Pubertal Suppression, Bone Mass, and Body Composition in Youth With Gender Dysphoria.

BACKGROUND AND OBJECTIVES: Puberty onset and development contribute substantially to adolescents' bone mass and body composition. Our objective with this study was to examine the effects of gonadotropin-releasing hormone agonists (GnRHa) on these puberty-induced changes among youth with gender dysphoria (GD). METHODS: Medical records of the endocrine diversity clinic in an academic children's hospital were reviewed for youth with GD seen from January 2006 to April 2017 with at least 1 baseline dual-energy radiograph absorptiometry measurement. RESULTS: At baseline, transgender females had lower lumbar spine (LS) and left total hip (LTH) areal bone mineral density (aBMD) and LS bone mineral apparent density (BMAD) z scores. Only 44.7% of transgender youth were vitamin D sufficient. Baseline vitamin D status was associated with LS, LTH aBMD, and LS BMAD z scores. Post-GnRHa assessments revealed a significant drop in LS and LTH aBMD z scores (transgender males and transgender females) without fractures and LS BMAD (transgender males), an increase in gynoid (fat percentage), and android (fat percentage) (transgender males and transgender females), and no changes in BMI z score. CONCLUSIONS: GnRHa monotherapy negatively affected bone mineral density of youth with GD without evidence of fractures or changes in BMI z score. Transgender youth body fat redistribution (android versus gynoid) were in keeping with their affirmed gender. The majority of transgender youth had vitamin D insufficiency or deficiency with baseline status associated with bone mineral density. Vitamin D supplementation should be considered for all youth with GD.

Neonatal urinary tract infection: clinical response to empirical therapy versus in vitro susceptibility at Bahrami Children's Hospital- Neonatal Ward: 2001-2010.

Urinary tract infection (UTI) is a neonatal life threatening infection which is usually treated with ampicillin plus an aminoglycoside or a third-generation cephalosporin. Recently, growing number of Escherchia coli species resistant to ampicillin and aminoglycosides have raised concerns regarding the necessity to change the empirical therapy. This motivates us to determine neonatal UTI clinical response to the used empirical antibiotics. This study was designed as a Case Series. All neonates admitted to Bahrami Children Hospital, Tehran, Iran, during 2001- 2010 with a diagnosis of UTI surveyed by simple non-random sampling. Totally, 97 cases (including 83 (85.6%) term, 8 (8.2%) post-term and 6 (6.2%) preterm neonates) with a mean age of 15.85 ± 7.05 days at admission ,average weight of 3195.57 ± 553g at birth and 3276.29 ± 599.182 g at admission were studied. Ampicillin resistance in 93 cases (95.9%), gentamicin resistance in 51 cases (52.6%) and trimethoprim- sulfamethoxazole resistance in 44 cases (45.4%) were the leading resistances in this study. Escherichia coli was the dominant organism in 76.3% (74 patients) of study population which was resistant to ampicillin in 95.9% (71 cases). Despite the observed resistant to initial empirical regimen antibiotics (especially ampicillin), 81.4% of patients responded to empirical therapy. However, we believe till conductance of more detailed studies regarding the relationship between empirical therapy and antibiogram concordance, physicians take ampicillin-resistant E coli infection issue into accounts from the first steps of management of critically ill neonates.