Increased frequency of idiopathic central precocious puberty in girls during the COVID-19 pandemic: preliminary results of a tertiary center study

Objectives Recent studies have demonstrated an increase in the frequency of idiopathic central precocious puberty (CPP) during the severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic. We compared the demographic, anthropometric, and clinical characteristics of idiopathic CPP patients diagnosed during a one-year period of the COVID-19 pandemic with the characteristics of patients diagnosed during the same period in the previous three-years. Methods Demographic, clinical, anthropometric, and laboratory data of all patients diagnosed in our Pediatric Endocrinology clinic with idiopathic CPP during a one-year period of the COVID-19 pandemic (April 2020–March 2021) and a three-year period before the pandemic (April 2017–March 2020) were evaluated retrospectively. Results A total of 124 patients (124 girls, zero boys) diagnosed with idiopathic CPP were included in this study. Sixty-six patients in the three-year period before the COVID-19 pandemic (April 2017–March 2020) and 58 patients (46.8%) in the one-year period during the COVID-19 pandemic period (April 2020–March 2021) were diagnosed with idiopathic CPP. Conclusions This study’s findings suggest that the number of girls diagnosed with idiopathic CPP during the one-year study period during the pandemic was more than double that of any of the previous three-years.

Influence of the Basal Metabolic Profile on the Evolution of the Pediatric Patient with Obesity

Childhood obesity is a problem of growing importance globally. It is associated with significant health problems. Knowing how to treat it effectively would improve the quality of life of these children. The aim of this chapter is to study how basal metabolism influences the somatometric evolution of the child and adolescent population with obesity in a pediatric endocrinology clinic. Study childhood obesity in a tertiary hospital by means of a multichannel impedanceometry study. All the patients had a basal metabolism lower than the calculated theoretical ideal. In overall terms, weight reduction is not achieved in this pediatric population. However, it is observed a decrease in fat content in the medium term (1-3 years). Bioelectrical impedanceometry measurement is a simple method in clinical practice to evaluate the energy consumption and the body composition. Knowing the body composition of these children would help to intervene more effectively to help control obesity and its health consequences.

Association Between Poor Sleep Quality and Glycemic Control in Adult Patients with Diabetes Referred to Endocrinology Clinic of Guilan: A Cross-sectional Study

Background: Diabetes is a prevalent chronic medical comorbid condition worldwide. Diabetes mellitus is associated with various sleep disorders. Objectives: We aimed to determine the prevalence of poor sleep and the main factors of sleep interruptions in patients with diabetes mellitus. We further evaluated the association of sleep interruptions with glycemic control in this cohort. Methods: We conducted a cross-sectional study on 266 patients with type 1 and type 2 diabetes who were recruited from a university outpatient endocrinology clinic. Patients completed a checklist including demographic and disease-related characteristics in addition to the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality. Using the PSQI cutoff score of 5, we created two subgroups of good sleepers (GS) and poor sleepers (PS). Results: Our results showed that good sleeper and poor sleeper diabetic patients were significantly different regarding sex, employment status, BMI, presence of diabetes-related complications, HbA1c, and 2-hour postprandial blood sugar (2HPPBS) (all significant at P < 0.05). The most prevalent factors of sleep interruptions were “waking up to use a bathroom”, “feeling hot”, “pain”, “having coughs or snores”, and “bad dreams”. Among the subjective factors of sleep interruption, problems with sleep initiation, maintenance, or early morning awakenings in addition to having pain or respiratory problems such as coughing or snoring had the most effects on HbA1c. Conclusions: Our study showed significant subjective sleep disturbances (both quality and quantity) in patients with diabetes mellitus (both type I and II) and its association with diabetes control. We further identified the main factors that led to sleep interruptions in this cohort.

41 Innovative solutions to support “Virtual First” pediatric endocrine care

Primary Subject area Endocrinology and Metabolism Background With the onset of the SARS-CoV-2 pandemic, health care providers everywhere were forced to rapidly shift the way they deliver care. Within our community-based academic organization, there was variability in response to required changes among different clinical areas, with many clinics ramping down their services while they restructured. In our pediatric endocrinology clinic, we had built the infrastructure to support virtual care using a provincial platform as part of a pilot program for our diabetes population in the year preceding the pandemic. This experience set the stage for a swift pivot to virtual care. To ensure ongoing high quality consultation and follow-up services during the pandemic, our clinic required rapid restructuring to successfully and immediately shift completely to a sustainable “virtual first” approach in March 2020. Objectives In the months following the onset of the SARS-CoV-2 pandemic, we sought to quickly develop and implement innovative strategies, using a quality improvement framework, to supplement virtual care and maintain high quality care delivery. Design/Methods As soon as physical distancing measures were implemented in March 2020, our multidisciplinary team held daily 30-minute meetings to troubleshoot, brainstorm, and strategize potential adaptations in care delivery to ensure we continued to meet patient and family needs with primarily virtual care. Barriers and problems were presented and prioritized, solutions proposed, then implemented with support of operation and e-health teams. Attention to educational needs for medical students, residents and fellows helped shape solutions. Results The following innovative solutions were successfully implemented within three months: • a drive thru hemoglobin A1C clinic for patients with diabetes • a streamlined “low touch” Auxology Clinic to supplement virtual visits when body measurement, vital signs or physical exam assessment were required • pre-visit preparation instructions for patients and families • active promotion of patient portal enrolment • re-design of follow-up orders content to allow providers to accurately indicate suitability of virtual care alone or with support measures • a workflow to allow quick conversion from in-person to virtual visits to prevent cancellations related to isolation requirements • an educational framework to ensure level-appropriate exposure to and involvement in patient care for trainees • auto-faxing of medication and supplies • printer mapping and workflow for external lab requisitions • provider/staff scheduling and role re-assignment to facilitate minimal number of on-site staff • support of the team to adopt best practices for virtual visits Conclusion While virtual care delivery existed before the pandemic, it was rarely used outside of pilot projects, or only from necessity, when travel to a health care facility was not possible. Herein we provide an overview of an innovative, primarily virtual, care delivery model to satisfy patient and family needs in a pediatric endocrinology clinic in an academic centre. Many components of our model have (and can be) applied or adapted to support care delivery in other clinical areas. The people, processes, and digital health adaptations required to support a primarily virtual mode of care were critical to its success.

