Effect of liraglutide on physical performance in type 2 diabetes: Results of a randomized, double-blind, controlled trial (LIPER2).

AIMS: To assess the effect of the GLP-1 analogue liraglutide on measures of cardiac function and physical performance in patients with type 2 diabetes (T2D). METHODS: In this phase-IV randomized double-blind placebo-controlled parallel-group clinical trial at a tertiary hospital, T2D patients with HbA1c levels of 7-10% with oral agents and/or intermediate-/long-acting insulin were allocated (computer-generated randomization, ratio 1:1) to either liraglutide 1.8 mg/day or a placebo for 6 months. The primary endpoint was maximum oxygen consumption (VO2max) during cycle ergometry, while other procedures included a 6-min walk test, echocardiography, anthropometry and blood tests. Safety endpoints were also monitored, and an intention-to-treat analysis was performed. RESULTS: A total of 24 patients (15 women) aged 52 (11.7) years, with diabetes duration of 8.7 (5.8) years, BMI 34.98 (6.2) kg/m2 and HbA1c 8.2% (0.68%), were randomized to liraglutide 1.8 mg daily or placebo. There were no differences in VO2max [17.98 (4.8) vs. 15.90 (4.96) mL/kg/min; P > 0.10], VE/VCO2 slope [30.18 (4.8) vs. 32 (4.49)], left ventricular ejection fraction or 6-min walk test [530.7 (86) vs. 503.9 (84) m] at 6 months. HbA1c was lower (6.7% vs. 7.7%; P = 0.005), with a trend towards lower maximum systolic blood pressure during ergometry [171.7 (24.4) vs. 192.5 (25.6); P = 0.052] in the liraglutide group at the end of the study. There were no severe adverse events. CONCLUSION: In this trial, liraglutide improved glycaemic control in T2D, but had no significant effects on either physical performance or myocardial function.

Recomendaciones sobre rehabilitación cardíaca en la cardiopatía isquémica de la Sociedad de Rehabilitación Cardio-Respiratoria (SORECAR) / Recommendations of the Cardio-Respiratory Rehabilitation Society (SORECAR) on cardiac rehabilitation in ischemic heart disease

La cardiopatía isquémica supone la mayor causa de muerte en España y en el mundo occidental. El programa de rehabilitación cardíaca engloba todas las medidas para realizar prevención secundaria en estos pacientes y mejorar la morbimortalidad. Es un programa eficaz, pero su implementación es escasa y variable, siendo inferior al 5% en España, por lo que se debería priorizar estrategias para facilitar la realización de estos programas. Un grupo de expertos fue nombrado por la Sociedad Española de Rehabilitación Cardio-Respiratoria (SORECAR) para realizar una revisión de todas las evidencias disponibles en rehabilitación cardíaca y elaborar un documento aplicándolo a la práctica clínica. El resultado ha sido la elaboración final de un protocolo de actuación en rehabilitación cardíaca, con instrucciones o recomendaciones a modo de resumen. Contiene aspectos sobre rehabilitación cardíaca para disminuir la variabilidad entre dichas Unidades y crear las bases para una adecuada acreditación de Unidades de Rehabilitación Cardíaca (AU)

Ischemic heart disease is the largest cause of death in Spain and the Western world. Cardiac rehabilitation programs encompass all the measures necessary for secondary prevention in these patients and to improve morbidity and mortality. These programs are effective, but their implementation is low and variable, being less than 5% in Spain. Consequently, priority should be given to strategies that facilitate the implementation of these programs. A group of experts was appointed by the Cardio-Respiratory Rehabilitation Society (SORECAR) to review all the available evidence on cardiac rehabilitation and apply it to develop a clinical practice document. The end result was the development of a protocol for cardiac rehabilitation, with instructions or summarized recommendations. The document discusses aspects of cardiac rehabilitation that reduce variation among these units and provides a basis for proper accreditation of cardiac rehabilitation units (AU)

La gestión de la esclerosis lateral amiotrófica / Treatment of amyotrophic lateral sclerosis

No disponible

Granuloma eosinófilo vertebral. Un caso clínico / Vertebral eosinophilic granuloma. A case report

