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Background Anaemia and vitamin D insufficiency (VDI) are among the most common nutritional problems. Anaemia screening is routinely performed; however, screening for VDI is not usually recommended. Objectives To study the association between anaemia and VDI and identify the risk factors for VDI. Methods We conducted a cross-sectional study of 120 infants aged 6–12 months attending a well-child clinic at Songklanagarind Hospital between December 2020 and November 2021. Sociodemographic data and 24-h food records were also collected. Blood samples were obtained for complete blood count and 25-hydroxyvitamin D [25(OH)D] levels. Logistic regression analysis was used to determine risk factors for VDI. Results The mean 25(OH)D level was 22.2 ± 8.9 ng/mL in anaemic infants and 27.2 ± 9.6 ng/mL in non-anaemic infants (P value 0.01). The median (IQR) Hb level was 11.1 g/dL (10.3, 11.4) in the VDI group and 11.4 g/dL (11, 12.1) in the non-VDI group (P value 0.002). The proportion of breastfed infants was higher in infants with anaemia (80%) (P < 0.001) and VDI (85.3%) (P < 0.001). Sunlight exposure Conclusion Infants with anaemia, short duration of sunlight exposure, breastfeeding, low vitamin D intake, and low iron intake were more likely to be vitamin D insufficient. However, after adjustment in the multivariate analyses, only sunlight exposure and vitamin D intake were significantly associated with vitamin D insufficiency.

There is limited information on vitamin D deficiency among childhood cancer survivors (CSS), especially in tropical countries. The aims of this study are to determine the prevalence and risk factors for vitamin D deficiency in CCSs. This study was conducted at the long-term follow-up clinic for CCSs at Prince of Songkla University, Songkhla, Thailand. All CCSs who were followed up between January 2021 and March 2022 were enrolled. Demographic data, dietary dairy intake, average weekly duration of outdoor activities, total 25-hydroxyvitamin D [25(OH)D] levels, parathyroid hormone levels, and blood chemistry were collected. A total of 206 CCSs with a mean age at follow-up of 10.8 ± 4.7 years were included. The prevalence of vitamin D deficiency was 35.9%. Female gender (odds ratio (OR): 2.11, 95% CI: 1.08–4.13), obesity (OR: 2.01, 95% CI: 1.00–4.04), lack of outdoor activities (OR: 4.14, 95% CI: 2.08–8.21), and lower dietary dairy intake (OR: 0.59, 95% CI: 0.44–0.80) were independent risk factors for vitamin D deficiency. Vitamin D deficiency was common in CCSs and associated with female gender, obesity, lack of outdoor activities, and lower dietary dairy intake. Regular 25(OH)D screening should be established in long-term care to identify those who require vitamin D supplements.

This study aimed to generate sex-specific percentile curves for the percentage of body fat (PBF) in Thai children using a bioelectrical impedance analysis (BIA). The secondary objective of this study was to determine the association between body fat and other anthropometric measurements. A cross-sectional study was conducted on 3455 Thai school children aged 6–18 years. The body-fat contents were measured using BIA. Smoothed percentile curves of PBF were derived using a scatter plot with a smooth curve fitted by the Loess method. The correlations between the body fat and the anthropometric measurements were assessed using the Spearman’s rank correlation. The 50th and lower body-fat-percentile curves of the boys slowly increased until age 12, after which they slightly decreased until age 15 and then slightly increased until age 18. In the higher boys’ percentiles, the body fat sharply increased until age 11 and then decreased until age 18. In the girls, the PBF percentiles increased steadily from 6 to 18 years. The body-mass index was strongly correlated with PBF and fat mass in both sexes. The waist-to-height ratios showed strong correlations with PBF and fat mass in the boys but were moderate in the girls. The use of PBF percentile curves can be an additional metric for the evaluation of obesity in Thai children.

Puberty is a normal physiological process of during which children develop secondary sex characteristics, experience growth acceleration, and achieve bone maturation and reproductive competence. The onset of puberty is initiated by the activation of the hypothalamic-pituitary-gonadal (HPG) axis. Precocious puberty is defined as the appearance of secondary sex characteristic at an age younger than 8 years in girls and 9 years in boys, or the beginning of menstruation before 9 years in girls. The most common etiology of central precocious puberty (CPP) is idiopathic (>90.0% in girls and 25.0-60.0% in boys), in which at present the etiologies of idiopathic CPP in some patients can be identified to be from a mutation of KISS1 or MKRN3 genes. The standard treatment for CPP is a gonadotropin-releasing hormone analog (GnRHa). The aims of treatment are to halt and regress the pubertal status of the patient to the prepubertal state that is appropriate for their age, prevent early onset of menses and attenuate the loss of height potential consequence upon advanced skeletal maturation. A study of long-term follow-ups of former CPP women at the age of mid-20s to 50 years found that most of the participants had regular menstrual cycles. The marital status and the pregnancy rate were the same as in controlled group and were not different between the GnRHa-treated and untreated CPP women.

