Prepubertal Group Research Articles

Prepubertal Children with Papillary Thyroid Carcinoma Present with More Invasive Disease Than Adolescents and Young Adults.

Introduction: Pediatric papillary thyroid carcinomas (PTCs) are more invasive than adult PTCs. No large, contemporary cohort study has been conducted to determine whether younger children are at higher risk for advanced disease at presentation compared to adolescents. We aimed to describe pediatric PTC and contextualize its characteristics with a young adult comparison cohort. Methods: The National Cancer Database was interrogated for pediatric and young adult PTCs diagnosed between 2004 and 2017. Clinical variables were compared between prepubertal (≤10 years old), adolescent (11-18 years old), and young adult (19-39 years old) groups. Multivariable logistic regression modeling for independent predictors of metastases was conducted. A subanalysis of microcarcinomas (size ≤10 mm) was performed. Results: A total of 4860 pediatric (prepubertal n = 274, adolescents n = 4586) and 101,159 young adult patients were included. Prepubertal patients presented with more extensive burden of disease, including significantly larger primary tumors, higher prevalence of nodal and distant metastases, and increased frequency of features such as lymphovascular invasion, and extrathyroidal extension (ETE). Prepubertal age was an independent predictor of positive regional nodes (adjusted odds ratio [AOR] = 1.36 [95% confidence interval {CI} 1.01-1.84], p = 0.04) and distant metastatic disease (AOR = 3.12 [CI 1.96-4.96], p < 0.001). However, there was no difference in survival between groups (p = 0.32). Prepubertal age independently predicted lymph node metastases for microcarcinomas (AOR = 2.19 [CI 1.10-4.36], p = 0.03). Prepubertal (n = 41) versus adolescent (n = 937) patient age was associated with gross ETE (p = 0.004), even with primary tumors ≤1 cm in size. Conclusions: Patients aged <11 years old present with more advanced disease than adolescents, with a higher likelihood of nodal and distant metastatic disease at time of diagnosis, although survival is high. Prepubertal children undergo more extensive treatment, likely reflective of more invasive disease at the outset, even in the setting of a subcentimeter primary tumor.

Increased double-strand breaks in aged mouse male germ cells may result from changed expression of the genes essential for homologous recombination or nonhomologous endjoining repair.

DNA double-strand breaks (DSBs) are commonly appearing deleterious DNA damages, which progressively increase in male germ cells during biological aging. There are two main pathways for repairing DSBs: homologous recombination (HR) and classical nonhomologous end joining (cNHEJ). Knockout and functional studies revealed that, while RAD51 and RPA70 proteins are indispensable for HR-based repair, KU80 and XRCC4 are the key proteins in cNHEJ repair. As is known, γH2AX contributes to these pathways through recruiting repair-related proteins to damaged site. The underlying reasons of increased DSBs in male germ cells during aging are not fully addressed yet. In this study, we aimed to analyze the spatiotemporal expression of the Rad51, Rpa70, Ku80, and Xrcc4 genes in the postnatal mouse testes, classified into young, prepubertal, pubertal, postpubertal, and aged groups according to their reproductive features and histological structures. We found that expression of these genes significantly decreased in the aged group compared with the other groups (P < 0.05). γH2AX staining showed that DSB levels in the germ cells from spermatogonia to elongated spermatids as well as in the Sertoli cells remarkably increased in the aged group (P < 0.05). The RAD51, RPA70, KU80, and XRCC4 protein levels exhibited predominant changes in the germ and Sertoli cells among groups (P < 0.05). These findings suggest that altered expression of the Rad51, Rpa70, Ku80, and Xrcc4 genes in the germ and Sertoli cells may be associated with increasing DSBs during biological aging, which might result in fertility loss.

