Total knee arthroplasty for neuropathic arthropathy in a patient with leprosy.

Patients with leprosy are known to tend to develop neuropathic arthropathy, known as Charcot joint. There are no case reports of total knee arthroplasty (TKA) in patients with leprosy with polyarticular neuropathic arthropathy, and the results are unknown. In this study, we report a case of TKA in a patient with leprosy with polyarticular neuropathic arthropathy and discuss its outcomes and indications. Right TKA using the NexGen Legacy Constrained Condylar Knee implant was performed in a 62-year-old man with neuropathic arthropathy in multiple joints with clinical symptoms, particularly in the right knee. Seven years post-operation, the American Knee Society Score-knee and -function, which represent knee function and activities of daily living on a scale of 100 points, were significantly improved compared with preoperative values, from 30 to 99 points and 0 to 60 points, respectively. Indications for arthroplasty for neuropathic arthropathy should be carefully considered in each individual case. In this case, the patient had neuropathic arthropathy in multiple joints; however, TKA was performed because recovery of function in the right knee was expected to significantly improve the patient's activities of daily living, and a good mid-term clinical outcome was achieved. Therefore, indications for arthroplasty should be considered in patients with systemic neuropathic arthropathy such as leprosy, and with accurate assessment and appropriate implant selection, good long-term outcomes may be expected.

Repercussões no cotidiano de crianças e adolescentes que viveram com hanseníase / Effects on the daily lives of children and teenagers who lived with leprosy

RESUMO O estudo apresenta como objetivo compreender as repercussões da doença na vida cotidiana de crianças e adolescentes acometidos pela hanseníase. Trata-se de uma pesquisa qualitativa com base no referencial teórico 'A Sociologia de Erving Goffman'. Foram entrevistados, individualmente, 14 participantes, sendo 9 crianças e 5 adolescentes tratados e curados da hanseníase. Utilizou-se entrevista semiestruturada, abrangendo informações sociodemográficas e questões norteadoras sobre a vivência dos participantes com a doença, aspectos familiares, sociais e percepções advindas da experiência. Os dados foram analisados pela sociologia de Erving Goffman. As narrativas enfatizam as repercussões do cotidiano relacionados com a história da descoberta da hanseníase, as redes de interação como família e profissionais de saúde, dos cuidados com a própria saúde, de estratégias de superação e expectativas. Verificou-se que o elemento predominante da pesquisa se ancora no temor de ser descoberto e desacreditado, na perspectiva de ter sua identidade de sadio ressignificada, pelo adoecimento e perante a vivência dos participantes com o preconceito, sigilo e segredo. Conclui-se, de modo simbólico, que os participantes vivenciaram uma construção de vida social negativa em torno da hanseníase. O adoecimento interfere de modo direto no cotidiano e desenvolvimento dos participantes, repercutindo principalmente nas relações sociais.

ABSTRACT The study aims to understand the effects of the disease on the daily lives of children and teenagers affected by leprosy. This was a qualitative research based on the theoretical framework of 'The Sociology of Erving Goffman'. We interviewed 14 participants individually, nine children and five teenagers, who underwent treatment for leprosy and were cured. A semi-structured interview was used, covering sociodemographic information and guiding questions about the participants' experiences with the disease, family, social aspects, and perceptions derived from the experiences. The data were analyzed by the sociology of Erving Goffman. The narratives emphasized the effects on daily life related to leprosy discovery, interaction networks, such as family and health professionals, health care, overcoming strategies and expectations. It was verified that the predominant element of the research is anchored in the fear of being discovered and discredited, in the perspective of having their identity of health resignified, by the illness, and by the evidence in view of the participant's experience due to prejudice, anonymity, and secret. This symbolically suggests that the participants experienced a certain construction of negative social life around leprosy. The illness directly interferes with their daily life and development, especially in the participant's social relationships.

