Educação e trabalho na saúde sob participação social organizada e disseminada: a acumulação das conferências livres nacionais 2022-2023 / Education and work in health under organized and disseminated social participation: the accumulation of national free conferences 2022-2023

A coletânea "Educação e trabalho na saúde sob participação social organizada e disseminada: a acumulação das conferências livres nacionais 2022 ­ 2023", reunida por Maria Luiza Jaeger, Ricardo Burg Ceccim e Priscila Viégas Barreto de Oliveira, é uma obra decorrente do cotejamento de seis conferências livres nacionais, realizadas entre final de 2022 e início de 2023, como parte da construção da 17ª Conferência Nacional de Saúde, das quais participou a Associação Científica Rede Unida […]. O foco da entidade é a Educação e Trabalho na Saúde, fazendo parte da comunidade de entidades/sociedades científicas com forte presença junto ao Conselho Nacional de Saúde, inclusive integrando várias de suas Comissões, em especial a Comissão Intersetorial de Recursos Humanos e Relações de Trabalho. A entidade também integra o Fórum de Entidades Nacionais de Trabalhadores da Área da Saúde, instância que congrega Conselhos, Federações e Associações presentes no campo da saúde. Considerada essa personalidade institucional, a Rede Unida integrou conferências nacionais livres onde o tema da Educação e Trabalho na Saúde formaram tópicos estratégicos ao debate dos rumos no Sistema Único de Saúde. […] A obra representa um esforço de memória e apoio ao exercício do controle social em saúde nos termos da Constituição Federal relativamente ao setor da saúde e especialmente no tocante à Lei Federal 8.142, de 28 de dezembro de 1990. A anotação "participação social organizada e disseminada" ao título da coletânea diz respeito à congregação de participantes país afora de modo orquestrado pelo Conselho Nacional de Saúde em um dispositivo inovador à democracia: a chancela às estratégias autogeridas, capazes de acumular engajamento, reflexão e contribuição cidadã às políticas públicas de saúde. Essa nova realidade certamente se tornará mais um patrimônio brasileiro aos sistemas de saúde. A coletânea inicia a acaba no escopo da Educação e Trabalho na Saúde, este é seu propósito: recolher da participação social organizada e disseminada as contribuições de um campo particular pouco reconhecido como campo nas áreas de Ensino da Saúde e da Saúde Coletiva. Contudo, um campo germinativo, potente e aglutinador à ciência, à docência, à intervenção e à inovação.

The optimal dose of oral tranexamic acid in melasma: A network meta-analysis.

BACKGROUND: Melasma is a chronic skin condition that adversely impacts quality of life. Although many therapeutic modalities are available there is no single best treatment for melasma. Oral tranexamic acid has been used for the treatment of this condition but its optimal dose is yet to be established. OBJECTIVES: We used network meta-analysis to determine the optimal dose of oral tranexamic acid for the treatment of melasma. METHODS: We conducted a comprehensive search of all studies of oral tranexamic acid for the treatment of melasma up to September 2020 using PubMed, EMBASE and the Cochrane Library database. The quality of the studies was evaluated using the Jadad score and the Cochrane's risk of bias assessment tool. Only high quality randomised controlled trials were selected. Some studies lacked standard deviation of changes from baseline and these were estimated using the correlation coefficient obtained from another similar study. RESULTS: A total of 92 studies were identified of which 6 randomized controlled trials comprising 599 patients were included to form 3 pair-wise network comparisons. The mean age of the patients in these studies ranged from 30.3 to 46.5 years and the treatment duration ranged from 8 to 12 weeks. The Jadad scores ranged from 5 to 8. The optimal dose and duration of oral tranexamic acid was estimated to be 750 mg per day for 12 consecutive weeks. LIMITATIONS: Some confounding factors might not have been described in the original studies. Although clear rules were followed, the Melasma Area and Severity Index and the modified Melasma Area and Severity Index were scored by independent physicians and hence inter-observer bias could not be excluded. CONCLUSION: Oral tranexamic acid is a promising drug for the treatment of melasma. This is the first network meta-analysis to determine the optimal dose of this drug and to report the effects of different dosages. The optimal dose is 250 mg three times per day for 12 weeks, but 250 mg twice daily may be an acceptable option in poorly adherent patients. Our findings will allow physicians to balance drug effects and medication adherence. Personalized treatment plans are warranted.

