Reação reversa macular da hanseníase: relato de caso / Macular reversal reaction in leprosy: a case report

A reação reversa maculosa consiste no aparecimento abrupto de máculas hipocrômicas, ocorrendo em pacientes hansenianos dimorfos que completaram o tratamento com poliquimioterapia para hanseníase multibacilar. Em geral, surgem entre 6 a 12 meses da alta, com baciloscopia negativa e boa resposta a corticoterapia sistêmica. Ressaltamos a dificuldade em diferenciar recidiva de um episódio reacional, já que não existem critérios clínicos bem estabelecidos que possibilitem este diagnóstico, além de existirem poucos relatos em literatura. Relatamos um caso clínico com diagnóstico de reação reversa macular após período variável de alta do tratamento de hanseniase dimorfa-dimorfa. Foi feita investigação por meio de anamnese rigorosa, exame dermatológico, exame histopatológico da lesão e baciloscopia, excluindo-se os critérios de recidiva, além de analisados dados anteriores do prontuário.O paciente foi submetido a corticoterapia sistêmica,apresentando melhora das lesões. Conclui-seque a reação reversa maculosa deve ser lembrada nos diagnósticos diferenciais com hanseníase recidivada e episódios reacionais clássicos, evitando retratamentos desnecessários.

Macular reversal reaction is the abrupt onset of hypochromic lesions, occurring in borderline leprosy patients who completed treatment with multidrugtherapy for multibacillary leprosy. In general, these reactions appear 6 to 12 months after medical discharge, showing negative skin smear and good response to systemic corticosteroid therapy. We emphasize the difficulty in differentiating relapse cases from leprosy reactions, as there are no well-established clinical criteria that allow this diagnosis, and moreover there are few reports about it in the literature. We report a borderline leprosy case diagnosed with macular reversal reaction after variable period of discharge from treatment. Detailed anamnesis, dermatological and histopathological examination and bacilloscopy, analysis of previous medical records, excluding the relapse criteria, were used for the investigation. The patient was submitted to systemic corticosteroid therapy, with improvement of the lesions. It is concluded that macular reversal reaction should be considered in the differential diagnosis of relapsed leprosy and classic reactional episodes, avoiding unnecessary retreatment.

Cutaneous manifestations in end-stage renal disease.

The prevalence of chronic kidney disease has increased over the last years. The effects of this disease are complex and may lead to dysfunction of multiple organs, including the skin, with most patients presenting with at least one dermatologic alteration. Sometimes these symptoms can be the first clear sign of kidney disease. This article discusses the skin manifestations related to severe renal impairment or end-stage renal disease (ESRD), which are divided into nonspecific and specific, and reviews the clinical features, etiopathogenesis and therapeutic options for these dermatoses. Early recognition and treatment reduce morbidity and improve these patients' quality of life.

Manifestações cutâneas na doença renal terminal / Cutaneous manifestations in end-stage renal disease

A prevalência da doença renal crônica aumentou nos últimos anos. Os efeitos dessa doença são complexos e podem levar à disfunção de múltiplos órgãos, entre eles, a pele. A maioria dos pacientes apresenta pelo menos uma alteração dermatológica. Algumas vezes, esses sintomas podem ser o primeiro sinal evidente de doença renal. Este artigo aborda as manifestações cutâneas relacionadas a disfunção renal grave ou doença renal terminal, divididas em não específicas e específicas, revisando quadro clínico, etiopatogenia e opções terapêuticas dessas dermatoses. Seu reconhecimento e trata mento precoces diminuem a morbidade, melhorando a qualidade de vida desses doentes.

The prevalence of chronic kidney disease has increased over the last years. The effects of this disease are complex and may lead to dysfunction of multiple organs, including the skin, with most patients presenting with at least one dermatologic alteration. Sometimes these symptoms can be the first clear sign of kidney disease. This article discusses the skin manifestations related to severe renal impairment or end-stage renal disease (ESRD), which are divided into nonspecific and specific, and reviews the clinical features, etiopathogenesis and therapeutic options for these dermatoses. Early recognition and treatment reduce morbidity and improve these patients' quality of life.

