The spatial epidemiology of leprosy in Kenya: A retrospective study.

BACKGROUND: Leprosy elimination defined as a registered prevalence rate of less than 1 case per 10,000 persons was achieved in Kenya at the national level in 1989. However, there are still pockets of leprosy in some counties where late diagnosis and consequent physical disability persist. The epidemiology of leprosy in Kenya for the period 2012 through to 2015 was defined using spatial methods. METHODS: This was a retrospective ecological correlational study that utilized leprosy case based data extracted from the National Leprosy Control Program database. Geographic information system and demographic data were obtained from Kenya National Bureau of Statistics (KNBS). Chi square tests were carried out to check for association between sociodemographic factors and disease indicators. Two Spatial Poisson Conditional Autoregressive (CAR) models were fitted in WinBUGS 1.4 software. The first model included all leprosy cases (new, retreatment, transfers from another health facility) and the second one included only new leprosy cases. These models were used to estimate leprosy relative risks per county as compared to the whole country i.e. the risk of presenting with leprosy given the geographical location. PRINCIPAL FINDINGS: Children aged less than 15 years accounted for 7.5% of all leprosy cases indicating active leprosy transmission in Kenya. The risk of leprosy notification increased by about 5% for every 1 year increase in age, whereas a 1% increase in the proportion of MB cases increased the chances of new leprosy case notification by 4%. When compared to the whole country, counties with the highest risk of leprosy include Kwale (relative risk of 15), Kilifi (RR;8.9) and Homabay (RR;4.1), whereas Turkana had the lowest relative risk of 0.005. CONCLUSION: Leprosy incidence exhibits geographical variation and there is need to institute tailored local control measures in these areas to reduce the burden of disability.

Subclinical atherosclerosis and cardiovascular markers in patients with lichen planus: A case-control study.

BACKGROUND: Lichen planus is an idiopathic and chronic inflammatory disease that affects the skin and the mucous membranes, and has been associated with an increased risk for cardiovascular diseases. Hyperhomocysteinemia has been regarded as a risk factor for atherosclerosis and cardiovascular diseases. Increased plasma fibrinogen levels are also associated with increased risk of myocardial infarction. OBJECTIVE: The main aim of this study is the evaluation of common carotid artery mean intima media wall thickness, serum fibrinogen and homocysteine levels in patients with lichen planus. METHODS: Forty-three patients with lichen planus and 43 age, gender and body mass index (BMI) matched healthy controls (from general population without the disease) were included in this study. RESULTS: Compared to the healthy controls, patients had statistically significant greater mean intima media wall thickness of the common carotid artery. Moreover, a positive correlation was observed between lichen planus and increased serum homocysteine and c-reactive protein levels. LIMITATIONS: The main limitation of this study is the small sample size due to the time limitation and financial constraints. CONCLUSION: Early diagnosis of atherosclerosis in patients with lichen planus might afford better prophylaxis, including weight control and/or lipid profile monitoring. Measurement of the mean intima media wall thickness of the common carotid artery by duplex high-resolution B-mode ultrasound scanning could be beneficial as a valuable method for early diagnosis of atherosclerosis in lichen planus.

PARK2 polymorphisms predict disease progression in patients infected with hepatitis C virus.

 Background. The protein encoded by PARK2 gene is a component of the ubiquitin-proteasome system that mediates targeting of proteins for the degradation pathway. Genetic variations at PARK2 gene were linked to various diseases including leprosy, typhoid and cancer. The present study investigated the association of single nucleotide polymorphisms (SNPs) in the PARK2 gene with the development of hepatitis C virus (HCV) infection and its progression to severe liver diseases. MATERIAL AND METHODS: A total of 800 subjects, including 400 normal healthy subjects and 400 HCV-infected patients, were analyzed in this study. The patients were classified as chronic HCV patients (group I), patients with cirrhosis (group II) and patients with hepatocellular carcinoma (HCC) in the context of cirrhosis (group III). DNA was extracted and was genotyped for the SNPs rs10945859, rs2803085, rs2276201 and rs1931223. RESULTS: Among these SNPs, CT genotype of rs10945859 was found to have a significant association towards the clinical progression of chronic HCV infection to cirrhosis alone (OR = 1.850; 95% C. I. 1.115-3.069; p = 0.016) or cirrhosis and HCC (OR = 1.768; 95% C. I. 1.090-2.867; p value = 0.020). CONCLUSION: SNP rs10945859 in the PARK2 gene could prove useful in predicting the clinical outcome in HCV-infected patients.

