Frecuencia de síntomas depresivos en pacientes con lepra de una ciudad del Caribe colombiano / Frequency of depressive symptoms in patients with leprosy in a colombian caribbean city

Resumen Introducción: la lepra afecta a millones de personas deteriorando la salud física y mental, generando complicaciones como síntomas depresivos que pueden afectar la calidad de vida. Objetivo: estimar la prevalencia de síntomas depresivos en una agremiación de pacientes y expacientes con enfermedad de Hansen de una ciudad del Caribe colombiano. Materiales y métodos: estudio descriptivo con muestreo no probabilístico en miembros de una agremiación de pacientes y ex-pacientes con enfermedad de Hansen de una ciudad del Caribe colombiano. Los síntomas depresivos fueron estimados mediante test de Beck I y los resultados se contrastaron con variables sociodemográficas y clínicas mediante análisis bivariado. Resultados: participaron 51 personas, con una edad promedio de 52 años (IC 35,7-68,5), y predominio del sexo masculino (57%). El 39% de la población cursó bachillerato, el 25% se encontraban en tratamiento al momento de la encuesta y el 33% presentaban algún grado de discapacidad. El 27%, 16% y 2% de la población presentó depresión leve, moderada y severa respectivamente. El síntoma depresivo más frecuentemente descrito fue la fatiga (13%) seguido de cambios en el apetito (84,2%), llanto (81,6%), y tristeza (79%). No se encontró relación estadísticamente significativa entre presencia de síntomas depresivos y características sociodemográficas, el tratamiento y la discapacidad. Conclusiones: el 35% de los encuestados con el test de Beck I obtuvo calificaciones compatibles con depresión, se recomienda incluir manejo especializado en salud mental dentro del abordaje integral del paciente y expaciente con enfermedad de Hansen.

ABSTACT Introduction: Leprosy affects millions of people, impairing both physical and mental health and giving rise to complications such as depressive symptoms that can impact the quality of life. Objective: To estimate the prevalence of depressive symptoms in an association of patients and former patients with Hansen's disease in a city in the Colombian Caribbean. Materials and methods: A descriptive study with non-probabilistic sampling was conducted among members of an association of patients and former patients with Hansen's disease in a city in the Colombian Caribbean. Depressive symptoms were assessed using the Beck Depression Inventory, and the results were compared with sociodemographic and clinical variables through bivariate analysis. Results: Fifty-one individuals participated, with an average age of 52 years (CI 35.7-68.5), and a male predominance (57%). Thirty-nine percent of the population had completed high school, 25% were undergoing treatment at the time of the survey, and 33% had some degree of disability. Twenty-seven percent, 16%, and 2% of the population exhibited mild, moderate, and severe depression, respectively. The most frequently reported depressive symptom was fatigue (13%), followed by changes in appetite (84.2%), crying (81.6%), and sadness (79%). No statistically significant relationship was found between the presence of depressive symptoms and sociodemographic characteristics, treatment, or disability. Conclusions: It is evident that 35% of respondents scored in the range indicative of depression on the Beck Depression Inventory. Specialized mental health management is recommended to be included in the comprehensive care of patients and former patients with Hansen's disease.

Concordance of acid-fast stain result and histopathologic vs clinical diagnosis of leprosy: A three-year retrospective study in a Tertiary Government Hospital and Sanitarium in the Philippines

Objectives@#In the Philippines, there has been a lack of information on the concordance between classifications of Hansen’s disease or leprosy clinically, histopathologically, and with AFS results. The study ultimately aimed to determine the concordance between the clinical diagnosis, histopathological results, and AFS results of patients with leprosy seen at the Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium (DJNRMHS). @*Methods@#This is a descriptive, retrospective, single-center study conducted at the DJNRMHS, a tertiary government hospital and one of the last remaining sanitaria in the country located in northern Metro Manila in the Philippines. The study reviewed and included all the patient records from the years 2017-2019 which included skin biopsy results and slit-skin smear with AFS. Leprosy patients were then classified based on the following classifications: World Health Organization (WHO) and Ridley-Jopling classifications; and the concordance of clinical diagnosis vs the histopathologic findings and clinical diagnosis vs AFS results were determined using kappa testing.

