Efecto postural de la estimulación galvánica vestibular en pacientes con enfermedad de Parkinson y camptocormia: serie de casos / Postural effect of vestibular galvanic stimulation in patients with Parkinson's disease and camptocormia: Case series

El objetivo de este trabajo es explorar el efecto postural de la estimulación galvánica vestibular (EGV) en camptocormia. Se trata de una serie de siete casos de pacientes con enfermedad de Parkinson y camptocormia que recibieron EGV. La variable resultado fue la flexión frontal del tronco (FFT), evaluada antes, inmediatamente después de la EGV y un mes después, con ojos abiertos y cerrados. También, se valoró la escala de equilibrio de Berg. La FFT después de la EGV presentó una reducción de 2,3 cm inmediatamente después de aplicar el tratamiento (p = 0,091) y de 2,7 cm un minuto después (p = 0,025). De los cinco pacientes que hicieron el seguimiento al mes, en cuatro de ellos se mantuvo el efecto o incluso, mejoró aún más (p = 0,082). No se observaron cambios en la escala de Berg. Nuestros resultados sugieren una mejora aguda en la postura después de una sesión de EGV, que disminuyó significativamente la FFT. La mayoría de los resultados tuvieron una importancia marginal probablemente debido al tamaño de la muestra.(AU)

The objective of this paper is to explore the postural effect of galvanic vestibular stimulation (GVS) in camptocormia. It is a retrospective case series of 7 Parkinson disease and camptocormia patients. Binaural monopolar GVS was administered. Main outcome variable was trunk forward flexion (TFF), assessed pre and immediately post GVS, and one month after. The TFF was assessed in the standing position, with open and closed eyes. The Berg balance scale was assessed before and 1 month after GVS. The TFF immediately after the GVS showed a reduction of 2.3 cm (p = 0.091) in the first reading, and after a 1-min stance (p = 0.025). Four of 5 patients maintained or even improved this effect a month after (p = 0.082). No changes in Berg balance scale were observed. Our results suggest an acute improvement in posture after one session of GVS, which significantly decreased TFF. Most of the results had a marginal significance due to small sample size.(AU)

[Postural effect of vestibular galvanic stimulation in patients with Parkinson's disease and camptocormia: Case series]. / Efecto postural de la estimulación galvánica vestibular en pacientes con enfermedad de Parkinson y camptocormia: serie de casos.

The objective of this paper is to explore the postural effect of galvanic vestibular stimulation (GVS) in camptocormia. It is a retrospective case series of 7 Parkinson disease and camptocormia patients. Binaural monopolar GVS was administered. Main outcome variable was trunk forward flexion (TFF), assessed pre and immediately post GVS, and one month after. The TFF was assessed in the standing position, with open and closed eyes. The Berg balance scale was assessed before and 1 month after GVS. The TFF immediately after the GVS showed a reduction of 2.3 cm (p = 0.091) in the first reading, and after a 1-min stance (p = 0.025). Four of 5 patients maintained or even improved this effect a month after (p = 0.082). No changes in Berg balance scale were observed. Our results suggest an acute improvement in posture after one session of GVS, which significantly decreased TFF. Most of the results had a marginal significance due to small sample size.

Translation and Validation of the Spanish Version of the SARC-F Questionnaire to Assess Sarcopenia in Older People.

OBJECTIVES: The revised European consensus on sarcopenia definition and diagnosis (EWGSOP2) includes the SARC-F questionnaire, the most valid and consistent sarcopenia screening tool, as the mandatory first step. Our aim was the translation, cross-cultural adaptation, and validation of the SARC-F questionnaire as a culturally-responsive Spanish-language version for the European population. STUDY DESIGN: Cross-sectional descriptive study, applying the two-step WHO methodology for translation and cross-cultural adaptation of health questionnaires, and harmonization with the Mexican-Spanish version. European Union Geriatric Medicine Society recommendations for SARC-F validation in European languages were considered. PARTICIPANTS: Outpatient clinics of a university hospital. INCLUSION CRITERIA: stable, ambulatory (including aids), community-dwelling population ≥65 years old. MAIN OUTCOME MEASURES: The self-reported 5-item SARC-F questionnaire was administered; scores ≥4 indicated sarcopenia. Sensitivity, specificity, accuracy-likelihood ratios, predictive values, and kappa statistics were calculated and consecutively compared with European Working Group on Sarcopenia in Older People (EWGSOP) and EWGSOP2 criteria. RESULTS: This Spanish version, administered in an average 70s, has adequate internal consistency (Cronbach alpha=0.779). For the validation study, 90 (43.3%) of 208 potentially eligible subjects (81.4 ± 5.9 years old, 75.6% women) were included. SARC-F identified 51 (56.7%) subjects with sarcopenia and 39 (43.3%) without the disease. Prevalence was 17.8% per EWGSOP and 25.6% per EWGSOP2 (58% accuracy and fair agreement: sensitivity, 78.3%; specificity, 50.8%). CONCLUSIONS: SARC-F is a feasible tool, suitable for bedside assessment in community-dwelling older patients. Wide diffusion of this culturally-responsible SARC-F Spanish version is expected as EWGSOP2 is adopted and sarcopenia assessment is broadly implemented in Spain.

Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild-to-moderate renal impairment.

