scholarly journals Hydrocortisone Suspension Provides Similar Growth Outcomes as Hydrocortisone Tablets in Young Children with CAH

2021 ◽  
Author(s):  
Heba Al-Rayess ◽  
O Yaw Addo ◽  
Elise Palzer ◽  
Mu'taz Jaber ◽  
Kristin Fleissner ◽  
...  
Keyword(s):  
Young Children ◽  
Growth Parameters ◽  
Bone Age ◽  
Age At Diagnosis ◽  
Skeletal Maturation ◽  
Negative Effects ◽  
Cross Sectional ◽  
Androgen Exposure ◽  
Small Doses ◽  
Z Scores

Abstract Background Young children with CAH require small doses (0.1-1.25 mg) of hydrocortisone (HC) to control excess androgen production and avoid the negative effects of overtreatment. The smallest commercially available HC formulation, before the recent FDA approval of HC granules, was a scored 5 mg tablet. The options to achieve small doses were limited to using a pharmacy-compounded suspension, which the CAH Clinical Practice Guidelines recommended against, or splitting tablets into quarters or eighths, or dissolving tablets into water. Methods Cross sectional chart review of 130 children with classic CAH treated with tablets versus a pharmacy-compounded alcohol-free hydrocortisone suspension to compare growth, weight, skeletal maturation, total daily HC dose and exposure over the first four years of life. Results No significant differences were found in height, weight, or BMI z-scores at 4 years, and in predicted adult height, before or after adjusting for age at diagnosis and sex. Bone age z-scores averaged 2.8 SDs lower for patients on HC suspension compared to HC tablets (p<0.001) after adjusting for age at diagnosis and sex. The suspension group received 30.4% lower (p>0.001) average cumulative HC doses by their 4th birthday. Conclusions Our data indicates that treatment with alcohol-free HC suspension decreased androgen exposure as shown by lower bone age z-scores, allowed lower average and cumulative daily HC dose compared to HC tablets, and generated no significant differences in SDS in growth parameters in children with CAH at 4 years of age. Longitudinal studies of treating with smaller HC doses during childhood are needed.

scholarly journals Hydrocortisone Suspension Provides Similar Growth Outcomes as Hydrocortisone Tablets in Young Children With Congenital Adrenal Hyperplasia: A Cross Sectional Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A84-A84
Author(s):  
Heba Al-Rayess ◽  
O Yaw Addo ◽  
Elise Palzer ◽  
Mu’taz Jaber ◽  
Kristin Fleissner ◽  
...  
Keyword(s):  
Young Children ◽  
Adult Height ◽  
Bone Age ◽  
Age At Diagnosis ◽  
Z Score ◽  
Linear Regression Models ◽  
Target Height ◽  
Cross Sectional ◽  
Final Adult Height ◽  
Z Scores

Abstract Young children with CAH require small doses (0.1–1.25mg) and incremental adjustments of hydrocortisone (HC) to control excess androgen production and avoid the negative effects of overtreatment. A recent 6 hour pharmacokinetic/pharmacodynamic study reported that alcohol-free HC suspension provides similar cortisol exposure to tablets (1), but more data is needed to assess its clinical efficacy. We performed a chart review to determine the effect of the alcohol-free HC suspension compared to tablets on height, weight, BMI, bone age z-scores and corrected height z-scores to target height z-scores in children aged 2 yrs and 4 yrs in a cohort with classic CAH. Independent 2-sample t-tests examined cumulative and average HC dose at 2 and 4 yrs. Triple logistic modeling of longitudinal heights were used to calculate predicted near-adult height. Adjusted linear regression models assessed the effect of HC suspension compared to tablets on final adult height. Charts of 130 children (70 females, 100 salt wasting and 30 simple virilizing) were reviewed. At 2 yrs, 97 were treated with tablets and 33 with suspension (17 previously switched from tablets). At 4 yrs, 89 were treated with tablets and 41 with suspension (25 switched). No significant differences in height or BMI z-scores at both 2 and 4 yrs, before or after adjusting for age at diagnosis and sex were found. Bone age z-scores averaged 7.2 SDs lower for patients treated with HC suspension only compared to patients on HC tablets at age 4 (p<0.001), and 5.93 SDs lower for patients switched from tablets to suspension compared to tablets (p<0.001). The suspension group received 16% lower (p=0.055) and 25% lower (p=0.002) cumulative HC doses by the ages of 2 yrs and 4 yrs respectively. Average daily HC dose was lower by 3.44 and by 4.46 mg/m2/d over the first 2 and 4 yrs of life respectively. No significant differences were found between patients treated with tablets and suspension in the predicted final adult height, its z-score or its corrected z-score to target height after adjusting for age at diagnosis, sex and diagnosis. Our data indicates that treatment with alcohol-free HC suspension decreased androgen exposure as shown by lower bone age z-scores, generated no significant differences in SDS in observed height, BMI or predicted near-adult height, and allowed for lower average and cumulative daily HC dose compared to HC tablets in children with CAH. Reference: (1) Sarafoglou et al., J Clin Pharmacol.2015;55(4):452–7.