Respuesta inmune en pacientes con diagnóstico de lepra

Introducción: La lepra es una entidad de expresión florida con afectación frecuente en el tegumento cutáneo y los nervios periféricos, por la predisposición que presenta el Mycobacterium leprae a estas estructuras. Las reacciones leprosas pueden aparecer en el curso de la enfermedad. Estas interrumpen la evolución crónica usual y la estabilidad clínica de los pacientes que la padecen. Objetivo: Caracterizar los estados reaccionales de la lepra. Materiales y métodos: Se realizó un estudio descriptivo en el período de enero de 2019 a septiembre de 2022, en pacientes que acudieron a la Consulta Provincial de Lepra en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. El universo estuvo constituido por 8 pacientes que presentaron estados reaccionales en la etapa mencionada. Se recogieron de las historias clínicas variables como: edad, sexo, clasificación de la lepra según Ridley-Jopling, tipo de estado reaccional, forma clínica y momento de aparición. Resultados: La mayor frecuencia estuvo entre el rango de 50 a 64 años, con un 50 %. El sexo masculino representa el 62,5 %. Se mostró prevalencia de la lepra lepromatosa en el 62,5 %. La reacción tipo II y las formas graves fueron las más frecuentes, con un 62,5 % y 75 % respectivamente. Existió predominio de las reacciones leprosas durante y después del tratamiento, sin diferencias entre estas, con un 37,5 %. Conclusiones: La reacción tipo II y las formas graves de presentación fueron las predominantes en pacientes masculinos, representados en el grupo etario de 50 a 64 años. La forma clínica preponderante en estos eventos fue la lepromatosa.

Introduction: Leprosy is a floridly expressed entity with frequent involvement of the cutaneous integument and peripheral nerves due to the predisposition of Mycobacterium leprae to these structures. Leprosy reactions may appear during the course of the disease. These interrupt the usual chronic course and the clinical stability of patients suffering from the disease. Objective: To characterize the reactional states of leprosy. Materials and methods: A descriptive study was carried out from January 2019 to September 2022 in patients who attended the Provincial Leprosy Clinic at the Clinical Surgical University Hospital Comandante Faustino Pérez Hernández, in Matanzas. The universe consisted of 8 patients who presented reactional states in the aforementioned stage. The variables, collected from the clinical records, were: age, sex; classification of leprosy according to Ridley-Jopling, type of reactional state, clinical form and time of onset. Results: The highest frequency was between 50 and 64 years, with 50%. The male sex represents 62.5%. Lepromatous leprosy prevalence was shown in 62.5%. The type II reaction and severe forms were the most frequent with 62.5% and 75% respectively. There was predominance of leprosy reactions during and after treatment without differences between them, with 37.5%. Conclusions: The type II reaction with severe forms of presentation was predominant in male patients represented in the age group of 50 to 64 years. The predominant clinical form in these events was the lepromatous one.

Lepromatous Spectrum -Unnoticed Or Overlooked Retrospective Analysis Of Lepromatous Spectrum Of Hansen's Disease In A Tertiary Care Centre

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.

Dapsone hypersensitivity syndrome: a case in rural area of Indonesia

Dapsone hypersensitivity syndrome is a potentially fatal adverse drug reaction ranging from mild to severe involvement. If left unrecognized and untreated, this syndrome may lead to death. We reported a 19-year-old female with dapsone hypersensitivity syndrome in the rural area of Papua, Indonesia. The diagnosis was made clinically with some supporting laboratory examinations. The patient was planned to be given systemic corticosteroid of dexamethasone along with supportive care. However, due to the limited resources, dexamethasone could not be given daily to the patient leading to a poor clinical outcome.

Sole, An Uncommon Location of Borderline Tuberculoid Hansen’s Disease

Leprosy a chronic granulomatous infection, frequently affects areas with relatively low temperature and which are trauma prone. Areas like scalp, palms and soles, groins, genitalia, axillae, eyelids, and perineum, have been described as “immune” to development of leprosy. But clinic-pathological and bacteriological evidence of involvement of these so-called “immune zones” has rarely been documented. Palmoplantar involvement is uncommon in leprosy and could be easily misdiagnosed. We report here a case of 65-year-old male who had a single, well defined, round, 5*5 cm, dull erythematous to hyperpigmented plaque with central clearing over medial aspect of left foot extension as single, erythematous, roundish 2*2cm, plaque with central clearing over medial aspect of left foot just below ankle, for 3 months. There was decreased sensation to hot and cold temperature and to fine touch and pain over the lesions. Sensory examination elsewhere on the body was normal. There was no motor loss, no thickened nerves, no deformities, trophic ulcers or evidence of reaction. Histopathology of sole lesion suggested borderline tuberculoid Hansen’s disease. Stain for AFB was negative. Slit skin smear was negative. Good response to MDT was seen at end of 4 months. Such presentation needs to be kept mind for diagnosis of leprosy for instituting timely and appropriate treatment

