Maria Kátia Gomes

Tuberculosis verrucosa cutis associated with tuberculous lymphadenitis

A 34‐year‐old man presented with a large cutaneous lesion on his left thigh that had started as a small papule when he was 13 years of age. The lesion had enlarged slowly over the last 21 years. The patient had received bacillus Calmette–Guérin (BCG) vaccination in childhood. The family history was significant for tuberculosis.

Pain and Its Consequences in Quality of Life: A Study with WHOQOL-Bref in Leprosy Patients with Neuropathic Pain

Chronic neuropathic pain emerges as a challenge in the treatment of leprosy patients after multidrug therapy discharge. The aim of this study was to determine the quality of life and its repercussions in leprosy patients with chronic pain. We studied male and female patients with chronic neuropathic pain in the last year. Neuropathic pain was confirmed using Douleur Neuropathique en 4 (DN4) and its intensity evaluated by visual analogue scale (VAS). A general questionnaire was applied to evaluate quality of life (WHOQOL-bref). Statistical analyses were composed by descriptive and central tendency. Spearman correlation was used to identify the relation between pain intensity, quality of life domains, and facets. Multiple linear regressions were performed to verify the influence of pain intensity on each facet. Neuropathic pain patients scored worst in physical and environment domains. The low facets were related to pain and discomfort, thinking and concentration, sexual activity, and recreation opportunities. Pain intensity has a high negative influence on psychological domain and recreation opportunities. These findings should contribute to the development of rehabilitation programs considering patients needs to improve their quality of life and true social reintegration.

A Method Used to Access the Functional Outcome of Tibial Posterior Tendon Transfer for Foot Drop in Leprosy

Objectives. The aim of this study was to access the postoperative functional results of posterior tibial tendon transfer for foot drop as a consequence of nerve palsy in leprosy. Material and Methods. Thirteen patients (9 males and 4 females) with ages ranging from 9 to 69 years were submitted to posterior tibial tendon transfer by the circumtibial route to correct foot drop in leprosy. The length of postoperative follow-up ranged from 1 to 5 years. The Stanmore system was used as a method for evaluating the functional results of postoperative posterior tibial tendon transfer. This system is made up of 7 different categories and the total score is 100. Results. According to the Stanmore system, the results were poor in 1 patient (7.6%), moderate in 2 feet (15.3%), good in 5 feet (38.4%), and excellent in 5 feet (38.4%). All the patients were satisfied with the final outcome. Conclusion. The posterior tibial tendon transfer for foot drop in leprosy was efficient in restoring normal function of the foot and gait without changing foot posture. In the absence of a standardized method for assessing the results of posterior tibial tendon transfer, the Stanmore system seems to be a good tool for an objective evaluation. Levels of Evidence : Therapeutic, Level IV

Idiopathic eruptive macular pigmentation associated with pregnancy

Idiopathic eruptive macular pigmentation (IEMP) is a rare condition that was first described by Degos et al. in 1978. It is characterized by the presence of asymptomatic pigmented macules involving the neck, trunk, and proximal extremities. There are <50 published cases, and only one associated with pregnancy. We describe an unusual case of diffuse IEMP, in which worsening was associated with pregnancy.

The Use of Assistive Technology to Promote Care of the Self and Social Inclusion in Patients with Sequels of Leprosy

Background This study is about the contribution of occupational therapy inside a rehabilitation group, and we focus on the autonomy of patients with disabilities due to leprosy. There are few studies on the use of assistive technology by leprosy patients; to our knowledge, none of them aim to have a subjective approach of care. Our purpose was to analyze the repercussions of assistive technology on autonomy of care of the self in patients with sequels of leprosy. Methods A qualitative, descriptive exploratory study with a semi-structured interview and a field observation as a research method was conducted between November 2014 and February 2015 at a University Hospital in Rio de Janeiro. Findings Eight patients from the service of Occupational Therapy were interviewed, and 44 hours of observation were performed. Interviews followed a semi-structured script and a field journal was used to take notes. Analysis was conducted by the hermeneutic approach. Costs were obtained after a global cost analysis of the fixed and variable expenses and direct and indirect costs to the manufactured products with an amount of 100 dollars. Results were grouped according to the following categories: contribution of the adapted devices for the care of the self and feelings and sensations provoked by the use of self-help devices. The reports revealed feelings, perceptions and meaningful contents about the social, familiar and individual dimensions, also the stigma coupled with leprosy. However, forms of re-signification were elaborated. Conclusions Assistive technology empowers the subject to perform care of the self and promotes social inclusion.

Chronic pain in leprosy: new aspects to be considered

Leprosy is still considered to be endemic in several developing countries, such as India and Brazil. Infection with Mycobacterium leprae leads to chronic granulomatous inflammation in skin and peripheral nerves that can lead to sensory, motor and autonomic impairments. Since the disease causes severe sensory loss, little attention has been given to pain in leprosy. However, chronic pain in leprosy is being increasingly recognized as an important late complication of leprosy. This article discusses the assessment of pain in leprosy and suggests factors that can contribute to the chronicity. We also consider pain as a multiple system output, bringing the possibility of new treatment options for chronic pain in leprosy.