scholarly journals Introduction to and Screening Visit Results of the Multicenter Pediatric Crohn’s Disease Growth Study

2020 ◽  
Vol 26 (12) ◽  
pp. 1945-1950 ◽  
Author(s):  
Neera Gupta ◽  
Robert H Lustig ◽  
Howard Andrews ◽  
Francisco Sylvester ◽  
David Keljo ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bone Age ◽  
Skeletal Maturation ◽  
Delayed Puberty ◽  
Z Score ◽  
Growth Study ◽  
Score Difference ◽  
Z Scores ◽  
The Mean

Abstract Background Statural growth impairment is more common in males with Crohn’s disease (CD). We assessed sex differences in height Z score differences and bone age (BA) Z scores and characterized age of menarche in a novel contemporary cohort of pediatric CD patients undergoing screening for enrollment in the multicenter longitudinal Growth Study. Methods Crohn’s disease patients (females with chronological age [CA] 5 years and older and younger than 14 years; males with CA 6 years and older and younger than 16 years) participated in a screening visit for the Growth Study. Height BA-Z scores are height Z scores calculated based on BA. Height CA-Z scores are height Z scores calculated based on CA. The height Z score difference equals height CA-Z score minus height BA-Z score. Results One hundred seventy-one patients (60% male) qualified for this analysis. Mean CA was 12.2 years. Mean height CA-Z score was −0.4, and mean height BA-Z score was 0.4 in females. Mean height CA-Z score was −0.1, and mean height BA-Z score was 0.2 in males. The absolute value of the mean height Z score difference was significantly greater in females (0.8) than males (0.3; P = 0.005). The mean BA-Z score in females (−1.0) was significantly lower than in males (−0.2; P = 0.002). The median CA at menarche was 13.6 (95% CI, 12.6–14.6) years. Conclusions Our screening visit data suggest that standardized height gain is lower in males with skeletal maturation and delayed puberty is common in females in CD. We are investigating these findings in the ongoing Growth Study.

Bone maturation along the spectrum from normal weight to obesity: a complex interplay of sex, growth factors and weight gain

2016 ◽  
Vol 29 (3) ◽  
Author(s):  
Karen Oerter Klein ◽  
Ron S. Newfield ◽  
Sandra G. Hassink
Keyword(s):  
Weight Gain ◽  
Bone Age ◽  
Normal Weight ◽  
Skeletal Maturation ◽  
Z Score ◽  
Complex Interplay ◽  
Bone Maturation ◽  
Multiple Factors ◽  
Excessive Weight ◽  
Z Scores

