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Kazemian SV, Hosseinzadeh E, Khodashenas MR, Dadgarmoghaddam M, Tabesh H. Anthropometric indices growth references (length, Weight and Head Circumferences) of children aged 0-24 months in North-East of Iran by GAMLSS. BMC Pediatr 2024; 24:649. [PMID: 39394559 DOI: 10.1186/s12887-024-05126-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 09/30/2024] [Indexed: 10/13/2024] Open
Abstract
BACKGROUND Growth references play a crucial role in the screening, evaluation, and surveillance of children, aiding in the early identification of the requirement for diverse growth-promoting interventions. Variations in human growth across distinct ethnic cohorts arise from genetic disparities, lifestyle variances, nutritional diversity, and diverse social and environmental contexts. Consequently, the selection of growth references markedly influences the prevalence of developmental disorders and nutritional imbalances in children. The study aims to assess the growth percentile of children in the north-east of Iran and establish population-specific reference charts for length, weight, and head circumference spanning from birth to 24 months. METHODS This cross-sectional population-based research conducted in the north-east of Iran, from 2016 to 2023. The Data extracted from the electronic health records of Mashhad University of Medical Sciences. All apparently healthy children aged from birth to 24 months who were measured at least once by health staff at the ages of birth,1,2,4,6,7,9,12,15,18,24 months were included. The target population of the study were 479,089 children (96.21%), encompassing 233,565 girls (48.75%) and 245,524 boys (51.25%). Gender-specific percentile curves for length, weight, and head circumference concerning age, as well as weight concerning length, were derived using the GAMLSS approach. RESULTS From the anthropometric information of 479,089 children (245,524 boys and 233,565 girls), growth charts were constructed. In comparison to the standard WHO chart, Iranian neonates displayed lower weight across all percentiles during the first month after birth, exhibited decreased head circumference at the 3rd percentile, and boys showed reduced length across all percentiles. After this age, Iranian children demonstrated increased weight, length, and head circumference. CONCLUSIONS This research introduces the inaugural large-scale endeavor for indigenous reference charts. Through the noted distinctions from the international reference, the utilization of this novel resource offers the potential to enhance the surveillance of children's growth within the area. Moreover, by accurately assessing growth anomalies such as underweight, stunting, and wasting, it expands the domain of impactful policies in this sphere. Simultaneously, it enables the exploration of the secular trend of children's growth in the forthcoming years.
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Affiliation(s)
- Seyedeh Vajiheh Kazemian
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Hosseinzadeh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Khodashenas
- Department of Foreign Languages, Faculty of English Literature, Farhangian University, Mashhad, Iran
| | - Maliheh Dadgarmoghaddam
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Kumar V, Sankar J, Jana M, Jat KR, Kabra SK, Lodha R. Comparison of Protocol-Based Continuous and Intermittent Tube Feeding in Mechanically Ventilated Critically Ill Children - An Open Label Randomized Controlled Trial. Indian J Pediatr 2024; 91:1001-1007. [PMID: 38064124 DOI: 10.1007/s12098-023-04941-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/03/2023] [Indexed: 09/21/2024]
Abstract
OBJECTIVES To compare the time taken to reach the target calories and proteins by protocol based "continuous tube feeding (CTF)" and "intermittent tube feeding (ITF)" in critically ill children. METHODS This trial was conducted in the Pediatric Intensive Care Unit (PICU) of a tertiary care institute. Eligible children were randomized to receive CTF or ITF. Target calories were defined as 70% of calorie amount as per the WHO formula and target protein was defined as 1.5 g/kg as per the American Society of Parenteral and Enteral Nutrition (ASPEN) criteria. The primary outcome was time taken to reach target calories, the secondary outcomes were time taken to reach target protein, incidence of feed intolerance, PICU mortality, duration of ventilation, and outcome on 28th day. RESULTS Fifty-eight children were randomized; 29 in each group. The baseline characters were comparable. The median (IQR) times for reaching target calories were 1.7 (1.4, 2.5) d and 1.8 (1.4, 4.4) d in the CTF and ITF groups, respectively [Hazards ratio (HR) 0.89 (95% CI 0.5, 1.5); p = 0.69]. For the target protein intake, the median times were comparable in the 2 groups [HR 0.82 (95% CI 0.4-1.5); p = 0.55]. The other outcomes were not significantly different between the groups. CONCLUSIONS The authors did not observe any difference in the time taken to reach target calories and protein between the two different modes of delivery of enteral nutrition.
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Affiliation(s)
- Vijaya Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Deshmukh VR, Oka GA. How do adolescents perceive body image and respond to body dissatisfaction? Int J Adolesc Med Health 2024:ijamh-2024-0112. [PMID: 39331626 DOI: 10.1515/ijamh-2024-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 09/07/2024] [Indexed: 09/29/2024]
Abstract
OBJECTIVES To assess adolescents' attitudes, satisfaction, and practices regarding their body image across body mass index (BMI) categories. METHODS In this cross-sectional survey (2019-2020), we recorded anthropometry of 2,089 girls and boys between 13 and 17 years from semi-urban schools in western India. Multidimensional Body-Self Relations Questionnaire (MBSRQ) was used for multidimensional attitudinal assessment of body image and weight-related variables. The Stunkard scale was used to assess body shape perception. RESULTS In higher age categories, boys were more satisfied with their appearance (p=0.012, p linearity=0.001), cared more about grooming (p=0.007, p linearity=0.001), and regarded themselves more physically fit (p=0.003, p linearity 0.030 up to 16 years). Boys with normal BMI were more satisfied with their appearance (p=0.001), fitness (p=0.024), and more alert about symptoms of illness (p<0.000) than others. With increasing BMI, older girls and boys were more preoccupied with their weight and perceived themselves to be heavier (p=0.001). A majority of underweight girls perceived their weight as normal. Students engaged in weight loss practices irrespective of their BMI category. Boys wanted a bigger, and girls a smaller body shape than their current shape. We found body shape dissatisfaction in 66.4 % adolescents, more in boys than in girls (p=0.001). CONCLUSIONS Body shape dissatisfaction is quite common among semiurban adolescents, with boys outnumbering girls. BMI, age, and sex are associated with weight perception and attitude toward body image. Unindicated weight loss practices are prevalent.
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Affiliation(s)
- Vaishali R Deshmukh
- Department of Paediatrics, 76038 Deenanath Mangeshkar Hospital and Research Centre , Pune, Maharashtra, India
| | - Gauri A Oka
- Central Research and Publication Unit, Bharati Vidyapeeth University Medical College and Hospital, Pune, Maharashtra, India
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Singh R, Mantan M, Mahajan A, Tyagi V, Goswami B. Seroprevalence of SARS-CoV-2 antibodies in children with nephrotic syndrome and chronic kidney disease: a cross-sectional study from India. Pediatr Nephrol 2024:10.1007/s00467-024-06534-y. [PMID: 39327265 DOI: 10.1007/s00467-024-06534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 08/29/2024] [Accepted: 08/29/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND There is a paucity of literature on the seroprevalence of SARS-CoV-2 antibodies among pediatric patients with underlying kidney disorders; few serosurveys among healthy children have shown seropositivity of 20-65% after different waves of infections. METHODS The study had a cross-sectional design and was conducted between January 2023 and July 2023; 163 children and adolescents (1-18 years) with nephrotic syndrome and chronic kidney disease (CKD) were screened for Anti-Spike SARS-COV-2 IgG antibodies as detected by a quantitative chemiluminescence immunoassay. Children with nephrotic syndrome, both steroid sensitive (SSNS) and steroid resistant (SRNS) were enrolled during disease remission. Correlation of SARS-CoV-2 seropositivity status was done with age, gender, disease type, treatment duration, immunosuppressants, previous SARS-CoV-2 infection, and immunization status. RESULTS Of 163 children (63.8% boys) with median age of 9 years; 101 (62%) had underlying nephrotic syndrome (61 SSNS and 40 SRNS), and 62 (38%) children had CKD. Seroprotective titers for SARS-COV2 antibodies were present in 100 (61.3%) children. The median titers for all patients were 37.1 BAU/mL; for nephrotic syndrome they were 27.1 BAU/mL and for CKD they were 76.7 BAU/mL (p = 0.0033). A total of 43 (26.4%) children had high positive antibody levels (> 200 BAU/ml). Among those with nephrotic syndrome 60.7% with SSNS and 43.5% SRNS had seropositive titers. Only 4 (2.5%) children had a history of previous COVID infection and 6 (3.7%) were vaccinated. CONCLUSIONS In a largely unvaccinated population of children with nephrotic syndrome and CKD, 61.3% were seropositive for SARS-CoV-2 IgG antibody indicating a past asymptomatic infection; titers were significantly higher in CKD compared to nephrotic syndrome.
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Affiliation(s)
- Richa Singh
- Division of Pediatric Nephrology, Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Mukta Mantan
- Division of Pediatric Nephrology, Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| | - Akanksha Mahajan
- Division of Pediatric Nephrology, Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Vernika Tyagi
- Division of Pediatric Nephrology, Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Binita Goswami
- Department of Biochemistry, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Sravani M, Selvam S, Iyengar A. Nutritional profile and infection-related hospital admissions in children with chronic kidney disease. Pediatr Nephrol 2024:10.1007/s00467-024-06532-0. [PMID: 39331075 DOI: 10.1007/s00467-024-06532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 08/23/2024] [Accepted: 09/09/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Protein energy wasting (PEW) and undernutrition are highly prevalent in children with chronic kidney disease (CKD), but their impact on clinical outcomes is not well described. This prospective longitudinal study in children with CKD assessed the association of nutritional parameters with infection-related hospital admissions (IRHA). METHODS Children with CKD2-5D aged 2-18 years and infection-free for 1 month were recruited over 5 years. Evaluation for undernutrition by subjective global nutritional assessment and for PEW using paediatric criteria was undertaken and categorized as mild (>2 criteria), standard (>3 criteria) and modified PEW (>3 criteria with short stature). The IRHA (severe viral, bacterial or fungal infections) were recorded. RESULTS Among 137 children (45 on dialysis; age 123 ± 46 months; 70% males), undernutrition was seen in 60% and PEW in 52%. In over 38 ± 21 months follow-up, 107 (78%) required hospital admissions (67% IRHA). The incidence rate of IRHA in days per patient-year was higher in those with undernutrition compared to well-nourished children [1.74 (1.27, 2.31) vs. 0.65 (0.44, 0.92) p < 0.0001] and higher in those with PEW compared to no PEW [1.74 (1.30, 2.28) vs. 0.56 (0.36, 0.82) p < 0.0001] respectively. On adjusted analysis, independent risk factors for IRHA were undernutrition, low BMI, hypoalbuminemia and dialysis status with modified PEW [OR 5.34 (2.16, 13.1) p < 0.001] and raised CRP [OR 4.66 (1.56, 13.9) p = 0.006] having the highest risk. Additionally, modified PEW and BMI were noted to have a twofold risk for recurrent infections. CONCLUSION In children with CKD2-5D, incidence rate of IRHA was significantly higher in those with undernutrition and PEW. While dialysis, poor nutritional status and inflammation were risk factors for IRHA, modified PEW and BMI were associated with recurrent infections.
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Affiliation(s)
- Madhileti Sravani
- Department of Pediatric Nephrology, St John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Sumitra Selvam
- Department of Biostatistics, St John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's National Academy of Health Sciences, Bengaluru, Karnataka, India.
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Sachan N, Dabas A, Mantan M, Dabla PK. Urinary biomarkers NG AL and beta-2 microglobulin in children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2024; 37:764-772. [PMID: 39166792 DOI: 10.1515/jpem-2024-0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/14/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVES To study the urinary neutrophil gelatinase-associated lipocalin (NGAL) and beta-2-microglobulin (β2M) levels as markers of tubular damage in children with type 1 diabetes (T1DM). METHODS Forty T1DM children and 40 age-matched controls were enrolled. Subjects with coexisting kidney disorder, intake of oral glucose lowering drugs and syndromic diabetes mellitus were excluded. Fasting plasma glucose, glycated hemoglobin (HbA1c), kidney function, urinary albumin-creatinine ratio (UACR), NGAL and β2M were measured and compared in cases and controls. RESULTS The median (IQR) age of cases and controls was 10.6 (8, 14.2) and 10.7 (8.4, 13.7) years, respectively. Cases had disease duration of 4 (3, 6.8) years and HbA1c 10.9 (9, 13.1) %. Microalbuminuria was seen in 14 (35 %). Median (IQR) levels of UACR were higher in cases than controls [19.38 (10.27, 35.26) and 6.49 (3.10, 11.65) µg/mg; p<0.001], similarly NGAL/creatinine [352.21 (191.49, 572.45) and 190.54 (125.91, 322.83) ng/mg; p=0.006], unlike β2M/creatinine [1.7 (0.43, 6.02) and 2.12 (1.05, 4.47) µg/mg; p=0.637]. Children with higher HbA1c (≥10 %) had higher urinary ACR and tubular biomarkers than HbA1c<10 % (p>0.05). Urinary ACR showed positive correlation with NGAL/creatinine (r=0.38, p=0.019) and β2M/creatinine (r=0.42, p=0.009). CONCLUSIONS Urinary biomarkers NGAL and β2M were elevated in the presence of normal urinary microalbumin levels suggestive of early tubular damage in T1DM.
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Affiliation(s)
- Nimisha Sachan
- Department of Pediatrics, 28862 Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Aashima Dabas
- Department of Pediatrics, 28862 Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Mukta Mantan
- Department of Pediatrics, 28862 Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Pradeep K Dabla
- Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Oza C, Khadilkar A, Bhor S, Curran K, Sambare C, Ladkat D, Bettiol A, Quinn M, Sproule A, Willoughby C, Peto T. Prevalence and Predictors of Diabetic Retinopathy, Its Progression and Regression in Indian Children and Youth With Type-1 Diabetes. Clin Med Insights Endocrinol Diabetes 2024; 17:11795514241275921. [PMID: 39233877 PMCID: PMC11372767 DOI: 10.1177/11795514241275921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/01/2024] [Indexed: 09/06/2024] Open
Abstract
Objective There are very few reports on the prevalence of diabetic retinopathy (DR) in children and youth with type-1 diabetes (T1D). Studies have also found very low rates of referral for DR screening in children and youth with T1D. We conducted this study to determine the prevalence of DR, to study the reliability of ISPAD screening recommendations and to identify predictors of DR, its progression and regression in Indian children and youth with T1D. Methods This study included 882 children and youth with T1D. Demographic data, anthropometry, blood pressure, sexual maturity rating, ophthalmological examination (slit lamp for cataract) and biochemical measurements were performed using standard protocols. Fundus images were captured using the Forus Health 3netra classic digital non-mydriatic fundus camera by the same experienced operator. De-identified images were assessed by a senior grader and ophthalmologist (Belfast Ophthalmic Reading Center). Severity of DR was graded as per the UK National Health Service (NHS) DR classification scale. Result We report 6.4% and 0.2% prevalence of DR and cataract in Indian children and youth with T1D, respectively. All the subjects with DR had early non-proliferative DR. We report that amongst subjects with DR, only 2 subjects were aged less than 11 years and had duration of illness less than 2 years. Presence of hypertension and older age were significant predictors of DR (P < .05). Subjects with DR had significantly higher triglyceride concentrations (P < .05), of these, 6.9% had progression and 2.9% had regression at 1 year follow up; the change in glycaemic control was a significant positive predictor of progression of DR (P < .05). None of the participants included in the study progressed to develop sight-threatening DR. Conclusion DR is not uncommon in Indian children and youth with T1D, thus screening for DR needs to be initiated early, particularly in older individuals with higher disease duration. Controlling blood pressure and triglyceride concentrations may prevent occurrence of DR. Improving glycaemic control may prevent progression of DR in Indian children and youth with T1D.
