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.

Educational workshop with adolescents on leprosy: case report / Taller educativo con adolescentes sobre la enfermedad de Hansen (Lepra): relato de experiencia / Oficina educativa com adolescentes sobre hanseníase: relato de experiência

ABSTRACT Objective: To report the experience of professors and students in the development and implementation of an educational workshop on leprosy with adolescents. Method: This is a case report from actions contained in a university extension project. Results: The workshop program was elaborated with duration of two hours, including five dynamic techniques adapted to the topic: adjective, face, traffic light, true or false and mosaic. It was verified that the construction of knowledge in light of the verbalization of the adolescents and the interest in working in the society they live through sharing this knowledge, especially those who were more involved in the process. Conclusion: It was concluded that the applied workshops enabled building knowledge and demystifying myths and stigmas socially constructed to adolescents, as well as allowed Nursing students to experience educational interventions on leprosy with adolescents.

RESUMEN Objetivo: Relatar la experiencia de docentes y discentes en la elaboración y en la aplicación de taller educativo sobre la enfermedad de Hansen con adolescentes. Método: Se trata de un relato de experiencia desde acciones contenidas en un proyecto de extensión universitaria. Resultados: El programa del taller fue elaborado con duración de dos horas, englobando cinco técnicas de dinámicas adaptadas a la temática: adjetivo, caras, semáforo, verdadero o falso y mosaico. Se certificó la construcción del conocimiento delante de la verbalización de los adolescentes y del interés en actuar en la sociedad en que viven por medio del compartir de ese conocimiento, principalmente de los que se mostraron más involucrados durante el proceso. Conclusión: Se concluye que los talleres aplicados posibilitaron la construcción del conocimiento y la desmitificación de mitos y estigmas socialmente construidos a los adolescentes, así como permitieron a los discentes de enfermería la vivencia en intervenciones educativas sobre enfermedad de Hansen con adolescentes.

RESUMO Objetivo: Relatar a experiência de docentes e discentes na elaboração e aplicação de oficina educativa sobre hanseníase com adolescentes. Método: Trata-se de um relato de experiência a partir de ações contidas em um projeto de extensão universitária. Resultados: O roteiro da oficina foi elaborado com duração de duas horas, englobando cinco técnicas de dinâmicas adaptadas à temática: adjetivo, face, semáforo, verdadeiro ou falso e mosaico. Verificou-se a construção de conhecimento diante da verbalização dos adolescentes e do interesse em atuar na sociedade em que vivem por meio do compartilhamento desse conhecimento, principalmente dos que se mostraram mais envolvidos durante o processo. Conclusão: Conclui-se que as oficinas aplicadas possibilitaram a construção do conhecimento e a desmistificação de mitos e estigmas socialmente construídos aos adolescentes, assim como permitiram aos discentes de enfermagem a vivência em intervenções educativas sobre hanseníase com adolescentes.

Leprosy educational practices with adolescents: an integrative literature review / Prácticas educativas sobre la enfermedad de Hansen (Lepra) con adolescentes: revisión integrativa de la literatura / Práticas educativas sobre hanseníase com adolescentes: revisão integrativa da literatura

ABSTRACT Objectives: to identify scientific evidence in the literature regarding educational actions on leprosy developed with adolescents. Method: an integrative review of the literature, with the following research question: what are the leprosy educational practices currently being developed with adolescents? The search was performed in the following databases: MEDLINE, Scopus, LILACS, CINAHL, BVS Hanseníase and other sources, using "adolescent"; "leprosy"; "health education"; "public health", and "public health practice" as keywords. Results: the sample was comprised of nine studies. Leprosy educational practices with adolescents verifiably promote change in knowledge when they are based on constructivist methodologies. The nurse is recognized as a professional with potential for developing these educational practices. Final considerations: actions for leprosy education with adolescents do lead to changes in knowledge, but new research is needed to evaluate their effectiveness in further improving this knowledge as well as changing behaviors and practices.

