Fenotipos clínicos en el diagnóstico sicopedagógico de las necesidades educativas especiales

El desarrollo científico tecnológico caracterizado, entre otros por los avances en el campo de las ciencias biomédicas, trascienden a la educación, especialmente se denotan los nexos entre la genética médica y la educación especial. En la provincia de Camagüey se desarrolla una investigación entre los servicios de Genética y el Centro de Diagnóstico y Orientación de la educación especial. A partir del análisis de la interrelación entre ambas ciencias se proyectan en la práctica de la atención de educandos con necesidades educativas especiales enfoques multi, inter y transdisciplinarios con el fin de contribuir al perfeccionamiento del diagnóstico sicopedagógico. El estudio se desarrolla con la colaboración de la Benemérita Universidad Autónoma de Puebla.

Scientific and technological development, characterized among cons by advances in the field of biomedical sciences, transcend education, especially the links between medical genetics and special education. In the province of Camagüey, research is being carried out between the Genetics services and the Diagnosis and Guidance Center for special education. Based on the analysis of the interrelation between both sciences, multi, inter and transdisciplinary approaches are projected into the practice of caring for students with special educational needs, in order to contribute to the improvement of psychopedagogical diagnosis. The study is developed with the collaboration of the Benemérita Universidad Autónoma de Puebla.

Miopatias com padrão distal: descrição clínica de pacientes do Estado da Bahia / Distal myopathies: clinical description of patients from the State of Bahia

INTRODUÇÃO: As miopatias são doenças cuja etiologia decorre de alterações estruturais e/ou funcionais no músculo esquelético. As miopatias distais são doenças musculares primárias em que fraqueza e, frequentemente atrofia, tem início nas mãos, antebraços, pés e segmento distal das pernas. Apesar de terem sido divididas como um grupo restrito de doenças, outras miopatias podem se manifestar com um padrão distal, como a miopatia nemalínica e as distrofias musculares cintura-membros. Devido à escassez de trabalhos que descrevem clinicamente as miopatias distais, este trabalho visou contribuir com essa caracterização. METODOLOGIA: Os pacientes foram selecionados no ambulatório de doenças neuromusculares do Hospital Universitário Professor Edgar Santos, em seguida avaliados clinicamente, através de exame físico e também com exames complementares: eletroneuromiografia, exames laboratoriais, estudo molecular e histopatológico. RESULTADOS: Quinze pacientes com padrão distal foram analisados, sendo 40% do sexo feminino, média de idade de 29,8 anos, seis (40|%) pacientes naturais da capital, Salvador-Bahia. Quanto ao padrão de distribuição de fraqueza, sete apresentavam padrão distal, enquanto oito, padrão distal-proximal. Os pacientes foram agrupados de acordo com a idade de início dos sintomas, sendo 11 iniciados na infância e adolescência (T em homozigose), um com sarcoglicanopatia (mutação c.229C>T em homozigose) e um com miopatia nemalínica (histopatológico com presença de corpos nemalínicos). DISCUSSÃO: Os achados identificados nos pacientes com diagnósticos firmados foram compatíveis com o que é visto na literatura, como apresentação clínica e mutações identificadas previamente. Destaca-se o componente distal pronunciado da paciente com sarcoglicanopatia, considerado incomum. Além disso, a descrição da ressonância magnética realizada nos indivíduos demonstrou um padrão típico. Na maior parte dos pacientes não se chegou a um diagnóstico etiológico, a despeito da investigação realizada com os exames complementares e clínicos. CONCLUSÃO: O presente estudo caracterizou uma amostra de pacientes com miopatias distais, corroborando que essas doenças se manifestam clinicamente de forma heterogênea. A caracterização e divisão entre grupos visa tornar mais fácil a investigação, devendo ser feita com exames complementares, considerados imprescindíveis para se estabelecer o diagnóstico etiológico dessas doenças