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Affiliation(s)
- Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Shital Bhor
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Katie Curran
- Centre for Public Health, Queen's University Belfast, Northern Ireland
| | - Chitra Sambare
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Dipali Ladkat
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Michael Quinn
- Centre for Public Health, Queen's University Belfast, Northern Ireland
| | - Alan Sproule
- Centre for Public Health, Queen's University Belfast, Northern Ireland
| | - Colin Willoughby
- Genomic Medicine, Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Northern Ireland
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Khadilkar AV, Oza C, Kajale N, Pulungan AB, Wacharasindhu S, Moelyo AG, Amalia G, Wejaphikul K, Julia M, Dejkhamron P, Khadilkar V. Local anthropometric parameters for assessing double burden of malnutrition in South Asian and Southeast Asian countries: a review and retrospective analysis. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 28:100473. [PMID: 39280018 PMCID: PMC11399708 DOI: 10.1016/j.lansea.2024.100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 09/18/2024]
Abstract
The double burden of malnutrition (DBM) is a significant public health issue in South and Southeast Asia (SA and SEA). This study aimed to assess the impact of using local and regional ethnicity-specific anthropometric references versus international references on the prevalence of DBM in these regions.A narrative review of DBM prevalence using local versus international standards was conducted. Additionally, deidentified datasets from India and Indonesia were analyzed to evaluate the effectiveness of different growth standards in identifying DBM. Anthropometric Z-scores were compared, and sensitivity, specificity, and positive predictive value (PPV) were calculated.WHO standards had the lowest specificity for identifying short stature in India and Indonesia. BMI-for-age charts using WHO Growth Reference (2007) had lower sensitivity and higher specificity for metabolic risk. Local references showed lower stunting and higher overweight or obesity prevalence. International standards overestimated stunting and underestimated obesity, leading to misclassification and missed cases of metabolic risk. Funding None.
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Affiliation(s)
- Anuradha V Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Lower Ground Floor, Block V, Jehangir Hospital, 32 Sassoon Road, Pune, 411001, Maharashtra, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, 411007, Maharashtra, India
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Lower Ground Floor, Block V, Jehangir Hospital, 32 Sassoon Road, Pune, 411001, Maharashtra, India
| | - Neha Kajale
- Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Lower Ground Floor, Block V, Jehangir Hospital, 32 Sassoon Road, Pune, 411001, Maharashtra, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, 411007, Maharashtra, India
| | - Aman B Pulungan
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Indonesia
| | - Suttipong Wacharasindhu
- Department of Pediatrics and School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Annang Giri Moelyo
- Department of Child Health, Faculty of Medicine Universitas Sebelas Maret, Indonesia
| | | | - Karn Wejaphikul
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Madarina Julia
- Department of Child Health, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Indonesia
| | - Prapai Dejkhamron
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Lower Ground Floor, Block V, Jehangir Hospital, 32 Sassoon Road, Pune, 411001, Maharashtra, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, 411007, Maharashtra, India
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Deepthi B, Krishnasamy S, Krishnamurthy S, Khandelwal P, Sinha A, Hari P, Jaikumar R, Agrawal P, Saha A, Deepthi RV, Agarwal I, Sinha R, Venkatachari M, Shah MA, Bhatt GC, Krishnan B, Vasudevan A, Bagga A, Krishnamurthy S. Clinical characteristics and genetic profile of children with WDR72-associated distal renal tubular acidosis: a nationwide experience. Pediatr Nephrol 2024:10.1007/s00467-024-06478-3. [PMID: 39150521 DOI: 10.1007/s00467-024-06478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 07/22/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Limited data, primarily from small case series, exist regarding the clinical profile, genetic variants, and outcomes of WDR72-associated distal renal tubular acidosis (WDR72-dRTA). METHODS Our study enrolled children diagnosed with WDR72-dRTA below 18 years of age from 9 Indian centers and analyzed their clinical characteristics, genetic profiles, and outcomes. Potential genotype-phenotype correlations were explored. RESULTS We report 22 patients (59% female) with WDR72-dRTA who were diagnosed at a median age of 5.3 (3, 8) years with polyuria (n = 17; 77.3%), poor growth (16; 72.7%), and rickets (9; 40.9%). Amelogenesis imperfecta was present in 21 (95.5%) cases. At presentation, all patients had normal anion gap metabolic acidosis; hypokalemia and nephrocalcinosis were seen in 17 (77.3%) patients each. Seven (31.8%) patients had concomitant proximal tubular dysfunction. Genetic analysis identified biallelic nonsense variants in 18 (81.8%) patients, including novel variants in 6 cases. A previously reported variant, c.88C > T, and a novel variant, c.655C > T, were the most frequent variants, accounting for 10 (45.5%) cases. Over a median follow-up of 1.3 (1, 8) years, the height velocity improved by 0.74 (0.2, 1.2) standard deviation scores, while 3 children (13.6%) progressed to chronic kidney disease (CKD) stage 2, with eGFR ranging from 67 to 76 mL/min/1.73 m2, respectively, after 11.3-16 years of follow-up. No specific genotype-phenotype correlation could be established. CONCLUSIONS WDR72-dRTA should be considered in children with typical features of amelogenesis imperfecta and dRTA. Biallelic nonsense variants are common in Asians. While most patients respond well to treatment with improved growth and preserved eGFR, on long-term follow-up, a decline in eGFR may occur.
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Affiliation(s)
- Bobbity Deepthi
- Pediatric Nephrology Services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Sudarsan Krishnasamy
- Pediatric Nephrology Services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | | | - Priyanka Khandelwal
- Division of Pediatric Nephrology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Aditi Sinha
- Division of Pediatric Nephrology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pankaj Hari
- Division of Pediatric Nephrology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rohitha Jaikumar
- Division of Pediatric Nephrology, Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Prajal Agrawal
- Division of Pediatric Nephrology, Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Abhijeet Saha
- Division of Pediatric Nephrology, Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - R V Deepthi
- Division of Pediatric Nephrology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Indira Agarwal
- Division of Pediatric Nephrology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India
| | - Mahesh Venkatachari
- Department of Pediatrics, All India Institute of Medical Sciences, Mangalagiri, India
| | - Mehul A Shah
- Little Star Children's Hospital, Hyderabad, India
| | - Girish Chandra Bhatt
- Division of Pediatric Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, India
| | - Balasubramanian Krishnan
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Anil Vasudevan
- Division of Molecular Medicine, St. John's Research Institute, Bangalore, India
- Department of Pediatric Nephrology, St. John's Medical College Hospital, Bangalore, India
| | - Arvind Bagga
- Division of Pediatric Nephrology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sriram Krishnamurthy
- Pediatric Nephrology Services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
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10
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Mondal KAP, Singh P, Singh R, Malhotra RK, Seth A. Daily versus fortnightly oral vitamin D 3 in treatment of symptomatic vitamin D deficiency in children aged 1-10 years: An open labelled randomized controlled trial. Clin Endocrinol (Oxf) 2024. [PMID: 39138889 DOI: 10.1111/cen.15124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 07/03/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE Compare the efficacy and safety of daily versus fortnightly oral vitamin D3 in treating symptomatic vitamin D deficiency in children aged 1-10 years. DESIGN Open labelled randomized controlled trial. PATIENTS Eighty children with symptomatic vitamin D deficiency were randomized into group daily (D) and group bolus (B) [40 in each group] to receive oral vitamin D3, 4000 IU daily or 60,000 IU fortnightly for 12 weeks respectively. Both groups received daily oral calcium of 500 mg/day. MEASUREMENTS Serum calcium (Ca), phosphate (P), alkaline phosphatase (ALP), 25-hydroxy cholecalciferol (25(OH)D), parathyroid hormone (PTH) levels, urine calcium: creatinine ratio and radiological score were assessed at baseline, 4 weeks and 12 weeks. At the end of 12 weeks, 74 children were available for evaluation of the efficacy and safety of both regimens. RESULTS Both regimens led to a significant increase in Ca and P levels and a fall in ALP and PTH levels from baseline to 4 and 12 weeks of therapy, with no intergroup difference. At 4- and 12-week assessments, all children in both treatment arms achieved 25(OH)D level in sufficiency range, with no significant difference in their geometric mean. Both regimens were associated with asymptomatic transient hypercalcemia [group D-51.4% vs. group B-34.3%; p -0.14] and hypercalciuria (5.7%) in group D that resolved spontaneously on follow-up. CONCLUSIONS Daily and fortnightly oral vitamin D3 in similar cumulative doses are efficacious for treating symptomatic vitamin D deficiency in children (1-10 years). Treated children should be monitored for serum 25(OH)D, Ca and urinary calcium creatinine ratio.
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Affiliation(s)
| | - Preeti Singh
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Ritu Singh
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Rajeev Kumar Malhotra
- Department of Delhi Cancer Registry, BR Ambedkar IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Anju Seth
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
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11
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Solomon RS, Solomon AR. Utility of anthropometry in defining overweight and obesity in urban South Indian children. J Family Med Prim Care 2024; 13:2952-2957. [PMID: 39228557 PMCID: PMC11368354 DOI: 10.4103/jfmpc.jfmpc_1656_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 09/05/2024] Open
Abstract
Introduction Waist-based indicators of obesity are being used to detect central obesity and are predictive for metabolic syndrome (MS). The aim of the study is to assess the basic anthropometric indices in children, to determine the prevalence of overweight and obesity, and to determine the association between various waist-based measurements and body mass index (BMI). Methodology A cross-sectional study was conducted among children aged 10 to 15 years attending government corporation schools in Chennai. Basic anthropometric measurements were taken. BMI, waist circumference/height ratio (WHtR), and waist circumference/hip circumference ratio (WHR) were calculated. The percentiles (Indian reference cutoffs) were determined for waist circumference (WC) and BMI. The prevalence of overweight and obesity was determined and compared to waist-based parameters. Results Of 820 children, males constituted 47.1%. Stunting was seen in 9.8% and 7.8% were underweight. 8.2% had BMI less than the 3rd percentile. The prevalence of overweight and obese children was 9% and 3.2%, respectively, with female predominance. The majority had WC less than the 5th percentile. The prevalence of children under risk for MS based on WC >70th percentile was 4.5% and based on WHtR >0.5 was 8.2%. A significant association was identified between all waist-based anthropometric measurements to detect children at risk for MS and overweight/obese children as per BMI category. WHtR >0.5 was an indicator of overweight/obese children in logistic regression analysis. Conclusion Early identification of children at risk of MS would require a combination of BMI to detect general obesity and waist-based anthropometric measurements to identify central obesity.
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Affiliation(s)
- Ritchie S. Solomon
- Department of Pediatric Cardiology, Institute of Child Health and Hospital for Children, Egmore, Chennai, Tamil Nadu, India
| | - Adlyne R. Solomon
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Mount Poonamallee Road, Chennai, Tamil Nadu, India
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12
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Kajale NA, Oza C, Ladkat D, Gondhalekar K, Katapally TR, Bhawra J, Mansukhani N, Bapat A, Khadilkar V, Khadilkar A. A Comparative Study of Bone-Health and Associated Factors in Healthy Indian Adolescents and Young Women. Indian J Endocrinol Metab 2024; 28:397-404. [PMID: 39371658 PMCID: PMC11451963 DOI: 10.4103/ijem.ijem_424_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/21/2024] [Accepted: 03/18/2024] [Indexed: 10/08/2024] Open
Abstract
Introduction Adolescence is a critical period for the accrual of bone mass. However, few studies have assessed the bone geometry in slum-dwelling girls/young women. We thus conducted this study: (1) to assess bone health in Indian adolescent girls and young women residing in slum vs nonslum (NS) areas and (2) to identify factors associated with poor bone health. Methods This cross-sectional case-control study was performed on 110 apparently healthy unmarried, nonpregnant, nonlactating, postmenarchal adolescent girls and young women aged 11 to 24 years residing in urban slums with the same number of age-matched controls from NS areas. Anthropometric, dietary, physical-activity and bone-health parameters (using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography-DXA and pQCT-respectively) were evaluated using standard protocols. A P value of < 0.05 was considered statistically significant. Results Slum girls were significantly shorter and lighter and had lower dietary intakes of calcium and protein after adjusting for total daily calorie intake than NS girls (P < 0.05). Areal bone-mineral density (BMD) at lumber spine (0.940 ± 0.13 vs1.042 ± 0.15 g/cm2), femur and total body (less-head), bone-mineral apparent density adjusted for volume at the lumbar spine (0.295 ± 0.04 vs 0.319 ± 0.04 g/cm3) and height-adjusted bone density at femur (0.862 ± 0.011 vs 0.905 ± 0.011 g/cm2) were significantly lower in slum dwelling participants as compared to their NS counterparts (P < 0.05). After adjusting for confounders like sunlight exposure, anthropometric parameters and dietary calcium intake, area of dwelling was still a significant factor for the difference in BMD. Conclusions The potential determinants of poor bone density and geometry in girls and young women residing in slums include residential location, dietary habits, and physical activity levels. Despite adjustments for confounding factors, differences in bone health between those in slum and nonslum areas suggest adaptations developed over generations of deprivation in these individuals, necessitating urgent intervention.