AbstractThe aim of the study was to define the prevalence and degree of advanced bone age (ABA) in normal vs. excessive weight children, and identify variables affecting ABA.We studied 167 children (3–18 years) with normal weight (28 F, 28 M), overweight (8 F, 12 M), and obesity (OB) (63 F, 28 M) at AI duPont Hospital for Children. We assessed bone age (BA), insulin, leptin, estradiol (E2), DHEAS, and IGF-1 levels.Almost 25% of OB children have ABA>2 SDS, 33% >2 years (range 2–6.5 years advanced). ABA correlated with leptin, DHEAS and BMI z-score in girls, and with IGF-1 z-score and BMI z-score in boys (p<0.01). Girls with ABA had higher BMI z-score (p<0.001), insulin levels (p=0.02), and rates of weight gain (p=0.03). Boys with ABA had greater BMI z-score (p<0.001), but rate of weight gain did not differ. The greatest degree of ABA was found combining variables by tertiles. The top tertile of BA/CA had the highest insulin and IGF-1 z-scores. The top combined tertiles of DHEAS and BMI z-score or DHEAS and leptin in girls had the highest BA/CA. In boys, the top tertiles of BMI z-score and IGF-1 z-score produced the highest BA/CA. The lowest combined tertiles of any variables related to the lowest BA/CA.Multiple factors influence skeletal maturation. Almost 25% of children with OB have ABA, associated with BMI z-score, and one or more of the following: insulin, leptin, DHEAS, IGF-1, and rate of weight gain. This report delineates the prevalence and degree of ABA by sex, in children with normal versus excessive weight.

scholarly journals The role of delayed bone age in the evaluation of stature and bone health in glucocorticoid treated patients with Duchenne muscular dystrophy

2019 ◽  
Vol 2019 (1) ◽  
Author(s):  
E. J. Annexstad ◽  
J. Bollerslev ◽  
J. Westvik ◽  
A. G. Myhre ◽  
K. Godang ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Bone Health ◽  
Bone Age ◽  
Treated Group ◽  
Skeletal Maturation ◽  
Mineral Density ◽  
Duration Of Treatment ◽  
Z Scores

Abstract Background Low bone mineral density and an increased risk of appendicular and vertebral fractures are well-established consequences of Duchenne muscular dystrophy (DMD) and the risk of fractures is exacerbated by long-term glucocorticoid treatment. Monitoring of endocrine and skeletal health and timely intervention in at-risk patients is important in the management of children with DMD. Methods As part of the Norwegian Duchenne muscular dystrophy cohort study, we examined the skeletal maturation of 62 boys less than 18 years old, both currently glucocorticoid treated (n = 44), previously treated (n = 6) and naïve (n = 12). The relationship between bone age, height and bone mineral density (BMD) Z-scores was explored. Results The participants in the glucocorticoid treated group were short in stature and puberty was delayed. Bone age was significantly delayed, and the delay increased with age and duration of treatment. The difference in height between glucocorticoid treated and naïve boys was no longer significant when height was corrected for delayed skeletal maturation. Mean BMD Z-scores fell below − 2 before 12 years of age in the glucocorticoid treated group, with scores significantly correlated with age, duration of treatment and pubertal development. When BMD Z-scores were corrected for by retarded bone age, the increase in BMD Z-scores was significant for all age groups. Conclusion Our results suggest that skeletal maturation should be assessed in the evaluation of short stature and bone health in GC treated boys with DMD, as failing to consider delayed bone age leads to underestimation of BMD Z-scores and potentially overestimation of fracture risk.

scholarly journals Is there an association between thyrotropin levels within the normal range and birth growth parameters in full-term newborns?

2018 ◽  
Vol 31 (9) ◽  
pp. 1001-1007
Author(s):  
Pantea Nazeri ◽  
Mamak Shariat ◽  
Yadollah Mehrabi ◽  
Parvin Mirmiran ◽  
Fereidoun Azizi
Keyword(s):  
Birth Weight ◽  
Growth Parameters ◽  
Full Term ◽  
World Health ◽  
Normal Range ◽  
Anthropometric Parameters ◽  
Cross Sectional ◽  
Z Scores ◽  
Term Newborns ◽  
Weight For Age

