Avaliação da limitação das atividades diárias e qualidade de vida de pacientes com hanseníase submetidos à cirurgia de neurólise para tratamento das neurites / Evaluation of the limitations in daily-life activities and quality of life in leprosy patients submitted to surgical neurolysis to treat neuritis / Evaluación de las limitaciones de las actividades diarias y calidad de vida de pacientes leprosos submetidos a cirugia de neurólisis para el tratamiento de las neuritis

A neurólise é indicada para reduzir o ­sofrimento neural e impedir a instalação de sequelas e incapacidades em pacientes com hanseníase. O objetivo deste estudo foi verificar o grau de limitação das atividades e a qualidade de vida de pacientes com hanseníase submetidos a neurólise para tratamento das neurites. Participaram do estudo os pacientes submetidos à neurólise no período de 1998 a 2011. Foram coletadas informações sociodemográficas e clínicas, limitações das atividades (SALSA) e a qualidade de vida (WHOQOL-bref). As análises estatísticas incluíram a frequência, as medidas de tendência central e dispersão, os testes de Mann-Whitney e Kruskall-Wallis e o coeficiente de correlação de Spearman adotando-se p<0,05. A amostra foi composta por 36 pacientes com média de idade de 44,0 anos e 3 anos de pós-operatório. Seis pacientes apresentaram grau 0 de incapacidade; 18, grau 1 e 12, grau 2. A principal diferença da escala SALSA ocorreu entre o grau 0 (média 31,8) e o grau 1 (média 42,56). Os valores obtidos na análise do WHOQOL-bref incluíram os domínios físico (média 11,10), psicológico (média 13,41), relações sociais (média 15,15), meio ambiente (média 11,63). As facetas do WHOQOL-bref mais comprometidas foram: capacidade para o trabalho; sentimentos ­negativos (psicológico); atividade sexual (relações sociais); recursos financeiros (meio ambiente). Apesar da realização da neurólise, a maior parte dos integrantes apresentou limitações nas atividades, sendo maior naqueles com incapacidades físicas. A maior insatisfação na qualidade de vida foi no domínio físico, principalmente no que se refere à dor e à necessidade de cuidados de saúde...

Neurolysis is indicated to reduce neural suffering and to prevent sequelae and disabilities in leprosy patients. The aim of this study was to determine the ­degree of limitation of daily activities and quality of life in leprosy patients submitted to neurolysis for neuritis treatment. The study included patients who underwent neurolysis from 1998 to 2011. We collected demographic and clinical information, data about activity limitations (Screening of Activity Limitation and Safety Awareness [SALSA]) and quality of life (WHO Quality of Life - Short Form-26 [WHOQOL-BREF]). Statistical analyses included frequency, central tendency and dispersion measures, Mann-Whitney and Kruskal-Wallis' tests, and Spearman's correlation coefficient adopting p<0.05. The sample consisted of 36 patients with a mean age of 44.0 years and three years of postoperative period. Six patients had disability grade 0, 18 patients had grade 1, and 12 patients had grade 2. The main difference between the SALSA scale occurred between grades 0 (mean 31.8) and 1 (mean 42.56). The results obtained in the analysis of the WHOQOL-BREF included the following domains: physical facets (mean 11.10), psychological facets (mean 13.41), social relationships (mean 15.15), and environmental facets (mean 11.63). The most affected facets of the WHOQOL-BREF were as follows: work ability (physical), negative feelings (psychological), sexual ­activity (social relationships), and financial resources (environmental). Despite the neurolysis, most subjects showed activity limitations, which were found to be higher in people with physical disabilities. The major dissatisfaction observed in the quality of life was in the physical domain, especially with regard to pain and the need for medical care...

