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Volume - 85, Issue - 4

Review
Pages 250 - 261
  • Tele-leprology: A literature review of applications of telemedicine and tele-education to leprosy

    • Caroline A. Nelson
    • Carrie L. Kovarik
    • Christiaan B. Morssink
    Volume 85, Issue 4

    | Published on December 2014

    Global efforts to eliminate leprosy have brought about a steep decline in prevalence; however, new cases are continually detected. Without early diagnosis and appropriate management, these individuals are at risk of disability, disfigurement, and social stigma. Telemedicine and tele-education are increasingly utilised strategies to maintain access to expert healthcare for leprosy patients scattered in low-accessibility areas. However, an overview of tele-leprology, the application of these strategies specifically to leprosy, is currently unavailable. This review provides such an overview and discusses future directions for research and implementation.

Original Papers
Pages 262 - 266
  • Results from the Clinical Trial of Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR): Decrease in Bacteriological Index

    • Maria Lucia Fernandes Penna
    • Samira Bűhrer-sékula
    • Maria Araci De Andrade Pontes
    • Rossilene Cruz
    • Heitor De Sá Gonçalves
    • Gerson Oliveira Penna
    Volume 85, Issue 4

    | Published on December 2014

    Background:

    Many believe that the regular treatment for multibacillary (MB) leprosy cases could be shortened. A shorter treatment allowing uniformity in treatment for all cases renders case classification superfluous and therefore simplifies leprosy control.

    Objective:

    To evaluate the association between treatment duration and the trend in bacteriological index (BI) decrease over time among patients given Uniform MDT (UMDT) compared to those given regular MDT (RMDT).

    Methods:

    An open-label randomised clinical trial to compare the present routine treatment with one lasting six month. Patient intake was from March 2007 to February 2012. To evaluate the trend of BI as a function of time, a multilevel linear with mixed effects model was fixed to the two study groups and also four groups after stratification by BI, less than 3 and 3 or more.

    Results:

    The BI fall was higher among those taking RMDT, this difference however was not statistically significant.

    Conclusion:

    The results presented here support the possibility of use of UMDT in the field, but further follow up is still needed for a final conclusion.

Original Papers
Pages 267 - 274
  • Patient profile and treatment satisfaction of Brazilian leprosy patients in a clinical trial of uniform six-month multidrug therapy (U-MDT/CT-BR)

    • Isis Polianna Silva Ferreira
    • Samira Buhrer-sékula
    • Maria Regina Fernandes De Oliveira
    • Heitor De Sá Gonçalves
    • Maria Araci De Andrade Pontes
    • Maria Lúcia Fernandes Penna
    • Rossilene Cruz
    • Gerson Oliveira Penna
    Volume 85, Issue 4

    | Published on December 2014

    Objective:

    To describe the profile of patients who participated in the Randomised Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U- MDT/CT-BR) and determine the level of satisfaction with a uniform therapy regimen, especially among paucibacillary patients.

    Design:

    This is a descriptive cross-sectional epidemiologic study nested in the wider U-MDT/CT-BR. The study was conducted using a convenience sample composed of patients from the Dona Libânia Dermatology Centre in Fortaleza, Ceará and from the Alfredo da Matta Foundation in Manaus, Amazonas in Brazil. The absolute and relative frequencies of categorical variables and the median age were calculated. Hypothesis testing was done using the Chi-squared and Mann-Whitney tests with a 0.05 level of significance.

    Results:

    Of the 859 patients included in the clinical trial, 342 were interviewed. The majority of patients were male (58.2%) and multibacillary (78.3%) with a median age of 42 (7–65) years. Most of the interviewees had not completed primary education (48.0%), earned an income below three times the minimum wage (53.8%), were non-smokers (85.1%), did not regularly consume alcohol (88.3%), had not experienced any leprosy-related discrimination (69.2%) and showed a basic knowledge of the disease. With regards to paucibacillary patients, 87.8% and 90.9% of the PB U-MDT and PB R-MDT groups, respectively, indicated that they had not thought of defaulting treatment at any time. On a satisfaction scale of 1–5 (with five as the highest score), 92.7% of PB U-MDT and 100.0% of PB R-MDT patients gave a mark between three and five.

    Conclusions:

    The data suggest that the introduction of clofazimine into the therapeutic regimen did not diminish the level of treatment satisfaction among PB patients.

Original Papers
Pages 275 - 287
  • Normal threshold values for a monofilament sensory test in sural and radial cutaneous nerves in Indian and Nepali volunteers

    • Inge Wagenaar
    • Wim Brandsma
    • Erik Post
    • Jan Hendrik Richardus
    Volume 85, Issue 4

    | Published on December 2014

    The monofilament test (MFT) is a reliable method to assess sensory nerve function in leprosy and other neuropathies. Assessment of the radial cutaneous and sural nerves, in addition to nerves usually tested, can help improve diagnosis and monitoring of nerve function impairment (NFI). To enable the detection of impairments in leprosy patients, it is essential to know the monofilament threshold of these two nerves in normal subjects. The radial cutaneous, sural, ulnar, median and posterior tibial nerves of 245 volunteers were tested. All nerves were tested at three sites on both left and right sides. Normal monofilament thresholds were calculated per test-site and per nerve. We assessed 490 radial cutaneous and 482 sural nerves. The normal monofilament was 2 g (Filament Index Number (FIN) 4.31) for the radial cutaneous and 4 g (FIN 4.56) for the sural nerve, although heavy manual laborers demonstrated a threshold of 10 g (FIN 5.07) for the sural nerve. For median and ulnar nerves, the 200 mg (FIN 3.61) filament was confirmed as normal while the 4 g (FIN 4.56) filament was normal for the posterior tibial. Age and occupation have an effect on the mean touch sensitivity but do not affect the normal threshold for the radial cutaneous and sural nerves. The normal thresholds for the radial cutaneous and sural nerves are determined as the 2 g (FIN 4.31) and the 4 g (FIN 4.56) filaments, respectively. The addition of the radial cutaneous and sural nerve to sensory nerve assessment may improve the diagnosis of patients with impaired sensory nerve function.

Original Papers
Pages 288 - 295
  • Leprosy and tuberculosis concomitant infection: A poorly understood, age-old relationship

    • Timothy Miles Rawson
    • Vaseem Anjum
    • Jasmin Hodgson
    • A Kameswara Rao
    • Krishna Murthy
    • Pss Sundar Rao
    • Jonnalagada Subbanna
    • PV Ranganadha Rao
    Volume 85, Issue 4

    | Published on December 2014

    Historically, archaeological evidence, post-mortem findings and retrospective analysis of leprosy institutions’ data demonstrates a high observed incidence of concomitant infection with leprosy and tuberculosis (TB). However, reports of concomitant infection in the modern literature remain scarce, with estimates of annual new case detection rates of concomitant infection at approximately 0.02 cases per 100,000 population. Whilst the mechanism for this apparent decline in concomitant infections remains unclear, further research on this topic has remained relatively neglected. Modelling of the interaction of the two organisms has suggested that the apparent decline in observations of concomitant infection may be due to the protective effects of cross immunity, whilst more recently others have questioned whether it is a more harmful relationship, predisposing towards increased host mortality. We review recent evidence, comparing it to previously held understanding on the epidemiological relationship and our own experience of concomitant infection. From this discussion, we highlight several under-investigated areas, which may lead to improvements in the future delivery of leprosy management and services, as well as enhance understanding in other fields of infection management. These include, a) highlighting the need for greater understanding of host immunogenetics involved in concomitant infection, b) whether prolonged courses of high dose steroids pre-dispose to TB infection? and, c) whether there is a risk of rifampicin resistance developing in leprosy patients treated in the face of undiagnosed TB and other infections? Longitudinal work is still required to characterise these temporal relationships further and add to the current paucity of literature on this subject matter.

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