Ultraviolet-A1 phototherapy in Asian skin: A review of 159 cases in Singapore.

BACKGROUND: Ultraviolet-A1 phototherapy has been used to treat many inflammatory dermatoses. AIMS: To determine the efficacy and safety of ultraviolet-A1 phototherapy in Asian skin. MATERIALS AND METHODS: We performed a review of records of patients undergoing ultraviolet-A1 phototherapy at our dermatology unit in Singapore from January 2007 to January 2011. Their electronic medical records were reviewed and a standardized questionnaire was filled up for data collection and tabulation. Chi-square or Fisher's exact tests were used to compare the difference in response between various groups for each characteristic. P value of < 0.05 was considered statistically significant. RESULTS: Our study comprised of 159 patients, of which 103 were patients with hand and foot eczema, 21 with atopic dermatitis, 17 with scleroderma and the remaining with miscellaneous dermatoses. Of these patients, 47.6% of patients with hand and feet eczema had good response after 10 sessions, which increased to 75% after 20 sessions and to 84.6% after 30 sessions. After 10 sessions, 47.6% of patients with atopic dermatitis had good response, which increased to 66.7% after 20 sessions. After 30 sessions, all the three remaining patients with atopic dermatitis experienced good response. For patients with scleroderma, only 11.8 and 10% had good response after 10 and 20 sessions, respectively, which increased to 40% after 30 sessions. LIMITATIONS: Limitations of our study include its retrospective design and, consequently, the lack of standardized treatment protocol, as well as subjective assessment in terms of clinical improvement. CONCLUSIONS: Ultraviolet-A1 phototherapy appears to be efficacious for the treatment of hand and foot eczema as well as atopic dermatitis. However, in patients with scleroderma, the response was partial and needed a longer duration of treatment.

Perfil epidemiológico dos contatos intradomiciliares de casos de hanseníase em capital hiperendêmica no Brasil / Epidemiological profile of in-house contacts of leprosy cases in a brazilian hypertendemic capital / Perfil pidemiológico de los contactos em casa de casos de leprosa em uma capital hipertendémica brasileña

Objetivo: Avaliar a situação dos contatos intradomiciliares dos casos de hanseníase notificados no ano de 2012 em São Luís/Maranhão. Métodos: Estudo quantitativo-descritivo-transversal, com coleta de dados utilizando-se instrumento estruturado. Resultados: A maioria dos contatos intradomiciliares eram mulheres (51,87%), idade entre 0 e 20 anos (40,29%), parentesco consanguíneo de 1º grau (54,92%), forma dimorfa (59,78%) e multibacilares (75,53%). Do total, 1880 (67,96%) não realizaram o exame dermatoneurológico. Entre os examinados, houve maior frequência no distrito Bequimão (28,48%), no qual 59,82% eram mulheres, idade entre 0 a 20 anos (44,77%). Ao exame, 91,27% apresentou-se normal. Dentre os suspeitos, 36,73% tinham hanseníase, 58,21% possuíam cicatriz da 1ª dose da BCG e 59,98% foram encaminhados a vacinação. A prevalência da doença entre os contatos foi de 1,62%. As ações da vigilância de contatos classificaram-se como precárias em São Luís. Conclusão: A maioria dos contatos registrados não foi examinada, evidenciando necessidade de fortificação das ações da vigilância no município

Objective: To evaluate the situation of in-house contacts of the cases of leprosy reported in 2012 in São Luis, Maranhão. Methods: Quantitative cross-sectional descriptive study, with data collection using a structured instrument. Results: The majority of in-house contacts were women (51.87%), from 0 to 20 years of age (40.29%), first-degree kinship (54.92%), dimorphic shape (59.78) and multibacillary (75.53%). In total, 1880 (67.96%) did not take the dermato-neurological exam. Among those tested, there was a greater frequency in the Bequimão district (2.48%), 59.82% were women, from 0 to 20 years of age (44.77%). On the exam, 91.27% were normal. Among those suspected of carrying the disease, 36.73% had leprosy, 58.21% had scars from the first dose of BCG and 59.98% were sent to receive vaccination. The prevalence of the disease among the contacts was 1.62%. The actions of contact monitoring were classified as precarious in São Luis. Conclusion: The majority of registered contacts were not examined, highlighting the need for strengthening of monitoring efforts in the city

