Levantamento de dados para estudo dos fatores associados à falha terapêutica em hanseníase / Data collection to study the factors associated with failure leprosy therapy

A Hanseníase é uma doença infectocontagiosa de caráter crônico, evolução lenta, causada pelo Mycobacterium leprae (M. leprae). A transmissão ocorre por meio do trato respiratório, e para o desenvolvimento da doença existe a necessidade da susceptibilidade, além do contato íntimo e prolongado. Para fins terapêuticos a Organização Mundial da Saúde (OMS) traz uma classificação mais simples que é baseada no número de lesões cutâneas. Os casos com até cinco lesões são considerados paucibacilares e aqueles com mais de cinco lesões são multibacilares. Apesar da implantação da poliquimioterapia (PQT) pela OMS ter sido um importante avanço técnico na história do controle da doença, em 2019 ainda foram notificados 202.185 novos casos no mundo, sendo o Brasil o segundo em concentração de casos. Um indicador importante para o controle da hanseníase são as taxas de retratamento, definido como nova notificação de hanseníase em paciente que já tenha recebido tratamento anterior, suas causas incluem abandono, insuficiência terapêutica, falência terapêutica, alteração de esquema por erro diagnóstico e recidiva. Embora um grande número de casos de recidivas seja detectado no Brasil, apenas 8,4%, 13,3% e 1,9% dos casos podem ser explicados por mutações que sabidamente conferem resistência bacilar aos medicamentos utilizados na PQT: rifampicina (RFP), dapsona (DDS) e ofloxacina (OFLO), respectivamente. Além dos aspectos relacionados ao patógeno, a contribuição do hospedeiro para esse cenário, apesar de pouco estudada, deve ser de grande importância. No geral a resposta ao medicamento é variável entre indivíduos, ocasionando falta de eficácia farmacológica ou reação adversas, em partes esses eventos podem ser explicados pela farmacogenética. Conhecer fatores genéticos que interferem no metabolismo dos medicamentos pode contribuir para melhores resultados terapêuticos. Dentre os desafios para atingir a eliminação da hanseníase estão a ausência de novas ferramentas de diagnóstico e de entendimento das causas associadas a recidiva e à não adesão a PQT, uma vez que a resistência medicamentosa explica pouco da reativação da doença, deste modo, o presente estudo teve como finalidade constituir banco de dados em hanseníase para estudos de associação do tipo caso-controle sobre os fatores associados com a falha terapêutica da PQT convencional. Dos 240 prontuários avaliados, 119 foram classificados como casos de falência terapêutica ou recidiva e 121 como sucesso terapêutico, aqui denominados como controles, a maioria dos pacientes era do sexo masculino, branco e procedente do estado de São Paulo; Em relação à faixa etária de diagnóstico, 18% foram diagnosticados com idade entre 40 e 49 anos, enquanto nos controles 14% tiveram diagnóstico com idade inferior a 19 anos; quanto à forma clínica da doença, 59% dos casos e 47% dos controles foram classificados como virchoviano. Dentre os casos de falência terapêutica ou recidiva, a resistência molecular explicou apenas 5,8 % dos casos de retratamento. Esse dado reforça a urgência de estudos que esclareçam as causas da falha terapêutica em hanseníase, contribuindo assim para o estabelecimento de medidas que visem o alcance de melhores índices relacionados aos desfechos terapêuticos.(AU)

Leprosy is a chronic infectious disease with insidious evolution, caused by Mycobacterium leprae (M. leprae). Transmission occurs through the respiratory tract, and the onset of the disease depends on susceptibility, in addition to intimate and prolonged contact with untreated patients. For therapeutic purposes, the World Health Organization's (WHO) classification is based on the number of skin lesions. Cases with up to five lesions are considered paucibacillary and those with more than five lesion are multibacillary. Although the implementation of multidrugtherapy (MDT) by WHO was an important technical advance in the history of disease control. In 2019, 202,185 new cases were reported in the world, with Brazil the second in the highest number of cases. An important indicator for the control of leprosy is retreatment rate, defined as a new notification of leprosy in a patient who has already received previous treatment. Its causes include abandonment, therapeutic failure, , alteration of the regimen due to diagnostic error and relapse. Although a large number of cases of relapses are detected in Brazil, only 8.4%, 13.3% and 1.9% of cases can be explained by mutations that are known to confer bacillary resistance to drugs used in the MDT: rifampicin (RFP), dapsone (DDS) and ofloxacin (OFLO), respectively. In addition to aspects related to the pathogen, the host's contribution to this scenario, although little studied, is highly important. In general, the response to the drug treatment is variable between individuals, causing a lack of pharmacological efficacy or adverse reactions. , These events may be explained by pharmacogenetics. Knowing genetic factors that interfere with drug metabolism can contribute to better therapeutic results. Among the challenges to achieve leprosy elimination are the absence of new diagnostic tools and understanding of the causes associated with relapse and non-adherence to MDT, since drug resistance explains little about the reactivation of the disease. Thus, the present study aimed at constituting a leprosy database for case-control association studies on factors associated with conventional MDT therapeutic failure. Of the 240 medical records evaluated, 119 were classified as cases of therapeutic failure or relapse and 121 as therapeutic success, here referred to as controls. The majority of patients were male, white and from the state of São Paulo. Regarding the age of diagnosis, 18% were diagnosed between 40 and 49 years, while in controls, 14% were diagnosed under 19 years; as to the clinical form of the disease, 59% of the cases and 47% of the controls were classified as lepromatous. Among the cases of therapeutic failure or relapse, molecular resistance explained only 5.8% of retreatment cases. This data reinforces the urgency of studies that clarify the causes of therapeutic failure in leprosy, thus contributing to the establishment of measures aimed at achieving better therapeutic outcomes(AU).