Comparison between histopathologic features of leprosy in reaction lesions in HIV coinfected and non-coinfected patients.

BACKGROUND: Leprosy and HIV are diseases that have a major impact on public health in Brazil. Patients coinfected with both diseases, appear to be at higher risk to develop leprosy reactions. OBJECTIVE: The aim of this study is to describe the histopathological aspects of cutaneous lesions during reactional states in a group of patients with HIV-leprosy coinfection, compared to patients with leprosy, without coinfection. METHODS: Two groups were established: group 1 comprised of 40 patients coinfected with HIV-leprosy; group 2, comprised of 107 patients with leprosy only. Patients presenting reactional states of leprosy had their lesions biopsied and comparatively evaluated. RESULTS: Reversal reaction was the most frequent feature in both groups, with dermis edema as the most common histopathological finding. Giant cells were seen in all group 1 histopathological examinations. Dermis edema was the most common finding in patients with erythema nodosum leprosum. CONCLUSION: Few histopathological differences were found in both groups, with reversal reaction as the most significant one, although this fact should be analyzed considering the predominant BT clinical form in the coinfected group and BB form in the group without HIV. Larger prospective studies in patients with HIV-leprosy coinfection are needed to confirm and broaden these results.

Comparison between histopathologic features of leprosy in reaction lesions in HIV coinfected and non-coinfected patients*

BACKGROUND: Leprosy and HIV are diseases that have a major impact on public health in Brazil. Patients coinfected with both diseases, appear to be at higher risk to develop leprosy reactions. OBJECTIVE: The aim of this study is to describe the histopathological aspects of cutaneous lesions during reactional states in a group of patients with HIV-leprosy coinfection, compared to patients with leprosy, without coinfection. METHODS: Two groups were established: group 1 comprised of 40 patients coinfected with HIV-leprosy; group 2, comprised of 107 patients with leprosy only. Patients presenting reactional states of leprosy had their lesions biopsied and comparatively evaluated. RESULTS: Reversal reaction was the most frequent feature in both groups, with dermis edema as the most common histopathological finding. Giant cells were seen in all group 1 histopathological examinations. Dermis edema was the most common finding in patients with erythema nodosum leprosum. CONCLUSION: Few histopathological differences were found in both groups, with reversal reaction as the most significant one, although this fact should be analyzed considering the predominant BT clinical form in the coinfected group and BB form in the group without HIV. Larger prospective studies in patients with HIV-leprosy coinfection are needed to confirm and broaden these results. .

Autophagy gene polymorphism is associated with susceptibility to leprosy by affecting inflammatory cytokines.

Autophagy and inflammation closely interact with each other, and together, they play critical roles in bacterial infection. Leprosy is caused by the infection of Mycobacterium leprae (M. leprae). The objective of the study was to investigate the association between polymorphisms in IRGM, an autophagy gene, and susceptibility to leprosy, and identify possible functions of the polymorphism in the infection of M. leprae. Two polymorphisms in IRGM, rs4958842 and rs13361189, were tested in 412 leprosy cases and 432 healthy controls. Levels of inflammatory cytokines including interleukin 1 beta, IL-4, IL-6, and interferon gamma (INF-γ) were measured after the infection of M. leprae in the peripheral blood mononuclear cell (PBMC) of subjects with different genotypes of rs13361189. Data showed that prevalence of rs13361189TC and CC genotypes were significantly higher in leprosy patients than in healthy controls (odds ratio (OR) = 1.49, 95 % confidence interval (CI) 1.09-2.04, P = 0.012; OR = 2.58, 95 % CI 1.65-4.05, P < 0.001; respectively). Furthermore, the frequency of rs13361189CC genotype was increased in patients with complications than those without complications (P = 0.011). When analyzing the effect of rs13361189 polymorphism on M. leprae infection, we identified that M. leprae-infected PBMC with rs13361189CC genotype expressed significantly elevated levels of INF-γ and IL-4 than those with TT genotype. Our results suggested autophagy gene polymorphism was associated with the increased risk of leprosy by affecting inflammatory cytokines.