AIM: To investigate the impact of renal function on the safety and efficacy of insulin glargine 300 U/mL (Gla-300) and insulin glargine 100 U/mL (Gla-100). MATERIALS AND METHODS: A meta-analysis was performed using pooled 6-month data from the EDITION 1, 2 and 3 trials (N = 2496). Eligible participants, aged ≥18 years with a diagnosis of type 2 diabetes (T2DM), were randomized to receive once-daily evening injections of Gla-300 or Gla-100. Pooled results were assessed by two renal function subgroups: estimated glomerular filtration rate (eGFR) <60 and ≥60 mL/min/1.73 m2 . RESULTS: The decrease in glycated haemoglobin (HbA1c) after 6 months and the proportion of individuals with T2DM achieving HbA1c targets were similar in the Gla-300 and Gla-100 groups, for both renal function subgroups. There was a reduced risk of nocturnal (12:00-5:59 am) confirmed (≤3.9 mmol/L [≤70 mg/dL]) or severe hypoglycaemia with Gla-300 in both renal function subgroups (eGFR <60 mL/min/1.73 m2 : relative risk [RR] 0.76 [95% confidence interval {CI} 0.62-0.94] and eGFR ≥60 mL/min/1.73 m2 : RR 0.75 [95% CI 0.67-0.85]). For confirmed (≤70 mg/dL [≤3.9 mmol/L]) or severe hypoglycaemia at any time of day (24 hours) the hypoglycaemia risk was lower with Gla-300 vs Gla-100 in both the lower (RR 0.94 [95% CI 0.86-1.03]) and higher (RR 0.90 [95% CI 0.85-0.95]) eGFR subgroups. CONCLUSIONS: Gla-300 provided similar glycaemic control to Gla-100, while indicating a reduced overall risk of confirmed (≤3.9 and <3.0 mmol/L [≤70 and <54 mg/dL]) or severe hypoglycaemia, with no significant difference between renal function subgroups.

Arterial spin labeling MRI is able to detect early hemodynamic changes in diabetic nephropathy.

PURPOSE: To investigate whether arterial spin labeling (ASL) MRI could detect renal hemodynamic impairment in diabetes mellitus (DM) along different stages of chronic kidney disease (CKD). MATERIALS AND METHODS: Three Tesla (3T) ASL-MRI was performed to evaluate renal blood flow (RBF) in 91 subjects (46 healthy volunteers and 45 type 2 diabetic patients). Patients were classified according to their estimated glomerular filtration rate (eGFR) as group I (eGFR > 60 mL/min/1.73 m2 ), group II (60 ≥ eGFR>30 mL/min/1.73 m2 ), or group III (eGFR ≤ 30 mL/min/1.73 m2 ), to determine differences depending on renal function. Studies were performed at 3T using a 12-channel flexible body array combined with the spine array coil as receiver. RESULTS: A 28% reduction in cortical RBF was seen in diabetics in comparison with healthy controls (185.79 [54.60] versus 258.83 [37.96] mL/min/100 g, P < 3 × 10-6 ). Differences were also seen between controls and diabetic patients despite normal eGFR and absence of overt albuminuria (RBF [mL/min/100 g]: controls=258.83 [37.96], group I=208.89 [58.83], P = 0.0018; eGFR [mL/min/1.73 m2 ]: controls = 95.50 [12.60], group I = 82.00 [20.76], P > 0.05; albumin-creatinine ratio [mg/g]: controls = 3.50 [4.45], group I = 17.50 [21.20], P > 0.05). A marked decrease in RBF was noted a long with progression of diabetic nephropathy (DN) through the five stages of CKD (χ2 = 43.58; P = 1.85 × 10-9 ). Strong correlation (r = 0.62; P = 4 × 10-10 ) was obtained between RBF and GFR estimated by cystatin C. CONCLUSION: ASL-MRI is able to quantify early renal perfusion impairment in DM, as well as changes according to different CKD stages of DN. In addition, we demonstrated a correlation of RBF quantified by ASL and GFR estimated by cystatin C. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1810-1817.

Efectos de la toxina botulínica tipo A y electroestimulación en la espasticidad flexora distal de la extremidad superior en el ictus. Ensayo clínico aleatorizado / Effects of botulinum toxin type A and electrostimulation on distal flexor spasticity of the upper limb in stroke. Randomized clinical trial

Objetivo. Determinar la eficacia de la estimulación eléctrica neuromuscular (EENM) asociada a la toxina botulínica (TB) tipo A en la función motora, capacidad funcional y espasticidad de la mano y la muñeca en pacientes con ictus crónico. Pacientes y métodos. Ensayo clinico randomizado controlado en 25 pacientes con ictus de más de 6 meses de evolución. Tras infiltración de 200 unidades de TB en la musculatura flexora de muñeca y dedos, los participantes se asignaron en dos grupos: EENM en músculos extensores (grupo 1), electroestimulación placebo (grupo 2). Evaluación a las 4 y 16 semanas de la infiltración mediante diferentes escalas de función motora (Fugl-Meyer Motor Assessment [FMA], Medical Research Council Scale [MRC], Motricity Index for Motor Impairment after stroke and dynamometry), capacidad funcional de miembro superior (Chedoke Arm and Hand Activity Inventory [CAHAI], Box and Block Test [BBT]) y tono muscular (escala modificada de Ashworth [MAS]). Resultados. A las 4 semanas, se observa mejoría significativa en: FMA 2,43 (DE 4,08) en el componente para el MS, MRC 0,22 (DE 0,42), CAHAI 4,21 y BBT 1,47 (DE 3,3), así como una reducción de la MAS 0,96 (DE 0,88) en muñeca y 1,17 (DE 1,37) en dedos. A los 4 meses se mantuvo la mejoría en la función motora respecto a los valores basales, pero no de la espasticidad. No se observaron diferencias en ninguna de las variables de función motora y capacidad funcional del MS entre los dos grupos. Conclusiones. La infiltración de TB tipo A en la espasticidad flexora distal del MS mejora la función motora, capacidad funcional y espasticidad en el ictus crónico, pero añadir EENM de la musculatura extensora de la muñeca y dedos no muestra beneficios adicionales (AU)

Objective. To evaluate the efficacy of the Neuromuscular Electrical Stimulation (NMES) associated to Botulinum Toxin (TB) type A in motor function, functional capacity and spasticity in chronic post-stroke upper limb (UL) spasticity. Patients and methods. A randomized controlled clinical trial was performed in 25 ictus patients with more than 6 months evolution. After infiltration of 200 units of TB in the flexor muscle of the finger and wrist muscles, the patients were assigned to two groups: NMES in extensor muscles (group 1) and sham-stimulation (group 2). Patients were assessed at weeks 4/16 post-injection by standard motor function scales (Fugl-Meyer Motor Assessment (FMA), Medical Research Council Scale (MRC), Motricity Index for Motor Impairment after stroke and dynamometry), UL functional capacity (Chedoke Arm and Hand Activity Inventory (CAHAI), Box and Block Test (BBT) and muscular tone (Modified Ashworth Scale (MAS)). Results. At week 4, significant improvement was observed in FMA 2.4 (SD 4.1) in UL component, MRC 0.2 (SD 0.4), CAHAI 4.2 and BBT 1.5 (SD 3.3), as well as a reduction in MAS 1.0 (SD 0.9) in the wrist and 1.2 (SD 1.4) in the fingers. At month 4, this effect was maintained in motor function but not in spasticity. No significant differences were observed in UL motor function, functional capacity between the groups. Conclusions. TB type A injection in UL distal flexor spasticity enhances motor function, functional capacity and spasticity in chronic stroke patients. Adding a program of NMES for the extensor wrist/fingers muscles does not provide any additional benefits (AU)

