Search

Objective: Outcomes of childhood‐onset Graves' disease (GD) and suggested duration of anti‐thyroid drug (ATD) therapy have been controversial. This study aimed to determine long‐term outcomes following ATD therapy, including remission and relapse rates. Design, patients and measurements: A retrospective study of 265 paediatric patients with GD who were initially treated with ATD was conducted. Long‐term outcomes were analysed. Results: Median (IQR) age at diagnosis was 11.5 (9.4, 13.7) years. Duration of ATD treatment was 4.3 (2.3, 6.7) years and time since diagnosis to the enrolment was 7.1 (3.8, 10.9) years. There were 77, 93 and 95 patients who underwent definitive treatment, had ATD discontinuation, and were still being treated with ATD, respectively. The remission rate was 21% (56 out of 265 patients) and relapse rate was 40% (37 out of 93 patients). Cumulative incidence of first remission increased with the duration of ATD treatment with maximum remission rate at 5.3 years following ATD therapy. Among patients who experienced relapse, approximately 50% had disease relapse which occurred within 1 year after ATD discontinuation. Patients with goitre size of less than 3.5 cm, thyroid‐stimulating hormone receptor antibody of less than 10 IU/L, no ophthalmopathy at diagnosis and methimazole dose requirement of less than 0.25 mg/kg/day at 1 year after treatment were more likely to achieve remission. Conclusions: Remission rate of childhood‐onset GD was relatively low following ATD treatment. Longer‐term ATD therapy was associated with increased remission rate. Approximately 50% of patients with relapse had disease relapse within 1 year following ATD discontinuation. [ABSTRACT FROM AUTHOR]

Background: Defects of incretin hormones and incretin effect may be underlying mechanisms of abnormal glucose metabolism in youth. Objective: To assess incretin hormone dynamics during an oral glucose tolerance test (OGTT) and incretin effect in obese children with prediabetes in comparison with those with normal glucose tolerance (NGT). Methods: Overweight and obese children were enrolled and classified according to OGTT results as NGT and prediabetes. Insulin sensitivity, insulin secretion, incretin hormone concentrations during OGTT; and incretin effect derived from OGTT and intravenous glucose tolerance test were determined and compared between NGT and prediabetes groups. Results: Sixty-three patients (43 NGT and 20 prediabetes) were enrolled. Their median (interquartile range) age was 12.5 (11.1, 13.8) years. Peak glucagon-like peptide-1 (GLP-1) was demonstrated at 30 min during OGTT and was higher in the prediabetes group (49.2 [35.6, 63.6] versus 36.5 [27.6, 44.2] pmol/L, p = 0.009). However, incremental areas under the curves (iAUCs) of GLP-1 and glucosedependent insulinotropic polypeptide (GIP) were not different between the two groups. There was no difference in incretin effect between NGT and prediabetes (NGT: 66.5% [60.2%, 77.5%] vs. prediabetes: 70.0% [61.5%, 75.0%], p = 0.645). Incretin effect had positive correlations with iAUCs of both GLP-1 and GIP (GLP-1: r = 0.40, p = 0.004 and GIP: r = 0.37, p = 0.009). Conclusions: Comparing between obese children with prediabetes and NGT, there were no differences in overall incretin hormone changes during OGTT and incretin effect. Incretin effect was positively correlated with iAUCs of GLP-1 and GIP. [ABSTRACT FROM AUTHOR]

