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1.
An. bras. dermatol ; 99(1): 53-56, Jan.-Feb. 2024. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1527707

ABSTRACT

Abstract Background: Thalidomide is the drug of choice for the treatment of type 2 leprosy reactions and is often associated with corticosteroids. The use of these drugs in multiple myeloma is associated with the risk of cardiovascular events, but there have been few studies assessing this risk in leprosy patients. Objective: To evaluate the occurrence of cardiovascular events in patients with multibacillary leprosy and their correlation with the use of thalidomide and prednisone. Methods: Analytical cross-sectional study of all patients diagnosed with multibacillary leprosy treated at the Dermatology Service between 2012 and 2022, using electronic medical records. Thromboembolic vascular events, both arterial and venous, including acute myocardial infarction, were considered. The main independent variable was the concomitant use of thalidomide and prednisone during follow-up. Results: A total of 89 patients were included, of which 19 used thalidomide and prednisone concomitantly. There were five cardiovascular events (26.3%), three of which of deep venous thrombosis. The combined use of medications was associated with the events (PR = 6.46 [3.92 to 10.65]; p<0.01). Study limitations: Small number of events, single-center retrospective study. Conclusion: The hypothesis of an association between cardiovascular events and the concomitant use of thalidomide and prednisone is supported, but more robust prospective studies are required for a better assessment.

2.
Cad. Saúde Pública (Online) ; 40(1): e00113123, 2024. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1528215

ABSTRACT

Abstract: This study aimed to investigate the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy in an endemic area in the Northeastern Brazil. This is a cross-sectional study of 120 individuals with leprosy. Demographic and clinical data and information on the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy were obtained. Delayed diagnosis in months was estimated for each participant by interviews. A multivariate Poisson's regression analysis was performed between the outcome and the independent variables. The median delay in the diagnosis of leprosy was 10.5 (4.0-24.0) months. Approximately 12.6% of participants had grade 2 disability (G2D) at the time of diagnosis. In the multivariate Poisson regression analysis, males, older age, low schooling level, residing in urban areas, multibacellar or tuberculoid leprosy, not seeking healthcare immediately after symptom onset, suspected leprosy, excessive referrals, and the need for three or more consultations to confirm the diagnosis were associated with longer diagnostic delay. This study found a significant delay in the diagnosis of leprosy in Arapiraca, Northeastern Brazil, which may explain the continuously high rate of G2D among new cases. Factors related to the individual and the health system were associated with longer diagnostic delay. Interventions to raise awareness of the disease among the general population and strengthen primary health care are urgently needed.


Resumo: Neste estudo objetivou-se investigar os fatores relacionados ao indivíduo e ao sistema de saúde que contribuem para o atraso no diagnóstico da hanseníase em uma área endêmica no Nordeste do Brasil. Trata-se de um estudo transversal que incluiu 120 pacientes com hanseníase. Foram obtidos dados demográficos, clínicos e informações sobre fatores relacionados ao indivíduo e ao sistema de saúde que contribuem para o atraso no diagnóstico da hanseníase. O atraso do diagnóstico em meses foi estimado para cada participante por meio de entrevistas. Foi realizada uma análise multivariada por regressão de Poisson entre o resultado e as variáveis independentes. A mediana de atraso no diagnóstico da hanseníase foi de 10,5 (4,0-24,0) meses. Aproximadamente 12,6% dos participantes apresentavam grau de incapacidade física 2 (GIF 2) no momento do diagnóstico. Na análise multivariada por regressão de Poisson, homens, idosos, baixa escolaridade, residir em área urbana, hanseníase multibacilar, hanseníase tuberculóide, não procurar atendimento imediatamente após perceber os primeiros sintomas, suspeita de hanseníase, encaminhamentos excessivos e três ou mais consultas necessárias para confirmação diagnóstica associaram-se ao maior atraso diagnóstico. Este estudo encontrou um atraso significativo no diagnóstico da hanseníase em Arapiraca, Nordeste do Brasil, o que pode explicar a taxa continuamente alta de GIF 2 entre os casos novos. Fatores relacionados ao indivíduo e ao sistema de saúde foram associados ao maior atraso no diagnóstico. Intervenções para aumentar a conscientização sobre a doença entre a população geral e fortalecer a atenção primária à saúde são urgentemente necessárias.


Resumen: El objetivo de este estudio fue investigar los factores relacionados con el individuo y el sistema de salud que contribuyen al diagnóstico tardío de la lepra en un área endémica del Nordeste de Brasil. Se trata de un estudio transversal que incluyó a 120 pacientes con lepra. Se obtuvieron datos demográficos, clínicos e informaciones sobre los factores relacionados con el individuo y el sistema de salud que contribuyen al diagnóstico tardío de la lepra. Se estimó el retraso del diagnóstico en meses para cada participante a través de entrevistas. Se realizó un análisis multivariante por regresión de Poisson entre el resultado y las variables independientes. La mediana de retraso en el diagnóstico de lepra fue de 10,5 (4,0-24,0) meses. Aproximadamente el 12,6% de los participantes tenían grado de discapacidad física 2 (GIF 2) en el momento del diagnóstico. En el análisis multivariante por regresión de Poisson se encontró que los hombres, ancianos, la baja escolaridad, vivir en área urbana, la lepra multibacilar, la lepra tuberculoide, no buscar atención médica inmediatamente tras notar los primeros síntomas, la sospecha de lepra, las derivaciones excesivas y la necesidad de tres o más consultas para confirmar el diagnóstico se asociaron con un mayor retraso del diagnóstico. Este estudio encontró un retraso significativo en el diagnóstico de la lepra en Arapiraca, Nordeste de Brasil, lo que puede explicar la tasa continuamente alta de GIF 2 entre los nuevos casos. Factores relacionados con el individuo y el sistema de salud se asociaron con el mayor retraso del diagnóstico. Intervenciones para aumentar la concienciación sobre la enfermedad entre la población general y fortalecer la atención primaria de salud son urgentemente necesarias.

