An Overview of Treatment Guidelines and Methods of Synthesis of Drugs Used in Leprosy Chemotherapy.

Leprosy is a Neglected Tropical Disease (NTDs) caused by Mycobacterium leprae (M. leprae). The treatment is considered effective, however, the high dose Multidrug Therapy (MDT) for a long period and its adverse effects result in the abandonment of the treatment by patients. Indeed, antimicrobial resistance is still an obstacle that must be overcome in the treatment of leprosy. In the present article, we reviewed the WHO guidelines for the chemotherapy of leprosy and the methods of synthesis of these drugs.

Política Nacional de Promoção da Saúde (PNPS): revisão da Portaria MS/GM nº 687, de 30 de março de 2006 / National Health Promotion Policy (PNPS)/Brazil: revision of the MS/GM Ordinance nº 687, of March 30th, 2006

A promoção da saúde vem sendo discutida desde o processo de redemocratização do Brasil, noqual a 8ª Conferência Nacional de Saúde se constituiu como o grande marco da luta pela universalizaçãodo sistema de saúde e pela implantação de políticas públicas em defesa da vida, tornando a saúde umdireito social irrevogável, como os demais direitos humanos e de cidadania.Nesse contexto, a Constituição Federal de 1988 instituiu o SUS e veio a assegurar o acesso universaldos cidadãos às ações e aos serviços de saúde, a integralidade da assistência com igualdade, sempreconceitos ou privilégios de qualquer espécie e com ampla participação social, capaz de responderpela promoção, prevenção, proteção e recuperação da saúde, conforme as necessidades das pessoas.O SUS, na Lei Orgânica da Saúde (Lei nº 8.080, de 19 de setembro de 1990), incorporou o conceitoampliado de saúde resultante dos modos de vida, de organização e de produção em um determinadocontexto histórico, social e cultural, buscando superar a concepção da saúde como ausência de doença,centrada em aspectos biológicos.Para se operar a política de saúde, incluindo a de promoção da saúde, é necessária a consolidaçãode práticas voltadas para indivíduos e coletividades, em uma perspectiva de trabalho multidisciplinar,integrado e em redes, de forma que considere as necessidades em saúde da população, em uma açãoarticulada entre os diversos atores, em um determinado território...

Infliximab: efficacy in psoriasis.

Moderate to severe psoriasis often needs to be addressed with standard disease modifying therapies such as methotrexate, cyclosporine, acitretin or ultraviolet radiation, which have their potential benefits and limitations. The tumor necrosis factor-alpha (TNF-α) is elevated in psoriatic plaques compared to non lesional skin as well as in the plasma of patients with moderate to severe psoriasis. Infliximab, a TNF-α blocker, has been recommended for the treatment of moderate to severe plaque psoriasis in adults who have failed to respond to these therapies or who cannot tolerate them. Its specific action on the bound and membrane forms of the pro-inflammatory cytokine TNF-α has made it the molecule of choice for obtaining quicker and longer remission in recalcitrant cases. However, the widespread use of infliximab in the Indian subcontinent is limited by its cost. This article reviews the international guidelines for use of infliximab, its dosage patterns, and efficacy in chronic plaque psoriasis, nail psoriasis, erythrodermic psoriasis, and pustular psoriasis as well as Indian experience.

Report of the Stigma Research Workshop for the development of scientific consensus papers and field guidelines on health-related stigma, held in Amsterdam, the Netherlands from 11-14 october 2010.

Summary In concurrence with the broad body of literature published on health-related stigma, there is a need for practical field guidance to contribute to the fight against leprosy-related stigma and discrimination. To this end, much can be gained by considering the accumulated knowledge and learned from experience with different stigmatising conditions; primarily HIV/AIDS, disability, tuberculosis, and mental health. Therefore a Stigma Research Workshop was organised from 11-14 October in Amsterdam, The Netherlands. The primary aim of the workshop was to produce scientific papers and field guidelines that could be used to target actions against health-related stigma and discrimination. Keynote presentations were offered by scientists and professionals from different health domains who shared their knowledge, experiences and research findings regarding health-related stigma. Group work was subsequently conducted to work towards agreed outputs on four different themes: i.e. research priorities, measurement, interventions, and counselling. The spectrum of expertise present enabled an interdisciplinary and inter-profession sharing of knowledge and practices. This resulted in the commencement of consensus papers and field guidelines related to the four themes. An evaluation by participants concluded that the workshop had been an informative and worthwhile activity that will strengthen the fight against stigma.

