Diabetic polyneuropathy may increase the handicap related to vestibular disease.

BACKGROUND AND AIMS: We undertook this study to assess the influence of diabetic peripheral neuropathy on self-reported disability and postural control during quiet stance of patients with peripheral vestibular disease, before and after a standardized program of vestibular rehabilitation (Cawthorne & Cooksey exercises). METHODS: Twenty patients with peripheral vestibular disease participated in the study (mean age 56+/-7.8 years), 10 with and 10 without peripheral neuropathy (age matched). The Dizziness Handicap Inventory and static posturography (eyes open/closed and firm/soft surface) were evaluated prior to rehabilitation and at week 7 of follow-up. RESULTS: Compared to patients without neuropathy, patients with neuropathy had more time elapsed since the diabetes was diagnosed, higher glycemia and HbAc level and higher composite scores on the Dizziness Handicap Inventory, but similar results on static posturography. After rehabilitation, although scores on the Dizziness Handicap Inventory decreased in the two groups, the difference between them persisted. In patients with neuropathy, static posturography showed improvement of postural control only with the eyes closed and soft surface, whereas in patients without neuropathy the postural control improved during all sensory conditions (eyes open/closed and firm/soft surface). CONCLUSIONS: In diabetic patients with peripheral vestibular disease, peripheral neuropathy contributes to self-reported disability and may interfere with complete balance recovery.

[Occult chronic kidney disease in patients with stable coronary heart disease]. / Insuficiencia renal crónica oculta en pacientes con enfermedad coronaria estable.

BACKGROUND AND OBJECTIVE: Chronic kidney disease (CKD) increases cardiovascular risk mainly in subjects with coronary heart disease. The aim of this study was to evaluate the prevalence of occult CKD (OCKD) in stable coronary heart disease patients and to study the factors associated in order to improve its detection. PATIENTS AND METHOD: Cross sectional study of 7,884 patients who had had a coronary event requiring hospitalization in the previous 6 months to 10 years. Glomerular filtration rate was estimated by means of the Modification of Diet in Renal Disease (MDRD) study equation. CKD was defined as a glomerular filtration rate lower than 60 ml/min/1.73 m(2), and OCKD when, in addition, serum creatinine was < 133 mmol/l in men and < 124 mmol/l in women. RESULTS: The mean age was 65.3 years, 73.7% male and 22.4% had CKD, 68.3% of them with normal serum creatinine. In subjects with OCKD the prevalence of risk factors and cardiovascular diseases associated was intermediate between subjects without CKD and subjects with CKD and high serum creatinine. Age, female sex, hypertension, diabetes, heart failure, cerebrovascular disease and peripheral artery disease were significantly and independently associated with OCKD in the multivariate analysis. CONCLUSIONS: Almost one in 4 subjects with stable coronary heart disease had CKD, most of them with normal serum creatinine, mainly women and older patients.

Insuficiencia renal crónica oculta en pacientes con enfermedad coronaria estable / Occult chronic kidney disease in patients with stable coronary heart disease

FUNDAMENTO Y OBJETIVO: La presencia de insuficiencia renal crónica (IRC) aumenta el riesgo de enfermedadcardiovascular, especialmente en los pacientes con enfermedad coronaria. El objetivode este estudio ha sido examinar la prevalencia de IRC oculta (IRCO) en pacientes con enfermedadcoronaria estable e investigar los factores asociados a ella para favorecer su detección.PACIENTES Y MÉTODO: Se ha realizado un estudio transversal en el que participaron 7.884 sujetosque habían ingresado por un episodio coronario entre 6 meses y 10 años antes. Se calculó elfiltrado glomerular según la ecuación abreviada del estudio Modification of Diet in Renal Disease(MDRD). Se consideró IRC cuando el filtrado glomerular era menor de 60 ml/min/1,73 m2 eIRCO cuando además la creatinina sérica era inferior a 133 mmol/l en varones y a 124 mmol/len mujeres.RESULTADOS: La edad media de la población estudiada era 65,3 años y el 73,7% eran varones.Presentaba IRC un 22,4%, de los que el 68,3% tenía cifras de creatinina normales. En los pacientescon IRCO la prevalencia de factores de riesgo y enfermedades cardiovasculares asociadasera intermedia entre aquellos sin IRC y entre los que presentaban IRC con creatinina elevada.La edad, el sexo femenino, la presencia de hipertensión arterial, diabetes, insuficienciacardíaca, enfermedad cerebrovascular y enfermedad arterial periférica se asociaron de manerasignificativa e independiente con la presencia de IRCO en el análisis multivariante.CONCLUSIONES: Casi uno de cada 4 pacientes con enfermedad coronaria estable presenta IRC, lamayoría de ellos con creatinina normal, siendo especialmente frecuente en las mujeres y con elaumento de la edad