La lesión medular es un proceso patológico que afecta a la médula espinal, produciendo pérdida de fuerza, déficit de sensibilidad por debajo del nivel de la lesión, alteración del control de los esfínteres, disfunción sexual y alteraciones en el sistema nervioso vegetativo. Su etiología es debida a causas traumáticas, congénitas o médicas. El granuloma eosinófilo es una de las formas clínicas de presentación de la histiocitosis X consiste en una lesión osteolítica solitaria, limitada al esqueleto, que afecta de forma preferente a niños y adultos jóvenes. En este artículo presentamos el caso de un niño de 12 años que ingresa en la Unidad de Lesionados Medulares del Hospital Universitario Insular de Gran Canaria por un cuadro de paraplejia secundaria a una fractura vertebral tras sufrir un traumatismo leve. Mediante pruebas de imagen y biopsia percutánea fue diagnosticado de granuloma eosinófilo en la vértebra D8

Bone marrow lesion is a pathological condition that affects the spinal cord, producing loss of force, sensitivity deficit below the lesion level, alteration of sphincter control, sexual dysfunction, and alterations in the vegetative nervous system. Its etiology is due to traumatic, congenital or medical causes. Eosinophilic granuloma is one of the clinical presentation forms of histiocytosis X and consists in a solitary osteolytic lesion, limited to the skeleton that basically affects children and young adults. In this article, we present the case of a 12 year old boy who was admitted to the Spinal Cord Injury Unit of the University Hospital Insular of Canary Islands, due to a paraplegic picture secondary to a vertebral fracture after suffering a mild traumatism. Eosinophilic granuloma of the D8 vertebra was diagnosed through imaging tests and percutaneous biopsy

Eficacia de la gabapentina en el tratamiento del dolor neuropático secundario a la lesión medular / Efficacy of the gabapentine in the treatment of the neuropathic pain due to spinal cord injury

en el tratamiento del dolor neuropático en pacientes afectos de lesión medular. Pacientes y métodos: Estudio prospectivo y comparativo en el que se incluyeron pacientes con lesión medular y dolor neuropático de acuerdo con la clasificación de Siddall y definición de la IASP, de más de tres meses de evolución y que no hubieran recibido tratamiento previo con gabapentina. Se valoraron y cuantificaron las características e intensidad del dolor neuropático y su interferencia con el sueño, así como su tolerabilidad a través de visitas seriadas. Resultados: Fueron incluidos 43 pacientes, 80,5 % varones con una edad media de 42 + 10,2 años. Se apreció mejoría en la descripción, valoración e intensidad del dolor en las escalas de Lattinen y McGill (p< 0,0001); así como en la interferencia con el sueño (p<0,0001) entre las dos visitas de seguimiento. La tolerabilidad del medicamento fue calificada como excelente en el 73,8%. Conclusiones: El tratamiento del dolor neuropático secundario a la lesión medular con gabapentina ofrece resultados satisfactorios en cuanto a la reducción de la intensidad y frecuencia del mismo; consigue disminuir la interferencia que produce en el sueño y constituye una alternativa segura, con pocos efectos secundarios

Objective: To evaluate the efficacy and tolerability of gabapentin in the treatment of neuropathic pain in patients with spinal cord injury. Patients and methods: Prospective and comparative study was designed. Individuals with spinal cord injury and neuropathic pain in accord with Siddall's classification and IASP's definition were included. The evolution of pain was longer than three moths and any patient had received previously treatment with gabapentine. Intensity and characteristic of neurophatic pain and its interference with sleep were measured and the tolerability was also assessed. Results: Fourty three patients were included, 80,5% men, 42+10,2 years aged. The results of description and intensity of pain in Lattinen and McGill scales were better (p<0,001), as also the interference with sleep (p<0,001) between the visits of control. Conclusions: The treatmet of neurophatic pain due to spinal cord with gabapentine offers satisfactory results to decrease its intensity and frecuency, to get a lower interference with sleep and it is a safe alternative with very few secundary effects

Fentanilo transdérmico en el tratamiento para el dolor neuropático del lesionado medular / Transdermal fentanyl in the treatment of neuropathic pain of spinal cord injured patient