Percepções de pessoas com sequelas pela hanseníase acerca do autocuidado / Perceptions of people with sequelae by leprosy about self-care / Percepciones de personas com sequelae por lepra sobre el autocuidado

Objetivo: o estudo teve como objetivo conhecer as percepções de pessoas com sequelas pela hanseníase acerca das ações de autocuidado, à luz do seu contexto cultural. Método: estudo descritivo, exploratório com abordagem qualitativa, realizado com 12 pessoas com sequelas pela hanseníase, atendidas em um hospital colônia no estado do Piauí. Foram utilizadas entrevistas semiestruturadas, que posteriormente foram submetidas à técnica do Discurso do Sujeito Coletivo, tendo como suporte neste processo o software Iramuteq versão 0.7. Resultados: evidenciou-se que as percepções das pessoas relacionadas ao autocuidado estão ligadas às práticas de higiene corporal e oral, necessitando de apoio ao autocuidado por meio da compreensão do seu universo cultural. Considerações Finais: o autocuidado abrange uma dimensão integral de cuidados que deve ser inserido no contexto cultural das pessoas, que realizado de forma eficiente, proporciona melhorias no bem-estar e na qualidade de vida. (AU)

Objective: The study aimed to know the perceptions of people with leprosy sequelae about self-care actions in the light of their cultural context. Methods: A descriptive, exploratory study with a qualitative approach, carried out with 12 people with leprosy sequelae, attended in a colony hospital in the state of Piauí. Semi-structured interviews were used, which were subsequently submitted to the Collective Subject Discourse technique, using Iramuteq software version 0.7 as support in this process. Results: It was shown that people's perceptions of self-care are related to body and oral hygiene practices, requiring support for self-care through the understanding of their cultural universe. Conclusion: Self-care encompasses an integral dimension of care that must be inserted in the cultural context of people, which performed efficiently, provides improvements in well-being and quality of life. (AU)

Objetivo: El estudio tuvo como objetivo comprender las percepciones de las personas con secuelas de lepra sobre las acciones de autocuidado a la luz de su contexto cultural. Métodos: Estudio exploratorio descriptivo con enfoque cualitativo, realizado con 12 personas con secuelas de lepra atendidas en un hospital de colonias en el estado de Piauí. Se utilizaron entrevistas semiestructuradas, que posteriormente se sometieron a la técnica de Discurso del sujeto colectivo, utilizando Iramuteq versión 0.7 como apoyo en este proceso. Resultados: Se demostró que las percepciones de las personas sobre el autocuidado están relacionadas con las prácticas de higiene bucal y corporal, lo que requiere apoyo para el autocuidado a través de la comprensión de su universo cultural. Conclusion: El autocuidado abarca una dimensión integral de la atención que debe insertarse en el contexto cultural de las personas, que se desempeña de manera eficiente, proporciona mejoras en el bienestar y la calidad de vida. (AU)

Grupo de autocuidado em hanseníase: benefícios na participação e resistências na adesão / Self-care group in leprosy: benefits from participation and resistances to adherence

Objetivos: Descrever a limitação de atividades e a participação social de indivíduos com hanseníase antes e após participação em grupo de autocuidado, analisar os benefícios do grupo e a não adesão. Métodos: Trata-se de uma pesquisa descritiva e exploratória com abordagem quanti-qualitativa com 18 pacientes em tratamento para hanseníase, atendidos e acompanhados em um centro de saúde em Palmas ­ Tocantins. Os dados foram coletados no período de março a dezembro de 2018 por meio de um Questionário de Identificação, da escala Screening of Activity Limitation and Safety Awareness (SALSA) e Participação Social, e Entrevista Semiestruturada. Os dados foram analisados pelo programa Statistical Package For Social Sciences (SPSS) e as entrevistas por meio de Análise de Conteúdo pela técnica análise categorial. Resultados: Embora a adesão ao grupo de autocuidado tenha sido baixa, a participação no mesmo contribuiu para redução dos escores das escalas Salsa e Participação Social e proporcionou aos pacientes conhecimento sobre a doença, troca de saberes, socialização, criação de vínculo, melhora da autonomia, do autocuidado e dos fatores emocionais. Conclusão: A limitação de atividades e a participação social dos pacientes podem ser prejudicadas pela hanseníase, entretanto, o grupo de autocuidado auxilia o paciente a lidar melhor com a doença.

Objectives: To describe the limitation of activities and social participation of individuals with leprosy before and after joining a self-care group, to analyze the benefits of the group and non-adherence. Methods: Descriptive and exploratory research with quantitative-qualitative approach with 18 patients undergoing treatment for leprosy, attended and followed up at a health center in Palmas - Tocantins. Data were collected from March to December 2018 through the Identification Questionnaire, SALSA Scales and Social Participation, and Semi- structured Interview. The data were analyzed by the Statistical Package for Social Sciences (SPSS) Program and the interviews were conducted through Content Analysis by the categorical analysis technique. Results: Although adherence to the self-care group was low, the participation in it contributed to a reduction in the scores of the Salsa and Social Participation scales and provided patients with knowledge about the disease, knowledge exchange, socialization, improvement of autonomy, self-care and emotional factors. Conclusion: Patient's limitation of activities and social participation may be impaired by leprosy, however, the self-care group helps them to better deal with the disease.