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Affiliation(s)
- Neha A. Kajale
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, Maharashtra, India
| | - Chirantap Oza
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Dipali Ladkat
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Ketan Gondhalekar
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Tarun R. Katapally
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
- DEPtH Lab, School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, N6A 3K7, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, N6A 3K7, Canada
- Children’s Health Research Institute, Lawson Health Research Institute, London, Ontario, N6A 4V2, Canada
| | - Jasmin Bhawra
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, ON, M5B 2K3, Canada
| | - Nina Mansukhani
- Department of Obstetrics and Gynecology, Jehangir Hospitals, Pune, Maharashtra, India
| | - Anita Bapat
- Department of Obstetrics and Gynecology, Jehangir Hospitals, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, Maharashtra, India
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Krishna GM, Dabas A, Mantan M, Kumar M A, Goswami B. Adrenocortical suppression in children with nephrotic syndrome treated with corticosteroids. Pediatr Nephrol 2024; 39:1817-1824. [PMID: 38253887 DOI: 10.1007/s00467-024-06294-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Children with nephrotic syndrome are exposed to alternate day steroids for prolonged periods and this poses the need for evaluation of adrenocortical suppression using the adrenocorticotropic hormone (ACTH) stimulation test. METHODS This cross-sectional study enrolled children (2-18 years) both with steroid sensitive nephrotic syndrome (SSNS) (n = 27) and steroid resistant (SRNS) (n = 25); those on daily prednisolone or having serious bacterial infections or hospitalized were excluded. The primary objective was to determine prevalence of adrenocortical suppression in those on low dose alternate day steroids for more than 8 weeks or having received > 2 mg/kg/d for > 2 weeks in the past 1 year and currently in remission. A baseline morning fasting sample of serum cortisol was taken and 25 IU of ACTH (Acton Prolongatum*) injected intramuscularly and repeat serum cortisol sample taken after 1 h. All patients with 1 h post ACTH cortisol < 18.0 µgm/dl were diagnosed with adrenal insufficiency. Receiver operating characteristic curve was drawn to predict the prednisolone dose for adrenal insufficiency. RESULTS Fifty-two (33 males) children were enrolled (mean age 9.4 years); proportion of adrenal insufficiency was 50% and 64% using baseline and post stimulation cutoffs. The total cumulative annual dose of prednisolone 0.22 mg/kg/day predicted adrenocortical suppression with AUC 0.76 (95% CI 0.63-0.89), with sensitivity of 63.9% and specificity of 81.3%. CONCLUSIONS A significant proportion of children with nephrotic syndrome were detected with adrenal insufficiency on ACTH stimulation test. A cumulative steroid intake of > 0.22 mg/kg/day on an alternate day basis emerged as a risk factor for predicting adrenocortical suppression.
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Affiliation(s)
- Ganesh M Krishna
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Aashima Dabas
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Mukta Mantan
- Division of Pediatric Nephrology, Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| | - Akshay Kumar M
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Binita Goswami
- Department of Biochemistry, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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14
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Alam A, Singh SK, Kumar R, Mannan R. Impact of Thyroid Autoimmunity on the Clinical and Biochemical Characteristics of Type 1 Diabetes Mellitus Patients. Cureus 2024; 16:e62307. [PMID: 39006700 PMCID: PMC11245889 DOI: 10.7759/cureus.62307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) is frequently associated with other autoimmune disorders that are characterized by the presence of organ-specific autoantibodies. Autoimmune thyroid disease (AIT) is the most frequent autoimmune disorder associated with T1DM. Thyroid peroxidase antibodies (TPOAb) serve as a marker for diagnosing AIT. Prior research indicates that thyroid dysfunction can negatively impact linear growth and glycemic control in subjects with T1DM. The present study was done to determine the impact of thyroid autoimmunity on the clinical and biochemical characteristics of patients with newly diagnosed T1DM. METHODS In this single-center, hospital-based, observational cross-sectional study, we enrolled 70 patients with newly diagnosed T1DM ≤18 years of age. Type 1 diabetes mellitus was diagnosed based on the acute onset of osmotic symptoms with or without diabetic ketoacidosis (DKA), severe hyperglycemia (blood glucose >13.9 mmol/l (>250 mg/dl)), and insulin requirement from the onset of diabetes. Secondary diabetes, pancreatic diabetes (Type 3c), and maturity-onset diabetes of the young (MODY) were excluded. Participants were screened for AIT disease using TPOAb testing. Based on the presence or absence of TPOAb, the participants were categorized into two groups: Group A comprised individuals with T1DM who tested positive for TPOAb, while Group B consisted of those who tested negative for TPOAb. RESULTS Out of 70 patients, 41.4% were girls and 58.6% were boys, with a mean age of 9.8±4.4 years. The prevalence of TPOAb among the cohort was 18.6%. A significant majority of patients (71.4%), presented with DKA. Group A showed significantly lower mean height standard deviation scores (SDS) compared to Group B (-0.3±0.6 vs. -0.8±0.5, p = 0.004), but no differences in weight SDS or BMI SDS. Hemoglobin A1C (HbA1c) levels, C-peptide levels, and frequency of DKA did not differ between groups. Group A had higher mean thyroid-stimulating hormone (TSH) levels (4.8±3.7 µU/ml vs. 2.6±1.5 µU/ml, p = 0.001) and a greater proportion of patients with TSH levels above the upper limit of normal compared to Group B (38.4% vs. 7.1%, p = 0.008). Additionally, Group A exhibited a higher frequency of glutamic acid decarboxylase antibody (GADA) positivity compared to Group B (46.1% vs. 17.5%, p = 0.04). CONCLUSION Patients positive for TPOAb exhibited significantly lower height SDS compared to TPOAb-negative patients. Additionally, T1DM patients with TPOAb positivity showed an increased frequency of GADA compared to those without TPOAb. However, no significant differences were found in HbA1c levels, C-peptide levels, or hematological parameters between TPOAb-positive and TPOAb-negative patients. These findings emphasize the impact of TPOAb on growth parameters in T1DM and advocate for routine screening of TPOAb in all T1DM patients, starting at the time of diabetes diagnosis.
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Affiliation(s)
- Ahmad Alam
- Endocrinology, Diabetes, and Metabolism, Rajiv Gandhi Centre for Diabetes and Endocrinology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
| | - Surya Kumar Singh
- Endocrinology, Diabetes, and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Ritesh Kumar
- Endocrinology, Diabetes, and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Raihan Mannan
- Physiology, All India Institute of Medical Sciences, Patna, IND
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15
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Ferozi S, Taneja AG, Bakshi N. Assessment of nutritional status, physical fitness and physical activity of school going adolescents (12-15 years) in Delhi. BMC Pediatr 2024; 24:331. [PMID: 38745151 PMCID: PMC11091987 DOI: 10.1186/s12887-024-04733-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/31/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Adolescence is a distinct period that is crucial for setting the foundation for long-term health. OBJECTIVE To assess the nutritional status, physical fitness, and physical activity of adolescents. METHODS The present cross-sectional study recruited 100 adolescents purposively. Information regarding general profile and lifestyle-related factors was collected using a questionnaire. Anthropometric data such as height, weight, BMI, and body fat% were collected using appropriate equipment. Physical fitness was assessed using a battery adapted from FITNESSGRAM® and PAQ-A assessed the physical activity. Dietary intake was analysed using a 2-day 24-hour dietary recall. RESULT The study revealed, 19% of the participants were overweight and 6% were obese. The majority (74%) were physically inactive and 15% had high body fat %. There was lower consumption of energy, carbohydrates, iron, and calcium, than the recommendations. Also, physical activity scores were negatively associated with macronutrient intake and trunk lift (strength and flexibility) [p < 0.05]. Data showed lower physical fitness scores. BMI and hand-grip strength was positively correlated [p < 0.05]. Push Ups (endurance) and Standing Broad Jump (power) showed a negative correlation with body fat%. Tennis ball throw and PACER (cardiorespiratory fitness) were positively associated with protein intake. A multiple regression analysis significantly showed that a unit increase in cell phone usage increases body fat% by 11.64 units. Standing broad jump increases by 38.6 cm and decreases with 28.76 cm with a unit increase in playing outside and tuitions timings respectively. CONCLUSION Poor nutritional status, physical fitness, and physical activity were reported among adolescents. It is imperative to plan intervention strategies to improve the overall health of adolescents.
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Affiliation(s)
- Shanza Ferozi
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
| | - Anu Gupta Taneja
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
| | - Neha Bakshi
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India.
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16
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Tamahane V, Bhanushali S, Shah N, Gupta A, Khadilkar V, Gondhalekar K, Khadilkar A, Shouche Y. A comparative study of the gut microbiome in Indian children with type 1 diabetes and healthy controls. J Diabetes 2024; 16:e13438. [PMID: 37381634 PMCID: PMC11070843 DOI: 10.1111/1753-0407.13438] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/11/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) occurs in genetically susceptible individuals due to certain environmental triggers causing destruction of insulin secreting beta cells. One of the environmental triggers studied recently in the pathogenesis and progression of T1DM is the role of gut microbiome. OBJECTIVES (1) To compare the gut microbiome profile of T1DM children with healthy age, gender, and body mass index (BMI) matched controls. (2) To assess the relationship of abundance of genera with glycemic control in children with T1DM. METHODS Cross-sectional, case-control study. Sixty-eight children with T1DM and 61 age-, gender-, and BMI-matched healthy controls were enrolled. QIAamp Fast DNA Stool Mini kit protocol and reagents were used for DNA isolation and Miseq sequencing platform for targeted gene sequencing. RESULTS Alpha and beta diversity analysis showed no significant differences in the abundance of microbes between the groups. At phylum level, Firmicutes was the dominant phylum followed by Actinobacteria and Bacteroidota in both groups. Analysis of microbiome at the genera level showed that percentage abundance for Parasutterella was higher in children with T1DM as compared to the healthy group (p < .05). A linear regression analysis showed that increase in abundance of Haemophilus (adjusted R2 = -1.481 p < .007) was associated with a significant decrease in glycated hemoglobin (HbA1c) concentrations (p < .05). CONCLUSION Our comparative study of gut microbiome profile showed significant differences in the taxonomial composition between Indian children with T1DM and healthy controls. Short chain fatty acid producers may play an important role in glycemic control.
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Affiliation(s)
- Vaishali Tamahane
- Hirabai Cowasji Jehangir Medical Research InstituteJehangir HospitalPuneIndia
- School of Health Sciences‐Savitribai Phule Pune UniversityPuneIndia
| | - Shivang Bhanushali
- National Centre for Microbial Resource—National Centre for Cell SciencePuneIndia
| | - Nikhil Shah
- Hirabai Cowasji Jehangir Medical Research InstituteJehangir HospitalPuneIndia
| | - Abhishek Gupta
- National Centre for Microbial Resource—National Centre for Cell SciencePuneIndia
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research InstituteJehangir HospitalPuneIndia
- School of Health Sciences‐Savitribai Phule Pune UniversityPuneIndia
| | - Ketan Gondhalekar
- Hirabai Cowasji Jehangir Medical Research InstituteJehangir HospitalPuneIndia
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research InstituteJehangir HospitalPuneIndia
- School of Health Sciences‐Savitribai Phule Pune UniversityPuneIndia
| | - Yogesh Shouche
- National Centre for Microbial Resource—National Centre for Cell SciencePuneIndia
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Kumar K, Lodha R, Jat KR, Jain V, Kabra SK. Prevalence of Metabolic Abnormalities and their Association with Asthma Symptom Control in Children. Indian J Pediatr 2024; 91:434-440. [PMID: 37470958 DOI: 10.1007/s12098-023-04716-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/01/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES To determine the prevalence of insulin resistance (IR), dyslipidemia and metabolic syndrome (MS) in children with asthma, aged 10 to 15 y, and to determine if these metabolic abnormalities showed an association with asthma symptom control and lung function. METHODS A cross-sectional study was conducted at a tertiary centre in north India. Consecutive children with physician diagnosed asthma were enrolled. Asthma symptom control over previous four weeks was assessed as per Global Initiative for Asthma (GINA) recommendations. Fasting plasma glucose, serum insulin and lipid levels were estimated. Homeostasis Model Assessment- Insulin Resistance (HOMA-IR) was used as a marker of IR. Spirometry was performed for assessing lung function. RESULTS Eighty-three children were enrolled. Median (IQR) age was 12.0 (11.0, 13.5) y and mean (SD) body mass index (BMI) Z score was -0.42 (1.0). Median (IQR) HOMA-IR was 1.65 (1.06, 2.39). Prevalence of IR was 42.3% (95% CI: 31.7-52.9%). Number of children with elevated triglycerides, total cholesterol, and low-density lipoprotein (LDL)-cholesterol was 4 (4.8%), 4 (4.8%) and 5 (6%), respectively. Sixty-seven (80.7%) children had low high-density lipoprotein (HDL)-cholesterol. Only one subject was found to have metabolic syndrome. Presence of IR and elevation in serum insulin and triglycerides were associated with poorer asthma control, independent of BMI. None of the metabolic parameters were associated with lung function, after adjusting for height. CONCLUSIONS Among children with asthma, aged 10 to 15 y, the prevalence of IR was 42.3% (95% CI: 31.7-52.9%). Elevated serum insulin, triglycerides, and presence of IR were associated with poorer asthma control, after adjusting for BMI.
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Affiliation(s)
- Ketan Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Vandana Jain
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Boro H, Patra S, Pasam KK, Dalvi M, Bundela V. Russell-Silver Syndrome With Growth Hormone Deficiency. Cureus 2024; 16:e60018. [PMID: 38854326 PMCID: PMC11162538 DOI: 10.7759/cureus.60018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
Russell-Silver syndrome (RSS) is a rare genetic disorder characterized by intrauterine growth restriction (IUGR), postnatal growth failure, and distinctive dysmorphic features. We present a case of a four-year-old male presenting with a slow growth velocity with a history of IUGR and surgical interventions, exhibiting classic RSS features. Laboratory investigations revealed low insulin-like growth factor 1 (IGF-1) and low growth hormone (GH) levels on stimulation tests. Clinical exome sequencing revealed a de novo mutation in the insulin-like growth factor 2 (IGF2) gene. Additionally, a variant of uncertain significance in the DHX37 gene was noted in the patient and the asymptomatic father. After genetic counseling, recombinant GH therapy was initiated. This case underscores the genetic complexity of RSS and highlights the importance of early diagnosis, genetic testing, and multidisciplinary management in optimizing outcomes for patients with RSS.
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Affiliation(s)
- Hiya Boro
- Endocrinology, Aadhar Health Institute, Hisar, IND
| | - Shinjan Patra
- Endocrinology, All India Institute of Medical Sciences, Nagpur, IND
| | | | - Mazhar Dalvi
- Endocrinology, Mediclinic Al Noor Hospital, Abu Dhabi, ARE
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Krishnasamy S, Deepthi B, Kamath N, Iyengar A, Thomas CC, Uthup S, Saha A, Mathew G, Agarwal I, Tiewsoh K, Bhat NK, Mandal K, Krishnamurthy S. Clinical characteristics, genetic profile and short-term outcomes of children with primary hyperoxaluria type 2: a nationwide experience. Pediatr Nephrol 2024; 39:1093-1104. [PMID: 37914965 DOI: 10.1007/s00467-023-06200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Three types of primary hyperoxaluria (PH) are recognized. However, data on PH type 2 (PH2), caused by defects in the GRHPR gene, are limited. METHODS We reviewed the medical records of patients < 18 years of age with genetically-proven PH2 from seven centres across India to identify the age of onset, patterns of clinical presentation, short-term outcomes and genetic profile, and to determine if genotype-phenotype correlation exists. RESULTS We report 20 patients (all with nephrolithiasis or nephrocalcinosis) diagnosed to have PH2 at a median (IQR) age of 21.5 (7, 60) months. Consanguinity and family history of kidney stones were elicited in nine (45%) and eight (40%) patients, respectively. The median (IQR) serum creatinine at PH2 diagnosis was 0.45 (0.29, 0.56) mg/dL with the corresponding estimated glomerular filtration rate being 83 (60, 96) mL/1.73 m2/min. A mutational hotspot (c.494 G > A), rare in Caucasians, was identified in 12 (60%) patients. An intronic splice site variant (c.735-1G > A) was noted in five (25%) patients. Four (20%) patients required surgical intervention for stone removal. Major adverse kidney events (mortality or chronic kidney disease (CKD) stages 3-5) were noted in six (30%) patients at a median (IQR) follow-up of 12 (6, 27) months. Risk factors for CKD progression and genotype-phenotype correlation could not be established. CONCLUSIONS PH2 should no longer be considered an innocuous disease, but rather a potentially aggressive disease with early age of presentation, and possible rapid progression to CKD stages 3-5 in childhood in some patients. A mutational hotspot (c.494 G > A variant) was identified in 60% of cases, but needs further exploration to decipher the genotype-phenotype correlation.
