ABSTRACT Introduction: it refers to the importance of the use of information and communication technologies in distance learning, considering the reflections of Ph D. López Palacio, Professor of Merit of “Marta Abreu” Central University of Las Villas, who has committed himself with the quality of education in this modality. Objective: to base the use of information and communication technologies in distance learning, according to the reflections of Ph D. López Palacio. Methods: a literature review was carried out from January to March 2019. Original and review articles in electronic and printed texts, in Spanish, were considered. Electronic articles were selected in SciELO, Dialnet and Google Scholar databases. The following criteria were included: mention of the use of information and communication technologies and distance learning. Development: criteria of several authors are presented, and especially the reflections of Ph D. López Palacio; the development of science and technology in Cuba and its influence in the educational field, its application in pedagogy from a theoretical and practical point of view, and the characteristics of distance learning and its perspectives in the Cuban educational context are based. Conclusions: the use of these technologies at present supports the work with the distance learning modality in higher education; it constitutes a renewal approach that favors the autonomous and independent study of students in training.

RESUMEN Introducción: refiere la importancia del uso de las tecnologías de la informática y las comunicaciones en la educación a distancia, considerando las reflexiones del Dr. Juan Virgilio López Palacio, Profesor de Mérito de la Universidad Central “Marta Abreu” de Las Villas, quien apuesta por la calidad de la educación en esta modalidad. Objetivo: fundamentar el uso de las tecnologías de la información y las comunicaciones en la educación a distancia, atendiendo a las reflexiones del Dr. Juan Virgilio López Palacio. Métodos: se realizó una revisión bibliográfica entre enero-marzo 2019. Se consideraron artículos originales y de revisión en textos digitales e impresos, en español. Los artículos en soporte digital fueron seleccionados en las bases de datos SciELO, Dialnet y Google Académico. Se tuvieron como criterios de inclusión: mención al uso de las tecnologías de la información y las comunicaciones y la educación a distancia. Desarrollo: se exponen criterios de varios autores, y en especial las reflexiones del Dr. Juan Virgilio López Palacio; se fundamentan el desarrollo de la ciencia y la tecnología en Cuba y su influencia en el campo educativo, su aplicación en la pedagogía desde el punto de vista teórico y práctico, y las características de la educación a distancia y sus perspectivas en el contexto educacional cubano. Conclusiones: el uso de estas tecnologías sustenta hoy el trabajo con la modalidad a distancia en la educación superior; constituye un enfoque renovador que favorece el estudio autónomo e independiente de los estudiantes en formación.

ABSTRACT Background: it refers to the importance of Didactics in the preparation of the university teaching staff, taking into account the suggestions of PhD. López Palacio, an outstanding professor at “Marta Abreu” Central University of Las Villas, who reaffirms the need to include these programs in all university degrees, where students who will later practice as teachers are trained. Objective: to base the importance of Didactics in the preparation of the university teaching staff, according to the suggestions of PhD. López Palacio. Method: a bibliographic review was carried out from January to March 2019. Original and review articles were considered in electronic and printed texts, in Spanish. The scanned articles were consulted on SciELO, Dialnet and Google Scholar. The inclusion criteria were included: mention of Didactics and the training of the university teaching staff. Development: criteria of several authors are presented and in particular the suggestions of PhD. López Palacio are taken as a reference, about the preparation of the university professor as a priority of the university of the 21st century and the role that Didactics plays in its formation, they propose some actions that demand the application of Didactics, as a science that offers the teacher a comprehensive preparation, valid for the different teaching levels. Conclusions: the teaching preparation of the university professor must begin since the beginning of its career with the introduction of Didactics in its curricula, and it will have its continuity in postgraduate programs to guarantee its steady and systematic updating.