A Pandemia e o Trabalho em Saúde: vozes do cotidiano / The Pandemic and Health Work: everyday voices

Com esta obra buscamos apresentar ao leitor reflexões sobre a COVID -19 e seus impactos no mercado de trabalho, especialmente num contexto de desigualdade social, onde muitos trabalhadores de ocupações essenciais ou não precisaram se expor ao vírus para manter a sua sobrevivência e a de sua família. Ao final das análises, pontuamos a necessidade proteção dos trabalhadores em tempos de Covid, orientações para os serviços e gestores de saúde, com a finalidade de desencadear a discussão sobre a invisibilidade de muitos trabalhadores que ficaram desprotegidos pelas políticas sociais brasileiras durante a pandemia de COVID-19. Com esse conjunto de textos, esperamos ampliar a compreensão sobre os efeitos da pandemia nos trabalhadores e trabalhadoras e, ao mesmo tempo, ativar o pensamento para iniciativas que são visibilizadas pelas autoras e autores. Ou seja, mais do que buscar aprendizagem com a experiência trágica da pandemia, pretendemos também construir novas manhãs para o trabalho na saúde. Objetivo oportuno, já que estamos diante da preparação da 17ª Conferência Nacional de Saúde, que terá o tema "Garantir Direitos e Defender o SUS, a Vida e a Democracia ­ Amanhã Vai Ser Outro Dia". Acreditamos que a pandemia será memória, aprendizagem e mobilização para retomarmos a agenda da proteção do trabalho, ampliarmos a compreensão de que o trabalho é direito humano e não dependência do capital, expandirmos iniciativas de políticas de proteção da vida e avançarmos no processo civilizatório que é necessário, como bem nos lembrou Sérgio Arouca na abertura da 8ª Conferência Nacional de Saúde, para que o SUS seja possível. Por fim, nossa homenagem às trabalhadoras e trabalhadores que, asfixiados pela pandemia e órfãos da ação governamental responsável, tiveram suas vidas tomadas nesses anos. Especialmente àqueles que foram vitimados desde sua inserção no trabalho em saúde. Aliás, não somente aos que partiram, também a todas as pessoas que se ocupam do trabalho em saúde nos sistemas, redes e serviços de saúde, mas também nos pontos de atenção nos territórios, com trabalhos informais e, muitas vezes, invisíveis. A vocês, nossas palmas, nosso reconhecimento e nossa luta para novas manhãs!

Vozes, olhares e sentidos da Participação Social no SUS / Voices, looks and senses of Social Participation in the SUS

Olhando para a trajetória histórica compreende-se melhor a relação entre "Democracia e Saúde" estabelecida para 16ª Conferência Nacional de Saúde realizada em 2019, pois a luta pelo direito à saúde e a implementação do SUS está vinculada a busca pela redemocratização e a ampliação dos direitos sociais no Brasil. As instâncias do controle social se consolidaram no decorrer das três décadas de sua existência, os movimentos sociais, bem como, as mais diversas organizações da sociedade civil, ocuparam estes espaços e buscaram transformá-los numa arena democrática de defesa da sua concepção de saúde, de política pública, de Estado, de desenvolvimento e de direitos humanos.

1ª Conferência Nacional de Vigilância em Saúde: processo ascendente e participativo / 1st National Health Surveillance Conference: bottom-up and participatory process

Este livro foi organizado e produzido para documentar e expandir o acesso às deliberações da 1ª Conferência Nacional de Vigilância em Saúde, com a expectativa de que se tornem vivas no cotidiano de todas as pessoas em todo o território brasileiro. Afinal, sistematizar o trabalho que se realiza pelo controle social no SUS é fundamental, inclusive para ocupar a condição de relevância pública que a Constituição Brasileira de 1988 atribuiu às ações e serviços de saúde. Tornar esse trabalho visível e reconhecê-lo nessa condição tem a dupla finalidade de fortalecer o SUS como política de saúde do estado brasileiro, conquistada pela população em esforço e luta, e de consolidar a relação entre a saúde e a democracia, aqui expressa pela designação das necessidades nos diferentes territórios e de forma ascendente, materializando a diretriz que embasa a institucionalidade do aparelho estatal na definição constitucional de que a saúde é bem de todos e que os governos devem agir para preservá-la e fortalecê-la.

