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.

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.

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.

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.