RESUMEN
Large polyglutamine expansions in Ataxin-2 (ATXN2) cause multi-system nervous atrophy in Spinocerebellar Ataxia type 2 (SCA2). Intermediate size expansions carry a risk for selective motor neuron degeneration, known as Amyotrophic Lateral Sclerosis (ALS). Conversely, the depletion of ATXN2 prevents disease progression in ALS. Although ATXN2 interacts directly with RNA, and in ALS pathogenesis there is a crucial role of RNA toxicity, the affected functional pathways remain ill defined. Here, we examined an authentic SCA2 mouse model with Atxn2-CAG100-KnockIn for a first definition of molecular mechanisms in spinal cord pathology. Neurophysiology of lower limbs detected sensory neuropathy rather than motor denervation. Triple immunofluorescence demonstrated cytosolic ATXN2 aggregates sequestrating TDP43 and TIA1 from the nucleus. In immunoblots, this was accompanied by elevated CASP3, RIPK1 and PQBP1 abundance. RT-qPCR showed increase of Grn, Tlr7 and Rnaset2 mRNA versus Eif5a2, Dcp2, Uhmk1 and Kif5a decrease. These SCA2 findings overlap well with known ALS features. Similar to other ataxias and dystonias, decreased mRNA levels for Unc80, Tacr1, Gnal, Ano3, Kcna2, Elovl5 and Cdr1 contrasted with Gpnmb increase. Preterminal stage tissue showed strongly activated microglia containing ATXN2 aggregates, with parallel astrogliosis. Global transcriptome profiles from stages of incipient motor deficit versus preterminal age identified molecules with progressive downregulation, where a cluster of cholesterol biosynthesis enzymes including Dhcr24, Msmo1, Idi1 and Hmgcs1 was prominent. Gas chromatography demonstrated a massive loss of crucial cholesterol precursor metabolites. Overall, the ATXN2 protein aggregation process affects diverse subcellular compartments, in particular stress granules, endoplasmic reticulum and receptor tyrosine kinase signaling. These findings identify new targets and potential biomarkers for neuroprotective therapies.
Asunto(s)
Colesterol/biosíntesis , Médula Espinal/patología , Ataxias Espinocerebelosas/patología , Proteinopatías TDP-43/patología , Animales , Ataxina-2 , Modelos Animales de Enfermedad , Técnicas de Sustitución del Gen , Ratones , Médula Espinal/metabolismo , Ataxias Espinocerebelosas/metabolismo , Proteinopatías TDP-43/metabolismoRESUMEN
BACKGROUND: Spinocerebellar ataxia type 2 is a progressive neurodegenerative disorder due to an unstable expansion of a CAG repeat in the ATXN2 gene. Although weight loss has been associated with disease progression in several neurodegenerative conditions, it has been barely assessed in patients with spinocerebellar ataxia type 2. OBJECTIVE: The objective of this study was to test whether body mass index is altered in patients with spinocerebellar ataxia type 2 with varying expansion sizes from early to late disease stages. METHODS: A cross-sectional case-control study was performed, which included 222 clinically and molecularly diagnosed patients and 214 sex- and age-matched healthy individuals. ATXN2 genotypes and sex were considered as risk factors. Clinical outcomes included the body mass index, age at onset, disease duration, Scale for the Assessment and Rating of Ataxia score, disease stage, dysphagia, and progression rate. Multiple linear regression models were generated. RESULTS: Body mass index was significantly decreased in male patients, but not in female patients, relative to control subjects. In addition to sex, body mass index was significantly associated with age at onset and progression rate. Conversely, body mass index, along with repeat length in ATXN2 expanded alleles and disease duration, was associated with Scale for the Assessment and Rating of Ataxia score. In addition, body mass index, along with the age at onset and the repeat length in ATXN2 normal and expanded alleles, has a significant influence on progression rate. CONCLUSIONS: Body mass index might be a useful biomarker of disease severity, particularly in male patients with spinocerebellar ataxia type 2 in the context of nutritional interventions or clinical trials assessing the efficacy of promising new drugs. © 2021 International Parkinson and Movement Disorder Society.
