Telemedicine Support for Primary Care Providers versus Usual Care in Patients with Heart Failure: Protocol of a Pragmatic Cluster Randomised Trial within the Brazilian Heart Insufficiency with Telemedicine (BRAHIT) Study.

Heart failure is a prevalent condition and a frequent cause of hospital readmissions and poor quality of life. Teleconsultation support from cardiologists to primary care physicians managing patients with heart failure may improve care, but the effect on patient-relevant outcomes is unclear. We aim to evaluate whether collaboration through a novel teleconsultation platform in the Brazilian Heart Insufficiency with Telemedicine (BRAHIT) project, tested on a previous feasibility study, can improve patient-relevant outcomes. We will conduct a parallel-group, two-arm, cluster-randomised superiority trial with a 1:1 allocation ratio, with primary care practices from Rio de Janeiro as clusters. Physicians from the intervention group practices will receive teleconsultation support from a cardiologist to assist patients discharged from hospitals after admission for heart failure. In contrast, physicians from the control group practices will perform usual care. We will include 10 patients per each of the 80 enrolled practices (n = 800). The primary outcome will be a composite of mortality and hospital admissions after six months. Secondary outcomes will be adverse events, symptoms frequency, quality of life, and primary care physicians' compliance with treatment guidelines. We hypothesise that teleconsulting support will improve patient outcomes.

Gait analysis of leprosy patients with foot drop using principal component analysis.

BACKGROUND: Peripheral nerve injury caused by leprosy can lead to foot drop, resulting in an altered gait pattern that has not been previously described using 3D gait analysis. METHODS: Gait kinematics and dynamics were analyzed in 12 patients with unilateral foot drop caused by leprosy and in 15 healthy controls. Biomechanical data from patients' affected and unaffected limbs were compared with controls using inferential statistics and a standard distance, based on principal components analysis (PCA). FINDINGS: Patients walked slower than controls (0.8 ± 0.2 vs. 1.1 ± 0.2 m/s, p = 0.003), with a reduced stance and increased swing percentage. The affected limb increased (p < 0.05) plantar flexion at the initial contact (-16.8o ± 8.3), terminal stance (-29.1o ± 11.5), and swing (-12.4o ± 6.2) in the affected limb compared to unaffected (-6.6o ± 10.3; -14.6o ± 11.6; 2.4o ± 7.6) and controls (-5.4o ± 2.5; -18.8o ± 5.8; -1.4o ± 3.9). Increased pelvic tilt and knee adduction/abduction range, with lower hip adduction, were observed. The second peak of ground reaction force (98.6 ± 5.2 %BW), ankle torque (0.99 ± 0.33 Nm/kg), and net ankle work in stance (-0.03 ± 5.4 J/Kg) decreased in the affected limb compared to controls (104.1 ± 5.5 %BW; 1.24 ± 0.4 Nm/kg; -4.58 ± 5.19 J/kg; p < 0.05). There were decreasing multivariate standard distances in the affected limb compared with the unaffected and controls. PCA loading factors highlighted the major differences between groups. INTERPRETATION: Leprosy patients with foot drop presented altered gait patterns in affected and unaffected limbs. There were remarkable differences in ankle kinematics and dynamics. Rehabilitation devices, such as ankle foot orthosis or tendon transfer surgeries to increase ankle dorsiflexion, could benefit these patients and reduce deviations from normal gait.

Development and clinical application of hydrogel formulations containing papain and urea for wound healing

Abstract Hydrogels are used for wound treatment, as they may contain one or more active components and protect the wound bed. Papain is one of the active substances that have been used with this purpose, alongside urea. In this paper, carboxypolymethylene hydrogels containing papain (2% and 10% concentrations) and urea (5% concentration) were produced. Physical-chemical stability was performed at 0, 7, 15 and 30 days at 2-8ºC, 25ºC and 40ºC, as well as the rheological aspects and proteolytic activity of papain by gel electrophoresis. Clinical efficacy of the formulations in patients with lower limb ulcers was also evaluated in a prospective, single-center, randomized, double-blind and comparative clinical trial. The results showed 7-day stability for the formulations under 25ºC, in addition to approximately 100% and 15% of protein activity for 10% and 2% papain hydrogel, respectively. The rheological profile was non-Newtonian for the 10% papain hydrogel tested. There were no significant differences regarding the mean time for healing of the lesions, although 10% papain presented a better approach to be used in all types of tissue present in the wound bed.

