Maria de Fátima de Medeiros Brito

Associação entre reação hansênica após alta e a carga bacilar avaliada utilizando sorologia anti PGL-I e baciloscopia

Leprosy (Hansens disease, HD) reactions are immune-inflammatory phenomena that occur during the evolution of the disease. Given the current criteria for treatment of the disease, this event is often observed after the patient has been released from treatment (RFT) from multi-drug therapy (MDT). A case-control study was conducted comparing laboratory results of cases of leprosy reactions after RFT from multibacillary MDT (MDT/MB) with a control group to analyze the possible association between posttreatment reactions and bacterial load using the ML Flow serological test for detection of antibodies to Mycobacterium leprae and the results of bacilloscopic skin smears. The study was conducted in two reference centers in Recife, Pernambuco State, Brazil, involving 208 patients. The results obtained indicate that posttreatment reaction is statistically associated with bacterial load through positive serology post-RFT. In conclusion, common risk factors exist between relapses and post-RFT reactions.

Avaliação dos efeitos adversos clínicos e alterações laboratoriais em pacientes com acne vulgar tratados com isotretinoína oral

BACKGROUND Oral isotretinoin therapy has completely changed the treatment of acne. The clinical adverse effects of isotretinoin are classified into two groups: mucocutaneous and systemic toxic. Laboratory alterations such as dyslipidemia and increase of hepatic enzymes are reported. OBJECTIVES To evaluate the tolerability of oral isotretinoin with special attention to lipid metabolism, hepatic function, and clinical adverse reactions. METHODS 150 patients clinically diagnosed with acne being treated with oral isotretinoin were included in the study. Clinical and laboratory evaluations were conducted before the start of therapy, one month after, and every three months thereafter until the completion of treatment. RESULTS Of the 150 patients evaluated, 48% were female and 52%, male. They were aged from 15 to 32 years. The most prevalent mucocutaneous adverse reaction associated with isotretinoin therapy was cheilitis, reported by 94% of the patients. Systemic clinical effects were much less common. Cholesterol, triglyceride, and transaminase levels were assessed and significant changes were not observed during treatment. CONCLUSION Patients showed adverse effects compatible to those described in the literature, which are mostly controlled with symptomatic medication. Isotretinoin is a safe drug and adverse and laboratory effects are well tolerated.

Retreatment in leprosy: a case-control study

OBJECTIVE To assess risk factors for retreatment of leprosy patients. METHODS A case-control study with patients from two reference care units in Recife, northeastern Brazil, in 2003. The case group included retreated patients (N=155) and the control group comprised those patients who were not retreated (N=155) matched by year of diagnosis and health care unit. Univariate and multivariate analyses were conducted to test the associations and odds ratios and related 95% confidence intervals were estimated. RESULTS The following factors were found to be significantly associated (p<0.05) with retreatment: occurrence of adverse immunological reactions after treatment completion (OR=2.3; 95% CI=1.18;4.83), final bacterial index > or = 1 (OR=6.43; 95% CI=1.67;24.74), therapeutic regimen consisting of sulfone monotherapy (OR=10; 95% CI=0.01;0.78) and reports of household contacts (OR=2.2; 95% CI=0.24;0.85). CONCLUSIONS The study findings reinforce that the use of dapsone monotherapy should be discontinued, and highlight the need for epidemiological monitoring of specific groups of leprosy patients after treatment completion through periodical clinical and laboratory evaluation. Further studies to explore the association between final bacterial index and retreatment are strongly recommended.

O retratamento por recidiva em hanseníase

FUNDAMENTOS: Estudos sobre os pacientes hansenianos retratados justificam-se pela dificuldade do diagnostico diferencial entre quadro reacional apos alta do tratamento especifico de hanseniase e recidiva, devido as limitacoes de criterios clinicos e laboratoriais para diferencia-los. OBJETIVOS: Verificar os procedimentos diagnosticos clinicos e laboratoriais que subsidiaram o retratamento por recidiva e a ocorrencia de episodios reacionais, em especial os que ocorreram apos o termino do tratamento. METODOS: Mediante o estudo retrospectivo de serie de casos foram estudados 155 pacientes hansenianos retratados por recidiva em duas unidades de referencia em hanseniase, no municipio de Recife/PE, Brasil. RESULTADOS: O criterio clinico foi o mais utilizado para a decisao de retratamento por recidiva, e as lesoes novas descritas foram principalmente do tipo macula e infiltracao. Os episodios reacionais apos alta ocorreram em 34% desses pacientes, e 33,9% relatavam a presenca de comunicantes com hanseniase. Dos 155 pacientes estudados apenas 14,9% realizaram exame histologico e 18,1% nao realizaram a baciloscopia antes de reiniciar a terapia especifica. CONCLUSAO: Este estudo evidenciou que os episodios reacionais apos o tratamento e a presenca de comunicantes com hanseniase ocorreram em torno de 30% nos pacientes retratados por recidiva e que se fazem necessarios outros estudos controlados para o melhor entendimento desses fatores.