Diseño. Estudio prospectivo, longitudinal y abierto. Objetivos. Valorar la eficacia analgésica del fentanilo transdérmico en dolor neuropático secundario a lesión medular comparándola con otros grupos de pacientes con dolor neuropático. Material y métodos. Se incluyeron pacientes con dolor neuropático afectos de lesión medular, conformándose un grupo control de enfermos amputados y afectos de un accidente cerebrovascular. Fueron registradas las características del dolor: intensidad según escala analógica visual y escala de Latineen, interferencia con el sueño y los efectos secundarios presentados. Se realizaron controles mediante visitas seriadas, monitorizándose los cambios manifestados respecto al dolor tras la administración del fentanilo transdérmico. En el estudio estadístico se emplearon la prueba de x 2 de Pearson y la prueba t, siendo considerados significativos valores de p < 0,05. Resultados. Treinta y dos pacientes fueron incluidos en el estudio, 20 lesionados medulares, 8 amputados y 4 pacientes afectos de un accidente cerebrovascular. La intensidad del dolor neuropático se redujo en ambos grupos, determinándose el descenso global en la escala analógica visual, de 7,54 a 3,8 a los tres meses (p < 0,05) y en la escala de Lattinen de 12,78 a 7,14 (p < 0,05). El descenso en la escala analógica visual fue menos intenso en el grupo de lesionados medulares, de 7,7 a 4,91 (p < 0,05), que en amputados y en pacientes con accidentes cerebrovasculares. Conclusiones. El fentanilo transdérmico es una alternativa terapéutica eficaz para el tratamiento del dolor neuropático secundario a lesión medular, si bien el descenso de intensidad del dolor es menor que en pacientes con dolor neuropático de otro origen

Design. Prospective, longitudinal and open-labeled study. Objectives. Assess analgesic efficacy of transdermal fentanyl in neuropathic pain secondary to spinal cord injury comparing it with other groups of patients with neuropathic pain. Material and methods. Patients with neuropathic pain affected by spinal cord injury were included, the control group being formed by amputee patients and those affected by cerebrovascular accident. The pain characteristics were recorded: intensity according to visual analogue scale and Lattinen scale, interference with sleep and side effects presented. Controls were conducted by seriated visits, monitoring the changes seen regarding pain after administration of transdermal fentanyl. Pearson's x 2 test and the t-test were used in the statistical study, values of p < 0.05 being considered as significant. Results. A total of 32 patients were included in the study, 20 with spinal cord injury, 8 amputees and 4 patients with cerebrovascular accident. Neuropathic pain intensity decreased in both groups, the global decrease on the visual analogue scale being determined from 7.54 to 3.8 at three months (p < 0.05) and on the Lattinen scale from 12.78 to 7.14 (p < 0.05). Decrease on the visual analogue scale was less intense in the spinal cord injured group, from 7.7 to 4.91 (p < 0.05), than in the amputees and in patients with cerebrovascular accidents. Conclusions. Transdermal fentanyl is an effective therapeutic alternative for treatment of neuropathic pain secondary to spinal cord injury although the decrease in pain intensity is less than in patients with neuropathic pain of another origin

¿Por qué sólo catorce? / No disponible

No disponible

Secondary tetraplegia due to giant-cell tumors of the cervical spine.

BACKGROUND AND PURPOSE: Giant-cell tumor of the bone is a neoplasm which rarely affects the spine, and occurs even more infrequently above the sacrum. The symptomatology depends on the tumor site, and may be attributable to a compression mechanism. Spinal cord injury is seldom a complication and tetraplegia is even more infrequent. In this paper, we present an unusual case involving a giant cell tumor. We also review its possible diagnoses and treatments. CLINICAL CASE: We present the case of giant-cell tumors in the cervical spine affecting C6 and C7, in a young woman who suffered tetraplegia due to spinal cord compression. After surgery and radiotherapy, the tumor reappeared, requiring a second operation. CONCLUSION: Early clinical diagnosis of giant-cell tumors of the spine is difficult because their development tends to go unnoticed. Imaging techniques, especially MRI, help identify them; but their diagnosis still requires histopathologic tests. Resection of the neoplasm is recommended, when possible. Curettage may allow recurrence and radiotherapy may lead to sarcomatous degeneration of the tumor.