Point-of-care ultrasound of peripheral nerves in the diagnosis of Hansen's disease neuropathy
Introduction Hansen's disease (HD) is the most common cause of treatable peripheral neuropathy in the world that may or may not involve skin manifestations, and physical examination based on simplified neurologic evaluation is a subjective and inaccurate procedure. High-resolution ultrasound (H...
Saved in:
Published in | Frontiers in medicine Vol. 9; p. 985252 |
---|---|
Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Frontiers Media S.A
09.09.2022
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | Introduction
Hansen's disease (HD) is the most common cause of treatable peripheral neuropathy in the world that may or may not involve skin manifestations, and physical examination based on simplified neurologic evaluation is a subjective and inaccurate procedure. High-resolution ultrasound (HRUS) can be used to evaluate peripheral nerves and is a validated technique of good reproducibility, permitting a detailed and precise examination.
Objectives
We proposed to establish objective criteria for absolute values of the measurement of the CSA of peripheral nerves and their indices of the ΔCSA and ΔTpT in the diagnosis of Hansen's disease neuropathy as compared with healthy voluntaries.
Materials and methods
In municipalities from different regions of Brazil, we randomly selected 234 volunteer Brazilian patients diagnosed with leprosy to be submitted to peripheral nerve echography and compared with 49 healthy Brazilian volunteers.
Results
Hansen Disease assessed by high resolution ultrasound is a primarily neural disease that leads to multiple hypertrophic mononeuropathy characterized by CSA values exceeding normal limits (Med CT = 10.2 mm
2
; UT = 9.8 mm
2
; UPT = 9.3 mm
2
; CFFH = 18.3 mm
2
; T = 9.6 mm
2
), and the pattern of asymmetry (ΔCSA>2.5 mm
2
with RR 13) and focality (ΔTPT > 2.5 mm
2
with RR 6.4) of this thickening has higher sensitivity (76,1%) and specificity (87,8 %) for its early diagnosis that laboratory tests. Analyzing each subject, the percentage of thickened nerves detected among the total number of nerves assessed was higher among patients with HD than among healthy individuals (
p
< 0.0001). Individuals with two or more thickened nerves were at 24.1 times higher relative risk (95% CI: 6.74–88.98) of HD. |
---|---|
AbstractList | Introduction
Hansen's disease (HD) is the most common cause of treatable peripheral neuropathy in the world that may or may not involve skin manifestations, and physical examination based on simplified neurologic evaluation is a subjective and inaccurate procedure. High-resolution ultrasound (HRUS) can be used to evaluate peripheral nerves and is a validated technique of good reproducibility, permitting a detailed and precise examination.
Objectives
We proposed to establish objective criteria for absolute values of the measurement of the CSA of peripheral nerves and their indices of the ΔCSA and ΔTpT in the diagnosis of Hansen's disease neuropathy as compared with healthy voluntaries.
Materials and methods
In municipalities from different regions of Brazil, we randomly selected 234 volunteer Brazilian patients diagnosed with leprosy to be submitted to peripheral nerve echography and compared with 49 healthy Brazilian volunteers.
