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BACKGROUND AND AIMS: Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae), an intracellular bacillus that systematically invades the peripheral nerves. Diagnosing leprosy neuropathy is still a defying skill, and late diagnosis and treatment are still a reality. Based on the biological characteristics of M. leprae, particularly its preference for invading the Schwann cells localized at the coldest areas of human body, we hypothesized that these areas have focal demyelination that may escape detection through standard nerve conduction studies (NCSs) protocols. METHODS: Twenty-five patients with confirmed multibacillary leprosy and 14 controls were accessed. A multisegmented NCS protocol (MP) was performed, targeting short segments through the coldest areas, to identify focal areas of slowed conduction velocity. The effectiveness of this multisegmented protocol was compared to the standard protocol (SP) to detect abnormalities. RESULTS: All leprosy patients presented an abnormal study with the MP, contrasting to 19 with the SP. The most frequent NCS pattern was an asymmetric neuropathy with focal slowing of conduction velocity, found in 23 out of 25 leprosy patients. Significant differences favoring the proposed method were observed when comparing the MP with the SP. Notably, the MP increased the sensitivity to detect abnormalities by 122%, 133%, and 257% for the median, peroneal, and tibial nerves, respectively. MP also increases sensitivity to detect focal abnormalities in the ulnar nerve. INTERPRETATION: The MP protocol significantly increases the sensitivity of NCSs to detect neurophysiological abnormalities in leprosy neuropathy.

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Anticipatory postural adjustments (APAs) involve a complex coordination of sensorimotor information that can be impaired in diseases that affect nerve conduction. Assessing APAs typically requires costly video recording technology, posing a challenge to the study of postural changes. This hurdle is compounded in impoverished communities affected by diseases such as leprosy, which often receive limited government support. Recent years have seen the validation of inertial sensors in wearable devices and smartphones for APA analysis in diverse populations, including adults, the elderly and people with Parkinson's disease. This progress offers economically efficient alternatives for the study of APA in leprosy. Do patterns of activation of anticipatory postural adjustment differ between leprosy patients and healthy controls? We also investigated the validity and replicability of APAs recorded in leprosy patients using inertial measurements and video capture recordings. Thirty healthy individuals in the control group and 30 individuals with leprosy in the leprosy group performed ten gait initiation trials. To record the APA for gait initiation, the participants stood on a 2 m platform. Each participant was informed that the experimenter would give an signal, after which the participant would initiate a two-step walk on the platform. Inertial recordings (low-cost method) and video capture recordings (gold-standard method) from center of mass displacements were used to extract the APA before gait initiation. The results show that APAs are similar between groups (control and leprosy), but leprosy patients have less consistent APAs. In addition, this study highlights the reproducibility and high correlation between the values of variables obtained from both instruments, the video recording as gold standard method and portable digital inertial sensor as a low-cost alternative method. These promising findings support the use of affordable inertial sensors to track and record APAs in underserved populations that lack easy access to gold standard methods such as video recording. This approach has the potential to improve the therapeutic care and rehabilitation of these patients. Although not currently part of official protocols for leprosy patients, this assessment method could prove particularly valuable in situations where significant sensorimotor impairments are suspected or documented.

