18p Deletion Syndrome With a 45, XY, t (14;18) (p11.1; p11.1), Karyotype.

Monosomy 18p deletion syndrome is a rare genetic disorder. We present an uncommon case of 18p deletion syndrome originating from a unique translocation between chromosomes 14 and 18 in an 11-year-old Saudi male, manifesting various clinical features. This case highlights the importance of understanding the genotype-phenotype correlations of 18p deletion syndrome to aid in the early recognition of the syndrome for its effective diagnosis and management.

Tackling access and payer barriers for growth hormone therapy in Saudi Arabia: a consensus statement for the Saudi Working Group for Pediatric Endocrinology.

Prompt diagnosis and early treatment are key goals to optimize the outcomes of children with growth hormone deficiency (GHD) and attain the genetically expected adult height. Nonetheless, several barriers can hinder prompt diagnosis and treatment of GHD, including payer-related issues. In Saudi Arabia, moderate-to-severe short stature was reported in 13.1 and 11.7 % of healthy boys and girls, respectively. Several access and payer barriers can face pediatric endocrinologists during the diagnosis and treatment of GHD in Saudi Arabia. Insurance coverage policies can restrict access to diagnostic tests for GHD and recombinant human growth hormone (rhGH) due to their high costs and lack of gold-standard criteria. Some insurance policies may limit the duration of treatment with rhGH or the amount of medication covered per month. This consensus article gathered the insights of pediatric endocrinologists from Saudi Arabia to reflect the access and payer barriers to the diagnostic tests and treatment options of children with short stature. We also discussed the current payer-related challenges endocrinologists face during the investigations of children with short stature. The consensus identified potential strategies to overcome these challenges and optimize patient management.

Comparing Real-Time Continuous Glucose Monitoring to Self-Monitoring of Blood Glucose: Advantages and Limitations for Children and Adolescents With Type 1 Diabetes.

Objectives We aimed to determine the benefits and drawbacks of real-time continuous glucose monitoring (rtCGM) compared with those of self-monitoring of blood glucose (SMBG) in children and adolescents with type 1 diabetes (T1D) and their impact on glycemic control, hypo- and hyperglycemic episodes, exercise, quality of life, and psychosocial factors. Methodology This quantitative, comparative, cross-sectional study was conducted between July 2022 and March 2023 at the Pediatric Endocrine Outpatient Clinic, King Abdulaziz University Hospital, Saudi Arabia. Data were obtained via a clinical interview with children and adolescents with T1D aged 2-18 years. Results The study involved 121 participants, with 71 (58.7%) male patients and 50 (41.3%) female patients. The participants' mean age was 11.9 ± 4.4 years. Compared with patients using SMBG, patients using rtCGM demonstrated a more significant decrease in the mean glycated hemoglobin (HbA1c) level from baseline (7.79 ± 1.17 vs. 8.92 ± 1.63, P = 0.001), a reduction in the number of hypoglycemic episodes (85.7% vs. 70.6%, P = 0.028), and stable blood glucose level during exercise (97.2% vs. 76.4%, P = 0.001). Additionally, 65 (92.9%) rtCGM users had undisturbed sleep compared with 22 (43.1%) SMBG users. Approximately 64 (91.4%) rtCGM users reported that the sensor helped decrease their anxiety levels and pain sensations. Conclusions In this novel study in Saudi Arabia, rtCGM demonstrated a significantly better impact than SMBG on glycemic control, hypo- and hyperglycemic episodes, and psychosocial factors in children and adolescents with T1D.

Effect of the COVID-19 Pandemic on Treatment Adherence Among Children With Congenital Adrenal Hyperplasia.

