peri and post puber heifers using the same adult bull for repetitive IVF. The overall results indicate that the same pathways are affected in embryos from immature parents. The targeted processes are overwhelmingly associated with cellular metabolism involving mitochondria function and the mTOR pathways amongst others. A very similar conclusion was also observed with embryos obtained from adult mothers under negative energy balance and the resulting calves obtained by surrogate gestations using blood DNA methylation to assess the intergenerational legacy. These results support a metabolic programming across generation associated with an energy deficient status of the parent.

Expression of Kisspeptin, Neurokinin B, and Dynorphin During Pubertal Development in Female Sheep

Puberty onset depends upon an increase in pulsatile GnRH/LH secretion, which in sheep is the result of reduced sensitivity to estrogen negative feedback. Neurons within the arcuate nucleus of the hypothalamus (ARC) expressing kisspeptin, neurokinin B (NKB), and dynorphin (i.e. KNDy neurons) express estrogen receptors and are believed to play a key role in mediating the effects of estrogen on GnRH/LH secretion. Therefore, the purpose of this study was to assess changes in kisspeptin, NKB, and dynorphin within the ARC across pubertal development in female sheep. Blood samples were collected at 12-minute intervals for 4 hours and assessed for LH secretion in five age groups of ewes: 5 months (n=6), 6 months (n=6), 7 months (n=5), 8 months (n=5), and 10 months (n=6) of age. Following each bleed, ewes were sacrificed, hypothalamic tissue containing the ARC was collected, and then processed for use in dual immunofluorescence and RNAscope. Mean LH and LH pulse frequencies followed the expected patterns: concentrations and frequencies were low during the prepubertal ages (5-7 months of age), intermediate during the peripubertal age (8 months of age), and elevated in the postpubertal age group (10 months of age). Using immunofluorescence, kisspeptin and NKB immuno-positive cell numbers did not change significantly (P > 0.50) over time with cell numbers averaging 235.3±16.8 and 231.3±16.8, respectively. Colocalization of kisspeptin and NKB was greater than 90% for all age groups. Using RNAscope, the total number of cells expressing mRNA for kisspeptin and dynorphin did not change significantly (P > 0.05) over time with cell numbers averaging 46.7±12.0 and 28.3±10.0 cells/hemisection, respectively. Taken together, our data suggest that the increase in LH secretion that drives puberty onset is not limited by changes in kisspeptin, NKB, or dynorphin expression, but may instead depend on other factors such as changes in receptor expression or changes in KNDy neuron activity via a reduction in inhibitory and/or an increase in stimulatory afferent inputs.

Systematic Isolation of Key Parameters for Estimating Skeletal Maturity on Knee Radiographs.

The ability to estimate skeletal maturity using a knee radiograph would be useful in anterior cruciate ligament (ACL) injuries and limb-length discrepancy in immature patients. Currently, a quick, accurate, and reproducible method is lacking. Serial knee radiographs made 3 years before to 2 years following the chronologic age associated with 90% of final height (an enhanced skeletal maturity gold standard compared with peak height velocity) were analyzed in 78 children. The Pyle and Hoerr (PH) knee method was simplified by developing discrete stages for the distal part of the femur, the proximal part of the tibia, the proximal part of the fibula, and the patella. The Roche-Wainer-Thissen (RWT) knee method was simplified from the 36 original parameters to 14 parameters by removing parameters that were poorly defined, were not relevant to the peripubertal age range, were poorly correlated with 90% final height, or were poorly reliable on a 20-radiograph pilot analysis. We also compared the recently described central peak value (CPV) of the distal part of the femur. The Greulich and Pyle (GP) left-hand bone age was included for comparison. In this study, 326 left knee radiographs from 41 girls (age range, 7 to 15 years) and 37 boys (age range, 9 to 17 years) were included. Stepwise linear regression showed higher correlation in predicting years from 90% final height using the modified RWT and demographic characteristics (R2 = 0.921) compared with demographic characteristics alone (R2 = 0.840), CPV and demographic characteristics (R2 = 0.866), GP and demographic characteristics (R2 = 0.899), and PH and demographic characteristics (R2 = 0.902). Seven parameters were excluded from the RWT and demographic characteristics model using stepwise linear regression and generalized estimating equations analysis, leaving 7 parameters (2 femoral, 4 tibial, and 1 fibular) in the final model. Compared with RWT and demographic characteristics (R2 = 0.921), there were minimal incremental increases by adding CPV (R2 = 0.921), GP (R2 = 0.925), or PH (R2 = 0.931). This large analysis of knee skeletal maturity systems isolated 7 discrete radiographic knee parameters that theoretically outperform the GP bone age in estimating skeletal maturity. We present a modified knee skeletal maturity system that can potentially preclude the need for additional imaging of the hand and wrist in reliably estimating skeletal maturity.