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The International Classification of Function, Disability, and Health (ICF-WHO, 2001) recognizes several dimensions of disability, such as body structure and function (and impairment thereof), activity (and activity restrictions) and participation (and participation restriction) and their interactions with contextual factor (personal and environmental). In this study, we map and analyse the relationship between the components of ICF in leprosy patients from two rural areas in Indonesia: Lewoleba (East Nusa Tenggara) and Likupang (North Minahasa). This study was part of a community outreach program by the KATAMATAKU team from Universitas Indonesia. The body structure was graded using the WHO hand and feet disability grade and the number of enlarged nerves, while the body function was measured by the Jebsen Taylor Hand Function Test (JTT) and Timed-up and Go (TUG). Activity limitation and participation restriction were measured using the Screening Activity Limitation Safety Awareness (SALSA) Scale and Participation Scale (P-scale), respectively. There were 177 leprosy patients from the two regions and 150 patients with complete data were included in the analysis. We found 82% (95% CI: 75.08%-87.32%) of subjects with multibacillary leprosy, 10.67% (95% CI: 6.67%-16.62%) of subjects with grade 2 WHO hand disability, and 9.33% (95% CI: 5.64%-15.06%) of subjects with grade 2 WHO foot disability. Assessment using the SALSA Scale showed 29.33% of subjects with limitation activity and 11.33% with participation restriction. Age was shown to have positive correlations with SALSA, JTT, and TUG. Inter-dimensional analysis showed that the SALSA scale had significant positive correlations with the number of nerve enlargements, P-scale, JTT, and TUG. SALSA scores of grade 2 WHO hand and foot disability were also significantly higher than grades 1 and 0. The participation scale also had a positive correlation with JTT but not TUG. Hand disability seemed to affect societal participation while foot did not. We used the ICF to describe and analyse dimensions of leprosy-related disability in Indonesia.

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BACKGROUND: Pure neuritic leprosy (PNL) is uncommon form of leprosy involving peripheral nerves. Some isolated case reports have shown imaging changes in the central nervous system (CNS) and also impairment in visual evoked potential (VEP), somatosensory evoked potential (SSEP) and brain stem auditory-evoked potentials (BAEPs) parameters in PNL, but there is lack of large study. This prospective observational study evaluates impairment in these central conduction studies among PNL patients. METHODS: We screened patients with leprosy presenting with features of neuropathy and/or thickened nerves. Patients with bacilli-positive nerve biopsies were included in the study and subjected to routine tests along with nerve conduction study (NCS), VEP, tibial SSEP and BAEPs. Parameters of these studies were analyzed based on data from previous studies. RESULTS: Of 76 patients screened for PNL 49 had positive findings in biopsy. Most of patients were male and mean age group was 46.35 ± 15.35 years. Mononeuritis multiplex was most common NCS pattern in 46.93% (23/49) patients. We found abnormal VEP in 13 out of 35 patients (37.14%). Similarly abnormal SSEP and BAEPs among 42.85% and 40% patients respectively. DISCUSSION: This study shows that in PNL significant number of patients have subclinical CNS involvement. Exact pathophysiology of CNS involvement is not known till now but study of VEP, SSEP and BAEPs parameter may help in early diagnosis of PNL.

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Abstract Background and objectives: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. Material and methods: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. Results: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. Limitation of study: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. Conclusion: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.

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BACKGROUND AND OBJECTIVES: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. MATERIAL AND METHODS: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. RESULTS: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. LIMITATION OF STUDY: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. CONCLUSION: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.

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ABSTRACT Objective: To report the experience of professors and students in the development and implementation of an educational workshop on leprosy with adolescents. Method: This is a case report from actions contained in a university extension project. Results: The workshop program was elaborated with duration of two hours, including five dynamic techniques adapted to the topic: adjective, face, traffic light, true or false and mosaic. It was verified that the construction of knowledge in light of the verbalization of the adolescents and the interest in working in the society they live through sharing this knowledge, especially those who were more involved in the process. Conclusion: It was concluded that the applied workshops enabled building knowledge and demystifying myths and stigmas socially constructed to adolescents, as well as allowed Nursing students to experience educational interventions on leprosy with adolescents.