BACKGROUND: This study determined the effect of the COVID-19 pandemic on adherence to medication among children with congenital adrenal hyperplasia (CAH) living in the Kingdom of Saudi Arabia (KSA). METHODS: Data were collected from April 2020 to April 2022 through face-to-face or telephonic interviews at a virtual paediatric endocrine clinic in Jeddah, KSA. RESULTS: A total of 55 children, with a mean age of 12.9 ± 5.8 years, participated in the study. Most children (32/55, 58%) were administered treatment by their mother. Before the COVID-19 pandemic, 51 patients (93%) reported adhering to their CAH treatment. After the onset of the COVID-19 pandemic, this number decreased to 49 (89%, p = 0.516). The most common reasons for non-adherence before and after the pandemic included restricted access to medication (supply and financial problems) and challenges in obtaining new prescriptions and refills. These challenges increased after the onset of the pandemic. Before and after the onset of the pandemic, mothers with a university degree were significantly more likely to administer medication than mothers without a university degree, but fathers' education level did not affect their role in medication administration, before or after the onset of the pandemic. CONCLUSION: This study confirms that the COVID-19 pandemic did not have a significant effect on medication adherence in children with CAH in Jeddah.

Congenital lipoid adrenal hyperplasia in a Saudi infant.

Summary: Congenital lipoid adrenal hyperplasia (CLAH) is characterized by a defect in the STAR protein-encoding gene that attenuates all steroidogenesis pathways. Herein, we present the first reported case in Saudi Arabia of a 46 XY, phenotypically female infant with an unfamiliar, darkened complexion compared to the family's skin color. Based on the clinical and biochemical findings, CLAH was diagnosed and glucocorticoid replacement therapy was initiated. As a result, we suggest that pediatricians should always investigate the possibility of adrenal insufficiency when encountering unusual dark skin. Learning points: Pediatricians should be prompted to rule out adrenal insufficiency in unexpectedly dark skin neonates. In such patients, pediatricians should not wait until the neonate develops an adrenal crisis. A low level of 17-hydroxyprogesterone does not always rule out the possibility of inherited adrenal gland disorders, and additional tests should be performed for early detection.

Ovarian cell tumor in a child with neurofibromatosis type 1.

Juvenile granulosa cell ovarian tumor is a rare cause ofpseudo-precociouspuberty. We report a case of a 6-year-old female with neurofibromatosis type 1 (NF1), associated with pseudo-precocious puberty (PPP). A thorough workup revealed a large multi-cystic right ovarian mass, which turned out to be a juvenile granulosa cell tumor (JGCT). This report documented a rare case of PPP caused by JGCT in a child with NF1. Verbal consent was taken from the family.

Résumé La tumeur ovarienne juvénile à cellules de la granulosa est une cause rare de puberté pseudo-précoce. Nous rapportons le cas d'une fillette de 6 ans atteinte de neurofibromatose de type 1 (NF1), associée à une puberté pseudo-précoce (PPP). Un bilan approfondi a révélé une grande masse ovarienne droite multikystique, qui s'est avérée être une tumeur juvénile des cellules de la granulosa (JGCT). Ce rapport a documenté un cas rare de PPP causé par JGCT chez un enfant atteint de NF1. Le consentement verbal a été recueilli auprès de la famille.. Mots-clés: Cellule de la granulosa, juvénile, neurofibromatose, tumeur ovarienne, puberté précoce.

Impact of Virtual Education Versus Traditional Learning Modalities on the Body Mass Index of Students During the COVID-19 Pandemic in Western Saudi Arabia: A Cross-Sectional Study.

