Profile of leprosy in children under 15 years of age monitored in a Brazilian referral center (2004-2012)

Abstract: Leprosy in children under 15 years of age is a serious public health problem. In this retrospective case series conducted in a Brazilian reference center (2004-2012), we found 18 cases with a mean age of 10.0±3.6 years of age and 16.6% between 0-5 years of age. Almost 56% of the cases were female, with a median time between the first symptoms and diagnosis of 11 months (4-24); 77.8% reported household contact with leprosy patients. Upon hospital admission, 66.7% presented mostly skin symptoms, while 27.8% presented a degree 2 disability. Most were classified as multibacillary (66.7%). Half of the sample developed a reaction (predominantly type 1) during the follow-up period, while 22.2% developed a late disability.

Clinical and pathological melanoma differences in young and old people / Diferenças clínicas e patológicas do melanoma em jovens e idosos

Background: Melanoma is often misdiagnosed in older people. Some clinical and histopathological features seem to differ according to age. Objectives: This case series aimed to identify clinicopathological differences of melanoma between older and younger patients. Methods: We identified all incident melanomas diagnosed in a dermatology outpatients unit from January/2007 to December/2014. Data were collected from medical records and pathology registries. RESULTS: We included 62 patients (mean age of 62.1 ± 4.2 years), with a median Breslow thickness of 4 mm (1.2 − 6.5). While men were majority in the older group, women prevailed between younger counterparts (p = 0.02). Multivariate analysis identified history of chronic sun exposure, multiple naevi, skin phototypes 1 and 2, in situ melanoma and the presence of another skin tumour to be correlated with age. In a logistic regression model, the presence of chronic sun exposure and nodular subtype were found to influence age. Major limitations include those inherent to cross ­sectional design, including selection and information biases, the lack of confounding factors analysis (including survival and prognosis), and the sample size. Conclusions: On this case series, melanoma seems to be more frequent in older men and in elders with chronic sun exposure; age was found to be significantly related to nodular subtype and chronic sun exposure.

Introdução: O melanoma é frequentemente diagnosticado de modo tardio em pessoas idosas. Algumas características clínicas e histopatológicas parecem diferir de acordo com a idade. Objetivos: Este estudo de série de casos tem por objetivo identificar as diferenças clínico­patológicas do melanoma entre pacientes idosos e jovens. Métodos: Identificaram­se todos os casos incidentes de melanoma diagnosticados em uma unidade ambulatorial de dermatologia de janeiro de 2007 a dezembro de 2014. Os dados foram coletados a partir da revisão dos prontuários médicos e registros do laboratório de patologia. Resultados: Foram incluídos 62 pacientes, com uma média etária de 62,1 ± 4,2 anos, e tumores com mediana de espessura de Breslow de 4 mm (1,2 − 6,5). Enquanto os homens foram maioria no grupo idoso, as mulheres prevaleceram entre os pacientes jovens (p = 0,02). Análise multivariada identificou que a exposição crônica ao sol, presença de múltiplos nevos, fototipos baixos, melanoma in situ e antecedentes de neoplasias cutâneas correlacionaram­se com a idade. Modelo de regressão múltipla confirmou que a exposição ao sol e o tipo nodular influenciam a idade. Conclusões: O melanoma foi mais frequente nesta amostra em homens idosos com exposição crônica ao sol; a idade correlacionou­se significativamente com o tipo nodular e exposição ao sol.

Impact of drug therapy on brachioradial pruritus

Abstract: Few studies have described therapeutic options in brachioradial pruritus. We describe a cross-sectional study of brachioradial pruritus patients treated in an outpatient unit. We reviewed medical records and interviewed brachioradial pruritus patients without indication for decompressive surgery, in order to access the perceptions of intensity of pruritus prior to treatment and response to therapy. We found that antidepressants and anticonvulsants were the most frequently prescribed drugs. Best reductions in pruritus were associated with its highest intensities prior to treatment, and with longer periods of therapy.

