Abstract: Background: Stevens-Johnson syndrome and toxic epidermal necrolysis are life-threatening blistering drug reactions with high incidence of ocular sequela. The term ‘Epidermal Necrolysis’ has been recently used to better describe the full spectrum of the disease that includes Stevens-Johnson syndrome and toxic epidermal necrolysis at opposite ends, which differ by the extent of body surface area with epidermal detachment. SCORTEN is a mortality prognosis score for ‘Epidermal Necrolysis’ cases that still needed validation in acquired immunodeficiency syndrome. Objective: To evaluate the SCORTEN performance in acquired immunodeficiency syndrome, and the differences in outcomes between acquired immunodeficiency syndrome and non- acquired immunodeficiency syndrome cohorts. Methods: Retrospective cohort study of AIDS and non-AIDS ‘Epidermal Necrolysis’ cases admitted to a Brazilian reference center from 1990-2014. Results: Five deaths (16.7%) occurred as a consequence of EN in 30 AIDS patients, and seven (17.9%) in 39 non-AIDS patients, relative risk (RR) .92 (p=1.0). SCORTEN showed great performance, with an Area Under the Receiver Operating Curve (AUC) (ROC) of 0.90 with a 95% confidence interval ranging from .81 to .99. The performance of SCORTEN was better among non- AIDS patients than AIDS patients: AUC non- acquired immunodeficiency syndrome =0.99 (CI 05% 0.96-1.00), AUC acquired immunodeficiency syndrome = 0.74 (CI 95% 0.53-0.95), p=.02. Study Limitations: Heterogeneity of cases, wide variation of systemic corticosteroid doses when used. Conclusion: SCORTEN is valid for the Brazilian population, including among those patients with acquired immunodeficiency syndrome, and, as such, its use is recommended for aiding treatment choice in this subgroup of patients.

Abstract: INTRODUCTION: Leprosy is mainly transmitted among family members who share genetic and ambient factors. The clinical form of leprosy in the index case and kinship could be risk factors for leprosy transmission. High antibody levels in household contacts (HC) in the absence of neural or skin lesions may characterize latent infection. This study aimed to evaluate the association between seropositivity for anti-phenolic glycolipid-I immunoglobulin M antibodies (APGL-I) in HC and the clinical classification of the index case and to analyze the association between APGL-I positivity with other factors such as age, kinship, and gender. METHODS: We performed a survey among 320 HC of 120 leprosy patients who were evaluated and followed-up in a leprosy outpatient clinic of a university hospital. All HC underwent complete skin examination, peripheral nerve palpation, skin sensory tests, and serologic tests for the detection and quantification of APGL-I. RESULTS: The overall seropositivity rate was 20%, and was greatly affected by kinship. APGL-I seropositivity was higher in siblings (41%), followed by parents (28%), spouses (26%), other (19%), and offspring (14%). Independent risk factors for seropositivity were being siblings (OR 3.3) and being a HC of an index case with indeterminate leprosy (OR 5.3). APGL-I seropositivity was associated with index cases with a bacillary index of 4 (88%; p<.001). Seropositivity among HC was not significantly associated with their gender and age. There was no statistical difference in the seropositivity rates of HC of index patients with paucibacillary and multibacillary leprosy. CONCLUSIONS: Strict evaluation and follow-up of HC with positive results for APGL-I is recommended. Special attention should be paid during the screening of siblings of the index cases, HC of patients with a high bacillary index, and HC of patients with indeterminate leprosy.