Enfermedad de Hansen / Hansen's Disease

La lepra o enfermedad de Hansen es una infección crónica causada por Mycobacterium leprae (M. leprae) o Mycobacterium lepromatosis (M. lepromatosis), es una enfermedad infecciosa curable que es endémica en más de 140 países de todo el mundo. La Organización Mundial de la Salud lo declaró eliminado como un problema mundial de salud pública en el año 2000, sin embargo, en 2017 se informaron aproximadamente 200 000 casos nuevos en todo el mundo. A pesar de la terapia farmacológica combinada disponible, continúa como un importante problema de salud pública, que conlleva un fuerte estigma. En Cuba, según el Anuario Estadístico de Salud de 2020, se reportaron durante ese año 116 casos, las provincias más afectadas fueron Santiago de Cuba con 25 nuevos casos y Guantánamo con 17 nuevos casos. La presentación de caso se trata de una joven de 20 años, en edad reproductiva, con manifestaciones generales de astenia, pérdida del cabello, adenopatías, poliartritis, lesiones cutáneas y fiebre, que hizo sospechar en una enfermedad del colágeno. En estos momentos con buena evolución y en seguimiento por atención primaria de salud de su provincia(AU)

Leprosy or Hansen's disease is a chronic infection caused by mycobacterium leprae (M. leprae) or mycobacterium lepromatosis (M. lepromatosis). It is a curable infectious disease, endemic in more than 140 countries around the world. Despite being declared eradicated as a global public health problem by the World Health Organization in 2000, approximately 200,000 new cases were reported worldwide in 2017. Despite available combination drug therapy, it remains a major public health problem, carrying strong stigma. In Cuba, according to 2020 health statistical yearbook, 116 cases were reported during that year. The most affected provinces were Santiago de Cuba (25 new cases) and Guantánamo (17 new cases). The case to be reported concerns a 20-year-old young woman of reproductive age, with general manifestations of asthenia, hair loss, adenopathies, polyarthritis, skin lesions, and fever; she suspected was a collagen disease. Currently, she is well and she is followed up by primary health care in her province(AU)

Lepra de presentación focal en un paciente con mononeuropatía cubital en Uruguay / Focal presentation leprosy in a patient with ulnar mononeuropathy in Uruguay

La lepra, o enfermedad de Hansen (EH), es una enfermedad infectocontagiosa crónica de evolución lenta, causada por el bacilo Mycobacterium Leprae. Resulta un problema de salud importante en áreas endémicas con un gran impacto en la calidad de vida de los pacientes. Actualmente, se presenta como una causa infrecuente de neuropatía en nuestra región, pero su sospecha diagnóstica y su tratamiento precoz repercute a nivel pronóstico y funcional. Nuestro objetivo es analizar un caso único de Enfermedad de Hansen en nuestro país, haciendo enfoque en la presentación clínica y el abordaje médico-quirúrgico. Se presenta un paciente con un cuadro de debilidad progresiva de mano izquierda y una lesión de piel cronificada a nivel de codo, cuyos hallazgos clínicos, neurofisiológicos e imagenológicos fueron concordantes con una lesión del nervio cubital por atrapamiento en el conducto epitrócleo-olecraneano. La anatomía patológica mostró un proceso granulomatoso crónico y la baciloscopia fue positiva para bacilos ácido-alcohol resistentes con coloración de Hansel positiva, haciéndose diagnóstico de mononeuropatía cubital secundaria a infección por M. Leprae. Dada la severidad del compromiso nervioso, se realiza cirugía de nervio periférico con epineurotomía y descompresión nerviosa. En el caso de nuestro paciente con neuropatía cubital secundaria a enfermedad de Hansen, la cirugía descompresiva fue exitosa en el alivio del dolor, mostrándose como una opción terapéutica de relevancia en este tipo de pacientes(AU)

