Association between neuropathic pain and A-Waves in leprosy patients with type 1 and 2 reactions

Neuropathic pain (NP) is a well-recognized feature of leprosy neuropathy. However, the diagnosis of NP is difficult using only clinical criteria. In the study reported here, by means of conventional nerve conduction studies, the authors sought for an association between long-latency responses and NP complaints in leprosy patients with type 1 and 2 reactions. Of the 27 ulnar nerves of leprosy patients, 18 with type 1 reaction (T1R) and 9 with type 2 reaction (T2R) were followed-up for 6 months before and after steroid treatment. Clinical characteristics of pain complaints and clinical function were assessed, as well as the presence of F- and A-waves of the ulnar nerve using nerve conduction studies. The clinical and the neurophysiologic findings were compared to note positive concordances (presence of NP and A-waves together) and negative concordances (absence of NP and A-waves together) before and after treatment. Both reactions presented a high frequency of A-waves (61.1% in T1R and 66.7% in T2R, P < 0.05) and prolonged F-waves (69.4% in T1R and 65.8% in T2R, P = 0.4). No concordances were seen between pain complaints and F-waves. However, significant concordances between NP and A-waves were observed, although restricted to the T2R group (χ(2) = 5.65, P = 0.04). After treatment, there was a significant reduction in pain complaints, as well as the presence of F- and A-waves in both groups (P < 0.05 for all comparisons). In conclusion, the presence of A-waves correlates well with pain complaints of neuropathic characteristics in leprosy patients, especially in those with type 2 reaction. Probably, such response shares similar mechanisms with the small-fiber dysfunction seen in these patients with NP, such as demyelination, intraneural edema, and axonal sprouting. Further studies using specific tools for small-fiber assessment are warranted to confirm our findings.

Evaluación de u test alternativo para el diagnstico de crecimiento auricular en base a la morfología de las ondas f en la fibrilación auricular / Evaluation of an alternative test for the diagnosis of atrial growth based on the morphology of the waves f in the atrial fibrillation

La fibrilación auricular, una arritmia frecuente, muestra en el ECG la sustitución de las ondas p por ondas f, algunas de mayor amplitud. Estas últimas se asocian a crecimiento auricular (factor predictivo en el manejo de FA); cuando no se dispone de eco-cardiógrafo en emergencias, es necesario un método diagnóstico alternativo para el crecimiento auricular en pacientes inestables; Proponemos como test diagnóstico: Crecimiento auricular (>40mm)>>0nda f gruesa (>0,1mV)". Nuestro estudio analítico toma como universo a pacientes atendidos por el servicio de cardiología del HCV de Cochabamba-Bolivia de 2005 a 2009, 1000 pacientes de forma aleatoria simple, muestra de 150 pacientes. La tasa de prevalencia de FA 15%(IC95%:13;17); sexo predominante masculino, 54,7%(RR=1(X2=0 y valor de p >0,05-No significativo)); edad con rango de 17-81 años, mediana de 53 años ((IC95%:50;56)(RIC = 21 años)); Clasificando se encontró onda f gruesa en 65%(IC95%:57;73) y crecimiento auricular izquierdo en 88%(IC95%:83;93); La correlación Crecimiento auricular>>Onda f gruesa encontrada dio un OR=1,5; ó 0,5 veces más posibilidad de presentar onda f gruesa en crecimiento auricular. Se encontró cardiomiopatía chagásica y reumática asociados, representando el 65%. Validez interna del test: S=66%; E=44%; VPP=90% y VPN = 15%, la capacidad para determinar crecimiento auricular con el test positivo (S) es baja, aceptable, pero la probabilidad de tener test positivo en crecimiento auricular (VPP) es muy alta; validez externa: Índice kappa = 0,6-Reproductibilidad inter-observador moderada, comparada con la eco-cardiografía. Se obtuvo mayor aplicación en cardiopatía chagásica (S=70%, E=57%, VPP=94%).

The atrial fibrillation (FA), a frequent arrhythmia, the ECG replaces the waves p with waves f, some of them, these last ones associate to atrial growth (factor predictive in the handling of AF); The Clinical Hospital Viedma (CHV), departmental center of reference, it doesn't have echo-cardiograph in emergencies, is necessary a new alternative diagnosis method for the atrial growth in unstable patient; We propose a diagnosis test: "atrial growth (>40mm) >>Wave thick f (>0,1mV)". Our descriptive-analytic and traversal study, taking of the universe, patients assisted by the cardiology service in the HCV of Cochabamba-Bolivia from 2005 to 2009 (4700-patient), a sample of 1000 patients, a simple aleatory way, we work with 150 patients (representative). Results: rate of prevalence of AF, 15%(IC95%:13;17); Masculine predominant sex, 54,7%(RR=1(X2=0 and value of p >0,05-no significant)); Age with 17-81 year-old range, mediana=53 anos(CI95%:50;56) and journey intercuartil (IQR)=21 years; Classifying was thick wave f in 65%(CI95%:57;73) and atrial left growth in 88%(IC95%:83;93); The correlation atrial growth>>Wave thick f", we obtained a OR=1,5; or 0,5 times more possibility to present wave thick f in atrial growth. We find Chagas myocardiophaty and pathologies rheumatic associates, both 65%; Internal validity of the test: S=66%; E=44%; PPV=90% and PNV=15%, the capacity to determine atrial growth with the positive test (S) it is acceptable, but the probability of having positive test in atrial growth (PPV) it is very high; External validity: Index kappa = moderated 0,6-Reproductibilidad inter-observer, compared with the echo-cardiography. Bigger application was obtained in Chagas myocardiopathy (S=70%, E=57%, PPV=94%).