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PURPOSE: The purpose of this study was to introduce and evaluate the Descriptive Ankle Fracture Classification (DAFC) system, a novel alphanumeric method for categorizing ankle fractures and fracture dislocations, and to assess its reliability and prognostic value compared to traditional classification systems (AO/OTA, Weber, and Lauge-Hansen). MATERIALS AND METHODS: A retrospective review was conducted on 90 patients who underwent surgical treatment for ankle fractures. Four observers of varying experience levels classified the fractures using the DAFC, AO/OTA, Weber, and Lauge-Hansen classification systems. Interobserver and intraobserver reliability were evaluated using Fleiss' Kappa coefficient. Functional outcomes were assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) and Olerud Molander Ankle Score (OMAS) systems, and comparisons were made across classification systems to determine prognostic value. RESULTS: The DAFC system demonstrated superior interobserver reliability, particularly for medial malleolus fractures (Kappa = 0.935-0.954) and syndesmotic injuries (Kappa = 0.873-0.891), compared to the other systems. Intraobserver reliability was consistently high across all categories in the DAFC system, with Kappa values ranging from 0.967 to 1.000. Functional outcomes revealed significant associations with the DAFC classification: patients with complete dislocation (D2) had significantly lower AOFAS and OMAS scores than those without dislocation (D0) (P = 0.011), and those with larger posterior malleolus fractures (P2) had poorer OMAS scores (P = 0.014). No statistically significant differences in AOFAS or OMAS scores were observed across AO/OTA, Weber, or Lauge-Hansen classifications. CONCLUSIONS: The DAFC system offers a reliable and comprehensive framework for ankle fracture classification, with the added benefit of prognostic insights, particularly regarding dislocation and posterior malleolus involvement. Its high interobserver and intraobserver reliability, even among observers with varying experience, suggests that the DAFC system is valuable for clinical use. Future research should focus on validating these findings in larger cohorts and assessing the DAFC system's impact on long-term patient outcomes. LEVEL OF EVIDENCE: Level IV, Retrospective cohort.
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Fraturas do Tornozelo , Humanos , Fraturas do Tornozelo/classificação , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Adulto Jovem , Reprodutibilidade dos Testes , Variações Dependentes do Observador , Prognóstico , Adolescente , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Leprosy reactions (LR) are immune-mediated complications of leprosy that may be associated with severe and irreversible nerve damage. Non-medical aspects, such as financing, service provision, and healthcare resources in the management of LR are generally overlooked as studies tend to concentrate on clinical features and treatment. Barriers to accessing care and services are a major cause of suboptimal care for people with leprosy. This study aims to explore the barriers to and facilitators of high-quality care and management of LR in two leprosy-endemic countries with different health care models - Indonesia and India - and identify areas for improvement. METHODS: A socio-ecological model was adopted. Data were obtained from 66 interviews with individuals who experienced LR and were seeking care at the two study sites. In addition, immediate family members of individuals with LR and healthcare workers attending to people with leprosy participated in seven focus group discussions (FGDs). RESULTS: This study highlights the significant impact of public health insurance regulations and uptake at the macrosystem level on the provision of healthcare services, clinical decision-making, care expenditure, and the psychological well-being of individuals with LR in Indonesia and India. Lack of specialized health professionals and communication challenges were identified in both study populations. Indonesian participants encounter additional challenges due to a fragmented information system and drug shortages. This study identifies key facilitators in providing high-quality care for LR-affected individuals, including financial assistance, availability of corticosteroid alternatives, timely provision of care, and counselling. It found that the high coverage of public health insurance cards in the Indonesian model has increased access to care among individuals affected by LR, despite the challenges. Conversely, the Indian model of care offers treatment subsidies. The advantage of the Indonesian model is its ability to provide wider access to high-quality care, whereas the Indian model focuses on those in most need. This study emphasizes the importance of addressing these challenges through improved communication strategies, education aimed at the affected individuals, and accessible medical care. Furthermore, variations in care-seeking behaviour and self-care practices were observed in both sites, underscoring the need for culturally sensitive and comprehensive approaches to the management of LR. CONCLUSION: The study findings demonstrate that the factors identified at the four systemic levels are interrelated and have an impact on the access, acceptability, and management of LR services. Despite its accessibility and wider coverage of public health insurance, the integrated service model in Indonesia faces challenges associated with complex regulations and the availability of medication. India's care model offers intensive, specialised care but has difficulties in ensuring sufficient health personnel, resources, and public health insurance coverage. These findings highlight the need to address these challenges to ensure timely, effective, and comprehensive care for individuals with LR.