3.
Cad. Saúde Pública (Online) ; 40(1): e00038723, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1528217

ABSTRACT

Abstract: Brazil has the second largest number of leprosy cases (a disease with a significant burden) in the world. Despite global and local efforts to eliminate this public health problem, inadequate or late diagnosis contribute to perpetuate its transmission, especially among household contacts. Tests such as the rapid IgM antibody detection (RT) and real-time polymerase chain reaction (RT-PCR) were developed to overcome the challenges of early diagnosis of leprosy. This study aimed to analyze the cost-effectiveness of a new diagnostic algorithm recommended by the Brazilian government to diagnose leprosy in household contacts of confirmed leprosy cases, which includes the RT and RT-PCR tests. A decision tree model was constructed and the perspective of the Brazilian Unified National Health System (SUS) and a 1-year time horizon were adopted. Only direct medical costs related to diagnostic tests were included. Effectiveness was measured as the number of avoided undiagnosed leprosy cases. Different scenarios were analyzed. The sequential use of RT, slit-skin smear (SSS) microscopy, and RT-PCR as recommended by the Brazilian Ministry of Health was compared to a base case (isolated SSS microscopy), yielding an incremental cost-effectiveness ratio of USD 616.46 per avoided undiagnosed leprosy case. Univariate sensitivity analysis showed that the prevalence of leprosy among household contacts was the variable that influenced the model the most. This is the first economic model to analyze a diagnostic algorithm of leprosy. Results may aid managers to define policies and strategies to eradicate leprosy in Brazil.


Resumo: O Brasil tem o segundo maior número de casos de hanseníase (doença com carga significativa) do mundo. Apesar dos esforços globais e locais para eliminar esse problema de saúde pública, o diagnóstico inadequado ou tardio contribui para perpetuar sua transmissão, especialmente entre contatos intradomiciliares. Exames como o teste rápido de anticorpos IgM (RT) e a reação em cadeia da polimerase em tempo real (RT-PCR) foram desenvolvidos para superar as barreiras do diagnóstico precoce da hanseníase. Este estudo teve como objetivo analisar a relação custo-efetividade de um novo algoritmo de diagnóstico recomendado pelo governo brasileiro para diagnosticar a hanseníase em contatos domiciliares de casos confirmados de hanseníase, que inclui os testes RT e RT-PCR. Foi construído um modelo de árvore de decisão e adotada a perspectiva do Sistema Único de Saúde (SUS) considerando o período de um ano. Foram incluídos apenas os custos médicos diretos relacionados aos exames diagnósticos. A efetividade foi medida considerando o número de casos evitados de hanseníase. Diferentes cenários foram analisados. O uso sequencial de RT, baciloscopia e RT-PCR, conforme recomendado pelo Ministério da Saúde, foi comparado a um caso base (baciloscopia isolada), obtendo-se uma razão de custo-efetividade incremental de USD 616,46 por caso evitado de hanseníase. A análise de sensibilidade univariada mostrou que a prevalência de hanseníase entre contatos intradomiciliares foi a variável que mais influenciou o modelo. Este é o primeiro modelo econômico a analisar um algoritmo diagnóstico da hanseníase. Os resultados poderão auxiliar os gestores na definição de políticas e estratégias para a erradicação da hanseníase no Brasil.


Resumen: Brasil tiene el segundo mayor número de casos de lepra (enfermedad con carga significativa) del mundo. A pesar de los esfuerzos globales y locales para eliminar ese problema de salud pública, el diagnóstico inadecuado o tardío contribuye a perpetuar su transmisión, sobre todo entre contactos intradomiciliarios. Los exámenes como la prueba rápida de anticuerpos IgM (RT) y la reacción en cadena de la polimerasa en tiempo real (RT-PCR) se desarrollaron para superar las barreras del diagnóstico precoz de la lepra. El objetivo de este estudio fue analizar la relación de costo-efectividad de un nuevo algoritmo de diagnóstico recomendado por el gobierno brasileño para diagnosticar la lepra en contactos domiciliarios de casos confirmados de lepra, que incluye las pruebas RT y RT-PCR. Se construyó un modelo de árbol de decisión y se adoptó la perspectiva del Sistema Único de Salud (SUS) teniendo en cuenta el periodo de un año. Solo se incluyeron los costos médicos directos relacionados con los exámenes diagnósticos. Se midió la efectividad teniendo en cuenta el número de casos de lepra evitados. Se analizaron distintos escenarios. Se comparó el uso secuencial de RT, baciloscopia y RT-PCR, conforme el Ministerio de Salud recomienda, con un caso base (baciloscopia aislada), y se obtuvo un cociente de costo-efectividad incremental de USD 616,46 por cada caso de lepra evitado. El análisis de sensibilidad univariante mostró que la prevalencia de lepra entre contactos intradomiciliarios fue la variable que más influyó el modelo. Este es el primer modelo económico que analiza un algoritmo diagnóstico de lepra. Los resultados podrán ayudar los gestores a definir políticas y estrategias para erradicar la lepra en Brasil.

4.
Epidemiol. serv. saúde ; 33: e2023090, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1528596

ABSTRACT

ABSTRACT Objective To analyze epidemiological characteristics, temporal trends and spatial distribution of leprosy cases and indicators in the state of Piauí, 2007-2021. Methods This was an ecological time-series study using data from the Notifiable Health Conditions Information System, describing the spatial distribution and the temporal trend of leprosy using Prais-Winsten regression. Results A total of 17,075 new cases of leprosy were reported. There was a falling trend in the overall detection rate [annual percentage change (APC) = -6.3; 95%CI -8.1;-4.5)], detection in children under 15 years of age (APC = -8,6; 95%CI -12,7;-4,3) and detection of cases with grade 2 physical disability (APC = -4,4; 95%CI -7,0;-1,8). There was a rising trend in the proportion of multibacillary cases. Spatial distribution of the average detection rate identified hyperendemic areas in the Carnaubais, Entre Rios, Vale dos Rios Piauí e Itaueiras regions. Conclusion High leprosy detection rates were found, despite the falling trend of indicators, except the proportion of multibacillary cases.