Background: The Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University has developed a residency research program and continuously improved the curriculum. The main source of funds for resident's research projects comes from the Faculty of Medicine. This fund was once limited, but it has been gradually increased. Objective: To assessed publication productivity during the past 30 years and its association with research funding. Materials and Methods: The present study was a retrospective cohort study, using the database containing detailed information on scholarly projects of the Ramathibodi's pediatric residents between 1983 and 2012. Univariate and multivariate analyses of factors that could be associated with publication productivity and types of study design were performed. Results: Three hundred forty-nine projects were included. These projects were categorized into three groups based upon research funding, no fund (F0) (n=255), funded at 50,000 THB or less (F1) (n=67), and funded at more than 50,000 THB (F2) (n=27). The demographic data of residents and mentors among the three groups were not significantly different. A significant increase in the number of publications was positively associated with more funds. The percentage of publications rose with increasing funds (16.5%, 28.4%, and 33.3% in F0, F1, and F2, respectively) (p=0.019). The percentages of the prospective study were also increased with increasing funds (31.4% to 46.3%, and 48.1% in F0, F1, and F2, respectively) (p=0.022). Multivariate analysis demonstrated that funds was the only factor associated with percentage of publications (odds ratio [OR] 2.54, 95% confidence interval [CI] 1.07 to 6.03) and with percentage of prospective study design (OR 7.16, 95% CI 3.50 to 14.66). Funds was an independent factor associated with journal impact factor (adjusted OR 4.09, 95% CI 1.41 to 11.87). Conclusion: An increase in pediatric residency research funding was a major factor associated with an increase in publication productivity. [ABSTRACT FROM AUTHOR]

Objective: To determine basal and gonadotrophin‐releasing hormone analogue (GnRHa)‐stimulated peak luteinising hormone (LH) cut‐offs to diagnose onset of early or normal puberty in girls with each Tanner stage of breast (II and III). Design, Patients and Measurements: A retrospective study of 601 girls with breast onset before 8 years of age who underwent GnRHa test was conducted. Patients were categorized as CPP and premature thelarche. Each group was divided into two subgroups; Tanner II and III. Cost‐effectiveness analysis was performed. Results: In comparison with basal LH cut‐off of 0.3 IU/L, basal LH cut‐off of 0.2 IU/L had comparable specificity (Tanner II: 98.0% vs 94.8%, Tanner III: 98.8% vs 93.8%), but greater sensitivity (Tanner II: 28.3% vs 41.7%, Tanner III: 45.2% vs 59.3%). Specificity of basal LH cut‐off of 0.2 IU/L was not inferior to that of the traditionally used peak LH of 5 IU/L. Using basal LH cut‐off of 0.2 IU/L followed by GnRHa test in girls with negative basal LH was more cost‐saving when compared with using the cut‐off of 0.3 IU/L. Moreover, using basal LH cut‐off of 0.2 IU/L followed by GnRHa test provided a cost reduction when compared with performing GnRHa test in all patients. Conclusions: Basal serum LH cut‐off of 0.2 IU/L could be a simple and cost‐saving tool for initial diagnosis of onset of early or normal puberty in girls with Tanner II and III before proceeding to GnRH testing. [ABSTRACT FROM AUTHOR]

Background: Intravenous hypotonic fluid administered in children is associated with an increased risk of developing hyponatremia. This finding has been reported from temperate countries where climate is relatively cold. But whether this risk also occurs in tropical countries has not been elucidated.Objective: The objective of this study was to determine the relationship between environmental temperature and serum sodium in non-critically ill children.Methods: A retrospective study.Results: A total of 1061 hospitalized children were enrolled. Incidences of hyponatremia were not different between patients who received isotonic and hypotonic fluids (29% vs. 31%). Subgroup analysis showed a trend of higher incidence of hyponatremia in patients who received hypotonic fluid than isotonic fluid only in patients admitted to the air-conditioned wards (29% vs. 21%, p = 0.08).Conclusion: Children admitted to the air-conditioned wards who received hypotonic fluid seemed to carry a higher risk of developing hyponatremia than those admitted to the non-air-conditioned ward. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 2-year-old girl having acute bronchitis and respiratory failure diagnosed with myxoedema coma, which is a form of hypothyroidism. It discusses the common misdiagnosis of this condition and how it could be instead diagnosed as central hypothyroidism with thyroxine supplement.

Owing to the rarity of DKA as compared with the other causes of headache in this particular patient, the DKA diagnosis was missed. Intracranial hypertension could be a presenting symptom of diabetic ketoacidosis. Acetazolamide aggravated diabetic ketoacidosis severity in a boy post-transplantation thalassaemia with intracranial hypertension. [Extracted from the article]