SIRT1 gene methylation in sperm differs in rams with high and low fertility

SIRT1 gene methylation in sperm differs in rams with high and low fertility

Differential diagnosis between constitutional delay of growth and puberty, idiopathic growth hormone deficiency and congenital hypogonadotropic hypogonadism: a clinical challenge for the pediatric endocrinologist

Differential diagnosis between constitutional delay of growth and puberty (CDGP), partial growth hormone deficiency (pGHD) and congenital hypogonadotropic hypogonadism (cHH) may be difficult. All these conditions usually present with poor growth in pre- or peri-pubertal age and they may recur within one familial setting, constituting a highly variable, but somehow common, spectrum of pubertal delay. Narrative review of the most relevant English papers published between 1981 and march 2020 using the following search terms "constitutional delay of growth and puberty," "central hypogonadism," "priming," "growth hormone deficiency," "pituitary," "pituitary magnetic resonance imaging," with a special regard to the latest scientific acquisitions. CDGP is by far the most prevalent entity in boys and recurs within families. pGHD is a rare, often idiopathic and transient condition, where hypostaturism presents more severely. Specificity of pGHD diagnosis is increased by priming children before growth hormone stimulation test (GHST); pituitary MRI and genetic analysis are recommended to personalize future follow-up. Diagnosing cHH may be obvious when anosmia and eunuchoid proportions concomitate. However, cHH can either overlap with pGHD in forms of multiple pituitary hormone deficiencies (MPHD) or syndromic conditions either with CDGP in family pedigrees, so endocrine workup and genetic investigations are necessary. The use of growth charts, bone age, predictors of adult height, primed GHST and low dose sex steroids (LDSS) treatment are recommended. Only a step-by-step diagnostic process based on appropriate endocrine and genetic markers together with LDSS treatment can help achieving the correct diagnosis and optimizing outcomes.

Huge abdominal mass with hematocolpometra due to imperforate hymen: an unusual clinical presentation

The imperforated hymen is one of the commonest genital tract malformations usually present with cyclic abdominal pain and an obstructive pelvic mass at post-pubertal age. The unusual pre­sentations are delayed menarche with obstructive symptoms rarely acute retention of urine, te­nesmus, and constipation. We report an unusual case of 12- year old girl with a huge mass in the lower abdomen examination revealed imperforate hymen at early pubertal age.&#x0D; Further investigation of Magnetic Resonance Imaging (MRI) confirmed hematocolpometra. Then, she underwent simple hymenotomy and drainage of collected menstrual blood from the genital tract. She recovered well during the postoperative periods. We conformed normal menstrual flow at her first follow-up. In conclusion, Imperforate hymen at peripubertal age with an unusual huge abdominopelvic mass concerns further imaging to assure the best outcome.

HUGE ABDOMINAL MASS WITH HEMATOCOLPOMETRA DUE TO IMPERFORATE HYMEN: AN UNUSUAL CLINICAL PRESENTATION

The imperforated hymen is one of the commonest genital tract malformations usually present with cyclic abdominal pain and an obstructive pelvic mass at post-pubertal age. The unusual pre­sentations are delayed menarche with obstructive symptoms rarely acute retention of urine, te­nesmus, and constipation. We report an unusual case of 12- year old girl with a huge mass in the lower abdomen examination revealed imperforate hymen at early pubertal age.&#x0D; Further investigation of Magnetic Resonance Imaging (MRI) confirmed hematocolpometra. Then, she underwent simple hymenotomy and drainage of collected menstrual blood from the genital tract. She recovered well during the postoperative periods. We conformed normal menstrual flow at her first follow-up. In conclusion, Imperforate hymen at peripubertal age with an unusual huge abdominopelvic mass concerns further imaging to assure the best outcome.

Localized Juvenile Spongiotic Gingival Hyperplasia : a Case Series

Localized juvenile spongiotic gingival hyperplasia is a relatively new histopathological diagnosis, presenting as a localized erythematous lesion of the anterior attached gingivae. Presenting in a peri-pubertal age, this condition is often misdiagnosed as ‘puberty gingivitis’. Here, two cases presenting to the Joint Paediatric-Oral Medicine clinic at the Eastman Dental Hospital are discussed. CPD/Clinical Relevance: Localized juvenile spongiotic gingival hyperplasia is a novel diagnosis, and one that is currently under-reported. Increased awareness of this condition is required for appropriate patient management.