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Grupos Focais , Pessoal de Saúde , Acessibilidade aos Serviços de Saúde , Hanseníase , Humanos , Índia , Indonésia , Hanseníase/terapia , Hanseníase/psicologia , Masculino , Feminino , Adulto , Pessoal de Saúde/psicologia , Pessoa de Meia-Idade , Família/psicologia , Pesquisa Qualitativa , Entrevistas como Assunto , Qualidade da Assistência à SaúdeRESUMO
Leprosy is a granulomatous disease affecting the skin, mucous membrane, and peripheral nerves. Irisin, a novel protein, has been associated with several inflammatory and metabolic diseases and has been demonstrated in peripheral nerve cells. The objective of this study was to compare the plasma irisin levels of newly diagnosed leprosy patients with those of healthy individuals while also assessing the role of irisin in the pathogenesis of leprosy. This case-control study was conducted between January 2024 and July 2024 and compared 29 newly diagnosed leprosy patients with 29 healthy controls. The participants' demographic information and disease history, such as the duration of the disease and whether any additional family members had leprosy, were documented. The subjects' serum irisin levels were quantified via enzyme-linked immunosorbent assay (ELISA). The serum level of irisin was significantly lower in the patient group than in the control group (p value < 0.001). We found lower Irisin levels in leprosy patients than healthy controls, suggesting potential as role as a biomarker for leprosy. Further investigations, involving a large sample sized assessed both during and after therapy, are necessary to clarify the function and predictive significance of irisin in leprosy.
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Biomarcadores , Fibronectinas , Hanseníase , Humanos , Fibronectinas/sangue , Estudos de Casos e Controles , Masculino , Feminino , Adulto , Hanseníase/sangue , Hanseníase/diagnóstico , Biomarcadores/sangue , Pessoa de Meia-Idade , Adulto Jovem , Ensaio de Imunoadsorção Enzimática , IdosoRESUMO
Hansen's disease is an infectious granulomatous disease with classical cutaneous and neurological profile and varied musculoskeletal manifestations. Poor awareness and low specificity of symptoms lead to a delay in the diagnosis of a treatable disease, culminating in worsening morbidity. A rare case series of Hansen's arthritis, showing complex, diverse, and rare combinations of musculoskeletal manifestations of acute lepra reaction over chronic arthritis, besides cutaneous and neurological manifestations, must be understood for early diagnosis and treatment to avoid debilitating complications.
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Artrite , Hanseníase , Humanos , Hanseníase/diagnóstico , Hanseníase/complicações , Masculino , Artrite/diagnóstico , Artrite/etiologia , Adulto , Feminino , Pessoa de Meia-Idade , Doença Crônica , Doença Aguda , SíndromeRESUMO
BACKGROUND: The WHO and Ethiopia's Ministry of Health have developed strategies to expand and integrate services for co-endemic neglected tropical diseases (NTDs) which manifest in the skin. To inform these strategies, we aimed to understand the social, economic and health system context of skin NTD care in Kalu woreda, Amhara region, Ethiopia, where cutaneous leishmaniasis (CL) and leprosy are endemic. METHODS: Between October 2020 and May 2022, we surveyed and reviewed records of 41 primary healthcare facilities and explored common disease experiences in focus group discussions (n=40) and interviews with people affected by leprosy (n=37) and CL (n=33), health workers (n=23), kebele authorities and opinion leaders (n=33) and traditional healers (n=7). Opportunities for integrated skin NTD service provision were explored through policy document review, interviews with health officials (n=25), and stakeholder meetings. RESULTS: Availability of diagnostic supplies and health worker competence to provide skin care was very limited across primary healthcare facilities, particularly for CL. People with leprosy commonly sought care from healthcare facilities, while people with CL administered self-care or sought help from traditional healers. Travel and costs of care at specialised facilities outside the district inhibited timely care-seeking for both diseases. Transmission discourses shaped different understandings of who was affected by leprosy and CL and expectations of behaviour during and after treatment. Many policy actors felt that existing supply chain interventions, decentralised treatment approaches and community engagement initiatives for leprosy could also benefit CL, but others also warned against increasing care-seeking unless CL treatment could be provided on a scale commensurate with the large burden they perceived. CONCLUSION: Our findings demonstrate significant gaps in the provision of care for skin NTDs within primary healthcare, very different health-seeking patterns for leprosy and CL, and a need to develop new models of care, especially for CL.