Objetivo Avaliar o estresse oxidativo, perfil antioxidante e de micronutrientes em pacientes portadores de hanseníase multibacilar e paucibacilar antes do tratamento poliquimioterápico. Métodos Analisaram-se 52 amostras de soro de pacientes portadores de hanseníase - 38 multibacilares e 14 paucibacilares -, usuários do ambulatório de dermatologia de um hospital público universitário, além de 30 amostras controles. Quantificaram-se marcador de peroxidação lipídica malondialdeído pelo método de substâncias reativas ao ácido tiobarbitúrico, antioxidante glutationa reduzida pelo método baseado na quantificação de tiol solúvel em ácido, antioxidante vitamina E por cromatografia líquida de alta eficiência, minerais selênio, zinco, cobre, magnésio por espectrometria de massa com fonte plasma acoplado, e sorologia do anticorpo glicolipídio fenólico I pelo método Enzyme-Linked Immunosorbent Assay. Foi utilizado teste não paramétrico de Mann-Whitney para comparar as variáveis quantificadas neste estudo entre os diferentes grupos, e correlação de Pearson para verificar associação dessas variáveis com o anticorpo. O critério de significância adotado foi de p<0,05. Resultados Houve diferença significativa para o malondialdeído (p<0,001) e vitamina E (p<0,001) no grupo controle comparado aos grupos com hanseníase, multibacilar e paucibacilar. No entanto, essas mesmas variáveis não diferiram entre os grupos multibacilar e paucibacilar (p=0,495 e p=0,920 respectivamente). A glutationa reduzida foi superior no grupo controle em relação ao grupo com hanseníase (p=0,012) e multibacilar (p=0,001), no entanto não diferiu do grupo paucibacilar (p=0,920). Quando comparada com os multibacilares e paucibacilares, a glutationa reduzida também não diferiu (p=0,063). Quanto aos minerais, todos se apresentaram dentro da normalidade, exceto o magnésio, cujos níveis foram deficientes em todos os pacientes do estudo. Não foi possível observar correlação do anticorpo glicolipídio fenólico I com as demais variáveis. Conclusão Os pacientes paucibacilares parecem possuir maior defesa antioxidante de glutationa reduzida, semelhante à de indivíduos saudáveis. Baixos níveis de vitamina E nos pacientes com hanseníase são sugestivos dos benefícios de suplementação. As alterações metabólicas observadas não evidenciaram relação com a sorologia do glicolipídio fenólico I.

Objective To determine the oxidative stress and the antioxidant and micronutrient profile of patients with multibacillary and paucibacillary leprosy before polychemotherapeutic treatment. Methods Thirty control samples and fifty-two serum samples from leprosy patients who attended the dermatology outpatient clinic of a public university hospital were analyzed; 38 of them had multibacillary and 14 paucibacillarty. Malondialdehyde, a marker of lipid peroxidation, was determined using the thiobarbituric acid reacting substances assay; the antioxidant reduced glutathione was determined using a method based on the quantification of acid-soluble thiol; the antioxidant vitamin E was determined using High-Performance Liquid Chromatography; the minerals selenium, zinc, copper and magnesium were determined using coupled-mass spectrometry, and the serum phenol I glycolipid antibody was determined using Enzyme-Linked Immunosorbent Assay. The nonparametric Mann-Whitney test was used to compare the variables quantified in the present study between the different groups, and Pearson's correlation analysis was used to verify the association between these variables and the antibody. The significance level was set at p<0.05. Results There was a significant difference in the content of malondialdehyde (p<0.001) and vitamin E (p<0.001) between the groups with multibacillary and paucibacillary leprosy (p=0.495 and p=0.920, respectively) and the control groups. Reduced glutathione levels were higher in the control group compared with those of the group with leprosy (p=0.012) and multibacillary leprosy (p=0.001), but did it not differ from that of the paucibacillary group (p=0.920). Reduced glutathione levels did not differ between the multibacillary and paucibacillary groups (p=0.063) either. All minerals were within normal limits, except for magnesium; magnesium deficiency was detected in all groups studied. No correlation was observed between the anti-phenolic glycolipid I antibody and the remaining variables. Conclusion Paucibacillary patients seem to have more pronounced reduced glutathione antioxidant defense, similar to that of healthy individuals. The low vitamin E levels of leprosy patients suggest the benefits of supplementation. The metabolic changes observed did not demonstrate an association with anti-phenolic glycolipid I serology.