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Affiliation(s)
- Sudarsan Krishnasamy
- Pediatric Nephrology Services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Bobbity Deepthi
- Pediatric Nephrology Services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Nivedita Kamath
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
| | | | - Susan Uthup
- Department of Pediatric Nephrology, Government Medical College, Thiruvananthapuram, India
| | - Anshuman Saha
- Department of Pediatric Nephrology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India
| | - Georgie Mathew
- Division of Pediatric Nephrology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Indira Agarwal
- Division of Pediatric Nephrology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Karalanglin Tiewsoh
- Division of Pediatric Nephrology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nowneet Kumar Bhat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
| | - Kausik Mandal
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sriram Krishnamurthy
- Pediatric Nephrology Services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
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Tandon A, Bhowmik E, Ali Z, Tripathi S, Bk A, Chen Y, Dabadghao P, Sudhanshu S, Bhatia V. Basic carbohydrate counting and glycemia in young people with type 1 diabetes in India: A randomized controlled trial. Nutrition 2024; 119:112318. [PMID: 38181475 DOI: 10.1016/j.nut.2023.112318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect on glycemic control and acceptability of basic carbohydrate counting (BCC) in children and young adults with type 1 diabetes (T1DM). METHODS Ninety-two children and young adults (6-25 y of age) with T1DM were randomized to receive either routine nutrition education (RNE), which addressed food groups, glycemic index, and effects of food and exercise on glycemia, or learn BCC with personalized portion size education. A continuous glucose monitoring study and glycosylated hemoglobin (HbA1c) were performed at baseline and after 12 wk. The primary outcome was a change in time-in-range from baseline through 12 wk. A questionnaire on the acceptability of BCC was administered. RESULTS At 12 wk, there was no significant difference in change in time-in-range between the two groups (BCC group: 1.2 ± 12.2; RNE group: 1.9 ± 12.3; P = 0.786). No significant changes were observed in the percentage of time that blood glucose was >180 or >250 mg/dL; <70 or <54 mg/dL; glycemic variability, percentage of nights with hypoglycemia and HbA1c. In subgroup analysis, there was a significant decrease in HbA1c in the BCC group among participants with higher maternal education (-0.5 versus 0.2, P = 0.042). The total score on the acceptability questionnaire was higher in the BCC group (P = 0.022). CONCLUSION Among children and young adults in our region with T1DM, BCC provided flexibility in food choices and perception of greater ease of insulin adjustment. Although BCC was equivalent to RNE in terms of glycemic control, larger studies may reveal benefit in outcomes in certain subgroups.
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Affiliation(s)
- Ambica Tandon
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Eshita Bhowmik
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Zebish Ali
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sarita Tripathi
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ajitha Bk
- Department of Statistics, Government Medical College, Thrissur, Kerala, India
| | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Siddhnath Sudhanshu
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vijayalakshmi Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Mondal S, Gargari P, Bose C, Garg MK, Chowdhury S, Mukhopadhyay S. Abnormal Body Composition Increases the Cardiometabolic Risk in Adolescents and Young Adults With Turner Syndrome. Endocr Pract 2024; 30:259-269. [PMID: 38042448 DOI: 10.1016/j.eprac.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/02/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE To determine the cardiometabolic risk of adolescents and adults with Turner syndrome (TS) and whether and how anthropometry and body composition predict this risk. METHODS We compared the anthropometric, biochemical, and dual-energy x-ray absorptiometry-derived body composition parameters of 103 girls and women with TS aged 12 to 30 years and 103 controls of the same age and body mass index: (1) between TS with and without metabolic syndrome (MetS), (2) between the different karyotypes of TS, and (3) between growth hormone recipients and nonrecipients. RESULTS Individuals with TS had higher prevalence rates of truncal obesity (57.2%), MetS (37.9%), prediabetes (20.4%), dyslipidemia (73.8%), hypertension (9.7%), and hepatic steatosis (15.5%) and a greater total body fat percentage (38.43% vs 34.26%) and fat mass index (9.15 vs 6.71 kg/m2) but a lower lean mass index (11.05 vs 12.49 kg/m2) than controls (P <.001). Individuals with TS and MetS (n = 39) had a higher total body fat percentage (41.74% vs 36.42%, P <.0001), truncal fat percentage (44.66% vs 36.09%, P <.0001), and visceral adipose tissue mass (495.57 vs 276 g, P <.0001) than those with TS but without MetS. Those with classic TS (45,X) had a higher prevalence of prediabetes (32.6% vs 10.5%, P =.01). Growth hormone recipients had a lower prevalence of MetS and lesser truncal obesity. Altered body composition was significantly correlated with metabolic risk. The truncal fat percentage independently predicted MetS (odds ratio, 1.12; 95% confidence interval, 1.003-1.24; P =.04). Waist circumference and waist-hip ratio predicted metabolic risk with good sensitivity and specificity. CONCLUSION Adverse cardiometabolic risk and altered body composition start early in life in TS. Postpubertal women with TS should be routinely assessed for truncal obesity, dysglycemia, dyslipidemia, and liver steatosis, irrespective of body mass index and karyotype.
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Affiliation(s)
- Sunetra Mondal
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Piyas Gargari
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Chiranjit Bose
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Mahendra Kumar Garg
- Department of Medicine and Endocrinology, All India Institute of Medical Sciences, Jodhpur, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India.
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Gupta R, Dabas A, Kohli S, Ramot R, Jyotsna VP, Goyal A, Gupta Y, Khadgawat R. Pragmatic Evaluation of Growth Hormone Stimulation Tests in Short Stature. Indian J Endocrinol Metab 2024; 28:137-144. [PMID: 38911107 PMCID: PMC11189287 DOI: 10.4103/ijem.ijem_326_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/09/2023] [Accepted: 09/24/2023] [Indexed: 06/25/2024] Open
Abstract
Introduction To assess the performance of growth hormone stimulation tests (GHSTs) in the evaluation of short stature. Methods It was a single-centre retrospective study carried out in children evaluated for short stature between January 2005 to March 2020. The clonidine stimulation test (CST) and glucagon stimulation test (GST) were used to assess growth hormone (GH) reserve (GST was performed only when peak GH levels were between 5 to ≤10 ng/mL on CST). A GH level of <5 ng/mL on CST or ≤10 ng/ml on both was used to corroborate GH deficiency. Results A total of 556 children were eligible for this study. The mean (SD) age was 12.9 (3.5) years, and 66.3% were male. The peak GH level [median (IQR)] was 5.50 ng/ml (1.90 - 7.50) on CST (at 60 minutes) and 7.45 ng/ml (2.15 - 10.77) on GST (at 120 minutes). On restricting sampling to two time points, the false positive rate was 13.6% on CST (60, 90 minutes) and 11.5% on GST (120, 150 minutes). Similarly, restricting to three time points was associated with a false positive rate of 8.5% on CST (60, 90, 120 minutes) and 3.8% on GST (90, 120, 150 minutes). Using the treating clinician-determined diagnosis of GHD as a reference standard, the optimal cut-off of peak GH on CST was 7.79 ng/ml (sensitivity: 83.8%; specificity: 89.4%). Conclusion Restricting the GH sampling to fewer time points is associated with an increase in the false positivity rate (FPR).
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Affiliation(s)
- Rahul Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Aashima Dabas
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Shweta Kohli
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Rekha Ramot
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P. Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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M AK, Mantan M, Mahajan B. Serum apolipoproteins (apoA-1, apoB, and apoB/apoA-1 ratio) for early identification of dyslipidemia in children with CKD. Pediatr Nephrol 2024; 39:849-856. [PMID: 37752382 DOI: 10.1007/s00467-023-06144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Dyslipidemia in children with chronic kidney disease (CKD) is identified based on lipid profile parameters; however, changes in lipoprotein quality precede quantitative changes. METHODS A cross-sectional study was done from January to October 2021; overweight, obese children, known cases of diabetes mellitus, hypothyroidism or on steroid therapy, or lipid lowering drugs were excluded. Clinical details were elicited and examinations done. Besides hemogram, kidney function tests, liver function tests, total cholesterol, low density lipoproteins (LDL), triglycerides, high density lipoproteins (HDL), and apolipoproteins A-1 and B were estimated to identify dyslipidemia. Relevant tests of significance were applied, and ROC curves were drawn for apoA-1, apoB, and apoB/apoA-1 ratios. RESULTS A total of 76 (61 M:15 F) children with median (IQR) age 7 (3.25-11) years were enrolled; cause of CKD was CAKUT in 82.3% patients. Dyslipidemia (alteration of 1 or more lipid parameters) was seen in 78.9% with a prevalence of 71.7% in early and 95.7% in later stages of CKD (P = 0.02); most had elevated serum triglyceride levels. The median (IQR) values of apoB, apoA-1, and apoB/apoA-1 ratio were 78 (58-110) mg/dl, 80 (63-96.75) mg/dl, and 0.88 (0.68-1.41), respectively; apoB, apoA-1, and apoB/apoA-1 ratio had a sensitivity of 26.67%, 86.67%, and 70%, respectively, and specificity of 87.5%, 62.5%, and 62.5%, respectively, for diagnosis of dyslipidemia. The ROC for apoB, apoA-1, and apoB/apoA-1 ratio showed AUC of 0.66, 0.68, and 0.74 (P = 0.4, 0.02, < 0.01), respectively. CONCLUSIONS The prevalence (78.9%) of dyslipidemia was high in patients with CKD especially in those with later stages. The ratio of apoB/apoA-1 was altered early and appears to be promising for early detection.
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Affiliation(s)
- Akshay Kumar M
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, 110002, India
| | - Mukta Mantan
- Division of Pediatric Nephrology, Department of Pediatrics, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, 110002, India.
| | - Bhawna Mahajan
- Department of Biochemistry GIPMER, University of Delhi, New Delhi, India
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Bhalla AK, Kaur H, Kaur R, Panigrahi I. Growth charts for weight and height of Indian children with Down syndrome. Am J Med Genet A 2024:e63571. [PMID: 38385609 DOI: 10.1002/ajmg.a.63571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
Age and gender specific growth charts for Indian children with Down syndrome (DS) based on longitudinal data have not been published. To establish percentile growth charts for DS children inhabiting northwestern parts of India, body weight and length/height of 1125 (Male: 752, Female: 373) children with DS aged <1 month to 10 years, enrolled from the "Genetics Clinic" were measured at half yearly age intervals in the "Growth Clinic" of the Institute from August 1994 to November 2018. A total of 2089 observations were made on these children using standardized anthropometric techniques and instruments following a prospective mixed-longitudinal growth research design. Using the LMS method, age and sex-specific percentile growth charts (<1 month to 10 years) for weight, and length/ height were generated. Unpaired t-test was used to compare mean growth attainments of study children with those of DS patients representing other population groups as well as their normal Multicentre Growth Reference Study (MGRS and Indian Academy of Pediatrics (IAP) counterparts. The 50th percentile growth curves for both weight and length/height of Indian children with DS demonstrated a regular increase. As compared to their normal MGRS and Indian (IAP) counterparts, the children with DS had lower weight and height attainments. The boys and girls with Down syndrome showed short stature (height < 3rd centile) from the age of 1 year till 10 years and also became underweight beyond 5 years. As compared to their normal counterparts, children with Down syndrome exhibited compromised auxological attainments. The use of growth charts presented herein may be used to compare and monitor growth and nutritional status of Indian children with Down syndrome.
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Affiliation(s)
- Anil Kumar Bhalla
- Child Growth & Anthropology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Harvinder Kaur
- Child Growth & Anthropology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rupinder Kaur
- Child Growth & Anthropology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Inusha Panigrahi
- Genetics & Metabolic Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Menon JC, Singh P, Archana A, Singh P, Mittal M, Kanga U, Mandal K, Seth A, Bhatia V, Dabadghao P, Sudhanshu S, Garg A, Vishwakarma R, Sarangi AN, Verma S, Singh SK, Bhatia E. High Frequency of Recessive WFS1 Mutations Among Indian Children With Islet Antibody-negative Type 1 Diabetes. J Clin Endocrinol Metab 2024; 109:e1072-e1082. [PMID: 37931151 DOI: 10.1210/clinem/dgad644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/06/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND While the frequency of islet antibody-negative (idiopathic) type 1 diabetes mellitus (T1DM) is reported to be increased in Indian children, its aetiology has not been studied. We investigated the role of monogenic diabetes in the causation of islet antibody-negative T1DM. METHODS We conducted a multicenter, prospective, observational study of 169 Indian children (age 1-18 years) with recent-onset T1DM. All were tested for antibodies against GAD65, islet antigen-2, and zinc transporter 8 using validated ELISA. Thirty-four islet antibody-negative children underwent targeted next-generation sequencing for 31 genes implicated in monogenic diabetes using the Illumina platform. All mutations were confirmed by Sanger sequencing. RESULTS Thirty-five (21%) children were negative for all islet antibodies. Twelve patients (7% of entire cohort, 34% of patients with islet antibody-negative T1DM) were detected to have pathogenic or likely pathogenic genetic variants. The most frequently affected locus was WFS1, with 9 patients (5% of entire cohort, 26% of islet antibody-negative). These included 7 children with homozygous and 1 patient each with a compound heterozygous and heterozygous mutation. Children with Wolfram syndrome 1 (WS) presented with severe insulin-requiring diabetes (including 3 patients with ketoacidosis), but other syndromic manifestations were not detected. In 3 patients, heterozygous mutations in HNF4A, ABCC8, and PTF1A loci were detected. CONCLUSION Nearly one-quarter of Indian children with islet antibody-negative T1DM had recessive mutations in the WFS1 gene. These patients did not exhibit other features of WS at the time of diagnosis. Testing for monogenic diabetes, especially WS, should be considered in Indian children with antibody-negative T1DM.
