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Abstract Background Some studies have reported the possible role of vitamin D3 in ameliorating disease outcomes in childhood infectious diarrhea. However, findings about its effectiveness and the association of serum vitamin D levels with diarrhea risk appear inconsistent. We aimed to determine the efficacy of oral vitamin D3 as an adjunct in managing childhood infectious diarrhea and the relationship between vitamin D status and the disease. Methods We searched the PubMed and Google Scholar electronic databases for relevant articles without limiting their year of publication. We selected primary studies that met the review’s inclusion criteria, screened their titles and abstracts, and removed duplicates. We extracted data items from selected studies using a structured data-extraction form. We conducted a quality assessment of randomized controlled trials (RCTs) and non-randomized studies with the Cochrane collaboration tool and the Newcastle Ottawa Scale, respectively. We assessed the strength of the relationship between serum vitamin D levels and diarrhea using the correlation model. We estimated the I2 and tau2 values to assess between-study heterogeneity. Results Nine full-text articles were selected, consisting of one RCT, three cross-sectional studies, two cohort studies, two longitudinal/prospective studies, and one case-control study. A total of 5,545 participants were evaluated in the nine studies. Six non-randomized studies provided weak evidence of the relationship between vitamin D levels and diarrhea risk as there was no correlation between the two variables. The only RCT failed to demonstrate any beneficial role of vitamin D3 in reducing the risk of recurrent diarrhea. The calculated I2 and tau2 values of 86.5% and 0.03, respectively suggested a high between-study heterogeneity which precluded a meta-analysis of study results. Conclusion Oral vitamin D3 may not be an effective adjunct in managing childhood infectious diarrhea. Additionally, the relationship between vitamin D status and infectious diarrhea appears weak. We recommend more adequately-powered RCTs to determine the effectiveness of vitamin D3 as an adjunct therapy in infectious diarrhea.

Abstract Background Haemostatic derangements are thought to be due to an imbalance between hepatic synthesis of pro-coagulants and urinary losses of anticoagulants. Objectives This study evaluated the coagulation profile of Nigerian children with nephrotic syndrome and examined the relationship between coagulation variables, disease state and steroid responsiveness. Methods A cross- sectional hospital based study on evaluation of coagulation profile of children with nephrotic syndrome compared with their age- and gender- matched controls. Results The median fibrinogen level in subjects and controls was the same (2.9 g/L). Sixteen of 46 (35%) children with nephrotic syndrome had hyperfibrinogenaemia. The median fibrinogen level of children in remission was 2.3 g/L and differed significantly when compared with those of children in relapse (p = 0.001). The median APTT of children with nephrotic syndrome was 45.0 s and differed significantly compared with those of controls (42.0 s) (p value = 0.02). The median prothrombin time in children with and without nephrotic syndrome were 12.0 and 13.0 s respectively, (p = 0.004). About 90% of children with nephrotic syndrome had INR within reference range. Thrombocytosis was found in 15% of children with nephrotic syndrome. The median platelet count in children with new disease was 432 × 103cells/mm3 and differed significantly when compared with those of controls (p = 0.01). INR was significantly shorter in children with steroid resistant nephrotic syndrome (SRNS) (median 0.8 s; IQR 0.8 -0.9 s) compared with controls (median 1.0 s; IQR 1.0 -1.1 s) (p = 0.01). Steroid sensitivity was the strongest predictor of remission in children with nephrotic syndrome; steroid sensitive patients were 30 times more likely to be in remission than in relapse (OR 30.03; CI 2.01 – 448.04). Conclusion This study shows that the haemostatic derangements in childhood nephrotic involve mostly fibrinogen, APTT, PT, INR and platelet counts. Antithrombin levels are largely unaffected. Variations in fibrinogen, APTT, PT and INR values may be due to the heterogeneous nature of the disease.

BackgroundAlthough several randomized controlled trials (RCTs) published over the past 5 years show that prenatal or postnatal probiotics may prevent or optimize the treatment of childhood asthma and atopic disorders, findings from the systematic reviews and meta-analyses of these studies appear inconsistent. More recent RCTs have focused on postnatal probiotics, and linked specific probiotic strains to better disease outcomes.ObjectiveThis systematic review aimed to determine if postnatal probiotics are as effective as prenatal probiotics in preventing or treating childhood asthma and atopic disorders.MethodsWe searched the PubMed, Medline, Google Scholar, and EMBASE databases for RCTs published within the past 5 years (from 2017 to 2022). We included only full-text RCTs on human subjects published in or translated into the English language. We retrieved relevant data items with a preconceived data-extraction form and assessed the methodological quality of the selected RCTs using the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials. We qualitatively synthesized the retrieved data to determine any significant differences in study endpoints of the probiotic and placebo groups.ResultsA total of 1,320 participants (688 and 632 in the probiotic and placebo groups) from six RCTs were investigated. One RCT showed that early Lactobacillus rhamnosus GG (LGG) led to a reduction in the cumulative incidence rate of asthma. Another study demonstrated that mixed strains of Lactobacillus paracasei and Lactobacillus fermentum could support clinical improvement in children with asthma while one trial reported a significant reduction in the frequency of asthma exacerbations using a mixture of Ligilactobacillus salivarius and Bifidobacterium breve. Three trials showed that a combination of LGG and Bifidobacterium animalis subsp lactis, Lactobacillus rhamnosus alone, and a probiotic mixture of Lactobacillus ŁOCK strains improved clinical outcomes in children with atopic dermatitis and cow-milk protein allergy.ConclusionsPostnatal strain-specific probiotics (in single or mixed forms) are beneficial in preventing and treating atopic dermatitis and other allergies. Similarly, specific strains are more effective in preventing asthma or improving asthma outcomes. We recommend more interventional studies to establish the most useful probiotic strain in these allergic diseases.

Objective: To compare prevalence of dental caries, oral hygiene status and associated risk factors of children in suburban and rural communities in the Southwest region of Nigeria. Material and Methods: Secondary data was extracted from cross-sectional researches conducted in two study locations involving 8 to 12 year olds. Data retrieved included age, gender, family structure, socioeconomic status, oral hygiene and dental caries. Caries assessment was done using WHO Oral Health Survey methods. Oral hygiene data was collected using Simplified Oral Hygiene Index (OHI-S) by Greene and Vermillion. Statistical significance was established at p

Background: Self-reported sexual dissatisfaction is a recognized contributor to poor quality of life and can affect productivity in the workplace. Aim: This was a preliminary survey of a cohort of physicians in Enugu metropolis, South East Nigeria investigating self-reported sexual satisfaction and its association with sociodemographic variables. Materials and Methods: Physicians’ self-report of sexual well-being as well as any impact thereof was assessed using an online-delivered structured questionnaire in September 2018. Informed consent was obtained. Results obtained were analyzed using the International Business Machine–Statistical Package for the Social Sciences (IBM-SPSS) version 20. Results: The participants, 62.0% males, were mostly married (82%) and young (mean age 38.2 ± 9.7). Majority (81.5%) of the participants were satisfied with their current sexual lives, 30.7% of them used sex enhancements, and 14.8% of the participants were willing to seek professional help over sexual health problems. Males were five times more likely than females to have sexual encounters outside current relationship (P = 0.003). Conclusion: The findings of this study shows that majority of the physicians are satisfied with their sexuality. The study also observed age and gender-related differences in the physicians’ sexual behaviors. The implication of the finding that most doctors are still reluctant to seek help for sexual health issues calls for a robust public health education with emphasis on sexual health.