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Leishmaniose Cutânea , Hanseníase , Doenças Negligenciadas , Humanos , Doenças Negligenciadas/terapia , Etiópia , Hanseníase/terapia , Feminino , Masculino , Leishmaniose Cutânea/terapia , Grupos Focais , Adulto , Pessoa de Meia-Idade , Medicina TropicalRESUMO
INTRODUCTION: Leprosy is a curable disease, treated by multidrug therapy. However, patients are often left with neuropathic damage leading to lifelong vulnerability to ulcers. Quantifying the value of interventions to improve ulcer healing is challenging as data on the health impact of plantar ulcers are scarce, especially in low- and middle-income countries. We aim to quantify the impact of plantar ulcers on patients' health-related quality of life (HRQoL) using methods which can inform decisions about the effectiveness and cost-effectiveness of alternative forms of management. METHODS: Generic HRQoL data were collected using the EuroQol (EQ)-5D-3L questionnaire in a randomised control trial in Nepal, treating plantar ulcers with leukocyte and platelet-rich fibrin or usual care. The trial followed 130 patients resulting in 600 observations. EQ-5D data were converted into a single 'utility' score by weighting the instrument's different dimensions using the preferences of the Sri Lankan population. Utility data were analysed using general estimating equation regressions. The impact of an ulcer on HRQoL was estimated whilst controlling for clinical and demographic covariables. RESULTS: Estimated mean utility (standard error) for the sample across all time points was 0.52 (0.02) for patients with an ulcer and 0.64 (0.01) with a healed ulcer. Controlling for clinical and demographic covariates, we estimate that the presence of an ulcer leads to a 0.12 (0.02) decrement in HRQoL compared with a healed ulcer. DISCUSSION: Based on the levels of health they report and the values of the general public, patients with a history of leprosy are at risk of significant HRQoL burden from neuropathic plantar ulcers. Quantifying this health impact provides important evidence to assess the effectiveness and cost-effectiveness of leprosy ulcer interventions and ensures that interventions for leprosy ulcers can be appropriately considered for funding under Universal Health Coverage against other potential uses of the same money.
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Úlcera do Pé , Hanseníase , Qualidade de Vida , Humanos , Nepal , Masculino , Hanseníase/complicações , Hanseníase/psicologia , Feminino , Úlcera do Pé/terapia , Pessoa de Meia-Idade , Adulto , Inquéritos e Questionários , Análise Custo-BenefícioRESUMO
Leprosy diagnosis is difficult to perform due to variable sensitivity and/or specificity of the tests. In addition, the collection of the blood samples requires laboratorial structure and trained professionals. In the present study, the diagnostic efficacy of M1 chimeric protein, which was recently showed to be antigenic for leprosy using a serum-based ELISA, was evaluated against patient urine. Paired serum and urine samples were collected from patients with paucibacillary (PB) and multibacillary (MB) leprosy, tegumentary and visceral leishmaniasis, tuberculosis, Chagas disease, malaria, and HIV-infected subjects. Samples from healthy individuals and household contacts were also used. The protein and peptides used to compose it were used as antigens, and results showed that the four peptides presented good sensitivity and specificity to detect MB leprosy, while M1 protein showed sensitivity and specificity of 98.5 % and 100 %, respectively, to detect both PB and MB leprosy, when an urine-based ELISA was performed. Positive (PPV) and negative (NPV) predictive values were 100 % and 98.3 %, respectively. In a serum-based ELISA, sensitivity and specificity were 96.9 % and 100 %, respectively, with PPV and NPV of 100 % and 96.5 %, respectively. In conclusion, preliminary data suggest that M1 protein could be considered for diagnosis of leprosy by using patient urine.
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Antígenos de Bactérias , Ensaio de Imunoadsorção Enzimática , Hanseníase Multibacilar , Hanseníase Paucibacilar , Mycobacterium leprae , Sensibilidade e Especificidade , Humanos , Ensaio de Imunoadsorção Enzimática/métodos , Hanseníase Multibacilar/diagnóstico , Hanseníase Multibacilar/urina , Hanseníase Multibacilar/imunologia , Antígenos de Bactérias/urina , Antígenos de Bactérias/imunologia , Mycobacterium leprae/imunologia , Mycobacterium leprae/genética , Hanseníase Paucibacilar/diagnóstico , Hanseníase Paucibacilar/imunologia , Hanseníase Paucibacilar/urina , Masculino , Feminino , Adulto , Proteínas Recombinantes de Fusão , Valor Preditivo dos Testes , Pessoa de Meia-Idade , Adulto Jovem , AdolescenteRESUMO
Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterised by recurrent painful nodules, abscesses, and sinus tract formation in intertriginous areas. Accurate staging of this disorder is crucial for appropriate management and prognosis. The role of imaging in the staging of HS is still evolving. Objectives To assess the correlation between clinical disease severity staging and high-resolution ultrasonography and colour doppler (HRUS-CD) staging in HS patients. Methods This was a cross-sectional, single-centre study in patients above 18 years of age with the clinical diagnosis of HS. All patients underwent clinical examination and high-resolution ultrasonography and colour doppler study with high-frequency linear probe (L+ 8-24 MHz). Correlations between clinical Hurley staging and the various ultrasonographic parameters i.e. SOS-HS (sonographic staging of severity of HS), degree of vascularisation, fibrotic scarring and oedema were explored and analysed. Spearman's correlation coefficient was applied to study the correlations and p<0.05 was considered significant. Results A total of 46 patients with HS who met the inclusion criteria were included. The majority of patients were clinically in Hurley stages 1 (32.6%; n=15) and 2 (56.5%; n=26) (41 in all). However, on the basis of ultrasonographic findings, significant numbers of patients had greater severity of staging on SOS-HS (58.5%; n=24/41), higher vascularity on colour doppler (26.8%; n=11), more severe grading of fibrous scarring (43.9%; n=18) and oedema (68.2%; n=28) in comparison to the clinical Hurley staging. Limitations Limitations of our study include a small sample size and cross-sectional design. Conclusion The results of the study indicate that the majority of the patients were under-staged and under-treated clinically, hence emphasising the role of high-resolution ultrasonography and colour doppler study in the accurate determination of HS severity. Future research should focus on standardised protocols and larger, prospective studies to establish the role of these imaging modalities in routine clinical practice.
