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.

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.

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.

Neurological Complications and Associated Risk Factors in Children Affected with Chronic Kidney Disease.

To investigate the correlation between chronic kidney disease (CKD) and the development of neurological disease among pediatric patients in Saudi Arabia. The present retrospective study recruited patients admitted to King Abdulaziz University Hospital during 2018. We reviewed electronic records to collect data on essential demographics including age, gender, and nationality; history of prior CNS disease or related symptoms; results of neurological physical examination; and findings of radiological investigations such as abdominal ultrasound, dimercaptosuccinic acid scan, micturating cystourethrogram, diethylene triamine pentaacetic acid scan, brain computed tomography, and magnetic resonance imaging. The most commonly diagnosed renal pathologies were neurogenic bladder and cystic kidney disease. The most common neurological manifestation was seizure disorder. Males were more frequently affected with neurological sequelae than females. The prevalence of neurological disorders was higher in patients over two years old. The most frequently observed stage of chronic kidney disease was stage 5. Most children who were affected with a neurological disorder required hemodialysis as part of their management plan. Patients with chronic kidney disease are at a high risk of neurocognitive defects. The type of management and renal diagnosis are significant factors that should be considered when anticipating central nervous system involvement in the case of chronic kidney disease.

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.

Determinants of bone mineral density through quantitative ultrasound screening of healthy children visiting ambulatory paediatric clinics.

OBJECTIVES: To investigate the determinants of bone mineral density through screening healthy children using a non-invasive quantitative ultrasound measurement device. METHODS: A descriptive cross-sectional study carried out at King AbdulAziz University Hospital, Jeddah, Kingdom of Saudi Arabia. between May 2018 and January 2019 through interviewing, examining, and screening healthy children visiting general paediatric. Total sample size encompassed 450 children. The inclusion criteria were healthy children between the ages of 2 and 20 years. Exclusion criteria were previous pathological fractures, chronic medical diseases, or long-term medications. Data entry and analysis was conducted using Statistical Package for Social Sciences version 24 (IBM Corp, Armonk, NY, USA). Chi-square tests were used to determine the association between categorical variables, with calculated p<0.05 considered significant. With one-way Anova testing to study the relationship between categorical variables and continuous variables. Results: A significant association with bone mineral density (BMD) was found during first 2 years with height (p=0.015), vitamin D supplementation (p=0.03), and breastfeeding (p=0.025). A directly proportional relationship with BMD was found with pubertal status, physical activity, diet, sun exposure, and calcium supplement intake. CONCLUSION: This is a novel study in the investigation of the dietary, lifestyle and demographic determinants of bone mineral density in the healthy middle-eastern child otherwise unaffected by chronic medical or metabolic disease or exposed to long term medications that could have affected bone metabolism.

The effect of body mass index and gender on lipid profile in children and adolescents in Saudi Arabia.

Objectives: The objectives of this study were to study the relationship between lipid profile components among different body mass index (BMI) groups and investigate the association between gender and BMI. Methodology: This cross-sectional study included 218 children and adolescents; 104 males and 114 females. Accepted age range was from 2 to 18 years. Data were collected from February to May during the year of 2017 and were analyzed using the Statistical Package for the Social Sciences. Standard deviation (SD) for BMI was calculated based on the World Health Organization guidelines. Lipid profile results were reviewed from laboratory reports. Results: Nearly 10.6% of the study population were found to be overweight; another 22.1% were suffering from obesity, of which 7.1% were morbidly obese. Children who had high levels of low-density lipoprotein (LDL) and low levels of high-density lipoprotein (HDL) were found among higher BMI groups, with elevated cholesterol levels noted in patients of increased weight. An increase in HDL levels was noted in 71% of the children who avoided fast-food consumption. Significant gender predisposition to changes in BMI was not found (P = 0.467). Conclusion: High BMI was found to be associated with increased levels of LDL cholesterol and decreased levels of HDL cholesterol. No significant association between gender and changes in lipid profile was established (P = 0.898). Recommendation: All pediatricians must keep an open eye on overweight and obese children, routinely taking their weight measurements and screening for dyslipidemia by obtaining a full lipid profile for every child whose weight is 2 SDs above the mean.

