Aashima Dabas

Developing Indigenous Therapeutic Calcium Supplementation for Treating Nutritional Rickets

cooling for encephalopathy (DANCE): a safety and pharmacokinetic trial. Pediatr Res 2015. in press. 7. Ohls RK, Kamath-Rayne BD, Christensen RD, Wiedmeier SE, Rosenberg A, Fuller JA, et al. Cognitive outcomes of preterm infants randomized to darbepoetin, erythropoietin or placebo. Pediatrics 2014;133:1023-30. 8. McAdams RM, McPherson RJ, Mayock DE, Juul SE. Outcomes of extremely low birth weight infants given early high-dose erythropoietin. J Perinatol 2013;33:226-30. 9. Rogers EE, Bonifacio SL, Glass HC, Juul SE, Chang T, Mayock DE, et al. Erythropoietin and hypothermia for hypoxic-ischemic encephalopathy. Pediatr Neurol 2014;51:657-62. 10. Fauchere JC, Koller B, Tschopp A, Dame C, Ruegger CM, Bucher HU, et al. Safety of early high-dose recombinant erythropoietin for neuroprotection in very preterm infants. J Pediatr 2015;167:52-7. 11. Leuchter RH, Gui L, Poncet A, Hagmann C, Lodygensky GA, Martin E, et al. Association between early administration of high-dose erythropoietin in preterm infants and brain MRI abnormality at term-equivalent age. JAMA 2014;312:817-24. 12. Ohlsson A, Aher SM. Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2006;3:CD004863.

Pubertal onset in apparently healthy Indian boys and impact of obesity

Objective: Primary - to determine the age of pubertal onset in Indian boys. Secondary - (a) to assess the impact of obesity on pubertal timing, (b) to assess the relationship between gonadotropins and puberty. Design: Cross-sectional. Setting: General community-seven schools across New Delhi. Participants: Random sample of 1306 school boys, aged 6–17 years. Materials and Methods: Anthropometric measurement for weight and height and pubertal staging was performed for all subjects. Body mass index (BMI) was calculated to define overweight/obesity. Serum luteinizing hormone (LH), follicle stimulating hormone, and serum testosterone were measured in every sixth subject. Main Outcome Measure: Age at pubertal onset-testicular volume ≥4 mL (gonadarche) and pubic hair Stage II. Results: Median age of attaining gonadarche and pubarche was 10.41 years (95% confidence interval [CI]: 10.2–10.6 years) and 13.60 (95% CI: 13.3–14.0 years), respectively. No significant difference in the age of attainment of gonadarche was observed in boys with normal or raised BMI, though pubarche occurred 8 months earlier in the latter group. Serum gonadotropins and testosterone increased with increasing stages of puberty but were unaffected by BMI. Serum LH level of 1.02 mIU/mL and testosterone level of >0.14 ng/mL showed the best prediction for pubertal onset. Conclusion: The study establishes a secular trend of the age of onset of puberty in Indian boys. Pubarche occurred earlier in overweight/obese boys. The cutoff levels of serum LH and testosterone for prediction of pubertal onset have been established.

Height velocity in apparently healthy north Indian school children

Objective: Linear growth is best estimated by serial anthropometric data or height velocity (HV). In the absence of recent data on growth velocity, we undertook to establish normative data in apparently healthy North Indian children. Materials and Methods: Prospective longitudinal study in a representative sample of 7710 apparently healthy children, aged 3–17 years from different regions of Delhi. Height was measured at baseline and at 12 months while pubertal examination was performed at baseline in a subset of children. Results: The data on HV and puberty were available in 5635 participants (73.08%; 2341 boys and 3294 girls) and 1553 participants (622 boys; and 931 girls), respectively. The mean peak height velocity (PHV) was 7.82 ± 2.60 cm in boys seen at 12–12.9 years and 6.63 ± 1.81 cm in girls at 10–10.9 years Although late maturing boys had a greater HV than early or normal maturers, it did not vary with the age of pubertal maturation in girls. HV correlated with parental height in prepubertal boys, girls, and pubertal boys (P < 0.01) while no correlation was seen in girls. Conclusions: The study presents normal height velocities in North Indian children. A secular trend was observed in achieving PHV in both boys and girls.