OBJECTIVE:  The emergence of the coronavirus disease has forced governments worldwide to implement non-pharmaceutical interventions that imposed strict confinement policies on their populations, including children and adolescents. Subsequently, the education system has shifted from traditional to online classroom settings, introducing physical and lifestyle changes in students. This study aimed to determine the impact of virtual education in comparison with that of traditional education on body weight among school-age students in western Saudi Arabia. METHODS:  This cross-sectional study was carried out between March 2020 and May 2021 and assessed pediatric patients at the Pediatric Endocrine Clinic at King Abdulaziz Hospital, Jeddah, Saudi Arabia. A clinical interview was performed to collect data on sociodemographic characteristics, physical activity levels, and electronic device usage. Body mass index (BMI) was determined using the Center for Disease Control and Prevention standards. RESULTS:  In total, 518 participants (262 female and 256 male students) aged six to 18 years were assessed. The BMI significantly increased from a mean of 19.24, before the pandemic, to 20.08, after the commencement of the virtual study modality (p<0.001) that involved the increased use of electronic devices. Moreover, the proportion of physical inactivity significantly increased during weekdays (39%) and weekends (37.5%). CONCLUSION:  Due to the many obesogenic factors influenced by the coronavirus disease 2019 (COVID-19) pandemic, the findings indicate the need for further research and interventions to avoid the incidence of overweight and obesity among students. Many obesogenic factors are influenced by the COVID-19 pandemic, which affect the student's physical activity and lifestyle by increasing the risk of overweight and obesity. Therefore Further research and interventions are needed.

The association of extreme body weight with bone mineral density in Saudi children.

Objective: The objective to investigate the effect of extreme body weight; obesity and undernutrition, on bone mineral density (BMD). Methodology: This study is a descriptive cross-sectional study carried between January and June of 2019, and included 224 children and adolescents without any comorbidities or chronic disease. Important data collected included anthropometrics, past medical and surgical history, history of medication intake, level of physical activity and pubertal assessment. Data entry and analysis were conducted using Statistical Package for Social Sciences version 24. Results: Gender distribution showed 48.2% were male and 51.8% were female. The mean age was 9.98 ± 3.5 years. Mean weight was 34.89 ± 18.2 kg. Mean BMD z-score was - 1.64 ± 1.4. Weight was considered to significantly correlate with BMD stature at a P = 0.014. Subjects who were underweight showed a lower mean BMD z-score of <-2 than those who were overweight/obese (mean BMD z-score = -1.60). Conclusion: Both extremes of weight are considered a significant risk factor for the development of low BMD in children. We recommend the early recognition of weight aberrations and consequent aggressive intervention with strict lifestyle modifications to promote the development of maximum peak bone mass.

Résumé Objectif: étudier l'effet du poids corporel extrême; l'obésité et la dénutrition, sur la densité minérale osseuse. Méthodologie: Cette étude est une étude transversale descriptive réalisée entre les mois de janvier et juin 2019, et a inclus 224 enfants et adolescents sans aucune comorbidité ni maladie chronique. Les données importantes recueillies comprenaient l'anthropométrie, les antécédents médicaux et chirurgicaux, les antécédents de prise de médicaments, le niveau d'activité physique et l'évaluation pubertaire. La saisie et l'analyse des données ont été effectuées à l'aide du progiciel statistique pour les sciences sociales (SPSS) version 24. Résultats: La répartition par sexe a montré que 48,2% étaient des hommes et 51,8% étaient des femmes. L'âge moyen était de 9,98 ± 3,5 ans. Le poids moyen était de 34,89 ± 18,2 kg. Le score z moyen de DMO était de -1,64 ± 1,4. On a considéré que le poids était significativement corrélé à la stature de la DMO à une valeur p de 0,014. Les sujets présentant une insuffisance pondérale ont présenté un score z de DMO moyen inférieur à <-2 que ceux qui étaient en surpoids/obèses (score z moyen de DMO = -1,60). Conclusion: Les deux extrêmes de poids sont considérés comme un facteur de risque important pour le développement d'une faible DMO chez les enfants. Nous recommandons la détection précoce des aberrations de poids et une intervention agressive conséquente avec des modifications strictes du mode de vie afin de favoriser le développement d'une masse osseuse maximale. Mots-clés: insuffisance pondérale; en surpoids; indice de masse corporelle; densité minérale osseuse; les enfants.

Classical 11ß-Hydroxylase Deficiency Caused by a Novel Homozygous Mutation: A Case Study and Literature Review.