Detection of previously undetected leprosy cases in Firozabad District (U.P.), India during 2006-2009: a short communication.

OBJECTIVES: This study was initiated to assess the extent of undetected (new) leprosy cases in Firozabad District of U.P. METHODS: A sample survey of more than 980,000 people was undertaken in nine blocks of the district during October 2006 to March 2009, using a household questionnaire and a cross section survey. RESULTS: A total of 774 previously undetected cases were detected (7.57 NCDR/10,000 population) over the 2.5 year period of the survey. The characteristics of previously undetected cases are described by age, sex, classification, urban/rural residence and disability. CONCLUSION: There are many undetected leprosy patients in the community. Active surveys can help in detecting previously undetected cases. The current programme is based on information, education and communication (IEC) to encourage case reporting. IEC activities should be designed in such a way that people can suspect leprosy and are self-motivated to know about free treatment, its availability, and effectiveness.

Differential trend of leprosy in rural and urban area of western Maharashtra.

Leprosy, major public health problem in Satara District with prevalence rate of 61/10000 population in 1990. With a view to eliminate Leprosy, Government of India launched National Leprosy Eradication Programme (NLEP) in Satara district during July 1990 to overcome the burden of Leprosy with Multi-Drug Treatment and subsequently Modified Leprosy Elimination Campaign and Block Leprosy Awareness Campaign. The objective of the study is to assess the differential trend of Leprosy in rural and urban area of Satara district. Record based retrospective time series study was conducted in Urban Leprosy Control Units and Primary Health Centers of Satara district on NLEP evaluation indicators; prevalence rate, new case detection rate, percentage of cases released from treatment, proportion of female cases among new cases, proportion of multi bacillary cases among new cases, proportion of grade-II disability among new cases and proportion of child cases among new cases. Leprosy elimination was achieved in rural area i.e. prevalence rate < 1/10000 population but disease was still endemic in urban area of Satara district i.e. prevalence rate of leprosy was 1.3/10000 population in March 2007-08. Not a single case of grade-II disability was reported in both urban and rural area since March 2006-07 onward. New case detection rate was decreased to 0.7/10000 population in rural area but upward trend was recorded in urban area from 0.1/10000 population to 1.1/10000 population since March 2006-07 and trend was statistically significant (chi2 trend = 37.26, p < 0.001*). Proportion of female cases among new cases decreased from 63% to 46.7% in rural area but reverse trend was observed in urban area from 39.6% to 52.8% with significant difference (chi2 trend = 5.42, p = 0.01*). Proportion of multi bacillary cases among new cases showed little fluctuation in rural area from 57% to 55.2% but proportion was decreased in urban area from 59.1% to 44.4% and trend was statistically significant (chi2 trend = 29.82, p < 0.001*). Proportion of child cases among new cases decreased from 23.7% to 10.4% in rural but reverse trend was observed in urban area from 7% to 22.2% since March 2005-06 and proportion was significant (chi2 trend = 15.90, p = 0.0001*). More than 90% cases were released from treatment in rural area but proportion was low in urban area and trend was statistically significant (chi2 trend = 19.38, p < 0.001*). The National Leprosy Eradication Programme showed favorable impact in rural area as compared to urban area in Satara District of Maharashtra.

Comparative efficacy and safety of topical permethrin, topical ivermectin, and oral ivermectin in patients of uncomplicated scabies.