Asunto(s)
Ataxias Espinocerebelosas , Índice de Masa Corporal , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Masculino , Índice de Severidad de la Enfermedad , Ataxias Espinocerebelosas/genéticaRESUMEN
Spinocerebellar ataxia type 2 (SCA2) is a progressive neurodegenerative disorder due to an unstable expansion of a CAG repeat in the ATXN2 gene. Despite clinical and experimental evidence indicating the relevance of the gonadotropic axis to the prognosis and therapeutics for several late-onset neurodegenerative disorders, its functioning and association with disease severity have not been previously explored in SCA2. To assess serum levels of testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), and their clinical relevance in SCA2 patients. A case-control study involving 94 Cuban SCA2 patients and 101 gender- and age-matched healthy controls was conducted. Testosterone, LH, and FSH serum levels were determined by radioimmunoassay or immunoradiometric assay systems. Clinical outcomes included age at onset, disease duration, Scale for the Assessment and Rating of Ataxia (SARA) score, and progression rate. Univariate general linear models were generated. Testosterone, LH, and FSH serum levels were significantly reduced in male SCA2 patients relative to control individuals. On average, there was a 35% reduction in testosterone levels in male patients versus male control individuals. Testosterone levels were associated with disease duration (r = 0.383; p = 0.025) and age at onset (r = 0.414; p = 0.011) in male SCA2 patients, but no association was observed between testosterone and CAG expansion size, SARA score, or progression rate. Testosterone levels might be a biomarker of disease progression in male SCA2 patients. Further studies are needed to explore the effects of low testosterone levels on non-motor symptoms, and to assess the potential of testosterone replacement therapy in male SCA2 patients.
Asunto(s)
Ataxias Espinocerebelosas/sangre , Testosterona/sangre , Adulto , Edad de Inicio , Estudios de Casos y Controles , Hormona Folículo Estimulante/sangre , Humanos , Hormona Luteinizante/sangre , Masculino , Persona de Mediana EdadRESUMEN
The prevalence estimations of hereditary ataxias are biased since most epidemiological studies are confined to isolated geographical regions and few nationwide studies are available. The study aims to assess the prevalence, distribution, and neurological features of the Cuban population with hereditary ataxias. A nationwide epidemiological study of hereditary ataxias was conducted in Cuba between March 2017 and June 2018. Patients were scheduled at the Cuban ataxia research center, various hospitals, or at their homes. Demographic and clinical variables were obtained through standardized questionnaires and validated clinical tools. Overall, 1001 patients were diagnosed with hereditary ataxias for a nationwide prevalence of 8.91 cases/100.000 inhabitants. Spinocerebellar ataxia type 2 (SCA2) was the commonest subtype, with highest prevalences at Holguín province (47.86/100.000), and a broad dissemination in the whole country. Most of neurological features were common between all SCA cohorts, but the frequencies of some of them varied between distinct subtypes. Within the SCA2 cohort, significant influences of long mutation size and higher disease duration over the muscle atrophy and oculomotor disorders were observed. Besides, higher disease durations were associated with resting tremor and dysphagia, whereas shorter disease durations were associated with hyperreflexia. The spreading of SCA2 to whole country and the documented raising of its prevalence set the rationales for higher-scope medical care and research strategies, supported in collaborative research networks. The wide epidemiological, clinical, and genetic characterization of this founder SCA2 population identifies this homogeneous cohort as an attractive source for the development of future clinical-genetic and therapeutic researches.
Asunto(s)
Degeneraciones Espinocerebelosas/epidemiología , Cuba/epidemiología , Humanos , Prevalencia , Degeneraciones Espinocerebelosas/genéticaRESUMEN
Pathogenic CAG (cytosine-adenine-guanine) expansions beyond certain thresholds in the ataxin-2 (ATXN2) gene cause spinocerebellar ataxia type 2 (SCA2) and were shown to contribute to Parkinson disease, amyotrophic lateral sclerosis and frontotemporal lobar degeneration. Regulation of ATXN2 gene expression and the function of the protein product are not known. SCA2 exhibits an inverse correlation between the size of the CAG repeat and the age at disease onset. However, a wide range of age at onset are typically observed, with CAG repeat number alone explaining only partly this variability. In this study, we explored the hypothesis that ATXN2 levels could be controlled by DNA methylation and that the derangement of this control may lead to escalation of disease severity and influencing the age at onset. We found that CpG methylation in human ATXN2 gene promoter is associated with pathogenic CAG expansions in SCA2 patients. Different levels of methylation in a SCA2 pedigree without an intergenerational CAG repeat instability caused the disease anticipation in a SCA2 family. DNA methylation also influenced the disease onset in SCA2 homozygotes and SCA3 patients. In conclusion, our study points to a novel regulatory mechanism of ATXN2 expression involving an epigenetic event resulting in differential disease course in SCA2 patients.