Prevalência de pacientes notificados com hanseníase no município de São Luís, Maranhão, durante 2010-2020 / Prevalencia de pacientes notificados con lepra en el municipio de São Luís, Maranhão, durante 2010-2020 / Prevalence of leprosy patients notified in the municipality of São Luís, Maranhão, from 2010 to 2020

Objetivo: identificar a prevalência de pacientes notificados com hanseníase em São Luís, Maranhão, durante 2010-2020. Método: estudo descritivo, exploratório, retrospectivo, transversal, quantitativo, realizado no Banco de Dados público do DATASUS cuja coleta ocorreu em agosto de 2021. A amostra foi composta por 9.387 pacientes notificados com Hanseníase. Resultados: observa-se prevalência amostral em maio de 2012, sexo masculino, faixa etária entre 30-39 anos, Ensino Médio completo, pardos, casos multibacilares, avaliação de incapacidade física e de cura no estágio Grau 0, apresentaram mais que cinco lesões, baciloscopia negativa, episódios sem reação,sendo abordados como casos novos cuja forma prevalente foi a dimorfa, tendo como esquema terapêutico mais prescrito a poliquimioterapia durante 12 meses e prevalência de cura. Conclusão: houve uma prevalência dos casos de hanseníase em homens jovens com bom grau de instrução escolar. Apesar da alta prevalência de casos novos, o tratamento foi efetivo de modo a levá-los à cura.(AU)

Objective: to identify the prevalence of patients notified with leprosy in São Luís, Maranhão, during 2010-2020. Method: descriptive, exploratory, retrospective, cross-sectional, quantitative study, conducted in the public database of the DATASUS whose collection occurred in August 2021. The sample was composed of 9,387 patients notified with Leprosy. Results: sample prevalence was observed in May 2012, male gender, age range 30-39 years, complete High School, brown, multibacillary cases, evaluation of physical disability and cure in Grade 0 stage, presented more than five lesions, negative bacilloscopy, episodes without reaction, being addressed as new cases whose prevalent form was the dimorphic, having as the most prescribed therapeutic scheme the polychemotherapy for 12 months and prevalence of cure. Conclusion: there was a prevalence of leprosy cases in young men with good schooling. Despite the high prevalence of new cases, the treatment was effective in order to lead them to cure(AU)

Objetivo: identificar la prevalencia de pacientes con lepra notificados en São Luís, Maranhão, durante 2010-2020. Método: estudio descriptivo, exploratorio, retrospectivo, transversal, cuantitativo, realizado en la base de datos pública DATASUS, la cual fue recolectada en agosto de 2021. La muestra estuvo conformada por 9.387 pacientes reportados con lepra. Resultados: se tiene una muestra de prevalencia en mayo de 2012, sexo masculino, grupo etario entre 30-39 años, bachillerato completo, pardos, casos multibacilares, valoración de incapacidad física y curación en la etapa Grado 0, presentaba más de cinco lesiones, baciloscopía negativa , episodios sin reacción, siendo abordados como casos nuevos cuya forma prevalente fue borderline, siendo el régimen terapéutico más prescrito la polimedicación durante 12 meses y prevalencia de cura.Conclusión: había una prevalencia de casos de lepra en hombres jóvenes con buena escolaridad. A pesar de la alta prevalencia de casos nuevos, el trataminto fue eficaz de manera que los curará(AU)

Development and validation of a multiplex real-time qPCR assay using GMP-grade reagents for leprosy diagnosis.

Leprosy is a chronic dermato-neurological disease caused by Mycobacterium leprae, an obligate intracellular bacterium. Timely detection is a challenge in leprosy diagnosis, relying on clinical examination and trained health professionals. Furthermore, adequate care and transmission control depend on early and reliable pathogen detection. Here, we describe a qPCR test for routine diagnosis of leprosy-suspected patients. The reaction simultaneously amplifies two specific Mycobacterium leprae targets (16S rRNA and RLEP), and the human 18S rRNA gene as internal control. The limit of detection was estimated to be 2.29 copies of the M. leprae genome. Analytical specificity was evaluated using a panel of 20 other skin pathogenic microorganisms and Mycobacteria, showing no cross-reactivity. Intra- and inter-operator Cp variation was evaluated using dilution curves of M. leprae DNA or a synthetic gene, and no significant difference was observed between three operators in two different laboratories. The multiplex assay was evaluated using 97 patient samples with clinical and histopathological leprosy confirmation, displaying high diagnostic sensitivity (91%) and specificity (100%). Validation tests in an independent panel of 50 samples confirmed sensitivity and specificity of 97% and 98%, respectively. Importantly, assay performance remained stable for at least five months. Our results show that the newly developed multiplex qPCR effectively and specifically detects M. leprae DNA in skin samples, contributing to an efficient diagnosis that expedites the appropriate treatment.