Results
Hansen Disease assessed by high resolution ultrasound is a primarily neural disease that leads to multiple hypertrophic mononeuropathy characterized by CSA values exceeding normal limits (Med CT = 10.2 mm
2
; UT = 9.8 mm
2
; UPT = 9.3 mm
2
; CFFH = 18.3 mm
2
; T = 9.6 mm
2
), and the pattern of asymmetry (ΔCSA>2.5 mm
2
with RR 13) and focality (ΔTPT > 2.5 mm
2
with RR 6.4) of this thickening has higher sensitivity (76,1%) and specificity (87,8 %) for its early diagnosis that laboratory tests. Analyzing each subject, the percentage of thickened nerves detected among the total number of nerves assessed was higher among patients with HD than among healthy individuals (
p
< 0.0001). Individuals with two or more thickened nerves were at 24.1 times higher relative risk (95% CI: 6.74–88.98) of HD. IntroductionHansen's disease (HD) is the most common cause of treatable peripheral neuropathy in the world that may or may not involve skin manifestations, and physical examination based on simplified neurologic evaluation is a subjective and inaccurate procedure. High-resolution ultrasound (HRUS) can be used to evaluate peripheral nerves and is a validated technique of good reproducibility, permitting a detailed and precise examination.ObjectivesWe proposed to establish objective criteria for absolute values of the measurement of the CSA of peripheral nerves and their indices of the ΔCSA and ΔTpT in the diagnosis of Hansen's disease neuropathy as compared with healthy voluntaries.Materials and methodsIn municipalities from different regions of Brazil, we randomly selected 234 volunteer Brazilian patients diagnosed with leprosy to be submitted to peripheral nerve echography and compared with 49 healthy Brazilian volunteers.ResultsHansen Disease assessed by high resolution ultrasound is a primarily neural disease that leads to multiple hypertrophic mononeuropathy characterized by CSA values exceeding normal limits (Med CT = 10.2 mm2; UT = 9.8 mm2; UPT = 9.3 mm2; CFFH = 18.3 mm2; T = 9.6 mm2), and the pattern of asymmetry (ΔCSA>2.5 mm2 with RR 13) and focality (ΔTPT > 2.5 mm2 with RR 6.4) of this thickening has higher sensitivity (76,1%) and specificity (87,8 %) for its early diagnosis that laboratory tests. Analyzing each subject, the percentage of thickened nerves detected among the total number of nerves assessed was higher among patients with HD than among healthy individuals (p < 0.0001). Individuals with two or more thickened nerves were at 24.1 times higher relative risk (95% CI: 6.74–88.98) of HD. |
Author | Conde, Guilherme Barreto, Josafá Gonçalves Silva, Claudia Maria Lincoln Salgado, Claudio Guedes Santana, Jaci Maria Da Silva, Moises Batista De Paula, Natália Aparecida Voltan, Glauber Filho, Fred Bernards Leite, Marcel Nani Frade, Marco Andrey Cipriani |
AuthorAffiliation | 3 Federal University of Pará, Belém , Pará , Brazil 1 Department of Interne Medicine - Dermatology, Faculty of Medicine of Ribeirão Preto, University of São Paulo , São Paulo , Brazil 2 Faculty of Medicine of Ribeirão Preto, University of São Paulo , São Paulo , Brazil |
AuthorAffiliation_xml | – name: 3 Federal University of Pará, Belém , Pará , Brazil – name: 1 Department of Interne Medicine - Dermatology, Faculty of Medicine of Ribeirão Preto, University of São Paulo , São Paulo , Brazil – name: 2 Faculty of Medicine of Ribeirão Preto, University of São Paulo , São Paulo , Brazil |
