Profile of dermatology inpatients and admissions over a four year period in a tertiary level government teaching hospital in North India.

BACKGROUND: Although dermatology is mostly an outpatient specialty, some patients with severe skin disease need hospital admission for management. There is a paucity of data regarding the profile of these dermatology in-patient admissions. AIMS: We studied the profile of patients admitted to the dermatology ward of our tertiary care government hospital in North India. METHODS: This was a retrospective analysis of discharge sheets of patients admitted in the dermatology ward from January 1, 2014 to December 31, 2017. RESULTS: Discharge sheets of 2032 admissions for 1664 patients were analyzed. The most common diagnoses in the admitted patients were immunobullous disorders (576, 28%), connective tissue diseases (409, 20%), infections, including leprosy and sexually transmitted infections (179, 8.8%), psoriasis (153, 7.5%) and reactive arthritis (92, 4.5%). The mean duration of admission was 13.95±11.67 days (range 1-118 days). Two hundred and fifty-six patients (15.38%) were re-admitted, accounting for 368 (18.11%) re-admissions. Patients with immunobullous disorders (OR 1.72, 95% CI 1.29-2.28) and psoriasis (OR 1.62, 95% CI 1.02-2.55) were more likely to be re-admitted. Adult patients, those who were admitted for more than four weeks, those who had comorbidities, and those who developed a complication during the hospital stay also had a greater likelihood of being re-admitted. LIMITATIONS: The retrospective design of the study, and the non-availability of data regarding transfers to other specialties or intensive care units and deaths were the main limitations of this study. CONCLUSION: This study describes the profile of patients admitted in a dermatology ward of a tertiary care centre center in North India. The patient profile and admission characteristics associated with a higher probability of re-admission were identified.

Colônia Santa Marta e a reintegração social dos ex-internos em Goias / Colony santa marta and the social reintegration of ex-interns in Goias

Analisa o problema da reintegração social dos ex-internos da Colônia Santa Marta em Goiânia, diante do processo de readequação dos antigos leprosários. A cura da doença e o fim da exigência de isolamento dos atingidos pela hanseníase também compõem esta análise. No entanto, o estudo está centrado no processo de constituição de uma política de assistência médica específica e de reintegração social dos ex-internos e os resultados do afastamento social e familiar a que eles estiveram obrigados durante o período de internamento

Stability of vocational interests after recent spinal cord injury.

OBJECTIVE: We sought to identify the stability of vocational interests among persons with spinal cord injury (SCI) first assessed during inpatient rehabilitation. DESIGN: Initial assessments were completed during inpatient rehabilitation an average of 50 days after SCI onset (n = 521). Follow-up measures, collected by mail, were obtained an average of 16.6 months postinjury (n = 190) and 29.1 months postinjury (n = 296). Participants (n = 135) completed all 3 assessments. Participants completed the 1994 Strong Interest Inventory (Campbell, 1971; Harmon, Hansen, Borgen, & Hammer, 1994), Form T317, a 317-item measure of vocational interests. RESULTS: Comparison of scale means across 3 times of measurement indicated significant changes in 2 of 6 general occupational themes (GOT), 8 basic interest scales (BIS), and 2 special scales (leadership style, risk taking/adventure). With 1 exception, a linear trend indicating an increase in reported interests accounted for observed relationships. An age by time interaction occurred with 1 GOT and 3 BIS. The average stability coefficient was 0.61 for the GOT, 0.59 for the BIS, and 0.70 for the special scales. The average coefficients were somewhat lower for the oldest participants. CONCLUSION: Interests do not appear to be static when first measured during inpatient rehabilitation after SCI. Rather, they evolve with average increases on select themes more compatible with the limitations of SCI. Stability coefficients suggest that interests are likely to change more than indicated in earlier studies.

Nursing interventions to manage anxiety levels of female inpatients admitted first time in a leprosy hospital.