RESUMEN Objetivo: Identificar las evidencias científicas de la literatura con relación a las prácticas educativas sobre la enfermedad de Hansen desarrolladas con adolescentes. Método: Se trata de una revisión integrativa de la literatura, con el cuestionamiento a continuación: ¿cuáles prácticas educativas sobre la enfermedad de Hansen están siendo desarrolladas con adolescentes? La búsqueda fue realizada en las bases de datos Medline, Scopus, Lilacs, CINAHL, Enfermedad de Hansen y en otras fuentes por medio de los descriptores: adolescente; enfermedad de Hansen; educación en salud; salud pública; y práctica de salud pública. Resultados: Nueve estudios compusieron la muestra. Se certificó que las prácticas educativas sobre enfermedad de Hansen con adolescentes promueven el cambio de conocimiento cuando se basan en la metodología constructivista y que el enfermero es reconocido como profesional con potencial para su desarrollo. Consideraciones finales: Las prácticas educativas sobre la enfermedad de Hansen con adolescentes resultan en cambios en el conocimiento, sin embargo, son necesarias nuevas investigaciones que evalúen su efectividad en la mejora del conocimiento y en los cambios de actitud y de prácticas.

RESUMO Objetivo: identificar as evidências científicas da literatura a respeito das práticas educativas sobre hanseníase desenvolvidas com adolescentes. Método: trata-se de uma revisão integrativa da literatura, com o seguinte questionamento: quais práticas educativas sobre hanseníase estão sendo desenvolvidas com adolescentes? A busca foi realizada nas bases de dados Medline, Scopus, Lilacs, CINAHL, Hanseníase e em outras fontes por meio dos Descritores: adolescente; hanseníase; educação em saúde; saúde pública; e prática de saúde pública. Resultados: nove estudos compuseram a amostra. Verificou-se que as práticas educativas sobre hanseníase com adolescentes promovem mudança de conhecimento quando se baseiam na metodologia construtivista e que o enfermeiro é reconhecido como profissional com potencial para o seu desenvolvimento. Considerações finais: as práticas educativas sobre hanseníase com adolescentes resultam em mudanças no conhecimento, porém são necessárias novas pesquisas que avaliem a sua efetividade na melhora do conhecimento e nas mudanças de atitude e de práticas.

Validation of Brazilian educational technology for disseminating knowledge on leprosy to adolescents / Validación de tecnología educativa brasileña para difusión de conocimientos sobre lepra entre adolescentes / Validação da tecnologia educacional brasileira para disseminação de conhecimento sobre a hanseníase para adolescentes

ABSTRACT Objective: Elaborate and validate an educational technology for adolescents on leprosy, focusing on preventing the disease and reducing stigma. Method: First, a prototype of the educational technology was elaborated and later analyzed by 17 adolescents and 7 researchers' experts in the leprosy area and educational technologies who answered a questionnaire with questions related to the subject. Subsequently, the technology has been applied to 43 adolescents, and a questionnaire was handed before and after the use of the game, so that questionnaire scores were compared by a Wilcoxon paired test. Results: After the data collection with researchers and adolescents, the answers received descriptive treatment, and the Content Validity Index was calculated, which reached a good level of agreement, with an overall value (0.86), although there were improvements to the technology, based on the perceptions of researchers and adolescents. Conclusions: There was an increase in knowledge about leprosy.

RESUMEN Objetivo: Elaborar y validar una tecnología educativa sobre lepra para adolescentes, enfocada en la prevención de la enfermedad y en la reducción del estigma. Método: Inicialmente, se elaboró un prototipo de tecnología educativa, luego analizado por 17 adolescentes y 7 investigadores expertos en las áreas de lepra y tecnologías educativas. Respondieron un cuestionario con preguntas relacionadas con la temática. Posteriormente, la tecnología fue utilizada con 43 adolescentes, a los que se les entregó un cuestionario antes y después del uso del juego. Los puntajes del cuestionario fueron comparados por Prueba Pareada de Wilcoxon. Resultados: Una vez recolectados los datos de los investigadores y los adolescentes, las respuestas recibieron tratamiento descriptivo y se calculó su Índice de Validez de Contenido, que alcanzó buen nivel de concordancia en su valor global (0.86), aunque igualmente se mejoró la tecnología acorde las percepciones de investigadores y adolescentes. Conclusiones: Se aumentó el conocimiento sobre lepra.