Asunto(s)
Metilación de ADN , Proteínas del Tejido Nervioso/genética , Regiones Promotoras Genéticas/genética , Ataxias Espinocerebelosas/genética , Adolescente , Adulto , Ataxina-3 , Ataxinas , Secuencia de Bases , Islas de CpG/genética , Epigénesis Genética , Salud de la Familia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Proteínas Nucleares/genética , Linaje , Reacción en Cadena de la Polimerasa , Proteínas Represoras/genética , Homología de Secuencia de Ácido Nucleico , Ataxias Espinocerebelosas/patología , Expansión de Repetición de Trinucleótido/genéticaAsunto(s)
Equilibrio Postural , Ataxias Espinocerebelosas/fisiopatología , Adolescente , Adulto , Ataxina-2/genética , Estudios Transversales , Marcha , Heterocigoto , Humanos , Modelos Lineales , Persona de Mediana Edad , Síntomas Prodrómicos , Índice de Severidad de la Enfermedad , Ataxias Espinocerebelosas/genética , Expansión de Repetición de Trinucleótido , Percepción Visual , Adulto JovenRESUMEN
Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant cerebellar ataxia characterized by a progressive cerebellar syndrome associated to saccadic slowing, peripheral neuropathy, cognitive disorders, and other multisystem features. SCA2 is caused by the abnormal expansion of cytosine-adenine-guanine triplet repeats in the encoding region of the ATXN2 gene and therefore the expression of toxic polyglutamine expansions in the ataxin 2 protein, which cause progressive neuronal death of Purkinje cells in the cerebellum and several pontine, mesencephalic, and thalamic neurons among other cells. Worldwide, SCA2 is the second most frequent type of spinocerebellar ataxia, only surpassed by SCA3. Nevertheless, in Holguin, Cuba, the disease reaches the highest prevalence, resulting from a putative foundational effect. This review discusses the most important advances in the genotypical and phenotypical studies of SCA2, highlighting the comprehensive characterization reached in Cuba through clinical, neuroepidemiological, neurochemical, and neurophysiological evaluation of SCA2 patients and pre-symptomatic subjects, which has allowed the identification of new disease biomarkers and therapeutical opportunities. These findings provide guidelines, from a Cuban viewpoint, for the clinical management of the disease, its diagnosis, genetic counseling, and therapeutical options through rehabilitative therapy and/or pharmacological options.
Asunto(s)
Ataxias Espinocerebelosas , Animales , Cuba/epidemiología , Predisposición Genética a la Enfermedad , Humanos , Incidencia , Fenotipo , Ataxias Espinocerebelosas/epidemiología , Ataxias Espinocerebelosas/genética , Ataxias Espinocerebelosas/fisiopatología , Ataxias Espinocerebelosas/terapiaRESUMEN
Cuban patients with Spinocerebellar Ataxia type 2 (SCA2) have reduced concentrations of zinc in serum and cerebrospinal fluid (CSF). To assess the effect and safety of zinc supplementation, 36 Cuban SCA2 patients were randomly assigned to receive daily either 50 mg ZnSO(4) or placebo, together with neurorehabilitation therapy in a randomized, double-blind, placebo-controlled clinical trial during 6 months. Outcome measures included the changes of zinc levels in CSF and serum, ataxia score, oxidative stress and saccadic eye movements. At the end of the study, the Zinc-treated group showed: (i) a significant increase of the Zn levels in the CSF, (ii) mild decrease in the ataxia scale subscores for gait, posture, stance and dysdiadochocinesia (iii) reduction of lipid's oxidative damage, and (iv) reduction of saccadic latency when compared with the placebo group. The treatment was safe and well tolerated by all subjects. This study demonstrated the efficacy and safety of Zn supplementation, combined with neurorehabilitation for SCA2 patients and therefore it may encourage further studies on the clinical effect of zinc supplementation in SCA2 based in the conduction of future clinical trials with higher number of subjects.
