Determinação do agente microbiano, perfil de resistência antimicrobiana e produção de biofilme em úlceras de membros inferiores em pacientes com sequelas de hanseníase e outras doenças crônicas / Determination of the microbial agent, antimicrobial resistance profile and biofilm production in lower limb ulcers in patients with leprosy sequelae and other chronic diseases

Úlceras crônicas são definidas quando o processo de reparação do tecido excede o período de 3 meses, dificultando sua cicatrização. Sua etiologia pode ser multifatorial, como a ocorrência de traumas e consequência de patologias, como hanseníase, hipertensão e diabetes. As úlceras abrigam diversos microrganismos colonizadores e residentes que podem tornar-se potenciais agravantes a sua condição clínica, visto sua capacidade de formação de biofilmes e resistência antimicrobiana, diminuindo a eficácia da terapêutica. O objetivo deste trabalho foi determinar os agentes microbianos presentes em úlceras de pacientes com doenças crônicas atendidos no ambulatório de feridas do Instituto Lauro de Souza Lima, avaliar a susceptibilidade antimicrobiana destes isolados e sua capacidade de produção de biofilme, bem como comparar os resultados evidenciados por swab e biópsia e correlacionar os resultados microbiológicos com dados clínicos dos pacientes. Foram coletadas amostras de exsudato por swab e biópsia de úlceras crônicas dos participantes com doenças crônicas. As amostras foram semeadas em ágar sangue, manitol, cetrimide e MacCnkey para posterior identificação microbiana. Também foi desempenhada a determinação da susceptibilidade aos antimicrobianos e capacidade de produção de biofilme dos isolados identificados por swab e biópsia. Foram identificados 47 microrganismos no total, sendo 26 (55%) isolados presentes no swab e 21 (45%) em biópsia. P. aeruginosa, P. mirabilis e S. aureus foram as bactérias comumente prevalentes em ambos os materiais de coleta, com predomínio de P. aeruginosa. Apenas 16 (36%) das bactérias demonstraram capacidade de produzir biofilme, com destaque para o grupo dos gram-positivos (92%) que também exibiram alto perfil de susceptibilidade frente linezolida e vancomicina. Meropenem foi o único fármaco a mostrar eficácia frente as cepas de P. aeruginosa presentes, enquanto o grupo das enterobactérias apresentaram menor resposta frente a amoxicilina com ácido clavulânico. Swab e biópsia apresentaram uma concordância geral de 60%, semelhante ao observado por outros estudos. Tais diferenças podem se dar devido à presença de colonizadores. A cobertura de zinco e bota de Unna foi correlacionada à ausência de sinais flogísticos de infecção. Os dados sociodemográficos mostram prevalência de indíviduos com baixa escolaridade e idade acima de 60 anos. O swab é menos invasivo e mais utilizado devido sua facilidade e baixo custo em relação a biópsia; contudo, deve ser considerado com mais cautela na análise dos resultados microbiológicos.

Chronic wounds are defined when the tissue repair process exceeds the period of 3 months, making it difficult to heal. Its etiology can be multifactorial, such as the occurrence of trauma and consequences of pathologies, such as leprosy, hypertension, and diabetes mellitus. Ulcers harbor several colonizing and resident microorganisms that can become potential aggravating factors for their clinical condition, given their ability to form biofilms and their antimicrobial resistance, decreasing the therapeutic efficacy. This study aimed to determine the microbial agents present in ulcers of patients with chronic conditions treated at the wound clinic of the Instituto Lauro de Souza Lima, to evaluate their antimicrobial susceptibility and ability to produce biofilm, as well as to compare the results evidenced by swab and biopsy and correlate the microbiological results with clinical data of the patients. Exudate samples were collected by swab and biopsy of leg ulcers from participants with chronic diseases. Samples were seeded on sheep blood agar, mannitol, cetrimide and MacConkey agar for subsequent microbial identification. The determination of antimicrobial susceptibility and biofilm production capacity of isolates identified by swab and biopsy was also performed. A total of 47 microorganisms were identified, 26 (55%) of which were isolated from the swab and 21 (45%) from the biopsy. P. aeruginosa, P. mirabilis and S. aureus were the commonly prevalent bacteria in both collection materials, with predominance of P. aeruginosa. Only 16 (36%) bacteria demonstrated the ability to produce biofilm, with emphasis on the gram-positive group (92%) that also exhibited a high profile of susceptibility to linezolid and vancomycin. Meropenem was the only drug to show efficacy against the strains of P. aeruginosa present, while the group of enterobacteria showed less response against amoxicillin with clavulanic acid. Swab and biopsy showed an overall agreement of 60%, similar to that observed by other studies. Such differences may occur due to the presence of colonizers. Zinc coating and Unna boot correlated with the absence of phlogistic signs of infection. Sociodemographic data show a prevalence of individuals with low education and aged over 60 years. The swab is less invasive and more used due to its ease and low cost compared to biopsy; however, it should be considered with more caution in the analysis of microbiological results