To evaluate ultrasonographic (US) cross-sectional areas (CSAs) of peripheral nerves, indexes of the differences between CSAs at the same point (∆CSAs) and between tunnel (T) and pre-tunnel (PT) ulnar CSAs (∆TPTs) in leprosy patients (LPs) and healthy volunteers (HVs). Seventy-seven LPs and 49 HVs underwent bilateral US at PT and T ulnar points, as well as along the median (M) and common fibular (CF) nerves, to calculate the CSAs, ∆CSAs and ∆TPTs. The CSA values in HVs were lower than those in LPs (p < 0.0001) at the PT (5.67/9.78 mm2) and T (6.50/10.94 mm2) points, as well as at the M (5.85/8.48 mm2) and CF (8.17/14.14 mm2) nerves. The optimum CSA- receiver operating characteristic (ROC) points and sensitivities/specificities were, respectively, 6.85 mm2 and 68-85% for the PT point, 7.35 mm2 and 71-78% for the T point, 6.75 mm2 and 62-75% for the M nerve and 9.55 mm2 and 81-72% for the CF nerve. The ∆CSAs of the LPs were greater than those of the HVs at the PT point (4.02/0.85; p = 0.007), T point (3.71/0.98; p = 0.0005) and CF nerve (2.93/1.14; p = 0.015), with no difference found for the M nerve (1.41/0.95; p = 0.17). The optimum ∆CSA-ROC points, sensitivities, specificities and p-values were, respectively, 1.35, 49%, 80% and 0.003 at the PT point, 1.55, 55-85% and 0.0006 at the T point, 0.70, 58-50% and 0.73 for the M nerve and 1.25, 54-67% and 0.022 for the CF nerve. The ∆TPT in the LPs was greater than that in the HVs (4.43/1.44; p <0.0001). The optimum ∆TPT-ROC point was 2.65 (90% sensitivity/41% specificity, p < 0.0001). The ROC analysis of CSAs showed the highest specificity and sensitivity at the PT point and CF nerve, respectively. The PT and T ∆CSAs had high specificities (> 80%) and ∆TPT had the highest specificity (> 90%). New sonographic peripheral nerve measurements (∆CSAs and ∆TPT) provide an important methodological improvement in the detection of leprosy neuropathy.

INTRODUCTION: This study evaluated the intracellular profile of interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-10 (IL-10) and interferon-γ (IFN-γ) in peripheral blood mononuclear cells (PBMCs) from leprosy patients based on oral infections presence to determine whether these coinfections could be associated with pro-inflammatory activity in leprosy. METHODS: Leprosy patients regardless of clinical form and specific leprosy treatment (n=38) were divided into two groups: Group I - leprosy patients with oral infections (n=19), and Group II - leprosy patients without oral infections (n=19). Non-leprosy patients presenting oral infections were assigned to the control Group (n=10). Intracellular IL-2, IL-4, IL-10 and IFN-γ production was evaluated by flow cytometry (FACS) before and 7 days after controlling the oral infection in the Group I, before and 7 days after dental prophylaxis in the Group II, and during oral infection process in control Group. RESULTS: Low percentages of CD3+ lymphocytes bearing IL-2, IL-10 and IFN-γ were observed in the Group I and Group II at baseline and 7 days after therapy or prophylaxis compared to controls. Group I showed reduced percentages of IL-4 at baseline and 7 days after therapy compared to controls, or at baseline of Group II, and the Group II showed reduced percentages of CD3+ cells bearing IL-4 compared to control. An increase of the percentages of CD3+cells bearing IL-4 was observed in the Group I after the oral infections treatment. CONCLUSIONS: The occurrence of oral infections favors the intracellular cytokines expression and, probably, the inflammatory reaction operating as a stimulatory signal triggering the leprosy reactions.

Leprosy is an ancient disease that remains endemic and continues to be a major public health problem in some tropical countries, where it has been internationally recognized as being linked to the underdevelopment conditions. The natural course of the disease covers a wide variety of clinical conditions with systemic involvement. In this paper, we review the findings obtained in studies of the pathological mechanisms of leprosy, including a survey of the literature and of our own work. The understanding and control of the wide variety of clinical conditions should help improve patient care and thus prevent the onset of physical impairment and the stigma of the disease.