Carotid intima-medial thickness and glucose homeostasis in Indian obese children and adolescents

Objective: To evaluate for subclinical atherosclerosis and its risk factors in Indian obese children. Materials and Methods: A cross-sectional, case–control study was conducted to recruit 80 children aged 6–17 years with constitutional obesity as cases and 23 age- and gender-matched controls with normal body mass index (BMI). Anthropometric and clinical evaluation was followed by biochemical analysis and body fat estimation by dual-energy X-ray absorptiometry in cases. Similar evaluation was performed for controls except laboratory parameters. Carotid intima-media thickness (CIMT) was measured with B-mode ultrasonography in both cases and controls to evaluate subclinical atherosclerosis. Results: The mean age of cases was 12.8 ± 3 years, with mean BMI of 29.2 ± 4.8 kg/m2. The mean CIMT was significantly higher in cases than controls (0.54 ± 0.13 vs. 0.42 ± 0.08; P < 0.001 across all ages). CIMT was significantly higher in participants who were hypertensive than nonhypertensive (0.6 ± 0.11 vs. 0.53 ± 0.11 mm; P = 0.04). CIMT showed a positive correlation with BMI (r = 0.23, P = 0.02), percentage body fat and fat mass index (r = 0.28 and 0.3 respectively; P < 0.001), but not with waist: hip ratio. CIMT showed significant positive correlation with blood glucose at 60 min (r = 0.22; P = 0.04), serum insulin at 60 min (r = 0.28; P = 0.01) while negative correlation with whole body insulin sensitivity (r = −0.27; P = 0.01). Conclusion: CIMT correlated significantly to blood pressure, insulin sensitivity, and body fat in Indian obese children.

Correlation of Bone Mineral Parameters with Anthropometric Measurements and the Effect of Glucocorticoids on Bone Mineral Parameters in Congenital Adrenal Hyperplasia: Correspondence

To the Editor:With reference to the recently published article on assessment of bone mineral density (BMD) in congenital adrenal hyperplasia [1], here are few remarks which need mention. Height has a significant influence on bone mass/density [2]. The relevance of including Figures 1 and 2 needs to be explained. Instead, the impact of age or fat mass on BMD in this cohort could have been analyzed. The authors have commented on significant decrease in the bone mass with increasing duration of steroid use in Table 3. The values depicted in the table show higher values in the group which received longer duration of steroids. As per assumption, was this because the mean age of children in the latter group was older which resulted in higher BMD in those receiving longer duration of steroids than younger subjects? The authors can clarify the same and provide details of analysis which support their conclusion. Alternately, a difference between the BMD of study subjects and BMD of comparative age/gender matched controls for younger ages or published Indian references for children ≥5 y [3] could have been used for comparison. Lastly, the authors may consider interpretation of bone mineral apparent density (BMAD) than BMD for the analysis to compensate for bone size [4]. Compliance with Ethical Standards

Dual ectopic thyroid: A rare entity

An 8-year-old girl was detected to have a swelling behind the tongue on incidental throat examination for cough. Intraoral examination revealed a glistening mass at the base of tongue (Fig. 1a), with absence of any palpable thyroid tissue externally. She also admitted to have odynophagia to solids for last 3 months. She was clinically euthyroid. A possibility of lingual thyroid was suspected. Her serum thyroid-stimulating hormone was elevated (46.1 mIU/mL; normal 0.27–4.2 mIU/mL), total thyroxine was low (4.2 μg/dL; normal 5.1–14.1 μg/dL) and total triiodothyronine (T3) was normal, suggestive of primary hypothyroidism. A Technetium-99m thyroid scintigraphy was done, which revealed increased tracer uptake at dual sites – both above and below hyoid bone – with absence of tracer uptake at normal thyroid site (Fig. 1b). This was followed by singlephoton emission computed tomography (SPECT) which revealed lingual thyroid tissue measuring 18 × 17.3 mm (Fig. 1c – marked with bold arrow) and an aberrant tissue 15 × 15 mm below hyoid bone, which was discontinuous with the lingual mass (Fig. 1c – marked with dotted arrow). What is it? (Answer on page 648)

Dual ectopic thyroid: A rare entity. Dual ectopic thyroid tissue.

An 8-year-old girl was detected to have a swelling behind the tongue on incidental throat examination for cough. Intraoral examination revealed a glistening mass at the base of tongue (Fig. 1a), with absence of any palpable thyroid tissue externally. She also admitted to have odynophagia to solids for last 3 months. She was clinically euthyroid. A possibility of lingual thyroid was suspected. Her serum thyroid-stimulating hormone was elevated (46.1 mIU/mL; normal 0.27–4.2 mIU/mL), total thyroxine was low (4.2 μg/dL; normal 5.1–14.1 μg/dL) and total triiodothyronine (T3) was normal, suggestive of primary hypothyroidism. A Technetium-99m thyroid scintigraphy was done, which revealed increased tracer uptake at dual sites – both above and below hyoid bone – with absence of tracer uptake at normal thyroid site (Fig. 1b). This was followed by singlephoton emission computed tomography (SPECT) which revealed lingual thyroid tissue measuring 18 × 17.3 mm (Fig. 1c – marked with bold arrow) and an aberrant tissue 15 × 15 mm below hyoid bone, which was discontinuous with the lingual mass (Fig. 1c – marked with dotted arrow). What is it? (Answer on page 648)