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Hidradenite Supurativa , Índice de Gravidade de Doença , Ultrassonografia Doppler em Cores , Humanos , Hidradenite Supurativa/diagnóstico por imagem , Estudos Transversais , Masculino , Feminino , Adulto , Ultrassonografia Doppler em Cores/métodos , Pessoa de Meia-Idade , Adulto Jovem , Ultrassonografia/métodos , AdolescenteRESUMO
Background Seborrheic dermatitis (SD) is a long-lasting inflammatory skin condition that predominantly impacts regions abundant in sebaceous glands, including the scalp. Objectives To assess the efficacy and anti-inflammatory effect of atorvastatin as an additive treatment among SD patients. Methods In a prospective, randomised, double-blind trial, 46 patients over 18 years old with mild to moderate scalp SD were randomly assigned to receive either 2% ketoconazole shampoo or 2% ketoconazole shampoo plus 5% atorvastatin. The severity of dermatitis was assessed based on the symptom scale of seborrheic dermatitis (SSSD), and the variables of erythema, scaling, and itching, at baseline and 4 weeks after the intervention. Results Based on our analyses, both treatment methods significantly reduced the SSSD scores. However, the average SSSD score in patients using ketoconazole shampoo plus atorvastatin decreased by an average of five points after 1 month. This reduction was comparable to the average decline of 3.5 points observed in the group using ketoconazole shampoo alone. Specifically, the severity of dermatitis, as assessed by the SSSD score, significantly decreased by 1.92 points more, in individuals using the atorvastatin-containing shampoo compared to the comparison group (P = 0.02). Limitation This research was conducted at a single centre which limits the validity of the findings. Conclusion The results of this study suggest that shampoo containing atorvastatin provides a statistically significant effect compared to ketoconazole shampoo alone, indicating its potential as an alternative treatment for SD. The treatment notably alleviates symptoms associated with scaling and itching which are the common manifestations of the condition.
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Atorvastatina , Dermatite Seborreica , Preparações para Cabelo , Cetoconazol , Dermatoses do Couro Cabeludo , Humanos , Dermatite Seborreica/tratamento farmacológico , Método Duplo-Cego , Masculino , Atorvastatina/uso terapêutico , Feminino , Adulto , Estudos Prospectivos , Pessoa de Meia-Idade , Cetoconazol/uso terapêutico , Dermatoses do Couro Cabeludo/tratamento farmacológico , Índice de Gravidade de Doença , Adulto Jovem , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Resultado do TratamentoRESUMO
Introduction With a vision of a 90% reduction of grade 2 disability (G2D) in the Global Leprosy Strategy by 2030, the management of trophic ulcer, a common G2D, has become a priority. Autologous injectable perilesional platelet rich plasma (PRP) is first generation, whereas autologous platelet rich fibrin membrane (PRFM) is second generation platelet concentrate helping in trophic ulcer healing by providing growth factors and cytokines. PRFM requires less amount of blood (8 mL) against 20 mL in PRP. Objectives Evaluate the effectiveness and safety of PRFM with total contact cast versus PRP with total contact cast in leprosy trophic ulcer. Methods Observer-blind, non-inferiority randomised controlled trial recruited clinically diagnosed leprosy trophic ulcer with wound area measurement <40 cm2 after obtaining informed consent. Calculated sample size was 26 per group considering the percentage success in the control group (PRP) 39.29% and the experimental group (PRFM) 55.55%, 5% significance-level, 80% power, non-inferiority limit 10%, and 10% drop-out rate. Randomisation was done by computer generated random number table and allocation concealment by sequentially numbered opaque sealed envelope (SNOSE) technique. PRP was prepared with first spin 1,600 rpm for 10 minutes and second spin 4,000 rpm for 10 minutes. PRFM was prepared by centrifugation at 2,600 rpm for 3 minutes. Four treatment sessions followed by two follow-ups at 2 weekly intervals were conducted. Results Baseline clinico-demographic profile was similar in both groups. The surface area was significantly reduced (Friedman's ANOVA P<0.001) in both PRP (from 422.48+657.30 sq cm to 247.84+635.96 sq cm) and PRFM (290.04+281.42 sq cm to 152.77+336.09 sq cm) with significant reduction from first FU onwards in both groups (Post-Hoc Dunn's test P<0.001). Complete improvement was noted in 12% of PRP and 23% of PRFM (Fischer's test P=0.465). Both groups showed improvement in DLQI. Limitations Short duration of treatment and follow-up (10 weeks). Conclusion PRFM with total contact cast is not inferior to PRP. Because of operational ease (less blood, less time), PRFM is a better alternative to PRP.
