Histoid leprosy: clinical and histopathological analysis of patients in follow-up in University Clinical Hospital of endemic country.

BACKGROUND: Histoid leprosy (HL) is a rare form of lepromatous leprosy, characterized by hyperchromic indurated nodules above normal skin. Its main histopathological aspect is spindle cells. Because it may simulate other aspects, such as dermatofibroma and neurofibroma, histoid leprosy poses itself as a diagnostic challenge. METHODS: This is a retrospective study with all patients having been selected from the leprosy clinic of the Hospital das Clínicas da Universidade de São Paulo from 2006 to 2016. RESULTS: There were 12 patients in this study, eight in the histoid group and four in the lepromatous leprosy group. The prevalence of HL was 1.12% in all leprosy subjects. All individuals from HL group were "de novo" cases, and the histopathological analysis of skin lesions presented spindle cells generating a storiform pattern. Immunohistochemistry for CD68, vimentin, and anti-BCG were positive in all 12 cases. Factor XIIIa was visualized only in the papillary dermis, and S100 protein was negative in all biopsies. Smooth-muscle actin was present in 62.5% of the HL samples. CONCLUSION: The prevalence of HL was similar to previous reports. However, all histoid patients were "de novo" cases, differing from published studies. Fusocellular macrophage transformation could be explained by the differences in cytoskeleton proteins expressed in histoid lesions in comparison to other leprosy variants, with emphasis on vimentin and smooth muscle actin.

Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil.

OBJECTIVE: We evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals. METHODS: This is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy. RESULT: Our data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis. CONCLUSION: The results of the present study demonstrated the importance of referral centers in support of basic health services within the decentralization strategy. But, the success of the program depends on the advent of new developmental tools to augment diagnostic accuracy for leprosy. However, it should be emphasized that for new diagnostic methods to be developed, a greater commitment on the part of the health care system regarding research is urgently needed.

Evaluation of cervical and anal intraepithelial neoplasia in women attending a sexually transmitted infection clinic.

BACKGROUND: The incidence of anal and cervical cancers and their precursors have increased in the past decades. Women with HIV and sexually transmitted infections are at a higher risk. Cervical human papilloma virus infection may serve as a reservoir and source of anal infection or vice versa. A higher incidence of anal cytological abnormality has been observed in patients with abnormal cervical cytology. OBJECTIVES: This cross sectional study was designed to estimate the prevalence and associations of anal and cervical cytological abnormalities in a cohort of sexually active women using Papanicolaou smears. METHODS: We conducted a single centre study of 35 consecutive HIV positive and 40 HIV negative women attending the sexually transmitted infection clinic. Cervical and anal specimens were obtained for cytology after a detailed history and examination. Chi square test and coefficient of correlation were used for comparison. RESULTS: Cervical dysplasia was observed in 22.6% (17.3% low-grade squamous intraepithelial lesion and 5.3% high grade squamous intraepithelial lesion) and anal dysplasia in 8% study subjects (6.7% low-grade squamous intraepithelial lesion and 1.3% high grade squamous intraepithelial lesion); no association was observed with HIV infection. A higher number of patients with cervical dysplasia (29.4%) were found to have concomitant anal dysplasia (P = 0.002). History of anal intercourse was reported in all patients with anal dysplasia and was higher (P < 0.037) in patients with cervical dysplasia. LIMITATIONS: The limitations included a small sample size, lack of correlation with histological findings and bias due to STI clinic-based recruitment of the study population. CONCLUSION: Cytology may be used to screen for cervical and anal dysplasia in women irrespective of HIV status. Women with cervical dysplasia may be preferentially screened for anal dysplasia and vice versa. Anal intercourse may be a risk factor for anal and cervical dysplasia.

Childhood leprosy: a retrospective descriptive study from Government Medical College, Kozhikode, Kerala, India.

