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1.
Methods Mol Biol ; 2314: 1-58, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34235647

RESUMO

Building upon the foundational research of Robert Koch, who demonstrated the ability to grow Mycobacterium tuberculosis for the first time in 1882 using media made of coagulated bovine serum, microbiologists have continued to develop new and more efficient ways to grow mycobacteria. Presently, all known mycobacterial species can be grown in the laboratory using either axenic culture techniques or in vivo passage in laboratory animals. This chapter provides conventional protocols to grow mycobacteria for diagnostic purposes directly from clinical specimens, as well as in research laboratories for scientific purposes. Detailed protocols used for production of M. tuberculosis in large scale (under normoxic and hypoxic conditions) in bioreactors and for production of obligate intracellular pathogens such as Mycobacterium leprae and "Mycobacterium lepromatosis" using athymic nude mice and armadillos are provided.


Assuntos
Técnicas Bacteriológicas , Infecções por Mycobacterium/microbiologia , Mycobacterium/crescimento & desenvolvimento , Animais , Tatus , Técnicas Bacteriológicas/instrumentação , Reatores Biológicos , Modelos Animais de Doenças , Humanos , Camundongos Nus , Viabilidade Microbiana , Mycobacterium/isolamento & purificação , Mycobacterium leprae/crescimento & desenvolvimento , Mycobacterium leprae/isolamento & purificação , Fatores de Tempo
2.
PLoS Negl Trop Dis ; 15(3): e0009201, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33725010

RESUMO

BACKGROUND: This study reviews the progress of leprosy elimination in Yunnan, China, over the past 30 years and identifies the challenges for the next stage of the program. METHODOLOGY/PRINCIPAL FINDINGS: Data were collected from the Leprosy Management Information System in China (LEPMIS). The progress made in the elimination of leprosy between 1990 and 2019 was measured. We defined two time periods, time period 1 (1990-2003) and time period 2 (2004-2019), because multidrug therapy (MDT) was launched for the treatment of leprosy in 1990 and a special fund from the central government was established for leprosy in 2004. During the past 30 years, the number of newly detected leprosy patients in Yunnan has steadily declined. In total, 703 newly detected leprosy patients were reported in 1990, and 353 and 136 cases were reported at the end of 2003 and 2019, respectively. At the end of 1990, 90.7% (117/129) of counties in Yunnan Province were identified as leprosy-endemic counties (>1 case per 100,000 population). By the end of 2003 and 2019, 39.3% (46/117) and 85.5% (100/117) of the leprosy-endemic counties, respectively, had dropped below the elimination threshold. The main challenges are the remaining leprosy-endemic counties, the high rate of cases with a contact history, insufficient early detection, and leprosy cases resulting in physical disability. CONCLUSIONS/SIGNIFICANCE: A multifaceted strategy for leprosy elimination in Yunnan Province has been successfully implemented, and remarkable progress has been made in the elimination of leprosy in this area. The priorities for leprosy elimination in the next stage are securing sustainable support and investment from the government, establishing an effective surveillance system, ensuring prompt early detection, providing treatment with MDT, preventing transmission of M. leprae, preventing disability, providing health education, and preventing recurrence of the epidemic situation of leprosy.


Assuntos
Erradicação de Doenças , Hanseníase/epidemiologia , Hanseníase/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Vigilância da População , Fatores de Tempo , Adulto Jovem
3.
Acta Trop ; 215: 105791, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33310076