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Affiliation(s)
- Jayakrishnan C Menon
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Pratibha Singh
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Archana Archana
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Preeti Singh
- Department of Paediatrics, Lady Hardinge Medical College, Delhi 110001, India
| | - Medha Mittal
- Department of Paediatrics, Chacha Nehru Bal Chikitsalay, Delhi 110031, India
| | - Uma Kanga
- Department of Immunogenetics and Transplant Immunology, All India Institute of Medical Sciences, Delhi 110029, India
| | - Kausik Mandal
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Anju Seth
- Department of Paediatrics, Lady Hardinge Medical College, Delhi 110001, India
| | - Vijayalakshmi Bhatia
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Siddhnath Sudhanshu
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Atul Garg
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Ruchira Vishwakarma
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Aditya Narayan Sarangi
- Department of Genome Analytics, BaseSolve Informatics Pvt Ltd, Ahmedabad, Gujrat 380006, India
| | - Shivendra Verma
- Department of General Medicine, GSVM Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Surya Kumar Singh
- Department of Endocrinology, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
| | - Eesh Bhatia
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
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Das G, Setlur K, Jana M, Ramakrishnan L, Jain V, Meena JP, Gupta AK, Dwivedi SN, Seth R. Serum Adipokines as Biomarkers for Surveillance of Metabolic Syndrome in Childhood Acute Lymphoblastic Leukemia Survivors in Low Middle-Income Countries. Nutr Cancer 2024; 76:262-270. [PMID: 38225859 DOI: 10.1080/01635581.2023.2301139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Serum adipokines (leptin and adiponectin) are dysregulated before the onset of metabolic syndrome and hence may be useful biomarkers for screening of cardiometabolic late effects in childhood Acute Lymphoblastic Leukemia (cALL) survivors. METHODS We compared serum adipokine levels between 40 cALL survivors (aged 10-18 years, >2 years from treatment completion) with similar controls. A multivariable logistic regression analysis was then done to assess the association of metabolic syndrome in cALL survivors with variables including adipokines and other metabolic parameters, demographic and treatment details, and Dual-energy X-ray absorptiometry scan-derived variables. RESULTS Compared to controls, cALL survivors had a higher prevalence of metabolic syndrome (8/40 vs. 2/40, P = .044) and central obesity (11/40 vs. 4/40, P = 0.042). Median Serum Leptin (7.39 vs. 4.23 ng/ml, P = 0.207) levels and derived Leptin-Adiponectin Ratio (1.44 vs. 0.80, P = 0.598), were higher but not statistically different in our survivors compared to controls; Adiponectin levels were similar (6.07 vs. 5.01 µg/ml, P = 0.283). In the cALL survivors, overweight/obesity (odds ratio [OR] 21.9, P = 0.020) or higher Leptin levels (OR 1.11, P = 0.047), were independently associated with metabolic syndrome. CONCLUSIONS Serum Leptin, independently predictive of metabolic syndrome in our cALL survivors, may be tested in larger studies to assess its utility in surveillance and initiation of early preventive measures.
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Affiliation(s)
- Gargi Das
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences-New Delhi, India
| | - Kritika Setlur
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences-New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences-New Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences-New Delhi, India
| | - Vandana Jain
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences-New Delhi, India
| | - Jagdish Prasad Meena
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences-New Delhi, India
| | - Aditya Kumar Gupta
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences-New Delhi, India
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences-New Delhi, India
| | - Rachna Seth
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences-New Delhi, India
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Oza C, Antani M, Mondkar SA, Kajale N, Ojha V, Goel P, Khadilkar V, Khadilkar AV. BoneXpert-derived bone health index reference curves constructed on healthy Indian children and adolescents. Pediatr Radiol 2024; 54:127-135. [PMID: 38099931 DOI: 10.1007/s00247-023-05824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Artificial intelligence (AI)-based applications for the assessment of the paediatric musculoskeletal system like BoneXpert are not only useful to assess bone age (BA) but also to provide a bone health index (BHI) and a standard deviation score (SDS) for both. This allows comparison of the BHI with age- and sex-matched healthy Caucasian children. OBJECTIVE We conducted this study with the objective of generating BHI curves using BoneXpert in healthy Indian children with BA between 2 and 17 years. METHOD We retrospectively reviewed anthropometric parameters, BHI, and BHI SDS data of digitalized left-hand radiographs (joint photographic experts group [jpg] format) of a cohort of 788 paediatric patients from a previous study to which they were recruited to compare various methods of BA assessment. The recruited children represented all age groups for both sexes. The corrected BHI for jpg images was calculated using the formula corrected BHI=BHI*(stature/(avL*50))^0.33333 where stature is height of subject and avL is average length of metacarpal bones. The reference Indian BHI curves and centiles were generated using the Lambda-Mu-Sigma method. RESULT The mean BHI and BHI SDS of the study group were 4.02±0.57 and -1.73±1.09, respectively. The average increase in median BHI from each age group was between 2.5% and 3% in both sexes up to age of 14 years after which it increased to 4.5% to 5%. The mean BHI of Indian children was lower than that of Caucasian children with maximum differences noted in boys at 16 years (21.7%) and girls at 14 years (16%). We report 8.4% SD of BHI for our study sample. Reference percentile curves for BHI according to BA were derived separately for boys and girls. CONCLUSION Reference data has been provided for the screening of bone health status of Indian children and adolescents.
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Affiliation(s)
- Chirantap Oza
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India
- Endogrow Paediatric and Adolescent Endocrine Centre, Ahmedabad, India
- Department of Paediatrics, Narendra Modi Medical College, Ahmedabad, India
| | - Misha Antani
- Department of Pathology, B. J. Medical College, Ahmedabad, India
| | - Shruti A Mondkar
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India
| | - Neha Kajale
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India
| | - Vikas Ojha
- Department of Radiology, Jehangir Hospital, Pune, India
| | - Pranay Goel
- Department of Biology, Indian Institute of Science Education and Research, Pune, India
| | - Vaman Khadilkar
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India
- Jehangir Hospital, Pune, India
| | - Anuradha V Khadilkar
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India.
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India.
- Jehangir Hospital, Pune, India.
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Mondal S, Gargari P, Nagendra L, Mandal S, Kumar RC, Shah P, Haldar M, Chowdhury S, Mukhopadhyay S. Growth hormone therapy is associated with improved uterine dimensions in girls with Turner syndrome prior to oestrogen replacement. Clin Endocrinol (Oxf) 2024; 100:66-75. [PMID: 37555570 DOI: 10.1111/cen.14957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Adult women with Turner syndrome (TS) have high rates of miscarriage, presumably due to the abnormal size and shape of the uterus. There is a paucity of data regarding the determinants of uterine volume (UtVol) in young girls with TS before the initiation of oestrogen replacement therapy (ERT). METHODS We performed a cross-sectional study on premenarchal girls with TS, aged 5-15 years, pubertal stage B1-B3, not having received ERT (n = 73) and 50 age-matched healthy controls. Anthropometric parameters and a history of growth hormone (GH) therapy (≥1 year) were noted. Uterine length (UtL), UtVol, and mean-ovarian-volume (MOV) standard-deviation scores (SDS) were determined from transabdominal ultrasonography data. RESULTS Girls with TS had lower median UtVol-SDS (-1.07 vs. 0.86; p < .001), UtL-SDS (-3.72 vs. -0.41; p < .001) and MOV-SDS (-5.53 vs. 1.96; p < .001) compared to age-matched controls. Among TS girls, recipients of GH (n = 38) had higher UtVol-SDS (-0.63 vs. -1.39; p = .0001), UtL-SDS (-1.73 vs. -6.49; p < .0001) but similar MOV-SDS compared to nonrecipients (n = 35). Those with normal uterine volume for age (NUVA, n = 29) had earlier initiation (7.8 vs. 9.3 years; p = .03) and a longer duration of GH (3.71 vs. 2.14 years; p = .002) than those with low UtVol for age (n = 44). UtVol-SDS correlated with duration of GH (ρ = 0.411, p = .01) and negatively with age at GH initiation (ρ = -0.479, p = .003). In a model adjusted for pubertal status, karyotype and height-SDS, GH use could independently predict having NUVA (odds ratio: 5.09, confidence interval: 1.63-15.94, p = .005). CONCLUSION GH therapy has a stimulatory effect on uterine dimensions in pre-and peripubertal girls with TS. Earlier initiation and longer duration of GH is important in TS girls before ERT.
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Affiliation(s)
- Sunetra Mondal
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Piyas Gargari
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Santanu Mandal
- Department of Radiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Rathin C Kumar
- Department of Radiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Pooja Shah
- Department of Radiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | | | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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Ompad DC, Padhan TK, Kessler A, Tozan Y, Jones AM, van Eijk AM, Sullivan SA, Haque MA, Pradhan MM, Mohanty S, Carlton JM, Sahu PK. The effectiveness of malaria camps as part of the malaria control program in Odisha, India. Sci Rep 2023; 13:22998. [PMID: 38155156 PMCID: PMC10754896 DOI: 10.1038/s41598-023-46220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/30/2023] [Indexed: 12/30/2023] Open
Abstract
Durgama Anchalare Malaria Nirakaran (DAMaN) is a multi-component malaria intervention for hard-to-reach villages in Odisha, India. The main component, malaria camps (MCs), consists of mass screening, treatment, education, and intensified vector control. We evaluated MC effectiveness using a quasi-experimental cluster-assigned stepped-wedge study with a pretest-posttest control group in 15 villages: six immediate (Arm A), six delayed (Arm B), and three previous interventions (Arm C). The primary outcome was PCR + Plasmodium infection prevalence. The time (i.e., baseline vs. follow-up 3) x study arm interaction term shows that there were statistically significant lower odds of PCR + Plasmodium infection in Arm A (AOR = 0.36, 95% CI = 0.17, 0.74) but not Arm C as compared to Arm B at the third follow-up. The cost per person ranged between US$3-8, the cost per tested US$4-9, and the cost per treated US$82-1,614, per camp round. These results suggest that the DAMaN intervention is a promising and financially feasible approach for malaria control.
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Affiliation(s)
- Danielle C Ompad
- School of Global Public Health, New York University, New York, NY, 10003, USA.
| | - Timir K Padhan
- Department of Molecular Biology and Infectious Diseases, Community Welfare Society Hospital, Rourkela, Odisha, 769042, India
| | - Anne Kessler
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | - Yesim Tozan
- School of Global Public Health, New York University, New York, NY, 10003, USA
| | - Abbey M Jones
- School of Global Public Health, New York University, New York, NY, 10003, USA
| | - Anna Maria van Eijk
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Steven A Sullivan
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | - Mohammed A Haque
- Department of Molecular Biology and Infectious Diseases, Community Welfare Society Hospital, Rourkela, Odisha, 769042, India
| | - Madan Mohan Pradhan
- Department of Health and Family Welfare, State Vector Borne Disease Control Programme, Bhubaneswar, Odisha, 751001, India
| | - Sanjib Mohanty
- Department of Molecular Biology and Infectious Diseases, Community Welfare Society Hospital, Rourkela, Odisha, 769042, India
| | - Jane M Carlton
- School of Global Public Health, New York University, New York, NY, 10003, USA
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
- Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Global Public Health, Baltimore, MD, 21205, USA
| | - Praveen K Sahu
- Department of Molecular Biology and Infectious Diseases, Community Welfare Society Hospital, Rourkela, Odisha, 769042, India
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Gupta P, Kumar B, Banothu KK, Jain V. Assessment of Cardiorespiratory Fitness in 8-to-15-Year-Old Children with Overweight/Obesity by Three-Minute Step Test: Association with Degree of Obesity, Blood Pressure, and Insulin Resistance. Indian J Pediatr 2023; 90:1216-1222. [PMID: 36066791 DOI: 10.1007/s12098-022-04311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess cardiorespiratory fitness in children and adolescents with overweight/obesity using the Kasch pulse recovery (KPR) test, and its correlation with severity of obesity, insulin resistance, and blood pressure (BP). METHODS This is a retrospective analysis of baseline data from a study evaluating the efficacy of yoga for reduction of body mass index (BMI) in children aged 8-15 y with overweight/obesity. KPR three-minute step test was done. Children were classified into cardiorespiratory fitness categories based on the post-KPR heart rate (HR); the maximal oxygen consumption (VO2 max) was calculated, and the correlation analysis was done. RESULTS One hundred fifty-five children with mean age of 11.6 ± 1.8 y and mean BMI of 26.2 ± 4.1 kg/m2 were included. Mean post-KPR-HR and calculated VO2 max were 119 ± 14 per minute and 48.7 ± 5.6 mL/kg/min, respectively. In children < 13 y, cardiorespiratory fitness was excellent or very good in 28%, good or sufficient in 58%, and poor or very poor in 14%. BMI, waist circumference (WC), resting HR, systolic BP, and homeostatic model of insulin resistance (HOMA-IR) were higher among those with poor/very poor fitness, with WC z score being statistically significant (p = 0.015). Post-KPR-HR showed positive correlation with BMI z score (r = 0.16, p = 0.044), WC z score (r = 0.21, p = 0.011), and HOMA-IR (r = 0.22, p = 0.012). CONCLUSION In children with overweight/obesity, 14% had poor cardiorespiratory fitness. Post-KPR-HR and calculated VO2 max had good correlation with measures of obesity and HOMA-IR. Further studies evaluating cardiorespiratory fitness and normative data of VO2 max for Indian children are warranted.
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Affiliation(s)
- Priyanka Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Kiran Kumar Banothu
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Vandana Jain
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Selvam S, K S. Assessment of Bone Health Using Dual-Energy X-Ray Absorptiometry (DEXA) And Its Association with Dietary Intakes, Serum Vitamin D Levels, and Anthropometric Measures in Healthy Urban Preschool Children. Indian J Pediatr 2023; 90:1191-1197. [PMID: 36350501 DOI: 10.1007/s12098-022-04364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To generate reference data for bone mineral content (BMC) and bone mineral density (BMD) measures among apparently healthy children aged 4-5 y and to study the relationship of BMC and BMD with age, sex, anthropometric measures, dietary intakes, and serum vitamin D levels. METHODS This cross-sectional study was conducted among 219 urban preschool children, aged 4.0-5.11 y. Bone health (BMC and BMD) was measured using dual energy X-ray absorptiometry (DEXA). Anthropometric parameters were measured using standard methodology. The 24-h dietary recall method was used to assess the dietary intake of the children. Serum vitamin D levels were assessed using the ELISA kit method. Percentiles for BMC and BMD for each age and sex were constructed using the lambda-mu-sigma (LMS) method. RESULTS The mean BMD and BMC among children was 0.75 ± 0.04 g/cm2 and 544.9 ± 87.6 g, respectively, and were significantly different by age and sex category. The BMC and BMD values of boys and girls increased with age, with boys having significantly higher values. A significant positive correlation was observed for BMC and BMD with anthropometric measures and dietary intake of calcium, phosphorous, protein, zinc, and B vitamins. CONCLUSION This study developed smoothed percentile curves for BMC and BMD in preschool children, which could be used as reference values for children from India.