Advances in Shared Decision Making in Brazil: The role of patient autonomy in curriculum reform, health system and clinical care.

Clinical practice in Brazil has rapidly transformed. Doctor-patient relationships are the focus of these transformations, either within health policies or in the context of medical training. The Brazilian Curriculum Guidelines have emphasized the doctor-patient relationship as part of medical skills and competences, based on patient-centered care. In this article, we present the political advances in patient-centered care. In addition, we address an overview of the Brazilian status quo of decision aids tools. Finally, we share experiences in curriculum reform for the advances of communication skills and the interfaces with narrative medicine and the arts in curricular medical training as a means to advance towards the practice of shared decision making.

CORRELATION BETWEEN QUALITY OF LIFE AND THE CLINICAL RESULTS OF PATIENTS WITH LEPROSY WITH DROP FOOT AFTER TENDON TRANSFER.

Objective: To evaluate the functional results of surgically correcting drop foot in patients with leprosy and compare their SALSA, Social Participation, and AOFAS score. Methods: Overall, 22 patients were subjected to posterior tibial tendon transfer via the subcutaneous route to the foot dorsum with an average follow-up of 56 months (min 12, max 70). In our sample, 15 of the enrolled patients were men and seven, women, aged between 20 and 73 years old who were operated on from January 2014 to December 2017. The Pearson's correlation test (r) was used to measure the correlation among those scales. A p < 0.05 was considered significant between the pre- and pos-operative AOFAS scale scores. Results: Pre-operative average AOFAS score was 59.6 (min 35, max 74) and 77.2 postoperative (min 36, max 97) (p < 0.0001), postoperative Salsa and Social Participation scale, 30.6 and 22.5, respectively. Statistical analysis suggests a strong positive correlation between AOFAS and Salsa scales (r = -0.83) and AOFAS and social participation (r = -0.78). Average dorsiflexion was 5.4 degrees. Conclusion: The surgical correction of drop foot positively affects the quality of life and social participation of patients with leprosy. Level of Evidence III, Retrospective Study.

Objetivo: Avaliar o resultado funcional da cirurgia de correção de pé caído em pacientes hansênicos e comparar as escalas Screening of Activity Limitation and Safety Awareness (SALSA) e de Participação social pós-operatórias com o escore da American Orthopaedic Foot and Ankle Society (AOFAS). Métodos: Avaliamos 22 pacientes submetidos à transposição do tibial posterior para o dorso do pé com mínimo de seguimento de 12 e máximo de 131 meses operados entre janeiro de 2013 e dezembro de 2017. Utilizamos o coeficiente de Pearson (r) para medir o grau de correlação entre as escalas funcionais e consideramos o valor de p < 0,05 na análise dos valores pré e pós-operatórios da AOFAS. Resultados: A média da AOFAS foi de 59,6 no pré-op (mín 35, máx 74) e 77,2 no pós-op (mín 36, máx 97) (p < 0,0001) e das escalas SALSA e participação social de 30,6 e 22,5 no pós-operatório. A análise estatística demonstrou correlação positiva forte (r = −0,83) com as escalas SALSA e de participação social (r = −0,78) quando comparadas ao AOFAS. O grau de dorsiflexão atingido foi de 5,4 graus em média. Linha de pesquisa: Evidência clínica e organizacional, modelos assistenciais, educacionais e avaliação de qualidade em APS - Pós-graduação em Clínica Médica da Faculdade de Medicina da UFRJ. Conclusão: A melhora da função através da correção cirúrgica do pé caído possui correlação direta na melhora da qualidade de vida dos pacientes portadores de hanseníase. Nível de Evidência III, Estudo Retrospectivo.