OBJECTIVE: To assess the profile and describe the clinical presentations and complications of childhood leprosy in a tertiary care hospital in North Kerala, South India during 2003-2012 and to analyse any change in the age-sex profile and the clinical pattern of leprosy in children below the age of 15 years over the 10-year study period. DESIGN: A retrospective descriptive study of children less than 15 years of age diagnosed with leprosy and registered for treatment in a tertiary care institution from 2003 to 2012. Demographic, clinical, investigative and treatment data were collected using a pre-set proforma. RESULTS: 138 (12.1%) of the total 1143 leprosy cases registered for treatment during the 10-year period were below 15 years of age. The 10-year study period witnessed a statistically insignificant decrease in the new childhood leprosy cases registered for treatment in our tertiary care institution. The majority of cases belonged to the 6-12 year age group (61.6%) with a male predominance. Borderline tuberculoid (BT) was the commonest clinical type (65.9%) followed by indeterminate leprosy (18.8%); 101 patients required paucibacillary (PB) and 37 needed multibacillary (MB) treatment. The number of patients requiring MB treatment showed a statistically significant increase and there was a significant decline in number of cases requiring PB treatment. During the entire study period no Type 2 lepra reaction was documented in patients below Hema 15 years and only two patients manifested Type 1 reaction. Ten (7.2%) out of the 138 patients were cases of relapse. There was a clear female predilection among relapse cases with the majority belonging to the adolescent age. CONCLUSIONS: Childhood leprosy still contributes to a significant proportion of the total case load denoting the continuing active horizontal transmission of leprosy. The rise in number of patients with more extensive disease in the background of declining disease prevalence is suggestive of the delay in diagnosis and treatment. A high relapse rate noted in the present study may be due to incorrect classification and treatment of MB as PB leprosy which in turn might have resulted in treatment failure due to inadequate treatment.

Progression of leprosy disability after discharge: is multidrug therapy enough?

OBJECTIVE: To evaluate the risk factors related to worsening of physical disabilities after treatment discharge among patients with leprosy administered 12 consecutive monthly doses of multidrug therapy (MDT/WHO). METHODS: Cohort study was carried out at the Leprosy Laboratory in Rio de Janeiro, Brazil. We evaluated patients with multibacillary leprosy treated (MDT/WHO) between 1997 and 2007. The Cox proportional hazards model was used to estimate the relationship between the onset of physical disabilities after release from treatment and epidemiological and clinical characteristics. RESULTS: The total observation time period for the 368 patients was 1 570 person-years (PY), averaging 4.3 years per patient. The overall incidence rate of worsening of disability was 6.5/100 PY. Among those who began treatment with no disability, the incidence rate of physical disability was 4.5/100 PY. Among those who started treatment with Grade 1 or 2 disabilities, the incidence rate of deterioration was 10.5/100 PY. The survival analysis evidenced that when disability grade was 1, the risk was 1.61 (95% CI: 1.02-2.56), when disability was 2, the risk was 2.37 (95% CI 1.35-4.16), and when the number of skin lesions was 15 or more, an HR = 1.97 (95% CI: 1.07-3.63). Patients with neuritis showed a 65% increased risk of worsening of disability (HR = 1.65 [95% CI: 1.08-2.52]). CONCLUSION: Impairment at diagnosis was the main risk factor for neurological worsening after treatment/MDT. Early diagnosis and prompt treatment of reactional episodes remain the main means of preventing physical disabilities.

Episódios reacionais hansênicos: estudo de fatores relacionados com adesão ao tratamento em uma unidade de referência / Leprosy rectional episodes: study of factores related to adherence to treatment in a unit of reference

As reações hansênicas são um dos maiores problemas para os profissionais de saúde no manejo dos portadores de hanseníase, tornando o controle das mesmas de fundamental importância para evitar complicações clínicas e sociais. A assiduidade às consultas para avaliação e controle é essencial para a cura. Este estudo avaliou a influência dos fatores sócio-demográficos e clínicos na adesão ao tratamento em estado reacional em um ambulatório de referência. Trata-sede um estudo do tipo série de casos, em pacientes em controle no ambulatório do NMT/UFPA nos anos de 2008 a 2009. Os resultados mostraram que pacientes do sexo masculino, adultos e com baixa escolaridade foram os mais acometidos pela hanseníase. As reações hansênicas do tipo 1(RR) foram as mais incidentes, tendo como principal queixa a dor. Apesar dos resultados não terem mostrado associação, com significância estatística, entre as variáveis estudadas e a não adesão ao tratamento, eles evidenciaram variáveis que interferem na assiduidade às consultas.