RESUMEN Introducción: refiere la importancia de la Didáctica en la preparación del personal docente universitario, teniendo en cuenta las sugerencias del Dr. Juan Virgilio López Palacio, profesor destacado de la Universidad Central “Marta Abreu” de Las Villas, quien reafirma la necesidad de incluir estos programas en todas las carreras universitarias, donde se forman alumnos que más tarde ejercerán como docentes. Objetivo: fundamentar la importancia de la Didáctica en la preparación del personal docente universitario, según las sugerencias del Dr. Juan Virgilio López Palacio. Métodos: se realizó una revisión bibliográfica entre enero-marzo 2019. Se consideraron artículos originales y de revisión en textos digitales e impresos, en español. Los artículos digitalizados se consultaron en SciELO, Dialnet y Google Académico. Se tuvo como criterios de inclusión: mención a la Didáctica y a la formación del personal docente universitario. Desarrollo: se exponen criterios de varios autores y en especial se toman como referente las sugerencias del Dr. López Palacio, sobre la preparación del profesor universitario como una prioridad de la universidad del siglo XXI y la influencia de la Didáctica en su formación, se proponen algunas acciones que demandan su aplicación como ciencia que ofrece al docente una preparación integral, válida para los diferentes niveles de enseñanza. Conclusiones: la preparación docente del profesor universitario debe comenzar desde el inicio de su carrera con la introducción de la Didáctica en sus currículos, y tendrá su continuidad en programas de posgrado para garantizar su actualización permanente y sistemática.

Resumo A relação entre filantropia, poder público e conhecimento científico é analisada a partir da experiência de Helena Antipoff na Sociedade Pestalozzi de Minas Gerais. Essa instituição promoveu, na primeira metade do século XX, iniciativas de auxílio às crianças “anormais”. O apoio às classes especiais, o trabalho do Consultório Médico Pedagógico, a criação da Associação de Assistência ao Pequeno Jornaleiro, as atividades do Instituto Pestalozzi e a Fazenda do Rosário são exemplos de parcerias entre poder público e filantropia. A centralidade do nome de Helena Antipoff na Sociedade Pestalozzi imprimiu na instituição a marca de sua idealizadora. Formada na Europa, mais especificamente no Instituto Jean-Jacques Rousseau, Helena Antipoff conciliou a filantropia e a ciência em prol dos “anormais”.

Abstract The relationships between philanthropy, government, and scientific knowledge are analyzed through the experience of Helena Antipoff at the Sociedade Pestalozzi of Minas Gerais. In the first half of the twentieth century, this institution spearheaded welfare initiatives for “abnormal” children. Support for disabled people, the work of the Medical Education Office, the creation of an association for the care of newsboys, and the activities of the Pestalozzi Institute and Fazenda do Rosário farm are examples of partnerships between the authorities and philanthropic organizations. Today, Sociedade Pestalozzi is strongly associated with the identity of its founder. Educated in Europe, at Institut Jean-Jacques Rousseau, Helena Antipoff conciliated philanthropy and science for the good of the “abnormal.”

Abstract Background: The presence of enthesitis is associated with higher disease activity, more disability and incapacity to work and a poorer quality of life in spondyloarthritis (SpA). There is currently no consensus on which clinical score should be used to assess enthesitis in SpA. The objective of the present work was to compare the correlation of three enthesitis indices (MASES, SPARCC and LEI) with measures of disease activity and function in a heterogeneous population of patients with axial and peripheral SpA. Methods: A cross-sectional study was conducted in three Brazilian public university hospitals; patients fulfilling ASAS classification criteria for peripheral or axial SpA were recruited and measures of disease activity and function were collected and correlated to three enthesitis indices: MASES, SPARCC and LEI using Spearman's Correlation index. ROC curves were used to determine if the the enthesitis indices were useful to discriminate patients with active disease from those with inactive disease. Results: Two hundred four patients were included, 71.1% (N = 145) fulfilled ASAS criteria for axial SpA and 28.9% (N = 59) for peripheral SpA. In axial SpA, MASES performed better than LEI (p = 0.018) and equal to SPARCC (p = 0.212) regarding correlation with disease activity (BASDAI) and function (BASFI). In peripheral SpA, only MASES had a weak but statistical significant correlation with DAS28-ESR (rs 0.310 p = 0.05) and MASES had better correlation with functional measures (HAQ) than SPARCC (p = 0.034). Conclusion: In this sample composed of SpA patients with high coexistence of axial and peripheral features, MASES showed statistical significant correlation with measures of disease activity and function in both axial and peripheral SpA.