RESUMO

BACKGROUND: Leprosy causes a range of symptoms, and most diagnoses are established based on the clinical picture. Therefore, false negative and positive diagnoses are relatively common. We analyzed the spatial pattern of leprosy misdiagnosis and associated factors in Brazil. METHOD: Exploratory analyses of Kernel density of the new case detection rate (NCDR) and proportion of misdiagnosis in Brazil, 2003-2017. Factors associated with misdiagnosis were identified by logistic regression at the 5% significance level. RESULT: A total of 574,181 new leprosy cases were recorded in Brazil within the study period, of which 7,477 (1.3%) were misdiagnoses. No spatial correlation was observed between the proportion of misdiagnoses and the NCDR. The likelihood of misdiagnosis was elevated for females [OR: 1.58 (1.51-1.66)], children [OR: 1.49 (1.36-1.64)]; paucibacillary [OR: 1.08 (1.02-1.13)], indeterminate clinical forms [OR: 2.37 (2.15-2.62)], for cases diagnosed in the frame of mass screenings [OR: 3.36 (3.09- 3.73)] and contact examination [OR: 2.30 (2.13-2.49)] and for cases with affected nerves but no skin lesions [OR: 2.47 (2.19-2.77)] when compared with those presenting both skin lesion and affected nerves. CONCLUSION: Misdiagnosis of leprosy is not correlated with the endemicity level in Brazil but rather with personal, diagnosis-related and disease characteristics.


Assuntos
Erros de Diagnóstico , Hanseníase/diagnóstico , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Adulto Jovem
4.
Epidemiol Serv Saude ; 29(5): e2019575, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33175008

RESUMO

OBJECTIVE: To analyze the trend of leprosy indicators in Goiás between 2001 and 2017. METHODS: An ecological time series study was conducted. Leprosy morbidity and operational indicators were calculated using Notifiable Health Conditions Information System data. Prais-Winsten regression was used for trend analysis. RESULTS: There was a falling trend in the detection rate in the general population (Annual Percent Change [APC] = -6.8 - 95%CI -8.2;-5.4) and in children under 15 years old (APC = -7.2 - 95%CI -8.5;-5.9); a rising trend in the proportion of grade 2 disability (APC = 3.7 - 95%CI 2.0;5.3) and in the proportion of examined physical disability (APC = 0.6 - 95%CI 0.3;0.8); healing and examined contacts proportions were stable. CONCLUSION: Detection rates decreased while the proportions of grade 2 physical disability and examined physical disability increased.


Assuntos
Indicadores Básicos de Saúde , Hanseníase , Adolescente , Brasil/epidemiologia , Criança , Pessoas com Deficiência/estatística & dados numéricos , Humanos , Incidência , Hanseníase/epidemiologia , Fatores de Tempo
6.
PLoS One ; 15(8): e0237165, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764785

RESUMO

This study's objective was to estimate the temporal trends of leprosy according to sex and age groups, as well as to estimate and predict the progression of the disease in a hyperendemic city located in the northeast of Brazil. This ecological time-series study was conducted in Imperatriz, Maranhão, Brazil. Leprosy cases diagnosed between 2006 and 2016 were included. Detection rates stratified by sex and age groups were estimated. The study of temporal trends was accomplished using the Seasonal-Trend Decomposition method and temporal modeling of detection rates using linear seasonal autoregressive integrated moving average model according to Box and Jenkins method. Trend forecasts were performed for the 2017-2020 period. A total of 3,212 cases of leprosy were identified, the average incidence among men aged between 30 and 59 years old was 201.55/100,000 inhabitants and among women in the same age group was 135.28/100,000 inhabitants. Detection rates in total and by sex presented a downward trend, though rates stratified according to sex and age presented a growing trend among men aged less than 15 years old and among women aged 60 years old or over. The final models selected in the time-series analysis show the forecasts of total detection rates and rates for men and women presented a downward trend for the 2017-2020 period. Even though the forecasts show a downward trend in Imperatriz, the city is unlikely to meet a significant decrease of the disease burden by 2020.