Leprosy causes not just physical disabilities but mental and psycho social problems which are further more enhanced in women due to their submissive and secondary role in an Indian culture. This is reflected in their reluctance and delay in seeking hospitalization and generates great anxiety while admitted as inpatients. Appropriate nursing care can relieve much anxiety and help in faster healing. This paper presents the findings from such research carried out at a leprosy referral hospitalin north India. Adult female leprosy patients newly admitted for the first time in a leprosy referral hospital were interviewed in depth using Hamilton Anxiety Rating Scale and observed before and after implementing a customized nursing care plan. On admission, out of 40 women admitted more than 80% showed moderate or severe anxiety. After well planned nursing interventions only 2 continued to have severe anxiety, and a majority in all age groups showed significant reductions in anxiety levels, and responded well to leprosy care at the hospital. Well planned nursing care reduces or minimizes anxiety levels of female leprosy patients admitted first time in the hospital, and should become a standard practice in all hospital admissions.

Factors influencing physical activity in institutionalized elderly patients with leprosy.

PURPOSE: The nursing literature has devoted little attention to the long-term influence of infectious diseases and the subsequent rehabilitation needs of the affected patients. This study was conducted to identify the factors associated with physical activity (PA) in older institutionalized adults with leprosy. METHOD: A cross-sectional research design was used. RESULTS: Data from 248 subjects (75.28 ± 8.64 years old) were analyzed. We found that fewer subjects in PA compared to older adults in general. Amputation, fear of falling (FF), the ability to perform activities of daily living, and instrumental activities of daily living (IADL) were the influencing factors of PA. Doing laundry, preparing a meal, taking medicines, and making telephone calls accounted for 23.4% of the PA variance. CONCLUSION: We suggest incorporating FF in the psychosocial indicators of the mobility assessment. The importance of promoting or maintaining four specific IADL abilities and participating in PA for leprosy patients living in a sanatorium is emphasized.

Dapsone hypersensitivity syndrome in non-leprosy patients: a retrospective study of its incidence in a tertiary referral center in Taiwan.

BACKGROUND: Dapsone hypersensitivity syndrome (DHS) is a potentially life-threatening adverse drug reaction consisting of fever, hepatitis, exfoliative dermatitis, lymphadenopathy and hemolytic anemia. The incidence of DHS is estimated to be 2% in leprosy patients. Because the incidence of this drug eruption may be different in different ethnicities and diseases, we thought to investigate the incidence of DHS in non-leprosy patients. METHODS: This is a retrospective study to examine the incidence, clinical manifestations and prognosis of DHS in non-leprosy patients who were given dapsone at the National Taiwan University Hospital between June 2001 and December 2005. RESULTS: The incidence of DHS among non-leprosy patients was 1.66%. These patients ran a relatively benign course as compared with leprosy patients. CONCLUSION: The incidence of DHS among non-leprosy patients was compatible to that observed among leprosy patients. DHS in non-leprosy patients runs a favorable course with low morbidity in our study.

A loucura herda um espaço deixado pela lepra: framentos de história oral com os pacientes-moradores do Hospital Colônia Itapuä / Insanity inherits a space left by leprosy: fragments of oral stories about the patients residing at Hospital Colônia Itapuä

Procura dar início a uma apreciaçäo mais detalhada a respeito do conflito entre os portadores de hanseníase, antigos moradores do Hospital Colônia Itapuä, e os seus novos vizinhos, os pacientes psiquiátricos, tema abordado na tese de Mestrado da autora.(AU)

Hanseníase no estado do Pará: perfil epidemiológico da população que demanda interação por reações hansênicas / Leprosy state of the Pará: profile epidemiological population with demand stay reactions leprosy