Background: Children with seizure disorders are faced with different oral conditions from lack of personal care, side effects of medications, and injuries from poor neuromuscular controls. Aims: This study aims to assess the oral health characteristics of children diagnosed with seizure disorders. Settings and Design: A cross-sectional survey was carried out among children aged 0–16 years who attended the outpatient neurology clinic of the Department of Paediatrics, Lagos University Teaching Hospital and an age- and gender-matched control group. Materials and Methods: Data were collected through interviewer-administered questionnaires to their parents/caregivers and oral examinations of the children. Statistical Analysis Used: Data entry was done using Statistical Package for Social Sciences version 20, and statistical analysis was performed using Chi-square test, and the level of significance was set at P < 0.05. Results: Two groups of 101 children each with seizure disorders and without seizure disorders aged between10 months and 16 years participated in the study. Majority of the participants with seizures –92 (91.1%) had never visited the dentist. The Decayed, Missing, Filled Teeth for participants with seizure disorders and control were 0.56 + 1.89 and 0.15 + 0.50, respectively. With regard to gingival hyperplasia, anterior open bite, proclined teeth, and fractures of teeth, patients with seizures showed significantly worse conditions compared with the control group. Conclusions: Result from this study showed that children who have seizures had poorer oral health and dental visit behavior than those without seizures. There is therefore a need for oral health care to be incorporated into recommended health care of these groups of patients to improve their quality of life.

Abstract Background Nigeria, like many other countries, faced challenges in dental care provision during the COVID-19 pandemic, necessitating limited care to emergencies only. However, the impact of restricted access to dental services on oral health remains a concern, particularly w ith preventive maintenance care. This study aims to identify the factors associated with dental service utilization during the COVID-19 pandemic among patients attending dental clinics in Nigeria, and their sources of information about COVID-19. Methods This cross-sectional study recruited 500 participants who had visited dental clinics before and during the pandemic. Data were collected through telephone interviews and online questionnaires betw een September and December 2021. Inferential analyses were conducted using ordered logistic regression models to assess the association between the independent (awareness of emergency dental treatments, knowledge of COVID-19 transmission routes in dentistry, awareness of required preparations in dental practice settings, fear of COVID-19 infection in dental settings), and dependent (utilization of dental services during the pandemic) variables after adjusting for confounding variables (age, sex, educational status, COVID-19 vaccinations status and COVID-19 status of live-in residents). The sources of COVID-19 information by dental patients was also identified. Statistical significance was established at 95% confidence level with a p value

Objective. Results: Eight full-text articles were selected, comprising four RCTs and four observational analytical studies. Two of the RCTs had a high risk of bias in three parameters of the Cochrane collaboration tool, while three non-randomized studies had low methodological quality. A total of 621 pediatric patients with SSNS were investigated in the eight studies: six participants dropped out in one study. Three RCTs indicate that zinc supplementation may lead to sustained remission or reduction in relapse rate. Similarly, three observational analytical studies suggest a significant relationship between reduced serum zinc levels and disease severity. Conclusion: Despite the association of zinc deficiency with increased morbidity in SSNS and the reduction of relapse rates with zinc supplementation, there is no robust evidence to recommend its use as a therapeutic adjunct. We recommend more adequately-powered RCTs to strengthen the current evidence. [ABSTRACT FROM AUTHOR]

Abstract Nigeria is facing the problem of soil degradation as a result of continuous deposition of spent oil in the soil. The physiochemical properties, including heavy metals concentrations, of spent oil contaminated soils and adjacent control soils were investigated at 0–15 and 15–30 cm depths at Ladipo and Berger auto-mobile Markets in Lagos, southwest Nigeria. The soils were collected in triplicate and analyzed in a 2 (location) * 2 (study site) * 2 (soil depth) factorial experiment. The results showed a uniform soil texture in both study sites and at both soil depths, with loamy sand at Ladipo and sandy loam at Berger. Bulk density was significantly decreased, while the total porosity (46.44%), organic C (21.79 g kg− 1), available P (16.48 mg kg− 1), Na+ (0.72 cmolc kg− 1) and K+ (0.81 cmolc kg− 1) increased in the contaminated site compared to the control site. Soil pH was higher at Ladipo (8.4) than at Berger (7.4). However, the soil pH and available P concentration decreased in the contaminated soil compared to the control at both locations, resulting in a decrease in available P concentration of more than 300% and 100% at Ladipo and Berger, respectively. At the Ladipo location, the concentration of Ca2+ was higher in the control than in the contaminated counterpart, while the opposite was true at the Berger location. The concentrations of the heavy metals Pb and Zn in the contaminated soils were low, while the Cu concentration was high. Although the concentrations of these heavy metals were below the standards for potential environmental risks, the high Cu concentration at both locations poses a potential ecological risk and may affect soil and human health as Cu accumulates in critical levels in the soil due to the continued irresponsible disposal of spent oil on the ground.

Background: Some studies have reported the possible role of vitamin D3 in ameliorating disease outcomes in childhood infectious diarrhea. However, findings about its effectiveness and the association of serum vitamin D levels with diarrhea risk appear inconsistent. We aimed to determine the efficacy of oral vitamin D3 as an adjunct in managing childhood infectious diarrhea and the relationship between vitamin D status and the disease. Methods: We searched the PubMed and Google Scholar electronic databases for relevant articles without limiting their year of publication. We selected primary studies that met the review's inclusion criteria, screened their titles and abstracts, and removed duplicates. We extracted data items from selected studies using a structured data-extraction form. We conducted a quality assessment of randomized controlled trials (RCTs) and non-randomized studies with the Cochrane collaboration tool and the Newcastle Ottawa Scale, respectively. We assessed the strength of the relationship between serum vitamin D levels and diarrhea using the correlation model. We estimated the I2 and tau2 values to assess between-study heterogeneity. Results: Nine full-text articles were selected, consisting of one RCT, three cross-sectional studies, two cohort studies, two longitudinal/prospective studies, and one case-control study. A total of 5,545 participants were evaluated in the nine studies. Six non-randomized studies provided weak evidence of the relationship between vitamin D levels and diarrhea risk as there was no correlation between the two variables. The only RCT failed to demonstrate any beneficial role of vitamin D3 in reducing the risk of recurrent diarrhea. The calculated I2 and tau2 values of 86.5% and 0.03, respectively suggested a high between-study heterogeneity which precluded a meta-analysis of study results. Conclusion: Oral vitamin D3 may not be an effective adjunct in managing childhood infectious diarrhea. Additionally, the relationship between vitamin D status and infectious diarrhea appears weak. We recommend more adequately-powered RCTs to determine the effectiveness of vitamin D3 as an adjunct therapy in infectious diarrhea. [ABSTRACT FROM AUTHOR]