Leprosy, or Hansen disease, is a cronic infectious-contagious illness of slow progression that is caused by the bacillus Mycobacterium Leprae. It continues to be a major health problem in endemic areas and has a great impact on the quality of life of patients who suffer from it. It is currently presented as an infrequent cause of neuropathy in our region, but its diagnostic suspicion and therefore its early treatment have repercussions at the prognostic and functional level. Our goal is to analyze a unique case of Hansen's disease in our country, focusing on the clinical presentation and the medical-surgical approach. We present a patient with progressive weakness of the left hand and a chronic skin lesion at the level of the elbow, whose clinical, neurophysiological and imaging findings were consistent with an ulnar nerve injury due to entrapment in the epitrochlear-olecranon canal. The pathology showed a chronic granulomatous process; then bacilloscopy was performed, which was positive for acid-fast bacilli with positive Hansel staining, making a diagnosis of ulnar mononeuropathy secondary to infection by M. Leprae. Given the severity of the nerve involvement, peripheral nerve surgery with epineurotomy and nerve decompression was performed.In the case of our patient with ulnar neuropathy secondary to Hansen's disease, decompressive surgery was successful in relieving pain, proving to be a relevant therapeutic option in this type of patient

Simulation-based training in Leprosy: development and validation of a scenario for community health workers / Entrenamiento en lepra por simulación: construcción y validación de escenario a agentes comunitarios de salud / Treinamento em hanseníase por simulação: construção e validação de cenário a agentes comunitários de saúde

ABSTRACT Objectives: To build and validate a clinical simulation scenario designed to instruct community health workers (CHWs) in active leprosy case detection. Methods: Methodological study involving the development of a simulated clinical scenario and content validation by experts. The Content Validity Index (CVI) was used to determine the level of agreement among the judging commitee, and a descriptive analysis of their recommendations was performed. Results: A simulated scenario with a simulated participant was developed — a simulation characterized by low complexity, moderate physical/environmental fidelity, moderate to high psychological fidelity, and high conceptual fidelity, lasting 50 minutes and capable of training up to 10 CHWs simultaneously. The scenario was validated by 14 experts, with a CVI exceeding 80% for all components. Conclusions: The validated clinical simulation possesses attributes that make it highly reproducible in various national health contexts, thereby contributing to the global "Towards Zero Leprosy" strategy.

RESUMEN Objetivos: Construir y validar escenario de simulación clínica para enseñar a agentes comunitarios de salud (ACS) acciones de búsqueda activa de la lepra. Métodos: Estudio metodológico de construcción de escenario clínico simulado y de validez de contenido por especialistas. Utilizado el Índice de Validez de Contenido (IVC) para determinar el grado de concordancia entre los jueces y el análisis descriptivo de las recomendaciones. Resultados: Creado una simulación escénica con participante simulado, de baja complejidad, mediana fidelidad física/ambiental, mediana/alta fidelidad psicológica y alta fidelidad conceptual, cuyo tiempo de duración total fue de 50 minutos, capaz de calificar hasta diez ACS simultáneamente. Catorce jueces validaron el escenario, obteniéndose IVC superior a 80% en todos los componentes. Conclusiones: La simulación clínica validada tiene atributos que la transforman altamente replicable en diferentes contextos de salud nacionales, pudiendo, de esa manera, contribuir con la estrategia global "Rumbo al cero lepra".

RESUMO Objetivos: Construir e validar cenário de simulação clínica para ensinar a agentes comunitários de saúde (ACS) ações de busca ativa da hanseníase. Métodos: Estudo metodológico de construção de cenário clínico simulado e de validação de conteúdo por especialistas. Utilizou-se o Índice de Validade de Conteúdo (IVC) para determinar o grau de concordância entre os juízes e a análise descritiva das recomendações. Resultados: Criou-se uma simulação cênica com participante simulado, de baixa complexidade, média fidelidade física/ambiental, média/alta fidelidade psicológica e alta fidelidade conceitual, cujo tempo de duração total é de 50 minutos, capaz de qualificar até dez ACS simultaneamente. Quatorze juízes validaram o cenário, obtendo-se IVC superior a 80% em todos os componentes. Conclusões: A simulação clínica validada tem atributos que a tornam altamente replicável em diferentes contextos de saúde nacionais, podendo, dessa forma, contribuir com a estratégia global "Rumo à zero hanseníase".

Father-Daughter Duo: How Unmasking Leprosy in Father Helped in Leprosy Diagnosis in the Daughter - A Case Report

In highly endemic countries like India, where tuberculosis (TB) and leprosy infection may coexist, screening the other disease before initiating treatment is important to prevent Rifampicin resistance since both diseases are treated with and sensitive to Rifampicin. Here, we report a leprosy case involving the unmasking of leprosy in a treated patient with Pulmonary TB. In this case, a high index of suspicion of Erythema Nodosum Leprosum (ENL) in a patient with no history of leprosy disease or treatment with anti-leprosy drugs was observed. He, however, had a history of taking anti-tuberculous medicine 1.5 years earlier. This case report also acknowledges the physician’s prompt referral of this patient to a dermatologist. Taking a detailed family history and screening helped us diagnose leprosy in the patient’s daughter. It also emphasises the atypical presentation of leprosy, which (although described in textbooks) is being reported here.

