Aetiology of Percociuos Puberty in Patients Presenting to A Tertiary Care Hospital

Background: Precocious puberty is a common paediatric endocrine disorder seen in clinical practice. This study was carried out to find out the aetiology of precocious puberty in children presenting in a tertiary care hospital.Methodology: This cross sectional study was done at paediatric endocrine outpatient department at BIRDEM General Hospital from July 2005 to June 2015. The clinical data as well as laboratory findings were collected from consecutive patients who presented for evaluation of precocious puberty.Result: Seventy one patients presented with precocious puberty during this study period. There was female preponderance (71.8%). The mean age at presentation of girls and boys were 4.8±2.1 years and 6.63±1.4 years respectively. Among the 51 girls who presented with precocious puberty 22(43.1%) had central precocious puberty (CPP), 5(9.8%) had peripheral precocious puberty (PPP) and 24(47%) had incomplete precocious puberty (IPP). Among the 22 girls with CPP 19(86.3%) were idiopathic & 3(13.6%) girls were hypothyroid. Among the 5 girls with PPP, 3(60%) had congenital adrenal hyperplasia (CAH) & 2(40%) had adrenal adenoma. In case of incomplete precious puberty among 24 girls, 20 (83.3%) had premature thelarche, 1(4.1%) had premature menarche & 3 (12.5%) had premature adrenarche. In 20 boys with precocious puberty, 7(35%) had CPP. Among them 3(42.8%) boys had hypothalamic hamartoma, 1(14.2%) boy had craniopharyngioma and other 3(42.8%) boys had idiopathic CPP. PPP was present in 11(55%) boys. Among them 8(72.7%) patient had CAH, 2(18.1%) had adrenal adenoma and 1(9.0%) had hepatoblastoma. Premature adrenarche was present in 2(10%) boys.Conclusions: Precocious puberty was more commonly found among girls as compared to boys. Central precocious puberty was more common among girls and majority were idiopathic. Among boy precocious pseudopuberty was more common and CAH was the commonest cause. Majority of boy with central precocious puberty had organic brain lesion.Bangladesh J Child Health 2017; VOL 41 (3) :143-146

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Sensitivity and specificity of using pelvic ultrasonographic parameters combined with basal gonadotropin levels to diagnose central precocious puberty in Thai girls

Asian Biomedicine ◽

10.2478/abm-2021-0004 ◽

2021 ◽

Vol 15 (1) ◽

pp. 27-34

Author(s):

Hataichanok B. Kongmanas ◽

Panruethai Trinavarat ◽

Suttipong Wacharasindhu

Keyword(s):

Precocious Puberty ◽

Predictive Value ◽

Tertiary Care ◽

Central Precocious Puberty ◽

Gnrh Analogue ◽

Care Hospital ◽

Premature Thelarche ◽

Agonist Stimulation ◽

Stimulation Tests ◽

Response Group

Abstract Background The criterion standard gonadotropin-releasing hormone (GnRH) stimulation tests to diagnose central precocious puberty (CPP) are time-consuming, inconvenient, and expensive. Objectives To determine predictive cut-off values codetermined by ultrasonographic parameters and basal gonadotropin levels in girls with premature sexual development and compare them results of criterion standard tests in a study of diagnostic accuracy. Methods Retrospective review of hormonal investigations and ultrasonographic uterine and ovarian parameters in a consecutive sample of girls at a single center, tertiary care hospital in Bangkok, Thailand. Results We separated data from 68 girls (age range 2–12 years) into 2 groups based on their response to a GnRH analogue agonist stimulation test. A “prepubertal response” group included girls with premature thelarche and thelarche variants (n = 18, 6.37 ± 1.77 years) and a “pubertal response” group, including girls with CPP (n = 50, 8.46 ± 1.46 years); excluding patients with pathological causes (n = 0). The basal level of luteinizing hormone (LH) had the largest area under receiver operating characteristic curves (AUC) of 0.84; 95% confidence interval [CI] 0.74–0.93) compared with basal levels of follicle stimulating hormone (AUC 0.77; 95% CI 0.64–0.90) or estradiol (0.70; 95% CI 0.56–0.85). An optimal cut-off of 0.25 IU/L LH was related to a pubertal response to GnRH analogue agonist stimulation tests with 75.0% sensitivity, 88.9% specificity, 94.7% positive predictive value (PPV), and 57.1% negative predictive value. Uterine and ovarian cut-off volumes of 3.5 cm3 and 1.5 cm3 were related to a pubertal response with 88.6% and 76.2% PPV, respectively. A uterine width cut-off of 1.7 cm combined with a basal LH cut-off of 0.25 IU/L increased specificity and PPV to 100%. Conclusion Combining uterine and ovarian ultrasonographic parameters with basal gonadotropin levels, especially uterine width and basal LH level, appears useful for diagnosis of CPP.