Microbiological findings in prepubertal and pubertal girls with vulvovaginitis

Vulvovaginitis is a common and challenging gynaecological problem in prepubertal and pubertal girls. Such an infection, owing to a wide range of aetiologies, if not responding to hygienic measures, needs further investigation through vaginal cultures, since treatment should be tailored accordingly. This study aimed to investigate the pathogens isolated in prepubertal and pubertal girls with signs and symptoms of vulvovaginitis. A total of 2314 symptomatic girls, 1094 prepubertal and 1220 pubertal, aged 2 to 16 years, were included. Vaginal samples were inoculated on specific culture plates followed by incubation in aerobic, anaerobic or CO2 atmosphere at 37 °C for 24 or 48 h, as appropriate. The identification of the isolated pathogens was carried out using Gram stain, conventional methods and the automated system VITEK 2 (BioMerieux, Marcy l’Etoile, France). Positive cultures were obtained from 587 (53.7%) of prepubertal girls and 926 (75.9%) of pubertal girls. A total of 613 and 984 pathogens were detected in prepubertal and pubertal subjects, respectively. Isolated bacteria included 40.1% and 22.8% Gram-positive cocci, 35.6% and 24.8% Gram-negative rods in the prepubertal and pubertal groups, respectively, with faecal pathogens being the most prevalent. Bacterial vaginosis was diagnosed in 22.8% of prepubertal and 37.9% of pubertal girls. Candida species were isolated mostly in the pubertal girls (14.5%).Conclusion: Culture results should be evaluated with caution in children with vulvovaginitis. In the prepubertal girls, the most common isolated pathogens were opportunistic bacteria of faecal origin while girls in late puberty were more susceptible to bacterial vaginosis and vulvovaginal candidiasis.What is Known:• Vulvovaginitis is the most frequent and challenging reason for referral to paediatric and adolescent gynaecology services.• Microbiological examination can prove to be a significant tool to help diagnosis although results should be evaluated with caution in children.What is New:• Significantly more positive vaginal cultures and pathogens were recorded in symptomatic pubertal girls compared to prepubertal children.• The prevalence of bacterial vaginosis was increased in both prepubertal and pubertal girls with vulvovaginitis although significantly more in girls at puberty.

Differences in body composition and physical fitness parameters among prepubertal and pubertal children engaged in extracurricular sports: the active health study.

BackgroundThis study aimed to analyze the associations of maturity status, chronological age and sex with physical fitness and body composition among active children.MethodsA total of 1682 children (72% boys; age = 11.22 ± 2.64 years; height = 147.57 ± 15.87 cm; weight = 44.55 ± 15.29 kg) from rural areas participating in extracurricular sports were divided into four groups according to their sex and maturity status (prepubertal and pubertal according to stages described by Tanner). Body composition (body mass index, muscle mass and fat mass) and physical fitness (20-m shuttle-run test, handgrip strength and vertical jump) were assessed using standardized procedures. A two-way ANOVA and product–moment correlations were performed.ResultsPrepubertal boys had more fat mass (%) than pubertal boys [P<0.001; effect size (ES): 0.45], while prepubertal girls had more muscle mass (%) than pubertal girls (P<0.001; ES: 0.47). The pubertal group displayed higher fitness outcomes (absolute values) regardless of sex (P<0.05). However, the prepubertal group had higher percentile values in the 20-m shuttle-run test and vertical jumps than the pubertal group regardless of sex (P < 0.001; ES: 0.29–0.48). All the measures of physical fitness were positively associated with chronological age and muscle mass (%).ConclusionsAlthough absolute values of body composition and physical fitness appear to increase among pubertal children participating in extracurricular sports, the percentiles indicate that puberty is accompanied with a loss of a physical fitness levels. Thus, extracurricular sports might not be enough to enhance fitness among adolescents.

Distribution of various histopathological patterns of ovarian lesions in different age groups

The spectrum of ovarian pathologies embraces wide age range among females because the risk of developing ovarian lesion starts from birth and follows diverse patterns through-out the life.1,2 The rate of development of complications, recurrence, progression to malignancy, morbidity and mortality, also varies according to the age of presentation of various ovarian pathologies.3,4,5 The prevalence of cystic lesions of ovary is more in reproductive age group as compared to post-menopausal women.6,7 Malignant neoplasms have more been observed in an advanced age group.8,9,10 The current study is aimed to observe the distribution of various histopathological patterns of ovarian lesions in different age groups. This study may be beneficial in stratifying patients, into different risk based groups and prognosis associated groups, depending upon the age of patient at the time of presentation. Methods: Total 150 cases of ovarian lesions were selected by convenient sampling in current descriptive study, carried out at Pathology department of Fatima Jinnah Medical University, Lahore from May, 2019 till June, 2020. Routine H &amp; E stained sections, from specimens of total abdominal hysterectomy with unilateral or bilateral salpingo-oophorectomy, unilateral or bilateral oophorectomy and salpingo-oophorectomy procedures, done either for primary ovarian lesion or other than primary ovarian pathology, in all age groups, were included. Results: A majority of ovarian lesions 123 (82%) were observed in the reproductive age group, mostly being non-neoplastic (89.5%). Out of 19 post-menopausal patients, 12 presented with malignant neoplasms. All patients belonging to pre-pubertal age group had non-neoplastic pathologies. Conclusion: The malignant ovarian tumors are prevalent in post-menopausal patients while reproductive age group predominantly exhibits non-neoplastic and benign ovarian lesions. The pre-pubertal age group commonly present with non-neoplastic ovarian pathologies. Keywords: Histopathological patterns of ovarian lesion, Malignant ovarian tumors, Reproductive age group.

