02992nas a2200517   4500000000100000008004100001260001300042653001500055653001000070653000900080653003100089653001100120653001000131653002100141653001900162653002600181653002100207653002400228653003000252653001100282653001100293653002300304653002800327653000900355653001600364653002800380653002200408653003200430653001700462653001600479100001200495700001400507700001400521700001800535700001400553700001300567700001200580700001400592245008400606856006100690300001400751490000700765050001500772520167300787022001402460       2013                            d  c2013 Sep10aAdolescent10aAdult10aAged10aAmbulatory Care Facilities10aBrazil10aChild10aChild, Preschool10aCohort Studies10aDisability Evaluation10aDisabled Persons10aDisease Progression10aDrug Therapy, Combination10aFemale10aHumans10aLeprostatic Agents10aLeprosy, Multibacillary10aMale10aMiddle Aged10aNervous System Diseases10aPatient Discharge10aProportional Hazards Models10aRisk Factors10aYoung Adult1 aSales A1 aCampos DP1 aHacker MA1 aCosta Nery JA1 aDuppre NC1 aRangel E1 aSarno E1 aPenna MLF00aProgression of leprosy disability after discharge: is multidrug therapy enough?  uhttp://onlinelibrary.wiley.com/doi/10.1111/tmi.12156/pdf  a1145-11530 v18  aSALES 20133 a<p><b>OBJECTIVE: </b>To evaluate the risk factors related to worsening of physical disabilities after treatment discharge among patients with leprosy administered 12 consecutive monthly doses of multidrug therapy (MDT/WHO).</p><p><b>METHODS: </b>Cohort study was carried out at the Leprosy Laboratory in Rio de Janeiro, Brazil. We evaluated patients with multibacillary leprosy treated (MDT/WHO) between 1997 and 2007. The Cox proportional hazards model was used to estimate the relationship between the onset of physical disabilities after release from treatment and epidemiological and clinical characteristics.</p><p><b>RESULTS: </b>The total observation time period for the 368 patients was 1 570 person-years (PY), averaging 4.3 years per patient. The overall incidence rate of worsening of disability was 6.5/100 PY. Among those who began treatment with no disability, the incidence rate of physical disability was 4.5/100 PY. Among those who started treatment with Grade 1 or 2 disabilities, the incidence rate of deterioration was 10.5/100 PY. The survival analysis evidenced that when disability grade was 1, the risk was 1.61 (95% CI: 1.02-2.56), when disability was 2, the risk was 2.37 (95% CI 1.35-4.16), and when the number of skin lesions was 15 or more, an HR = 1.97 (95% CI: 1.07-3.63). Patients with neuritis showed a 65% increased risk of worsening of disability (HR = 1.65 [95% CI: 1.08-2.52]).</p><p><b>CONCLUSION: </b>Impairment at diagnosis was the main risk factor for neurological worsening after treatment/MDT. Early diagnosis and prompt treatment of reactional episodes remain the main means of preventing physical disabilities.</p>  a1365-3156