Activity limitations in leprosy and their association to cognition and neuropsychiatric symptoms / Limitaciones de tarea en la enfermedad de Hansen y su relación con cognición y síntomas neuropsiquiátricos / Limitações de tarefa na hanseníase e sua associação com cognição e sintomas neuropsiquiátricos

ABSTRACT Objectives: to analyze activity limitations in patients with leprosy and their association to cognition and neuropsychiatric symptoms. Methods: this cross-sectional design study included sixty patients with multibacillary leprosy assisted at a reference center. Participants were divided according to their physical disability and submitted to instruments assessing daily activities (basic and instrumental), cognitive functions, and neuropsychiatric symptoms. The order of the instruments was random to avoid any interference of test sequence on the results. Results: fifty-five percent of the participants presented physical disabilities. All patients were independent in performing basic activities but sixty-six percent presented difficulties in performing instrumental activities. Cognitive decline and neuropsychiatric symptoms were seen in advanced stages of the disease, but they were more associated to patient age than to leprosy. Conclusions: leprosy patients presented physical disabilities and difficulties in performing instrumental daily activities. Cognitive decline and neuropsychiatric symptoms were more associated to aging than to leprosy itself.

RESUMEN Objetivo: analizar limitaciones de tarea en pacientes con Lepra y su relación con cognición y síntomas neuropsiquiátricos. Métodos: este estudio transversal incluyó 60 pacientes con Lepra multibacilar atendidos en centro de referencia. Participantes fueron divididos segundo la disfunción física y evaluados cuanto a las actividades diarias (básicas y instrumentales), funciones cognitivas y síntomas neuropsiquiátricos. Orden de aplicación de los instrumentos aleatoria para evitar interferencia de la secuencia de tests sobre los resultados. Resultados: de los participantes, 55% presentaron disfunción física. Todos pacientes eran independientes en las actividades básicas, pero 66% mostraron dificultades en las actividades instrumentales. Declive cognitivo y síntomas neuropsiquiátricos fueron observados en etapas avanzadas de la enfermedad, pero estos estaban más relacionados a la edad del paciente que a la Lepra. Conclusiones: pacientes con Lepra evidenciaron disfunción física y dificultades en las actividades instrumentales. Declive cognitivo y síntomas neuropsiquiátricos están más relacionados al envejecimiento que a la Lepra.

RESUMO Objetivo: analisar as limitações de tarefa em pacientes com hanseníase e sua associação com cognição e sintomas neuropsiquiátricos. Métodos: este estudo transversal incluiu 60 pacientes com hanseníase multibacilar atendidos em um centro de referência. Os participantes foram divididos segundo a disfunção física e avaliados quanto às atividades diárias (básicas e instrumentais), às funções cognitivas e aos sintomas neuropsiquiátricos. A ordem de aplicação dos instrumentos foi aleatória para evitar interferência da sequência dos testes sobre os resultados. Resultados: dos participantes, 55% apresentaram disfunção física. Todos os pacientes eram independentes nas atividades básicas, mas 66% mostraram dificuldades nas atividades instrumentais. Declínio cognitivo e sintomas neuropsiquiátricos foram observados em estágios avançados da doença, porém estes estavam mais associados à idade do paciente do que à hanseníase. Conclusões: pacientes com hanseníase evidenciaram disfunção física e dificuldades nas atividades diárias instrumentais. Declínio cognitivo e sintomas neuropsiquiátricos estão mais associados ao envelhecimento do que à hanseníase.

Recovery of Dementia Syndrome following Treatment of Brain Inflammation.