Análise do perfil clínico-epidemiológico e sociodemográfico de pacientes com hanseníase diagnosticados no Instituto Lauro de Souza Lima entre 2015 e 2019 / Analysis of the clinical-epidemiological and sociodemographic profile of leprosy patients diagnosed at the Lauro de Souza Lima Institute between 2015 and 2019

INTRODUÇÃO: A hanseníase causada pelo Mycobacterium leprae acomete a pele e os nervos periféricos e gerar graves sequelas. O Brasil apresenta alto índice de prevalência e incidência com o segundo maior número de casos da doença no mundo. Conhecer o perfil dos pacientes é fundamental para melhorar o atendimento e traçar políticas de controle da doença. OBJETIVOS: Identificar aspectos clínico-epidemiológicos e sociodemográficos de casos novos de hanseníase diagnosticados no Instituto Lauro de Souza Lima (ILSL) (Bauru-SP) no período de 2015 a 2019. MÉTODOS: Estudo epidemiológico transversal retrospectivo a partir de dados secundários obtidos de prontuários médicos. RESULTADOS: Foram diagnosticados 177 novos casos de hanseníase, sendo 38,4% dos pacientes naturais de outros estados. A maioria da população era do sexo masculino (59,9%), a faixa etária mais prevalente foi de 60 a 74 anos (29,9%), 79,1% pertenciam à raça branca e 65,6% possuíam pouca ou nenhuma escolaridade. A forma clínica dimorfa foi a mais frequente (42,4%), a baciloscopia foi positiva em 38,4% dos pacientes (49,0% entre os homens e 22,5% entre as mulheres) e 56,9% possuíam incapacidades no diagnóstico. A maioria dos pacientes do município de Bauru (n=31) era originária de regiões com elevado nível de vulnerabilidade social. CONCLUSÃO: O perfil dos pacientes atendidos aponta para predominância de homens maduros com baixa escolaridade, multibacilares já com incapacidades, sugerindo uma endemia oculta que pode sustentar a manutenção da hanseníase. Políticas públicas voltadas para essa faixa populacional devem ser consideradas a redução da carga da hanseníase no estado de São Paulo.(AU)

INTRODUCTION: Leprosy is an infectious disease caused by Mycobacterium leprae that affects the skin and peripheral nerves and can result in severe sequelae. Brazil has high prevalence and incidence rates of leprosy, being the second country with highest number of leprosy cases in the world. To know the profile of leprosy patients is essential to improve care and design policies in order to control the disease. OBJECTIVES: To identify clinical, epidemiological and sociodemographic aspects of new cases of leprosy diagnosed at the Lauro de Souza Lima Institute (ILSL)/SES-SP from 2015 to 2019. METHODS: A retrospective cross-sectional epidemiological study based on secondary data obtained from medical records. RESULTS: 177 new cases of leprosy were diagnosed at ILSL, with 38.4% patients born in other states. The majority of the population was male (59.9%), the most prevalent age group was 60 to 74 years old (29.9%), 79.1% belonged to the white race and 65.6% had little or none schooling. The dimorphic clinical form was the most frequent (42.4%), slit skin smear was positive in 38.4% of patients (49.0% among men and 22.5% among women) and 56.9% had disabilities at diagnosis. In the municipality of Bauru, most cases were from regions with a high level of social vulnerability. CONCLUSION: The profile of patients points to a predominance of mature men with low education, multibacillary and showing disabilities, suggesting a hidden endemic that can support the maintenance of leprosy. Public policies aimed at this group of the population must be considered for the reduction of leprosy burden in the state of São Paulo

Epidemiological situation of leprosy in a province in China: a long time to diagnosis and a high rate of deformity.

BACKGROUND: This epidemiological study aimed to analyse both the distribution and characteristics of leprosy in an endemic province in Northwest China. METHODS: The medical records of leprosy patients in the province of Shaanxi, China, from 1998 to 2018 were collected from the Chinese Leprosy Management Information System (LEPMIS). Epidemiological variables were analysed in this study. RESULTS: A total of 477 new cases were diagnosed between 1998 and 2018 in this region. The average annual detection rate was 0.070/100,000 population, and the average annual prevalence was 0.305/100,000 population. The mean age of the newly diagnosed patients was 46.7 years, and the ratio of males to females was 2.5:1. There were 399 cases (83.6%) of multibacillary (MB) leprosy. One hundred forty-eight patients (31.0%) had grade 2 disability. The mean diagnosis time for new cases was 62.0 months. CONCLUSION: This epidemiological study showed that the characteristics of newly diagnosed leprosy cases in our province were a long time to diagnosis and a high rate of deformity, indicating the need for actions focusing on early diagnosis and treatment and strengthening the detection of leprosy in low-prevalence areas.

