Leptin level in Thai children and adolescents: Relation to BMI and sexes.

Objective: The prevalence of obesity is rapidly increasing worldwide, including Thai children. Serum leptin is demonstrated largely that it increased in the dynamic phase in childhood –onset obesity. To our knowledge, there was no data of leptin measurement in this age group of our population. Methods: Therefore, we measured serum leptin by an immunoradiometric assay in sample from 208 obese and non-obese healthy children aged 2-18 years old. Its relationship to body mass index (BMI), ages and sexes were analyzed. Results: The mean serum leptin concentration in obese children was 35.06 + 17.31 ng/ml compared with 14.70 + 8.93 ng/ml in the non - obese children (p < 0.001). The obese female had significant higher level than in obese male group (43.26 + 16.82 vs. 30.34 + 15.85 ng/ml; p < 0.001), but they were not different in the non - obese group. The results showed that serum leptin correlated with BMI (r = 0.71; p < 0.001) and with % weight for height (%wt for ht) (r = 0.60, p < 0.001), respectively. Leptin levels in both sexes compared to age were also demonstrated. We did not find leptin deficiency or leptin resistance in all obese cases. Conclusion: In summary, leptin level in Thai children were increased according to BMI, % wt for ht and sexes as demonstrated in other ethnic groups. However, there is neither leptin deficiency nor leptin resistance demonstrated in this study.

Clinical pictures of type 2 diabetes in Thai children and adolescents is highly related to features of metabolic syndrome.

Prevalence of type 2 diabetes (T2DM) in children and adolescents has increased, parallelled to the increased prevalence of obesity around the world. The objectives of this study are (1) to identify the clinical presenting features of T2DM in Thai children and adolescents, and (2) to identify evidence of feature of metabolic syndrome in these affected. We analyzed 26 T2DM patients who were treated by Pediatric endocrinologists in our hospital. The study showed that their mean ages (+/- SD) at diagnosis was 12.1 +/- 2.3 years, all were obese and 96% had acanthosis nigricans. Fifty three percents (53%) presented with clinical signs and symptoms which included DKA (19.2%), clinical triad of polyuria, polydipsia and weight loss (15.4%), only polyuria, polydipsia (11.5%) and abnormal menstruation (7%). The rest of 46.2% had no clinical symptoms. The initial fasting or random plasma glucose found above diagnostic range in 84.5%, the rest of 15.5% were diagnosed by using oral glucose tolerance test. Dyslipidemia was found in 75%. Fifteen percents had no family history. Eighty percents had three or more than three features of metabolic syndrome. In conclusions, clinical picture of type 2 diabetes in Thai youth varied from asymptomatic to severe illness (DKA). Almost all had clinical features of metabolic syndrome. Childhood obesity has become epidemic in our population. Such clinical picture should alert all pediatricians to be aware of chronic diseases and for making an early diagnosis and preventing long-term complications in the future.

Persistent hyperinsulinemic hypoglycemia of infancy: experience at Siriraj Hospital.

BACKGROUND: Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is the most common cause of recurrent or persistent hypoglycemia in early childhood. Conventionally, pancreatectomy (Px) has often been recommended to control hypoglycemia. However, PHHI can be managed successfully by intensive medical treatment to avoid pancreatectomy. METHOD: Data from 10 infants (8M, 2F) with PHHI were retrospectively analyzed. RESULTS: Eight patients (80%) developed symptoms within 72 hours after birth (early-onset). Six patients (60%) underwent 85 per cent-95 per cent Px due to failure of medical treatment. Two patients who underwent less than 95 per cent Px required second Px (97% and 99%). One patient developed permanent diabetes mellitus and malabsorption. Hypoglycemia could be successfully managed by medication alone in four patients (40%). Of these, three patients had early-onset neonatal hypoglycemia. Medication could be discontinued in three patients (75%). Three of ten patients (30%) had delayed development. Pancreatectomies and/or the diagnosis of PHHI were made late for these patients. One of these three children also developed epilepsy. CONCLUSIONS: Patients with PHHI frequently require pancreatectomy which commonly results in long-term complications especially diabetes mellitus and malabsorption. Our data suggest that PHHI can be managed successfully with an intensive medical regimen even in patients with early-onset hypoglycemia. Although medical management is very laborious for the family and physician, it should be applied until euglycemia is accomplished. Moreover, the early diagnosis of PHHI and the successful hypoglycemic control are very necessary to prevent permanent neurologic sequelae.

Intensive diabetes education program and multidisciplinary team approach in management of newly diagnosed type 1 diabetes mellitus: a greater patient benefit, experience at Siriraj Hospital.

