Peripheral nerve abnormality in HIV leprosy patients.

BACKGROUND: The geographical overlap of HIV (human immunodeficiency virus) and leprosy infection has become increasingly frequent and worrying, bringing many clinical issues. Peripheral neuropathy is very frequent in leprosy because of the predilection of its etiologic agent by Schwann cells of the peripheral nervous system, and it also affects individuals with HIV as one of the most common neurological manifestations. METHODOLOGY/PRINCIPAL FINDINGS: The present study compared a cohort of 63 patients diagnosed with leprosy and coinfected with HIV with a cohort of 64 patients with leprosy alone, who were followed at the outpatient clinic of the Nucleus of Tropical Medicine of the Federal University of Pará, Brazil. We observed that HIV-coinfected leprosy patients presented greater odds of overall peripheral nerve damage (nerve function impairment-NFI) than patients with leprosy alone. More sensitive damage was observed, especially in patients coinfected with multibacillary forms. Leprosy patients coinfected with HIV presented higher chances of motor damage with improvement over time using multidrug therapy (MDT) and highly active antiretroviral therapy (HAART), along with a greater extent of damage and occurrence of neuritis. The data suggest that in addition to patients presenting possible damage caused by leprosy, they also had a greater damage gradient attributable to HIV disease, but not related to HAART because most of these patients had been on the treatment for less than a year. Neuritis was treated with prednisone at doses recommended by the WHO, and coinfected patients had the highest rate of clinical improvement in the first 60 days. CONCLUSIONS/SIGNIFICANCE: The clinical characteristics of the two diseases should be considered in leprosy patients coinfected with HIV for better diagnosis and treatment of peripheral neuropathy. We suggest that new simplified assessment tools that allow the evaluation of the NFI of these patients be developed for use in the service.

Laser therapy in wound healing associated with diabetes mellitus - Review.

OBJECTIVE: To determine the most effective parameter in healing wounds related to diabetes mellitus, as well as the most widely used type of laser. METHODOLOGY: consisted of bibliographic searching the databases Bireme, SciELO, PubMed/Medline and Lilacs by using the keywords related to the topic. Were selected from these keywords, papers discussing the use of laser on wounds associated with diabetes, published in the period 2005-2014, in Portuguese or English. RESULTS: After analyzing the research, 12 studies consistent with the theme were selected. CONCLUSION: Based on this review, the studies that showed more satisfactory results in healing diabetic wounds were those who applied energy densities in the range of 3-5 J/cm2, power densities equal to or below 0.2 W/cm2 and continuous emission. The He-Ne laser with a wavelength of 632.8 nm was used more often.

Laser therapy in wound healing associated with diabetes mellitus - Review

Abstract: The article discusses the results of a literature review on the application of low intensity laser therapy on the healing of wounds associated diabetes mellitus in the last 10 years. Objective: To determine the most effective parameter in healing wounds related to diabetes mellitus, as well as the most widely used type of laser. Methodology: consisted of bibliographic searching the databases Bireme, SciELO, PubMed/Medline and Lilacs by using the keywords related to the topic. Were selected from these keywords, papers discussing the use of laser on wounds associated with diabetes, published in the period 2005-2014, in Portuguese or English. Results: After analyzing the research, 12 studies consistent with the theme were selected. Conclusion: Based on this review, the studies that showed more satisfactory results in healing diabetic wounds were those who applied energy densities in the range of 3-5 J/cm2, power densities equal to or below 0.2 W/cm2 and continuous emission. The He-Ne laser with a wavelength of 632.8 nm was used more often.

Leprosy Reactions in Patients Coinfected with HIV: Clinical Aspects and Outcomes in Two Comparative Cohorts in the Amazon Region, Brazil.