Resumo Uma das medidas de controle da leishmaniose visceral (LV) no Brasil se baseia na identificação e eliminação do reservatório canino. Existe considerável controvérsia relativa a esta estratégia incluindo a correta identificação dos cães positivos e a variação temporal da relação hospedeiro-parasita, o que torna esta medida ainda mais desafiadora. Uma coorte dinâmica de 62 cães foi acompanhada trimestralmente utilizando-se métodos sorológicos, parasitológicos e a PCR. A taxa de positividade por PCR foi maior em comparação à dos métodos sorológicos e parasitológicos, e mostrou tendência à diminuição com o passar do tempo, enquanto que a positividade sorológica apresentou tendência a aumento, após seis meses. Observou-se positividade concomitante em todos os testes em 10,4% das amostras e, negatividade concomitante, em 29,1%. A sensibilidade geral variou de 43,6% a 64,1%, não sendo uniforme ao longo do estudo. A proporção de cães com e sem sinais clínicos que foram positivos ao exame parasitológico ou à PCR não foi estatisticamente diferente. Contudo, foi possível identificar como positivos um maior número de animais assintomáticos por meio da técnica de PCR, em comparação aos testes ELISA e imunocromatográfico. A PCR pode ser bastante útil para a vigilância epidemiológica de áreas onde casos de LV canina ainda não tenham sido descritos e onde estratégias de controle podem ser implantadas para limitar a disseminação da doença. Não obstante o avanço nas ferramentas diagnósticas, diagnosticar a LVC continua um desafio.

Abstract One of the measures to control visceral leishmaniosis (VL) in Brazil is the identification and culling of the canine reservoir. There is much controversy concerning this strategy, including the proper identification of positive dogs and the fact that the host-parasite relationship changes over time make it more challenging. A dynamic cohort of 62 dogs was followed every three months using serological and parasitological examinations and PCR. Positivity by PCR was higher than by serology and by parasitological examinations and showed a tendency to decrease over time, while serology tended to increase after six months. Concomitant positivity in all tests was observed in 10.4% of the samples, and negativity in 29.1%. Overall sensitivity ranged from 43.6 to 64.1%, and was not uniform over time. The proportion of dogs with or without clinical signs was not different by cytology or PCR but PCR was able to identify a larger number of asymptomatic dogs compared to ELISA and immunochromatography. PCR can be useful for surveillance of areas where cases of canine VL have not yet been detected and in which control strategies can be implemented to limit the spread of the disease. Despite the advance in diagnostic tools CVL diagnosis remains a challenge.

Racional: Através de variações rítmicas, o diafragma influencia a pressão do EEI, atuando como um esfíncter externo. O registro manométrico da sua pressão caracteriza-se por aumento de pressão na inspiração resultante da contração da crura diafragmática que envolve o esfíncter. Objetivo: Descrever um método de medida da pressão do esfíncter esofágico inferior (EEI) durante manobras inspiratórias padronizadas, com cargas crescentes. Métodos: Oito voluntários sadios (sexo feminino, média de idade de 31,5 anos) participaram do estudo. Uma manometria esofágica de alta resolução e impedanciometria mediram a pressão do EEI durante manobras inspiratórias com o Threshold sob cargas de 12, 24 e 48 cm H2O. Resultados: Comparando-se as médias houve diferença significativa entre a pressão máxima do EEI e a sua pressão basal máxima durante o primeiro (diferença de 76,19±17,92, p=0,0008), segundo (diferença 86,92±19,01, p=0,0004) e terceiro segundos da manobra (diferença 90,86±17,93, p=0,0002), tanto com carga de 12 cm de H2O, quanto com 24 e 48 cm. Conclusão: Esta manobra é uma padronização da pressão inspiratória do EEI e pode diferenciar melhor pacientes com doença do refluxo de indivíduos sadios, podendo também ser útil na monitorização do tratamento desses pacientes por meio do treinamento muscular inspiratório.

