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1.
Artigo em Inglês | MEDLINE | ID: mdl-33681915

RESUMO

INTRODUCTION: Leprosy recurrence is the reappearance of the disease after treatment with current schemes and discharged for cure and may have variable incubation periods. METHODS: This is a descriptive observational study of leprosy recurrence in Espírito Santo diagnosed between January 2018 and January 2020. RESULTS: One hundred and ninety-two cases were available, of which 30 were diagnosed with leprosy recurrence. CONCLUSIONS: In 25 cases, the incubation period was 5-15 years after the first treatment, favoring bacillary persistence. In the remaining 5 cases, the disease had recurred after 15 years, pointing to reinfection as none of them exhibited drug resistance.


Assuntos
Hanseníase , Brasil , Resistência a Medicamentos , Humanos , Hanseníase/tratamento farmacológico , Recidiva , Centros de Atenção Terciária
2.
An Bras Dermatol ; 96(2): 224-227, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33637399

RESUMO

Leprosy is one of the neglected diseases in the world and Brazil is the second country with more cases. A retrospective study was conducted based on the medical records of 196 leprosy patients diagnosed during the course of 13 years at a university hospital. The aim was to describe the adverse effects of polychemotherapy, as well the most prevalent and most vulnerable populations. In the study, dapsone was the most implicated drug, especially in women, and the risk increased with age. The authors conclude that with this patient profile, greater vigilance should be taken regarding possible adverse effects, especially anemia.


Assuntos
Hansenostáticos , Hanseníase , Brasil , Clofazimina/uso terapêutico , Dapsona/efeitos adversos , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Hansenostáticos/efeitos adversos , Hanseníase/tratamento farmacológico , Estudos Retrospectivos , Rifampina/uso terapêutico
3.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48012

RESUMO

Pacientes com hanseníase resistentes a medicamentos já ofertados na rede pública passam a contar com um novo tratamento disponível no Sistema Único de Saúde (SUS). O antibiótico Claritromicina já é utilizado no SUS para o tratamento de outras patologias, como infecções de vias aéreas superiores e inferiores, infecções na pele e tecidos moles, entre outros, e agora passa a fazer parte do rol de medicamentos para tratamento da hanseníase.


Assuntos
Hanseníase/tratamento farmacológico , Claritromicina/farmacologia , Sistema Único de Saúde
4.
s.l; s.n; 2021. 6 p. tab, ilus.
Não convencional em Inglês | Sec. Est. Saúde SP, CONASS, HANSEN, SESSP-ILSLPROD, Sec. Est. Saúde SP, SESSP-ILSLACERVO, Sec. Est. Saúde SP | ID: biblio-1146794

RESUMO

Lobomycosis, also referred to as lacaziosis, is an endemic cutaneous and subcutaneous fungal disease that mainly affects Amazonian forest dwellers in Brazil. There is no disease control program in place in Brazil, and antifungal therapy failures are common, and the therapy is inaccessible to most patients. We performed a randomized, unblinded clinical trial testing the cure rate of multiple drug therapy (MDT) for leprosy with surgical excision, with or without itraconazole. A control arm consisted of patients who did not adhere to either therapeutic regimens but continued to be followed up. Multiple drug therapy consisted of monthly supervised doses of 600 mg rifampicin, 300 mg clofazimine, and 100 mg dapsone, in addition to daily doses of 50 mg clofazimine and 100 mg dapsone. The patients in the MDT plus itraconazole arm also received itraconazole 100 mg twice daily. We followed up 54 patients from the MDT group and 26 patients from the MDT plus itraconazole group for an average of 4 years and 9 months. The 23 controls were followed up for 6 months on average. The following endpoints were observed: 1) unchanged (no apparent improvement), 2) improved (reduction in lesion size and/or pruritus), and 3) cured (complete remission of the lesions, no viable fungi, and no relapse for 2 years after the end of the drug treatment). The results indicated a significantly greater likelihood of cure associated with the use of multidrug therapy for leprosy with or without itraconazole when compared with the control group. The addition of itraconazole to MDT was not associated with improved outcomes, suggesting that MDT alone is effective(AU).