Paracoccidioidomicose afetando a mucosa bucal: relato de caso / Paracoccidioidomycosis affecting the buccal mucosa: case report / Paracoccidioidomicosis con afectación de la mucosa oral: relato de caso

Introdução: A paracoccidioidomicose é uma infecção micótica sistêmica com manifestações pulmonares primária que podem apresentar lesões cutâneas e orais. É mais comum no Brasil e em alguns outros países da América Latina, representando um importante problema de saúde pública devido às suas características potencialmente fatais. Relato de caso: Trabalhador rural de 53 anos, fumante e etilista, apresentando lesão ulcerada de aspecto moriforme em mucosa bucal direita. Realizou-se biópsia incisional cujo laudo histopatológico foi de paracoccidioidomicose. O paciente foi encaminhado ao médico infectologista para tratamento por meio de itraconazol (200mg por dia) por 18 meses. Após 03 meses de tratamento já apresentava regressão da lesão. Considerações Finais: Portanto, o objetivo deste trabalho é enfatizar a importância do cirurgião-dentista no reconhecimento das lesões oral e realização da biópsia para o correto diagnóstico e manejo desta doença por meio de um relato de caso clínico... (AU)

Paracoccidioidomycosis is a systemic mycotic infection with primary pulmonary manifestations that can present cutaneous and oral lesions. It is more common in Brazil and some other Latin American countries, representing an important public health problem due to its potentially fatal characteristics. Case report: 53-year-old rural worker, smoker and drinker, presenting an ulcerated lesion with a moriform aspect in the right oral mucosa. An incisional biopsy was performed, and the histopathological report was of paracoccidioidomycosis. The patient was referred to the infectious disease physician for treatment with itraconazole (200mg per day) for 18 months. After 03 months of treatment, he already had regression of the lesion. Final Considerations: Therefore, the objective of this paper is to emphasize the importance of the dentist in recognizing oral lesions and performing a biopsy for the correct diag... (AU)

La paracoccidioidomicosis es una infección micótica sistémica con manifestaciones pulmonares primarias que pueden presentar lesiones cutáneas y bucales. Es más común en Brasil y algunos otros países de América Latina, lo que representa un importante problema de salud pública debido a sus características potencialmente fatales. Caso clínico: trabajador rural de 53 años, fumador y bebedor, con lesión ulcerada de aspecto moriforme en mucosa oral derecha. Se realizó biopsia incisional y el informe histopatológico fue de paracoccidioidomicosis. El paciente fue remitido al médico de enfermedades infecciosas para tratamiento con itraconazol (200 mg al día) durante 18 meses. Después de 03 meses de tratamiento, ya tenía regresión de la lesión. Consideraciones finales: Por lo tanto, el objetivo de este trabajo es enfatizar la importancia del odontólogo en el reconocimiento de las lesiones bucales y la realización de una biopsia para el correcto diagnóstico y manejo de esta enfermedad a través de la presentación de un caso clínico... (AU)

Evidências científicas sobre as úlceras de pernas como sequela da hanseníase / Evidencias científicas sobre las úlceras de piernas como secuela de la lepra / Scientific evidence on leg ulcers as leprosy sequel

Resumo Objetivo Investigar as evidências científicas sobre as úlceras de pernas como sequela da hanseníase. Métodos Revisão Integrativa da Literatura (RIL). Para identificação do tema e questão de pesquisa, utilizou-se a estratégia PICo, na sequencia procedeu-se a busca nas bases de dados: Index to Nursing and Allied Health Literature (Cinahl), Literatura Latino-americana e do Caribe em Ciências da Saúde (Lilacs), Banco de dados em Enfermagem (BDENF), EMBASE (Elsevier), PUBMED (National Library of Medicine), SCOPUS (Elsevier), Web of Science (Clarivate Analytics), selecionados os descritores específicos para cada uma delas e elaboradas as respectivas estratégias de busca. Os idiomas considerados foram: inglês, português e espanhol. O período da RIL foi indeterminado. Para a seleção dos estudos, utilizou-se a ferramenta Ryyan que permitiu dois dos autores independentemente incluir, excluir, ou ficar indeciso, as discordâncias foram solucionadas por um terceiro. Os artigos selecionados foram classificados de acordo com a Agency for Healthcare Research and Quality (AHRQ). E para a interpretação dos resultados os artigos foram agrupados por semelhança e categorizados da seguinte maneira: autor, ano país, nível de evidência, objetivos e resultados, conclusão e recomendação. Resultados Identificou-se 415 estudos e 10 foram incluídos na revisão. O resultado principal obtido foi o tratamento tópico da úlcera, as vulnerabilidades e os determinantes que assolam os acometidos pela hanseníase não foram estudados. Conclusão Não há fortes evidências sobre as terapias para o tratamento de úlceras de pernas decorrentes da hanseníase que apoiem a diminuição de sequelas incapacitantes ocasionadas pela doença perpetuando o estigma e a desigualdade social.