RésuméObjectifs: Les objectifs de cette étude étaient d'étudier la relation entre les composantes de profil lipidique chez les groupes de différents corps (IMC) Indice de masse et étudier l'association entre le sexe et l'IMC. Méthodologie: Cette étude transversale comprenait 218 enfants et des adolescents ; 104 hommes et 114 femmes. Tranche d'âge accepté était de 2 à 18 ans. Données ont été recueillies entre février et mai, au cours de l'année 2017 et ont été analysées en utilisant le logiciel de statistiques pour les Sciences sociales. Écart-type (SD) pour IMC a été calculé selon les directives de l'Organisation mondiale de la santé. Par des rapports de laboratoire, les résultats du profil lipidique ont été examinées. Résultats: Près 10,6 % de la population étudiée s'est avéré pour être une surcharge pondérale ; un autre 22,1 % souffraient de l'obésité, dont 7,1 % étaient obèses morbides. Les enfants qui avaient des niveaux élevés de lipoprotéines de basse densité (LDL) et de faibles niveaux de lipoprotéines de haute densité (HDL) ont été trouvés parmi les groupes IMC élevé, avec des niveaux élevés de cholestérol a noté chez les patients de l'augmentation du poids. Une augmentation des niveaux de HDL a été notée dans 71 % des enfants qui ont évité la consommation fast food. Prédisposition significative entre les sexes à l'évolution de l'IMC n'a pas été trouvée (P = 0,467). Conclusion: IMC élevé s'est avéré pour être associés à l'augmentation des niveaux de cholestérol LDL et une diminution des taux de cholestérol HDL. Aucune association significative entre le sexe et les changements dans le profil lipidique a été créée (P = 0,898). Recommandation: Tous les pédiatres doivent garder un oeil ouvert sur les enfants en surpoids et obèses, systématiquement leurs mesures de poids et de dépistage de la dyslipidémie en obtenant un bilan lipidique complet pour tous les enfants dont le poids sont 2 SDD au-dessus de la moyenne.

Implication of Topical Steroids in the Onset of Osteoporosis.

The systemic bioavailability of steroids has long been implicated as a cause for osteoporosis (OP); however, much less is known about the effect of topical steroids on bone homeostasis. This is a case of an 11-year-old male who is a known case of generalised pustular psoriasis for 8-year duration with frequent exacerbations controlled with topical betamethasone dipropionate. He presented with generalised progressive bone pain and positive history of bone fracture. The diagnosis of OP was established on the results of DEXA, which were -2.7 SD and -2.4 SD for the lumbar spine and whole body, respectively. Although the cutoff value is the same (<-2 SD) in children, the definition of OP is more reliant on the densitometry Z score, as opposed to adults, who are approached using the T score. The element of psoriasis poses a risk for the development of OP due to the presence of a chronic inflammatory disease state that increases bone turnover. Furthermore, the compromised skin barrier and associated vasodilation seen in psoriasis enhance the absorption of topically applied agents and increase their bioavailability. Children are a targeted risk group as they are more vulnerable to the manifestation of systemic adverse affects of topically applied steroids as a result of their increased ratio of total surface area relative to their body weight and slower drug metabolism. We recommend that children undergoing long-term topical steroid therapy be screened for OP with the consideration of instituting prophylactic treatment especially in those suffering from chronic inflammatory disease states.

Growth characteristics in children with congenital adrenal hyperplasia.

OBJECTIVES: To evaluate the growth parameters in congenital adrenal hyperplasia patients in Jeddah, Saudi Arabia.  Methods: This is a descriptive retrospective study over the period of 5 years. Data analysis was using Statistical Package for Social Science. The study included 90 participants in which 61 were girls and 29 were boys aged 0 to 18 years . They were evaluated in Pediatric Endocrinology Clinic at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, between January  2012 and January 2017. RESULTS: A total of 90 subjects, of which 67.8% were females and 32.2% were males. Subjects who were underweight  constituted 19.1% of the population, while those who were obese were estimated up to 17.6% of the population. Of the children, 25.7% were suffering from short stature and 74.3% had normal height. Approximately 11.8% of the children who suffered from short stature also suffered from hypothyroidism. Mid-parental height of those who suffered from short stature is 159.8 cm. CONCLUSION: This study showed a significant effect of congenital adrenal hyperplasia on both height, weight, and body mass index. Risk factors includes glucocorticoids dosage, compliance to treatment, and regular follow up. Personalized treatment approach should be followed with all patients diagnosed with congenital adrenal hyperplasia as well as close monitoring and targeted therapy.

Initial presentations and associated clinical findings in patients with classical congenital adrenal hyperplasia.

BACKGROUND: The objective of this study was to investigate the initial presenting features of children with classical congenital adrenal hyperplasia (CAH). METHODS: This is a descriptive retrospective study over a period of 5 years. Data analysis was performed using Statistical Package for Social Science. RESULTS: Ambiguous genitalia (AG) was the commonest initial presentation marking 50.7% of the patients. On the other hand, 33.3% presented with a salt-losing crisis, 4.1% of whom presented with shock, while 14.5% had a combined presentation of both AG and a salt-losing crisis. CONCLUSIONS: CAH should be highly suspected in all females born with AG. Contrarily, affected male newborns more frequently present with a salt-losing crisis, and considering the recent institution of newborn screening in Saudi Arabia, earlier detection in these children is anticipated.