Systemic treatment of psoriasis in special population.

Psoriasis is a common skin disorder affecting approximately 1% of the general population. The treatment of psoriasis depends on the body surface area involvement, quality of life impairment and associated co-morbidities. Special population comprising of pregnant women, lactating mothers, elderly individuals and children, is more vulnerable. They are not included in drug trials; rendering the data for use of systemic treatment scant and is mainly based on anecdotal evidence. In this narrative review, we discuss systemic treatment options in this special population. Though couples planning a family are not considered a special population, they form a subset that require special therapeutic consideration and have also been included in this review.

Prevalence of eczema among older persons: A population-based cross-sectional study.

Background There are very few population-based studies on the prevalence of eczema among older persons Aims To estimate the prevalence and types of eczema in those aged 65 years or more in the community and to evaluate the effectiveness of community-based interventions for case finding. Methods In the first stage of this cross-sectional survey, trained health workers of a non-governmental organization surveyed the eligible population and identified persons likely to have eczema. In the second stage, dermatologists examined such persons to ascertain the diagnosis. Statistical analysis was done using Epi Info software version 7. Prevalence of eczema was expressed in percentages. Chi-square test was used for comparing the difference in prevalence of eczema in various age groups and sex. Results Health workers identified 98 persons as possible cases of eczema after interviewing 385 older persons in the community. Among them 95 persons were examined by dermatologists and 44 were confirmed to have eczema (diagnostic accuracy of health workers = 46.3%).Point prevalence of eczema was 11.4% (44/385). Prevalence was similar in males and females. It was greater (18.2 %) among persons aged 81 years or more. Asteatotic eczema, gravitational eczema and lichen simplex chronicus were the more common types of eczema. Limitations: Possible underestimation of the prevalence rates due to limited medical knowledge of health workers; limited facilities for examination and investigations at the medical camps and home visits. Conclusion There appears to be a considerable burden of eczema among older persons in the community. A community-based approach involving non-governmental organizations has the potential to identify cases and offer care close to their homes.

Postoperative Complications of Minimally Invasive Intramedullary Nail Fixation Versus Plate Fixation for Distal Fibular Fractures in Elderly Patients: A Retrospective Double Cohort Study in a Geriatric Trauma Unit in the Netherlands.

Intramedullary fixation using a fibular nail is a minimally invasive alternative to conventional plate fixation that provides superior biomechanical strength and allows immediate full weightbearing postoperatively. The study aim was to compare the postoperative complications of minimally invasive intramedullary fibular nail fixation to plate fixation for Lauge-Hansen supination external rotation type 4 (Weber B) fractures in patients aged 65 years or older treated in a single geriatric trauma unit in the Netherlands. A retrospective cohort study was performed including patients aged 65 years or older with a Lauge-Hansen supination external rotation type 4 (Weber B) fracture treated with either intramedullary fibular fixation or plate fixation between January 2017 and January 2019. A total number of 58 patients were included with a mean age of 73.9 years (range 65-95). The intramedullary fixation-cohort (n = 13) had a significantly higher mean age (82.5 vs 71.4 years, p = .002) and Charlson Co-morbidity Index (4.7 vs 3.6, p = .005) compared to the plate fixation-cohort (n = 45). The total number of postoperative complications was lower after intramedullary fixation (n = 2, 15%) compared to plate fixation (n = 15, 33%), although this relative difference was not significant (p = .307). All 2 complications observed after intramedullary fixation were wound infections demanding no debridement or implant removal. No implant related complications, hospital-acquired complications or mortality were observed after intramedullary fixation. Despite the higher mean age and co-morbidity status of patients treated with minimally invasive intramedullary fibular nailing, the total number of postoperative complications was lower after intramedullary fixation compared to plate fixation. This technique might be a promising alternative in selected patients.

Leprosy in Elderly and Children among New Cases - A 3-Year Retrospective Study.