Assuntos
Humanos , Masculino , Feminino , Quimioterapia Combinada , Lobomicose/tratamento farmacológico , Rifampina/uso terapêutico , Clofazimina/uso terapêutico , Itraconazol/uso terapêutico , Dapsona/uso terapêutico , Hanseníase/tratamento farmacológico
5.
PLoS One ; 15(12): e0244451, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33373997

RESUMO

Worldwide, Drug-resistant Tuberculosis (DR-TB) remains a big problem; the diagnostic capacity has superseded the clinical management capacity thereby causing ethical challenges. In Sub-Saharan Africa, treatment is either inadequate or lacking and some diagnosed patients are on treatment waiting lists. In Uganda, various health system challenges impeded scale-up of DR-TB care in 2012; only three treatment initiation facilities existed, with only 41 of the estimated 1010 RR-TB/MDR-TB cases enrolled on treatment yet 300 were on the waiting list and there was no DR-TB treatment scale-up plan. To scale up care, the National TB and leprosy Program (NTLP) with partners rolled out a DR-TB mixed model of care. In this paper, we share achievements and outcomes resulting from the implementation of this mixed Model of DR-TB care. Routine NTLP DR-TB program data on treatment initiation site, number of patients enrolled, their demographic characteristics, patient category, disease classification (based on disease site and human immunodeficiency virus (HIV) status), on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) statuses, culture results, smear results and treatment outcomes (6, 12, and 24 months) from 2012 to 2017 RR-TB/MDR-TB cohorts were collected from all the 15 DR-TB treatment initiation sites and descriptive analysis was done using STATA version 14.2. We presented outcomes as the number of patient backlog cleared, DR-TB initiation sites, RR-TB/DR-TB cumulative patients enrolled, percentage of co-infected patients on the six, twelve interim and 24 months treatment outcomes as per the Uganda NTLP 2016 Programmatic Management of drug-resistant Tuberculosis (PMDT) guidelines (NTLP, 2016). Over the period 2013-2015, the RR-TB/MDR-TB Treatment success rate (TSR) was sustained between 70.1% and 74.1%, a performance that is well above the global TSR average rate of 50%. Additionally, the cure rate increased from 48.8% to 66.8% (P = 0.03). The Uganda DR-TB mixed model of care coupled with early application of continuous improvement approaches, enhanced cohort reviews and use of multi-disciplinary teams allowed for rapid DR-TB program expansion, rapid clearance of patient backlog, attainment of high cumulative enrollment and high treatment success rates. Sustainability of these achievements is needed to further reduce the DR-TB burden in the country. We highly recommend this mixed model of care in settings with similar challenges.


Assuntos
Coinfecção/tratamento farmacológico , Assistência à Saúde/organização & administração , Infecções por HIV/tratamento farmacológico , Implementação de Plano de Saúde , Hanseníase/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Adulto , Assistência ao Convalescente/organização & administração , Assistência ao Convalescente/estatística & dados numéricos , Antirretrovirais/uso terapêutico , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Quimioprevenção/métodos , Estudos de Coortes , Coinfecção/microbiologia , Assistência à Saúde/métodos , Assistência à Saúde/estatística & dados numéricos , Farmacorresistência Bacteriana Múltipla , Feminino , Infecções por HIV/virologia , Humanos , Hanseníase/microbiologia , Masculino , Pessoa de Meia-Idade , Modelos Organizacionais , Mycobacterium leprae/isolamento & purificação , Mycobacterium tuberculosis/isolamento & purificação , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/estatística & dados numéricos , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Uganda , Adulto Jovem
8.
Curr Opin Ophthalmol ; 31(6): 514-520, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33002989

