Prevalencia y factores de riesgo para discapacidades de grado 2 entre los niños y adolescentes recién diagnosticados de lepra: un análisis basado en las historias clínicas de la india / [Prevalence of and risk factors for grade 2 disabilities among newly diagnosed children and adolescents with leprosy: a chart-based analysis from india]

Objectivos: La lepra infantil es un buen indicador de transmisión comunitaria de la enfermedad y la necesidad de un diagnóstico precoz. La discapacidad de Grado 2 (G2D) en niños revela un retraso en el diagnóstico, a nivel de la atención sanitaria o en su reconocimiento y derivación por la familia. Este trabajo determina la proporción de G2D entre los nuevos casos de lepra diagnosticados en niños y adolescentes e identifica los factores asociados a su presencia.Métodos: Se llevó a cabo un análisis retrospectivo de las historias clínicas de niños y adolescentes ≤18 años diagnosticados durante 5 años, comprendidos entre abril de 2014 y septiembre de 2019, con especial atención a la presentación de G2D en el momento del diagnóstico.Resultados: Los niños y adolescentes constituían el 8.26% (327/3955) de todos los casos. De entre ellos, 58 (17.7%) presentaban G2D en el momento del diagnóstico. La G2D era más frecuente entre los del grupo de 15–18 años y estaba significativamente relacionada con un retraso del diagnóstico, la presencia de convivientes, presentar lepra multibacilar, engrosamiento neural y neuritis.Conclusiones: Se informa de un elevado número de casos G2D entre los casos nuevos de lepra de niños y adolescentes, mucho mayor que la media nacional de los adultos. Con tan elevada proporción de casos G2D, el objetivo de cero discapacidades en niños en la India para el 2020 no se ha cumplido. Las actividades sanitarias dirigidas hacia una detección precoz en niños pueden reducir el retraso en el diagnóstico, y prevenir la aparición de discapacidades. (AU)

Objectives: Leprosy in children is a strong indicator of disease transmission in the community and the rapidity of case detection. Grade 2 disability (G2D) in children denotes a delay in diagnosis, which could be due to delay either at the health care level or in recognition and referral by the family. The current study determines the proportion of G2D among newly diagnosed leprosy-affected children and adolescents and identifies the associated factors.Methods: A 5-year retrospective analysis of records of children and adolescents aged ≤18 years newly diagnosed with leprosy between April 2014 and September 2019, was carried out with special reference to G2D presentation at the time of diagnosis.Results: Children and adolescents comprised 8.26% (327/3955) of all subjects. Among them, 58 (17.7%) had G2D at the time of diagnosis. G2D occurred more frequently among the 15–18 years age group and was significantly associated with registration delay, presence of household contact cases, having multibacillary leprosy, nerve thickening and neuritis.Conclusions: We report a high rate of G2D among newly diagnosed leprosy cases in children and adolescents, much higher than the reported national average for adults. With such a high occurrence of G2D, the target of having zero disability in childhood cases is unlikely to be met in India in 2020. Early case detection activities with a child-focused approach may reduce the delay in diagnosis, preventing leprosy-associated disability in children. (AU)

Bilateral periorbital oedema revealed as systemic lupus erythematosus in a young male.

Systemic lupus erythematosus is an autoimmune connective tissue disorder that has well established cutaneous features and typically affects women. However, isolated bilateral periorbital involvement is a rare clinical presentation of systemic lupus erythematosus, which may often delay the diagnosis and treatment. We report such a case in a 20-year-old male.

Thalidomide in the treatment of erythema nodosum leprosum (ENL) in an outpatient setting: A five-year retrospective analysis from a leprosy referral centre in India.

Erythema nodosum leprosum (ENL), or type 2 lepra reaction, is a multi-system immune-mediated complication in patients with multibacillary leprosy, frequently associated with chronicity and recurrences. Management of ENL requires high doses of oral corticosteroids, which may not be universally effective and pose serious adverse effects. Thalidomide has proven to be a steroid-sparing agent and is useful in controlling the reactions. However, many centres do not employ it in outpatient settings due to adverse effects and teratogenicity risk. Hence, we studied the feasibility of treating ENLs and reported the therapeutic outcome.This is a five-year record-based analysis of ENL leprosy patients treated with thalidomide, includingdescriptive statistics of demographic variables. Clinical characteristics were stratified by treatment compliance status (yes/no). Incidence rates and rate ratios for recovery stratified by bacillary index, type of ENL presentation and MDT treatment status were calculated.Out of 102 ENL patients treated with thalidomide, 68 (66.7%) were compliant and improved. Among them, ENL recurrence was noted in 11(16.2%) patients. The commonest thalidomide side effect was pedal oedema (73.5%). Patients with bacillary index (BI) less than or equal to 4.0 had a 37% increase in the incidence of recovery. Patients with acute ENL were almost twice as likely to recover as those with chronic ENL. Also, the improvement was two and a half times greater among those who completed MDT as compared to those on MDT. The study showed that thalidomide treatment for patients with ENL is possible in outpatientclinics. We also successfully prevented pregnancies to a larger extent through counselling for contraception.We observed that early institution of thalidomide induces faster remission and prevents ENL recurrence.

Comorbidities associated with non- healing of plantar ulcers in leprosy patients.

BACKGROUND: Non-healing plantar ulcers are one of the significant causes of disability in leprosy patients. Plantar ulcers often take months or years to heal, affecting the patient's quality of life. Presence of comorbid conditions in these patients can delay wound healing. The study aimed to evaluate the role of associated comorbid conditions as risk factors in ulcer healing. METHODOLOGY/PRINCIPAL FINDINGS: A total of 66 leprosy patients with plantar ulcers registered at LEPRA Society-Blue Peter Public Health and Research Center (BPHRC), Hyderabad, India from June 2018 to June 2019 were studied. Comprehensive clinical assessment was done, including screening for comorbid conditions and treated as per the recommended guidelines. About two-thirds of the participants were aged 50 and above, of which more than half were illiterates, and 93.5% were living below the poverty line. Majority of ulcers were seen on the forefoot; with the head of meta-tarsal bone 27 (41.6%) as the commonest site, followed by calcaneum 23 (38.3%) and great toe 10 (16.6%). Mean ulcer depth was 0.61 (0.57) cm, the area was 5.24 (6.73) cm2 and ulcer volume was 4.72 (14.33) cm3. Ulcer dimensions were significantly associated with low body mass index, hypertension and smoking. CONCLUSIONS/SIGNIFICANCE: Identifying the risk factors delaying wound healing and detailed assessment of ulcers are of profound importance to predict the outcome of plantar ulcers in leprosy patients. The study findings indicate the need for better policies by the leprosy control program for the comprehensive management of plantar ulcers.