Disabilities in leprosy: an open, retrospective analyses of institutional records

Abstract Background and objectives: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. Material and methods: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. Results: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. Limitation of study: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. Conclusion: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.

Disabilities in leprosy: an open, retrospective analyses of institutional records.

BACKGROUND AND OBJECTIVES: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. MATERIAL AND METHODS: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. RESULTS: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. LIMITATION OF STUDY: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. CONCLUSION: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.

The reliability of information records in the Health Information System: surveillance of intra-domiciliary leprosy contacts / confiabilidade dos registros de informações no Sistema de Informação em Saúde: vigilância de contatos intradomiciliares de hanseníase / La confiabilidad de los registros de las informaciones en sistema de Información en Salud: vigilancia de los contactos intradomiciliares de hanseniase

The objective of this study was to compare intra-domiciliary contacts (IDCs) in the Health Information System (SIS) with records of people diagnosed with leprosy. This was a cross-sectional, retrospective, and quantitative study based on the physical information collected in medical records and the SIS records in 2015 and 2016, in a municipality in the countryside of the State of São Paulo. We used an instrument with variables related to IDCs such as gender, age, relationship, disease, BCG-ID vaccine, SIS records, and descriptive analysis. Out of the 81 IDCs from 40 diagnosed patients, 72 were evaluated, and 71 were included in the SIS. One IDC became ill after the end of treatment of the index case. The prevalent gender among IDCs was female, young adults, and children. A difference of 12.4% as observed between the physical and SIS records; a difference of 11.1% was observed when correlating 81 records with the frequency of the 72 evaluated IDCs. It is concluded that the IDC and SIS records are in disagreement.

O objetivo deste estudo foi comparar os contatos intradomiciliares (CIs) do Sistema de Informação em Saúde (SIS) com os registros de pessoas diagnosticadas com hanseníase. Estudo transversal, retrospectivo e quantitativo, baseado nas informações coletadas em registros físicos e do SIS em 2015 e 2016, em um município do interior do Estado de São Paulo. Foi utilizado um instrumento com variáveis relacionadas aos CIs: sexo, idade, relacionamento, doença, vacina BCG-ID, registros SIS e análise descritiva. Dos 81 CIs de 40 pacientes diagnosticados, 72 foram avaliados e 71 foram incluídos no SIS. 01 CIs adoeceu após o término do tratamento do caso índice. O sexo prevalente dos CIs é feminino, adulto jovem e filho. Entre os registros físicos e do SIS, houve uma diferença de 12,4%; e correlacionando os mesmos registros (81) com a frequência dos CIs avaliados (72), há uma diferença de 11,1%. Conclui-se que existe discordância entre os registos de CIs nos registos com o SIS.

El estudio tiene el objetivo de comparar las anotaciones de comunicantes intradomiciliares (CI) del Sistema de Información en Salud (SIS), con las de los prontuarios de las personas diagnosticadas con leprae. En el presente trabajo se analizaron los resultados obtenidos en el análisis de los resultados obtenidos en el análisis de los resultados obtenidos, evaluados en los registros del SIS. De los 81 CI de 40 pacientes diagnosticados, 72 fueron evaluados y 71 fueron incluidos en el SIS. Y en el caso de las mujeres, El grado de parentesco frecuente fue infantil, mujeres y adultos jóvenes. Entre las anotaciones del SIS y los prontuarios, hay diferencia del 12,4%; y correlacionando los mismos registros (81) con la frecuencia de los CI evaluados (72), hay una diferencia del 11,1%. Se concluye que hay discordancia entre los registros de CI en los prontuarios con el SIS.

Tratamento da úlcera plantar devido à hanseníase / Treatment of leprosy-induced plantar ulcers

Introdução: A úlcera plantar por hanseníase é uma lesão no pé resultante da falta de sensibilidade plantar. O objetivo é descrever o tratamento realizado em portadores de úlceras plantares por hanseníase. Métodos: Estudo de prontuários de portadores de úlcera plantar atendidos no Hospital Sarah em Brasília, de 2006 a 2016, quanto ao sexo, idade, etiologia, localização e tratamento. Resultados: Foram atendidos 27 pacientes, 17(62,96%) homens e 10 (37,04%) mulheres, procedentes de Goiás e DF, na faixa etária de 41 a 60 anos (40,74%). Todos necessitaram de um ou mais procedimentos cirúrgicos. Conclusão: Observou-se maior frequência no sexo masculino, grau avançado, localizadas no primeiro artelho. Todos necessitaram de procedimentos cirúrgicos e não cirúrgicos, evoluindo com cicatrização completa da ferida, amputação transtibial em um caso e de artelhos em sete casos, e 90% dos casos apresentaram recorrência da úlcera após um ano.

