Blood glucose monitoring in critically ill adult patients: type of sample and method of analysis. Systematic review and meta-analysis.

INTRODUCTION: The clinical guideline for the management of sepsis, recommends using arterial blood samples for glycaemic control. A multicentre study in 86 Spanish intensive care units (ICU) revealed that 85.4% of ICUs used capillary puncture. OBJECTIVE: To analyse the reliability of glycaemia by comparing different blood samples (arterial, venous, capillary) and instruments (glucometers, gasometers, central laboratory). Secondarily, to estimate the effect of confounding variables and the performance of measuring instruments as determined by different quality standards. METHODOLOGY: Systematic review and meta-analysis with search in PubMed, CINAHL and Embase databases in September-2021 and September-2022, with no time or language limits. Grey literature sources: DART-Europe, OpenGrey and Google Scholar. Results summarised by qualitative (description of results, study characteristics) and quantitative (meta-analysis to assess standardised mean difference) synthesis. Methodological quality of articles assessed with Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). PROTOCOL: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP. RESULTS: A total of 32 articles and 5451 patients were included. No discrepancies were obtained between arterial glucometer vs laboratory samples [bias (95%CI): 0.01 (-0.12 to 0.14) mg/dL]. In contrast, arterial samples with a gasometer did significantly overestimate [bias (95%CI): 0.12 (0.01 to 0.24) mg/dL]. The same trend is seen in capillaries with a glucometer, although not significantly [bias (95%CI): 0.07 (--0.02 to 0.15) mg/dL]. There is discrepancy between studies on the effect of haematocrit and acid-base balance. The greatest consensus is on the poor agreement of glucometer with capillary vs laboratory samples in the presence of shock and vasopressor support, renal failure or during vitamin C treatment. CONCLUSIONS: The evidence to date recommends the use of arterial blood with a blood glucose meter for better reliability of glycaemic analysis and less effect of possible confounding variables, frequently present in the critically ill adult patient.

Alopecia frontal fibrosante: estudio retrospectivo de 75 pacientes / Frontal Fibrosing Alopecia: A Retrospective Study of 75 Patients

ANTECEDENTES Y OBJETIVO: La alopecia frontal fibrosante (AFF) es un tipo de alopecia cicatricial cuya incidencia está en aumento. Detallamos las características demográficas y clínicas, y los tratamientos utilizados en los pacientes con AFF atendidos en la consulta de tricología de un hospital de complejidad intermedia. MATERIAL Y MÉTODO: Se recopilaron de forma retrospectiva los datos de todos los pacientes diagnosticados de AFF atendidos en la consulta de Tricología del Hospital Universitario Infanta Sofía desde mayo de 2016 hasta mayo de 2018. Se evaluó la asociación entre la gravedad, el patrón clínico y la necesidad del tratamiento oral con el resto de las características de los pacientes. RESULTADOS: Se incluyeron un total de 75 pacientes (73 mujeres y 2 varones). El diagnóstico en la mayoría de los casos fue clínico, y se realizó estudio histológico en 13 pacientes (17,3%). La mediana de la edad de inicio del cuadro fue de 61 [12] años. En 70 casos (93,3%) se observó afectación de las cejas y en 7 pacientes (9,6%) se objetivaron signos de liquen orogenital. Asociaban hipotiroidismo 11 casos (14,7%) y en 15 (20,0%) se observaron signos de rosácea. Solo 5 (21,7%) de los pacientes con patrón lineal presentaban retroceso grave. En los pacientes inestables y/o sintomáticos (24 casos) se instauró tratamiento oral (con inhibidores de la 5 alfa reductasa, hidroxicloroquina, corticoides o isotretinoína) o intralesional con corticoides, logrando la estabilización en 18 pacientes (75,0%). Un total de 10 pacientes de los 15 que presentaban signos de rosácea, y 10 de los 20 pacientes que presentaban pápulas faciales precisaron tratamiento sistémico. CONCLUSIÓN: La mayoría de nuestros pacientes son mujeres posmenopáusicas. Hemos encontrado un aumento de la proporción de casos con un liquen orogenital en relación con la población general, y una menor gravedad en los pacientes con un patrón lineal. Se ha objetivado la presencia de pápulas faciales con más frecuencia en pacientes más jóvenes, y una mayor probabilidad de necesitar tratamiento oral en los pacientes con rosácea y con pápulas faciales