Deterioro de la calidad de vida en cuidadores familiares de pacientes con discapacidad por ictus: una entidad a considerar / Loss of quality of life in family caregivers of stroke patients: an entity to be considered

Objetivos. Detectar los aspectos más afectados en la calidad de vida relacionada con la salud de dichos cuidadores y conocer las posibles relaciones con variables dependientes del paciente y del cuidador. Métodos. Estudio transversal de 215 cuidadores familiares de pacientes con discapacidad por ictus (1:3 hombre/mujer, edad media 63,6 (±11,03) años). La principal variable de resultado fue la percepción de salud medida con el cuestionario Short Form 36 (SF-36). También se recogieron datos demográficos y de comorbilidad, así como variables dependientes del individuo cuidado. Las pruebas estadísticas utilizadas fueron: χ2, t-Student y el coeficiente de correlación de Spearman. Resultados. La vitalidad y la salud general fueron las dimensiones peor valoradas por todos los cuidadores. En comparación con la población general, las mujeres cuidadoras entre 45 y 54 años presentaron una disminución significativa en las subescalas de vitalidad (p=0,003), función social (p=0,01), rol emocional (p=0,038) y salud mental (p=0,002). Las mujeres cuidadoras entre 55 y 64 años también mostraron una disminución de la función social (p=0,027) y el rol emocional (p=0,024). Los hombres cuidadores no presentaron una afectación significativa de su CVRS. Conclusiones. Cuidar tiene un impacto negativo en la CVRS, especialmente para las mujeres cuidadoras de mediana edad. La presencia de depresión y dolor musculoesquelético en el cuidador, el tiempo dedicado al cuidado y la discapacidad del paciente influyen en este deterioro de la calidad de vida. Los cuidadores juegan un papel determinante en la recuperación del ictus, por lo que identificar estrategias para mejorar el manejo de la situación es útil para evitar que el rol del cuidador resulte en una pérdida de su calidad de vida(AU)

Introduction. Among stroke consequences highlights the negative impact on the informal carers’ health related quality of life (HRQoL). Objectives. To identify HRQoL dimensions most greatly affected in stroke caregivers and stablish relations with dependent variables of survivors and caregivers. Methods. Transversal study of 215 informal caregivers of stroke survivors (1:3 man/woman, mean age 63.6 (±11.03) years). Main outcome measure was health perception assessed with the Short Fom 36 (SF-36). Clinical and demographic data of stroke patients were also registered. Statistical tests used were Chi-square, t-Student test and Spearman correlation coefficient. Results. Vitality and general health were the most affected dimensions perceived by caregivers. In comparaison with the Spanish general population, female caregivers aged 45–54 years presented a significant reduction in the SF-36 subscales of vitality (p=0.003), social function (p=0.01), emotional role (p=0.038) and mental health (p=0.002). Female caregivers aged 55–64 years also showed a significant reduction in social function (p=0.027) and emotional role (p=0.024). Male caregivers did not present significant lower HRQoL. Conclusions. Caregiving experience has a negative impact on HRQoL, specially middle-aged female caregivers. Some carer physical and psychological characteristics (depression, musculoskeletal pain, time spent on caring) and survivor disability shown to influence carers outcomes. Caregivers play an important role in the recovery of stroke patients, so that the identification of strategies which help them to cope with the stroke might avoid that the role of caring results in a loss of quality of life(AU)

[Loss of quality of life in family caregivers of stroke patients: an entity to be considered]. / Deterioro de la calidad de vida en cuidadores familiares de pacientes con discapacidad por ictus: una entidad a considerar.

INTRODUCTION: Among stroke consequences highlights the negative impact on the informal carers' health related quality of life (HRQoL). OBJECTIVES: To identify HRQoL dimensions most greatly affected in stroke caregivers and establish relations with dependent variables of survivors and caregivers. METHODS: Transversal study of 215 informal caregivers of stroke survivors (1:3 man/woman, mean age 63.6 (±11.03) years). Main outcome measure was health perception assessed with the Short Fom 36 (SF-36). Clinical and demographic data of stroke patients were also registered. Statistical tests used were Chi-square, t-Student test and Spearman correlation coefficient. RESULTS: Vitality and general health were the most affected dimensions perceived by caregivers. In comparison with the Spanish general population, female caregivers aged 45-54 years presented a significant reduction in the SF-36 subscales of vitality (p=0.003), social function (p=0.01), emotional role (p=0.038) and mental health (p=0.002). Female caregivers aged 55-64 years also showed a significant reduction in social function (p=0.027) and emotional role (p=0.024). Male caregivers did not present significant lower HRQoL. CONCLUSIONS: Caregiving experience has a negative impact on HRQoL, specially middle-aged female caregivers. Some carer physical and psychological characteristics (depression, musculoskeletal pain, time spent on caring) and survivor disability shown to influence carers outcomes. Caregivers play an important role in the recovery of stroke patients, so that the identification of strategies which help them to cope with the stroke might avoid that the role of caring results in a loss of quality of life.