Author_xml | – sequence: 1 givenname: Glauber surname: Voltan fullname: Voltan, Glauber – sequence: 2 givenname: Fred Bernards surname: Filho fullname: Filho, Fred Bernards – sequence: 3 givenname: Marcel Nani surname: Leite fullname: Leite, Marcel Nani – sequence: 4 givenname: Natália Aparecida surname: De Paula fullname: De Paula, Natália Aparecida – sequence: 5 givenname: Jaci Maria surname: Santana fullname: Santana, Jaci Maria – sequence: 6 givenname: Claudia Maria Lincoln surname: Silva fullname: Silva, Claudia Maria Lincoln – sequence: 7 givenname: Josafá Gonçalves surname: Barreto fullname: Barreto, Josafá Gonçalves – sequence: 8 givenname: Moises Batista surname: Da Silva fullname: Da Silva, Moises Batista – sequence: 9 givenname: Guilherme surname: Conde fullname: Conde, Guilherme – sequence: 10 givenname: Claudio Guedes surname: Salgado fullname: Salgado, Claudio Guedes – sequence: 11 givenname: Marco Andrey Cipriani surname: Frade fullname: Frade, Marco Andrey Cipriani |
BookMark | eNpVkc9rFTEQxxepYK29e9ybXvaZ35u9CFKsLRT0oOBFwiSZvJeyL1mT3UL_e3d9Rexphpkvnxm-39fNWcoJm-YtJTvO9fAhHNHvGGFsN2jJJHvRnDM2qE5L_fPsv_5Vc1nrPSGEciYF5efNr285prnLoXNQsF3GuUDNS_JtDu2EJU4HLDC2CcsD1jamdj5g6yPsU66xbqobSBXTu7pOK0LFVbuUPMF8eHzTvAwwVrx8qhfNj-vP369uuruvX26vPt11TvBh7ngQJHC0whNLMGDQJNhBMOo9C0wr7J1XllvtQHlNnZQAPUVNvOgpHxS_aG5PXJ_h3kwlHqE8mgzR_B3ksjdQ5uhGNL2nJDCrQHIigrDWSrScetsLKhy4lfXxxJoWu9rqMK2WjM-gzzcpHsw-P5hBEqGVXgHvnwAl_16wzuYYq8NxhIR5qYb1VCuuiNr-JiepK7nWguHfGUrMlqzZkjVbsuaULP8DN4acYw |
CitedBy_id | crossref_primary_10_25259_IJPGD_36_2022 crossref_primary_10_3389_fmed_2022_1059448 crossref_primary_10_1371_journal_pone_0285450 crossref_primary_10_1038_s41598_024_60457_0 |
Cites_doi | 10.1111/jdv.15569 10.1007/978-3-642-25594-6 10.1007/978-1-4614-7184-4 10.1371/journal.pntd.0005766 10.1111/jon.12590 10.1007/s002560050584 10.1016/j.cult.2014.03.006 10.47276/lr.77.4.371 10.1371/journal.pntd.0004276 10.1371/journal.pntd.0005111 10.1128/CMR.19.2.338-381.2006 10.1371/journal.pntd.0000498 10.1007/s11910-012-0328-x 10.1007/s00256-016-2517-1 10.1016/j.clinph.2018.03.036 10.1148/radiol.11101644 10.47276/lr.78.4.416 10.1148/radiol.2501080397 10.1590/0004-282X20130046 10.1016/S1474-4422(09)70026-2 10.1590/0074-02760170173 10.1016/j.diii.2015.09.014 10.1111/ane.13432 10.1016/S0887-2171(00)90043-X 10.1002/mus.23417 10.1016/j.cmi.2019.05.020 10.47276/lr.88.4.574 10.1002/mus.23269 10.1590/S0074-02762013000300001 10.1016/j.clinph.2013.03.007 10.1148/radiol.13122901 10.1590/S0365-05962009000500008 10.1055/s-0033-1356385 |
ContentType | Journal Article |
Copyright | Copyright © 2022 Voltan, Filho, Leite, De Paula, Santana, Silva, Barreto, Da Silva, Conde, Salgado and Frade. 2022 Voltan, Filho, Leite, De Paula, Santana, Silva, Barreto, Da Silva, Conde, Salgado and Frade |
Copyright_xml | – notice: Copyright © 2022 Voltan, Filho, Leite, De Paula, Santana, Silva, Barreto, Da Silva, Conde, Salgado and Frade. 2022 Voltan, Filho, Leite, De Paula, Santana, Silva, Barreto, Da Silva, Conde, Salgado and Frade |
DBID | AAYXX CITATION 7X8 5PM DOA |
DOI | 10.3389/fmed.2022.985252 |
DatabaseName | CrossRef MEDLINE - Academic PubMed Central (Full Participant titles) Directory of Open Access Journals |
DatabaseTitle | CrossRef MEDLINE - Academic |