Vitamin D is an essential micronutrient in children for bone mineralization and bone growth. There are two forms of natural vitamin D, vitamin D2 and vitamin D3. Natural vitamin D is obtained from 2 main sources, dietary vitamin D intake and cutaneous vitamin D synthesis from sunlight exposure. Natural vitamin D requires a 2-step enzymatic hydroxylation process to be turned into active form of 1,25-dihydroxyvitamin D, firstly, 25-hydroxylation in the liver, and secondly, 1α-hydroxylation in the kidneys. Although breast milk is highly nutritive containing adequate amounts of most important vitamins, it contains only a small amount of vitamin D, approximately 15-50 IU/L, which does not reach the recommended daily requirement of 400 IU for infants. Exclusively breastfed infants are at risk to develop vitamin D deficiency if sunlight exposure is limited. Despite the excess of sunshine for the whole year in Southeast Asian countries including Thailand, various studies have found that more than 30.0% of children and adolescents had vitamin D insufficiency. The factors associated with vitamin D insufficiency in children include maternal vitamin D deficiency, exclusively breastfed as infants, insufficient daytime outdoor activities, use of sunscreens, extensive skin coverage by clothing, and lack of vitamin D supplementation and dietary fortification. To prevent vitamin D deficiency in infants, a global consensus in 2016 recommended that vitamin D supplementation should be included in routine national health care programs along with other essential micronutrients and immunizations.

Background In 2011, we described 104 girls who were diagnosed as early puberty (EP) during 2003–2005. In 2019–2020, the former EP women had been followed up 14 years after attaining their final height. Objective To determine the reproductive function and metabolic profiles of former EP women. Study design Fifty-seven former EP women were evaluated for reproductive function and examined for health status. Blood samples were obtained for metabolic profiles of glucose, lipids and insulin, and testosterone levels. Results In 2020, the average age of the study women was 22.9 ± 1.7 years. The average height was 156.7 ± 5.6 cm. The average weight had increased from 52.5 ± 7.8 kg in 2011 to 58.5 ± 11.1 kg in 2020 and average body mass index (BMI) from 21.4 ± 2.9 to 23.8 ± 4.0 kg/m2. Obesity (BMI>25 kg/m2) was found in 8.8% (five participants) in 2011 and had increased to 22.8% (13 participants) in 2020. Most participants (79%) had regular menstrual cycle. Of the 17 married women, 4 (23.5%) had 1–2 children. Dividing the participants into obese and nonobese groups, the average fasting plasma glucose, lipid profiles, and testosterone levels were similar in both groups. However, the average systolic blood pressure and the serum insulin levels and HOMA-IR assessments were significantly higher in the obese group than in the nonobese group. Conclusion The former EP women had normal menstruation and reproductive function. The former EP women with average BMI at the follow-up had normal metabolic profiles while those who later became obese had significantly higher systolic blood pressure, serum insulin, and HOMA-IR assessments.

Ablepharon macrostomia syndrome (AMS) is a rare congenital disorder. To our knowledge, only 20 cases have been reported to date, and all in patients from Western countries. We report a case of AMS in a Thai patient, who presented at age 3 months with severe ectropion of both upper and lower eyelids, alopecia totalis, no palpable clitoris, and hypoplasia of both labia minora and labia majora. Trio whole exome sequencing analysis was performed, which revealed a heterozygous missense c.223G>A (p.Glu75Lys) variation in TWIST2. To our knowledge, this is the first reported case of AMS in a patient from Thailand and the first reported case of AMS in Asia.

Background This study assessed the cleft lip/palate (CL/P) healthcare provision using data from the Thailand National Health Security Office from fiscal years 2012–2016. Methods Four national databases of Thailand comprising 1) admitted patient visit, 2) non-admitted patient visit, 3) birth defects registry and 4) civil registration databases were analyzed. All duplicate records were removed by a matching process using national identity number and date of birth prior to data extraction. Modified Geographic Information System was also used to compare each provincial patients with CL/P of Thailand to the number of provincial live births with CL/P. Results The results showed that the number of live births with CL/P during this period was 7,775 cases (1,555 cases/fiscal year). While the number of cases with CL/P registered under the Universal Health Care Coverage with hospital stay was 6,715 (86.37%), 927 cases (11.92%) visited hospitals without a stay, and the remaining 133 cases (1.71%) never visited any hospital. Modified Geographic Information System result showed that the provincial CL/P healthcare was relatively well-balanced with the provincial live births with CL/P (r = 0.92, p Conclusion This study showed that the percentage of patients with CL/P receiving hospital treatment was 98. The Thai Universal Health Care Coverage scheme has promoted the accessibility to CL/P treatment. In order to achieve the best possible comprehensive cleft care coverage, periodical assessment and improvement of the function and accuracy of the national database registry are recommended.

