Clinical and electrophysiological characteristics of neuropathic pain in leprosy patients: A prospective cross-sectional study

Introduction: Neuropathic pain is a common and disabling late complication of leprosy. We investigated the clinical and electrophysiological characteristics of neuropathic pain in leprosy patients by evaluating nerve conduction, sympathetic skin response (SSR) and A-waves. Methods: Twenty one leprosy patients with neuropathic pain validated by the Douleur Neuropathique en 4 (DN4) Questionnaire were selected for study. Pain intensity was measured by the visual analog scale. Demographic and clinical data were collected for all patients. Clinical data included appraisal of the median, ulnar, radial, tibial and common peroneal nerves, assessment of the sympathetic skin response and conventional electrophysiological recordings. Results: Among all electroneuromyographic presentations, multifocal mononeuropathy was still the most prevalent. Sensory loss was observed more frequently than motor deficits. As most patients presented advanced clinical forms of leprosy and were under treatment, this high mean was found and the ulnar nerve was most frequently affected. The sympathetic skin response was absent in 16 patients. Higher DN4 Questionnaire scores were observed in women and in those receiving corticosteroid therapy. These inferences are possible to be made, but our study's limitations don't allow us to be certain about it. The statistical significance found only permits us to evidence what we related on the textual part of the study. Limitations: The small number of patients studied, the lack of sophisticated diagnostic methods for leprosy, as well as the difficulties in assessing nerve conduction were the main limitations of this study. Conclusion: The neurophysiological and clinical findings in leprous neuropathy were modest despite the conspicuous neuropathic pain. Although electrophysiological studies are a vital tool to verify nerve damage, variations in the clinical presentation of leprosy neuropathic pain render the diagnosis challenging. Further studies are needed to describe the neurophysiological evolution of this disease

Funcionalidade de idosos cadastrados em uma unidade da estratégia saúde da família segundo categorias da classificação internacional de funcionalidade / Functionality elderly enrolled in a family health strategy unit according to the level of the international classification of functioning

OBJETIVOS: Investigar a funcionalidade de idosos cadastrados na Estratégia Saúde da Família ESF e classificar pelas categorias de Atividade e Participação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde CIF. MÉTODO: Pesquisa transversal, descritiva, realizada em 124 idosos cadastrados na ESF Águas Lindas I, município de Ananindeua, Pará, Brasil. A coleta de dados ocorreu no ambiente domiciliar dos idosos. Investigaram-se as características sociodemográficas, a funcionalidade, pelo Índice de Katz e escala de Lawton, e o nível de Atividade e Participação, segundo a CIF. A análise estatística foi realizada no programa SPSS 18.0, utilizando a média, desvio-padrão e o teste Qui-quadrado de Pearson x2, com descrição da frequência relativa simples de cada domínio avaliado. RESULTADOS: 66,9 % dos idosos eram do sexo feminino, com média de idade 68,5 dp±8,19 anos, casados n=61 e recebiam aposentadoria n=69. Cerca de 65% dos idosos eram independentes para todas as atividades avaliadas pelo Índice de Katz e escala de Lawton. Quanto à classificação da funcionalidade pela CIF, a maioria foi classificada com códigos que indicam nenhuma dificuldade. CONCLUSÃO: A maior parcela dos idosos estudados apresenta-se ativa e participativa, ou seja, é capaz de desempenhar uma tarefa diária, o que talvez represente um envelhecimento com poucas perdas.

OBJECTIVE: To investigate the functionality of elderly enrolled in the Family Health Strategy and sort by categories of activity and participation of the International Classification of Functioning, Disability and Health ICF. METHOD: This is a cross-sectional, descriptive survey of 124 elderly enrolled in the Family Health Strategy of Aguas Lindas I, Ananindeua municipality, Pará state, Brazil. Data was collected in the elderly's homes. Variables were sociodemographic characteristics, functionality index by Katz and Lawton scale and level of activity and participation according to the ICF. Statistical analysis was performed using SPSS 18.0 program and the chi-square test x2, with description of simple relative frequency of each domain assessed. RESULTS: 66.9% of the elderly were female, with mean age 68.5 SD±8.19, married n=61 and receiving retirement n=69. About 65% of the elderly were independent for all activities assessed by the index of Katz and Lawton scale. As for the classification of functioning by ICF, most were classified with codes indicating no difficulty. CONCLUSION: The largest share of the elderly present active and participatory, in other words, are able to perform a daily task, which may represent an aging with few losses.

O cuidado hospitalar na hanseníase: um perfil do estado do Pará de 2008 a 2014 / Hospital care in leprosy: a profile of Pará, Brazil, 2008-2014

Os casos de internação por hanseníase representam as complicações e as situações mais graves da doença. Objetivou-se traçar um perfil epidemiológico da internação hospitalar por hanseníase, no estado do Pará, de 2008 a 2014. Para isso, realizou-se uma pesquisa descritiva de dados secundários disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. A análise efetuada foi, predominantemente,descritiva e os testes Qui-Quadrado e Teste-G foram utilizados quando pertinentes. Calculou-se,a taxa de internação e óbito para cada 10 mil internações ou óbitos por doenças infecciosas e parasitárias para o Pará e outras Unidades de Federação. Verificou-se que, nesse período, 740 pessoas foram internadas com a doença no estado, representando uma taxa de 12,86/10 mil internações por doenças infecciosas e parasitárias. Das internações totais, 526 (71,08%) foram homens e 524 (70,81%) encontravam-se na faixa etária de 20 a 59 anos; 61 (8,25%) possuíam até 19 anos. Dos atendimentos, 79,73% (n=590) foram registrados pelo regime público de saúde, 92,30% (n=683)em caráter eletivo e 84,19% (n=623) fora da região metropolitana de Belém. No ranking regional por taxa de internação o estado encontra-se em último lugar e em penúltimo no ranking nacional. O perfil de internação por hanseníase no Pará acompanha o perfil epidemiológico da doença, sendo mais comum em homens com idade economicamente ativa. O acometimento de crianças e adolescentes é preocupante,pois representa uma exposição precoce e maiores chances de desenvolver incapacidades.Os registros no estado foram mais baixos quando comparados a estados de média e baixa endemicidade.

