The Correlation between Anthropometric Variables and Muscular Strength in Patients Coinfected with Leprosy and HIV.

Background: Peripheral nerve disease may lead to physical disability because of decreased muscle strength and/or loss of sensitivity in the dermatomes of affected peripheral nerves. Both human immunodeficiency virus (HIV)- and leprosy-affected patients can develop neurological damage; therefore, the coinfection of these diseases presents new challenges to the health care of these patients. Aims and Objective: This study aimed to investigate the motor alterations of patients coinfected with HIV and leprosy and their relationship with clinical and anthropometric characteristics, compared with individuals with isolated diseases. Materials and Methods: In this cross-sectional study, 90 individuals were divided equally into three groups: HIV/acquired immunodeficiency syndrome (AIDS) group, leprosy group and HIV/leprosy group. All individuals underwent an evaluation of muscle strength and upper limb endurance adjusted for the Brazilian standards, a palm print pressure test using a digital dynamometer and anthropometric measurements (weight, height and skin folds). Results: The HIV/leprosy group had the highest mean body mass index, followed by the leprosy group and the HIV/AIDS group. Skinfolds were similar between the groups. Multiple linear regression, adjusted for sex and age, revealed the coinfection of HIV and leprosy as possible contributor to a worse prognosis of muscle function, highlighting the bilateral reduction in the levels of palm print compression strengths compared with isolated diseases (HIV and leprosy). High CD4 count and shorter antiretroviral therapy duration were associated with worse indices of muscle strength, such as gripping and resistance, in coinfected patients. Conclusion: Patients coinfected with HIV and leprosy exhibited greater motor damage than those with isolated diseases. Thus, motor damage may be related to the sum of the neurological manifestations of the two morbidities.

Clinical and electrophysiological characteristics of neuropathic pain in leprosy patients: A prospective cross-sectional study.

Introduction Neuropathic pain is a common and disabling late complication of leprosy. We investigated the clinical and electrophysiological characteristics of neuropathic pain in leprosy patients by evaluating nerve conduction, sympathetic skin response (SSR) and A-waves. Methods Twenty one leprosy patients with neuropathic pain validated by the Douleur Neuropathique en 4 (DN4)Questionnaire were selected for study. Pain intensity was measured by the visual analog scale. Demographic and clinical data were collected for all patients. Clinical data included appraisal of the median, ulnar, radial, tibial and common peroneal nerves, assessment of the sympathetic skin response and conventional electrophysiological recordings. Results Among all electroneuromyographic presentations, multifocal mononeuropathy was still the most prevalent. Sensory loss was observed more frequently than motor deficits. As most patients presented advanced clinical forms of leprosy and were under treatment, this high mean was found and the ulnar nerve was most frequently affected. The sympathetic skin response was absent in 16 patients. Higher DN4 Questionnaire scores were observed in women and in those receiving corticosteroid therapy. These inferences are possible to be made, but our study's limitations don't allow us to be certain about it. The statistical significance found only permits us to evidence what we related on the textual part of the study. Limitations The small number of patients studied, the lack of sophisticated diagnostic methods for leprosy, as well as the difficulties in assessing nerve conduction were the main limitations of this study. Conclusion The neurophysiological and clinical findings in leprous neuropathy were modest despite the conspicuous neuropathic pain. Although electrophysiological studies are a vital tool to verify nerve damage, variations in the clinical presentation of leprosy neuropathic pain render the diagnosis challenging. Further studies are needed to describe the neurophysiological evolution of this disease.

Leprosy in elderly people and the profile of a retrospective cohort in an endemic region of the Brazilian Amazon.

BACKGROUND: Leprosy has a global presence; more than 180 thousand new cases were registered in 2013, 15% of which were found in the Americas. The elderly are a very susceptible demographic in terms of developing illnesses, mainly because of characteristics natural to the senescence of the human organism. This study's goals were to analyze leprosy in an elderly population from a hyperendemic region of the Brazilian Amazon in a historical series from 2004 to 2013 and to determine the clinical and epidemiological profile of a series of leprosy cases of elderly people in the period spanning from 2009 to 2013. METHODS: To achieve these goals, an observational, longitudinal, retrospective and descriptive study was put together to analyze leprosy in elderly people from data acquired from the Notification Aggravations Information System. Furthermore, a profile of the disease from a retrospective cohort based on data collected from medical records was developed. RESULTS: The number of new cases and the leprosy detection rate decreased across the observed period but remained stable among the elderly. The trend for the next ten years indicates decreases in the number of cases and in the detection rate in the general population and an increase in only the elderly. The overall profile was characterized by a predominance of males (64.32%), the multibacillary clinical form (87.57%), Type 1 reaction episodes (37.50%) and some physical incapacity at diagnosis (49.19%). The risk of reaction was greater in the first six months of multidrug therapy, and the positive result from the skin smear was associated with the greater chance of reactional condition development. CONCLUSIONS: The resulting data demonstrate that leprosy amongst the elderly deserves attention because of the increased susceptibility to disability in this age group, with their higher risk of reaction and their greater level of co-morbidity.