RESUMEN Objetivo: Relatar la experiencia de docentes y discentes en la elaboración y en la aplicación de taller educativo sobre la enfermedad de Hansen con adolescentes. Método: Se trata de un relato de experiencia desde acciones contenidas en un proyecto de extensión universitaria. Resultados: El programa del taller fue elaborado con duración de dos horas, englobando cinco técnicas de dinámicas adaptadas a la temática: adjetivo, caras, semáforo, verdadero o falso y mosaico. Se certificó la construcción del conocimiento delante de la verbalización de los adolescentes y del interés en actuar en la sociedad en que viven por medio del compartir de ese conocimiento, principalmente de los que se mostraron más involucrados durante el proceso. Conclusión: Se concluye que los talleres aplicados posibilitaron la construcción del conocimiento y la desmitificación de mitos y estigmas socialmente construidos a los adolescentes, así como permitieron a los discentes de enfermería la vivencia en intervenciones educativas sobre enfermedad de Hansen con adolescentes.

RESUMO Objetivo: Relatar a experiência de docentes e discentes na elaboração e aplicação de oficina educativa sobre hanseníase com adolescentes. Método: Trata-se de um relato de experiência a partir de ações contidas em um projeto de extensão universitária. Resultados: O roteiro da oficina foi elaborado com duração de duas horas, englobando cinco técnicas de dinâmicas adaptadas à temática: adjetivo, face, semáforo, verdadeiro ou falso e mosaico. Verificou-se a construção de conhecimento diante da verbalização dos adolescentes e do interesse em atuar na sociedade em que vivem por meio do compartilhamento desse conhecimento, principalmente dos que se mostraram mais envolvidos durante o processo. Conclusão: Conclui-se que as oficinas aplicadas possibilitaram a construção do conhecimento e a desmistificação de mitos e estigmas socialmente construídos aos adolescentes, assim como permitiram aos discentes de enfermagem a vivência em intervenções educativas sobre hanseníase com adolescentes.

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ABSTRACT Objectives: to identify scientific evidence in the literature regarding educational actions on leprosy developed with adolescents. Method: an integrative review of the literature, with the following research question: what are the leprosy educational practices currently being developed with adolescents? The search was performed in the following databases: MEDLINE, Scopus, LILACS, CINAHL, BVS Hanseníase and other sources, using "adolescent"; "leprosy"; "health education"; "public health", and "public health practice" as keywords. Results: the sample was comprised of nine studies. Leprosy educational practices with adolescents verifiably promote change in knowledge when they are based on constructivist methodologies. The nurse is recognized as a professional with potential for developing these educational practices. Final considerations: actions for leprosy education with adolescents do lead to changes in knowledge, but new research is needed to evaluate their effectiveness in further improving this knowledge as well as changing behaviors and practices.

RESUMEN Objetivo: Identificar las evidencias científicas de la literatura con relación a las prácticas educativas sobre la enfermedad de Hansen desarrolladas con adolescentes. Método: Se trata de una revisión integrativa de la literatura, con el cuestionamiento a continuación: ¿cuáles prácticas educativas sobre la enfermedad de Hansen están siendo desarrolladas con adolescentes? La búsqueda fue realizada en las bases de datos Medline, Scopus, Lilacs, CINAHL, Enfermedad de Hansen y en otras fuentes por medio de los descriptores: adolescente; enfermedad de Hansen; educación en salud; salud pública; y práctica de salud pública. Resultados: Nueve estudios compusieron la muestra. Se certificó que las prácticas educativas sobre enfermedad de Hansen con adolescentes promueven el cambio de conocimiento cuando se basan en la metodología constructivista y que el enfermero es reconocido como profesional con potencial para su desarrollo. Consideraciones finales: Las prácticas educativas sobre la enfermedad de Hansen con adolescentes resultan en cambios en el conocimiento, sin embargo, son necesarias nuevas investigaciones que evalúen su efectividad en la mejora del conocimiento y en los cambios de actitud y de prácticas.