Background: Through rhythmic variations, the diaphragm influence lower esophageal sphincter (LES) pressure acting as an external sphincter. LES pressure recording is characterized by increased pressure in inspiration due to contraction of the diaphragmatic crura that involves the sphincter. Aim: To describe a method of measuring LES pressure during standardized inspiratory maneuvers with increasing loads. Methods: The study population comprised of eight healthy female volunteers (average age of 31.5 years). An esophageal high-resolution manometry and impedance system was used for measuring the LES pressure during 3-second inspiratory efforts under 12, 24 and 48 cm H2O loads (Threshold maneuvers). Results: There was a significant difference between the average maximum LES pressure and the average maximum basal LES pressure during the first (76.19±17.92 difference, p=0.0008), second (86.92±19.01 difference, p=0.0004), and third seconds of the maneuver (90.86±17.93 difference, p=0.0002), with 12, 24 and 48 cmH2O loads. Conclusion: This maneuver is a standardization of the inspiratory LES pressure and may better differentiate patients with reflux disease from healthy individuals, and may also be useful for monitoring the treatment of these patients through inspiratory muscle training.

Traqueobronquite aguda é uma forma rara da aspergilose invasiva e geralmente ocorre em pacientes com imunodepressão grave. Relatamos o caso de um paciente no pós-transplante de medula óssea com a manifestação desta doença, dando ênfase aos achados tomográficos encontrados.

Acute tracheobronchitis is a rare manifestation of invasive aspergillosis, generally occurring in severely immunocompromised patients. The authors report the case of a patient presenting with this condition after bone-marrow transplantation, with emphasis on tomographic findings.

El trabajo tiene como objetivo analizar el comportamiento del acero AISI 1045 sometido a deformado en frío con el empleo de rodillo simple y luego traccionado. Se analiza el efecto de las imperfecciones cristalinas del material después de ser sometido a ambos procesos de deformación y tracción. El diseño de experimento contempla las variables empleadas en el proceso de deformación, las cuales están relacionadas con la fuerza, el avance y el número de revoluciones. Se determina en las microestructuras observadas, las imperfecciones en la estructura metalográfica con la reducción del tamaño promedio de los granos producto de los efectos combinados de deformación tracción. Las probetas para la deformación plástica se prepararon según se establece para el ensayo de tracción tradicional; en este caso, la superficie se endureció con un rodillo hasta lograr una dureza según fueron cambiadas las variables del proceso. La observación metalográfica se hizo posible a través del encapsulado de las muestras ya que las mismas son de pequeños tamaños.

In this paper the analysis of the behaviour of the AISI 1045 steel subjected to cold deformation by using a simple roller and then stressed, is carry out. It is also analyzed the effect of crystalline imperfections of this alloy being subjected to hardened and both processes of deformation and traction. The experimental design takes into account the variables employed in the deformation process, which are related to the force, the displacement and the number of revolutions. The imperfections in the metallographic structure are determined by microscopic observation which allows assessing the reduction of the average size of grains due to the combined effects of the deformation and traction. The test tubes for the deformation were prepared as indicated for traditional traction tests. In this study the surface was hardened using a roller until achieving the specific hardness due to the changes on process variables. The metallographic observation became possible through the encapsulation of samples, due to their small sizes.

OBJECTIVE: Translate, culturally adapt, and validate a new Spanish version of the Oral Health Impact Profile (OHIP) for older persons in Mexico City, Mexico. METHODS: A validation study of the new version of OHIP-Mx-49 was carried out through interviews and clinical examinations of people aged 60 or older in the southern area of Mexico City. The following variables were analyzed: sociodemographic (age, sex, marital status, level of schooling, and whether the subject lived alone), clinical (current number of teeth, coronal and root caries, dental hygiene, and the use of removable prostheses and dentures), and self-perception (of the need for dental and general health care). The OHIP-Mx-49 value was calculated as the sum of the scores in seven dimensions: functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. The internal consistency (Cronbach's alpha coefficient), replicability (intraclass correlation coefficient), and convergent and discriminant validity (Mann-Whitney and Kruskal-Wallis tests) were assessed. RESULTS: Of the 131 people interviewed (average age: 73.8 ± 8.3 years), 77.9% were women. High internal consistency values were obtained for the OHIP-Mx-49 (0.96) and the dimensions (0.79-0.86), and replicability in the instrument (0.877) and all the dimensions except social disability (0.176). The average OHIP-Mx-49 score was 37.1 ± 35.3; higher scores were observed in people with 1-9 teeth (P = 0.02), people who did not have coronal caries (P = 0.02), and people who perceived a need for dental care (P = 0.01). CONCLUSIONS: The OHIP-Mx-49 is a reliable and valid instrument that can be used with older Mexicans.