Abstract Background Musculoskeletal ultrasound imaging (MSUI) is an efficient monitoring and re-evaluation tool used for the management of musculoskeletal conditions in several clinical domains. Its utilization among physiotherapists, particularly in African countries, is yet to be explored. Objective This study investigated the knowledge, attitude, and perception of physiotherapists on the utilization of MSUI in the clinical management of musculoskeletal conditions. Methods One hundred and ninety-two consenting Nigerian-based physiotherapists practicing in public and private health institutions participated in this cross-sectional survey. They responded to a three-sectioned structured questionnaire, investigating socio-demographic and occupational characteristics, knowledge, attitude, and utilization of MSUI for the management of musculoskeletal conditions. Data were analyzed with descriptive statistics and Pearson’s chi-square test at a significant level of 0.05. Results The majority (79.2%) of the respondents had positive knowledge of MSUI and its benefits as a clinical modality for managing MSCs. However, only 4.2% had utilized MSUI in clinical practice. Non-utilization of MSUI was commonly attributed to a lack of access to MSUI (60.3%) and its unavailability in most diagnostic centers (42.9%). Almost all (99.0%) of them agreed to the necessity for increased availability of MSUI to physiotherapists for enhancement of physiotherapy interventions in the management of MSCs. Conclusion Knowledge of MSUI among Nigerian-based physiotherapists is adequate, but its utilization as a clinical tool is poor. Improved availability of MSUI to physiotherapists is necessary as well as specialty training on the utilization and interpretation of MSUI.

Background Disasters represent substantial health risks to the human population. Proper interventions at all stages of disaster management (DM) are essential for human-related outcomes. The role of physiotherapy in DM should not be underestimated, but unfortunately information on the involvement of physiotherapists in DM is limited in sub-Saharan Africa. Methods One hundred and fifty Nigeria-based and trained physiotherapists were recruited to complete a questionnaire investigating the knowledge, practices and perceived barriers of the role of physiotherapists in DM. Results Physiotherapists had moderate knowledge of their role at every stage of DM. However, their involvement in specific DM-related activities during various stages of DM in the country was low. Major barriers to the involvement of physiotherapists in DM included a lack of established government policies on the integration of physiotherapists in DM (90.0%) and a lack of specialty clinical practice areas in DM (89.3%). For improved involvement of physiotherapists in DM in Nigeria, respondents recommended creating an awareness of the role of physiotherapists in DM (91.3%), providing continuous education programmes on DM (90.6%) and inclusion of DM in physiotherapy training programmes in Nigeria (90.0%). Conclusion Physiotherapists perceived that they are not adequately involved in DM in Nigeria, despite their moderate knowledge of their role during DM. [ABSTRACT FROM AUTHOR]

Objective(s): In order to recommend a more effective approach to manage insulin resistance, we monitored the activities of glycolytic kinases, insulin signaling molecules, and incretin hormones and identified the possible targets related to the insulin-sensitizing effects of combined pharmacological and dietary intervention involving avicularin and lettuce. Materials and Methods: Insulin resistance was induced in rats with a fructose-rich diet and confirmed from baseline analysis of FBS (>250 mg/dl), insulin (>25 µIU/ml), and HOMA-IR (>10). For 12 weeks, the insulin-resistant rats were treated exclusively with 5000 mg/kg b.w avicularin (DAvi) or by dietary placement on lettuce (DLet) or a combination of both and compared with non-insulin resistant rats. Results: Avicularin reversed alterations in HbAlc and insulin levels. DLet produced no significant effect on the incretins GLP 1 (P=0.909) and GIP (P=0.990), but DAvi slightly stimulated GLP 1 but not GIP. A strong positive correlation was found between improved β-cell responsiveness and the insulin signaling molecules: Akt2 (r=0.7248), IRS 1 (r=0.5173), and PI3K (r=0.7892). Only the combined avicularin and lettuce reversed the Akt2 levels (P=0.728). The lettuce meal slightly stimulated PI3K but normalized IRS 1 while avicularin treatment slightly stimulated IRS 1 but restored the PI3K levels (P=0.815). The positive correlation between p-cell responsiveness and hexokinase (r=0.5959), PFK (r=0.6222), and PK (r=0.6591) activities were statistically significant. Alterations in glycolytic kinases were reversed by DLet and in combination with avicularin. Conclusion: A combined pharmacological and dietary approach with avicularin and lettuce is required to effectively reverse insulin resistance. [ABSTRACT FROM AUTHOR]

Objective: To compare prevalence of dental caries, oral hygiene status and associated risk factors of children in suburban and rural communities in the Southwest region of Nigeria. Material and Methods: Secondary data was extracted from cross-sectional researches conducted in two study locations involving 8 to 12 year olds. Data retrieved included age, gender, family structure, socioeconomic status, oral hygiene and dental caries. Caries assessment was done using WHO Oral Health Survey methods. Oral hygiene data was collected using Simplified Oral Hygiene Index (OHI-S) by Greene and Vermillion. Statistical significance was established at p<0.05. Results: The prevalence of dental caries in Group A and Group B study participants were 13.4% and 22.2% respectively. Children from rural community had significant higher caries prevalence (p=0.00) and poorer oral hygiene (P=0.00) compare with their counterparts in the suburban community. There was a significant association between oral hygiene, age and dental caries in suburban participants (p=0.02) while among the rural participants there was significant association between gender and dental caries (p=0.04). Children with poor oral hygiene have increased odds of having dental caries compared to children with good oral hygiene in the two study communities. Conclusion: Dental caries was more prevalent among the rural dwellers than the sub-urban dwellers. There is a need to make oral health care services/products available, accessible and affordable for the rural community. [ABSTRACT FROM AUTHOR]