Objective: Two main objectives were established. First objective was to determine the prevalence of the cleft lip and/or cleft palate (CL/P) in Thailand from 2012 to 2015 using the orofacial clefts (OFCs) registry and civil registration. Second objective was to conduct a quality control of this OFC registry especially for the Birth Defects Registration (BDR). Design: Registry-based survey. Setting: Analyzing data from the Thailand National Health Security Office. Participants: Registered patients with CL/P in Thailand from 2012 to 2015. Intervention: None Main Outcome Measure: Duplicated records were verified using National Identity Number (Thai ID#) and date of birth. The prevalence of CL/P and specific phenotypes was then calculated. From this prevalence estimate method, quality assurance of the OFCs registry was possible. Results: For the main outcome, the population-weighted pool prevalence of CL/P was 2.14 per 1000 live births (95% confidence interval of 2.08-2.20). Thai ID# and expense reimbursement systems were the main factors driving this cases capturing. However, this OFCs registration still requires active case finding with clinical verification, improvement of staff training and databases networking. Conclusions: This study reported a very high CL/P prevalence of Thailand. Strengths and limitations of these OFCs registry and BDR were described.

Fragmented QRS is an abnormal sign in an ECG resulting from ventricular dyssynchrony. The presence of fragmented QRS (fQRS) is related to mortality in patients with repaired tetralogy of Fallot (rTOF). This study aimed to analyze the correlations between fQRS and ventricular function parameters from cardiac magnetic resonance (CMR) images. A total of 54 patients with rTOF or repaired DORV, TOF type who had been investigated by CMR at Songklanagarind Hospital from January 2012 to August 2019 were retrospectively reviewed. Most of the patients (47 patients, 87%) were diagnosed with TOF and most of these (57.4%) were treated with a transannular patch (TAP) on the right ventricular outflow tract (RVOT). Forty-four patients (81%) had fQRS. The median time interval between EKG and CMR was 4.2 months (IQR 1.1, 6.9). Patients with fQRS had significantly higher RVEDVi (145.6 [IQR 121.1, 173.1) vs. 115.9 [IQR 96.2, 146.9] mL/m2, p = 0.037), higher RVESVi (82.5 [IQR 62.9, 100.8] vs. 58.6 [IQR 46, 77.2] mL/m2, p = 0.032) and higher RVEDV/LVEDV ratio [1.6 (IQR 1.4, 1.9) vs. 1.4 (IQR 1.3, 1.5), p = 0.026]. The extent of fQRS was significantly associated with an increase in RVEDVi (r = 0.39, p = 0.004) and RVESVi (r = 0.45, p

Background In 2011, we described 64 girls diagnosed with central precocious puberty (CPP) during 1995–2009. In 2019, the former CPP patients were 16–30 years of age and had been followed-up for 6–20 years after cessation of gonadotropin-releasing hormone analog (GnRHa) treatment. Objectives To determine the menstrual cycle, reproductive function, and long-term sequelae of the former GnRHa-treated and untreated CPP patients. Methods Sixty-seven former CPP women diagnosed during January 1995 to December 2010 were evaluated in 2019 for current menstrual cycle and pregnancy rate and for general health status, weight, height, blood pressure, and metabolic profiles of glucose, lipids, insulin, and testosterone. Results In 2019, the former CPP women averaged 20.7 ± 2.7 years of age (range: 16.5–30). Eighty-three percent had a regular menstrual cycle. Of the 14 married women, six (43%) were fertile with 1–2 children. The untreated women had a significantly higher rate of obesity (BMI >25 kg/m2) than the GnRHa-treated women (72.1% vs. 36.6%, p Conclusions At a 10–20-year follow-up, our former CPP patients had regular menstruation, normal reproductive function, and normal metabolic outcomes. The low prevalence of PCOS of 3% suggests that CPP is not a risk factor for PCOS, at least during early adulthood.

Objective: To determine the prevalence and risk factors of school violence among Thai high school students usinga Thai version of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child AbuseScreening Tool-Children: Institute Version (ICAST-CI).Material and Methods: A cross-sectional study was conducted at two high schools in Hat Yai municipality, Songkhla, southern Thailand with 480 students. Univariate logistic regression analysis was used to assess the risk factors associated with school violence.Results: Overall, 88.8% of the students reported experiencing violence at school in their lifetimes. The prevalences of psychological, physical and sexual violence were 84.0%, 66.9% and 30.6%, respectively. The most commonly reported violence patterns among each form of violence were swearing (87.8%), slapping on hand/arm (66.4%), and showing pornography (67.3%), respectively. Students with good school performance tended to report psychological violence [odds ratio (OR)=3.03, 95% confidence interval (CI)=1.13-8.07] whereas students aged >15 years were less likely to report physical violence (OR=0.47, 95% CI=0.31-0.71). Sexual violence was reported more among male students (OR=1.71, 95% CI=1.12-2.61) and students aged >15 years regardless of gender (OR=1.58, 95% CI=1.04-2.39). Students were more likely to be reported as a perpetrator than teachers in most patterns of violence.Conclusion: The prevalence of school violence among high school students in Hat Yai municipality, southern Thailand, is significant. and the patterns of violence are similar to other ICAST-CI studies. Violence at school should be recognized as a serious problem, and preventive measures should be implemented nationwide.