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Burden and baseline characteristics of patients with decompensated liver disease in Tertiary Care Hospital Gujrat.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.02.4699 ◽

2021 ◽

Vol 28 (02) ◽

pp. 165-170

Author(s):

Irfan Younus ◽

Muhammad Zahid Ali ◽

Muhammad Ajmal ◽

Hina Akhtar ◽

Javeria Ali ◽

...

Keyword(s):

Hepatitis B ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Decompensated Cirrhosis ◽

Care Hospital ◽

Medical Department ◽

Laboratory Findings ◽

Cross Sectional ◽

Gi Bleed

Objective: To determine the load, clinical and laboratory findings of the patients with decompensated cirrhosis admitted in medical department of tertiary care hospital and to make plan for the improvement of these patients. Study Design: Cross Sectional study. Setting: Department of medicine of Aziz Bhatti Shaheed Teaching Hospital, Gujrat. Period: from 1st January 2019 to 31st March 2019. Material & Methods: All 964 patients who were admitted included in study, clinical and laboratory features of patients with decompensated cirrhosis were recorded. Results: Male were in majority (53.7%), median age was 39 years. Decompensated cirrhosis was found in 216 (22.4%), patients due to complication of Diabetes Mellitus were 170 (17.6%), COPD & Asthma was found in 130 patients(13.5%), Stroke & Hypertension in 126 patients while Gastroenteritis 6% and infectious diseases RTI, UTI, Enteric Fever etc were present in 46 patients. Among 216 patients, one hundred & seventy eight were Hepatitis C Positive, fifteen had Hepatitis B, and eight had history of alcohol consumption. Seven patients were both Hepatitis B and C positive while in 3.6% etiology was other than mentioned above. Ascites was noted in two hundred six patients, 36.5% had variceal bleed while 51 admitted due to encephalopathy. Conclusion: HCV related cirrhosis and its complications like upper GI bleed, encephalopathy, ascites and hepatoma are major burden on our hospitals and need special attention.

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Laboratory Profiles of Pleural effusion Collected from Children: Experience at a Tertiary Care Hospital in Bangladesh

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v5i1.16201 ◽

2013 ◽

Vol 5 (1) ◽

pp. 26-27

Author(s):

Mahmudul Hasan ◽

Md Rafiqul Islam ◽

Abdul Matin ◽

Ranjit Ranjan Roy ◽

Md Abdullah Yusuf ◽

...

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

College Hospital ◽

Laboratory Findings ◽

Cross Sectional ◽

Medical College ◽

Almost All

Background: Pleural effusion occurs in many reasons. Laboratory tests are necessary to find out the causes. Objective: This study was an attempt to know the laboratory findings of pleural effusion. Methodology: This cross-sectional study of thirty (30) admitted cases with pleural effusion confirmed by chest radiography and aspiration of pleural fluid from one (1) year to twelve (12) years age of either sex were collected purposively. This study was carried out from July 2009 to February 2010 in the Department of Pediatrics at Rajshahi Medical College Hospital. All information were recorded in pre tested semi structured questionnaire. Results: Color of pleural fluid was straw in 56.7%, clear in 30.0%, blood stained in 13.3%. In this study, lymphocyte predominance among 56.7% cases, acid fast bacilli in 3.3% cases and raised protein of more than 3gm/dl and sugar less then 60mg/dl in 93.3% cases in pleural fluid. Conclusion: In almost all cases protein is raised and sugar is less in pleural fluid. DOI: http://dx.doi.org/10.3329/jssmc.v5i1.16201 J Shaheed Suhrawardy Med Coll, 2013;5(1):26-27

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Long-Term Outcomes of Patients with Central Precocious Puberty due to Hypothalamic Hamartoma after GnRHa Treatment: Anthropometric, Metabolic, and Reproductive Aspects

Neuroendocrinology ◽

10.1159/000477584 ◽

2017 ◽

Vol 106 (3) ◽

pp. 203-210 ◽

Cited By ~ 5

Author(s):

Carolina O. Ramos ◽

Ana C. Latronico ◽

Priscilla Cukier ◽

Delanie B. Macedo ◽

Danielle S. Bessa ◽

...