Schamberg's disease: case report with therapeutic success by using colchicine

Abstract: Pigmented purpuric dermatoses (PPD) include a spectrum of diseases with different clinical aspects, but with similar histopathological features. Specific clinical findings allow the division of PPD in variants. Schamberg's disease is the most common. Treatment is sometimes ineffective and recurrences are common. There are reports of patients who responded well to the use of colchicine. We report the case of a 32-year-old woman, previously healthy, with a history of onset of asymptomatic lesions in legs. She presented purpuric skin eruptions and brownish stains diffusely distributed in the lower limbs. Biopsy was compatible with PPD. We decided for the introduction of colchicine, with good clinical response. The patient has been followed on outpatient basis for ten months without recurrence.

Factors related to blood pressure control in a prospective cohort of hypertensive outpatients / Fatores relacionados ao controle da pressão arterial em coorte prospectiva de pacientes hipertensos ambulatoriais

Previous studies have reported a controversial relationship between inadequate blood pressure control and predictor variables. Current prospective cohort study analyzes the interference of age, gender, diabetes and medication adherence in the control of blood pressure of hypertensive outpatients. Patients were interviewed under blind conditions to determine medication adherence, and clinical variables assessment were standardized. Univariate analysis of variance identified the variables correlated to blood pressure control at the end of the follow-up period. Missing data were excluded from analysis. After adjusting for confounders with univariate analysis, the association between the outcome (BP control rate) with significant factors and the calculated adjusted odds ratios (OR) and their 95% CI was analyzed by logistic regression. No interference by age or medication adherence in blood pressure control was reported. In fact, the higher the number of medications in use, the greater were the chances of having blood pressure control in disorder. Females are associated with a 3.1 increase in odds ratio of poor blood pressure control. Compared with non-diabetic hypertensive patients, hypertensive diabetic ones had a lower chance of poor blood pressure control.

Estudos anteriores encontraram relações controversas entre o inadequado controle da pressão arterial e variáveis preditoras. Nesta coorte prospectiva, objetivamos analisar a interferência da idade, do gênero, da presença de diabetes e da adesão à medicação no controle da pressão arterial em pacientes hipertensos ambulatoriais. Os pacientes foram entrevistados sob condições de cegamento dos avaliadores na mensuração da adesão à medicação, e a metodologia de avaliação das variáveis clínicas foi padronizada. Uma análise univariada identificou quais variáveis correlacionaram-se com o controle da pressão arterial ao final do período de seguimento. Dados faltantes foram excluídos da análise. Após ajuste para variáveis de confusão por meio da análise univariada, analisamos as associações entre o desfecho (controle da pressão arterial) e variáveis preditoras, e calculamos o odds ratio ajustado e seu intervalo de confiança de 95%, utilizando regressão logística. Não encontramos interferência da idade ou aderência aos medicamentos no controle tensional. Constatamos que, quanto maior o número de medicamentos em uso, maiores as chances de apresentar controle tensional fora das metas. O gênero feminino associou-se com o aumento de 3,1 vezes na chance de mau controle da pressão arterial. Comparados com pacientes hipertensos não diabéticos, os hipertensos diabéticos tiveram menores chances de apresentar mau controle tensional.

Surgical treatment of type I neuritis in a teenage boy with borderline tuberculoid leprosy

Exacerbation of the immune response against Mycobacterium leprae can lead to neuritis, which is commonly treated via immunosuppression with corticosteroids. Early neurolysis may be performed concurrently, especially in young patients with a risk of functional sequelae. We report the case of a young patient experienced intense pain in the left elbow one year after the treatment of tuberculoid-tuberculoid leprosy. The pain was associated with paresthesias in the ulnar edge and left ulnar claw. After evaluation, the diagnosis was changed to borderline tuberculoid leprosy accompanied with neuritis of the left ulnar nerve. Early neurolysis resulted in rapid reduction of the pain and recovery of motor function.