BACKGROUND: Ivermectin has opened a new era in the management of scabies as orally effective drug. However, topical route has been little explored for ivermectin. AIMS: To compare the efficacy and safety of topical permethrin, oral ivermectin, and topical ivermectin in the treatment of uncomplicated scabies. METHODS: This was an open-label, randomized, comparative, parallel clinical trial conducted in 315 patients, randomly allocated to 3 groups. First group received permethrin 5% cream as single application, second group received tablet ivermectin 200 mcg/kg as single dose, and third group received ivermectin 1% lotion as single application. All the patients received anti-histaminic for pruritus. The patients were followed up at intervals of 1, 2, 3, and 4 weeks. If there were no signs of cure, the same intervention was repeated at each follow up. Primary efficacy variable was clinical cure of lesions. Statistical analysis was done by chi square test and one way ANOVA test using SPSS version 12. RESULTS: At the end of first week, cure rate was 74.8% in permethrin group, 30% in oral ivermectin group, and 69.3% in topical ivermectin group (P < 0.05). At the end of second week, cure rate was 99% in permethrin group, 63% in oral ivermectin group, and 100% in topical ivermectin group (P < 0.05). At the end of third week, 100% cure rate was observed in permethrin and topical ivermectin group while 99% in oral ivermectin group (P = 0.367). No serious adverse events were observed. CONCLUSIONS: Permethrin and topical ivermectin were equally effective against scabies while oral ivermectin was significantly less effective up to 2 weeks. Topical ivermectin can be used as an alternative to permethrin.

Initial experience with robotic navigation for catheter ablation of paroxysmal and persistent atrial fibrillation.

BACKGROUND AND PURPOSE: Remote robotic navigation (RRN) technology has been developed to facilitate catheter ablation of symptomatic atrial fibrillation (AF). Here, we assess procedural parameters of AF ablation obtained during initial use of RRN compared with a control group treated with a manual ablation approach. METHODS: Consecutive patients with symptomatic paroxysmal or persistent AF were subjected to radiofrequency catheter ablation with RRN (Sensei X [Hansen Medical, Mountain View, CA]; n = 25; mean age, 60 ± 2.3 years) or using the standard manual technique (n = 61; mean age, 62 ± 1.4 years). A circumferential pulmonary vein isolation approach guided by 3-dimensional electroanatomical mapping was followed. RESULTS: Remote robotic navigation was associated with reduction of overall fluoroscopy time by 26%. In a case-control subgroup analysis comparing 25 patients with similar clinical characteristics from each group, mean fluoroscopy time was reduced by 22%. Acute isolation of pulmonary veins was achieved in 97% (RRN) and 96% (conventional ablation), respectively. Ablation times and frequency of adverse events were not significantly different among study groups. CONCLUSIONS: The early use of RRN resulted in a significant reduction of overall fluoroscopy time and was equally effective and safe compared with manual catheter ablation.

Oral isotretinoin in different dose regimens for acne vulgaris: a randomized comparative trial.

BACKGROUND: Oral isotretinoin is recommended for severe nodulocystic acne in the doses of 1-2 mg/kg/day which is usually associated with higher incidence of adverse effects. To reduce the incidence of side-effects and to make it more cost-effective, the lower dose regimen of isotretinoin has been used. AIM: To compare the efficacy and tolerability of oral isotretinoin in daily, alternate, pulse and low-dose regimens in acne of all types and also to assess whether it can be used for mild and moderate acne also. METHODS: One hundred and twenty patients with acne were randomized into four different treatment regimens each consisting of 30 patients. Group A was prescribed isotretinoin 1 mg/kg/day, Group B 1 mg/kg alternate day, Group C 1 mg/kg/day for one week/four weeks and Group D 20 mg every alternate day for 16 weeks. Patients were further followed for eight weeks to see any relapse. Side-effects were also recorded. RESULTS: Though the daily high dose treatment Group A performed better initially at eight weeks, at the end of therapy at 16 weeks results were comparable in Group A , B and D. Patients with severe acne did better in Group A than in Group B, C and D. Patients with mild acne had almost similar results in all the groups while patients with moderate acne did better in Group A, B and D. Frequency and severity of treatment-related side-effects were significantly higher in treatment Group A as compared to Group B, C and D. CONCLUSION: We conclude that for severe acne either conventional high doses of isotretinoin may be used or we can give conventional high dose for initial eight weeks and later maintain on low doses. Use of isotretinoin should be considered in mild to moderate acne also, in low doses; 20 mg, alternate day seems to be an effective and safe treatment option in such cases.