Análisis de la marcha a los 6 meses de una prótesis total de rodilla: evolución y correlación con variables clínicas / Gait analysis after total knee arthroplasty: evolution and correlation with clinical variables

Objetivos: Analizar los cambios en los parámetros temporoespaciales de la marcha tras la prótesis total de rodilla (PTR) y su correlación con variables clínicas. Pacientes y métodos: Estudio prospectivo en pacientes con gonartrosis severa en espera de PTR. Se realizó el análisis de la marcha (sistema Gait Mat-II) previamente a la cirugía y 6 meses después. Se recogieron las variables sexo, altura, peso, índice de masa corporal, conservación del ligamento cruzado posterior, balance articular, fuerza muscular, Knee Society Score y dolor. Los resultados prequirúrgicos y posquirúrgicos se compararon mediante el test de Student para datos apareados. Las correlaciones mediante la prueba de Pearson. Significación: p≤0,05. Resultados: Se incluyeron 54 pacientes: el 76,1% eran mujeres; edad de 71,5 (DE: 7,74) años; peso de 78,8 (DE: 13,25) kg; altura de 1,54 (DE: 0,07)m. A los 6 meses de la cirugía se observó la disminución de los siguientes tiempos: de apoyo de la extremidad intervenida (0,88 a 0,81s), de doble apoyo (0,2 a 0,17s), de paso de la extremidad intervenida (0,68 a 0,63s) y de la contralateral (0,67 a 0,63s). La velocidad aumentó de 0,62 a 0,68m/s, correlacionándose positivamente con el incremento de la fuerza de flexores y extensores de rodilla. Conclusiones: A los 6 meses de la PTR hubo cambios significativos en los parámetros temporoespaciales de la marcha. La velocidad de la marcha aumentó 0,06m/s, correlacionándose positivamente con el incremento de la fuerza muscular (AU)

Objective: To analyse changes in gait temporospatial parameters after total knee arthroplasty (TKA) and assess its correlation with clinical variables. Patients and methods: It's a prospective study. Consecutive patients awaiting TKA for severe knee osteoarthritis were recruited. Prior to surgery and 6 months postoperatively gait analysis was performed with Gait Mat II system. Other variables such as sex, weight, height, body mass index (BMI), posterior cruciate ligament (PCL) preservation, range of movement, muscular strength, Knee Society Score (KSS) and visual analogue scale (VAS) pain were registered. Statistical testing for pre-postoperative differences was done with paired t test and Pearson correlation between gait parameters and variables after TKA was performed. The significance level was p≤0,05 Results: 54 patients were involved: 76.1% women; age 71.5 years (SD 7.74); weight 78.8kg (SD 13.25); height 1.54m (SD 007). A significant reduction in stance time for treated side (0.88 to 0.81s) and double support time (0.2 to 0.17s) was observed 6 months after surgery, as step time decreased in treated (0.68 to 0.63s) and in opposite side (0.67 to 0.63s). Velocity increased from 0.62m/s to 0.68m/s (p<0.001). Significant correlation between velocity and difference in knee flexors’ and extensors’ strength was found. Conclusion: Significant changes in temporospatial gait parameters were observed 6 months after TKA. Gait velocity improved 0.06m/s, correlating positively with the increase of the muscular force (AU)

Satisfacción de pacientes y cuidadores con el programa de rehabilitación seguido tras el ictus / Patient and caregiver satisfaction with rehabilitation services after stroke

ObjetivoEvaluar la satisfacción con el programa rehabilitador del ictus de pacientes y cuidadores. Identificar los factores dependientes del propio paciente y del proceso asistencial relacionados con mayor insatisfacción en nuestra área.Material y métodosEstudio transversal en 74 pacientes ingresados en Rehabilitación con el diagnóstico de ictus (el 70,3% eran varones, con edad media de 65,4±12,2, índice de Barthel al alta de 70,5±27) desde junio de 2005 hasta junio de 2006. La satisfacción con la rehabilitación seguida durante el ingreso y el soporte al alta hospitalaria se evaluaron mediante el cuestionario de satisfacción de Pound, administrado telefónicamente 13 meses de media después del alta hospitalaria. Se entrevistó a 85 cuidadores, de los que el 71% era familiar directo (cónyuge o relación filial) y el 80,9% era de sexo femenino.ResultadosEl 52,9% de los pacientes cumplimentó el cuestionario: más del 80% refirió estar completamente satisfecho con el trato y la información recibidos durante el ingreso. En cuanto al tratamiento, el 52,7% se mostró satisfecho; la cantidad de tratamiento recibido fue el aspecto peor valorado. La menor satisfacción correspondió al soporte recibido tras el alta hospitalaria, con menos del 25% de satisfechos. Un 83,1% de cuidadores cumplimentó el cuestionario: el 74,1% estaba satisfecho con la información recibida, el 63,5% con la formación sobre el tratamiento del paciente y el 42,4% con el soporte al alta. Sólo la depresión y el tiempo de evolución tras el ictus se relacionaron con mayor insatisfacción (p<0,05).ConclusionesAunque la satisfacción de pacientes y cuidadores con la información recibida es alta, se detectan elevados porcentajes de insatisfacción con la cantidad de tratamiento recibido y el soporte social al alta hospitalaria, por lo que es necesario incluir medidas sistemáticas de información, formación y soporte al alta en el programa de rehabilitación del ictus(AU)

ObjectivesTo assess patient and caregiver satisfaction with the regular rehabilitation care after stroke. To identify patient features or aspects of the rehabilitation programme related to lower rates of satisfaction in our area.Material and methodsCross-sectional study of 74 stroke in-patients admitted from June 2005 to June 2006 (70.3% men, age 65.4±12.2 years, Barthel discharge 70.5±27). A telephone Satisfaction questionnaire (Pound 1999) was administered at 13.6±3.1 months to assess satisfaction regarding in-patient care, therapy and recovery, and services after hospital discharge. Three items addressed to caregiver satisfaction were also included. A total of 84 caregivers were identified: 71% relatives (partner or children), of which 80.9% were women.ResultsThe satisfaction questionnaire was completed by 52.9% of patients. Over 80% of interviewed patients were completely satisfied with in-patient care, and 52.7% were satisfied with therapy and recovery during admission, but more patients were dissatisfied with the amount of therapy received. The lowest rate of satisfaction was related to the services after discharge, with less than 25% of patients satisfied. A total of 83.1% of caregivers completed the questionnaire, of which 74.1% were satisfied with the information provided. Stroke educational training was given to 63.5% of caregivers, and 42.4% were given support after discharge. Only the presence of depression during admission and time passed after stroke were significantly related to patient satisfaction. (p<0.05).ConclusionsDissatisfaction with some aspects of stroke rehabilitation is considerable in our care area. Despite general patient and caregiver satisfaction regarding information provided, high dissatisfaction rates are also detected related to the amount of therapy and the social support provided after hospital discharge...(AU)

[Patient and caregiver satisfaction with rehabilitation services after stroke]. / Satisfacción de pacientes y cuidadores con el programa de rehabilitación seguido tras el ictus.

