Talidomida usada por pacientes com eritema nodoso hansênico / Thalidomide used by patients with erythema nodosum leprosum

INTRODUÇÃO: A talidomida é um fármaco utilizado atualmente no tratamento do eritema nodoso hansênico no Brasil. MÉTODOS: Estudo prospectivo para acompanhar a evolução clínica, registrar os eventos adversos e determinar as concentrações plasmáticas de talidomida em dose diária de 100mg/dia, em 20 pacientes com manifestações clínicas de eritema nodoso hansênico, divididos em dois grupos: após ou em curso da poliquimioterapia para hanseníase. RESULTADOS: Não foram observadas diferenças significativas nos grupos no decorrer do estudo, tanto na evolução clínica favorável dos pacientes, de 70 por cento e 90 por cento, quanto nos eventos adversos registrados que foram tontura e sonolência. Os teores plasmáticos de talidomida em D7 e D14 foram de 0,82±0,4μg/mL e 0,79±0,3μg/mL no grupo 1 e de 0,82±0,4 e 1,55±1,0 no grupo 2, respectivamente. CONCLUSÕES: Na amostra estudada, a poliquimioterapia não interferiu na evolução clínica, na incidência dos efeitos adversos e nos níveis plasmáticos de talidomida.

INTRODUCTION: Thalidomide is a drug currently used in Brazil for treating erythema nodosum leprosum. METHODS: This was a prospective study to follow up clinical evolution, record adverse events and determine plasma thalidomide levels from a dose of 100 mg/day, among 20 patients with clinical manifestations of erythema nodosum leprosum, divided into two groups: during or after leprosy multidrug therapy. RESULTS: No significant differences between the groups were seen during the study, either in relation to favorable clinical evolution among the patients (70 percent and 90 percent), or in relation to the adverse events recorded, which were dizziness and somnolence. The plasma thalidomide levels on D7 and D14 were 0.82 ± 0.4μg/ml and 0.79 ± 0.3 μg/ml in group 1 and 0.82 ± 0.4 and 1.55 ± 1.0 in group 2, respectively. CONCLUSIONS: In this sample, the multidrug therapy had no effect on the clinical evolution, incidence of adverse events and plasma thalidomide levels.

Perfil hematológico de pacientes de hanseníase com episódios reacionais de eritema nodoso / Hematologic profile of leprosy patients in reactional episode of erythema nodosum leprosum

Neste trabalho foram avaliados os parâmetros hematológicos de dezoito pacientes com eritema nodoso hansênico.(ENH). Oito desses pacientes tiveram ENH intenso e moderado e dez pacientes tiveram ENH leve. Os resultados mostraram que os pacientes com ENH intenso e moderado, tiveram alteraçoes significativas nos resultados hematológicos: deficiência de ferro, um tempo aumentado de lise de euglobulina e hiperfibrinogenemia. Contudo, nenhuma alteraçao foi observada nos outros parâmetros estudados (tempo de protrombina, corpos de Heinz e produtos de degradaçao do fibrinogênio) em todos os casos de ENH.

Fibrinolytic phenomenon in leprosy.

Fibrinolytic activity in eighty-one patients with different types of leprosy and thirty-two normal healthy controls was studied by Euglobulin Lysis Time Method, Fibrinolytic activity was markedly decreased in patients with lepromatous leprosy and those with ENL reaction. Decline in fibrinolytic activity during ENL was independent of frequency of attacks. Fibrinolytic activity was partly restored after subsidence of ENL reaction, though it failed to attain normal levels. Cutaneous vasculitis seems to be most probable cause of fall in fibrinolytic activity in lepromatous leprosy and ENL reaction.

Alpha-1-antitrypsin in leprosy.

Estimation of Alpha-1-antitrypsin (AAT) levels was carried out in 52 patients of various types of leprosy. Fifty age and sex matched healthy individuals served as controls. The mean level of AAT in controls was 290.12 +/- 59.56 mg/dl. In patients of tuberculoid leprosy (TT), borderline tuberculoid leprosy (BT) and borderline leprosy (BB), the AAT levels were found to be 284 +/- 47.03, 314.37 +/- 31.56 and 324.44 +/- 32.05 mg/dl respectively. These were statistically insignificantly raised when compared with controls. In borderline lepromatous leprosy (BL), lepromatous leprosy without erythema nodosum leprosum (LL without ENL) and in LL with ENL there was a statistically significant rise in AAT levels. The maximum levels of AAT were observed in patients of LL with ENL (mean 500.8 +/- 93.44 mg/dl. P less than 0.001).

Investigation of coagulation abnormalities in patients with erythema nodosum leprosum.

Twenty erythema nodosum leprosum (ENL) patients were examined. Coagulation studies were carried out in 13 of them during their active stage and 7 in the latent stage. From these 13 patients, 6 were re-examined when the disease became latent. From these observations a conclusion can be drawn that there are coagulation abnormalities in the majority of ENL patients in the active stage and these abnormalities will return to normal values when the disease becomes latent.