DatabaseTitleList | CrossRef MEDLINE - Academic |
Database_xml | – sequence: 1 dbid: DOA name: Directory of Open Access Journals url: https://www.doaj.org/ sourceTypes: Open Website |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 2296-858X |
EndPage | 985252 |
ExternalDocumentID | oai_doaj_org_article_7d10f2b6a5304f4bbb5eb31db7414cac 10_3389_fmed_2022_985252 |
GrantInformation_xml | – fundername: ; |
GroupedDBID | 53G 5VS 9T4 AAFWJ AAYXX ACGFS ACXDI ADBBV ADRAZ AFPKN ALMA_UNASSIGNED_HOLDINGS AOIJS BAWUL BCNDV CITATION DIK GROUPED_DOAJ HYE IAO IEA IHR IHW ISR KQ8 M48 M~E OK1 PGMZT RPM 7X8 ITC 5PM |
ID | FETCH-LOGICAL-c439t-3f40f3eb4d0b0efef80fb9421dd2f286e7cd6b3b8ca6d81c55aa71e80d4713963 |
IEDL.DBID | RPM |
ISSN | 2296-858X |
IngestDate | Fri Oct 04 13:08:46 EDT 2024 Tue Sep 17 21:35:58 EDT 2024 Thu Aug 15 22:51:44 EDT 2024 Thu Sep 26 19:19:55 EDT 2024 |
IsDoiOpenAccess | true |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Language | English |
License | This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c439t-3f40f3eb4d0b0efef80fb9421dd2f286e7cd6b3b8ca6d81c55aa71e80d4713963 |
Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Reviewed by: Abdallah El-Sayed Allam, Tanta University, Egypt; Plamen Todorov Todorov, Plovdiv Medical University, Bulgaria Edited by: Federica Veronese, Azienda Ospedaliero Universitaria Maggiore della Carità, Italy This article was submitted to Dermatology, a section of the journal Frontiers in Medicine |
OpenAccessLink | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9504868/ |
PQID | 2718636066 |
PQPubID | 23479 |
PageCount | 1 |
ParticipantIDs | doaj_primary_oai_doaj_org_article_7d10f2b6a5304f4bbb5eb31db7414cac pubmedcentral_primary_oai_pubmedcentral_nih_gov_9504868 proquest_miscellaneous_2718636066 crossref_primary_10_3389_fmed_2022_985252 |
PublicationCentury | 2000 |
PublicationDate | 2022-09-09 |
PublicationDateYYYYMMDD | 2022-09-09 |
PublicationDate_xml | – month: 09 year: 2022 text: 2022-09-09 day: 09 |
PublicationDecade | 2020 |
PublicationTitle | Frontiers in medicine |
PublicationYear | 2022 |
Publisher | Frontiers Media S.A |
Publisher_xml | – name: Frontiers Media S.A |
References | Chacha (B2) 2009; 84 Miyamoto (B33) 2014; 270 Klauser (B31) 2011; 259 Lugão (B9) 2015; 9 Frade (B10) 2013; 36 Suk (B16) 2013; 13 Lugão (B18) 2017; 46 Bathala (B19) 2017; 11 Bignotti (B26) 2014; 9 Bernardes F (B7) 2017; 112 Pottecher (B30) 2016; 97 Nagappa (B34) 2021; 144 Klauser (B32) 2009; 250 Visser (B35) 2012; 46 Chen (B27) 2006; 77 Lugão (B8) 2016; 10 Kerasnoudis (B21) 2013; 124 Martinoli (B15) 2000; 21 Boehm (B23) 2014; 35 (B11) 2009; 8 Tagliafico (B22) 2012; 46 Wortsman (B14) 2013 (B1) 2017 B5 Lothet (B29) 2019; 29 Gurung (B36) 2019; 25 Alemu Belachew (B3) 2019; 33 Jain (B20) 2009; 3 Grimm (B24) 2018; 129 Martinoli (B28) 2000; 29 Martinoli (B17) 2000; 21 Peer (B25) 2013 El Gency (B12) 2017; 88 Van Brakel (B13) 2007; 78 Scollard (B4) 2006; 19 Garbino (B6) 2013; 71 |