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Hanseníase , Fibrina Rica em Plaquetas , Plasma Rico em Plaquetas , Humanos , Masculino , Feminino , Hanseníase/complicações , Adulto , Pessoa de Meia-Idade , Resultado do Tratamento , Moldes Cirúrgicos , Método Simples-Cego , Cicatrização , Úlcera Cutânea/terapia , Úlcera Cutânea/etiologia , Adulto JovemRESUMO
BACKGROUND: Ankle fractures are among the most common types of fractures in the orthopaedic field, and the Lauge-Hansen classification is commonly used to categorize rotational ankle fractures. This study evaluated and compared the clinical and radiological outcomes of surgically treated supination external rotation (SER) and pronation external rotation (PER) injuries of grades III or IV. METHODS: We retrospectively reviewed and enrolled 104 patients who underwent open reduction and internal fixation for SER or PER injuries classified as Grades III or IV between January 2016 and December 2021, all performed at a single center. Of these, 72 belonged to the SER group and 32 to the PER group. The average postoperative follow-up durations were 31.3 months (range, 24 to 74) for the SER group and 32.1 months (range, 24 to 71) for the PER group. Clinical and radiological outcomes were assessed 24 months after surgery and compared between the two groups. Details of concomitant surgical procedures performed and postoperative complications were also evaluated. RESULTS: All clinical outcome variables, including the Foot and Ankle Outcome Score, Visual Analog Scale for pain, and ankle range of motion, were comparable between the two groups. Similarly, no statistically significant differences were observed in the development of post-traumatic arthritis or in the frequency of syndesmotic widening 24 months postoperatively. However, the time required for fibular union was significantly longer in the PER group, taking 5.6 ± 2.2 months compared to 3.4 ± 1.3 months in the SER group on average (p < 0.001). CONCLUSIONS: Our study demonstrated that both types of rotational ankle fractures can achieve equivalent clinical and radiological outcomes with surgical treatment. Given the prolonged time to fibular union in the PER group, careful monitoring during postoperative follow-up is required.
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Fraturas do Tornozelo , Fixação Interna de Fraturas , Pronação , Amplitude de Movimento Articular , Supinação , Humanos , Fraturas do Tornozelo/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Rotação , Fixação Interna de Fraturas/métodos , Resultado do Tratamento , Idoso , Adulto JovemRESUMO
We carried out the health situation analysis in the Legal Amazon through morbidity and mortality indicators and the comparison between intra and inter-state federation of the region and Brazil. Analysis of the health situation, trends, and identification of clusters in the Brazilian Amazon, for the period from 2010 to 2021, using secondary data available in official health information systems. Circulatory diseases were the main cause of death, representing 23% of deaths. External causes and respiratory diseases contributed 16% and 9% of deaths, respectively; 52.6% of infant deaths occurred in the early neonatal period, and the infant mortality rate remained above the national average. The ratio of maternal mortality was also high and above the national average between 2010 and 2021. The dengue incidence rate remained below the national average with a drop trend of -59.50%. However, rates of Chagas disease, AIDS, Hansen's disease, American cutaneous leishmaniasis and tuberculosis remained above average rates in the country. It was concluded that the population of the Brazilian Amazon faces health challenges. The findings facilitate the identification of territorial priorities for the implementation of actions that impact morbidity and mortality reduction in the region.
