Bacterial load in the nose and its correlation to the immune response in leprosy patients.

INTRODUCTION: Leprosy, whose etiologic agent is M. leprae, has its clinical manifestations correlated with distinct immunologic forms. The mechanism of infectivity and dissemination of the disease are not completely known, although the nasal mucosa is supposed to have an important role in pathogenesis. OBJECTIVE: To correlate the clinical and bacteriological parameters with that of nasal biopsy and immunological tests, such as lepromin and ML-Flow results, in untreated leprosy patients. MATERIAL AND METHOD: Two hundred and twenty-two patients were evaluated, clinically classified and subjected to skin smear, nasal biopsy, ML-Flow, and Mitsuda test. RESULTS: 689% of the cases were borderline cases. Nasal biopsy revealed 91.4% positivity in those who had specific antibodies against M. leprae on blood sample. Lepromatous leprosy cases were 100% positive on ML-flow test, had a large involvement in the nasal mucosa (91%), positive skin smears (100%) and negative Mitsuda test. Nasal bacillary index showed a good correlation with ML-Flow and had similar results when compared to skin smear. The tests agreement was good, revealing that nasal biopsy can be reliable in the diagnosis of multibacillary clinical forms and in the evaluation of the immunological status of leprosy patients. CONCLUSION: The presence of disseminated bacilli in the nasal mucosa was similar to skin involvement, when correlated with Mitsuda test and ML-Flow. As a result, the role of nasal bacillary index may play an important role in the clinical and immunologic characterization of leprosy patients.

Avaliação da reprodutibilidade ultrassonográfica como método para medida do tecido subcutâneo da ponta nasal / Evaluation of the ultrasound reproducibility as a method to measure the subcutaneous tissue of the nasal tip

INTRODUÇÃO: A prévia avaliação da anatomia do paciente é fundamental para atingir uma ponta nasal bem definida em rinoplastia. A espessura do tecido subcutâneo é essencial para a harmonia estética dessa região. Técnicas de mensuração dessas estruturas no paciente "in vivo" não estão padronizadas na literatura. OBJETIVO: Avaliar a variabilidade interobservador do método ultrassonográfico para medida da espessura do tecido subcutâneo da ponta nasal por de ultrasonografia. MÉTODO: 47 voluntários submeteram-se a ultrasonografia da ponta nasal por dois especialistas em radiologia que utilizaram a mesma técnica de exame com transdutor eletrônico linear na frequência de 5 a 9 MHz. Avaliou-se a espessura do tecido subcutâneo através da medida do ponto de maior projeção do domo da cartilagem alar maior até a pele. Estudo prospectivo. RESULTADOS: As médias das medidas do tecido subcutâneo da ponta nasal obtidas pelos examinadores não apresentaram diferenças estatisticamente significante (p = 0. 5303). Na análise da reprodutibilidade entre examinadores encontrou-se coeficiente de correlação interclasse r (Pearson) 0,9333, isto é, uma excelente reprodutibilidade interobservadores. CONCLUSÃO: A ultrassonografia demonstrou-se reprodutível e excelente concordância entre os examinadores para avaliação da espessura do tecido subcutâneo da pele, auxiliando o cirurgião na análise pré-operatória do paciente e na escolha da melhor técnica cirúrgica para cada caso.

INTRODUCTION: The previous evaluation of the patient's anatomy is crucial to achieve a sharp nasal tip in a rhinoplasty. The thickness of the subcutaneous tissue is indispensable for the esthetical harmony of the area. Techniques to measure such structures on the patient 'in vivo' are not found in literature. OBJECTIVE: Evaluate the inter-observer inconsistency of the ultrasound method to measure the thickness of the subcutaneous tissue of the nasal tip by way of an ultrasound. METHOD: 47 volunteers were submitted to a nasal tip ultrasound performed by two radiology specialists, who used the same exam technique with a linear electronic transducer at a frequency between 5 and 9 MHz. The thickness of the subcutaneous tissue was evaluated by measuring the point with the highest protrusion of the largest alar cartilage dome towards skin. Prospective study. RESULTS: The measurement averages of the subcutaneous tissue of the nasal tip achieved by the examiners did not show statistically significant differences (p = 0. 5303). When analyzing the reproducibility between examiners, an interclass 'r'correlation coefficient (Pearson) 0. 9333, i. e. , an excellent inter-observer reproducibility was found. CONCLUSION: The ultrasound proved to be reproducible and examiners satisfactorily agree about evaluating the thickness of the subcutaneous tissue of the skin, thus helping the surgeon perform the pre-surgical analysis and find the best surgical technique for each case.