Congenital adrenal hyperplasia (CAH) is an uncommon condition and 11ß-hydroxylase deficiency (11ßOHD) accounts for 0.2-8% of cases. In this study, we report a three-year-old girl with a known diagnosis of classical CAH on maintenance treatment with hydrocortisone who presented with abnormal genitalia and persistent hypertension. Genetic testing confirmed the diagnosis of autosomal recessive CAH due to 11ßOHD as a result of a novel homozygous pathogenic mutation, c.53dup p.(Gln19Alafs*21), in the CYP11B1 gene. Physicians should consider the possibility of classical 11ßOHD in CAH patients presenting with persistent hypertension, even if other laboratory biomarkers are equivocal.

Indices of insulin resistance and adiposity can detect obesity-related morbidity in pediatrics.

OBJECTIVES: To evaluated obesity-related morbidity prevalence among overweight/obese children and adolescents in Saudi Arabia, adiposity indicators and insulin resistance as obesity-related morbidity predictors. METHODS: We enrolled 318 overweight/obese children attending a Pediatric Endocrinology Clinic at King Abdulaziz University Hospital, Saudi Arabia, aged 2-20 years in this retrospective cross-sectional study from September 2019 to March 2021. All children had nutritional obesity, and their body mass index (BMI) standard deviation score was higher than one standard deviation score above the mean for their age and gender. Clinical adiposity indices including BMI, waist circumference (WC), waist-hip ratio (WHR), and bioimpedance analysis (BIA) of body composition were assessed. Biochemical testing of insulin resistance through homeostasis model assessment for insulin resistance and fasting insulin was performed, along with receiver operating curve analysis to obtain optimal cut-off points for obesity-related morbidity. RESULTS: Obesity related morbidity was found in 61.9%, whereas insulin resistance was detected among 64.7% of the patients. Body mass index standard deviation score, WC, BAI of body composition-derived body fat, homeostasis model assessment for insulin resistance, and fasting insulin are significant obesity-related morbidity predictors, and the cut-off points were established. CONCLUSION: Obesity-related morbidity is widely prevalent among obese children and insulin resistance is a key factor in its prediction. Clinical adiposity indices, given their accuracy and practicability, are important predictors of obesity-related morbidity.

The relationship between body weight and dietary habits with respect to the timing of puberty among saudi children and adolescents.

Objective: The objective is to investigate the timing of pubertal onset as determined by the development of secondary sexual characteristics in relation to body weight and dietary patterns among Saudi females. Methods: Children/adolescents visiting general and endocrinology pediatric clinics in King AbdulAziz University Hospital were invited to participate in this study. Female subjects between the ages of 5 and 20 years were included in this study, and those with syndromic disease, chronic comorbidities, endocrinopathies, organic causes of precocious puberty, positive family history of early pubertal onset, and under chronic medication were excluded from the study. Data were collected through clinical interviews with the consent of the legal guardians, and physical examinations were conducted. Results: A.total of 164 females were investigated. The mean age of thelarche, adrenarche, and menarche was 10, 11.3, and 12.2 years, respectively. We found a significant correlation between higher weight standard deviation and an earlier age of both thelarche and adrenarche. In addition, daily consumption of fast foods was significantly associated with an earlier menarchal age. Consumption of nonorganic poultry was linked to early thelarche. Conclusion: Efforts should be directed to increase public and community awareness that fast food consumption, inorganic poultry, and higher body weight are important modifiable factors that lead to an earlier onset of female puberty across different parameters: breast development, adrenarche, and menstruation.