Background: The burden of tuberculosis (TB) in Nigeria remains high, and diagnosis in children, a challenge. We aimed to document yield from Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) as a mode of diagnosis for children and the variables associated with a positive result. Methods: This was a retrospective review of TB treatment cards of children aged 0–15 years managed from January 2017 to December 2021 across six public tertiary institutions in Nigeria. The data obtained were analyzed using the descriptive and inferential statistics. Statistical significance was set at P < 0.05. Results: Of 1489 children commenced on TB treatment, 1463 (97.9%) had sufficient data for analysis the median age of study participants was 60 months (interquartile range [IQR]: 24, 120), and 814 (55.6%) were males. Xpert MTB/RIF test was performed in 862 (59%) participants and MTB was detected in 171 (19.8%) participants, of which 6.4% (11/171) had RIF resistance reported. The use of Xpert MTB/RIF rose from 56.5% in 2017 to 64% in 2020 but fell to 60.9% in 2021. We found that older age (> 10 years), the presence of pulmonary TB (PTB), and a negative human immunodeficiency virus (HIV) status were associated with positive Xpert MTB/RIF tests (P = 0.002, 0.001, and 0.012, respectively). Conclusion: The utilization of Xpert MTB/RIF in children increased in the years before the COVID-19 pandemic. Factors associated with MTB detection by Xpert MTB/RIF include older age, the presence of PTB, and a negative HIV status. Clinical and radiological evaluation continues to play vital roles in the diagnosis of childhood TB in Nigeria.

Background: The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the causative agent of the coronavirus disease-2019 (COVID-19) has caused a crisis in healthcare systems worldwide. Doctors are on the frontline in the fight against this war. The frontline workers are putting in all their efforts and skills to caring for patients who have contracted this novel contagious virus. The mental well-being of doctors is important. The SARS-CoV-2 has become a nosocomial infection and occupational hazard to healthcare workers. Aim: The aim is to investigate the mental well-being of doctors' practicing in Nigeria during the COVID-19 pandemic. Materials and Methods: This is part of a larger study. It is a cross-sectional survey carried out among doctors in Nigeria. Two questionnaires were adapted and used for this which included the World Health Organisation (WHO-5) well-being index, a validated and reliable short questionnaire on mental well-being. Participants in the study were recruited online. The research populations are doctors and dentists working in Nigeria. Results: The participants were 302 comprising 195 (64.6%) women doctors. The mean WHO well-being index for women was 69.90 ± 18.81, t = 3.295; P = 0.001 which was statistically significant. Multiple regression analysis of predictors of WHO well-being among medical doctors amidst the COVID-19 pandemic for the female gender coefficient = −4.384; P = 0.048. The female gender was a predictor of poor well-being. Conclusion: The mental well-being of doctors is very important. Female doctors had significantly lower mental well-being compared to their male counterparts. Physicians should have access to psychological support from their employers regularly.

Background: Family planning services are an important aspect of reproductive health as it helps in the improvement of maternal health. During the coronavirus disease-2019 (COVID-19) pandemic, several measures were taken by the Nigerian government to control the virus, which included restriction of movements including curfews and lockdown. Aim: This article is a review of the impact of the COVID-19 pandemic on the accessibility of family planning services in Nigeria. Materials and Methods: This is a narrative review of articles related to the accessibility of family planning services during the COVID-19 pandemic. The literature search was done using Medline, Google Scholar, and PubMed. The keywords used for searching for the literature were COVID-19 and family planning services in Nigeria. The literature search review was done from June 2020 to November 2021. Results: The study found both supply- and demand-side service disruptions. There was a disruption in the supply chain management system, affecting the production and distribution of family planning commodities. The demand-side issues were because of the lockdown measures on health seeking behaviour, absence, and increased cost of transportation. Conclusion: Accessing and utilizing various contraceptive methods were disrupted by the COVID-19 pandemic. This is due to several factors including the restriction of movements put in place by the Nigerian government to control the pandemic. The improvement of the use of various pregnancy preventive strategies has the potential to reduce poverty. It is imperative to develop adaptive systems to provide ongoing contraceptive services, by implementing innovations to sustain demand and supply of family planning services during pandemics.

Aim: To evaluate the oral health knowledge and behavior among primary school pupils. Patients, Materials and Methods: This was a cross-sectional, descriptive study, in which a systematic sampling method was used to enroll 450 subjects into the study. The data collection tool was a self-administered, structured, pretested questionnaire. Results: Of the 450 enrollees, 434 pupils who duly completed their questionnaires participated in the study. Their mean age was 11.7 ± 1.64 years and more than half (229, 52.8) of the pupils were of male gender. About half (52.3%) of the pupils had adequate level of oral health knowledge. Majority had never visited a dentist (75%) before and had never used dental floss (66.6%). A higher proportion (72.3%) of the pupils with adequate level of oral health knowledge received parental supervision during brushing, had visited the dentist, and had frequent dental visit. Conclusion: The study revealed that about half of the study population had adequate level of knowledge. It also revealed inadequate oral health behaviour among the pupils. Pupils who had adequate knowledge had better behaviour.

Background Several studies have shown that the impact of maternal mental health disorders on newborns’ well-being in low and middle-income countries (LMIC) are underreported, multi-dimensional and varies over time and differs from what is reported in high-income countries. We present the prevalence and risk factors associated with common mental disorders (CMDs) among breastfeeding mothers whose infants were admitted to Nigerian tertiary care facilities. Methods This was a national cross-sectional study involving mothers of hospitalised babies from eleven Nigerian tertiary hospitals. We used the WHO self-reporting Questionnaire 20 and an adapted WHO/UNICEF ten-step breastfeeding support package to assess mothers’ mental health and breastfeeding support. Results Only 895 of the 1,120 mothers recruited from eleven tertiary healthcare nurseries in six geopolitical zones of Nigeria had complete datasets for analysis. The participants’ mean age was 29.9 ± 6.2 years. One in four had CMDs; 24.0% (95% CI: 21.235, 26.937%). The ages of mothers, parity, gestational age at delivery, and length of hospital stay were comparable between mothers with and those without CMDs. Antenatal care at primary healthcare facilities (adjusted odds ratio [aOR:13], primary education [aOR:3.255] living in the south-southern region of the country [aOR 2.207], poor breastfeeding support [aOR:1.467], polygamous family settings [aOR:2.182], and a previous history of mental health disorders [aOR:4.684] were significantly associated with CMDs. In contrast, those from the middle and lower socioeconomic classes were less likely to develop CMDs, with [aOR:0.532] and [aOR:0.493], respectively. Conclusion In Nigeria, the prevalence of CMDs is relatively high among breastfeeding mothers with infants admitted to a tertiary care facility. Prior history of mental illness, polygamous households, mothers living in the southern region and low or no educational attainment have a greater risk of developing CMDs. This study provides evidence for assessing and tailoring interventions to CMDs among breastfeeding mothers in neonatal nurseries in LMIC.