AbstractBackgroundIt has been suggested that thyroid hormone concentration at birth may have some role in regulating foetal growth. The aim of this study was to provide seminal data regarding any association between thyrotropin (TSH) concentration within the normal range and growth parameters at birth in full-term newborns.MethodsIn this cross-sectional study conducted in Tehran, Iran, 314 mother-newborn pairs were randomly selected from health care centres responsible for congenital hypothyroidism screening. Neonatal TSH concentration was measured using a heel-prick blood sample taken from all neonates 3–5 days after birth, as part of the routine neonate screening. Anthropometrics, including birth weight, length and head circumference were obtained from the birth record of each neonate. The z-score values for weight-for-age, weight-for-length, length-for-age and head-for-age were calculated using the World Health Organisation growth standards.ResultsThe median interquartile range neonatal TSH values were 0.9 mIU/L (0.4–1.7 mIU/L). Neonates in the top tertile of TSH values had higher birth weights and weight-for-age z-scores than those in the bottom tertile (p<0.05). In addition, neonatal TSH was associated with weight-for-age z-scores in unadjusted (β=0.113, p=0.020) and adjusted (β=0.122, p=0.013) analysis. However, in both unadjusted and adjusted analysis, no association was observed between TSH concentrations of neonates and weight-for-length, length-for-age and head-for-age z-scores.ConclusionsOur findings indicate a positive association between the normal range of neonatal screening TSH concentration and birth weight; however, this association was not observed for other anthropometric parameters at birth.

Factors Influencing Academic Stress on Students of University of Economics and Business - Vietnam National University

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Nham Phong Tuan ◽  
Nguyen Ngoc Quy ◽  
Nguyen Thi Thanh Huyen ◽  
Hong Tra My ◽  
Tran Nhu Phu
Keyword(s):  
Academic Stress ◽  
Stress Factors ◽  
Negative Effects ◽  
Cross Sectional ◽  
Stress Scale ◽  
Perceptions And Attitudes ◽  
National University ◽  
Questionnaire Surveys ◽  
The University ◽  
The Impact

The objective of this study is to investigate the impact of seven factors causing academic stress on students of University of Economics and Business - Vietnam National University: Lack of leisure time, Academic performance, Fear of failure, Academic overload, Finances, Competition between students, Relationships with university faculty. Based on the results of a practical survey of 185 students who are attending any courses at the University of Economics and Business - Vietnam National University, the study assesses the impact of stress factors on students. The thesis focuses on clarifying the concept of "stress" and the stress level of students, while pointing out its negative effects on students. This study includes two cross-sectional questionnaire surveys. The first survey uses a set of 16 questions to assess students’ perceptions and attitudes based on an instrument to measure academic stress - Educational Stress Scale for Adolescents (ESSA). The second survey aims to test internal consistency, the robustness of the previously established 7-factor structure. Henceforth, the model was brought back and used qualitatively, combined with Cronbach’s Alpha measurement test and EFA discovery factor analysis. This study was conducted from October 2019 to December 2019. From these practical analyzes, several proposals were made for the society, the school and the students themselves.

scholarly journals Optimal Household Water Access Fosters the Attainment of Minimum Dietary Diversity among Children Aged 6–23 Months in Malawi

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 178
Author(s):  
Zizwani Brian Chilinda ◽  
Mark L. Wahlqvist ◽  
Meei-Shyuan Lee ◽  
Yi-Chen Huang
Keyword(s):  
Young Children ◽  
Dietary Diversity ◽  
World Health ◽  
Food Groups ◽  
Water Access ◽  
Direct Role ◽  
Cross Sectional ◽  
Child Undernutrition ◽  
Health Organization ◽  
Minimum Dietary Diversity

Along with sanitation and hygiene, water is a well-known driver of child undernutrition. However, a more direct role of household (HH) water access in shaping dietary diversity remains unexplored. We assessed the association between HH water access and achievement of minimum dietary diversity (MDD) among young children. We utilized nationally-representative cross-sectional data from the 2015/16 Malawi Demographic and Health Survey, which included 4727 mother–child dyads, respectively, (26.8 ± 6.8 years, range 15–49 years) and (13.9 ± 4.9 months, range 6–23 months). HH water access was categorized as (1) basic or no access, (2) intermediate, or (3) optimal. MDD was defined as feeding a child, during the previous day, at least four of the food groups defined by the World Health Organization. Only 27.7% of the children achieved MDD standards; most of the children who achieved MDD were from HHs with optimal water access (58.4%, p < 0.001). However, only 5.9% of the mother–child dyads were from HHs with optimal water access. After adjusting for covariates, children from HHs with optimal water access had higher odds of achieving MDD than those from HHs with basic or no water access (aOR = 1.74, CI = 1.24–2.46). Our results highlight the need to incorporate water-based strategies into national nutritional policies to increase dietary diversity among Malawian infants and young children.