OBJETIVOS: Traducir, adaptar culturalmente y validar una nueva versión en español del instrumento denominado perfil de impacto de la salud bucal (OHIP) en adultos mayores de la Ciudad de México, México. MÉTODOS: Estudio de validación de la nueva versión OHIP-Mx-49 mediante entrevistas y exámenes clínicos a personas de 60 años o más del sur de la Ciudad de México. Se analizaron variables sociodemográficas (edad, sexo, estado civil, nivel de escolaridad y si vive solo), clínicas (número de dientes presentes, caries coronal y radicular, higiene de la dentadura, y uso de prótesis removible y dentadura total) y de autopercepción (necesidad de tratamiento dental y de salud general). Como valor del OHIP-Mx-49 se tomó la suma de las puntuaciones alcanzadas en sus siete dimensiones: limitación funcional, dolor, incomodidad psicológica, inhabilidad física, inhabilidad psicológica, inhabilidad social e incapacidad. Se evaluó la consistencia interna (coeficientes a de Cronbach), la repetibilidad (coeficiente de correlación intraclase) y la validez convergente y discriminativa (pruebas de Mann-Whitney y de Kruskal-Wallis). RESULTADOS: De las 131 personas entrevistadas (edad promedio: 73,8 ± 8,3 años), 77,9% eran mujeres. Se obtuvieron valores elevados de consistencia interna, tanto del OHIP-Mx-49 (0,96) como de las dimensiones (0,79-0,86), y de repetibilidad en el instrumento (0,877) y todas las dimensiones, excepto inhabilidad social (0,176). La puntuación promedio del OHIP-Mx-49 fue de 37,1 ± 35,3; se observaron mayores puntuaciones en las personas con 1-9 dientes (P = 0,02), las que no presentaron caries coronal (P = 0,02) y las que percibían necesitar tratamiento dental (P = 0,01). CONCLUSIONES: El OHIP-Mx-49 es un instrumento confiable y válido que puede aplicarse en adultos mayores mexicanos.

El trabajo muestra las técnicas empleadas en un diseño de experimento que permite evaluar el comportamiento de las variables independientes fuerza (P), desde 500 hasta 2500 N, número de revolución (n) mínimo 27, medio 54 y máximo 110 rev/min y avance (s), 0,075, 0, 125 y 0,25 mm/rev, para determinar el comportamiento de la variable dependiente dureza (H), cuando una probeta de acero AISI 1045 es sometida a tratamiento superficial por rodadura para crear un estado compresivo que lo deforme e incremente su resistencia al desgaste y la fatiga. Se realiza el procesamiento estadístico de las variables involucradas en el proceso donde se demuestra el incremento de la dureza desde 220 hasta 262 HV. Se empleó el método de microscopía óptica para analizar el efecto del endurecimiento por deformación, estableciendo el mecanismo de endurecimiento del acero por el deslizamiento de los granos en la red cristalina por el fenómeno de la acritud.

The work shows the techniques employees in an experiment design that allows to evaluate the behavior of the independent variables force (P), from 500 up to 2500 N, revolution number (n) minimum 27, half 54 and maximum 110 rev/min and advance (s), 0,075, 0, 125 and 0,25 mm/rev, to determine the behavior of the variable dependent hardness (H), when a steel test tube AISI 1045 are subjected to superficial treatment for rolling to create a compressive state that the unsightly thing and increase its resistance to abrasive wear and the fatigue. He/she is carried out the statistical prosecution of the variables involved in the process where the increment of the hardness is demonstrated from 220 up to 262 HV. The method of optic microscopy was used to analyze the effect of the hardening for deformation, establishing the mechanism of hardening of the steel for the slip of the grains in the crystalline net for the phenomenon of the acrimony.

