[Guidelines for the treatment of Hansen's disease in Japan (third edition)].

ad hoc committee of Japanese Leprosy Association recommends revised standard treatment protocol of leprosy in Japan, which is a modification of World Health Organization's multidrug therapy (WHO/MDT, 2010). For paucibacillary (PB) leprosy, 6 months treatment by rifampicin and dapsone (MDT/PB) is enough. However, for high bacterial load multibacillary (MB) leprosy, 12 months treatment seems insufficient. Thus, (A) For MB with bacterial index (BI) > 3 before treatment, 2 years treatment by rifampicin, dapsone and clofazimine (MDT/MB) is necessary. When BI becomes negative and active lesion is lost within 2 years, no maintenance therapy is necessary. When BI is still positive, one year of MDT/MB is added (3 years in total), followed by maintenance therapy by dapsone and clofazimine until BI negativity and loss of active lesions. (B) For MB with BI < 3 or fresh MB (less than 6 months after the onset of the disease) with BI > 3, 1 year treatment by MDT/MB is necessary. When BI becomes negative and active lesion is lost within one year, no maintenance therapy is necessary. When BI is still positive or active lesion is remaining, additional therapy with MDT/MB for one more year is recommended. Brief summary of diagnosis, purpose of therapy, character of drugs, and prevention of deformity is also described.

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.

Surgical correction of deformities and disabilities in leprosy patients.

Despite some positive experiences, surgical rehabilitation, presently, is minimally available in endemic countries and the contingent of patients in need of this modality of treatment is enlarging constantly. With the reduction of prevalence of leprosy and the progressive integration of care of leprosy-affected persons into the general health services, surgical rehabilitation should be made available in these centres. Training health personnel of general health services in leprosy surgery is mandatory and urgent. There is a need for the settlement of a multi-organizational task-force (WHO-ILEP-ILA) to deal with this problem. The aim of this task-force should be the definition of strategies to organize such training and to increase awareness among medical societies and schools regarding this issue. This group should also remember that the referral centres in Africa, Asia, North and South America should act as reservoir of this knowledge and, as such, should be fully supported and enhanced, since they have an important and unique role to play in the training of general health services personnel.

Avaliaçäo das incapacidades em pacientes hansenicos atendidos nos servicos publicos de saude do Distrito Federal, com alta em 1995 / Assessment of the Disabilities in Patients of Hansens Disease in the Distrito Federals Public Health Services, Discharged in 1995

A lepra e uma doenca secular, transmissivel, que atinge pele, nervos e olhos, endemica em paises subdesenvolvidos e tem alto poder incapacitante e estigmatizante, sendo a avaliacao de incapacidades um indicador e instrumento importante para o controle da hanseniase, reducao do problema medico-social e estigma da doenca. Esse trabalho levantou a ocorrencia de incapacidades e deformidades fisicas em 656 pacientes portadores de hanseniase, em todas as faixas etarias, atendidos no Distrito Federal e que tiveram alta por cura em 1995. Correlacionou as incapacidades com idade, tempo de tratamento e formas clinicas da doenca. partindo da classificacao das taxas de evolucao dos graus de incapacidades fisicas, os pacientes foram classificados nos seguintes grupos: manutencao, reducao e piora das incapacidades, sendo estes grupos tambem correlacionados com o tempo de tratamento e forma clinica. A faixa etaria mais acometida por incapacidade foi a maior de 45 anos com percentual de 29,7 por cento. Houve predominio do sexo masculino. Verificou-se uma correlacao entre a forma clinica e a taxa de incapacidade fisica encontrada. O grupo multibacilar e o mais incapacitante e o que teve o tempo de tratamento maior que 36 meses foi o que apresentou o elevado percentual de nao avaliados (61,9 por cento). Para o controle desta endemia, os bons programas devem manter suas acoes voltadas na descoberta de casos precoce, na adocao de uma terapeutica eficaz e na aplicacao de tecnicas disponiveis de tratamento e acompanhamento das incapacidades (Au);

A study of medico-social problems of the inmates of a leprosy colony in Mysore.

A study of the inmates of a leprosy colony in Mysore revealed that there were more male cases and that the deformities were also more common among the male patients. There was no cases among inmates below 20 years of age group 31-50 years. 93.2% of the inmates were illiterate and 96.6% of the patients were ignorant of the cause, spread, prognosis of the disease and prevention of disabilities. This indicated an urgent need of health education among the leprosy patients and their families. All the inmates, including the apparently healthy relatives reported loss of income due to disease and disabilities. Rehabilitation of the inmates by raising poultry, breeding sheep and sericulture activities must be encouraged.