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PURPOSE: The purpose of this study was to introduce and evaluate the Descriptive Ankle Fracture Classification (DAFC) system, a novel alphanumeric method for categorizing ankle fractures and fracture dislocations, and to assess its reliability and prognostic value compared to traditional classification systems (AO/OTA, Weber, and Lauge-Hansen). MATERIALS AND METHODS: A retrospective review was conducted on 90 patients who underwent surgical treatment for ankle fractures. Four observers of varying experience levels classified the fractures using the DAFC, AO/OTA, Weber, and Lauge-Hansen classification systems. Interobserver and intraobserver reliability were evaluated using Fleiss' Kappa coefficient. Functional outcomes were assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) and Olerud Molander Ankle Score (OMAS) systems, and comparisons were made across classification systems to determine prognostic value. RESULTS: The DAFC system demonstrated superior interobserver reliability, particularly for medial malleolus fractures (Kappa = 0.935-0.954) and syndesmotic injuries (Kappa = 0.873-0.891), compared to the other systems. Intraobserver reliability was consistently high across all categories in the DAFC system, with Kappa values ranging from 0.967 to 1.000. Functional outcomes revealed significant associations with the DAFC classification: patients with complete dislocation (D2) had significantly lower AOFAS and OMAS scores than those without dislocation (D0) (P = 0.011), and those with larger posterior malleolus fractures (P2) had poorer OMAS scores (P = 0.014). No statistically significant differences in AOFAS or OMAS scores were observed across AO/OTA, Weber, or Lauge-Hansen classifications. CONCLUSIONS: The DAFC system offers a reliable and comprehensive framework for ankle fracture classification, with the added benefit of prognostic insights, particularly regarding dislocation and posterior malleolus involvement. Its high interobserver and intraobserver reliability, even among observers with varying experience, suggests that the DAFC system is valuable for clinical use. Future research should focus on validating these findings in larger cohorts and assessing the DAFC system's impact on long-term patient outcomes. LEVEL OF EVIDENCE: Level IV, Retrospective cohort.

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Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterised by recurrent painful nodules, abscesses, and sinus tract formation in intertriginous areas. Accurate staging of this disorder is crucial for appropriate management and prognosis. The role of imaging in the staging of HS is still evolving. Objectives To assess the correlation between clinical disease severity staging and high-resolution ultrasonography and colour doppler (HRUS-CD) staging in HS patients. Methods This was a cross-sectional, single-centre study in patients above 18 years of age with the clinical diagnosis of HS. All patients underwent clinical examination and high-resolution ultrasonography and colour doppler study with high-frequency linear probe (L+ 8-24 MHz). Correlations between clinical Hurley staging and the various ultrasonographic parameters i.e. SOS-HS (sonographic staging of severity of HS), degree of vascularisation, fibrotic scarring and oedema were explored and analysed. Spearman's correlation coefficient was applied to study the correlations and p<0.05 was considered significant. Results A total of 46 patients with HS who met the inclusion criteria were included. The majority of patients were clinically in Hurley stages 1 (32.6%; n=15) and 2 (56.5%; n=26) (41 in all). However, on the basis of ultrasonographic findings, significant numbers of patients had greater severity of staging on SOS-HS (58.5%; n=24/41), higher vascularity on colour doppler (26.8%; n=11), more severe grading of fibrous scarring (43.9%; n=18) and oedema (68.2%; n=28) in comparison to the clinical Hurley staging. Limitations Limitations of our study include a small sample size and cross-sectional design. Conclusion The results of the study indicate that the majority of the patients were under-staged and under-treated clinically, hence emphasising the role of high-resolution ultrasonography and colour doppler study in the accurate determination of HS severity. Future research should focus on standardised protocols and larger, prospective studies to establish the role of these imaging modalities in routine clinical practice.