References_xml | – volume: 33 start-page: 1205 year: 2019 ident: B3 article-title: Position statement: LEPROSY: diagnosis, treatment and follow-up publication-title: J Eur Acad Dermatology Venereol. doi: 10.1111/jdv.15569 contributor: fullname: Alemu Belachew – volume-title: Atlas of Peripheral Nerve Ultrasound 2013 With Anatomic and MRI Correlation. year: 2013 ident: B25 doi: 10.1007/978-3-642-25594-6 contributor: fullname: Peer – year: 2013 ident: B14 publication-title: Dermatologic Ultrasound with Clinical and Histologic Correlations doi: 10.1007/978-1-4614-7184-4 contributor: fullname: Wortsman – volume: 11 start-page: 1 year: 2017 ident: B19 article-title: Extensive sonographic ulnar nerve enlargement above the medial epicondyle is a characteristic sign in Hansen's neuropathy publication-title: PLoS Negl Trop Dis. doi: 10.1371/journal.pntd.0005766 contributor: fullname: Bathala – volume: 29 start-page: 406 year: 2019 ident: B29 article-title: Ultrasound-derived nerve cross-sectional area in extremes of height and weight publication-title: J Neuroimaging. doi: 10.1111/jon.12590 contributor: fullname: Lothet – volume: 29 start-page: 142 year: 2000 ident: B28 article-title: US and MR imaging of peripheral nerves in leprosy publication-title: Skeletal Radiol. doi: 10.1007/s002560050584 contributor: fullname: Martinoli – volume: 9 start-page: 525 year: 2014 ident: B26 article-title: Ultrasonography of peripheral nerves: anatomy and pathology publication-title: Ultrasound Clin. doi: 10.1016/j.cult.2014.03.006 contributor: fullname: Bignotti – volume: 77 start-page: 371 year: 2006 ident: B27 article-title: Inter-observer reliability in assessment of sensation of skin lesion and enlargement of peripheral nerves in leprosy patients publication-title: Lepr Rev. doi: 10.47276/lr.77.4.371 contributor: fullname: Chen – volume: 9 start-page: 1 year: 2015 ident: B9 article-title: Asymmetric nerve enlargement: a characteristic of leprosy neuropathy demonstrated by ultrasonography publication-title: PLoS Negl Trop Dis. doi: 10.1371/journal.pntd.0004276 contributor: fullname: Lugão – volume: 10 start-page: 1 year: 2016 ident: B8 article-title: Ultrasonography of leprosy neuropathy: a longitudinal prospective study publication-title: PLoS Negl Trop Dis. doi: 10.1371/journal.pntd.0005111 contributor: fullname: Lugão – volume: 19 start-page: 338 year: 2006 ident: B4 article-title: The continuing challenges of leprosy publication-title: Clin Microbiol Rev. doi: 10.1128/CMR.19.2.338-381.2006 contributor: fullname: Scollard – ident: B5 – volume: 3 start-page: 1 year: 2009 ident: B20 article-title: High-resolution sonography : a new technique to detect nerve damage in leprosy publication-title: PLoS Negl Trop Dis doi: 10.1371/journal.pntd.0000498 contributor: fullname: Jain – volume: 13 start-page: 1 year: 2013 ident: B16 article-title: Ultrasound of Peripheral Nerves publication-title: Curr Neurol Neurosci Rep. doi: 10.1007/s11910-012-0328-x contributor: fullname: Suk – volume: 46 start-page: 137 year: 2017 ident: B18 article-title: Leprosy with ulnar nerve abscess: ultrasound findings in a child publication-title: Skeletal Radiol. doi: 10.1007/s00256-016-2517-1 contributor: fullname: Lugão – volume: 129 start-page: 1403 year: 2018 ident: B24 article-title: Nerve ultrasound normal values – Readjustment of the ultrasound pattern sum score UPSS publication-title: Clin Neurophysiol. doi: 10.1016/j.clinph.2018.03.036 contributor: fullname: Grimm – volume: 259 start-page: 808 year: 2011 ident: B31 article-title: Bifid median nerve in carpal tunnel syndrome: assessment with US cross-sectional area measurement publication-title: Radiology. doi: 10.1148/radiol.11101644 