PURPOSE: to compare cut off points corrected for age and gender (COOP) with fixed cut off points (FCOP) for fasting plasma insulin and Homeostatic model assessment-insulin resistance (HOMA-IR) for the diagnosis of IR in obese children and adolescents and their correlation with dyslipidemia. METHODS: A multicenter, cross-sectional study including 383 subjects aged 7 to 18 years, evaluating fasting blood glucose, plasma insulin, and lipid profile. Subjects with high insulin levels and/or HOMA-IR were considered as having IR, based on two defining criteria: FCOP or CCOP. The frequency of metabolic abnormalities, the presence of IR, and the presence of dyslipidemia in relation to FCOP or CCOP were analyzed using Fisher and Mann-Whitney exact tests. RESULTS: Using HOMA-IR, IR was diagnosed in 155 (40.5%) and 215 (56.1%) patients and, using fasting insulin, 150 (39.2%) and 221 (57.7%), respectively applying FCOP and CCOP. The use of CCOP resulted in lower insulin and HOMA-IR values than FCOP. Dyslipidemia was not related to FCOP or CCOP. Blood glucose remained within normal limits in all patients with IR. There was no difference in the frequency of IR identified by plasma insulin or HOMA-IR, both for FCOP and CCOP. CONCLUSION: The CCOP of plasma insulin or of HOMA-IR detected more cases of IR as compared to the FCOP, but were not associated with the frequency of dyslipidemia. As blood glucose has almost no fluctuation in this age group, even in the presence of IR, fasting plasma insulin detected the same cases of IR that would be detected by HOMA-IR.
Adolescent ; Blood Glucose ; Child ; Cross-Sectional Studies ; Diagnosis ; Dyslipidemias ; Fasting ; Humans ; Insulin Resistance ; Insulin ; Obesity ; Overweight ; Plasma

Breast Neoplasms ; diagnosis ; Female ; Humans ; Rhabdomyosarcoma ; diagnosis

PURPOSE: To compare pupil-size determination using a digital camera with the Rosenbaum-pupil-comparison and the millimeter-ruler methods. METHODS: The pupil size of 30 eyes of 15 medical students with a mean age of 27 years was measured by two examiners using a digital camera, Rosenbaum pupil comparison, and direct millimeter rule. Both examiners determined the mean pupil sizes for bright, dim, and dark settings. RESULTS: The mean pupil size as measured by both examiners at bright and dim light conditions was 5.6 mm (range 4.5 to 7.5) and 6.3 mm (range 4.5 to 8.0) respectively. The mean measurement for both examiners for dark is 7.0 (range 6.5 to 7.5). Only the digital camera was able to measure in dark setting with mean of 7.0 mm (range 6.5 to 7.5) for both examiners. Inter-examiner difference was lowest for the digital photography in all simulated settings. CONCLUSION: The use of digital camera in determining pupil size was comparable to Rosenbaum chart and direct millimeter rule with lower inter-examiner differences.
Human ; Adult ; EYE ; PUPIL ; PHOTOGRAPHY

Displaced fracture of the distal third of the clavicle usually occurs after direct trauma to the shoulder and typically results in superior displacement of the proximal fragment. We report a previously undescribed case of downward displacement of the clavicle caused by a fall on an outstretched hand, and we suggest the mechanism of injury.

Displaced fracture of the distal third of the clavicle usually occurs after direct trauma to the shoulder and typically results in superior displacement of the proximal fragment. We report a previously undescribed case of downward displacement of the clavicle caused by a fall on an outstretched hand, and we suggest the mechanism of injury.

No abstract available.
Dislocations* ; Thumb*

Functional gastrointestinal disorders (FGIDs) are classified as a combination of persistent gastrointestinal symptoms. The Rome IV criteria can elucidate several factors in the pathogenesis of FGIDs. The frequency of FGIDs can differ between clinical and nonclinical settings and between geographic regions. To determine the global prevalence of FGIDs in neonates and toddlers according to the Rome IV criteria. We included cohort and descriptive observational studies reporting the prevalence of FGIDs according to the Rome IV criteria in children aged 0–48 months. We searched the Medline, Embase, Lilacs, and CENTRAL databases from May 2016 to the present day. Furthermore, unpublished literature was searched to supplement this information. The Strengthening the Reporting of Observational Studies in Epidemiology statement was used to evaluate the risk of bias. A meta-analysis of the proportions was performed using MetaProp in R. The results are reported in forest plots. We identified and analyzed 15 studies comprising 48,325 participants. Six studies were conducted in Europe, three in Latin America, two in North America, and four in Asia.Most participants were 12–48 months old (61.0%) and were recruited from the community.The global prevalence of FGIDs was 22.0% (95% confidence interval, 15–31%). The most common disorder was functional constipation (9.0%), followed by infant regurgitation syndrome (8.0%). Its prevalence was higher in the Americas (28.0%). FGIDs, as defined by the Rome IV criteria, are present in 22% of children, and the most common primary disorder is functional constipation. A higher prevalence of FGIDs has been reported in America.

A five-year review of anorectal complications seen following radiotherapy for cervical carcinoma was done with the following objectives: 1) to present the profile of patients presenting with anorectal complications following radiation treatment for cervical cancer; 2) to describe the manifestations of these complications and findings on proctosigmoidoscopy with biopsy; and 3) to present the approaches in their management. A total of 116 patients, all with confirmed diagnosis of cervical cancer, were seen over this period. Mean age was 49.5 years. All received external beam cobalt and intracavitary radium. Complications were observed from 10 days to 20 months after treatment. Anal bleeding was the most common complaint (62%), followed by rectovaginal fistula (14%). Residual/recurrent malignancy was noted in seven patients (6%). Treatment modalities varied considerably, ranging from conservative and symptomatic treatment for bleeding, pain, constipation, and diarrhea, to major abdominal procedures for rectovaginal fistula

Human ; Rectovaginal Fistula ; Constipation ; Sigmoidoscopy ; Uterine Cervical Neoplasms ; Cobalt ; Pain ; Biopsy ; Diarrhea ; Anus Diseases