OBJECTIVES: To assess patient and caregiver satisfaction with the regular rehabilitation care after stroke. To identify patient features or aspects of the rehabilitation programme related to lower rates of satisfaction in our area. MATERIAL AND METHODS: Cross-sectional study of 74 stroke in-patients admitted from June 2005 to June 2006 (70.3% men, age 65.4 + or - 12.2 years, Barthel discharge 70.5 + or - 27). A telephone Satisfaction questionnaire (Pound 1999) was administered at 13.6 + or - 3.1 months to assess satisfaction regarding in-patient care, therapy and recovery, and services after hospital discharge. Three items addressed to caregiver satisfaction were also included. A total of 84 caregivers were identified: 71% relatives (partner or children), of which 80.9% were women. RESULTS: The satisfaction questionnaire was completed by 52.9% of patients. Over 80% of interviewed patients were completely satisfied with in-patient care, and 52.7% were satisfied with therapy and recovery during admission, but more patients were dissatisfied with the amount of therapy received. The lowest rate of satisfaction was related to the services after discharge, with less than 25% of patients satisfied. A total of 83.1% of caregivers completed the questionnaire, of which 74.1% were satisfied with the information provided. Stroke educational training was given to 63.5% of caregivers, and 42.4% were given support after discharge. Only the presence of depression during admission and time passed after stroke were significantly related to patient satisfaction. (p<0.05). CONCLUSIONS: Dissatisfaction with some aspects of stroke rehabilitation is considerable in our care area. Despite general patient and caregiver satisfaction regarding information provided, high dissatisfaction rates are also detected related to the amount of therapy and the social support provided after hospital discharge. According to these results, systematic information and training programs for patients and caregivers should be included in stroke rehabilitation, as well as providing social support at discharge.

Crecimiento, madurez y pronóstico de la escoliosis. Métodos de valoración de la madurez / Growth, maturity and prognosis of scoliosis. Maturity evaluation methods

Objetivos. Actualizar los conocimientosexistentes respecto a la relación entre el crecimiento y laevolución de la escoliosis idiopática del adolescente (EIA).Determinar la utilidad de los diferentes métodos de valoracióndel final del crecimiento.Estrategia de búsqueda. Se hicieron búsquedas en el CochraneControlled Trials Register, MEDLINE (2000 hasta marzo2009), Trip Database y en las listas de referencias de losartículos. También se consultó a expertos.Selección de estudios. Estudios de revisión y pronósticossobre la historia natural y pronóstico de las EIA, así comoestudios diagnósticos sobre métodos de evaluación de lamadurez ósea en las EIA.Síntesis de resultados y conclusiones. Las curvas torácicas,un ángulo de Cobb mayor de 25° en el momento del diagnósticoy la velocidad de progresión de la curva son losfactores que han demostrado tener más utilidad en el pronósticode las EIA. A pesar de que existen métodos de mayorfiabilidad para la estimación de la madurez ósea, en lapráctica clínica, el signo de Risser y la menarquia siguensiendo los parámetros más utilizados para valorar el estadopuberal de las pacientes con EIA(AU)

Objectives. Up-date the existing knowledgeregarding the relationship between growth and evolution of adolescent idiopathic scoliosis (AIS). Determine the utilityof the different evaluation methods at the end of thegrowth.Search strategy. Searches were made in the CochraneControlled Trials Register, MEDLINE (2000 up to March2009), Trip Database and in the list of references of the articles.Experts were also consulted.Screening of studies. Review studies and prognosis on naturalhistory and prognosis of AIS and diagnostic studies onbone maturity evaluation methods.Synthesis of results and conclusions. Thoracic curves, Cobbangle greater than 25° at the time of the diagnosis and progressionrate of the curve are the factors that have beenshown to have the most utility in the prognosis of AIS. Eventhough there are methods having greater reliability to estimatebone maturity, in the clinical practice, the Risser signand menarche continue to be the parameters used most toevaluate the pubertal status of patients with AIS(AU)

Hipoglucemia reactiva posprandial: ¿mito o realidad? / Postprandial reactive hypoglycemia: myth or reality?

La hipoglucemia reactiva posprandial se caracteriza por síntomascompatibles con hipoglucemia en situación posprandial, habitualmentedurante las 4 horas postingesta, coincidiendo con glucemiasmenores de 60 mg/dL. Esta entidad ha sido muy cuestionada, fundamentalmentedebido a los diferentes criterios utilizados para ladefinición de hipoglucemia, a la inespecificidad de la clínica y al usoinapropiado de la sobrecarga oral de glucosa. Gran parte de la confusiónse debe al procedimiento diagnóstico utilizado. Lo fundamentales la interpretación de la clínica que refiere el paciente junto conla concentración glucémica en el momento de los síntomas. La clínicareferida por los pacientes se puede poner de manifiesto condiferentes test diagnósticos. Los principales son la sobrecarga oralde glucosa, el test de desayuno hiperglucídico, la monitorizaciónambulatoria de glucemia capilar y la monitorización continua de glucosaintersticial. Inicialmente estos pacientes son tratados con unaalimentación baja en hidratos de carbono, con ingestas repartidas alo largo del día. Sin embargo, algunos de ellos necesitarán tratamientofarmacológico. Los fármacos más utilizados son los inhibidoresde las alfaglucosidasas, aunque se han utilizado otros muchos(AU)