P-470 Impact of patient characteristics at ovarian tissue cryopreservation on follicle activation and survival

Abstract Study question Does first-line chemotherapy prior to ovarian tissue cryopreservation and diseases impact on the signaling pathways governing follicle activation and survival in pre-pubertal and adult patients? Summary answer Chemotherapy increases follicle apoptosis rate without affecting early follicular activation. Moreover, damages varied according to the time of last exposure and the diseases. What is known already Chemotherapeutic agents can impair the ovarian stockpile inducing a decrease of the reproductive potential of female cancer survivors. Among fertility preservation methods, cortical tissue cryopreservation is offered in patients who already started their treatment or cannot postpone it, and it is currently the only available procedure for pre-pubertal patients. Few studies did not report negative impact of prior first-line chemotherapy on ovarian tissue cryopreservation outcomes, the consequences of the treatment on the follicle activation in human remain to be further investigated. Identifying the signaling modifications induced by chemotherapy exposure is essential to address this question. Study design, size, duration Fragments of cryopreserved ovarian tissue from young adult (12-29 years old, n = 8) and pre-pubertal (3-10 years old, n = 7) cancer patients donated for research were thawed and cultured for 24h. Analyses of the follicle and stroma survival, as well as the PI3K/AKT/mTOR and Hippo signaling pathways were conducted at thawing and after culture. The different patients were grouped according to their pubertal stage and those who received chemotherapy before ovarian banking were compared to non-exposed patients. Participants/materials, setting, methods To assess the distribution and morphology of the follicles, the structure of the stroma, and the apoptosis, histological investigations were performed through follicular counting, Sirius Red staining, immunostaining, and TUNEL staining. The PI3K/AKT/mTOR and Hippo signaling pathways were investigated to explore the follicular activation among the different groups by gene expression and protein analyses on isolated follicles and cortex, respectively. Main results and the role of chance The deleterious impact of chemotherapy exposure prior to tissue banking was observed specifically on quiescent follicles by TUNEL staining at thawing and after culture in both adult and pre-pubertal patients. After 24h of culture, tissues previously exposed to chemotherapy displayed a higher rate of follicles containing DNA damages than the non-exposed fragments in adults (40.9% versus 19.1%), and pre-pubertal (48.3% versus 17.6%) patients. The atresia rates and DNA damages appeared to be lower into the tissue of patients that received their last cure 4-5 months before the cryopreservation among the treated adult and pre-pubertal groups. DNA reparation mechanisms were assessed through gH2Ax staining and revealed a correlation with the diseases as a higher phosphorylation rate of H2Ax protein was observed in tissues from acute leukemia patients compare to the others at thawing (p = 0.009) and after 24h (p &amp;lt; 0.001). Although protein analyses on Kit Ligand, key regulator of the follicle activation, showed an increase of expression into the groups treated by chemotherapy, genes and protein involved in the PI3K/AKT/mTOR and Hippo pathways showed similar expression levels in the chemo-treated groups compared to the non-exposed groups, irrespective of the age. Limitations, reasons for caution The study of follicle survival was limited to histological analyses, while follicular activation evaluations were limited to the evaluation of two main signaling, PI3K/AKT/mTOR and Hippo. Moreover, considering the heterogeneity of the human model, and the limited number of patients included, the results should be interpreted with caution. Wider implications of the findings Our results highlight the deleterious impact of previous chemotherapeutic treatment on follicle survival without affecting follicular activation. Besides sustaining the “burn out effect” theory, our results suggested that the time of last exposure and the pathology of the patient could impact the outcomes of the cryopreserved ovarian tissue. Trial registration number not applicable

A preliminary study on the relationship between environmental endocrine disruptors and precocious puberty in girls

To explore the associations of environmental endocrine disruptors on precocious puberty in girls. This was a case-control study in which 30 girls with precocious puberty and 46 age- and race-matched prepubertal females were enrolled. The concentrations of 10 environment endocrine disruptors (bisphenol A, bisphenol B, butylparaben, propylparaben, ethvlparaben, methylparaben, mono-butyl phthalate, mono-2-ethylhexyl phthalate, monoethyl phthalate, and monomethyl phthalate) in urine and 10 steroid hormones (dihydrotestosterone, corticosterone, hydrocortisone, 11-deoxycortisol, 17α-hydroxy progesterone, 4-androstene-3,17-dione, estrone, deoxycorticosterone, pregnenolone, and dehydroepiandrosterone) in serum were detected with the liquid chromatography-mass spectrometry (LC-MS). According to the Mann-Whitney U test, urinary levels of bisphenol A, monobutyl phthalate, and monomethyl phthalate were significantly higher in the precocious group than in the prepubertal group, and blood levels of hydrocortisone, 11-deoxycortisol, corticosterone, deoxycorticosterone, and pregnenolone were significantly lower in the precocious group than in the prepubertal group (p<0.05, VIP>1). Our findings confirm the association between phthalate exposure and the incidence of precocious puberty in girls. Control and reduction of children exposure to phthalate esters should be considered as a health priority.