Tuberculose esplênica durante tratamento de psoríase com infliximabe

Psoriasis is a chronic inflammatory disease affecting the skin and occasionally the joints. The biological agents have been engineered to target a specific step in the inflammatory cascade that leads to psoriasis, including tumor necrosis factor, which has a central role in the host defense against Mycobacterium tuberculosis. This is a case report about a psoriatic patient who presented splenic tuberculosis during treatment with infliximab.

Percepção da doença e automedicação em pacientes com escabiose

BACKGROUND: The high prevalence of scabies associated with low rate of self-diagnosis and stigmatization of infested people contribute to self medication. OBJECTIVES: To ascertain perception of patients with scabies, regarding the condition, diagnostic possibilities considered, practice of self medication and their feelings when diagnosis is made. METHODS: In a prospective study of cases, 65 patients seen at the Dermatology Outpatients Clinic of the Universidade Federal de Pernambuco, in Recife, Brazil, with clinical diagnosis of scabies were interviewed. RESULTS: Only 47.7% believed that their symptoms were due to scabies, and 86% thought that they could be related to other diseases, such as infections, insect bites and allergy to contactants. Self medication was observed in 55.4% of patients, and the products mostly used were soaps and herbs. The diagnosis of scabies led to negative feelings in 56.7% of cases. CONCLUSIONS: This study showed a low degree of suspicion of scabies among the people infested. Self medication was used in over half the cases, usually with improper products to treat the parasitosis. The diagnosis of scabies often leads to negative feelings, indicating the need of integral care of patients.

Síndrome da resposta inflamatória sistêmica: denominação possivelmente aplicável a fenômenos dermatológicos

The systemic inflammatory response syndrome consists of an acute inflammatory response induced by inflammatory factors related to sepsis and extensive injuries. Parallel to the chronic course of some dermatological diseases, acute manifestations, characterized by the exacerbation of pre-existing lesions and the presence of systemic signs and laboratorial changes, may occur. In this article, etiopathogenic aspects of Systemic inflammatory response syndrome and its presence in some dermatoses are discussed.

Avaliação laboratorial dos efeitos colaterais pelo uso da acitretina em crianças portadoras de ictiose lamelar: seguimento por um ano

FUNDAMENTOS: Os retinoides orais representam uma das principais terapeuticas dermatologicas nas ultimas decadas e tem sido indispensaveis para o tratamento das desordens de queratinizacao, particularmente a psoriase, ictioses e acne.1 OBJETIVOS: Avaliar a tolerabilidade da acitetrina com atencao para os efeitos no metabolismo lipidico, funcao hepatica e no sistema osteoarticular em criancas portadoras de ictiose lamelar. METODOS: Estudo prospectivo de 10 criancas portadoras de ictiose lamelar avaliadas clinica e laboratorialmente pelo periodo de um ano. Cada paciente foi inicialmente tratado com 10mg.dia ou aproximadamente 0,5mg.kg-1.dia. As doses foram ajustadas de acordo com a eficacia clinica e mantidas por um ano. RESULTADOS: Das 10 criancas estudadas, todas evoluiram com alguma resposta clinica satisfatoria ao final de um ano de acompanhamento. Nao foram observadas alteracoes nas transaminases e nos lipideos sericos, e, das seis criancas em que foi estudada a idade ossea, apenas uma apresentou alteracao. CONCLUSAO: O uso da acitretina, quando administrada em doses adequadas e pelo periodo de um ano, e seguro e eficaz, sendo justificada sua utilizacao pelos beneficios dessa medicacao e tendo em vista a insignificância das alteracoes laboratoriais apresentadas no estudo em questao.