Correlation between quality of life and the clinical results of patients with leprosy with drop foot after tendon transfer / Avaliação de pacientes com hanseníase pós transposição tendínea para pé caído e sua correlação com a qualidade de vida

ABSTRACT Objective: To evaluate the functional results of surgically correcting drop foot in patients with leprosy and compare their SALSA, Social Participation, and AOFAS score. Methods: Overall, 22 patients were subjected to posterior tibial tendon transfer via the subcutaneous route to the foot dorsum with an average follow-up of 56 months (min 12, max 70). In our sample, 15 of the enrolled patients were men and seven, women, aged between 20 and 73 years old who were operated on from January 2014 to December 2017. The Pearson's correlation test (r) was used to measure the correlation among those scales. A p < 0.05 was considered significant between the pre- and pos-operative AOFAS scale scores. Results: Pre-operative average AOFAS score was 59.6 (min 35, max 74) and 77.2 postoperative (min 36, max 97) (p < 0.0001), postoperative Salsa and Social Participation scale, 30.6 and 22.5, respectively. Statistical analysis suggests a strong positive correlation between AOFAS and Salsa scales (r = −0.83) and AOFAS and social participation (r = −0.78). Average dorsiflexion was 5.4 degrees. Conclusion: The surgical correction of drop foot positively affects the quality of life and social participation of patients with leprosy. Level of Evidence III, Retrospective Study.

RESUMO Objetivo: Avaliar o resultado funcional da cirurgia de correção de pé caído em pacientes hansênicos e comparar as escalas Screening of Activity Limitation and Safety Awareness (SALSA) e de Participação social pós-operatórias com o escore da American Orthopaedic Foot and Ankle Society (AOFAS). Métodos: Avaliamos 22 pacientes submetidos à transposição do tibial posterior para o dorso do pé com mínimo de seguimento de 12 e máximo de 131 meses operados entre janeiro de 2013 e dezembro de 2017. Utilizamos o coeficiente de Pearson (r) para medir o grau de correlação entre as escalas funcionais e consideramos o valor de p < 0,05 na análise dos valores pré e pós-operatórios da AOFAS. Resultados: A média da AOFAS foi de 59,6 no pré-op (mín 35, máx 74) e 77,2 no pós-op (mín 36, máx 97) (p < 0,0001) e das escalas SALSA e participação social de 30,6 e 22,5 no pós-operatório. A análise estatística demonstrou correlação positiva forte (r = −0,83) com as escalas SALSA e de participação social (r = −0,78) quando comparadas ao AOFAS. O grau de dorsiflexão atingido foi de 5,4 graus em média. Linha de pesquisa: Evidência clínica e organizacional, modelos assistenciais, educacionais e avaliação de qualidade em APS - Pós-graduação em Clínica Médica da Faculdade de Medicina da UFRJ. Conclusão: A melhora da função através da correção cirúrgica do pé caído possui correlação direta na melhora da qualidade de vida dos pacientes portadores de hanseníase. Nível de Evidência III, Estudo Retrospectivo.

Paraneoplastic Dermatoses in Breast Cancer: Malignant Acanthosis Nigricans with Tripe Palm.

Our patient was a 43-year-old, single black woman, born and living in Paracambi, State of Rio de Janeiro, who worked as a surgical instrumentalist. She was sent to our sector of dermatology due to hypochromia and diffuse skin roughness that had first appeared 8 years previously. She had been diagnosed 6 months before admission with ductal infiltrating metastatic carcinoma in the right breast, with therapeutic failure of chemotherapy and radiotherapy. Her menarche had occurred at age 13 years, she reported normal menstrual cycles from there on, and she had never been pregnant. She denied neoplasias and other comorbidities in her family history.

Internato de Saúde Mental para alunos de Medicina: qual o melhor cenário de formação? / Internado de Salud Mental para alumnos de Medicina: ¿ cuál es el mejor escenario de formación? / Mental Health Internship for Medical students: which is the best training setting?