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Erythema nodosum leprosum (ENL), an inflammatory reaction in leprosy, causes painful nodules, fever, and malaise due to immune system activation. Thalidomide is an effective treatment, although associated with important adverse effects. We aimed to evaluate the association of genetic variants in genes encoding tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1ß) and interleukin-6 (IL-6) with the response to treatment of ENL with thalidomide. 148 patients from the South and Northeast regions of Brazil were included. Genomic DNA was isolated from blood and/or saliva samples using commercial kits, and genetic variants in TNF, IL6, IL1ß, and IFNγ genes were genotyped by TaqMan system. We identified an association between polymorphisms in TNF (rs1799964C, rs1800630A, rs1799724T and rs1800629A) IL1ß (rs4848306G, rs1143623G, rs16944A, and rs1143627A), IL6 (rs2069840C and rs2069845G) and IFNγ (rs2430561T) with thalidomide dose variation in a time-dependent manner. Associations of IL6 and TNF haplotypes with thalidomide dosage variation over the time of treatment were also observed. Polymorphisms in TNF, IL6, IL1ß, and IFNγ genes may modulate their expression levels, potentially impacting the required dosage of thalidomide in the treatment of ENL. Our findings should be confirmed in further studies to estimate the size effect of these polymorphisms on ENL treatment with thalidomide.

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Leprosy diagnosis is difficult to perform due to variable sensitivity and/or specificity of the tests. In addition, the collection of the blood samples requires laboratorial structure and trained professionals. In the present study, the diagnostic efficacy of M1 chimeric protein, which was recently showed to be antigenic for leprosy using a serum-based ELISA, was evaluated against patient urine. Paired serum and urine samples were collected from patients with paucibacillary (PB) and multibacillary (MB) leprosy, tegumentary and visceral leishmaniasis, tuberculosis, Chagas disease, malaria, and HIV-infected subjects. Samples from healthy individuals and household contacts were also used. The protein and peptides used to compose it were used as antigens, and results showed that the four peptides presented good sensitivity and specificity to detect MB leprosy, while M1 protein showed sensitivity and specificity of 98.5 % and 100 %, respectively, to detect both PB and MB leprosy, when an urine-based ELISA was performed. Positive (PPV) and negative (NPV) predictive values were 100 % and 98.3 %, respectively. In a serum-based ELISA, sensitivity and specificity were 96.9 % and 100 %, respectively, with PPV and NPV of 100 % and 96.5 %, respectively. In conclusion, preliminary data suggest that M1 protein could be considered for diagnosis of leprosy by using patient urine.

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We carried out the health situation analysis in the Legal Amazon through morbidity and mortality indicators and the comparison between intra and inter-state federation of the region and Brazil. Analysis of the health situation, trends, and identification of clusters in the Brazilian Amazon, for the period from 2010 to 2021, using secondary data available in official health information systems. Circulatory diseases were the main cause of death, representing 23% of deaths. External causes and respiratory diseases contributed 16% and 9% of deaths, respectively; 52.6% of infant deaths occurred in the early neonatal period, and the infant mortality rate remained above the national average. The ratio of maternal mortality was also high and above the national average between 2010 and 2021. The dengue incidence rate remained below the national average with a drop trend of -59.50%. However, rates of Chagas disease, AIDS, Hansen's disease, American cutaneous leishmaniasis and tuberculosis remained above average rates in the country. It was concluded that the population of the Brazilian Amazon faces health challenges. The findings facilitate the identification of territorial priorities for the implementation of actions that impact morbidity and mortality reduction in the region.

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BACKGROUND: Leprosy, being a neglected tropical disease, remains a significant public health concern in several parts of the world, especially Sri Lanka, where it has long been associated with stigma. This study aims to assess the stigma faced by People Affected by Leprosy (PAL) undergoing treatment and to identify the factors associated with this stigma. METHODS: A cross-sectional study was conducted among 109 Leprosy affected people attending the Central Leprosy Clinic and all dermatology clinics of the National Hospital of Sri Lanka (Colombo), selected using a consecutive sampling method. Data collection was done through an interviewer-administered questionnaire. Stigma was quantified using a validated and adapted version of the Stigma Assessment and Reduction of Impact (SARI) tool, which evaluates stigma pertaining to four domains: Experienced Stigma (ES), Disclosure Concerns (DC), Internalized Stigma (IS), and Anticipated Stigma (AS). Spearman's correlation and Mann-Whitney U tests were used to analyze associations, with statistical significance set at 0.05. RESULTS: The dataset showed a non-normal, right-skewed distribution. The mean total SARI score was 9.82 (SD = 10.23). Disclosure Concerns (rs=-2.66; p = 0.005) and Anticipated Stigma (rs=-3.6; p < 0.001) demonstrated weak - moderate negative correlations with the time since diagnosis. On the other hand, the correlation between time since diagnosis and Experienced Stigma (rs=0.22; p = 0.022) was positive and weak. Participants without disability had significantly lower scores in DC (p = 0.049), IS (p = 0.01), and AS (p = 0.01) compared to those with disability. Patients who did not develop Leprosy reactions displayed significantly lower scores across all SARI domains as well as the total SARI score (all p < 0.05) compared to those who did. CONCLUSIONS: The findings suggest that over time, People Affected by Leprosy become less concerned about disclosing their diagnosis and anticipate less stigma but may experience greater overall stigma. Disability status and Leprosy reactions are key factors in determining the level of stigma faced by them.

