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.

Tecnologias em saúde da hanseníase no âmbito da Atenção Primária à Saúde: revisão de escopo / Leprosy health technologies in Primary Health Care: a scoping review / Tecnologías en salud de la lepra en el ámbito de la Atención Primaria a la Salud: revisión del alcance

Objetivo: mapear as tecnologias em saúde para manejo no cuidado à pessoa com hanseníase na Atenção Primária à Saúde. Método: revisão de escopo baseada na metodologia do JBI, em seis bases de dados, seguindo a checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Foram incluídos estudos publicados em qualquer idioma, com diferentes abordagens metodológicas. Resultados: os 14 estudos incluídos na revisão mostram que a aplicabilidade de tecnologias para o manejo do cuidado a pessoa com hanseníase na Atenção Primária à Saúde, possibilitam a confirmação de diagnóstico, acompanhamento, monitoramento e prevenção de incapacidades. Conclusão: nota-se que tecnologia em saúde se apresentam como ferramentas que auxiliam no processo de cuidado na assistência a pessoas com hanseníase, a fim de permitir aos profissionais de saúde conhecimento sobre a doença, proporcionando qualidade na sua prática de saúde.

Objective: to map health technologies for managing the care of people with leprosy in Primary Health Care. Method: scoping review based on the JBI methodology in six databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Studies published in any language were included, with different methodological approaches. Results: the 14 studies included in the review show that the applicability of technologies for the management of care for people with leprosy in Primary Health Care makes it possible to confirm diagnosis, follow-up, monitoring, and prevention of disabilities. Conclusion: it has been noted that health technologies are tools that help in the process of caring for people with leprosy, to provide health professionals with knowledge about the disease, improving quality of health practice.

Objetivo: mapear las tecnologías en salud para el manejo en el cuidado a la persona con lepra en la Atención Primaria a la Salud. Método: revisión del alcance basada en la metodología del JBI, en seis bases de datos, siguiendo la checklist Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Se han incluido estudios publicados en cualquier idioma, con diferentes enfoques metodológicos. Resultados: los 14 estudios incluidos en la revisión muestran que la aplicabilidad de tecnologías para el manejo del cuidado a la persona con lepra en la Atención Primaria a la Salud posibilita la confirmación de diagnóstico, seguimiento, monitoreo y prevención de incapacidades. Conclusión: se percibe que las tecnologías en salud se presentan como herramientas que ayudan en el proceso de cuidado en la asistencia a personas con lepra, con fines de permitir a los profesionales de salud el acceso al conocimiento sobre la enfermedad, proporcionando calidad en su práctica de salud.

A reparação possível: o respeito aos direitos humanos das pessoas com hanseníase / The Possible Reparation: Respect for the Human Rights of People with Leprosy / La reparación posible: el respeto a los derechos humanos de las personas con lepra

A hanseníase é uma das enfermidades mais antigas que se tem notícia, com registros que remontam a antiguidade. Ao longo dos tempos, as pessoas com a doença foram despojadas de seus direitos humanos por meio de políticas de isolamento, exclusão e até de cunho eugênico, apartando seus filhos do convívio com pais e mães portadores. O desafio, na atualidade, é a promoção, pelas Nações que viveram a moléstia em sua história, de políticas voltadas a prevenir abusos e afronta aos direitos humanos e reparar, inclusive com indenizações, os males sofridos no apartheid histórico.

Leprosy is one of the oldest known illnesses, with records dating back to antiquity. Over time, people with the disease have been stripped of their human rights through policies of isolation, exclusion and even eugenic policies, separating their children from their mothers and fathers who are carriers. The challenge today is the promotion, by Nations that have experienced the disease in their history, of promoting policies aimed at preventing abuses and affronts to human rights and repairing, including with compensation, the evils suffered during historical apartheid.

La lepra es una de las enfermedades más antiguas conocidas, con registros que se remontan a la antigüedad. Con el tiempo, las personas con la enfermedad han sido despojadas de sus derechos humanos mediante políticas de aislamiento, exclusión e incluso políticas eugenésicas, separando a sus hijos de sus madres y padres portadores. El desafío hoy es la promoción, por parte de las Naciones que han experimentado la enfermedad en su historia, de promover políticas destinadas a prevenir abusos y afrentas a los derechos humanos y reparar, incluso mediante compensaciones, los males sufridos durante el apartheid histórico.

Epidemiología y clínica de los pacientes con lepra en un centro de referencia de Paraguay / Epidemiology and clinical features of patients with leprosy in a reference center in Paraguay

RESUMEN Introducción: lepra (enfermedad de Hansen) es una patología infecciosa desatendida que afecta piel y nervios periféricos, desencadenando neuropatías y complicaciones como deformidades y discapacidades. Objetivos: determinar características epidemiológicas y clínicas de pacientes con lepra en el Centro de Especialidades Dermatológicas del Ministerio de Salud Pública y Bienestar Social de Paraguay, de enero 2021 a diciembre 2022. Metodología: estudio descriptivo, observacional, retrospectivo, de corte transversal. La gestión y análisis de datos se realizó en planilla electrónica (Excel del programa Microsoft Office 365 versión 2405), luego se realizó estadística descriptiva. Resultados: se diagnosticaron 123 casos de lepra, 45 (36,58 %) eran mujeres y 78 (63,42 %) varones; las edades estaban entre 17 y 86 años, el rango más afectado fue de 41 a 50 años. Eran lepra multibacilar 112 casos (91,06%). El signo más frecuente fue la placa infiltrada, presentada en 88 casos (71,54%). 58 pacientes (47,15%) presentaron reacciones lepromatosas, siendo, 31 casos de tipo 1 (53,45 %). 34 casos (27,64%) presentaron discapacidad grado 1 y 10 casos (8,13%) discapacidad grado 2. Conclusión: el perfil del paciente con lepra fue del sexo masculino entre 41 a 50 años, siendo la mayoría casos multibacilares. Es fundamentales el diagnóstico precoz y el tratamiento adecuado para reducir la carga de la enfermedad y las discapacidades.

