BackgroundContinuous Glucose Monitoring (CGM) has become an increasingly investigated tool, especially with regards to monitoring of diabetic and critical care patients. The continuous glucose data allows the calculation of several glucose variability parameters, however, without specific application the interpretation of the results is time-consuming, utilizing extreme efforts. Our aim was to create an open access software [Glycemic Variability Analyzer Program (GVAP)], readily available to calculate the most common parameters of the glucose variability and to test its usability.MethodsThe GVAP was developed in MATLAB® 2010b environment. The calculated parameters were the following: average area above/below the target range (Avg. AUC-H/L); Percentage Spent Above/Below the Target Range (PATR/PBTR); Continuous Overall Net Glycemic Action (CONGA); Mean of Daily Differences (MODD); Mean Amplitude of Glycemic Excursions (MAGE). For verification purposes we selected 14 CGM curves of pediatric critical care patients. Medtronic® Guardian® Real-Time with Enlite® sensor was used. The reference values were obtained from Medtronic®’s own software for Avg. AUC-H/L and PATR/PBTR, from GlyCulator for MODD and CONGA, and using manual calculation for MAGE.ResultsThe Pearson and Spearman correlation coefficients were above 0.99 for all parameters. The initial execution took 30 minutes, for further analysis with the Windows® Standalone Application approximately 1 minute was needed.ConclusionsThe GVAP is a reliable open access program for analyzing different glycemic variability parameters, hence it could be a useful tool for the study of glycemic control among critically ill patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12938-015-0035-3) contains supplementary material, which is available to authorized users.

BackgroundContinuous glucose monitoring (CGM) originally was developed for diabetic patients and it may be a useful tool for monitoring glucose changes in pediatric intensive care unit (PICU). Its use is, however, limited by the lack of sufficient data on its reliability at insufficient peripheral perfusion. We aimed to correlate the accuracy of CGM with laboratory markers relevant to disturbed tissue perfusion.Patients and MethodsIn 38 pediatric patients (age range, 0–18 years) requiring intensive care we tested the effect of pH, lactate, hematocrit and serum potassium on the difference between CGM and meter glucose measurements. Guardian® (Medtronic®) CGM results were compared to GEM 3000 (Instrumentation laboratory®) and point-of-care measurements. The clinical accuracy of CGM was evaluated by Clarke Error Grid -, Bland-Altman analysis and Pearson’s correlation. We used Friedman test for statistical analysis (statistical significance was established as a p < 0.05).ResultsCGM values exhibited a considerable variability without any correlation with the examined laboratory parameters. Clarke, Bland-Altman analysis and Pearson’s correlation coefficient demonstrated a good clinical accuracy of CGM (zone A and B = 96%; the mean difference between reference and CGM glucose was 1,3 mg/dL, 48 from the 780 calibration pairs overrunning the 2 standard deviation; Pearson’s correlation coefficient: 0.83).ConclusionsThe accuracy of CGM measurements is independent of laboratory parameters relevant to tissue hypoperfusion. CGM may prove a reliable tool for continuous monitoring of glucose changes in PICUs, not much influenced by tissue perfusion, but still not appropriate for being the base for clinical decisions.

The efficiency of each question in the mathematics written final exam is not recorded by the institutions organizing the graduation exam. In order to overcome this deficiency the committee of final exams in mathematics and the Hungarian Educational Authority ask schools to send-beyond the total marks obtained on the paper-the scores of each question of all individual candidates to the Authority every year since 2012. Because a high proportion of schools complied with this request between 2012 and 2015, the researchers were provided valuable information for a deeper analysis on the effectiveness of exams. In this paper we have carried out an analysis of the efficiency of questions set in the written examination papers both on the intermediate and on the higher level in the last four years, on the basis of these voluntary data reports.