RESUMO

PURPOSE OF REVIEW: Ocular manifestations of leprosy do occur despite advances in the areas of leprosy research. Understanding the nuances in the domain shall guide the clinician for effective patient-centered care. RECENT FINDINGS: Despite the existence of microbiologic cure for leprosy, ocular manifestations of this disease do occur. Advances in genetic and genomic studies have better characterized the interaction that the bacteria has with the host. The ocular features vary with the spectrum of the disease. Its careful correlation can help to predict the bacillary load of the patient. Investigations are particularly relevant in multibacillary cases. The WHO suggests a treatment duration longer than the 2 years in ocular involvement. SUMMARY: The isolation of lepra bacilli from the iris biopsy in negative skin smear patients and multidrug therapy completion highlights the potential role of bactericidal agents in the planned intraocular treatment. Lepra reactions need careful titration of oral steroids and appropriate antibacterial agents. Advances in phacoemulsification with in the bag implantation of intraocular lenses is a game changer in the management of the most common cause of blindness of leprosy. Advances in vaccine research in leprosy are promising.


Assuntos
Oftalmopatias , Hanseníase , Animais , Biópsia , Quimioterapia Combinada , Oftalmopatias/tratamento farmacológico , Humanos , Lentes Intraoculares , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/microbiologia , Hanseníase/patologia , Facoemulsificação
9.
PLoS Negl Trop Dis ; 14(9): e0008583, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32936818

RESUMO

BACKGROUND: Subclinical infection with Mycobacterium leprae is one potential source of leprosy transmission, and post-exposure prophylaxis (PEP) regimens have been proposed to control this source. Because PEP trials require considerable investment, we applied a sensitive variation of the kinetic mouse footpad (MFP) screening assay to aid in the choice of drugs and regimens for clinical trials. METHODOLOGY/PRINCIPAL FINDINGS: Athymic nude mice were inoculated in the footpad (FP) with 6 x 103 viable M. leprae and treated by gastric gavage with a single dose of Rifampin (SDR), Rifampin + Ofloxacin + Minocycline (SD-ROM), or Rifapentine + Minocycline + Moxifloxacin (SD-PMM) or with the proposed PEP++ regimen of three once-monthly doses of Rifampin + Moxifloxacin (RM), Rifampin + Clarithromycin (RC), Rifapentine + Moxifloxacin (PM), or Rifapentine + Clarithromycin (PC). At various times post-treatment, DNA was purified from the FP, and M. leprae were enumerated by RLEP quantitative PCR. A regression analysis was calculated to determine the expected RLEP value if 99.9% of the bacilli were killed after the administration of each regimen. SDR and SD-ROM induced little growth delay in this highly susceptible murine model of subclinical infection. In contrast, SD-PMM delayed measurable M. leprae growth above the inoculum by 8 months. The four multi-dose regimens delayed bacterial growth for >9months post-treatment cessation. CONCLUSIONS/SIGNIFICANCE: The delay in discernable M. leprae growth post-treatment was an excellent indicator of drug efficacy for both early (3-4 months) and late (8-9 months) drug efficacy. Our data indicates that multi-dose PEP may be required to control infection in highly susceptible individuals with subclinical leprosy to prevent disease and decrease transmission.


Assuntos
Infecções Assintomáticas/terapia , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Mycobacterium leprae/efeitos dos fármacos , Profilaxia Pós-Exposição/métodos , Animais , Carga Bacteriana/efeitos dos fármacos , Claritromicina/uso terapêutico , Combinação de Medicamentos , Hanseníase/transmissão , Camundongos , Camundongos Nus , Minociclina/uso terapêutico , Moxifloxacina/uso terapêutico , Mycobacterium leprae/crescimento & desenvolvimento , Rifampina/análogos & derivados , Rifampina/uso terapêutico
10.
Int J Mol Sci ; 21(17)2020 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-32824985