BACKGROUND: Leprosy, caused by Mycobacterium leprae, can lead to scarring and deformities. Human immunodeficiency virus (HIV), a lymphotropic virus with high rates of replication, leads to cell death in various stages of infection. These diseases have major social and quality of life costs, and although the relevance of their comorbidity is recognized, several aspects are still not fully understood. METHODOLOGY/PRINCIPAL FINDINGS: Two cohorts of patients with leprosy in an endemic region of the Amazon were observed. We compared 40 patients with leprosy and HIV (Group 1) and 107 leprosy patients with no comorbidity (Group 2) for a minimum of 2 years. Group 1 predominantly experienced the paucibacillary classification, accounting for 70% of cases, whereas Group 2 primarily experienced the multibacillary classification (80.4% of cases). There was no significant difference in the prevalence of leprosy reactions among the two groups (37.5% for Group 1 vs. 56.1% for Group 2), and the most frequent reaction was Type 1. The appearance of Group 1 patients' reversal reaction skin lesions was consistent with each clinical form: typically erythematous and infiltrated, with similar progression as those patients without HIV, which responded to prednisone. Patients in both groups primarily experienced a single episode (73.3% in Group 1 and 75% in Group 2), and Group 1 had shorter reaction periods (≤3 months; 93.3%), moderate severity (80%), with 93.3% of the patients in the state of acquired immune deficiency syndrome, and 46.7% presenting the reaction at the time of the immune reconstitution inflammatory syndrome. CONCLUSIONS/SIGNIFICANCE: This study used a large sample and makes a significant contribution to the clinical outcomes of patients in the reactive state with comorbid HIV and leprosy. The data indicate that these diseases, although concurrent, have independent courses.

Análise da qualidade de vida de pacientes queimados submetidos ao tratamento fisioterapêutico internados no Centro de Tratamento de Queimados / Analysis of the burned patients’ life quality submitted to the handling physical therapist interned in the Center of Handling of Burned

Objetivo: Verificar a Qualidade de Vida (QV) de pacientes grandes queimados hospitalizados no centro de tratamento de queimados (CTQ) em Ananindeua-PA, e que tiveram atendimento fisioterapêutico durante a hospitalização. Método: A pesquisa foi submetida e aprovada pelo Centro de Ensino e Pesquisa do HMUE de Ananindeua-PA e pelo Comitê de Ética em Pesquisa com Seres Humanos (CEP) da Fundação Hospital de Clínicas Gaspar Viana. A amostra constou de 16 pacientes internados e optou-se por uma estatística descritiva-analítica. O presente Estudo tem caráter observacional- descritivo, utilizando o questionário Short Medical Outcomes Study 36-Item Short-Form Health Survey, o SF-36. Resultados: Observou-se melhora em todos os domínios, tendo maior significância estatisticamente em aspecto social, dor e na saúde mental, tendo como parâmetro p valor <0,05. O fisioterapeuta tem a capacidade de entender os objetivos médicos, as modalidades de tratamento e o comportamento do paciente, já que tem uma compreensão da magnitude da queimadura, das sequelas sistêmicas, das complicações e do prognóstico geral. Conclusão: Os resultados obtidos mostram a necessidade de desenvolver programas e campanhas de prevenção na população em geral e no ambiente familiar, visto que a maioria dos casos ocorre dentro do próprio domicílio e que estes acidentes poderiam ter sido evitados. A longa hospitalização leva o indivíduo a dispor de mais tempo para refletir sobre a própria existência, ajudando-o a organizar planos e a manter a confiança na recuperação.