Association between sarcopenia and diabetes in community dwelling elderly in the Amazon region - Viver Mais Project.

BACKGROUND: Studies indicate the intrinsic relationship between sarcopenia and diabetes mellitus (DM) pathophysiological mechanisms. Changes in insulin and muscular metabolism are features of diabetic patients and can interact as sarcopenic accelerators. Conversely, sarcopenic patients feature lower glucose tolerance and higher serum insulin levels, predisposing them to DM. OBJECTIVE: To study the association between sarcopenia and DM in a community-dwelling elderly population of the Amazon region. METHODS: Cross-sectional study, performed in Belém, Brazil, with 1078 patients aged above 60 years old from the Viver Mais Project (VMP). The definition of sarcopenia was based in the European Working Group on Sarcopenia in Older People (EWGSOP). Calf circumference >31 cm was considered normal, muscle strength was discriminated by BMI and measured with the hand grip test, and gait speed <0.8 m/s configured low performance. DM was diagnosed when reported by the patient or medical form, use of hypoglycemic medications/insulin and in the presence of fasting glucose >126 mg/dl or glycated hemoglobin (HbA1c) >6.5% on two occasions. Other medical and socio-demographic data were extracted from medical forms. RESULTS: The frequency of sarcopenia was 9.4%, while DM was present in 36.87% of the patients, and had an increased occurrence in the sarcopenic group. Female sex, advanced age, DM, coronary insufficiency, osteoporosis, body mass index, waist circumference, triglycerides and functionality were associated with sarcopenia. In multivariate analysis, sarcopenia remained strongly associated with DM (OR: 3.208, 95%CI: 1.784-5.769). CONCLUSION: This study describes strong and independent association between sarcopenia and DM. To further clarify these findings, broader prospective cohorts are necessary.

Funcionalidade de idosos cadastrados em uma unidade da estratégia saúde da família segundo categorias da classificação internacional de funcionalidade / Functionality elderly enrolled in a family health strategy unit according to the level of the international classification of functioning

OBJETIVOS: Investigar a funcionalidade de idosos cadastrados na Estratégia Saúde da Família ESF e classificar pelas categorias de Atividade e Participação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde CIF. MÉTODO: Pesquisa transversal, descritiva, realizada em 124 idosos cadastrados na ESF Águas Lindas I, município de Ananindeua, Pará, Brasil. A coleta de dados ocorreu no ambiente domiciliar dos idosos. Investigaram-se as características sociodemográficas, a funcionalidade, pelo Índice de Katz e escala de Lawton, e o nível de Atividade e Participação, segundo a CIF. A análise estatística foi realizada no programa SPSS 18.0, utilizando a média, desvio-padrão e o teste Qui-quadrado de Pearson x2, com descrição da frequência relativa simples de cada domínio avaliado. RESULTADOS: 66,9 % dos idosos eram do sexo feminino, com média de idade 68,5 dp±8,19 anos, casados n=61 e recebiam aposentadoria n=69. Cerca de 65% dos idosos eram independentes para todas as atividades avaliadas pelo Índice de Katz e escala de Lawton. Quanto à classificação da funcionalidade pela CIF, a maioria foi classificada com códigos que indicam nenhuma dificuldade. CONCLUSÃO: A maior parcela dos idosos estudados apresenta-se ativa e participativa, ou seja, é capaz de desempenhar uma tarefa diária, o que talvez represente um envelhecimento com poucas perdas.

OBJECTIVE: To investigate the functionality of elderly enrolled in the Family Health Strategy and sort by categories of activity and participation of the International Classification of Functioning, Disability and Health ICF. METHOD: This is a cross-sectional, descriptive survey of 124 elderly enrolled in the Family Health Strategy of Aguas Lindas I, Ananindeua municipality, Pará state, Brazil. Data was collected in the elderly's homes. Variables were sociodemographic characteristics, functionality index by Katz and Lawton scale and level of activity and participation according to the ICF. Statistical analysis was performed using SPSS 18.0 program and the chi-square test x2, with description of simple relative frequency of each domain assessed. RESULTS: 66.9% of the elderly were female, with mean age 68.5 SD±8.19, married n=61 and receiving retirement n=69. About 65% of the elderly were independent for all activities assessed by the index of Katz and Lawton scale. As for the classification of functioning by ICF, most were classified with codes indicating no difficulty. CONCLUSION: The largest share of the elderly present active and participatory, in other words, are able to perform a daily task, which may represent an aging with few losses.

