Reduction of plantar pressures in leprosy patients by using custom made shoes and total contact insoles.

OBJECTIVE: The purpose of this study was to observe whether our custom made shoes and total contact insoles can effectively increase the plantar contact areas and reduce peak pressures in patients with leprosy. DESIGN: In the rehabilitation laboratory of a tertiary medical center. Six male and two female leprosy patients were recruited in this study. In this study, parameters related to foot pressures were compared between these patients wearing commercial available soft-lining kung-fu shoes and our custom made shoes with total contact insoles. The custom made shoes were made with larger toe box and were able to accommodate both the foot and the insoles. Custom made total contact insoles were made with the subtalar joints under neutral and non-weight-bearing positions. The insole force measurement system of Novel Pedar-X (Novel, Munich, Germany) was used to measure the plantar forces. The parameters of contact area (cm(2)), peak plantar pressures (kPa), contact time (s), and pressure time integral (kPa s) were measured. RESULTS: There were significant contact area increases in the right and left foot heel areas, left medial arch, and second to fifth toes after wearing the custom made shoes and insoles. There were significant decreases in peak plantar pressures in bilateral heels, left lateral midfoot, bilateral second to fourth metatarsal areas, and left fifth metatarsal head after wearing the custom made shoes and insoles (p<0.05). CONCLUSIONS: Plantar ulceration is a common serious disability in leprosy patients. As a result, footwear and measures able to reduce plantar pressures may be beneficial in preventing plantar ulcers from occurring in these patients. Our custom made shoes and total contact insoles were proven to be effective in increasing contact areas and decreasing peak pressures in plantar surfaces, and may therefore be a feasible treatment option in preventing leprosy patients from developing plantar ulcers.

Tendencias a nivel global de la rehabilitación de discapacidades y sus implicaciones para los programas de lepra / No disponible

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Indices baciloscópicos e morfológico na hanseníase após doze doses do esquema poliquimioterápico (PQT/OMS) / Bacilloscopic and morphologic indexes in leprosy after twelve doses of multidrug therapy (WHO/MDT)

A hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae e que ainda apresenta altas taxas de prevalência nas regiões norte, nordeste e centro-oeste do Brasil. Atualmente, o esquema poliquimioterápico (PQT) preconizado para os pacientes multibacilares tem duração de 12 meses; após o término da última dose esses pacientes recebem alta, sem a necessidade de qualquer avaliação bacteriológica. No presente estudo avaliou-se os índices baciloscópico (IB) e morfológico (IM) de 73 pacientes multibacilares, no momento do diagnóstico e ao final de 12 doses da PQT. Após o término das 12 doses, o IM foi positivo em 20,54% deles, sendo todos virchovianos; esses pacientes continuaram a receber a medicação até 24 meses, persistindo a positividade em 4,11% deles; estes continuaram com a medicação até a negativação do IM. Neste sentido, os autores sugerem que os IB e IM deveriam ser realizados ao final do tratamento e, nos casos de positividade do IM, os pacientes poderiam continuar recebendo a medicação por 24 meses ou mais, evitando, assim, possíveis recidivas e transmissão. A mesma recomendação é feita para pacientes portadores de alguma imunodeficiência.

Alteracoes prococes articulares dos pes na hanseniase virchoviana / ?

Neste estudo avaliamos 20 (vinte) pacientes com hanseniase virchoviana (17 homens e 3 mulheres) com media etaria de 48 anos. Todos os pacientes foram submetidos a exame radiologico dos pes e 10 (dez) a eletroneuromiografia dos membros inferiores. Consideramos tambem, as avaliacaoes clinicas, estatisticas e funcionais. Nos resultados obtidos, somente 10.0 por cento dos pacientes apresentaram alteracoes radiologicas precoces com comprometimento osteo-articular dos pes, enquanto 90.0 por cento das eletroneuromiograifas mostravam-se alteradas. Contudo, nao houve alteracoes no aspecto clinico-funcional

Reactive oxygen intermediates inactive Mycobacterium leprae in the phagocytes from human peripheral blood

Reactive oxygen intermediates such as hydrogen peroxide, superoxide, and hydroxyl radicals are important microbicidal components, and they could also play a role in an infection with Mycobacterium leprae. A comparative study of the level of hydrogen peroxide and superoxide produced by peripheral blood phagocytes from normal healthy individuals and lepromatous leprosy patients showed a deficiency in superoxide production in the patients. In the phagocytes from normal healthy individuals, there was good release of superoxide ions, and this mediated the killing of M. leprae. The lack of superoxide production allowed the viability of M. leprae inside the macrophages from leprosy patients. This deficiency could be rectified by the use of an immunomodulator, the delipidified cell wall of M. leprae. This modulation resulted in the ability of the patients' phagocytes to respond to M. leprae, to produce reactive oxygen intermediates such as superoxide, and also to kill the bacteria. These observations indicate that delipidified cell wall could have significant potential to positively modulate the immune-deficient cells of leprosy patients.

Surto de pseudo-exacerbaçao em pacientes dimorfo com vasculites granulomatosas especificas dissemidadas / I occasion of pseudo exacerbacion in bordeline patient with spread specific granulomatous vasculites

Um paciente idoso de cor negra com diagnostico de hanseniase virchowiana e tuberculoide ganglionar, apos apresentar surtos de eritema nodoso no primeiro ano de tratamento e internado com surto reacional caracterizado por difusa infiltraçao eritematosa cutanea, edema intenso de maos e pes e lesoes necroticas, tipo vasculite, nos membros inferiores que evoluem para ulceraçoes e extensas necroses dos segmentos anteriores dos pes. Falece em choque. Os achados de autopsia permitem demonstrar reaçao granulomatosa tuberculoide, disseminada nas localizaçoes cutaneo-neurais, mucosas e viscerais normalmente envolvidas na hanseniase virchowiana, chamando atençao o comprometimento quase generalizado dos vasos nestas localizaçoes por reaçao granulomatosa em todos os niveis da parede vascular. Nas extremidades ha nitida correlaçao entre estas vasculites que envolvem veias e arterias de pequeno calibre e as necroses cutaneas. A interpretaçao para estes achados e de que este paciente apresentou na vigencia do tratamento um surto reacional do tipo pseudo-exacerbaçao ou "reversal reaction" que caprichosamente envolveu pequenos vasos...