RESUMO

The aim of this study is to examine the use of an inflammasome competitor as a preventative agent. Coronaviruses have zoonotic potential due to the adaptability of their S protein to bind receptors of other species, most notably demonstrated by SARS-CoV. The binding of SARS-CoV-2 to TLR (Toll-like receptor) causes the release of pro-IL-1ß, which is cleaved by caspase-1, followed by the formation and activation of the inflammasome, which is a mediator of lung inflammation, fever, and fibrosis. The NLRP3 (NACHT, LRR and PYD domains-containing protein 3) inflammasome is implicated in a variety of human diseases including Alzheimer's disease (AD), prion diseases, type 2 diabetes, and numerous infectious diseases. By examining the use of 4,4'-diaminodiphenyl sulfone (DDS) in the treatment of patients with Hansen's disease, also diagnosed as Alzheimer's disease, this study demonstrates the diverse mechanisms involved in the activation of inflammasomes. TLRs, due to genetic polymorphisms, can alter the immune response to a wide variety of microbial ligands, including viruses. In particular, TLR2Arg677Trp was reported to be exclusively present in Korean patients with lepromatous leprosy (LL). Previously, mutation of the intracellular domain of TLR2 has demonstrated its role in determining the susceptibility to LL, though LL was successfully treated using a combination of DDS with rifampicin and clofazimine. Of the three tested antibiotics, DDS was effective in the molecular regulation of NLRP3 inflammasome activators that are important in mild cognitive impairment (MCI), Parkinson's disease (PD), and AD. The specific targeting of NLRP3 itself or up-/downstream factors of the NLRP3 inflammasome by DDS may be responsible for its observed preventive effects, functioning as a competitor.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Dapsona/farmacologia , Inflamassomos/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Pneumonia Viral/tratamento farmacológico , Doença de Alzheimer/patologia , Clofazimina/farmacologia , Disfunção Cognitiva/patologia , Humanos , Interleucina-1beta/metabolismo , Hanseníase/tratamento farmacológico , Hanseníase/genética , Pandemias , Transtornos Parkinsonianos/patologia , Rifampina/farmacologia , Glicoproteína da Espícula de Coronavírus/metabolismo , Receptor 2 Toll-Like/genética
11.
PLoS Negl Trop Dis ; 14(8): e0008521, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32750059

RESUMO

India has the highest burden of leprosy in the world. Following a recent WHO guideline, the Indian National Leprosy Programme is introducing post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) in all high-endemic districts of the country. The aim of this study is to estimate the long-term cost-effectiveness of SDR-PEP in different leprosy disability burden situations. We used a stochastic individual-based model (SIMCOLEP) to simulate the leprosy new case detection rate trend and the impact of implementing contact screening and SDR-PEP from 2016 to 2040 (25 years) in the Union Territory of Dadra Nagar Haveli (DNH) in India. Effects of the intervention were expressed as disability adjusted life years (DALY) averted under three assumption of disability prevention: 1) all grade 1 disability (G1D) cases prevented; 2) G1D cases prevented in PB cases only; 3) no disability prevented. Costs were US$ 2.9 per contact. Costs and effects were discounted at 3%. The incremental cost per DALY averted by SDR-PEP was US$ 210, US$ 447, and US$ 5,673 in the 25th year under assumption 1, 2, and 3, respectively. If prevention of G1D was assumed, the probability of cost-effectiveness was 1.0 at the threshold of US$ 2,000, which is equivalent to the GDP per capita of India. The probability of cost-effectiveness was 0.6, if no disability prevention was assumed. The cost per new leprosy case averted was US$ 2,873. Contact listing, screening and the provision of SDR-PEP is a cost-effective strategy in leprosy control in both the short (5 years) and long term (25 years). The cost-effectiveness depends on the extent to which disability can be prevented. As the intervention becomes increasingly cost-effective in the long term, we recommend a long-term commitment for its implementation.


Assuntos
Programas Governamentais , Hanseníase/tratamento farmacológico , Hanseníase/prevenção & controle , Profilaxia Pós-Exposição/economia , Quimioprevenção/economia , Análise Custo-Benefício , Humanos , Índia , Hansenostáticos/economia , Hansenostáticos/uso terapêutico , Hanseníase/diagnóstico , Hanseníase/economia , Profilaxia Pós-Exposição/métodos , Anos de Vida Ajustados por Qualidade de Vida , Rifampina/economia , Rifampina/uso terapêutico
12.
PLoS Negl Trop Dis ; 14(8): e0008329, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32760161