ABSTRACT Introduction: Leprosy (Hansen's disease) is a neglected infectious disease that affects skin and peripheral nerves, triggering neuropathies and complications such as deformities and disabilities. Objective: determine epidemiological and clinical characteristics of patients with Leprosy in the Dermatological Specialties Center of the Ministry of Public Health and Social Welfare of Paraguay, from January 2021 to December 2022. Methodology: descriptive, observational, retrospective, cross-sectional study. Data management and analysis was carried out in an electronic spreadsheet (Excel from Microsoft Office 365 version 2405), then descriptive statistics were performed. Results: 123 cases of leprosy were diagnosed, 45 (36.58 %) were women and 78 (63.42 %) were men; the ages were between 17 and 86 years, the most affected range was 41 to 50 years. 112 cases (91.06 %) were multibacillary leprosy. The most frequent sign was infiltrated plaque, present in 88 cases (71.54 %). 58 patients (47.15 %) presented lepromatous reactions, 31 cases of type 1 (53.45 %). 34 cases (27.64 %) presented grade 1 disability and 10 cases (8.13 %) grade 2 disability. Conclusion: The profile of the patient with leprosy was male between 41 and 50 years, the majority being multibacillary cases. Early diagnosis and adequate treatment are essential to reduce the burden of the disease and disabilities.

Perfil epidemiológico da hanseníase em Bacabal - MA, Brasil, 2008-2017 / Epidemiological profile of leprosy in Bacabal -Ma, Brazil, 2008-2017 / Perfil epidemiológico de la lepra en Bacabal -Ma, Brasil, 2008-2017

Introdução:A hanseníase é uma enfermidade infectocontagiosa que pode gerar desde a incapacidade as sequelas físicas quando não tratada precocemente. Objetivo:Descrever o perfil epidemiológico da Hanseníase em Bacabal no estado do Maranhão. Metodologia:Trata-se de um estudo transversal, retrospectiva com abordagem quantitativa, sobre casos de hanseníase registrados no Sistema de Informação de Agravos de Notificação no período de 2008 a 2017 sendo analisados por estatística descritiva. Resultados:Foram diagnosticados 1.309 casos, na faixa etária de 20 a 34 anos (25,7%), sexo masculino (60,2%), raça/pretos (39,8%), com ensino fundamental (63,5%), ocupação de agropecuários (32,3%), atenção básica notificou a maioria dos casos (49,9%) e residiam na zona urbana (78,7%). Verificou-se que a classificação operacional predominante foi em casos Multibacilar (76%), na forma clínica dimorfa (60,9%), múltiplas lesões de 2 a 5 (33%), sem nervos afetados (60,6%) e os pacientes não tiveram nenhuma incapacidade física (45,5%). Apenas 43% dos casos realizaram a baciloscopia e a poliquimioterapia Multibacilar com 12 doses predominou com 75,8% nos casos diagnosticados. A maioria dos casos eram classificados como novos (77,8%), foram detectados por demanda espontânea (38,5%) e mais da metade foram curados (80,3%). Conclusões:A hanseníase é uma doença endêmica na região se configurando um problema saúde pública devido a elevada magnitude dos casos. Ressalta-se a importância da realização de atividades educativas com enfoque na prevenção através da busca ativa para o diagnóstico precoce; no intuito de rastrear casos e contatos na comunidade a fim de reduzir as sequelas físicas sendo um fator determinante para o enfrentamento da doença (AU).

Introduction:Leprosy is an infectious disease that can cause disability and physical sequelae when not treated early.Objective:To describe the epidemiological profile of leprosy in Bacabal, state of Maranhão. Methodology:This was a cross-sectional, retrospective, quantitative study on leprosy cases reported to the Notifiable Diseases Information System from 2008 to 2017. Data were analyzed using descriptive statistics. Results:A total of 1,309 cases were diagnosed, in the age group of 20 to 34 years (25.7%), male (60.2%), black race (39.8%), with elementary education (63.5%), and working in agriculture (32.3%). Primary care reported most cases (49.9%), and the majority of cases were from urban areas (78.7%). The predominant operational classification was multibacillary cases (76%), in the dimorphic clinical form (60.9%), from 2 to 5 multiple lesions (33%), without affected nerves (60.6%), and no physical disability (45.5%). Only 43% of cases underwent bacilloscopy, and multibacillary polychemotherapy with 12 doses was the most common treatment, accounting for 75.8% of diagnosed cases. Most cases were classified as new (77.8%) and were detected by spontaneous demand (38.5%), and more than Half were cured (80.3%).Conclusions: Leprosy is a disease endemic to the region and represents a public health challenge due to the high magnitude of cases. The importance of educational activities focusing on prevention through an active search for early diagnosis is highlighted to track cases and contacts in the community toreduce physical sequelae, which are crucial in combating the disease (AU).