Introduction: Leprosy-induced plantar ulcers result from a lack of plantar sensitivity. Objective: This study aimed to describe the treatment provided to patients with leprosy-induced plantar ulcers. Methods: We retrospectively reviewed the medical records of patients with plantar ulcers treated at Sarah Hospital in Brasilia from 2006 to 2016 and collected information about sex, age, etiology, location, and treatment. Results: A total of 27 patients (17 [62.96%] men, 10 [37.04%] women; 40.74% were aged 41­60 years) were treated from Goiás and the Federal District. All required ≥1 surgical procedure. Conclusion: A higher frequency of advanced grade was observed in men, primarily on the first toe. All needed surgical and non-surgical procedures and achieved complete wound healing. Transtibial amputation was required in 1 case and toe amputation in 7 cases; 90% patients developed ulcer recurrence after 1 year.

Alternate Anti-Leprosy Regimen for Multidrug Therapy Refractory Leprosy: A Retrospective Study from a Tertiary Care Center in North India.

A subset of multibacillary (MB) leprosy patients manifest with clinical "nonresponsiveness" to the fixed-duration, World Health Organization multidrug therapy MB regimen (WHO-MDT-MBR). The aim of this retrospective study was to assess the effectiveness and safety of alternate anti-leprosy therapy (ALT) in such patients. This is an analysis of patients' records, registered in the leprosy clinic of our institute over a period of 6 years (2010-2015). The criteria for inadequate response/nonresponsiveness to treatment were as follows: 1) persistent/new lesions after completing ≥ 12 months of WHO-MDT-MBR (isolated reactions were ruled out histopathologically) and 2) persistent positive/increasing value of the morphological index (MI) and a 2 log increase in the bacteriological index (BI) after ≥ 12 months of WHO-MDT-MBR. Such cases were treated with ALT consisting of minocycline, clofazimine, and ofloxacin (24 months). Of 556 patients registered during the study period, 40.3% (224) were slit-skin smear (SSS) positive and 59.7% (332) were SSS negative. Of all, 35 patients (6.3%) satisfied the criteria for clinical nonresponsiveness. Of 224 SSS-positive patients, these 35 patients amounted to 15.6%. The mean BI and MI of these patients after completion of ≥ 12 months of WHO-MDT-MBR were 5.3 ± 0.6 and 14 ± 6.8%, respectively. After 6 months of treatment with ALT, MI became negative (0) in all these patients. After completion of ALT, the mean BI and MI became 1.7 ± 0.7 and 0%, respectively (P < 0.0001). There were 16 patients with corticosteroid-dependent recurrent/chronic erythema nodosum leprosum, who had excellent response with significant reduction in the number of reactional episodes and mean dose of prednisolone required (P < 0.0001). No serious adverse effects were noted. We conclude that ALT is safe and effective in the management of MB leprosy patients who are nonresponsive to 12 months of WHO-MDT-MBR.

O domicílio como importante fator de transmissão da hanseníase / The home as an important leprosy transmission factor

Objetivo: descrever o perfil dos domicílios e dos contatos intradomiciliares que apresentaram um ou mais casos da doença após a primeira notificação. Método: trata-se de um estudo quantitativo, descritivo, transversal, retrospectivo. Estudaram-se 52 pacientes que apresentaram a doença após a notificação do caso índice no SINAN. Coletaram-se os dados em prontuário e realizaram-se entrevistas por meio de formulário. Analisaram-se os dados no programa estatístico EPI INFO 7.1.1.0, realizando-se a análise estatística descritiva. Resultados: notificaram-se, nos anos de 2013 e 2014, 101 casos de hanseníase. Revela-se que a média de contatos foi de 3,6 por domicílio, sendo que 46 conviviam há mais de dez anos com o caso índice; em relação aos contatos desses domicílios, a escolaridade é baixa; 65,4% deles não receberam a vacina BCG; 61,5% não foram avaliados clinicamente e 21,2% dos contatos ainda sofreram algum tipo de discriminação/preconceito. Conclusão: acredita-se que o controle dos contatos é um dos pilares estratégicos para a quebra da cadeia de transmissão da doença no domicílio, associado ao diagnóstico precoce, tratamento e prevenção de incapacidades físicas.(AU)

Objective: to describe the profile of households and household contacts who presented one or more cases of the disease after the first notification. Method: this is a quantitative, descriptive, cross-sectional, retrospective study. Fifty-two patients who presented the disease after notification of the index case in SINAN were studied. Data was collected from medical records and interviews were conducted using a form. Data were analyzed using the statistical program EPI INFO 7.1.1.0, and descriptive statistical analysis was performed. Results: in 2013 and 2014, 101 cases of leprosy were reported. The average number of contacts was 3.6 per household, and 46 had been living with the index case for over ten years; Regarding the contacts of these households, the education level is low; 65.4% of them did not receive the BCG vaccine; 61.5% were not clinically evaluated and 21.2% of contacts still suffered some kind of discrimination/prejudice. Conclusion: it is believed that contact control is one of the strategic pillars for breaking the disease transmission chain at home, associated with early diagnosis, treatment and prevention of physical disabilities.(AU)