AIM/BACKGROUND: This research aims to prevent progression from mild cognitive impairment (MCI) to Alzheimer's disease. A Japanese study of leprosy patients revealed that the incidence of dementia in leprosy patients was lower than that in patients taking dapsone who had never been treated. But a similar study the following year refuted the finding of less dementia in leprosy patients taking dapsone. According to conflicting reports, Mycobacterium leprae was a factor in reducing the incidence of Alzheimer's disease. Thus, we formed a hypothesis that if dapsone is administered to patients without leprosy but with MCI and the prophylactic effect of dementia syndrome is observed over a long period of time, we can determine whether dapsone can prevent the progression of MCI to dementia syndrome. If dementia does not occur after treating inflammation in brain cells while dementia develops after a certain long-term period (usually within 2-3 years), brain cell inflammation can be demonstrated as the cause of dementia. METHODS: This is a prospective cohort research. We report on an elderly patient diagnosed with MCI from February 2008 to January 2019. The patient took dapsone 100 mg once a day from 2010 to 2015 for the treatment of MCI. Since 2016, the production of dapsone has ceased in Korea. In June 2018, the patient was diagnosed with Alzheimer's disease. The patient took Aricept for the treatment of Alzheimer's disease but complained of serious side effects. And dapsone was re-administered to the patient from November 2018. RESULTS: The patient recovered to MCI and improved her daily life owing to the treatment with dapsone. The drug controls the inflammatory response in the brain, irrespective of whether proteins are deposited in neurons. CONCLUSIONS: This finding means that dementia syndrome is an inflammatory disease. This research suggests that diagnostic criteria for Alzheimer's disease should be based on the presence or absence of inflammation in neurons. Because inflammation in neurons can occur in middle age due to various causes, we can treat inflammation in neurons and prevent and treat dementia syndrome, including Alzheimer's disease.

Limitação de atividade e restrição à participação social em pessoas com hanseníase: análise transversal da magnitude e fatores associados em município hiperendêmico do Piauí, 2001 a 2014 / Limitación de la actividad y restricción de la participatión social en personas con lepra: análisis transversal de la magnitud y factores asociados en un municipio hiperendémico de Piauí, 2001 a 2014 / Activity limitation and social participation restriction of people with leprosy: a cross-sectional analysis of magnitude and associated factors in a hyperendemic municipality in the state of Piauí, Brazil, 2001-2014

Objetivo: analisar a magnitude e os fatores associados à limitação de atividade e restrição à participação social em pessoas com hanseníase de 2001 a 2014, em Picos, Piauí. Métodos: estudo transversal com dados coletados por meio de entrevistas e exames físicos; foram utilizadas as escalas SALSA (Screening of Activity Limitation and Safety Awareness) e de participação social; calcularam-se razões de prevalência (RP) brutas. Resultados: participaram do estudo 263 pessoas com hanseníase; a limitação de atividade foi associada com grau de incapacidade I/II (RP=1,66; IC95% 1,14;2,41), idade ≥60 anos (RP=1,68; IC95% 1,09;3,02) e baixa escolaridade (RP=1,76; IC95% 1,26;2,45); observou-se correlação entre escore olho-mão-pé e limitação de atividade (r=0,29; p<0,001) e restrição à participação (r=0,27; p<0,001). Conclusão a limitação de atividade e a restrição à participação apresentaram alta prevalência no contexto estudado, e foram associadas a gravidade da doença, idade avançada e vulnerabilidade social.

Objetivo: analizar la magnitud y factores asociados con la limitación de actividad y restricción de la participación social en personas con lepra entre 2001 a 2014 en Picos/PI. Métodos: Estudio transversal con dados recopilados en entrevistas y exámenes físicos. Se utilizaron las escalas SALSA (Screening of Activity Limitation and Safety Awareness) y de participación social. Se calcularon las razones de prevalencia bruta (RP). Resultados: 263 personas con lepra participaron en el estudio. La limitación de actividad se asoció con el grado de discapacidad I/II (RP=1,66; IC95% 1,14;2,41), edad ≥ 60 años (RP= 1,68; IC95% 1,09;3,02) y baja escolaridad (RP=1,76; IC95% 1,26;2,45). Hubo una correlación entre la puntuación ojo-mano-pie y la limitación de actividad (r=0,29; p<0,001) y la restricción de participación (r=0,27; p<0,001). Conclusión: la limitación de la actividad y la restricción de participación mostraron una alta prevalencia en el contexto estudiado y se asociaron con la gravedad, la vejez y la vulnerabilidad social.

Objective: to analyse the magnitude and factors associated with activity limitation and social participation restriction of people with leprosy from 2001 to 2014 in Picos, Piauí, Brazil. Methods: this was a cross-sectional study with data collected through interviews and physical examinations; the SALSA Scale (Screening of Activity Limitation and Safety Awareness) and Social Participation Scale were used; crude prevalence ratios (PR) were calculated. Results: 263 people with leprosy participated in the study; activity limitation was associated with grade I/II disability (PR=1.66; 95%CI 1.14;2.41), age ≥60 years (PR=1.68; 95%CI 1.09;3.02) and low schooling (PR=1.76; 95%CI 1.26;2.45); correlation was found between eye-hand-foot score and activity limitation (r=0.29; p<0.001) and participation restriction (r=0.27; p<0.001). Conclusion: activity limitation and participation restriction had high prevalence in the context studied and were associated with disease severity, advanced age and social vulnerability.