BACKGROUND: Leprosy occurs in all age groups, with adults constituting the majority. However, leprosy in children always drew the attention of epidemiologists as a guide to transmission of leprosy. With increasing life expectancy and decreasing prevalence of leprosy, there is going to be a significant rise of leprosy among elderly in India. In elderly leprosy patients, clinical signs are often quiet, which makes it a hidden source of infection. The detection of leprosy in elderly is of epidemiological importance, hence it is critical that due attention be given to leprosy in elderly as a possible contributor to hidden leprosy in India. AIM: To analyze leprosy in elderly and in children from the records of new patients seen over the past 3-year period. METHODS: Analysis of details of "leprosy in elderly" and "leprosy in children'" from the records of new leprosy patients seen at a dermatology OPD of a teaching hospital over a period of 3 years. RESULTS: Out of 157 patients, 34 (21.6%) were above 45 years, while 18 (11.4%) were below 15 years, the difference being statistically significant (P > 0.05). Bacteriological Index (BI) values in elderly were higher compared to children. In addition, elderly had a higher percentage of multibacillary (MB) leprosy compared to children both clinically (35% vs 22%) and histopathologically (38% vs 22%). CONCLUSION: Leprosy in elderly is an important entity, and there is a need to study it as a distinct group. It will provide information on hidden leprosy load and apprise us on sources of infection in the community.

Presence of Senescent and Memory CD8+ Leukocytes as Immunocenescence Markers in Skin Lesions of Elderly Leprosy Patients.

Leprosy is an infectious disease that remains endemic in approximately 100 developing countries, where about 200,000 new cases are diagnosed each year. Moreover, multibacillary leprosy, the most contagious form of the disease, has been detected at continuously higher rates among Brazilian elderly people. Due to the so-called immunosenescence, characterized by several alterations in the quality of the immune response during aging, this group is more susceptible to infectious diseases. In view of such data, the purpose of our work was to investigate if age-related alterations in the immune response could influence the pathogenesis of leprosy. As such, we studied 87 individuals, 62 newly diagnosed and untreated leprosy patients distributed according to the age range and to the clinical forms of the disease and 25 healthy volunteers, who were studied as controls. The frequency of senescent and memory CD8+ leukocytes was assessed by immunofluorescence of biopsies from cutaneous lesions, while the serum levels of IgG anti-CMV antibodies were analyzed by chemiluminescence and the gene expression of T cell receptors' inhibitors by RT-qPCR. We noted an accumulation of memory CD8+ T lymphocytes, as well as reduced CD8+CD28+ cell expression in skin lesions from elderly patients, when compared to younger people. Alterations in LAG3 and PDCD1 gene expression in cutaneous lesions of young MB patients were also observed, when compared to elderly patients. Such data suggest that the age-related alterations of T lymphocyte subsets can facilitate the onset of leprosy in elderly patients, not to mention other chronic inflammatory diseases.

Idosos de uma antiga colônia brasileira de hanseníase: vulnerabilidade clínico-funcional e autopercepção vocal e auditiva / Elders in a former brazilian leprosy colony: clinical and functional vulnerability and vocal and hearing self-perception

RESUMO Objetivo Verificar a associação entre vulnerabilidade clínico-funcional e autopercepção vocal e auditiva de idosos com histórico de hanseníase. Método Estudo transversal desenvolvido com 117 idosos de uma antiga colônia de hanseníase no sudeste do Brasil. Foram analisadas informações sociodemográficas, e os protocolos: Índice de Vulnerabilidade Clínico-funcional (IVCF-20), Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S), Rastreio de Alteração Vocal em Idosos (RAVI) e Índice de Desvantagem Vocal 10 (IDV-10). O IVCF-20 classifica o idoso como robusto, em risco de fragilização e frágil. Para análise dos dados utilizou-se o modelo de regressão logística ordinal de chances proporcionais. Resultados 37,6% dos idosos foram classificados em robustos, 35,0% em risco de fragilização e 27,4% em frágeis. A alteração vocal (RAVI), desvantagem vocal (IDV-10) e restrição à participação auditiva (HHIE-S) foram observadas em 65,8%, 24,8% e 48,7% dos idosos, respectivamente. Na análise multivariada, verificou-se que idosos mais velhos (OR=1,11; IC: 1,05-1,16) e com desvantagem vocal (OR=4,11; IC 95%: 1,77-9,56) tiveram maiores chances de serem classificados como em risco de fragilização ou frágil. A presença simultânea de desvantagem vocal e restrição à participação auditiva (46,9%) foi maior entre os idosos frágeis. Conclusão O aumento da idade dos idosos e a presença de desvantagem vocal tem associação com a maior vulnerabilidade clínico-funcional. As altas prevalências de alterações vocais e auditivas reforçam a necessidade da inclusão do fonoaudiólogo nas políticas públicas voltadas ao cuidado de pessoas com histórico de hanseníase.