Down syndrome (DS) is the most common chromosomal disorder causing mental retardation with a worldwide average prevalence of 1-2 cases per 1000 births. This study aimed to determine the comorbidities associated with DS and the coverage of health care services and developmental interventions for DS livebirths in Southern Thailand.A total of 149 livebirth DS infants, recruited through the prospective birth defects registry system during 2009-2013 in 3 provinces in Southern Thailand, were regularly followed-up every 3-6 months. The data collection form included the infants' demographic data, associated congenital anomalies, and developmental interventions.The DS infants were born at an average gestational age of 38.5±2.3 weeks with average birth weight of 2760±478 g, length 48.5±2.2 cm, and head circumference 32.7±1.2 cm. Congenital heart diseases, gastrointestinal defects and congenital hypothyroidism were found in 43.0%, 6.7%, and 12.1% of the cases, respectively. The percentage of DS infants who received developmental interventions in this current study were significantly greater than in a previous study covering the years 1992-2002: early stimulation program 90.0% vs. 65.6% (P0.01), and speech training program 74.8% vs. 38.9% (P0.01), respectively, and the infants in our study began intervention programs significantly earlier, 0.58±0.39 years vs. 1.69±0.66 years, respectively.Congenital heart disease was the most common comorbidity associated with DS. The coverage of health care services and developmental interventions for DS children has generally improved in Southern Thailand. One hundred percent coverage of health services and interventions for children with special needs is expected in the near future.

Background. Clinical characteristics of fragile X syndrome (FXS) have been well documented in Caucasians, whereas in Asians they have rarely been described. Those that have been conducted used small cohorts that utilized DNA for diagnosis and larger cohorts that utilized cytogenetics for diagnosis. This study is to describe clinical characteristics of FXS in a large cohort of Thai patients diagnosed by standard molecular methods. Methods. Seventy-seven index cases and 46 affected relatives diagnosed with FXS were recruited into the study. To determine frequencies of common characteristics of FXS in prepubertal boys, we reviewed 56 unrelated cases aged between 18 and 146 months. To list rare medical problems, we reviewed 75 cases aged between 8 months to 71 years old, including 53 index cases and 22 affected relatives. In addition, we selected 16 clinical studies from various ethnicities for comparison with our findings. Results. In prepubertal boys with FXS, attention deficit and/or hyperactivity, prominent ears, macroorchidism, and elongated face were observed in 96%, 80%, 53%, and 48% of patients, respectively, whereas recognizable X-linked inheritance presented in 11% of patients. IQ scores ranged between 30 and 64 (mean ± SD = 43±9, n=25). We observed clinical findings that rarely or have never been reported, for example, medulloblastoma and tetralogy of Fallot. Conclusion. Attention deficit and/or hyperactivity and prominent ear are the most common behavioral and physical features in prepubertal boys with FXS, respectively. There are differences in frequencies of clinical characteristics observed between ethnicities; however, it is difficult to draw a solid conclusion due to different recruitment criteria and sample sizes within each study.

Background Preterm infants are at high risk of developing congenital hypothyroidism (CH) due to the immaturity of the hypothalamic-pituitary-thyroid (HPT) axis, loss of iodine supply from the mother and preterm health problems. Objectives To study the incidence and etiologies of CH in preterm infants who were born or admitted in our institute during 2010–2015. Methods The medical records of preterm infants diagnosed with CH as defined by the thyroid-stimulating hormone (TSH) level at the time of the first or second screening >10 mU/L and/or free T4 Results Of 2777 preterm infants, 73 cases (2.6%) were diagnosed as CH. The average TSH levels at the first and second screenings were 20.85 and 15.42 mU/L, respectively. The patients were treated with thyroxine at an average initial dosage of 15 μg/kg/day. At 2–3 years of age, after thyroxine discontinuation for 6–10 weeks and regular thyroid function tests for 2 years, 58 patients (79.5%) were diagnosed as having transient CH and 15 patients (20.5%) were diagnosed as having permanent CH. We found no clinical or laboratory parameters in the neonatal period that could differentiate permanent from transient CH. Thyroid scintigraphy (99 m pertechnetate) revealed two patients (13.3%) with ectopic thyroid, one with thyroid hypoplasia (6.7%), eight with normal thyroid (53.3%) and four with enlarged thyroid (26.7%). Conclusions CH was common in preterm infants with an estimated incidence of 2.6%. Thyroxine should be given to preterm infants with higher initial values of TSH >10 mU/L in order to prevent delayed treatment of permanent CH that could be confirmed later.