Postprandial reactive hypoglycemia is characterized by symptomsthat are compatible with hypoglycemia in a postprandial situation,usually within 4 hours of eating, coinciding with blood sugar levelsbelow 60 mg/dl. This entity has been widely questioned, mainly dueto the different criteria used to define hypoglycemia, to the lack ofspecificity concerning its clinical manifestations and to the inappropriateuse of the glucose tolerance test. A large part of the confusionis due to the diagnostic procedure used. Most fundamental are theinterpretation of the clinical manifestations reported by the patienttogether with the blood sugar concentration at the time when thesymptoms occur. The clinical manifestations reported by the patientscan be made evident through different diagnostic tests. The maintests are the glucose tolerance test, the hyperglucidic breakfast test,ambulatory capillary blood glucose monitoring and continuous interstitialglucose monitoring. At first these patients are treated with a lowcarbohydratediet, with meals spread throughout the day. However,some of those patients will require a pharmacological treatment. Themost commonly used drugs are the a-glucosidase inhibitors, althoughmany others have been used(AU)

[Trunk control test: early predictor of gait balance and capacity at 6 months of the stroke]. / Test de control de tronco: predictor precoz del equilibrio y capacidad de marcha a los 6 meses del ictus.

INTRODUCTION: It has been challenging to establish a prognostic tool in the acute period following stroke to predict gait outcomes. The purpose of this study is to determine the relationship between trunk control and other early functional prognostic measures with equilibrium and the capacity to ambulate at six months following acute stroke. METHODS: Sixty-eight patients with stoke admitted consecutively to the Physical Medicine and Rehabilitation unit were followed prospectively. At one and two weeks following admission, the following data were collected: sex, age, type of stroke, urinary incontinence, National Institutes of Health Stroke Scale (NIHSS) and the Trunk Control Test (TCT). At six months following acute stroke, balance was assessed with the Berg Balance score, baropodometry, and computerized posturography as well as gait capacity (measured as velocity and gait ability and limits) RESULTS: This study found a significant correlation between age, sex, urinary incontinence, TCT and NIHSS at one and two weeks from onset of stroke and the results of equilibrium and gait capacity at six months (p<0.05). When the TCT is <37 in the second week following acute stroke, the Berg Balance score was found to be lower, and with worse gait characteristics (<0.001). The TCT score in the second week is predictive of the achieving functional gait at the six month endpoint (area beneath the curve 0.920). CONCLUSIONS: The TCT is a simple and quick test which may be considered as an early prognostic indicator for functional motor endpoints in the patient with stroke.

Test de control de tronco: predictorprecoz del equilibrio y capacidadde marcha a los 6 meses del ictus / Trunk control test: early predictor of gait balance and capacity at 6 months of the stroke

Introducción. Es un reto difícil establecer en las fases inicialesun pronóstico de capacidad de marcha tras sufrir un ictus. El objetivode este estudio es determinar la relación del control de tronco yotros factores de pronóstico funcional evaluados precozmente con elequilibrio y la capacidad de marcha a los 6 meses.Métodos. Se estudian prospectivamente 68 pacientes consecutivosingresados en nuestro servicio de medicina física y rehabilitación. Ala semana y a las 2 semanas del ictus se recogen los siguientes datos:sexo, edad, tipo de ictus, incontinencia urinaria, NIHSS (National Institutesof Health Stroke Scale) y el test de control de tronco (TCT). A los 6meses del ictus se mide el equilibrio (escala de Berg, baropodometría yposturografía computarizada), así como la capacidad de marcha (velocidad,grado de autonomía y ámbito).Resultados. Existe una relación significativa de la edad, sexo, incontinenciaurinaria, TCT y NIHSS a la semana y a las 2 semanas del ictuscon el equilibrio y capacidad de marcha a los 6 meses (p<0,05).Cuando el TCT es <37 en la segunda semana del ictus, a los 6 meses elvalor de Berg es menor, y la autonomía y ámbito de marcha peor(<0,001). El TCT de la segunda semana del ictus es un predictor de conseguirmarcha funcional a los 6 meses (area bajo la curva ROC 0,920).Conclusiones. El TCT es un test sencillo y rápido que puede considerarsecomo un factor pronóstico precoz de función motora finalen el ictus (AU)

Introduction. It has been challenging to establish a prognostictool in the acute period following stroke to predict gaitoutcomes. The purpose of this study is to determine the relationshipbetween trunk control and other early functional prognosticmeasures with equilibrium and the capacity to ambulate atsix months following acute stroke.Methods. Sixty-eight patients with stoke admitted consecutivelyto the Physical Medicine and Rehabilitation unit were followedprospectively. At one and two weeks following admission,the following data were collected: sex, age, type of stroke, urinaryincontinence, National Institutes of Health Stroke Scale(NIHSS) and the Trunk Control Test (TCT). At six months followingacute stroke, balance was assessed with the Berg Balancescore, baropodometry, and computerized posturography as wellas gait capacity (measured as velocity and gait ability and limits)Results. This study found a significant correlation betweenage, sex, urinary incontinence, TCT and NIHSS at one and twoweeks from onset of stroke and the results of equilibrium andgait capacity at six months (p<0.05). When the TCT is <37 in thesecond week following acute stroke, the Berg Balance score wasfound to be lower, and with worse gait characteristics (< 0.001).The TCT score in the second week is predictive of the achievingfunctional gait at the six month endpoint (area beneath the curve0.920).Conclusions. The TCT is a simple and quick test which maybe considered as an early prognostic indicator for functional motorendpoints in the patient with stroke (AU)

Calidad de vida en pacientes con amputación de extremidad inferior / Health-related quality of life in patients with lower limb amputations