Objetivo: describir el perfil de los hogares y contactos familiares que presentaron uno o más casos de la enfermedad después de la primera notificación. Método: este es un estudio cuantitativo, descriptivo, transversal, retrospectivo. Se estudiaron 52 pacientes que presentaron la enfermedad después de la notificación del caso índice en SINAN. Los datos se recopilaron de los registros médicos y las entrevistas se realizaron mediante un formulario. Los datos se analizaron utilizando el programa estadístico EPI INFO 7.1.1.0 y se realizó un análisis estadístico descriptivo. Resultados: en 2013 y 2014, se informaron 101 casos de lepra. El número promedio de contactos fue de 3.6 por hogar, y 46 habían estado viviendo con el caso índice por más de diez años; con respecto a los contactos de estos hogares, el nivel educativo es bajo; el 65,4% de ellos no recibieron la vacuna BCG; el 61.5% no fueron evaluados clínicamente y el 21.2% de los contactos aún sufrieron algún tipo de discriminación/prejuicio. Conclusión: se cree que el control de contacto es uno de los pilares estratégicos para romper la cadena de transmisión de enfermedades en el hogar, asociado con el diagnóstico temprano, el tratamiento y la prevención de discapacidades físicas.(AU)

Perfil epidemiológico dos indivíduos com grau dois de incapacidade física nos casos novos de hanseníase, durante 10 anos, em Guarapuava-PR / Epidemiological profile of grade 2 physical disability individuals in new cases of leprosy, during 10 years, in Guarapuava-PR

A Hanseníase é uma patologia infectocontagiosa e crônica, possui alto poder incapacitante e representa um grave problema para a saúde pública no Brasil. OBJETIVO: Traçar o perfil dos casos novos de hanseníase, classificados com o grau 2 de incapacidade física (GIF2) no momento do diagnóstico e descrever as principais incapacidades causadas pela doença. MÉTODOS: Estudo epidemiológico transversal, cujo levantamento de dados foi baseado nos prontuários, registros em Livros Ata nos arquivos do Ambulatório Municipal de Pneumologia e Dermatologia Sanitária de Guarapuava-PR e no Sistema de Informação de Agravos de Notificação do Ministério da Saúde. RESULTADOS: A presença do GIF2 foi mais frequente no sexo masculino, com cor de pele branca, baixa escolaridade, classificação operacional multibacilar, forma clínica virchowiana. As principais incapacidades encontradas foram lesões tróficas ou traumáticas em pés e garra em mãos. CONCLUSÃO: Há necessidade de intensificar as ações educativas para prevenção, contribuindo para o diagnóstico precoce da doença e evitando as incapacidades. (AU)

Leprosy was an infectious and chronic pathology, with high incapacitating power, and represents a serious problem for public health in Brazil. OBJECTIVE: To describe the profile of new cases of leprosy classified as grade 2 physical disability (G2D) at the time of diagnosis, and to describe the main disabilities caused by the disease. METHODS: Cross-sectional epidemiological study, whose data collection was based on medical records, records in books in the archives of the Municipal Ambulatory of Pneumology and Sanitary Dermatology of Guarapuava-PR, and in the Information System of Notifiable Ministry of Health Diseases. RESULTS: The presence of GIF2 is more frequent in maleswith white skin color, low level of education, multibacillary operational classification, virchowian clinical form. The main disabilities were trophic or traumatic lesions in the foot, and claw hands. CONCLUSION: It is necessary to enhance educational actions for prevention, contributing to the early diagnosis of the disease, and avoiding disabilities. (AU)

Epidemiological and clinical profile of HIV-infected patients from Southwestern Goias State, Brazil.

Knowledge about epidemiological distribution patterns of HIV infection in different geographic regions is relevant to understand the dynamics of the disease in Brazil. This study aims to characterize the epidemiological and clinical profile of HIV-infected patients from Southwestern Goias State, from 2005 to 2015. A standardized questionnaire was used to collect clinical-epidemiological, virological, and immunological data from the medical records of all HIV-infected patients (n=539) who were followed at the regional reference center of Jatai, Goias State, Brazil, from 2005 to 2015. We detected the prevalence of male patients and the heterosexual route of transmission, as well as an expressive number of young women infected with HIV. The HIV infection was more prevalent in reproductive ages (55.3%). Most patients presented clinical manifestations related to HIV infection at the time of diagnosis. Twenty-four patients presented coinfection with hepatitis C virus, syphilis, hepatitis B virus, leprosy or Chagas disease. Pneumonia caused by Pneumocystis jirovecii was the most common opportunistic infection, followed by neurotoxoplasmosis, tuberculosis, and neurocryptococcosis. Combined antiretroviral therapy improved CD4+ T-cell counts: the mean CD4+ T-cell counts after treatment was twice as high as those found at the first medical appointment; and highly active antiretroviral therapy promoted viral suppression in a significant number of patients. Considering the increasing distribution of HIV infection to the interior of Brazil, this descriptive study outlines the clinical-epidemiological characteristics of HIV infection in Southwestern Goias and contributes to develop local prevention strategies and public service plans.