Applicability of Adults 2015 American Thyroid Association Differentiated Thyroid Cancer Guidelines for Postoperative Risk Stratification and Postradioiodine Treatment Dynamic Risk Stratification in Pediatric Population.

Purpose This retrospective study aimed to study the applicability of 2015 adult American Thyroid Association (ATA) differentiated thyroid cancer (DTC) postoperative risk stratification and guidelines in the pediatric population for evaluating the number of metastatic lymph nodes in the postoperative risk stratification and postradioactive iodine (RAI) treatment dynamic risk stratification (DRS) using response to treatment (RTT) reclassification. In addition, the effect of pubertal status and gender was assessed on disease presentation and prognosis. Methods Data of 63 DTC patients aged 20 years or less, stratified into prepubertal, pubertal, and postpubertal age groups, was divided into low, intermediate, and high-risk groups using pediatric ATA recurrence risk stratification. Forty-seven patients were classified as responders (excellent and indeterminate responses) and incomplete responders (biochemical and structurally incomplete responses) by assessing the RTT at 1.5 years follow-up similar to recommendation of 2015 adult DTC ATA guidelines. Results Female-to-male ratio showed a trend of gradual increase with increasing age. Significantly more responders were observed in low- and intermediate-risk groups than in high-risk group ( p = 0.0013; p = 0.017, respectively), while prepubertal group had more extensive (N1b) disease. Using DRS at follow-up of 1.5 year, pubertal and postpubertal groups showed significantly better response to RAI. More female than male patients showed response and took significantly less time to respond to RAI ( p = 0.003). Conclusion RAI response in pediatric DTC depends on pubertal status, gender, and number of malignant nodes. DRS using RTT classification may be applicable early at 1.5 years after initial therapy in different pubertal age and risk groups.

Association of Salivary IGF and IGF/IGFBP-3 Molar Ratio with Cervical Vertebral Maturation Stages from Pre-Adolescent to Post-Adolescent Transition Period-A Cross-Sectional Exploratory Study.

Background: The relevance of growth determination in orthodontics is driving the search for the most precise and least invasive way of tracking the pubertal growth spurt. Objectives: The aim was to explore whether minimally invasive salivary estimation of biomarkers Insulin-like growth factor (IGF-1) and Insulin-like growth factor binding protein-3 (IGFBP-3) could be used to estimate skeletal maturity with diagnostic accuracy, especially in children and adolescent age groups. Subjects and methods: The cross-sectional study was conducted on 105 participants aged 6–25 years from the out-patient Department of Preventive Dental Science at Majmaah University between the period 2 January 2021 and 12 July 2021. Each subject’s lateral cephalogram radiograph was categorized based on skeletal maturity, and saliva samples were estimated for IGF-1 and IGFBP-3 using the respective ELISA kits. Two-way ANOVA with interaction was applied to examine the main effects due to cervical vertebral maturation staging (CVS), Sex and interaction effect due to CVS, and Sex on study parameters. Karl Pearson’s Product Moment Correlation Coefficient was calculated for finding a significant association between IGF, IGFBP3, and the IGF-1/IGFBP3 molar ratio. Results: Highest mean salivary IGF-1 was observed in the pubertal peak stage, which coincides with cervical vertebral maturity stages 3 and 4 (CVS3 and CVS4) for both males (2.57 ng/mL) and females (1.57 ng/mL) and the lowest mean level of IGF-1 for females (0.85 ng/mL) and males (1.22 ng/mL) was observed during the prepubertal stage. There exists a significant variation in IGF-1 between males and females in the pubertal stage (p < 0.01), but the difference is very narrow in the prepubertal and post-pubertal groups (p > 0.05). There was no significant interaction effect of different skeletal stages and gender on the IGFBP3 and the IGF-1/IGFBP3 molar ratio (p > 0.05), but there exists a significant interaction effect on IGF-1 (p < 0.05). Conclusion: Estimation of the IGF-1 and the IGF-1/IGFBP3 molar ratio in saliva, being a non-invasive biological marker, could serve as an adjunctive tool along with radiographic assessment in estimating growth maturity in the adolescence age group. By initiating orthodontic treatment during the mandibular growth peak in adolescence, a positive outcome is ensured in managing skeletal deformities within the craniofacial complex.