RESUMEN Objetivo Analizar características epidemiológicas, tendencias temporales, distribución espacial de casos y indicadores de lepra en el estado de Piauí, 2007-2021. Métodos Estudio ecológico de series temporales con datos del Sistema de Información de Enfermedades de Notificación que describen la distribución espacial y la tendencia temporal de la lepra mediante la regresión de Prais-Winsten. Resultados Se notificaron 17.075 nuevos casos de lepra. Hubo tendencia decreciente en las tasas de detección general [variación porcentual anual (VPA) = -6,3; IC95% -8,1; -4,5], detección en menores de 15 años (VPA = -8,6; IC95% -12,7; -4,3), y detección de casos con discapacidad física grado 2 (VPA = -4,4; IC95%-7,0; -1,8). Hubo una tendencia creciente en la proporción de casos multibacilares. La distribución espacial de la tasa promedio de detección identificó áreas hiperendémicas en las regiones de Carnaubais, Entre Rios, Vale dos Rios Piauí y Itaueiras. Conclusión Se observaron altas tasas de detección de lepra, a pesar de la tendencia decreciente de los indicadores, excepto la proporción de casos multibacilares


RESUMO Objetivo Analisar características epidemiológicas, tendência temporal, distribuição espacial de casos e indicadores da hanseníase no estado do Piauí, 2007-2021. Métodos Estudo ecológico de séries temporais com dados do Sistema de Informação de Agravos de Notificação, descrevendo a distribuição espacial e a tendência temporal da hanseníase pela regressão de Prais-Winsten. Resultados Foram notificados 17.075 novos casos de hanseníase. A distribuição espacial da taxa média de detecção identificou áreas hiperendêmicas nas regiões Carnaubais, Entre Rios, Vale dos Rios Piauí e Itaueiras. Verificou-se tendência decrescente nas taxas de detecção geral [variação percentual anual (VPA) = -6,3; IC95% -8,1;-4,5], de detecção em menores de 15 anos (VPA = -8,6; IC95%12,7;-4,3) e de detecção de casos com grau 2 de incapacidade física (VPA = -4,4; IC95%-7,0;1,8), e tendência crescente na proporção de casos multibacilares. Conclusão Observaram-se elevadas taxas de detecção de hanseníase, apesar da tendência decrescente dos indicadores, exceto a proporção de casos multibacilares.

5.
Mem. Inst. Oswaldo Cruz ; 119: e230129, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1534930

ABSTRACT

BACKGROUND Leprosy is a highly neglected disease that is considered a serious public health problem in many countries. This illness is characterised by a variety of clinical and histopathological manifestations that are related to the patient immune response. OBJECTIVES This work aimed evaluate the profile of circulating immune mediators in the plasma from patients classified clinically as paucibacillary (PB), multibacillary (MB), households contacts (HHC), type1 leprosy reaction (T1R), type2 leprosy reaction (T2R) and control individuals without medical history of leprosy (CTL). METHODS To assessment of the plasma immune mediators was used multiplex microbeads immunoassay "Luminex". FINDINGS The results showed that patients (PB) had a regulatory-biased profile, while MB revealed a pro-inflammatory trend of highly expressed biomarkers. HHC display conspicuously increased levels in the plasma of the chemokines (CCL2, CCL3, CCL4, CCL5 and CXCL8), pro-inflammatory cytokines (IFN-γ,TNF and IL-1β), modulating cytokines (IL-9 and IL-1Ra) and growth factors (PDGF, G-CSF and IL-2). Interestingly, HHC displayed superior production of IFN-γ as compared to other leprosy groups, indicating a putative protective role for this cytokine during chronic Mycobacterium leprae exposure. MAIN CONCLUSION Further investigations are currently underway to elucidate the potential of these mediators as biomarkers applicable to the diagnosis/prognosis of leprosy and also T1R and T2R leprosy reactions.

6.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 42: e2023022, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1521602

ABSTRACT

ABSTRACT Objective: To describe leprosy involvement and physical disability profiles in children and adolescents under 15 years old. Methods: Ecological time series study, based on data from the Brazilian Notifiable Diseases Information System, including new cases of leprosy residing in Palmas (TO), from 2001 to 2020. Results: A total of 471 notified cases in children and adolescents under 15 years of age were evaluated, resulting in a detection coefficient of 26.5 per 100,000 inhabitants. Of these, 52% (n=243) were women, 5% (n=24) corresponded to grade two disability, and 36% (n=168) were diagnosed through spontaneous demand. The temporal trend analysis showed a 0.5% reduction in the detection coefficient. There was a significant decrease in the diagnosis of the undetermined and tuberculoid clinical forms and a significant increase in the dimorphous form. Diagnosis through contact examination increased significantly by 13.1% and that through spontaneous demand decreased by 4.9%. The detection coefficient of cases with grade two disability reduced significantly by 7.4% while those with grade one increased by 16.8%. Conclusions: Despite the downward trend in the detection coefficient in children and adolescents under 15 years of age and in cases with grade two disability, other factors indicate failure in the adequate management of leprosy in Palmas.


RESUMO Objetivo: Descrever os perfis de acometimento de hanseníase e incapacidade física em menores de 15 anos. Métodos: Estudo ecológico de série temporal, baseado em dados do Sistema Nacional de Agravos de Notificação, incluindo casos novos de hanseníase residentes em Palmas (TO), no período de 2001 a 2020. Resultados: Foram avaliados 471 casos notificados em crianças e adolescentes menores de 15 anos, resultando em um coeficiente de detecção de 26,5 por cem mil habitantes. Destes, 52% (n=243) eram do gênero feminino, 5% (n=24) correspondiam ao grau dois de incapacidade física, e 36% (n=168) foram diagnosticados por demanda espontânea. A análise de tendência temporal mostrou queda do coeficiente de detecção em 0,5%. Houve queda significativa no diagnóstico das formas clínicas indeterminada e tuberculoide e aumento significativo da dimorfa. O diagnóstico por exame de contato teve um aumento significativo de 13,1% e o por demanda espontânea, queda significativa de 4,9%. O coeficiente de detecção de casos com grau dois de incapacidade apresentou uma queda significativa de 7,4%, enquanto o de casos com grau um, apresentou um aumento de 16,8%. Conclusões: Apesar da tendência de queda do coeficiente de detecção em menores de 15 anos e do coeficiente de detecção de casos com grau dois de incapacidade, outros fatores indicam falha no manejo adequado da hanseníase em Palmas.

