RESUMO
The reliability of methods of testing nerve function is important, since diagnostic decision making is a direct function of the quality of the test. Three methods of nerve function testing were investigated at the Danish Bangladesh Leprosy Mission (DBLM) in north Bangladesh, and assessed for inter-observer reliability. The three methods were 1) ballpoint pen test (BPT) for sensory function; 2) graded Semmes Weinstein monofilament test (SWM) for sensory function and 3) voluntary muscle testing (VMT) for motor function. The weighted kappa (kappa w) statistic was used to express inter-observer reliability. Using this statistic, 0 represents agreement no better than random, and 1.0 complete agreement. kappa w values of > or = 0.80 are reckoned to be adequate for monitoring and research. Fifty-three patients were tested, a Senior physiotechnician acting as 'gold standard' against whom four other staff physiotechnicians were assessed. All three testing methods were found to have minimal inter-observer variation, with the kappa w for inter-observer agreement using BPT being 0.86, the SWM 0.92, and VMT 0.94. It is concluded that in trained and experienced hands, all three methods are reliable and repeatable to a level allowing confident use of results obtained in monitoring and research.
Assuntos
Hanseníase Tuberculoide/diagnóstico , Doenças Musculares/diagnóstico , Medição da Dor/instrumentação , Medição da Dor/métodos , Transtornos de Sensação/diagnóstico , Bangladesh , Feminino , Humanos , Antígeno de Mitsuda , Hanseníase Virchowiana/complicações , Hanseníase Tuberculoide/complicações , Masculino , Doenças Musculares/etiologia , Reprodutibilidade dos Testes , Transtornos de Sensação/etiologia , Sensibilidade e Especificidade , Limiar Sensorial , Índice de Gravidade de Doença , Resistência à TraçãoRESUMO
In a combined clinical, radiological, and laboratory study of 77 patients throughout the leprosy spectrum, 10 patients had an enthesitis which has not been described previously as far as is known and which was not associated with the characteristics of erythema nodosum leprosum reactions. C reactive protein and alpha 1 acid glycoprotein values were significantly lowered only in those patients with leprosy and enthesitis. No radiological abnormalities were found.
Assuntos
Hanseníase/patologia , Doenças Musculares/patologia , Tendinopatia/patologia , Adulto , Proteína C-Reativa/análise , Pré-Escolar , Feminino , Humanos , Imunoglobulina M/análise , Hanseníase/complicações , Hanseníase/imunologia , Masculino , Pessoa de Meia-Idade , Doenças Musculares/etiologia , Orosomucoide/análise , Palpação , Fator Reumatoide/análise , Tendinopatia/etiologiaRESUMO
We examined 55 clinic patients with biopsy-proven Hansen's disease and catalogued the ocular findings. Forty patients had lepromatous disease and 15 had tuberculoid disease. Visual acuity was 20/40 or better in 52 patients. Examination of pupillary size in all cases and after dilation with cocaine and hydroxyamphetamine in 15 cases showed decreased sympathetic innervation to the iris dilator muscle in seven cases. Ocular inflammation was uncommon: there was one case of active interstitial keratitis, three of episcleritis, and four of iritis. Although 41 patients had ocular problems attributable to Hansen's disease, the severity of the ocular complications was much less than reported in similar studies from other countries. We believe that the differences were the result of effective antimicrobial and anti-inflammatory therapy.
Assuntos
Oftalmopatias/epidemiologia , Hanseníase/complicações , Adolescente , Adulto , Idoso , Criança , Córnea/inervação , Oftalmopatias/etiologia , Humanos , Pressão Intraocular , Hanseníase/classificação , Pessoa de Meia-Idade , Doenças Musculares/etiologia , Doenças do Sistema Nervoso/etiologia , Músculos Oculomotores , Pupila , Estados Unidos , Acuidade VisualAssuntos
Educação em Saúde , Hanseníase/reabilitação , Modalidades de Fisioterapia/educação , Contratura/etiologia , Oftalmopatias/etiologia , Mãos/patologia , Mãos/cirurgia , Humanos , Perna (Membro)/patologia , Perna (Membro)/cirurgia , Hanseníase/complicações , Doenças Musculares/etiologia , Paralisia/etiologiaRESUMO
For eighty-six cases of leprous paralysis of the intrinsic muscles of the hand, a modified Bunnell opponensplasty (transfer of a finger flexor) was done. Good results were seen in eighteen and fair results in sixty-three. The five poor results occurred because of infection, weakness, or deformity. Adjuvant procedures, as needed, were interphalangeal arthrodeis of the thumb, capsulorrhaphy of the wrist, and additional tendon transfers.