Duas novas flavanonas naturais, 5-hidroxi-6,7-(2",2"-dimetilcromeno)flavanone (1) e 5-metoxi-3-hidroxi-6,7-(2",2"-dimetilcromeno)flavanone (2), foram isoladas dos extratos das raízes de L. yucatanensis e L. xuul, respectivamente. Adicionalmente, quatro novos metabólitos, os flavanóides glicosídicos quercetina-3-ramnoglucosídeo e caempferol-3-ramnoglucosídeo, juntamente com 4-hidroxi-N-metil-prolina, e o éster metílico do ácido p-cumárico, foram isolados pela primeira vez das folhas de L. xuul. Os metabólitos foram identificados usando os dados espectroscópicos obtidos e pela comparação desses com aqueles encontrados na literatura.

Two new natural flavanones, 5-hydroxy-6,7-(2",2"-dimethylchromene)flavanone (1) and 5-methoxy-3-hydroxy-6,7-(2",2"-dimethylchromene)flavanone (2), were isolated from the root extracts of L. yucatanensis and L. xuul, respectively. Additionally, four known metabolites, the glycosidic flavonoids quercetin-3-rhamnoglucoside and kaempferol-3-rhamnoglucoside, together with 4-hydroxy-N-methyl-proline, and p-coumaric acid methyl ester, were isolated for the first time from the leaves of L. xuul. The various metabolites were identified on the basis of their spectroscopic data and by comparison with those reported in the literature.

FUNDAMENTOS: A neurite silenciosa é definida como deterioração da função nervosa na ausência de dor neural, diferenciando-se da neurite franca, em que ocorre dor no nervo periférico, com ou sem prejuízo da função nervosa. Sua detecção precoce é importante para tentar impedir o estabelecimento de seqüelas decorrentes da hanseníase. OBJETIVOS: Conhecer a freqüência das neurites silenciosas em portadores de formas multibacilares de hanseníase. MÉTODOS: Cento e três pacientes (18,4% BB, 47,6% BL e 34% LL) foram acompanhados durante o período médio de 64,6 meses a partir do momento do diagnóstico, durante e após a poliquimioterapia, por meio da avaliação do grau de incapacidade. RESULTADOS: Foram analisados doentes que tiveram piora do grau de incapacidade no término de tratamento, ou ao fim do seguimento, em relação ao grau manifestado antes do tratamento ou no término do tratamento medicamentoso. Ao todo, pelo menos cinco pacientes (4,9% do total) evoluíram com neurite silenciosa, durante ou após a poliquimioterapia. CONCLUSÃO: Preconiza-se exame neurológico seqüencial cuidadoso dos pacientes multibacilares, de modo a detectar e tratar precocemente a neurite silenciosa.

BACKGROUND: Silent neuritis is defined as deterioration of the neural function without neural pain, in contrast to overt neuritis, characterized by pain in the peripheral nerve that may accompany damage to neural function. Its early detection is important to prevent the development of leprosy disabilities. OBJECTIVES: To evaluate the frequency of silent neuritis in multibacillary leprosy patients. METHODS: One hundred and three patients (18.4% BB, 47.6% BL and 34% LL) were followed-up for an average of 64.6 months from diagnosis, during and after multidrug therapy, in relation to physical impairments and according to a disability grade. RESULTS: Patients that presented a worsening of the disability grade by the end of treatment or at the end of follow-up compared to the baseline grade or to the end of treatment, were studied. Altogether we detected five patients (4.9% of the total) that developed silent neuritis, during or after multidrug therapy. CONCLUSION: We recommend a careful regular neurological examination of multibacillary patients, with a view to prompt detection and treatment of silent neuritis.

The effect of the intraperitoneal administration of a protein hydrolysate of Chlorella vulgaris microalga at a dose of 500 mg/kg of weight during 6 days, as a supplement of the conventional diet in the recovery of the immunocompetence of Balb/c mice with protein-energy malnutrition experimentally induced by diet restriction, was evaluated. The intervention with the hydrolysate led to the restoration of the count of total leukocytes at values similar to those of the control group and to an increase in the levels of lymphocytes in peripheral blood. It also stimulated the proliferation of the cells from the mononuclear phagocytic system and the metabolism of the macrophages, expressed by a higher activity of the lysosomal acid phsosphatase and the rise of the relative weight and the hematopoietic activity of the spleen. These modullating actions allow to consider the product as an immunological active compound capable of inducing an increased state of nonspecific resistance in the organism.