RésuméObjectif: Étudier le moment de l'apparition de la puberté tel que déterminé par le développement de caractères sexuels secondaires en relation avec le poids corporel et les habitudes alimentaires chez les femmes saoudiennes. Méthodes: Les enfants / adolescents visitant les cliniques pédiatriques générales et d'endocrinologie de l'hôpital universitaire King AbdulAziz ont été invités à participer à cette étude. Les sujets de sexe féminin âgés de 2 à 18 ans ont été inclus dans cette étude, et ceux atteints de maladie syndromique, de comorbidités chroniques, d'endocrinopathies, de causes organiques de puberté précoce, d'antécédents familiaux d'apparition pubertaire précoce et sous traitement chronique ont été exclus de l'étude . Les données ont été recueillies lors d'entretiens cliniques avec le consentement des tuteurs légaux et des examens physiques ont été effectués. Résultats: Un total de 163 femmes ont été étudiées. L'âge moyen de la larche, de l'adrénarche et de la ménarche était respectivement de 10, 11,3 et 12,2 ans. Nous avons trouvé une corrélation significative entre un écart-type de poids plus élevé et un âge plus précoce de la larche et de l'adrénarche. De plus, la consommation fréquente de fast-foods était significativement associée à un âge ménarché plus précoce. Une consommation plus élevée de volaille non biologique était liée à la croissance précoce. Conclusion: Des efforts devraient être déployés pour sensibiliser le public et la communauté aux habitudes alimentaires et au poids corporel en tant que facteurs modifiables importants qui favorisent l'apparition précoce de la puberté féminine, indépendamment de leurs effets les uns sur les autres.

Testicular adrenal rest tumors in children with congenital adrenal hyperplasia.

OBJECTIVES: To identify testicular adrenal rest tumors (TARTs) prevalence among children with congenital adrenal hyperplasia (CAH) and to assess hormonal control role as a contributing factor for TART development. Testicular adrenal rest tumors are benign tumors complicating CAH. It affects adult males with CAH commonly, with a reported prevalence of 40% on average, and up to 94%. There is insufficient data regarding their prevalence in children aged above 4 years and adolescents. METHODS: This descriptive study included 21 children and adolescents with CAH (17 salt wasting type, 4 non salt wasting type) aged 4-20 years who were screened for TARTs by routine testicular ultrasonography from October 2012 to December 2020 at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Serum adrenocorticotropic hormone, 17-hydroxy progesterone, testosterone, dehydroepiandrosterone, and luteinizing hormone levels were measured. RESULTS: Testicular adrenal rest tumors were detected in 6 (28%) patients (median age: 12.5 years). The youngest affected child was 8 years old. All patients with TARTs were asymptomatic with impalpable testicular masses at the time of detection. Bilateral involvement was observed in 5 patients, while one patient had unilateral involvement. All patients with TARTs had poor hormonal control, and 4 patients had advanced bone age. CONCLUSION: Testicular adrenal rest tumors development has been shown to correlate with poor hormonal control. Annual screening of young children with CAH for TART development is crucial, even for asymptomatic or with impalpable testicular masses.

Extensive subcutaneous fat necrosis complicated by neonatal hypercalcaemia.

subcutaneous fat necrosis is a benign and often self-limiting inflammatory disorder experienced by newborns who were exposed to perinatal stress in the form of asphyxia, hypothermia, cord prolapse, and/or sepsis. lesions are usually benign and self-limiting, with complete resolution anticipated within a few weeks up to 6 months. they can be accompanied by multiple complications. of which the most significant and of life-threatening potential is neonatal hypocalcaemia. if not timely anticipated and adequately treated, the patient might deteriorate due to dehydration and acute renal failure. symptoms of neonatal hypercalcaemia can be variable in this age group, transcending from a nonspecific presentation of irritability, poor feeding, vomiting and constipation to the well-recognised polyuria, polydipsia, and dehydration. therapeutic options are provided through initial hyperrehydration and calcium wasting diuretics, switching feeds to a low calcium and vitamin D formula milk, institution of systemic steriods and if necessary, inititating bisphosphonate therapy in hypercalcaemia that is severe, recalcitrant to the previously mentioned treatment modalities, and/or when a rapid decrease in serum calcium levels is desired. in this report we describe a case of a 10 month old female infant with moderate neonatal hypercalcaemia as a complication of extensive SCFN manifestating by the age of 10 days and persisting into a prolonged clinical course of up to 9 months until most of the lesions were resolved.