Psychological Impact of Diabetic Care on Satisfaction and Quality of Life of Diabetes Patients Attending Endocrinology Clinic, LAUTECH Teaching Hospital, Osun State, Southwest, Nigeria

Aims: Diabetes mellitus (DM) is a complex, debilitating and chronic illness that presents substantial challenges to every individual living with the condition. The impact of DM reaches far beyond the physical symptoms of the disease, often the emotional distress and psychosocial impact on the quality of life (QoL) of these patients complicates the effective management of the disease. Therefore, the objective of this study was to evaluate the impact of psychological experience and satisfaction with diabetic care on quality of life of diabetes patients. Study Design: This was a descriptive research survey design carried out among diabetes patients attending endocrinology clinic of LAUTECH Teaching Hospital, Osogbo, Osun State, Southwest, Nigeria between August to December 2020. Methodology: Sample size determination was obtained using Taro Yamane’s formula and sample consisted of one hundred and ten (110) diabetic patients attending endocrinology clinic of LAUTECH Teaching Hospital, Osogbo. Samples were selected using convenience sampling method. Data were collected using modified Kessler psychological distress scale and Diabetes Quality of life Instrument and analyzed using descriptive statistics of frequencies, percentages and table. Inferential statistics of chi-square was used to test hypotheses at 0.05 level of significance. Results: The results showed that more than half of the patients had poor psychological experience 61(55.5%) with diabetic care, though majority were satisfied 66(60.0%) with diabetic care but demonstrated poor quality of life 65(59.1%). The result also showed a significant relationship between psychological experience and quality of life (x2=5.564; df=1; p-value=0.018), level of satisfaction with diabetic care and quality of life (x2=25.280; df=2; p-value=0.000), level of satisfaction with diabetic care and psychological experience of diabetes patients (x2=25.185; df=1; p-value=0.000). Conclusion: Promotion of psychological wellbeing of diabetes patients and quality outcome of diabetic care as well as patient-centered psychological care are essential by providing care that is respectful and responsive to individual patient preferences, needs and values.

Becker’s nevus syndrome: a case report

Background Becker’s nevus syndrome is a syndrome characterized by the presence of a Becker’s nevus with ipsilateral breast hypoplasia or hypoplastic defects of the muscle, skin, or skeleton. The nevus usually consists of a circumscribed, unilateral, irregularly shaped hyperpigmented macule, commonly occurring around the anterior upper trunk, with/without hypertrichosis and/or acneiform lesions. This rare syndrome has not been reported in our locality to the best of our knowledge. Case presentation We report the case of a 15-year-old Igbo female patient who presented to our pediatric endocrinology clinic, University of Nigeria Teaching Hospital, Enugu, with complaints of asymmetry of the breasts and hyperpigmented macules on the side. Based on her symptoms, diagnosis of Becker’s nevus syndrome was made. The diagnosis of Becker’s nevus syndrome is mostly clinical, based on the presence of a Becker’s nevus with ipsilateral breast hypoplasia or hypoplastic defects of the muscle, skin, or skeleton. In our patient, there was a Becker’s nevus with ipsilateral breast hypoplasia. This syndrome, belonging to the class of epidermal nevus syndromes, is very rare, and is usually benign. She was placed on spironolactone tablets 50 mg daily, which have been associated with an improvement in the size of the hypoplastic breast, and her fears were allayed. Conclusion This syndrome has not been reported in our locality to the best of our knowledge and, therefore, has a propensity for misdiagnosis by clinicians because of its rarity. We therefore report this to create awareness among clinicians regarding this condition that is associated with much psychosocial trauma among patients, and that can be easily managed with oral spironolactone.

THE RELATIONSHIP BETWEEN SEROTONINE, HISTAMINE AND THE BRAIN`S ELECTRICAL ACTIVITY IN PATIENTS WITH DEPRESSION AND ENDOCRINE DISORDERS

Introduction. Depression is a persistent mental state of sadness that can affect an individual`s thoughts, behavior, emotion and well-being. The electroencephalogram (EEG) is of great importance both for experimental neurophysiology and for clinical diagnosis. The purpose of our study was to establish if there is a connection between the values of serotonine, histamine and EEG in patients with depression and endocrine pathology based on the collected data. Materials and methods. We included 50 individuals diagnosed with depression from Endocrinology Clinic of Craiova, over a period of 2 years (2018-2020). Serotonine and histamine were measured in blood and urine/24 hours in all the sample. Electroencephalography was performed to this patients. Outcomes. In our study, 27 patients had mild depression, 17 had moderate depression and 6 had a severe disorder Also, the serotonine values were low (normal value 80-400 μg/L) in patients with depression and endocrine pathology. Conclusion. In patients with EEG abnormalities occure significant changes in the values of serotonine and histamine (increased urinary histamine and decreased serotonine levels).