contributor: fullname: Klauser – volume: 78 start-page: 416 year: 2007 ident: B13 article-title: International workshop on neuropathology in leprosy - consensus report publication-title: Lepr Rev. doi: 10.47276/lr.78.4.416 contributor: fullname: Van Brakel – volume: 250 start-page: 171 year: 2009 ident: B32 article-title: Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers publication-title: Radiology. doi: 10.1148/radiol.2501080397 contributor: fullname: Klauser – volume: 21 start-page: 205 year: 2000 ident: B17 article-title: Ultrasonography of peripheral nerves publication-title: Neurol Sci contributor: fullname: Martinoli – volume: 71 start-page: 397 year: 2013 ident: B6 article-title: Primary neural leprosy: Systematic review | Hanseníase neural primária: Revisão sistemática publication-title: Arq Neuropsiquiatr. doi: 10.1590/0004-282X20130046 contributor: fullname: Garbino – volume: 8 start-page: 217 year: 2009 ident: B11 article-title: Leprosy as a neurological disease publication-title: Lancet Neurol doi: 10.1016/S1474-4422(09)70026-2 – volume: 112 start-page: 822 year: 2017 ident: B7 article-title: Evidence of hidden leprosy in a supposedly low endemic area of Brazil publication-title: Mem Inst Oswaldo Cruz. doi: 10.1590/0074-02760170173 contributor: fullname: Bernardes F – volume: 97 start-page: 471 year: 2016 ident: B30 article-title: Peripheral hypertrophic neuropathy due to leprosy: ultrasound and MR imaging findings publication-title: Diagn Interv Imaging. doi: 10.1016/j.diii.2015.09.014 contributor: fullname: Pottecher – volume: 144 start-page: 155 year: 2021 ident: B34 article-title: Sonographic pattern of median nerve enlargement in Hansen's neuropathy publication-title: Acta Neurol Scand. doi: 10.1111/ane.13432 contributor: fullname: Nagappa – volume-title: Guidelines for the Diagnosis, Treatment and Prevention of Leprosy. year: 2017 ident: B1 – volume: 21 start-page: 205 year: 2000 ident: B15 article-title: Ultrasonography of peripheral nerves publication-title: Semin Ultrasound CT MRI. doi: 10.1016/S0887-2171(00)90043-X contributor: fullname: Martinoli – volume: 46 start-page: 717 year: 2012 ident: B22 article-title: Reliability of side-to-side ultrasound cross-sectional area measurements of lower extremity nerves in healthy subjects publication-title: Muscle Nerve. doi: 10.1002/mus.23417 contributor: fullname: Tagliafico – volume: 25 start-page: 1315 year: 2019 ident: B36 article-title: Diagnostic accuracy of tests for leprosy: a systematic review and meta-analysis publication-title: Clin Microbiol Infect. doi: 10.1016/j.cmi.2019.05.020 contributor: fullname: Gurung – volume: 88 start-page: 574 year: 2017 ident: B12 article-title: Peripheral neuropathy is not the end but the beginning publication-title: Lepr Rev. doi: 10.47276/lr.88.4.574 contributor: fullname: El Gency – volume: 46 start-page: 38 year: 2012 ident: B35 article-title: Morphological changes of the epineurium in leprosy: a new finding detected by high-resolution sonography publication-title: Muscle Nerve. doi: 10.1002/mus.23269 contributor: fullname: Visser – volume: 36 start-page: 71 year: 2013 ident: B10 article-title: New sonographic measures of peripheral nerves: a tool for diagnosis of peripheric nerve involvment in leprosy publication-title: Hansenol Int. doi: 