Laboratory confirmation of Buruli ulcer disease in Togo, 2007-2010.

BACKGROUND: Since the early 1990s more than 1,800 patients with lesions suspicious for Buruli ulcer disease (BUD) have been reported from Togo. However, less than five percent of these were laboratory confirmed. Since 2007, the Togolese National Buruli Ulcer Control Program has been supported by the German Leprosy and Tuberculosis Relief Association (DAHW). Collaboration with the Department for Infectious Diseases and Tropical Medicine (DITM), University Hospital, Munich, Germany, allowed IS2404 PCR analysis of diagnostic samples from patients with suspected BUD during a study period of three years. METHODOLOGY/PRINCIPAL FINDINGS: The DAHW integrated active BUD case finding in the existing network of TB/Leprosy Controllers and organized regular training and outreach activities to identify BUD cases at community level. Clinically suspected cases were referred to health facilities for diagnosis and treatment. Microscopy was carried out locally, external quality assurance (EQA) at DITM. Diagnostic samples from 202 patients with suspected BUD were shipped to DITM, 109 BUD patients (54%) were confirmed by PCR, 43 (29.9%) by microscopy. All patients originated from Maritime Region. EQA for microscopy resulted in 62% concordant results. CONCLUSIONS/SIGNIFICANCE: This study presents a retrospective analysis of the first cohort of clinically suspected BUD cases from Togo subjected to systematic laboratory analysis over a period of three years and confirms the prevalence of BUD in Maritime Region. Intensified training in the field of case finding and sample collection increased the PCR case confirmation rate from initially less than 50% to 70%. With a PCR case confirmation rate of 54% for the entire study period the WHO standards (case confirmation rate ≥50%) have been met. EQA for microscopy suggests the need for intensified supervision and training. In January 2011 the National Hygiene Institute, Lomé, has assumed the role of a National Reference Laboratory for PCR confirmation and microscopy.

Social participation of people affected by leprosy after discontinuation of multidrug therapy.

OBJECTIVES: To evaluate social participation of individuals completing treatment for leprosy and to describe the relationship with physical sequelae and sociodemographic characteristics. DESIGN: A cross-sectional, descriptive study was performed involving all leprosy affected people who were treated between 1998 and 2006 in São José do Rio Preto, Brazil. General and clinical data were collected and the subjects were assessed using the degree of physical disability of the WHO (DPD-WHO), the Eye-hand-foot (EHF) score, and the participation scale (PS), which measures social participation of individuals with stigmatising problems. RESULTS: Of the 335 people treated in the period, 223 (66.6%) were interviewed. Of these, 51.6% were women, the mean age was 54 years (+/- 15.7 years), 66.4% had up to 6 years of formal education, 42.6% worked and 26.9% were retired. There was a predominance of dimorphous (borderline) leprosy (39.9%). Participants' physical and mental health was considered good in the month preceding the interview in 50.2% and 59.2%, respectively. Disabilities according to the DPD-WHO and EHF scores affected 32% of the participants and restrictions in social participation occurred in 35.4%. Multivariate analysis demonstrated a significant association between restrictions in social participation and family income of less than three minimum salaries (US$ 160.50), associated diseases, hospitalisation within the previous year and physical disability. CONCLUSION: The prevalence of restrictions in social participation is high, even after completing treatment for leprosy. Physical disability, associated diseases, recent hospitalisation and low family incomes influence the social participation of these individuals.

Non-typical morphology and localization in Turkish atopic dermatitis patients with onset before the age of 18 years.