Mycobacterium marinum infection: a case report

The infection by Mycobacterium marinum in humans is relatively uncommon. When it occurs, it mainly affects the skin, usually with a chronic, indolent and benign evolution. The diagnosis requires a high index of suspicion, and a significant delay may be observed between the first symptoms to the final diagnosis. This present case reports a M. marinum infection in an immunocompetent patient that had a chronic undiagnosed injury on the dominant hand for at least five years. The patient had several medical consultations, without proper suspicion, hampering adequate diagnostic investigation. Histopathology detected tuberculoid granulomas, but showed no acid-fast bacilli. The culture in appropriate medium and the polymerase chain reaction-restriction enzyme analysis (PRA)-hsp65 confirmed the diagnosis. Treatment with clarithromycin (1 g/day) for three months was effective. Although uncommon, this infection is a contact zoonosis. Therefore, it is important for clinicians to be aware of this diagnosis and properly guide preventable measures to professionals that are in risk group.(AU)

Mycobacterium marinum infection: a case report

The infection by Mycobacterium marinum in humans is relatively uncommon. When it occurs, it mainly affects the skin, usually with a chronic, indolent and benign evolution. The diagnosis requires a high index of suspicion, and a significant delay may be observed between the first symptoms to the final diagnosis. This present case reports a M. marinum infection in an immunocompetent patient that had a chronic undiagnosed injury on the dominant hand for at least five years. The patient had several medical consultations, without proper suspicion, hampering adequate diagnostic investigation. Histopathology detected tuberculoid granulomas, but showed no acid-fast bacilli. The culture in appropriate medium and the polymerase chain reaction-restriction enzyme analysis (PRA)-hsp65 confirmed the diagnosis. Treatment with clarithromycin (1 g/day) for three months was effective. Although uncommon, this infection is a contact zoonosis. Therefore, it is important for clinicians to be aware of this diagnosis and properly guide preventable measures to professionals that are in risk group.

Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil

BACKGROUND: Chronic leg ulcer may have an impact on patients' quality of life. OBJECTIVES: This study aimed to identify the impact of leg ulcers on patient's quality of life using the Dermatology Life Quality Index and to define the main factors correlated with this perception. METHOD: Cross-sectional, non-probabilistic sampling study. We included patients with chronic leg ulcers being treated for at least 3 months. A sociodemographic and clinical survey was conducted to assess the profile of the ulcers. We administered a screening for depressive symptoms and the Dermatology Life Quality Index. We performed a descriptive statistical analysis, chi-square test and Mann-Whitney test for categorical data, Pearson for numeric variables, and multiple regression for categorical data. RESULTS: Forty-one patients were assessed. Their mean age was 61.78 years. Venous ulcers (48.8%) were the most prevalent. Seventy-three percent of the sample perceived no impact/low impact on quality of life in the past week, and 26.8% perceived moderate/high impact. A multiple regression analysis identified the causes of lesion, pain related to the ulcers, time of onset, and severity of the depressive symptoms as the variables that had an influence on quality of life. CONCLUSIONS: The majority of the sample perceived low or no impact of the condition on the quality of the life. The variables etiology of the lesion (p<0.001), pain related to the ulcers (p=0.001), time of onset (p=0.006), and severity of the depressive symptoms (p<0.001) had an influence on the quality of life, suggesting the need for further studies with more robust designs to confirm the causal relationship between these characteristics and quality of life. .

Padrões clínicos de acne em mulheres de diferentes faixas etárias / Acne in women: clinical patterns in different age-groups

FUNDAMENTOS: Acne é dermatose comum que acomete ambos os gêneros e todas as faixas etárias. Mulheres apresentam diferentes padrões clínicos da doença, além de frequente persistência da acne após a adolescência. OBJETIVO: Analisar características clínicas e epidemiológicas associadas às diferentes faixas etárias acometidas por acne feminina. MÉTODOS: Estudo transversal envolvendo mulheres com diagnóstico de acne, atendidas em ambulatório de dermatologia geral. Variáveis relacionadas à doença e às pacientes foram avaliadas com o emprego de questionário padronizado. RESULTADOS: Avaliaram-se 103 pacientes, cuja idade média na época da consulta foi 21,7 ± 7,3 anos. Definiram-se dois subgrupos com idade de corte de 21 anos e idades médias de 15,8 ± 2,3 e 28,0 ± 5,1 anos. Houve correlação entre a duração do quadro e a idade das pacientes na consulta (R = 0,7). Observaram-se diferenças entre os grupos nas frequências de uso de contraceptivo oral combinado (OR = 48,1), lesões no colo (OR = 11,6), lesões no dorso (OR = 0,2), predominância na topografia superior da face (OR = 0,1) e idade de início das lesões (OR = 1,8). No grupo de mulheres adultas, 80 por cento relataram início do quadro antes dos 20 anos. CONCLUSÕES: Identificaram-se padrões clínicos cronológicos e topográficos que caracterizaram a acne feminina em diferentes faixas etárias, alertando para a importância da abordagem diagnóstica e terapêutica individualizada.