RESUMO Objetivo: identificar as evidências científicas da literatura a respeito das práticas educativas sobre hanseníase desenvolvidas com adolescentes. Método: trata-se de uma revisão integrativa da literatura, com o seguinte questionamento: quais práticas educativas sobre hanseníase estão sendo desenvolvidas com adolescentes? A busca foi realizada nas bases de dados Medline, Scopus, Lilacs, CINAHL, Hanseníase e em outras fontes por meio dos Descritores: adolescente; hanseníase; educação em saúde; saúde pública; e prática de saúde pública. Resultados: nove estudos compuseram a amostra. Verificou-se que as práticas educativas sobre hanseníase com adolescentes promovem mudança de conhecimento quando se baseiam na metodologia construtivista e que o enfermeiro é reconhecido como profissional com potencial para o seu desenvolvimento. Considerações finais: as práticas educativas sobre hanseníase com adolescentes resultam em mudanças no conhecimento, porém são necessárias novas pesquisas que avaliem a sua efetividade na melhora do conhecimento e nas mudanças de atitude e de práticas.

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ABSTRACT Objective: Elaborate and validate an educational technology for adolescents on leprosy, focusing on preventing the disease and reducing stigma. Method: First, a prototype of the educational technology was elaborated and later analyzed by 17 adolescents and 7 researchers' experts in the leprosy area and educational technologies who answered a questionnaire with questions related to the subject. Subsequently, the technology has been applied to 43 adolescents, and a questionnaire was handed before and after the use of the game, so that questionnaire scores were compared by a Wilcoxon paired test. Results: After the data collection with researchers and adolescents, the answers received descriptive treatment, and the Content Validity Index was calculated, which reached a good level of agreement, with an overall value (0.86), although there were improvements to the technology, based on the perceptions of researchers and adolescents. Conclusions: There was an increase in knowledge about leprosy.

RESUMEN Objetivo: Elaborar y validar una tecnología educativa sobre lepra para adolescentes, enfocada en la prevención de la enfermedad y en la reducción del estigma. Método: Inicialmente, se elaboró un prototipo de tecnología educativa, luego analizado por 17 adolescentes y 7 investigadores expertos en las áreas de lepra y tecnologías educativas. Respondieron un cuestionario con preguntas relacionadas con la temática. Posteriormente, la tecnología fue utilizada con 43 adolescentes, a los que se les entregó un cuestionario antes y después del uso del juego. Los puntajes del cuestionario fueron comparados por Prueba Pareada de Wilcoxon. Resultados: Una vez recolectados los datos de los investigadores y los adolescentes, las respuestas recibieron tratamiento descriptivo y se calculó su Índice de Validez de Contenido, que alcanzó buen nivel de concordancia en su valor global (0.86), aunque igualmente se mejoró la tecnología acorde las percepciones de investigadores y adolescentes. Conclusiones: Se aumentó el conocimiento sobre lepra.

RESUMO Objetivo: Elaborar e validar uma tecnologia educacional para adolescentes com hanseníase, focando na prevenção da doença e redução do estigma. Método: Inicialmente, um protótipo da tecnologia educacional foi elaborado, e então analisado por 17 adolescentes e 7 pesquisadores especialistas na área de hanseníase e tecnologias educacionais, que responderam a um questionário com questões relacionadas ao tema. Posteriormente, a tecnologia foi aplicada a 43 adolescentes, e um questionário foi entregue antes e após o uso do jogo, para que os escores dos questionários fossem comparados com o teste de Wilcoxon pareado. Resultados: Após a coleta de dados com os pesquisadores e adolescentes, as respostas foram submetidas a um tratamento descritivo, e o Índice de Validade de Conteúdo foi calculado, alcançando bom nível de concordância, com valor global de 0,86, embora houvesse melhorias a serem feitas na tecnologia, de acordo com as percepções dos pesquisadores e adolescentes. Conclusões: Houve um aumento no conhecimento sobre a hanseníase.

