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Objectives The role of insulin sensitivity (IS) in the development and progression of metabolic syndrome (MS) in subjects with type-1 diabetes (T1D) is being increasingly recognized. As patients with T1D lack endogenous insulin secretion, measurement of insulin concentration by immunoassay or by indices such as homeostasis model of assessment for insulin resistance (HOMA-IR) is not helpful in assessing IS. Hence, some equations have been developed and validated against data from euglycemic-hyper-insulinemic clamp tests (the gold standard) to estimate IS. 1) To assess IS using available equations (EDC, SEARCH and CACTI) and relationship of IS with MS and microalbuminuria in adolescents with T1D, (2) To compare the predictive value of these equations for detection of MS and derive a cut-off to predict the future risk of development of MS and microalbuminuria and (3) To identify the most accurate non-invasive and easy-to-use equation for detecting patients with double diabetes (DD) in a clinical setting. Methods This cross-sectional study included 181 adolescents aged 12–18 years with T1D. Demographic data and laboratory measurements were performed using standard protocols. IS was calculated using following equations:(1) EDC=24.31−12.22×(WHR)−3.29×(hypertension)−0.57×(HbA1c), (2) SEARCH=exp(4.64725−0.02032(waist)−0.09779(HbA1c)−0.00235(Triglycerides), (3)CACTI-exA=exp(4.1075–0.01299×(waist)−1.05819×(insulin dose)−0.00354×(Triglycerides)−0.00802×(DBP)). Results IS determined by all three methods had significant negative correlation (p Conclusions IS by SEARCH equation may be used in routine clinical practice to detect DD in Indian adolescents with T1D at risk of developing metabolic as well as microvascular complications.

Objectives Children with type 1 diabetes (T1D) having diabetic nephropathy (DN) are at increased risk of developing end stage renal disease. The present study aimed to determine the prevalence of DN and its predictors in Indian children and youth with T1D. Methods This cross-sectional study included 319 children and youth (2.6–21 years) with T1D having disease duration of at least 2 years. Demographic data and laboratory findings were obtained using standard questionnaires and protocols. Diagnosis of diabetic nephropathy was based on albuminuria on two occasions within a period of 3 months. Results The prevalence of DN in our study subjects was 13.4%. 7.5% subjects were known cases of diabetic nephropathy on treatment with enalapril. Hypertension was found in 14.3% subjects with DN in contrast to 4.1% without DN (p Conclusions We found a high prevalence of DN in children and youth with T1D including in children under the age of 10 years. Early screening and timely intervention are required to retard the disease progression and avoid end stage renal disease.

Introduction Children with type 1 diabetes (T1D) are at the same risk of developing metabolic syndrome (MS) as the general population. Several environmental factors such as lifestyle, exogenous insulin therapy (over-insulinization) and genetic/familial factors are thought to underlie the phenotype of 'double diabetes' (co-existence of MS components in patients with T1D). Objectives To determine the prevalence of overweight/obesity and MS and to identify its predictors in Indian children, adolescents and young adults with T1D. Methods This cross-sectional study included 355 children and youth aged 6-23 years with T1D. Demographic data were obtained from patients using questionnaires. Anthropometry, blood pressure, sexual maturity rating, biochemical measurements and body composition measurements were performed using standard protocols. Insulin resistance (IR) was calculated using estimated glucose disposal rate (eGDR) and MS was diagnosed using the international diabetes federation (IDF) consensus definition 2017. Results The prevalence of overweight/obesity and MS in our study was 15.5% and 4.5%, respectively. Abnormal HDL-cholesterol was the most common component of MS (55.6%) among children with T1D. Age, gender, body mass index (BMI) and eGDR were identified as significant predictors of the likelihood of MS. Conclusions We found a similar prevalence of MS in children with T1D as compared to other healthy children, which emphasises the need for monitoring of eGDR to determine IR in these children.

Autoimmune polyglandular syndrome-1 (APS-1)also known as autoimmune polyendocrinopathy candidiasis ectodermal dystrophy is a rare autosomal recessive disorder caused by mutation of AIRE gene on chromosome 21q22.3 with an overall prevalence of