Introducción: La lepra es una enfermedad infectocontagiosa que puede generar desde la discapacidad a consecuencias físicas si no se trata precozmente. Objetivo:Describir el perfil epidemiológico de la Lepra en Bacabal, estado de Maranhão. Metodología:Se trata de un estudio transversal, retrospectiva con abordaje cuantitativo, sobre casos de lepra registrados en el Sistema de Información de Enfermedades de Notificación Obligatoria en el período de 2008 a 2017 analizados por estadística descriptiva. Resultados:Se diagnosticaron 1.309 casos, con edad entre 20 a 34 años (el 25,7%), varones (el 60,2%), raza/negros (el 39,8%), con enseñanza básica (el 63,5%), ocupación de agropecuarios (el 32,3%), la atención primaria reportó la mayor parte de los casos (el 49,9%) y vivían en zonas urbanas (el 78,7%). Se verificó que la clasificaciónoperacional predominante fue en casos Multibacilar (el 76%), en la forma clínica dimorfa (el 60,9%), múltiples lesiones de 2 a 5 (el 33%), sin niervos afectados (el 60,6%) y los pacientes no tuvieron ninguna incapacidad física (el 45,5%). Solo el 43% de los casos se realizaron la baciloscopia y la poliquimioterapia Multibacilar con 12 dosis predominó con el 75,8% en los casos diagnosticados. La mayoría de los casos eran clasificados como nuevos (el 77,8%), se detectó por demanda espontánea (el 38,5%) y másde la mitad se curaron (el 80,3%). Conclusiones: La lepra es una enfermedad endémica en la región se configurando un problema salud pública debido a la elevada magnitud de los casos. Se subraya la importancia de la realización de actividades educativas con hincapié en la prevención por intermedio de la búsqueda activa para el diagnóstico temprano; en el intuito de rastrear casos y contactos en la comunidad con la finalidad de reducir las discapacidades físicas que son un factor determinante para afrontar enfrentar la enfermedad (AU).

Factors associated with sputum conversion time among patients with drug-resistant tuberculosis in Kenya

Background: Drug-resistant tuberculosis (DR-TB) is a form of antimicrobial resistance that is difficult and costly to treat. It is caused by TB bacteria that are resistant to at least one of the first-line existing TB medications, resulting in fewer treatment options and increasing mortality rates. Treatment for this form of TB, known as DR-TB, requires a minimum of 18-24 months of treatment with drugs that are less effective, more toxic, and more expensive than those needed for drug-susceptible TB. Methods: This was a retrospective review of secondary data for patients diagnosed with DR-TB in Kenya from 2014 to 2019. Each patient had a two-year follow-up period to monitor sputum conversion time and the associated factors. The enrolled patients comprised all patients diagnosed with DR-TB within the 47 counties in Kenya and enrolled at any drug-resistant registered treatment center. Results: A total of 2674 patients were enrolled for review to establish factors associated with conversion and we only found out that the type of resistance a patient enrolled on gender, intensive phase regiment, modification of intensive phase, and waiting time before treatment initiation were the only significant factors that would influence when a patient would convert from being sputum positive to negative. Conclusions: Patients with resistant TB require correct diagnosis and timely start of medication with good follow-up to avoid being lost to follow-up or failing on the medication started. Additionally, healthcare workers need continuous training to gain more knowledge in case of detection for patients coming to hospitals.

Hanseníase na atenção básica: saberes e práticas dos profissionais da Estratégia Saúde da Família / Leprosy in primary care: knowledge and practices of professionals in the Family Health Strategy

O objetivo deste estudo é descrever a capacitação de profissionais de saúde na avaliação dermatoneurológica e do grau de incapacidade física em hanseníase, realizada em um posto de Saúde. Trata-se de uma Pesquisa-ação desenvolvida de maio a agosto de 2019 com médicos, enfermeiros e fisioterapeuta da atenção básica. Foi utilizado para coleta de dados questionário autoaplicado, através da plataforma Google Forms, gravação audiovisual e registro em diário de campo durante as oficinas teóricas e práticas. O processo interpretativo deu-se através da análise de conteúdo. Inicialmente, foi realizado o diagnóstico situacional, no qual os profissionais relataram insegurança e deficiência tanto no conhecimento como na habilidade para o atendimento ao paciente com hanseníase. Além disso, não participaram de capacitações acerca do tema. Foram realizadas oficinas para desenvolver competências necessárias. A avaliação das oficinas mostrou uma melhoria do conhecimento e das práticas de cuidado aos usuários durante o estudo. É importante o incentivo às capacitações periódicas dos profissionais de saúde da atenção básica. Além disso, incluir na prática o monitoramento sistemático dos casos novos, busca ativa de casos suspeitos e dos contatos da pessoa com hanseníase. Para que se interrompa a cadeia de transmissão, faz-se necessária a adoção dessas práticas a fim de controlar os casos de hanseníase.

The aim of this study is to describe the training of health professionals in the dermatoneurological assessment and the degree of physical disability in leprosy performed at a health center. This is an action research developed from may to august 2019 with doctors, nurses and physical therapists in primary care. A self-administered questionnaire was used for data collection, through the google forms platform, audiovisual recording and field diary recording during the theoretical and practical workshops. The interpretive process took place through content analysis. Initially, the situational diagnosis was carried out, where professionals reported insecurity and deficiency in both knowledge and ability to care for patients with leprosy. In addition, they did not participate in training on the subject. Workshops were held to develop necessary skills. The evaluation of the workshops showed an improvement in knowledge and care practices for users during the study. It is important to encourage periodic training of primary care health professionals. Include in practice the systematic monitoring of new cases, active search for suspected cases and contacts of the person with leprosy. In order to interrupt the chain of transmission, it is necessary to adopt these practices in order to control leprosy cases.