scholarly journals Discrimination and Health: The Mediating Effect of Acculturative Stress

2021 ◽  
Vol 18 (10) ◽  
pp. 5312
Author(s):  
Alfonso Urzúa ◽  
Alejandra Caqueo-Urízar ◽  
Diego Henríquez ◽  
David R. Williams
Keyword(s):  
Mental Health ◽  
Racial Discrimination ◽  
Acculturative Stress ◽  
Short Form ◽  
Cross Sectional Study ◽  
Ethnic Discrimination ◽  
Mediating Effect ◽  
Physical And Mental Health ◽  
Negative Effects ◽  
Cross Sectional

There is not much evidence on the effects of south–south migration and its consequences on physical and mental health. Our objective was to examine the mediating role of Acculturative Stress in the association between ethnic discrimination and racial discrimination with physical and mental health. This research is a non-experimental, analytical, cross-sectional study. A total of 976 adult Colombian migrants living in Chile were interviewed. We used the Everyday Discrimination Scale, the acculturative stress scale, and the Medical Outcomes Study Short Form (SF-12) for health status; we found that racial and ethnic discrimination had a negative effect on physical and mental health. In the simultaneous presence of both types of discrimination, racial discrimination was completely absorbed by ethnic discrimination, the latter becoming a total mediator of the effect of racial discrimination on mental and physical health. Our findings are consistent with the literature, which suggests that there are various types of discrimination which, individually or in their intersectionality, can have negative effects on health.

scholarly journals Asthma patients experience increased symptoms of anxiety, depression and fear during the COVID-19 pandemic

2021 ◽  
Vol 18 ◽  
pp. 147997312110296
Author(s):  
Geertje M de Boer ◽  
Laura Houweling ◽  
Rudi W Hendriks ◽  
Jan H Vercoulen ◽  
Gerdien A Tramper-Stranders ◽  
...  
Keyword(s):  
Online Survey ◽  
Anxiety And Depression ◽  
Negative Effects ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Care Workers ◽  
Asthma Patients ◽  
Negative Effect ◽  
Patients Experience ◽  
Anxiety Depression

Population studies showed a decrease in psychological wellbeing during the COVID-19 pandemic. Asthma is associated with a negative effect on anxiety and depression, which might worsen during the COVID-19 lockdown. The aim of the study was to compare fear, anxiety and depression between asthma patients and patients wit hout asthma pre-COVID-19 and during COVID-19 pandemic. This study compares fear, anxiety and depression in asthma patients and controls between pre-COVID-19 and during COVID-19 lockdown with a cross-sectional online survey. Participants were invited to fill out several questionnaires pertaining to fear, anxiety, depression, asthma control and quality of life. Asthma patients (N = 37) displayed, during the course of the pandemic, a clinically relevant increase in anxiety (3.32 ± 2.95 vs. 6.68 ± 3.78; p < 0.001) and depression (1.30 ± 1.15 vs. 3.65 ± 3.31; p < 0.001), according to the hospital anxiety and depression levels (HADS) compared to pre-COVID-19 assessment. This was not seen in controls. Also, asthma patients displayed more anxiety about acquiring COVID-19 disease compared to controls ((5.11 ± 1.99 vs. 3.50 ± 2.79), p = 0.006). Patients with asthma experienced an increase in anxiety and depression levels and were more afraid of acquiring COVID-19 disease compared to controls. Also, patients with asthma were more likely to avoid healthcare facilities due to fear of acquiring COVID-19 disease compared to controls. Therefore, we advise health care workers to address these possible negative effects on mental health by phone or e-consults.

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