Leprosy reactions are one of the biggest problems for health professionals in the management of patients with leprosy, making control of these fundamentally important to avoid medical complications and social problems. The attendance to appointments for evaluation and control is essential to healing. This study evaluated the influence of socio-demographic and clinical factors in adherence to treatment in a reactive state in a outpatient referral. This is a study of type series of cases in patients in control in the outpatient department of the NMT / UFPA in the years 2008-2009. The results showed that male, adults and low education patients were the most affected by leprosy. Leprosy reactions of 1 (RR) type had the highest incidence, with pain as the chief complaint. Although the results have not shown an association with statistical significance between variables and non-adherence to treatment, they showed variables that interfere in attendance to appointments.

Using a clinic based creativity initiative to reduce HIV related stigma at the Infectious Diseases Institute, Mulago National Referral Hospital, Uganda.

BACKGROUND: Stigma has been associated with chronic health conditions such as HIV/AIDS, leprosy, tuberculosis, Mental illness and Epilepsy. Different forms of stigma have been identified: enacted stigma, perceived stigma, and self stigma. Stigma is increasingly regarded as a key driver of the HIV/AIDS epidemic and has a major impact on public health interventions. OBJECTIVES: The initiative was to provide activities in the clinic while patients waited to be seen by healthcare professionals. It was envisaged this would contribute to reduction of clinic based stigma felt by clients. METHODS: This was a repeated cross-sectional survey (October-November 2005 and March-April 2007) that was conducted at the Infectious Diseases Institute clinic (IDC) at Mulago, the national referral hospital in Uganda. We utilized quantitative (survey) and qualitative (key informants, focus group discussions) methods to collect the data. Data were collected on stigma before the creativity initiative intervention was implemented, and a second phase survey was conducted to assess effectiveness of the interventions. RESULTS: Clients who attended the IDC before the creativity intervention were about twice as likely to fear catching an infection as those who came after the intervention. The proportion that had fears to be seen by a friend or relative at the clinic decreased. Thus during the implementation of the Creativity intervention, HIV related stigma was reduced in this clinic setting. CONCLUSIONS: The creativity intervention helped to build self esteem and improved communication among those attending the clinic; there was observed ambiance at the clinic and clients became empowered, with creative, communication and networking skills. Improved knowledge and communication are key in addressing self stigma among HIV positive individuals.

A profile of patients treated at a national leprosy outpatient referral clinic in Rio de Janeiro, Brazil, 1986-2007.

OBJECTIVE: To analyze a profile of patients treated at a national leprosy outpatient referral clinic in metropolitan Rio de Janeiro, Brazil, over a period of more than two decades, and the subgroup of nationally registered leprosy cases from the same residential area, as well as all registered cases statewide. METHODS: An observational, descriptive analysis was carried out for patients treated from 1986 to 2007 at the Souza Araújo Outpatient Clinic (Ambulatório Souza Araújo, ASA), a national referral center for the diagnosis and treatment of leprosy at the Oswaldo Cruz Foundation (Fiocruz) that serves clients from the city of Rio de Janeiro and other municipalities in the metropolitan area of Rio de Janeiro State. Demographic and clinical data for the subgroup of leprosy cases registered with Brazil's National Disease Notification System (Sistema Nacional de Informação de Agravos de Notificação, SINAN) between 2001 and 2007 and residing in the same municipalities as the ASA patients, and for all registered cases statewide, were also analyzed. RESULTS: Among the ASA patients, there was a decrease in average family income (from 3.9 to 2.7 times the minimum salary between the periods 1998-2002 and 2003-2007); the proportion of multibacillary (MB) patients (from 52.7% to 46.9%); and the proportion of patients younger than 15 years old (from 12.8% to 8.7%). Among the MB patients, the average initial and final bacilloscopic indices were significantly higher in 2003-2007. Compared with the SINAN cases, more ASA cases involved disability and were younger than 15 years old. CONCLUSIONS: Patients living with leprosy in the metropolitan area of the state of Rio de Janeiro belong to the most deprived social strata and have not benefited from the overall improvement in socioeconomic conditions in Brazil.