RESUMO

The drug thalidomide has resurged in the world market under restrictive conditions for marketing and use. In Brazil, there are still cases of pregnant women using thalidomide even after the implementation of laws that regulate the control of use (Law No. 10.651/2003 and Collegiate Board Resolution No. 11/2011). The objective of this study was to discuss the control of thalidomide use in Brazil, based on a scoping review of the scientific literature, documents, and data from the Ministry of Health. A total of 51 studies and documents related to the following subthemes were selected: (1) organization of access and use of thalidomide in the health system; (2) epidemiological and population characteristics of people affected by leprosy; and (3) occurrence of pregnancy and cases of embryopathy with the use of thalidomide. The results showed that Brazil has no unified information database about thalidomide patients. Furthermore, there is inconsistency in the accreditation of public health centers that dispense this medicine, in a country that has a high consumption of thalidomide in the Unified Health System. A large part of this amount of dispensed medicine is intended for the treatment of erythema nodosum leprosum, mainly in the North, Northeast, and Central-West regions of the country, which are endemic for leprosy. This disease is the only one among the clinical indications of the medicine approved in Brazil that does not have a Clinical Protocol and Therapeutic Guidelines. The control of thalidomide use in Brazil presents historical regulatory failures. These are currently linked to the organization and structure of primary healthcare in the country, as well as to the lack of leadership of the Ministry of Health and National Health Surveillance Agency when it comes to managing the process of control of this use.


Assuntos
Hanseníase/tratamento farmacológico , Talidomida/efeitos adversos , Talidomida/uso terapêutico , Anormalidades Induzidas por Medicamentos/epidemiologia , Brasil/epidemiologia , Eritema Nodoso/tratamento farmacológico , Feminino , Humanos , Hansenostáticos/efeitos adversos , Hansenostáticos/uso terapêutico , Hanseníase/epidemiologia , Hanseníase Virchowiana/tratamento farmacológico , Masculino , Gravidez
13.
Fontilles, Rev. leprol ; 32(5): 361-370, mayo-ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-198461

RESUMO

OBJETIVO: El objetivo del estudio es cribar convivientes de personas diagnosticadas de lepra con un elevado índice bacteriológico en un centro de referencia. MÉTODOS: El estudio hospitalario incorporo a 334 personas recién diagnosticadas de lepra con un elevado índice bacteriológico. El hospital de referencia es el de Champa, Chhattisgarh, India. Se anotaron todos los convivientes de estos casos registrados de lepra y se les ofreció ser examinados. RESULTADOS: De 334 casos con un índice bacteriológico elevado (IB), 252 (75%) eran varones y 82 (25%) mujeres, con edades comprendidas entre los 12 y los 75 años. Sesenta y dos (18%) presentaron discapacidad Grado 2 y un 32% presentaron un índice bacteriológico mayor de 5 en el momento del diagnóstico. Se registraron un total de 1,397 convivientes para cribaje y 678 (49%) fueron examinados clínicamente para detectar lepra. Ciento dieciséis convivientes presentaron signos de lepra y, de entre ellos, 57 (44%) se identificaron como nuevos casos, 11 (10%) como casos conocidos en tratamiento y 48 (41%) habían sido tratados anteriormente por la enfermedad. CONCLUSIÓN: El estudio revela que el cribaje de convivientes de pacientes con elevados IB es un método efectivo para la detección de posibles nuevos casos y enfatiza la necesidad continua de cribaje y seguimiento. La educación sanitaria y la motivación de los convivientes incrementara su presentación voluntaria para ser cribados y así detectar nuevos casos


OBJECTIVE: The study aimed to screen household contacts of persons diagnosed with leprosy having a high bacterial index, at a tertiary referral centre. METHODS: This hospital based study involved 334 persons who were newly diagnosed as leprosy with a high bacterial index, attending a tertiary referral hospital, Champa, Chhattisgarh, India. We enumerated all the household contacts of registered cases and invited them to be screened for leprosy. RESULTS: Of 334 high BI cases, 252 (75%) were male and 82 (25%) were female, with ages ranging from 12 to 75 years. Sixty two (18%) had Grade 2 disability and 32% had a bacterial index of above 5+ at the time of diagnosis. A total of 1,397 household members were enrolled for screening and 678 (49%) were examined for leprosy. One hundred and sixteen household members were found to have signs of leprosy, and among these, 57 (49%) were identified as new cases, 11 (10%) were known cases on treatment and 48 (41%) had been previously treated for leprosy. CONCLUSION: This study showed that screening of household contacts of high BI cases is an effective method of leprosy case detection and emphasizes the continuing need to screen and follow up. Continued health education and motivation of household contacts will enhance voluntary reporting for periodical screening