O cuidado hospitalar na hanseníase: um perfil do estado do Pará de 2008 a 2014 / Hospital care in leprosy: a profile of Pará, Brazil, 2008-2014

Os casos de internação por hanseníase representam as complicações e as situações mais graves da doença. Objetivou-se traçar um perfil epidemiológico da internação hospitalar por hanseníase, no estado do Pará, de 2008 a 2014. Para isso, realizou-se uma pesquisa descritiva de dados secundários disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. A análise efetuada foi, predominantemente,descritiva e os testes Qui-Quadrado e Teste-G foram utilizados quando pertinentes. Calculou-se,a taxa de internação e óbito para cada 10 mil internações ou óbitos por doenças infecciosas e parasitárias para o Pará e outras Unidades de Federação. Verificou-se que, nesse período, 740 pessoas foram internadas com a doença no estado, representando uma taxa de 12,86/10 mil internações por doenças infecciosas e parasitárias. Das internações totais, 526 (71,08%) foram homens e 524 (70,81%) encontravam-se na faixa etária de 20 a 59 anos; 61 (8,25%) possuíam até 19 anos. Dos atendimentos, 79,73% (n=590) foram registrados pelo regime público de saúde, 92,30% (n=683)em caráter eletivo e 84,19% (n=623) fora da região metropolitana de Belém. No ranking regional por taxa de internação o estado encontra-se em último lugar e em penúltimo no ranking nacional. O perfil de internação por hanseníase no Pará acompanha o perfil epidemiológico da doença, sendo mais comum em homens com idade economicamente ativa. O acometimento de crianças e adolescentes é preocupante,pois representa uma exposição precoce e maiores chances de desenvolver incapacidades.Os registros no estado foram mais baixos quando comparados a estados de média e baixa endemicidade.

Cases of hospitalization represent severest cases of leprosy, with more complications. This study aimed to criate an epidemiological profile of hospital admissions for leprosy in the state of Pará, Brazil, from 2008 to 2014. To this end, we carried out a descriptive study of secondary data provided by the Department of the Unified Health System Information of Brazil. The analysis was performed predominantly descriptive and Chi-square test and G-tests were used when appropriate. It calculated the rate of hospitalization and rate of death for every 10,000 hospitalizations or deaths due to infectious and parasitic diseases to the Pará and other units of federation. It was found that during this period 740 people were hospitalized with the disease in the state, representing a rate of 12.86 / 10 000 admissions for infectious and parasitic diseases. Of total admissions, 526 (71.08%) were men and 524 (70.81%) were in the age group 20-59 years;61 (8.25%) were in the age group 0-19 years. Of cases, 79.73% (n = 590) were recorded by the public health system, 92.30% (n = 683) on an elective basis and 84.19% (n = 623) outside the metropolitan area of Belém. Was observed that this state is last in regional ranking by hospitalization rate and second to last in the national ranking. The leprosy hospital admission profile in Pará is similar to the epidemiology of the disease, is more common in young men. The involvement of children and adolescents is worrisome because it’s represent the early exposure and more risk to develop disabilities. The records in the state were lower when compared to the average of states and low endemicity.

Funcionalidade familiar e atividade e participação dos idosos cadastrados em uma Estratégias Saúde da Família

O objetivo deste estudo foi investigar a funcionalidade familiar e Atividade e Participação de idosos cadastrados em uma Estratégia Saúde da Família (ESF). Método: trata-se de uma pesquisa transversal com abordagem quantitativa realizada em 124 idosos, de ambos os sexos, pertencentes ao território de abrangência da ESF Águas Lindas I, município de Ananindeua, Pará, Brasil. Os dados foram obtidos através da aplicação de um protocolo para coleta de dados sociodemográficos, do índex de Katz para avaliação das atividades básicas diárias, da escala de Lawton para avaliação das atividades instrumentais diárias e o APGAR da família para investigação do funcionamento familiar. A partir dos achados obtidos do índex de Katz e da escala de Lawton procedeu-se a classificação da funcionalidade e incapacidade dos idosos, utilizando-se majoritariamente os componentes Atividade e Participação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Foi criado um banco de dados no software Microsoft Excel 2007 e posteriormente aplicados testes estatísticos para as variáveis sociodemográficas através do programa eletrônico SPSS 18.0. Para análise de significância foi utilizado o teste Qui-quadrado de Pearson (X²), admitindo-se nível a: 0,05 (5%) e valor de p≤ 0,05. Para as variáveis de desfecho foi calculado a frequência relativa simples de cada domínio avaliado. Resultados: Observou-se que a maioria dos idosos estudados era do sexo feminino, com média de idade ± 68,5 anos, casado, com baixo nível de escolaridade, aposentado e ajudavam nas despesas domésticas. Na análise bivariada entre sexo e outras condições socioeconômicas, identificou-se relação com situação conjugal e escolaridade. Quanto as variáveis de desfecho, a maioria alegou boa funcionalidade familiar e também independência para execução das atividades básicas de vida diária. Para as atividades instrumentais de vida diária observou-se dependência parcial para a maior parte dos participantes da pesquisa. Os dados referentes ao índex de Katz e a escala de Lawton foram classificados de acordo a lista de Atividade e Participação da CIF. Conclusões: a maioria dos idosos estudados que estão sob os cuidados de uma equipe Saúde da Família apresenta até então envelhecimento com poucas perdas segundo os resultados encontrados, com satisfatório desempenho funcional, exceto para tarefas instrumentais. Ressalta-se o sistema familiar funcional na visão da maioria dos idosos