As Diretrizes Curriculares do curso de graduação em Medicina de 2014 incluem a Saúde Mental (SM) como uma das áreas obrigatórias do internato. O objetivo deste trabalho é apresentar o internato integrado de SM e de Medicina de Família e Comunidade (MFC) da Universidade Federal do Rio de Janeiro (UFRJ) e a fundamentação da escolha da Atenção Primária à Saúde (APS) como cenário de formação dos internos. Trata-se do relato da experiência do internato integrado de SM e MFC da UFRJ e da discussão de seus marcos teóricos. A alta prevalência de sofrimento psíquico e transtornos mentais na APS, o fato de ela ser a porta de entrada do Sistema Único de Saúde (SUS) e o fato de que a faculdade de Medicina deve formar médicos generalistas fazem deste cenário lócus privilegiado para o treinamento dos internos de Medicina em SM.(AU)

Las Directrices Curriculares del Curso de Graduación en Medicina de Curso de 2014 incluyen la salud mental (SM) como una de las áreas obligatorias del internado. El objetivo de este trabajo es presentar el internado integrado de SM y Medicina de Familia y Comunidad (MFC) de la UFRJ y la fundamentación de la Escuela de Atención Primaria de la Salud (APS) como escenario de formación de los internos. Se trata del relato del internado integrado de SM y MFC de la UFRJ y de la discusión de sus marcos teóricos. La alta prevalencia de sufrimiento psíquico y trastornos mentales en la APS, el hecho de que la APS es la puerta de entrada del sistema único de salud (SUS) y el hecho de que la facultad de medicina debe formar a médicos generalistas, hace que este escenario sea un locus privilegiado para el entrenamiento de los internos de medicina en salud mental.(AU)

The 2014 Curricular Guidelines of the medical undergraduate courses include Mental Health (MH) as one of the required areas of internship. The objective of this paper is to present the integrated internship for MH and Family and Community Medicine (FCM) of UFRJ, as well as the rationale for choosing Primary Health Care (PHC) as the setting for the internship training. It presents a report of the experience of the integrated internship for MH and FCM of UFRJ and the discussion of its theoretical frameworks. The high prevalence of psychological distress and mental disorders in PHC, the fact that PHC is the gateway to the unified national health system (SUS) and the fact that the medical school must train general practitioners, make PHC a privileged locus for the training of medical interns in mental health.(AU)

Lepromatous Reaction Type II: Clinical and Laboratory Aspects.

In Type II lepromatous reaction, there is exacerbation of humoral immunity, classified as Gell & Coombs Type III hypersensitivity reaction. It is more common in lepromatous borderline (LB) and lepromatous lepromatous (LL) patients. Our objective was to study the clinical and laboratorial expressions of lepromatous Type II reactions, establishing concordances between them, and for this the medical records of leprosy patients observed at the Clementino Fraga Filho University Hospital of the Federal University of Rio de Janeiro (HUCFF/UFRJ) were reviewed. There were a total of 358 leprosy cases over a period of 12 years. Demographic, clinical, and laboratory data of 133 patients with Type II reaction were collected. Among the 133 patients, 19 were classified as borderline borderline (BB), 15 (11.3%) as LB, and 97 (72.9%) as LL. Mitsuda intradermal reaction was negative in all the 49 patients who underwent this test. Histopathologic study confirmed the diagnosis. Lepromatous patients (LP) presented positive bacilloscopy more frequently (73.91% of 68 patients) than borderline patients (BP) (26.9% of 24 patients). Among BP, 44% presented erythema nodosum leprosum (ENL), which was seen in 71% of LP. Erythema multiforme (EM) occurred in 32% of BP and 13% of LP. Lucio phenomenon (LPh) was observed in 8 of 34 BP (23.6%), and 15 of 97 LP (15.4%). The understanding of the laboratorial and clinical presentations of reactional episodes are relevant to the development of preventive and therapeutic strategies, in order to avoid potential complications and comorbidities that cause disability, paralysis, deformities, and stigma of leprosy.

Giant basal cell carcinoma associated with vitiligo.

We report a woman with two giant Basal cell carcinomas (BCCs) on the back, the largest with 12 cm in diameter, inside a vitiligo plaque. They were metatypical subtype BCC associated with a nodular subtype area. Thinking of BCC in vitiligo lesion is extremely important. Giant BCC and vitiligo are rare association.

Nevus Comedonicus: Case Report.

Nevus comedonicus is a rare cutaneous anomaly, characterized by the clustering of papules with firm, blackened horny buffers. It in general has a zosteriform pattern and affects both genders equally. In some patients, there is formation of cysts, abscesses, and fistulas, aggravating its psychosocial impact. The association with extracutaneous lesions characterizes the nevus comedonicus syndrome. Despite several therapeutic options, the result is unsatisfactory in most cases. We report the case of a man with an exuberant congenital lesion, affecting the left suprascapular region, arm, and forearm.

