Systematic review of the biological variation data for diabetes related analytes.

BACKGROUND: Objective interpretation of laboratory test results used to diagnose and monitor diabetes mellitus in part requires the application of biological variation data (BVD). The quality of published BVD has been questioned. The aim of this study was to quality assess publications reporting BVD for diabetes-related analytes using the Biological Variation Data Critical Appraisal Checklist (BIVAC); to assess whether published BVD are fit for purpose and whether the study design and population attributes influence BVD estimates and to undertake a meta-analysis of the BVD from BIVAC-assessed publications. METHODS: Publications reporting data for glucose, HbA1c, adiponectin, C-peptide, fructosamine, insulin like growth factor 1 (IGF-1), insulin like growth factor binding protein 3 (IGFBP-3), insulin, lactate and pyruvate were identified using a systematic literature search. These publications were assessed using the BIVAC, receiving grades A, B, C or D, where A is of highest quality. A meta-analysis of the BVD from the assessed studies utilised weightings based upon BIVAC grades and the width of the data confidence intervals to generate global BVD estimates. RESULTS: BIVAC assessment of 47 publications delivered 1 A, 3 B, 39C and 4 D gradings. Publications relating to adiponectin, C-peptide, IGF-1, IGFBP-3, lactate and pyruvate were all assessed as grade C. Meta-analysis enabled global BV estimates for all analytes except pyruvate, lactate and fructosamine. CONCLUSIONS: This study delivers updated and evidence-based BV estimates for diabetes-related analytes. There remains a need for delivery of new high-quality BV studies for several clinically important analytes.

Secuelas graves de la cirugía del hallux valgus: opciones quirúrgicas para su tratamiento / Serious sequellae of the hallux valgus surgery: More options for its surgical treatment

Objetivo. Se expone un procedimiento para tratar las secuelas originadas por fracaso de técnicas correctoras del hallux valgus, que producen grave acortamiento del primer radio con metatarsalgia severa y dificultad para realizar el tercer rocker. Material y métodos. El trabajo, realizado en 2 hospitales de Madrid y Barcelona, analiza los resultados clínicos y radiológicos de 40 casos, en los que predomina el sexo femenino en un 97,5%. Técnicamente consiste en realizar una artrodesis metatarsofalángica, previa distracción ósea con un minifijador externo, y posteriormente interponer un injerto óseo de cresta ilíaca, estabilizándolo con una placa o con el mismo minifijador. Resultados. El acortamiento medio preoperatoriamente fue de 2,5 cm y el alargamiento obtenido osciló entre 1,5 y 3,0 cm. La integración ósea clínica y radiológica se consiguió a los 2-4 meses, manteniéndose esta al año de seguimiento. Para valorar los resultados, se aplicaron los criterios de Blauth y Falliner en periodos intermedios y al año de la cirugía, mediante la Escala Visual Analógica (VAS score/dolor, escala 1-10) que fueron favorables en un 80%, sin modificarse en el tiempo. La tasa de fracasos fue del 7,5%; cabe destacar la no integración del injerto y la infección, que requirieron cirugía adicional. Discusión. Hay escasas publicaciones sobre graves secuelas de la cirugía del hallux valgus, tampoco hay pautas establecidas al respecto, salvo la artrodesis convencional. El problema se plantea cuando el paciente presenta grave acortamiento con metatarsalgia severa y una artrodesis metatarsofalángica directa que agravaría el problema al acortar más el primer radio. En dichos casos nuestros procedimientos están indicados (AU)

Objective. The purpose of this study is to present a method for treating the serious consequences that result from failure of corrective techniques used for hallux valgus, which produces severe shortening of the first ray, and makes it difficult to perform the third rocker. Material and methods. In this study, conducted in 2 hospitals in Madrid and Barcelona, an assessment was made of the clinical and radiological results of 40 cases, of which 97.5% were female. Technically it involves making a metatarsophalangeal arthrodesis after bone distraction with an external mini-fixation, and then inserting an iliac crest bone graft, stabilising it with a plate or the mini-fixator. Results. The pre-operative shortening was 2.5 cm. and elongation obtained was between 1.5 and 3.0 cm. Clinical and radiological bone graft integration was achieved at 2-4 months, although full integration occurred after one year. Falliner and Blauth criteria were used to evaluate the results at 6 and 12 months follow-up, and using Visual Analogue Scale (VAS score/pain, scale 1-10), being favourable in 80%, and not changing over time. The failure rate was 7.5%, which included the non-integration of the graft and infection, requiring additional surgery. Discussion. There are not many publications on the number and type of complication for hallux valgus surgery, or guidelines established, only the treatment by conventional fusion. The problem arises when the patient presents a severe shortening of the ray, and direct fusion would aggravate the insufficiency of the first ray and the transference metatarsalgia. In these cases, these procedures would be indicated (AU)

Serious sequellae of the hallux valgus surgery: More options for its surgical treatment. / Secuelas graves de la cirugía del hallux valgus: opciones quirúrgicas para su tratamiento.

OBJECTIVE: The purpose of this study is to present a method for treating the serious consequences that result from failure of corrective techniques used for hallux valgus, which produces severe shortening of the first ray, and makes it difficult to perform the third rocker. MATERIAL AND METHODS: In this study, conducted in 2 hospitals in Madrid and Barcelona, an assessment was made of the clinical and radiological results of 40 cases, of which 97.5% were female. Technically it involves making a metatarsophalangeal arthrodesis after bone distraction with an external mini-fixation, and then inserting an iliac crest bone graft, stabilising it with a plate or the mini-fixator. RESULTS: The pre-operative shortening was 2.5cm. and elongation obtained was between 1.5 and 3.0cm. Clinical and radiological bone graft integration was achieved at 2-4 months, although full integration occurred after one year. Falliner and Blauth criteria were used to evaluate the results at 6 and 12 months follow-up, and using Visual Analogue Scale (VAS score/pain, scale 1-10), being favourable in 80%, and not changing over time. The failure rate was 7.5%, which included the non-integration of the graft and infection, requiring additional surgery. DISCUSSION: There are not many publications on the number and type of complication for hallux valgus surgery, or guidelines established, only the treatment by conventional fusion. The problem arises when the patient presents a severe shortening of the ray, and direct fusion would aggravate the insufficiency of the first ray and the transference metatarsalgia. In these cases, these procedures would be indicated.