Efficacy of hemoporfin photodynamic therapy for pulsed dye laser-resistant facial port-wine stains in 107 children: A retrospective study.

BACKGROUND: Port-wine stains occur in 0.3-0.5% newborns, mainly on the face and neck. Pulsed dye laser is recognized as the gold standard treatment; nevertheless, it is associated with a low cure rate and a high recurrence rate. AIMS: This study aims to evaluate the efficacy of hemoporfin photodynamic therapy for pulsed dye laser-resistant port-wine stains in children. METHODS: We studied 107 children who received hemoporfin photodynamic therapy for port-wine stains on the face and neck that were resistant to pulsed dye laser. After intravenous injection of 5 mg/kg hemoporfin, the local lesion was irradiated with 532 nm LED green light for 20 min with a power density of 80-100 mW/cm2. A total of 65 patients were given a second treatment after eight weeks. The efficacy and therapeutic responses were recorded at four days and eight weeks after each treatment. RESULTS: The efficacy was positively correlated with the number of treatments received; two treatment sessions yielded significantly better results compared to a single treatment with a response rate of 96.9%, a significant response rate of 50.8% and a cure rate of 21.5%, respectively (P < 0.001). After two treatment sessions, the efficacy was negatively correlated with age (P = 0.04). The efficacy for port-wine stains located on the lateral part was better than that of the central face (P = 0.04). The efficacy for the pink type was better than that for the red and purple types (P = 0.03). No allergic or systematic adverse reactions were reported. LIMITATIONS: No objective measurement data were available. CONCLUSION: Hemoporfin photodynamic therapy is effective and safe for pulsed dye laser-resistant facial port-wine stains in children.

Red cell ektacytometry in two patients with chronic hemolytic anemia and three new α-spectrin variants.

Red blood cell (RBC) morphology is, in general, the key diagnostic feature for hereditary spherocytosis (HS) and hereditary elliptocytosis (HE). However, in hereditary pyropoikilocytosis (HPP), the severe clinical form of HE, the morphological diagnosis is difficult due to the presence of a RBC morphological picture characterized by a mixture of elliptocytes, spherocytes, tear-drop cells, and fragmented cells. This difficulty increases in new-borns and/or patients requiring frequent transfusions, making impossible the prediction of the disease course or its severity. Recently, it has been demonstrated that the measurement of osmotic gradient ektacytometry (OGE), using a laser-assisted optical rotational ektacytometer LoRRca (MaxSis, RR Mechatronics), allows a clear differentiation between HS and HE, where the truncated osmoscan curve reflects the inability of the already elliptical cells to deform further under shear stress in the face of hypotonicity. In HPP, however, the RBCs appear to have a significantly decreased ability to maintain deformability in these conditions, and the classical trapezoidal profile of HE is less evident or indistinguishable from HS. Here, two unrelated patients with hereditary hemolytic anemia (HHA) due to HPP and HS, respectively, are described with the joint inheritance of a complex set of five genetic defects. Two of these defects are novel alpha-spectrin gene (SPTA1) variants, one is a microdeletion that removes the entire SPTA1 gene, and two are well-known low-expression polymorphic alleles: α-LELY and α-LEPRA. In the HPP patient (ID1), with many circulating spherocytes, the interactions between the two SPTA1 gene variants may lead, in addition to an elongation defect (elliptocytes), to a loss of membrane stability and vesiculation (spherocytes), and RBCs appear to have a significantly decreased ability to maintain deformability in hypotonic conditions. Due to this, the classical trapezoidal profile of HE may become less evident or indistinguishable from HS. The second patient (ID2) was a classical severe form of HS with the presence of more than 20% of spherocytes and few pincered cells. The severity of clinical manifestation is due to the coinheritance of a microdeletion of chromosome 1 that removes the entire SPTA1 gene with a LEPRA SPTA1 variant in trans. The diagnostic interest of both observations is discussed.