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Background Chronic skin conditions are different from internal illnesses since they are often immediately visible to others. Patients feel self-conscious and often go through depression, anxiety, fear of stigma and a substantial psychological, social and economic impact. It is crucial for healthcare professionals to gather information about various strategies and psychosocial interventions that can be used to manage psychological distress associated with skin conditions and avoid it from being neglected amidst other health conditions. Mindful Self-Compassion (MSC) can be used for this. It is a resource-building mindfulness-based self-compassion training programme that uses a combination of personal development training and psychotherapy designed to enhance one's capacity for self-compassion by cultivating spacious awareness as a basis for compassionate action. Aims This study examined the impact of mindful self-compassion on depression, anxiety, stress, dermatology-specific quality of life, self-esteem and well-being in a sample of 88 adults aged 18-55 years suffering from chronic skin conditions. Methods This study used an experimental waitlist control design. Participants were recruited from two skin clinics using purposive sampling in Mumbai, Maharashtra. Pre-test data was collected through self-reported questionnaires on psychological distress, dermatology-specific quality of life, self-esteem and well-being. Participants who were experiencing psychological distress were randomly assigned to either the experimental or waitlist control group. The intervention named 'mindful self-compassion' was delivered through an online platform, twice a week, over a period of 4 weeks. Post-test data was collected later on all variables. Results ANCOVA was utilised where pre-test scores were used as covariates. Differences in pre-test and post-test scores between the intervention group and waitlist control group for depression, anxiety, stress, dermatology-specific quality of life, self-esteem and well-being were analysed. Participants in the intervention group were found to have lower levels of depression, anxiety and stress as compared to the waitlist control group and also had enhanced levels of self-esteem, well-being and dermatological quality of life. These differences were found to be statistically significant (p < 0.001). Limitations The sample reflected heterogenous skin conditions, not a specific skin condition. The study was quantitative in nature, and we could not use any qualitative methods to assess the subjective experience of participants. Due to time constraints, follow-up data could not be gathered from participants to assess long-term effects on participants. Conclusion Mindful self-compassion can be effectively used to manage psychological distress in skin conditions. Dermatologists can become acquainted with basic signs of mental distress and the importance of psychological interventions. By collaborating with mental health professionals, patients can be given holistic treatment.

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ABSTRACT: Tinsley, GM, Meyer, MK, Ptak, SM, Yu, D, Provost, JA, Hansen, NJ, and Carbuhn, AF. Body composition changes over a collegiate playing career in NCAA Division I women's soccer players. J Strength Cond Res 39(1): e40-e55, 2025-Although body composition is known to influence success in organized sport, the longitudinal body composition changes produced by sport specialization are not well characterized for women's soccer. To address this need, this study reports the body composition changes of NCAA Division I women's soccer players over their entire collegiate playing career. Serial dual-energy x-ray absorptiometry (DXA) scans were performed throughout players' involvement in collegiate women's soccer. Analyses of all players with multiple DXA scans (n = 80) and players with ≥3 years of DXA data (n = 17) were performed using linear mixed-effects models that included effects of time, playing position, game minutes, and interactions. In all athletes (n = 80; 2.1 ± 1.2 years of participation), significant increases in bone mass (1.4%), total lean mass (1.7%), and fat-free mass index (0.3 kg·m-2) occurred. These changes coincided with increased arm and leg bone mass, increased lean mass in all regions, and decreased body fat percentage and leg fat mass. In athletes with ≥3 years of collegiate data (n = 17; 3.5 ± 0.4 years of participation), larger increases in bone mass (3.0%), bone mineral density (2.2%), total lean mass (2.5%), fat-free mass index (0.4 kg·m-2), and segmental bone and lean mass were observed. Larger decreases in body fat percentage and leg fat mass were also noted. Although playing position was related to body composition characteristics, changes in outcomes were generally unrelated to position or game minutes. In summary, beneficial changes in multiple aspects of body composition were observed over years of participation in a collegiate women's soccer program.