OBJECTIVE: This study aimed to determine the frequency of coinfections in leprosy patients and whether there is a relationship between the presence of coinfections and the development of leprosy reactional episodes. METHOD: A cross-sectional study based on an analysis of the medical records of the patients who were treated at the Leprosy Clinics of the Ribeirão Preto Medical School, University of São Paulo, was conducted from 2000 to 2010. Information was recorded regarding the age, sex, clinical status, WHO classification, treatment, presence of reactions and coinfections. Focal and systemic infections were diagnosed based on the history, physical examination, and laboratory tests. Multinomial logistic regression was used to evaluate the associations between the leprosy reactions and the patients' gender, age, WHO classification and coinfections. RESULTS: Two hundred twenty-five patients were studied. Most of these patients were males (155/225 = 68.8%) of an average age of 49.31±15.92 years, and the most prevalent clinical manifestation was the multibacillary (MB) form (n = 146), followed by the paucibacillary (PB) form (n = 79). Erythema nodosum leprosum (ENL) was more prevalent (78/122 = 63.9%) than the reversal reaction (RR) (44/122 = 36.1%), especially in the MB patients (OR 5.07; CI 2.86-8.99; p<0.0001) who exhibited coinfections (OR 2.26; CI 1.56-3.27; p,<0.0001). Eighty-eight (88/225 = 39.1%) patients exhibited coinfections. Oral coinfections were the most prevalent (40/88 = 45.5%), followed by urinary tract infections (17/88 = 19.3%), sinusopathy (6/88 = 6.8%), hepatitis C (6/88 = 6.8%), and hepatitis B (6/88 = 6.8%). CONCLUSIONS: Coinfections may be involved in the development and maintenance of leprosy reactions.

Uma revisão centrada no impacto de doenças e intervenções dermatológicas no ato solidário de doar sangue é apresentada aos dermatologistas para melhor aconselhamento dos seus pacientes. Esta é uma revisão das atuais normas técnicas brasileiras sobre procedimentos hemoterápicos conforme determinado pela Portaria Ministerial no 1353/2011 do Ministério da Saúde e atuais normas internas do Hemocentro de Ribeirão Preto, um centro de referência regional em procedimentos hemoterápicos. Critérios para inaptidão definitiva: doenças autoimunes (>1 órgão comprometido), antecedente pessoal de câncer diferente de carcinoma basocelular, dermatite atópica ou psoríase graves, pênfigo foliáceo, porfirias, filariose, hanseníase, tuberculose ou paracoccidioidomicose extrapulmonares e uso prévio de etretinato. São condições de inelegibilidade temporária: uso de outros retinóides sistêmicos, corticoides sistêmicos, inibidores da 5-alfa-redutase, vacinas, metotrexato, betabloqueadores, minoxidil, anticonvulsivantes e antipsicóticos. Outras condições responsáveis por inaptidão temporária: acidente ocupacional com material biológico, "piercing", tatuagem, doenças sexualmente transmissíveis, herpes, infecções bacterianas, entre outras. Discussão: Talidomida atualmente não consta na lista de medicações teratogênicas. Apesar do uso da finasterida já ter sido considerada como critério para inaptidão definitiva, de acordo com sua meia-vida curta a restrição atual de 1 mês ainda é demasiadamente longa. Dermatologistas devem ser capazes de aconselhar seus pacientes sobre o momento adequado para doar sangue e discutir o impacto da suspensão de medicações nos resultados do tratamento de forma a respeitar os períodos de restrição designados.