Resumen Objetivo investigar las evidencias científicas sobre las úlceras de piernas como secuela de la lepra. Métodos revisión integradora de la literatura (RIL). Para la identificación del tema y pregunta de la investigación, se utilizó la estrategia PICo, luego se procedió a la búsqueda en las bases de datos: Index to Nursing and Allied Health Literature (Cinahl), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs), Banco de dados em Enfermagem (BDENF), EMBASE (Elsevier), PUBMED (National Library of Medicine), SCOPUS (Elsevier), Web of Science (Clarivate Analytics), se seleccionaron los descriptores específicos para cada una y se elaboraron las respectivas estrategias de búsqueda. Se consideraron los idiomas inglés, portugués y español. El período de la RIL fue indeterminado. Para la selección de los estudios, se utilizó la herramienta Ryyan, que permitió dos de los autores independientemente incluir, excluir o estar indeciso, las discrepancias fueron resueltas por un tercero. Los artículos seleccionados se clasificaron según la Agency for Healthcare Research and Quality (AHRQ). Y para la interpretación de los resultados, los artículos se agruparon por semejanza y se categorizaron de la siguiente manera: autor, año, país, nivel de evidencia, objetivos y resultados, conclusión y recomendación. Resultados se identificaron 415 estudios y se incluyeron 10 en la revisión. El resultado principal obtenido fue el tratamiento tópico de la úlcera, las vulnerabilidades y los determinantes que asolaron a los afectados por la lepra no fueron estudiados. Conclusión no hay fuertes evidencias sobre las terapias para el tratamiento de úlceras de piernas resultantes de la lepra que justifiquen la reducción de secuelas incapacitantes provocadas por la enfermedad, perpetuando el estigma y la desigualdad social.

Abstract Objective To investigate the scientific evidence on leg ulcers as leprosy sequel. Methods This is an Integrative Literature Review (ILR). In order to identify the theme and research question, the PICo strategy was used, in the sequence the search was carried out in Index to Nursing and Allied Health Literature (CINAHL), Latin American & Caribbean Literature in Health Sciences (LILACS), (BDENF), EMBASE (Elsevier), PUBMED (National Library of Medicine), SCOPUS (Elsevier), Web of Science (Clarivate Analytics) databases. Specific descriptors were selected for each of them and respective search strategies were created. The languages considered were English, Portuguese and Spanish. The ILR period was indeterminate. For the study selection, the Ryyan tool was used and allowed two of the authors to independently include, exclude or remain undecided, disagreements were solved by a third party. The selected articles have been ranked according to the Agency for Healthcare Research and Quality (AHRQ). And for interpretation of results, the articles were grouped by similarity and categorized into author, country year, level of evidence, objectives and results, conclusion and recommendation. Results 415 studies were identified and 10 were included in the review. The main outcome was the topical treatment of ulcers, the vulnerabilities and the determinants that afflict those affected by leprosy were not studied. Conclusion There is no strong evidence on therapies for the treatment of leprosy-induced leg ulcers that support the reduction of disabling sequel caused by disease perpetuating stigma and social inequality.

Septic shock due to Candida famata (Debaryomyces hansenii) candidemia in an ICU immunocompetent trauma-patient.

Sepsis related to Candida famata (C. famata) fungemia is extremely rare in immunocompetent patients. Moreover, septic shock has not been reported due to this yeast. A previously healthy young multi-trauma male, presented septic shock from C. famata, after he had been admitted in the Intensive Care Unit (ICU) due to haemorrhagic shock. Risk factors for candidemia in ICU patients are the presence of a central venous catheter (CVC), Total Parenteral Nutrition (TPN), use of broad-spectrum antimicrobials, immunosuppression and the length of ICU stay. The presence of CVCs, prior use of antibiotics, prolonged hospitalization, disruption of skin flora and immunocompromised states have been identified as predisposing risk factors for C. famata fungemia. It is worth noting that the present case concerns a non-immunocompromised patient, but long ICU stay and brain injury may indicate a state of immunoparalysis. Identification of the yeast was performed by partial amplification and sequencing of the 26S ribosomal DNA gene [hypervariable region D1/D2; partial sequencing of the act1 gene confirmed the identity of the strain as Debaryomyces hansenii (GenBank submission ID: 1688297)] The patient quickly recovered from sepsis after initiation of amphotericin B and was discharged on the 60th day.