7.
Rev. Inst. Med. Trop ; 18(2)dic. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1529464

ABSTRACT

Introducción: La lepra o enfermedad de Hansen es una enfermedad infectocontagiosa, crónica, causada por el bacilo Mycobacterium leprae. Es causante de neuropatía periférica, y afecta a la piel, nervios periféricos, vías aéreas superiores y ojos. El objetivo fue evaluar las características clínicas y sociodemográficas a los pacientes con Lepra que acudieron Hospital Menonita Km 81 de Itacurubi de la Cordillera en los años 2018-2022. Material y Método: Estudio observacional descriptivo. retrospectivo, de corte transversal en pacientes con Lepra del Hospital Menonita Km 81 en la ciudad de Itacurubi de la Cordillera del Departamento de Cordillera del año 2018 al 2022. Los datos se obtuvieron de la revisión de las fichas epidemiológicas de pacientes con diagnóstico de lepra en el período abarcado en un periodo de 5 años, 2018 al 2022. Resultados: Fueron reportados 286 casos de lepra en pacientes provenientes de los 18 departamentos del Paraguay. El año con más casos detectados fue el 2019 con 79 casos, siendo el departamento de Alto Paraná con mayor incidencia con 17 casos diagnosticados, seguido del año 2018 con 76 casos. La ocupación más frecuente de los pacientes fue la agricultura. El sexo más frecuente fue el masculino 203 (71%) casos con lepra. El rango de edad de mayor frecuencia fue entre 49- 63 años de edad (29,56%). El motivo de consulta más frecuente fue el de Mácula en 139 (49%). Conclusión: Se requiere aumentar la calidad de la atención primaria y el compromiso del personal de salud para el control y el diagnóstico oportuno de la Lepra en nuestro país.


Introduction: Leprosy, or Hansen's disease, is a chronic infectious disease caused by Mycobacterium leprae. It causes peripheral neuropathy and affects the skin, peripheral nerves, upper airways, and eyes. The objective was to evaluate the clinical and sociodemographic characteristics to patients with Leprosy who attended Mennonite Hospital Km 81 of Itacurubí de la Cordillera in the years 2018-2022 Material and Method: descriptive observational study, retrospective of cross-sectional in patients with Leprosy of the Mennonite Hospital Km 81 in the city of Itacurubi de la Cordillera of the Department of Cordillera from the year 2018 to 2022. Data were obtained from the review of epidemiological records of patients with a diagnosis of leprosy in the period covered in a period of 5 years, 2018-2022. Results: Of the 18 departments in Paraguay, 286 cases of leprosy were reported. The year with the most cases detected was 2019, with 79 cases, with the department of Alto Paraná having the highest incidence, with 17 cases diagnosed, followed by 2018 with 76 cases. Agriculture was the most common occupation. The most frequent sex was male (203 [71%] patients) with leprosy. The most frequent age range was 49-63 years (29.56%), and the most frequent reason for consultation was macular in 139 patients (49%). Conclusion: It is necessary to increase the quality of primary care and commitment of health personnel in the control and timely diagnosis of leprosy in our country.

8.
Rev. Ciênc. Saúde ; 13(4): 38-45, Dezembro 2023.
Article in English, Portuguese | LILACS | ID: biblio-1526655

ABSTRACT

Objetivo: Avaliar a quantidade anual de baciloscopias para hanseníase realizadas no Sistema Único de Saúde (SUS) nos últimos dez anos. Métodos: Foi realizado um estudo ecológico, longitudinal, retrospectivo e quantitativo, utilizando dados do Sistema de InformaçõesAmbulatoriais (SIA/SUS). A quantidade de baciloscopias para hanseníase a cada 100.000 residentes foi estimada para o Brasil e suas cinco macrorregiões, avaliada entre 2013 e 2022 com nível de significância (a) de 5%. Resultados:Mais de 1,3 milhões de baciloscopias foram notificadas nos últimos dez anos no SUS. A mediana da incidência anual foi de 67 baciloscopias para hanseníase por 100.000 residentes, sendo a máxima observada em 2013 (82) e a mínima em 2022 (46). As incidências anuais nas macrorregiões Norte, Centro-oeste e Nordeste foram significativamente superiores à estimativa nacional, enquanto no Sul e Sudeste foram inferiores (p<0,05). A tendência temporal foi considerada decrescente para a estimativa nacional (p= 0,002), com variação percentualanual de -5,6% (IC95% = -3,8%; -8,2%). Entretanto, após desconsiderar os anos da pandemia de COVID-19 (2020-2022), a tendência tornou-se estacionária (p= 0,181). Além disso, a incidência durante o período pré-pandêmico foi significativamente maior quandocomparada ao terceiro ano após o advento da pandemia em todas as macrorregiões do Brasil (p<0,05). Conclusão:Foi possível concluir que o SUS realizou um número expressivo de baciloscopias para hanseníase nos últimos dez anos, mas existem disparidades macrorregionais no Brasil, bem como um impacto significativo da pandemia de COVID-19


Objective:To evaluate the annual number of skin smear microscopies for leprosy performed in the Unified Health System (SUS) in the last decade. Methods:An ecological, longitudinal, retrospective, and quantitative study was conducted using data from the Ambulatory Information System (SIA/SUS). The number of skin smear microscopies for leprosy per 100,000 residents was estimated for Brazil and its five macroregions, between 2013 and 2022, with a significance level (a) of 5%.Results:More than 1.3 million skin smear microscopies were reported in the last decade in the SUS. The median annual incidence was 67 skin smear microscopies for leprosy per 100,000 residents, with the maximum observed in 2013 (82) and the minimum in 2022 (46). Annual incidences in the North, Central-West, and Northeast macro-regions were significantly higher than the national estimate, whereas in the South and Southeast, they were lower (p <0.05). The temporal trend was considered decreasing for the national estimate (p = 0.002), with an annual percentage variation of -5.6% (95%CI = -3.8%; -8.2%). However, after disregarding the years of the COVID-19 pandemic (2020-2022), the trend became stationary (p = 0.181). Furthermore, the incidence during the pre-pandemic period was significantly higher compared with the third year after the advent of the pandemic in all macro-regions of Brazil (p<0.05).Conclusion:It was possible to conclude that the SUS performed a significant number of skin smear microscopies for leprosy in the last ten years, but there are macro-regional disparities in Brazil and a significant impact of the COVID-19 pandemic


