BACKGROUNDLeprosy is an infectious disease that may lead to irreversible nerve damage, compromising patient's quality of life and leading to loss of working years.OBJECTIVESTo evaluate the epidemiological profile of patients followed at a University Hospital.MATERIALS AND METHODSThis is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010.RESULTSThe mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension.CONCLUSIONSThis study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication.
Caso Clínico: Homem de 65 anos, diabético tipo 2, e em tratamento por hanseníase virchowiana (10 a cartela de rifampicina, clofazimina e dapsona) foi admitido na enfermaria da Clínica Médica por lesões ulcerativas nas faces extensoras de membros superiores. Duas semanas antes do internamento procurou atendimento médico em outro serviço por quadro de febre, inapetência e convulsões (sic), para o qual foi prescrito ceftriaxona por 5 dias. No 3 o dia de tratamento, surgiram lesões inicialmente pustulosas, que evoluíram para úlceras confluentes. Estas lesões localizavam-se principalmente em cotovelos, mas acometiam também antebraços e pernas. Ao exame físico, apresentava linfonodomegalia cervical anterior, madarose e fígado palpável a 1 polpa digita do rebordo costal direito. Qual o diagnóstico? A. Farmacodermia B. Reação hansênica tipo 1 C. Reação hansênica tipo 2 D. Fenômeno de Lucio E. Piodermite QUIZ
RESUMOOBJETIVO: Avaliar as características clínicas e terapêuticas dos pacientes com neurite no Ambulatório de Hanseníase em Hospital Universitário entre janeiro de 2005 e dezembro de 2013. MÉTODOS: Estudo observacional, retrospectivo, baseado na revisão de prontuários. Foram analisados 108 prontuários e a análise estatística foi feita por médias e medianas (Microsoft Excel ® ). RESULTADOS: A média de idade foi de 49,3 anos. Aproximadamente 67% da população eram homens e a maioria dos pacientes é procedente do Paraná, sendo que boa parte pertencente à Curitiba e região metropolitana. As formas multibacilares prevaleceram, com a forma virchowiana (40,2%), seguida pela dimorfa (27,1%). Dos pacientes, 34% apresentaram neurite. O espessamento neural foi detectado em mais da metade dos pacientes e quase 50% dos pacientes desenvolveram reações hansênicas, mais comuns nos multibacilares. Cerca de 75% dos doentes foram submetidos a avaliação funcional inicial e 45,6% destes apresentavam algum grau de incapacidade ao diagnóstico. Dos 37 pacientes com neurite em uso de poliquimioterapia específica associada ao tratamento da neurite, apenas 4 melhoram o grau funcional, enquanto 2 pacientes tiveram piora e em 18 indivíduos houve apenas a estabilização do quadro clínico. CONCLUSÃO: Foi observado predomínio das formas multibacilares e a presença significativa da neurite nas reações hansênicas. Houve estabilização das incapacidades funcionais com as terapêuticas atuais utilizadas no Serviço.Descritores: Hanseníase, Neurite, Infecção.ABSTRACT OBJECTIVE: Evaluate the clinical and therapeutic characteristics of patients with neuritis in Leprosy Clinic at University Hospital between January 2005 and December 2013. METHODS: Observational and retrospective study based on medical records review. About 108 medical records were analyzed and the statistical analysis was performed by means and medians (Microsoft Excel®). RESULTS: The mean age was 49.3 years, approximately 67% of the population were men, the majority of patients are coming from Paraná, with much of belonging to the metropolitan area of Curitiba. The multibacillary forms prevailed, with lepromatous (40.2%), followed by borderline (27.1%). Thirty four percent of patients had neuritis. The nerve enlargement was detected in more than half of patients and almost 50% of patients developed leprosy reactions, most common in multibacillary. Approximately 75% of patients underwent initial functional assessment and 45.6% of them had some degree of disability at diagnosis. Few patients confirmed the diagnosis by biopsy or nerve electromyography. Thirty seven patients with neuritis using specific multidrug therapy associated with the treatment of neuritis, only 4 upgrade functional class, while 2 patients worsened and 18 patients there was only the stabilization of the clinical status. CONCLUSION: It was observed a predominance of multibacillary and the significant presence of neuritis in leprosy reactions. There was stabilization of functional disabilities with current therapies used...
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