Perception about the Medical Internship at Federal University of Rio de Janeiro by the Service's Preceptors in Primary Health Care: a Case Study / Percepção sobre o Internato de Medicina da Universidade Federal do Rio de Janeiro pelos Preceptores do Serviço na Atenção Básica: um Estudo de Caso

ABSTRACT Introduction A preceptor is understood as a health care professional with an important role in introducing students and recently graduated doctors into professional practice. However, studies into medical teaching in the Family Health Strategy (FHS) have shown inadequacies in the quality, training and time spent by the tutors with students. In the municipality of Rio de Janeiro (RJ), the expansion of the FHS was belated, resulting in a vacuum of medical students being inserted into the network. Objective To understand the perception of Family Health Strategy physician preceptors regarding their performance with medical student interns from the Federal University of Rio de Janeiro (UFRJ). Methods This is a case study which employed a qualitative method and took place in the city of Rio de Janeiro (RJ). Semi-structured interviews were conducted between September 2011 and March 2012, with 15 preceptors from six Family Clinics receiving UFRJ medical interns. Interviews were recorded, transcribed, read and subjected to thematic content analysis, resulting in the establishment of five categories: encouragement and motivation; appreciation; training; real world versus academic world; teaching-service integration. Results The preceptors report that they feel recognized and encouraged by the students, but do not feel appreciated by the service coordinators, who fail to allocate adequate space and time to their preceptorship activities. A good relationship is established with both tutors and students. The preceptors would like to be trained in preceptorship and to strengthen their ties to UFRJ. They view their time with the students as both precious and challenging, because it stimulates them to rethink their care practices. They recognize in the internship the opportunity for students to gain practical experience of what has been learned in theory. Conclusion The preceptors' work is supported by the good relationship established between preceptors, tutors and students but efforts are needed to value the professionals who perform this practice.

RESUMO Introdução O preceptor é entendido como o profissional da rede assistencial que tem importante papel na inserção do graduando e do recém-graduado na prática profissional. Entretanto, estudos sobre o ensino da prática médica na Estratégia Saúde da Família (ESF) têm mostrado inadequações na qualidade, na capacitação e no tempo destinado pelos preceptores aos estudantes. No município do Rio de Janeiro (RJ), a expansão da ESF se deu tardiamente, o que resultou num vácuo da inserção do aluno de Medicina na rede. Objetivo Conhecer as percepções dos médicos preceptores da Estratégia Saúde da Família quanto à sua atuação junto aos internos de Medicina da Universidade Federal do Rio de Janeiro (UFRJ). Método Pesquisa exploratória, do tipo estudo de caso, de abordagem qualitativa, realizada no município do RJ. Foram realizadas entrevistas semiestruturadas, entre setembro de 2011 e março de 2012, com 15 preceptores das seis Clínicas da Família que recebem internos de Medicina da UFRJ. As entrevistas foram gravadas, transcritas, lidas e tratadas por meio da técnica de análise de conteúdo temática, da qual emergiram cinco categorias: estímulo e motivação; valorização; capacitação; mundo real versus mundo acadêmico; integração ensino-serviço. Resultados Os preceptores se sentem reconhecidos e estimulados pelos alunos, mas não sentem a valorização pela chefia do serviço, que não libera espaço físico e horário para as atividades. Há uma boa relação estabelecida com os tutores e os alunos da UFRJ, mas desejam receber capacitação para a preceptoria e estreitar o vínculo com a UFRJ. Percebem o tempo destinado ao aluno como precioso e ao mesmo tempo desafiador, estimulando-os a repensar suas práticas do cuidado. Reconhecem no estágio a oportunidade para os internos vivenciarem na prática o que foi apreendido na teoria. Conclusão A prática de preceptoria encontra sustentação na boa relação estabelecida entre os preceptores, tutores e alunos, mas são necessários esforços para a valorização dos profissionais que desempenham esta prática.