Asunto(s)
Suplementos Dietéticos , Placebos , Ataxias Espinocerebelosas/tratamiento farmacológico , Sulfato de Zinc/administración & dosificación , Sulfato de Zinc/uso terapéutico , Adolescente , Adulto , Catalasa/sangre , Cuba , Método Doble Ciego , Humanos , Malondialdehído/sangre , Persona de Mediana Edad , Movimientos Sacádicos/fisiología , Ataxias Espinocerebelosas/fisiopatología , Ataxias Espinocerebelosas/rehabilitación , Superóxido Dismutasa/sangre , Resultado del Tratamiento , Adulto Joven , Zinc/sangreRESUMEN
BACKGROUND: Spinocerebellar ataxia type 2 (SCA2) is a neurodegenerative disease presenting with redox imbalance. However, the nature and implications of redox imbalance in SCA2 physiopathology have not been fully understood. OBJECTIVE: The objective of this study is to assess the redox imbalance and its association with disease severity in SCA2 mutation carriers. METHODS: A case-control study was conducted involving molecularly confirmed SCA2 patients, presymptomatic individuals, and healthy controls. Several antioxidant parameters were assessed, including serum thiol concentration and the superoxide dismutase, catalase, and glutathione S-transferase enzymatic activities. Also, several prooxidant parameters were evaluated, including thiobarbituric acid-reactive species and protein carbonyl concentrations. Damage, protective, and OXY scores were computed. Clinical correlates were established. RESULTS: Significant differences were found between comparison groups for redox markers, including protein carbonyl concentration (F = 3.30; p = 0.041), glutathione S-transferase activity (F = 4.88; p = 0.009), and damage (F = 3.20; p = 0.045), protection (F = 12.75; p < 0.001), and OXY (F = 7.29; p = 0.001) scores. Protein carbonyl concentration was positively correlated with CAG repeat length (r = 0.27; p = 0.022), while both protein carbonyl concentration (r = -0.27; p = 0.018) and OXY score (r = -0.25; p = 0.013) were inversely correlated to the disease duration. Increasing levels of antioxidants and decreasing levels of prooxidant parameters were associated with clinical worsening. CONCLUSIONS: There is a disruption of redox balance in SCA2 mutation carriers which depends on the disease stage. Besides, redox changes associate with markers of disease severity, suggesting a link between disruption of redox balance and SCA2 physiopathology.
Asunto(s)
Ataxias Espinocerebelosas/metabolismo , Ataxias Espinocerebelosas/patología , Adulto , Anciano , Biomarcadores/metabolismo , Estudios de Casos y Controles , Femenino , Heterocigoto , Humanos , Masculino , Persona de Mediana Edad , Mutación/genética , Oxidación-Reducción , Ataxias Espinocerebelosas/genética , Expansión de Repetición de Trinucleótido/genéticaRESUMEN
BACKGROUND: Spinocerebellar ataxia type 2 (SCA2) is a neurodegenerative disorder due to a CAG-repeat expansion. This work is intended to identify modifiers of the clinical phenotype in SCA2, following up on recent genome-wide association analyses that demonstrated the prominent role of DNA-damage repair and methylation for the severity and progression of polyglutamine diseases. In particular, we assessed the impact of MTHFR as rate-limiting enzyme in DNA methylation pathways, which modulates cerebellar neurotransmission and motor neuron atrophy. METHODS: A sample of 166 Cuban SCA2 patients and of 130 healthy subjects from the same geographical and ethnic background was selected. The ATXN2 CAG repeat length was determined by PCR followed by polyacrylamide gel electrophoresis. Two amino acid substitutions known to decrease the enzyme activity of MTHFR, encoded by C677T and A1298C polymorphisms, were assessed by PCR/RFLP. RESULTS: No significant differences were observed for C677T or A1298C alleles or genotype frequencies between cases and controls, confirming that disease risk in SCA2 does not depend on MTHFR activity. However, MTHFR A1298C genotypes showed a significant association with saccade latency. CONCLUSIONS: \MTHFR A1298C polymorphism is associated with saccade latency in SCA2 patients, but not with disease risk, age at onset or maximal saccade velocity. These results provide evidence that folate-mediated onecarbon metabolism might be important in the physiopathology of SCA2.