Limitation of activity and restriction of social participation in relation to age range, gender, and education in people with leprosy

Abstract Background: In Brazil, 38,000 new cases of leprosy are discovered each year, making it a public health problem. Objective: To identify whether or not there is an association between activity limitations and the restriction of social participation with some demographic data (age range, gender, and education) of the patients in a Basic Health Unit (BHU), diagnosed with leprosy. Methods: The SALSA scale was used to assess activity limitations, whereas the Participation scale was used to assess the restriction of social participation. Results: The assessments were conducted with 31 BHU patients diagnosed with leprosy. Males were the most affected by leprosy, the multibacillary was the most prevalent, and education proved to be an important factor when related to the disease injuries among the evaluated individuals. Regarding activity limitations and the restriction of social participation, the percentage of individuals without limitations and without restrictions was greater in both scales. Study limitations: The main limitation is the small study sample. Conclusion: It can be concluded that, for the studied sample, no association was observed between the activity limitations, evaluated by the Salsa scale, nor the restriction of social participation, evaluated by the Participation Scale, with the analyzed demographic data.

Functioning and disability in leprosy

This study has been carried out to investigate the frequency of musculoskeletal symptoms in people affected by leprosy and correlate this to their functional capacity to perform daily living and working activities and to their degree of disability. This cross-sectional study was performed on 100 clients who answered a questionnaire on personal and clinical data, the Nordic Musculoskeletal (QNSO), and the shoulder, arm and hand dysfunction (DASH) questionnaires. The mean age was 53.63 years and there was a predominance of men (67%), low education (53%), and multibacillary disease (84%). Physical impairment affected 95% of respondents and 92% indicated pain and/or paresthesia in the arms that interfered in functional capacity.Respondents with musculoskeletal symptoms have more difficulty to perform daily living and working activities compared to those without musculoskeletal symptoms (p-value<0.05). The presence of physical disabilities was not associated with difficulties to perform daily living (p-value=0.29) and labor activities (p-value=0.87). The majority of patients experienced pain and/or paresthesia of the arms, and this was associated with difficulties to perform daily living and working activities. However, the presence of physical disability does not seem to cause major impediments or limitations to perform these activities.

Análise da capacidade funcional de idosos com hanseníase através de três instrumentos

O envelhecimento populacional é um fenômeno de grande impacto nas políticas econômica e sanitária mundiais, desafiando a manutenção da funcionalidade, autonomia,independência e participação social do idoso. Assim, doenças com desfecho incapacitante e crônico, como a hanseníase, merecem destaque. Objetivou-se analisar a capacidade funcional de idosos com hanseníase. Estudo descritivo, transversal, desenvolvido com 77idosos com hanseníase acompanhados em centro de Dermatologia de Fortaleza, Ceará.Foi realizada entrevista, consulta ao prontuário e aferição de peso, altura e pressão arterial sistêmica. Os documentos utilizados na coleta de dados, foram o Formulário de entrevista;a Escala de Lawton e Brody, o Índice de Katz e a Escala SALSA. Realizou-se análise estatística descritiva e inferencial. Os aspectos éticos da resolução nº466/12 foram respeitados em todas as fases do estudo. Os resultados revelaram uma média de idade de68,23 ±6,11 anos, com maioria do sexo masculino (63,6%), em união estável/casado(66,2%), procedente de Fortaleza (59,7%), coabitante com cônjuge e filho(s) (53,2%),com escolaridade média de 4,14 ±4,01 anos de estudo e renda familiar mensal média de2,04 ± 1,71 salários mínimos. O valor glicêmico médio foi de 108,14 mg/dL ±49,39, com64,9% idosos com glicemia normal, 28,6% com pressão arterial limítrofe e 48,1% com índice de massa corporal normal. As características clínicas predominantes relacionadas a hanseníase foram: positividade no índice bacilos cópico (51,9%), forma clínica dimorfa(51,9%), esquema de tratamento multibacilar (68,8%) e Grau de Incapacidade Física (GIF) zero (59,7%). Os participantes obtiveram uma média de 22,34 ±4,77 pontos na escala de Lawton e Brody, prevalecendo a classificação independente (58,5%)...