ABSTRACT Purpose Verifying the association between clinical-functional vulnerability and vocal and auditory self-perception in seniors presenting a history of leprosy. Methods Cross-sectional study encompassing 117 elderly people from an old leprosy colony in southeastern Brazil. The research analyzed sociodemographic information and the following protocols: Clinical-Functional Vulnerability Index-20 (IVCF-20), Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S), Screening for Vocal Change in the Elderly (RAVI) and Vocal Handicap Index 10 (IDV-10). For data analysis, the ordinal logistic regression model of proportional odds was used. Results 37.6% of the elderly were classified as robust, 35.0% at risk of fragility and 27.4% as frail. Vocal alteration (RAVI), vocal handicap (IDV-10) and restriction to auditory participation (HHIE-S) were observed in 65.8%, 24.8% and 48.7% respectively, in the studied population. In the multivariate analysis, it was found the oldest group (OR = 1.11; CI: 1.05-1.16) and those with vocal handicap (OR = 4.11; 95% CI: 1.77-9.56) were more likely to be classified as at risk of fragility or already fragile. The simultaneous presence of vocal handicap and restriction of auditory participation (46.9%) was larger among frail elderly people. Conclusion The increasing age of the elderly and the presence of vocal handicap is associated with greater clinical-functional vulnerability. The high prevalence of both voice and hearing disorders reinforces the need for the speech therapist to be included in public policies, directed towards caring for people with a history of leprosy.

Temporal trend of leprosy among the elderly in Brazil, 2001 - 2018.

OBJECTIVE: To describe the temporal trends of leprosy indicators among the elderly in Brazil in 2001 - 2018. METHODS: This was an ecological time-series study of new leprosy cases in the elderly reported to the Notifiable Diseases Information System. Prais-Winsten generalized linear regression was used to estimate temporal variations. RESULTS: There were 687 317 new leprosy cases in Brazil from 2001 - 2018, of which 129 214 (18.8%) were among elderly people. Overall detection rates in the elderly and of new cases with grade-2 disability showed a falling trend, with an annual percent change of -4.6% (95%CI = -5.1 to -4.0) and -3.9% (95%CI = -4.6 to -3.2). New case and new multibacillary case proportions showed an increasing trend, with an annual percent change of 2.9% (95%CI = 2.6 to 3.3) and 1.4% (95%CI = 1.0 to 1.7), respectively. Detection rates for new leprosy cases in elderly people in Brazil are decreasing, but the proportion of new cases and multibacillary cases are trending upwards. CONCLUSIONS: New cases are shifting to older age groups, and demographic transition and immunosenescence are an influence. Inadequate reduction of grade-2 disability indicates a high risk of physical disability persists. Improved contact tracing and more effective action are needed in this age group.

Tendência de indicadores epidemiológicos da hanseníase em idosos no ceará de 2002 a 2014 / The trend of leprosy epidemiological indicators in the elderly population from the ceará state (2002 to 2014) / Tendencia de indicadores epidemiológicos de la hanseníase en ancianos en el Ceará de 2002 a 2014

Objetivo: Descrever os indicadores epidemiológicos da hanseníase em idosos no Ceará de 2002 a 2014. Métodos: Estudo ecológico de série temporal exploratória realizado com dados secundários do Sistema de Informação de Agravos de Notificação do Ceará. Resultados: Registrou-se 8.641 casos, destes, 88,29% casos novos e 3,56% recidivas de hanseníase. A detecção de casos novos permaneceu hiperendêmica (63,3/100.000 habitantes). Durante a série analisada, a prevalência de hanseníase manteve-se com valor considerado alto (7,3/10.000 habitantes), e, o percentual de casos GIF 1 ou 2 ao diagnóstico foi de 29,55%, sendo a proporção de idosos com GIF 2 de 8,46%. Conclusão: Conclui-se que a hanseníase em idosos no Ceará diminuiu ao longo do período analisado, porém continua com índice hiperendêmico para a população estudada