Background: Diastasis Recti Abdominis (DRA) or increased inter-rectus distance (IRD) is among the most common pregnancy-related physical disorders in women. Studies are scarce on its correlates in an African population. Objectives: The aim of this study was to determine anthropometric and maternal correlates of DRA in Nigerian parous women. Materials and Methods: Eighty nine (89) consenting parous women (20–45 years) participated in this observational study. The IRD was measured with an electronic digital caliper at the umbilical level alongside other anthropometric measurements (weight, height, waist circumference (WC), hip circumference (HC)). Information on participants’ age, mode of delivery (MOD), parity, and age of last child (AOLC) was obtained. Data were analyzed with descriptive statistics and inferential statistics of Pearson’s and Spearman’s rank correlations, respectively, with subsequent linear regression analysis at an alpha level of P < 0.05. Results: The IRD significantly correlated with WC (r= 0.213, P = 0.045) and waist-to-hip ratio (WHR), (r = 0.357, P = 0.001). Significant regression equations were determined for the prediction of IRD based on WC and WHR. However, the other variables studied showed no significant (P > 0.05) correlation with IRD. Conclusion: WC and WHR are predictors of IRD in parous women, and these should be considered as important variables in the management of DRA associated with pregnancy.

Abstract Background Over 20 million preschool-age children (PSAC) in Nigeria require periodic chemotherapy (PC) for soil-transmitted helminth (STH) infections. Persistently low coverage for this age group threatens the World Health Organization (WHO) 2030 target for eliminating STH infections. Current strategies for targeting PSAC have been largely ineffective. Hence, PSAC are mostly dewormed by their parents/caregivers. However, little is known of the perception and attitude of parents/caregivers of PSAC to deworming in this setting. Methods A mixed methods design, combining a community-based interviewer-administered questionnaire-survey (n = 433) and focus group discussions (FGD) (n = 43) was used to assess the perceptions and attitudes of mothers to periodic deworming of preschool children aged 2–5 years in Abakpa-Nike, Enugu, Nigeria. Results Coverage of periodic deworming in PSAC is 42% (95% CI: 37.3–46.8%). There is significant difference in the specific knowledge of transmission of STH (AOR = 0.62, 95% CI: 0.48–0.81, p = 0.000), complication of STH infections (AOR = 0.77, 95% CI: 0.61–0.98, p = 0.034), accurate knowledge of deworming frequency (AOR = 0.41, 95% CI: 0.18–0.90, p = 0.026), and knowledge of PC drug, mebendazole (AOR = 0.28, 95% CI: 0.09–0.90, p = 0.031), and pyrantel (AOR = 8.03, 95% CI: 2.22–29.03, p = 0.001) between mothers who periodically deworm their PSAC and those who do not. There is no significant difference in specific knowledge of the symptoms of STH infections (AOR = 0.76, 95% CI: 0.57–1.02, p = 0.069) and PC drug, Albendazole (AOR = 1.00, 95% CI: 0.46–2.11, p = 0.972). FGD revealed misconceptions that are rooted in stark ignorance of the disease. Overall attitude to deworming is positive and favourable. Conclusions Poor coverage of periodic deworming for STH infections in PSAC in this setting are primarily driven by poor specific knowledge of the risks and burden of the infection. Focused health education on the burden and transmission of STH infections could complement existing strategies to improve periodic deworming of PSAC in this setting.

IntroductionThe importance of involving men in reproductive, maternal and child health (RMCH) programs is increasingly recognized globally. In Nigeria, most MCH services do not actively engage fathers.AimTo assess men's knowledge, involvement in MCH and the barriers in Southwest Nigeria. Predictors of good knowledge and involvement were also assessed.MethodsThis was a community-based cross sectional study. Quantitative and qualitative methods were used in data collection which was done within a period of three months in 2018. Quantitative data were collected with interviewer administered questionnaires from 418 respondents who were selected by multistage sampling methodology. The topic was further explored using focus group discussion (FGD). Quantitative data were analysed using EPI-INFO version 7. Quantitative variables were summarized using means and standard deviations while multivariable analysis was carried out to determine predictors of good knowledge and involvement in MCH. A combination of deductive and inductive analysis was used for the qualitative data.ResultsOverall, 65% of men had good knowledge of MCH while 60.8% had good involvement. Predictors of good knowledge were being a Christian (AOR 1.674, 95% CI 1.045-2.679), being of Yoruba tribe (AOR 1.753, 95% CI 1.100-2.796), having post-secondary education (AOR 1.984, 95% CI 1.002-3.928), having more under-fives in the household (AOR 2.162 95% CI 1.365-3.425) and spouse having post-secondary education (AOR 2.755, 95% CI 1.189-6.382). Predictors of good involvement in MCH include higher educational level of spouse: secondary (AOR 2.852, 95% CI 1.214-6.699), post-secondary (AOR 2.270, 95% CI 1.000-5.161) and having good knowledge of MCH (AOR 2.518, 95% CI 1.587-3.994). From the FGD, other factors which influence involvement were related to traditional/cultural orientation, time constraint and finance among others.ConclusionMen's knowledge and their involvement in maternal and child health were sub-optimal. For improvement, community-based intervention programmes should be designed for men and implemented, taking into consideration their traditional/cultural roles, religious orientation, busy schedules, and educational backgrounds. They should be re-oriented on their patriarchally informed belief about their perceived roles in RMCH.

Global differences in the observed causes of chronic kidney disease (CKD) in children are well documented and are attributed to dissimilarities in clime, race, hereditary, and ancestry. Thus, familial clustering and disparities in CKD prevalence rates across ethnic and racial groups indicate that the progression of renal disease has a strong genetic component. Mammalian studies have demonstrated a feasible nexus between nutrition and non-genetic exposure (around the time of conception and in epigenetic changes) in the expression of major genes identified in renal organogenesis. The major consequence is a reduction in the number of nephrons, with subsequent predisposition to hypertension and CKD. Identifying these epigenetic changes is crucial (due to their potentially reversible nature), as they may serve as future therapeutic targets to prevent kidney fibrosis and CKD. Despite progress in the field of epigenetics in oncology, research in other subspecialties of medicine is largely experimental with few existing studies regarding the clinical implication of epigenetics in renal disease. Therapeutic trajectories for CKD in children based on the influence of epigenetics may eventually revolutionize the management of this disease. The aim of the current narrative review is to appraise the role of epigenetics in CKD, and highlight the potential future therapeutic pathways. [ABSTRACT FROM AUTHOR]

