ABSTRACT
Limited evidence suggests that the SARS-CoV-2 infection can accelerate the progression of neurodegenerative diseases, but this has been not verified in the spinocerebellar ataxias (SCA). The objective of this study is to assess the impact of COVID-19 on the mental health and motor features of SCA2. A follow-up study was carried out in 170 Cuban SCA2 subjects and 87 community controls between 2020 and 2021. All subjects underwent a structured questionnaire to assess the risks of exposure to COVID-19, the confirmation of COVID-19 diagnosis, and the Hospital Anxiety and Depression Scale (HADS). Moreover, 36 subjects underwent the Scale for the Assessment and Rating of ataxia (SARA). The risk of exposure to SARS-CoV-2 and the frequency of COVID-19 were similar between the ataxia cohort and the community controls. Within the ataxia group, significantly increased HADS scores existed at the 2nd visit in both groups, but this increase was more evident for the infected group regarding the depression score. Moreover, a significant within-group increase of SARA score was observed in the infected group but not the non-infected group, which was mainly mediated by the significant increase of the speech item score in the infected group. Similar results were observed within the subgroup of preclinical carriers. Our study identified no selective vulnerability nor protection to COVID-19 in SCA2, but once infected, the patients experienced a deterioration of mental health and speech function, even at preclinical disease stage. These findings set rationales for tele-health approaches that minimize the detrimental effect of COVID-19 on SCA2 progression and identify SCA2 individuals as clinical model to elucidate the link between SARS-CoV-2 infection and neurodegeneration.
ABSTRACT
Fundamento: las enfermedades cerebrovasculares constituyen un problema de salud a nivel mundial y una de las principales causas de mortalidad y discapacidad global. Objetivo: caracterizar clínicamente a los pacientes con enfermedad cerebrovascular isquémica ingresados en el Servicio de Medicina Interna del Hospital General Docente Guillermo Domínguez López en el período comprendido entre mayo de 2019 y mayo de 2021. Método: se realizó un estudio descriptivo de corte transversal en el Servicio de Medicina Interna del Hospital General Docente Guillermo Domínguez López en el municipio Puerto Padre en la provincia Las Tunas en el período comprendido entre mayo de 2019 y mayo de 2021. La población de estudio estuvo conformada por 184 pacientes con diagnóstico de enfermedad cerebrovascular isquémica. La muestra coincidió con el universo al estudiar el total de pacientes. Se caracterizaron las siguientes variables: edad, sexo, factores de riesgo, formas clínicas de presentación, complicaciones y supervivencia al egreso. Se utilizó estadística descriptiva. Los resultados se presentaron en cuadros de distribución de frecuencias para su mejor comprensión y análisis. Resultados: predominaron los pacientes de sexo masculino (53,80 %) y el grupo etáreo de 65 a 74 años con un 33,15 %. El principal factor de riesgo fue la hipertensión arterial (58,29 %) y predominó el infarto cerebral aterotrombótico con un 47,83 % como forma clínica de presentación. Las infecciones respiratorias (28 %) fueron las de mayor incidencia en cuanto a complicaciones. El 92,93 % de los pacientes egresaron vivos. Conclusiones: predominaron los hipertensos mayores de sesenta años, ingresados con infarto cerebral aterotrombótico.
Background: cerebrovascular diseases are a global health problem and one of the main causes of mortality and global disability. Objective: to clinically characterize patients with ischemic cerebrovascular disease admitted to the Internal Medicine Service of the Guillermo Domínguez López General Teaching Hospital in the period between May 2019 and May 2021. Method: a descriptive cross-sectional study was carried out in the Internal Medicine Service of the Guillermo Domínguez López General Teaching Hospital in the Puerto Padre municipality in Las Tunas province in the period between May 2019 and May 2021. The study population consisted of 184 patients diagnosed with ischemic cerebrovascular disease. The sample coincided with the universe when studying the total number of patients. The following variables were characterized: age, sex, risk factors, clinical forms of presentation, complications, and survival to discharge. Descriptive statistics were used. The results were presented in frequency distribution tables for better understanding and analysis. Results: male patients (53.80 %) and the age group of 65 to 74 years with 33.15 % predominated. The main risk factor was arterial hypertension (58.29 %) and atherothrombotic cerebral infarction prevailed with 47.83 % as the clinical form of presentation. Respiratory infections (28 %) were the ones with the highest incidence in terms of complications. 92.93 % of the patients were discharged alive. Conclusions: hypertensive patients over sixty years of age, admitted with atherothrombotic cerebral infarction, predominated.