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Busca de Comunicante/estatística & dados numéricos , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Família , Hanseníase/tratamento farmacológico , Carga Bacteriana , Distribuição por Idade e Sexo , Índia/epidemiologia
14.
An Bras Dermatol ; 95(5): 652-654, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32651045

RESUMO

Leprosy is an infectious disease with chronic evolution, caused by Mycobacterium leprae, an acid-fast bacillus that mainly affects the skin and peripheral nervous tissue. Many of the clinical manifestations of leprosy can mimic connective tissue diseases. The authors present the case of a 49-year-old woman who had been treated for four years for systemic lupus erythematosus in a rheumatological service. Skin biopsy of a plaque on the inguinal region was compatible with borderline lepromatous leprosy associated with a type 1 lepra reaction. The patient is undergoing treatment with multibacillary multidrug therapy, showing clinical improvement.


Assuntos
Hanseníase Dimorfa , Hanseníase Virchowiana , Hanseníase , Quimioterapia Combinada , Feminino , Humanos , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/tratamento farmacológico , Pessoa de Meia-Idade , Mycobacterium leprae
16.
Rev Soc Bras Med Trop ; 53: e20200114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32491105

RESUMO

INTRODUCTION: Although supervised doses are essential for reducing leprosy treatment failure, the impact of specific drug interactions has rarely been assessed. This study aimed to estimate the risk of leprosy treatment suspension in patients receiving polypharmacy. METHODS We performed this case-control study in which the primary outcome was defined as the need to discontinue multibacillary leprosy treatment for at least one supervised dose, and the main risk factor was the detection of polypharmacy. Multivariate analysis by logistic regression was used for calculating odds ratio (OR). RESULTS: This study included 103 patients, of whom 43 needed to discontinue leprosy treatment (hemolysis = 26, hepatitis = 2, hemolysis associated with hepatitis = 6, and suspected treatment resistance = 9) and the rest did not. The severity of drug interactions had no effect on treatment discontinuation. Patients who used five or more drugs in addition to leprosy treatment had almost a 4-fold greater risk of treatment suspension (OR, 3.88; 95% confidence interval: 1.79-9.12; p < 0.001). The number of drugs used also positively influenced the occurrence of hemolysis (p < 0.001). No patient presented evidence of molecular resistance to rifampicin, dapsone, or ofloxacin treatment, as evidenced by genetic sequencing detection of rpoB, folp1, and gyrA mutations. CONCLUSIONS: Polypharmacy has deleterious effects on the already difficult-to-adhere-to treatment of leprosy and polypharmacy induces hemolysis. Additional measures must be taken to avoid the undesirable effects of inadequate polypharmacy.


Assuntos
Interações Medicamentosas , Hansenostáticos/administração & dosagem , Hanseníase/tratamento farmacológico , Polimedicação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Hansenostáticos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
17.
Brasília; CONITEC; jun. 2020.
Não convencional em Português | BRISA/RedTESA | ID: biblio-1121396