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Causas de Morte , Mortalidade Infantil , Brasil/epidemiologia , Humanos , Lactente , Mortalidade Infantil/tendências , Causas de Morte/tendências , Feminino , Recém-Nascido , Criança , Pré-Escolar , Morbidade/tendências , Adulto , Adolescente , Masculino , Sistemas de Informação em Saúde , Pessoa de Meia-Idade , Adulto Jovem , Mortalidade Materna/tendências , Idoso , Mortalidade/tendênciasRESUMO
BACKGROUND: The global elimination of leprosy transmission by 2030 is a World Health Organization (WHO) target. Nepal's leprosy elimination program depends on early case diagnosis and the performance of health workers and facilities. The knowledge and skills of paramedical staff (Leprosy Focal Person, LFP) and case documentation and management by health facilities are therefore key to the performance of health care services. METHODS: The performance of health workers and facilities was evaluated through a combined cross-sectional and retrospective study approach of 31 health facilities and their LFPs in Dhanusa and Mahottari Districts in Madhesh Province, Nepal. An average of 6 patients (paucibacillary, PB, or multibacillary, MB) per health facility registered within the 2018/2019 fiscal year were also enrolled in the study. LFP knowledge (e.g., of the three cardinal signs) and skills (e.g., nerve palpation) and facility processes (e.g., record keeping) were scored (e.g., 0, 1) and then rescaled to a proportion, where 1 is perfect. Internal benchmarking was used to guide performance management. RESULTS: Overall LFP knowledge and skill scores of health workers ranged from 0.16 to 0.63 (median 0.53, 95% confidence interval (CI), 0.46-0.6). Case documentation scores ranged from 0.15 to 0.87 (median 0.37, 95% CI 0.36-0.38), case management scores from 0.38 to 0.79 (median 0.54, 95% CI 0.53-0.55) and overall healthcare scores from 0.36-0.62 (median 0.48, 95% CI 0.47-0.49). Leprosy-related training was significantly related to the knowledge and skills of the health workers. All identified cases (n = 187) adhered to the complete treatment and release after treatment (RFT) scheme, out of which 84.5% were satisfied with the service they were provided. Leprosy disability and ear hand and feet (EHF) scores were not significantly reduced in treated patients during the study period, but counseling by LFPs significantly improved cases' positive beliefs and practices regarding self-care. CONCLUSION: Overall leprosy care median performance was low (53%) and can be improved by evidenced-based training, onsite coaching, monitoring, and supervision to facilitate leprosy transmission elimination. The results highlight many of the challenges facing leprosy elimination programs.
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Hanseníase , Humanos , Nepal , Hanseníase/terapia , Hanseníase/prevenção & controle , Estudos Transversais , Estudos Retrospectivos , Masculino , Feminino , Instalações de Saúde/normas , Adulto , Competência Clínica/estatística & dados numéricos , Pessoal Técnico de Saúde/educação , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Leprosy, being a neglected tropical disease, remains a significant public health concern in several parts of the world, especially Sri Lanka, where it has long been associated with stigma. This study aims to assess the stigma faced by People Affected by Leprosy (PAL) undergoing treatment and to identify the factors associated with this stigma. METHODS: A cross-sectional study was conducted among 109 Leprosy affected people attending the Central Leprosy Clinic and all dermatology clinics of the National Hospital of Sri Lanka (Colombo), selected using a consecutive sampling method. Data collection was done through an interviewer-administered questionnaire. Stigma was quantified using a validated and adapted version of the Stigma Assessment and Reduction of Impact (SARI) tool, which evaluates stigma pertaining to four domains: Experienced Stigma (ES), Disclosure Concerns (DC), Internalized Stigma (IS), and Anticipated Stigma (AS). Spearman's correlation and Mann-Whitney U tests were used to analyze associations, with statistical significance set at 0.05. RESULTS: The dataset showed a non-normal, right-skewed distribution. The mean total SARI score was 9.82 (SD = 10.23). Disclosure Concerns (rs=-2.66; p = 0.005) and Anticipated Stigma (rs=-3.6; p < 0.001) demonstrated weak - moderate negative correlations with the time since diagnosis. On the other hand, the correlation between time since diagnosis and Experienced Stigma (rs=0.22; p = 0.022) was positive and weak. Participants without disability had significantly lower scores in DC (p = 0.049), IS (p = 0.01), and AS (p = 0.01) compared to those with disability. Patients who did not develop Leprosy reactions displayed significantly lower scores across all SARI domains as well as the total SARI score (all p < 0.05) compared to those who did. CONCLUSIONS: The findings suggest that over time, People Affected by Leprosy become less concerned about disclosing their diagnosis and anticipate less stigma but may experience greater overall stigma. Disability status and Leprosy reactions are key factors in determining the level of stigma faced by them.
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Hanseníase , Estigma Social , Humanos , Hanseníase/psicologia , Sri Lanka , Estudos Transversais , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem , Idoso , AdolescenteRESUMO
PURPOSE: This study aimed to report the incidence, characteristics, and prognosis of corneal perforation in patients with leprosy. STUDY DESIGN: Retrospective observational study. METHODS: Patients who presented with leprosy and visited a specialised ophthalmology hospital (Miyata Eye Hospital, Miyazaki, Japan) between 1980 and 2020 were included. Their medical charts were retrospectively reviewed, and the incidence of lagophthalmos and corneal perforation was examined. Additionally, the presentation, treatment, and prognosis of patients with corneal perforations were assessed. RESULTS: In total, the records of 472 eyes of 236 patients (128 men and 108 women; mean age, 81.2 ± 7.5 years) diagnosed with leprosy were reviewed. Forty-one patients were diagnosed with lagophthalmos, and two of these patients (4.8%) showed signs of corneal perforation. Patients with lagophthalmos presented significantly more frequently with cicatricial contraction of eyelids (p < 0.001), superficial punctate keratopathy (p < 0.001), epithelial defect (p = 0.039), and corneal ulcer (p < 0.001) compared with patients without lagophthalmos. Patients with corneal perforation had uveitis more frequently compared with those without corneal perforation (p = 0.01). CONCLUSION: Patients with leprosy frequently develop lagophthalmos. Patients with uveitis associated with leprosy are especially at risk of corneal perforation.