Impact of COVID-19 lockdown on glycemic control in children and adolescents.

OBJECTIVES: To identify how children and adolescents with type 1 diabetes were coping with their condition during the COVID-19 lockdown, by detecting differences in blood glucose control and in lifestyle, including diet, physical activity, and mood deterioration, before and during the lockdown. METHODS: This descriptive, cross-sectional study was conducted between April and June 2020 at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Data were collected from interviews, using various forms of telecommunication. RESULTS: The total sample size was 150 patients, 48 (28%) of whom were males and 102 (72%) females. The mean age of the patients was 12.45 years. The lockdown was associated with a significant increase in patients' weight (p=0.001), body mass index (p=0.001), and blood glucose readings (p=0.007) compared to their values before the lockdown. Conclusion: A negative impact of the COVID-19 lockdown was found on blood glucose values and BMI, which may correlate with a lack of physical activity, increased consumption of carbohydrates and fast food, and mood deterioration.

Polycystic Ovary Syndrome Among Female Adolescents With Congenital Adrenal Hyperplasia.

OBJECTIVES: Polycystic ovary syndrome is a common endocrine disease in adolescent females that is usually diagnosed based on clinical and hormonal abnormalities. Female adolescents with poorly controlled congenital adrenal hyperplasia are at increased risk of developing polycystic ovary syndrome. This study aimed to determine the prevalence of polycystic ovary syndrome and assess its relationship with hormonal control among adolescents with congenital adrenal hyperplasia. METHODS: This retrospective descriptive study included 40 pubertal female adolescents aged between 12 and 20 years with at least two years after menarche diagnosed with classical congenital adrenal hyperplasia since birth who were screened routinely for polycystic ovary syndrome via pelvic ultrasonography between 2012 and 2020 at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia. Serum adrenocorticotropic hormone, 17-hydroxy -progesterone, testosterone, dehydroepiandrosterone sulfate, luteinizing hormone, and follicle-stimulating hormone levels were measured. RESULTS: Polycystic ovary syndrome was detected via routine pelvic ultrasonography in 12/40 (30%) females. The median age of the affected females was 16.6 years, with the youngest female aged 12.5 years. The bone age of the patients had advanced ≤3 years. Further, serum adrenocorticotropic hormone was determined to be an independent factor affecting polycystic ovary syndrome development, indicating poor hormonal control (P = 0.005). CONCLUSION: Polycystic ovary disease is likely a complication of poorly controlled congenital adrenal hyperplasia disease. Therefore, increasing the awareness of polycystic ovary disease among congenital adrenal hyperplasia females via routine ultrasonography screening is advisable to facilitate the early diagnosis and improve disease management.

Quantitative ultrasound screening of bone mineral density on children with short stature.

OBJECTIVES: To assess bone mineral density (BMD) of children with short stature using quantitative ultrasound (QUS) and compare it to children with normal height. Methods: We conducted a descriptive, cross-sectional controlled study between May 2018 and February 2019 at various pediatric clinics in Jeddah, Saudi Arabia. In total, 219 children were included: 100 had short stature, and 119 were of normal height. Data were collected from one-on-one interviews, and BMD was measured using quantitative ultrasound. Results: Children with short stature had significantly lower BMD z-scores than children with normal height (pless than 0.05). The use of vitamin D supplements was related to higher BMD z-scores in children with short stature (p less than 0.05). A significant association was found between higher BMD z-scores, and both age (p=0.05) and height (p=0.02). Through a further division of children with short stature into those with and those without growth hormone deficiencies, we show that growth hormone deficiency was positively associated with lower BMD z-scores; however, the p-value was 0.06. Conclusions: Compared with children of normal height, those with short stature had lower BMD. Height, vitamin D supplementation, and age were all significantly correlated with higher BMD, while growth hormone deficiency was correlated with lower BMD.