RESUMO Objetivo: Elaborar e validar uma tecnologia educacional para adolescentes com hanseníase, focando na prevenção da doença e redução do estigma. Método: Inicialmente, um protótipo da tecnologia educacional foi elaborado, e então analisado por 17 adolescentes e 7 pesquisadores especialistas na área de hanseníase e tecnologias educacionais, que responderam a um questionário com questões relacionadas ao tema. Posteriormente, a tecnologia foi aplicada a 43 adolescentes, e um questionário foi entregue antes e após o uso do jogo, para que os escores dos questionários fossem comparados com o teste de Wilcoxon pareado. Resultados: Após a coleta de dados com os pesquisadores e adolescentes, as respostas foram submetidas a um tratamento descritivo, e o Índice de Validade de Conteúdo foi calculado, alcançando bom nível de concordância, com valor global de 0,86, embora houvesse melhorias a serem feitas na tecnologia, de acordo com as percepções dos pesquisadores e adolescentes. Conclusões: Houve um aumento no conhecimento sobre a hanseníase.

Validation of Brazilian educational technology for disseminating knowledge on leprosy to adolescents.

OBJECTIVE: Elaborate and validate an educational technology for adolescents on leprosy, focusing on preventing the disease and reducing stigma. METHOD: First, a prototype of the educational technology was elaborated and later analyzed by 17 adolescents and 7 researchers' experts in the leprosy area and educational technologies who answered a questionnaire with questions related to the subject. Subsequently, the technology has been applied to 43 adolescents, and a questionnaire was handed before and after the use of the game, so that questionnaire scores were compared by a Wilcoxon paired test. RESULTS: After the data collection with researchers and adolescents, the answers received descriptive treatment, and the Content Validity Index was calculated, which reached a good level of agreement, with an overall value (0.86), although there were improvements to the technology, based on the perceptions of researchers and adolescents. CONCLUSIONS: There was an increase in knowledge about leprosy.

Leprosy educational practices with adolescents: an integrative literature review.

OBJECTIVES: to identify scientific evidence in the literature regarding educational actions on leprosy developed with adolescents. METHOD: an integrative review of the literature, with the following research question: what are the leprosy educational practices currently being developed with adolescents? The search was performed in the following databases: MEDLINE, Scopus, LILACS, CINAHL, BVS Hanseníase and other sources, using "adolescent"; "leprosy"; "health education"; "public health", and "public health practice" as keywords. Results: the sample was comprised of nine studies. Leprosy educational practices with adolescents verifiably promote change in knowledge when they are based on constructivist methodologies. The nurse is recognized as a professional with potential for developing these educational practices. Final considerations: actions for leprosy education with adolescents do lead to changes in knowledge, but new research is needed to evaluate their effectiveness in further improving this knowledge as well as changing behaviors and practices.

Educational workshop with adolescents on leprosy: case report.

OBJECTIVE: To report the experience of professors and students in the development and implementation of an educational workshop on leprosy with adolescents. Method: This is a case report from actions contained in a university extension project. RESULTS: The workshop program was elaborated with duration of two hours, including five dynamic techniques adapted to the topic: adjective, face, traffic light, true or false and mosaic. It was verified that the construction of knowledge in light of the verbalization of the adolescents and the interest in working in the society they live through sharing this knowledge, especially those who were more involved in the process. CONCLUSION: It was concluded that the applied workshops enabled building knowledge and demystifying myths and stigmas socially constructed to adolescents, as well as allowed Nursing students to experience educational interventions on leprosy with adolescents.

Botulinum toxin type A in chronic neuropathic pain in refractory leprosy.

OBJECTIVE: Neuropathic pain is a chronic syndrome that is difficult to treat and often affects patients with leprosy. Recommended treatment includes the the use of analgesic drugs, codeine, tricyclic antidepressants, neuroleptics, anticonvulsants and thalidomide, but without consensus on uniform dose and fully satisfactory results. To analyze botulinum toxin type A (BoNT-A) effectiveness in treatment of chronic neuropathic pain in refractory leprous patients, as well as evaluate and compare the quality of life of patients before and after using the medication. METHODS: We used a specific protocol including clinical, demographic, DN4 protocol, analogue scale (VAS), sensory evaluation and evaluation of the WHOQOL-BREF. Therapeutic intervention was performed with BOTOX® BTX-A 100U administered subcutaneously. Fifteen patients were evaluated on days 0, 10 and 60. RESULTS: Patients on VAS showed pain between 5 and 10, in one case there was complete pain relief in 60 days, while others showed improvement in the first week with the return of symptoms with less intensity after this period. WHOQOL-BREF's domains Quality of Life and Physical to have a significant increase in QOL. CONCLUSION: BoNT-A proved to be a good therapeutic option in relieving pain with improved quality of life for these patients.