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BACKGROUND: Detection of infection with Mycobacterium leprae allows timely prophylactic treatment, thereby reducing transmission as well as the risk of permanent, leprosy-associated nerve damage. However, since there is no worldwide-implemented standard test for M. leprae infection, detection of infection in asymptomatic individuals remains a major challenge for control programs in endemic areas. In previous studies, we developed and field-tested a lateral flow assay (LFA) quantitatively detecting human IgM against M. leprae-specific phenolic glycolipid I (anti-PGL-I), a marker for both active and past infection. This rapid test utilizes luminescent, background-free, up-converting reporter particles (UCP) and immunochromatography (i.e. the UCP-LF test platform) for accurate quantitation of anti-PGL-I IgM without operator bias. The aim of this study was to evaluate the final version of this quantitative UCP-based rapid test (i.e. PGL-I QURapid), using serum and fingerstick blood (FSB). METHODS: The test comprises a lateral flow strip, in a standard plastic or biodegradable cassette. It can be provided with a humanized, recombinant control to monitor test performance and calculate accurate anti-PGL-I IgM levels. The performance of this QUR-test was assessed using serum and FSB from patients with leprosy (n = 214), tuberculosis (n = 20), buruli ulcer (n = 19), leishmaniasis (n = 14), non-tuberculous mycobacterial (n = 35) infections, as well as healthy Dutch individuals (n = 710) and humanized, recombinant anti-PGL-I IgM antibodies. Plot receiver operating characteristic curves were created and sensitivity (Sn), specificity (Sp) and the area under the curve were calculated to evaluate test performance. RESULTS: Test results classified multibacillary leprosy patients with 95.0% Sn and 100% Sp using serum and 91.5% Sn and 99.8% Sp using FSB. Qualitative test results could be read after 2 min flow time, with accurate quantitation from 10 min onwards. The new anti-PGL-I IgM control supports production of batches with predetermined seropositivity thresholds and monitoring of the PGL-I QUR-test in various settings. CONCLUSION: The operational version of the PGL-I QURapid with point-of-care applicability, meets the WHO target product profile criteria. Thus, this QUR-test is ready for public health implementations.

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BACKGROUND/INTRODUCTION: Leprosy control remains a challenge in Nepal. Single-dose rifampicin post-exposure prophylaxis (SDR-PEP) shows promise in reducing leprosy incidence among contacts of index cases, contributing to reducing the transmission of Mycobacterium (M.) leprae. This study evaluates the effectiveness of routine SDR-PEP implementation in Nepal in addition to contact screening, focusing on its impact on reducing leprosy risk among contacts and potential population-level effects. METHODOLOGY: We conducted a retrospective cohort study to compare leprosy case notification rates and leprosy risk among close contacts. We compared two districts implementing SDR-PEP (the intervention group) and two without (the comparator group). Data from 2015 onwards included demographics, index case types, and contact relationships. Statistical analyses, including Cox regression and Kaplan-Meier survival curves, assessed the impact of SDR-PEP implementation. FINDINGS: All four districts showed a decrease in case notification rates since 2015, with the steepest decline in the intervention districts. The risk of developing leprosy among contacts was significantly lower in the intervention districts (HR 0.28, 95% CI 0.18-0.44). SDR-PEP offered 72% protection, consistent over time, as shown in Kaplan-Meier plots. The protective effect was equally strong in blood-related contacts (HR 0.29 versus 0.27 in others, p = 0.32), and the proportion of MB cases among incident cases was not significantly different post-PEP (51.4% vs. 53.6%, p = 0.82). CONCLUSIONS: This study demonstrates the substantial protective effect of integrating SDR-PEP in routine leprosy control programs with contact screening, significantly lowering leprosy risk among contacts. SDR-PEP is equally effective for blood-related contacts and does not preferentially prevent PB cases. While suggesting potential population-level impact, the study design does not allow for firm conclusions at this level. Further research is needed to fully assess SDR-PEP's effectiveness in diverse contexts and optimize its implementation. Integrating SDR-PEP within well-organized contact screening programs is effective and is expected to reduce leprosy transmission when applied as a rolling intervention.