Objective: To describe the epidemiological indicators of leprosy in the elderly in Ceará from 2002 to 2014. Methods: Ecological study of an exploratory time series performed with secondary data from the Information System of Notifiable Diseases of Ceará. Results: A total of 8,641 cases were recorded, of which 88.29% were new cases and 3.56% were leprosy recurrences. The detection of new cases remained hyperendemic (63.3 / 100,000 inhabitants). The prevalence of leprosy remained high (7.3 / 10,000 inhabitants), and the percentage of GIF cases 1 or 2 at diagnosis was 29.55%, and the proportion of elderly individuals with GIF 2 of 8.46%. Conclusion: It is concluded that leprosy in the elderly in Ceará decreased during the analyzed period, but continues with a hyperendemic index for the studied population

Objetivo: Describir los indicadores epidemiológicos de la lepra en ancianos en Ceará de 2002 a 2014. Métodos: Estudio ecológico de serie temporal exploratoria realizado con datos secundarios del Sistema de Información de Agravios de Notificación de Ceará. Resultados: Se registraron 8.641 casos, 88,29% casos nuevos y 3,56% recidivas de lepra. La detección de casos nuevos permaneció hiperendémica (63,3/100.000 habitantes). La prevalencia de la lepra se mantuvo con un valor considerado alto (7,3 / 10.000 habitantes), y el porcentaje de casos GIF 1 o 2 al diagnóstico fue del 29,55%, siendo la proporción de ancianos con GIF 2 de 8,46%. Conclusión: Se concluye que la hanseniasis en ancianos en Ceará disminuyó a lo largo del período analizado, pero continúa con índice hiperendémico para la población estudiada. Conclusión: Se concluye que la hanseniasis en ancianos en Ceará disminuyó a lo largo del período analizado, pero continúa con índice hiperendémico para la población estudiada

Leprosy in the elderly population of Alagoas / A hanseníase na população idosa de Alagoas

Objective: to describe the epidemiological profile of elderly persons with leprosy in the state of Alagoas. Method: a descriptive epidemiological study of leprosy cases among the elderly reported to the Disease Notification Information System between 2005 and 2015 was carried out. Results: a total of 896 cases were identified, with a predominance of 60-69 years old (60.5%), who were male (50.4%), had no schooling (34.8%), no source of income (54.1%), multibacillary forms of the disease (67.9%), and a high proportion of grade I (30.3%) and II (11.8%) disability at diagnosis. Hyperendemicity was noted during the survey period, with a mean detection rate of 29.48 cases per 100,000 inhabitants. Conclusion: leprosy is a growing disease among the elderly and early detection should be encouraged in this population to prevent the impairment of active aging.

Objetivo: descrever o perfil epidemiológico de idosos com hanseníase no estado de Alagoas. Método: trata-se de um estudo epidemiológico descritivo dos casos de hanseníase em idosos notificados no Sistema de Informação de Agravos de Notificação em Alagoas, no período de 2005 a 2015. Resultados: foram identificados 896 casos em que o perfil da amostra revelou predominância da faixa etária de 60 a 69 anos (60,5%), sexo masculino (50,4%), sem escolaridade (34,8%), nenhuma fonte de renda (54,1%), formas multibacilares (67,9%) e elevada proporção de grau I e II de incapacidade no momento do diagnóstico, (30,3%) e (11,8%) respectivamente. Destaca-se a hiperendemicidade no período, com taxa de detecção média de 29,48 casos por 100 mil habitantes. Conclusão: assim, percebe-se a hanseníase como enfermidade crescente no idoso, devendo-se incentivar ações de detecção precoce nessa população, a fim de prevenir o comprometimento do envelhecimento ativo.

Dependence on others for oral hygiene and its association with hand deformities and functional impairment in elders with a history of leprosy.