BACKGROUND: Acne is a frequent skin disease that occurs in both sexes and all age-groups. Women present several clinical disease patterns; moreover, persistence after adolescence is common. OBJECTIVE: To analyze clinical and epidemiological characteristics associated with different age-groups affected by acne in women. METHODS: Cross-sectional study involving female patients diagnosed with acne, at a general dermatology outpatient clinic. Variables related to disease and patients were assessed through a standardized questionnaire. RESULTS: One hundred and three women were assessed. The average age of patients at the time of the consultation was 21.7 ± 7.3 years. Two groups were defined (cut-off age of 21 years), with means of 15.8 ± 2.3 and 28.0 ± 5.1 years. There was correlation between disease duration and current age (R=0.7). There were group differences among frequencies of covariables: combined oral contraceptive (OR=48.1), lesions located on upper chest (OR=11.6), lesions on upper dorsum (OR=0.2), predominance on upper half of face (OR=0.1) and age at disease onset (OR=1.8). Among adult women, 80 percent reported acne onset before 20 years of age. CONCLUSION: Chronologic and topographic patterns of female acne in different age-groups were defined, reinforcing the importance of an individualized diagnostic and therapeutic approach.

Caracterização e prevalência de síndrome metabólica em idosos segundo dois critérios diagnósticos diferentes / Characterization and prevalence of metabolic syndrom in elderly according to two different diagnostic criteria

A prevalência de síndrome metabólica (SM) aumenta com a idade, assim como o risco cardiovascular associado a essa condição. Poucos estudos têm direcionado atenção à SM na população idosa. O objetivo deste estudo foi determinar a prevalência de SM segundo dois diferentes critérios diagnósticos em população idosa hipertensa e/ou diabética de baixa renda, bem como reconhecer a concordância diagnóstica entre os dois critérios e as diferenças dos componentes entre os gêneros. Foram avaliados 190 idosos do Programa Hiperdia na cidade de Colombo – PR. A amostra tinha idade média de 67,95 anos, mais de 64 eram mulheres, e 26,3 portadores de diabete. O diagnóstico de SM foi realizado em 51,6 da amostra quando aplicados os critérios do NCEP-ATP III, e em 60,5 quando aplicados os componentes propostos pela IDF, com concordância elevada (Rho = 0,760). As idosas apresentaram maior prevalência de SM (p < 0,001) quando comparadas aos homens, maior prevalência de positividade no componente circunferência abdominal aumentada, e menores valores de HDL-colesterol (p = 0,03).

The prevalence of metabolic syndrome (MS) increases with aging, as well as the associated cardiovascular risk to this condition. Few studies have directed attention to MS in the elderly population. The objective of this study was to determine the prevalence of MS according to two different diagnostic criteria in a hypertension and/or diabetic elderly population of low income, as well as recognizing the diagnostic agreement between this two criteria and the differences of the components between genre. It had been evaluated 190 elderly of the Hiperdia Program in the city of Colombo - PR. The sample had average age of 67,95 years, more than 64 were women, and 26,3 of the elderlies had diabetes. The MS diagnosis was carried through in 51,6 of the sample when applied the criteria of NCEP-ATP III, and in 60,5 when applied the components considered for the IDF, with high agreement (Rho = 0,760). The female elderly ones had presented greater ratio of the diagnosis of MS (p < 0,001) when compared with the men, greater ratio in the increased abdominal circumference component, and minor values of HDL-cholesterol (p = 0,03).