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Perfuração da Córnea , Doenças Palpebrais , Hanseníase , Humanos , Masculino , Estudos Retrospectivos , Feminino , Incidência , Japão/epidemiologia , Perfuração da Córnea/epidemiologia , Perfuração da Córnea/diagnóstico , Perfuração da Córnea/etiologia , Idoso de 80 Anos ou mais , Idoso , Hanseníase/epidemiologia , Hanseníase/complicações , Hanseníase/diagnóstico , Doenças Palpebrais/epidemiologia , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/etiologia , Seguimentos , Pessoa de Meia-Idade , Prognóstico , Acuidade Visual , LagoftalmiaRESUMO
OBJECTIVES: The purpose of this study was to determine reference points for thermal perception in cutaneous lesions of leprosy, a disease caused by Mycobacterium leprae characterised by hypoesthesia in skin lesions due to nerve and Schwann cell infection. Early diagnosis is essential to control transmission and effectively treat the disease. METHODS: Quantitative thermal testing (QTT) has been proposed as a valuable tool for early detection of the disease, initiation of treatment, and monitoring of nerve damage. A thermal analyser was used to determine warm and cold perception thresholds (WPT and CPT, respectively) in skin lesions of 42 leprosy patients and 22 healthy controls. RESULTS: The thresholds were determined using a 0.25 cm2 thermal stimulator, the method of limits, and the receiver operating characteristic (ROC) curve. Thermal thresholds were higher in patients' skin lesions compared to unaffected areas and controls. The reference points calculated for the WPT and CPT were 36.55 and 26.35°C, respectively, with high sensitivity and specificity. CONCLUSION: The nerve fibres affected by leprosy caused altered thermal sensitivity in the patients' lesions, especially in warm sensation. A smaller thermal stimulator and the method of limits were effective in detecting early sensory deficits in nerve fibres, demonstrating the potential for early detection of the disease.
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Hanseníase , Fibras Nervosas , Limiar Sensorial , Humanos , Hanseníase/complicações , Hanseníase/diagnóstico , Masculino , Feminino , Adulto , Fibras Nervosas/patologia , Pessoa de Meia-Idade , Estudos de Casos e Controles , Sensação Térmica , Adulto Jovem , Pele/inervação , Curva ROC , Sensibilidade e Especificidade , Mycobacterium leprae/isolamento & purificação , Idoso , Diagnóstico PrecoceRESUMO
BACKGROUND: Recent epidemiological data shows significant rates of grade 2 disability at point-of-diagnosis among new leprosy cases in Pakistan. This indicates a feature of extensive diagnostic delay; the disability burden appears unmoving and disproportionate to the falling leprosy incidence rates. Therefore, this study was required to understand reasons for delay in diagnosis and treatment of leprosy. METHODS: A qualitative design of 7 semi-structured interviews was employed to reveal perceptions and understandings of various leprosy stakeholders in Pakistan, termed "leprosy experts". Subsequent inductive analysis was used to identify themes and subthemes concerned with delay in the diagnosis and treatment of leprosy. RESULTS: Leprosy experts identified three main areas, or domains, to which delay can be attributed: 1. Awareness and beliefs about leprosy, within the general population, 2. Knowledge and clinical experience of leprosy, among healthcare professionals, 3. Leprosy control program infrastructure, allocation of resources and institutional funding. These domains were each viewed as consequent to the larger theme of 'low-endemicity'. Strong correlations between diagnostic delay and socioeconomic status, gender, geography and health system challenges, were also mentioned, and which intersected the three major themes. CONCLUSION: Reasons for diagnostic delay are evident in all tiers of the healthcare hierarchy in Pakistan. Thus, an approach at multiple levels is justified, to improve the general awareness of leprosy, education of healthcare professionals, and organizational structuring. Additionally, cultural features relevant to different communities in Pakistan which might be different from other care access frameworks demonstrated a need for further study into the health beliefs of Pakistani patients in a wide range of communities.