Botulinum toxin type A in chronic neuropathic pain in refractory leprosy / Toxina Botulínica Tipo A em Dor Neuropática Crônica em Hanseníase

ABSTRACT Neuropathic pain is a chronic syndrome that is difficult to treat and often affects patients with leprosy. Recommended treatment includes the the use of analgesic drugs, codeine, tricyclic antidepressants, neuroleptics, anticonvulsants and thalidomide, but without consensus on uniform dose and fully satisfactory results. Objective: To analyze botulinum toxin type A (BoNT-A) effectiveness in treatment of chronic neuropathic pain in refractory leprous patients, as well as evaluate and compare the quality of life of patients before and after using the medication. Methods: We used a specific protocol including clinical, demographic, DN4 protocol, analogue scale (VAS), sensory evaluation and evaluation of the WHOQOL-BREF. Therapeutic intervention was performed with BOTOX® BTX-A 100U administered subcutaneously. Fifteen patients were evaluated on days 0, 10 and 60. Results: Patients on VAS showed pain between 5 and 10, in one case there was complete pain relief in 60 days, while others showed improvement in the first week with the return of symptoms with less intensity after this period. WHOQOL-BREF's domains Quality of Life and Physical to have a significant increase in QOL. Conclusion: BoNT-A proved to be a good therapeutic option in relieving pain with improved quality of life for these patients.

RESUMO A dor neuropática é uma síndrome crônica que é difícil de tratar e freqüentemente afeta pacientes com hanseníase. O tratamento recomendado inclui o uso de drogas analgésicas, codeína, antidepressivos tricíclicos, neurolépticos, anticonvulsivantes e talidomida, mas sem consenso sobre dose uniforme e resultados plenamente satisfatórios. Objetivo: Busca-se analisar a efetividade da toxina botulínica tipo A no tratamento da dor neuropática crônica hansênica refratária. Método: Estudo de intervenção do tipo ensaio clínico em portadores de dor neuropática crônica hansênica. Foram coletados dados epidemiológicos, protocolo DN4, escala analógica da dor (EVA), avaliação sensitiva, motora a avaliação do WHOQOL-Bref. Realizado intervenção terapêutica com toxina botulínica tipo A 100U. Os pacientes foram avaliados nos dias de 0, 10 e 60. A dor neuropática foi mais frequente no sexo masculino, na faixa etária de 40 à 49 anos. Resultados: Da forma Dimorfa, multibacilar com baciloscopia positiva e incapacidades presentes. Os escores EVA variam entre 5 e 10, todos os pacientes apresentaram alterações sensoriais. O WHOQOL-Bref apresentou melhora após o tratamento com TxBA. A TxBA foi bem tolerada o único efeito adverso notável foi dor leve. E com apenas uma única aplicação de TxBA promoveu efeitos analgésicos a longo prazo em pacientes com dor associada à alodinia, sugerindo que a analgesia observada pode ser causada por um efeito periférico da TxBA em terminações nociceptivas. Conclusão: O estudo sugere que a TxBA é uma boa opção para os casos de dor neuropática crônica hansênica, no entanto, novos estudos são necessários para confirmar estes resultados.

Evaluation of the cutaneous sensation of the face in patients with different clinical forms of leprosy.

BACKGROUND: Leprosy can be considered to be the most common peripheral neuropathy of infectious etiology and constitutes a public health problem. The standard routine examination for assessing sensory impairment in leprosy neuropathy basically evaluates hands, feet and eyes. However, evaluation of facial cutaneous sensation is not routinely performed. OBJECTIVES: The aim of this study was to evaluate facial cutaneous sensation in patients with different clinical forms of leprosy and compare the findings with those from healthy individuals. METHODOLOGY: 19 healthy controls and 71 leprosy patients who were being treated at a national reference center for leprosy in Brazil underwent facial sensation assessment using the Semmes-Weinstein monofilament test. This test was applied over the facial areas corresponding to the ophthalmic, maxillary and mandibular distal branches of the trigeminal nerve. RESULTS: The predominant clinical form in terms of changes to facial cutaneous sensation was lepromatous leprosy (LL), followed by the borderline-borderline (BB), and borderline-lepromatous (BL) forms, in comparison with healthy individuals. The distal branches most affected were the zygomatic (28.2%; 20/71), buccal (23.9%; 17/71) and nasal (22.5%; 16/71). There was asymmetrical sensory impairment of the face in 62.5% (20/32) of the cases. CONCLUSION: The face is just as impaired in leprosy as are the feet, hands and eyes, but facial impairment is underdiagnosed. Our evaluation on the different sensory branches and evidence of asymmetrical impairment of the face confirm the classically described pattern of leprosy neuropathy, i.e. consisting of asymmetrical and predominantly sensory peripheral neuropathy.