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)

Avaliação para o manejo da úlcera neuropática associada à hanseníase: produção e validação de vídeo educativo / Evaluation for the management of leprosy-associated neuropathic ulcer: production and validation of educational video

A hanseníase é uma das maiores causas de complicações neuropáticas no mundo. Dentre estas, estão as úlceras neuropáticas, consideradas uma das causas mais comuns de amputações, morbidade e mortalidade, consequência de uma assistência à saúde embasada em procedimentos fragmentados com baixa resolutividade. Estudo de delineamento metodológico, com abordagem quali-quantitativa dos dados, que objetivou desenvolver um vídeo para intervenção educativa sobre avaliação para manejo da úlcera neuropática associada à hanseníase, a ser disponibilizado a enfermeiros. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa e foi realizada em 4 etapas: 1: Produção do roteiro e storyboard; 2:Validação do roteiro e storyboard; 3: Edição do vídeo e 4: Estudo piloto. A produção do conteúdo do roteiro e storyboard seguiu as recomendações do Ministério da Saúde e da Wound, Ostomy and Continence Nurses. A validação de conteúdo e aparência foi realizada por um comitê de especialistas. O instrumento apresentou os seguintes quesitos: objetivo; conteúdo; relevância; ambiente; funcionalidade, usabilidade e eficiência, os quais foram considerados validados a partir da concordância de 78% entre os avaliadores, calculada por meio do Índice de Validade de Conteúdo. Entre os especialistas na temática, houve maior prevalência do sexo feminino (88,9%), com idade entre 29 e 62 anos (média de 42,3 anos e desvio padrão de 11,0 anos), sendo a maior titulação acadêmica o doutorado (55,6%), e tempo de atuação profissional entre seis e 30 anos (média de 14,9 anos e desvio padrão de 8,2 anos). Dos especialistas em vídeo, a maioria era do sexo feminino (62,5%), com idade entre 30 e 46 anos (média de 37,5 anos e desvio padrão de 6,4 anos), com maior número de mestres (50%) e tempo de atuação profissional entre 2 e 24 anos (média de 10,8 anos e desvio padrão de 7,3 anos). Para todos os quesitos avaliados, obteve-se um Índice de Validade de Conteúdo superior ao mínimo preconizado. Após a adequação do roteiro e storyboard em face da validação, o vídeo foi gravado e, a partir de uma préedição, um estudo piloto (validação semântica) foi realizado por meio da técnica de grupo focal, com a participação de nove enfermeiros que atuavam na assistência à pessoa com hanseníase. Houve prevalência do sexo feminino (88,9%), com idade entre 29 e 50 anos e maior titulação acadêmica em nível de mestrado (55,6%), sendo que a maioria (55,6%) atuava na Estratégia Saúde da Família. A partir da análise de conteúdo do grupo focal, emergiram as categorias: dialogar sobre os objetivos propostos; identificar a aplicabilidade do vídeo na prática clínica do enfermeiro e valorizar a consulta de enfermagem na avaliação de pessoas com úlcera neuropática associada à hanseníase. Acredita-se que o vídeo educativo validado poderá auxiliar na realização de uma avaliação de enfermagem eficaz, segura e com qualidade à pessoa com úlcera neuropática decorrente da hanseníase

Leprosy is one of the major causes of neuropathic complications in the world. Among the complications most commonly found are neuropathic ulcers, considered one of the most common causes of amputations, morbidity and mortality in the world, as a consequence of health care based on fragmented procedures with low resolution. This is a methodological design study with qualitative and quantitative data, aiming to develop a video for educational intervention on evaluation for the management of neuropathic ulcer associated with leprosy, to be made available to nurses. The research was approved by the Research Ethics Committee and was carried out in 4 stages: 1: Production of the script and storyboard; 2: Script and storyboard validation; 3: Video editing and 4: Pilot study. The production of script content and storyboard followed the recommendations of the Ministry of Health and Wound, Ostomy and Continence Nurses. Validation of content and appearance was performed by a committee of experts. The instrument presented the following requirements: objective; content; relevance; environment; functionality, usability and efficiency, which were considered validated from the agreement of 78% between the evaluators, calculated through the Content Validity Index Among the specialists in the subject, there was a higher prevalence of female (88.9%), aged between 29 and 62 years (mean of 42.3 years and standard deviation of 11.0 years), the highest academic qualification being the doctoral degree (55.6%), and professional performance time between six and 30 years (mean of 14.9 years and standard deviation of 8.2 years). Of the video specialists, the majority were female (62.5%), aged between 30 and 46 years (mean of 37.5 years and standard deviation of 6.4 years), with a greater number of masters (50%) and time of professional activity between 2 and 24 years (mean of 10.8 years and standard deviation of 7.3 years). For all evaluated items, a Content Validity Index higher than the recommended minimum was obtained. After the adaptation of the script and storyboard in the face of validation, the video was recorded and, from a pre-edition, a pilot study (semantic validation) was performed through the focal group technique, with the participation of nine nurses who assisted the person with leprosy. There was a prevalence of females (88.9%), aged between 29 and 50 years, and a higher academic degree at the master's level (55.6%), with the majority (55.6%) working in the Family Health Strategy. From the content analysis of the focus group, the following categories emerged: dialogue about the proposed objectives; to identify the applicability of the video in the clinical practice of the nurse and to value the nursing consultation in the evaluation of people with neuropathic ulcer associated with leprosy. It is believed that the validated educational video can help in the performance of an effective, safe and quality nursing assessment to the person with neuropathic ulcer due to leprosy