Bone age is useful for pediatric endocrinologists in evaluating various disorders related to growth and puberty. Traditional methods of bone age assessment, namely Greulich and Pyle (GP) and Tanner-Whitehouse (TW), have intra- and interobserver variations. Use of computer-automated methods like BoneXpert might overcome these subjective variations.The aim of our study was to assess the validity of BoneXpert in comparison to manual GP and TW methods for assessing bone age in children of Asian Indian ethnicity.We extracted from a previous study the deidentified left hand radiographs of 920 healthy children aged 2-19 years. We compared bone age as determined by four well-trained manual raters using GP and TW methods with the BoneXpert ratings. We computed accuracy using root mean square error (RMSE) to assess how close the bone age estimated by BoneXpert was to the reference rating.The standard deviations (SDs) of rating among the four manual raters were 0.52 years, 0.52 years and 0.47 years for GP, TW2 and TW3 methods, respectively. The RMSEs between the automated bone age estimates and the true ratings were 0.39 years, 0.41 years and 0.36 years, respectively, for the same methods. The RMSE values were significantly lower in girls than in boys (0.53, 0.5 and 0.47 vs. 0.39, 0.47 and 0.4) by all the methods; however, no such difference was noted in classification by body mass index. The best agreement between BoneXpert and manual rating was obtained by using 50% weight on carpals (GP50). The carpal bone age was retarded in Indian children, more so in boys.BoneXpert was accurate and performed well in estimating bone age by both GP and TW methods in healthy Asian Indian children; the error was larger in boys. The GP50 establishes "backward compatibility" with manual rating.

Background and Objectives: Disease specific growth charts are useful to monitor growth and disease progress in specific disorders such as Turner syndrome. As there is a paucity of data on spontaneous growth of Indian girls with Turner syndrome, the objectives were to construct reference curves for height and assess height velocity in Indian girls with Turner syndrome from 5 centers from western India. Material and Methods: Three hundred forty-eight readings of height and weight on 113 genetically proven girls with Turner Syndrome from 5 centers from western India were collected and retrospectively analyzed. Data were collected over the last 2 decades (GH treatment naive girls were included). The method described by Lyon et al. was used to compute smoothed standard deviations and percentiles for height. For computing growth velocities, longitudinal data were used on 104 untreated girls (longitudinal readings for height for a minimum of 3 years were used). Midparental height z scores (MPHZ) were computed. Results: In girls with Turner syndrome, the mean adult height was found to be 140.1 cm. Height velocity was low at all ages compared to normal girls with a notable difference beyond the age of 10 years where normally, a growth spurt is expected. The MPH Z-score correlated positively with the height Z-score. The 3rd, 50th, and 97th height percentiles of Turner girls at all ages were lower than normal girls' charts. Conclusion: Turner syndrome charts for height are presented; these charts may be used to monitor growth in girls with Turner syndrome.

Implementation of COVID restrictions following lockdown led to changes in routines of subjects with type 1 diabetes due to closure of schools and outdoor activities. The aim of this study was to assess the impact of decreased physical activity due to COVID restrictions on cardio-metabolic risk parameters (waist circumference, laboratory and body composition parameters) in Indian children and youth with T1D.This observational study included 312 participants (2-21 years) with T1DM having disease duration of ≥6 months. Demographic, anthropometric, body composition data and investigations were recorded at two time points (during COVID restrictions when children came for follow up, pre COVID restriction data from medical and electronic records).Glycemic control improved during COVID restrictions (Hba1c: 9.8 ± 2.0%) as compared to pre COVID restrictions (Hba1C: 10.0 ± 1.9%) (p 0.05). However, due to significant reduction in physical activity (p 0.05) there was significant increase in waist circumference z-scores (-0.9 ± 1.1 vs -1.6 ± 1.1), body fat percentage z-scores (-0.2 ± 1.0 vs -0.3 ± 0.9) and lipid parameters like cholesterol, low density lipid cholesterol and triglyceride concentrations (p 0.05) without any significant change in body mass index z-scores (p 0.05).Prolonged COVID restrictions, although led to modest improvement in glycemic control, there was worsening of cardio-metabolic risk factors or indices of adiposity like waist circumference, body fat percentage and lipid parameters which could be attributed to decreased time spent in physical activity.