Background: Internally displaced persons (IDPs) from North Eastern Nigeria have limited access to dental health facilities. Information on their oral health problems is limited. There is a need to determine their oral health status and treatment needs. Objectives: The objective of this study is to assess the oral health status and treatment needs of persons in an IDP camp and provide needed oral health services. Materials and Methods: A descriptive cross-sectional study among adults and their children in an IDP camp in Lagos. Pro forma with sections on biodata, oral hygiene practice and status, and periodontal parameter was used. Descriptive statistics were used in data analysis, with P < 0.05 considered statistically significant. Results: One hundred and twenty-three individuals (67 adults and 56 children) were seen. Mean age was 16.7 ± 12.8 years, adults were 28 ± 4.9 years, and children were 3.8 ± 3.1 years. Females represented 61%. Most (68.7%) adults had secondary school education, while most children (73.2%) had not commenced formal education. Fewer (41.7%) brushed twice daily. Only 8.5% had visited the dentist. Overall caries prevalence was 20.3%, and mean Decayed, Missing, and Filled Teeth (DMFT) was 0.7 ± 1.7, while the mean dmft for children with primary teeth was 0.3 ± 1.0. Mean DMFT was significantly associated with the past dental visits (P = 0.003) and presence of at least one oral condition (P = 0.000). The restorative index was zero, while unmet treatment need was 76.7%. Low dental treatment index was 30.6%. Of the 30.1% with toothache, only 16.2% sought treatment in the hospital. Sixty-three respondents received dental treatment in the form of scaling and polishing, fluoride therapy, atraumatic restorative treatment and extractions. Conclusion: The IDPs had a caries prevalence of 20.3% and a DMFT of 0.7 which were relatively low. However, their unmet treatment needs were high, coupled with a zero-restorative index. The IDPs benefited from free oral health-care services.

Objectives National immunisation coverage rate masks subnational immunisation coverage gaps at the state and local district levels. The objective of the current study was to determine the sociodemographic factors associated with incomplete immunisation in children at a sub-national level.Design Cross-sectional study using the WHO sampling method (2018 Reference Manual).Setting Fifty randomly selected clusters (wards) in four districts (two urban and two rural) in Enugu state, Nigeria.Participants 1254 mothers of children aged 12–23 months in July 2020.Primary and secondary outcome measures Fully immunised children and not fully immunised children.Results Full immunisation coverage (FIC) rate in Enugu state was 78.9% (95% CI 76.5% to 81.1%). However, stark difference exists in FIC rate in urban versus rural districts. Only 55.5% of children in rural communities are fully immunised compared with 94.5% in urban communities. Significant factors associated with incomplete immunisation are: children of single mothers (aOR=5.74, 95% CI 1.45 to 22.76), children delivered without skilled birth attendant present (aOR=1.93, 95% CI 1.24 to 2.99), children of mothers who did not receive postnatal care (aOR=6.53, 95% CI 4.17 to 10.22), children of mothers with poor knowledge of routine immunisation (aOR=1.76, 95% CI 1.09 to 2.87), dwelling in rural district (aOR=7.49, 95% CI 4.84 to 11.59), low-income families (aOR=1.56, 95% CI 1.17 to 2.81) and living further than 30 min from the nearest vaccination facility (aOR=2.15, 95% CI 1.31 to 3.52).Conclusions Although the proportion of fully immunised children in Enugu state is low, it is significantly lower in rural districts. Study findings suggest the need for innovative solutions to improve geographical accessibility and reinforce the importance of reporting vaccination coverage at local district level to identify districts for more targeted interventions.

To assess the causes and pattern of traumatic dental injuries in children presenting for care at a tertiary health care facility. This was a prospective study with sample consisting of patients who attended the Paediatric Dental Clinic in a period of nine months. Data, including clinical and radiographic examinations were collected using the American Academy of Pediatric Dentistry (AAPD) recommended format for recording of dental injuries. A total of 55 children, 37(67.3%) males and 18 (32.7%) females aged 1 to 16 years (mean 9.6?3.9 years) sought treatment for 83 traumatised teeth. Twenty (36.4%) patients sought treatment within one week after the injury. The most frequent cause of dental trauma was fall (65.5%), followed by collision (16.4%) and the most common place of occourrence was at home (50.9%). Though compromised aesthetics was the most common reason for seeking dental care, trauma to the dentition was by chance finding in 12(14.5%) of the patients. Seventy-two (86.8%) of the teeth were permanent teeth while 11(13.2%) were primary teeth. Both primary and permanent teeth had more fractures than luxation injuries. Treatment carried out include supportive therapy, composite restoration, pulp therapy, re-implantation and/splinting, extraction and provision of prosthesis. Tooth fracture was the most common injury presented in both the primary and permanent dentition. The majority of injuries occourred in the home and few parents/caregivers sought dental care for their children/ward immediately after trauma. Parents and teachers are advised to seek immediate treatment of traumatic dental injury to avoid complications and complex treatments. [ABSTRACT FROM AUTHOR]

Background and Objective: The rubber dam is used in dentistry to create saliva-free working environment during operative procedures. Despite its numerous advantages, utilization is poor in dental schools. We sought to determine undergraduate dental students' perception, educational satisfaction, and attitude regarding the use of rubber dam. Materials and Methods: This cross-sectional survey was carried out among 5th and 6th year undergraduate dental students. A structured questionnaire was developed that sought their perception, educational satisfaction, and attitude regarding the use of rubber dam. Data collected were analyzed using IBM SPSS version 21.0. P

INTRODUCTION: clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Despite abundance of asthma guidelines, prevalence has continued to increase globally. There is need to assess how the contents of asthma guidelines are put to clinical use by doctors in the management of children with asthma. This study aims at evaluating the clinical practice of paediatric residents in applying GINA guidelines. METHODS: cross-sectional descriptive study of paediatric residents from 23 university teaching hospitals in Nigeria using structured questionnaire. Data analyses were with Statistical Package for Social Sciences (SPSS) version 19 (Chicago IL). Chi square was used to assess for any significant associations between categorical variables. A p = 0.05 was regarded to be statistically significant. RESULTS: sixty-six paediatric residents aged 27- 40 years were enrolled into the study (37 females and 29 males). One-third had spent more than three years in residency training. Fifty-eight residents (87.9%) were aware of the GINA guidelines while 46 (69.7%) were familiar with its contents. Only 39 (59.1%) residents adhered to the GINA guidelines. Twenty of the 35 junior residents (57.1%) compared to 26 of 31 (83.9%) senior residents were familiar with the GINA guidelines (p=0.031) while 15 of 35 junior residents (42.9%) compared to 24 of 31 senior residents (77.4%) consistently follow the GINA guidelines (p=0.006). Adherence to GINA guidelines was not influenced significantly by years of graduation or training (p=0.05). CONCLUSION: the use of the GINA guidelines was poor among paediatric residents. Application of contents rather than just availability of asthma guidelines may partly account for increasing asthma prevalence globally.