Objective: The aim of the study is to verify quality of life (QV) of big patients being burned hospitalized: in the Center of Handling of Burned (CTQ) in Ananindeua, PA, that had physiotherapeutic service and to verify in which domains of QV of those patients were more committed or preserved, during the hospitalization. Method: The research was submitted and approved by the Center of Education and researches of the HMUE of Ananindeua, PA, and by the Committee of Ethics in Research with Human Beings from the Foundation of Hospital das Clínicas Gaspar Viana. Sample was comprised of 16 patients interned opted by a descriptiveanalytic statistics. The present study has character observational-descriptive, using the questionnaire Shorts Medical Outcomes Study 36-Article Shorts-Form Health Survey, the SF-36. Results: It was observed improves in all of the bigger domains having statistical significance in social aspect, pain and in the mental health, having as parameter p value < 0.05. Physiotherapists have the capacity of understand the medical objectives, the modalities of handling and the behavior of the patient, since have a comprehension of the magnitude of the burn, of the systemic sequels, of the complications and of the general prognostic. Conclusions: The results obtained show the need to develop programs and campaigns of prevention in the population in general and at home, because the majority of the cases occurs at residence and these accidents could be avoided. The long hospitalization leads the individual to have more time for reflect about his life, helping him to organize his thoughts and to maintain the confidence in the recuperation.

Avaliação clínico-epidemiológica em pacientes multibacilares em uma unidade de referência de hansenologia da amazônia / Clinical and epidemiologycal evaluation of multibacillary patients from a reference center for leprosy in the brazilian amazon

O mycobacterium leprae (bacilo de hansen) possui propriedades imunogênicas especiais, responsáveis pelo alto poder incapacitante da hanseníase. Objetivou-se estudar o perfil clínico-epidemiológico de pacientes hansenianos multibacilares, de acordo com a classificação de madri, correlacionar o índice baciloscópico com o número de troncos afetados pela neurite franca no início e término do tratamento, correlacionar o grau de incapacidade com a forma clínica, à entrada e à saída desses pacientes. Selecionaram-se 158 prontuários de pacientes diagnosticados com hanseníase multibacilar, avaliados pelo exame baciloscópico e neurológico. O estudo foi realizado no centro de referência em dermatologia sanitária dr. Marcelo cândia, em marituba, pará, brasil. Desses pacientes, 52% estavam na faixa etária de 15 a 54 anos, 80,4% eram do sexo masculino, 80% tiveram alta por cura e 84% eram casos novos. A forma clínica predominante foi a dimorfa, com 68% dos casos. A forma virchowiana (mhv) apresentou maior número de pacientes com grau de incapacidade ii. A presença de incapacidade grau zero foi estatisticamente significante na forma dimorfa (mhd), que possui aproximadamente 2,69 vezes maior probabilidade de evoluir para neurite que a mhv. Os nervos periféricos mais afetados foram: o tibial posterior, o ulnar, o fibular e o mediano. Conclui-se que a forma virchowiana tem maior potencial de produção de incapacidades tipo ii, enquanto que os portadores de mhd evoluem mais vezes para neurite; e que não há diferença no acometimento de troncos nervosos em relação ao índice baciloscópico.

Mycobacterium leprae (hansen's baccillus) displays special immunogenic properties responsible by the high incapacitating power of leprae. The aims of this study were to determine the clinical-epidemic profile of multibacillar leprosum patients according to madri's classification, correlate the baciloscopic index with the amount of nerve trunks affected by the classic neuritis prior and post-treatment, and correlate the inability degree of this patient with the clinical form at entrance and outcome. Medical records from 158 selected subjects with multibacilar leprosy from the center of reference in sanitary dermatology dr. Marcelo cândia, in marituba, pará, brazil were accessed to evaluate the baciloscopic and neurological exam. . Fifth two percent of the patients were in the range of 15 to 54 years, 80.4% Were male, 80% reach outcome for cure, and 84% were new cases. The predominant clinical form was dimorfa, comprising 68% of the cases. The virchowian form (mhv) was present in the majority of subjects with degree ii of incapacity, the presence of degree zero of incapacity was statistically significant in the dimorfa form (mhd), whose subjects displayed around 2.69 Fold more chance of evolving with neuritis symptoms than mhv. The most affected peripheric nerves at the moment and during the diagnosis were: tibia posterior, ulnar, fibula, and the median nerve. In conclusion, mhv is at greater potential to develop degree ii of incapacity, whereas mhd barriers more frequently evolve to neuritis, and there is no difference among the nervous trunks affected in regard to the bacterious index.