Avaliação para o manejo da úlcera neuropática associada à hanseníase: produção e validação de vídeo educativo / Evaluation for the management of leprosy-associated neuropathic ulcer: production and validation of educational video

A hanseníase é uma das maiores causas de complicações neuropáticas no mundo. Dentre estas, estão as úlceras neuropáticas, consideradas uma das causas mais comuns de amputações, morbidade e mortalidade, consequência de uma assistência à saúde embasada em procedimentos fragmentados com baixa resolutividade. Estudo de delineamento metodológico, com abordagem quali-quantitativa dos dados, que objetivou desenvolver um vídeo para intervenção educativa sobre avaliação para manejo da úlcera neuropática associada à hanseníase, a ser disponibilizado a enfermeiros. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa e foi realizada em 4 etapas: 1: Produção do roteiro e storyboard; 2:Validação do roteiro e storyboard; 3: Edição do vídeo e 4: Estudo piloto. A produção do conteúdo do roteiro e storyboard seguiu as recomendações do Ministério da Saúde e da Wound, Ostomy and Continence Nurses. A validação de conteúdo e aparência foi realizada por um comitê de especialistas. O instrumento apresentou os seguintes quesitos: objetivo; conteúdo; relevância; ambiente; funcionalidade, usabilidade e eficiência, os quais foram considerados validados a partir da concordância de 78% entre os avaliadores, calculada por meio do Índice de Validade de Conteúdo. Entre os especialistas na temática, houve maior prevalência do sexo feminino (88,9%), com idade entre 29 e 62 anos (média de 42,3 anos e desvio padrão de 11,0 anos), sendo a maior titulação acadêmica o doutorado (55,6%), e tempo de atuação profissional entre seis e 30 anos (média de 14,9 anos e desvio padrão de 8,2 anos). Dos especialistas em vídeo, a maioria era do sexo feminino (62,5%), com idade entre 30 e 46 anos (média de 37,5 anos e desvio padrão de 6,4 anos), com maior número de mestres (50%) e tempo de atuação profissional entre 2 e 24 anos (média de 10,8 anos e desvio padrão de 7,3 anos). Para todos os quesitos avaliados, obteve-se um Índice de Validade de Conteúdo superior ao mínimo preconizado. Após a adequação do roteiro e storyboard em face da validação, o vídeo foi gravado e, a partir de uma préedição, um estudo piloto (validação semântica) foi realizado por meio da técnica de grupo focal, com a participação de nove enfermeiros que atuavam na assistência à pessoa com hanseníase. Houve prevalência do sexo feminino (88,9%), com idade entre 29 e 50 anos e maior titulação acadêmica em nível de mestrado (55,6%), sendo que a maioria (55,6%) atuava na Estratégia Saúde da Família. A partir da análise de conteúdo do grupo focal, emergiram as categorias: dialogar sobre os objetivos propostos; identificar a aplicabilidade do vídeo na prática clínica do enfermeiro e valorizar a consulta de enfermagem na avaliação de pessoas com úlcera neuropática associada à hanseníase. Acredita-se que o vídeo educativo validado poderá auxiliar na realização de uma avaliação de enfermagem eficaz, segura e com qualidade à pessoa com úlcera neuropática decorrente da hanseníase

Leprosy is one of the major causes of neuropathic complications in the world. Among the complications most commonly found are neuropathic ulcers, considered one of the most common causes of amputations, morbidity and mortality in the world, as a consequence of health care based on fragmented procedures with low resolution. This is a methodological design study with qualitative and quantitative data, aiming to develop a video for educational intervention on evaluation for the management of neuropathic ulcer associated with leprosy, to be made available to nurses. The research was approved by the Research Ethics Committee and was carried out in 4 stages: 1: Production of the script and storyboard; 2: Script and storyboard validation; 3: Video editing and 4: Pilot study. The production of script content and storyboard followed the recommendations of the Ministry of Health and Wound, Ostomy and Continence Nurses. Validation of content and appearance was performed by a committee of experts. The instrument presented the following requirements: objective; content; relevance; environment; functionality, usability and efficiency, which were considered validated from the agreement of 78% between the evaluators, calculated through the Content Validity Index Among the specialists in the subject, there was a higher prevalence of female (88.9%), aged between 29 and 62 years (mean of 42.3 years and standard deviation of 11.0 years), the highest academic qualification being the doctoral degree (55.6%), and professional performance time between six and 30 years (mean of 14.9 years and standard deviation of 8.2 years). Of the video specialists, the majority were female (62.5%), aged between 30 and 46 years (mean of 37.5 years and standard deviation of 6.4 years), with a greater number of masters (50%) and time of professional activity between 2 and 24 years (mean of 10.8 years and standard deviation of 7.3 years). For all evaluated items, a Content Validity Index higher than the recommended minimum was obtained. After the adaptation of the script and storyboard in the face of validation, the video was recorded and, from a pre-edition, a pilot study (semantic validation) was performed through the focal group technique, with the participation of nine nurses who assisted the person with leprosy. There was a prevalence of females (88.9%), aged between 29 and 50 years, and a higher academic degree at the master's level (55.6%), with the majority (55.6%) working in the Family Health Strategy. From the content analysis of the focus group, the following categories emerged: dialogue about the proposed objectives; to identify the applicability of the video in the clinical practice of the nurse and to value the nursing consultation in the evaluation of people with neuropathic ulcer associated with leprosy. It is believed that the validated educational video can help in the performance of an effective, safe and quality nursing assessment to the person with neuropathic ulcer due to leprosy