La neurólisis es indicada para reducir el sufrimiento neural e impedir la instalación de secuelas e incapacidades en pacientes con lepra. El objetivo de este estudio fue verificar el grado de limitación de las actividades de la vida diaria y la calidad de vida de pacientes con lepra sometidos a neurólisis para el tratamiento de las neuritas. Participaron del estudio los pacientes sometidos a neurólisis en el período de 1998 a 2011. Fueron recolectadas informaciones sociodemográficas y clínicas, limitaciones de las actividades (SALSA) y la calidad de vida (WHOQOL-bref). Los análisis estadísticos incluirán la frecuencia, las medidas de tendencia central y dispersión, los tests de Mann-Whitney, Kruskall-Wallis y los coeficientes de correlación de Spearman adoptando p<0,05. La muestra fue compuesta por 36 pacientes con edad media de 44,0 años y 3 años de post-operatorio. Seis pacientes presentan grado 0 de incapacidad, 18 grado 1 y 12 grado 2. La principal diferencia en la escala SALSA ocurrió entre el grado 0 (media=31,8) y el grado 1 (media=42,56). Los valores obtenidos en el análisis de WHOQOL-bref incluyen los dominios físico (media 11,10); psicológico (media 13,41); relaciones sociales (media 15,15); medio ambiente (media 11,63). Las facetas del WHOQOL-bref más comprometidas fueron la capacidad para el trabajo; sentimientos negativos (psicológico); actividad sexual (relaciones sociales); recursos financieros (medio ambiente). A pesar de la realización de la neurólisis, la mayor parte de los integrantes presentaron limitaciones en las actividades, siendo mayor en aquellos con incapacidades físicas. La mayor insatisfacción en la calidad de vida fue en el dominio físico, principalmente en los que se refiere al dolor y la necesidad de cuidados de salud...

Avaliação neurofuncional no pré e pós-operatório de neurólise no dano neural devido à hanseníase / Pre and post operative neurofunctional assessment of neurolysis surgery in nerve damage in leprosy patients

O presente estudo teve como objetivo analisar, por meio do exame neurofuncional, a eficácia da cirurgia de neurólise em pacientes com neurite hansênica. Tratou-se de um estudo prospectivo, do tipo descritivo. Teve como universo de estudo a população portadora de neurite hansênica do Estado do Amazonas, tratada na FUAM-AM. Foram selecionados 27 participantes os quais foram triados para cirurgia eletiva de neurólise no período de outubro de 2004 a janeiro de 2005, correspondendo a 64 cirurgias eletivas. Foi realizada uma avaliação neurofuncional pré-operatória compreendendo o teste de força muscular manual, teste de sensibilidade pelos estesiômetros de Semmes-Weinstein, avaliação da dor por meio de escala analógica visual e classificação do grau de incapacidade.A mesma avaliação foi repetida um mês após a cirurgia. Os principais nervos operados foram, em ordem decrescente, medial e ulnar, fibular comum e tibial posterior. A forma clínica mais comum entre os mesmos foi a virchowiana (67 por cento), seguida da dimorfa-virchoviana (19 por cento), tuberculóide (7 por cento) e dimorfa-tuberculóide (7 por cento). Setenta e quatro por cento dos pacientes operados encontravam-se em alta clínica e 26 por cento ainda realizavam tratamento por poliquimioterapia. A principal queixa apresentada foi dor (55 por cento). Em relação ao grau de incapacidade, 70 por cento apresentaram grau I e 30 por cento apresentaram grau II. No pós-operatório, foi relatada melhora da dor em 64 por cento das cirurgias, 30 por cento não apresentaram alteração e 6 por cento apresentaram piora. Cinqüenta e seis por cento dos nervos com comprometimento motor não apresentaram melhora, 32 por cento melhoraram em até um grau e 12 por cento apresentaram piora em até um grau. Trinta e quatro por cento dos pacientes apresentaram melhora da sensibilidade, e 66 por cento se mostraram com quadro inalterado.