BACKGROUND: Hanifin and Rajka's criteria (HRC) are the gold standard for the diagnosis of atopic dermatitis (AD). Apart from the age-related distribution and typical morphology of the lesions as defined in one of the major criteria of HRC, patients may also show nontypical morphology and localization. AIM: The aim of this study was to find the frequency of nontypical morphology and localization in Turkish AD patients with onset before the age of 18 years, who were diagnosed according to HRC. METHODS: This was a methodological study based on the analysis of patients' data derived from the checklists of HRC and precise clinical documentation of each patient. A total of 321 Turkish patients diagnosed between 1996 and 2004 with the onset of AD before the age of 18 years were allocated to the study group. RESULTS: 49.5% of patients had nontypical localization of AD, the majority being infants or children who had flexural involvement rather than the typical cheek or extremity lesions. Lichenified/exudative eczematous pattern was the most frequent morphologic type (45.5%); however, 54.5% of the patients showed combined or isolated variants, e.g. nummular and seborrheic patterns, in particular. CONCLUSIONS: A considerable amount of Turkish patients with AD before the age of 18 years presented with nontypical morphology and/or localization according to their age group. The confirmation of our findings in a multicentric prospective study would further allow a completion and correction of the diagnostic criteria of AD for age groups.

Evaluation of national leprosy eradication programme in Satara District, Maharashtra.

The aim of this study was to evaluate the impact of national leprosy eradication programme (NLEP) in Satara District. A retrospective record based study was conducted in the district leprosy control unit with evaluation indicators like prevalence rate (PR), new case detection rate (NCDR), percentage of cases released from treatment, proportion of female cases among new cases, proportion of multi bacillary (MB) cases among new cases, proportion of grade-2 disability among new cases and proportion of child cases among new cases and trend was analyzed for statistical significance by using Chi-square test. During study period from year March 2003-04 to March 2007-08, there was decrease in PR of leprosy from 2.46/10000 population to 0.62/10000 population, NCDR decreased from 3.46/10000 population to 0.77/10000 population and trend was statistically significant (p<0.001*, P<0.001*) respectively. Declining trend of grade 2 disability among new cases was noted and this was statistically significant (p<0.01*). Proportion of female cases among new cases showed little fluctuation from 43.3% to 47.5% but trend was statistically significant (p<0.03*). Proportion of MB cases among new cases increased from 44.4% to 53.6% while proportion of child cases among new cases decreased from 16.5% to 12% and trend was statistically significant (p <0.001*, p<0.001*) respectively. The NLEP has a favorable impact towards elimination of leprosy in Satara District, Maharashtra.

Efetividade da vitamina E sobre o estresse oxidativo, em hansenianos da forma multibacilar sob tratamento / Effectiveness of vitamin E on oxidative stress in patients with leprosy, multibacillary form of under treatment

INTRODUÇÃO: A hanseníase é uma doença infecto contagiosa crônica, causada pelo Mycobacterium leprae, enão foi exterminada no Brasil, que atualmente, ocupa o segundo lugar em número absoluto de casos, perdendoapenas para a Índia. A doença hanseníase não provoca estresse oxidativo, e sim a terapêutica utilizada. Diversos trabalhos evidenciam a redução do estresse oxidativo, em diferentes patologias, pelo uso da vitamina E. Na hanseníase, no entanto, a literatura é escassa a respeito desse efeito OBJETIVO: O objetivo deste estudo foi verificar a redução, pela vitamina E, do estresse oxidativo causado pelo uso da dapsona, clofazimina e rifampicina no tratamento pacientes hansenianos, da forma multibacilar. CASUÍSTICA E MÉTODO: Foi avaliada a presença prévia de estresse oxidativo em 32 pacientes hansenianos, da forma multibacilar, por meio de exames de sangue e, posteriormente, os pacientes foram divididos em 2 grupos, aleatoriamente, com 16 pacientes em cada grupo,denominados: grupos “com vitamina E” e “controle”. Os pacientes do grupo “com vitamina E” fizeram uso de800 UI/dia, por via oral, de vitamina E e o grupo “controle” não fez uso de suplemento vitamínico. Decorridos30, 60 e 90 dias de tratamento suplementar, foram coletadasamostras de sangue dos 2 grupos para determinar a concentração de metahemoglobina e presença de corpos de Heinz. RESULTADOS: Os resultados foram submetidos ao testeestatístico Qui-quadrado (χ2). Não foi encontrada diferença entre os 2 grupos.CONCLUSÃO: Conclui-se que a vitamina E na dose e duração de tratamentos utilizados, não confere efeitoprotetor contra o estresse oxidativo causado pela dapsona, clofazimina e rifampicina utilizada pelos pacientesportadores de hanseníase da forma multibacilar.

