Compreendendo a “alta em hanseníase”: uma análise de conceito

Resumo OBJETIVO Analisar o conceito de alta em hanseníase. MÉTODOS Estudo teórico pautado no referencial metodológico de análise de conceito. Realizou-se levantamento bibliográfico, de dezembro de 2015 a janeiro de 2016, nas bases SCOPUS, CINAHL, PUBMED, LILACS, SCIELO e BDENF, mediante uso dos descritores “Hanseníase” e “Alta do Paciente”, obtendo-se 13 estudos. RESULTADOS Identificou-se alta por cura, alta medicamentosa, alta bacteriológica e pós-alta como possíveis usos do conceito. Os atributos definidos foram conclusão da poliquimioterapia, conclusão da poliquimioterapia para paucibacilares, conclusão da poliquimioterapia para multibacilares e cura da hanseníase. Como antecedentes, identificou-se infecção pelo M. leprae, acometimento de pele e de nervos periféricos, diagnóstico e tratamento e reações hansênicas. Saída do registro ativo de casos de hanseníase e continuidade de atenção em saúde foram os consequentes. Apresentou-se um caso modelo e um caso contrário. CONCLUSÕES A análise ampliou o conceito “alta em hanseníase”, para além da clínica focada na poliquimioterapia

Physical disabilities in leprosy patients after discharge from multidrug therapy in Northern Brazil

Chronic sequelae and disabilities are one of the main problems in leprosy. The current study aimed to estimate the prevalence of disabilities in leprosy patients after successfully completing multidrug therapy in Araguaína, Tocantins State, Brazil. This was a cross-sectional study including 282 cases diagnosed from 2004 to 2009. The degrees of disability at diagnosis and at discharge from treatment were collected from medical records and the National Information System for Notifiable Diseases (SINAN). A simplified neurological workup was performed after discharge from treatment. The prevalence of disabilities at diagnosis was 29.4%, and 8.9% of then was grade II. Between diagnosis and discharge, the degree of physical disability worsened in 25% of cases. At diagnosis, the proportion of deformities was significantly higher in men (RR = 1.7; 95%CI: 1.23-2.37). There was a significant association between disability and multibacillary disease (p < 0.001) and occurrence of reactions (p < 0.001). The data show that after discharge from multidrug therapy, in order to prevent chronic sequelae and functional limitations, continuous monitoring is still needed for individuals that have been recorded as cured and thus deleted from the records

Masting is uncommon in trees that depend on mutualist dispersers in the context of global climate and fertility gradients

The benefits of masting (volatile, quasi-synchronous seed production at lagged intervals) include satiation of seed predators, but these benefits come with a cost to mutualist pollen and seed dispersers. If the evolution of masting represents a balance between these benefits and costs, we expect mast avoidance in species that are heavily reliant on mutualist dispersers. These effects play out in the context of variable climate and site fertility among species that vary widely in nutrient demand. Meta-analyses of published data have focused on variation at the population scale, thus omitting periodicity within trees and synchronicity between trees. From raw data on 12 million tree-years worldwide, we quantified three components of masting that have not previously been analysed together: (i) volatility, defined as the frequency-weighted year-to-year variation; (ii) periodicity, representing the lag between high-seed years; and (iii) synchronicity, indicating the tree-to-tree correlation. Results show that mast avoidance (low volatility and low synchronicity) by species dependent on mutualist dispersers explains more variation than any other effect. Nutrient-demanding species have low volatility, and species that are most common on nutrient-rich and warm/wet sites exhibit short periods. The prevalence of masting in cold/dry sites coincides with climatic conditions where dependence on vertebrate dispersers is less common than in the wet tropics. Mutualist dispersers neutralize the benefits of masting for predator satiation, further balancing the effects of climate, site fertility and nutrient demands