2019 ACR/EULAR classification criteria and therapy in predicting organ damage accrual in patients with childhood-onset systemic lupus erythematosus: A retrospective study over the last 29 years.

We explored damage occurrence in patients with childhood-onset SLE (cSLE) and aimed to predict the risk of organ damage occurrence in time. The retrospective study included patients treated for cSLE at the Centre of Reference for Pediatric and Adolescent Rheumatology of the Republic Croatia over a 29-year period. The disease development of 97 patients (77 females) with cSLE was examined. The median (Q1, Q3) follow-up time was 6.5 (2.3, 12.0) years. SDI was determined at 5 time points (6, 12, 24, 36 months, and last follow-up). Thirty-eight patients (48%) had organ damage at the last follow-up. Prepubertal group of patients showed higher SLEDAI scores at the disease onset, while post-pubertal group had significantly lower proportion of patients with relapses. We estimated the time from the first symptom to the moment of damage and our findings suggest that it is unlikely that organ damage will occur in 50% of patients in the first 6years since the diagnosis. The number of 2019 ACR/EULAR classification criteria at the time of diagnosis associated with SDI determined after 1year of the follow-up period. The patients who received higher doses of glucocorticoids accumulated damage faster and mycophenolate mofetil was found to be a more frequent therapy in patients with SDI ≥3. Knowing that damage will most likely happen after the first 6years after diagnosis in 50% of patients enables physicians to better predict damage occurrence. High number of 2019 ACR/EULAR criteria and treatment with glucocorticoids in childhood-onset SLE are associated with damage accrual and these findings could enable us to detect patients which should be closely monitored for higher risk of damage development.

Phenomenology of obsessive-compulsive disorder in children and adolescents: Sample from a tertiary care center in Istanbul, Turkey.

BACKGROUNDObsessive-compulsive disorder (OCD) is a heterogeneous disease in many respects and exhibits this diversity in terms of phenomenology. It also displays several different characteristics in children compared to adults.AIMTo describe the socio-demographic and phenomenological features of children with OCD and to investigate the impact of these features on response to pharmacotherapy. METHODSThis retrospective study was carried out with 150 children and adolescents who had been diagnosed with OCD between 2014 and 2018. Data was collected by examining the files of the patients with diagnosis of OCD and similar disorders from the hospital database. Yale-Brown Obsessive-Compulsive Scale for Children was used for the assessment of obsession-compulsion subtypes. The Clinical Global Impression (CGI) scale was used to evaluate the severity of the disease (CGI-S) and global improvement (CGI-I). The predictors of treatment response were evaluated using linear regression analysis. The level of significance for all statistic tests was set as P < 0.05. RESULTSThe sample was divided into prepubertal (44%) and adolescent (56%) age groups. The most prevalent obsessions were contamination and aggression obsessions, and the most frequent compulsions were washing and checking. While contamination was observed more commonly in the prepubertal age group, the religious obsession was seen more frequently in adolescents. Patients with aggression obsession presented a higher frequency of comorbid anxiety (P = 0.022) and mood (P = 0.047) disorder. CGI-I scores did not differ according to phenomenological subgroups (P > 0.05). A lower CGI-I score was linked to a lower CGI-S score (95% confidence interval 0.21-0.39, P < 0.001) and the prepubertal age of admission (95% confidence interval 0.03-0.87, P = 0.020). CONCLUSIONThe phenomenology of OCD shows differences depending on the age group and the comorbid psychiatric disorders. Earlier identification and treatment of OCD may help to prevent the impairment of the mental health of children and adolescents.

Inverse age-related changes between hypothalamic NPY and KISS1 gene expression during pubertal initiation in male rhesus monkey