Seroepidemiologic survey of the household contacts of leprosy patients

SUMMARY OBJECTIVE: Leprosy is a disabling infectious disease caused by Mycobacterium leprae. This study aimed to investigate the prevalence of leprosy among household contacts of leprosy patients. METHODS: This study is a serological survey in household contacts of leprosy patients who had been treated or were undergoing treatment in the city of Presidente Prudente, São Paulo, Brazil, from 2006-2016, using clinical examination and screening for anti- Phenolic glycolipid-I antibodies with Mycobacterium leprae-flow serology. RESULTS: A total of 263 index cases of leprosy were identified during the study period. Of these, 53 were approached, and among their household contacts, 108 were examined. The ML-flow test was positive in 2 (1.85%) individuals, but clinical examination revealed no signs or symptoms of leprosy in them. Therefore, they were considered to have a subclinical infection. Leprosy was not confirmed in any household contacts. In this study, a lower percentage of household contacts, when compared to that in the literature, had a positive Mycobacterium leprae-flow test result. CONCLUSION: The use of Mycobacterium leprae-flow should be encouraged during the follow-up of at-risk populations, such as the household contacts of leprosy patients.

Current Situation and Challenges Surrounding People`s Organizations on Hansen`s Disease : Prospects for the 2nd Global Forum

Discrimination against persons affected by leprosy or Hansen’s disease has deep roots, marginalizing individuals and communities. In September 2019, “Global Forum of People’s Organization on Hansen’s Disease (POs)” was organized in Manila, the Philippines, as a pre-event of the 20th International Leprosy Congress, which was the largest-ever international gathering of persons affected by the disease and led to “the Manila Declaration” to present the collective voice of all the participants. However, how to realize them was not thoroughly discussed during the forum and thus remains an issue for the future. In light of the fact that the second Global Forum is scheduled to be held in conjunction with the 21st International Leprosy Congress in November 2022, this article aims at clarifying what the forum should strive for in order to put the Manila Declaration into action by 1) examining the significance and impact of the first Global Forum, 2) identifying challenges currently faced by the POs from four domains (performance, staff capacity, internal organization, and external relationships), and 3) providing recommendations in three areas (strengthening and networking of POs, promoting their participation in leprosy related activities through effective advocacy, and sustained support by governments and donor agencies for POs).

Fenómeno de Lucio como forma de presentación de enfermedad de Hansen / Lucio's phenomenon as a presentation of Hansen disease / Fenômeno de Lucio como forma de apresentação da hanseníase

Resumen: Introducción: la enfermedad de Hansen es una enfermedad infecciosa crónica, causada por Mycobacterium leprae, que afecta principalmente piel y nervios periféricos. Las reacciones leprosas son eventos agudos que se asocian a un aumento de la morbimortalidad de la enfermedad. Objetivo: presentar el caso clínico de un paciente con fenómeno de Lucio, a través del cual se llegó al diagnóstico de enfermedad de Hansen, y remarcar la importancia de tener presente esta enfermedad, poco frecuente en nuestro país, para su correcto diagnóstico. Discusión: el fenómeno de Lucio es un tipo de reacción leprosa mediada por inmunocomplejos. Se caracteriza clínicamente por máculas o placas eritematovioláceas, de aparición súbita, que evolucionan a úlceras necróticas y curan dejando cicatrices estrelladas atróficas. De no mediar tratamiento, puede ser fatal, debido a sobreinfección y sepsis. Este se basa en el tratamiento específico de la infección, asociado a prednisona y un correcto manejo de las heridas.

Summary: Introduction: Hansen disease is a chronic infectious disease caused by Mycobacterium leprae, which mainly affects the skin and peripheral nerves. Leprosy reactions are acute events associated to an increase in the morbimortality of the disease. Objective: the study aims to present the clinical case of patient with Lucio´s phenomenon, which allowed the diagnosis of Hansen disease, and to emphasize on the importance of having this disease in mind for an appropriate diagnosis, despite it being rather unusual in our country. Discussion: Lucio´s phenomenon is a kind of leprosy reaction mediated by immune complexes. Clinically, it is characterized by the sudden onset of macules or blue hemorrhagic plaques, with a rapid evolution to necrotic ulcers, and it heals leaving star-shaped atrophic scars. If it is not treated, it may be fatal due to superinfection and sepsis. Treatment is based on specific medication for the infection, associated to prednisone and the correct handling of injuries.