Hindi translation and validation of quality of life score in Indian patients with epidermolysis bullosa; and its correlation with the clinical severity assessment scores: A cross-sectional study.

BACKGROUND: Quality of life (QoL) has not been evaluated in Indian patients having epidermolysis bullosa (EB). AIMS: The aims of the study were to measure health-related QoL in Indian patients having EB using the quality of life in epidermolysis bullosa (QoLEB) questionnaire, and to find its correlation with clinically measured disease severity. METHODS: In this observational cross-sectional study, the QoLEB questionnaire was translated from English to Hindi (QoLEB-Hin) and culturally adapted without a change in concept following standard guidelines. QoLEB-Hin and three clinical scores that have been independently validated in EB, that is, Birmingham Epidermolysis Bullosa severity score (BEBs), Instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa (iscorEB) and Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI), were administered to EB patients/their parents in the presence of an expert. This was followed by validity and correlation studies. RESULTS: Fifty-four patients were recruited (19-females, 35-males; median age 5 years, range 0.025-36 years and 12 patients with an age >13 years). The parents answered the questions for 42 patients (age <13 years). Dystrophic epidermolysis bullosa was diagnosed in 32 (59.2%) patients (dominant dystrophic epidermolysis bullosa [DDEB]-19 [35.2%] and recessive dystrophic epidermolysis bullosa [RDEB]-13 [24.1%]). Junctional epidermolysis bullosa (JEB) and epidermolysis bullosa simplex (EBS) were each diagnosed in 11 (20.4%) patients. The mean ± standard deviation (SD) of QoLEB-Hin score of all epidermolysis bullosa patients was 11.3 ± 7.6 (range 0-28; median and interquartile range [IQR], 10, 10) and reflected an overall moderate degree of affliction on QoL of patients. Mean ± SD of QoLEB-Hin scores for EBS, JEB, DDEB and RDEB were 5.4 ± 3.7 (range, 1-13; median and IQR, 6, 6), 11 ± 6.2 (range, 1-22; median and IQR, 10, 6), 9 ± 5.7 (range, 0-19; median and IQR, 10, 10) and 20.1 ± 6.4 (range, 12-28; median and IQR, 19, 12.5), respectively (P < 0.001, Kruskal-Wallis analysis of variance). Cronbach's alpha coefficient of 0.946 was obtained for all items indicating excellent internal consistency and reliability. Mean sample adequacy was 0.91; absolute fit based off diagonal values was 0.99; indices root mean square error of approximation and root mean square residual were 0.04 and 0.05, respectively, and Tucker Lewis index was >1 indicating overfit. The mean time taken to complete the questionnaire was 6.1 min (range, 6-8 min). QoLEB-Hin correlated significantly (P < 0.001) with BEBs (ρ = 0.79), iscorEB (ρ= 0.63) and EBDASI (ρ = 0.77). Three multiple linear regression models were used to ascertain the strength of relationship between QoL-Hin, and BEBs, iSCOREB and EBDASI, respectively, after adjusting for age, gender and disease subtype. The EBDASI clinical score accounted for approximately 74% (R2 = 0.736, P < 0.001) of the variability in QOL-Hin, as compared to 73% and 55% by BEBs (R2 = 0.731, P < 0.001) and iscorEB (R2 = 0.545, P < 0.001), respectively. LIMITATIONS: Parents filled out the questionnaires for many patients and probably led to an overall moderate degree of affliction of QoL. Comparison with Dermatology Life Quality Index and other QoL scores were not done in this study. Furthermore, the scoring was done at one point in time, and test-retest measurements could not be performed. CONCLUSION: This study validated QoLEB-Hin in an Indian population finding an overall moderate reduction in QoL due to EB. Maximally affected QoL was seen in patients with RDEB. Furthermore, QoLEB-Hin had a variable positive correlation and association with all clinical severity assessment scores.

Leprosy in children in Cuba: Epidemiological and clinical description of 50 cases from 2012-2019.