A focused and commented review on the impact of dermatologic diseases and interventions in the solidary act of donating blood is presented to dermatologists to better advise their patients. This is a review of current Brazilian technical regulations on hemotherapeutic procedures as determined by Ministerial Directive #1353/2011 by the Ministry of Health and current internal regulations of the Hemotherapy Center of Ribeirão Preto, a regional reference center in hemotherapeutic procedures. Criteria for permanent inaptitude: autoimmune diseases (>1 organ involved), personal history of cancer other than basal cell carcinoma, severe atopic dermatitis or psoriasis, pemphigus foliaceus, porphyrias, filariasis, leprosy, extra pulmonary tuberculosis or paracoccidioidomycosis, and previous use of etretinate. Drugs that impose temporary ineligibility: other systemic retinoids, systemic corticosteroids, 5-alpha-reductase inhibitors, vaccines, methotrexate, beta-blockers, minoxidil, anti-epileptic, and anti-psychotic drugs. Other conditions that impose temporary ineligibility: occupational accident with biologic material, piercing, tattoo, sexually transmitted diseases, herpes, and bacterial infections, among others. Discussion: Thalidomide is currently missing in the teratogenic drugs list. Although finasteride was previously considered a drug that imposed permanent inaptitude, according to its short halflife current restriction of 1 month is still too long. Dermatologists should be able to advise their patients about proper timing to donate blood, and discuss the impact of drug withdrawal on treatment outcomes and to respect the designated washout periods.

FUNDAMENTOS: A biomembrana vegetal tem sido usada para tratamento de úlceras cutâneas. OBJETIVOS: Avaliar a ação da biomembrana vegetal no tratamento de úlceras venosas crônicas, comparando-a ao tratamento à base de colagenase. MÉTODOS: Foram selecionados 14 pacientes tratados com biomembrana vegetal e sete com Fibrase® (grupo controle), acompanhados clínico-fotograficamente pelo índice de cicatrização das úlceras (ICU) por 120 dias, por meio do software ImageJ, e biopsiados no primeiro e 30º dias para estudo histopatológico. RESULTADOS: A biomembrana vegetal foi superior em relação ao controle na cicatrização das úlceras no 30º dia, especialmente na fase inflamatória, confirmada pela exsudação abundante e pelo desbridamento. Houve tendência superior à angiogênese seguida de reepitelização com maiores ICUs no 90º e 120º dias. CONCLUSÃO: A análise conjunta dos achados clínicos e histopatológicos sugere que a biomembrana vegetal atuou como um fator indutor da cicatrização, especialmente na fase inflamatória, confirmada pela exsudação abundante das lesões, promovendo a transformação do microambiente das úlceras venosas crônicas e estimulando a angiogênese e a posterior reepitelização.

BACKGROUND: The vegetal biomembrane has been used to treat cutaneous ulcers. OBJECTIVES: To assess the role of the vegetal biomembrane on the chronic venous ulcers treatment compared to treatment with collagenase cream. METHODS: Fourteen patients were selected to be treated with vegetal biomembrane and 7 with Fibrase®(CONTROL), followed clinically and photographically by the Wound Healing Index by ImageJ during 120 days and biopsied on the 1st and 30th days for histological examination. RESULTS: The vegetal biomembrane was better in promoting healing of the ulcers, especially on the inflammatory phase, confirmed by abundant exudation and wound debridement than the CONTROL group, on the 30th day. There was a greater tendency to angiogenesis followed by re-epithelialization with highest wound healing index on the 90th and 120th days. CONCLUSION: A combined analysis of clinical and histopathological findings suggests that the vegetal biomembrane acted as a factor inducing wound healing, especially on the inflammatory phase, confirmed by abundant exudation of the lesions promoting the transformation of the microenvironment of the chronic venous ulcers, and also stimulating angiogenesis and subsequent re-epithelialization.