Hanseníase persiste, até o momento, como problema de saúde pública. No Estado do Pará é hiperendêmica. O objetivo principal deste estudo foi descrever e analisar o perfil epidemiológico de 270 pacientes internados por reação hansênica em um Hospital Universitário, no período de 1992 a 1999, num total de 477 admissões. As variáveis apontaram como de maior freqüência o sexo masculino (73 por cento), idade mediana de 32 anos, categoria solteiro (60,2 por cento), estudante (20,7 por cento), procedência da capital do Estado (51,1 por cento). As internações por reação aconteceram em 94,5 por cento durante a quimioterapia. A RR ocorreu em 4 por cento, sendo prevalentes o ENH (93,7 por cento) e a forma Virchowiana (90,5 por cento). Houve predominância na ocorrência de 1 a 3 episódios (83 por cento). Os indicadores hospitalares das reações revelaram o tipo de alta melhorado (97,3 por cento), freqüência de necrópsias (20 por cento), motivo de alta por conduta médica com recomendação de complementação de tratamento ambulatorial (56,5 por cento), tempo de permanência mediano de 13 dias, motivo de permanência maior vinculada à evolução própria da patología (93,4 por cento). O tratamento clínico foi indicado em 96,4 por cento das internações , sendo 3,6 dos pacientes admitidos à cirurgia.

Aspectos de la enfermedad de Hansen en pacientes internados en un hospital general

Presentamos una revisión, realizada por el Servicio de Dermatología del Hospital Nacional en el período comprendido entre marzo de 1993 y 1998, sobre 30 pacientes con diagnóstico de Hansen, internados por motivos diferentes, para lo cual hemos clasificado en 5 grupos principalmente, lo que nos permitió conocer algunos aspectos interesantes de estos pacientes: los dignósticos deferenciales que se plantearon, la intensidad de los episódios reaccionales con manifestaciones sistémicas. Otros grupos son: el de las complicaciones y el de las intercurrencias clínicas. La mayor parte de estos paceintes corresponden a la forma lepromatosa. En dicho período se registraron en un total 120 pacientes con Hansen en el Servicio de Dermatología, representando los internados el 25% del total. En 20 casos el diagnóstico se determinó en el momento de la internación, siendo importante que los médicos de planta y urgencias estén precavidos en los países endémicos sobre dicho diagnóstico. En todos los casos se realizó en base a parámetros clínicos, bacteriológicos e histológicos.

Association between leprosy and hepatitis B infection: a survey in Goiânia, central Brazil

This investigation presents the results of hepatitis B virus screening among leprosy patients conducted in central Brazil as a preliminary information for a HBV vaccination programme. The main objectives were to assess the seroprevalence of HBV serum markers among lepromatous patients and to analyse institutionalization as risk factor for HBV infection in this population. Two groups of lepromatous patients were studied, 83 outpatients and 171 institutionalized ones. Screening for HBV serum markers included the detection of HBsAg, anti-HBc by radioimmune assay (RIA). The prevalence of carrier state (HBsAg) was 4.8% and 8.8% among outpatients and institutionalized, respectively, (p > 0.05). Seroprevalence of exposure (all markers) was statistically significant different between outpatients (16.9%) and institutionalized ones (50.3%). Institutionalized patients had an almost four fold risk of HBV infection when compared to the outpatients, and the highest risks were among patients with more than 21 years of residence in the colony, after adjusting for age and sex

Association between leprosy and hepatitis B infection. A survey in Goiânia, central Brazil.

This investigation presents the results of hepatitis B virus screening among leprosy patients conducted in central Brazil as a preliminary information for a HBV vaccination programme. The main objectives were to assess the seroprevalence of HBV serum markers among lepromatous patients and to analyse institutionalization as risk factor for HBV infection in this population. Two groups of lepromatous patients were studied, 83 outpatients and 171 institutionalized ones. Screening for HBV serum markers included the detection of HBsAg, anti-HBc by radioimmune assay (RIA). The prevalence of carrier state (HBsAg) was 4.8% and 8.8% among outpatients and institutionalized, respectively, (p > 0.05). Seroprevalence of exposure (all markers) was statistically significant different between outpatients (16.9%) and institutionalized ones (50.3%). Institutionalized patients had an almost four fold risk of HBV infection when compared to the outpatients, and the highest risks were among patients with more than 21 years of residence in the colony, after adjusting for age and sex.