INTRODUCTION: In 1993, Cuba achieved leprosy elimination according to the World Health Organization's (WHO) indicator of less than one case per 10,000 population. Despite this achievement, detection of new cases occurs every year among all age groups including children. Detection of new cases in children reveals persistent transmission of the infection. OBJECTIVE: To describe the clinical and epidemiological features of leprosy in individuals younger than 15 years (childhood leprosy) reported to the Cuban National Leprosy Control Program (NLCP) between 2012 and 2019. METHODS: We conducted a retrospective descriptive study between 2012 and 2019 to assess the clinical and epidemiologic features of individuals under the age of 15 years with a confirmed diagnosis of leprosy reported to the NLCP. We reviewed the NLCP database and collected data to better define the total number of cases of leprosy in adults, children (younger than 15 years). We assessed socio-demographic variables (age, gender, and province of residence) as well as variables of clinical interest including operational classification and staging at diagnosis, bacillary index, grade of disability by WHO staging. Additionally, we evaluated epidemiological variables including passive versus active surveillance of cases, contact investigation focusing specifically in household transmission, and the degree of kinship as well as standing of the child within the focus of transmission when there were additional cases. RESULTS: We identified fifty children during the study period corresponding to 3% of the overall cases of leprosy comprising all age groups in Cuba. In the age group younger than 15 years, the majorities of cases was from the Granma province and most were between the ages of 10 and 14 years. Clinically, multibacillary/lepromatous forms were the most common type identified with positive bacillary index. The majority of children diagnosed with leprosy during our study period had a history of a relative with a confirmed diagnosis of leprosy. CONCLUSIONS: Detection of cases of leprosy in individuals younger than 15 years of age in Cuba demonstrates ongoing transmission of M. leprae in specific geographic hotspots. Its frequency in the early adolescence, the predominant clinical forms, and the mode of detection associated with sources of suspected familiar infection demonstrated that there is a need for further efforts by the NLCP to conduct active surveillance activities among affected communities to identify cases of leprosy earlier with the goal of preventing further household and community transmission.

Bacillus of Calmette and Guérin (BCG) and the risk of leprosy in Ciudad del Este, Paraguay, 2016-2017.

OBJECTIVES: Paraguay has experienced a 35% reduction in the detected incidence of leprosy during the last ten years, as the vaccination coverage against tuberculosis (Bacillus of Calmette and Guérin [BCG] vaccine) reached ≥95% among infants. The objective of this case-control study was to evaluate the protective effect of BCG on the risk of leprosy. METHODS: We used a population-based case-control study of 20 leprosy confirmed cases reported among residents of Ciudad del Este, Paraguay, diagnosed in 2016-2017. Three controls were selected from a random sample of households from the city. We assessed vaccine effectiveness using 1- odds ratio [OR], and confounding for age, gender, education, occupation, and marital status using stratified and exact logistic regression, and explored if there was effect modification calculating the synergy factor (SF) and relative excess risk due to interaction (RERI). RESULTS: After controlling for age, gender, education, occupation and marital status, the OR of BCG scar on the risk of leprosy was 0.10 (95% confidence interval [CI], 0.02 to 0.45), for an estimate of vaccine effectiveness of 89.5% reduced risk of leprosy (95% CI, 55.2 to 98.1). There was evidence of heterogeneity by which the effectiveness of BCG seemed stronger among younger persons (Breslow-Day and Z-test of the SF had a p<0.05), and both the RERI and SF indicated a less then multiplicative and additive interaction of BCG and younger age. CONCLUSIONS: BCG vaccination was associated with a decreased risk of leprosy in the study population, particularly in persons born after 1980.

Epidemiological Characteristics and Trends of Registered Leprosy Cases in China From 2004 to 2016.