FUNDAMENTOS: A biomembrana vegetal do látex da seringueira Hevea brasiliensis tem sido usada como curativo para úlceras cutâneas. OBJETIVOS: Avaliar a segurança da biomembrana vegetal como curativo em relação à hipersensibilidade ao látex. MÉTODOS: Foram selecionados pacientes com úlceras cutâneas constituindo-se os grupos: controle - baixa exposição profissional ao látex (n=17); alta exposição profissional (n=14); ulcerados em uso da biomembrana vegetal (n=13); ulcerados-controle sem uso da biomembrana vegetal (n=14) e casos novos (n=9), submetidos à avaliação pré e após 3 meses de uso da biomembrana vegetal. Todos foram submetidos à avaliação clínico-epidemiológica quanto à hipersensibilidade ao látex e IgE específica (UniCap®), e os grupos controle e controle exposto ao látex ao "patch test". RESULTADOS: A história de hipersensibilidade foi positiva em 64,7% dos pacientes do grupo-controle, 71,4% do controle exposto ao látex, 61,5% dos ulcerados em uso da biomembrana vegetal, 35,7% dos ulcerados-controle, e apenas 22,2% no grupo casos novos. Ao teste de contato dos grupos controle e controle exposto ao látex, apenas um indivíduo do grupo C (baixo contato) apresentou eritema na primeira leitura, negativando-se na segunda. A média de contato com látex no grupo-controle exposto ao látex foi de 3,42 horas/dia. No ensaio fluoroimunoenzimático, a grande maioria dos soros foi classificada como zero (variação 0 a 6). Nenhum soro recebeu classificação acima de 2, não sendo considerada classificação significante para hipersensibilidade (classificação > 4). CONCLUSÃO: A biomembrana vegetal mostrou-se segura como curativo, pois não induziu reações de hipersensibilidade entre os voluntários submetidos ao "patch test", nem entre os usuários da biomembrana vegetal, como demonstrado clinica e imunologicamente pela dosagem de IgE.

BACKGROUND: The natural biomembrane of latex extracted from Hevea brasiliensis has been used as a dressing for skin ulcers. OBJECTIVES: To evaluate how safe the natural biomembrane is in relation to hypersensitivity to latex when used as a dressing. METHODS: We selected patients with skin ulcers, forming the following groups: control - low occupational exposure to latex (n = 17); latex-exposed control - high occupational exposure (n = 14); ulcerated, using the natural biomembrane (n = 13); ulcerated control, not using the natural biomembrane (n = 14); and new cases (n = 9), assessed before and after 3 months of using the natural biomembrane. All patients underwent clinical and epidemiological evaluation for latex hypersensitivity and specific IgE (UniCap®), and the control and latex-exposed control groups underwent the patch test. RESULTS: Hypersensitivity was positive in 64.7% of the patients in the control group, 71.4% of the patients in the latex-exposed control group, 61.5% of the ulcerated using the natural biomembrane, 35.7% of the ulcerated control, and only 22 , 2% of the new cases. In the patch test of the control and latex-exposed control groups, only one individual in the control group (low contact) showed erythema in the first reading, which became negative in the second. The mean contact with latex in the latex-exposed control group was 3.42 hours / day. In the fluoroimmunoenzymatic assay, most of the sera was classified as zero (range 0-6). No serum was rated above 2, which is not considered significant for hypersensitivity (classification > 4). CONCLUSION: The natural biomembrane proved to be safe as a dressing, for it did not induce hypersensitivity reactions among the volunteers who underwent the patch test or among users of the natural biomembrane, as it was clinically and immunologically demonstrated by IgE levels.

INTRODUÇÃO: Este estudo avaliou se as reações hansênicas podem estar associadas a infecções orais. MÉTODOS: Pacientes com hanseníase (n=38) com (Grupo I) e sem (Grupo II) infecções orais foram selecionados. As reações foram identificadas pelas características clínicas, histopatológicas, associadas a proteína-C-reativa (PCR) e proteína indutora de interferon-gamma de 10kDa (IP-10) séricos determinados antes e após a eliminação dos focos de infecção. RESULTADOS: Grupo I apresentou mais reações que o grupo II, e melhora das reações após o tratamento odontológico. PCR e IP-10 séricos não diferiram antes e após o tratamento odontológico, entretanto diferiram entre os grupos. CONCLUSÕES: As infecções orais podem ser exacerbadores das reações hansênicas.