Worsening of the disability grade during leprosy treatment: prevalence and its determinants in Southern Nigeria.

Background: In Nigeria, little is known about the development of new or additional physical disability during leprosy treatment. The objective of this study was to determine the prevalence and evaluate factors associated with worsening of physical disability during leprosy treatment in Nigeria. Methods: This was a retrospective cohort study conducted among leprosy patients treated in six referral facilities in six States in Nigeria between January 2011 and December 2015. Multivariable logistic regression analysis was used to identify predictors of worsening disability after treatment. Results: Of 984 leprosy patients who completed treatment, the mean age of the patients was 39.8±17.6 years and 57.4% (565/984) of them were male. Also, 51.6% (508/984) of the patients had either grade 1 or 2 disability at diagnosis, but this declined to 30.8% (303/984) following treatment (p<0.001). Overall, 4.7% (46/984) of the cases developed new or additional disability (or worsening disability) during treatment. The cases with the greatest odds for developing worsening physical disability were patients from the southwest (adjusted odds ratio [aOR] 15.9; 95% CI 3.8-67.4) and southeast zones (aOR 4.7; 95% CI 1.1-19.2), and patients who had a leprosy reaction requiring additional corticosteroid therapy (aOR 11.7; 95% CI 4.4-31.2). Conclusion: Sustained capacity building for health professionals on better monitoring and management of leprosy and its complications is strongly recommended in Nigeria.

Saphenous nerve transfer: A new approach to restore sensation of the sole.

BACKGROUND: Loss of protective sensation of the sole may lead to repeated trauma, chronic nonhealing ulcers, and even amputation. Saphenous nerve (SN) to posterior tibial nerve (PTN) transfer can restore sensation of the sole. METHOD: This study was conducted in a tertiary referral center in Central India. Twenty-one patients (32 feet) diagnosed with loss of sensation of the sole were included in this study. Causes of loss of sensation were Hansen's disease (n = 18), complex sciatic nerve injury (n = 1), lumbosacral spinal tumor (n = 1), and lumbosacral meningomyelocele (n = 1). Seventeen feet (14 patients) had ulcers on the sole. Preoperative and postoperative sensory tests performed on the sole included tests for touch, pain, temperature, pressure, vibration, and two-point discrimination. Results were classified as per the British Medical Research Council (MRC) scoring system. RESULTS: Seventeen patients (26 feet) were available for follow-up at 6 months after surgery. All patients had improvement in sensory parameters. Ulcers completely healed in 13 feet and reduced in size in four feet. MRC score improved from S0 in 22 feet and S1 in 10 feet to S3 + in 20 feet, S3 in four feet, and S2 in two feet. CONCLUSIONS: Sensory neurotization with SN transfer to PTN can restore protective sensation to the sole and help in the healing of ulcers.

Langerin (CD207)-positive cells in leprosy: Possible implications for pathogenesis of the disease with special emphasis on dermal immunoreactivity.

Leprosy is a disease caused by Mycobacterium leprae, which is characterized by two distinct poles, the tuberculoid pole and the lepromatous pole, depending on the immune response to the bacillus. Langerin-positive cells are dendritic cells that appear to play an essential role in the development of the disease. These cells are specialized in the processing and presentation of antigens, exerting an important function in the activation of the immune system. To evaluate the expression of langerin-positive cells (CD207+) in skin lesion fragments of patients with a diagnosis of M. leprae infection and to associate the expression of these cells with the polar forms of the disease. Langerin-positive cells were detected in larger numbers in lesions of patients with the tuberculoid form compared to those with the lepromatous form. The presence of a larger number of these cells in patients with the tuberculoid form suggests an important participation of langerin-positive cells, capturing antigens and favoring an effective immune response to infection with M. leprae.