Background: Malaria is a major public health problem in sub-Saharan Africa. Several efforts are being made to reduce its prevalence and morbidity in Nigerian children with emphasis on vector control measures. Methods: This was a crosssectional descriptive study conducted on 382 febrile children seen at a tertiary hospital in Nigeria over an eight-month period. A structured questionnaire was used to collect information on ociodemographic, vector control measures and care given to the subjects. Investigations conducted included malaria microscopy and total leukocyte count. Results: Eighty percent (308/382) employed at least one vector control measures to prevent malaria infection, and majority 232 (75.2%) use only one control measure. The commonest control measures used included always keeping doors and windows shut 298 (96.7%) and/or netted 280 (90.9%), use of conventional insecticide sprays 183 (59.4%), use of insecticide treated bed nets (ITNs) 178 (57.8%) and ensuring child sleeps at night with body adequately covered 77 (25%). Approximately half (178/315) of households who owned ITN used it, and only 40.4% (72/178) used it daily. It was noted that children that slept under an insecticide treated bed net (RR 0.56, 95% CI 0.33-0.94; P=0.029) and those who slept well covered at night (RR 0.26, 95% CI 0.12-0.61; P=0.002) had less risk of malaria infection. The use insecticide treated bed net however lost significance following adjustment for other control measures used and socio-demographic factors of interest (RR 0.63, 95% CI 0.36-1.10; P=0.101). Conclusion: There is need to intensify education on appropriate malaria control measures especially proper use of insecticide-treated nets and suitable clothing during sleep at night.

Brassica juncea (Indian mustard) seeds are consumed in treatment of high blood pressure, headache and prevention of heart disease. The aim of the present study was to investigate the effects of methanol extract of Brassica juncea seeds [BJME] on the heart and liver of adult Albino Wistar rats. A total of 24 albino rats of both sexes were divided into 6 groups [I - VI] of 4 rats per group. Groups I to IV received graded doses of the methanol extract by oral gavage while groups V and VI (controls) received 2 ml/kg body weight of 3 % Tween 80 and water respectively via oral gavage once daily. Treatment lasted for four weeks and the serum levels of aspartate transaminase (AST), alanine transaminase (ALT) and alkaline phosphatase (ALP) were estimated. The animals were sacrificed and the heart and liver tissues were excised for further histological processing for light microscopy. There was significant increase in AST and ALT levels following BJME treatment when compared to the controls. ALP activity did not differ significantly among the treatment and control groups. Histopathological changes consistent with toxic injury were observed in the heart and liver tissues of BJME- treated rats. In conclusion, the results of this study show that sub-acute administration of methanol seed extract of Brassica juncea can exert cardiotoxic and hepatotoxic effects in rats. [ABSTRACT FROM AUTHOR]

Purpose: Glucocorticoids (GCs) are commonly used for several acute and chronic pediatric diseases. However, chronic treatment may result in hypothalamic-pituitary-adrenal axis (HPA) dysfunction. Glucocorticoid-induced adrenal insufficiency (GI-AI) is indeed the most frequent cause of adrenal insufficiency (AI) in children, possibly resulting in a life-threatening event such as adrenal crisis (AC). It is generally underestimated, especially when using non-systemic glucocorticoid formulations. This review aims at summarizing current evidence on the effects of long-term GC treatment on the HPA axis, management of GC tapering and assessment of the HPA recovery., Methods: We conducted a narrative review of the relevant literature focusing on pathogenic mechanisms, predictive factors, diagnosis and treatment of GI-AI., Results: All types of GCs, whatever the route of administration, may have suppressive effects on the HPA axis, especially when compounds with higher potency and long half-life are used. Moreover, chronic GC administration is the most common cause of Cushing syndrome in children. In order to overcome the risk of GI-AI, slow withdrawal of GCs is necessary. When approaching the replacement dose, it is recommended to switch to shorter half-life formulations such as hydrocortisone. Assessment of HPA axis recovery with basal and stimulated cortisol levels may help detecting children at risk of AC that may require hydrocortisone supplementation., Conclusion: The management of GI-AI in children is challenging and many areas of uncertainty remain. Improving the knowledge on long-term GC effects on HPA in children, the management of steroid discontinuation and emergency dosing may help preventing GI-AI symptoms and acute hospital admission for AC., (© 2024. The Author(s).)

Cushing's syndrome (CS) is characterised by signs and symptoms resulting from excessive and prolonged exposure to exogenous glucocorticoids or endogenous hypercortisolism. In childhood, exogenous CS represents the main cause of CS due to the widespread therapeutic use of glucocorticoids, while endogenous CS is very rare and accounts for about 10% of CS cases. According to the origin of the hypercortisolism, the ACTH-dependent form due to pituitary ACTH-secreting tumours is the most common form of endogenous CS in paediatric age (about 75-80% of cases), following by adrenal causes (about 15-20% of cases) including adenoma, carcinoma (which has a peak of incidence in the first decade), bilateral adrenal hyperplasia or Carney complex, with a different distribution by age. Ectopic ACTH-secreting CS, genetic forms of pituitary adenomas are more uncommon. The insidious onset of hypercortisolism and the absence of salient early signs make the diagnosis of endogenous CS difficult. Facial changes, weight gain with simultaneous growth failure, prepubertal virilisation, or hypogonadism in adolescence represent some of the key features of CS. The diagnostic workup is essentially aimed at confirming hypercortisolism through screening tests whose diagnostic accuracy is not 100% and therefore the combination of more than two tests is mandatory to confirm the diagnosis of CS., (© 2024. The Author(s).)

CTNNB1 [OMIM *116806] encodes β-catenin, an integral part of the cadherin/catenin complex, which functions as effector of Wnt signaling. CTNNB1 is highly expressed in brain as well as in other tissues, including heart. Heterozygous CTNNB1 pathogenic variations are associated with a neurodevelopmental disorder characterized by spastic diplegia and visual defects (NEDSDV) [OMIM #615075], featuring psychomotor delay, intellectual disability, behavioral disturbances, movement disorders, visual defects and subtle facial and somatic features. We report on a new series of 19 NEDSDV patients (mean age 10.3 years), nine of whom bearing novel CTNNB1 variants. Notably, five patients showed congenital heart anomalies including absent pulmonary valve with intact ventricular septum, atrioventricular canal with hypoplastic aortic arch, tetralogy of Fallot, and mitral valve prolapse. We focused on the cardiac phenotype characterizing such cases and reviewed the congenital heart defects in previously reported NEDSDV patients. While congenital heart defects had occasionally been reported so far, the present findings configure a higher rate of cardiac anomalies, suggesting dedicated heart examination to NEDSDV clinical management., (© 2023 The Authors. Clinical Genetics published by John Wiley & Sons Ltd.)