It is accepted worldwide that an effective multidisciplinary management team is essential for providing comprehensive self-management training to type I diabetics and their families. Therefore, the authors developed an intensive multidisciplinary education team that included pediatric endocrinologists, a dietitian, a psychologist, nurses, scientists and volunteers in the Department of Pediatrics, Siriraj Hospital in August 1996. This study aimed to analyze twenty-four newly diagnosed diabetics who underwent this specified program and multidisciplinary team approach in comparison to twenty-eight diabetic patients who were diagnosed before the program and team were established in order to see whether the length of hospitalization had been reduced and to compare the readmission rates of recurrent DKA with previous patients. The results demonstrated that by using the intensive program and multidisciplinary team the average length of admission was reduced from 36.04 days to 17.63 days (p value = 0.03). The readmission rate in the first year after diagnosis was also reduced from 17.8 per cent to 4 per cent. Concerning diabetes control, the average HbA1c level showed significantly better control. Therefore, this study demonstrated a successful team and program for newly diagnosed Thai childhood and adolescent diabetics and also emphasized that a multidisciplinary team approach with an effectively intensive education program is important in helping diabetics and families cope with their emerging problems and receive the long-term benefits of effective self-care.

Clostridium difficile infection in febrile neutropenic malignancy children.

C.difficile infections were studies in 30 febrile neutropenic malignancy children with diagnoses of ALL (15), AML (9), non-Hodgkin lymphoma (3) and others (3). All children have been on chemotherapy during induction phase (15), maintenance phase (9), consolidation phase (3) and pulse therapy phase (3). They were treated with ceftazidime and amikacin intravenously for at least 7 days. Stool specimens were collected before and 2 and 4 weeks after starting antibiotics. C.difficile toxin A in stools were detected by ELISA method which showed positive results in 11 cases (36.7%). There were 5, 5, and 2 positive specimens at before and 2, and 4 weeks respectively. All 5 cases of the first group had history of the last receiving antibiotic longer than 3 months. All of positive C.difficile toxin cases had no diarrhea or abdominal pain. Chemotherapy and cephalosporin were the important factors for colonization of C.difficile in malignancy children.

Serum IGF-I, IGF-II and IGFBP-3 levels in children with isolated growth hormone deficiencies and panhypopituitarism.

Serum IGF-I,IGF-II and IGFBP-3 levels were measured by radio-immunometric assay in 24 children, 16 with isolated growth hormone deficiencies (GHD) and 8 with panhypopituitarism. AII serum parameters were significantly lower in panhypopituitarism than in isolated GHD. Serum IGF-I levels were lower than the normal range in 50 percent of the patients. However, 66.7 percent of isolated GHD children older than 10 years had serum IGF-I levels lower than the normal range. AII isolated GHD children had serum IGFBP-3 levels lower than the 50th percentile or mean of normal range. Combined IGF-I and IGF-II levels had no more advantage than IGF-L levels in the diagnosis of isolated GHD. Serum IGFII levels were lower than normal range in 87.5 percent. In conclusion, serum IGFBP-3 measurement is useful than IGF-I in all age groups. Low serum IGF-II levels and panhypopituitarism were demonstrated in this study.

Three years of growth hormone therapy in children with growth hormone deficiency.

The objects is to study the long-term therapeutic effect of recombinant DNA hGH by administration of biosynthetic hGH for 2 ½ - 3 years to 12 children with growth hormone (GH) deficiency, consisted of 7 males, 5 females; whose ages ranged from 3 years 4 months to 17 years old. All patients fulfilled the criteria of GH deficiency namely; growth rate less than 7 ng/ml after clonidine and dopa-propranolol stimulation test. Ten patients had idiopathic GH deficiency. Two had hypopituitarism as a result of brain tumors and cranial surgery. The growth rate was observed over a pretreatment period of 12 months. The patients received 0.1 µ/kg of recombinant DNA hGH subcutaneously 6 days per week. In males with GH-deficiency, pre-treatment mean height was 2.6 cm per year. The mean height increment at 6th, 12th, 24th, 30th, and 36th month of treatment were 6, 11.2, 14.1, 17.6, 20.6 and 23.4 cm respectively. The females had mean height increment during pre-treatment period of 2.2 cm per year. The mean height increment on 6th, 12th, 18th, 24th, and 30th month of treatment were 4.7, 7.8, 10.3, 14.2 and 14.4 cm respectively. All patients have a significant satisfactory response to recombinant DNA hGH in term of height increment. There was no report of either side effect or complication. Every patient has had improved sense of physical, mental and psycho-social well-being.

Correlation between urine specific gravity and osmolality in infants with acute diarrhea.

A total of 447 specimens of urine collected from infants with acute diarrheal disease at periods of 0-8, 8-16, 16-24, 24-48 and 48-72 hours after admission were studied for correlation between specific gravity and osmolality, specific gravity and sum of sodium and potassium, and osmolality and sum sodium and potassium. There is significant correlation between specific gravity and osmolality of urine from combination of every period 0-8 hour, and 48-72 hour period. In contrast, there is no correlation between specific gravity and osmolality with sum of sodium and potassium of urine at every period of the study. The correlation between specific gravity and osmolality of urine were tabulated and will be used as guidelines for monitoring adequact of hydration in infants with diarrheal disease.