Objetivo: Evaluar la situación de los contactos intradomiciliares de los casos de hanseniasis notificados en el año 2012 en São Luis - MA. Métodos: Estudio cuantitativo-descriptivo-transversal, con recolección de datos utilizando instrumento estructurado. Resultados: La mayoría de los contactos intradomiciliares eran mujeres (51,87%), edad entre 0 y 20 años (40,29%), parentesco consanguíneo de primer grado (54,92%), forma dimorfa (59,78%), multibacilares (75,53%). Del total, 1880 (67,96%) no realizaron el examen dermatoneurológico. Entre los examinados, hubo mayor frecuencia en el distrito de Bequimão (28,48%), el 59,82% eran mujeres, entre 0 a 20 años (44,77%). En el examen, el 91,27% se presentó normal. Entre los sospechosos, el 36,73% tenían hanseniasis, el 58,21% tenía cicatriz de la 1ª dosis de BCG y el 59,98% fueron encaminados a la vacunación. La prevalencia de la enfermedad entre los contactos fue del 1,62%. Las acciones de la vigilancia de contactos se clasificaron como precarias en San Luis. Conclusión: La mayoría de los contactos registrados no fueron examinados, evidenciando necesidad de fortificación de las acciones de la vigilancia en el municipio

Grau de incapacidade física de pacientes com hanseníase / The level of physical inability of patients with leprosy

Objetivo: avaliar o grau de incapacidade física de pacientes com hanseníase. Método: estudo quantitativo, transversal, retrospectivo, com 73 pacientes diagnosticados com hanseníase. Para a coleta de dados utilizou-se instrumento pré-estruturado contendo dados sociodemográficos e epidemiológicos extraídos das fichas de investigação do SINAN e do prontuário eletrônico. Os dados foram analisados no software IBM® SPSS® , versão 21.0. Resultados: constatou-se que pacientes do sexo masculino com baixa escolaridade, forma clínica dimorfa, virchowiana e neural pura, classificação operacional multibacilar e a presença de um ou mais nervos afetados tiveram maior chance de apresentar algum grau de incapacidade física. Conclusão: ressalta-se a importância da avaliação do grau de incapacidade física no momento do diagnóstico de hanseníase e as orientações para o autocuidado.(AU)

Incidence of mycobacterial disorders in Indian adult male service population followed for over two decades.

BACKGROUND: The comprehensive epidemiology of mycobacterial disorders is scarce from our country. The incidence of Tuberculosis (TB) and Leprosy in a cohort of military personnel followed for a long duration was evaluated in this study. METHODS: The data for this descriptive epidemiologic study was derived from the electronic medical records (EMR) data of the service personnel enrolled between 1990 and 2015. They were recruited between the ages of 17 and 18 years in good health and their morbidity data was derived from the medical records. The incidence rate (IR) was calculated as per person-years (py) using appropriate statistical methods. RESULTS: The study population includes 51,217 participants (median age 33 years, range 17-54) with a mean follow up of 12.5 years. Yearly evaluation of the data gave a cumulative follow up duration of 613,925py. A total of 530 patients developed TB, giving an IR of 86.3 per 100,000 person years (95% CI 79.2-93.9). Leprosy was diagnosed in 59 cases giving an IR of 9.6 per 100,000py (95% CI 7.4-12.3). Pulmonary (71%) and pleural (24%) locations were the most common sites of the TB infection. The data about the contribution of the mycobacterial disorders towards the mortality and the subtypes of leprosy was not available in the EMR. CONCLUSION: Low IR of mycobacterial disorders was observed in this study when compared with the previous reports. Healthy lifestyle and good socioeconomic status could explain the low IR of mycobacterial disorders in the military personnel.