Cases of hospitalization represent severest cases of leprosy, with more complications. This study aimed to criate an epidemiological profile of hospital admissions for leprosy in the state of Pará, Brazil, from 2008 to 2014. To this end, we carried out a descriptive study of secondary data provided by the Department of the Unified Health System Information of Brazil. The analysis was performed predominantly descriptive and Chi-square test and G-tests were used when appropriate. It calculated the rate of hospitalization and rate of death for every 10,000 hospitalizations or deaths due to infectious and parasitic diseases to the Pará and other units of federation. It was found that during this period 740 people were hospitalized with the disease in the state, representing a rate of 12.86 / 10 000 admissions for infectious and parasitic diseases. Of total admissions, 526 (71.08%) were men and 524 (70.81%) were in the age group 20-59 years;61 (8.25%) were in the age group 0-19 years. Of cases, 79.73% (n = 590) were recorded by the public health system, 92.30% (n = 683) on an elective basis and 84.19% (n = 623) outside the metropolitan area of Belém. Was observed that this state is last in regional ranking by hospitalization rate and second to last in the national ranking. The leprosy hospital admission profile in Pará is similar to the epidemiology of the disease, is more common in young men. The involvement of children and adolescents is worrisome because it’s represent the early exposure and more risk to develop disabilities. The records in the state were lower when compared to the average of states and low endemicity.

Abordagem das atividades funcionais e da influência dos fatores ambientais em pacientes hemiparéticos pós-AVE antes e após o tratamento fisioterapêutico / Addressing functional activities and the influence of environmental factors in post-stroke hemiparetic patients before and after physical therapy

O Acidente Vascular Encefálico (AVE) é a principal causa de incapacidade neurológica, sendo a hemiparesiaa sequela mais comum da doença. As limitações físico-funcionais associadas à influência de fatoresambientais afetam diretamente a funcionalidade dos indivíduos. Para a efetividade da reabilitação neurológica é indispensável que o fisioterapeuta conheça o perfil funcional do paciente a fim de traçar o plano de tratamento que atenda as reais necessidades. Objetivo: Analisar as atividades funcionais e a influência dos fatores ambientais em pacientes hemiparéticos pós-AVE antes e após o tratamento fisioterapêutico.Método: Foram avaliados 12 pacientes hemiparéticos pós-AVE antes e após 20 sessões de fisioterapia, utilizando-se o Índice de Barthel (IB) e um modelo avaliativo baseado no core set abreviado da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) para AVE, com base no sistema de qualificadores genéricos da CIF. Resultados: Observou-se melhora significativa para as atividadesandar (d450) (p = 0,0033), vestir (d540) (p = 0,018) e comer (d550) (p = 0,018), de acordo com um modelo avaliativo baseado na CIF. Por meio do IB, detectou-se melhora significativa para as atividades de alimentação (p = 0,0341), vestir (p = 0,0277), toalete (p = 0,0117) e subir/descer escadas (p = 0,0077). Os fatores ambientais família imediata (e310) e profissionais da saúde (e355) foram os que mais influenciarampositivamente na condição de saúde dos pacientes. Conclusão: A Fisioterapia mostrou-se eficaz para melhorar a condição de saúde dos pacientes, visto que de acordo com a percepção deles algumas atividades diárias puderam ser executadas com mais facilidade ao final do tratamento fisioterapêutico. Para atender às necessidades do paciente, é importante elaborar o plano de tratamento individual, ressaltando o contexto em que ele está inserido, visando atender as reais limitações nas atividades e restrições à participação.

Stroke is the leading cause of neurological disability and hemiparesis is its most common sequelae. The physical and functional limitations combined with the influence of environmental factors directly affect an individual?s functionally. For an effective neurological rehabilitation, it is essential that physiotherapists know the patient?s functional profile in order to plan the treatment to meet his/her real needs. Objective: To analyze the functional activities and influence of environmental factors in post-stroke hemiparetic patients before and after physical therapy. Method: Twelve post-stroke hemiparetic patients were evaluated before and after 20 physical therapy sessions with the Barthel Index (BI) and an evaluation model based on an abbreviated core set of the International Classification of Functioning, Disability and Health (ICF) for stroke, based in the generic qualifiers system of the ICF. Results: There was significant improvement for the activities walk (d450) (p = 0.0033), dress (d540) (p = 0.018) and eat (d550) (p = 0.018) for the evaluation model based on the ICF. According to the BI, significant improvement was detected for the activities of feed (p = 0.0341), dress (p = 0.0277), toilet (p = 0.0117), and up/down stairs (p = 0.0077). The environment factors immediate family and health professionals were the most positive influence on the health status of patients. Conclusion: Physical therapy was effective for improving the condition of patients since, according to the patients, some daily activities can be performed with more ease at the end of the physical therapy treatment. To meet their needs, it is important to develop an individual treatment plan, emphasizing the context in which he/she is inserted, in order to address the real limitations on activities and restrictions to participation.