INTRODUCTION: Myopathies are diseases which etiology results from structural and/or functional changes in skeletal muscle. Distal myopathies are a group of muscular pathologies in which weakness and atrophy begins and predominates in distal limbs, like hands and feet. Although it has been divided as a restrict group of diseases, other myopathies can manifest with that pattern of weakness, such nemaline myopathy and limb-girdle muscular dystrophies. Due to the scarcity of studies that described clinically the distal myopathies, this study focuses on clinical characterization of myopathies with distal pattern of weakness. METHODOLOGY: The patients were selected in the outpatient clinic for neuromuscular diseases at Professor Edgar Santos University Hospital. Those subjects were clinically evaluated through physical examination, laboratory tests, electroneuromyography, magnetic resonance (MRI) and histopathological study. RESULTS: Fifteen patients with distal pattern were analyzed, being 40% female, mean age 29.8 years, six (40 %) patients were born in the capital, Salvador-Bahia. As for the pattern of weakness distribution, seven had an exclusive distal pattern, while eight had a distal-proximal pattern. Patients were grouped according to the age of onset of symptoms, of which 11 were initiated in childhood and adolescence ( T in homozygous in exon 53 in another and one patient were diagnosed by biopsy), one with sarcoglicanopathy (mutation c.229C> T in homozygous) and one with nemaline myopathy (histopathological with the presence of nemalinic bodies). DISCUSSION: The findings identified in patients with established diagnoses were compatible with what is seen in the literature, such as clinical presentation and previously identified mutations. We highlight the pronounced distal component of the patient with sarcoglicanopathy, considered to be uncommon. In addition, the description of MRI performed in the individuals demonstrated a typical pattern. Most of the patients were not diagnosed, despite the research done with the complementary and clinical exams. CONCLUSION: The present study characterized a sample of patients with distal myopathies, corroborating that these diseases manifest themselves clinically heterogeneously. The characterization and division between groups aims to make the investigation easier, and should be done with complementary tests, considered essential to establish the etiological diagnosis of these diseases

Nueva mutación en el gen ATM en paciente con ataxis telangiectasia: Caso clínico / New mutation in ATM gen in patient whith Ataxia Telangiectasia: Clinical case

Introducción: El síndrome de ataxia telangiectasia (AT) es una enfermedad genética autosómica recesiva de compromiso multisistémico, con un espectro clínico amplio, ocasionada por la mutación del gen ATM, lo que causa la disminución o ausencia de la proteinkinasa ATM, por lo que se alteran procesos del ciclo celular, reparación del ADN y apoptosis. El objetivo de este artículo es el de reportar el caso de una paciente con síndrome de AT causada por una mutación no reportada previamente en la literatura. Caso clínico: Paciente originaria de Colombia, de 14 años de edad, con manifestaciones clínicas y fenotípicas clásicas del síndrome de AT a partir de los 6 años de edad, con alteración pondoestatural, infecciones respiratorias a repetición, telangiectasias oculocutáneas y compromiso neurológico progresivo, caracterizado por regresión en su desarrollo psicomotor, ataxia y apraxia oculomotora. Se realizó secuenciación del gen ATM que demostró mutación en homocigosis no reportada previamente en la literatura. Discusión: En Latinoamérica son escasos los reportes de pacientes con AT y pocos aquellos en donde se describen los hallazgos moleculares. Los estudios moleculares son una herramienta que facilita el diagnóstico y permite orientar mejor el manejo y pronóstico de pacientes con enfermedades neurodegenerativas. El reporte de variantes moleculares no descritas es de gran importancia para establecer la causa etiológica de este tipo de patologías en grupos poblacionales diversos, como lo son los países de Latinoamérica.

Introduction: The ataxia telangiectasia syndrome (AT) is a genetic disease with an autosomal recessive inheritance pattern, with multisystem involvement and a broad clinical spectrum. It is caused by the mutation of the ATM gene, causing reduction or absence of the ATM proteinkinase, altering processes in the cell cycle, DNA repair and apoptosis. The objective of this article is to report the case of a patient with ataxia telangiectasia syndrome, caused by a mutation not previously reported in the literature. Case report: A 14 year-old patient native to Colombia, with classic clinical and phenotypical manifestations of AT syndrome, which started at 6 years of age with pondostatural alteration, recurrent respiratory infections, oculocutaneus telangiectasias and progressive neurological disorder that included: regression in her psychomotor development, ataxia and oculomotor apraxia. ATM gene sequencing is performed evidencing a homozygous mutation not reported in literature. Discussion: In Latin America are sparse the number of reports of patients with ataxia telangiectasia and only few of these describe their molecular findings. Molecular studies allow the diagnosis and a better orientation in the management and prognosis of patients with neurodegenerative diseases. The report of undescribed molecular variants is of great importance to establish the etiology of such diseases in diverse population groups, such as the countries of Latin America.

Análisis clínic y molecular de una pacientecon pentasomia del cromoooma x. / Clinical and Molecular Analysis of a Patient with X-Chromosome Pentasomy.