Subject(s)
Humans , Demography
9.
Rev. enferm. UERJ ; 31: e74198, jan. -dez. 2023.
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1524801

ABSTRACT

Objetivo: analisar as repercussões da COVID-19 na vida das pessoas afetadas pela hanseníase e promover intervenções de enfrentamento aos problemas vivenciados pelos usuários. Método: estudo qualitativo do tipo pesquisa participante, realizado de dezembro de 2021 a junho de 2022 na região metropolitana de Recife em oito serviços de saúde de referência para hanseníase. Realizaram-se entrevistas semiestruturadas, telemonitoramento e intervenções nos grupos de autocuidado com usuários acometidos pela hanseníase, e oficinas com profissionais e gestores. Resultados: observaram-se repercussões financeiras, no acesso aos serviços de saúde e na socialização dos usuários. As intervenções realizadas com usuários promoveram melhores práticas de conhecimento sobre a patologia, empoderamento e autocuidado. As oficinas com gestores e profissionais propiciaram a retomada e implementação de novos grupos de autocuidado, atividades comprometida na pandemia. Conclusão: a COVID-19 trouxe repercussões na situação financeira, socialização e acesso a serviços de saúde, com piora da situação de vulnerabilidade social e isolamento, já presentes no contexto da hanseníase.


Objective: to analyze the repercussions of COVID-19 on the lives of people affected by leprosy and to promote interventions to cope with the problems experienced by users. Method: qualitative study of the participant research type, carried out from December 2021 to June 2022 in the metropolitan region of Recife in eight reference health services for leprosy. Semi-structured interviews, telemonitoring and interventions were carried out in self-care groups with users affected by leprosy, and workshops with professionals and managers. Results: there were financial repercussions, on access to health services and on the socialization of users. Interventions carried out with users promoted better knowledge practices about the pathology, empowerment and self-care. The workshops with managers and professionals facilitated the resumption and implementation of new self-care groups, activities compromised in the pandemic period. Conclusion: COVID-19 had repercussions on the financial situation, socialization and access to health services, with a worsening of the situation of social vulnerability and isolation, already present in the context of leprosy.


Objetivo: analizar las repercusiones del COVID-19 en la vida de las personas afectadas por la lepra y promover intervenciones para el enfrentamiento de los problemas vividos por los usuarios. Método: estudio cualitativo de tipo investigación participante, realizado de diciembre de 2021 a junio de 2022 en la región metropolitana de Recife en ocho servicios sanitarios de referencia para la lepra. Se realizaron entrevistas semiestructuradas, telemonitoreo e intervenciones en grupos de autocuidado junto a usuarios afectados por lepra y talleres con profesionales y gestores. Resultados: hubo repercusiones financieras en el acceso a los servicios de salud y en la socialización de los usuarios. Las intervenciones realizadas con los usuarios promovieron mejores prácticas de conocimiento sobre la patología, empoderamiento y autocuidado. Los talleres con directivos y profesionales facilitaron la reanudación e implementación de nuevos grupos de autocuidado, actividades comprometidas en la pandemia. Conclusión: el COVID-19 tuvo repercusiones en la situación económica, socialización y acceso a los servicios de salud, con empeoramiento de la situación de vulnerabilidad social y aislamiento, ya presente en el contexto de la lepra.

10.
Nursing (Ed. bras., Impr.) ; 26(303): 9867-9875, set.2023. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1511825

ABSTRACT

Objetivo: Avaliar a qualidade de vida de pacientes durante e após o tratamento de hanseníase. Método: Estudo descritivo, exploratório e quantitativo. Realizado através da escala de qualidade de vida WHOQOL-bref. CAAE: 58389422.0.0000.5587. Resultados: Participaram 33 (100%) pacientes que tiveram diagnóstico de Hanseníase, a amostra foi tabulada separando entre dois grupos, 13 (100%) em tratamento ativo e 20 (100%) com tratamento finalizado. Para os pacientes ainda em tratamento: no domínio físico 31% referem boa qualidade de vida e 23% referem ruim, já no meio ambiente, psicológico e relações sociais 08% referem boa qualidade de vida e 23% ruim, respectivamente. Para os participantes com tratamento finalizado, o domínio físico, meio ambiente, psicológico e relações sociais obtiveram 40% com boa qualidade de vida e 05% ruim. Conclusão: os pacientes que finalizaram tratamento apresentam melhor qualidade de vida do que os pacientes em tratamento de hanseníase, demonstrando a importância de realizar o tratamento corretamente.(AU)


Objective: To evaluate the quality of life of patients during and after leprosy treatment. Method: Descriptive, exploratory and quantitative study. It was carried out using the WHOQOL-bref quality of life scale. CAAE: 58389422.0.0000.5587. Results: 33 (100%) patients diagnosed with leprosy took part in the study. The sample was divided into two groups: 13 (100%) in active treatment and 20 (100%) with treatment completed. For patients still undergoing treatment: in the physical domain 31% reported a good quality of life and 23% a poor one, while in the environmental, psychological and social relations domains 08% reported a good quality of life and 23% a poor one, respectively. For participants who had completed treatment, 40% reported good quality of life in the physical, environmental, psychological and social relations domains and 05% reported poor quality of life. Conclusion: Patients who have completed treatment have a better quality of life than patients undergoing leprosy treatment, demonstrating the importance of carrying out treatment correctly.(AU)


Objetivo: Evaluar la calidad de vida de los pacientes durante y después del tratamiento de la lepra. Método: Estudio descriptivo, exploratorio y cuantitativo. Se realizó utilizando la escala de calidad de vida WHOQOL-bref. CAAE: 58389422.0.0000.5587. Resultados: Participaron en el estudio 33 (100%) pacientes diagnosticados de lepra. La muestra se tabuló en dos grupos: 13 (100%) en tratamiento activo y 20 (100%) con tratamiento finalizado. Para los pacientes aún en tratamiento: en el dominio físico el 31% informó de una buena calidad de vida y el 23% de una mala, mientras que en los dominios ambiental, psicológico y de relaciones sociales el 08% informó de una buena calidad de vida y el 23% de una mala, respectivamente. En el caso de los participantes que habían completado el tratamiento, el 40% informó de una buena calidad de vida en los dominios físico, ambiental, psicológico y de relaciones sociales y el 05% informó de una mala calidad de vida. Conclusión: Los pacientes que han completado el tratamiento tienen una mejor calidad de vida que los pacientes en tratamiento contra la lepra, lo que demuestra la importancia de llevar a cabo el tratamiento correctamente.(AU)