Keyword(s):

Precocious Puberty ◽

Final Height ◽

Standard Deviation Score ◽

Central Precocious Puberty ◽

Cross Sectional Study ◽

Hypothalamic Hamartoma ◽

Cross Sectional ◽

Female Patients ◽

Tertiary Center ◽

The Mean

Background: Hypothalamic hamartoma (HH) represents the commonest cause of organic central precocious puberty (CPP). Follow-up of these patients in adulthood is scarce. Objective: To describe the anthropometric, metabolic, and reproductive parameters of patients with CPP due to HH before and after treatment with gonadotropin-releasing hormone analog (GnRHa). Methods: We performed a retrospective and cross-sectional study in a single tertiary center including 14 patients (7 females) with CPP due to HH. Results: The mean duration of GnRHa treatment was 7.7 ± 2.4 years in boys and 7.9 ± 2.1 years in girls. GnRHa treatment was interrupted at the mean chronological age (CA) of 12.1 ± 1.1 years in boys and 10.7 ± 0.5 years in girls. At the last visit, the mean CA of the male and female patients was 21.5 ± 3.2 and 24 ± 3.9 years, respectively. Eleven of the 14 patients reached normal final height (FH) (standard deviation score -0.6 ± 0.9 for males and -0.6 ± 0.5 for females), all of them within the target height (TH) range. The remaining 3 patients had predicted height within the TH range. The mean body mass index and the percentage of body fat mass was significantly higher in females, with a higher prevalence of metabolic disorders. All patients presented normal gonadal function in adulthood, and 3 males fathered a child. Conclusion: All patients with CPP due to HH reached normal FH or near-FH. A higher prevalence of overweight/obesity and hypercholesterolemia was observed in the female patients. Finally, no reproductive disorder was identified in both sexes, indicating that HH per se has no deleterious effect on the gonadotropic axis in adulthood.

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The clinico-demographic study of morbidity and mortality in patients with organophosphate compound poisoning at tertiary care hospital in rural India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20172277 ◽

2017 ◽

Vol 4 (3) ◽

pp. 809

Author(s):

Sanjay A. Mundhe ◽

Siddheshwar V. Birajdar ◽

Sheshrao S. Chavan

Keyword(s):

Clinical Features ◽

Tertiary Care ◽

Ventilatory Support ◽

Care Facility ◽

Morbidity And Mortality ◽

Care Hospital ◽

Prognostic Information ◽

Laboratory Findings ◽

Cross Sectional ◽

Suicidal Intention

Background: Organophosphates (OP) are commonly used and potentially fatal insecticides. Given the unrestricted availability and widespread use, OP poisoning is very much common following either accidental or intentional exposures. Many parameters are proposed to predict outcome, yet there is no consensus about these parameters. This study aimed to investigate different factors associate with morbidity and mortality in rural population that can help in identifying patients in need of intensive care and treatment to prevent deaths.Methods: This was a cross-sectional observational study of 323 patients, admitted to the tertiary care rural public hospital with OP poisoning between December 2015 to November 2016.Results: Of the 323 patients studied, 62.85% were male, 227 (70.27%) were suicides, 241 (74.61%) ingested OP compounds, 40 (12.38%) patients developed intermediate syndrome and 56 (17.34%) died. There were statistically significant differences between ventilatory support group and no ventilatory group for suicidal intention, sex, comorbid psychiatric conditions, route of exposure, certain clinical features on admission, GCS score, POP scale, time from exposure to initiation of treatment, plasma pseudocholinesterase levels, oxygen saturation, and random blood sugar levels (p<0.05).Conclusions: OP poisoning is a life-threatening condition which requires immediate management. Early initiation of decontamination, atropine and pralidoxime therapy, with supportive ICU care, can save lives. Different demographic, exposure related parameters; some of the clinical features, treatment variables and certain laboratory findings can provide useful prognostic information and help to predict outcomes. A measures to control unchecked availability of these compounds and early transfer of victims to health care facility is needed to save many lives.

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Clinical and laboratory findings in the differential diagnosis of central precocious puberty and premature thelarche

Türk Pediatri Arşivi ◽

10.5152/tpa.2015.2281 ◽

2015 ◽

Vol 50 (1) ◽

pp. 20-26 ◽

Cited By ~ 10

Author(s):

Gonul Catli ◽

Pinar Erdem ◽

Ahmet Anik ◽

Ayhan Abaci ◽

Ece Bober

Keyword(s):

Differential Diagnosis ◽

Precocious Puberty ◽

Central Precocious Puberty ◽

Laboratory Findings ◽

Premature Thelarche

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The pattern of gonadotropin and estradiol secretion in exaggerated thelarche

Acta Endocrinologica ◽

10.1530/acta.0.1280345 ◽

1993 ◽

Vol 128 (4) ◽

pp. 345-350 ◽

Cited By ~ 24

Author(s):