As vulnerabilidades das mulheres na hanseníase: uma revisão integrativa de literatura / Women's vulnerability in leprosy: an integrative literature review / Las vulnerabilidades de las mujeres en la lepra: una revisión integradora de la literatura

Objetivo: compreender as vulnerabilidades a que as mulheres com hanseníase estão expostas e quais as implicações tanto para sua saúde como para sua vida social, religiosa, política e familiar. Metodologia: Trata-se de uma revisão integrativa da literatura. A coleta de dados foi realizada no mês de abril de 2024, na base de dados do Scientific Electronic Library Online (SciELO). O descritor utilizado foi: mulheres and hanseníase. Resultados: Ao todo, 19 artigos foram selecionados. A partir da análise realizada, optou-se por produzir três categorias temáticas (vulnerabilidade, corpo e estigma) para classificar o ponto central dos artigos escolhidos. Conclusão: Necessita-se de pesquisas que possam cada vez mais elucidar quais são as necessidades de mulheres com o diagnóstico ou em tratamento da hanseníase e pensar em políticas públicas, no gerenciamento e administração da enfermidade a partir da atenção primária.

Objective: To understand the vulnerabilities to which women with leprosy are exposed and the implications for both their health and their social, religious, political, and family life. Methodology: This is an integrative literature review. Data collection was conducted in April 2024 in the Scientific Electronic Library Online (SciELO) database. The descriptor used was women and leprosy. Results: In total, nineteen articles were selected. Based on the analysis conducted, it was decided to produce three thematic categories (vulnerability, body, and stigma) to classify the crucial point of the chosen articles. Conclusion: There is a need for research that can increasingly elucidate the needs of women diagnosed with or undergoing treatment for leprosy, and to consider public policies, management, and administration of the disease from primary care.

Objetivo: comprender las vulnerabilidades a las que están expuestas las mujeres con lepra y las implicaciones tanto para su salud como para su vida social, religiosa, política y familiar. Metodología: Se trata de una revisión integradora de la literatura. La recolección de datos se realizó en abril de 2024 en la base de datos de la Scientific Electronic Library Online (SciELO). El descriptor utilizado fue: mujeres y lepra. Resultados: En total, se seleccionaron diecinueve artículos. A partir del análisis realizado, se optó por producir tres categorías temáticas (vulnerabilidad, cuerpo y estigma) para clasificar el punto central de los artículos elegidos. Conclusión: Se necesitan investigaciones que puedan elucidar cada vez más cuáles son las necesidades de las mujeres con diagnóstico o en tratamiento de la lepra y considerar políticas públicas, así como la gestión y administración de la enfermedad desde la atención primaria.

Analysis of leprosy cases in the state of Pará between 2001 and 2020 / Análise dos casos de hanseníase no estado do Pará entre 2001 e 2020 / Análisis de los casos de lepra en el estado de Pará entre 2001 y 2020

Background and Objectives: leprosy is a mycobacteriosis known for centuries and prevalent to this day and, despite the reduction in the number of cases, it still affects many Brazilians. To this end, this study aimed to assess the clinical forms of leprosy in the state of Pará between 2001 and 2020. Methods: an ecological study was carried out using data from the Notifiable Diseases Information System (SINAN) of patients with leprosy according to three classifications, such as notified clinical form, notified operational classification and notified degree of disability, collected between 2001 and 2020. Results: the milder forms of leprosy showed a greater decrease than the more severe form, combined with a greater drop in cases in the paucibacillary class compared to the multibacillary classification. Furthermore, grade zero disability showed a large reduction in cases, in contrast to grades one and two, which remained stationary. Conclusion: despite the evident decrease in leprosy in the state, the most serious forms of the disease, which are related to higher levels of disability and transmission, showed little reduction.(AU)

Justificativa e Objetivos: a hanseníase é uma micobacteriose conhecida há séculos e prevalente até os dias atuais e, apesar da diminuição dos números de casos, ainda atinge diversos brasileiros. Para tanto, este estudo tem como objetivo avaliar as formas clínicas da hanseníase no estado do Pará entre 2001 e 2020. Métodos: foi realizado estudo ecológico a partir de dados do Sistema de Informação de Agravos de Notificação (SINAN) de pacientes com hanseníase de acordo com três classificações, como forma clínica notificada, classificação operacional notificada, e grau de incapacidade notificado, coletados entre os anos de 2001 e 2020. Resultados: as formas mais brandas da hanseníase tiveram um decrescimento maior do que a forma mais grave, aliado a uma maior queda dos casos da classe paucibacilar em comparação com a classificação multibacilar. Além disso, o grau zero de incapacidade apresentou grande redução dos casos, em contraste aos graus um e dois, que se mantiveram estacionários. Conclusão: apesar do decréscimo evidente da hanseníase no estado, as formas mais graves da doença, que estão relacionadas a maiores níveis de incapacidade e transmissão, apresentaram pouca redução. (AU)

Justificación y Objetivos: la lepra es una micobacteriosis conocida desde hace siglos y prevalente hasta el día de hoy y, a pesar de la reducción del número de casos, todavía afecta a muchos brasileños. Para ello, este estudio tiene como objetivo evaluar las formas clínicas de lepra en el estado de Pará entre 2001 y 2020. Métodos: se realizó un estudio ecológico utilizando datos del Sistema de Información de Enfermedades de Declaración Obligatoria (SINAN) de pacientes con lepra según tres clasificaciones, tales como forma clínica notificada, clasificación operativa notificada y grado de invalidez notificado, recopiladas entre 2001 y 2020. Resultados: las formas más leves de lepra tuvieron una disminución mayor que la forma más grave, combinado con una mayor caída de casos en la clase paucibacilar, en comparación con la clasificación multibacilar. Además, la discapacidad de grado cero mostró una gran reducción de casos, en contraste con los grados uno y dos, que se mantuvieron estacionarios. Conclusiones: a pesar de la evidente disminución de la lepra en el estado, las formas más graves de la enfermedad, que se relacionan con mayores niveles de discapacidad y transmisión, mostraron poca reducción.(AU)