Resumo: Introdução: a hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae, que acomete principalmente pele e nervos periféricos. As reações hansênicas são eventos agudos que estão associados ao aumento da morbimortalidade da doença. Objetivo: apresentar o caso de um paciente com fenômeno de Lúcio, por meio do qual se chegou ao diagnóstico de hanseníase, e ressaltar a importância de se ter em mente esta doença, rara em nosso meio, para seu correto diagnóstico. Discussão: o fenômeno de Lúcio é um tipo de reação hansênica mediada por imunocomplexos. Caracteriza-se clinicamente por máculas ou placas eritêmato-violáceas de início súbito que evoluem para úlceras necróticas e cicatrizam, deixando cicatrizes estreladas atróficas. Sem tratamento pode ser fatal, devido a superinfecção e sepse; a terapia está baseada no tratamento específico da infecção, associado à prednisona e no manejo correto da ferida.

Erroneous reduction of HbA1c levels in patients with type 2 diabetes mellitus on dapsone treatment for Hansen’s disease - a single-center retrospective cohort study

Background: Dapsone treatment may reduce HbA1c levels in patients with diabetes. Aims: To assess the prevalence and characteristics of dapsone associated reduction of HbA1c in patients with Hansen’s disease. Methods: A retrospective data review of outpatient and inpatient charts of consecutive patients with Hansen’s disease and type 2 diabetes mellitus was conducted over two years from January 2014 to January 2016 at the Department of Dermatology, CMC Vellore, India. Results: Of the 245 patients with a confirmed diagnosis of Hansen’s disease who were on oral dapsone 100 mg/day as part of their treatment regimen, 49 patients had diabetes and were eligible for the study as per predetermined inclusion criteria. Of these, 35 subjects (71%) had an HbA1c discordantly lower than the corresponding mean plasma glucose levels. Patients with discordant HbA1c levels were more likely to be male and to have a higher RBC mean corpuscular volume (MCV). A greater reduction in HbA1c levels was seen during the initial 3 months of therapy of dapsone treatment. Limitations: The small sample size and retrospective design were limitations of this study. Also, we did not analyze the role of methemoglobinemia or the utility of alternative measures of glycemic control in these patients. Conclusion: We describe a high prevalence of dapsone associated inappropriate HbA1c lowering in type 2 diabetes mellitus patients. This may have serious implications for the management of diabetes in patients on therapy with dapsone.

Clinical and radiological assessment of rhinomaxillary syndrome in Hansen’s disease

Background: More than four million people today live with Hansen’s disease, and 200,000 new cases are diagnosed every year. Lifetime effects of Hansen’s disease manifest as changes to bones of the face, hands and feet, resulting in physical impairment, secondary complications and facial changes that can be detrimental to quality of life, particularly among the elderly. Aims: This study aimed to perform a detailed characterization of rhinomaxillary syndrome and its clinical manifestations in older persons treated in the past for Hansen’s disease. Methods: This was a cross-sectional study to characterize rhinomaxillary syndrome among older persons (age 60+ years) resident at Pedro Fontes Hospital, Cariacica, Espírito Santo, Brazil. Computed tomography images were examined with three-dimensional reconstructions to assess alterations to maxillofacial bones according to criteria for radiological rhinomaxillary syndrome. Participants were examined to assess facial alterations according to criteria for clinical rhinomaxillary syndrome. Results: Rhinomaxillary syndrome was investigated in 16 participants (ten females and six males), median age 70 (range 60–89) years, age at diagnosis 20 (6–43) years and time since diagnosis 46 (26–70) years. Four participants fully met radiological rhinomaxillary syndrome criteria, four partially. All participants with full radiological rhinomaxillary syndrome presented with facial changes which met criteria for clinical rhinomaxillary syndrome, including “saddle nose” (loss of nasal dorsal height and shortened length of nose, due to cartilaginous and/or bone collapse), concave middle third of the face with sunken nose, maxillary retrognathia and inverted upper lip. Limitations: Clinical histories were incomplete for some participants because records were lost at the hospital over time. Conclusion: Until Hansen’s disease is eliminated from endemic countries, persons affected will continue to present with rhinomaxillofacial alterations caused by Mycobacterium leprae infection. Clinical protocols for assessment and long-term care need to include otorhinolaryngological evaluation, mainly to prevent secondary complications. When rhinomaxillofacial bone changes are suspected, this evaluation should be supported by computed tomography imaging, if available.