Luigi R Garibaldi ◽

Thomas Aceto ◽

Colleen Weber

Keyword(s):

Precocious Puberty ◽

Central Precocious Puberty ◽

Bone Age ◽

Premature Thelarche ◽

Premature Adrenarche ◽

Estradiol Secretion ◽

Secretory Potential ◽

Estrogen Effects ◽

Estrogen Effect ◽

Similar Peak

Purpose: To assess the dynamics of the pituitary-ovarian axis in exaggerated thelarche, defined as premature thelarche associated with signs of systemic estrogen effects (advanced bone age and/or growth acceleration) without progression to complete puberty. Subjects and methods: Seven girls (age <2.5 years) with exaggerated thelarche, 6 girls with inactive pituitary-ovarian axis (premature adrenarche) and 21 girls with activated axis (central precocious puberty) had serum FSH, LH and E2 measured serially before and 1 to 24 h after gonadotropin-releasing hormone agonist (GnRHa) administration (leuprolide, 20 μg/kg sc), used as a test of combined pituitary-ovarian stimulation. Results: Although girls in the exaggerated thelarche and adrenarche group had similar [mean (SEM)] baseline FSH [3.2 (0.9) vs 1.4 (0.3) IU/I], LH [0.36(0.1) vs 0.27 (0.02) IU/I] and E2 [20 (1.2) vs 21 (2) pmol/l] concentrations, and similar peak post-GnRHa LH concentrations [5.5 (1.1) vs 2.4 (0.5) IU/I], girls with exaggerated thelarche achieved higher peak FSH [41(9) vs 14 (3) IU/I, p< 0.01] and E2 [243 (40) vs 37 (6) pmol/l, p<0.001] concentrations after GnRHa. In comparison to patients with exaggerated thelarche, girls with precocious puberty had higher (p<0.01-0.001) baseline LH [3.6 (0.8) IU/I], baseline E2 [69 (11) pmol/l], GnRHa-stimulated peak LH [68 (1 7) IU/I] and peak E2 [648 (58) pmol/l] concentrations, but similar FSH parameters. Conclusions: Girls with exaggerated thelarche exhibit substantial E2 secretory potential that can be demonstrated by GnRHa stimulation, is predominantly FSH-driven, and probably accounts for the manifestations of estrogen effect seen in these girls.

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Morbidity patterns and outcome in children with severe acute malnutrition at a Tertiary Care Hospital.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.09.3528 ◽

2020 ◽

Vol 27 (09) ◽

pp. 1799-1803

Author(s):

Waqas Ali ◽

Asif Ali Khuhro ◽

Sanam Bano Rajper ◽

Fazal Ur Rehman

Keyword(s):

Tertiary Care Hospital ◽

Severe Acute Malnutrition ◽

Tertiary Care ◽

Cross Sectional Study ◽

Bottle Feeding ◽

Acute Malnutrition ◽

Care Hospital ◽

Laboratory Findings ◽

Cross Sectional ◽

Study Setting

Objectives: We planned this study to find out morbidity patterns as well as outcome of admitted children aged less than 5 years of age with severe acute malnutrition (SAM). Study Design: Cross Sectional study. Setting: Department of Pediatrics Medicine, Ghurki Trust Teaching Hospital, Lahore. Period: From 1st January 2018 to 30th June 2018. Material & Methods: A total of 80 children aged 1 to 59 months, of both genders, having SAM were considered. Physical examination, detailed clinical as well as laboratory findings related to nutritional status and comorbidities were noted. Outcome in terms of recovery/discharge, left against medical advice (LAMA) or death during the stay was noted in all the children. Results: Out of a total of 80 children, 20 (25.0%) were aged 1 to 6 months, 39 (48.8%) from 7 to 24 months and 21 (26.2%) from 25 to 59 months. Most of the patients, 39 (48.8%) were from 7 to 24 months of age, 62 (77.5%) were admitted through emergency, 52 (65.0%) had WHZ score-4SD and 27 (33.8%) using bottle feeding. Severe wasting without having edema was reported in 67 (83.8%) children. Diarrhea was the commonest comorbidity, found in 43 (53.8%) children, followed by sepsis 17 (21.3%) and pneumonia 15 (18.8%). There were 69 (86.3%) children noted having anemia. Hyponatremia was the commonest metabolic abnormality seen in 40 (25.0%) children. In terms of outcome, 71 (88.7%) children recovered well and got discharged while mortality was reported in 5 (6.3%) children. Conclusion: Diarrhea along with sepsis and pneumonia along with metabolic abnormalities were found to be more prevalent amongst children having SAM. Early identification of anemia as well as infections in children with SAM can contribute to better outcome.

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