The neuroendocrine mechanism underlying the sinusoidal wave nature of gonadotropin–releasing hormone pulse generator activity from infantile to adult age still needs to be meticulously defined. Direct inhibition of kisspeptin neurons by neuropeptide Y (NPY) and close intimacy between the two rekindle the importance of these two neuropeptides controlling reproductive axis activity. Thus, the present study was undertaken to decipher simultaneous fluctuations and to profile correlative changes in the relative expression of KISS1, NPY, and their receptor genes from the mediobasal hypothalamus of infant (n = 3), juvenile, pre-pubertal, and adult (n = 4 in each stage) male rhesus monkey (Macaca mulatta) by RT-qPCR. Significant elevation (p < 0.05−0.01) in KISS1 and KISS1R and low (p < 0.05) expression in NPY and NPY1R mRNA in the adult group as compared to the pre-pubertal group was observed. Moreover, significantly high (p < 0.05) expression of NPY and NPY1R mRNA with non-significant (p> 0.05) decline in KISS1 and KISS1R in pre-pubertal animals in comparison to infants describe inverse correlative age-associated changes during pubertal development. Current findings imply that NPY may contribute as a neurobiological brake for the dormancy of kisspeptin neurons before pubertal onset, while dwindling of this brake is likely to occasion kisspeptin dependent hypothalamic–pituitary–gonadal axis activation at puberty. These findings may help in the development of clinical and therapeutic strategies to regulate fertility in humans.

Effect of sexual maturation on testicular morphometry and echotexture and their association with intratesticular blood flow in ossimi rams

Twelve Ossimi rams divided into two groups viz., pre-pubertal (4 to 5 months old, n=6), and post-pubertal (30 to 48 months old, n=6) were submitted to B-mode testicular ultrasonography (US) for evaluation of testicular length, width, thickness and volume. Testicular artery was submitted to pulsed-wave Doppler examination to measure the resistive index (RI) and pulsatility index (PI) in both groups. Testicular width (34.50±3.71mm) and volume (58.80±9.98 mm3) showed significantly (P<0.05) higher values in the pre-pubertal ram lambs compared with the post-pubertal group (33.60±1.25 mm and 56.70±4.07mm3). Blood flow indices (RI and PI) were significantly (P<0.05) higher in pre-pubertal (0.62±0.15 and 0.98±0.20) than post-pubertal (0.45±0.12 and 0.63±0.18) group. The pre-pubertal group recorded testicular echogenicity of 82.5±12.47 compared to the post-pubertal ones (76.8±13.15). In pre-pubertal group, testicular volume was highly correlated (p<0.01) with testicular length (r= 0.933), width (r= 0.935), and thickness (r= 0.813), while for mature group, testicular volume showed strong association with testicular length (r= 0.813). At both groups, RI and PI values showed strong positive associations (p<0.01). It was concluded that RI and PI were directly affected by sexual maturation and could be used as a marker for selection and/or replacing males in flocks.

Study of sexual assaults among minor victim girls

The rights of children which include the right to live, the right to health care and the right to protection from economic and sexual exploitation are at jeopardy. The basic objective of the study was to analyze the factors that make the minor girls to be victimized and to reveal the diversity of genital injuries amongst the minor survivors of sexual assault. Among all victim girls below 18 years coming to the department under POCSO Act, the details pertaining to age, religion, literacy, socio economic status, site and place of incidence, time interval between incidence and medico legal examination, number of assailants and relationship with assailants were noted. The victimized children were examined to ascertain the types of sexual abuse along with the pattern of the physical and genital injuries. Three out of four perpetrators of such crime happen to be close acquaintance, accomplish or relative. Two third of recent hymen tears were encountered in pre pubertal age groups where statistical significance (p<0.001) was also noted. This study will enhance the awareness of health care providers, policy makers, police personnel, counsellors and all other community members.

Labial Agglutination in Different Age Groups: A Case Series

Labial adhesion or agglutination is varying degree of apposition between the labia minora which may be complete or partial. Here, a case series of five patients of different age groups ranging from toddler, prepubertal, postpartum and postmenopausal age groups were included. Most often, labial adhesions are encountered in prepubertal age group due to hypoestrogenic state. Parents most often diagnose incidentally while changing diapers. Similar hypoestrogenic environment encountered in postmenopausal state where in addition to apposition, women have co-existent genitourinary symptoms for which they seek care. Old people may be delayed in seeking care due to uncertainty. Labial adhesions among reproductive age group are quite rare. Most of the case has a past history of trauma which was not adequately managed and the agglutination developed as a remote complication. All the five patients were managed as per the severity of adhesions. Treatment included from conservative approach of oestrogen cream application to surgical adhesiolysis.