BACKGROUND AND OBJETIVE: Chronic kidney disease (CKD) increases cardiovascular risk mainly insubjects with coronary heart disease. The aim of this study was to evaluate the prevalence ofoccult CKD (OCKD) in stable coronary heart disease patients and to study the factors associatedin order to improve its detection.PATIENTS AND METHOD: Cross sectional study of 7,884 patients who had had a coronary event requiringhospitalization in the previous 6 months to 10 years. Glomerular filtration rate was estimatedby means of the Modification of Diet in Renal Disease (MDRD) study equation. CKD wasdefined as a glomerular filtration rate lower than 60 ml/min/1.73 m2, and OCKD when, in addition,serum creatinine was < 133 mmol/l in men and < 124 mmol/l in women.RESULTS: The mean age was 65.3 years, 73.7% male and 22.4% had CKD, 68.3% of them withnormal serum creatinine. In subjects with OCKD the prevalence of risk factors and cardiovasculardiseases associated was intermediate between subjects without CKD and subjects with CKDand high serum creatinine. Age, female sex, hypertension, diabetes, heart failure, cerebrovasculardisease and peripheral artery disease were significantly and independently associatedwith OCKD in the multivariate analysis.CONCLUSIONS: Almost one in 4 subjects with stable coronary heart disease had CKD, most ofthem with normal serum creatinine, mainly women and older patients

Achievement of therapeutic goals and utilization of evidence-based cardiovascular therapies in coronary heart disease patients with chronic kidney disease.

To evaluate whether the presence of chronic kidney disease (CKD) influenced the rate of prescription of evidence-based cardiovascular preventive therapies and attainment of therapeutic goals in patients with stable coronary heart disease, 7,884 patients (mean age 65.4 years; 81.7% men; 22.4% with CKD) attended to in 1,799 primary-care centers and who had had a coronary event requiring hospitalization in the previous 6 months to 10 years were recruited. Glomerular filtration rate (GFR) was estimated using the MDRD Study equation. Results indicated that patients with CKD received more diuretics (47.6% vs 32.8%; p = 0.034), calcium channel blockers (29.3% vs 23.2%, p = 0.027); and blockers of the angiotensin-renin system (76.4% vs 65.3%; p <0.001). The lower prescription rate of antiaggregants, beta blockers, and statins in subjects with CKD did not reach statistical significance in multivariate analysis. A lower percentage of subjects with CKD achieved good control of blood pressure (39.2% vs 65.4%; p <0.001) and glycosylated hemoglobin (43.9% vs 53.4%; p <0.001) relative to patients without CKD. Only 11.8% of patients with CKD had optimum control of all risk factors. Using multivariate analysis, the presence of CKD was inversely related to the degree of risk-factor control, especially in groups with low GFR. In conclusion, patients with stable coronary heart disease and CKD attended to in primary-care centers had poorer control of coronary heart disease risk factors than those with normal GFR despite receiving a similar rate of prescription of evidence-based cardiovascular disease preventive therapies.

Variantes anatómicas de la columna vertebral / Normal variants of spine

Las variantes normales se ven frecuentemente en la práctica radiológica. La importancia de detectarlas es identificar aquellas que presentan factores de riesgo y necesitan exámenes adicionales. En este artículo se presentan cinco casos donde se detectaron incidentalmente variantes anatómicas de la columna