OBJECTIVE: To analyse the frequency of dependence on others for oral hygiene and its association with hand deformities, frailty and dependence on others for basic activities of daily living (BADL) among elders with a history of leprosy. BACKGROUND: Dependence on others for oral hygiene has not been considered in multifunctional geriatric assessments. MATERIAL AND METHODS: Edentulous elders with a history of leprosy who used complete dentures and resided in a former leprosy colony were classified as independent or partially/completely dependent on others for brushing their dentures or rinsing and for BADL, and as frail or robust. The presence of hand deformities was assessed by an occupational therapist. RESULTS: 28.4% and 14.9% were completely/partially dependent on others for brushing and rinsing, respectively. The dependence for BADL was observed in 21.6% and hand deformities in 17.6%. A higher odds of dependence for brushing/rinsing was found among elders who were dependent on others for BADL. Brushing dependence (61.5%) was more frequent among participants with hand deformities than those without this condition (21.3%) (OR: 6.8; 95% IC: 1.2-37.9; P = .028). There was no association between frailty and brushing (P = .068) or rinsing (P = .202) dependence. CONCLUSION: Approximately one-third of elders have a dependence on others for brushing; a smaller proportion is dependent on others for rinsing. Older people who are dependent on others for BADL and who present hand deformities are more likely to be dependent on others for denture brushing and rinsing. Elders may perform oral self-care even when they present frailty.

Factors associated with the functional capacity of older adults with leprosy / Factores asociados a la capacidad funcional de las personas mayores con lepra / Fatores associados à capacidade funcional de idosos com hanseníase

ABSTRACT Objective: to investigate the association between socio-demographic and clinical factors and the functional capacity of older adults with leprosy. Method: cross-sectional analytical study conducted in Fortaleza, Ceará, Brazil, with 77 older adult patients with leprosy in a referral service, through interview, medical records and application of the Katz Index and the Lawton and Brody Scale. Results: the mean age was 68.23 years, with prevalence of men, in stable union/married, with mean monthly family income of 2.04 minimum wages, positive bacillary index, clinical dimorphic form and grade zero disability. In the Lawton and Brody scale, independence (58.5%) was predominant and associated to the variables "living arrangement" and "educational attainment". Total independence (87.0%) was predominant in the Katz Index and statistically associated to the variable monthly family income. Conclusion: most of the participants were classified as independent in the instruments used. Furthermore, the instruments pointed to a greater number of associations with socio-demographic and clinical factors not related to leprosy.

RESUMEN Objetivo: investigar la asociación de factores sociodemográficos y clínicos a la capacidad funcional de los ancianos con lepra. Método: estudio transversal, analítico, realizado en Fortaleza, Ceará, realizado entre 77 ancianos con lepra mediante entrevista, acompañados en servicio de referencia, consulta al prontuario y aplicación del Índice de Katz y de la Escala de Lawton y Brody. Resultados: la edad promedio era de 68,23 años, con prevalencia del sexo masculino, unión estable/casado, renda familiar mensual promedio de 2,04 salarios mínimos, índice bacteriológico positivo, forma clínica dimorfa y grado de incapacidad física cero. En la escala de Lawton y Brody prevaleció la independencia (58,5%) asociada a las variables "con quien reside" y "escolaridad". Se destacó la independencia total (87,0%) en el índice de Katz, asociándolo estadísticamente a la variable "ingreso mensual del hogar". Conclusión: la mayoría de los participantes demostró independencia de acuerdo con los instrumentos utilizados. Además, las escalas señalaron un número mayor de asociaciones a factores sociodemográficos y clínicos no relacionados con la lepra.

RESUMO Objetivo: investigar a associação de fatores sociodemográficos e clínicos à capacidade funcional de idosos com hanseníase. Método: estudo transversal, analítico realizado em Fortaleza, Ceará, com 77 idosos com hanseníase acompanhados em serviço de referência, através de entrevista, consulta ao prontuário e aplicação do Índice de Katz e Escala de Lawton e Brody. Resultados: a média de idade foi de 68,23 anos, com prevalência de sexo masculino, união estável/casado, renda familiar mensal média de 2,04 salários mínimos, índice baciloscópico positivo, forma clínica dimorfa e Grau de Incapacidade Física zero. Na escala de Lawton e Brody prevaleceu a independência (58,5%) com associação às variáveis "com quem reside" e "escolaridade". Destacou-se a independência total (87,0%) no índice de Katz, associando-se estatisticamente a variável renda familiar mensal. Conclusão: a maioria dos participantes mostrou-se independente nos instrumentos utilizados. Ademais, os instrumentos apontaram mais associações a fatores sociodemográficos e clínicos não relacionados com a hanseníase.

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%)...

Neuropathy in elderly: lessons learnt from nerve biopsy.