Perfil sociodemográfico e clínico dos pacientes em atendimento fisioterapêutico no Hospital Universitário da Universidade Federal de Juiz de Fora / Sociodemographic and clinical profile of patients in physical therapy at the University Hospital of the Federal University of Juiz de Fora

A Hanseníase é uma doença endêmica no Brasil e se manifesta por sinais e sintomas dermatoneurológicos, tendo alto poder incapacitante. Assim, o fisioterapeuta desempenha importante papel na prevenção de incapacidades motoras e sensitivas. O objetivo deste trabalho foi traçar o perfil sociodemográfico e clínico de pacientes atendidos no Serviço de Fisioterapia do Hospital Universitário da Universidade Federal de Juiz de Fora e fazer um breve relato do trabalho realizado em Hanseníase. Foram coletadas informações nos prontuários eletrônicos e fichas de avaliação de 16 pacientes em atendimento entre outubro de 2013 e março de 2014. Após análise exploratória, foram calculadas frequências simples, médias, desvio padrão e percentuais das variáveis analisadas. A idade média dos pacientes foi de 56,6 anos sendo que receberam o diagnóstico com 47,7 anos. A maioria dos pacientes eram homens (56,2%), da raça branca (62,5%), aposentados (56,2%) e moradores de Juiz de Fora (75%). Houve predomínio do tipo multibacilar (81,2%) e da forma clínica virchowiana (31,3%). Quatorze finalizaram o tratamento poliquimioterápico, embora metade usasse medicação para prevenção de incapacidades e 5 tinham deformidades instaladas. Os primeiros sintomas observados foram: manchas, fraqueza, dores no corpo e perda de sensibilidade. Verificamos que este perfil é semelhante ao de outros serviços: homens, brancos, aposentados, idosos e adultos jovens, com hanseníase multibacilar da forma clínica virchowiana. A maioria não apresenta sequelas, não foi avaliada quanto ao grau de incapacidade e metade estava em reação no momento da pesquisa. Os sintomas, sequelas e principais queixas justificam sua presença em um Serviço de Reabilitação.

Health information system model for monitoring treatment and surveillance for leprosy patients in indonesia (case study in Pekalongan District, Central Java, Indonesia).

After India and Brazil, Indonesia has the third highest incidence/prevalence of leprosy in the world. Every year thousands of new cases and case with grade-2 disability are reported and, while the recovery rate lingers only 80-90 %. Therefore, more than 10 % of leprosy patients drop out of treatment and can be a source of new infections in the community. Our research was aimed at determining apparent difficulties in the leprosy control program as well as how a health information system (HIS) could assist the Indonesian leprosy control program. We used qualitative method with deep interview and observation of document. One of the difficulties which the Indonesian leprosy control program faces is discontinuity of patient's data due to rotating staff as well as the treatment monitoring and queries patients which should be monitored after treatment has ceased. Technology implementation is feasible through short message service (sms) reminders and web base applications. The leprosy control program urgently needs to implement continuous monitoring and recording of patients because of the particular characteristics of this contagious disease.

Electronic medical records in dermatology: practical implications.

BACKGROUND: Electronic medical records (EMRs) can be of great use in dermatological data recording. Unfortunately, not many studies have been carried out in this specific area. AIMS: We attempt to evaluate the use of an EMR system in dermatology, comparing it with a conventional paper-based system. METHODS: Two hundred patient records of patients attending the dermatology outpatient department were studied over a 3-month period. Half the reports were entered in the conventional paper-based format while the other half was entered in an EMR system. The time taken for each consultation was recorded and the same was carried out for the first subsequent follow-up visit. RESULTS: The average time taken for the completion of the EMR-based consultation for new cases was 19.15 min (range, 10-30 min; standard deviation, 6.47). The paper-based consultation had an average time of 15.70 min (range, 5-25 min; standard deviation, 6.78). The P-value (T-test was used) was 0.002, which was significant. The average time taken for consultations and entering progress notes in the follow-up cases was slightly less than 10 min (9.7) for EMR while it was slightly more than 10 min (10.3) for the paper format. The difference was not statistically significant. The doctors involved also mentioned what they felt were the advantages and disadvantages of the system along with suggestions for improvement. CONCLUSION: The use of an EMR system in dermatology (or for that matter in any specialty) may overawe most users at the beginning, but once a comfort level is established, EMR is likely to outscore conventional paper recording systems. More time-motion-case studies are required to ascertain the optimal usage of EMR systems.