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OBJECTIVE: Elaborate and validate an educational technology for adolescents on leprosy, focusing on preventing the disease and reducing stigma. METHOD: First, a prototype of the educational technology was elaborated and later analyzed by 17 adolescents and 7 researchers' experts in the leprosy area and educational technologies who answered a questionnaire with questions related to the subject. Subsequently, the technology has been applied to 43 adolescents, and a questionnaire was handed before and after the use of the game, so that questionnaire scores were compared by a Wilcoxon paired test. RESULTS: After the data collection with researchers and adolescents, the answers received descriptive treatment, and the Content Validity Index was calculated, which reached a good level of agreement, with an overall value (0.86), although there were improvements to the technology, based on the perceptions of researchers and adolescents. CONCLUSIONS: There was an increase in knowledge about leprosy.

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OBJECTIVES: to identify scientific evidence in the literature regarding educational actions on leprosy developed with adolescents. METHOD: an integrative review of the literature, with the following research question: what are the leprosy educational practices currently being developed with adolescents? The search was performed in the following databases: MEDLINE, Scopus, LILACS, CINAHL, BVS Hanseníase and other sources, using "adolescent"; "leprosy"; "health education"; "public health", and "public health practice" as keywords. Results: the sample was comprised of nine studies. Leprosy educational practices with adolescents verifiably promote change in knowledge when they are based on constructivist methodologies. The nurse is recognized as a professional with potential for developing these educational practices. Final considerations: actions for leprosy education with adolescents do lead to changes in knowledge, but new research is needed to evaluate their effectiveness in further improving this knowledge as well as changing behaviors and practices.

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OBJECTIVE: To report the experience of professors and students in the development and implementation of an educational workshop on leprosy with adolescents. Method: This is a case report from actions contained in a university extension project. RESULTS: The workshop program was elaborated with duration of two hours, including five dynamic techniques adapted to the topic: adjective, face, traffic light, true or false and mosaic. It was verified that the construction of knowledge in light of the verbalization of the adolescents and the interest in working in the society they live through sharing this knowledge, especially those who were more involved in the process. CONCLUSION: It was concluded that the applied workshops enabled building knowledge and demystifying myths and stigmas socially constructed to adolescents, as well as allowed Nursing students to experience educational interventions on leprosy with adolescents.

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OBJECTIVE: Neuropathic pain is a chronic syndrome that is difficult to treat and often affects patients with leprosy. Recommended treatment includes the the use of analgesic drugs, codeine, tricyclic antidepressants, neuroleptics, anticonvulsants and thalidomide, but without consensus on uniform dose and fully satisfactory results. To analyze botulinum toxin type A (BoNT-A) effectiveness in treatment of chronic neuropathic pain in refractory leprous patients, as well as evaluate and compare the quality of life of patients before and after using the medication. METHODS: We used a specific protocol including clinical, demographic, DN4 protocol, analogue scale (VAS), sensory evaluation and evaluation of the WHOQOL-BREF. Therapeutic intervention was performed with BOTOX® BTX-A 100U administered subcutaneously. Fifteen patients were evaluated on days 0, 10 and 60. RESULTS: Patients on VAS showed pain between 5 and 10, in one case there was complete pain relief in 60 days, while others showed improvement in the first week with the return of symptoms with less intensity after this period. WHOQOL-BREF's domains Quality of Life and Physical to have a significant increase in QOL. CONCLUSION: BoNT-A proved to be a good therapeutic option in relieving pain with improved quality of life for these patients.

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ABSTRACT Neuropathic pain is a chronic syndrome that is difficult to treat and often affects patients with leprosy. Recommended treatment includes the the use of analgesic drugs, codeine, tricyclic antidepressants, neuroleptics, anticonvulsants and thalidomide, but without consensus on uniform dose and fully satisfactory results. Objective: To analyze botulinum toxin type A (BoNT-A) effectiveness in treatment of chronic neuropathic pain in refractory leprous patients, as well as evaluate and compare the quality of life of patients before and after using the medication. Methods: We used a specific protocol including clinical, demographic, DN4 protocol, analogue scale (VAS), sensory evaluation and evaluation of the WHOQOL-BREF. Therapeutic intervention was performed with BOTOX® BTX-A 100U administered subcutaneously. Fifteen patients were evaluated on days 0, 10 and 60. Results: Patients on VAS showed pain between 5 and 10, in one case there was complete pain relief in 60 days, while others showed improvement in the first week with the return of symptoms with less intensity after this period. WHOQOL-BREF's domains Quality of Life and Physical to have a significant increase in QOL. Conclusion: BoNT-A proved to be a good therapeutic option in relieving pain with improved quality of life for these patients.