Perfil dos pacientes acometidos pela hanseníase em um centro de atenção secundária à saúde / Profile of leprosy patients in a secondary health care center

Objetivo: descrever o perfil sociodemográfico e clínico de pacientes com hanseníase. Método: estudo quantitativo, retrospectivo, descritivo, de base populacional, fonte documental, realizado em um centro de referência para hanseníase, com 55 prontuários de pacientes. A coleta de dados foi realizada a partir de um formulário estruturado contemplando variáveis sociodemográficas, clínicas e da avaliação neurológica simplificada. Os dados foram analisados por meio de técnicas de estatística descritiva e inferencial e apresentados em forma de tabela. Resultados: perfil caracterizado por homens, faixa etária entre os 31 e 45anos de idade, baixa escolaridade, tipo multibacilar da doença, grau de incapacidade física zero, sendo os pés o sítio corporal mais comprometido e sem nervos afetados. Conclusão: a situação da doença na instituição remete a uma situação em pouco desenvolvimento, com demanda passiva de pacientes antigos, embora alguns pontos indiquem um aumento na cadeia de transmissão.

Perfil socioeconômico dos pacientes atendidos pelo Centro de Referência em Reabilitação da Hanseníase da Zona da Mata Mineira / Socioeconomic profile of the patients attended at the Reference Center for Rehabilitation of Leprosy of the Southeast of Minas Gerais State

A hanseníase é uma doença crônica, infectocontagiosa, causada pelo bacilo de Hansen (Mycobacterium leprae), que acomete peles e nervos periféricos, com alto poder incapacitante e forte estigma social, provocando um sofrimento aos seus portadores, para além de seus sintomas físicos. Tendo os indicadores sociais um papel determinante nesse processo, objetivou-se traçar o perfil socioeconômico dos pacientes atendidos pelo Centro de Referência em Reabilitação da Hanseníase da Zona da Mata Mineira. Para tanto, foram analisados 99 prontuários e suas respectivas fichas de abordagem social, dos usuários atendidos de janeiro de 2004 a junho de 2011. Os resultados apontam o predomínio de pacientes do sexo masculino (54,5%), advindos de áreas urbanas (84,8%), com baixa escolaridade (54,5%) e renda familiar igual ou inferior a dois salários mínimos (60,6%), em faixa etária que compreende a população economicamente ativa, residindo em casa própria (69,7%), com infraestrutura adequada (73,7%), porém convivendo com uma média de quatro ou mais pessoas neste mesmo espaço (24,2%). Tais resultados demonstram que os protocolos de intervenções clínicas devem integrar-se às medidas de melhoria das condições de vida da população para uma efetiva política de controle da doença, uma vez que sua ocorrência está diretamente relacionada às desigualdades sociais existentes.

Leprosy is a chronic disease, infectious contagious, caused by bacillus Mycobacterium leprae, that affects skins and peripheral nerves, with a high power disabling and strong social stigma, promoting suffering to patients beyond their physical symptoms. As the social indicators a key role in this process, it was aimed to trace the socioeconomic profile of the patients attended at the Reference Center for Rehabilitation of Leprosy of the Southeast of Minas Gerais State. For that, 99 patients records and their respective social approach files, from patients attended between January 2004 and June 2011, were analyzed. The results indicate most of men (54.5%), from urban areas (84.8%) with low education level (54.5%) and a familiar income equal to or less than two minimum wages (60,6%), in economically active age group, living in own home (69.7%) with a suitable infrastructure (73.7%) but living with an average of four or more people in the same house (24.2%). These results show that measures to improve people's living conditions should be integrated into clinical protocol interventions, for an effective disease control policy, since its occurrence is directly related to the existing social differences.

Effectiveness, safety and tolerability of cyclosporine versus supportive treatment in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A record-based study.

BACKGROUND: Toxic epidermal necrolysis and Stevens-Johnson syndrome comprise life-threatening, drug-induced mucocutaneous disease spectrum. Interest in cyclosporine, a calcineurin inhibitor that can block the function of T-cells, has increased with the discovery of the importance of granulysin in apoptosis in toxic epidermal necrolysis. In our hospital, cyclosporine is given to Stevens-Johnson syndrome/toxic epidermal necrolysis patients as an adjunctive therapy. AIMS: This study is an observational, record-based study comparing the effectiveness and safety of patients receiving cyclosporine versus only supportive therapy. METHODOLOGY: Medical records as bed-head tickets and laboratory investigation reports of Stevens-Johnson syndrome/toxic epidermal necrolysis patients admitted in the hospital over a period of 1 year were collected. Data regarding clinico-demographic profile, suspected drug causing Stevens-Johnson's syndrome/toxic epidermal necrolysis, SCORTEN, body surface area involved, treatment received and outcome were obtained. RESULTS: Twenty-eight patients were analyzed. Nineteen belonged to the cyclosporine group (supportive treatment + cyclosporine), nine to supportive treatment only group. Among the suspected drugs, antiepileptics formed the major group (28.6%). Five patients in the supportive only group and one in the cyclosporine group died. Time for stabilization and reepithelialization and duration of recovery were significantly lower in the cyclosporine group (P < 0.001, P= 0.007, P= 0.01, respectively). The standardized mortality ratio was 0.32 in cyclosporine group which is nearly 3.3 times lower than the only supportive treatment. LIMITATIONS: As it was a record-based study, certain confounding factors (serum blood urea nitrogen) could not be adjusted. CONCLUSION: Cyclosporine (5 mg/kg/day) for 10 days from onset of Stevens-Johnson syndrome/toxic epidermal necrolysis may decrease the risk of dying, may provide faster healing of lesions and might lead to early discharge from hospital.