Introducción: la Pentasomia del X (49,XXXXX) es una alteración cromosómica poco frecuente, que afecta a mujeres y fue descrita en 1963 por Kesaree y Wooley. Hasta la fecha se han reportado menos de 30 casos en la literatura. Se presenta un caso de pentasomia del cromosoma X, y mediante técnicas de biología molecular (microsatélites) se determino el origen materno de los cromosomas X adicionales. Caso clínico: paciente de 28 meses, con talla baja proporcionada, braquicefalia, fascies característica, genitales externos femeninos con labios mayores hipoplásicos, braquidactilia, clinodactilia bilateral del quinto dedo, luxación de rodilla derecha, deformidad en varo. Se realizó cariotipo en sangre periférica que reportó un complemento cromosómico 49,XXXXX. Materiales y métodos: se realizó extracción de ADN y PCR para la amplificación de ocho microsatélites o STR’s tetra y dinucleotídicos situados a lo largo del cromosoma X. Los productos amplificados se analizaron en el secuenciador ALF EXPRESS. Con la información alélica se realizó la construcción del haplotipo y el análisis de dosis génica mediante la determinación del área bajo la curva. Resultados y discusión: el análisis de los ocho STR’s realizados en la paciente y sus padres, permitió establecer que los cromosomas X extras corresponden a información alélica heredada de la madre. Se analizan los resultados y los eventos que se han documentado como relacionados con los fenómenos de no disyunción. Conclusión: el origen de la doble no disyunción que generó la pentasomia es materna, en donde un ovulo tetrasómico, con cuatro copias de cromosoma X fue fecundado con un espermatozoide monosómico normal.

Introduction: Pentasomy X is a rare chromosomal disorder which affects women. It was first described in 1963 by Kesaree and Wooley. Up to date, less than 30 cases have been reported. We report a case of 28 month old female patient with clinical features of Pentasomy X. Cytogenetic and molecular analysis revealed that her karyotype was 49,XXXXX and that the additional X chromosomes were maternal in origin. Case report: We present a 28 month old female patient with short stature, brachycephaly, characteristic facies, with female external genitalia, hypoplasic labia majora, brachydactyly, bilateral clinodactyly of the fifth finger, dislocation of the right knee with genu varum deformities. Chromosome analysis revealed a karyotype of 49, XXXXX. Materials and methods: We performed DNA extraction and subsequent PCR amplification of 8 microsatellites (STR’s) throughout the X chromosome. The amplified products were analyzed in the ALF EXPRESS sequencer. The allelic information obtained was used to construct haplotypes and to analyze gene dosage through the determination of the area under the curve. Results and discussion: Through the analysis of eight STR’s in the patient and her parents we were able to determine that the extra X chromosomes were inherited from the mother. We analyze our results and other well documented events that have been related to non-disjunctions. Conclusion: We confirmed through molecular analysis of X-linked DNA markers that the aneuploidy developed from two maternal non-disjunctions.

Establishment and Management of Medical Genetic Clinic Based on Genetic Testing Network / 대한진단검사의학회지

BACKGROUND: With the progress of the Human Genome Project, genetic testing has become widely available and useful for the confirmation and treatment planning of various conditions. Additionally, the need for genetic counseling and consultation service has been increasing. We tried to establish and manage a medical genetic clinic within the department of laboratory medicine by using a genetic testing network. METHODS: An Inter-laboratory network has been organized between Soonchunhyang University Bucheon Hospital and Samsung Medical Center since January, 2005. As clinical laboratory physicians, we provide medical services ranging from genetic counseling to genetic testing. In this study we surveyed the need and demand for genetic consultation services using a questionnaire. RESULTS: Of the 30 cases that were requested to receive a genetic consultation, 24 were referred to the genetic clinic during the last 11 months. Of these, 18 underwent genetic tests. The request for genetic consultation came mainly from neurology, obstetrics, and pediatrics departments and the distribution of requested disease entities was very heterogeneous. Operating processes became more settled compared to the early period and specific work fields were secured in the genetic consultation services. Over 80% of the respondents replied that a medical genetic clinic was important and that public relations campaign should be continued. CONCLUSIONS: Establishment of a medical genetic clinic by using a genetic testing network has led to important changes that the department of laboratory medicine is most suitable for genetic testing and medical genetic consultations and laboratory physicians should be concerned in that field. A medical genetic consultation system based on extensive genetic information and knowledge could enhance opportunities for cooperation in genetic research.

Exploration in teaching model of medical genetis / 中华医学教育探索杂志

The combination of lecturing and Problem-based Learning(PBL)teaching method is adopted in medical genetis. It is conducive to the development of self-directed learning skills, team skills,and problem-solving skills.