RESUMO
The introduction, implementation, successes and failures of multidrug therapy (MDT) in all Hansen's disease endemic countries are discussed in this paper. The high efficacy of leprosy treatment with MDT and the global reduction of prevalence led the World Health Organization, in 1991, to establish the goal of elimination of Hansen's disease (less than 1 patient per 10,000 inhabitants) to be accomplished by the year 2000. Brazil, Nepal and East Timor are among the few countries that didn't reach the elimination goal by the year 2000 or even 2005. The implications of these aspects are highlighted in this paper. Current data from endemic and previously endemic countries that carry a regular leprosy control programme show that the important fall in prevalence was not followed by the reduction of the incidence. This means that transmission of Mycobacterium leprae is still an issue. It is reasonable to conclude that we are still far from the most important goal of Hansen's disease control: the interruption of transmission and reduction of incidence. It is necessary to emphasize to health managers the need of keeping Hansen's disease control activities to better develop control programmes in the future. The recent international proposal to interrupt the transmission of leprosy by the year 2020 seems to unrealistic and it is discussed in this paper. The possibility of epidemiological impact related to the human immunodeficiency virus/Hansen's disease coinfection is also considered.
Assuntos
Humanos , Hanseníase/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Incidência , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/prevenção & controle , PrevalênciaRESUMO
The introduction, implementation, successes and failures of multidrug therapy (MDT) in all Hansen's disease endemic countries are discussed in this paper. The high efficacy of leprosy treatment with MDT and the global reduction of prevalence led the World Health Organization, in 1991, to establish the goal of elimination of Hansen's disease (less than 1 patient per 10,000 inhabitants) to be accomplished by the year 2000. Brazil, Nepal and East Timor are among the few countries that didn't reach the elimination goal by the year 2000 or even 2005. The implications of these aspects are highlighted in this paper. Current data from endemic and previously endemic countries that carry a regular leprosy control programme show that the important fall in prevalence was not followed by the reduction of the incidence. This means that transmission of Mycobacterium leprae is still an issue. It is reasonable to conclude that we are still far from the most important goal of Hansen's disease control: the interruption of transmission and reduction of incidence. It is necessary to emphasize to health managers the need of keeping Hansen's disease control activities to better develop control programmes in the future. The recent international proposal to interrupt the transmission of leprosy by the year 2020 seems to unrealistic and it is discussed in this paper. The possibility of epidemiological impact related to the human immunodeficiency virus/Hansen's disease coinfection is also considered.
Assuntos
Hanseníase/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Humanos , Incidência , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/prevenção & controle , PrevalênciaRESUMO
A hidratação cutânea é, sem dúvida alguma, uma das modalidades terapêuticas mais empregadas pelos dermatologistas em sua prática clínica diária. Neste artigo se apresenta o resultado clínico de um estudo fase IV, aberto, multicêntrico, prospectivo, de uso de extratos de Imperata cylindrica e de Triticum vulgare ceramidas vitaminas A, C, E e F silanol (Epidrat® Ultra) em 168 voluntários portadores de xerose cutânea associada a causas específicas (dermatite atópica, psoríase, xerose senil, hanseníase, climatério e senilidade, diabetes mellitus ou hipotireoismo). Após 30 dias de uso do produto houve alívio, médio, de 40,38% dos sinais (p<0,0001) e 37,08% dos sintomas (p<0,0001) de xerose entre os voluntários (redução média da soma dos sinais e sintomas foi de 40,51% p<0,0001). Antes do uso do produto 61,3% dos voluntários possuíam xerose moderada/grave/muito grave, o que involuiu para 23,2% dos mesmos ao final da avaliação (p<0,0001) inversamente, dos 38,7% dos voluntários considerados com xerose ausente/leve no início do estudo, a porcentagem dos mesmos subiu para 76,2% (p<0,0001, para ambos os comportamentos). Segundo os investigadores, o alívio completo/acentuado da xerose notado foi de 57,1% e, para os voluntários, de 60,7% (p<0,0001). Além do mais, o produto apresentou boa tolerabilidade de uso, com incidência reduzida de eventos adversos realmente relacionados ao seu uso (13,8%) que, em última análise, poderia ser da própria evolução clínica adaptativa da terapêutica tópica, talvez, observada com o uso de qualquer produto tópico, cosmecêutico ou farmacológico. Estes dados, portanto, estabelecem Epidrat® Ultra como uma boa opção terapêutica para abordagem de quadros graves de xerose cutânea.