RESUMO

INTRODUÇÃO: O termo mais amplamente utilizado para a quimioprofilaxia e/ou imunoprofilaxia é "profilaxia pós-exposição (PEP)". A PEP pode ser usada para expressar quimioprofilaxia ou imunoprofilaxia, ou ainda, para ambas. Embora a intervenção seja simples, a administração de uma única dose de rifampicina aos contatos de um caso índice de hanseníase, como mais uma ferramenta de redução da transmissão da doença, depende de planejamento para sua operacionalização, de modo a não causar danos às pessoas afetadas, cujos contatos deverão receber a PEP. Além disso, a PEP nunca havia sido instituída na rotina de serviços de hanseníase no Brasil. CONDIÇÃO CLÍNICA: A hanseníase é uma doença infecciosa causada por uma bactéria chamada Mycobacterium leprae (bacilo de Hansen) (6), (7), (8). A sua transmissão ocorre principalmente pelas vias aéreas superiores, por meio das secreções e do ar (7), (8), (9), e não por objetos utilizados pelo paciente (1), (8). A doença acomete principalmente os nervos superficiais da pele e troncos nervosos periféricos, mas também pode afetar olhos, mucosas e órgãos internos (6), (8). TECNOLOGIA: rifampicina 300mg, cápsula e 20mg/ml, suspensão oral. PROJETO PEP-HANS: Por meio da Portaria SCTIE/MS nº 32, de 30/06/2015, a rifampicina dose única foi incorporada no SUS para a quimioprofilaxia de contatos de doentes de hanseníase para realização do referido estudo. A pesquisa foi realizada entre os anos de 2016 a 2018, em municípios selecionados dos estados do Mato Grosso, Pernambuco e Tocantins, uma vez que tais estados configuram importantes áreas endêmicas no país e os municípios atenderam aos critérios de elegibilidade do estudo. TRATAMENTO: O protocolo de tratamento consistiu em rifampicina 600mg (2 comprimidos de 300mg) em dose única, administrado no segundo mês de tratamento do caso índice (aproximadamente 4 semanas do início do tratamento do caso índice); em crianças acima de 5 anos de idade, a administração seria de 450mg rifampicina e, em crianças ou adultos com peso inferior a 30 kg, a recomendação foi administrar rifampicina 10 a 20mg/kg. JUSTIFICATIVA DE EXCLUSÃO: a área demandante avaliou que a tecnologia deveria ser desincorporada, uma vez que o projeto de pesquisa foi concluído em 2018, conforme relatório final do projeto PEP-Hans. Para ampliação de uso da rifampicina para a quimioprofilaxia de contatos de doentes de hanseníase no âmbito do Sistema Único de Saúde, há necessidade de condução de outros estudos sobre o assunto. A CGDE/SVS/MS está encaminhando duas propostas ao DECIT/SCTIE/MS: um estudo multicêntrico de quimioprofilaxia pós-exposição para contatos e um estudo de avaliação e monitoramento dos contatos que foram submetidos à quimioprofilaxia pelo PEP-Hans. RECOMENDAÇÃO PRELIMINAR DA CONITEC: Pelo exposto, o plenário da Conitec, em sua 85ª reunião ordinária, realizada no dia 04 de fevereiro de 2020, recomendou, por unanimidade, a exclusão no SUS da rifampicina 300mg e 20mg/ml para quimioprofilaxia de contatos de pacientes com hanseníase. CONSULTA PÚBLICA: Foram recebidas 127 contribuições, sendo 121 técnico-científicas e 6 contribuições de experiência e opinião. A maioria concordou com a recomendação inicial da Conitec pela exclusão, sendo os principais argumentos no sentido de que as evidências do benefício da quimioprofilaxia são limitadas e a preocupação de não induzir resistência bacteriana à rifampicina que é o único bactericida do arsenal terapêutico da doença. A Sociedade Brasileira de Dermatologia (SBD) e demais profissionais de saúde participaram da consulta pública e as suas considerações foram devidamente apreciadas. RECOMENDAÇÃO FINAL: Os membros da Conitec presentes na 87ª reunião ordinária, no dia 03 de junho de 2020, deliberaram, por unanimidade, recomendar a exclusão da rifampicina para a quimioprofilaxia de contatos de pacientes com hanseníase no Sistema Único de Saúde. Foi assinado o Registro de Deliberação nº 517/2020. DECISÃO: excluir a rifampicina para quimioprofilaxia de contatos de pacientes com hanseníase, no âmbito do Sistema Único de Saúde ­ SUS, conforme a Portaria nº 18, publicada no Diário Oficial da União nº 112, seção 1, página 143, em 15 de junho de 2020.