A assistência de enfermagem aos portadores de hanseníase assistidos pelo Programa de Saúde da Família / Nursing care for leprosy patients assisted by the Family Health Program / Atención de enfermería a pacientes con lepra atendidos por el Programa de Salud Familiar

Objetivo: analisar a assistência de enfermagem utilizada no atendimento de portadores de hanseníase. Método: estudo retrospectivo, prospectivo, com abordagem quantitativa, realizada em postos de saúde da família no município de Tamandaré/PE, com 60 prontuários do período de 2010 a 2014 e 14 profissionais de enfermagem. A coleta de dados foi realizada com um questionário e analisados no software SSPS, Excel, apresentados em tabelas. Resultados: constatou-se que a assistência de enfermagem no combate e controle da hanseníase, onde 93% dos entrevistados mencionaram a consulta de enfermagem sendo a metodologia mais importante realizada nesta unidade de saúde. Conclusão: o índice de portadores de hanseníase existente no programa de saúde é pouco expressivo segundo o Ministério da Saúde, entretanto merece a devida atenção e rever o papel da promoção e prevenção de enfermagem em relação doença.(AU)

Objective: analyze the nursing care used in the care of leprosy patients. Method: retrospective, prospective study, with a quantitative approach, carried out in family health centers in the municipality of Tamandaré/PE, with 60 records from 2010 to 2014 and 14 nursing professionals. Data collection was performed with a questionnaire and analyzed using SPSS software, Excel, presented in tables. Results: one found that nursing care to combat and control Hansen's disease, where 93% of respondents mentioned that nursing consultation is the most important method performed in this health unit. Conclusion: the index of existing leprosy patients in the health program is little expressive according to the Ministry of Health; however, it deserves due attention and review of the role of nursing promotion and prevention in relation to the disease.(AU)

Objetivo: analizar los cuidados de enfermería utilizados en el cuidado de los enfermos de lepra. Método: Estudio retrospectivo, prospectivo, de enfoque cuantitativo, llevado a cabo en los centros de salud de la familia en el municipio de Tamandaré/PE, con 60 registros de 2010 a 2014 y 14 profesionales de enfermería. La recolección de datos se realizó con un cuestionario y fueron analizados utilizando el software SPSS, Excel, y presentados en las tablas. Resultados: se encontró que los cuidados de enfermería para combatir y control de la lepra, donde el 93% de los entrevistados mencionaron que la consulta de enfermería es el método más importante realizado en esta unidad de salud. Conclusión: el índice de enfermos de lepra existentes en el programa de salud es poco expresivo de acuerdo con el Ministerio de Salud; sin embargo, merece la debida atención y revisión del papel de promoción y prevención de enfermería en relación a la enfermedad.(AU)

Clinical and epidemiological profile of leprosy patients attended at Ceará, 2007-2011.

BACKGROUND: Leprosy is an infectious chronic condition associated with potentially serious physical, social and psychological impacts. OBJECTIVES: To characterize the clinical and epidemiological profile of leprosy patients treated from 2007 to 2011 in the University Hospital of Ceará, Northeastern Brazil. METHODS: This is a retrospective and descriptive study. The study population consisted of residents in the state of Ceará treated in a dermatology clinic between 2007-2011. Clinical and epidemiological data analyzed were obtained from medical records and from the database of national Information System for Notifiable Diseases. RESULTS: 475 cases were analyzed, mostly women (51.8%), aged 45-59 years (35.0%) - mean of 45.2 years at diagnosis - with 6.3% of children under 15 , with low education (73.7%), white color (68.8%), residency in the city of Fortaleza (82.3%), and no defined work occupation (59.6%). At diagnosis, most patients were multibacillary (MB) (65.5%), had borderline clinical form (48.0%), and 22.7% had physical disability (8.0% with grade 2), predominantly in MB cases (p <0.001). We observe worsening of disability in 5.1% of cases post-MDT. The proportion of cases with reactional episodes was 42.7%, mainly during MDT (51.2%). CONCLUSION: This is the first study conducted in this hospital context, revealing late diagnosis, high burden of disease, hidden endemicity, and high social vulnerability in the state of Ceará. This study reinforces the need to strengthen health care network for timely diagnosis and treatment, aiming at longitudinality of assistance.