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BACKGROUND: Leprosy is one of the neglected tropical diseases associated with significant morbidity in endemic regions. It causes disability affecting the daily activities and social participation of affected individuals. Understanding the prevalence and trend of leprosy-related disability throughout the world and the accuracy of disability data counted by WHO is crucial in guiding efforts to be made towards the targets set by WHO to be achieved by 2030. This study aims to show the significance of reporting leprosy-related disability at the end of MDT and critique how disability is counted in the context of WHO data. METHODS: This is a mixed method study with a 5-year retrospective analysis of outcomes of newly diagnosed leprosy patients at ALERT Hospital in Ethiopia from 2016 to 2020. A comparative review and analysis of leprosy related G2D (Grade 2 Disability), globally, regionally, and in Ethiopia using WHO data was also done. In addition, semi-structured interview of health workers (HCWs) and professionals working in the field of leprosy at various organizations was conducted. RESULTS: The trend of G2D among newly diagnosed leprosy patients shows no decline globally for the past 20 years. It is increasing in Africa and stable in the Southeast Asian and American regions where majority of leprosy patients are found showing the gap in early case identification and prompt treatment of leprosy cases. The total number of newly diagnosed leprosy cases at ALERT hospital between January 2016 and December 2020 were 1032 and among those patients who had completed treatment the prevalence of G2D was 33% at diagnosis and 23% at completion. The interview has also shown gaps in the completeness and quality of disability data reported to WHO and how disability is counted. CONCLUSION: Leprosy related G2D among newly diagnosed patient is not declining worldwide and even increasing in endemic regions like Ethiopia. More training should be given to health professionals in assessing disability. WHO should make some changes in the way it counts disability as the current definitions are prone to interpretation bias and lacks uniformity among various programmes and health workers. Prospective studies are needed in assessing disability progression post MDT so as design interventions and strategies in preventing worsening of disability after patients are discharged from treatment centre.

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INTRODUCTION: Leprosy reactions being closely related to damage to peripheral nerves and physical disabilities associated with disease progression. Disabilities in childhood can have a devastating effect with impaired children's cognitive, emotional, social, and educational development. We followed up the progression of leprosy reactions in children identifying associated factors with the emergence and/or worsening of nerve damage. MATERIALS AND METHODS: A prospective longitudinal cohort study was performed in patients under 15 years of age affected by leprosy reactions diagnosed at the Leprosy referral unit in the Amazon region of Brazil. The follow-up time was a cohort for 2 years from diagnosis. A clinical evaluation and the simplified neurological were performed at diagnosis and every 6 months, until the end of the follow-up period. PRINCIPAL FINDINGS: Of the 77 children monitored, 38 had reactions and were recruited. Only 23.7% (9/38) of patients improved their initial neurological impairment and 42.1% (16/38) had progression of the leprosy reaction with worsening of the initial nerve damage. Two or more reaction episodes, nerve damage and two or more nerves affected at diagnosis, isolated neuritis, silent neuritis and low educational level of caregiver had a significant association with the emergence and/or worsening of neural damage. CONCLUSIONS: A high proportion of children had progression of the leprosy reaction with worsening neural damage. The absence of warning signs of inflammation, such as pain and exacerbation of skin lesions, appears to contribute to the worse prognosis of reactions. Early diagnosis, systematic monitoring especially of neural function, beyond the educate caregivers to recognize the reactional episode early and to helping with children's self-care are very important measures to minimize the emergence or worsening of neural damage resulting from leprosy reactions.