Percepção sobre o Internato de Medicina da Universidade Federal do Rio de Janeiro pelos Preceptores do Serviço na Atenção Básica: um Estudo de Caso / Perception about the Medical Internship at Federal University of Rio de Janeiro by the Service Preceptors in Primary Health Care: a Case Study

RESUMO Introdução O preceptor é entendido como o profissional da rede assistencial que tem importante papel na inserção do graduando e do recém-graduado na prática profissional. Entretanto, estudos sobre o ensino da prática médica na Estratégia Saúde da Família (ESF) têm mostrado inadequações na qualidade, na capacitação e no tempo destinado pelos preceptores aos estudantes. No município do Rio de Janeiro (RJ), a expansão da ESF se deu tardiamente, o que resultou num vácuo da inserção do aluno de Medicina na rede. Objetivo Conhecer as percepções dos médicos preceptores da Estratégia Saúde da Família quanto à sua atuação junto aos internos de Medicina da Universidade Federal do Rio de Janeiro (UFRJ). Método Pesquisa exploratória, do tipo estudo de caso, de abordagem qualitativa, realizada no município do RJ. Foram realizadas entrevistas semiestruturadas, entre setembro de 2011 e março de 2012, com 15 preceptores das seis Clínicas da Família que recebem internos de Medicina da UFRJ. As entrevistas foram gravadas, transcritas, lidas e tratadas por meio da técnica de análise de conteúdo temática, da qual emergiram cinco categorias: estímulo e motivação; valorização; capacitação; mundo real versus mundo acadêmico; integração ensino-serviço. Resultados Os preceptores se sentem reconhecidos e estimulados pelos alunos, mas não sentem a valorização pela chefia do serviço, que não libera espaço físico e horário para as atividades. Há uma boa relação estabelecida com os tutores e os alunos da UFRJ, mas desejam receber capacitação para a preceptoria e estreitar o vínculo com a UFRJ. Percebem o tempo destinado ao aluno como precioso e ao mesmo tempo desafiador, estimulando-os a repensar suas práticas do cuidado. Reconhecem no estágio a oportunidade para os internos vivenciarem na prática o que foi apreendido na teoria. Conclusão A prática de preceptoria encontra sustentação na boa relação estabelecida entre os preceptores, tutores e alunos, mas são necessários esforços para a valorização dos profissionais que desempenham esta prática.

ABSTRACT Introduction A preceptor is understood as a health care professional with an important role in introducing students and recently graduated doctors into professional practice. However, studies into medical teaching in the Family Health Strategy (FHS) have shown inadequacies in the quality, training and time spent by the tutors with students. In the municipality of Rio de Janeiro (RJ), the expansion of the FHS was belated, resulting in a vacuum of medical students being inserted into the network. Objective To understand the perception of Family Health Strategy physician preceptors regarding their performance with medical student interns from the Federal University of Rio de Janeiro (UFRJ). Methods This is a case study which employed a qualitative method and took place in the city of Rio de Janeiro (RJ). Semi-structured interviews were conducted between September 2011 and March 2012, with 15 preceptors from six Family Clinics receiving UFRJ medical interns. Interviews were recorded, transcribed, read and subjected to thematic content analysis, resulting in the establishment of five categories: encouragement and motivation; appreciation; training; real world versus academic world; teaching-service integration. Results The preceptors report that they feel recognized and encouraged by the students, but do not feel appreciated by the service coordinators, who fail to allocate adequate space and time to their preceptorship activities. A good relationship is established with both tutors and students. The preceptors would like to be trained in preceptorship and to strengthen their ties to UFRJ. They view their time with the students as both precious and challenging, because it stimulates them to rethink their care practices. They recognize in the internship the opportunity for students to gain practical experience of what has been learned in theory. Conclusion The preceptors’ work is supported by the good relationship established between preceptors, tutors and students but efforts are needed to value the professionals who perform this practice.

The Use of Assistive Technology to Promote Care of the Self and Social Inclusion in Patients with Sequels of Leprosy.