Clinical and epidemiological profile of leprosy patients attended at Ceará, 2007-2011

Abstract: Background: Leprosy is an infectious chronic condition associated with potentially serious physical, social and psychological impacts. Objectives: To characterize the clinical and epidemiological profile of leprosy patients treated from 2007 to 2011 in the University Hospital of Ceará, Northeastern Brazil. Methods: This is a retrospective and descriptive study. The study population consisted of residents in the state of Ceará treated in a dermatology clinic between 2007-2011. Clinical and epidemiological data analyzed were obtained from medical records and from the database of national Information System for Notifiable Diseases. Results: 475 cases were analyzed, mostly women (51.8%), aged 45-59 years (35.0%) - mean of 45.2 years at diagnosis - with 6.3% of children under 15 , with low education (73.7%), white color (68.8%), residency in the city of Fortaleza (82.3%), and no defined work occupation (59.6%). At diagnosis, most patients were multibacillary (MB) (65.5%), had borderline clinical form (48.0%), and 22.7% had physical disability (8.0% with grade 2), predominantly in MB cases (p <0.001). We observe worsening of disability in 5.1% of cases post-MDT. The proportion of cases with reactional episodes was 42.7%, mainly during MDT (51.2%). Conclusion: This is the first study conducted in this hospital context, revealing late diagnosis, high burden of disease, hidden endemicity, and high social vulnerability in the state of Ceará. This study reinforces the need to strengthen health care network for timely diagnosis and treatment, aiming at longitudinality of assistance.

Centro de Referência em Dermatologia Sanitária: caracterizando usuários com úlceras de pernas / Reference Center for Sanitary Dermatology: characterizing users with leg ulcers

O objetivo desse estudo foi descrever as características sociodemográficas e epidemiológicas da população atendida na sala de curativo de um ambulatório dermatológico. Trata-se de um estudo de corte seccional, descritivo baseado no levantamento de casos de pessoas atendidas para o tratamento de úlceras crônicas decorrentes de dermatopatias. A fonte de dados para a pesquisa foram os prontuários disponibilizados pelo Serviço de Arquivo Médico e Estatística (SAME) do Instituto Lauro de Souza Lima (ILSL), correspondendo ao período de janeiro a dezembro do ano de 2011. Foram avaliados 486 prontuários, dos quais, na população estudada, apontaram as características sociodemográficas predominantes: o gênero masculino (57%), idade 70 e mais anos (36,42%), casados (49,4%), aposentados (34,6%), raça branca (87,9%), escolaridade com ensino fundamental incompleto (19,8%), procedentes do Estado de São Paulo (98,15%). A comorbidade prevalente foi a Hipertensão Arterial Sistêmica (n=224; 46,1), acompanhada de Diabetes mellitus II com 117 (24,1%). A maioria das úlceras (n=218; 44,9%) encontradas foi neuropática, a média de tempo de existência em anos foi de 5,4 anos, com desvio padrão de 7,2. Tais achados servem de alerta aos gestores e profissionais, para que conheçam a situação das pessoas atendidas na sala de curativo, no que tange as suas características sociodemográficas, clínicas e epidemiológicas para implementação de protocolos, ações políticas e assistenciais.

The aim of this study was to describe the sociodemographic and epidemiological characteristics of the population served in the dressing room of a dermatological clinic. This is a descriptive cross-sectional cohort study based on the survey of cases of people met for the treatment of chronic ulcers resulting from skin diseases. A source of data for the study were the records made available by the Medical Records and Statistics (SAME) of the Instituto Lauro de Souza Lima (ILSL), corresponding to the period from January to December of 2011 records 486 of which were evaluated in the study population sociodemographic characteristics predominated: males (57%), age 70 years old and over (36.42%), married (49.4%), retired (34.6%), white (87.9%), incomplete primary school education (19.8%), from the State of São Paulo (98.15%). A prevalent comorbidity was Hypertension (n=224; 46.1), followed by diabetes mellitus II with 117 (24.1%). Most ulcers (n=218; 44.9%) was found neuropathic, the average time of existence in years was 5.4 years, with a standard deviation of 7.2. These findings serve as a warning to managers and professionals, so that they know the situation of people met in the dressing room, regarding their sociodemographic, clinic and epidemiological characteristics for implementing protocols, policies and assistance actions.

Leprosy in a University Hospital in Southern Brazil.

BACKGROUND: Leprosy is an infectious disease that may lead to irreversible nerve damage, compromising patient's quality of life and leading to loss of working years. OBJECTIVES: To evaluate the epidemiological profile of patients followed at a University Hospital. MATERIALS AND METHODS: This is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010. RESULTS: The mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension. CONCLUSIONS: This study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication.

Leprosy in a University Hospital in Southern Brazil

AbstractBACKGROUND:Leprosy is an infectious disease that may lead to irreversible nerve damage, compromising patient's quality of life and leading to loss of working years.OBJECTIVES:To evaluate the epidemiological profile of patients followed at a University Hospital.MATERIALS AND METHODS: This is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010.RESULTS:The mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension.CONCLUSIONS:This study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication.