Highlights Identifying leprosy reactions is important to prevent disability. HRUS with CD can be useful compared to NCS to diagnose acute inflammatory activity. HRUS with CD helps reactions diagnosis in minimal and complete NCS abnormalities.

-The disease described in the Bible's Book of Job is controversial and had been of interest of theologists, psychiatrists, and dermatologists for many years. We describe several signs and symptoms compatible with chronic renal failure with neurological alterations.Key Words: bible, Job, chronic renal failure. Resolvendo o enigma de Jó: uma provável descrição bíblica de insuficiência renal crônica com sintomas neurológicosResumo -A doença descrita no livro bíblico de Jó é controversa, e tem interessado a teólogos, psiquiatras e dermatologistas, há tempos. Neste trabalho os autores apontam para evidências do diagnóstico de insuficiência renal crônica com alterações neurológicas.PAlAvrAs-chAve: bíblia, Jó, insuficiência renal crônica.

Background: Pruritus is a common complaint in dermatology. Wartenberg, in 1943, associated pruritus with neuropathy, relating it to the “posterior antebrachial cutaneous nerve neuropathy”. In 1968, Waisman described patients with frequent pruritus complaints in the upper limb during the summer, which he named “brachioradial summer pruritus”. Currently, this pruritus is named brachioradial pruritus (BRP). BRP is characterized by a chronic pruritus, usually localized, with a long duration, and without apparent cutaneous abnormalities. Neurological disorders both from the central and peripheral nervous systems, including multiple sclerosis, are associated with pruritus. Objective: To investigate correlations between symptomatic dermatomes and alterations in the myotomes, as evidenced by electroneuromyography (ENMG). Methods: Forty-six patients with BRP dermatological diagnoses were subjected to upper limb ENMG. Results: Among 46 patients with C5 to C8 dermatomal pruritus, we evaluated 113 symptomatic dermatomal areas. Overall, 39 (85%) patients had radicular involvement and 28 (60%) had agreement between complaint and the ENMG findings (p=0.015). A total of 80% of the patients with complaints at C7 and 47% at C6 had radicular involvement at the same level. Conclusions: Among the patients who presented complaints, 47 and 80%, respectively, had ENMG alterations in the C6 and C7 myotomes. We conclude that peripheral nervous system involvement is associated with BRP.

Introduction/Aims The A‐wave is a late response related either to demyelination or early axonal regeneration. It may be helpful in the evaluation of some peripheral neuropathies. In leprosy, previous studies suggested that A‐waves could be a neurophysiological marker of pain in patients during reactions. Herein we have attempted to further assess the profile and clinical correlates of A‐waves by exploring a large leprosy cohort. Methods Between 2015 and 2018, 63 patients with leprosy (47 men and 16 women) had A‐waves in nerve conduction studies and were included in this study. We included patients regardless of whether they were experiencing leprosy reactions or not. We then compared clinical features in nerves with and without A‐waves. Results The mean age of study participants was 46.5 ± 12.3 years and most had borderline leprosy. From this cohort, we assessed separately 83 motor nerves that demonstrated A‐waves (group A+) and 29 motor nerves that did not demonstrate A‐waves (group A−). Neuropathic pain (NP) was found in 66 of 83 nerves in group A+, but only 5 of 29 in group A− (79.5 vs 17.2%, P < .001). In contrast, no significant between‐group difference emerged regarding presence of reactions, sensory function (based on Semmes‐Weinstein evaluations), or muscle strength. A‐waves were found in nerves with neuropathic pain experiencing (39 of 66 = 59%) or not experiencing (27 of 66 = 41%) leprosy reactions. Discussion These results show that A‐waves are associated with neuropathic pain in leprosy patients, regardless of the nerves affected and the immune status (in reaction or not).