Testicular Volume of Boys Aged 5-17 Years in Relation to Sexual Maturity Rating and Clinical Onset of Puberty in an Urban Setting in Gujarat, India

Background : Assessment of Sexual Maturity Rating and Testicular Volume are indispensable in the routine assessment of puberty in boys. There is paucity of data in Indian population for Testicular Volume particularly in early adolescence. Aims : The aims of the study were to collect data for testicular volume,correlate testicular volume with Sexual Maturity Rating (SMR) and the clinical onset of puberty; and to identify Testicular abnormalities in boys aged 5 to 17 years in an Urban setting in Gujarat, India. Materials and Methods : A prospective observational study was undertaken in boys aged5 to 17years of age from Gujarat from April, 2019 to August, 2019. Mean Testicular Volume was measured with a Prader抯 orchidometer. Parameters like Age, Weight and Height were also measured and Body Mass Index (BMI) was calculated. Pubertal stage was categorized using Tanner staging. Data was statistically analyzed using Microsoft Excel and SPSS software. Results : 977 boys were included in the study. Mean age at SMR stage 2 was 11.22 years. SMR stage 2 was earliest seen at 6 years and latest at 15 years of age. 15% of boys in pre-adolescence, 60% in early adolescence and 94% in middle adolescence showed changes of Puberty. Precocious puberty was detected in 33 boys (3.38%). Delayed Puberty was detected in 4 boys (0.4%) and Undescended Testes in 4 boys (0.4%). Testicular Volume showed positive correlation with Weight, Height and BMI.

Clinical Profile of Children with Celiac Disease in Gujarat.

Introduction : Celiac Disease (CD), an autoimmune enteropathy, triggered by the ingestion of gluten in genetically susceptible individuals, is one of the commonest causes of malabsorption in the west. It is now well documented from north India where wheat is the staple diet. We report here 22 children of CD from Gujarat to bring the awareness amongst the pediatricians for its early diagnosis. The clinical presentation, serological tests & duodenal biopsy confirms the diagnosis. The results of Gluten Free Diet (GFD) are quite gratifying. Methodology : Retrospective analysis of presentation of children diagnosed to have CD was done from maintained database of CD patients of last 5 years. Results : Twenty two children were diagnosed to have CD at our centre in last 5 years. The age of presentation was from 14 months to 11 years. Short stature, pallor & chronic diarrhoea were the commonest features. Distention of abdomen, anorexia, pain in abdomen & oedema were other manifestations. Vomiting, voracious appetite, irritability & dermatitis were also noted in some cases. Rickets, rectal prolapse & clubbing were less common findings. Serological tests, besides routine investigations & duodenal biopsy confirmed the diagnosis. Gluten Free Diet (GFD) showed impressive results in 3 to 6 months time. Conclusion : CD is well documented in north India, but it also exists in Gujarat. With clinical presentation of stunted growth, chronic diarrhoea & unexplainable anaemia, one should think of CD. Some other less common & atypical features should also be kept in mind. The results of serological tests for CD are fairly reliable. Still, it is mandatory to confirm the diagnosis by duodenal biopsy. The results of GFD are quite rewarding. To emphasize for compliance of GFD & to provide the list of GFD to the parent & regular follow up are essential components of management.

Advances in management of urinary tract infections.

Urinary Tract Infections (UTI) are a common bacterial infection in children. The diagnosis of UTI is very often missed in young children due to minimal and non-specific symptoms. The developing renal cortex in young children is vulnerable to renal scarring resulting in hypertension and chronic renal failure. A clinically suspected case of UTI should be defined and documented with urine culture report. After the diagnosis of UTI, its category should be defined. It will guide for proper radioimaging evaluation, choice of antimicrobial agent, duration of treatment, need of chemoprophylaxis etc. Even a single confirmed UTI should be taken seriously. Rational use of modern radioimaging for proper evaluation is essential. UTI in neonates, nosocomial UTI and UTI due to ESBL producing organisms are special situations, to be identified and managed with advanced therapy promptly and appropriately.