Asunto(s)
Variación Genética/genética , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Polimorfismo de Nucleótido Simple/genética , Movimientos Sacádicos/fisiología , Ataxias Espinocerebelosas/genética , Ataxias Espinocerebelosas/fisiopatología , Adulto , Carbono , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ataxias Espinocerebelosas/diagnósticoRESUMEN
The objective of this study was to determine the prevalence of hereditary ataxias in Cuba, with a special focus on the clinical and molecular features of SCA2. Clinical assessments were performed by neurological examinations and application of the SARA scale. Molecular analyses of genes SCA1-3, SCA6, SCA17 and DRPLA identified 753 patients with SCA and 7173 asymptomatic relatives, belonging to 200 unrelated families. 86.79% of all SCA patients were affected with SCA2. In the Holguin province, the average population prevalence of SCA2 is 40.18x10(5) inhabitants, with the remarkable figure of 141.66x10(5) in the Baguanos municipality. The high prevalence of the SCA2 mutation in Holguin reflects most likely a founder effect. The stabilization of the prevalence along time suggests the existence of premutated chromosomes with pure CAG, acting as reservoir for further expansions. CAG repeat length correlated inversely with age at onset, accounting for 80% of the variability. Genetic anticipation was observed in the 80% of transmissions. Repeat instability was greater in paternal transmissions whereas CAG expansions without anticipation was observed in 10.97% suggesting the effect of CAA interruptions in the CAG segment, which decrease the toxicity of the abnormal ataxin-2, and/or other protective factors.
Asunto(s)
Efecto Fundador , Ataxias Espinocerebelosas/epidemiología , Ataxias Espinocerebelosas/genética , Adolescente , Adulto , Edad de Inicio , Anciano , Anticipación Genética , Niño , Preescolar , Cuba/epidemiología , Femenino , Frecuencia de los Genes , Humanos , Masculino , Persona de Mediana Edad , Proteínas del Tejido Nervioso/genética , Prevalencia , Índice de Severidad de la Enfermedad , Expansión de Repetición de Trinucleótido , Adulto JovenRESUMEN
Introducción : La predicción del riesgo cardiovascular favorece la prevención de eventos cardiovasculares. Objetivo : Estimar el riesgo cardiovascular y determinar la condición periodontal de pacientes con síndrome coronario agudo. Método : Se realizó un estudio transversal en 60 sujetos admitidos en la Unidad de Cuidados Coronarios del Hospital Provincial Vladimir Ilich Lenin, con diagnóstico de síndrome coronario agudo, que a su vez cumplieron con los criterios de inclusión. Se tuvieron en cuenta los principios de ética médica, se empleó el índice Periodontal de Russell y se determinó el riesgo cardiovascular según las Tablas de Predicción de Riesgo Cardiovascular aprobadas para Cuba. Se evaluaron las variables incluidas en dichas tablas. Resultados : El infarto agudo de miocardio se presentó en el 58,3 por ciento. El 55,0 por ciento eran del sexo masculino, 35,0 por ciento se encontraban en el grupo de edad de 55 a 64 años. En relación con la condición periodontal, el 76,7 por ciento presentó periodontitis. Según los factores de riesgo explorados la adicción tabáquica estuvo presente en el 71,7 por ciento y la hipertensión arterial en el 65,0 por ciento de los sujetos. El 25,0 por ciento de los pacientes con riesgo cardiovascular bajo presentaba periodontitis. Conclusiones : Según las tablas de predicción de riesgo cardiovascular empleadas, más de la mitad de los pacientes con síndrome coronario agudo presentaron riesgo cardiovascular bajo o moderado, sin embargo, la mayoría de estos presentaban periodontitis(AU)