Assuntos
Doenças Endêmicas/estatística & dados numéricos , Previsões/métodos , Hanseníase/epidemiologia , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Cidades/estatística & dados numéricos , Feminino , Humanos , Incidência , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
7.
Sci Rep ; 10(1): 9774, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32555205

RESUMO

Erythroderma is characterized by erythema and scaling affecting more than 80% of the body surface area. It is potentially life-threatening, and diagnosis of the underlying disease is a challenge. Despite laboratory improvements, many cases remain idiopathic. We aimed to analyze clinical and laboratory findings of 309 erythrodermic patients to find clues to the etiologic diagnosis. We performed a prospective study at the University of São Paulo Medical School, from 2007 to 2018, with patients with acquired erythroderma. Clinical, laboratory, histology, and molecular biology data were collected. The median age at diagnosis was 57 years, with a male-to-female ratio of 2.2. Eczema was the most frequent etiology (20.7%), followed by psoriasis (16.8%), Sézary syndrome (12.3%), drug eruption (12.3%), atopic dermatitis (8.7%), and mycosis fungoides (5.5%). Other diagnoses (6.8%) included pemphigus foliaceous, paraneoplastic erythroderma, adult T-cell leukemia/lymphoma, dermatomyositis, pityriasis rubra pilaris, lichen planus, bullous pemphigoid, and leprosy. In 52 patients (16.8%), it was not possible to elucidate erythroderma etiology. Atopic dermatitis developed erythroderma at an earlier age (median 25 years; P = 0.0001). Acute onset was associated with drug reactions and atopic dermatitis (median time from erythroderma to diagnosis of 1 and 1.5 months, respectively; P = 0.0001). Higher immunoglobulin E levels were observed in atopic dermatitis (median 24,600 U/L; P = 0.0001). Histopathology was helpful and was consistent with the final diagnosis in 72.4%. Monoclonal T-cell proliferation in the skin was observed in mycosis fungoides (33.3%) and Sézary syndrome (90.9%). At the last assessment, 211 patients (69.3%) were alive with disease, 65 (21.7%) were alive without disease, and 27 (9.1%) died with active disease. Erythroderma is a challenging syndrome with a difficult diagnostic approach. Younger age and higher immunoglobulin E levels are associated with atopic dermatitis; acute onset is observed in drug eruptions and atopic dermatitis. Histopathology and molecular biology tests are essential tools in the investigation of erythroderma.


Assuntos
Dermatite Esfoliativa/etiologia , Dermatite Esfoliativa/patologia , Dermatopatias/complicações , Centros de Atenção Terciária/estatística & dados numéricos , Dermatite Esfoliativa/classificação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Tempo
8.
Int J Mycobacteriol ; 9(2): 223-225, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32474550

RESUMO

Patients with leprosy rarely present ulcerated lesions that can appear during reactional states like Lucio's phenomenon (LP), as in our case. LP is a rare complication of multibacillary leprosy due to massive bacilli invasion of endothelial cells causing a thrombotic syndrome. The initial macular lesion is purpuric followed by multiple infiltrated papules and nodules, some of them ulcerated, associated to loss of sensation on lower limbs. The importance of recognizing ulcers as a specific cutaneous manifestation of leprosy allows early diagnosis and treatment, and therefore avoiding the development of disabilities and persistence of illness. Infection by Mycobacterium lepromatosis is associated with LP and it should be especially sought in patients from endemic areas.


Assuntos
Infecções por Mycobacterium/diagnóstico , Mycobacterium/patogenicidade , Úlcera/microbiologia , Úlcera/patologia , Adulto , Diagnóstico Diferencial , Células Endoteliais/patologia , Feminino , Humanos , Hansenostáticos/uso terapêutico , Hanseníase Multibacilar/diagnóstico , Infecções por Mycobacterium/complicações , Infecções por Mycobacterium/tratamento farmacológico , Pele/microbiologia , Pele/patologia , Fatores de Tempo , Úlcera/diagnóstico
9.
Int J Mycobacteriol ; 9(2): 226-228, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32474551

RESUMO

Erythema multiforme (EM)-like erythema nodosum leprosum (ENL) is a rare atypical presentation, and its late appearance after the completion of multidrug therapy (MDT) is unusual. We describe the case of a lepromatous leprosy patient who after the completion of MDT presented to us with late EM-like ENL and was found to be resistant to rifampicin. We discuss the implications of this finding and the potential role of resistant bacilli in causing reactions with atypical presentations.