Video-dermoscopic Assessment of Capillaroscopic Pattern in Hansen's Disease

Leprosy is a chronic granulomatous infectious disease with a proven role of Mycobacterium leprae invasion into endothelial cells. Animal studies have shown evidence of involvement of vasa nervorum in the process of nerve invasion. Capillaries act as the mirror image of vascular involvement in any rheumatic disorder and holds good for leprosy also. Nailfold capillaroscopy (NFC) is a non-invasive, easily reproducible technique to study proximal nailfold capillaries. The aim of this study is to investigate morphological nailfold capillaroscopic alterations in patients with leprosy in its various forms and comparison with the normal individual. Total 20 Leprosy patients and 20 normal age and sex matched individuals recruited for nailfold capillaroscopic examination using video dermoscopye. Among 20 normal individuals, 3(15%) individuals showed tortuous capillaries and microhemorrhages each, 2(10%) showed meandering vessels, 1(5%) each showed megacapillaries, dilated/ectatic capillaries and bizarre vessels. Out of 20 leprosy patients, 11 (55%) patients showed bizarre and meandering capillaries, 10(50%) showed dilated vessels and avascular areas, 9(45%) showed capillary dropouts and neovascularisation, 8(40%) showed tortuous vessels, 6(30%) haemorrhages and 4 (20%) showed megacapillaries. Findings like avascular areas, capillary dropouts, haemorrhages were more noticed in lepromatous and borderline lepromatous leprosy, whereas early capillary abnormalities like dilated, meandering, bizarre vessels and neoangiogenesis were noticed more in borderline tuberculoid leprosy. However, statistical significant difference between clinical and dermoscopic observations was not seen in this study. Further studies with a large sample size are required to find out the same. Morphological changes may denote micro-vascular invasion by Mycobacterium leprae and may act as warning signs of fore- coming complications like loss of sensation and trophic ulcers. Follow-up studies are required to understand such correlation, if any.

A Study of Knowledge and Attitude about Leprosy among the Physiotherapy Students and Practitioners: A Cross-Sectional Study

Physiotherapy adds quality to the life of people. It provides support to people with disability. Leprosy is such a debilitating condition in which people suffer concerning their functionality and emotional parameters even after bacteriological cure. Leprosy is having several types of social stigmas attached to it which could be the reason for the discrimination among this population. Boosting the knowledge and building up a strong and positive attitude among physiotherapy students and practitioners against leprosy will be of help in overcoming the various multiple taboos associated with this condition. This research work aims at evaluating the knowledge and attitude towards leprosy among physiotherapy students and professionals in India. This study involves 300 voluntary participants from the physiotherapy field (students and professionals) above the age of 18 years from any gender from India, with a good hold on the English language. The response of all the participants was descriptively analyzed. Among study participants the mean score for the knowledge was estimated to be 65.47±14.69. Out of 300 participants, only 72 participants have shown a high level of knowledge with a mean score value of 84.54±5.23, and 228 participants showed a low level with a mean score value of 59.44±11.14. The mean score for the attitude related questions was 54.7±26.21. 189 respondents presented a favorable response with a mean of 71.16±16.56 whereas 111 respondents presented an unfavorable attitude with a mean value of 26.67±11.86. The findings of this research work gave us an insight into the “low-level knowledge” and a relatively “favorable behavior” towards the patient affected by leprosy among the physiotherapy students and practitioners in India. However, still, there is a need to enhance the knowledge and improve attitude among the Physiotherapy students and professionals by educating them and including leprosy in sufficient details in physiotherapy curriculum. Properly designed research cum intervention studies are necessary to understand the gaps in knowledge and attitudinal problems and take remedial measures.

