Mensuração do ângulo articular do cotovelo no teste de tensão neural em indivíduos com hanseníase / Mensuration of elbow joint angle in the application of the neural tension test in individuals with leprosy

A hanseníase é uma patologia crônica e granulomatosa, que atinge a pele e o sistema nervoso periférico pela invasão no sistema imune do Mycobacterium leprae. O objetivo deste estudo foi mensurar o ângulo articular do cotovelo com a aplicação do teste de tensão neural do nervo ulnar em pacientes com hanseníase. Na aplicação do teste de tensão neural, foram utilizadas a goniometria e a fotometria para a mensuração do ângulo articular do cotovelo, sendo que para a realização da fotometria foi utilizada uma câmera Samsung de 12.1 Mega pixels, e os dados foram analisados pelo software Corel Draw X5 (Microsoft®). Foram selecionados 44 indivíduos da Fundação Pró-Hansen, com média de idade de 48,13±12,55 anos, divididos em três grupos: G1, G2 e G3. O G1 compreende voluntários com hanseníase e sensibilidade preservada; o G2, aqueles com hanseníase e com perda de sensibilidade; e o G3, o controle. Na goniometria, foi encontrada diferença significativa (p<0,05) na comparação dos grupos G1 e G2 com o controle tanto do membro direito quanto esquerdo, porém não foi encontrada diferença na comparação entre os dois grupos com hanseníase. Na fotometria, houve diferença entre G2 e o controle bilateralmente e entre o G1 e o controle no lado esquerdo. Comparando-se o lado direito e esquerdo, não foi encontrada diferença em nenhum grupo. Os pacientes com hanseníase apresentaram diminuição da ADM de flexão de cotovelo no teste de tensão neural do ulnar em ambos os lados quando comparados ao grupo controle.

Leprosy is a chronic and granulomatous disease, which affects skin and peripheral nervous system by invasion of Mycobacterium leprae in the immune system. The objective of this study was to evaluate the ulnar neural tension test in leprosy patients. In applying the test of neural tension, it was done goniometry and photometry to measure the angle of the elbow joint, and to perform the photometry we used a Samsung camera, 12.1 Mega pixels, and the data were analyzed using Corel Draw Software X5 (Microsoft®). We selected 44 individuals of Pro-Hansen Foundation, with an average age of 48.13±12.55 years, divided in three groups: G1, G2 and G3. G1 consisted of leprosy volunteers with preserved sensibility; the G2, the ones with leprosy and with no sensibility; and G3 was control group. In goniometry, it was found significant difference (p<0.05) when comparing the G1 and G2 with control of both the right and left limb, but no difference was found when comparing the two leprosy groups. In photometry, it was found difference between G2 and the control and bilaterally between the G1 and control on the left side. Comparing the right and left limbs, difference was not found in any group. Patients with leprosy showed a decrease in range of movement of elbow flexion in ulnar neural tension test in both sides when compared to the control group.

An assessment of emotional pain among subjects with chronic dermatological problems in Lagos, Nigeria.