Subject(s)
Humans , Indicators of Quality of Life , Leprosy , Mycobacterium leprae
11.
Rev. Ciênc. Méd. Biol. (Impr.) ; 22(2): 188-196, set 2023. fig
Article in English | LILACS | ID: biblio-1516244

ABSTRACT

Introduction: Hansen's disease, or leprosy is caused by Mycobacterium leprae (M. leprae), is a major public health problem in developing countries, and affecting the skin and peripheral nerves. However, M. leprae can also affect bone tissue, mucous membranes, liver, eyes, and testicles, producing a variety of clinical phenotypes. MicroRNAs (miRNAs) have been expressed in the various clinical forms of leprosy and could potentially be used for its diagnosis. Objective: in silico design of the molecular structure of miRNAs expressed in leprosy. Methodology: we performed a nucleotide sequence search of 17 miRNAs expressed in leprosy, designing in silico the molecular structure of the following miRNAs: miRNA-26a, miRNA-27a, miRNA-27b, miRNA-29c, miRNA-34c, miRNA-92a-1, miRNA- 99a-2, miRNA-101-1, miRNA-101-2, miRNA-125b-1, miRNA-196b, miRNA-425-5p, miRNA-452, miRNA-455, miRNA-502, miRNA-539, and miRNA-660. We extracted the nucleotides were from the GenBank of National Center for Biotechnology Information genetic sequence database. We aligned the extracted sequences with the RNA Folding Form, and the three-dimensional molecular structure design was performed with the RNAComposer. Results: we demonstrate the nucleotide sequences, and molecular structure projection of miRNAs expressed in leprosy, and produces a tutorial on the molecular model of the 17 miRNAs expressed in leprosy through in silico projection processing of their molecular structures. Conclusion: we demonstrate in silico design of selected molecular structures of 17 miRNAs expressed in leprosy through computational biology.


Introdução: a doença de Hansen, ou hanseníase é causada pelo Mycobacterium leprae (M. leprae), é um grande problema de saúde pública nos países em desenvolvimento e afeta, a pele e os nervos periféricos. Entretanto, o M. leprae também pode comprometer o tecido ósseo, membranas mucosas, fígado, olhos e testículos, produzindo uma variedade de fenótipos clínicos. MicroRNAs (miRNAs) têm sido expressos nas várias formas clínicas da hanseníase e podem ser potencialmente utilizados para seu diagnóstico. Objetivo: objetivou-se com esse experimento modelar computacionalmente a estrutura molecular dos miRNAs expressos na hanseníase. Metodologia: realizou-se como metodologia uma pesquisa das sequências nucleotídicas de 17 miRNAs expressos na hanseníase, desenhando em modelo computacional a estrutura molecular dos seguintes miRNAs: miRNA-26a, miRNA-27a, miRNA-27b, miRNA- 29c, miRNA-34c, miRNA-92a-1, miRNA-99a-2, miRNA-101-1, miRNA-101-2, miRNA-125b-1, miRNA-196b, miRNA-425-5p, miRNA-452, miRNA-455, miRNA-502, miRNA-539, e miRNA-660. Extraiu-se os nucleotídeos do banco de dados do GenBank of National Center for Biotechnology Information . Alinhou-se as sequências extraídas com o RNA Folding Form, e o projeto da estrutura molecular tridimensional foi realizado com o RNAComposer. Resultados: demonstrou-se como resultados as sequências dos nucleotídeos e a projeção da estrutura molecular dos miRNAs expressos na hanseníase, e produzimos um tutorial sobre o modelo molecular dos 17 miRNAs expressos em hanseníase através do processamento de suas estruturas moleculares em projeção computacional. Conclusão: foi demonstrado computacionalmente o projeto de estruturas moleculares selecionadas de 17 miRNAs expressos em hanseníase através da biologia computacional.


Subject(s)
Peripheral Nerves , Skin , Biomarkers , MicroRNAs , Leprosy , Mycobacterium leprae , Testis , Bone and Bones , Eye , Liver , Mucous Membrane
12.
Article | IMSEAR | ID: sea-223153

ABSTRACT

Background: Leprosy (or Hansen’s disease) continues to present considerable challenges regarding containment and early diagnosis. Leprosy is considered to be primarily a neural disease that first affects the sensory function of small fibres. Although the condition is well described in terms of clinical manifestations and histology, few studies have been undertaken to detect damage done to small-fibre sensory nerves. In vivo confocal microscopy is a useful tool for conducting a detailed evaluation of these structures, although its use in individuals affected by leprosy has still not been explored. Objective: To evaluate in vivo confocal microscopy findings in Hansen’s disease patients and their association with clinical variables relating to this disease. Method: A cross-sectional case-series type study was carried out between October 2019 and May 2021, in Recife, Pernambuco, Brazil. Socio-demographic and clinical data were gathered from 21 patients with leprosy. The douleur neuropathique 4 neuropathic pain questionnaire was used to evaluate pain. In vivo confocal microscopy of the cornea was employed to evaluate the small-calibre fibres. Findings were compared with those for a control group of 23 healthy individuals. Results: In relation to clinical parameters, 90.5% of the patients were classified as “multibacillary” according to the World Health Organization criteria, and 70% as dimorphic or borderline, in accordance with the Madrid classification. Around 52.4% had received a diagnosis after one year or less of living with the disease, while 95.2% presented alterations in small-fibre sensory function and 35% presented such alterations in the large fibre. Neuropathic pain was present in 81% of the patients. In vivo confocal microscopy found no statistically significant difference in mean age and distribution according to sex between the Hansen disease patients and the control group of healthy individuals. The median-of-means for dendritic cells and volume of sub-basal nerve fibres in the control group were used to test for normality. Both eyes of all leprosy patients examined contained higher number of dendritic cells than the median value and a volume of sub-basal nerve fibres lower than the mean. These differences were statistically significant (P < 0.001 and P < 0.001, respectively). Multibacillary individuals had a median number of dendritic cells two times that of paucibacillary individuals (P = 0.035). Limitations: No association was found between the variables examined using in vivo confocal microscopy and clinical variables relating to small-fibre damage, the neuropathic pain questionnaire or alterations detected by the neurological examination. We believe, however, that Cochet-Bonnet esthesiometry of the cornea may have revealed such an association. Conclusion: In vivo confocal microscopy is a useful diagnostic tool for detecting small fibre loss in individuals affected by leprosy and may constitute a useful addition to the range of tools available to help curb the effects of neuropathy in these patients.