A profile of patients treated at a national leprosy outpatient referral clinic in Rio de Janeiro, Brazil, 1986-2007 / Perfil de los enfermos tratados en un servicio nacional de remisión de pacientes ambulatorios con lepra en Río de Janeiro, Brasil, 1986-2007

OBJECTIVE: To analyze a profile of patients treated at a national leprosy outpatient referral clinic in metropolitan Rio de Janeiro, Brazil, over a period of more than two decades, and the subgroup of nationally registered leprosy cases from the same residential area, as well as all registered cases statewide. METHODS: An observational, descriptive analysis was carried out for patients treated from 1986 to 2007 at the Souza Araújo Outpatient Clinic (Ambulatório Souza Araújo, ASA), a national referral center for the diagnosis and treatment of leprosy at the Oswaldo Cruz Foundation (Fiocruz) that serves clients from the city of Rio de Janeiro and other municipalities in the metropolitan area of Rio de Janeiro State. Demographic and clinical data for the subgroup of leprosy cases registered with Brazil's National Disease Notification System (Sistema Nacional de Informação de Agravos de Notificação, SINAN) between 2001 and 2007 and residing in the same municipalities as the ASA patients, and for all registered cases statewide, were also analyzed. RESULTS: Among the ASA patients, there was a decrease in average family income (from 3.9 to 2.7 times the minimum salary between the periods 1998-2002 and 2003-2007); the proportion of multibacillary (MB) patients (from 52.7% to 46.9%); and the proportion of patients younger than 15 years old (from 12.8% to 8.7%). Among the MB patients, the average initial and final bacilloscopic indices were significantly higher in 2003-2007. Compared with the SINAN cases, more ASA cases involved disability and were younger than 15 years old. CONCLUSIONS: Patients living with leprosy in the metropolitan area of the state of Rio de Janeiro belong to the most deprived social strata and have not benefited from the overall improvement in socioeconomic conditions in Brazil.

OBJETIVO: Analizar el perfil de los enfermos tratados en un servicio nacional de remisión de pacientes ambulatorios con lepra ubicado en la zona metropolitana de Río de Janeiro, Brasil, durante más de dos decenios, y el subgrupo de casos de lepra registrados a nivel nacional de la misma zona de residencia, así como todos los casos registrados a nivel estatal. MÉTODOS: Se llevó a cabo un análisis observacional y descriptivo de los pacientes tratados desde 1986 a 2007 en el servicio ambulatorio Souza Araújo (ASA), un centro de remisión nacional para el diagnóstico y el tratamiento de la lepra en la Fundación Oswaldo Cruz, que atiende a pacientes de la ciudad de Río de Janeiro y de otros municipios de la zona metropolitana del Estado de Río de Janeiro. También se analizaron los datos demográficos y clínicos del subgrupo de casos de lepra registrados con el Sistema Nacional de Notificación de Enfermedades del Brasil (SINAN) entre el 2001 y el 2007 residentes en los mismos municipios que los pacientes atendidos en el ASA, y de todos los casos registrados a nivel estatal. RESULTADOS: En los pacientes atendidos en el ASA hubo una disminución en los ingresos familiares promedio (de 3,9 a 2,7 veces el sueldo mínimo entre los períodos 1998-2002 y 2003-2007), en la proporción de pacientes multibacilares (de 52,7% a 46,9%), y en la proporción de pacientes menores de 15 años de edad (de 12,8% a 8,7%). En los pacientes multibacilares, los índices baciloscópicos promedio inicial y final fueron significativamente mayores en el período 2003-2007. En comparación con los casos del SINAN, en el ASA hubo más casos con discapacidad y en menores de 15 años de edad. CONCLUSIONES: Los pacientes con lepra de la zona metropolitana del Estado de Río de Janeiro pertenecen al estrato social más bajo y no se han beneficiado con el mejoramiento general de la situación socioeconómica en el Brasil.

Profile of patients affected by Hansen's disease seen at the Outpatient Clinic of Dermatology at Hospital Evangélico de Curitiba.

