Utility of wrist circumference in recognition of metabolic syndrome in overweight and obese South Indian children and adolescents.

OBJECTIVE: To describe the utility of wrist circumference in the identification of cardiometabolic risk in overweight and obese children. METHODS: A cross-sectional study was conducted in the obesity clinic of a tertiary care referral hospital over a two year period. All children and adolescents aged 5-17 years with nutritional overweight and obesity were recruited. Data pertaining to chronological age, sex, risk factors and family history were collected. Clinical assessment of anthropometry: Weight, height, body mass index (BMI), Tanner's stage, wrist circumference, blood pressure, waist circumference and triceps skinfold thickness done as per standard criteria. Biochemical assessment of blood glucose, serum insulin, lipid profile, and Homeostatic Model for Insulin Resistance performed after 12 h of fasting. RESULTS: We recruited 118 subjects (mean age 10.9 years, 71.1% males, 87.3% obese and 12.7% overweight); 30 (25.4%) had metabolic syndrome. The mean z scores of wrist circumference of children who presented with and without metabolic syndrome was 2.7 ± 0.8 and 2.1 ± 0.7, respectively (p<0.05). We observed a fair positive correlation between wrist circumference z score and BMI z score, (r=0.5; p<0.05). On receiver operating characteristic curve analysis, 97th percentile of wrist circumference predicted metabolic syndrome among overweight and obese children with a sensitivity of 86.7% and specificity of 37.5% (AUC=0.675). CONCLUSIONS: Wrist circumference with 97th percentile as a cut-off is a useful tool to identify metabolic syndrome amongst overweight and obese children and adolescents.

Clinical Profile of Adolescents With Delayed Puberty.

One year study on forty-eight adolescents with delayed puberty revealed etiology of constitutional delay, hypogonadotrophic hypogonadism (HH), hypergonadotrophic hypogonadism, chronic systemic disease, hypothyroidism and sex reversal in 14(29.2%), 13 (27%), 12 (25%), 5 (10.4%), 3 (6.3%) and 1 (2.1%) cases, respectively. Earlier presentation, male preponderance, significant normal variants and utility of GnRH analogue testing observed .

Factors influencing growth in children with growth hormone deficiency - a case-control study.

INTRODUCTION: To assess the response of South Indian children with growth hormone deficiency (GHD) to growth hormone therapy, optimal duration of therapy for good catch up, and factors determining the response of our children to growth hormone therapy. MATERIAL AND METHODS: We conducted a case control study at a paediatric endocrine unit of a tertiary paediatric hospital. Children diagnosed with growth hormone deficiency were initiated on GH (cases) or followed up without GH therapy (controls). Detailed clinical, biochemical, radiological, and treatment parameters were recorded at baseline and follow-up. Data were analysed using IBM SPSS version 21. RESULTS: We enrolled 23 subjects in group I (cases who received GH) and group II (controls with untreated children), and both the groups were comparable at baseline. Group I (-4.12 ±1.7 to -2.81 ±1.52) had significant height increase on follow-up after GH therapy compared to group II (-3.55 ±1.7 to -3.51 ±1.52) (p > 0.05). Growth velocity in group I (13.25 ±5.6 cm/year, SD score 4.55 ±5.42) was significantly higher compared to group II (3.4 ±1.8 cm/year, SD score -1.62 ±2.38). Duration of growth hormone therapy, presence of ectopic posterior pituitary, and BA: CA ratio independently impacted the growth velocity SD scores. Kaplan Meier analysis curve showed 15 months of GH therapy was needed to attain a height within ±2 SD of the target height. CONCLUSIONS: Early diagnosis, pre-pubertal status, delayed bone age, and presence of ectopic posterior pituitary on MRI are determinants of a better response. Growth hormone must be administered for at least 15 months for catch up height SDs within target height SD range.

Response of South Indian girls with central precocious puberty to gonadotrophin analogue (GnRHa) therapy - a single center experience.

AIM OF THE STUDY: To describe the clinical, auxological, biochemical and radiological response to GnRH analogue in female children with central precocious puberty (CPP). MATERIAL AND METHODS: The data on 22 female children presenting with the larche < 8 years, pubarche < 8 years or menarche < 9 years diagnosed as CPP was collected from the records over a four year period. Assessment included growth parameters, Tanners staging; bone age (BA) by Greulich and Pyle method, ultrasonography of abdomen to assess uterine length and ovarian size and z score derived; biochemical evaluation included serum luteinising hormone (LH), follicle stimulating hormone (FSH) and estradiol (E2); and MRI brain. The children were initiated on injection Leupride 0.9 mg/kg 3 monthly (body weight   30 kg received 22.5 mg). The predicted adult height (PAH) was calculated with Bayley Pinneau method. RESULTS: Treatment was started at the mean chronological age (CA) of 6.09 ±2.1 years and continued till 8.3 ±2.4 years. MRI brain was abnormal in 4 children. Duration of treatment was 2.1 ±0.4 years. The height z scores reduced from 0.5 ±2.4 to 0.18 ±2.4 (p < 0.05). A significant reduction in tanner's stage, uterine size and ovarian volume was observed in the study period. BA/CA ratio reduced from 1.27 ±0.4 to 1.07 ±0.3. PAH z score improved from 1.47 ±1.6 to 0.2 ±2.3 (p < 0.05). CONCLUSIONS: We observed a good clinical and radiological response to GnRHa therapy in girls with CPP and a significant improvement in PAH. Long term follow up is needed to assess the attainment of final height.

Effect of silica nanoparticles on microbial biomass and silica availability in maize rhizosphere.

The effect of silica nanoparticles and conventional silica sources on the changes in microbial biomass and silica availability to pure soil and maize rhizosphere was studied. Nanosilica (20-40 nm) was synthesized from rice husk and comprehensively characterized. The efficiency of nanosilica was evaluated in terms of its effects on beneficial microbial population such as phosphate solubilizers, nitrogen fixers, silicate solubilizers, microbial biomass carbon and nitrogen content, and silica content in comparison with other silica sources such as microsilica, sodium silicate, and silicic acid. Nanosilica significantly (P < 0.05) enhanced microbial populations, total biomass content (C = 1508 µg g(-1) and N = 178 µg g(-1) ), and silica content (14.75 mg mL(-1) ). Although microsilica sources enhanced factors associated with soil fertility, their use by maize roots and silicification in soil was found to be less. The results show that nanosilica plays a vital role in influencing soil nutrient content and microbial biota and, hence, may promote the growth of maize crop.