17-Hydroxylase/17,20-lyase deficiency is a rare congenital disorder accounting for 1% of congenital adrenal hyperplasia. This disease is recessively expressed as autosomal inheritance through mutations in the CYP17A1 gene, leading to defective levels of glucocorticoids and sex hormones. Individuals with loss-of-function mutations usually present with phenotypic female genitalia, primary amenorrhea, or hypertension in puberty caused by excessive production of mineralocorticoids. In this report, we describe a girl with CYP17A1 mutations diagnosed even though the pathognomonic symptoms had not developed. Herein, we report a case of a 3-year-old girl who prenatally diagnosed as a 46, XY female. After birth, the baby had normal female-type external genitalia without symptoms. She underwent a gonadectomy at the age of 3 years. To explore the pathogenesis of her condition, her genomic data were reviewed for genes involved in disorders of sexual differentiation (DSDs) using high-throughput sequence data from a whole-exome study. Pathogenic variants causing frameshift mutation involving codon 329 of CYP17A1 and a concomitant missense mutation involving codon 358 of the same gene were detected, mutations which are likely to result in loss of function of the enzyme. Each mutation was inherited from each of the parents, both holding carrier status. In addition, her younger sister (46, XX) acquired those identical variants without any abnormal phenotypical traits. Loss-of-function mutations of CYP17A1 which may cause secondary hypertension are not commonly identified in early life because of the wide spectrum of clinical manifestations and various pathophysiologies, which manifest in different sexes. Affected cases usually present later in life with hypertension or primary amenorrhea. High-throughput sequencing is suggested in DSD cases as it may give a precise diagnosis, enabling a proactive treatment plan and prevention of sequelae that potentially occur in puberty.

Down syndrome (DS) is the most common chromosomal disorder that causes mental retardation. In 2009, a population-based birth defects study was implemented in three provinces in southern Thailand. This study aimed to determine the prevalence of DS in the studied regions, and the proportion of DS fetuses detected by prenatal screening. Data were obtained from a population-based surveillance study undertaken during 2009-2013. Entries in the birth defects registry included live births, stillbirths after 24 weeks gestational age, and terminations of pregnancy following prenatal diagnosis. Infants with clinical characteristics of DS had a chromosomal study to make a definite diagnosis. Of the total 186 393 births recorded during the study period, 226 DS cases were listed, giving a prevalence of 1.21 per 1000 births [95% confidence interval (CI) 1.05-1.37]. The median maternal age was 36.5 years with a percentage of maternal age ≥35 years of 60.6%. Seventy-seven cases (34.1% of all cases) were diagnosed prenatally and these pregnancies were terminated. The prevalence of DS per 1000 births was significantly higher in older women, from 0.47 (95% CI 0.28-0.67) in mothers aged

This is the first population-based study in Thailand on the prevalence of congenital limb defects (CLD). Data were obtained from recently established birth defects registries in three southern Thailand provinces during 2009-2013. Entries in the birth defects registries included live births, stillbirths after 24 weeks gestational age, and terminations of pregnancy following a prenatal diagnosis of fetal anomaly. The total of 186 393 births recorded included 424 CLD cases, giving an average prevalence of 2.27 per 1000 births (95% CI, 2.05-2.49). The most common CLD was talipes equinovarus (44.1%), followed by polydactyly (13.9%) and syndactyly (9.4%). The prevalence significantly increased with maternal age from 1.81 in mothers aged

Summary Background The quality of the information contained in a medical record is dependent on the knowledge and skills of the doctor. The auditing of medical records is one of the items included in the competency evaluation of residents at the Department of Pediatrics, Prince of Songkla University (PSU), Thailand. Objectives To determine the percentages of ‘not met’ and ‘not acceptable’ charts written by residents, which parts of the residents’ writing required improvement and associated factors. Methods The charts of four newly admitted cases at each ward were selected non-randomly by attending staff for bi-weekly audit. The audit form comprised 15 components, with each component scored as ‘met’ or ‘not met’. Medical records with more than two ‘not met’ items were categorised as ‘not acceptable’. Results From September 2012 to October 2013, a total 506 in-patient medical records written by PSU paediatric residents were reviewed. The components identified as having the highest rates of ‘not acceptable’ completion were ‘initial investigations’ (5.3%), ‘summary of investigations’ (4.5%) and ‘progression of clinical conditions’ (4.3%). The reasons for a ‘not acceptable’ evaluation were ‘incomplete documentation’ (65.0%), ‘lack of follow-up’ (26.7%) and ‘incorrect clinical reasoning’ (8.3%). Using logistic regression analysis, the charts of patients from the chronic illness wards were found to be most significantly associated with the ‘not acceptable’ rating. Residents need skills and knowledge when completing patient records Conclusions Residents need skills and knowledge when completing patient records, and attending staff should be aware that it is their responsibility to ensure that residents complete documentation fully and correctly.