Análise do protocolo complementar de investigação diagnóstica dos casos de hanseníase em menores de 15 anos nos municípios prioritários do estado do Rio de Janeiro em 2009 e 2010 / Analysis of the additional protocol of diagnostic investigation of cases of leprosy in children under 15 years in priority municipalities in the state of Rio de Janeiro in 2009 and 2010

Introdução: A ocorrência de hanseníase em crianças e adolescentes é preocupante porque seu aumento é considerado indicador de maior gravidade da endemia hansênica. O Ministério da Saúde instituiu, em 2008, o Protocolo Complementar de Investigação Diagnóstica em Menores de 15 Anos (PCID < 15), a ser preenchido pelos profissionais das unidades de saúde quando diagnosticado um caso de hanseníase nesta faixa etária. O presente estudo pretendeu analisar criticamente as informações contidas nas fichas do PCID < 15, nos municípios prioritários do estado do Rio de janeiro. Métodos: dos campos; 15,4% destes tiveram percentual de pre. Foi realizado estudo seccional retrospectivo, utilizando análise estatística descritiva das informações contidas nos registros dos PCID < 15 nos anos de 2009 e 2010, dos municípios considerados prioritários para a Gerência de Dermatologia Sanitária da Secretaria de Estado de Saúde do Rio de Janeiro. Foi analisada a completitude dos campos, incluindo a consistência das informações daqueles referentes à classificação operacional e número de lesões de pele, além da análise epidemiológica das 172 fichas incluídas no estudo. Resultados: O percentual de preenchimento foi excelente, na maioria dos campos; 15,4% destes tiveram percentual de pre enchimento considerado regular (itens “prontuário”, de refletir a situação epidemiológica dos pacientes me“tempo de residência”, “número de pessoas da família com problemas de pele”, e “cicatriz de BCG”). Não foi analisada a porcentagem de preenchimento do campo “grau de incapacidade física”. Ocorreu forte concordância (coeficiente Kappa k = 0,76, p < 0,0001) entre os campos “número de lesões de pele” e “classificação operacional”, com apenas 7% de casos inconsistentes...

Introduction: The occurrence of leprosy in children and adolescents is of concern because its increase is consid-ered an indicator of severity of leprosy. The Ministry of Health established in 2008 an Additional Protocol of Di-agnostic Research in Children under 15 Years (PCID <15), to be fulfilled by professionals in the health units when-ever a case of leprosy in patients in this age group is diag-nosed.The present study aimed to critically analyze the information contained in the files of the PCID < 15, in priority municipalities of Rio de Janeiro State. Methods: We conducted a retrospective cross-sectional study us-ing descriptive statistics, based on the evaluation of the information contained in the records of leprosy cases registered in PCID <15 years in 2009 and 2010 from the priority municipalities according to the cri-teria of the Sanitary Dermatology Department of the Rio de Janeiro State Health Secretariat. We analyzed the completeness of fields including the consistency of the information fields according to the operational clas-sification and number of skin lesions, contained in the 172 records included in the study. Results: Excellent per-centage of completion, according to the parameters of SINAN, occurred in most fields, with only 15.4% of fields with regular percentage of completion (“records”, “residence time”, “number of people in the family with skin diseases”, and “BCG vaccination scar”). The study revealed a strong concordance (Kappa coefficient k = 0.76, p <0.0001) between the fields number skin le-sions and operational classification, with inconsistency in only 7% of cases. There was a slight predominance of females, 92.3% of cases between 5 and 14 years, 71.6% diagnosed with six months or more after the onset of signs and symptoms, 58.6% of patients had history of leprosy in the family, 85% of cases had up to 5 skin le-sions and 83.6% had a BCG scar...

Introducción: La lepra en los niños, niñas y adolescentes es preocupante, ya que su incremento es un indicador de lepra endémica más grave. El Ministerio de Salud estableció en 2008, el Protocolo de Investigación adi-cional de diagnóstico en los niños menores de 15 años (Pontificio Consejo <15), que se completará por los pro-fesionales en las unidades de salud cuando un caso de lepra diagnosticados en este grupo de edad. El presente estudio tuvo como objetivo analizar críticamente la in-formación contenida en los archivos de los municipios prioritarios PCID menores de 15 en el estado de Río de Janeiro. Métodos: Se realizó un estudio retrospectivo de corte transversal mediante el análisis estadístico des-criptivo de la información contenida en los registros de PCID <15 años en 2009 y 2010, las ciudades consideradas prioritarias para la gestión de Dermatología Sanitaria de la Secretaría de Salud del Estado de Río de Janeiro. Se analizó la totalidad de los campos, incluyendo la consis-tencia de la información de los que operan en la clasi-ficación y el número de lesiones en la piel, además de un análisis epidemiológico de 172 fichas incluidas en el estudio. Resultados: El porcentaje de cumplimiento fue excelente en la mayoría de los campos, el 15,4% porcen-taje de pases completos de ellas fueron consideradas regular (artículos de “grabación”, “tiempo de residencia”, “número de miembros de la familia con problemas de la piel”, y “cicatriz de la BCG”). No se analizó el porcentaje de finalización de la “discapacidad física”. Hubo un fuerte acuerdo (coeficiente kappa k = 0,76, p <0,0001) entre los campos “número de lesiones en la piel” y de operación “clasificación” con sólo el 7% de los casos inconsisten-tes...

