Cataract in children and adolescents with fibrocalculous pancreatic diabetes.

Cataracts have been infrequently reported in Fibrocalculous pancreatic diabetes (FCPD) which is a form of diabetes secondary to chronic, non-alcoholic pancreatitis in tropical countries. A retrospective study was carried out to find out frequency of cataracts in children and adolescents with FCPD admitted in the Paediatric Unit at Bangladesh Institute of Research and Rehabilitation on Diabetes, Endocrine and Metabolic disorders (BIRDEM). A total of 83 patients with FCPD were admitted during the study period of 2000 to 2007. Among them twenty patients (24%) had bilateral cataracts who were enrolled in the study. Mean age at the onset of diabetes was 13.9±1.7 years. There was female preponderance. Ninety percent patients were girls. There was longer duration of symptoms in all patients. Mean duration of symptoms before diagnosis was 15.0±10.2 months. All patients had hyperglycaemia, mean HbA1c value was 18.4±5.1. Most of the patients had snowflake type cortical deposits and posterior subcapsular cataract.

Hypertriglyceridemia associated with eruptive xanthomas and lipemia retinalis in newly diagnosed diabetes mellitus.

Severe hypertriglyceridemia can cause the deposit of lipids in the dermis (eruptive xanthomas) and in the retina (lipemia retinalis). Lipemia retinalis and eruptive xanthoma are occasionally seen in patients with diabetes mellitus and are thought to be due to abnormalities in the serum lipid fractions. Here a 15 year's old girl presented with typical symptoms of diabetes with skin lesions over hands and feet. On examination skin lesions were non-tender yellow papules with creamy-colored centers on extensor surfaces of the arms, hands and feet. Ophthalmoscopic examination showed creamy white retinal vessels with a faded pinkish white retinal back ground both in the periphery and posterior pole of the retina. Laboratory findings showed a grossly lipemic serum with markedly elevated serum levels of triglycerides 8869mg/dl cholesterol 498mg/dl. Her fasting blood glucose was 20.8mmol/l, 2 hours after breakfast was 50.5mmol/l and HbA1c was 14.6%. Eruptive xanthomas and lipaemia retinalis can occur in primary and secondary hyperlipoproteinemias, therefore a careful personal and family history as well as laboratory investigations is recommended in order to detect an underlying cause.

Effect of Type 1 Diabetes Mellitus on Height, Weight and Body Mass Index in Children and Adolescents Attending a Specialized Diabetes Care Center of Bangladesh.

Growth in children is influenced by multiple factors, including endocrine diseases like diabetes mellitus (DM). Data on growth parameters in children with type 1 DM (T1DM) are scarce in Bangladesh. This cross-sectional study, aimed to evaluate the anthropometric parameters of children with T1DM, was conducted at the Changing Diabetes in Children (CDiC), Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders General Hospital-2 (BIRDEM-2), Dhaka, Bangladesh from May 2018 to April 2019. Data on anthropometric parameters (standing height, weight, body mass index [BMI]) were collected in 2 groups, Group A: 82 children with T1DM and Group B: 82 age-sex matched otherwise healthy children having no DM. The age range of the study subjects was 2-9 years; there were 43 males and 39 females in each group. Height for age Z scores (HAZ) and percentile distribution, weight for age Z (WAZ) scores and percentile distribution, body mass index (BMI), body mass for age Z scores (BAZ) and percentile distribution were calculated using the reference values suggested by Indian Association of Pediatrics. Metabolic control was evaluated by measuring glycosylated hemoglobin (HbA1c). With slight male predominance (52.44%), the mean age of Group A and Group B was 14.27±3.77 years. The percentile distribution of height for age revealed significantly higher number of stunted subjects in Group A compared to Group B, both in male and female (p<0.05). The percentile distribution of weight showed higher number of underweight subjects in Group A than in Group B, both in males and females though the difference was statistically significant (p<0.05) only in males. Incase of males, the frequency of underweight respondents (according to weight for age Z scores) was significantly higher in Group A than in Group B. The mean of height in Group A (1.48±0.2 meter) was lower than in Group B (1.57±0.16 meter) and the mean weight in Group A (47.16±15.34kg) was also lower than Group B (49.82±14.77kg), though, these differences were not statistically significant (p>0.05). The HAZ and WAZ scores were lower in Group A than in Group B both in male and female subjects, though only in male respondents the difference of WAZ was statistically significant (p<0.05). The mean difference of HbA1c level was statistically significant in between the groups both incase of weight for age distribution and body mass for age distribution (p<0.05). This study concludes that children and adolescent with T1DM were shorter and lighter compared to their non-diabetic, otherwise healthy peers.

Prevalence of obesity among affluent school children in Dhaka.

A cross sectional study was conducted in September 2006 in one of the private schools in Dhaka, Bangladesh to see the prevalence of obesity among affluent school children and adolescents. Informed consent was taken from school authority to take anthropometric measurement of all school children. Standing height was measured with a stadiometer and weight with a bathroom scale. Waist and hip circumference were measured with a measuring tape. The body mass index (BMI) was calculated using weight in kilogram/(height in meter)2 formula. Obesity was defined as BMI≥95th percentile for age and sex, over weight as BMI≥85th percentile for age and sex, normal weight as BMI between 5th and 84th percentile and underweight as BMI <5th percentile. Official centers for disease control (CDC) growth chart for boys and girls age 2-20 years was used. Children and adolescents were divided into group 1(3-5 years), Group 2(6-9years), group 3(10-13 years) and group 4(14-18 years). There were a total of 468 children and adolescents (male 266, female 202). In group 1 there were 110 children, in group 2 there were177 children, in group 3 and 4 there were 149 and 32 adolescents respectively. The prevalence of obesity was 17.9%, higher among males (19.9%), compared to females (15.3%). Obesity was highest (27.7%) in group 2, 14.5% in group 1, 10.7% in group 3 and 9.4% in group 4.

Cleidocranial dysplasia.

Cleidocranial dysplasia (CCD) is a disorder that affects mostly those bones which derived from endochrondal and intramembranous ossification, such as the cranium and the clavicles. CCD is present at a frequency of one in one million individuals. Over 500 cases have been reported. A 13 years old boy reported in the Paediatric Endocrinology outpatient department, Bangladesh Institute of Research and Rehabilitation on Diabetes, Endocrine and Metabolic Disorders (BIRDEM) on 6th April 2006 with complaints of not growing according to his age, a wide gap over the head since birth and delayed shedding of primary teeth and also eruption of secondary teeth. The boy had elongated facies with midfacial hypoplasia, depressed nasal bridge with hypertelorism. His anterior fontanelle was open about 3/1.5 cm. He had short clavicle and his shoulders could be easily apposed. Radiological findings showed anterior fontanellle and sutures were open and widened, all decidual teeth were intact and all secondary teeth were impacted beneath the primary teeth and hypoplastic clavicle. He was diagnosed as a case of Cleidocranial Dysplasia on the basis of history, clinical examination and investigation.