The aim of this study was to analyze, through neurofunctional assessment, the effectiveness of the neurolysis surgery in patients with neuritis due to leprosy. It was a prospective and descriptive study. The subjects of this study were the population with neuritis due to leprosy of Amazon state, treated in Fundação Alfredo da Matta (FUAM-AM). 27 participants were selected for elective surgery of neurolysis from October 2004 to January 2005, corresponding to 64 elective surgeries. A preoperative neurofunctional assessment was carried out including manual muscle strength testing, sensibility test using Semmes-Weinstein nylon filaments, pain assessment using a visual analogical scale and classification of rate disability. The same assessment was repeated one month after surgery. The main nerves that underwent surgery were, in decreasing order, medial and ulnar, fibular and posterior tibial. The clinical form more frequently was the lepromatous form (67 percent), following by the lepromatous-borderline (19 percent), tuberculoid (7 percent) and tuberculoid-borderline (7 percent). Seventy four percent of patients had already finished clinical treatment and 26 percent were still using multidrug therapy. Fifty five percent referred pain complaint. Concerning rate disability, 70 percent had level I and 30 percent level II. During the postoperative, patients referred to get better pain sensation in 64 percent of surgeries, 30 percent did not have alteration and 6 percent were worst. Fifty six percent of motor nerves degeneration did not improve, 32 percent improved one level and 12 percent have become worse one level. Thirty four percent of patients referred improvement of sensibility and 66 percent referred no improvement.

Leprosy

Leprosy remains an important health problem wordlwide. The disease is caused by a chronic granulomatous infection of the skin and peripheral nerves with Mycobacterium leprae. The clinical range from tuberculoid to lepromatous leprosy is a result of variation in the cellular immune response to the mycobacterium. The resulting impaiment of nerve function causes the disabilities associated with leprosy. This review summarises recent advances in understanding of the biology of leprosy, clinical features of the disease, the current diagnostic criteria, and the new approaches to treatment of the infection and the immune-mediated complications. Supervised multi-drug therapy (MDT) for fixed durations is highly effective for all forms of the disease. The widespread implementation of MDT has been associated with a fall in the prevalence of the leprosy but as yet no reduction in the case-detection rate globally. Thus, leprosy control activities must be maintained for decades to interrupt transmission of infection

La chimiotherapie anti-hansenienne face a la nevrite (orieentations nouvelles) / The chimiotherapie anti-hansenienne face has the nevrite (new orieentations).

The mechanisms of activity of chemotherapy, immnunotherapy, antibiotic therapy and surgery in hansenic neuritis are presented. The clinical, bacteriological and pathological pictures of the different types, varieties and stages of neuritis are described and should serve as a guide for the institution of the appropriate therapeutical measures.

Foot ulcers in hansens Disease

In this report we present the results of our observations of 2 patients in the New York City area with ulcers on the plantar surface. Our purpose in describing these cases is to emphasize the need to consiuder hansens diase in the diagnosis of ulcers of the foot. We have been able to heal theserefractory ulcers by the use of sodium sulfoxone (Diasone sodium), the specific for hansens disease. A critical evaluation of the newr technics for confirmation of this diagnosis is presented. The awareness of the existence of hansens disease helps to differentiate it from the more common causes of leg and foot ulcers in peripheral vascular diseases. Thus there is a need to evaluate all lower extremity ulcers with specifc diagnostic tests, such as blood sugar for diabetes cryoglobulins for cryoglobulinemia ulcer biopsy for epithelioma and a complete blood count bone marrow biopsy and coombs test for sickle cell anemia cooleys anemia and hemolytic anemia. A careful history and accurate physical examination can usually differentiate a thromboangiitis obliterans ulcer from that of peripheral arteriosclerosis obliterans. Similarly the ulcer of varicose veins is differentiated from that of diabetic neuritis by physival evaluation and the postphlebilitic ulcer is differenbtiated from that of choronic lymphedema by lymphangiography. The following are 2 typical cases of foot ulcers due to hansens disease found in the New York City area.