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Leprosy is a chronic infectious disease which mainly affects the skin, nasal mucosa, and peripheral nerves. The aim of this study was to compare between the efficacies of serum anti-phenolic glycolipid 1 (APGL-I) level versus slit skin smear (SSS) in diagnosis of leprosy. This study involved 58 leprosy cases who were clinically examined, slit-skin smears were taken from all at diagnosis from four sites and APGL-I levels were seroassayed using ELISA. The mean age of studied group was 39.42 ± 15.2, 44.8% of patients were males and 55.2% were females. The majority of patients (72.4%) had multibacillary leprosy (MBL) followed by (27.6%) of patients had paucibacillary leprosy (PBL). SSS had sensitivity of 71.5% and specificity of 84% (area under curve; AUC = 0.763, 95% CI 0.427-0.823) while APGL-I had a sensitivity of 80% and specificity of 85% (area under curve; AUC = 0.830, 95% CI 0.424-0.852). Both serum Anti-PGL-1 levels and slit skin smear are useful in diagnosing leprosy, but their effectiveness depends on disease stage and patient's immune response. Being inexpensive, easy and noninvasive technique, APGL1 can be an adjunct method for the detection of leprosy in the population while slit skin smear having higher specificity. Combining both methods or using sequential diagnostic approaches could enhance accuracy and reduce missed diagnoses.

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INTRODUCTION: The World Health Organization (WHO) recommends rifampicin, dapsone and clofazimine multi-drug therapy (MDT) for the treatment of leprosy. Severe adverse effects include dapsone hypersensitivity syndrome, skin pigmentation, haemolytic anaemia, and hepatitis. At the Hospital for Tropical Diseases (HTD), London, United Kingdom monthly rifampicin, ofloxacin and minocycline (mROM) is used as first line treatment for leprosy. OBJECTIVES: To determine the clinical outcomes and experiences of individuals treated with mROM. METHODS: A retrospective study of individuals with leprosy who were prescribed mROM at HTD was conducted. Demographic and clinical data were collected on outcomes including relapses, leprosy reactions, bacterial index (BI) and adverse effects. Individuals were interviewed using a semi-structured questionnaire to understand their experiences of mROM. RESULTS: 29 individuals were identified and 20 interviewed. 26 (89.7%) individuals completed monthly mROM. 9 (31%) had switched from WHO MDT to mROM (five of whom (55.6%) were interviewed). BI reduced significantly following mROM treatment (p = 0.04). 17 individuals (58.6%) experienced a leprosy reaction. One of the 29 (3.4%) relapsed. The relapse rate was 9.5/1000 person years. 49 reports of adverse effects were either mild or moderate. The most frequent adverse effect (14/49) reported was orange discolouration of urine. No adverse effect required hospitalisation or discontinuation of mROM. Most individuals reported that skin lesions improved by the time they had completed mROM. CONCLUSIONS: In this small study in a non-endemic setting mROM was safe, effective and acceptable. mROM therapy is associated with improvement in skin lesions, decline in bacterial index and acceptable adverse effects. Larger, prospective, randomised studies are needed to determine whether relapse rates with mROM are equivalent or better than WHO MDT and to provide robust data on the seemingly better adverse effect profile of mROM.

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La lepra infantil, aquella que afecta a niños de hasta 14 años, se caracteriza por la demora en su diagnóstico, ya que habitualmente es confundida con otras dermatosis. Su presencia en un niño es un indicador epidemiológico relevante, dado que señala la transmisión activa de la enfermedad. Presentamos 4 pacientes de entre 5 y 14 años asistidos en un hospital público de la Ciudad de Buenos Aires. Dos pacientes presentaron lepra borderline tuberculoide; uno, lepra lepromatosa; y otra, lepra indeterminada. La Organización Mundial de la Salud facilita la terapéutica para la población entre 10 y 14 años, pero no contempla a los menores de 10 años. Esta dificultad implica adecuar la dosis y la forma farmacéutica a cada paciente menor de la edad referida. Finalmente, es de destacar que el diagnóstico de los pacientes llevó al diagnóstico y tratamiento de la enfermedad en convivientes adultos.