13.
Medisan ; 27(4)ago. 2023. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1514571

ABSTRACT

Se describe el caso clínico de un paciente infectado por el virus de la inmunodeficiencia humana en fase sintomática precoz, quien fue asistido en el Servicio de Dermatología del Hospital Clínico Quirúrgico Docente Dr. León Cuervo Rubio en Pinar del Río por presentar lesiones eritematosas infiltradas de tres meses de evolución en el miembro inferior derecho, con alteración de la sensibilidad térmica y dolorosa. Se le indicó baciloscopia y estudio histopatológico que confirmaron el diagnóstico de sospecha de lepra dimorfa tuberculoide, por lo que se comenzó a aplicar poliquimioterapia combinada con terapia antirretroviral, lo cual favoreció la evolución del paciente.


The case report of a patient infected by the human immunodeficiency virus in early symptomatic phase is described, who was seen at the Dermatology Service of the Dr. León Cuervo Rubio Teaching Clinical Surgical Hospital of Pinar del Río for presenting infiltrated erythematous lesions of three months of evolution in the right lower limb, with altered pain and thermal sensation. A basiloscopic and histopathologic study was indicated, which confirmed the presumptive diagnosis of borderline tuberculoid leprosy, and therefore polychemotherapy combined with antiretroviral therapy was started, which favored the patient's evolution.


Subject(s)
Mycobacterium leprae
14.
Article | IMSEAR | ID: sea-223136

ABSTRACT

Introduction: The COVID-19 pandemic imposed new challenge to the implementation of the National Leprosy Eradication Programme. According to national data, after lockdown due to COVID-19, there was a 29% reduction in total leprosy cases reported in the first quarter (April-June) of 2020 in comparison to 2019. Objectives: To explore the difficulties faced by different stakeholders of the National Leprosy Eradication Programme like policy makers, doctors, grass root level health workers as well as leprosy patients during COVID-19 pandemic with respect to programme implementation and access to leprosy care. Materials and Methods: Qualitative research was undertaken including two focus-group-discussions held among six leprosy patients diagnosed after lockdown and nine ASHA workers as well as six in-depth interviews of doctors, leprologists, and programme managers. Ethics committee approval was sought and informed consent was obtained from all participants. All focus-group-discussions were electronically recorded and the in-depth interviews telephonically recorded, transcribed and translated from Bengali-to-English. Transcripts were separately coded by researchers and thematically analysed with the help of Visual-Anthropac software version 1.0. Results: Solitary focus on COVID-19 control, capacity building and information, education and communication, leprosy case search & surveillance, co-infection among health workers, transportation issues were the themes explored from focus-group-discussions of health workers and ASHA workers. Similarly, the present study identified six themes from in-depth interviews of programme manager, leprologists, programme manager as diagnostic difficulty, operational issues, rehabilitation issues, capacity building & information education and communication activities and way forward. Limitations: The research reveals the perceptions of rural population of Eastern India with high leprosy prevalence, which might not be applicable for urban areas or low prevalent districts Conclusion: The solitary focus of the administration towards COVID and shifting the infrastructure and human resource only towards the management of COVID can lead to resurgence of the leprosy. Having an organised framework of operations, catering to the need of the front-line workers in rendering services, utilizing the digital platform and social media, and focusing on rehabilitation would be needed to overcome the crisis

15.
Article | IMSEAR | ID: sea-218872

ABSTRACT

Introduction: Leprosy is a chronic granulomatous disease presents variedly depending on the patient's immune status at the time of infection. In this study, we are planning to perform a retrospective analysis to characterise the trend of Lepromatous spectrum of Hansen's disease cases registered in Tertiary care centre. To analyse the incidence,Aim: clinical patterns and variants of Lepromatous spectrum of Hansen's disease cases registered in Tertiary care centre. Objectives: To describe the epidemiological trend of Lepromatous Spectrum of Hansen's Disease and its clinical variants. A Retrospective observational study involving Lepromatous spectrum of Hansen's diseaseMethodology cases registered in leprosy clinic in last 5 years (2017-2021). Patient demographic details, duration of disease, clinical presentations , investigation details like slit skin smear, biopsy reports, treatment data was extracted from the Leprosy case register and data analysis was done in this study. 129 leprosy patients (BL-69, LL-43, Histoid-15, PureResults neuritic-2) reported during the period of 2017 to 2021[ 5 years]. 2018and 2019 had maximum number of cases approximately 30 new cases of leoromatous leprosy . Hypopigmented patches and glove & stocking anaesthesia seen in 59.8% cases, skin nodules seen in 45.7%, earlobe infiltration seen in 21.7%, epistaxis &saddle nose deformity seen in 4.3%, gynaecomastia seen in 2.2%, trophic ulcer seen in 26.1% at the time of presentation mainly involving the foot followed by hands, only nerve involvement without skin lesion present in 1.1% of cases. Claw hand was the most common deformity witnessed . The presence of Wartenberg sign was observed in 10 patients. Apart from ulnar and common peroneal nerve involvement present in 100 %of the patients, other peripheral nerves were involved in significant number of patients.All these patients showed positive acid fast bacilli in slit skin smear . Active surveillanceConclusion and early detection of the disease are imperative to prevent the spread of M. leprae. It is essential for timely implementation of treatment which will prevent deformities and disabilities. Active case detection plays the major role in early diagnosis of leprosy.