INTRODUCTION: Leprosy is a chronic contagious infectious disease caused by Mycobacterium leprae, and has not been wiped out in Brazil, which currently ranks second in the absolute number of cases, second only to India. The disease is not leprosy causes oxidative stress, but the therapy used. Several studies show the reductionof oxidative stress in different pathology, the use of vitamin E. In leprosy, however, the literature is scarce about this effect. OBJECTIVE: The aim of this study was the reduction by vitamin E, oxidative stress caused by the use of dapsone, rifampicin and clofazimine for treating leprosy patients, the multibacillary form.PATIENTS AND METHODS: We reviewed the previous presence of oxidative stress in 32 leprosy patients, themultibacillary form, through blood tests and then the patients were divided into two groups randomly, with 16 patients in each group, namely: groups with vitamin E “and” control “. Patients in the group with vitamin E “made use of 800 IU / day orally, vitamin E and” control “group did not use vitamin supplement. After 30, 60 and 90 days of treatment, blood samples were collected from two groups to determine the concentration of methemoglobin and the presence of Heinz bodies.RESULTS: The results were subjected to statistical test Chi-square (χ2). No difference was found between thetwo groups. CONCLUSION: We conclude that vitamin E dose and durationof treatments, does not confer a protective effect against oxidative stress caused by dapsone, rifampicinand clofazimine used by patients with multibacillary leprosy.

IFNG +874 T>A single nucleotide polymorphism is associated with leprosy among Brazilians.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, a low virulence mycobacterium, and the outcome of disease is dependent on the host genetics for either susceptibility per se or severity. The IFNG gene codes for interferon-γ (IFN-γ), a cytokine that plays a key role in host defense against intracellular pathogens. Indeed, single nucleotide polymorphisms (SNPs) in IFNG have been evaluated in several genetic epidemiological studies, and the SNP +874T>A, the +874T allele, more specifically, has been associated with protection against infectious diseases, especially tuberculosis. Here, we evaluated the association of the IFNG locus with leprosy enrolling 2,125 Brazilian subjects. First, we conducted a case-control study with subjects recruited from the state of São Paulo, using the +874 T>A (rs2430561), +2109 A>G (rs1861494) and rs2069727 SNPs. Then, a second study including 1,370 individuals from Rio de Janeiro was conducted. Results of the case-control studies have shown a protective effect for +874T carriers (OR(adjusted) = 0.75; p = 0.005 for both studies combined), which was corroborated when these studies were compared with literature data. No association was found between the SNP +874T>A and the quantitative Mitsuda response. Nevertheless, the spontaneous IFN-γ release by peripheral blood mononuclear cells was higher among +874T carriers. The results shown here along with a previously reported meta-analysis of tuberculosis studies indicate that the SNP +874T>A plays a role in resistance to mycobacterial diseases.

Recurrence of leprosy cases in the State of Mato Grosso, Central-West Brazil.