Childhood leprosy, which affects children up to 14 years old, is characterized by a delay in diagnosis since it is usually confused with other dermatoses. Its presence in a child is a relevant epidemiological indicator since it signals active disease transmission. We present 4 patients between 5 and 14 years old who attended a public hospital in Buenos Aires ­two patients with borderline tuberculoid leprosy, one with lepromatous leprosy, and one with indeterminate leprosy.The World Health Organization provides therapy for people between 10 and 14 but does not consider children under 10. This difficulty implies adapting the dosage and pharmaceutical form to each patient under this age. Finally, it should be noted that the diagnosis of the patients led to the diagnosis and treatment of the disease in adult cohabitants.

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Children and their families living in leprosarium areas may have a lower quality of life than the general population. However, there is limited evidence on health-related quality of life and its associated factors among children living in previous leprosarium settlement areas. Hence, this study aimed to compare the health-related quality of life among children living in previous leprosarium and non-leprosarium settlement areas in eastern Ethiopia. A community-based comparative cross-sectional study was conducted among 515 randomly selected children aged 8 to 18 years living in the Amir Nur and Babile districts from January to February 30, 2024. Data were collected through interviews with children and parents using the Pediatric Quality of Life Inventory Version 4. The data were analyzed using STATA version 14. Simple and multiple linear regression was employed to identify associations between independent and outcome variables. The overall mean health-related quality of life scores were 73.98 ± 18.47 and 77.67 ± 14.72 in the child self-reports (P = 0.01) and 55.78 ± 12.03 and 55.61 ± 8.50 (P = 0.85) in the parent proxy reports in the previous leprosarium and nonleprosarium settlement areas, respectively. In multiple linear regression, child education (ß = 14.69; 95% CI: 8.69, 20.69), the absence of neglected and tropical diseases (ß = 4.02; 95% CI: 0.66, 7.37), and child face washing habits (ß = 5.54, 95% CI: 2.14, 8.95) increase health-related quality of life. However, a previous history of neglected and tropical diseases (ß = -8.54; 95% CI: -12.93, -4.15) and the absence of hand washing facilities (ß = -8.57; 95% CI, -15.22, -1.92) decrease the mean health-related quality of life. Based on child self-reports, one in four children from previous leprosarium areas had poor health-related quality of life compared to children living in none leprosarium areas. Children's educational status, their daily habits of washing their face, not having neglected, and tropical diseases had improved health-related quality of life. To improve health-related quality of life, stakeholders should pay attention to and work on the early detection and treatment of neglected and tropical diseases, child education, and proper sanitation practices in the leprosarium community.

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Leprosy is a chronic, debilitating disease lacking a definitive diagnostic biomarker. Serum anti-phenolic glycolipid-I (PGL-I) IgM antibody level is considered an important diagnostic and prognostic marker for leprosy patients. However, there is limited evidence on the role of anti-PGL-I IgM antibody level as early predictive biomarker of subclinical infection among Egyptian household contacts of leprosy patients. This study investigates the relationship between specific leprosy risk factors, diagnostic parameters of eighty-three leprosy cases, and serum anti-PGL-I IgM antibody levels in their corresponding household contacts. Our results demonstrate that anti-PGL-I IgM antibody level was significantly higher among contacts when more than four residents shared the same room with a leprosy case (p = 0.032). Additionally, anti-PGL-I IgM antibody level markedly increased in contacts of leprosy cases with disabilities (p = 0.001) or damaged nerves (p = 0.001). Our ROC curve analysis of anti-PGL-I antibody level as a predictor of exposure or infection among contacts revealed a cut-off value of 0.1, with a sensitivity of 75.0% and a specificity of 54.5%, indicating that most exposed household contacts are correctly identified. The overall accuracy of the ROC curve analysis was 72.3%, highlighting the practical utility of anti-PGL-I antibody level as a predictor for exposure or infection among household leprosy contacts. In conclusion, seropositivity of anti-PGL-I antibodies (> 0.1) among household leprosy contacts may be associated with a higher leprosy exposure risk. Continuous monitoring of anti-PGL-I antibody level in household leprosy contacts may potentially contribute to early detection and management of leprosy.