Cataract surgery in leprosy patients: visual outcomes and complications

Background: Objective of study was to study the outcome of cataract surgery in terms of visual results and intra and postoperative complications in case of leprosy patient. Methods: The study analyzed all new cataract cases with leprosy at the outpatient unit, including patients cured of leprosy with senile or complicated cataracts but excluding those with corneal or retinal issues. Small incision cataract surgery was performed, with outcomes and complications assessed. Data collection and analysis utilized descriptive statistics. Follow-ups occurred at discharge and 1-, 4-, and 12-weeks post-surgery, revealing visual acuity ranging from good (6/6-6/18) to poor (<6/60). Results: The study involved 117 eyes from 98 patients (55 males, 43 females, ages 30-89). Pre-surgery, visual acuity was good in 6 eyes (5.12%), borderline in 29 (24.78%), and poor in 82 (70.08%). Post-surgery, 78 eyes (66.67%) had good, 25 (21.37%) borderline, and 10 (8.55%) poor visual acuity. At 12 weeks, 91.14% had good, 5.9% borderline, and 2.95% poor acuity. Common intraoperative issues included posterior capsular rupture in 8 eyes (6.84%), cortical matter loss in 4, iris prolapse in 2, and zonular dehiscence in 1. Early postoperative complications were iridocyclitis in 11 eyes (9.4%) and hyphema in 7 (5.98%), with late complications like chronic anterior uveitis, corneal decompensation, and choroidal detachment occurring in 3 and 2 eyes respectively. Conclusions: Visual outcome was good and the rates of intra and post-operative complications were minimal in our study. Functional vision can be achieved with timely surgical intervention.

Evaluation by community health agents of the attributes of primary health care for fighting leprosy: a cross-sectional study

OBJECTIVE: To evaluate whether the attributes of Primary Healthcare are present in leprosy control actions in Londrina from Community Health Workers' (CHW) perspectives. METHOD: Observational and evaluative study. Data collection occurred between January and March 2020 in Londrina, Paraná, using the questionnaire "Primary Care Assessment Tool (PCATool) - Hansen's disease - CHW version" and a population-based census of 246 CHWs from 52 Primary Healthcare Units. The analyses used a cutoff point (≥ 6.6), central tendency, and dispersion measures. One-way ANOVA and Tukey's post hoc tests were used to analyze differences. Results: The general performance towards the primary healthcare attributes were evaluated as strong (mean = 6.95 / SD = 1.08) and the essential score (mean = 7.39 / SD = 1.0). On the other hand, the derived score was evaluated as poor (mean = 6.07 / sd = 1.06). Concerning the Access attribute, the rural zone had a lower score than the urban (mean = 4.47 / SD = 1.63). Conclusion: The study highlights issues that can be improved, such as first contact access, catalog of services offered to leprosy patients, information provided to the community, professional training, and differences in PHC performance between urban and rural regions.

Cardiovascular events associated with thalidomide and prednisone in leprosy type 2 reaction

Abstract Background: Thalidomide is the drug of choice for the treatment of type 2 leprosy reactions and is often associated with corticosteroids. The use of these drugs in multiple myeloma is associated with the risk of cardiovascular events, but there have been few studies assessing this risk in leprosy patients. Objective: To evaluate the occurrence of cardiovascular events in patients with multibacillary leprosy and their correlation with the use of thalidomide and prednisone. Methods: Analytical cross-sectional study of all patients diagnosed with multibacillary leprosy treated at the Dermatology Service between 2012 and 2022, using electronic medical records. Thromboembolic vascular events, both arterial and venous, including acute myocardial infarction, were considered. The main independent variable was the concomitant use of thalidomide and prednisone during follow-up. Results: A total of 89 patients were included, of which 19 used thalidomide and prednisone concomitantly. There were five cardiovascular events (26.3%), three of which of deep venous thrombosis. The combined use of medications was associated with the events (PR = 6.46 [3.92 to 10.65]; p<0.01). Study limitations: Small number of events, single-center retrospective study. Conclusion: The hypothesis of an association between cardiovascular events and the concomitant use of thalidomide and prednisone is supported, but more robust prospective studies are required for a better assessment.

Hidden leprosy in a low-endemic area in southern Brazil: changes in endemicity following an active search

ABSTRACT Background: Leprosy, a neglected tropical disease, is reported in over 120 countries, with upwards of 200,000 new cases annually. This Cross-Sectional Cohort Study aimed to delineate the epidemiological profile of leprosy in a low-endemic area in southern Brazil, both before and after implementing an active search strategy. Methods: The study examined two surveillance periods in Cac ador, Santa Catarina, Brazil. The active search strategy was carried out through the application of the LSQ by the community health workers as a screening and detection tool for new cases of leprosy and this was compared with passive case detection. The first spanned from 2014 to 2020, and the second from January 2021 to August 2023. Findings: 48 leprosy cases were reported throughout the study, 83.3 % of which were diagnosed as multibacillary. The first period had an average detection rate of 0.38 cases per 10,000 inhabitants, increasing to 1.19 cases per 10,000 inhabitants in the second period. Notably, there was a substantial shift in the degree of physical disability (GD), with more Grade 0 and Grade 1 disabilities observed post-active search. Main Conclusions: The study underscores the efficacy of active search strategies in early diagnosis, highlighting a 300 % increase in the annual average of diagnosed cases. This large number of detected cases demonstrates the high sensitivity of the LSQ. This approach significantly aids in uncovering hidden cases of leprosy, enhancing disease management and control in low-endemic areas indicating that the Ministry of Health should intensify leprosy control activities in these regions.