ABSTRACT
RESUMEN Fundamento: la resistencia a la insulina y las alteraciones metabólicas asociadas, como la dislipemia, la hipertensión, la obesidad y la hipercoagulabilidad, influyen en la aparición cada vez más prematura y la severidad de la aterosclerosis que desarrollan los pacientes con diabetes mellitus Objetivo: evaluar los marcadores bioquímicos de aterosclerosis subclínica en pacientes con diabetes mellitus tipo 2. Método: se realizó un estudio descriptivo y transversal para evaluar marcadores bioquímicos de aterosclerosis subclínica en 100 pacientes con diabetes mellitus tipo 2 atendidos en el Hospital General Docente Guillermo Domínguez López desde abril del 2020 hasta marzo del 2021. Las variables analizadas fueron: edad, sexo, tensión arterial, antecedentes patológicos personales de diabetes mellitus, hábitos tóxicos y riesgo cardiovascular. Estos pacientes fueron clasificados según su riesgo cardiovascular global utilizando las gráficas de riesgo que establece la Organización Mundial de la Salud para la región de las Américas y se les realizaron las determinaciones de colesterol total, triglicéridos, LDL colesterol, HDL colesterol, creatinina, ácido úrico, cistatina C, fibrinógeno, proteína C reactiva de alta sensibilidad. La información se procesó mediante métodos de estadística descriptiva, principalmente tasas y porcientos. Resultados: la mayoría de los pacientes se clasificaron en riesgo cardiovascular global 2 y 3. Sus marcadores mostraron asociación con las categorías de riesgo establecidas en cada paciente. Las determinaciones de triglicéridos, HDL-colesterol y ácido úrico fueron las más significativas para identificar el daño vascular en los pacientes con diabetes mellitus tipo 2. Conclusiones: hubo una relación directa entre los valores alterados de la proteína C reactiva de alta sensibilidad y el riesgo cardiovascular global en los pacientes estudiados.
ABSTRACT Background: insulin resistance and associated metabolic alterations, such as dyslipidemia, hypertension, obesity and hypercoagulability, influence the increasingly premature appearance and severity of atherosclerosis that patients with diabetes mellitus develop. Objective: to evaluate the biochemical markers of subclinical atherosclerosis in patients with type 2 diabetes mellitus. Method: a descriptive and cross-sectional study was carried out to evaluate biochemical markers of subclinical atherosclerosis in 100 patients with type 2 diabetes mellitus treated at the Guillermo Dominguez López General Teaching Hospital from April 2020 to March 2021. The used variables were: age, sex, blood pressure, personal medical history of diabetes mellitus, toxic habits and cardiovascular risk. These patients were classified according to their global cardiovascular risk using the risk charts established by the World Health Organization for the Americas region and total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, creatinine, uric acid determinations were performed, cystatin C, fibrinogen, high-sensitivity C-reactive protein. The information was processed using descriptive statistics methods, mainly rates and percentages. Results: most of the patients were classified in global cardiovascular risk 2 and 3. Their markers showed association with the risk categories established in each patient. The determinations of triglycerides, HDL-cholesterol and uric acid were the most significant to identify vascular damage in patients with type 2 diabetes mellitus. Conclusions: there was a direct relationship between altered values of high-sensitivity C-reactive protein and global cardiovascular risk in the studied patients.
ABSTRACT
Although there are no convincing evidences of detrimental effect of SARS-CoV2 infection on the cerebellum, the COVID-19 pandemic could impact the life quality of patients with cerebellar ataxias, but few studies have addressed this concern. To assess the motor and mental health changes caused by the COVID-19 pandemics in Cuban patients with cerebellar ataxias, three hundred four patients with cerebellar ataxias and 167 healthy controls were interviewed for risks of exposure to COVID-19, and the self-perception of the pandemics' impact on the disease progression and on the mental health. All subjects underwent the Hospital Anxiety and Depression Scale. The patients reported low exposition to SARS-CoV2 infection, but one case was confirmed with a mild COVID-19. Overall, depressive and anxiety symptoms were significantly and marginally increased in patients, respectively, with higher scores in cases with severe and moderate ataxia. Positive patient's impression of psychopathological changes was associated to increased age, age at onset, and anxiety. Sixty-seven patients had a positive self-perception of ataxia progression, which was mainly influenced by higher anxiety scores but not by the adherence to at-home exercise programs. However, the practice of physical exercise was related with lower depression and anxiety scores, but this therapeutical effect was not significantly influenced by the disease stage. We demonstrated the negative effect of the COVID-19 pandemic on the mental and motor deficits in Cuban patients with cerebellar ataxias and the positive effect of the at-home physical exercise programs on their mental well-being. These findings give rationales to develop tele-medicine approaches to minimize these health impacts and to study the long-term effects of such sequelae and accordingly define their treatments.