Effect of natalizumab treatment on the rate of No Evidence of Disease Activity in young adults with multiple sclerosis in relation to pubertal stage

Approximately 40% of young-onset multiple sclerosis (MS) patients experience breakthrough disease, which carries a high risk for long-term disability, and requires using therapies beyond traditional first-line agents. Despite the increasing use of newer disease-modifying treatments (DMTs) in this population, data are not available to guide the need for escalating DMTs and there is a scarcity of data on the effects of natalizumab in children and young adults with active disease. We performed a retrospective analysis of the rate of No Evidence of Disease Activity (NEDA), tolerability, and safety of natalizumab in a multi-center cohort of 36 children and young adults with highly active MS. All patients had active disease and initiated treatment with natalizumab. The primary endpoint was the rate of achieving NEDA-3 status, within two years of natalizumab treatment. To examine a possible effect of age on the outcome of treatment, outcomes were also analyzed by pre-pubertal (n = 13 children aged 9–13 years) and pubertal subgroups (n = 23 young adolescents aged 14–20 years). The NEDA-3 status of the pre-pubertal group was 92% in the first and second year and in the pubertal group - 96% in the first year and 92% in the second year. Natalizumab reduced the number and volume of brain lesions in both pre-pubertal and pubertal groups. Treatment was well-tolerated, only 8 patients (22.2%) had adverse events during the 2-year study period. Our analysis shows that natalizumab is effective and well-tolerated in pre-pubertal and pubertal MS patients.

P042 Profile of systemic lupus erythematous patients at presentation 10 years of Single center experience-Tripoli-Libya

Abstract Background Juvenile Systemic Lupus Erythematous (JSLE) is a systemic autoimmune disorder with speckled manifestations that can emerge overstretched period of time and can affect any organ system, most frequently the skin, joints, kidneys, and the nervous, hematologic, and cardiovascular systems. The Aim is to examine the clinical features, serologic and laboratory characteristics associated with SLE. To probe and outline Clinical and Immunologic features of Incomplete Lupus Erythematous (ILE) patients who progressed from ILE to SLE. Methods The files of patients diagnosed as SLE in pediatric rheumatology clinic from 2001 to 5/2021 were retrospectively reviewed. Result Thirty SLE cases were included; Females were more prevalent with a female: male ratio of 14:1. Mean age at presentation 11 ± 4 years (range of 5 months-13 years), Disease onset was before sixth birthday in (7%), above twelve years in (40%) of the patients, and 53% of the patients was among 6 –12 years age group (31% &amp; 37% of them fulfilled the SLICC &amp; ACR criteria respectively at diagnosis) .The Mean duration between the onset of symptoms and SLE diagnosis was 6 months ±2 years. The Pre-pubertal age group presented early. At diagnosis, 50% of the patient got SLICC score criteria &amp;lt;4, on other hand 70% of the patients had ACR score criteria less than four Variable The most common presenting feature was arthritis (83%) (polyarticular arthritis) followed by dermatological manifestations (46%) photosensitivity, malar rash, and discoid rash in order of most frequent, fatigability (37%), renal manifestation (23%) most commonly as hematuria, one case diagnosed as lupus nephritis by renal biopsy. ANA was positive in 87%, anti-ds-DNA positive in 40% and Anti sm positive in 17%. The most frequently used medications were steroids and hydroxychlorqiune, the most commonly used steroid sparing medications were azathioprine (43%), Mycophenolate mofetil (40%) and ciclosporin (13%), 26% were on antihypertensive, 3% required rituximab to control their disease and one patient received Eltromboag to treat refractory thrombocytopenia. the mean follow-up duration 46.9 ± 43.6m, 20% lost follow up, 13% died due to disease complications (renal system involvement, thrombocytopenia and neurological system involvements). Conclusion jSLE in Libya is very rare before the sixth birthday and presented early among 6–12 years age group with a delay of less than one year between the first presentation and time of diagnosis. SLICC criteria was sufficient to diagnose the disease in &amp;gt; 50% of patients. High index of suspension should be maintained because in some patient’s years may be passed before fulfilling the diagnostic criteria. The most common cause of death is renal involvement. Glucocorticoids are the backbone of jSLE treatment in the acute phase. Both azathioprine and Mycophenolate mofetil are sufficient to control the disease in most patients. The disease outcome is accepted in our cohort as most patients have mild disease activity with low dose steroid and a steroid-sparing agent.

Sex estimation through geometric morphometric analysis of the frontal bone: an assessment in pre-pubertal and post-pubertal modern Spanish population