Abordagem das atividades funcionais e da influência dos fatores ambientais em pacientes hemiparéticos pós-AVE antes e após o tratamento fisioterapêutico / Addressing functional activities and the influence of environmental factors in post-stroke hemiparetic patients before and after physical therapy

O Acidente Vascular Encefálico (AVE) é a principal causa de incapacidade neurológica, sendo a hemiparesiaa sequela mais comum da doença. As limitações físico-funcionais associadas à influência de fatoresambientais afetam diretamente a funcionalidade dos indivíduos. Para a efetividade da reabilitação neurológica é indispensável que o fisioterapeuta conheça o perfil funcional do paciente a fim de traçar o plano de tratamento que atenda as reais necessidades. Objetivo: Analisar as atividades funcionais e a influência dos fatores ambientais em pacientes hemiparéticos pós-AVE antes e após o tratamento fisioterapêutico.Método: Foram avaliados 12 pacientes hemiparéticos pós-AVE antes e após 20 sessões de fisioterapia, utilizando-se o Índice de Barthel (IB) e um modelo avaliativo baseado no core set abreviado da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) para AVE, com base no sistema de qualificadores genéricos da CIF. Resultados: Observou-se melhora significativa para as atividadesandar (d450) (p = 0,0033), vestir (d540) (p = 0,018) e comer (d550) (p = 0,018), de acordo com um modelo avaliativo baseado na CIF. Por meio do IB, detectou-se melhora significativa para as atividades de alimentação (p = 0,0341), vestir (p = 0,0277), toalete (p = 0,0117) e subir/descer escadas (p = 0,0077). Os fatores ambientais família imediata (e310) e profissionais da saúde (e355) foram os que mais influenciarampositivamente na condição de saúde dos pacientes. Conclusão: A Fisioterapia mostrou-se eficaz para melhorar a condição de saúde dos pacientes, visto que de acordo com a percepção deles algumas atividades diárias puderam ser executadas com mais facilidade ao final do tratamento fisioterapêutico. Para atender às necessidades do paciente, é importante elaborar o plano de tratamento individual, ressaltando o contexto em que ele está inserido, visando atender as reais limitações nas atividades e restrições à participação.

Stroke is the leading cause of neurological disability and hemiparesis is its most common sequelae. The physical and functional limitations combined with the influence of environmental factors directly affect an individual?s functionally. For an effective neurological rehabilitation, it is essential that physiotherapists know the patient?s functional profile in order to plan the treatment to meet his/her real needs. Objective: To analyze the functional activities and influence of environmental factors in post-stroke hemiparetic patients before and after physical therapy. Method: Twelve post-stroke hemiparetic patients were evaluated before and after 20 physical therapy sessions with the Barthel Index (BI) and an evaluation model based on an abbreviated core set of the International Classification of Functioning, Disability and Health (ICF) for stroke, based in the generic qualifiers system of the ICF. Results: There was significant improvement for the activities walk (d450) (p = 0.0033), dress (d540) (p = 0.018) and eat (d550) (p = 0.018) for the evaluation model based on the ICF. According to the BI, significant improvement was detected for the activities of feed (p = 0.0341), dress (p = 0.0277), toilet (p = 0.0117), and up/down stairs (p = 0.0077). The environment factors immediate family and health professionals were the most positive influence on the health status of patients. Conclusion: Physical therapy was effective for improving the condition of patients since, according to the patients, some daily activities can be performed with more ease at the end of the physical therapy treatment. To meet their needs, it is important to develop an individual treatment plan, emphasizing the context in which he/she is inserted, in order to address the real limitations on activities and restrictions to participation.