Correlation of tri-ponderal mass index with insulin-like growth factor-I and insulin-like growth factor binding protein-3 in children and adolescents.

PURPOSE: We aimed to investigate the relationship between the tri-ponderal mass index (TMI), a new indirect measure of fat mass, and insulin-like growth factor (IGF)-I/IGF binding protein (IGFBP)-3. METHODS: The study included 1,630 children and adolescents who visited Jeonbuk National University Children's Hospital. Each patient's medical record was retrospectively reviewed for age, sex, height, weight, body mass index (BMI), TMI, and IGF-1 and IGFBP-3 levels. Study participants were divided by sex and then categorized by age, BMI, and TMI. Finally, the correlations of TMI with IGF-1 level, IGF-1 standard deviation score (SDS), IGFBP-3 level, IGFBP-3 SDS, and IGF-1/IGFBP-3 ratio were investigated. RESULTS: All participants were <19 years of age. BMI correlated with IGF-1 and IGFBP-3 levels in both sexes; however, the relationship with TMI differed by sex. TMI correlated with IGF-1 and IGFBP-3 SDS in boys and with IGF-1, IGFBP-3, and IGFBP-3 SDS in girls across all ages. In boys, BMI and TMI significantly correlated with IGF-1, IGF-1 SDS, IGFBP-3, IGFBP-3 SDS, and the IGF-1/IGFBP-3 ratio in the normal-weight group. TMI also correlated with IGF-1, IGFBP-3, and IGFBP-3 SDS in the overweight group. In girls, BMI significantly correlated with IGF-1, IGF-1 SDS, IGFBP-3, IGFBP-3 SDS, and the IGF-1/IGFBP-3 ratio in the normal-weight group and with IGFBP-3 and IGFBP-3 SDS in the overweight group, while TMI correlated with IGF-1, IGF-1 SDS, and the IGF-1/IGFBP-3 ratio in the normal-weight group; with IGF-1, IGFBP-3, and IGFBP-3 SDS in the overweight group; and with IGFBP-3 SDS in the obese group. CONCLUSION: TMI may more strongly correlate with IGFBP-3 level than BMI in overweight boys and with IGFBP-3 SDS in overweight and obese girls. The correlation of IGFBP-3 SDS with TMI may be helpful for evaluating weight status in adolescent girls.

Analysis of Cause-of-Death Mortality in Children and Young Adults with Diabetes: A Nationwide 10-Year Follow-Up Cohort Study.

We examined the associations of clinical characteristics and cause-of-death patterns with mortality in children and young adults (<30 years) with diabetes. We analyzed a nationwide cohort sample from the KNHIS database using propensity score matching from a sample of 1 million people from 2002 to 2013. There were 10,006 individuals in the diabetes mellitus (DM) group and 10,006 in the control (no DM) group. The numbers of deaths were 77 in the DM group and 20 in the control group. The deaths of patients in the DM Group were 3.74 (95% confidence interval (CI) = 2.25-6.21) times higher than in the control group. Type 1 DM, type 2 DM and unspecified DM were 4.52 (95% CI = 1.89-10.82) times, 3.25 (95% CI = 1.95-5.43) times and 10.20 (95% CI = 5.24-20.18) times higher, respectively. Mental disorders were 2.08 times higher in the risk of death (95% CI = 1.27-3.40). Mortality rates have increased in children and young adults with diabetes alone. Therefore, in the future, it is necessary to identify the cause of the increased mortality rate among young diabetic people and select vulnerable groups among them so that early prevention can be achieved.

Delayed Diagnosis of Falciparum Malaria with Acute Kidney Injury.

Prompt malaria diagnosis is crucial so antimalarial drugs and supportive care can then be rapidly initiated. A 15-year-old boy who had traveled to Africa (South Africa, Kenya, and Nigeria between January 3 and 25, 2011) presented with fever persisting over 5 days, headache, diarrhea, and dysuria, approximately 17 days after his return from the journey. Urinalysis showed pyuria and hematuria. Blood examination showed hemolytic anemia, thrombocytopenia, disseminated intravascular coagulation, and hyperbilirubinemia. Plasmapheresis and hemodialysis were performed for 19 hospital days. Falciparum malaria was then confirmed by peripheral blood smear, and antimalarial medications were initiated. The patient's condition and laboratory results were quickly normalized. We report a case of severe acute renal failure associated with delayed diagnosis of falciparum malaria, and primary use of supportive treatment rather than antimalarial medicine. The present case suggests that early diagnosis and treatment is important because untreated tropical malaria can be associated with severe acute renal failure and fatality. Physicians must be alert for correct diagnosis and proper management of imported tropical malaria when patients have travel history of endemic areas.