Leprosy is an infectious disease caused by Mycobacterium leprae. China was once one of the countries with severe leprosy epidemics, but its incidence has remained low in recent years. Despite this, there has been no decrease in its incidence more recently, and it is still a public health problem which needs to be controlled. In this study, we analyzed the epidemiological characteristics and trends in the detection rate of new cases of leprosy in China between 2004 and 2016. There were 4,519 cases of leprosy in 28 provinces, municipalities, and autonomous regions between 2004 and 2016, and the total incidence was 0.02815 (per 100,000 individuals) and 21 deaths. The overall incidence of leprosy showed an inverted "V" distribution (i.e., an increase followed by a decrease). Yunnan, Sichuan, Guangdong, Guizhou, and Guangxi were the top five regions with the highest incidence rates, and they accounted for 68.7% of the total cases. There were more male patients than female patients, and peasants accounted for 71.7% of the leprosy cases. The patients with leprosy in China were mainly concentrated in the age-group 15-44 years, as this group accounted for 57.2% of the total cases. The purpose of this study is to explore the epidemiology of leprosy in China. This analysis will be useful for future monitoring of leprosy and establishment of public health measures in China, in keeping with the "Programme for the Elimination of Leprosy in China 2011-2020."

T-Regulatory Cells in Erythema Nodosum Leprosum: An Immunohistochemical and Image Morphometric Study.

ABSTRACT: Erythema nodosum leprosum (ENL) occurs as an immune-inflammatory complication of multibacillary leprosy (MBL), precipitated by an interaction between the host, bacilli, and the environment. This complication often causes significant morbidity due to systemic involvement and needs to be treated aggressively. T-regulatory cells (T-regs) are the immunomodulatory subset of T cells that are hypothesized to play a role in ENL. We have performed immunohistochemistry for FoxP3 (T-reg), CD3 (pan-T), CD4 (helper T), and CD8 (cytotoxic T) on 50 biopsy-proven cases of ENL along with 84 biopsy-proven cases of paucibacillary leprosy (PBL) (n = 49) and MBL (n = 35). Image morphometry was applied to objectively assess the relative preponderance of these subsets of T cells. The area fraction of T-regs showed a trend of reduction from PBL to MBL to ENL (P = 0.068), whereas the FoxP3:CD3 (T-reg: pan-T) ratio showed a significant reduction across these groups (P = 0.023). However, there was no significant difference of T-regs or FoxP3:CD3 ratio between MBL and ENL. The T-regs showed a significant positive correlation (P = 0.007) with the cytotoxic T cells in the skin biopsy. The presence of dermal eosinophils in ENL showed a trend association with the FoxP3:CD3 ratio (P = 0.05). Various histopathological parameters including epidermal spongiosis, dermal stromal edema, dermal ill-formed granuloma, and the presence of bacilli within the endothelium and vascular smooth muscle correlated with various T-cell subsets. Our study, one of the largest on this topic, objectively assessed the role of T-regs in the spectrum of leprosy. Nevertheless, the precipitation of ENL from MBL is probably not associated with the T-reg subset alone.

Predictive nomogram for leprosy using genetic and epidemiological risk factors in Southwestern China: Case-control and prospective analyses.

BACKGROUND: There is a high incidence of leprosy among house-contacts compared with the general population. We aimed to establish a predictive model using these genetic factors along with epidemiological factors to predict leprosy risk of leprosy household contacts (HHCs). METHODS: Weighted genetic risk score (wGRS) encompassing genome wide association studies (GWAS) variants and five non-genetic factors were examined in a case-control design associated with leprosy risk including 589 cases and 647 controls from leprosy HHCs. We constructed a risk prediction nomogram and evaluated its performance by concordance index (C-index) and calibration curve. The results were validated using bootstrap resampling with 1000 resamples and a prospective design including 1100 HHCs of leprosy patients. FINDING: The C-index for the risk model was 0·792 (95% confidence interval [CI] 0·768-0·817), and was confirmed to be 0·780 through bootstrapping validation. The calibration curve for the probability of leprosy showed good agreement between the prediction of the nomogram and actual observation. HHCs were then divided into the low-risk group (nomogram score ≤ 81) and the high-risk group (nomogram score > 81). In prospective analysis, 12 of 1100 participants had leprosy during 63 months' follow-up. We generated the nomogram for leprosy in the validation cohort (C-index 0·773 [95%CI 0·658-0·888], sensitivity75·0%, specificity 66·8%). Interpretation The nomogram achieved an effective prediction of leprosy in HHCs. Using the model, the risk of an individual contact developing leprosy can be determined, which can lead to a rational preventive choice for tracing higher-risk leprosy contacts. FUNDING: The ministry of health of China, ministry of science and technology of China, Chinese academy of medical sciences, Jiangsu provincial department of science and technology, Nanjing municipal science and technology bureau.