INTRODUCTION: This study evaluated whether leprosy reactions could be associated with oral infection. METHODS: Leprosy patients (n = 38) with (Group I) and without (Group II) oral infections were selected. Reactions were identified from the clinical and histopathological features associated with serum C-reactive protein (CRP) and10kDa interferon-gamma-induced protein (IP-10) levels, determined before and after elimination of the foci of infection. RESULTS: Group I presented more reactions than group II did, and improvement of the reactions after dental treatment. Serum CRP and IP-10 did not differ before and after the dental treatment, but differed between the groups. CONCLUSIONS: Oral infection could be an exacerbating factor in leprosy reactions.

A cross-sectional clinical trial in which the serum anti-phenolic glycolipid (anti-PGL-1) antibodies were analysed in household contacts (HHC) of patients with leprosy as an adjunct early leprosy diagnostic marker was conducted. The families of 83 patients underwent clinical examination and serum anti-PGL1 measurement using enzyme-linked immunosorbent assay. Of 320 HHC, 98 were contacts of lepromatous leprosy (LL), 80 were contacts of borderline lepromatous (BL), 28 were contacts of borderline (BB) leprosy, 54 were contacts of borderline tuberculoid (BT), 40 were contacts of tuberculoid (TT) and 20 were contacts of indeterminate (I) leprosy. Consanguinity with the patients was determined for 232 (72.5%) HHC. Of those 232 contacts, 183 had linear consanguinity. Forty-nine HHC had collateral consanguinity. Fifty-eight contacts (18.1%) tested positive for anti-PGL1 antibodies. The number of seropositive contacts based on the clinical forms of the index case was 17 (29.3%) for LL, 15 (25.9%) for BL, one (1.7%) for BB, 14 (24.1%) for BT, three (5.2%) for TT and eight (13.7%) for I. At the one year follow-up, two (3.4%) of these seropositive contacts had developed BT leprosy. The results of the present study indicate that the serum anti-PGL-1 IgM antibody may be useful for evaluating antigen exposure and as a tool for an early leprosy diagnosis in HHC.

CONTEXTO E OBJETIVO: Diabetes mellitus é uma síndrome clínica que freqüentemente leva ao desenvolvimento de complicações crônicas, e também, alta susceptibilidade a infecções, provavelmente devido a um defeito na defesa imunológica, que pode ser relacionada ao controle metabólico da doença. Neste estudo, propomos avaliar o efeito do controle metabólico no comportamento imunocelular de pacientes diabéticos tipo 1 e 2 através da proliferação in vitro de células mononucleares de sangue periférico (PBMC) em pacientes com controle metabólico inadequado e adequado. TIPO DE ESTUDO E LOCAL: Estudo experimental e laboratorial, realizado em hospital universitário. MÉTODOS: Estudamos 11 diabéticos do tipo 1 e 13 do tipo 2 além de 21 controles saudáveis, divididos em dois grupos (11/10), pareados para sexo e idade aos diabéticos tipo 1 e 2. Usamos culturas de PBMCs estimuladas com concanavalina (Con-A) para medir a incorporação de ³H-timidina após 72 horas de cultura de células. As culturas foram realizadas no primeiro dia de internação para os pacientes em controle metabólico inadequado, e repetidas após o controle metabólico adequado. RESULTADOS: O índice de estimulação das culturas estimuladas com Con-A nos diabéticos tipo 1 foi significantemente maior que na cultura de indivíduos saudáveis e diabéticos tipo 2, independentemente do controle metabólico. Além disso, foi observada uma correlação negativa entre o índice de proliferação e o índice de massa corporal e níveis de proteína-C. CONCLUSÃO: O aumento na capacidade de proliferação de linfócitos de diabéticos tipo 1 não é causado por hiperglicemia e/ou insulinopenia relacionada a controle inadequado.