Assuntos
Quimioterapia Combinada/efeitos adversos , Hansenostáticos/uso terapêutico , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Rifampina/uso terapêutico , Adulto , Farmacorresistência Bacteriana/genética , Eritema Multiforme/diagnóstico , Eritema Multiforme/patologia , Eritema Nodoso/diagnóstico , Eritema Nodoso/patologia , Humanos , Masculino , Mycobacterium lepraemurium/efeitos dos fármacos , Mycobacterium lepraemurium/genética , Rifampina/farmacologia , Fatores de Tempo
11.
Vet Comp Orthop Traumatol ; 33(3): 161-166, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32000274

RESUMO

OBJECTIVE: The aim of this study was to determine if either the rate of onset of clinical signs or duration from initial clinical signs to surgical decompression affected the overall quality or duration of recovery in dogs with intervertebral disc extrusion. STUDY DESIGN: This was a retrospective case series of 131 client owned dogs. Medical records of dogs surgically treated with hemilaminectomy for intervertebral disc extrusion between January 2016 and December 2017 were reviewed for signalment, neurological grade at presentation, rate of onset and duration of clinical signs and surgical variables. These variables were analysed to determine their effect on return of pain sensation, urinary continence and ambulation. RESULTS: Duration of clinical signs prior to surgery and rate of onset of signs did not correlate with return of pain sensation, urinary continence or ambulation. Preoperative neurological grade was the main variable that was found to be associated with outcome. CONCLUSIONS: Delay from initial clinical signs of intervertebral disc extrusion to surgery is unlikely to affect the ultimate outcome or the length of time for a dog to regain pain sensation, urinary continence or ambulation. The rate of onset of signs likewise does not influence these outcomes.


Assuntos
Doenças do Cão/cirurgia , Deslocamento do Disco Intervertebral/veterinária , Animais , Doenças do Cão/fisiopatologia , Cães , Feminino , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Masculino , Dor , Estudos Retrospectivos , Vértebras Torácicas , Fatores de Tempo , Resultado do Tratamento
12.
An Bras Dermatol ; 95(1): 52-56, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31952993

RESUMO

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.


Assuntos
Avaliação da Deficiência , Hanseníase/patologia , Hanseníase/fisiopatologia , Estudos Transversais , Progressão da Doença , Face/anormalidades , Feminino , Seguimentos , Deformidades Adquiridas do Pé/patologia , Deformidades Adquiridas do Pé/fisiopatologia , Deformidades Adquiridas da Mão/patologia , Deformidades Adquiridas da Mão/fisiopatologia , Humanos , Índia , Masculino , Registros Médicos , Nervos Periféricos/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo
13.
An Bras Dermatol ; 95(1): 91-94, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31889593

RESUMO

This ecological study aims to analyze both the tendency and the characteristics of leprosy in the elderly population in the state of Bahia, 2001-2017. The tendency was analyzed through joinpoint regression. Epidemiological variables were also included in the study. The average detection rate was 38.73/100,000, with prevalence of men (45.19/100,000). A downward trend occurred in both genders, from 2004, with a greater magnitude in women (annual percent change [APC]=-3.4%). Men presented higher proportions of the multibacillary forms and physical disabilities. The epidemiological scenario indicates the need of implementation of actions that stimulate early diagnosis and treatment of the elderly population.