Introduction : Prediction of cardiovascular risk favors prevention of cardiovascular events. Objective : To estimate cardiovascular risk and determine the periodontal condition of patients with acute coronary syndrome. Methods : A cross-sectional study was carried out with 60 subjects admitted to the coronary care unit at Hospital General Docente Vladimir Ilich Lenin, with a diagnosis of acute coronary syndrome and, in turn, meeting with the inclusion criteria. The principles of medical ethics were taken into account, the Russell's Periodontal Index was used, and cardiovascular risk was determined according to the cardiovascular risk prediction tables approved for Cuba. The variables included in these tables were evaluated. Results : Acute myocardial infarction occurred in 58.3 percent of the patients. 55.0 percent were male, and 35.0 percent were in the age group 55-64 years. Regarding their periodontal condition, 76.7 percent presented periodontitis. According to the explored risk factors, tobacco addiction was present in 71.7 percent, while arterial hypertension was present in 65.0 percent of the subjects. 25.0 percent of the patients with low cardiovascular risk had periodontitis. Conclusions : According to the used cardiovascular risk prediction tables, more than half of the patients with acute coronary syndrome presented low or moderate cardiovascular risk; however, most of these had periodontitis(AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana EdadRESUMEN
Patients with spinocerebellar ataxia type 2 (SCA2), develop severe pontine nuclei, inferior olives, and Purkinje cell degeneration. This form of autosomal dominant cerebellar ataxia is accompanied by progressive ataxia and dysarthria. Although the motor dysfunction is well characterized in these patients, nothing is known about their motor learning capabilities. Here we tested 43 SCA2 patients and their matched controls in prism adaptation, a kind of visuomotor learning task. Our results show that their pattern of brain damage does not entirely disrupt motor learning. Rather, patients had impaired adaptation decrement, but surprisingly a normal aftereffect. Moreover, the mutation degree could discriminate the degree of adaptation. This pattern could reflect the net contribution of two adaptive mechanisms: strategic control and spatial realignment. Accordingly, SCA2 patients show an impaired strategic control that affects the adaptation rate, but a normal spatial realignment measured through the aftereffect. Our results suggest that the neural areas subserving spatial realignment are spared in this form of spinocerebellar ataxia.
Asunto(s)
Adaptación Fisiológica/fisiología , Ataxias Espinocerebelosas/fisiopatología , Adolescente , Adulto , Anciano , Electronistagmografía , Femenino , Efecto Tardío Figurativo/fisiología , Humanos , Aprendizaje/fisiología , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Desempeño Psicomotor/fisiología , Movimientos Sacádicos/fisiología , Ataxias Espinocerebelosas/clasificaciónRESUMEN
Motor and sensitive nerve conduction studies, visual (VEP), brainstem auditory (BAEP) and somatosensory (SSEP) evoked potentials in 82 patients with spinocerebellar ataxia type 2 (SCA2), 62 presymptomatics relatives and 80 controls, correlating it with CAG repeat, disease duration and ataxia score were assessed. All the groups showed differences in the amplitude of sensory action potentials in median and sural nerves. Sural amplitude was negatively correlated with disease duration and ataxia score. Differences among patients and controls in the mean latency and conduction velocity of sensory action potentials were found. Abnormal morphology and replicability of SSEPs and BSAEPs were found in patients and presymptomatics. Moreover, consistent increase in latencies of P40 component of SSEPs, III and V peaks and I-III interpeak of BSAEPs was found in patients. A positive correlation was found between latency of III and V waves, I-III and III-V interpeak latencies of BSAEPs and disease duration. CAG repeat and electrophysiological markers assessed were not correlative. Electrophysiological alterations in the SCA2 appeared in presymptomatic stages. These alterations are consistent markers which could be used to evaluate the progression of the disease.