Perfil epidemiológico de casos e óbitos da hanseníase em mato grosso: 2011-2020 / Epidemiological profile of leprosy cases and deaths in mato grosso: 2011-2020 / Perfil epidemiológico de los casos de lepra y las muertes en mato grosso: 2011-2020

RESUMO Objetivo: caracterizar o perfil epidemiológico dos casos e óbitos da hanseníase em Mato Grosso - Brasil, no período de 2011 a 2020. Método: estudo observacional, de base populacional, de todos os casos e óbitos notificados por hanseníase no período de 2011 a 2020. A posteriori, foi realizado os paramentos dos indivíduos notificados, estimando-se a tendência por meio da regressão de Prais-Winsten. Resultados: nos anos de estudo foram registrados 37.623 casos novos, taxa média de 114,7/100 mil habitantes com maiores taxas de incidência nos casos multibacilares e no sexo masculino, assim como na proporção de óbitos (58%; 88,2%) respectivamente. Quanto à tendência, foi crescente ao longo dos anos e no sexo feminino. Conclusão: os resultados sugerem que há um perfil de casos mais incidentes, possíveis áreas com disseminação da doença e atraso do diagnóstico, ressaltando a necessidade da utilização dos indicadores como forma de monitorar a endemia, fortalecendo a atenção e vigilância integral à hanseníase.

ABSTRACT Objective: To characterize the epidemiological profile of leprosy cases and deaths in Mato Grosso - Brazil, from 2011 to 2020. Method: A population-based observational study of all leprosy cases and deaths reported between 2011 and 2020. Subsequently, the reported individuals were matched, and the trend was estimated using the Prais-Winsten regression. Results: 37,623 new cases were registered in the study years, with an average rate of 114.7/100,000 inhabitants, with higher incidence rates in multibacillary cases and males, and in the proportion of deaths (58%; 88.2%), respectively. As for the trend, it has increased over the years and among women. Conclusion: The results suggest a profile of more incident cases, possible areas with the spread of the disease, and delayed diagnosis, highlighting the need to use indicators to monitor the endemic and strengthen comprehensive care and surveillance of leprosy.

RESUMEN Objetivo: Caracterizar el perfil epidemiológico de los casos y muertes por lepra en Mato Grosso - Brasil, de 2011 a 2020. Método: estudio observacional basado en la población de todos los casos y muertes por lepra notificados entre 2011 y 2020. Posteriormente, se emparejaron los individuos declarados y se estimó la tendencia mediante la regresión de Prais-Winsten. Resultados: Se registraron 37.623 nuevos casos en los años de estudio, una tasa media de 114,7/100.000 habitantes, con tasas de incidencia más elevadas en los casos multibacilares y en los varones, así como en la proporción de muertes (58%; 88,2% respectivamente). En cuanto a la tendencia, ha aumentado con los años y en el sexo femenino. Conclusión: Los resultados sugieren que existe un perfil de más casos incidentes, posibles zonas de propagación de la enfermedad y un retraso en el diagnóstico, lo que pone de manifiesto la necesidad de utilizar indicadores como forma de seguimiento de la endemia, de reforzar la atención integral y la vigilancia de la lepra.

A pandemia covid-19 e o acompanhamento das pessoas afetadas pela hanseníase nos serviços de saúde / The covid-19 pandemic and the follow-up of people affected by leprosy in health services / La pandemia de covid-19 y el seguimiento de las personas afectadas de lepra en los servicios sanitarios

RESUMO Objetivo: analisar o acompanhamento das pessoas afetadas pela hanseníase nos serviços de saúde durante a pandemia COVID-19. Método: estudo exploratório, descritivo com abordagem qualitativa, desenvolvido em Unidades Básicas de Saúde e no Serviço de Referência de Hanseníase de Campina Grande-Paraíba - Brasil. Coleta de dados entre os meses de outubro de 2021 e fevereiro de 2022. A população do estudo foi composta por usuários em tratamento e em acompanhamento de reações hansênicas. Os dados foram analisados através da Análise de Conteúdo de Bardin. Resultados: emergiram três categorias, sendo o déficit de conhecimento dos usuários sobre a hanseníase e seu controle, os sentimentos desses frente a doença e ao tratamento, e o controle da hanseníase fragilizado na Atenção Primária à Saúde. Conclusão: observou-se fragilidade no acompanhamento dos usuários afetados pela hanseníase, relacionado a falta de medicação e de profissionais, assim como na própria percepção do usuário com relação à doença.

ABSTRACT Objective: To analyze the follow-up of people affected by leprosy in health services during the COVID-19 pandemic. Method: This is an exploratory, descriptive study with a qualitative approach, carried out in Basic Health Units and the Leprosy Reference Service in Campina Grande-Paraíba - Brazil. Data collection between October 2021 and February 2022. The study population consisted of users undergoing treatment and being monitored for leprosy reactions. The data was analyzed using Bardin's Content Analysis. Results: Three categories emerged: users' lack of knowledge about leprosy and its control, their feelings about the disease and treatment, and weakened leprosy control in Primary Health Care. Conclusion: We observed fragility in the follow-up of users affected by leprosy, related to the lack of medication and professionals, as well as the user's perception of the disease.

RESUMEN Objetivo: Analizar el seguimiento de las personas afectadas de lepra en los servicios sanitarios durante la pandemia de COVID-19. Material y método: estudio exploratorio, descriptivo, con abordaje cualitativo, realizado en Unidades Básicas de Salud y en el Servicio de Referencia en Lepra de Campina Grande-Paraíba - Brasil. Recogida de datos entre octubre de 2021 y febrero de 2022. La población del estudio estaba formada por usuarios que seguían un tratamiento y eran controlados para detectar reacciones leprosas. Los datos se analizaron mediante el análisis de contenido de Bardin. Resultado: surgieron tres categorías, a saber, la falta de conocimientos de los usuarios sobre la lepra y su control, sus sentimientos sobre la enfermedad y el tratamiento, y el debilitamiento del control de la lepra en la Atención Primaria de Salud. Conclusión: Observamos fragilidad en el seguimiento de los usuarios afectados por la lepra, relacionada con la falta de medicación y de profesionales, así como con la propia percepción de la enfermedad por parte del usuario.