CONTEXT AND OBJECTIVE: Diabetes mellitus is a clinical syndrome that frequently leads to the development of chronic complications and high susceptibility to infections. It is probably due to defective immunological defense, which may be related to metabolic control of the disease. The aim of this study was to evaluate the effect of metabolic control on immune-cell behavior in type 1 and type 2 diabetic patients. For this, the in vitro proliferation of peripheral blood mononuclear cells (PBMC) was analyzed in patients with inadequate and adequate metabolic control. DESIGN AND SETTING: Experimental/laboratory study at a university hospital. METHODS: Eleven type 1 and thirteen type 2 diabetic patients were studied, together with 21 healthy individuals divided in two groups (11/10), who were matched by sex and age with those diabetic patients. PBMC cultures stimulated with concanavalin-A (Con-A) were used to measure ³H-thymidine incorporation after 72 hours of cell culturing. For patients with inadequate metabolic control, culturing was performed on the first day of patient hospitalization and again after intensive treatment to achieve adequate control. RESULTS: The proliferation index for Con-A-stimulated cultures from type 1 diabetic patients was significantly greater than that for cultures from healthy individuals and type 2 diabetic patients, independent of metabolic control. A negative correlation between the proliferation cell index and body mass index and serum C-reactive protein levels was also observed. CONCLUSION: The increase in the proliferation capacity of type 1 diabetic T lymphocytes was probably not caused by hyperglycemia and/or insulinopenia related to inadequate metabolic control.

FUNDAMENTOS: Úlcera de perna (UP) caracteriza-se por perda do tegumento nas extremidades dos membros inferiores causada geralmente por disfunção vascular. OBJETIVOS: Caracterizar clínica e epidemiologicamente a amostra populacional com UP atendida nos centros de saúde de Juiz de Fora. PACIENTES E MÉTODOS: Submetidos ao protocolo clínico 124 pacientes com UP, de Juiz de Fora e região de janeiro/1999 a agosto/2001. RESULTADOS: A média de idade foi 64 anos, 65,3% do sexo feminino, média de 3,7 indivíduos/família e renda inferior a R$540,00 (86,8%). Associavam-se às úlceras insuficiência venosa (90,3%), hipertensão arterial sistêmica (54%), obesidade (20,2%) e diabetes mellitus (16,1%). A associação insuficiência venosa e hipertensão arterial foi freqüente (43,7%) e significante (p<0.01) para predisposição às úlceras. Foram classificadas como venosas (79%), hipertensivas (15,4%), mistas e outras(5,6%). Acometiam terço distal das pernas (90%), de tamanho grande (5cm) em cerca de 90% da amostra, com médias de 8,7cm e 9,6cm para os eixos vertical e horizontal, respectivamente. Estavam acompanhadas de hipercromia (92,7%), lipodermatoesclerose (68,5%) e varicosidades (66,9%), com duração média de 94,2 meses, e 50% das úlceras eram recidivantes. CONCLUSÕES: Os dados sugerem que a úlcera de perna seja doença crônica significativa na população idosa e de baixa renda de Juiz de Fora e região.

BACKGROUND: Leg ulcers are characterized as tissue loss in the lower extremities, generally caused by vascular dysfunction. OBJECTIVES: Verify the clinical and epidemiological profiles of the population sample with leg ulcers treated at the health centers of Juiz de Fora (Brazil). MATERIAL AND METHODS: 124 leg-wound patients were evaluated between January 1999 and August 2001 and submitted to a clinical protocol. RESULTS: The mean age was 64 years, with females in the majority (65.3%). The mean family composition was 3.7 persons, and family income was around US$200.00 (86.8%). Venous insufficiency (90.3%), systemic arterial hypertension (54%), obesity (20.2%) and diabetes mellitus (16.1%) were the most frequent events associated with the ulcers. An association of venous insufficiency and arterial hypertension was frequent in 43.7% of the sample, and significant (p<0.01) to predisposition to the ulcers. These were classified as venous (79%), hypertensive (15.4%), mixed and other (5.6%). The ulcers were generally localized in the distal third of legs (90%) and considered large (5 cm) in about 90% of the sample, with means of 8.7 cm and 9.6 cm to vertical and horizontal axes, respectively. The ulcers were accompanied mainly by hyperpigmentation (92.7%), lipodermatosclerosis (68.5%) and varicose veins (66.9%), with a mean duration of 94.2 months and 50% of them recurrent. CONCLUSIONS: The data suggested that leg ulcer is an important chronic disease in the elderly and poor population of Juiz de Fora and region.