Assuntos
Hanseníase/epidemiologia , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Doenças Endêmicas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Fatores Socioeconômicos , Fatores de Tempo
14.
Ghana Med J ; 54(4 Suppl): 71-76, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33976444

RESUMO

Across the globe, the outbreak of the COVID-19 pandemic is causing distress with governments doing everything in their power to contain the spread of the novel coronavirus (SARS-CoV-2) to prevent morbidity and mortality. Actions are being implemented to keep health care systems from being overstretched and to curb the outbreak. Any policy responses aimed at slowing down the spread of the virus and mitigating its immediate effects on health care systems require a firm basis of information about the absolute number of currently infected people, growth rates, and locations/hotspots of infections. The only way to obtain this base of information is by conducting numerous tests in a targeted way. Currently, in Ghana, there is a centralized testing approach, that takes 4-5 days for samples to be shipped and tested at central reference laboratories with results communicated to the district, regional and national stakeholders. This delay in diagnosis increases the risk of ongoing transmission in communities and vulnerable institutions. We have validated, evaluated and deployed an innovative diagnostic tool on a mobile laboratory platform to accelerate the COVID-19 testing. A preliminary result of 74 samples from COVID-19 suspected cases has a positivity rate of 12% with a turn-around time of fewer than 3 hours from sample taking to reporting of results, significantly reducing the waiting time from days to hours, enabling expedient response by the health system for contact tracing to reduce transmission and additionally improving case management. Funding: Test kits were provided by AngloGold Ashanti Obuasi Mine (AngloGold Ashanti Health Foundation). The American Leprosy Mission donated the PCR machine, and the mobile laboratory van was funded by the Embassy of the Kingdom of the Netherlands (EKN). AAS, YAA was supported by (PANDORA-ID-NET RIA2016E-1609) and ROP supported by EDCTP Senior Fellowship (TMA2016SF), both funded by the European and Developing Countries Clinical Trials Partnership (EDCTP2) programme which is supported under Horizon 2020, the European Union.


Assuntos
Teste de Ácido Nucleico para COVID-19/métodos , COVID-19/diagnóstico , Unidades Móveis de Saúde , Vigilância da População , SARS-CoV-2/isolamento & purificação , Adolescente , Adulto , Busca de Comunicante , Transmissão de Doença Infecciosa/prevenção & controle , Diagnóstico Precoce , Feminino , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/genética , Fatores de Tempo , Adulto Jovem
15.
Eur J Trauma Emerg Surg ; 46(1): 121-130, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30251154

RESUMO

PURPOSE: The goal of this study was to assess if unprotected weight-bearing as tolerated is superior to protected weight-bearing and unprotected non-weight-bearing in terms of functional outcome and complications after surgical fixation of Lauge-Hansen supination external rotation stage 2-4 ankle fractures. METHODS: A multicentered randomized controlled trial was conducted in patients ranging from 18 to 65 years of age without severe comorbidities. Patients were randomized to unprotected non-weight-bearing, protected weight-bearing, and unprotected weight-bearing as tolerated. The primary endpoint of the study was the Olerud Molander Ankle Score (OMAS) 12 weeks after randomization. The secondary endpoints were health-related quality of life using the SF-36v2, time to return to work, time to return to sports, and the number of complications. RESULTS: The trial was terminated early as advised by the Data and Safety Monitoring Board after interim analysis. A total of 115 patients were randomized. The O'Brien-Fleming threshold for statistical significance for this interim analysis was 0.008 at 12 weeks. The OMAS was higher in the unprotected weight-bearing group after 6 weeks c(61.2 ± 19.0) compared to the protected weight-bearing (51.8 ± 20.4) and unprotected non-weight-bearing groups (45.8 ± 22.4) (p = 0.011). All other follow-up time points did not show significant differences between the groups. Unprotected weight-bearing showed a significant earlier return to work (p = 0.028) and earlier return to sports (p = 0.005). There were no differences in the quality of life scores or number of complications. CONCLUSIONS: Unprotected weight-bearing and mobilization as tolerated as postoperative care regimen improved short-term functional outcomes and led to earlier return to work and sports, yet did not result in an increase of complications.