BACKGROUND: This study is about the contribution of occupational therapy inside a rehabilitation group, and we focus on the autonomy of patients with disabilities due to leprosy. There are few studies on the use of assistive technology by leprosy patients; to our knowledge, none of them aim to have a subjective approach of care. Our purpose was to analyze the repercussions of assistive technology on autonomy of care of the self in patients with sequels of leprosy. METHODS: A qualitative, descriptive exploratory study with a semi-structured interview and a field observation as a research method was conducted between November 2014 and February 2015 at a University Hospital in Rio de Janeiro. FINDINGS: Eight patients from the service of Occupational Therapy were interviewed, and 44 hours of observation were performed. Interviews followed a semi-structured script and a field journal was used to take notes. Analysis was conducted by the hermeneutic approach. Costs were obtained after a global cost analysis of the fixed and variable expenses and direct and indirect costs to the manufactured products with an amount of 100 dollars. Results were grouped according to the following categories: contribution of the adapted devices for the care of the self and feelings and sensations provoked by the use of self-help devices. The reports revealed feelings, perceptions and meaningful contents about the social, familiar and individual dimensions, also the stigma coupled with leprosy. However, forms of re-signification were elaborated. CONCLUSIONS: Assistive technology empowers the subject to perform care of the self and promotes social inclusion.

The Use of Ozone in High Frequency Device to Treat Hand Ulcers in Leprosy: a Case Study.

Leprosy leads to chronic granulomatous inflammation in skin and peripheral nerves that can lead to sensory, motor and autonomic impairments. Autonomic dysfunctions may result in dryness and cracking of the skin. In this study, we present the use of ozone provided by a high-frequency device to treat hand ulcers (wounds) in an 80-year-old man who was diagnosed as multibacillary in 2007. In the first visit, the patient was evaluated and received verbal and written instructions about self-care. Treatment consisted of five sessions, once per week. The ozone provided by a high-frequency device seemed to be useful in the treatment of ulcers, thus, contributing to the healing process. Research that investigates the use of high frequencies in the treatment of ulcers associated or not with other interventions (self-care strategies, protective clothing, adapted tools and footwear adaptation) is strongly recommended.

Primary Motor Cortex Representation of Handgrip Muscles in Patients with Leprosy.

BACKGROUND: Leprosy is an endemic infectious disease caused by Mycobacterium leprae that predominantly attacks the skin and peripheral nerves, leading to progressive impairment of motor, sensory and autonomic function. Little is known about how this peripheral neuropathy affects corticospinal excitability of handgrip muscles. Our purpose was to explore the motor cortex organization after progressive peripheral nerve injury and upper-limb dysfunction induced by leprosy using noninvasive transcranial magnetic stimulation (TMS). METHODS: In a cross-sectional study design, we mapped bilaterally in the primary motor cortex (M1) the representations of the hand flexor digitorum superficialis (FDS), as well as of the intrinsic hand muscles abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi (ADM). All participants underwent clinical assessment, handgrip dynamometry and motor and sensory nerve conduction exams 30 days before mapping. Wilcoxon signed rank and Mann-Whitney tests were performed with an alpha-value of p<0.05. FINDINGS: Dynamometry performance of the patients' most affected hand (MAH), was worse than that of the less affected hand (LAH) and of healthy controls participants (p = 0.031), confirming handgrip impairment. Motor threshold (MT) of the FDS muscle was higher in both hemispheres in patients as compared to controls, and lower in the hemisphere contralateral to the MAH when compared to that of the LAH. Moreover, motor evoked potential (MEP) amplitudes collected in the FDS of the MAH were higher in comparison to those of controls. Strikingly, MEPs in the intrinsic hand muscle FDI had lower amplitudes in the hemisphere contralateral to MAH as compared to those of the LAH and the control group. Taken together, these results are suggestive of a more robust representation of an extrinsic hand flexor and impaired intrinsic hand muscle function in the hemisphere contralateral to the MAH due to leprosy. CONCLUSION: Decreased sensory-motor function induced by leprosy affects handgrip muscle representation in M1.

Oleoma treated with oral colchicine: Report of two cases and review of the literature.

Oleoma is a non-allergic, foreign body type granulomatous reaction. It appears as response to oily exogenous substances injected to the dermis or subcutis for aesthetical purposes. Treatment for localized lesions is surgical. When they are multiple, steroids may show some result. Newer therapeutic possibilities are being introduced and colchicine constitutes an alternative that is financially accessible and safe in moderate doses for certain dermatological illnesses. We present two women with oleoma on the legs treated with oral colchicine. This option was due to the extension of the clinical picture, which would not have a good surgical outcome. There was significant improvement in one patient, while we had to interrupt the medication in the other because of side effects.

