Peripheral neuropathy of the upper extremity: medical comorbidity that confounds common orthopedic pathology.

In the orthopedic patient, the diagnosis of a compression neuropathy may be straightforward. However, various medical comorbidities can obscure this diagnosis. It is paramount for the practicing orthopedic surgeon to have an appreciation for the medical pathology of common axonal neuropathies to properly diagnose, treat, and refer a patient with altered sensation in the upper extremity. The prevalence of diabetes in the United States is 10%, and roughly 20% of diabetic patients have peripheral neuropathy. In addition to diabetes, 32% of heavy alcohol users present with polyneuropathy. With advancements in the treatment of human immunodeficiency virus/acquired immunodeficiency syndrome clinicians may see the long-term effects of the virus manifested as axonal neuropathies and extreme allodynia. In some regions of the world, Hansen's disease usurps diabetes as the most common cause of polyneuropathy. Based on patient demographics and social habits, Lyme disease, multiple sclerosis, and syphilis can all manifest as polyneuropathies. Understanding the common medical causes of neuropathy will aid the orthopedic surgeon in differentiating simple compression neuropathies from diseases mimicking or confounding them.

Indentificação dos alelos HLA de classe I e classe II em pacientes co-infectados com hanseniase e AIDS / Identification of alleles HLA of classroom I and classroom II in patients co-infectedes with leprosy and AIDS

A imunidade celular do hospedeiro e quem determina a evoluçao e o quadro clinico do paciente, tanto na hanseniase como na infecçao pelo virus da imunodeficiencia adquirida (HIV). O virus HIV, assim como o Micobacterium leprae (M. leprae) sao antigenos intracelulares que estimulam a resposta imune celular e o perfil Th1. Os linfocitos T (LT) reconhecem esses antigenos quando apresentados juntamente com as moleculas do complexo HLA na superficie da celula apresentadora de antigeno (APC), desencadeando a resposta imune especifica. Muitos estudos tem sido realizados na tentativa de associar o complexo HLA com as diversas patologias. Na hanseniase, o complexo HLA tem sido amplamente estudado, na tentativa de elucidar os mecanismos que levam ao direcionamento da forma clinica, uma vez que estes alelos atuam de forma direta na resposta imune atraves da apresentaçao do peptideo antigenico para celula T. Estudos realizados com os alelos HLA de classe I apresentaram resultados controversos enquanto que a maioria das pesquisas de classe II, os resultados sao mais concordantes revelando associaçoes positivas dos alelos HLA-DR2 e HLA-DR3, com a forma tuberculoide (HT) e do alelo HLA-DQ1, com a forma virchoviana (HV). No HIV os alelos HLA parecem estar mais fortemente associados a deterioraçao imunologica que com a manifestaçao clinica da doença. Varios estudos associam consistentemente os alelos de classe I, HLA-B35 e HLA-Cw4 com a aceleraçao da progressao para a aids enquanto os alelos HLA-A1, HLA-B8, HLA-B27, HLA-Cw7 e os de classe II, HLA-DR3 e HLA-DQ2 estao associados a progressao lenta...

Lepromatous leprosy in an HIV-positive patients in Spain

We report a 35-year-old HIV-positive male effected by lepromatous leprosy which, to our knowledge, is the first case of its kind in Spain. The relationship between the two conditions is discussed