Coprevalência de hanseníase em contatos com idade entre 5 e 15 anos no nordeste brasileiro / Coprevalencia de hanseniasis en contactos con edad entre 5 y 15 años en el nordeste brasileño / Hanseniasis coprevalence in contacts with age between 5 and 15 years in the northeast of brazil

Objetivo avaliar a coprevalência da hanseníase em contatos com idade compreendida entre 5 e 15 anos. Método estudo descritivo, com abordagem quantitativa, realizado no período de novembro de 2014 a julho de 2015. A população do estudo foi composta por contatos intradomiciliares e peridomiciliares de pessoas atingidas pela hanseníase, que estivessem na faixa etária de 5 a 15 anos. A amostra estudada foi constituída de 73 contatos. Resultados do total de avaliados, 30 (41,0%) foram intradomiciliares e 43 (59,0%), peridomiciliares. Entre os contatos, 27 (37,0%) foram considerados sintomáticos dermatológicos; destes, 17 (23,3%) suspeitos para hanseníase por apresentarem de uma a oito lesões, sendo a maioria mancha hipocrômica (82,3%). Conclusão entre os contatos examinados neste estudo, com idades compreendidas entre 5 e 15 anos, a coprevalência da hanseníase não foi diagnosticada, mas o número de contatos classificados como suspeitos foi elevado, o que se torna preocupante do ponto de vista epidemiológico.

Objetivo evaluar la coprevalencia de la lepra en contactos con edad comprendida entre 5 y 15 años. Método estudio descriptivo, con abordaje cuantitativo, de noviembre de 2014 a julio de 2015. Población del estudio compuesta por contactos intradomiciliares y peridomiciliares de personas afectadas por la lepra, que estuvieran en el grupo de edad de 5 a 15 años. Muestra estudiada de 73 contactos. Resultados del total de evaluados, 30 (41,0%) fueron intradomiciliares y 43 (59,0%), peridomiciliares. Entre los contactos, 27 (37,0%) fueron considerados sintomáticos dermatológicos; de estos, 17 (23,3%) sospechosos de lepra por presentar de una a ocho lesiones, siendo la mayoría mancha hipocrómica (82,3%). Conclusión entre los contactos examinados en este estudio, con edades entre 5 y 15 años, la coprevalencia de la lepra no fue diagnosticada, pero el número de contactos clasificados como sospechosos fue elevado, lo que se vuelve preocupante desde el punto de vista epidemiológico.

Objective to evaluate the co-prevalence of leprosy in contacts between the ages of 5 and 15 years. Method this is a descriptive study, with a quantitative approach, carried out from November 2014 to July 2015. The study population was composed of intradomiciliary and peridomiciliary contacts of people affected by leprosy who were in the age range of 5 to 15 years. The sample consisted of 73 contacts. Results of the total of evaluated, 30 (41.0%) were intradomiciliary and 43 (59.0%), peridomiciliary. Among the contacts, 27 (37.0%) were considered dermatological symptomatic; Of these, 17 (23.3%) suspected leprosy patients had one to eight lesions, most of them hypochromic spots (82,3%). Conclusion among the contacts examined in this study, aged between 5 and 15 years, the co-prevalence of leprosy was not diagnosed, but the number of contacts classified as suspects was high, which is worrisome from the epidemiological point of view.

