Keywords

anesthetic foot attitude chronic pain comorbidity COVID-19 cytokines Diabetes direct and indirect health information technology hypocalcemia interleukin-10 Knowledge knowledge leprosy Leprosy neurolysis neuropathy NTD offloading passive and active case finding peak plantar pressure physical disability polymorphism practice–theory pressure ulcers sensory neuropathy social aspects stigma sustainable development goals Training

Volume - 92, Issue - 2

editorial
Pages 95 - 96
Editorial
Pages 97 - 101
Original Papers
Pages 102 - 113
  • Progression of peripheral nerve injury in leprosy: Evaluation of the effect of nerve decompression surgery in an endemic region of Brazil

    • Maria Dias Torres Kenedi
    • Elifaz de Freitas Cabral
    • Kazue Narahashi
    • Silvana Teixeira de Miranda
    • Catarina Mabel da Cunha Moreira
    • Diogo Correia e Silva
    • Cleumar Silva do Nascimento
    • Wanderlei Ruffato
    • Antonio José Ledo Alves da Cunha
    • Maria Kátia Gomes
    Volume 92, Issue 2

    | Published on June 2021

    Aim:

    To evaluate the progression of nerve injury in leprosy patients undergoing peripheral nerve decompression surgery.

    Methodology:

    Observational study of retrospective, descriptive-analytical cohort. In the convenience sample, individuals with leprosy who underwent peripheral nerve decompression surgery at the Casa de Saúde Santa Marcelina, Porto Velho/RO, between 2000 and 2019 were evaluated nerve by nerve, before and after surgery.

    Results:

    Note that 574 individuals underwent 2549 surgeries of the ulnar, median, tibial and/or fibular nerves. Most individuals were male (51.6%), of brown race (80.3%), multibacillary (90.9%), aged between 31 and 60 years (73.2%) and originating from other municipalities in the state of Rondônia, Northern Region of Brazil (67.4%). Most individuals maintained or improved the GD (WHO Grade of Disability), the sensory or the motor nerve function in the limbs operated.

    Conclusion:

    The improvement or maintenance of the DG was observed in more than 80% of the operated individuals. In the nerve-to-nerve analysis, considering the sensory and motor functions for all operated nerve trunks, there was an improvement or maintenance of the values presented in the preoperative period for most individuals. According to the results obtained in this study, we concluded that peripheral nerve decompression surgery was able to interrupt the progression of nerve injury in more than 80% of the operated individuals. Considering the potential of the surgery as a preventive procedure, we recommend its indication even for individuals with grade 0 of disability but that present persistent pain or neural thickening after four weeks of clinical treatment without other symptoms.

Original Papers
Pages 114 - 123
  • Laterality judgement task in people affected by leprosy

    • Desiree Alves dos Santos
    • Maria Dias Torres Kenedi
    • Felipe José Jandre dos Reis
    • Antonio José Ledo Alves da Cunha
    • Maria Kátia Gomes
    Volume 92, Issue 2

    | Published on June 2021

    Leprosy is characterized by the involvement of the skin and peripheral nerves. This involvement can be presented by sensory, motor, and autonomic changes. Impaired hand sensibility may decrease the information that reaches specific areas of the central nervous system, resulting in changes in perception. During the laterality judgment task (or the ability to distinguish between left and right), an indivudual observes an image of a hand, performs a mental body rotation and compares the image with their body reprsentation in the brain, wich requires integrating sensory inputs with the sensory and motor systems.

    Objective:

    This study compared the performance on the left/right judgment task between people with nerve damage caused by leprosy and asymptomatic controls.

    Materials and Methods:

    Patients performed a task using the software Recognise®. Results were compared with those of a control group, comprising healthy individuals.

    Results:

    The study included 33 participants, of whom 20 were patients with leprosy (patient group) and 13 were healthy individuals (control group). The mean rate of correct responses by the patient group was 70% for the right hand and 62% for the left hand. The mean rate of correct responses by the control group was 83.4% for the right hand and 83.8% for the left hand.

    Conclusion:

    Patients demonstrate changes in body configuration, resulting in an influence of proprioceptive information on the subject’s current posture. These results may imply the presence of changes to the representation of the hand area in the brain’s sensory cortex.

Original Papers
Pages 124 - 133
  • Situation of the foot at risk due to leprosy in the municipality of Rio de Janeiro

    • Caroline Abreu
    • Marja Vilhena
    • Silvana Teixeira de Miranda
    • Eduardo Alexander
    • Maria Cristina Dias da Silva
    • Antônio José Ledo Alves da Cunha
    • Maria Katia Gomes
    Volume 92, Issue 2

    | Published on June 2021

    Management of tibial neuritis is often hindered by silent neuropathy. The morbidity could be easily detected when the healthcare provider uses the systematic approach of simplified neurological evaluation recommended by the Brazilian Ministry of Health. Evolution from grade 1 disability (G1D) to grade 2 disability (G2D) is not uncommon after treatment with WHO/MDT owing to the development of plantar ulcers, osteomyelitis, and the need for surgical amputation.

    Objective:

    We aimed to analyze the clinical course of patients with leprosy who presented with plantar anesthesia and G1D in the feet.

    Methods:

    This is a retrospective longitudinal observational case study. We reviewed the records of Hansen’s disease between 2004 and 2018 in four healthcare units in the Municipality of Rio de Janeiro. The sample comprised patients with leprosy (G1D or G2D) and anesthetic foot who underwent treatment and completed follow-up until discharge from WHO/MDT. Descriptive analysis and comparison between variables were performed using Fisher’s exact test with p < 0.05.

    Results:

    Forty-nine patients were selected from 135 medical records. There was an increase in the physical disability grade in 20.4% of the cases due to the occurrence of plantar ulcers in 10.2% and in 49% of the patients with post-discharge complications. Chronic pain was the most reported symptom (22.4%).

    Conclusion:

    Inadequate and prolonged use of glucocorticoids for chronic pain, noncompliance in the use of orthosis and adequate footwear, and nonreferral for surgical decompression of the tibial nerve suggest the need for professional training in the therapeutic approach to nerve damage in leprosy.

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