Background: This was a prospective pilot study to estimate the burden of malnutrition in the age group of 2.5–5 years and to evaluate the usefulness of dietary changes in them. This research was conducted by the Department of Paediatrics Krishna Institute of Medical Sciences, Karad in selected Anganwadi at Rethare Bk., This study was undertaken to combat the issue of malnutrition of children’s in the age group of 2.5 to 5 years. According to WHO-Moderate Acute Malnutrition is defined by a weight-for-height indicator between -3 and -2 z-scores (standard deviations) of the international standard or by a mid-upper arm circumference (MUAC) between 11 cm and 12.5 cm. Severe Acute Malnutrition is defined by very low weight for height below -3z scores of the median WHO growth standards by visible severe wasting. The children identified with SAM & MAM were started on a high nutrition laddu called the Krishna laddu which was specially designed by the Krishna Institute of Medical Sciences Deemed To be University to cater to the deficiencies in malnourished children. The aim of the study was to determine the effectiveness of Krishna laddu in treating malnutrition in children aged between 2.5–5 years. Methods: This was a prospective study. Total of 43 children attending the 2 selected anganwadi adopted by the Krishna Institute of Medical Sciences, Karad (aged between 2.5–5 years) were screened for malnutrition and graded according to Severe Acute Malnutrition and Moderate Acute Malnutrition and were given Krishna Laddu on a daily basis. Their anthropometry was serially recorded on a weekly basis over a period of 1.5 years to determine the effectiveness of the Krishna Laddu in improving the nutritional status in the malnourished children. Results: The prevalence rate of malnutrition was 23% (21% MAM and 2% SAM) in the children aged between 2.5–5 years the given population which was reduced to 8% MAM after their diet was added with Krishna Laddu. Conclusions: Krishna Laddu proved to be beneficial in the nutritional rehabilitation of malnourished children. The highlights of this research were: 1) early identification of malnutrition 2) prompt initiation of a nutritious diet to improve outcome 3) serial monitoring of these children to plot the outcome. 4) All the ingredients used for making the laddu are easily available in the kitchen. 5) The preparation is low cost, making it feasible for use in any setup.

Prevalence of metabolic syndrome (MS) is increasing in children with type-1 diabetes (T1D). Genetic and environmental factors shared among family members are considered significant risk factors. We conducted this study to assess the association of parental MS with development of metabolic risk (MR) in patients with T1D.This cross-sectional study included 29 patients with T1D along with their parents (29 triads). Demographic data, anthropometry, blood pressure, biochemical measurements and body composition measurements were performed using standard protocols. Insulin resistance was calculated using estimated glucose disposal rate (eGDR) in patients and using HOMA-IR in their parents. MS was diagnosed using International Diabetes Federation Consensus Definition, 2017.Of total study participants, 44.8% patients with T1D had MR while 25.3% of parents had MS. Low HDL was identified as the most common component of MS. 64.3% patients with T1D, who had parents with MS, had MR. The odds ratio (OR) for development of MR in patients with T1D with parents affected by MS was 4.9 (95% confidence interval 1.0-24.1) while relative risk (RR) was 2.4 (95% confidence interval 0.9-6.1). MR in patients with T1D was found to have a strong correlation with parental MS and also with development of double diabetes (DD).In conclusion, parental MS increases the risk of development of metabolic abnormalities in patients with T1D. Thus, positive family history may serve as a useful indicator for targeted screening to detect DD.

Objectives While growth charts depicting 7 percentile lines for height and weight are useful for healthcare workers and pediatricians, endocrinologists need indication-specific z score cutoffs to plan investigations and treatment. The current Indian charts do not offer lower percentile/z scores (−2.25, −2.5, and −3 z score) lines. Also, increasing prevalence of childhood overweight and obesity necessitates a quick screening of nutritional status without calculations while using the same growth chart. Our objectives were to produce extended and user-friendly growth charts for 0–18-year-old Indian children that depict −2.25, −2.5, and −3 z score height lines in addition to the standard 7 lines and to add a quick BMI assessment tool as an inset. Methods LMS values from IAP 2015 growth charts (5–18 years) and WHO 2006 MGRS charts ( Results The extended height charts (with 10 lines), standard (7 lines) weight charts, and quick BMI assessment tool are presented in a single unified chart for use by endocrinologists. Conclusions These charts will help in defining specific height z score cutoffs as well as screen for overweight and obesity without any calculations in Asian Indian children.

Objectives In March 2020, lockdown was imposed in India to combat spread of Coronavirus, which was extended till 31st May. Implementation of lockdown and limited outdoor activities resulted in changes in routines of children with diabetes. The aim of this study was to assess the impact of lockdown on glycemic control, weight and body mass index (BMI) patterns of children with type 1 diabetes (T1DM) from different socio-economic (SE) classes. Methods This observational study included 77 children and youth (5–20 years) with T1DM having disease duration of ≥6 months. Demographic data and investigations were recorded at two time points (post lockdown when the children came for follow up, pre lockdown data from medical records). Results Glycemic control improved (pre lockdown HbA1C 79.4±19.2 vs. post lockdown Hba1C 74.5±16.9 mmol/mol, p0.01) Conclusions During coronavirus lockdown, glycemic control was adequately maintained in children with T1DM, highlighting importance of stronger family support system leading to more steady daily routine.