Sex estimates is a key step of biological profile assessment in a forensic or anthropologic context. In this study, the sexual dimorphism of the frontal bone was analyzed to assess the accuracy of sex estimates using a geometric morphometric approach in a pre-pubertal and post-pubertal sample. The shape of the frontal bone was digitized on the lateral cephalograms of 87 pre-pubertal subjects (42 males, mean age 10.14, SD ± 1.48 years; 45 females mean age 10.02, SD ± 1.11 years) and 103 post-pubertal ones (53 males, mean age 29.33 SD ± 11.88 years; 50 females, mean age 26.77 SD ± 11.07 years). A generalized Procrustes analysis (GPA) was performed for shape analyses, filtering the effects of position, rotation, translation, and size. A principal component analysis (PCA) was performed on the GPA transformed variables, and a multiple logistic regression model was used to assess the accuracy of sex estimates. In both age groups, the average size of the centroid was significantly larger in males. The females presented shapes with a shorter distance between P2 (glabella) and P1 (supratoral) and a general narrowing of the structure on the sagittal plane. In the pre-pubertal group, the shape difference was not statistically significant. In the post-pubertal group, the mean shape was significantly different between the sexes. The method displayed a high accuracy for sex estimates (88.7% males, 90.3% females) also when applied in a validation sample (82.6% males and 94.1% females). The described morphometric analysis of the frontal bone is based on a limited number of landmarks, which allows sex estimates with high accuracy in post-pubertal subjects, while it is not applicable in pre-pubertal ones.

Age-related histomorphometric and ultrastructural changes in the Sertoli cells of Japanese quail (Coturnix Coturnix japonica)

Prepared sections from pre-pubertal, pubertal, adult, and aged Japanese quail testes were examined by light microscopy and transmission electron microscopy (TEM) and measurements of seminiferous tubular diameter (STD), luminal diameter (SLD), epithelial height (SEH) and cross-sectional area of the seminiferous tubules (AST) were taken using an image analyzer. Apoptotic Sertoli cells with features such as cell shrinkage and chromatin condensation were observed in pre-pubertal and aged quail. There was a significant difference between the mean Sertoli cell number (SCN), SLD, SEH, STD and AST among the four age groups (P < 0.001). The highest SCN (mean ± standard error) was recorded in the adult (30.53 ± 0.42), with the aged group displaying the lowest mean (11.80 ± 0.27) SCN. Spearman’s rho correlation coefficients demonstrated a strong relationship between the SCN and SEH in the pubertal (ρ=0.915; P < 0.001), adult (ρ=0.878; P < 0.001), and aged (ρ=0.858; P < 0.001) groups, while a significant moderate correlation was observed in the pre-pubertal (ρ=0.606; P < 0.001) group. There were significant moderate correlations between the SCN and STD in the pre-pubertal (ρ=0.445; P < 0.001), pubertal (ρ=0.653; P < 0.001), adult (ρ=0.440; P < 0.001), and aged (ρ=0.514; P < 0.001) groups. Furthermore, significant moderate correlations were estimated between the SCN and AST in the pre-pubertal (ρ=0.453; P < 0.001), pubertal (ρ=0.661; P < 0.001), adult (ρ=0.393; P = 0.001), and aged (ρ=0.498; P < 0.001) groups. This study provides baseline data on the morphology and development of the Sertoli cell, as well as testicular morphometry in avian species during the pre-pubertal, pubertal, adult, and aged stages using the Japanese quail as a model.

The Relationship Between Salivary Dehydroepiandrosterone Sulphate (DHEAS) Levels and Skeletal Maturation Parameters Before and During Pubertal Growth Spurt in Children

Objectives: This study aimed to assess the skeletal maturation by using salivary DHEAS levels and its correlation with existing skeletal maturity parameters represented by cervical vertebrae and MP3 region radiographs in adolescents in pre-pubertal and pubertal age groups. Methods: In this study, 80 children in the age range of 8 - 14 years were divided into two equal groups based on their chronological age as group I (pre-pubertal group) and group II (pubertal group). Pre-existing lateral cephalograms and medial phalanx of third finger (MP3) radiographs of their left hands were assessed. The levels of the DHEAS of each individual were analysed by ELISA kit. ANOVA with post-hoc Tukey’s test and student t-test were used for statistical analysis. P-value &lt; 0.05 was considered significant. Results: The mean level of DHEAS values shown in the present study was 4.36 +/- 0.32 ng/mL in group I and 5.73+/-0.39 ng/mL in group II. This study showed that in group I, more subjects were in stage 1 of cervical vertebral maturation than stage 2 and there were significant differences between the two stages (P-value = 0.011); also, in group II, more subjects were in stage 3 than 4 and there were significant differences between the two stages (P-value = 0.017). This study revealed the highest salivary DHEAS levels to be in the F stage of pre-pubertal MP3 development in addition to the H stage of MP3 development in pubertal children. This study noted that there were significant differences for salivary DHEAS levels between males and females not only in pre-pubertal (P-value = 0.031), but also in pubertal stages (P-value &lt; 0.001). Conclusions: Salivary DHEAS, like cervical vertebra and MP3 radiographs, can be used for growth assessment in young adolescents.