Qualidade de vida de pacientes em hemodiálise em um hospital público de Belém - Pará / Quality of life of hemodialysis patients in a Brazilian Amazonian public hospital

Introdução: A doença renal crônica (DRC) dialítica afeta a qualidade de vida do paciente, por vezes de maneira mais intensa que outras doenças crônicas, como artrite reumatóide, insuficiência cardíaca, doença arterial coronariana e doença pulmonar obstrutiva crônica, exercendo efeito negativo sobre os níveis de energia e vitalidade, limitando as interações sociais e prejudicando a saúde psíquica. Objetivo: Avaliar a qualidade de vida de pacientes com IRC em programa de hemodiálise ambulatorial em um hospital público de Belém - Pará. Método: O estudo baseou-se em dados coletados em entrevista, utilizando a versão brasileira do questionário SF-36. Foram avaliados 50 pacientes, com idade média de 48 +- 16 anos e tempo médio em hemodiálise de 3 +- 2,9 anos, 62% do sexo masculino. Resultados: A dimensão mais afetada foi relativa aos aspectos físicos, com pontuação média de 36 +- 36 e 58% dos pacientes no quartil mais baixo, enquanto saúde mental e aspectos sociais demonstraram relativa preservação, com a maioria dos pacientes alocados no quartil mais elevado. A população masculina apresentou piores escores que a feminina quanto a aspectos fpisicos e vitalidade. A idade correlacionou-se negativamente com a capacidade funcional. Os pacientes em hemodiálise há mais de um ano apresentam melhores níveis no domínio aspectos sociais e houve correlação positiva entre o tempo em diálise e a capacidade funcional. Conclusão: os domínios analisados estiveram globalmente comprometidos na população estudada, em especial com relação aos aspectos físicos, sugerindo a influência negativa da presença de doença crônica, com tratamento prolongado sobre esses âmbitos.

Introduction: Chronic kidney disease (CKD) affects the quality of dialysis patient's life, sometimes more intensely than other chronic diseases such as rheumatoid arthritis, heart failure, coronary artery disease and chronic obstructive pulmonary disease, exerting a negative effect on energy levels and vitality, limiting social interactions and impairing mental health. Objective: To evaluate the quality of life of patients with CRF on hemodialysis outpatients in a public hospital in Belém - Pará Method: The study was based on data collected in interviews, using the Brazilian version of SF-36. We evaluated 50 patients, mean age 48 + - 16 years and average time on hemodialysis 3 + - 2.9 years, 62% male. Results: The most affected dimension was related to physical aspects, with an average score of 36 + - 36 and 58% of patients in the lowest quartile, while mental health and social aspects demonstrated relative preservation, with the majority of patients allocated in the highest quartile . The male population had worse scores than the female respects fpisicos and vitality. The age was negatively correlated with functional capacity. Patients on dialysis for more than a year have the best levels in the areas social and positive correlation between time on dialysis and functional capacity. Conclusion: The areas examined were broadly committed to this population, especially in relation to the physical aspects, suggesting the negative influence of the presence of chronic disease, with prolonged treatment on these fronts.

[Quality of life of hemodialysis patients in a Brazilian Public Hospital in Belém - Pará].

INTRODUCTION: End-stage chronic kidney disease (CKD) requiring dialysis affects the quality of life sometimes more severely than other chronic diseases, such as rheumatoid arthritis, heart failure, coronary artery disease, and chronic obstructive pulmonary disease, exerting a negative effect on the energy and vitality levels, limiting social interactions, and hindering psychic health. OBJECTIVE: To evaluate the quality of life of patients with CKD on hemodialysis in a public Brazilian Amazonian hospital. METHODS: Data were collected through interview based on the Brazilian version of the SF-36 questionnaire. The study was conducted on 50 patients (mean age, 48 ± 16 years; mean hemodialysis time, 3 ± 2.9 years). RESULTS: The most affected domain was role limitations due to physical health, with a mean score of 36 ± 36, and 58% of the patients in the lowest quartile, while mental health and social functioning were relatively preserved, with most patients in the highest quartile. Men obtained poorer scores than women did for role limitations due to physical health and vitality. Age correlated negatively with physical functioning. Patients on hemodialysis for more than one year had better scores in the social functioning domain, with a positive correlation between dialysis time and physical functioning. CONCLUSIONS: The domains assessed were globally impaired in the population studied, especially regarding role limitations due to physical health, suggesting that chronic disease with prolonged treatment has a negative influence on those domains.