Population aging is a phenomenon of great impact on economic policies and globalhealth, challenging the maintenance of functionality, autonomy, independence and socialparticipation of the elderly. Thus, diseases with disabling and chronic outcomes shouldbe highlighted, such as leprosy. Aimed to analyze the functional capacity in elderlypatients with leprosy according to the SALSA scale, Katz index and Lawton and Brodyscale. Descriptive, cross-sectional study, developed with 77 elderly leprosy followed inDermatology Center of Fortaleza, Ceará. Interview, consultation of medical records andmeasurement of weight, height and blood pressure was performed. The documents usedin data collection were the interview form, Lawton and Brody Scale, the Katz Index andthe SALSA Scale. Descriptive and inferential statistical analysis was performed. Theethical aspects of Resolution 466/12 were respected at all stages of the study. The resultsrevealed an average age of 68.23 (± 6.11) years, with most males (63.6%) in stable union/married (66.2%), coming from Fortaleza (59.7 %), cohabiting with a spouse and son(53.2%), with average schooling of 4.14 (± 4.01) years and average monthly familyincome of 2.04 (± 1.71) minimum wages. The average blood glucose value was 108.14mg / dL (± 49.39), with 64.9% older people with normal blood glucose, 28.6% withborderline blood pressure, and 48.1% with normal body mass index. The predominantclinical features related to leprosy were bacterial index positive (51.9%), borderlineclinical form (51.9%), multibacillary treatment (68.8%), and no disability (59.7%).Participants had an average of 22.34 (± 4.77) points in the scale Lawton and Brody,prevailed independent classification (58.5%)...

Avaliação da limitação das atividades diárias e qualidade de vida de pacientes com hanseníase submetidos à cirurgia de neurólise para tratamento das neurites / Evaluation of the limitations in daily-life activities and quality of life in leprosy patients submitted to surgical neurolysis to treat neuritis / Evaluación de las limitaciones de las actividades diarias y calidad de vida de pacientes leprosos submetidos a cirugia de neurólisis para el tratamiento de las neuritis

A neurólise é indicada para reduzir o ­sofrimento neural e impedir a instalação de sequelas e incapacidades em pacientes com hanseníase. O objetivo deste estudo foi verificar o grau de limitação das atividades e a qualidade de vida de pacientes com hanseníase submetidos a neurólise para tratamento das neurites. Participaram do estudo os pacientes submetidos à neurólise no período de 1998 a 2011. Foram coletadas informações sociodemográficas e clínicas, limitações das atividades (SALSA) e a qualidade de vida (WHOQOL-bref). As análises estatísticas incluíram a frequência, as medidas de tendência central e dispersão, os testes de Mann-Whitney e Kruskall-Wallis e o coeficiente de correlação de Spearman adotando-se p<0,05. A amostra foi composta por 36 pacientes com média de idade de 44,0 anos e 3 anos de pós-operatório. Seis pacientes apresentaram grau 0 de incapacidade; 18, grau 1 e 12, grau 2. A principal diferença da escala SALSA ocorreu entre o grau 0 (média 31,8) e o grau 1 (média 42,56). Os valores obtidos na análise do WHOQOL-bref incluíram os domínios físico (média 11,10), psicológico (média 13,41), relações sociais (média 15,15), meio ambiente (média 11,63). As facetas do WHOQOL-bref mais comprometidas foram: capacidade para o trabalho; sentimentos ­negativos (psicológico); atividade sexual (relações sociais); recursos financeiros (meio ambiente). Apesar da realização da neurólise, a maior parte dos integrantes apresentou limitações nas atividades, sendo maior naqueles com incapacidades físicas. A maior insatisfação na qualidade de vida foi no domínio físico, principalmente no que se refere à dor e à necessidade de cuidados de saúde...