In Thailand, road traffic injuries are the leading cause of death for youth ages 15-19 years, with 80% of the injuries and deaths from motorcycle accidents.To determine the prevalence of child and young adolescent motorcyclists in Hat Yai municipality and their risk behaviors.A cross-sectional study was conducted between June 2011 and March 2012 in which 2,471 students, ages 8 to 18 years, were recruited from 9 primary and secondary schools in Hat Yai municipality. The questionnaire included questions on being a motorcycle rider or passenger, risky behaviors, and helmet use while riding.Of the total, 1,573 (63.7%) were riders and 898 (36.3%) were pillion passengers. The majority of the riders younger than 15 years rode their motorcycle mainly only in narrow streets for a short trip. Only 30% of the riders wore a helmet every time they rode a motorcycle. About 10% of the participants riding or a passenger on a motorcycle had consumed alcohol at least once before riding their motorcycle. Multiple logistic regression analysis found that motorcycle injuries were significantly associated with speeds greater than 60 km/h, not wearing a helmet while riding, and alcohol consumption before riding (odds ratios 1.63, 1.59, and 3.09, respectively).Nearly two thirds of young adolescents in Hat Yai municipality were motorcycle riders. These young adolescents were at risk of traffic injuries because more than 50% of them had ridden at high speed or not worn a helmet while riding, and some of them had consumed alcohol before riding.

Background The Royal College of Pediatricians of Thailand requires that all its residents complete a full thesis before their final Thai Pediatric Board Examination. The Department of Pediatrics of the Faculty of Medicine, Prince of Songkla University (PSU) has been certified for pediatric residency training since 1985. Objectives To determine the number of articles published in medical journals that are based on the theses of residents during 25 years of pediatric resident training, and how long after finishing their residency training the articles were published. Methods Medical journal databases were searched for the names of former pediatric residents. The faculty staff who had supervised them during their training were asked to confirm whether the residents had published their work. Results During the 25 years (1988–2012), we found records of 34 articles based on the theses of 130 residents published in a medical journal (26%). In the early phase (1988–2002), 15 articles from 67 theses (22%) were published: 10 (67%) in Thai or regional English language journals, and 5 (33%) in international peer-reviewed journals. In the second phase (2003–2012), 19 articles from 63 theses (30%) were published: 6 (32%) in regional English language journals, and 13 (68%) in peer-reviewed international journals. Conclusions The publication rate of PSU pediatric residency research theses during the 25 years was 26%. We recommend that our faculty devote more time to ensuring supervision of the thesis writing component of the residency training to increase the publication rate of research theses by our residents.

Background:Short stature is one of the common disorders referred for investigation of an endocrine disorder. The etiologies of short stature vary and are commonly grouped into pathological and non-pathological disorders. The objective of the study was to determine the etiologies and describe the characteristics of short stature patients who attended the Pediatric Endocrinology Clinic and to compare factors between normal variant short stature (NVSS) and growth hormone deficiency (GHD).Methods:This was a retrospective review of 572 patients referred for evaluation of short stature between January 2004 and December 2015. Short stature was defined as height below −2 standard deviation score (SDS) by gender and age based on population data of Thai children.Results:In total, 521 patients were identified as having short stature. NVSS was the most common etiology (44.9%) and pathological short stature was found in 35.3% of the cases, of which 21.2% had GHD. The median age at presentation of NVSS patients was 8.6 years while that of pathological short stature patients was 2.1 years (pConclusions:NVSS was the most common etiology of short stature, followed by syndromic short stature and GHD. Physical examination is crucial to identify GHD from syndromic short patients.

Background: Congenital hypothyroidism (CH) is one of the common causes of intellectual disability which can be prevented by early detection of an elevated thyroid stimulating hormone (TSH) level in the newborn and by treatment with thyroxine. In Thailand, neonatal TSH screening was implemented nationwide in 2005. The objective of the study was to determine the etiologies and the estimated incidences of CH in southern Thailand before and after the implementation of a neonatal TSH screening program in 2005. Methods: The medical records of pediatric patients who were diagnosed with primary CH at Songklanagarind Hospital during 1995–2013 were retrospectively reviewed. The study was divided into two time periods: study period 1 (SP1) (1995–2004) and study period 2 (SP2) (2005–2013), the time before and after TSH program implementation. Results: The most common form of CH during SP1 was overt permanent CH (66%), mostly caused by athyreosis or ectopic thyroid. In SP2, the most common form of CH was mild permanent CH (39%) (mostly due to dyshormonogenesis), followed by overt CH (32%) and transient CH (29%). The overall annual estimated incidence of CH per 10,000 live births in Songkhla Province was 1.69 (1:5021) in SP1, increasing to 4.77 (1:2238) in SP2; in all 14 provinces in southern Thailand, the estimated incidence was 1.24 (1:8094) in SP1 and 2.33 (1:4274) in SP2. Conclusions: Neonatal TSH screening has a significant impact on the increased detection of the mild form of permanent and transient CH cases, which may be important for the prevention of brain damage from less severe CH although this remains to be documented.