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Affiliation(s)
- Sumithra Selvam
- Division of Epidemiology, Biostatistics and Population Health, St John's Research Institute, Koramangala, Bangalore, Karnataka, 560034, India.
| | - Srinivasan K
- Division of Epidemiology, Biostatistics and Population Health, St John's Research Institute, Koramangala, Bangalore, Karnataka, 560034, India
- Department of Psychiatry and Division of Mental Health & Neurosciences, St. John's Medical College & Hospital, St John's National Academy of Health Sciences, Koramangala, Bangalore, Karnataka, India
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Kozhisseri N, Rajaram D, Cheluvaraj P. Prevalence of Elevated Blood Pressure and Its Relationship With Anthropometric Risk Factors in Students of a Pre-university Girls' College in Bangalore: A Cross-Sectional Study. Cureus 2023; 15:e49774. [PMID: 38161531 PMCID: PMC10757738 DOI: 10.7759/cureus.49774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Background There is a growing concern regarding elevated blood pressure in adolescence. Children and adolescents with high blood pressure are at risk for adult hypertension. Being overweight and obese are important risk factors for hypertension. This study aimed to determine the prevalence of elevated blood pressure and its association with anthropometric risk factors among students of a pre-university girls' college. Methodology A cross-sectional study was conducted among 337 students at a pre-university girls' college aged 15-19 years in urban Bangalore. A self-administered, semi-structured, pretested questionnaire collected the sociodemographic details, family history, and lifestyle. Height, weight, waist circumference (WC), and hip circumference were measured. Standard cut-off levels were used for body mass index (BMI), WC, waist-hip ratio (WHR), and waist-height ratio (WHtR). Resting blood pressure was determined using a digital blood pressure monitor. It was classified into normotensive, pre-hypertension (>90th to <95th percentile), and hypertension (>95th percentile). Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA). Pre-hypertension and hypertension were considered as having elevated blood pressure. Results The prevalence of pre-hypertension and hypertension was 21.4% (n = 72, 95% confidence interval (CI) = 17.0-25.7) and 9.8% (n = 33, 95% CI = 6.6-13.0), respectively. The prevalence of overweight was 20.2% (n = 68, 95% CI = 15.9-24.5) and obesity was 12.2% (n = 41, 95% CI = 8.7-15.7). WC, WHR, and WHtR were abnormal in 34.7% (n = 117, 95% CI = 29.6-39.8), 47.5% (n = 160, 95% CI = 42.1-52.8), and 45.7% (n = 154, 95% CI = 50.4-51.0), respectively. There was a statistically significant correlation between systolic blood pressure and BMI (p < 0.001), WC (p < 0.001), and WHtR (p < 0.001), as well as diastolic blood pressure and BMI (p < 0.001), WC (p = 0.008), and WHtR (p = 0.011). Statistically significant differences in mean BMI (p = 0.004), WC (p < 0.001), WHR (p = 0.007), and WHtR (p = 0.001) between normal, pre-hypertensive, and hypertensive students were also noted. Conclusions Pre-hypertension and hypertension are fundamental problems in pre-university girl students. With a similarly increased prevalence of obesity and other anthropometric risk factors, students must be aware of hypertension and its risk factors.
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Affiliation(s)
| | - Dinesh Rajaram
- Community Medicine, Ramaiah Medical College, Bangalore, IND
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Oza C, Antani M, More C, Mondkar S, Khadilkar V, Gondhalekar K, Khadilkar A. Assessment of pubertal onset and disorders of puberty in Indian children and youth with type-1 diabetes. J Pediatr Endocrinol Metab 2023; 36:1052-1060. [PMID: 37743516 DOI: 10.1515/jpem-2023-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES Disorders of pubertal development are enlisted as associated conditions in children and adolescents with type-1 diabetes (T1D). We conducted this study with objective (1) To estimate the median age at onset of puberty and luteinizing hormone (LH) and sex-steroid concentrations in Indian adolescents with T1D and (2) To assess the impact of puberty on glycemic control and insulin resistance (IR). METHODS This cross-sectional study included 399 children and youth aged 6-23 years with T1D. Demographic, anthropometric, biochemical and pelvic ultrasound data were collected using standard protocols. IR was calculated using estimated glucose disposal rate and puberty was assessed using Tanner staging. RESULTS Median age at onset of thelarche, pubarche and menarche were 11.3, 11.4 and 12.8 years in girls and that of gonadarche and pubarche were 10.6 and 12.7 years for boys. The mean LH and sex-steroid concentrations of subjects with T1D were similar to healthy subjects at each stage of puberty. The cut-offs of LH and sex-steroids derived from healthy Indian children yielded high sensitivity and specificity in determining pubertal onset. The prevalence of precocity, delayed puberty, ovarian cysts and polycystic ovaries was 0.9 , 5.1, 5.1 and 8.6 %, respectively. Glycaemic control and insulin sensitivity was poor in pubertal subjects. CONCLUSIONS The age at onset of puberty, LH, and sex-steroid concentrations in subjects with T1D were like otherwise healthy Indian children with poor glycemic control and IR in pubertal subjects. Although most complications of T1D are associated with poor glycemic control, pubertal disorders were significantly low despite the less-than-optimal glycemic control.
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Affiliation(s)
- Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Misha Antani
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
- Department of Pathology, B.J. Medical College, Ahmedabad, India
| | - Chidvilas More
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Shruti Mondkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
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Sachan N, Dabas A, Mantan M, Dabla PK. Urinary Biomarkers NGAL and Beta-2 Microglobulin for Detection of Diabetic Nephropathy in Type 1 Diabetes Mellitus.. [DOI: 10.21203/rs.3.rs-3417003/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Abstract
Objectives: Urinary neutrophil gelatinase-associated lipocalin (NGAL) and beta-2 microglobulin(β2M) have been evaluated as markers of tubular damage in type 2 diabetes mellitus. There is limited data on their performance to screen nephropathy in type 1 diabetes mellitus (T1DM).
Methods: This case-control study enrolled 40 children with T1DM and 40 age-matched controls age 2-18 years. Subjects with coexisting renal disorder and syndromic diabetes mellitus were excluded. Fasting plasma glucose, glycated hemoglobin (HbA1c), and renal function were measured. Urinary levels of urine albumin-creatinine ratio (ACR), neutrophil gelatinase-associated lipocalin (NGAL) and beta-2 microglobulin (β2M) were measured for an associated with disease duration, glycemic control and microalbuminuria. Correlation (r) was measured for statistical association between biochemical markers and area-under-curve (AUC) calculated to predict nephropathy.
Results: The median (IQR) age of cases and controls was 10.6(8,14.2) and 10.7 (8.4,13.7) years, respectively, disease duration 4 (3,6.8) years and HbA1c 10.9(9.,13.1)% in cases. Microalbuminuria was seen in 14(35%) but none had macroalbuminuria.The urinary ACR and NGAL were significantly higher in cases than controls [19.38 (10.27,35.26) and 6.49 (3.10,11.65) µg/mg; p<0.001] and [352.21(191.49,572.45) and 190.54 (125.91,322.83) ng/mg; p=0.006], respectively, unlike β2M [1.7 (0.43,6.02) and 2.12 (1.05,4.47) µg/mg; p=0.637]. Children with higher HbA1C (>10%) had higher urinary ACR, NGAL and β2M levels than those with HbA1C<10%. Urinary ACR showed positive correlation with NGAL/creatinine (r= 0.38, p value=0.019) and β2M/ creatinine (r=0.48, p value= 0.004) in cases. The AUC was 0.57 (95% CI 0.36,0.78); p value= 0.48 for NGAL/creatinine, and 0.62 (95%CI 0.43,0.81); p value=0.21 for β2M /creatinine to predict microalbuminuria (ACR >30mg/g).
Conclusion: Urinary biomarkers NGAL and β2M showed a good correlation with ACR suggesting their role in screening of diabetic tubulopathy before overt glomerular damage in T1DM.
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Affiliation(s)
| | | | | | - Pradeep Kumar Dabla
- Govind Ballabh Pant Institute of Postgraduate Medical Education and Research: Govind Ballabh Pant Hospital
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Shah N, Kulkarni A, Mongad D, Jaani K, Kajale N, Tamahane V, Bhor S, Ladkat D, Khadilkar V, Gondhalekar K, Shouche Y, Khadilkar AV. Pilot Study on Gut Microbiota Profile in Indian Children with Type 1 Diabetes. Indian J Endocrinol Metab 2023; 27:404-409. [PMID: 38107732 PMCID: PMC10723603 DOI: 10.4103/ijem.ijem_22_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 11/03/2022] [Accepted: 11/20/2022] [Indexed: 12/19/2023] Open
Abstract
Background Non-genetic factors like microbial dysbiosis may be contributing to the increasing incidence/progression of type 1 diabetes mellitus (T1DM). Objectives To analyse the gut microbiota profile in Indian children with T1DM and its effect on glycaemic control. Methodology Faecal samples of 29 children with T1DM were collected and faecal microbial DNA was extracted and subjected to 16S rRNA (ribosomal RNA) sequencing and further analysis. Results The dominant phyla in children with T1DM were Firmicutes and Bacteroidetes. Butyrate-producing bacteria Blautia and Ruminococcus showed a significant negative correlation with the glycosylated haemoglobin (HbA1C) levels (p < 0.05). Coprococcus and Propionibacterium were important negative predictors of glycaemic control (p < 0.05). Conclusion Our study suggests that Indian children with T1DM have a distinct gut microbiome taxonomic composition and that short-chain fatty acid-producing bacteria like Ruminococcus and Blautia (butyrate-producing) may play an important role in the glycaemic control of subjects with T1DM.
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Affiliation(s)
- Nikhil Shah
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
- Department of Pediatrics, Cloudnine Hospital, Malad, Mumbai, Maharashtra, India
| | - Abhijit Kulkarni
- National Centre for Cell Science (NCCS), Pune, Maharashtra, India
| | - Dattatray Mongad
- National Centre for Cell Science (NCCS), Pune, Maharashtra, India
| | - Kunal Jaani
- National Centre for Cell Science (NCCS), Pune, Maharashtra, India
| | - Neha Kajale
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Vaishali Tamahane
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Shital Bhor
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Dipali Ladkat
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Ketan Gondhalekar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Yogesh Shouche
- National Centre for Cell Science (NCCS), Pune, Maharashtra, India
| | - Anuradha V. Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
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Sharma K, Sharma V, Kumar V, Bhat N, Chacham S, Rathaur VK, Verma PK. Short Stature for Age in Children of 5 to 16 Years: The First Research from the Northern Himalayan Region of India. Indian J Community Med 2023; 48:692-695. [PMID: 37970157 PMCID: PMC10637605 DOI: 10.4103/ijcm.ijcm_748_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/26/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction Anthropometric parameters play vital role in monitoring growth in pediatrics. Many etiological factors lead to short stature. So, before assessing the etiological factors short stature needs to be addressed. This study aimed to screen short stature for age in school-going children aged 5 to 16 years in Uttarakhand. Material and Methods In this cross-sectional observational study, the height (through stadiometer) and weight (through weight machine) of 4189 students of government and private school in Rishikesh (Uttarakhand) aged 5-16 years were measured after the verbal assent of the students and individual's height is in the 3rd percentile for the mean height of a given age, sex, and population group and was considered short stature. The data collection was performed from October 2019 to July 2021. The data were categorized according to different age groups to 5-8 years, 9-12 years, and 13-16 years. The data were recorded in Microsoft (MS) Excel spreadsheet program. Statistical Package for the Social Sciences (SPSS) v23 (IBM Corp.) was used for data analysis. Descriptive statistics were elaborated in the form of means or standard deviations and medians or Interquartile range IQRs for continuous variables and frequencies and percentages for categorical variables. The Chi-square test was used for group comparisons for categorical data. Results 7.1% of children were short stature (height 143.16 ± 15.09 cm) in the Himalayan belt, and males were more prone to short stature at age of 9-12 years. Conclusion In the growing phase of children, the etiology of short stature has to be rectified, so the children can achieve such proper growth. Parents and physicians have to assess and monitor the growth of children timely. This study can be a stepping stone for further epidemiological studies.
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Affiliation(s)
- Karishma Sharma
- Department of Anatomy, All India Institute of Medical Sciences Rishikesh, Srinagar, Srikot, Rishikesh, Uttarakhand, India
| | - Vishakha Sharma
- Department of Pediatrics, All India Institute of Medical Sciences Rishikesh, Srinagar, Srikot, Rishikesh, Uttarakhand, India
| | - Vinod Kumar
- Department of Pediatrics, All India Institute of Medical Sciences Rishikesh, Srinagar, Srikot, Rishikesh, Uttarakhand, India
| | - Nowneet Bhat
- Department of Pediatrics, All India Institute of Medical Sciences Rishikesh, Srinagar, Srikot, Rishikesh, Uttarakhand, India
| | - Swathi Chacham
- Department of Pediatrics, All India Institute of Medical Sciences Rishikesh, Srinagar, Srikot, Rishikesh, Uttarakhand, India
| | - Vyas K. Rathaur
- Department of Pediatrics, VCSGGIMS&R, Srinagar, Srikot, Rishikesh, Uttarakhand, India
| | - Prashant K. Verma
- Department of Pediatrics, All India Institute of Medical Sciences Rishikesh, Srinagar, Srikot, Rishikesh, Uttarakhand, India
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Sehgal M, Jain V, Agarwala S, Dhua A, Goel P, Yadav DK, Bakhshi S, Kalaivani M. Anthropometric Outcomes in Survivors of Pediatric Solid Tumors. Nutr Cancer 2023; 75:1795-1802. [PMID: 37545131 DOI: 10.1080/01635581.2023.2242104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023]
Abstract
Nutritional status is an important aspect of childhood cancer, with a bearing on the disease and subsequent survivorship. We sought to evaluate the long-term anthropometric outcomes in a cohort of pediatric solid tumor survivors treated between 1994 and 2016. Anthropometry was noted at the time of presentation, after completion of therapy, and at the last follow-up. The z-scores for weight-for-age, height-for-age, and BMI-for-age were calculated using WHO growth charts for ages <5 years and the Indian Academy of Pediatrics growth charts for age >/= 5 years. BMI was calculated for adult survivors. We included 317 survivors, comprising 48, 81, and 188 survivors of Hepatoblastoma (HB), Malignant Germ cell Tumor (MGCT), and Wilms Tumor (WT) respectively. The median age at diagnosis was 24.5 (IQR 59-13.2) months, with a follow-up ranging from 5 to 19.54 years. The z-scores of the collective cohort and individual cohorts of HB, MGCT, and WT showed an improving trend from diagnosis to the last follow-up. The difference in the prevalence of malnutrition was found to be statistically significant when any two-time points were compared. Of the 28 adult survivors, 43% were noted to be underweight. Thus, anthropometric measures improve during follow-up, however, up to 15% of children persist in being malnourished.