The Risky Health Behaviours of Male Adolescents in the Southern Italian Region: Implications for Sexual and Reproductive Disease

Recent epidemiological studies suggest an increase of sexual and reproductive chronic diseases caused by problematic behaviours acquired during peri-pubertal age. The aims of our study were: (i) to investigate awareness of sexual transmitted infections (STIs) among adolescents; (ii) to describe the close relationship between possibly incorrect lifestyles during adolescence and reproductive and sexual disturbances during adulthood. The “Amico-Andrologo” survey is a permanent nationwide surveillance program supported by the Italian Ministry of Health. We administered a validated structured interview to investigate the lifestyle of adolescents and their knowledge of STIs. We selected a cohort of 360 male high-school students aged ≥18 years old. In this cohort, 150 (41.5%) were smokers while 59 (19.7%) smoked more than 10 cigarettes/day; 25 (9.3%) declared a consumption ≥6 drinks/weekend; and 65 (19.7%) were habitual cannabis consumers (at least twice/week). Among the sample of students selected, the main sources of sexual disease information were the internet and friends. The perceived level of knowledge on STIs was the same between students that used contraceptive methods and students that did not. The present results demonstrate that adolescents in Calabria do not receive appropriate information about risky health behaviours. Therefore, there is a necessity for specific educational programs to increase awareness of dangerous behaviours during the transitional age that is relevant for a safe sexual and reproductive adult life.

Predictive factors of ketoacidosis in type 1 diabetes mellitus

Background Diabetic ketoacidosis (DKA) is an acute complication in type 1 diabetes mellitus (DM) and a significant cause of morbidity and mortality in developing countries. Diabetic ketoacidosis can be prevented by good management of the disease. Risk factors from previous studies that increase the DKA incidence were peripubertal age, female gender, low socio-economic status, low parental education status, DKA at the first diagnosis of type 1 DM, infection, psychological problems, poor metabolic control, and non-compliance with insulin treatment.&#x0D; Objective To determine whether sex, age, socio-economic status, parental education level, DKA at the initial diagnosis of type 1 DM, infection, psychological problems, poor metabolic control, and failing to take insulin as needed were predictive of DKA in type 1 DM patients.&#x0D; Methods We conducted a retrospective cohort study using medical records from type 1 DM patients aged 0-20 years, at the Department of Child Health, Dr. Sardjito Hospital, Yogyakarta, from January 2011 to May 2017. We assessed for the incidence and predictors of DKA. Logistic regression analysis was done to determine which factors increased DKA incidence.&#x0D; Results A total of 57 type 1 DM patients were recruited, with DKA incidence of 37 (65%). Five (8.8%) DKA patients died. Multivariate analysis revealed that infection (OR 5.23; 95%CI 1.47 to 19.68; P=0.014) and DKA at the first diagnosis of type 1 DM (OR 5.37; 95%CI 1.40 to 19.52; P=0.011) were significant risk factors for DKA. &#x0D; Conclusion Infection and DKA at the first diagnosis of type 1 DM are significant predictors of increased DKA incidence.

Growth Pattern and Clinical Profile of Indian Children with Classical 21-Hydroxylase Deficiency Congenital Adrenal Hyperplasia on Treatment.

To prospectively assess the growth parameters in a cohort of children with classical 21-hydroxylase deficiency congenital adrenal hyperplasia, comprehensively profile their clinical data and evaluate the prevalence of testicular adrenal rest tumors among affected boys. Children with congenital adrenal hyperplasia aged 0-18 y were prospectively followed up for six mo to 2 y (mean follow-up: 17 ± 6 mo). Baseline data were obtained by interviewing parents and from clinic records. Anthropometry, biochemical parameters, X-ray for bone age, and ultrasound scrotum (in boys >5 y) for testicular adrenal rest tumors were performed. Among the 81 children (32 boys, 49 girls), two-thirds (57) had salt-wasting and the remaining had simple virilizing type and the mean age at enrolment was 6.2 ± 4.9 y. The overall height standard deviation score was -0.6 (-2.0 to 0.8) with a greater compromise in children in the age groups 0-2 y and > 10 y and those with salt-wasting type. Overall, 25 (31%) children had short stature and 45 (55.6%) had growth velocity below the reference range. Bone age advancement beyond 2 standard deviation score was seen in 46% of children assessed. Testicular adrenal rest tumors were detected in 5 out of 21 boys (23.8%). The auxological pattern observed in this homogenously-managed Indian pediatric cohort with congenital adrenal hyperplasia highlights that infancy and peri-pubertal age groups are the most vulnerable, reiterating the importance of diligent growth monitoring. The high prevalence of testicular adrenal rest tumors merits the incorporation of annual ultrasound in the follow-up protocol of these patients.