In Thailand, studies of growth date back to 1975, but there have been no studies examining any trends in increasing/decreasing growth.To determine if there have been any secular trends of increasing/decreasing growth and/or ages at puberty in Thai children.In 2012, a cross-sectional study of growth was conducted in 3460 children. The median heights and weights and the ages of pubertal maturation were compared with previous studies. Correlations between the secular trends and the health statistics indicators were calculated.From 1975-2012, the median final height of boys and girls had increased by 1.32 and 0.86 cm/decade and weight by 2.49 and 1.76 kg/decade, respectively. In girls, the age at thelarche and menarche had declined by 0.39 and 0.12 years/decade, respectively. In boys, the age at testicular enlargement Tanner II had declined by 0.15 years/decade. Increased physical growth was positively correlated to life expectancy, per capita income and prevalence of overweight/obesity was negatively correlated to prevalence of malnutrition and under-five mortality rate.The positive secular trend towards an increase in growth and a decline in the age at onset of puberty of Thai children is correlated with improvements in overall living conditions in Thailand.

Declines in the onset age of secondary sexual development have been reported in a number of recent studies in western and Asian countries. A study of Hat-Yai school girls in 1994 in Thailand showed that the ages at thelarche and menarche were 9.9 and 12.4 years, respectively. This study was to determine whether there was a decline in the average age of puberty in Hat-Yai school girls from 1994 to 2012.A cross-sectional study was conducted in 2140 healthy Hat-Yai school girls, aged 6-18 years, from June 2011 to March 2012. Breast and pubic hair development was assessed by the Tanner staging method. Probit analysis was used to calculate the median ages of different stages of breast and pubic hair development, and the age of menarche.The median ages of girls having thelarche and menarche were 9.6 (95% CI, 9.4-9.8) and 12.2 (95% CI, 11.9-12.4) years, which declined from 9.9 (95% CI, 9.7-10.1) and 12.4 years (95% CI, 12.2-12.6) in the 1994 study respectively, however, without statistical significance. The youngest ages of girls who had breast stage 2 and menarche were 7.2 and 9.2 years, respectively. The final height at age 14 years in this cohort (157.3 cm) was 2.3 cm greater than that of girls in 1994 (155.0 cm).From 1994 to 2012, the age at onset of thelarche and menarche of girls in Hat-Yai municipality declined by 0.2 and 0.3 years, respectively. The earlier age at onset of puberty had no effect on final adult height.

Background: The Department of Pediatrics, Prince of Songkla University (PSU) with 7-10 pediatric residents per year has implied a 360-degree evaluating instrument for residency training since 2007. Objective: We determined the competency ratings of pediatric residents during their training. Methods: During 2007-2011, 23 pediatric residents finished the pediatric residency program. At each ward rotation, each pediatric resident was rated for competency skills by four different categories of raters: attending staff, nurses, medical students, and the patients’ parents. The average score of each competency given by each category of raters was calculated, and was compared to scores of multiple-choice questions (MCQ) and constructed response questions (CRQ) of Thai Board of Pediatric Examination. Results: The mean overall scores of each resident rated by the attending staff, nurses, medical students, and patients’ parents increased with year of residency training. The mean overall scores of each resident rated by attending physicians were positively correlated with the MCQ (r = 0.42, p = 0.04) and CRQ (r = 0.71, p < 0.001) scores of the Thai Board of Pediatrics Examination. Conclusion: The 360-degree assessments with ratings by attending physicians during the pediatric training are reliable for assessment the medical knowledge of the residents.

Disorders of sex development (DSD) is a group of sexual differentiation disorders resulting in genital anomalies with defects in gonadal hormone synthesis and/or incomplete genital development. These conditions result in problems concerning the sex assignment of the child. This study aims to describe the clinical features, diagnosis and management of children with DSD in southern Thailand.The medical records of 117 pediatric patients diagnosed with DSD during the period of 1991-2011 were retrospectively reviewed.Disorders of sex development were categorized into 3 groups: sex chromosome abnormalities (53.0%), 46,XX DSD (29.9%) and 46,XY DSD (17.1%). The two most common etiologies of DSD were Turner syndrome (36.8%) and congenital adrenal hyperplasia (29.9%). Ambiguous genitalia/intersex was the main problem in 46,XX DSD (94%) and 46,XY DSD (100%). Sex reassignment was done in 5 children (4.3%) at age of 3-5 years: from male to female in 4 children (1 patient with congenital adrenal hyperplasia, 1 patient with 45,X/46,XY DSD, and 2 patients with 46,XX ovotesticular DSD) and from female to male in 1 patient with 46,XX ovotesticular DSD. Of the total 20 children with 46,XY DSD, 16 (80%) were raised as females.Management of DSD children has many aspects of concern. Sex assignment/reassignment depends on the phenotype (phallus size) of the external genitalia rather than the sex chromosome.