Assuntos
Fraturas do Tornozelo/cirurgia , Moldes Cirúrgicos , Muletas , Deambulação Precoce , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Suporte de Carga , Adolescente , Adulto , Idoso , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Volta ao Esporte , Retorno ao Trabalho , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
Indian J Dermatol Venereol Leprol ; 86(2): 141-149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31736465

RESUMO

Background: Leprosy was declared to be eliminated from India in 2006, but recent reports point to an increase in newly detected cases despite the overall fall in prevalence. Aim: This study aimed to analyze the patterns and trends of epidemiological and operational indicators of leprosy at a tertiary care center in northern India over a decade. Methods: This is a 10-year retrospective study from 2005 to 2014 conducted at the urban leprosy centre (ULC) of the Department of Dermatology, Venereology, and Leprology, Government Medical College, Jammu (J and K), India. Data were obtained from the preformatted standard leprosy cards of the urban leprosy centre. Details of demographic data, clinical features, smear results and treatment received were collected from individual cards and analyzed to observe various epidemiological trends. Results: A total of 743 cases were analyzed for the period 2005-2014, of which 8.6% were childhood cases, 52.5% patients were immigrants, and 56.4% were farmers and laborers. Lepromatous cases showed a significantly increasing trend when compared with tuberculoid cases (P < 0.05). Smear positivity was seen in 29.6% of cases and showed an increasing trend (P < 0.05). An important observation was the increase in multibacillary cases. World Health Organization (WHO) grade 2 disability also showed an increasing trend over the past decade pointing to delayed diagnosis. Limitation: The study is limited by its retrospective design. Conclusion: The increasing trend of lepromatous and multibacillary cases and cases with grade 2 disability is a poor sign as it indicates delays in diagnosis. Further, smear-positive cases contribute to continued transmission of disease in the community. Leprosy has been declared to be eliminated, but recent reports including the present study suggest a rise in newly detected cases and hence in disease burden.


Assuntos
Hanseníase/diagnóstico , Hanseníase/epidemiologia , Centros de Atenção Terciária/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diagnóstico Tardio , Feminino , Humanos , Índia/epidemiologia , Hanseníase/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-31089006

RESUMO

Background: Rituximab is being increasingly used for the treatment of pemphigus. Data derived from single-center studies following a uniform treatment protocol are limited. Effect of demography and disease type on treatment response is poorly characterized. Objective: Our aim was to assess the effectiveness of biosimilar rituximab in pemphigus patients who had received rituximab as per rheumatoid arthritis protocol (2 doses, 1g each, infused 14 days apart). Methods: It was a retrospective review of 146 eligible patients to assess the proportion of patients achieving complete remission off treatment, time to achieve complete remission off treatment, proportion of patients who relapsed after achieving complete remission off treatment, time taken to relapse, duration and total cumulative dose of corticosteroids administered after rituximab. Additionally, we tried to find whether a correlation existed between age, gender, total duration of illness before rituximab and pemphigus disease type with the above-mentioned outcome measures. Results: Of 146 patients, 107 (73.3%) attained complete remission off treatment. Mean interval between first dose rituximab administration and complete remission off treatment was 6.6 ± 3.4months. Complete remission off treatment was sustained for a mean duration of 9.1 ± 8.5 months before relapse. Over a mean follow-up duration of 24.9 ± 17.1 months (median 23, maximum 68 months), 75 of 107 patients (76.5%) who had achieved complete remission after first cycle of rituximab relapsed. A mean total cumulative dose of 3496 ± 2496 mg prednisolone was prescribed over a mean duration of 7.2 ± 4.7 months after first cycle of rituximab. Time taken to achieve remission was significantly longer in pemphigus foliaceus and these patients required significantly higher cumulative dose of prednisolone over a longer duration after rituximab. No deaths and long-term complications were recorded. Limitations: Only clinical parameters were assessed. Immunological parameters including B-cell counts and enzyme-linked immunosorbent assay for anti-desmoglein antibody titers were not carried out. Conclusion: This study reinforces the beneficial role of rituximab in pemphigus. Pemphigus foliaceus patients required a higher total cumulative dose of prednisolone over a longer time to achieve remission and the remission lasted longer than that in pemphigus vulgaris.


