Hansenologia internationalis最新文献

A middle aged man (48 years) with short duration of illness (7 days) was admitted in the state of acute renal failure with erythema nodosum leprosum. He had repeated episodes of erythema nodosum leprosum in the past. His blood pressure was normal (150/80 mmHg). During his hospital stay he was in the state of progressive anaemia (Hb = 8.8 g/dl to 7.2 g/dl), oliguria (urine out-put = 250-350 ml/day), azotaemia (blood urea = 198 mg/dl to 218 mg/dl) and impaired renal function tests with fatal outcome. Kidneys were smooth, congested and weighing 150 g each with histological features of rapidly progressive (crescentric) glomerulonephritis, a result of immune complex deposition from recurrent erythema nodosum leprosum episodes.

The control situation of hanseniasis patients' contacts needs a deeper study which would show the reality in the public health centers and their consequence over the whole country. The increasing of the prevalence rate of the disease added to the bad social-economic conditions of the patients and contacts gave us subsidies to important studies to understand the present epidemiological picture. This research had the purpose of diagnosing the control situation of hanseniasis patients' contacts in a public health center which had, at the moment of this research (1983) 160 hanseniasis patients (incidence of 1.2/1000) and 757 contacts registered in a Subprogram of Hansen's Disease Control.

Facies leprosa was characterized by a combination of nasal change and resorption of nasal bone, anterior nasal spine, supra-incisive alveolar region and anterior alveolar process of the maxilae, associated with the loss of upper incisors teeth, according to the criteria of radiographic interpretation.

Main modes of international participation in hanseniasis control in Brazil, both public and private, are briefly described: public modes are established country to country or through Pan-american Health Organization; the others are essentially identified as "voluntary organizations". A descriptive assessment of this experience in Brazil follows. Considering our vast territory and a huge accumulated social debt, possible cooperative work is explored, adopting clear criteria (establishing priorities, planning and participative management), viewing basic actions as public attribuitions complemented by internacional organisms when necessary.

Aiming to verify the occurrence of alterations in certain skeletal structures in lepromatous face, 70 patients from the "Hospital Lauro de Souza Lima", were clinically and radiographically analysed through a longitudinal study with a 3 years interval: their average age was of 45.41 years and 48.41 years respectively for the first and second examinations.

In the control of endemic leprosy in Brazil, a qualitative and quantitative lack of human resources was felt as one of its most serious difficulties. Consequently, a systematical review on the practices of Human Resources on Leprosy was carried out, covering the period between 1940 and 1980. An interesting paradox was then observed: sectorial authorities always recognized that courses and training are an important tool in order to improve the conditions for operating the leprosy control but when they are put in practice, they result transitory and ineffective. The maintenance of this fact, associated to low salaries and inadequate working conditions indicated the necessity of formulating and implanting a policy for the development of Human Resources in leprosy at a nationwide level. The experience consisted of setting up a sheme of encouragement and support to State Health Departments for training at local level; at regional level, extension courses were organized by the Nacional Departament, in Amazonia, Mid-west, South, Northeast and Southeast. The strengthening and/or development of a referral system at state level were reached through the national specialization course of Sanitary Dermatology; international qualifications were obtained, as a complement, by joint action with Pan-American Organization of health. Results, details, characteristics and strategies of this process are presented and discussed by discursive and tabular forms.

The authors have studied 270 Hansen's disease patients diagnosed and registered at the Neurologic and Dermatologic Sanitary Unit, in Crato, Ceará, from June, 1981 till August, 1983. This work presents an analysis of the aspects of the endemy, with percentual and absolute values and compares them with the consulted data. Finally the authors emphasize the disease's morbidity and characterize it as a serious and present problem of public health in Crato, Ceará.

In Hansen's disease, the third part of advanced incidences or non treated cases exhibit some patterns of physical incapacity, besides the prejudice and beliefs generated by deformities-which the patients may present if they do not get a correct treatment. Which basis on this problematical question of the disease a group of professionals composed of medical doctors, nurses, physical therapist, occupational therapist and social worker made a study of the incapacities of the Hansen's disease patients through a detailed physical exam. This study intended to identify sensory and motor injuries of the face, upper and lower limbs. This study also develops a research about the necessity to systematize the assistance given in a public health center.

Hanseniasis patients and contacts of Virchowian patients, totaling 467 persons have been submitted to Mitsuda's reaction. These individuals have been divided into five groups: group 1 compounded of 59 persons, relatives of Virchowian patients; group 2 - 171 persons, employees of the Hospital Lauro de Souza Lima working there for more than one year; group 3 - 127 hanseniasis patients in activity, Mitsuda negative; group 4 - 63 hanseniasis patients in activity, Mitsuda positive; group 5 - 47 Virchowian patients, inactive, Mitsuda negative. The analysis of the data showed that: a) hanseniasis patients, both Mitsuda positive and negative, do not present positivity to Fernandez's reaction; b) early reaction can be observed more frequently in individuals of group 1 than in those of group 2. Mitsuda's antigen causes the reversal of Fernandez's reaction in about 30% of indirect contacts; c) the percentage of negative Mitsuda's reactions (without induration) does not differ between groups 1 and 2, though indurations smaller than 5 mm have been as many as 10 times more frequent in individuals of group 1. A second application of the antigen in Mitsuda negative persons showed the reversal of the test in 100% of the tested subjects.