Assuntos
Humanos , Rifampina/farmacocinética , Recall de Medicamento , Profilaxia Pós-Exposição/organização & administração , Hanseníase/tratamento farmacológico , Avaliação da Tecnologia Biomédica , Sistema Único de Saúde , Brasil , Análise Custo-Benefício
18.
Infect Dis Poverty ; 9(1): 53, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448360

RESUMO

BACKGROUND: Leprosy can be cured, but physical disability (PD) as a result of the infection can progress in the post-release from treatment phase. This study evaluated the likelihood of, and factors associated with, the progression of the PD grade post-release from treatment among leprosy patients treated in Cáceres-MT, Brazil in the period 2000 to 2017. METHODS: A retrospective cohort study and survival analysis were performed in the hyperendemic municipality of Cáceres in the state of Mato Grosso. The study population consisted of newly diagnosed leprosy patients released from treatment between January 1, 2000 and December 31, 2017. The main outcome was the progression of the PD grade with regard to probability and time; and the evaluated covariates included clinical, operational and demographic variables. The Cox proportional risk model was used to estimate the risk ratio (Hazard Ratios) of the covariates. Both an univariate and a multivariate analysis were implemented, with 95% confidence intervals. RESULTS: The mean time for progression of the PD grade was 162 months for PB and 151 months for MB leprosy patients. The survival curve showed that 15 years after the release from treatment, the probability of PD grade progression was 35%, with no difference between PB and MB or age groups. Leprosy reactions and registered medical complaints of any kind during treatment were identified as risk factors with Hazard Ratios of 1.6 and 1.8 respectively. CONCLUSIONS: People released from treatment as cured of leprosy are susceptible to worsening of the PD, especially those who have had complications during multi-drug therapy treatment. This indicates that leprosy patients should be periodically monitored, even after the successful completion of multidrug therapy.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/estatística & dados numéricos , Hanseníase/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Criança , Estudos de Coortes , Feminino , Humanos , Hanseníase Multibacilar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Adulto Jovem
20.
Sci Rep ; 10(1): 6839, 2020 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-32322091

RESUMO

Leprosy continues to be the belligerent public health hazard for the causation of high disability and eventual morbidity cases with stable prevalence rates, even with treatment by the on-going multidrug therapy (MDT). Today, dapsone (DDS) resistance has led to fear of leprosy in more unfortunate people of certain developing countries. Herein, DDS was chemically conjugated with five phytochemicals independently as dapsone-phytochemical conjugates (DPCs) based on azo-coupling reaction. Possible biological activities were verified with computational chemistry and quantum mechanics by molecular dynamics simulation program before chemical synthesis and spectral characterizations viz., proton-HNMR, FTIR, UV and LC-MS. The in vivo antileprosy activity was monitored using the 'mouse-foot-pad propagation method', with WHO recommended concentration 0.01% mg/kg each DPC for 12 weeks, and the host-toxicity testing of the active DPC4 was seen in cultured-human-lymphocytes in vitro. One-log bacilli cells in DDS-resistant infected mice footpads decreased by the DPC4, and no bacilli were found in the DDS-sensitive mice hind pads. Additionally, the in vitro host toxicity study also confirmed that the DCP4 up to 5,000 mg/L level was safety for oral administration, since a minor number of dead cells were found in red color under a fluorescent microscope. Several advanced bioinformatics tools could help locate the potential chemical entity, thereby reducing the time and resources required for in vitro and in vitro tests. DPC4 could be used in place of DDS in MDT, evidenced from in vivo antileprosy activity and in vitro host toxicity study.


Assuntos
Simulação por Computador , Dapsona , Hansenostáticos , Hanseníase/tratamento farmacológico , Mycobacterium leprae/crescimento & desenvolvimento , Compostos Fitoquímicos , Dapsona/síntese química , Dapsona/química , Dapsona/farmacologia , Humanos , Hansenostáticos/síntese química , Hansenostáticos/química , Hansenostáticos/farmacologia , Hanseníase/metabolismo , Hanseníase/patologia , Compostos Fitoquímicos/química , Compostos Fitoquímicos/farmacologia
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