OBJECTIVE: To study the utility of nerve biopsy in providing diagnostic, therapeutic or prognostic information that aid in clinical management in elderly subjects with peripheral neuropathy. METHODS: Clinico-pathological data of 100 elderly subjects aged 65 and above with peripheral neuropathy who underwent nerve biopsy in the last decade (2002-2011) was reviewed. RESULTS: The study included 100 subjects (M:F 78:22). Mean age at biopsy and symptom duration was 69.62±4.8 years and 24.17±40.4 months, respectively. The most common pattern of was distal symmetric sensorimotor polyneuropathy (35%), followed by multiple mononeuropathy (29%) and asymmetric sensorimotor neuropathy (15%). The nerve biopsy was 'diagnostic' in 24%, (definite vasculitis in 12, leprosy in 10 and acute inflammatory demyelinating polyradiculoneuropathy in 2) and proved 'essential' or 'helpful' in therapeutic management in 81% subjects. In 60 (60%) patients, where a pre-biopsy aetiological diagnosis could be arrived at based on the available data, nerve biopsy confirmed the diagnosis in 29 of 60 (48.3%), and offered a new diagnosis in 25 (41.7%). A higher yield of biopsy was noted in subjects with asymmetric/multiple mononeuropathy compared with symmetric neuropathies (32.7% versus 17.7%). In 40 (40%) patients without a pre-biopsy aetiological diagnosis, nerve biopsy was 'essential' in 7 of 40 (17.5%) as it provided a definitive diagnosis (definite vasculitis: 5, leprosy: 2), and 'helpful' in 21 of 40 (52.5%) (ischaemic neuropathy: 10, possible vasculitis: 9, probable vasculitis: 2). CONCLUSION: Nerve biopsy aided in the detection of potentially treatable disorders and influenced patient management in a significant proportion of elderly subjects with peripheral neuropathy (81%), particularly in subset with undiagnosed neuropathies confirming that it's a useful tool in diagnosis of neuropathy in the elderly. With minor differences, the aetiological profile in our biopsied neuropathic elderly subjects may reflect the findings in other similar cohorts.

Association between the degree of physical impairment from leprosy and dependence in activities of daily living among the elderly in a health unit in the State of Minas Gerais

Introduction In addition to the common alterations and diseases inherent in the aging process, elderly persons with a history of leprosy are particularly vulnerable to dependence because of disease-related impairments. Objective determine whether physical impairment from leprosy is associated with dependence among the elderly. Methods An analytical cross-sectional study of elderly individuals with a history of leprosy and no signs of cognitive impairment was conducted using a database from a former leprosy colony-hospital. The patients were evaluated for dependence in the basic activities of daily living (BADL) and instrumental activities of daily living (IADL), respectively) and subjected to standard leprosy physical disability grading. Subsequently, descriptive and univariate analyses were conducted, the latter using Pearson's chi-squared test. Results A total of 186 elderly persons were included in the study. Of these individuals, 53.8% were women, 49.5% were older than 75 years of age, 93% had four or less years of formal education, 24.2% lived in an institution for the long-term care of the elderly (ILTC), and 18.3% had lower limb amputations. Among those evaluated, 79.8% had visible physical impairments from leprosy (grade 2), 83.3% were independent in BADL, and 10.2% were independent in IADL. There was a higher impairment grade among those patients who were IADL dependent (p=0.038). Conclusion s: The leprosy physical impairment grade is associated with dependence for IADL, creating the need for greater social support and systematic monitoring by a multidisciplinary team. The results highlight the importance of early diagnosis and treatment of leprosy to prevent physical impairment and dependence in later years. .

O envelhecer institucionalizado de sujeitos sequelados pela Hanseníase da U/E Abrigo João Paulo II / The institutionalized older subjects sequelae by Leprosy of U/E Abrigo João Paulo II