BACKGROUND: Leprosy or Hansen's disease is a chronic infectious disease with worldwide distribution. Although it is a curable disease, it remains as a public health problem, with Brazil being the second most endemic country in the world. The skin lesions and neural damage, which lead to physical disabilities, affect the patients' self-esteem, cause a decrease in quality of life and interfere in the patients' lives. OBJECTIVE: Identify the profile of the patients affected by leprosy seen at the Outpatient Clinic of Dermatology of Hospital Evangélico de Curitiba and characterize the levels of quality of life of the sample in the week prior to the survey by means of the Dermatology Life Quality Index questionnaire. METHOD: Application of the Dermatology Life Quality Index to 22 patients diagnosed with leprosy in the period from May to October 2009. RESULTS: Among the 22 patients who participated in the study, 55% were male and 45% were female, with a mean age of 50.2 years. The scores obtained with the Dermatology Life Quality Index ranged from 1 to 25 points, with a mean of 10.23. Most of the patients (50%) had scores in the range severe or very severe; 31.8% of the patients obtained scores in the range mild or moderate, and 18.2% of the patients reported that there was no impairment of their quality of life. CONCLUSION: The profile of the patients affected by leprosy in this study were men, with a mean age of 50 years and presenting the multibacillary form of the disease. The application of the Dermatology Life Quality Index questionnaire allowed us to verify that the score severe or very severe for quality of life was predominant in the sample, with higher impact on women and no significant difference concerning pauci or multibacillary leprosy.

Perfil dos pacientes acometidos pela hanseníase atendidos no Ambulatório de Dermatologia do Hospital Evangélico de Curitiba / Profile of patients affected by Hansen's disease seen at the Outpatient Clinic of Dermatology at Hospital Evangélico de Curitiba

FUNDAMENTOS: A hanseníase é uma enfermidade infecto-contagiosa, com distribuição mundial. Apesar de curável, permanece como um problema de saúde pública, sendo o Brasil o segundo país mais endêmico do mundo. As lesões cutâneas e o acometimento neural, que levam às principais incapacidades físicas, pioram a autoestima dos doentes, levam a uma queda da qualidade de vida e interferem na vida dos mesmos. OBJETIVO: Traçar um perfil dos pacientes acometidos pela hanseníase, atendidos no Ambulatório de Dermatologia do Hospital Evangélico de Curitiba, e caracterizar os níveis de qualidade de vida da amostra na semana prévia à pesquisa, por meio do questionário Dermatology Life Quality Index. MÉTODO: Aplicação do Dermatology Life Quality Index em 22 pacientes diagnosticados com hanseníase no período de maio a outubro de 2009. RESULTADOS: Em meio aos 22 pacientes que participaram do estudo, encontraram-se 55 por cento do sexo masculino e 45 por cento do sexo feminino, com idade média de 50,2 anos. Os escores obtidos na aplicação do Dermatology Life Quality Index variaram de 1 a 25 pontos, sendo a média 10,23. A maioria dos pacientes (50 por cento) apresentou escore na dimensão do grave ou muito grave; 31,8 por cento dos pacientes, do leve ao moderado, e 18,2 por cento dos pacientes informaram que não houve comprometimento da qualidade de vida. CONCLUSÃO: O perfil de pacientes acometidos pela hanseníase encontrado neste estudo foram homens, com idade média de 50 anos e com forma multibacilar. A aplicação do Dermatology Life Quality Index permitiu verificar que o escore de comprometimento de qualidade de vida grave ou muito grave foi predominante na amostra, tendo mais impacto nas mulheres e não apresentando diferença em relação à hanseníase pauci ou multibacilar.