Avaliação da limitação das atividades diárias e qualidade de vida de pacientes com hanseníase submetidos à cirurgia de neurólise para tratamento das neurites

La neurolisis es indicada para reducir el sufrimiento neural e impedir la instalacion de secuelas e incapacidades en pacientes con lepra. El objetivo de este estudio fue verificar el grado de limitacion de las actividades de la vida diaria y la calidad de vida de pacientes con lepra sometidos a neurolisis para el tratamiento de las neuritas. Participaron del estudio los pacientes sometidos a neurolisis en el periodo de 1998 a 2011. Fueron recolectadas informaciones sociodemograficas y clinicas, limitaciones de las actividades (SALSA) y la calidad de vida (WHOQOL-bref). Los analisis estadisticos incluiran la frecuencia, las medidas de tendencia central y dispersion, los tests de Mann-Whitney, Kruskall-Wallis y los coeficientes de correlacion de Spearman adoptando p<0,05. La muestra fue compuesta por 36 pacientes con edad media de 44,0 anos y 3 anos de post-operatorio. Seis pacientes presentan grado 0 de incapacidad, 18 grado 1 y 12 grado 2. La principal diferencia en la escala SALSA ocurrio entre el grado 0 (media=31,8) y el grado 1 (media=42,56). Los valores obtenidos en el analisis de WHOQOL-bref incluyen los dominios fisico (media 11,10); psicologico (media 13,41); relaciones sociales (media 15,15); medio ambiente (media 11,63). Las facetas del WHOQOL-bref mas comprometidas fueron la capacidad para el trabajo; sentimientos negativos (psicologico); actividad sexual (relaciones sociales); recursos financieros (medio ambiente). A pesar de la realizacion de la neurolisis, la mayor parte de los integrantes presentaron limitaciones en las actividades, siendo mayor en aquellos con incapacidades fisicas. La mayor insatisfaccion en la calidad de vida fue en el dominio fisico, principalmente en los que se refiere al dolor y la necesidad de cuidados de salud.

Evaluation of the limitations in daily-life activities and quality of life in leprosy ­patients submitted to surgical neurolysis to treat neuritis

La neurolisis es indicada para reducir el sufrimiento neural e impedir la instalacion de secuelas e incapacidades en pacientes con lepra. El objetivo de este estudio fue verificar el grado de limitacion de las actividades de la vida diaria y la calidad de vida de pacientes con lepra sometidos a neurolisis para el tratamiento de las neuritas. Participaron del estudio los pacientes sometidos a neurolisis en el periodo de 1998 a 2011. Fueron recolectadas informaciones sociodemograficas y clinicas, limitaciones de las actividades (SALSA) y la calidad de vida (WHOQOL-bref). Los analisis estadisticos incluiran la frecuencia, las medidas de tendencia central y dispersion, los tests de Mann-Whitney, Kruskall-Wallis y los coeficientes de correlacion de Spearman adoptando p<0,05. La muestra fue compuesta por 36 pacientes con edad media de 44,0 anos y 3 anos de post-operatorio. Seis pacientes presentan grado 0 de incapacidad, 18 grado 1 y 12 grado 2. La principal diferencia en la escala SALSA ocurrio entre el grado 0 (media=31,8) y el grado 1 (media=42,56). Los valores obtenidos en el analisis de WHOQOL-bref incluyen los dominios fisico (media 11,10); psicologico (media 13,41); relaciones sociales (media 15,15); medio ambiente (media 11,63). Las facetas del WHOQOL-bref mas comprometidas fueron la capacidad para el trabajo; sentimientos negativos (psicologico); actividad sexual (relaciones sociales); recursos financieros (medio ambiente). A pesar de la realizacion de la neurolisis, la mayor parte de los integrantes presentaron limitaciones en las actividades, siendo mayor en aquellos con incapacidades fisicas. La mayor insatisfaccion en la calidad de vida fue en el dominio fisico, principalmente en los que se refiere al dolor y la necesidad de cuidados de salud.

Idiopathic histiocytoid Sweet syndrome: a case report with clinical and histopathological considerations

Histiocytoid Sweet syndrome is characterized by a predominant neutrophilic dermal infiltrate. Usual clinical differential diagnosis includes erythema multiforme, drug eruption, and erythema nodosum. Histiocytoid Sweet syndrome is considered an uncommon histopathological variant of the disease.

Nevus Comedonicus: Case Report

Nevus comedonicus is a rare cutaneous anomaly, characterized by the clustering of papules with firm, blackened horny buffers. It in general has a zosteriform pattern and affects both genders equally. In some patients, there is formation of cysts, abscesses, and fistulas, aggravating its psychosocial impact. The association with extracutaneous lesions characterizes the nevus comedonicus syndrome. Despite several therapeutic options, the result is unsatisfactory in most cases. We report the case of a man with an exuberant congenital lesion, affecting the left suprascapular region, arm, and forearm.