10.1590/S0074-02762013000300001 contributor: fullname: Frade – volume: 124 start-page: 1881 year: 2013 ident: B21 article-title: Cross sectional area reference values for sonography of peripheral nerves and brachial plexus publication-title: Clin Neurophysiol. doi: 10.1016/j.clinph.2013.03.007 contributor: fullname: Kerasnoudis – volume: 270 start-page: 481 year: 2014 ident: B33 article-title: Carpal tunnel syndrome: diagnosis by means of median nerve elasticity-improved diagnostic accuracy of US with sonoelastography publication-title: Radiology. doi: 10.1148/radiol.13122901 contributor: fullname: Miyamoto – volume: 84 start-page: 495 year: 2009 ident: B2 article-title: Sistema nervoso periférico e pressupostos da agressão neural na hanseníase publication-title: An Bras Dermatol. doi: 10.1590/S0365-05962009000500008 contributor: fullname: Chacha – volume: 35 start-page: 459 year: 2014 ident: B23 article-title: High-resolution ultrasonography of peripheral nerves: measurements on 14 nerve segments in 56 healthy subjects and reliability assessments publication-title: Ultraschall der Medizin. doi: 10.1055/s-0033-1356385 contributor: fullname: Boehm |
SSID | ssj0001325413 |
Score | 2.2909899 |
Snippet | Introduction
Hansen's disease (HD) is the most common cause of treatable peripheral neuropathy in the world that may or may not involve skin manifestations,... IntroductionHansen's disease (HD) is the most common cause of treatable peripheral neuropathy in the world that may or may not involve skin manifestations, and... |
SourceID | doaj pubmedcentral proquest crossref |
SourceType | Open Website Open Access Repository Aggregation Database |
StartPage | 985252 |
SubjectTerms | cross-sectional area Hansen's disease high-resolution ultrasound leprosy Medicine neuropathy |
SummonAdditionalLinks | – databaseName: Directory of Open Access Journals dbid: DOA link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV3Pi9UwEA6yB_Eirj_w6SoRBPEQzc82Paq4PIQVDy7sRUKmSfDB0i72vYP_vTNpV15PXry2oU3nS_vNZKbfMPY6FtNr30RhLUiBDNEKMEmJ7DOSi4kSIm3oX3xttpf2y5W7Omr1RTVhszzwbLj3bVKyaGiiw8C7WABwGP-pBEiFto99_foqdxRM1d0Vg4GPMnNeEqOwDmHKJAyq9bvOO-30ioeqXP_Kx1xXSB5RzvkDdn_xFfmHeY6n7E4eHrK7F0s2_BH78W3cDXsxFkH1W_xwjReZqE0SHwsnBeMqGXDNB6pqnPhu4Ojt8TQX1-0mGrWNtLf8ZuJLooZXfUtqU_z7Mbs8__z901Ys7RJEj17FXphiZTEZbJIgc8nFywKd1SolXRCP3PapAQO-j03yqncuxlZlLxMSlMEX8Qk7GcYhP2W8pM751tBPuMV6JSO0JaYISPBgwZUNe3trvHAzq2IEjCbI0IEMHcjQYTb0hn0k6_4dR3rW9QCiHBaUw79Q3rBXt9gEXP-U1IhDHg9T0EiupHnWNBvWrkBb3XF9Ztj9rEranSPFQf_sf0zxObtHT13rz7ozdrL_dcgv0GHZw8u6Nv8A0_3twg priority: 102 providerName: Directory of Open Access Journals – databaseName: Scholars Portal Journals: Open Access dbid: M48 link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwlV3di9QwEA9ygvgi5xeuX0QQxIccaT7a9EFExWMRVnxwYV8kZJpEF5ZWt7tw99870_bUwr342DakdCbT-U1m8hvGXoasG-XKIIwBKdBDVAJ0LERyCZ2LDhICbeivPpfLtfm0sZu_x6MnAfbXhnbUT2q9351d_Lp8iwb_hiJO9LeogUScn0qd1c4qiz_km8poQ-t9NYH9YcdFYzA09EtWqi6Fs24z5i2vnWTmpwY6_xkGnVdQ_uOSzk_ZnQlL8nej8u-yG6m9x26tpmz5ffbtS7dtD6LLguq7-HGHk_TURol3mRPD8UApsOMtVT32fNtyRIM8jsV3255GLQPtPb_q-ZTI4QP_JbUxvnzA1ucfv35YiqmdgmgQdRyEzkZmncBECTLllJ3MUBtVxKgy6itVTSxBg2tCGV3RWBtCVSQnIzowjYb6kJ20XZseMZ5jbV2l6ZBuNq6QAaocYgAEAGDA5gV7fSU8_3NkzfAYbZCgPQnak6D9KOgFe0_S_TOO-K6HG93-u5_Mx1exkFlBGayWJhsAsAl0EQEBkWlCs2AvrnTj0T4o6RHa1B17r9D5EidaWS5YNVPa7I3zJ-32x8C0XVtiJHSP_-NznrDbdDWUodVP2clhf0zPELcc4PmwHH8Dz5ftjA priority: 102 providerName: Scholars Portal |