Neurolysis is indicated to reduce neural suffering and to prevent sequelae and disabilities in leprosy patients. The aim of this study was to determine the ­degree of limitation of daily activities and quality of life in leprosy patients submitted to neurolysis for neuritis treatment. The study included patients who underwent neurolysis from 1998 to 2011. We collected demographic and clinical information, data about activity limitations (Screening of Activity Limitation and Safety Awareness [SALSA]) and quality of life (WHO Quality of Life - Short Form-26 [WHOQOL-BREF]). Statistical analyses included frequency, central tendency and dispersion measures, Mann-Whitney and Kruskal-Wallis' tests, and Spearman's correlation coefficient adopting p<0.05. The sample consisted of 36 patients with a mean age of 44.0 years and three years of postoperative period. Six patients had disability grade 0, 18 patients had grade 1, and 12 patients had grade 2. The main difference between the SALSA scale occurred between grades 0 (mean 31.8) and 1 (mean 42.56). The results obtained in the analysis of the WHOQOL-BREF included the following domains: physical facets (mean 11.10), psychological facets (mean 13.41), social relationships (mean 15.15), and environmental facets (mean 11.63). The most affected facets of the WHOQOL-BREF were as follows: work ability (physical), negative feelings (psychological), sexual ­activity (social relationships), and financial resources (environmental). Despite the neurolysis, most subjects showed activity limitations, which were found to be higher in people with physical disabilities. The major dissatisfaction observed in the quality of life was in the physical domain, especially with regard to pain and the need for medical care...

La neurólisis es indicada para reducir el sufrimiento neural e impedir la instalación de secuelas e incapacidades en pacientes con lepra. El objetivo de este estudio fue verificar el grado de limitación de las actividades de la vida diaria y la calidad de vida de pacientes con lepra sometidos a neurólisis para el tratamiento de las neuritas. Participaron del estudio los pacientes sometidos a neurólisis en el período de 1998 a 2011. Fueron recolectadas informaciones sociodemográficas y clínicas, limitaciones de las actividades (SALSA) y la calidad de vida (WHOQOL-bref). Los análisis estadísticos incluirán la frecuencia, las medidas de tendencia central y dispersión, los tests de Mann-Whitney, Kruskall-Wallis y los coeficientes de correlación de Spearman adoptando p<0,05. La muestra fue compuesta por 36 pacientes con edad media de 44,0 años y 3 años de post-operatorio. Seis pacientes presentan grado 0 de incapacidad, 18 grado 1 y 12 grado 2. La principal diferencia en la escala SALSA ocurrió entre el grado 0 (media=31,8) y el grado 1 (media=42,56). Los valores obtenidos en el análisis de WHOQOL-bref incluyen los dominios físico (media 11,10); psicológico (media 13,41); relaciones sociales (media 15,15); medio ambiente (media 11,63). Las facetas del WHOQOL-bref más comprometidas fueron la capacidad para el trabajo; sentimientos negativos (psicológico); actividad sexual (relaciones sociales); recursos financieros (medio ambiente). A pesar de la realización de la neurólisis, la mayor parte de los integrantes presentaron limitaciones en las actividades, siendo mayor en aquellos con incapacidades físicas. La mayor insatisfacción en la calidad de vida fue en el dominio físico, principalmente en los que se refiere al dolor y la necesidad de cuidados de salud...

Escala Salsa e grau de Incapacidades da Organização Mundial de Saúde: avaliação da limitação de atividades e deficiência na hanseníase / SALSA scale and disability grading system of the World Health Organization: evaluation of physical activity limitations and disability of individuals treated for leprosy

Verificar o grau de incapacidades da OMS (GI-OMS) e a limitação de atividades avaliada pela escala Screening of Activity Limitation and Safety Awareness (SALSA) pós-alta medicamentosa dos pacientes que tiveram hanseníase. Estudo transversal que incluiu pacientes tratados entre 2007 a 2009, em São José do Rio Preto-SP, Brasil. Utilizou-se protocolo próprio para coletar dados gerais e clínicos, construído com base no Check List da Classificação Internacional Funcionalidade, Incapacidade e Saúde. A deficiência foi medida pelo GI-OMS e a limitação de atividades pelo SALSA que tem variação de 10 a 80 e ponto de corte ≥25. De 84 pessoas tratadas no período, 54(64,3%) foram entrevistadas, sendo 31(57,4%) homens, idade 53,8(dp16,3) e 33(61,2 %) possuía até 6 anos de educação formal. A forma clinica dimorfa predominou 17(32,1%), 21(38,9%) considerou sua saúde física "boa". A analise dos escores SALSA e variáveis estudadas resultou em significância aos que relataram lesão significante (valor-p=0,04), baixa renda familiar (valor-p=0,04), baixa escolaridade (valor-p=0,00), formas clínicas multibacilares (valor-p=0,01) e deficiências avaliadas pelo GI-OMS (valor-p=0,01). As limitações de atividades são freqüentes (57,4%), assim como as deficiências medidas pelo GI-OMS (68,5%), atingem as formas multibacilares, pessoas que relataram lesão significante, de baixa renda e escolaridade.

