INDIAN PEDIATRICS 64 VOLUME 57 __ JANUARY 15, 2020 RESEARCH LETTER DEVI DAYAL 1 , JAIVINDER YADAV 1* , KEERTHIVASAN SEETHARAMAN 1 , ANSHITA AGGARWAL 2 AND RAKESH KUMAR 1 Departments of 1 Pediatrics and 2 Endocrinology, PGIMER, Chandigarh, India. *jai1984yadav@gmail.com REFERENCES 1. Latronico AC, Brito VN, Carel JC. Causes, diagnosis, and treatment of central precocious puberty. Lancet Diabetes Endocrinol. 2016;4:265-74. 2. Atta I, Laghari TM, Khan YN, Lone SW, Ibrahim M, Raza J. Precocious puberty in children. J Coll Physicians Surg Pak. 2015;25:124-8. 3. Bajpai A, Sharma J, Kabra M, Kumar Gupta A, Menon PSN. Precocious puberty: clinical and endocrine profile and factors indicating neurogenic precocity in Indian children. J Pediatr Endocrinol Metab. 2002;15:1173-81. 4. Cisternino M, Arrigo T, Pasquino AM, Tinelli TABLE I PATIENT CHARACTERISTICS ACCORDING TO SEX AND TYPE OF PRECOCIOUS PUBERTY (N=55) Characterisitics Males Females Central (n=15) Peripheral (n=4) Central (n=19) Peripheral (n=10) Incomplete (n=7) Age at onset, y 3.0 (3.2) 3.3 (3.7) 5.2 (2.5) 3.3 (1.9) 4.5 (3.2) Age at diagnosis, y 3.6 (3.7) 3.4 (3.7) 5.8 (2.7) 4.3 (2.9) 6.4 (2.2) Delay in diagnosis, y 0.6 (1.2) 0.2 (0.2) 0.7 (0.7 1.0 (1.6) 1.8 (2.8) BA advancement, y 4.1 (4.0) 5.6 (2.2) 4 (2.6) 2.6 (2.6) 1.2 (1.7) Height Z-scores 1.2 (1.9) -0.03 (2.8) 1.5 (1.4) 0.3 (1.7) 0.6 (0.6) Basal LH, IU/L 4.1 (4.3) 0.1 (0.0) 2.7 (2.5) 0.3 (0.4) 0.2 (0.2) Basal FSH, IU/L 3.0 (5.7) 0.3 (0.2) 4.2 (2.0) 1.6 (2.1) 2.4 (0.8) *Etiology Idiopathic (7), Adrenal tumor (1), Idiopathic (12), CAH (4), Isolated thelarche Hypothalamic hamar- CAH (2), Hypothalamic Ovarian cyst (2), (4), Isolated toma (3), Hydro- Hypo-thyroidism hamartoma (1), Hypothyroidism (2), pubarche (3) cephalus (3), Mega (1) Hydrocephalus (2), McCune-Albright cisterna magna (1), Radiation-induced (2), syndrome (1), Brain tumor (1) Brain tumor (2) Adrenal tumor (1) All values in mean (SD); BA: bone age; CAH: Congenital adrenal hyperplasia; FSH: follicle stimulating hormones; LH: leutinizing hormone; *number of cases in parenthesis. C, Antoniazzi F, Beduschi L, et al. Etiology and age incidence of precocious puberty in girls: a multicentric study. J Pediatr Endocrinol Metab. 2000;13:695-701. 5. Rohani F, Salehpur S, Saffari F. Etiology of precocious puberty, 10 years study in Endocrine Reserch Centre (Firouzgar), Tehran. Iran J Reprod Med. 2012;10:1-6. 6. Kumar M, Mukhopadhyay S, Dutta D. Challenges and controversies in diagnosis and management of gonadotropin dependent precocious puberty: An Indian perspective. Indian J Endocr Metab. 2015;19:228-35. 7. Dayal D, Aggarwal A, Seetharaman K, Muthuvel B. Central precocious puberty complicating congenital adrenal hyperplasia: North Indian experience. Indian J Endocr Metab. 2018;22:858-9. 8. Güven A, Nurcan Cebeci A, Hancili S. Gonadotropin releasing hormone analog treatment in children with congenital adrenal hyperplasia complicated by central precocious puberty. Hormones (Athens). 2015;14: 265-71. Nutritional Rickets with Severe Complications in Syrian and Iraqi Refugee Children We investigated the presence of nutritional rickets in Syrian and Iraqi refugee infants who presented to hospital in Turkey in 2017. 25(OH)D levels were examined in 77 refugee children. Nutritional rickets was diagnosed in 22 (28.5%) children; 11 patients with rickets did not follow up. Keywords: Management, Prevalence, Vitamin D. The civil war in Syria in recent years has caused an enormous refugee crisis [1]. Nearly 4 million people have entered Turkey. Over 90% of whom are Syrian refugees. There are 142 thousand Iraqi refugees in Turkey [2]. In our country, routine use of a daily 400 IU vitamin D supplement is recommended for infants. Vitamin D has been provided free of charge to all infants during their first year since 2005 [3]. Syrians and Iraqi refugees benefit from health services free of charge if they register. This study aimed to investigate the presence of nutritional rickets in Syrian and Iraqi refugee infants who presented to our hospital.