Objetivos. Averiguar la calidad de vida percibida (CV) de los pacientes con amputación del miembro inferior. Conocer la relación entre factores funcionales, clínicos y sociales con la percepción de calidad de vida. Metodología.Se realiza estudio transversal en pacientes afectos de amputación de miembro inferior y que realizan controles periódicos en nuestro servicio. Las variables recogidas fueron: demográficas; sociales (convivencia, ingresos económicos, características del domicilio); clínicas: causas de amputación, lateralidad, tiempo medio de deambulación al día (TMD). Escalas de valoración funcional (Barthel y Houghton), escala de depresión de Yesavage (GDS), índice de comorbilidad de Charlson, escala cognitiva de Pfeiffer, escala de calidad de vida percibida Short Form-36 (SF-36) y valoración de estado de salud global medido con escala visual analógica (EVAsalud). Resultados. Se reclutaron un total 56 pacientes, con una edad media de 67 años. Sexo: 49 hombres y 7 mujeres. 41 unilaterales y 15 bilaterales. El 90 % de los pacientes estaban protetizados. La mediana de Houghton fue 8; Barthel 90, GDS 2, Charslon 3, Pfiffer 0, EVAsalud 63,5. Los resultados del cuestionario SF-36 fueron inferiores a la media observada en la población general, agrupados por edad. La media del componente resumen físico SF-36 fue 36,7 y del componente resumen mental 45. Se establecieron correlaciones moderadas pero significativas del SF-36 con Barthel; TMD; GDS; Charlson; Pfeiffer y características del domicilio. Conclusiones. La calidad de vida percibida de nuestra muestra es inferior a la de la población no amputada y se ve influida por factores demográficos, clínicos y sociales

Aim. This study aimed to assess health-related quality of life (HRQOL) in patients with lower limb amputation (LLA). The relationship between HRQOL and demographic, clínical, social and functional evaluation was also studied. Methods. Observational study. A cross-sectional study was conducted in patients with lower-limb amputation who had periodic controls in our service. The variables collected were demographic, social (living arrangement, income, home characteristics), clínical: causes of amputation, laterality, mean time of deambulation/day (Tdd); functional assessment scales (Barthel score and Houghton); Yesavage's Geriatric depression scale (GDS), Charlson Comorbidity index; Pfeiffer Cognitive scale, Quality of life. Short Form-36 (SF-36) and subjective score of health (visual analogical score of health; Health-VAS). Results. A total of 56 in-patients were enrolled. They had a mean age of 67 years. Gender: 49 men, 7 women; 41 were unilateral and 15 bilateral lower limb amputation. Ninety percent of the patients had prosthetic fitting. The mean Houghton values was 8, Barthel 90, GDS 2, Charlson 3, Pfiffer 0, Health-VAS 63,5. Mean physical components score SF-36 was 36,7 and mental components score 45. The quality of life correlated significantly with Barthel, Tdd, GDS, Charlson, Pfiffer and home living circumstances. Conclusions. HRQOL scores in subjects with LLA are lower than those observed in the general population. The HRQOL values are related to clinical, functional and demographic circumstances

Menarquia y signo de Risser en la escoliosis idiopática del adolescente. Algunas consideraciones críticas / Menarche and the risser sign in idiopathic scoliosis of the adolescent. Some critical considerations

Introducción. La validez del signo de Rissercomo factor predictivo continúa siendo un aspecto controvertido. Diseñamos un estudio para evaluar su evolución en el periodo perimenarquial y su utilidad en el manejo clínico y pronóstico de las escoliosis idiopáticas del adolescente (EIA).Material y método. Se trata de un estudio retrospectivo de 132 niñas con EIA. Los criterios de inclusión fueron un ángulo de Cobb 10°, una fecha de menarquia conocida y un mínimo de 4 controles durante 2 años perimenarquiales. Se consideraron 3 momentos en el seguimiento: 1 año premenarquia (máximo crecimiento de la talla), menarquia y 1 año posmenarquia (la talla tiende a estabilizarse). Las variables principales registradas fueron el signo de Risser, la velocidadde crecimiento de talla y el ángulo de Cobb, la fecha de menarquia y el ángulo de Cobb al final del seguimiento. La muestra fue dividida en 2 grupos: niñas con curvas menores y mayores de 30° al final del seguimiento.Resultados. Un año premenarquia, el 91 % de las niñas presentaba Risser 0 y no hubo diferencias entre grupos al final del seguimiento. En la menarquia, más del 75 % de las niñas aún presentaba Risser 0 o 1 a pesar de que el porcentaje de Risser 2 fue superior en curvas que alcanzaron más de 30° al final del estudio. No se observaron diferencias en la distribución del signo de Risser entre los grupos un año después de la menarquia.Conclusiones. El signo de Risser en el seguimiento de laEIA proporciona poca información adicional en el pronóstico de la escoliosis y su utilidad en la práctica clínica parece ser pobre

Introduction. The validity of the Risser sign as a predictive factor is still controversial. We have designed a study to assess its evolution in the perimenarcheal period and its usefulness in clinical management and prognosis of adolescent idiopathic scoliosis (AIS).Patients and method. A cohort of 132 girls with AIS wasstudied retrospectively. Inclusion criteria: Cobb angle 10°, well-documented date of menarche and at least 4 controls during 2 years pre-menarche. Three time-points in the follow- up were considered: 1 year pre-menarche (maximal height growth), menarche and 1 year post-menarche (height growth tends to stabilize). Main variables collected: Risser sign, height and angle growth velocity, date of menarche and Cobb value at the end of follow-up. The sample was divided in 2 groups: girls with curves less than and more than 30° atthe end of follow-up.Results. At 1 year pre-menarche, more than 91 % of thegirls had Risser 0 and no differences were observed between groups at the end of follow-up. At the time of menarche, more than 75 % of girls still presented Risser grades 0 or 1, even though the percentage of Risser grades 2 was higher in the curves 30° at the end of the study. No differences were observed in Risser sign distribution between groups at 1 year post-menarche.Conclusion. Risser signs in AIS follow-up provide little additional information in scoliosis prognoses and its usefulness in clinical practice seems to be poor

Trastornos tiroideos y diabetes / Thyroid dysfunction and diabetes mellitus

La diabetes mellitus tipo 1 (DM1) es una enfermedad autoinmunitaria que predispone a la aparición de otras similares. La combinación más frecuente es la asociación de DM1 y enfermedad tiroidea autoinmunitaria. Ambas se caracterizan por la existencia de autoanticuerpos específicos de órgano, que pueden tener un papel en el cribado de dichas enfermedades para su diagnóstico precoz. En este artículo se analizan las principales publicaciones referentes a la prevalencia de autoinmunidad tiroidea en pacientes con DM1 en diferentes grupos de edad (niños, adultos), así como en situaciones especiales (diabetes autoinmunitaria latente del adulto y embarazo). Asimismo, se analiza la significación pronóstica de la presencia de dicha autoinmunidad tiroidea, es decir, su valor predictivo de evolución a disfunción tiroidea, la influencia sobre el control metabólico y el crecimiento, y las posibilidades terapéuticas contempladas en la actualidad. Finalmente, se recogen las recomendaciones actuales referentes al cribado de estas enfermedades tiroideas autoinmunes en los pacientes con DM1