Malignização de úlcera de longa duração em paciente com sequela de hanseníase: um relato de caso / Malignant transformation of a long-term ulcer in a patient with leprosy sequelae: a case report

Resumo A úlcera de Marjolin (UM) é uma condição rara definida como um tumor maligno na pele decorrente de feridas crônicas e inflamação. Os achados histológicos mais comuns nas UMs são os carcinomas de células escamosas (CCE) ou carcinomas espinocelulares (CEC), como carcinomas basocelulares (CBC) e melanomas malignos (MM). O objetivo deste estudo é relatar o caso de um paciente com sequela de hanseníase que apresentou malignização de sua úlcera em perna direita de longa duração e, a partir disso, compreender a progressão e a importância do diagnóstico precoce da UM. O diagnóstico da UM foi realizado mediante biópsia incisional da lesão e, após obtido o resultado positivo, o paciente foi encaminhado a um serviço de Oncologia. O tratamento da UM é multidisciplinar, sendo a abordagem cirúrgica a primeira opção terapêutica. O manejo adequado e a vigilância de úlceras crônicas pela equipe de saúde tornam-se necessários para o reconhecimento precoce da UM.

Abstract Marjolin's ulcer (MU) is a rare condition defined as a malignant skin tumor arising from chronic wounds and inflammation. The most common histological findings in MUs are squamous cell carcinomas (SCC) (or spinocellular carcinomas [SPC]), such as basal cell carcinomas (BCC) and malignant melanomas (MM). The aim of this study is to report the case of a patient with sequelae of leprosy who presented malignant transformation in a long-standing ulcer on the right leg, thereby contributing to understanding of the progression and significance of early diagnosis of MU. The MU was diagnosed by incisional biopsy of the lesion and upon obtaining a positive result the patient was referred to an oncology service. Treatment of MU is multidisciplinary and surgical excision is the first therapeutic option. Proper management and surveillance of chronic ulcers by the healthcare team are necessary for early recognition of MU.

Perfil das notificações de hanseníase em menores de 15 anos no Nordeste do Brasil / Profile of leprosy notifications in children under 15 years of age in Northeastern Brazil / Perfil de notificaciones de lepra en niños menores de 15 años en el Noreste de Brasil

Objetivo: analisar o perfil epidemiológico dos novos casos de hanseníase em menores de 15 anos no Nordeste do Brasil, entre 2012 e 2022. Método: estudo ecológico, retrospectivo, epidemiológico, realizado por meio de dados do Sistema de Informação de Agravos de Notificação do Ministério da Saúde, em dezembro de 2023. Resultados: Foram notificados 9.252 novos casos em menores de 15 anos. Destes, 4.853 (52,5%) foram no sexo masculino, 5.783 (62,5%) na faixa etária dos 10-14 anos, 6.245 (67,5%) em pardos e 6.026 (65,1%) com o ensino fundamental incompleto. Houve predominância de casos paucibacilares (N=4.826/52,2%), dimorfos (N=3.170/34,3%), com grau zero de incapacidade (N=6.975/75,4%), com lesão única (N=3.645/39,4%), baciloscopia negativa (N=3.708/40,1%), sem reação (N=6.110/66,1%) e encaminhado para seis doses da poliquimioterapia (N=4.772/51,6%).Considerações finais: constatou-se que a hanseníase em menores de 15 anos é um acentuado problema de saúde pública, necessitando de ações para seu controle

Objective: to analyze the epidemiological profile of new cases of leprosy in children under 15 years of age in Northeast Brazil, between 2012 and 2022. Method: ecological, retrospective, epidemiological study, carried out using data from the Ministry's Notifiable Diseases Information System of Health, in December 2023. Results: 9,252 new cases were reported in children under 15 years of age. Of these, 4,853 (52.5%) were male, 5,783 (62.5%) were aged 10-14, 6,245 (67.5%) were mixed race and 6,026 (65.1%) were educated fundamental incomplete. There was a predominance of paucibacillary cases (N=4,826/52.2%), dimorphic (N=3,170/34.3%), with zero degree of disability (N=6,975/75.4%), with a single lesion (N=3,645 /39.4%), negative smear microscopy (N=3,708/40.1%), no reaction (N=6,110/66.1%) and referred for six doses of multidrug therapy (N=4,772/51.6%). Final considerations: it was found that leprosy in children under 15 years of age is a serious public health problem, requiring actions to control it

Objetivos:analizar el perfil epidemiológico de los nuevos casos de lepra en niños menores de 15 años en el Nordeste de Brasil, entre 2012 y 2022. Método: estudio epidemiológico, ecológico, retrospectivo, realizado con datos del Sistema de Información de Enfermedades de Declaración Obligatoria del Ministerio de Salud, en diciembre de 2023. Resultados: Se reportaron 9.252 nuevos casos en menores de 15 años. De ellos, 4.853 (52,5%) eran hombres, 5.783 (62,5%) tenían entre 10 y 14 años, 6.245 (67,5%) eran mestizos y 6.026 (65,1%) tenían educación fundamental incompleta. Hubo predominio de casos paucibacilares (N=4.826/52,2%), dimórficos (N=3.170/34,3%), con cero grado de discapacidad (N=6.975/75,4%), con lesión única (N=3.645/39,4%), baciloscopia negativa (N=3.708/40,1%), sin reacción (N=6.110/66,1%) y remitido para seis dosis de poliquimioterapia (N=4.772/51,6%). Consideraciones finales: se encontró que la lepra en niños menores de 15 años es un grave problema de salud pública, requiriendo acciones para su control