CNS tumours and their treatment commonly lead to endocrinopathies in children. Advances in surgical techniques, chemotherapy and radiotherapy have improved the survival in children with CNS tumours however they have also added to the late effect burden. Since the pituitary and hypothalamus regulate many important bodily functions, loss in their function leads to major derangements in growth and hormonal milieu. This article is a review of clinical presentation, diagnosis and management of endocrinopathies encountered in common sellar and supra-sellar CNS tumours in children. The management is divided into mainly two sections: immediate (peri and post-operative) and long term.

Malnutrition among under-five children (U5C) in India is a major public health problem due to double burden caused by nutritional transition. WHO cut-offs are adopted as global growth standards which define how children should grow in condition of optimal nutrition and health. Growth references which are representative of population-specific existing growth patterns need to be updated regularly which is cumbersome; hence, the author's group published 'synthetic growth references' for Indian children of age 0-18 years.The objective of this study is to field test the new synthetic growth references in U5C for height-for-age, weight-for-age and body mass index (BMI)-for-age against WHO charts in urban and rural Indian children to estimate prevalence of various indices of malnutrition.A cross-sectional anthropometric assessment of apparently healthy rural and urban Indian U5C attending vaccination centre was performed using standard protocols. They were converted toWHO charts significantly overestimated stunting and malnutrition as compared to synthetic references with difference in sensitivity of 7.2% and 8.5%, respectively, and converse for over-nutrition by 2.1%. The most commonly affected parameter of malnutrition was underweight. Stunting was significantly higher in rural population using both cut-offs (The synthetic references limit the spread of weight and BMI and do not overestimate stunting and wasting. They may be more useful for identification of malnutrition and may thus be recommended for routine screening in Indian U5C.

We present a 7-year-old girl with Rubinstein-Taybi syndrome (RTS) and slipped capital femoral epiphysis (SCFE). She underwent bilateral arthroscopy with implant fixation for the SCFE and the symptoms resolved. This was followed by fracture of the femur after minor trauma. Dual energy X-ray absorptiometry (DXA) scan done to evaluate her bone health revealed a low bone mineral density (BMD). Our case highlights the finding of low BMD on DXA and rare association of SCFE in a child with RTS. The conundrum in this case is whether this child can be labelled to have osteoporosis as defined by the criteria given by the International Society for Clinical Densitometry guidelines.

We present a 58-day-old male infant with neonatal diabetes and septic arthritis of hip. He was born of a consanguineous marriage at 35 weeks of gestation and was asymptomatic till presentation. Family history revealed his older sibling had suffered from meningitis and a second sibling had neonatal diabetes (died due to an unknown infection). Our patient underwent arthroscopy for septic arthritis and symptoms resolved after antibiotic therapy. Genetic testing was performed for the lipopolysaccharide-responsive beige-like anchor (LRBA) mutation (known to be associated with neonatal diabetes and autoimmune disorders); however, the result revealed a homozygous mutation in PDX-1 gene which is known to cause neonatal diabetes with or without exocrine pancreatic insufficiency. Our case suggests that in neonatal diabetes with atypical infections, genetic causes other than LRBA mutation, like PDX-1 mutation, may be suspected. A genetic diagnosis aids both in treatment and prognostication of neonatal diabetes.

Wolcott-Rallison syndrome (WRS), the most common cause of permanent neonatal diabetes mellitus (DM) in consanguineous families, has a poor prognosis, with a mean survival of 5.8 years. Majority of children with WRS succumb to the disease in the first decade of life. We present the long-term follow-up of an 8-year-2-month-old girl with genetically proven WRS who was born to a non-consanguineous parentage. She is on basal bolus regimen of insulin therapy for DM. In addition, she was noted to have features of skeletal dysplasia at 3 years and 3 months of age, which has led to her short stature. Surprisingly, she has had no episodes of hepatitis or liver dysfunction so far, which is frequently seen in children with WRS. To the best of our knowledge, she is the oldest surviving patient with WRS reported in India and South Asia.

We present a 9-year-old male child having history of fractures on trivial trauma with a family history of the same. He was treated for osteogenesis imperfecta (OI; zolendronate, calcium and vitamin D) and showed clinical improvement. On evaluating his bone health using dual energy X-ray absorptiometry and peripheral quantitative CT, we found that the child had bone density within the reference range but a smaller bone mass for his height, low muscle mass and thin bones with a lower strength strain index in comparison with healthy children. Our case suggests that treatment with bisphosphonates results in increase in bone density; however, bones remain thin and the lean body mass in these children may also be low. Controlled physical activity to improve muscle health and newer approaches to improve bone geometry would result in better bone health in children with OI.