Type 1 diabetes is an autoimmune endocrine disorder that often occurs in association with other autoimmune diseases, including autoimmune thyroid disease. These diseases are associated with organ- specific autoantibodies. Using these autoantibodies to screen subjects makes it possible to diagnose both diseases, even before the clinical signs develop. In this review, the author examines major publications dealing with the prevalence of thyroid autoimmunity in type 1 diabetic patients (children and adults), as well as in other less common conditions, such as latent autoimmune diabetes in adults (LADA), and during pregnancy. Furthermore, he also analyzes the prognostic value of thyroid autoimmunity, that is, its value in predicting progression to either overt or subclinical hypothyroidism, its influence on glycemic control or on growth in terms of height and weight, and current therapeutic options. Finally, current recommendations for screening for autoimmune thyroid disease in type 1 diabetic patients are summarized

Estudio baropodométrico en el hemipléjico vascular: relación con la discapacidad, equilibrio y capacidad de marcha / Baropodomeptry Study In Vascular Hemiplegic Subject: Relationship with disability, balance and gait capacity

Objetivo. Análisis baropodométrico en hemipléjicos crónicos por accidente vascular cerebral (AVC) para evaluar su relación con medidas de equilibrio, marcha y discapacidad. Pacientes y método. Estudio descriptivo transversal en 37 hemipléjicos crónicos por AVC. En el estudio baropodométrico estático y dinámico (BAROPODÓMETRO ELECTRÓNICO MIDI-CAPTEURS S.A. BJL GROUP V. 2.08 [TWIN 99-Versión 1.02]) se analiza: área de contacto del apoyo plantar, simetría de distribución del peso corporal, presiones plantares y línea de progresión del paso. La discapacidad, equilibrio y capacidad de marcha se analizan mediante: functional independence measure (FIM), escala de Berg, velocidad de marcha, y escalas de marcha modified functional walking categories (MFWC) y scandinavian stroke scale. Resultados. La superficie apoyo relativa (SAR) del pie parético fue del 74 % respecto al sano, y se correlacionó significativamente con FIM (r 0,573), velocidad de marcha y equilibrio. La asimetría de distribución del peso corporal se correlacionó con FIM, velocidad de marcha, escala de Berg y escala MFWC. En dinámica, la superficie de apoyo plantar del paso parético fue significativamente menor (155 cm 2 frente a 139,8 cm 2, p = 0,01). El 48,6 % de los pacientes presentaron una alteración de la línea de progresión del paso del pie pléjico. La SAR dinámica en ambos pies se relacionó con FIM, Berg y velocidad de marcha. Conclusión. La asimetría en la superficie de apoyo plantar y en la distribución del peso corporal en estática, y la asimetría en la superficie de apoyo plantar en dinámica se relacionan significativamente con la discapacidad, equilibrio y capacidad de marcha en el hemipléjico vascular

Purpose. Assess static and dynamic baropodometry in chronic stroke patients. Evaluate its relationship to balance, gait and disability measurements. Patients and method. A descriptive cross-sectional study of 37 patients with chronic hemiparesis after stroke. Static and dynamic baropodometry (performed with MIDI-CAPTEURS S.A. BJL GROUP V. 2.08 ELECTRONIC PEL-38 BAROPODOMETRY SYSTEM [TWIN 99-1.02 version software]) was used to analyze plantar surface contact area, weight bearing symmetry, maximum and mean plantar pressures and gaitline. Disability, balance and gait were measured with the Functional Independence Measure (FIM), Berg Balance Scale (BBS), walking speed, Modified Functional Walking Categories (MFWC) and Scandinavian Stroke Scale (SSS). Results. Relative plantar surface in the paretic foot regarding the non-paretic side was 74 % and was significantly correlated with the Functional Independence Measure (FIM) (r 0.573), walking speed and BBS. Body weight bearing asymmetry correlated with FIM, walking speed, BBS and the MFWC. Plantar surface of paretic step was statistically smaller (155 cm 2 vs. 139.8 cm 2, p 0.01) and 48.6 % of patients showed asymmetry and abnormalities on the progression line of the paretic side. Correlation with FIM, BBS and walking speed was significant for the plantar step surface of both feet during the step. Conclusion. Plantar surface asymmetry and body weight bearing asymmetry in static standing as well as the dynamic plantar surface asymmetry along the step are significantly related with disability, balance and gait ability in stroke patients

[Short form 36 health questionnaire in hemiplegic patients 2 years after stroke]. / Cuestionario de salud Short Form 36 en pacientes hemipléjicos a los 2 años postictus.

INTRODUCTION: Many studies show that subjects with sequelae after stroke have a worse health perception in western societies. Due to the shortage of papers on the Spanish population in this regard, a study was carried out to assess health perception in hemiplegic patients 2 years after stroke in comparison with that of the general population and correlate health perception with demographic, clinical and functional variables. METHODS: Cross-sectional study of 212 community stroke survivors. The main variables collected were: health perception assessed with the Short Form 36 (SF-36), disability assessed with the motor Functional Independence Measure (FIM) and Geriatric Depression Scale (GDS). Statistical tests used: chi2, Student t test and Spearman correlation coefficient. RESULTS: In comparison with the Spanish general population, health perception in hemiplegic male stroke patients is diminished in all areas. In hemiplegic female patients, physical function is the only subscale significantly affected in all age groups. Variables related to worse health perception are: presence of depression, dependence and the belief of the need for kind of social support, A significant correlation was observed between SF-36 values and the motor FIM (r = 0.737 with physical function) and the GDS (r = -0.821 with mental health). CONCLUSIONS: Health perception in hemiplegic patients 2 years after stroke is diminished in comparison with that 348 of the general population. Factors which determine worst health perception are depression, motor dependence, need of caregiver assistance and need of social support.