Title | Point-of-care ultrasound of peripheral nerves in the diagnosis of Hansen's disease neuropathy |
URI | https://search.proquest.com/docview/2718636066 https://pubmed.ncbi.nlm.nih.gov/PMC9504868 https://doaj.org/article/7d10f2b6a5304f4bbb5eb31db7414cac |
Volume | 9 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1La9wwEBZJDqWX0ifdNA0qFEoP3pX1sOVjGhqWwpYcGsilGI0ltYaNHeLdQ_99Z2Rvia-9-GDLr5kx34zm8yfGPrqoGmkLl2kNIkOEKDNQPs-CDQguyglwNKG_-V6sb_S3W3N7xMzhX5hE2m-gXXbbu2XX_k7cyvu7ZnXgia2uN5eVIaE4uzpmx6VSj0r0NLGisObJ1diSxAKsQg8F0gSVcllZI42cQVBS6p-ll3Ny5CO0uXrOnk1pIr8YH-cFOwrdS_ZkMzXCX7Gf133b7bI-ZkTd4vstXmSgFZJ4HzmJFye1gC3viNA48LbjmOhxP_Lq2oFGrR1NK38a-NSj4UnaklYo_vOa3Vx9_XG5zqaVErIGE4pdpqIWUQXQXoAIMUQrIlRa5t7LiK4IZeMLUGAbV3ibN8Y4V-bBCo_YpPAbfMNOur4LbxmPvjK2VPT_bdQ2Fw7K6LwDxHbQYOKCfT4Yr74fBTFqLCTI0DUZuiZD16OhF-wLWfffOJKyTjv6h1_15NC69LmIEgpnlNBRA4DBAj_3gLmOblyzYB8Ovqkx9Kmf4brQ74daIq6S3FlRLFg5c9rsjvMjGFNJRHuKodP_PvMde0qvmvhm1Rk72T3sw3tMUHZwngp73G60PU_B-RdVWe1m |
link.rule.ids | 230,315,733,786,790,870,891,2115,24346,27955,27956,53825,53827 |
linkProvider | National Library of Medicine |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lb9QwELZKkaAX3qjL00hIiEOyjh-Jc4SKaoFu1UOLekGWJ7YhYptUTfYAvx7bSVDDDa6xo9j5bM2M5_M3CL3WjlVU5jrhHEjiLUSRADNZYqX1xoVpAjoc6K-P89UZ_3QuzneQmO7CRNJ-BXXabC7Spv4euZWXF9Vy4oktT9YHpQhCcXJ5A930-5WKa0F6PFphPurJ2JCU9CFY6TGyQRWU0rSUggo6M0JRq3_mYM7pkdfszeFd9GUa6UAz-ZFue0irX3-JOP7zVO6hO6MHit8NzffRjm0eoFvrMcf-EH09aeumT1qXBFYY3m786LpQfAm3Dgdd5ChEsMFN4Ep2uG6w9yGxGSh7dRd6rXQ4sX7T4TH9g6NqZih-_PMROjv8cHqwSsYiDEnlfZU-YY4TxyxwQ4BYZ50kDkpOM2Oo8yjbojI5MJCVzo3MKiG0LjIrifFmj_nt_RjtNm1j9xF2phSyYOFqr-MyIxoKp40G7zYAB-EW6O2EiroctDaUj1ECgiogqAKCakBwgd4H2P70CyrZ8UF79U2NP1gVJiOOQq4FI9xxABAWWGbAu1G80tUCvZpAV35XhVSJbmy77RT1JjsoqeX5AhWz1TD74rzFYxz1uUdMn_z3my_R7dXp-kgdfTz-_BTthWlHWlv5DO32V1v73PtBPbyIq_43LEINpA |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lj9MwELZgkVZceCPK00hIiENSJ7YT5wgLVXl01QMrrZCQ5fEDIrpJtUkP8OuxnRQ1HPeaOIqdz6OZ8Xz5BqFXylGdi0IljAFJvIcoE6AmS6yw3rlQRUCFA_3VabE8Y5_O-flBq69I2tdQp83mIm3qn5Fbub3Q8z1PbL5enVQ8CMWJ-da4-XV0w9tsXh4k6vF4hfrMJ6NDYdKnYZXHyQZl0DxPK8Fznk8cUdTrnwSZU4rkgc9Z3Ebf9rMdqCa_0l0Pqf7zn5DjlZZzB90aI1H8dhhyF12zzT10vBpr7ffR93VbN33SuiSww_Bu42fYhSZMuHU46CNHQYINbgJnssN1g30sic1A3au7MGqpwsn16w6PZSAc1TNDE-TfD9DZ4sPXk2UyNmNItI9Z-oQ6Rhy1wAwBYp11gjioWJ4ZkzuPti21KYCC0KowItOcK1VmVhDj3R_1Zv4QHTVtYx8h7EzFRUnDL76OiYwoKJ0yCnz4AAy4m6E3e2TkdtDckD5XCSjKgKIMKMoBxRl6F6D7Ny6oZccL7eUPOX5kWZqMuBwKxSlhjgEAt0AzAz6cYlrpGXq5B1566wolE9XYdtfJ3LvuoKhWFDNUTnbE5I3TOx7nqNM94vr4yk--QMfr9wv55ePp5yfoZlh1ZLdVT9FRf7mzz3w41MPzuPH_AnyKECQ |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Point-of-care+ultrasound+of+peripheral+nerves+in+the+diagnosis+of+Hansen%27s+disease+neuropathy&rft.jtitle=Frontiers+in+medicine&rft.au=Voltan%2C+Glauber&rft.au=Filho%2C+Fred+Bernards&rft.au=Leite%2C+Marcel+Nani&rft.au=De+Paula%2C+Nat%C3%A1lia+Aparecida&rft.date=2022-09-09&rft.issn=2296-858X&rft.eissn=2296-858X&rft.volume=9&rft_id=info:doi/10.3389%2Ffmed.2022.985252&rft.externalDBID=n%2Fa&rft.externalDocID=10_3389_fmed_2022_985252 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2296-858X&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2296-858X&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2296-858X&client=summon |