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Affiliation(s)
- Mehak Sehgal
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vishesh Jain
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prabudh Goel
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Srivastava A, Poddar U, Mathias A, Mandelia A, Sarma MS, Lal R, Yachha SK. Achalasia cardia sub-types in children: Does it affect the response to therapy? Indian J Gastroenterol 2023; 42:534-541. [PMID: 37300794 DOI: 10.1007/s12664-023-01344-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/26/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Achalasia sub-types affect treatment response in adults, but there is no similar data in children. We studied the differences in clinico-laboratory features and response to therapy between achalasia sub-types in children. METHODS Forty-eight children (boys:girls-25:23, 14 [0.9-18] years) with achalasia (clinical, barium, high-resolution manometry [HRM], gastroscopy) were evaluated. The sub-type was determined by Chicago classification at HRM. Pneumatic dilatation (PD) or surgery was the primary therapy. Success was defined as Eckhardt score of ≤ 3. RESULTS Dysphagia (95.8%) and regurgitation (93.8%) were the most common symptoms. Forty of 48 cases had an adequate HRM study: Type I (n-19), II (n-19) and III (n-2). Types I and II had similar clinical profile. Type II had higher basal lower esophageal sphincter (LES) pressure (30.5 [16.5-46] vs. 22.5 [13-43] mmHg; p = 0.007) and less dilated esophagus on timed barium esophagogram (TBE, 25 [13-57] vs. 34.5 [20-81] mm; p = 0.006) than type I. Both types had similar success (86.6% [13/15] vs. 92.8% [13/14]; p = 1) after first PD and need of post-PD myotomy (5/17 vs. 1/16; p = 0.1) in follow-up. Twenty-three cases had TBE before and after PD; 15 (65.2%) had good clearance. These subjects required myotomy (1/15 vs. 4/8; p = 0.03) and repeat PD (5/15 vs. 4/8; p = 0.08) less often than those with poor clearance on TBE. CONCLUSION Types I and II achalasia have similar frequency and clinical profile. Type II has higher LES pressure and less dilated esophagus than Type I. Both respond equally well to initial PD. Type I required post-PD myotomy more often, though not significantly. TBE is useful for assessing therapeutic response.
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Affiliation(s)
- Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Amrita Mathias
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Ankur Mandelia
- Pediatric Surgical Superspecialty, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Richa Lal
- Pediatric Surgical Superspecialty, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Surender Kumar Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
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Agarwal A, H B S, Mathur SB, Kalra BS, Arora R, Khanna A, Rajeshwari K. Adverse drug reactions in children and adolescents on daily antitubercular regimen: An observational longitudinal study. Indian J Tuberc 2023; 70 Suppl 1:S76-S81. [PMID: 38110265 DOI: 10.1016/j.ijtb.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES Subsequent to introduction of daily fixed dose combination (FDC) regimen with increased dosages and inclusion of ethambutol in continuation phase of antitubercular therapy (ATT) in India, this study was done to evaluate adverse drug reactions (ADRs) in children and adolescents. METHODS Longitudinal observational study conducted in tertiary teaching hospital. Children (1 month-18 year), with newly diagnosed drug sensitive tuberculosis, started on daily FDC regimen of ATT, were included. Participants were followed up at 2 weeks, 8 weeks and 6 months. Division of AIDS (DAIDS) severity grading and World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality assessment was done. RESULTS In 99 participants, 29 experienced ADRs. Most commonly ADRs involved hepatobiliary (11.1%) and gastrointestinal (8.1%) systems. Grade 3 severity noted in 35.5% ADRs. Certain causality classified in 19.3%. Presence of ADRs was significantly higher in participants with vs without malnutrition [40.5% vs 21.1% (p = 0.036)]. Tendency for more severe ADRs noted in participants with vs without malnutrition [Grade 3 ADRs out of all ADRs: 64.7% vs 0% (p < 0.001)]. CONCLUSION Incidence and severity of ADRs has increased after introduction of daily FDC of ATT. Most common ADR observed were hepatobiliary. Malnutrition and less weight for age were risk factors for occurrence and severity of ADRs.
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Affiliation(s)
- Anurag Agarwal
- Department of Pediatrics, Maulana Azad Medical College & Associated Hospitals, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Sharadhi H B
- Department of Pediatrics, Maulana Azad Medical College & Associated Hospitals, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Surendra Bahadur Mathur
- Department of Pediatrics, Maulana Azad Medical College & Associated Hospitals, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Bhupinder Singh Kalra
- Department of Pharmacology, Maulana Azad Medical College & Associated Hospitals, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Reema Arora
- Chest Clinic (TB), Lok Nayak Hospital, New Delhi, India
| | | | - K Rajeshwari
- Department of Pediatrics, Maulana Azad Medical College & Associated Hospitals, Bahadur Shah Zafar Marg, New Delhi, 110002, India
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Mondal S, Gargari P, Bose C, Chowdhury S, Mukhopadhyay S. Prevalence and Predictors of Prediabetes in Adolescents and Young Adults with Turner Syndrome: A Cross-Sectional Study from Eastern India. Indian J Endocrinol Metab 2023; 27:335-345. [PMID: 37867982 PMCID: PMC10586561 DOI: 10.4103/ijem.ijem_22_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/25/2023] [Accepted: 03/09/2023] [Indexed: 10/24/2023] Open
Abstract
Background Individuals with Turner syndrome (TS) have a high risk for prediabetes/type 2 Diabetes Mellitus (T2DM). There is scarce data regarding risk factors for prediabetes in TS, specially from South Asia. Methods We conducted a cross-sectional study on girls with TS aged 12-30 years who had achieved pubertal stage B3 and above-spontaneously or with oestrogen. Anthropometric measurements and biochemical tests were conducted, and medical records were reviewed for details about pubertal onset and progression, growth hormone (GH) and oestrogen therapy. Results Out of 129 patients with TS in our database, 99 met the criteria for inclusion, mean age 18.33+/-3.78 years and mean BMI 20.57+/- 3.71 kg/m2. Prevalence of prediabetes was 23.23%. Plasma-glucose measured after 75 g-oral-anhydrous-glucose-load (OGTT-PPG) identified five additional prediabetes cases, who had normal fasting plasma glucose (FPG) or HbA1c%. Compared to those without prediabetes, TS with prediabetes (n = 23) had higher mean body weight, BMI, waist circumference (WC) [42.02+/- 5.83 vs 36.22+/-8.07, 22.77+/-2.78 vs 19.91+/- 3.72, 85.26+/- 3.52 vs 81.08+/- 4.59, pall < 0.03 ], higher median WC-to-height ratio (WHtR) and WC-to-hip ratio (WHR)((0.64 [0.6-0.69] vs 0.59[0.56- 0.66], 0.9[0.84-1.12] vs 0.85[0.75-1.01], pboth < 0.02), and higher LDL-cholesterol, triglycerides, and greater prevalence of hepatosteatosis (47.1% vs 21.1%, P < 0.01). Among GH recipients (n = 36), those with prediabetes had delayed initiation and shorter duration of GH therapy. There were no differences in cardiometabolic parameters or the prevalence of diabetes between different karyotypic variants of TS. BMI, WC and WHR had significant positive correlation with FBG, OGTT-PPG and HbA1c% (pall < 0.004). Delay in oestrogen initiation had a significant correlation with OGTT-PPG (Spearman's-rho = 0.69, P < 0.004). BMI, WHR and pubertal status were independent predictors for prediabetes (OR: 1.27 [1.03-1.57]), 1.18 [1.04-1.34]) and 0.09[0.02-0.38], respectively, pall < 0.02), but karyotype was not. BMI had the highest sensitivity [cut-off: 21.04 kg/m2 (sensitivity: 82.6%, specificity: 62.2%) and WHR had the highest specificity [cut-off: 0.89 (sensitivity: 73.9%, specificity 78.4%)] for predicting prediabetes. Conclusion Indian girls with TS have a high risk for prediabetes, irrespective of underlying karyotype and should be screened with oral glucose challenge to identify prediabetes. Timely intervention against central obesity and early initiation of GH and oestrogen should be ensured in TS. Late presenting girls should be closely monitored for dysglycaemia before and during treatment with GH and/or oestrogen.
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Affiliation(s)
- Sunetra Mondal
- Department of Endocrinology, Healthworld Hospitals, Durgapur, West Bengal, India
| | - Piyas Gargari
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Chiranjit Bose
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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Iyengar A, Collins S, Ashok JMR, Vasudevan A. Nutrition-Focused Physical Examination for Detecting Protein Energy Wasting in Children with Chronic Kidney Disease. Indian J Nephrol 2023; 33:264-269. [PMID: 37781562 PMCID: PMC10503584 DOI: 10.4103/ijn.ijn_145_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 06/22/2022] [Indexed: 10/03/2023] Open
Abstract
Introduction There is a need to explore less laborious point-of-care assessment tools to diagnose protein energy wasting (PEW) in children with chronic kidney disease (CKD). This cross-sectional study was undertaken to assess the profile of specific nutrition-focused physical examination (NFPE) and mid-arm muscle area (MAMA) in children with CKD and determine their role in the diagnosis of PEW. Methods PEW criterion was applied to all eligible children and MAMA was derived from mid-arm circumference and triceps skin fold thickness. NFPE signs examined were muscle wasting (MW) and subcutaneous fat loss (FL). Results One hundred and twenty-six children with CKD (86 in CKD stages 2-4 and 40 on dialysis) were studied. PEW was prevalent in 41.8% children with CKD2-4 and in 72.5% on dialysis. In children with CKD 2-4, low MAMA, MW, and FL were significantly associated with PEW with an odd's ratio of 5.3 (1.55,18.30), 10.6 (3.8,29.8), and 10.5 (3.7,29.2) respectively (P = <0.001). Similarly, in children on dialysis, low MAMA, MW, and FL were more likely to be associated with PEW with an odd's ratio of 17 (2.2,127.7); P = 0.017, 16.6 (3,90.8); P = 0.001 and 19 (2.1,170.3); and P = 0.009, respectively. MW demonstrated high sensitivity and specificity [80.6 and 72%, respectively, with a positive predictive value (PPV) of 67.4%] to diagnose PEW in the CKD 2-4 group and in those on dialysis [86.2 and 72.1%, respectively, with PPV of 89.3%]. Conclusion Clinical signs based on NFPE are useful in detecting PEW in children with CKD2-4 and in those on dialysis.
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Affiliation(s)
- Arpana Iyengar
- Department of Pediatric Nephrology, St John’s National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Sheeba Collins
- Department of Pediatric Nephrology, St John’s National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - John Michael Raj Ashok
- Department of Biostatistics, St John’s National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Anil Vasudevan
- Department of Pediatric Nephrology, St John’s National Academy of Health Sciences, Bengaluru, Karnataka, India
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Shah N, Khadilkar A, Oza C, Bhor S, Ladkat D, Gondhalekar K, More C, Khadilkar V. Adiponectin-leptin ratio as a marker of cardio-metabolic risk in Indian children and youth with type 1 diabetes. J Pediatr Endocrinol Metab 2023:jpem-2023-0087. [PMID: 37128662 DOI: 10.1515/jpem-2023-0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Adiponectin/leptin ratio (ALR) is a promising novel marker of cardio-metabolic risk in patients with metabolic syndrome. Our aim was to study the association of adiponectin-leptin ratio with markers of obesity and adiposity and also to assess its usefulness as a marker of increased cardiometabolic risk (CMR) in Indian children and youth with type 1 diabetes mellitus. METHODS This observational study included 79 children and youth with type 1 diabetes (T1DM) (10-21 years) having disease duration>6 months. Demographic data and laboratory findings were obtained from patients' records. Patients with ALR<1 were categorised as having increased CMR and those with ALR>1 were categorised as having no CMR. RESULTS ALR showed a significant negative correlation with body mass index (BMI), waist and hip circumference and body fat percentage (p<0.05). Body fat percentage was the single most important predictor of ALR. Children and youth with increased CMR had higher weight, BMI, waist and hip circumferences and body fat percentage as compared to those with no CMR (p<0.05). In T1DM children with dyslipidemia, ALR was significantly lower as compared to those without dyslipidemia (p<0.05). CONCLUSIONS ALR may be a useful marker for adiposity and increased cardiometabolic risk in Indian children and youth with type 1 diabetes mellitus.
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Affiliation(s)
- Nikhil Shah
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
- Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
- Interdiscplinary School of Health Sciences, Savitribai Phule University, Pune, India
| | - Chirantap Oza
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
- Department of Pediatrics, Narendra Modi Medical College, Ahmedabad, Gujarat, India
| | - Shital Bhor
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Dipali Ladkat
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Ketan Gondhalekar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Chidvilas More
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
- Interdiscplinary School of Health Sciences, Savitribai Phule University, Pune, India
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Neighbors CE, Myers ER, Weerasinghe NP, Wijayaratne GB, Bodinayake CK, Nagahawatte A, Tillekeratne LG, Woods CW. Influenza Vaccination Implementation in Sri Lanka: A Cost-Effectiveness Analysis. Vaccines (Basel) 2023; 11:vaccines11050932. [PMID: 37243036 DOI: 10.3390/vaccines11050932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
Influenza causes an estimated 3 to 5 million cases of severe illness annually, along with substantial morbidity and mortality, particularly in low- and middle-income countries (LMICs). Currently, Sri Lanka has no influenza vaccination policies and does not offer vaccination within the public healthcare sector. Therefore, we performed a cost-effectiveness analysis of influenza vaccine implementation for the Sri Lankan population. We designed a static Markov model that followed a population cohort of Sri Lankans in three age groups, 0-4, 5-64, and 65+ years, through two potential scenarios: trivalent inactivated vaccination (TIV) and no TIV across twelve-monthly cycles using a governmental perspective at the national level. We also performed probabilistic and one-way sensitivity analyses to identify influential variables and account for uncertainty. The vaccination model arm reduced influenza outcomes by 20,710 cases, 438 hospitalizations, and 20 deaths compared to no vaccination in one year. Universal vaccination became cost-effective at approximately 98.01% of Sri Lanka's 2022 GDP per capita (incremental cost-effectiveness ratio = 874,890.55 Rs/DALY averted; 3624.84 USD/DALY averted). Results were most sensitive to the vaccine coverage in the 5-64-year-old age group, the cost of the influenza vaccine dose in the 5-64-years-old age group, vaccine effectiveness in the under-5-years-old age group, and the vaccine coverage in the under-5-years-old age group. No value for a variable within our estimated ranges resulted in ICERs above Rs. 1,300,000 (USD 5386.15) per DALY adverted. Providing influenza vaccines was considered highly cost-effective compared to no vaccines. However, large-scale national studies with improved data are needed to better inform estimates and determine the impact of vaccination implementation.