RESUMO A dor neuropática é uma síndrome crônica que é difícil de tratar e freqüentemente afeta pacientes com hanseníase. O tratamento recomendado inclui o uso de drogas analgésicas, codeína, antidepressivos tricíclicos, neurolépticos, anticonvulsivantes e talidomida, mas sem consenso sobre dose uniforme e resultados plenamente satisfatórios. Objetivo: Busca-se analisar a efetividade da toxina botulínica tipo A no tratamento da dor neuropática crônica hansênica refratária. Método: Estudo de intervenção do tipo ensaio clínico em portadores de dor neuropática crônica hansênica. Foram coletados dados epidemiológicos, protocolo DN4, escala analógica da dor (EVA), avaliação sensitiva, motora a avaliação do WHOQOL-Bref. Realizado intervenção terapêutica com toxina botulínica tipo A 100U. Os pacientes foram avaliados nos dias de 0, 10 e 60. A dor neuropática foi mais frequente no sexo masculino, na faixa etária de 40 à 49 anos. Resultados: Da forma Dimorfa, multibacilar com baciloscopia positiva e incapacidades presentes. Os escores EVA variam entre 5 e 10, todos os pacientes apresentaram alterações sensoriais. O WHOQOL-Bref apresentou melhora após o tratamento com TxBA. A TxBA foi bem tolerada o único efeito adverso notável foi dor leve. E com apenas uma única aplicação de TxBA promoveu efeitos analgésicos a longo prazo em pacientes com dor associada à alodinia, sugerindo que a analgesia observada pode ser causada por um efeito periférico da TxBA em terminações nociceptivas. Conclusão: O estudo sugere que a TxBA é uma boa opção para os casos de dor neuropática crônica hansênica, no entanto, novos estudos são necessários para confirmar estes resultados.

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BACKGROUND: Leprosy can be considered to be the most common peripheral neuropathy of infectious etiology and constitutes a public health problem. The standard routine examination for assessing sensory impairment in leprosy neuropathy basically evaluates hands, feet and eyes. However, evaluation of facial cutaneous sensation is not routinely performed. OBJECTIVES: The aim of this study was to evaluate facial cutaneous sensation in patients with different clinical forms of leprosy and compare the findings with those from healthy individuals. METHODOLOGY: 19 healthy controls and 71 leprosy patients who were being treated at a national reference center for leprosy in Brazil underwent facial sensation assessment using the Semmes-Weinstein monofilament test. This test was applied over the facial areas corresponding to the ophthalmic, maxillary and mandibular distal branches of the trigeminal nerve. RESULTS: The predominant clinical form in terms of changes to facial cutaneous sensation was lepromatous leprosy (LL), followed by the borderline-borderline (BB), and borderline-lepromatous (BL) forms, in comparison with healthy individuals. The distal branches most affected were the zygomatic (28.2%; 20/71), buccal (23.9%; 17/71) and nasal (22.5%; 16/71). There was asymmetrical sensory impairment of the face in 62.5% (20/32) of the cases. CONCLUSION: The face is just as impaired in leprosy as are the feet, hands and eyes, but facial impairment is underdiagnosed. Our evaluation on the different sensory branches and evidence of asymmetrical impairment of the face confirm the classically described pattern of leprosy neuropathy, i.e. consisting of asymmetrical and predominantly sensory peripheral neuropathy.

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