Psychological distress and quality of life in leprosy patients with neuropathic pain.

Leprosy is widely known because of progressive damage to the peripheral nerves. In spite of multidrug therapy, some patients develop chronic neuropathic pain after bacteriological cure. Chronic pain is associated with psychological distress and is also an important predictor of poor quality of life. The aim of this study is to assess psychological distress in leprosy patients with chronic neuropathic pain, and its repercussions on their quality of life. The sample of this cross-sectional study comprised patients with chronic neuropathic pain after multidrug therapy. Neuropathic pain was confirmed by clinical examination and by the Douleur neuropathique en 4 questions questionnaire. Pain intensity was assessed using a visual analogic scale (VAS) ruler. The psychological health of the participants was measured using the 12-item General Health Questionnaire, and the WHOQOL-bref was used to assess quality of life. The mean pain intensity reported by participants on the VAS was 7.1 cm (SD = 2.9). No differences in pain intensity with respect to gender were observed. Psychological distress was present in 76.2% of participants, being higher in those with Grade 2 of disability. Patients with psychological distress had the lowest mean scores in all domains of the WHOQOL-bref. The lowest mean scores according to domain were physical (9.9; SD = 3.3), followed by environment (11.9; SD = 3.0), psychological (13.5; SD = 2.6) and social relations (14.0; SD = 3.7). In conclusion, our study identified the presence of psychological distress in most of the participants. Patients with chronic neuropathic pain who were also found to have high psychological distress levels had higher pain intensity and a poorer quality of life.

Physical disability and social participation in patients affected by leprosy after discontinuation of multidrug therapy.

OBJECTIVES: To describe the social participation frequency and the physical disability of patients who were discharged after the multidrug therapy (MDT/WHO) and factors associated with these variables. METHOD: A cross-sectional and analytical study, examining associations, which took place Nova Iguaçu/Brazil. A random sample of patients treated with multidrug therapy from 1997 to 2006 was selected. The rationale for sample size was determined by the estimated proportion of physical disability in the amount of 23%, with an acceptable sampling error rate of 5%; significance level was established as 5% among the 1080 patients finally a total sample of 225 patients. The evaluations were performed from January 2010 to December 2011 and Socio-demographic and clinical data were collected from the applications completed in the national notifiable diseases information system (SINAN). RESULTS: In the period of interest, 2179 cases were diagnosed with leprosy; 1080 met the criteria for inclusion. Of these, 225 were randomly selected patients who had mean age 56.12 (±17.34 years), 55.6% were women, 39.9% went to high school and 28.9% were Caucasians. A total of 55.3% (125) showed multibacillary form, with a predominant dimorphous leprosy in 40.4%. Physical disability was present in 60.9% and social restrictions in 24.9% of patients. The variable physical disability was associated with the therapeutic regimen multibacillary and social participation. CONCLUSION: We observed a high frequency of disability and social restriction after long period after the start of MDT/WHO suggesting the late diagnosis of leprosy or inadequate follow-up after discharge. This study highlights the importance of systematic monitoring of these patients with their own criteria which could be held at the Family Health Strategy.

Quality of life and its domains in leprosy patients after neurolysis: a study using WHOQOL-BREF.

Surgical nerve decompression in leprosy is indicated to prevent or treat nerve damage, and to improve sensory motor function and quality of life (QoL). The purpose of this study was to describe QoL of leprosy patients after surgical nerve decompression. Participants who underwent neurolysis in the last 5 years were recruited. The assessment consisted of collecting demographic and clinical information, QoL and its domain scores. Descriptive statistical analysis of demographic and clinical data was presented. Included 33 patients (43 +/- 11.0 years) who had neurolysis with a total of 61 nerves operated. The results of WHOQOL-bref showed that overall QoL mean was 11.2 (+/- 3.63) and domains scored as follow: physical (11.0 +/- 3.56), environment (11.47 +/- 2.11), psychological (13.29 +/- 2.79) and social relations (15.03 +/- 3.66). Measures of QoL should become part of the standard battery of tools used to assess health and well-being and it may contribute to identifying patients' needs in rehabilitation.