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Objective: Treatment adherence is crucial for the success of growth hormone (GH) therapy. Reported non-adherence rates in GH treatment have varied widely. Several factors may have an impact on adherence. Apart from these factors, the global impact of the Coronavirus disease-2019 (COVID-19) pandemic, including problems with hospital admission and routine follow-up of patients using GH treatment, may have additionally affected the adherence rate. The primary objective of this study was to investigate adherence to treatment in patients receiving GH. In addition, potential problems with GH treatment during the pandemic were investigated. Objective: Treatment adherence is crucial for the success of growth hormone (GH) therapy. Reported non-adherence rates in GH treatment have varied widely. Several factors may have an impact on adherence. Apart from these factors, the global impact of the Coronavirus disease-2019 (COVID-19) pandemic, including problems with hospital admission and routine follow-up of patients using GH treatment, may have additionally affected the adherence rate. The primary objective of this study was to investigate adherence to treatment in patients receiving GH. In addition, potential problems with GH treatment during the pandemic were investigated. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the impact of flipped learning in faculty development program (FDP) dedicated for developing key-feature questions (KFQs), and to compare examinees’ success and their opinions for the KFQs in a board exam.

Osteogenesis imperfecta (OI) is a disease caused by defective collagen synthesis. Collagen type 1 is found in many structures in the cardiovascular system. Endothelial dysfunction, which develops prior to the emergence of structural and clinical signs of atherosclerosis, is believed to play a key role in atherogenesis. Endothelial dysfunction may be detected presymptomatically by non-invasive radiologic methods, such as flow-mediated dilatation (FMD) and carotid intima-media thickness (CIMT). These modalities may provide early indicators of endothelial dysfunction. This cross-sectional comparative study aimed to investigate early-stage radiological markers of endothelial dysfunction and cardiovascular diseases in OI patients and healthy controls and to investigate the correlation of findings with OI genotype. Thirty patients diagnosed with OI were paired with thirty healthy age- and gender-matched controls and echocardiogram findings were compared. None of the patients had known underlying cardiovascular disease. The mean age was 13.18 ± 2.91 years. According to Sillence classification, 15 patients had type 1 OI, 10 had type III, and 5 had type IV. Mean CIMT in the OI group was higher in the control group (OI group: 0.42 ± 0.06 vs. healthy controls: 0.34 ± 0.04 mm, p<0.01), and mean FMD percent was lower in the patient group (p<0.01). Left ventricular ejection fraction was 78.97 ± 10.32 vs. 77.56 ± 8.50 %, (OI group: 7.00 ± 3.06 vs. healthy controls: 12.14 ± 1.99, p=0.56), and fractional shortening was 42.68 ± 11.94 vs. 40.23 ± 7.99 %, (p=0.35), in OI patients and controls, respectively. Pediatric patients with OI without clinical signs of cardiovascular abnormality had significantly worse CIMT and FMD findings than healthy controls. However, no difference was determined when comparing left ventricular ejection fraction or fractional shortening. OI patients may need to be screened for cardiovascular system complications starting from an early age. [ABSTRACT FROM AUTHOR]

Objective: This aim of this study was to investigate the effect of additional insulin dosing for high fat/high energy density mixed meal over 12 hours. Methods: In this single-center, non-blinded, randomized, cross-over study, a high fat/high energy density test meal was used to study the impact on glycemic response of either carbohydrate counting (CC) on the first day and the Pańkowska algorithm (PA) on the second test day. The two methods were compared in 20 adolescents with type 1 diabetes (T1D), aged 9-18 years, using insulin pump therapy and continuous glucose monitoring on postprandial early (0-120 min), late (120-720 min), and total (0-720 min) glycemic response. Results: There was no difference between groups in the duration of normoglycemia in the early period. Postprandially, 50% of patients developed hypoglycemia using the PA at a median of 6.3 (5.6-7.9) hours and the PA was subsequently modified for the remaining ten patients. Area under the curve (AUC) for the early period decreased non-significantly in the CC group, indicating less normoglycemia. No significant difference was found in the AUC of the PA (no hypoglycemia n=4) and modified PA groups (no hypoglycemia n=6) over the whole period (0-12 hours). AUC for level 2 hyperglycemia was statistically greater in the PA-no hypoglycemia patients compared to modified PA-no hypoglycemia patients. Conclusion: There were inter-individual differences in glycemic response to high fat/high energy density meals. An individualized approach to insulin dosing by evaluating food diary and postprandial glucose monitoring appears to be optimal for children and adolescents with T1D. [ABSTRACT FROM AUTHOR]