Este estudo objetiva (i) identificar como o estigma da hanseníase se relaciona ao processo de envelhecimento de idosos que foram compulsoriamente asilados, ainda jovens, na Unidade Especial Abrigo João Paulo II, e (ii) analisar a história de vida dos idosos, a partir do relato de suas impressões sobre o envelhecimento. A pesquisa foi realizada na U/E Abrigo João Paulo II, com participação de 12 idosos sequelados pela hanseníase, de idade entre 60 e 94 anos, 50% homens e 50% mulheres, residentes nessa Instituição, selecionados em 2 etapas: análise e avaliação de prontuários e entrevista com os sujeitos, seguindo um roteiro de questionário. Quanto ao nível educacional, apresentam baixo nível de escolaridade, sendo 16,66% analfabetos; e 83,33% com primário incompleto. Em em relação ao vínculo conjugal, observou-se que 75% são viúvos; 16,66%, solteiros; e 8,33%, casados. Destes últimos, 41,66% tiveram filhos biológicos; 25% filhos adotivos; 16,66% filhos biológicos e adotados; e 16,66% não tiveram filhos. O intuito foi ultrapassar o critério estatístico dos dados, e o discurso construído e socialmente aceito em torno da Hanseníase, trazendo vozes que expressam subjetividades, desvelando os diferentes modos de viver o envelhecimento, colaborando na construção de um saber gerontológico interdisciplinar.

Objective: Identify how the stigma of leprosy is related to the aging process of elderly people who were forcibly asylees, still young in the Special Housing Unit John Paul II and analyze the history of life for seniors, from the account of his views on aging . Methodology: The survey was conducted in the Special Housing Unit John Paul II, featuring 12 seniors sequelae by leprosy and residents in this institution. The research had two stages: analysis and evaluation of medical records and interview the subjects selected following a script of the questionnaire. Results and Discussion: There were 12 seniors, aged 60-94 years, 50% men and 50% are women. As for the educational level have low levels of schooling, and 16.66% are illiterate and 83.33% with incomplete primary, and in relation to marital bond was observed that 75% are widowed, single and 16.66% 8.33 % married and 41.66% of those already mentioned have biological children, adopted children 25%, 16.66% biological and adopted children and 16.66% had no children. Conclusion: The aim was to overcome the statistical data, and the discourse constructed and socially acceptable around the leprosy, bringing those voices that express subjectivity, revealing the different ways of experiencing aging, helping to build an interdisciplinary gerontological knowledge.

Rifampicin-resistant Mycobacterium leprae in an elderly leprosy patient in the people's Republic of China.

The reported number of registered leprosy patients worldwide declined with the introduction of multidrug therapy. However, the emergence of rifampicin resistance in leprosy patients engenders difficulties for an individual patient, and its dissemination could pose a threat to leprosy control. This study reports an elderly patient who was diagnosed with rifampicin-resistant lepromatous leprosy. This case indicates that inadequate treatment and poor compliance may eventually result in rifampicin resistance in Mycobacterium leprae and clinical relapse.

Cognitive performance of long-term institutionalized elderly patients with schizophrenia: a case control study / Desempenho cognitivo em pacientes idosos com esquizofrenia: um estudo caso-controle

Cognitive impairment is inherent to the ageing process. Several studies suggest that patients with late-life schizophrenia have more marked cognitive impairment. Objective: The aim of this study was to compare the cognitive performance of elderly institutionalized patients with schizophrenia and institutionalized elderly control patients without neurological or psychiatric diseases, matched for age, educational level and institutionalization time. Methods: The Cambridge Examination for Mental Disorders of the Elderly (CAMCOG) was used to test 10 institutionalized elderly patients with schizophrenia. Results were compared with those of 10 institutionalized control patients with history of Hansens disease. Results: Patients with schizophrenia showed a worse performance in terms of total CAMCOG score and on its subtests of orientation, language, abstraction, and memory. Patients with schizophrenia also disclosed a non-significant trend toward lower scores on the MMSE and on calculus. Conclusion: Findings demonstrated that schizophrenia was associated to worse cognitive impairment in long-term institutionalized elderly patients compared with institutionalized patients without neurological or psychiatric diseases.

Prejuízo cognitivo é inerente ao processo de senescência. Estudos tem sugerido que pacientes idosos com esquizofrenia apresentam esse prejuízo de maneira mais acentuada. Objetivo: O objetivo deste estudo foi comparar o desempenho cognitivo de pacientes idosos com esquizofrenia, institucionalizados, com indivíduos idosos, institucionalizados, sem doenças neurológicas ou psiquiátricas, pareados pela idade, escolaridade e tempo de institucionalização. Métodos: Cambridge Examination for Mental Disorders of the Elderly (CAMCOG) foi aplicado em 10 pacientes, institucionalizados, com esquizofrenia, cujo desempenho cognitivo foi comparado ao de 10 indivíduos, institucionalizados, com história de doença de Hansen. Resultados: Pacientes com esquizofrenia apresentaram um pior desempenho na pontuação total do CAMCOG e em seus subitens orientação, linguagem, abstração e memória. Pacientes com esquizofrenia também apresentaram uma tendência, não significativa, para menor pontuação no MEEM e cálculo. Conclusão: Nossos achados demonstram que a esquizofrenia está associada a piora do comprometimento cognitivo em pacientes idosos com institucionalização de longa permanência comparados a pacientes institucionalizados sem doenças neurológicas ou psiquiátricas.

