A evolução da terapêutica / The evolution of therapy

O artigo comenta sobre algumas substâncias para tratamento da hanseníase. Atenta para as reações que tais medicamentos podem provocar

[Discussions regarding the reconstruction of the significance of leprosy in the post-sulfone period, Minas Gerais, in the 1950s]. / Discussões em torno da reconstrução do significado da lepra no período pós-sulfônico, Minas Gerais, na década de 1950.

From a historical viewpoint, all the elements surrounding a disease, from its name to the weight of meaning attached to it, are the result of "negotiations" in which many sections of society are participants. In the case of leprosy, the discovery of sulfones in 1941 made a significant contribution towards transforming our understanding of this disease, leading to questions being raised as to the measures adopted for its prevention and control, particularly the compulsory isolation of sufferers. On the basis of these assumptions, this article examines the debate which took place regarding the process whereby the old prophylactic procedures for the control of leprosy were replaced, in an important national journal, Arquivos Mineiros de Leprologia, in the 1950s.

Discussões em torno da reconstrução do significado da lepra no período pós-sulfônico, Minas Gerais, na década de 1950 / Discussions regarding the reconstruction of the significance of leprosy in the post-sulfone period, Minas Gerais, in the 1950s

Da perspectiva histórica, todos os elementos que envolvem uma doença, desde sua nomeação até a carga de significado que lhe é atribuída, resultam de "negociações" elaboradas por múltiplos atores sociais. No caso da lepra, a descoberta das sulfonas, em 1941, contribuiu de forma significativa para a transformação do entendimento dessa enfermidade, gerando um questionamento acerca das ações utilizadas para o seu controle/combate, sobretudo o isolamento compulsório dos doentes. Com base nesses pressupostos, este artigo analisa o debate que se constituiu acerca do processo de substituição das antigas práticas profiláticas para o controle da lepra, em um importante periódico de circulação nacional, Arquivos Mineiros de Leprologia, na década de 1950.

From a historical viewpoint, all the elements surrounding a disease, from its name to the weight of meaning attached to it, are the result of "negotiations" in which many sections of society are participants. In the case of leprosy, the discovery of sulfones in 1941 made a significant contribution towards transforming our understanding of this disease, leading to questions being raised as to the measures adopted for its prevention and control, particularly the compulsory isolation of sufferers. On the basis of these assumptions, this article examines the debate which took place regarding the process whereby the old prophylactic procedures for the control of leprosy were replaced, in an important national journal, Arquivos Mineiros de Leprologia, in the 1950s.

Los 100 años de Tratamiento de lepra en Fontilles: 2º parte / No disponible

No disponible

[History of leprosy in Reunion Island from the beginning of the 18th century until today]. / Histoire de la lèpre à La Réunion du début du XVIII(e) siècle à nos jours.

This article traces the history of leprosy in Reunion from the early eighteenth century, which long paralleled the slave trace. Lepers were confined to a lazaretto and treated with herbs. Father Raimbault, "doctor" and chaplain of the lepers in the middle of the twentieth century, is still honored today. The improvement in living standards and the use of sulfones finally resulted in the control of leprosy. Nonetheless, from 2005 to 2011, an average of three new cases per year were detected among a population of 800,000 inhabitants.

Dermatitis herpetiformis.

Dermatitis herpetiformis (DH) is an autoimmune, pleiomorphic, papulovesicular disorder associated with celiac disease and gluten sensitivity. DH is characterized by subepidermal bullae on hematoxylin and eosin staining and granular immunoglobulin A deposits in the dermal papillae using the direct immunofluorescence method. Antibodies to tissue transglutaminase and epidermal transgulatminase can be measured serologically, although biopsy is still required for definitive diagnosis of DH. Gluten free diet (GFD) is the first-line therapeutic approach that can alleviate both cutaneous and intestinal manifestations of this condition, while dapsone and sulfones target the skin eruption only. Combined therapy with GFD and dapsone is an initial treatment of choice to control the cutaneous manifestations of DH. This article will provide a comprehensive review of DH, including its epidemiology, clinical and pathological findings, diagnostic evaluation, and management.

La quimioterapia de la lepra: una historia interpretatia / No disponible

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The inclusivity of exclusion: isolation and community among leprosy-affected people in the South Pacific.

From 1911 to 1969 those people diagnosed with leprosy in the South Pacific were gradually isolated and received medical treatment at the Central Lepers' Hospital, Makogai Island, Fiji. Until the discovery of sulfones in the 1940s leprosy was largely incurable and it was expected that those who went to the island would never return. This paper assumes that the stigma attendant on leprosy which provoked the isolation order is itself a form of disability. The paper draws on patients'stories to explore their individual and collective experience of isolation and suggests that for many, collective isolation on Makogai was an enabling experience. On Makogai, leprosy was the 'norm', the social disability of stigma was removed and people were able to be self-sufficient, to build community and social relationships and to live a fairly ordinary island life.