Assuntos
Diagnóstico Tardio , Conhecimentos, Atitudes e Prática em Saúde , Hanseníase , Humanos , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Paquistão/epidemiologia , Feminino , Masculino , Pesquisa Qualitativa , Entrevistas como Assunto , Pessoal de Saúde/psicologia , AdultoRESUMO
ABSTRACT: Tinsley, GM, Meyer, MK, Ptak, SM, Yu, D, Provost, JA, Hansen, NJ, and Carbuhn, AF. Body composition changes over a collegiate playing career in NCAA Division I women's soccer players. J Strength Cond Res 39(1): e40-e55, 2025-Although body composition is known to influence success in organized sport, the longitudinal body composition changes produced by sport specialization are not well characterized for women's soccer. To address this need, this study reports the body composition changes of NCAA Division I women's soccer players over their entire collegiate playing career. Serial dual-energy x-ray absorptiometry (DXA) scans were performed throughout players' involvement in collegiate women's soccer. Analyses of all players with multiple DXA scans (n = 80) and players with ≥3 years of DXA data (n = 17) were performed using linear mixed-effects models that included effects of time, playing position, game minutes, and interactions. In all athletes (n = 80; 2.1 ± 1.2 years of participation), significant increases in bone mass (1.4%), total lean mass (1.7%), and fat-free mass index (0.3 kg·m-2) occurred. These changes coincided with increased arm and leg bone mass, increased lean mass in all regions, and decreased body fat percentage and leg fat mass. In athletes with ≥3 years of collegiate data (n = 17; 3.5 ± 0.4 years of participation), larger increases in bone mass (3.0%), bone mineral density (2.2%), total lean mass (2.5%), fat-free mass index (0.4 kg·m-2), and segmental bone and lean mass were observed. Larger decreases in body fat percentage and leg fat mass were also noted. Although playing position was related to body composition characteristics, changes in outcomes were generally unrelated to position or game minutes. In summary, beneficial changes in multiple aspects of body composition were observed over years of participation in a collegiate women's soccer program.
Assuntos
Absorciometria de Fóton , Composição Corporal , Futebol , Humanos , Feminino , Composição Corporal/fisiologia , Futebol/fisiologia , Adulto Jovem , Densidade Óssea/fisiologia , Atletas/estatística & dados numéricos , Universidades , Adolescente , Estudos LongitudinaisRESUMO
There are conflicting reports regarding the roles of T helper-17 (Th17) and T regulatory (Treg) cells in type 1 leprosy reactions (T1Rs). Also, literature on the correlation of immunological parameters with a validated scoring system and the effect of treatment on cytokines is lacking. Adult patients with untreated T1R and nonreactional spectrum-matched controls were included in the study for comparison of levels of Th17 and Treg pathway cytokines in serum, skin lesions (reactional), and peripheral blood mononuclear cells (PBMCs) culture supernatants. Venous blood samples were collected at baseline and after resolution of reaction (post treatment with nonsteroidal anti-inflammatory drugs [NSAIDs] or steroids) for serum cytokine estimation and PBMC stimulation assays, and lesional (reactional) skin biopsy for cytokine messenger RNA (mRNA) estimation. Thirty-two cases of T1R were recruited (23 patients completed follow-up). Serum levels of cytokines were not significantly different between cases and controls or between pre- and post-treatment samples. Tissue mRNA and Mycobacterium leprae (M. leprae) antigen-stimulated PBMC culture supernatant levels of Interleukin (IL)-17A, IL-17F, IL-6, and IL-23 were significantly higher in T1R than in controls. Levels of IL-10 and Transforming Growth Factor-beta (TGF-ß) were comparable among the two groups. The levels of all cytokines were significantly reduced after treatment. There was no significant difference in magnitude of the fall between those treated with steroids versus NSAIDs. This study suggests heightened Th17 response in T1R, with a prominent inability of the regulatory cytokines IL-10 and TGF-ß to control the associated inflammation. The dynamics of change after resolution of T1R were comparable between NSAID and oral steroid treatment groups.
Assuntos
Citocinas , Hanseníase , Leucócitos Mononucleares , Pele , Linfócitos T Reguladores , Células Th17 , Humanos , Adulto , Masculino , Células Th17/imunologia , Feminino , Citocinas/sangue , Leucócitos Mononucleares/imunologia , Leucócitos Mononucleares/metabolismo , Linfócitos T Reguladores/imunologia , Pele/microbiologia , Pele/imunologia , Pele/patologia , Hanseníase/imunologia , Hanseníase/sangue , Hanseníase/microbiologia , Pessoa de Meia-Idade , Mycobacterium leprae/imunologia , Estudos de Casos e Controles , Adulto Jovem , Anti-Inflamatórios não Esteroides/uso terapêutico , Interleucina-17/sangueRESUMO
This report documents the first known cases of lepromatous leprosy in patients with chronic mucocutaneous candidiasis (CMC) linked to a gain-of-function mutation in the STAT1 gene. Two related patients, a mother and daughter, who both suffer from CMC and lepromatous leprosy, carry a heterozygous STAT1 mutation (c.821G>A; p.R274Q). Both individuals exhibited similarly high levels of total and phosphorylated STAT1 in CD4+ T cells and decreased interleukin 17A transcripts. This mutation underscores a complex relationship between genetic susceptibility to infections and the necessity to evaluate each case individually.