Se evaluó el efecto de la administración intraperitoneal de un hidrolizado proteico de la microalga Chlorella vulgaris en una dosis de 500 mg/kg de peso durante 6 días, como complemento de la dieta convencional en la recuperación de la inmunocompetencia de ratones Balb/c con malnutrición proteico-energética inducida experimentalmente por restricción dietética. La intervención con el hidrolizado implicó la restauración del conteo de leucocitos totales a valores similares a los del grupo control; a un incremento en los niveles de linfocitos en sangre periférica; estimuló la proliferación de las células del sistema fagocítico mononuclear y el metabolismo de los macrófagos, expresado por una mayor actividad de la enzima fosfatasa ácida lisosomal y al aumento del peso relativo y actividad hematopoyética del bazo. Estas acciones moduladoras permiten considerar al producto como un preparado inmunológicamente activo capaz de inducir un estado incrementado de resistencia no específica en el organismo.

FUNDAMENTOS: As incapacidades constituem o principal problema decorrente da hanseníase. É importante identificar os fatores de risco envolvidos, de modo a acompanhar os pacientes mais propensos com maior atenção. OBJETIVOS: Determinar se a presença de nervos periféricos espessados e/ou dolorosos no momento do diagnóstico se correlaciona com a ocorrência de incapacidades físicas no exame inicial, bem como com episódios posteriores de neurite, em pacientes multibacilares, durante e após a poliquimioterapia. MÉTODOS: Foram estudados 103 pacientes portadores de formas multibacilares de hanseníase, sendo anotados a presença de nervos periféricos acometidos no momento o diagnóstico, o grau de incapacidade antes do tratamento (GIAT), e a ocorrência de episódios de neurites durante e após a poliquimioterapia para multibacilares. RESULTADOS: A detecção de nervos periféricos acometidos à época do diagnóstico correlacionou-se estatisticamente (p< 0,005) com a ocorrência de incapacidades físicas (GIAT > 0). Do mesmo modo, correlacionou-se significativamente (p < 0,05) com a ocorrência de neurites, durante a poliquimioterapia e no acompanhamento subseqüente (período médio de seguimento dos pacientes de 64,6 meses, a partir do diagnóstico). CONCLUSÃO: Sublinha-se a necessidade de realização de cuidadoso exame dos nervos periféricos por ocasião do diagnóstico, tanto para uma maior atenção para incapacidades já instaladas, quanto com relação à prevenção de incapacidades posteriores. Os profissionais que lidam com os portadores desta enfermidade devem estar atentos ao acometimento neurológico inicial por constituir fator de suscetibilidade às neurites e seqüelas neurológicas.

BACKGROUND: Disabilities constitute the main problem of leprosy. It is important to identify risk factors involved, so it can be possible the prone patients be followed-up more carefully. OBJECTIVES: To determine if the presence of thick and/or painful peripheral nerves at diagnosis correlates with disabilities already present at the initial examination, as well as with subsequent development of neuritis, during and after multidrug therapy. METHODS: One hundred and three patients with multibacillary forms of leprosy were studied, and we noted the presence of compromised peripheral nerves at diagnosis, the disability grade before treatment (DGBT), and the occurrence of neuritis episodes during and after multibacillary multidrug therapy. RESULTS: The detection of affected peripheral nerves at diagnosis correlated statistically (p < 0.005) with the occurrence of disabilities (DGBT > 0). It also correlated significantly with the development of neuritis in the follow-up (average of 64.6 months from diagnosis, during and after multidrug therapy). CONCLUSIONS: We emphasize the need of a good examination of peripheral nerve trunks in multibacillary patients at the diagnosis, in order to improve the detection of disabilities already present, and specially to prevent further disabilities. Healthy professionals who deal with leprosy patients must be aware to the inicial neurological impairments because those patients are more susceptible to the occurrence of neuritis and neurological sequelae.