16.
Indian J Lepr ; 2023 Jun; 95: 147-151
Article | IMSEAR | ID: sea-222645

ABSTRACT

It is well known that Mycobacterium leprae tends to target the cooler parts of the body and can involve the oral cavity. Despite this, macrocheilia - a condition where the lips become enlarged - caused by leprosy is rarely documented. There are few reported cases of leprous macrocheilia in India. We present a unique case of an elderly woman with borderline tuberculoid leprosy in type I reaction who developed leprous macrocheilia.

17.
Indian J Lepr ; 2023 Jun; 95: 89-102
Article | IMSEAR | ID: sea-222637

ABSTRACT

This is an exploratory research study to check if artificial intelligence (AI) based image marker tool can aid leprosy screening to detect leprosy cases early in field situation and reduce the financial and personnel burden. We aimed to collect clinical leprosy skin lesion images and develop an AI model to identify and differentiate them. A total of 368 clinically diagnosed leprosy and 28 non-leprosy skin lesions were collected by an expert leprologist from 151 eligible patients using a multimodal imaging protocol. A Siamese-based Few Shot Learning (FSL) model was trained as it is a meta learning approach on an extremely small data set with fewer disease classes (disease conditions as categories). The number of class labels were increased by fine-grained grouping of skin lesions based on skin morphology (Nine leprosy subgroups) and further divided into train-set and test-set. An AI model was successfully developed, and the results indicated an accuracy of 91.25% and 73.12% on train-set and test-set for two-way one-shot task, respectively. The best sensitivity-specificity for the test-set were 72.39%-73.66% (two-way one-shot task). This early research data indicates that the development of AI based leprosy screening application is feasible using the skin lesion image as marker. The FSL method was successfully used in this training the small data set. However, this is a small sample size study, and more leprosy cases need to be enrolled along with an equal number of non- leprosy cases while improving model architecture to reduce overfit or bias problem. Moreover, as of now this tool cannot be used for neural leprosy (having no skin lesion) as well as lepromatous leprosy having diffuse infiltration. This tool will need further development and validation on pictures taken by different categories of common health care workers using available mobile phones.

18.
Indian J Lepr ; 2023 Jun; 95: 103-109
Article | IMSEAR | ID: sea-222636

ABSTRACT

Despite the multidrug regimen, Hansen’s disease still remains a public health scourge. The present study aims to study the epidemiological and clinical trends of Hansen’s disease in a tertiary care center for a period of 1 year. A cross sectional study was carried out in the outpatient department of the institute for a period of 1 year from July 2020 to June 2021 and all leprosy cases were included in the study. The patients were examined thoroughly, and the diagnosis was done using WHO criteria. The nerves involved, lepra reactions were identified and disability was graded using WHO grading. Out of 62 patients, maximum number of patients (15 patients) were in the 21-30 years age group (24.2%). The most common type of leprosy was borderline lepromatous leprosy (32.25%) and nerve enlarged was the ulnar nerve (63.9%). As per WHO classification, 51(82.25%) cases were classified as MB and 11(17.7%) cases as PB. Among these 62 patients 25 ( 40%) were slit skin smear positive for AFB). A total of 18 patients (29.03%) presented with lepra reactions of which 10 presented with type 1 and 8 with type 2 reactions. A total of 25 patients (40.32%) presented with deformities which shows delayed diagnosis and inadequate timely treatment of disease and its complications. Our data shows that only 13% of cases reported within one year of noticing the symptoms. Community based studies are required to understand the reasons for such a situation in this area. Efforts must be made to prevent its spread, promote early detection, ensure proper treatment, and maintain patient follow-up

19.
Indian J Lepr ; 2023 Jun; 95: 111-119
Article | IMSEAR | ID: sea-222635

ABSTRACT

The disability and progress of leprosy patients is monitored by the WHO disability grading system which has limited sensitivity in leprous neuropathy. This study aims to report the spectrum of leprosy patients at a tertiary care neurology service and compare WHO grading, modified Rankin Scale (mRS) and Leprosy Neuropathy Scale (LNS) in monitoring the treatment outcome. The patients with leprosy diagnosed as per WHO criteria were subjected to medical history and clinical examination. Their disability was graded as per WHO grading scale, modified Rankin scale (mRS) and LNS. These parameters were repeated and compared after six months of multiple drug therapy (MDT). Thirty-eight patients with leprosy, aged 40 (`5-80) years, 33 of whom were males have been evaluated. The duration of symptoms was 24 (91-120) months. Mononeuropathy was present in 14, mononeuropathy multiplex in 24, trophic ulcer in two, claw hand in 11, wrist drop in two, foot drop in four, facial palsy in one, Charcot’s joint in one and lepra reaction in seven patients. Their disability as per WHO grade 1 and 2 was in 19 patients each. After 6 months of MDT, WHO grade improved in two patients, mRS revealed improvement in seven and LNS in nine patients. LNS- a clinical scale, seems more effective and easier to use for monitoring the progress/ outcome of neuropathy in leprosy patients and may complement the WHO grading scale

20.
Indian J Lepr ; 2023 Jun; 95: 121-129
Article | IMSEAR | ID: sea-222634

ABSTRACT

Skin sores, ulcers, nerve weakness, and disfigurement are a few most common leprosy complications when the diagnosis is delayed and not treated timely. The chronic nature of leprosy and the associated risks of deformities make it the most horrifying illness in human history. Although leprosy affects every segment of the population, adolescents and their highly sophisticated social life put them at additional risk and prone to severe socio-psychological problems. This study has systematically collected and reviewed published literature and arranged findings in a single report to provide a comprehensive understanding of adolescents affected by leprosy. Findings indicate that early adolescents are affected mainly compared to children (0-10 years). Household contact is the primary source of infection among adolescents, and changes in daily life, poor wellbeing, the experience of stigma, self-isolation, and reduced social mobility are prominent issues among affected adolescents. Adolescents with one or both parents affected with leprosy showed signs of anxiety, depression, poor academic performance, or dropout. Leprosy among adolescents demands extra attention due to their precarious and unsafe behavioural traits and their comparably extensive peer and social engagements. This review shows that systematic and well planned studies are required on directly or indirectly leprosy affected adolescents to further research relevant issues for defining the problems and finding solutions to various challenges so as to frame effective interventions and policies

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