To verify the disability grading system of the World Health Organization (DG-WHO) and activity limitations evaluated by the Screening of Activity Limitation and Safety Awareness (SALSA) scale of individuals who completed treatment for leprosy. A cross-sectional study that included patients treated from 2007 to 2009 in São José do Rio Preto, Brazil. A questionnaire, designed using the International Classification of Functioning, Disability and Health checklist, was used to collect general and clinical data. Disability was measured by the DG-WHO and activity limitations by SALSA, using a score of 10 to 80 with a cutoff point of 25. Of 84 individuals treated, 54 (64.3%) were interviewed: 31 (57.4%) were men, mean age was 53.8 (SD 16.3) and 33 (61.2%) had up to 6 years of schooling. Borderline leprosy predominated in 17 (32.1%) participants, and 21 (38.9%) participants considered their physical health "good". The analysis of the SALSA scores and studied variables were significant for individuals who reported important injuries (p=0.04), low family income (p=0.04), little schooling (p=0.00), multibacillary clinical form (p=0.01) and disabilities evaluated by DG-WHO (p=0.01). Activity limitations are common (57.4%) in this population, as are disabilities identified by DG-WHO (68.5%) and are directly associated to the multibacillary clinical form, important injuries, low family income and little schooling.

Pós-alta em Hanseníase no Ceará: limitação da atividade funcional, consciência de risco e participação social / Pos-alta hospitalária en Lepra en Ceará: limitación de actividad funcional, conciencia de riesgo y participación social / Post-treatment of Leprosy in Ceará: activity and functional limitation, safety awareness and social participation

Caracterizar a limitação funcional, de atividade, consciência de risco, e restrição à participação social em pessoas atingidas pela hanseníase no pós-alta. Estudo seccional-descritivo com 69 residentes em Sobral, Ceará, com alta entre 2003 a 2005. Foram realizados exame físico dermato-neurológico, avaliação demográfica, de limitação funcional-atividade-consciência de risco e de restrição à participação social. Vinte (28,9 por cento) apresentaram escores SALSA 19 e 20 e escore EHF zero. O maior escore EHF foi alcançado por dois participantes, com 25 e 28 na escala SALSA. Na escala de participação 37 (53,6 por cento) não apresentaram restrição e tinham escore EHF zero. Dois (2,9 por cento) com escore EHF zero tinham leve restrição e 1 (1,5 por cento), grande restrição. Reafirma-se a potencialidade destas ferramentas para a atenção integral aos portadores.

To characterize the functional limitation, activity limitation, risk conscience, and the social participation in people reached by hansen's disease in the post-MDT period. Cross-sectional, descriptive study, accomplished in 2006. Sixty-nine residents in Sobral that had discharge from MDT between 2003-2005 participated. The subjects were interviewed: demographic evaluation, dermato-neurological exams, evaluation of functional limitation-activity-risk conscience and the restriction in social participation. Twenty (28.9 percent) presented SALSA scores 19 and 20 and EHF score zero. The largest EHF score was reached by two participants, with scores 25 and 28 in the SALSA scale. In the participation scale 37 (53.6 percent) didn't present restriction and had EHF scores zero. Two (2.9 percent) with EHF score zero had mild restriction, and 1 (1.5 percent) severe restriction. This study reaffirms the potentiality of these tools for integral care of people reached.

Caracterizar la limitación funcional de actividad, conciencia de riesgo y restricción a la participación social en personas atingidas por la lepra en el post-alta. Estudio seccional y descriptivo con 69 sitiados en Sobral, Ceará, con alta entre 2003 y 2005. Fueron hechos examen físico dermatológico y además neurológico, evaluación demográfica, de limitación funcional, actividad y conciencia de riesgo y de restricción a la participación social. Veinte (28,9 por ciento) presentaron escores SALSA 19 y 20 escore EHF cero. La mayor EHF fue alcanzada por dos participantes, con 25 y 28 años en la escala SALSA. En la categoría participación, 37 (53,6 por ciento) no presentaron restricción y tenían escore EHF cero. Dos (2,9 por ciento) con EHF cero tenían poca restricción y 1 (1,5 por ciento), gran restricción. Delante de eso, se afirma una vez más la potencialidad de éstas herramientas para la atención integral a los portadores.