BACKGROUND: Leprosy or Hansen's disease is a chronic infectious disease with worldwide distribution. Although it is a curable disease, it remains as a public health problem, with Brazil being the second most endemic country in the world. The skin lesions and neural damage, which lead to physical disabilities, affect the patients' self-esteem, cause a decrease in quality of life and interfere in the patients' lives. OBJECTIVE: Identify the profile of the patients affected by leprosy seen at the Outpatient Clinic of Dermatology of Hospital Evangélico de Curitiba and characterize the levels of quality of life of the sample in the week prior to the survey by means of the Dermatology Life Quality Index questionnaire. METHOD: Application of the Dermatology Life Quality Index to 22 patients diagnosed with leprosy in the period from May to October 2009. RESULTS: Among the 22 patients who participated in the study, 55 percent were male and 45 percent were female, with a mean age of 50.2 years. The scores obtained with the Dermatology Life Quality Index ranged from 1 to 25 points, with a mean of 10.23. Most of the patients (50 percent) had scores in the range severe or very severe; 31.8 percent of the patients obtained scores in the range mild or moderate, and 18.2 percent of the patients reported that there was no impairment of their quality of life. CONCLUSION: The profile of the patients affected by leprosy in this study were men, with a mean age of 50 years and presen ting the multibacillary form of the disease. The application of the Dermatology Life Quality Index questionnaire allowed us to verify that the score severe or very severe for quality of life was predominant in the sample, with higher impact on women and no significant difference concerning pauci or multibacillary leprosy.

[Leprosy outpatient clinic in Aichi Prefecture, Japan].

Until the Japanese Leprosy Prevention Law was abolished in 1996, leprosy patients, regardless of their severity, had to be treated by accredited doctors. The majority of them had to be confined in a sanatorium to be treated, since only few hospitals/sanatoria had outpatient clinics for leprosy patients. This de facto confinement limited their occupational, social, financial, and family options, but no clear criteria/guidelines allowing discharge existed. The importance of leprosy outpatient clinics was almost never debated until 1962, when Tofu Association (a foundation established in 1952 to support the confined patients) and the National Suruga Sanatorium planned the opening of the clinic. This clinic looked after total of 4,977 patients until the abolishment of the Law. Since 1996, 349 persons consulted the clinic as of 2010. The importance of the continuation of these clinics is beyond dispute, even in low-endemic countries. However, the diminishing number of patients and demands in this country makes the management difficult. Thus, coordination with the local clinics and dermatologists is inevitable.

Avaliação do estado nutricional e do consumo alimentar de pacientes com hanseníase do Ambulatório de Dermatologia Sanitária / Assessment of nutritional status and dietary intake in patients with Hansen's Disease under care at Dermatology Clinic Health

A Hanseníase é uma doença sistêmica, infectocontagiosa, de evolução crônica. Seu tratamento é realizado por meio de poliquimioterapia que pode desencadear algumas alterações nutricionais. Sendo assim, este trabalho teve como objetivo avaliar o estado nutricional e o consumo alimentar de pacientes com Hanseníase em acompanhamento no Ambulatório de Dermatologia Sanitária. Estudo de delineamento transversal, no qual realizou avaliação antropométrica, laboratorial e dietética. A amostra final foi de 39 pacientes, de ambos os sexos, com concentração de indivíduos na faixa etária a avaliação foi realizada apenas após o início do trata-entre os 40-50 anos, predomínio do ensino fundamen-tal incompleto e baixa renda familiar. A população se caracterizou pelo sedentarismo, sobrepeso, ocorrência de doenças crônicas não transmissíveis, insegurança alimentar e nutricional, consumo muito elevado de gorduras e inadequação de micronutrientes essenciais para a prevenção de doenças. Os resultados mostraram a necessidade da inserção do nutricionista na equipe multiprofissional, a fim de promover alimentação ade-quada e a prevenção de comorbidades, garantindo a promoção à saúde e a segurança alimentar. No entanto, não foi possível associar esses distúrbios nutricionais ao diagnóstico/tratamento da Hanseníase, uma vez que a avaliação foi realizada apenas após o início do tratamento da doença.

Leprosy is a systemic, infectious disease with a chronic course. It can be treated by drug therapy combination that may induce nutritional changes. Thus, this study aimed to assess the nutritional status and dietary in-take of leprosy patients under care at the Dermatology Clinic Health. Cross-sectional study, which was held on anthropometric, dietary and laboratory evaluation. The final sample of 39 patients of both sexes, presented a concentration of individuals aged between 40-50 years, prevalence of incomplete primary education and low family income. The population was characterized by sedentary, overweight, occurrence of chronic non-com-municable diseases, food and nutrition insecurity, high consumption of fats and inadequacy of micronutrients essentials for disease prevention. The results showed the necessity of inserting a nutritionist in the multidisci-plinary team in order to promote proper nutrition and the prevention of comorbid conditions, ensuring the promotion of health and food safety. However, it could not associate these nutritional disorders to the diagno-sis/treatment of leprosy, since the evaluation was per-formed only after the start of the treatment of disease.