O trabalho cotidiano com a AIDS: as representaçöes dos profissionais em uma unidade hospitalar. Relatório da etapa I: a situaçäo dos profissionais e a problematizaçäo da AIDS / The quotidian work with the AIDS: professional representations in a hospital unit. Report of the first stage: the professional/situation and the AIDS problematic

Relata os resultados do estudo realizado em 1991, no Hospital Emílio Ribas, com a caracterizaçäo do perfil dos profissionais, sua situaçäo de trabalho e a repercussäo da AIDS no trabalho cotidiano; o estudo abrange 227 (97 por cento do total) dos trabalhadores, de todos os grupos ocupacionais, que atuavam diretamente com os pacientes. Alguns resultados confirmaram tendências observadas em outros estudos: a majoritária participaçäo feminina no trabalho; grande capacidade produtiva da força de trabalho de jovem com média de 38 anos; a maioria com jornada completa e com situaçäo salarial bastante defasada do mercado de trabalho. Observa-se dois pólos em relaçäo à escolaridade: 48,5 por cento dos profissionais tinham nível universitário e 34 por cento apresentava até o 1 grau completo. Há uma variedade de crenças religiosas adotadas pelos profissionais, e chama a atençäo a proporçäo elevada de crenças espiritualistas em relaçäo à populaçäo em geral. Os profissionais referem ter recebido orientaçöes ou treinamentos para o desenvolvimento de suas funçöes, com conteúdo fundamentalmente técnico operacional. Säo relatadas dificuldades estruturais de trabalho na instituiçäo, dentre elas, falta de recursos materiais e humanos, má organizaçäo e gerenciamento, baixos salários, carga horária excessiva, falta de apoio psicológico, etc..Neste quadro, os pacientes de AIDS têm sido considerados pelos profissionais como portadores de um comportamento näo adequado (pacientes "agressivos", "näo cooperativos"...). Acredita-se que sem uma intervençäo específica, além do aparecimento e legitimaçäo de um novo estigma em relaçäo a estes pacientes, os profissionais continuaräo sobrecarregados, enfrentando uma jornada de trabalho "penosa", dolorosa para ambos, pacientes e profissionais de saúde.

[Epidemiological immunological studies on leprosy in Okinawa. 6. Lepromin, lymphocyte transformation, FLA-ABS and leproagglutination tests in the in-and out-patients with leprosy and the relationships among these tests and personal or family history or clinical findings of the patients].

In- and out-patients with leprosy in Okinawa were surveyed by using the following immunological tests: cutaneous reaction to Mitsuda's lepromin (40 million bacilli/ml) (LPR), lymphocyte transformation test with Dharmendara's antigen (DL-LTT), that with phytohemagglutinin (PHA-LTT), fluorescent leprosy antibody absorption test (FLA-ABS) and Leproagglutination test with cardiolipin-lecithin antigen (LAT). A correlation between two tests and a relationship between the test and personal or family history or clinical finding of the patients were evaluated by non-parametric statistics. Spearman's rank correlation coefficient was significant between LPR and DL-LTT, while a reverse correlation was found between LPR and FLA-ABS, DL-LTT and FLA-ABS, and DL-LTT and LAT, respectively. High reactivity in PHA-LTT was found in almost all of patients, irrespective of type and stage of leprosy, suggesting general immune responsiveness of leprosy patients in Okinawa. The other tests showed a significant difference in the mean rank of reaction values according to clinical findings such as type and stage of leprosy, property of skin lesion, loss of eyebrow, and bacteriological test. The use of LPR and DL-LTT for the study of cell-mediated immunity in leprosy was therefore confirmed. FLA-ABS was found useful for early serodiagnosis, while LAT for the study of autoimmunity in leprosy. None of these immunological tests showed significant difference among the subgroups of patients classified by the following items: presence or absence of consanguineous patient with leprosy, living place, place of onset, presence or absence of neural symptoms such as the enlargement of peripheral nerve, claw hand and facial palsy, ocular and nasal involvement, ENL in lepromatous and borderline leprosy and conditions in the treatment. On the other hand, LPR showed higher reactivity in female than in male, in the patients at home than those discharged, and in the patients with drop foot than those without. Higher reactivity of DL-LTT was also found in male than in female and in the patients with plantar ulcer than those without. FLA-ABS reactivity was significantly higher in the discharged patients than the inpatients, in the period of 5 to 9 years after onset than that of 20 or more years, but the reactivity was lower in the patients with drop foot than those without. LAT reactivity was significantly higher in the 30-39 years old patients than 0-19 years old, and in the patients with physical work than those with mental.(ABSTRACT TRUNCATED AT 400 WORDS)

A study of dermatological conditions in leprosy in-patients.