The incidence and/or prevalence of both childhood diabetes and the percent of type 2 diabetes mellitus (T2DM) cases in children and young adolescents have been increasing worldwide. This study aimed to examine the 20-year trends of childhood diabetes in a single tertiary medical center in Southern Thailand. The medical records of pediatric diabetic patients, aged 0–15 years, diagnosed at Songklanagarind Hospital from 1995 to 2014 were retrospectively reviewed. During the 20-year period, 156 children were diagnosed with DM: 99 (63.4%) with T1DM, 43 (27.6%) with T2DM, 2 (1.3%) with neonatal diabetes, and 12 (7.7%) with secondary diabetes. The estimated incidence of new patients with diabetes per 100 000 per year doubled from 0.12 in 1995–2000, to 0.24–0.28 in 2001–2004, and further increased to 0.39–0.48 in 2005–2012 and 0.59–0.64 in 2013–2014; and also the proportion of T2DM cases increased from 10%–15% during 1995–2003 to 25%–30% during 2004–2008, and 35%–40% during 2009–2014. At the time of diagnosis, the fasting plasma glucose and glycated hemoglobin levels were significantly greater in T1DM than T2DM patients while the lipid profiles were more abnormal in T2DM than T1DM patients. The estimated incidences of both T1DM and T2DM in pediatric patients have increased markedly over the 20-year period, and also the percentage of T2DM cases, from 10%–15% in 1995 to 35%–40% in 2014.

Background:Childhood obesity is associated with abnormal glucose metabolism and type 2 diabetes mellitus (T2DM). This study evaluated the prevalence of abnormal glucose metabolism in asymptomatic obese children and adolescents, and determined the percentage of T2DM development after 3–6 years of follow-up.Methods:During 2007–2013, 177 obese children and adolescents who had normal fasting plasma glucose (FPGResults:Glucose metabolism alterations were detected in 81.4% of the participants: 63.8% with NGT-HI, 15.3% with IGT, and 2.3% with T2DM. The median levels of homeostasis model assessment-insulin resistance (HOMA-IR) in patients with IGT (8.63) were significantly greater than those in the patients with NGT (4.04) (pConclusions:Glucose metabolism alteration was commonly found among obese adolescents. Factors associated with T2DM development were greater weight status and the severity of insulin resistance as shown by higher HOMA-IR levels.

ObjectiveTo determine iodine intake and urinary iodine excretion (UIE) in a group of pregnant Thai women and the concentration of thyroid-stimulating hormone (TSH) in their neonates.DesignA prospective cohort study.SettingThree districts of Songkhla, southern Thailand.SubjectsTwo hundred and thirty-six pregnant women.ResultsA quarter of the participants lacked knowledge of iodine and the prevention of iodine deficiency, although 70 % used iodized salt. Those who did not use iodized salt stated that they had no knowledge about iodine (57 %) and no iodized salt was sold in their village (36 %). The median iodine intake in the three districts was 205–240 μg/d, with 53–74 % of pregnant women having iodine intake sd1·56) mU/l, with 8·9 % of neonates having TSH > 5 mU/l.ConclusionsThe studied women and their fetuses were at risk of mild iodine deficiency. About a quarter of the participants lacked knowledge of the importance of iodine. Education regarding the importance of iodine supplements and the promotion of iodized salt should be added to national health-care policies in order to prevent iodine-deficiency disorders, diseases that are subclinical but have long-term sequelae.

To assess the nutritional intake and gestational weight gain of pregnant women and the relationship between nutritional intake, gestational weight gain, and neonatal birth weight.A prospective cohort study was carried out in three districts of Songkhla Province in southern Thailand. Nutritional intakes were calculated based on a 24-h food record and a food frequency checklist. The women were followed until delivery and the neonatal birth weight recorded.Two hundred and thirty-six pregnant women with a mean age of 27.2 +/- 6.2 years were recruited. The average daily energy intake was 1806 +/- 482 kcal. The average gestational weight gain was 12.2 +/- 4.6 kg and the average neonatal birth weight was 3054 +/- 474 g. Micronutrient intakes were overall inadequate averaging only 50-80% of recommended levels. Neonatal birth weight was significantly positively correlated with gestational weight gain (r = 0.17, p = 0.01), but was not correlated with maternal nutritional intakes.Pregnant women in rural areas of Songkhla Province consume adequate macronutrients with appropriate gestational weight gain, but generally consume inadequate micronutrients. A nutritional education program explaining the importance of micronutrients should be a focus of a public education program.

This is the first population-based study in Thailand on the prevalence of congenital limb defects (CLD). Data were obtained from recently established birth defects registries in three southern Thailand provinces during 2009-2013. Entries in the birth defects registries included live births, stillbirths after 24 weeks gestational age, and terminations of pregnancy following a prenatal diagnosis of fetal anomaly. The total of 186 393 births recorded included 424 CLD cases, giving an average prevalence of 2.27 per 1000 births (95% CI, 2.05-2.49). The most common CLD was talipes equinovarus (44.1%), followed by polydactyly (13.9%) and syndactyly (9.4%). The prevalence significantly increased with maternal age from 1.81 in mothers aged30 years to 2.75 in mothers 30 to 35 years, and to 2.94 in mothers ≥35 years (P = 0.004). Overall 9.4% of the CLDs were syndromic CLD, again with significantly greater percentages in pregnant women aged ≥35 years than the non-syndromic CLD (32.5% vs 17.5% respectively, P = 0.03). In conclusion, the overall prevalence of CLD in the 3 southern Thailand provinces examined was 2.27 per 1000 births, and syndromic CLD was significantly higher in pregnant women aged ≥35 years than younger pregnant women.