Objective: Since the outbreak of COVID-19 pandemic, several centers of pediatric endocrinology worldwide have observed a significant increase in the number of girls presenting with precocious or early puberty. We aimed to compare the incidence rates of female precocious puberty before and during the different phases of COVID-19 pandemic., Methods: We have retrospectively analyzed all the consultations recorded in the outpatient clinic database of the Endocrinology Unit of Bambino Gesù Children's Hospital, Rome, Italy, from the lockdown start in March 2020 up to September 2020, in comparison with the consultations recorded in the same months of 2019, 2021 and 2022. Age, height, weight, body mass index, Tanner's pubertal stage and bone age at presentation, birth weight, ethnicity, family history of central precocious puberty (CPP), maternal age at menarche, history of adoption were retrieved from clinical records. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) both at baseline and after gonadotropin-releasing hormone (GnRH) stimulation, and basal estradiol levels were collected., Results: In 2019, 78 girls with suspected precocious puberty were referred for endocrinological consultation, compared to 202 girls in 2020, 158 girls in 2021 and 112 girls in 2022. A significant increase in the proportion of girls diagnosed with rapidly progressive CPP was observed in 2020, compared to 2019 (86/202 vs. 18/78, p<0.01). In the following periods of 2021 and 2022, a gradual decrease in the number of cases of progressive CPP was evident, so much that the number of cases was not significantly different from that observed in 2019 (56/158 in 2021 and 35/112 in 2022, p=0.054 and p=0.216 respectively, compared to 2019)., Conclusions: Our research suggests that drastic lifestyle changes, such as those imposed by COVID-19 lockdown, and the consequent stress may affect the regulation of pubertal timing. The remarkable increase in CPP cases observed during the 2020 first pandemic wave seems to be reduced in 2021 and 2022, concurrently with the progressive resumption of daily activities. These data seem to support the hypothesis of a direct relationship between profound life-style changes related to the pandemic and the rise in precocious puberty cases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Chioma, Chiarito, Bottaro, Paone, Todisco, Bizzarri and Cappa.)

Background: Male hypogonadism may be associated with micropenis and cryptorchidism in newborn, absent or incomplete pubertal development when it occurs during childhood. During puberty, androgen replacement therapy plays a pivotal role in subjects with hypogonadism to induce sexual maturation, growth acceleration, anabolic effects on fat-free mass growth increasing muscle strength, directly and indirectly on the attainment of peak bone mass in young men. Moreover, in newborns with congenital hypogonadism, androgen therapy could be effective to increase genital size., Summary: Testosterone replacement therapy (TRT) represents the cornerstone of the management of hypogonadism in boys. During puberty, replacement therapy needs to be modulated with gradual dosing increase to better mimic the physiologic pubertal development. Currently, intramuscular testosterone (T) esters (in particular testosterone enanthate) and subcutaneous T pellets are the only formulations approved by the US Food and Drug Administration for delayed puberty, while no preparation is approved for long-term use in the adolescent age. Several new T formulations (as transdermal, nasal, subcutaneous, and oral formulation) are recently developed to improve the pharmacokinetic profile and to ease the administration route increasing patient compliance in adult males with hypogonadism. All these formulations are not approved for pediatric age, although some of them are used as "off-label" regimens. This special issue is aimed to illustrate new T formulations and their potential role as replacement therapy in the pediatric population, as well as to highlight investigational areas to contribute to health care improvement in these patients., Key Messages: Despite the lack of evidence-based guidelines regarding the choice of T formulation in the pediatric population, new formulations appear to have a potential role for TRT in adolescent age. They have been designed for adult age with a little flexibility of dosage, although a few formulations may be attractive for pubertal induction and penile enlargement thanks to their greater flexibility and easing of administration. On the other hand, long-acting and stable formulations could meet post-pubertal needs, increasing TRT compliance in a critical phase as the adolescent age. Further controlled, long-term safety, and efficacy studies for all these new T formulations within the pediatric population are needed., (© 2021 S. Karger AG, Basel.)

Excess body weight has been considered beneficial to bone health because of its anabolic effect on bone formation; however, this results in a poor quality bone structure. In this context, we evaluated the involvement of circulating extracellular vesicles in the impairment of the bone phenotype associated with obesity. Circulating extracellular vesicles were collected from the plasma of participants with normal weight, as well as overweight and obese participants, quantified by flow cytometry analysis and used to treat mesenchymal stromal cells and osteoblasts to assess their effect on cell differentiation and activity. Children with obesity had the highest amount of circulating extracellular vesicles compared to controls. The treatment of mesenchymal stromal cells with extracellular vesicles from obese participants led to an adipogenic differentiation in comparison to vesicles from controls. Mature osteoblasts treated with extracellular vesicles from obese participants showed a reduction in differentiation markers in comparison to controls. Children with obesity who regularly performed physical exercise had a lower circulating extracellular vesicle amount in comparison to those with a sedentary lifestyle. This pilot study demonstrates how the high amount of circulating extracellular vesicles in children with obesity affects the bone phenotype and that physical activity can partially rescue this phenotype.

Epidemic obesity is the most important risk factor for prediabetes and type 2 diabetes (T2D) in youth as it is in adults. Obesity shares pathophysiological mechanisms with T2D and is likely to share part of the genetic background. We aimed to test if weighted genetic risk scores (GRSs) for T2D, fasting glucose (FG) and fasting insulin (FI) predict glycaemic traits and if there is a causal relationship between obesity and impaired glucose metabolism in children and adolescents. Genotyping of 42 SNPs established by genome-wide association studies for T2D, FG and FI was performed in 1660 Italian youths aged between 2 and 19 years. We defined GRS for T2D, FG and FI and tested their effects on glycaemic traits, including FG, FI, indices of insulin resistance/beta cell function and body mass index (BMI). We evaluated causal relationships between obesity and FG/FI using one-sample Mendelian randomization analyses in both directions. GRS-FG was associated with FG (beta = 0.075 mmol/l, SE = 0.011, P = 1.58 × 10-11) and beta cell function (beta = -0.041, SE = 0.0090 P = 5.13 × 10-6). GRS-T2D also demonstrated an association with beta cell function (beta = -0.020, SE = 0.021 P = 0.030). We detected a causal effect of increased BMI on levels of FI in Italian youths (beta = 0.31 ln (pmol/l), 95%CI [0.078, 0.54], P = 0.0085), while there was no effect of FG/FI levels on BMI. Our results demonstrate that the glycaemic and T2D risk genetic variants contribute to higher FG and FI levels and decreased beta cell function in children and adolescents. The causal effects of adiposity on increased insulin resistance are detectable from childhood age., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)