OBJECTIVE: To compare new registrations of recurrences of leprosy cases in primary healthcare units (PHUs) and in specialized units in the State of Mato Grosso. METHODS: This was a cross-sectional study based on all new registrations (N = 323) of recurrences of leprosy cases within the Notifiable Disease Information System (SINAN) between 2004 and 2006 that were made in the State of Mato Grosso, Central-West Brazil. The cases diagnosed were compared regarding sex, age, clinical-laboratory characteristics and geographical distribution among the municipalities. To compare and calculate the proportions of the variables, the chi-square test at the significance level of 5% was used. RESULTS: Among the new registrations of recurrences, 20% were confirmed at specialized units and 80% at PHUs. However, most of the diagnoses at PHUs presented negative bacilloscopy findings (c2 = 12.34; p = 0.002). Seventy-one per cent of the cases were among males; the mean age was 43 years. No differences in the percentages of registrations were observed between the healthcare units with regard to clinical form, operational classification or degree of physical incapacity. Out of the total number of municipalities in the state, 64.7% presented recurrences and these accounted for 6 to 20% of all registrations. CONCLUSIONS: The new registrations of cases of recurrence in Mato Grosso were influenced by the diagnoses made at PHUs, thus suggesting that there is a deficiency within the healthcare services in recognizing cases of recurrence.

Recidivas de casos de hanseníase no estado de Mato Grosso / Recurrencia de casos de hanseníasis en el estado de Mato Grosso, Centro-Oeste de Brasil, 2004-2006 / Recurrence of leprosy cases in the State of Mato Grosso, Central-West Brazil

OBJETIVO: Comparar as novas entradas por recidiva de hanseníase em unidades básicas de saúde (UBS) e em unidades especializadas (UE) no estado de Mato Grosso. MÉTODOS: Estudo transversal com base em todos os registros (N = 323) de recidivas de hanseníase do Sistema de Informação de Agravos de Notificação (Sinan) de 2004 a 2006, notificados no estado de Mato Grosso. Os casos diagnosticados foram comparados quanto ao sexo, idade, aspectos clínico-laboratoriais e distribuição geográfica nos municípios. Para a comparação e cálculo das proporções das variáveis utilizou-se o teste qui-quadrado ao nível de significância de 5 por cento. RESULTADOS: Das novas entradas de recidiva, 20 por cento foi confirmado nas UE e 80 por cento em UBS; entretanto, a maioria dos diagnósticos em UBS tinham baciloscopia negativa (÷² =12,34; p = 0,002)...

OBJECTIVE: To compare new registrations of recurrences of leprosy cases in primary healthcare units (PHUs) and in specialized units in the State of Mato Grosso. METHODS: This was a cross-sectional study based on all new registrations (N = 323) of recurrences of leprosy cases within the Notifiable Disease Information System (SINAN) between 2004 and 2006 that were made in the State of Mato Grosso, Central-West Brazil. The cases diagnosed were compared regarding sex, age, clinical-laboratory characteristics and geographical distribution among the municipalities. To compare and calculate the proportions of the variables, the chi-square test at the significance level of 5 percent was used. RESULTS: Among the new registrations of recurrences, 20 percent were confirmed at specialized units and 80 percent at PHUs. However, most of the diagnoses at PHUs presented negative bacilloscopy findings (c2 = 12.34; p = 0.002)...

OBJETIVO: Comparar las nuevas entradas por recurrencia de hanseníasis en unidades básicas de salud (UBS) y en unidades especializadas (UE) en el estado de Mato Grosso, en Centro-Oeste de Brasil. MÉTODOS: Estudio transversal con base en todos los registros (N=323) de recurrencias de hanseníasis del Sistema de Información de Agravios de Notificación (SINAN) de 2004 a 2006, notificados en el estado de Mato Grosso. Los casos diagnosticados fueron comparados con relación a sexo, edad, aspectos clínicos-laboratoriales y distribución geográfica en los municipios. Para la comparación y cálculo de las proporciones de las variables se utilizó la prueba de Chi-cuadrado con nivel de significancia de 5 por ciento. RESULTADOS: De las nuevas entradas de recurrencia, 20 por ciento fueron confirmadas en las UE y 80 por ciento en UBS; mientras que la mayoría de los diagnósticos en UBS tenían baciloscopia negativa (c2 =12,34; p = 0,002)...