Fractura luxación de Lisfranc en un paciente con enfermedad de Hansen. Presentación de caso / Lisfranc fracture-dislocation in a patient with Hansen´s Disease. Case presentation

Introducción: Las lesiones de la articulación de Lisfranc se producen por traumas de alta energía; pero cuando se presentan en pacientes con enfermedad de Hansen y daño del sistema nervioso periférico, los traumas repetitivos de pequeña intensidad pueden conducir a este tipo de lesión. Objetivo: Presentar un caso interesante dada la asociación en un paciente con Hansen de una lesión de Lisfranc causado por un trauma de baja energía. Presentación de caso: Paciente de 64 años de edad fototipo V, con antecedentes de Hansen Lepromatoso, que por traumas repetitivos de baja intensidad y un proceso séptico sobreañadido, presentó fractura-luxación de Lisfranc del tipo divergente, se comentan los antecedentes, el cuadro clínico, los exámenes laboratorio, ultrasonidos, estudio radiológico y el tratamiento impuesto. Conclusiones: La discapacidad en manos y pies por trastornos neurológicos en pacientes con lepra lepromatosa de más de 5 años de evolución es bastante frecuente, pero asociado a luxofractura de Lisfranc de tipo divergente, por trauma de baja intensidad, no lo es, ya que este tipo de lesión normalmente se produce por traumas de alta energía(AU)

Introduction: Lisfranc joint lesions are produced by high energy traumas, but when they present in patients with Hansen´s disease and damage to the peripheral nervous system, the low intensity repeated traumas can lead to this type of lesion. Objective: To present an interesting case, given a particular association on a patient with Hansen´s disease and a Lisfranc lesion, caused by a low energy trauma. Case presentation: 64 years old Phototype V patient with antecedents of lepromatous Hansen´s disease who presented Lisfranc fracture-dislocation of a divergent type after low intensity repeated traumas, and a septic superadded process. The antecedents, clinical picture, laboratory tests, ultrasounds, radiological study, and the treatment indicated are all analyzed. Conclusions: Disability in hands and feet due to neurological disorders in patients with lepromatous leprosy of more than 5 years of evolution is very frequent, but it is not so frequent when associated to a Lisfranc fracture-dislocation of a divergent type due to low intensity trauma, because this type of lesion is normally caused by high energy traumas(AU)

The diagnostic challenge of mapping elephantiasis in the Tigray region of northern Ethiopia.

BACKGROUND: In Ethiopia, lymphatic filariasis and podoconiosis are the two neglected tropical diseases planned to be mapped together within the recently launched Ethiopian neglected tropical diseases master plan (2013-2015). However, other disorders cause tropical lymphedema, and this report aims to identify clinical epidemiological aspects of limb swelling in northern Ethiopia and to provide an algorithm orienting the clinical diagnosis. METHODS: Medical records of patients with lower limb elephantiasis attending the Italian Dermatological Centre of Mekele, Tigray capital city, over a 4-year period (2005-2009) were retrospectively analyzed. Nine variables were collected from the charts comprising demographic data, job, origin, literacy, clinical, histopathologic, microscopic, and cultural findings. RESULTS: Over a total of 511 patients, lymphedema resulted from trauma (40.7%), chronic venous insufficiency (12.5%), deep mycoses (10.8%), lymphatic filariasis (9.2%), elephantiasis nostras verrucosa (7.0%), tropical ulcer (6.3%), leprosy (4.9%), recurrent infections (3.1%), podoconiosis (1.8%), tuberculosis (1.0%), malignancy (1.3%), Kaposi's sarcoma (1.0%), leishmaniasis (0.2%), and neurofibromatosis (0.2%). CONCLUSIONS: Advanced-stage elephantiasis, chronic osteomyelitis, and podoconiosis not previously reported in Tigray were observed. Further epidemiological investigation and training programs addressed to healthcare providers at the peripheral level are needed to detect elephantiasis early, prevent disabilities, and improve patients' quality of life.

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.

Medieval orthopaedic history in Germany: Hieronymus Brunschwig and Hans von Gersdorff.

Hans von Gerssdorff and Hieronymus Brunschwig, who flourished in Germany in the latter half of the fifteenth century, have both left early printed treatises on Surgery which give excellent woodcuts showing pictures of instruments, operations, and costumes, at the end of the medieval period. Hieronymus Brunschwig or Hieronymus Brunschwygk (ca. 1450 - ca. 1512), was a German surgeon (wundartzot), alchemist and botanist. He was notable for his methods of treatment of gunshot wounds. His most influential book was the Buch der Cirurgia. Gersdorff(1455-1529) was a military surgeon who gained wide experience during 40 years of campaigning and was an expert in the treatment of battlefield injuries. His work covers anatomy, surgery, leprosy, and glossaries of anatomical terms, diseases, and medications.

Chromoblastomycosis in Kerala, India.

BACKGROUND: We are reporting 35 new cases of Chromoblastomycosis from Central Kerala. A majority of the cases from India are reported from the Sub Himalayan belt and South India. The disease scenario in India and abroad is briefly reviewed. AIMS: To study chromoblastomycosis in Central Kerala including the demographic and clinico- investigative profile. METHODS: This report is a retrospective record analysis of 35 cases of chromoblastomycosis who presented to the Dermatology Outpatient department of our tertiary center from January 2003 to July 2010 after obtaining Institutional Review Board approval. RESULTS: The disease was found to be more common among male agriculturists. The majority of cases were from the central districts of Kerala in and around the Western Ghats. The lower extremity (60%) was more affected with 40% of the subjects remembering a prior history of trauma. Sclerotic bodies were demonstrable in scrapings from black dots in 42.8%. The characteristic mixed mycotic granuloma was demonstrable in 77.1% of cases. The most common species isolated was Fonsecaea pedrosoi. CONCLUSIONS: Chromoblastomycosis is very common in Central Kerala. The disease mainly affects male agriculturists especially those employed in rubber plantations. The most common organism is F. pedrosoi.