Background: Administration of insulin may be associated with substantial cutaneous adverse effects, such as lipoatrophy and lipohypertrophy (LH), which can cause glycemic excursions above and below the target levels for blood glucose. Our aim was to evaluate the effect on compliance with the use of insulin administration site, dermatological complications and diabetes management in children with type 1 diabetes (T1D). Methods: Patients aged 0‐21 years who were followed up with the diagnosis of T1D for at least one year were included. A 14‐question survey including demographic characteristics and a subjective opinion of skin‐related complications of insulin administration was given. Data were obtained from the medical records to evaluate the effect of dermatological complications on diabetes management. This study was checked with the STROBE checklist. Results: Two hundred and fifty‐four patients were included and 53% of these were female. The mean age was 14.9 ± 4.7 years and the duration of T1D was 7.3 ± 4.1 years. The mean HbA1c level was 8 ± 1.4% and the mean total insulin dose was 0.84 ± 0.25 units/kg/day. More than half of the individuals (57%) were receiving multiple daily injections (MDI) and 43% were on insulin pump therapy (IPT). Of the participants, 11.8% reported LH, 7.5% wound, 21.7% allergy, 55.5% bleeding, 41.3% bruising and 47.2% pain. LH rates varied significantly by regimen, 17.1% in MDI and 4.6% with IPT (p =.001). Those with LH were using higher median doses of insulin (0.97 U/kg/day) than those who did not (0.78 U/kg/day; p =.016). LH was reported more frequently (18.3%) in patients with frequent hypoglycemia (p =.007). Positive correlation between BMI‐SDS and LH in patients aged <18 years was found (p =.043). LH rates by site were: right arm 20.8%, left arm 26.4%, right abdomen 26.4%, left abdomen 22.6% and 1% in the right and left leg. Conclusions: Local complications of insulin therapy are common in young patients with T1D. The complication with the most impact on metabolic control was LH, present in nearly 12% of patients. Users of IPT have a significantly lower risk of LH. The results emphasise the importance of individualised education for young T1D patients and their families about injection site preference and rotation techniques. Relevance to clinical practice: The diabetes team should check the insulin administration sites of children with type 1 diabetes at each visit and provide repeated education about the dermatological complications of insulin. [ABSTRACT FROM AUTHOR]

Aim: Our aim was investigate the effect of polychlorobifenyls (PCBs) and other factors on puberty precocious (PP) in girls were diagnosed with idiopatic PP and premature thelarche (PT). Materials and Methods: The study group included 50 girls aged between 2-8 years old with PP and PT. The control group included 50 healthy girls with same age range and no puberty findings. Data was collected in terms of breast and pubic hair stages, weight, height, body mass index (BMI), standard deviation scores (SDSs), location of residence, gestational age and maternal age at menarche (AAM). Twenty-one PCB levels were evaluated in serum and urine. One-Way ANOVA test was used for comparison between the groups. For subgroup analysis, Mann-Whitney U test, multiple regression analysis were used. Results: The mean age of the study and control groups were 6.70±1.20 and 5.23±1.25 years, respectively. The studied PCBs were not detectable found in either the study or the control groups. The BMI SDSs of the patients in study and healthy groups were 0.49±1.09 and -0.12±1.28, respectively (p=0.1). Weight SDSs in the study group were found to be significantly higher than healthy group (0.72±1.35 vs -0.20±1.47, p=0.008 Maternal AAM of the patients in study group was significantly lower (p=0.006). In study group 98% of the patients were living in down town and district, whereas this ratio was 92% in control group (p=0.024). In study group 29 patients (58%) were diagnosed with PT. Basal follicle stimulating hormone and estradiol levels, bone age and uterine longest axis dimensions results were significantly different. Conclusion: We found that studied PCBs don't influence on PP in girls aged between 2-8 years old. However, weight SDS, maternal AAM, location of residence of the patients had a significant role on PP in this patient population. [ABSTRACT FROM AUTHOR]