BACKGROUND AND OBJECTIVE: Frontal fibrosing alopecia is an increasingly common form of scarring alopecia. The aim of this study was to describe the demographic and clinical characteristics of patients with FFA seen at the trichology unit of a medium-sized regional hospital and to report on treatments used. MATERIAL AND METHOD: We reviewed the medical records of all patients with FFA seen at the trichology unit of Hospital Universitario Infanta Sofía in Madrid, Spain between May 2016 and May 2018. We analyzed associations between disease severity, clinical patterns, need for oral medications, and other characteristics. RESULTS: Seventy-five patients (73 women and 2 men) were studied. Diagnosis was clinical in most cases and 13 cases (17.3%) were confirmed histologically. Median (interquartile range) age at reported onset of symptoms was 61 (12) years. Involvement of the eyebrows was recorded in 70 patients (93.3%) and signs of oral and genital lichen planus in 7 (9.6%). Eleven patients (14.7%) had hypothyroidism and 15 (20.0%) had signs of rosacea. Only 5 of the patients who presented a linear pattern (21.7%) had severe hairline recession. Patients with unstable and/or symptomatic disease (n = 24) were treated with oral medications (5-alpha reductase inhibitors, hydroxychloroquine, corticosteroids, and isotretinoin) or intralesional corticosteroids. Eighteen patients (75.0%) achieved disease stability. Ten of the 15 patients with signs of rosacea and 10 of those with facial papules required systemic treatment. CONCLUSION: Most of the patients in this series of FFA were postmenopausal women. The prevalence of oral and genital lichen planus was higher than that observed in the general population. Patients with a linear pattern had less severe disease. Facial papules were more common in younger patients and both facial papules and rosacea were associated with a greater need for oral treatment

Adaptación cultural y validación al castellano del cuestionario National Eye Institute Visual Function Questionnaire 25 / Crosscultural adaptation and validation into Spanish of the questionnaire National Eye Institute Visual Function Questionnaire 25

INTRODUCCIÓN: Los avances en medicina han contribuido al aumento del promedio de vida, existiendo un mayor número de pacientes crónicos. Esto hace que la evaluación de la calidad de vida de los pacientes en varios aspectos, entre ellos el relacionado con su visión, haya adquirido una especial importancia. OBJETIVO: Validación de la traducción y adaptación cultural al castellano de uno de los cuestionarios de calidad de vida relacionada con la visión más ampliamente empleados. Se ha buscado que el cuestionario en castellano sea equivalente semántica y conceptualmente, así como de contenido técnico y de criterio que el ya validado en inglés. MÉTODO: Estudio observacional analítico de una cohorte de pacientes en los que se ha analizado la calidad de vida relacionada con la visión. El estudio se ha desarrollado en 2 fases, una primera de traducción y adaptación cultural al castellano del cuestionario NEI VFQ-25 y, la segunda, de estudio psicométrico de la fiabilidad y validez de la escala en la versión en castellano. RESULTADOS: El análisis de fiabilidad y validez refleja que la traducción y adaptación cultural cumple con los requisitos esperados y ha sido bien aceptada por los usuarios. CONCLUSIÓN: Se puede disponer de un cuestionario validado en castellano para evaluar la calidad de vida en pacientes con enfermedades crónicas como la degeneración macular asociada a la edad

INTRODUCTION: Advances in medicine have contributed to a higher average life expectancy, as well as an increasing number of chronic diseases patients. This longevity means that the assessment of the quality of life, particularly that related to vision, has become very relevant. OBJECTIVE: The validation of the translation and cross-cultural adaptation into Spanish of one of the most widely used vision-related quality of life questionnaires. It has sought to ensure that the Spanish version of the questionnaire was equivalent in semantic, conceptual, and technical content and criteria level, compared to its already validated English version. METHOD: An analytical observational study was conducted using a cohort of patients, in whom their quality of life related to vision was analysed. The study was developed in two steps; the first was the translation and cross-cultural adaptation to Spanish of the NEI VFQ-25 questionnaire. The second one was the psychometric study of the reliability and validity of the scale of the Spanish version. RESULTS: The analysis of the terms of reliability and validity showed that the translation and cross-cultural adaptation met the expected requirements and was well accepted by users. CONCLUSION: There is now a possibility of having a Spanish validated questionnaire available to assess the quality of life related to vision in patients with chronic diseases, such as age-related macular degeneration

Respuesta a: Intervalos de confianza para el coeficiente kappa en Sánchez-Sánchez et al / Response to: Confidence intervals for Kappa coefficient in Sánchez-Sánchez et al

No disponible