Comparison of two systems of classification of leprosy based on number of skin lesions and number of body areas involved--a clinicopathological concordance study.

BACKGROUND AND AIMS: WHO guidelines classify leprosy patients for therapeutic purposes into paucibacillary (PB) and multibacillary (MB) leprosy based on the number of skin lesions. An alternative system of classification has been in practice in Nepal from 1985 onwards, based on the number of body areas involved in patients of leprosy. We attempted a clinicopathological approach for comparison of these two systems of classification in leprosy patients for their ability to demarcate patients into groups of PB and MB leprosy. MATERIALS AND METHODS: The study included 108 leprosy patients (80 males and 28 females). Complete clinical examination and body charting was carried out in each patient noting the count of skin lesions and the number of body areas involved. Slit skin smears and skin biopsies were taken from an active skin lesion in all patients. RESULTS: On analysis, it was observed that there was good clinicopathological correlation between patients with 5 or < 5 skin lesions and 2 or < 2 body areas involved. (Clinical 95% and histological 96%) A similar correlation was also observed in the other group of patients with > 5 skin lesions and > 2 body areas involved, (Clinical 94% and histological 96%). There were almost identical numbers of patients represented in these two groups of classification. CONCLUSIONS: Our findings suggest that patients with involvement of 2 or less body areas can be classified as PB leprosy and those with more than 2 body areas involved can be classified as MB leprosy for the purposes of therapy. The study of areas of involvement in leprosy patients not only provides additional patient information but also adds another parameter as a basis for the study of leprosy patients.

MDT-MB therapy in paucibacillary leprosy: a clinicopathological assessment.

BACKGROUND: The World Health Organization recommends treatment regimens for paucibacillary (PB) and multibacillary (MB) leprosy, which differ in their duration and components. Hence accurate classification of the disease is required. To overcome difficulties in classification Uniform Multi Drug Therapy (U-MDT) has been recommended. AIM: To evaluate the benefit of adding clofazimine to paucibacillary regimens in leprosy patients by measuring clinical and histological resolution. METHODS: Forty-four paucibacillary patients were included in the study. Twenty-two patients were given MDT-PB regimen and the remaining MDT-MB regimen for six months . Skin biopsies were done before the commencement and at the end of treatment. Clinical and histological resolutions were measured according to the standard criteria a laid down. The results were analyzed using Fishers' test and Crammers' V test. RESULTS: Clinical improvement was observed in 90.9% in the MB group as compared to 27.3% in the PB group. Regression in the nerve swelling was observed in 70% in the MB group and in 37.5% in the PB group while histological resolution was observed in 72.8% and 54.5% respectively. CONCLUSIONS: Addition of clofazimine helps to resolve leprosy lesions both clinically and histologically, thus justifying the concept of Uniform MDT regimen for all patients.

WHO disability grading: operational definitions.

The WHO disability grading has been in use for many years. Its main use has been as an indicator for early case detection/reporting. More recently, the WHO grading has also been used as a change indicator of impairments for patients while on treatment. In such instances, the individual scores for eyes hand, and feet are added to obtain the so-called EHF sum score. A major drawback in the use of the grading system has been the lack of operational definitions of the descriptions for the grades. This may result in data and results of comparisons of data across programs and countries being flawed. The paper discusses the WHO grading in the light of its dual use: as an indicator for early case detection and as an indicator for change in impairments. The paper presents operational definitions for the grading options.

New concerns about thalidomide.

Recently, the Food and Drug Administration (FDA) approved thalidomide for the treatment of the painful symptoms of erythema nodosum leprosum. This most recent FDA decision is a marked reversal to its previous rejection of this drug in the 1960s. The initial rejection by the FDA in the 1960s spared countless American children as thalidomide was shown to cause birth defects and miscarriages worldwide. The FDA's reputation as one of the finest consumer safety authorities was strengthened because of this decision. The recent approval of thalidomide by the FDA, with accompanying strict guidelines and monitoring procedures, has not only brought forth potential benefits, but also created new potential problems.