Cuidado clínico farmacêutico e estratégia para o uso racional e adesão ao tratamento em pacientes com hanseníase numa Policlínica do Recife / Pharmaceutical clinical care and strategy to rational use and adhesion to treatment in Hansen's disease patients at a policlinic from Recife

Introdução: a hanseníase é uma doença de fácil diagnóstico, possuindo tratamento e cura. Quando diagnosticada tardiamente, pode trazer graves consequências para os portadores e seus familiares. Uma vez que o tratamento da hanseníase está inserido no componente estratégico da assistência farmacêutica, são exigidos cuidados e orientação. Há necessidade de intervenção clínica farmacêutica, com objetivo de acompanhar prescrições medicamentosas, analisando a adesão dos pacientes ao tratamento com a promoção de ações de educação em saúde, além de minimizar a ocorrência de eventos adversos relacionados aos fármacos do tratamento com possível redução de custos associados aos agravos. Objetivo: realizar o monitoramento para identificar e tratar as possíveis intercorrências que estão comumente presentes no tratamento de hanseníase. Metodologia: a realização do estudo deu-se com o acompanhamento dos pacientes atendidos no serviço de referência a partir da aplicação de questionários em consultas periódic as, vis to que a adesão ao tratamento, reduç ão dos eventos adver sos e controle dos comunic antes são de suma impor tância para o controle epidemiológico. Resultados: os principais sintomas dos indivíduos acometidos foram dormência e eritema nodoso hansênico. A maioria utilizava como tratamento o esquema multibacilar e talidomida. O acometimento relatado dos pacientes foi em nível moderado. Os pacientes possuíam comorbidades como hipertensão, artrose e diabetes. O acompanhamento clínico foi relatado como positivo pela maioria dos entrevistados. Conclusão: o desfecho do estudo mostra que a adesão do paciente é crucial para o êxito do tratamento e o acompanhamento do farmacêutico clínico constitui um pilar positivo, contribuindo para a prevenção de agravos e conscientização da comunidade.

Introduction: Hansen's disease is an easily diagnosed disease, with treatment and cure available. When diagnosed late, it can bring serious consequences for patients and their families. Since the treatment of Hansen's disease is part of the strategic component of pharmaceutical assistance, care and guidance are required. There is a need for clinical pharmaceutical intervention, aiming to monitor drug prescriptions, analyze patients' adherence to treatment while promoting health education actions, in addition to minimizing the occurrence of adverse events related to treatment drugs with possible reduction in costs associated to grievances. Objective:thus, the present study aimed to monitor, identify, and treat possible complications commonly present in the treatment of Hansen's disease. Methodology: The study was carried out with the follow-up of patients seen at the reference service, through the application of questionnaires in periodic appointments, since adherence to treatment, reduction of adverse events and control of communicants are of short importance for epidemiological control. Results:The main symptoms of Hansen's disease patients were numbness and leprosy nodosum erythema. Most used the multibacillary scheme and thalidomide as treatment. The reported involvement of patients was at a moderate level. Patients had other comorbidities such as hypertension, arthrosis and diabetes. The clinical assistance was reported as positive by most interviewees. Conclusion: The outcome of the study shows that patient's compliance is crucial for the success of treatment and the clinical pharmacist's accompaniment is a positive pillar, contributing to the prevention of complications and community awareness.

Challenges Faced by People Affected with Leprosy During the COVID-19 Pandemic: A Questionnaire Based Study

This study aims to assess the continuity of medical care, the impact on disease condition and to highlight the major challenges faced by people affected by leprosy during the pandemic. Telephonic questionnaire-based survey was conducted among previously registered patients of leprosy at referral hospitals in India. Leprosy affected people aged >18 years, either on treatment or who had completed treatment with access to phone and willingness to participate were included. The questions were asked pertaining to demographic details, baseline disease characteristics and various problems faced during lockdown relating to livelihood, finances, treatment, and mental status. A total of 196 patients consented to participate in the study. Mean age of study participants was 37.31 (13.86) years, male participants (n=123, 62.7%) were more than females (n=73, 37.2%). Overall, 101 patients (51.5%) experienced exacerbation, 21 patients (10.7%) reported improvement and 74 patients (37.8%) reported no change in disease status during the pandemic. Most common difficulty faced was the procurement of medicines (115 patients, 58.6%) followed by difficulty in diagnostic testing (61 patients, 31.1%). Course of treatment was interrupted in 16 patients. Most of the patients (n=147, 75%), agreed that teleconsultation services would aid in management of their disease. The majority of patients (88.2%) were able to continue some form of treatment. Two patients (1%) tested positive for COVID-19. Nearly all patients (n=189, 96.4%) were informed regarding the risks and preventive measures related to COVID-19. Fifty percent of the patients reported deterioration in mental health due to the pandemic. The present study highlights the gaps in healthcare delivery and social inequalities along with their impact on the health, livelihood and mental status of people affected by leprosy during the current COVID-19 pandemic.