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Affiliation(s)
- Coralei E Neighbors
- Hubert-Yeargan Center for Global Health, Duke University, Durham, NC 27710, USA
| | - Evan R Myers
- Division of Women's Community and Population Health, Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Nayani P Weerasinghe
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
| | - Gaya B Wijayaratne
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
| | - Champica K Bodinayake
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA
| | - Ajith Nagahawatte
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA
| | - L Gayani Tillekeratne
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Christopher W Woods
- Hubert-Yeargan Center for Global Health, Duke University, Durham, NC 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
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Mohanraj S, Prasad HK. Delayed Puberty. Indian J Pediatr 2023; 90:590-597. [PMID: 37127825 DOI: 10.1007/s12098-023-04577-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
Abstract
Testicular volume ≥4 ml and appearance of breast budding are the first signs of puberty. Delayed puberty is diagnosed in the absence of thelarche by 13 y or menarche by 15 y in girls and absence of testicular enlargement by 14 y in boys. Delayed puberty can be due to hypogonadotrophic hypogonadism, hypergonadotrophic hypogonadism or eugonadotrophic eugonadism characterised by low, elevated and normal gonadotrophin levels, respectively. Constitutional Delay of Growth and Puberty (CDGP) and systemic illness should be considered before pathological causes. Assessment of sexual maturity by Tanner's staging and anthropometric assessment on growth chart is pivotal. Lack of menarche in girls with thelarche suggests structural abnormalities of reproductive tract or disorders of sexual development. Measurement of bone age helps to interpret hormone measurements and decide on timing of pubertal induction. Ultrasound assessment of abdomen gives valuable clues to pubertal onset (in girls) and possible underlying etiology. Karyotyping is mandatory in all girls with delayed puberty and short stature, and delayed menarche and boys with hypergonadotrophic hypogonadism. Gonadotrophin releasing hormone analogue stimulation test may help distinguish hypogonadotrophic hypogonadism from CDGP. Pubertal induction is done with intramuscular testosterone and oral estradiol in boys and girls, respectively. Hormone replacement is begun at low doses and slowly escalated over 2 y to mimic a physiological puberty process. Short course of testosterone for 3 to 6 mo is helpful in adolescent boys with CDGP and psychological distress. Attainment of adult sexual maturity by 18 y is mandatory to rule out disorders of hypothalamic pituitary gonadal axis.
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Affiliation(s)
- Swathi Mohanraj
- Department of Pediatrics, Mehta Multispeciality Hospitals India Pvt. Ltd., Chennai, Tamil Nadu, India
| | - Hemchand Krishna Prasad
- Department of Pediatric Endocrinology, Mehta Multispeciality Hospitals India Pvt. Ltd., 2, Mc Nichol's Road, Chetpet, Chennai, Tamil Nadu, India.
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Alam A, Singh SK, Kumar R. Prevalence of Organ-Specific Autoimmunity in Patients With Type 1 Diabetes Mellitus. Cureus 2023; 15:e38855. [PMID: 37303388 PMCID: PMC10256565 DOI: 10.7759/cureus.38855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) is associated with other autoimmune disorders that are characterized by presence of organ-specific autoantibodies. The present study was undertaken to assess the prevalence of organ-specific autoantibodies among newly diagnosed T1DM subjects of India and to study its relationship with glutamic acid decarboxylase antibody (GADA). We also compared the clinical and biochemical parameters in GADA-positive and -negative T1DM subjects. METHODS In a hospital-based cross-sectional study, we studied 61 patients with newly diagnosed T1DM ≤ 30 years of age. T1DM was diagnosed on the basis of acute onset of osmotic symptoms with or without ketoacidosis, severe hyperglycaemia [blood glucose > 13.9 mmol/l (>250 mg/dl)] and insulin requirement from the onset of diabetes. Subjects were screened for autoimmune thyroid disease (thyroid peroxidase antibody [TPOAb]), celiac disease (tissue transglutaminase antibody [tTGAb]), and gastric autoimmunity (parietal cell antibody [PCA]). RESULTS Of the 61 subjects, more than one-third (38%) had at least one positive organ-specific autoantibody. In particular, 13 (21.3%) were found to be positive for TPOAb, nine (14.8%) were positive for tTGAb and 11 (18%) were positive for PCA. GADA was positive in 15 (25%) subjects. The frequency of TPOAb tended to be higher in patients who had GADA positivity compared with those with no circulating GADA (40% vs. 15.2%; p=0.07). Subjects positive for GADA were also more likely to be PCA positive compared with those who were GADA negative (40 vs.10.9%, p=0.02). There were no differences in frequency of diabetic ketoacidosis, body mass index, hemoglobin A1C (HbA1c), insulin requirement or fasting C-peptide in GADA-positive and -negative patients. CONCLUSION We support the recommendation for regular screening of organ-specific autoantibodies, in particular TPOAb, tTGAb and PCA in all patients with T1DM. Detection of these autoantibodies at onset may prevent complications associated with delayed diagnosis of these disorders. We also conclude that there is higher frequency of TPOAb and PCA in GADA-positive T1DM patients as compared to negative ones. However, patients with positive GADA had similar clinical and biochemical parameters compared to GADA-negative subjects. Lastly, low GADA positivity in our study cohort as compared to Western populations suggests the heterogenous nature of T1DM in the Indian population.
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Affiliation(s)
- Ahmad Alam
- Endocrinology, Diabetes and Metabolism, Rajiv Gandhi Centre for Diabetes and Endocrinology, Jawaharlal Nehru Medical College Hospital (JNMCH) Aligarh Muslim University, Aligarh, IND
- Endocrinology, Diabetes and Metabolism, Department of Endocrinology and Metabolism, Institute of Medical Sciences (IMS) Banaras Hindu University, Varanasi, IND
| | - Surya K Singh
- Endocrinology, Diabetes and Metabolism, Department of Endocrinology and Metabolism, Institute of Medical Sciences (IMS) Banaras Hindu University, Varanasi, IND
| | - Ritesh Kumar
- Endocrinology, Diabetes and Metabolism, Department of Endocrinology and Metabolism, Institute of Medical Sciences (IMS) Banaras Hindu University, Varanasi, IND
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Sharma S, Sinha A, Malik R, Bagga A. Gastrostomy Tube Feeding in Indian Children with Advanced Chronic Kidney Disease. Indian J Pediatr 2023; 90:400-402. [PMID: 36800164 DOI: 10.1007/s12098-023-04499-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/17/2023] [Indexed: 02/18/2023]
Abstract
Guidelines recommend initiating supplemental enteral feeding through a nasogastric (NG) or gastrostomy tube (G-tube) in patients with chronic kidney disease who have inadequate oral intake despite repeated nutritional counseling. While G-tube placement is shown to improve both nutritional status and anthropometric indices of children with CKD in developed regions, information from developing countries is lacking. This retrospective report reviewed the impact of G-tube feeding on nutritional intakes and anthropometric parameters over a 1-y follow-up in 5 children with CKD-5D managed at one tertiary care center in India. Gastrostomy feeding facilitated significant increments in caloric and protein intake and was easy and safe. However, G-tube feeding led to additional expenses, and the changes in growth parameters were variable in the short term. A longer follow-up appears necessary to understand its impact on wasting, growth velocity, and stature.
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Affiliation(s)
- Shally Sharma
- Divisions of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Sinha
- Divisions of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Rohan Malik
- Divisions of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Bagga
- Divisions of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Santra A, Rai S, Misra P, Yadav K, Goswami K, Kaur G. Comparison of Different Anthropometric Indicators for Assessment of Nutritional Status Among Adolescent Girls in an Urban Resettlement Colony in New Delhi: A Cross-Sectional Study. Cureus 2023; 15:e37242. [PMID: 37162786 PMCID: PMC10164345 DOI: 10.7759/cureus.37242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 05/11/2023] Open
Abstract
Background In India, 44.8% of adolescent girls are under-nourished, while about 8%-13% of girls are overweight. Though several studies have been done regarding the nutritional status of adolescent girls over the years, there have been no significant changes. Also, there are several different anthropometric indicators for nutritional status assessment, due to which there are huge variations in the prevalence of malnutrition across different studies. So the objectives of this study were to determine the prevalence of malnutrition using different anthropometric indicators and compare them. Methods A random sample of 426 girls was taken from Health Management Information Systems (HMIS) of the Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), and a semi-structured questionnaire was administered among 386 of them to determine associated factors. Height, weight, and mid-upper arm circumference (MUAC) were measured for 386 girls, and BMI for age and height for age z scores were calculated using WHO AnthroPlus. Mid-upper arm circumference for age z scores (MUAC for age) were calculated using Lambda-Mu-Sigma (LMS) charts by the CDC for girls aged one year to 20 years. Results It was found in this study that using BMI for age z scores (BAZ), 33.4% of the adolescent girls were malnourished; 18.9% (95% CI 15.1-23.2) being underweight, 10.6% (95% CI: 7.7-14.1) being overweight, and 3.9% (95% CI: 2.2-6.3) were obese. While using BMI solely as an indicator, the prevalence of thinness was 51.8% (95% CI: 46.9-56.9), while that of overweight and obesity was 10.6% (95% CI: 5.7-11.5) and 1.0% (95% CI: 0.2-2.6), respectively. The prevalence of under-nutrition by MUAC for age z scores was 53.4% (95% CI: 48.2-58.4), and that of over-nutrition was 1.8% (95% CI: 1.0-3.7). BMI for age z scores positively and strongly correlated with both MUAC and MUAC for age z scores and had a significant association with both on univariable linear regression. Though there was a negative correlation between BMI for age z scores and height-for-age z scores, it was not significant. Height-for-age z scores, even though positively correlated with MUAC for age z scores, the correlation was not that strong.
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Affiliation(s)
- Archismita Santra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Sanjay Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Puneet Misra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Kiran Goswami
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Gurdeep Kaur
- Department of Dietetics, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Impact of Anxiety on Growth of Indian Children and Adolescents: A Cross-Sectional Multicenter Study. Indian J Pediatr 2023; 90:411-412. [PMID: 36757654 DOI: 10.1007/s12098-023-04503-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
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Seetharaman K, Lal SB, Prasad KK, Kumar Y, Bhatia A, Malhotra S. Role of Serology, Dietary Assessment, and Fecal Gluten Immunogenic Peptides for Predicting Histologic Recovery in Children with Celiac Disease. Dig Dis Sci 2023; 68:529-540. [PMID: 36459294 DOI: 10.1007/s10620-022-07762-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 11/07/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND A strict lifelong gluten-free diet (GFD) remains the only treatment of celiac disease (CD). Adherence to gluten-free diet is best reflected by mucosal healing. Noninvasive tools capable of predicting mucosal recovery in CD patients need to be identified. AIMS To compare the ability of various modalities used to assess compliance to GFD, for predicting persistent mucosal damage in children with CD. METHODS A prospective, single-center, observational study on children with CD on a GFD was conducted between January 2020 and April 2021. Children with CD on GFD were consecutively enrolled and various modalities used to assess adherence to GFD were compared. RESULTS One hundred and fifty children (Mean age 12.2 ± 3.6 years, 58% Boys) on GFD (Mean duration 6 ± 3.1 years) were enrolled in the study. Persistent mucosal damage was seen in 88% of the enrolled. Fecal gluten immunogenic peptide (GIP) was positive in 87.8% (129/147). Antibodies to tissue transglutaminase (TGA-IgA) and/or deamidated gliadin peptide (DGP) were positive in 32% (48/150) whereas antibody to synthetic neoepitopes of TGA-IgA was positive in 24.8% (37/149). Non-compliance as assessed by local questionnaire, Biagi score, and dietitian detailed interview were 62.7%, 60%, and 75.3%, respectively. Serology had the highest specificity (83%) and fecal GIP had the highest sensitivity (89%). On logistic regression analysis, only non-compliance by Biagi score predicted poor mucosal recovery. CONCLUSION Fecal GIP may be sensitive to detect only "one-point dietary transgression." None of the existing modalities used to assess compliance to GFD accurately predict persistent mucosal damage. A subset of patients may develop gluten tolerance.
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Affiliation(s)
- Keerthivasan Seetharaman
- Division of Pediatric Gastroenterology and Hepatology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Sadhna Bhasin Lal
- Division of Pediatric Gastroenterology and Hepatology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Kaushal Kishor Prasad
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yashwant Kumar
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Bhatia
- Department of Experimental Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunita Malhotra
- Department of Dietetics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Selvaraj M, Prasad HK, White S, Prasanna B, Sangaralingam T. Prevalence and Determinants of Occurrence of Dyslipidemia in Subjects with Type 1 Diabetes Mellitus. Indian J Pediatr 2023; 90:118-123. [PMID: 35366198 DOI: 10.1007/s12098-022-04130-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/18/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe the prevalence and determinants of occurrence of dyslipidemia in children and adolescents with type 1 diabetes mellitus (T1DM). METHODS A cross-sectional study was conducted in the diabetic clinic of a tertiary care referral hospital over two years. Subjects with T1DM aged 2-18 y had assessment of Lipid profile after 12 h of fasting. Glycemic control was assessed by glycosylated hemoglobin (HbA1C). Modifiable and nonmodifiable determining factors were assessed during clinic visit as per standard criteria. Body mass index (BMI) more than 23rd adult equivalent and 27th adult equivalent were considered as overweight and obesity, respectively. Lipid parameters were considered as abnormal if: Low density lipoprotein (LDL) > 100 mg/dL, high density lipoprotein (HDL) < 40 mg/dL, triglycerides > 100 mg/dL (< 10 y) and > 130 mg/dL (> 10 y). RESULTS A total of 171 subjects (mean age: 11.8 ± 3.5 y, M:F = 75:96) were recruited during the study period. The mean fasting LDL level, HDL level, and triglyceride level observed in the study sample were 106.6 ± 26.9 mg/dL (62% abnormal), 52.6 ± 14.3 mg/dL (9.4% abnormal), and 85.3 ± 39.4 mg/dL (10.5% abnormal), respectively; 115 (67.3%) of the subjects had at least one abnormality in the serum lipid profile. On multivariate analysis, HbA1C was the most significant factor in determining the occurrence of dyslipidemia (p < 0.05). HbA1C was 9.9 ± 1.6 in subjects with abnormal LDL versus 9.1 ± 1.5 in those with normal LDL (p < 0.05). CONCLUSION Prevalence of dyslipidemia in the study children and adolescents with T1DM was 67.3%. HbA1C remains the most important modifiable determinant of the occurrence of dyslipidemia.
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Affiliation(s)
- Meghana Selvaraj
- Department of Pediatrics, Mehta Multispeciality Hospitals India Pvt. Ltd, Chennai, Tamil Nadu, India
| | - Hemchand Krishna Prasad
- Department of Pediatric Endocrinology, Mehta Multispeciality Hospitals India Pvt. Ltd, Chennai, Tamil Nadu, 600031, India.
| | - Sherline White
- Department of Pediatrics, Mehta Multispeciality Hospitals India Pvt. Ltd, Chennai, Tamil Nadu, India
| | - Bala Prasanna
- Department of Pediatrics, Mehta Multispeciality Hospitals India Pvt. Ltd, Chennai, Tamil Nadu, India
| | - Thangavelu Sangaralingam
- Department of Pediatrics, Mehta Multispeciality Hospitals India Pvt. Ltd, Chennai, Tamil Nadu, India
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