Cognitive performance of long-term institutionalized elderly patients with schizophrenia: A case control study.

Cognitive impairment is inherent to the ageing process. Several studies suggest that patients with late-life schizophrenia have more marked cognitive impairment. OBJECTIVE: The aim of this study was to compare the cognitive performance of elderly institutionalized patients with schizophrenia and institutionalized elderly control patients without neurological or psychiatric diseases, matched for age, educational level and institutionalization time. METHODS: The Cambridge Examination for Mental Disorders of the Elderly (CAMCOG) was used to test 10 institutionalized elderly patients with schizophrenia. Results were compared with those of 10 institutionalized control patients with history of Hansen's disease. RESULTS: Patients with schizophrenia showed a worse performance in terms of total CAMCOG score and on its subtests of orientation, language, abstraction, and memory (p≤0.05). Patients with schizophrenia also disclosed a non-significant trend toward lower scores on the MMSE and on calculus. CONCLUSION: Findings demonstrated that schizophrenia was associated to worse cognitive impairment in long-term institutionalized elderly patients compared with institutionalized patients without neurological or psychiatric diseases.

Prejuízo cognitivo é inerente ao processo de senescência. Estudos tem sugerido que pacientes idosos com esquizofrenia apresentam esse prejuízo de maneira mais acentuada. OBJETIVO: O objetivo deste estudo foi comparar o desempenho cognitivo de pacientes idosos com esquizofrenia, institucionalizados, com indivíduos idosos, institucionalizados, sem doenças neurológicas ou psiquiátricas, pareados pela idade, escolaridade e tempo de institucionalização. MÉTODOS: "Cambridge Examination for Mental Disorders of the Elderly" (CAMCOG) foi aplicado em 10 pacientes, institucionalizados, com esquizofrenia, cujo desempenho cognitivo foi comparado ao de 10 indivíduos, institucionalizados, com história de doença de Hansen. RESULTADOS: Pacientes com esquizofrenia apresentaram um pior desempenho na pontuação total do CAMCOG e em seus subitens orientação, linguagem, abstração e memória (p≤0.05). Pacientes com esquizofrenia também apresentaram uma tendência, não significativa, para menor pontuação no MEEM e cálculo. CONCLUSÃO: Nossos achados demonstram que a esquizofrenia está associada a piora do comprometimento cognitivo em pacientes idosos com institucionalização de longa permanência comparados a pacientes institucionalizados sem doenças neurológicas ou psiquiátricas.

Psychological well-being and associated factors among elderly Hansen's Disease patients in leprosaria.

OBJECTIVES: We investigated psychological well-being and associated factors among elderly Hansen's Disease (HD) patients in three national leprosaria in Japan. METHODS: Three questionnaires on physical and social factors, and psychological well-being based on the 12-item of General Health Questionnaire (GHQ-12) were used to survey all HD patients admitted to three leprosaria in Japan. The number of respondents over 65 years old who completed all 12 items of GHQ-12 was 754 (459 men and 295 women) with a response rate of 80.9%. Data were analyzed by t-test and analysis of covariance (ANCOVA) to determine factors associated with psychological well-being. RESULTS: The impairment in 8 physical functions, walking, eating, and toileting for both men and women, bathing for men, and vision, dressing and grooming for women, were significantly related to high GHQ-12 scores by t-test and ANCOVA. Having no close friends, less frequent contact with neighbors, and no or less frequent participation in group activities in men, and inactive daily life style in male and female HD patients, were related to high GHQ-12 scores by both analyses. CONCLUSION: The present results showed that physical factors and inactive daily life style were related to psychological well-being for both men and women. Social factors were related to psychological well-being among elderly male HD patients in Japan. Further follow-up study is necessary to examine the causal relationships among psychological well-being and associated factors.