Posttraumatic giant proliferating trichilemmal cysts on the parietal region of the scalp.

Proliferating trichilemmal (pilar) cysts, also known as pilar tumors, are most commonly found on the scalp of elderly women. Proliferating trichilemmal cysts are rare, slowly growing, lobular masses inherited autosomal dominantly and localized on scalps, and believed to arise due to a complication of a trauma and inflammation, and 5-10% of people are reported to be effected. Herein, we present the case of a 70-year-old woman with a 23-year history of multiple enlarging scalp masses. Clinically, squamous cell carcinoma was considered in the differential diagnosis, and the lesion was totally excised. Our case emphasizes the necessity for detailed clinical and pathological correlation for differential diagnosis.

Marjolin ulcer: an overlooked entity.

Marjolin ulcer is a well-defined, but uncommon malignant ulcer that occurs in chronic wounds and cutaneous scars. Jean-Nicolas Marjolin was credited with describing this phenomenon in 1828. This entity is frequently overlooked and therefore inadequately treated leading to a poor prognosis. The malignant transformation of an ulcer is most commonly associated with burn scars, but has been reported in many other types of chronic, non healing wounds such as traumatic wounds, venous stasis and chronic pressure ulcers, fistulas, lacerations and leprosy ulcers. Development of malignancy tends to be slow with an average time of approximately 25 years. Various theories concerning pathogenesis of Marjolin ulcer have been proposed. Well-differentiated squamous cell carcinoma (SCC) is the most common histological type of Marjolin ulcer. Biopsy with histopathologic interpretation remains the gold standard for the diagnosis, with radical surgical excision being the treatment of choice. A high index of suspicion should be held by any health care provider when evaluating a chronic, non healing wound. This is a case report of a Marjolin ulcer arising on the left buttock of a patient with a long-standing history of a traumatic wound.

Topically applied rhGM-CSF for the wound healing: a systematic review.

The process of wound healing involves a complex interplay of cells, mediators, growth factors and cytokines. GM-CSF has been shown to be involved in a number of processes essential in this event. Topically applied rhGM-CSF has been reported to successfully treat wounds with diverse etiology, including burns, chronic venous leg ulcers, pressure ulcers, and leprosy ulcers, both in animal experiments and clinical studies. To evaluate the effect of the rhGM-CSF on wound healing, 8 RCT studies and 23 clinical studies and case reports are collected for analysis of the evidence. The overall effects of rhGM-CSF on the healing of wound are diverse. Topically applied rhGM-CSF is beneficial for deep partial-thickness burn wounds, chronic leg ulcers, and leprosy ulcers. rhGM-CSF may have a positive effect on other type of chronic ulcers such as pressure ulcers and cancer related ulcers, but the evidence is not sufficient for generalised use at present. rhGM-CSF is suggested have no accelerating effect on the healing of healthy wounds or surgical incisions.

Skin manifestations of child abuse.

Child abuse is a major public health problem all over the world. There are four major types of abuse: physical abuse, sexual abuse, emotional abuse and neglect. The most common manifestations of child abuse are cutaneous and their recognition; and differential diagnosis is of great importance. Clinicians, especially dermatologists, should be alert about the skin lesions of child abuse. In the diagnosis and management of child abuse, a multidisciplinary approach with ethical and legal procedures is necessary. In this manuscript, cutaneous manifestations of physical, sexual, emotional abuse and neglect are reviewed and discussed.

Long term sustainability and efficacy of self-care education on knowledge and practice of wound prevention and management among leprosy patients.

In a chronic disease like leprosy, assessment of self-care education of long duration is necessary to find out its effectiveness and to bring out sustainability both in the point of view of the provider and of the recipient. Self-care education was imparted to patients for 8 years in the Katpadi Block as part of 'prevention of impairment and disability' programme from the year 2000 onwards. The patients were provided with knowledge regarding 'inspection' for pre-disposing factors of wound development and about external causes (trauma) or dangerous environments for wound development. Additionally, they were given practice on self-care techniques for prevention and management of wounds. Staff as part of their routine work has been doing this. An evaluation, done by independent assessor, compared the effect of this programme with a control area where no such programme was going on. This showed that the self-care education resulted in very high level of knowledge and practice compared to the control area, even up to 100% practice in some aspects. Self-care education is effective, can be sustained for a long time and also can be carried out as part of routine work.