Influence of various environmental factors on the growth of children and adolescents in Jeddah, Kingdom of Saudi Arabia.

OBJECTIVES: To evaluate the association between various environmental factors and the anthropometric measurements of children and adolescents. METHODS: This retrospective studywasperformed from September 2017 to April 2018 and included 393 children aged 2-18 years. Data were extracted through patient and/or parentinterviews and from medical records of endocrine ambulatory clinics. RESULTS: Among underweight children,the proportion of mixed-fed children was the highest, and among normal weight children, most were either bottle-fed or mixed-fed. Most overweight children were mixed-fed, and most obese children were breastfed. Underweight status was noted most commonly in children playing videogames for <2 hours/day, followed by those playing>4 and 2-4 hours/day. Normal weight was noted most commonly in those playing for >4 hours/day, followed by those playing <2 and 2-4 hours/day. Overweight status was noted most commonly in those playing videogames for >4 hours/day, followed by those playing 2-4 and <2 hours/day. Most children playing videogames for <2 hours/day were obese. Mean BMIs were the highest in those who exercised 1-2 times/week. P-values for the association between passive smoking indoors and BMI, weight, and height were 0.045, 0.150, and 0.854, respectively. Regarding socioeconomic status, log BMI values were 1.22, 1.23, and 1.26 in low-, medium-, and high-income families, respectively (P-value, 0.001). CONCLUSION: Children who were bottle-fed in their first year of life, played video games >2 hours/day, did not exercise regularly, were exposed to indoor passive smoking, and had a high socioeconomic status had a higher BMI and weight than their counterparts. (www.actabiomedica.it).

Various causative factors and associated complications of childhood obesity in Jeddah, Western Region, Saudi Arabia.

Objective: The objective of the study was to investigate the causative factors and complications attributable to obesity in children living in Jeddah, Saudi Arabia. Methods: This is a retrospective study encompassing a sample size of 151 children and adolescents between the ages of 4 and 20 years. Data were collected through reviewing medical records, medical files on the hospital electronic system, and clinical interviews conducted with legal guardians. The date of the study was from January to June 2018, and the study was carried out in Jeddah, Western Region, Saudi Arabia. Results: Data were entered, coded, cleaned, and analyzed using the Statistical Package for the Social Sciences (IBM SPSS), version 22. The analysis was done by assessing the significance of various risk factors and sequelae in their contribution to pediatric obesity by one-way ANOVA for nominal variables of more than two categories and independent-samples t-test for the nominal variables with two categories. The sample was 47% of the male gender, whereas females made for the remaining 53%. The causation of obesity was distributed among the following factors: an unhealthy diet, a sedentary lifestyle, medications such as glucocorticoids, and complications attributed to obesity including gastroesophageal reflux, hypertension, precocious puberty, sleep apnea, psychological disturbances, and fatty liver diseases. Conclusion: Environmental factors were found to be the most predominant cause, where the majority of children were found to be leading a sedentary lifestyle, following an unhealthy diet, and skipping meals. The most recurring complications involved psychosocial and behavioral abnormalities, and among the medical consequences, gastroesophageal reflux and obstructive sleep apnea were the most prevalent.