Different profiles of chemokines, cytokines and cell growth factors in plasma samples from patients with leprosy, leprosy reactions and households contacts

BACKGROUND Leprosy is a highly neglected disease that is considered a serious public health problem in many countries. This illness is characterised by a variety of clinical and histopathological manifestations that are related to the patient immune response. OBJECTIVES This work aimed evaluate the profile of circulating immune mediators in the plasma from patients classified clinically as paucibacillary (PB), multibacillary (MB), households contacts (HHC), type1 leprosy reaction (T1R), type2 leprosy reaction (T2R) and control individuals without medical history of leprosy (CTL). METHODS To assessment of the plasma immune mediators was used multiplex microbeads immunoassay "Luminex". FINDINGS The results showed that patients (PB) had a regulatory-biased profile, while MB revealed a pro-inflammatory trend of highly expressed biomarkers. HHC display conspicuously increased levels in the plasma of the chemokines (CCL2, CCL3, CCL4, CCL5 and CXCL8), pro-inflammatory cytokines (IFN-γ,TNF and IL-1β), modulating cytokines (IL-9 and IL-1Ra) and growth factors (PDGF, G-CSF and IL-2). Interestingly, HHC displayed superior production of IFN-γ as compared to other leprosy groups, indicating a putative protective role for this cytokine during chronic Mycobacterium leprae exposure. MAIN CONCLUSION Further investigations are currently underway to elucidate the potential of these mediators as biomarkers applicable to the diagnosis/prognosis of leprosy and also T1R and T2R leprosy reactions.

Avaliação do perfil de citocinas séricas e óxido nítrico na hanseníase experimental murina / Evaluation of the serum cytokines profile and nitric oxide in experimental murine leprosy

Introdução: a hanseníase é uma do-ença infecciosa crônica causada pelo Mycobacterium leprae (M. leprae), um para-sita intracelular obrigatório. Assim, a resis-tência do hospedeiro a esse patógeno depen-de da imunidade celular. O uso de modelos experimentais tem permitido o estudo da hanseníase do ponto de vista imunológico, microbiológico e terapêutico, entretanto, as diferenças na progressão da infecção entre os modelos mais empregados (camundongos imunocompetentes, BALB/c, e camundongos congenitamente atímicos, nude) são pouco estudadas. Objetivo: comparar a evolução da infecção pelo M. leprae em camundongos BALB/c e nude quanto à multi-plicação bacilar e avaliação do perfil inflamatório sistêmico pela quantificação sérica de citocinas e óxido nítrico (NO). Métodos: os camundongos foram inoculados com M. leprae nos coxins plantares e avaliados aos 3, 5 e 8 meses após a infecção. Resultados: camundongos nude apresentaram multiplicação bacilar progressiva nos coxins plantares. Em camundongos BALB/c, o número de bacilos foi maior aos 5 meses. Em relação à quantificação de citocinas, nos camundongos BALB/c houve aumento de IL-2 e IL-17A e diminuição de IL-6 e NO aos 8 meses de inoculação. Nos camundongos nude, verificou-se o aumento do TNF aos 8 meses de inoculação e manutenção dos níveis de NO. Conclusão: os resultados encontrados sugerem que em camundongos BALB/c ocorre a ativação de uma resposta imune capaz de controlar a multiplicação do M. leprae, em contrapartida em camundongos nude a infecção é progressiva a despeito de altos níveis de TNF. (AU)

Introduction: leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae), an obligate intracellular parasite. Thus, host resistance to this pathogen depends on cellular immunity. The use of experimental models has made it possible to study leprosy from an immunological, microbiological, and therapeutic point of view. However, the differences in the progression of the infection between the most used models (immunocompetent mice, BALB/c, and congenitally athymic mice, nude) have been little studied. Objective: to compare the evolution of M. leprae infection in BALB/c and nude mice in terms of bacillary multiplication and evaluation of the systemic inflammatory profile by quantifying serum cytokines and nitric oxide (NO). Methods: the mice were inoculated with M. leprae in the footpads and evaluated at 3, 5, and 8 months after infection. Results: nude mice showed progressive bacillary multiplication in the footpads. In BALB/c mice, the number of bacilli was higher at 5 months. In terms of cytokine quantification, BALB/c mice showed an increase in IL-2 and IL-17A and a decrease in IL-6 and NO at 8 months of inoculation. In the nude mice, there was an increase in TNF at 8 months of inoculation and maintenance of NO levels. Conclusion: the results suggest that BALB/c mice activate an immune response capable of controlling the multiplication of M. leprae, whereas in nude mice the infection is progressive despite high levels of TNF. (AU)

Infections in the era of immunobiologicals

Abstract Immunobiologicals represent an innovative therapeutic option in dermatology. They are indicated in severe and refractory cases of different diseases when there is contraindication, intolerance, or failure of conventional systemic therapy and in cases with significant impairment of patient quality of life. The main immunobiologicals used in dermatology basically include inhibitors of tumor necrosis factor-alpha (anti-TNF), inhibitors of interleukin-12 and -23 (anti-IL12/23), inhibitors of interleukin-17 and its receptor (anti-IL17), inhibitors of interleukin-23 (anti-IL23), rituximab (anti-CD20 antibody), dupilumab (anti-IL4/IL13) and intravenous immunoglobulin. Their immunomodulatory action may be associated with an increase in the risk of infections in the short and long term, and each case must be assessed individually, according to the risk inherent to the drug, the patient general condition, and the need for precautions. This article will discuss the main risks of infection associated with the use of immunobiologicals, addressing the risk in immunocompetent and immunosuppressed patients, vaccination, fungal infections, tuberculosis, leprosy, and viral hepatitis, and how to manage the patient in the most diverse scenarios.