Asunto(s)
Potenciales Evocados/fisiología , Familia , Conducción Nerviosa/fisiología , Ataxias Espinocerebelosas/genética , Ataxias Espinocerebelosas/fisiopatología , Adolescente , Adulto , Edad de Inicio , Anciano , Anciano de 80 o más Años , Electrofisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conducción Nerviosa/efectos de la radiación , Estadísticas no ParamétricasRESUMEN
Introducción: Las competencias informacionales han sido reconocidas como de gran importancia en la educación doctoral. No se conocen las percepciones de doctorandos del sector de la salud en la provincia Holguín en relación con las competencias informacionales. Objetivo: Valorar las percepciones de doctorandos del sector de la salud en la provincia Holguín relacionadas con las competencias informacionales. Materiales y Métodos: Se realizó un estudio exploratorio que partió de un universo de 32 y que incluyó a 24 doctorandos del sector de la salud en la provincia Holguín que completaron el cuestionario ALFINVES sobre competencias informacionales en una versión en español. Resultados: Se obtuvo que las respuestas dadas a las preguntas en cuanto al conocimiento, alcanzaron puntuaciones entre 7,59 y 8,66 puntos. En el ámbito de las habilidades, los ítems que menor puntuación obtuvieron fueron los correspondientes al uso de índices para localizar la información y el empleo de sistemas de gestión de bibliografía. Mientras tanto, los ítems de menor puntuación en lo concerniente con las actitudes, correspondieron a la aprobación del tema de investigación de conjunto con el tutor y al conocimiento de los fundamentos del derecho de autor y la propiedad intelectual. Conclusiones: Se comprobó que los estudiantes de doctorado del sector de la salud en la provincia Holguín tienen autopercepciones altas de las competencias informacionales, desde las perspectivas del conocimiento, habilidades y actitudes, aunque se identificaron aspectos susceptibles a mejoramiento(AU)
Introduction: Informational competence is of great importance in doctoral education. The perceptions of doctoral students in the health sectorin Holguin province (SSHo) with respect to informational competence are not known. Objective: To assess the perceptions of doctoral students in the SSHo in relation to their informational competencies. Material and Methods: An exploratory study was carried out on a universe of 32 students that included 24 SSHo doctoral students who completed the study questionnaire. A Spanish version of the ALFINVES questionnaire was used to assess informational competencies. Results: The answers given to the questions related to knowledge reached scores between 7,59 and 8,66 points. In the area of skills, the items with the lowest scores were the use of indexes to locate information and the use of bibliographic management systems. Meanwhile, the items with the lowest scores relating to attitudes corresponded to the approval of the research topic in conjunction with their tutors, and the knowledge of the basics of copyright and intellectual property. Conclusions: It was found that SSHo doctoral students have high self-perceptions of their informational competencies from the perspectives of knowledge, skills, and attitudes; however, aspects susceptible to improvement were identified(AU)
Asunto(s)
HumanosRESUMEN
RESUMEN Introducción: La adherencia terapéutica constituye uno de los principales problemas de las intervenciones en salud. Una de las poblaciones en las que se evidencian dificultades en la adherencia al tratamiento es en los pacientes quemados. Objetivo: Determinar la validez y confiabilidad de dos instrumentos para la evaluación de la adherencia al tratamiento y sus dimensiones influyentes en pacientes quemados hospitalizados. Métodos: Desde el enfoque cuantitativo se realizó un estudio transversal, en el periodo comprendido de enero de 2017 a diciembre de 2019. Se establecieron como variables de la investigación la adherencia al tratamiento y los factores influyentes en la adherencia al tratamiento. Se utilizó el criterio de expertos, la prueba piloto y por último se aplicaron los dos cuestionarios a 90 pacientes quemados. Resultados: Ambos instrumentos demostraron tener validez de contenido. La fiabilidad test-retest del instrumento para evaluar la adherencia terapéutica fue considerable y significativa, mientras que la consistencia interna fue aceptable. En el instrumento que evalúa las dimensiones influyentes en la adherencia terapéutica la fiabilidad fue muy fuerte y la consistencia buena. Conclusiones: Los dos instrumentos elaborados para la evaluación de la adherencia terapéutica en pacientes quemados hospitalizados, presentaron validez de contenido y confiabilidad.
ABSTRACT Introduction: Therapeutic adherence constitutesone of tema in problems of health interventions. One of the populations in which difficulties in adherence to treatment are evidence disburn patients. Objective: To determine the validity and reliability of two instruments for the evaluation of adherence to treatment and the irinfluential dimensions in hospitalized burn patients. Methods: From the quantitative approach, a cross-sectional study was conducted, in the period from January 2017 to December 2019. Adherence to treatment and influencing adherence to treat ment were established as research variables. Expert judgment wasused, the pilot test and finally the two question naireswere applied to 90 burn patients. Results: Both instruments proved to have content validity. The test-retestreliability of the instrument to evaluate therapeuticad herence was considerable and significant, whilethe internal consistency was acceptable. Reliability was very strong and consistency good in the instrument that evaluates the influencing dimensions in therapeutic adherence. Conclusions: The two instruments developed forthe evaluation of therapeutic adherence in hospitalized burn patients present content validity and reliability.