RésuméObjectif: Étudier les facteurs de causalité et les complications imputables à l'obésité chez les enfants vivant à Djedda, en Arabie saoudite. Méthodes: Il s'agit d'une étude rétrospective couvrant un échantillon de 151 enfants et adolescents âgés de 4 à 20 ans. Les données ont été collectées à travers l'examen des dossiers médicaux, des fichiers médicaux sur le système électronique de l'hôpital et des entretiens cliniques menés avec des tuteurs légaux. La date d'étude était de janvier à juin 2018 et a été réalisée à Djeddah, dans l'ouest de l'Arabie saoudite. Résultats: Les données ont été entrées, codées, nettoyées et analysées à l'aide d'un logiciel de statistiques sociales (IBM SPSS), version 22. L'analyse a été réalisée en évaluant l'importance de divers facteurs de risque et de leurs conséquences dans leur contribution à l'obésité pédiatrique par une ANOVA à un facteur pour les variables nominales de plus de deux catégories et Test t de l'échantillon indépendant pour les variables nominales à deux catégories. L'échantillon comprenait 47% du sexe masculin alors que les femmes représentaient les 53% restants. La cause de l'obésité a été répartie entre les facteurs suivants: une alimentation malsaine, un style de vie sédentaire, des médicaments tels que les glucocorticoïdes, et les complications attribuées à l'obésité comprennent le reflux gastroesophagien, l'hypertension, la puberté précoce, l'apnée du sommeil, des troubles psychologiques et des maladies de foie grasses. Conclusion: Les facteurs environnementaux ont été la principale cause, la majorité des enfants menant une vie sédentaire, suivant un régime alimentaire malsain et sautant des repas. Les complications les plus récurrentes concernaient des anomalies psychosociales et comportementales, et parmi les conséquences médicales, le reflux gastro-oesophagien et l'apnée obstructive du sommeil étaient les plus répandus.

Endocrinopathies complicating transfusion-dependent hemoglobinopathy.

OBJECTIVES: To investigate the prevalence and significance of different endocrinopathies in children and adolescents with transfusion-dependent thalassemia and sickle-cell anemia. METHODS: This is a descriptive, retrospective study between January 2010 and July 2018 in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Data was collected through reviewing electronic hospital medical records then filling out data collection sheets and was interpreted through the IBM SPSS Statistics for Windows version 20.0 (IBM Corp, Armonk, NY, USA). Results: The total sample size was 119 patients, gender equality was almost achieved with 55.5% being male and 45.5% being female. The most common endocrinopathies were identified in the following order of short stature (39.5%), diabetes mellitus (29.4%), hypogonadism (12.6%), osteopenia (12.6%), osteoporosis (9.2%), hypothyroidism (9.2%), hypocortisolism (3.4%), and hypoparathyroidism (2.5%). All of which were statistically significant in their relationship to hemoglobinopathies with the exception of osteopenia and osteoporosis. Hypogonadism and hypocortisolism were found to be statistically significant in their relationship to a positive history of splenectomy at p=0.026 and p=0.012. Short stature was found to be statistically significant in its relationship to the male gender with a p=0.001. Conclusion: Endocrinopathy is a frequent complication of hemoglobinopathies, for which the most common were found to be short stature, diabetes mellitus,  and low bone mineral density.

Various causative factors and associated complications of childhood obesity in Jeddah, western region, Saudi Arabia.

OBJECTIVE: to investigate the causative factors and complications attributable to obesity in children living in jeddah, saudi arabia. METHODS: this is a retrospective study encompassing a sample size of 151 children and adolescents between the ages of 4 and 20 years. data was collectived through revieweing medical records, medical files on the hospital electironic system and clinical interviews conducted with legal guardians. date of study was from january to june 2018, and was carried in jeddah, western region, saudi arabia. RESULTS: data was entered, coded, cleaned and analysed using statistical package for social science (IBM SPSS), version 22. the analysis was done by assessing the significance of various risk factors ands equalae in their contribution to paediatric obesity by one way ANOVA for nominal variables of more than two categories and independent sample t-test for the nominal variables with two categories. the sample was 47% of the male gender whereas females made for the remaining 53%. the causation of obesity was distributed among the following factors: an unhealthy diet, a sedentary lifestyle, medications such as glucocorticoids, and complications attributed to obesity included gastro-oesophageal reflux, hypertension, precocious puberty, sleep apnoea, psychological disturbances and fatty liver diseases. CONCLUSION: environmental factors were found to be the most predominant cause, where the majority of children were found to be leading a sedentary lifestyle, following an unhealthy diet, and skipping meals. the msot recurring complications involved psychosocial and behavioural abnormalities, and among the medical consequences, gastro-oesophageal reflux and obstructive sleep apnoea were the most prevalent.