Three hundred and sixty six in-patients in a leprosy hospital were examined for other dermatological conditions. Eighty eight of them displayed ichthyosiform changes. A peculiar condition of a verrucous hyperkeratotic growth on the anterior aspect of ankle, not described previously, was observed in four patients. It was noted that 11 out of 12 patients with scabies did not have the classical lesions in web spaces of the hands.

Levantamento de incapacidades em pacientes hansenianos do município de Catanduva, SP-1986: condiçöes de atendimento para sua prevençäo nos treze municípios abrangidos pelo Escritório Regional da Saúde de Catanduva ERSA - 30 / Survey of the disability in leprosy patients of the Catanduva urban community, SP-1986: care conditions for the prevention in 13 urban communities included in ERSA-30

Foram examinados, durante o ano de 1986, no Centro de Saúde I "Dr. José Perri" de Catanduva - SP, 190 hansenianos (85,7% do total de pacientes registrados) com o propósito de se avaliar a presença e o grau de incapacidade física. Os pacientes eram de ambos os sexos, com ligeiro predomínio para os homens (57,9%), com idade variando de 9 a 90 anos (média de 50,7% ñ 16,8 anos e mediana de 51,5 anos). Todos os pacientes foram submetidos a um questionário elaborado para este fim e tiveram sua incapacidade física avaliada, e o índice de incapacidade calculado segundo o modelo da OMS de 1969, proposto por BECHELLI & MARTINEZ DOMINGUEZ. As 13 Unidades Sanitárias pertencentes ao ERSA-30 foram avaliadas com o propósito de se levantar os recursos existentes, na atualidade, voltados para as medidas de prevençäo de incapacidades físicas e de reabilitaçäo do paciente hanseniano. A incapacidade física foi relacionada com as variáveis como sexo, forma clínica, idade, grau de instruçäo, renda mensal, tipo de trabalho, tempo de evoluçäo e de tratamento da doença, intervalo de tempo entre o início da doença e o início do tratamento e presença de reaçäo, e submetidas à análise estatística pelo método do qui-quadrado. O teste de significância de Fischer foi utilizado para análise do coeficiente de correlaçäo de Person. 69,5% dos pacientes apresentaram algum grau de incapacidade. Consideradas somente as lesöes de mäos e pés, esta proporçäo foi de 53,7%. A grande proporçäo de pacientes com comprometimento ocular (47,9%) deveu-se, principalmente, a patologias que aparentemente näo se relacionam com a hanseníase, fazendo com que o índice de incapacidade também fosse calculado considerando-se somente as lesöes dos membros (mäos e pés). As diferenças encontradas entre os sexos-maior proporçäo para as mulheres, com avaliaçäo ocular e maior para os homens, sem avaliaçäo ocular - näo foram estatisticamente significantes...

Aspectos da assistência de enfermagem na hanseníase: prevençäo da úlcera plantar / Aspects of nursing care in hanseniasis: prevention of plantar ulcer

Foram estudados 206 pacientes hansenianos com anestesia plantar internados em hospital, a fim de verificar as variáveis que influenciam na ocorrência da úlcera plantar. A coleta de dados foi realizada mediante entrevista com preenchimento de formulário específico. Os resultados submetidos a tratamento estatístico, demonstraram que o sexo, a idade, a escolaridade, a ocupaçäo e o tempo de anestesia plantar näo interferem na ocorrência da úlcera plantar. Acreditando-se no real valor preventivo das técnicas simples, fez-se um levantamento do conhecimento e da prática dessas técnicas nos pacientes com ou sem úlcera plantar. Verificou-se que os pacientes hansenianos com pé anestésico sem úlcera plantar, conhecem e praticam mais as técnicas simples de prevençäo do que aqueles que têm úlcera plantar