OBJECTIVE -To validate fasting indices of insulin sensitivity and secretion in a diverse pediatric population against gold standard estimates from euglycemic and hyperglycemic clamps. RESEARCH DESIGN AND METHODS-A total of 31 children (mean BMI 25.1 Ϯ 4.9 kg/m 2 , mean age 8.7 Ϯ 1.4 years, 15 girls and 16 boys, 12 black and 19 white) underwent euglycemic and hyperglycemic clamps 2-6 weeks apart to derive insulin sensitivity indices (SI Eug clamp and SI Hyper clamp ). Fasting samples were used to derive the homeostasis model assessment of insulin resistance index (HOMA-IR), HOMA of percent ␤-cell function (HOMA-B%), quantitative insulin sensitivity check index (QUICKI), insulinogenic index, antilipolytic insulin sensitivity index (ISI-FFA), and C-peptide-to-insulin ratio.RESULTS -The QUICKI correlated best with SI Eug clamp (r ϭ 0.69, P Ͻ 0.05) and had greater correlations to SI Eug clamp than did either SI Hyper clamp (r ϭ 0.45, P Ͻ 0.05) or the HOMA-IR (r ϭ Ϫ0.51, P Ͻ 0.05). Both fasting insulin and the insulinogenic index correlated well with first-and steady-phase insulin secretion (r's from 0.79 to 0.86, P Ͻ 0.05). HOMA-B% was not as highly correlated (r ϭ 0.69 -0.72, P Ͻ 0.05). Fasting C-peptide-to-insulin ratio was not significantly correlated with clamp-derived metabolic clearance rate of insulin. ISI-FFA was not correlated with the degree of free fatty acid suppression obtained from the clamps.CONCLUSIONS -The QUICKI, fasting insulin, and the insulinogenic index all closely correlate with corresponding clamp-derived indices of insulin sensitivity and secretion in this diverse pediatric cohort. These results, if replicated in similarly diverse populations, suggest that estimates based on fasting samples can be used to rank order insulin secretion and sensitivity in pediatric cohorts. Diabetes Care 25:2081-2087, 2002O besity and type 2 diabetes are diseases that have assumed considerable public health importance in the 21st century in both developed and developing countries (1-3). The increased prevalence of both these conditions in children adds an added dimension of seriousness to these modern day epidemics (4). Since insulin resistance appears central to the development of the metabolic syndrome X (1,5), accurate quantification of insulin's in vivo action, secretion, and disposal is necessary. While a combination of hyperglycemic and euglycemic-hyperinsulinemic clamp studies supplies the gold standard for quantifying these parameters (6), clamp studies are expensive and difficult tests to perform and require highly trained personnel. The difficulties with obtaining sequential clamp studies are even more pronounced for young children who may have more difficulty with clamp procedure requirements.For the purpose of epidemiologic studies, several indices based on fasting blood that estimate insulin sensitivity, secretion, and disposal have been developed for adults. The homeostasis model assessment of insulin resistance index (HOMA-IR), the HOMA of percent ␤-cell function (HOMA-B%), the insulinogenic index...

Objective Early presentation and prompt diagnosis of acute appendicitis are necessary to prevent progression of disease leading to complicated appendicitis. We hypothesize that patients had a delayed presentation of acute appendicitis during the COVID-19 pandemic, which affected severity of disease on presentation and outcomes. Patients and methods We conducted a retrospective review of all patients who were treated for acute appendicitis at Morgan Stanley Children's Hospital (MSCH) between March 1, 2020 and May 31, 2020 when the COVID-19 pandemic was at its peak in New York City (NYC). For comparison, we reviewed patients treated from March 1, 2019 to May 31, 2019, prior to the pandemic. Demographics and baseline patient characteristics were analyzed for potential confounding variables. Outcomes were collected and grouped into those quantifying severity of illness on presentation to our ED, type of treatment, and associated post-treatment outcomes. Fisher's Exact Test and Kruskal-Wallis Test were used for univariate analysis while cox regression with calculation of hazard ratios was used for multivariate analysis. Results A total of 89 patients were included in this study, 41 patients were treated for appendicitis from March 1 to May 31 of 2019 (non-pandemic) and 48 were treated during the same time period in 2020 (pandemic). Duration of symptoms prior to presentation to the ED was significantly longer in patients treated in 2020, with a median of 2 days compared to 1 day (p = 0.003). Additionally, these patients were more likely to present with reported fever (52.1% vs 24.4%, p = 0.009) and had a higher heart rate on presentation with a median of 101 beats per minute (bpm) compared to 91 bpm (p = 0.040). Findings of complicated appendicitis on radiographic imaging including suspicion of perforation (41.7% vs 9.8%, p < 0.001) and intra-abdominal abscess (27.1% vs 7.3%, p = 0.025) were higher in patients presenting in 2020. Patients treated during the pandemic had higher rates of non-operative treatment (25.0% vs 7.3%, p = 0.044) requiring increased antibiotic use and image-guided percutaneous drain placement. They also had longer hospital length of stay by a median of 1 day (p = 0.001) and longer duration until symptom resolution by a median of 1 day (p = 0.004). Type of treatment was not a predictor of LOS (HR = 0.565, 95% CI = 0.357–0.894, p = 0.015) or duration until symptom resolution (HR = 0.630, 95% CI = 0.405–0.979, p = 0.040). Conclusion Patients treated for acute appendicitis at our children's hospital during the peak of the COVID-19 pandemic presented with more severe disease and experienced suboptimal outcomes compared to those who presented during the same time period in 2019. Level of Evidence III

According to adolescent and parent reports, overweight is associated with poorer QOL in adolescence, regardless of race; however, compared with overweight white adolescents, blacks report less impairment in QOL. Future research is required to determine whether differences in QOL are predictive of treatment success.