A kritikus állapotú betegek stressz-hyperglykaemiájának értékelése az elmúlt évtizedben jelentősen megváltozott. A vércukor szoros kontrolljának mortalitást csökkentő hatását igazolta több jelentős vizsgálat, ugyanakkor az ezt célzó inzulinkezelés megnöveli a hypoglykaemia kockázatát, amely független mortalitási tényező lehet. A hypoglykaemia szempontjából kiemelt jelentőségű a gyermekpopuláció, a fejlődő idegrendszer miatt. Ezek alapján joggal merül fel a vércukorváltozások intenzív osztályos monitorizálásának igénye, különösen gyermek betegeknél. A hagyományos, vérmintából történő vércukor-meghatározások nem tesznek lehetővé kellően szoros monitorizálást. A cukorbetegek számára kifejlesztett, a szövet közti glükóz meghatározásán alapuló módszerek (continuous glucose monitoring) jó alternatívát jelenthetnek az intenzív osztályos monitorizálásra, amennyiben felmérjük a rendszer korlátait. A mérés a szövet közti folyadékban történik, így a szöveti perfúzió változásai zavarhatják a pontosságát. A folyamatos glükózmonitoring módszer intenzív osztályos alkalmazását jelenleg még nem javasolják, amíg a rendszer megbízhatóságáról nem áll rendelkezésre elegendő adat. Összefoglaló közleményükben a szerzők a magyar klinikai gyakorlatban elterjedt Medtronic folyamatos szubkután glükózmonitorizáló rendszert értékelik, részben saját eredményeik alapján. Orv. Hetil., 2013, 154, 1043-1048 Kulcsszavak: intenzív terápia, hyperglykaemia, hypoglykaemia, szöveti glükóz monitorizálása, CGM Role of continuous subcutaneous glucose monitoring in intensive careCritical care associated with stress hyperglycaemia has gained a new view in the last decade since the demonstration of the benefi cial effects of strong glycaemic control on the mortality in intensive care units. Strong glycaemic control may, however, induce hypoglycaemia, resulting in increased mortality, too. Pediatric population has an increased risk of hypoglycaemia because of the developing central nervous system. In this view there is a strong need for close monitoring of glucose levels in intensive care units. The subcutaneous continuous glucose monitoring developed for diabetes care is an alternative for this purpose instead of regular blood glucose measurements. It is important to know the limitations of subcutaneous continuous glucose monitoring in intensive care. Decreased tissue perfusion may disturb the results of subcutaneous continuous glucose monitoring, because the measurement occurs in interstitial fl uid. The routine use of subcutaneous continuous glucose monitoring in intensive care units is not recommended yet until suffi cient data on the reliability of the system are available. The Medtronic subcutaneous continuous glucose monitoring system is evaluated in the review partly based on the authors own results. Orv. Hetil., 2013, 154, 1043-1048. Ennek kialakulásában szerepet játszanak a stressz hatá-sára létrejövő hormonális és celluláris változások. Szív-

Background and aims: Nutritional support may improve outcome during Pediatric Intensive Care Unit (PICU) stay, but guidelines are limited and based on consensus rather than evidence. Aims: We aimed to study current practice in nutritional management of PICUs worldwide. Methods: An online questionnaire, composed of 59 questions, was distributed to members of the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS). The IRB waived the need for informed consent. Results: We analysed 189 questionnaires accounting for 89000 admissions in 156 PICUs covering 52 countries. A nutritional protocol and nutrition support team (NST) are present in respectively 52% and 57% of PICUs. Presence of a NST is associated with number of beds and admissions. Energy requirements are based on various equations and few PICUs use indirect calorimetry (14%). Lipid targets range from < 1.5 to > 3.5 g/ kg/day, protein targets from 0.9 to 3 g/kg/day. Glucose administration during the first 24 hours varies from <2 to >10 mg/kg/min. Enteral nutrition (EN), preferably by gastric tube (68-88%), is started within 24 hours after admission in 60% of the PICUs. In 55% of the PICUs parenteral nutrition (PN) is started within 48 hours in patients intolerable to EN. Insufficient EN, providing < 50% or < 80% of target calories, is respectively supplemented with PN in 48% and 24% of PICUs. Conclusions: Nutritional practices, in terms of requirements, timing and route, are highly variable in PICUs worldwide. Even the limited available guidelines are not consistently followed. The potential impact on outcome warrants uniform evidence based guidelines with consistent implementation.