Clinical and demographic trends in a sexually transmitted infection clinic in Mumbai (1994-2006): an epidemiologic analysis.

BACKGROUND: People presenting to sexually transmitted infections (STIs) clinics represent an important risk group for HIV infection; prevention strategies will depend on the clinical attendance. AIMS: The demographic and clinical changes in clinic attendees in Mumbai, as well as the factors associated with HIV infection in this clinic over a 13-year period, were assessed. METHODS: STI clinic data in 3417 individuals (1994 to 2006) were analyzed: clinical presentation, types of STIs, and serology over the 13-year period. We used a logistic regression model to assess socio-demographic and clinical associations with HIV infection. RESULTS: The clinic evaluated 689 patients in 1994 and the number had dropped to 97 in 2006. In 1994, the majority of STIs seen in the clinic were bacterial (53%, 95% confidence interval [CI] 50% to 57%); however, this proportion had dropped in 2006 (28%, 95% CI: 19% to 38%). There was a proportional increase in viral STIs during the same time period. Although women attending the clinic were younger than men, they were more likely to be married. The overall seropositivity for HIV was 28%. Viral STIs were more likely to be associated with HIV than bacterial infections (odds ratio: 1.5, 95% CI: 1.2 to 1.9). CONCLUSIONS: Viral infections were the most common STIs in recent years in a tertiary care center in Mumbai. HIV prevalence was high in this population. Thus, these clinical data suggest that STI patients were and continue to be an important group for HIV prevention in the country.

Control of blinding eye diseases in leprosy: strategies for India.

Over half of the people affected by leprosy worldwide are in India, many of whom are severely disabled when they present for care. Changes in policy and the integration of the leprosy programme with general health services has given rise to new challenges for the control of blinding eye disease in leprosy patients. This paper looks at the challenges posed: management, materials, manpower, money, and mobility--all of which are common barriers to the availability, access, and utilization of services--and to monitoring existing programmes. We consider strategies to overcome these challenges and fulfill the goal of VISION 2020--eliminating avoidable blindness--through the provision of comprehensive eye care and strengthening the existing infrastructure. Formal cooperation between national governments, non-governmental organisations, and International Development Agencies will need to continue, although possibly, in different roles and with plans modified to be relevant to the local needs of leprosy patients.

[Summary of questionnaires on slit skin smear test in clinics, hospitals, and university hospitals].

We have performed a questionnaire to survey the present conditions of the slit skin smear test, a method to diagnose leprosy. The answer was obtained from 40 (93.0%) out of 43 clinics, department of dermatology of university and other hospitals and leprosy sanatoriums. Slit skin smear test was carried out in most institutions. However, when inspection frequency was low, a laboratory technician performed Ziehl-Neelsen staining or its variation using a normal slide glass. A few institutions carried out fluorescence staining. Both physician and technician examined the slides in most cases, however, in more than half of the leprosy sanatoriums, technician was the only person examined. Bacterial index was evaluated in most institutions, while only for the presence of bacteria was examined 5 institutions. Slit skin smear test is simple and easy, but accuracy is different with skills, glass slides to be used and methods for staining and inspection. Supply of the glass slide with a marker, the spread of staining methods, technical improvement of an inspection are demanded in future.

Increased prevalence of human T cell lymphotropic virus type 1 in patients attending a Brazilian dermatology clinic.

Brazil may have the highest absolute number of individuals infected by human T cell lymphotropic virus type 1 (HTLV-1). It has been suggested that the prevalence of HTLV-1 is increased in patients with skin diseases. This study shows a higher prevalence of this infection in 1,229 patients attending a Brazilian dermatology clinic (0.7%) when compared to blood donors (0.22%). Of note, one additional patient tested positive for HTLV-2. The main skin diseases described in HTLV-1 seropositives were vitiligo (2 cases), dermatophytosis (2 cases), and leprosy (2 cases). A 23-year-old woman received a diagnosis of infectious dermatitis.