Assuntos
Fatores Imunológicos/uso terapêutico , Pênfigo/tratamento farmacológico , Rituximab/uso terapêutico , Adulto , Feminino , Seguimentos , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
18.
Sci Rep ; 9(1): 16675, 2019 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-31723144

RESUMO

Household contacts (HHC) of leprosy patients exhibit high-risk of developing leprosy and contact tracing is helpful for early diagnosis. From 2011 to 2018,2,437 HHC were examined in a clinic in Rio de Janeiro, Brazil and 16S qPCR was used for diagnosis and monitoring of contacts. Fifty-four HHCs were clinically diagnosed with leprosy at intake. Another 25 exhibited leprosy-like skin lesions at intake, 8 of which were confirmed as having leprosy (50% of which were qPCR positive) and 17 of which were diagnosed with other skin diseases (6% qPCR positive). In skin biopsies, qPCR presented a sensitivity of 0.50 and specificity of 0.94. Furthermore, 955 healthy HHCs were followed-up for at least 3 years and skin scrapings were collected from earlobes for qPCR detection. Positive qPCR indicated a non-significant relative risk of 2.52 of developing the disease. During follow-up, those who progressed towards leprosy exhibited 20% qPCR positivity, compared to 9% of those who remained healthy. Disease-free survival rates indicated that age had a significant impact on disease progression, where patients over 60 had a greater chance of developing leprosy [HR = 32.4 (3.6-290.3)]. Contact tracing combined with qPCR may assist in early diagnosis and age is a risk factor for leprosy progression.


Assuntos
Busca de Comunicante/métodos , DNA Bacteriano/análise , DNA Ribossômico/análise , Características da Família , Hanseníase/diagnóstico , Mycobacterium leprae/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real/métodos , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Hanseníase/epidemiologia , Hanseníase/genética , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Mycobacterium leprae/genética , Fatores de Tempo , Adulto Jovem
19.
An Bras Dermatol ; 94(5): 603-607, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777363

RESUMO

The objective of this study was to describe the trend of detection of the disease in Brazil from 1990 to 2016. The joinpoint regression model was used. There was a significant trend of decreased detection in the country (average annual percent change -1.8%) and in the South (average annual percent change=-3.5%) and Southeast regions (average annual percent change=-4.5%). The Northeast (average annual percent change=0.2%), the Central-West (average annual percent change=-1.5%), and the North (average annual percent change=-2.6%) showed a stationary trend (p>0.05). Eleven states showed a decreasing trend. Alagoas (average annual percent change=2.1%) and Rio Grande do Norte (average annual percent change=1.4%) presented significant increase (p<0.001). The heterogeneous pattern of trend between regions and states shows that efforts are needed to eliminate the disease.


Assuntos
Hanseníase/epidemiologia , Brasil/epidemiologia , Geografia , Humanos , Fatores de Tempo
20.
An. bras. dermatol ; 94(5): 603-607, Sept.-Oct. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1054864

RESUMO

Abstract The objective of this study was to describe the trend of detection of the disease in Brazil from 1990 to 2016. The joinpoint regression model was used. There was a significant trend of decreased detection in the country (average annual percent change −1.8%) and in the South (average annual percent change = −3.5%) and Southeast regions (average annual percent change = −4.5%). The Northeast (average annual percent change = 0.2%), the Central-West (average annual percent change = −1.5%), and the North (average annual percent change = −2.6%) showed a stationary trend (p > 0.05). Eleven states showed a decreasing trend. Alagoas (average annual percent change = 2.1%) and Rio Grande do Norte (average annual percent change = 1.4%) presented significant increase (p < 0.001). The heterogeneous pattern of trend between regions and states shows that efforts are needed to eliminate the disease.


Assuntos
Humanos , Hanseníase/epidemiologia , Fatores de Tempo , Brasil/epidemiologia , Geografia
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