RESUMEN
BACKGROUND: Spinocerebellar ataxia type 2 (SCA2) is an inherited and still incurable neurodegenerative disorder. Evidence suggests that pro-oxidant agents as well as factors involved in antioxidant cellular defenses are part of SCA2 physiopathology. AIM: To assess the influence of superoxide dismutase (SOD3) and catalase (CAT) enzymatic activities on the SCA2 syndrome. METHOD: Clinical, molecular, and electrophysiological variables, as well as SOD3 and CAT enzymatic activities were evaluated in 97 SCA2 patients and in 64 age- and sex-matched control individuals. RESULTS: Spinocerebellar ataxia type 2 patients had significantly lower SOD3 enzymatic activity than the control group. However, there were no differences between patients and controls for CAT enzymatic activity. The effect size for the loss of patients' SOD3 enzymatic activity was 0.342, corresponding to a moderate effect. SOD3 and CAT enzymatic activities were not associated with the CAG repeat number at the ATXN2 gene. SOD3 and CAT enzymatic activities did not show significant associations with the age at onset, severity score, or the studied electrophysiological markers. CONCLUSION: There is a reduced SOD3 enzymatic activity in SCA2 patients with no repercussion on the clinical phenotype.
RESUMEN
Spinocerebellar ataxia type 2 (SCA2) is part of a group of at least nine dominantly inherited disorders characterized by progressive degeneration of specific neuronal populations and a shared mutational mechanism involving the expansion of a CAG repeat tract in coding regions of novel genes. Efforts have been made to identify biomarkers of disease progression, which would allow timely preventive therapeutic interventions. In the present study was assessed the influence of several genome instability biomarkers on SCA2 clinical severity. A case-control design was applied on exfoliated epithelial buccal cells to determine micronuclei frequency and others nuclear anomalies, using 5% Giemsa stains. The slides were analyzed under 1000X magnification and nuclei morphological anomalies were identified according to Tolbert PE, et al. (1992) and Bolognesi C, et al. (2013) criteria. It was found a highly significant increase in micronuclei frequency in cases related to age and sex-matched healthy controls (p <0.001). There was a trend for karyolytic, pyknotic and condensed chromatin cells to be increased in SCA2 cases, and a significant association was found between binucleated cells and disease duration (r = 0.46; p = 0.027). Nor the CAG repeat length neither the age at onset correlated significantly with any of the studied markers (p >0.05). Our results are consistent with report previous in similar neurodegenerative diseases, and suggest that micronuclei and binucleated cells constitute potential peripheral biomarkers for SCA2. These results should be validated by other studies.
Asunto(s)
Micronúcleos con Defecto Cromosómico , Mucosa Bucal/ultraestructura , Ataxias Espinocerebelosas/patología , Adulto , Edad de Inicio , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Inestabilidad Genómica , Humanos , Masculino , Pruebas de Micronúcleos , Persona de Mediana Edad , Mutación , Ataxias Espinocerebelosas/genética , Adulto JovenRESUMEN
BACKGROUND: Spinocerebellar ataxia type 2 is a neurodegenerative disorder caused by a CAG repeat expansion in ATXN2 gene. There is high clinical variability among affected patients suggesting the occurring of modifier genes influencing the clinical phenotype. OBJECTIVE: The objective is to assess the association of GSTO1 rs4925 and GSTO2 rs2297235 SNPs on the clinical phenotype in SCA2 patients. METHODS: A case-control study was performed in a sample of 120 SCA2 Cuban patients and 100 healthy subjects. Age at onset, 60° Maximal Saccade Velocity and SARA score were used as clinical markers. GSTO1 rs4925 and GSTO2 rs2297235 SNPs were determined by PCR/RFLP. RESULTS: Distribution of the GSTO1 alleles and genotypes was nearly equal between the control group and SCA2 patients. GSTO1 genotypes were not associated to clinical markers in SCA2 patients. Distribution of the GSTO2 "G" allele and "AG" genotype differed significantly between SCA2 patients and controls. Symptomatic SCA2 individuals had a 2.29-fold higher chance of carrying at least one "G" allele at GSTO2 rs2297235 than controls (OR=2.29, 95% CI: 1.29-4.04). GSTO2 genotypes were significantly associated to age at onset (p=0.037) but not to 60° Maximal Saccade Velocity or SARA score in SCA2 patients. CONCLUSION: The GSTO1 rs4925 polymorphism is not associated to SCA2. Meanwhile, the GSTO2 rs2297235 "AG" genotype is associated to SCA2 but failed to show any association with clinical markers, with the exception of a potential association with the age at disease onset.