BACKGROUND: In dermatology, it is known that there is a significant co-morbidity between dermatological disorders and psychological complications, and it has been estimated that in at least one-third of patients with skin diseases, their effective management involves consideration of associated emotional factors. In Africa, particularly Nigeria, despite the prevalent dermatological disorders with their possible attendant mental health complications, little or no work has been done in the field of psycho-dermatology, hence the rationale for this study. METHODS: A prospective study was carried out in the dermatology/venerology clinic of Lagos University Teaching Hospital (LUTH). Ethical clearance and consent were obtained to conduct the study. The subjects were selected by simple random sampling from adult patients that have had their dermatological disorders for at least six months before presentation in the clinic. Those with other co-existing chronic medical illness such as hypertension, diabetes, or haemoglobinopathy were excluded from the study. Controls were obtained to match for age and sex from apparently healthy workers in a nearby general hospital. Each subject was evaluated with a questionnaire to obtain necessary socio-demographic data: Psychache scale (PAS), and subscales C, D, and J of Symptom Check List (SCL-90). The data generated was analyzed to obtain means, and t-test was used to compare the means; p = 0.05 was taken as being significant. The analyses were done using SPSS version 10. RESULTS: Eighty subjects with dermatological disorders, and of equal sex distribution, were evaluated, with mean age of 33 +/- 12.1 years. Equal number of controls matched for sex and mean age of 34.6 +/- 7.3 years were also evaluated. Among the subjects, 16.3% had Acne, followed by Urticaria (13.8%), Vitiligo (12.5%), Tinea (11.3%), Hansen's disease (5%), and others (41.1%). From assessment with PAS and SCL subscales, the mean scores by the subjects were much higher than those of the controls and in each group the males scored slightly higher than their female counterparts. On assessment with PAS, the subjects had much higher mean score of 28.94 +/- 12.61 and the controls: 18.92 +/- 7.1 with "t" of 6.19*; and the difference was statistically significant at p < 0.05 and critical "t" of 1.66. On SCL; subscale C, the mean scores for the subjects and controls were: 7.89 +/- 7.69 and 5.02 +/- 5.23 respectively and the difference was statistically significant with "t" of 2.75*. For subscale D, the mean score by the subjects was 11.09 +/- 10.56, and the controls had 4.84 +/- 6.08; and statistically significant difference with "t" of 4.59*. On subscale J, the subjects' mean score was 4.68 +/- 5.44, the controls: 1.98 +/- 3.19 with statistically significant "t" of 3.83*. CONCLUSIONS: The results showed that subjects with dermatological disorders suffered from significant emotional pain when compared to the healthy controls; the males had higher mean scores on PAS and SCL subscales, hence more likely to suffer emotional pain than their female counterparts. Finally, the need to have consultation-liaison psychiatry in the dermatology facilities in Nigeria was emphasized.

Avaliaçäo da microbiota bacteriana nasal de hansenianos / Evaluation of the nasal bacterial microbiota of bearers of Hansen's Disease

Este estudo teve como objetivo comparar a microbiota bacteriana nasal de portadores de hanseníase lepromatosa, tratados sistematicamente com Rifampicina, Clofazimina e Sulfa, com um grupo de indivíduos sadios sem o uso de antibióticos. Foram coletadas amostras de mucosa nasal de 57 hansenianos, internos do Hospital de Dermatologia Sanitária de Curitiba, e de 40 indivíduos com mucosa normal. Na coleta, as mucosas nasais foram avaliadas quanto à presença de lesöes, e as amostras semeadas em meios para pesquisa de Saureus e enterobactérias. Nos hansenianos observou-se S. aureus em 100 por cento; Proteus mirabilis em 91 por cento; E. coli, Enterobacter aerogenes, Klebsiella pneumonia e Pseudomonas aeruginosa em 24 por cento, resistentes aos antibióticos testados no antibiograma. Nos indivíduos sadios isolou-se S. aureus em 100 por cento e P. aeruginosa em 0,5 por cento, sensíveis aos antibióticos testados, e näo foram isoladas amostras do gênero Proteus. Conclui-se que nos portadores de hanseníase estudados, a microbiota nasal encontra-se alterada e resistente devido ao emprego sistemático dos antibióticos do esquema tríplice

Contribuiçao para o estudo da inespecificidade da reaçao de Mantoux em altas concentraçoes (hipótese de Palmer) em lepromatosos e em doentes de afecçoes diversas / ?

Em sucessivos trabalhos, Palmer e colaboradores obtiveram dados que os levaram a concluir pela inespecificidade frequente de prova tuberculínica em altas concentraçoes, em consequência de co-sensibilizaçao com outros ácido-resistentes encontrados em diversas áreas geográficas. Na tese, procura-se trazer uma contribuiçao ao esclarecimento da hipótese de Palmer e colaboradores, pelo estudo da influência que o M. leprae exerceria sôbre a resposta à reaçao de Mantoux em várias diluiçoes (1:1000, 1:100, 1:10). Para isso, foram testados grande quantidade de bacilo alcool-ácido-resistente em lesoes cutâneas, e internados nos Sanatórios Cocais e Aimorés