Actualización en tratamiento de la lepra / no disponible

El tratamiento de la lepra ha variado, crecido y mejorado ostensiblemente en los últimos años y ello ha ayudado a eliminar esta enfermedad como problema de Salud Pública en muchos países. Sin embargo, son necesarios aún más estudios para el desarrollo de nuevos tratamientos. La llegada de nuevas drogas al arsenal terapéutico, como el ofloxacino o la minociclian, van sin dudas a reducir el tiempo de tratamiento, así como disminuir la aparición de efectos colaterales frecuentes en los esquemas hasta ahora recomendados. La talidomida, redescubierta en la actualidad como droga muy importante, no sólo para las leprorreacciones sino además para otras muchas patologías con importante componente inmunológico/inflamatorio, es objeto de numerosas investigaciones en la actualidad. Y, sobre todo, reconocer esta enfermedad que es la lepra como la expresión de una complicada – pero cada vez mejor conocida- cascada de acontecimientos inmunológicos, ha abierto un sinfín de nuevas posibilidades en el campo de la terapéutica, los inmunomoduladores, que también desempeñan un importante papel durante los episodios reacciónales, los cuales continúan siendo, a pesar de los avances actuales, el auténtico problema para el paciente bajo tratamiento. Como esta enfermedad infecciosa, la vacuna debe ser al final el objeto de todas las investigaciones, pues con la desaparición de la susceptibilidad de la población, el resto de los tratamientos, si no existen pacientes, poco han de aportar. Nuevas vacunas están haciendo su aparición en el abanico terapéutico de la lepra, de forma aislada o sumadas a los tratamientos por vía oral. Basado en las informaciones de textos de leprología actuales, así como en búsquedas en Internet acerca de investigaciones en curso sobre los nuevos tratamientos, este trabajo intenta mostrar un estudio cuidadoso de los esquemas terapéuticos en la actualidad y de las nuevas posibilidades que están surgiendo en los campos de la Farmacología y la Inmunología

The leprosy treatment has changed, grown and improved especially in the last few years, and this factor has helped to eliminate this disease as a Public Health problema inmany countries. Since the time the leprosy patients were espelled society until our days has improved very much. Although our country still has a big problem, and yet is necessary to do more research to develop new treatments. The introduction of new drugs to the therapeutic “arsenal”, as the ofloxacín or the minocicline, no doubt will reduce the time treatment, as to reduce the appearance of side-effect in the therapeutic plans recommended until now. The thalidomide, rediscovered nowadays as a drug very valued not only for the leprosy reactions as for the many other diseases with a very important immunological component/inflammatory is a target for many recent research. And for all, recognize this disease that is the leprosy as difficult expression but after all better known as an immunological cascade happening has opened many possibilities without an end in the therapeutically area, the immunomodulators, that develop a very important role during the reaction episodes, that continue to be, besides of the modern advances, the real treatment for the patients on treatment. As an infectious disease, the vaccine has to be the main objective of all the research, because with the with draw of the population susceptibility, the rest of the therapeutic if, doesn´t exist one sick, it won´t be necessary to add very much to it. New vaccines are appearing in the therapeutically leprosy cast, alone or together with the oral treatment. Based on the papers information about modern leprosy, as in research in the internet after information about new heading treatments, this paper is willing to show a new synthesized vision of the way followed in pharmacology for the leprosy treatment, studying carefully the therapeutically plans nowadays and showing new possibilities that are being evaluated in the pharmacology and immunology areas

Lepra de Lucio y eritema necrotizante / No disponible

Se comenta la historia y características de la lepra de Lucio y eritema necrotizante y su preferencia geográfica por México, aunque se han descrito en otros países. Se expone la experiencia personal de dos casos de Lucio y 22 eritemas necrotizantes en enfermos lepromatosos no difusos y la evolución mortal en dos pacientes (AU)

We coment the history and characteristics of the Lucio's Leprosy and the Necrotrisans erythema and it's geographical preference by Mexico even though it is also spread out other countries. We expuse our personal experience of two Lucio's cases and the 22 Necrotisans erythema in lepromatous patients not difused and the mortal evolution in two patients (AU)

Effects of novel manufacturing technology on blood and dialysate flow distribution in a new low flux "alpha Polysulfone" hemodialyzer.