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Neglected tropical diseases (NTD) are chronic infectious diseases affecting low-income populations (mainly in tropical and subtropical climates), characterized by high morbidity and low mortality. This study described the epidemiology of mortality from NTDs in the state of Maranhão, Brazil. Data from the Brazilian Mortality Information System evidenced 2,642 deaths from NTDs between 2001 and 2021; 31.13% were related to leishmaniasis (mainly the visceral form) and 20.82% to leprosy. A total of 211 municipalities in Maranhão had registered mortality due to NTDs. We identified, high-risk spatial and spatiotemporal conglomerates in the western and southern areas of Maranhão, comprising mostly municipalities with high social vulnerability and low human development. Integrated mapping of NTDs may allow the development of public intervention policies and is an important strategy to control and eliminate NTDs in the most affected populations.

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BACKGROUND: In Tanzania like other developing countries, TB detection is hindered by totally missed, late notification, and delayed diagnosis of active cases. Apart from having TB control strategies and interventions to detect patients and put them on treatment to cut down the chain of transmission, TB remains a health concern. Limited data exist on the burden and trends of tuberculosis in Mwanza, which includes fishing communities and living conditions that are associated with high TB transmission like overcrowding. This study aimed to determine tuberculosis trends in the Mwanza region of Tanzania for five years, from 2017 to 2021. METHODS: We extracted routine TB diagnostic data from 2017 to 2021 from eight districts of the Mwanza region of Tanzania from the electronic TB database. Data were captured in Microsoft Office Excel 2007 with district TB and leprosy coordinators and then imported into STATA 13 (Stata Corp LLC, College Station, TX, USA) for analysis. We estimated the TB case detection rate per 100,000 population. RESULTS: A total of 6,414 laboratory-confirmed tuberculosis cases were detected in eight districts of the Mwanza region in Tanzania from 2017 to 2021. The average tuberculosis detection rate in five years was 34.7 per 100,000 population. Overall, the TB detection rate was two times higher in people without HIV (30.5) compared to those infected with HIV; 13.4 per 100,000 population. Of the 15 rifampicin-resistant TB cases detected in the year 2018, 66.7% (10/15) were HIV-negative compared to 33.3% (5/15) infected with HIV. CONCLUSION: The TB case detection rate decreased in Mwanza region from 43.9 in 2017 to 21.4 per 100,000 population in 2021. Other parameters were missing in the database, which indicates remarkable gaps in the established database to monitor TB management in the region. The program may consider investigating and improving the documentation of information necessary to attain its goals.

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BACKGROUND: Despite being preventable and curable, leprosy remains endemic in some undeveloped regions, including China. Wenshan Zhuang and Miao Autonomous Prefecture (Wenshan prefecture) currently bears the highest leprosy burden in China. In this ecological study, we aimed to analyze the epidemiological characteristics as well as identify and visualize the high-risk townships of Wenshan prefecture using the most updated leprosy data from 2010 to 2022. METHODS: Geographical information system combined with spatial scan statistics was used for newly detected leprosy cases abstracted from the Leprosy Management Information System in China. Global Moran's I index was used to uncover the spatial pattern of leprosy at the township level. Spatial scan statistics, encompassing purely temporal, purely spatial, spatial variation in temporal trends, and space-time analysis, were implemented for detecting the risk clusters. RESULTS: Between 2010 and 2022, Wenshan prefecture detected 532 new leprosy cases, comprising 352 (66.17%) males and 180 (33.83%) females. The aggregated time primarily occurred between October 2010 and March 2014. The distribution pattern of newly detected leprosy cases was spatially clustered. We identified four high-risk spatial clusters encompassing 54.51% of the new cases. Furthermore, spatial variation in temporal trends highlighted one cluster as a potential high-risk area. Finally, two space-time clusters were detected, and the most likely cluster was predominantly located in the central and northwest regions of Wenshan prefecture, spanning from January 2010 to September 2013. CONCLUSIONS: In this ecology study, we characterized the epidemiological features and temporal and spatial patterns of leprosy in Wenshan prefecture using the most recent leprosy data between 2010 and 2022. Our findings offer scientific insights into the epidemiological profiles and spatiotemporal dynamics of leprosy in Wenshan prefecture. Clinicians and policymakers should pay particular attention to the identified clusters for the prevention and control of leprosy.