The main target for low flux hemodialyzers is an efficient low molecular weight solutes clearance. Such efficiency is largely dependent on the optimization of diffusion between blood and dialysis solution. The diffusion process can be impaired if there is a mismatch between blood and dialysate flow distribution in the dialyzer. Thus optimized flow distribution both in the blood and dialysate compartment becomes quintessential for the maximal efficiency of the diffusion process within the hemodialyzer. The present paper describes the distribution of the blood and dialysate flows in a new low flux polysulfone hollow fiber hemodialyzer characterized by a specific undulation of the fibers and a new cutting technology of the fibers for an improved micro-flow condition in the blood compartment headers. Twelve Diacap alpha Polysulfone LO PS 15 (1.5 sqm) (B. Braun Medizintechnologie, Melsungen Germany) were employed for the study. Six were analyzed in vitro and six were studied in vivo. Blood flow distribution was studied in vitro by dye injection in the blood compartment during experimental extracorporeal circulation utilizing human blood with hematocrit adjusted at 33%. Sequential images were obtained with a helical scanner in a fixed longitudinal section of the dialyzer 1 cm thick. Average and regional blood flow velocities were measured utilizing the reconstructed imaging sequence. The method allowed the calculation of single fiber blood flow (SF Qb) and the mass transfer zone (MTR) definition in digitally subtracted images. The patterns 20-10 and 40-30 were utilized. The same technology was used to evaluate flow distribution in the dialysate compartment after dye injection in the Hansen's connector. Regional dialysate flow was calculated in central and peripheral sample areas of 1 cm2. Six in vivo hemodialysis treatments on patients with end stage renal disease were performed at three different blood flow rates (250-350 and 450 ml/min) in order to measure urea, creatinine and phosphate clearance. Macroscopic and densitometrical analysis revealed that flow distribution was homogeneous in the blood compartment while in the dialysate compartment a slight difference between the peripheral and central regions in terms of flow velocity was observed. This however was not generating channeling phenomena. Urea creatinine and phosphate clearances were remarkably high and so were the Kt/V observed in all sessions, especially in relation to the studied blood flows. In conclusion, a significant blood to dialysate flow match with optimized countercurrent flow condition was observed in the studied hollow fiber hemodialyzers. Such optimization might be due both to the improved dialyzer design at the level of the blood header and to the specific fiber undulation that prevents dialysate channeling.

Historia de la Terapéutica de la Lepra / A history of the management of lepra

La Historia de la Terapéutica de la Lepra se divide en tres períodos: incurabilidad, monoterapia y multiterapia. Se describen las diferentes medicaciones en estos períodos y las últimas novedades así como el tratamiento de las reacciones (AU)

Hanseníase: poliquimioterapia e monoterapia, Araraquara, Säo Paulo - 1990-1993 / Leprosy polichemotherapy and new therapeutics in Araraquara, Säo Paulo -1990-1993

Com o objetivo de conhecer os resultados da nova terapêutica da hanseníase por poliquimioterapia estudamos sua aplicaçäo em pacientes em Araraquara-SP no período de 1990 a 1993, do Serviço Especial de Saúde de Araraquara. Como o tratamento é de longa duraçäo, somente a partir de 1993 começamos a observar a eficiência dos resultados em relaçäo a monoterapia. Obtivemos alta por cura em 65 por cento para multibacilares e 48,5 por cento para paucibacilares e sem recidiva, enquanto para os pacientes tratados com a terapia anterior, a cura foi de 35,4 por cento. Baseado nestes resultados concluímos que é importante a poliquimioterapia na cura da hanseníase.

Agranulocitose induzida pelo uso de dapsona em paciente com hanseníase tuberculóide / Agranulocytosis induced by use of dapsone in pacient with tuberculoid leprosy

Relato de caso de paciente do sexo feminino, sob tratamento para hanseníase tuberculóide, em uso de 100mg/dia de dapsona, que desenvolveu agranulocitose e septicemia. Discutem-se os mecanismos envolvidos, as causas possíveis e o quadro clínico. Sugere-se cautela durante o uso dessa droga, principalmente nas primeiras 12 semanas de tratamento.

Hanseníase dimorfa com padröes diversos de reaçäo granulomatosa em pele e vísceras / Borderline leprosy with several patterns of granulomatous reactions in skin and visceras

Um paciente com história de no mínimo 12 anos de evoluçao, considerado como portador de Hanseníase virchoviana e com todas as seqüelas características (madarose, queda de pirâmide nasal, fibrose e atrofia dos testículos) além de episódios de Eritema nodoso hansênico, apresenta padroes diversos de reaçao granulomatosa em pele, nervos e vísceras. Observa-se granulomas virchovianos ativos, granulomas virchovianos regressivos, granulomas dimorfos difusos, e granulomas com padrao tuberculóide na presença de rica baciloscopia incluindo bacilos típicos. O aspecto mais interessante é o encontro de granulomas tuberculóides múltiplos em linfonodos, medula óssea, fígado e baço. A rica baciloscopia e a presença de bacilos típicos, apesar do predomínio de reaçao granulomatosa de padrao tuberculóide fala a a favor de uma piora da doença. Discute-se a interpretaçao imunológica deste tipo de reaçao e sua relaçao com a má evoluçao do paciente.

Hanseníase / Leprosy

O presente trabalho tem por objetivo revisar os novos conceitos sobre hanseníase, suas manifestaçöes clínicas e os métodos diagnósticos. E dado ainda um enfoque especial aos avanços em relaçäo ao tratamento desta patologia