Determinants of patients' delay with disability in the diagnosed leprosy cases in the three major states of India: A case-control study.

BACKGROUND: Skin lesions are the most common early symptoms of leprosy, often ignored by patients at an early stage and misdiagnosed as other dermatological diseases by healthcare personnel, leading to delay in diagnosis and treatment of leprosy precipitating permanent neurological deficit, deformities and serious disabilities. AIMS: The objective is to evaluate the duration of delay and factors responsible for the delay in reporting of patients, among the newly detected leprosy cases (Grade 1 and Grade 2 disability patients). METHODS: A case-control study was conducted during 2014-2016 in three major states of India (Delhi, Gujarat and West Bengal) in 140 randomly recruited newly registered adult leprosy patients (aged 18 years and above) with Grade 2/1 disabilities (cases) and 140 Grade 0 disability patients (controls) in each of these Indian states. RESULTS: It is established that the major contributors for the delay in the early diagnosis of leprosy have been patient-related factors. The median patient delay in the three states of Delhi, Gujarat and West Bengal were five months (0.7-1.8), 2.8 months (2-14) and 12 months (2-24), respectively. LIMITATIONS: The study design is case-control and has an inbuilt reporting bias due to the retrospective nature of data collection but the data collection was carried with caution to reduce the recall bias. As the study is carried out in three states, generalisation of interpretation was cautiously executed. The matching ratio of cases and controls was 1:1 in this study, but we could not increase the controls due to operational feasibility during the conduct of the study. CONCLUSION: Patient delay is a crucial factor responsible for the disability among new leprosy cases. A higher patient delay in these three states reflects that the community is not aware about the signs and symptoms of leprosy. Reducing patient delay is very important for reducing disabilities in the newly diagnosed cases.

An insight into the mental health needs of the common public of Tamil Nadu, India, subjected to COVID-19 lockdown, a rare unprecedented crisis.

Purpose: COVID-19, a major "Public Health Emergencies of International Concern", had sought greater attention among researchers to study its pathogenesis, associated complications and management. However, there are only few studies that had studied its potential impact on mental health of general public, who are subjected to social distancing, community lockdown and restrictions in their routine activities. Objectives: The aim of this study is to assess the prevalence of psychological distress and mental health needs among general public in Tamil Nadu subjected to lockdown, social distancing amidst COVID-19 crisis. Tamil Nadu is one of the worst affected states of southern India. Methods: A self-administered, web-based application study using "WHO-Self Reported Questionnaire-20", in bilingual version, both English and Tamil, is used to screen the public for the level of distress. The study is done while the state is under extended lockdown and restricted movement. Key findings: A total of 918 respondents participated in the survey and it is found that about more than one third of the respondents (∼35%) are under psychological distress. A significant association between younger age group, female gender, unmarried, people with children are found to be under distress. The lockdown had increased the frequency of smoking and quantity of cigarettes among smokers, also has increased the frequency of drinking among alcohol consumers. Of the SRQ-20 items recorded, stress related neurotic symptoms (> 70%) was observed more than the depressive mood. About 33% of those scored > 7, had suicidal tendency. The districts declared red zones had significantly reported a greater number of respondents under distress. Conclusion: Besides effectively mitigating the COVID-19 crisis, in terms of prevention, control and treatment strategies, it is prerogative to effectively manage fear, distress due to the COVID-19 and associated anxiety and depression among the public.

But: Le COVID-19, une importante « Urgence de santé publique de portée internationale ¼, a demandé une plus grande attention des chercheurs pour étudier sa pathogenèse, les complications associées et la prise en charge. Cependant, rares sont les études qui ont étudié son impact potentiel sur la santé de la population, qui est soumise à l'éloignement social, au confinement communautaire et à des restrictions dans ses activités courantes. Objectifs: Le but de cette étude est d'évaluer la prévalence de la détresse psychologique et des besoins de santé mentale dans la population du Tamil Nadu soumise au confinement, à la distanciation sociale au milieu de la crise du COVID-19. Le Tamil Nadu est l'un des États les plus touchés du sud de l'Inde. Méthodes: Une étude d'application auto-administrée en ligne utilisant le « WHO-Self Reported Questionnaire-20 ¼, en version bilingue, en anglais et en tamoul, est utilisée pour dépister le niveau de détresse. L'étude est effectuée alors que l'État est sous confinement prolongé et mouvements restreints. Principales conclusions: Sur les 918 répondants qui ont participé à l'enquête, on constate qu'environ plus d'un tiers des répondants (∼35%) sont en détresse psychologique. Les plus jeunes, les femmes, les célibataires, les personnes avec enfants se trouvent en situation de détresse de façon significative. Le confinement a augmenté la fréquence du tabagisme et la quantité de cigarettes chez les fumeurs, a également augmenté la fréquence de consommation d'alcool chez les consommateurs d'alcool. Parmi les items SRQ-20 enregistrés, les symptômes névrotiques liés au stress (> 70 %) ont été plus observés que l'humeur dépressive. Environ 33 % des sujets, ayant obtenu un score supérieur à 7, avaient une tendance suicidaire. Les districts déclarés zone rouge avaient notablement signalé un plus grand nombre de répondants en détresse. Conclusion: En plus d'atténuer efficacement la pandémie du COVID-19, en termes de stratégies de prévention, de contrôle et de traitement, il est capital de gérer efficacement la peur, la détresse due au COVID-19, l'anxiété et la dépression associées et d'étendre le soutien psychosocial au public.

Expression of annexin-A1 in blood and tissue leukocytes of leprosy patients.

INTRODUCTION: In leprosy, immune system mediators that regulate the infectious process act in a complex manner and can lead to several clinical outcomes. To understand the behavior of these mediators we quantified the expression of annexin-A1 (ANXA1) in the peripheral blood and plasma as well as tissue leukocytes in all clinical forms of leprosy and compared with healthy controls. METHODS: Seventy healthy controls and 70 patients with leprosy, tuberculoid (TT) (n = 13), borderline tuberculoid (BT) (n = 15), borderline borderline (BB) (n = 13), borderline lepromatous (BL) (n = 15), and lepromatous leprosy (LL) (n = 14), were selected. Phenotyping of the lymphocyte cells and the intracellular expression of ANXA1 in leukocytes was performed by immunofluorescence. Plasma protein levels were determined by enzyme-linked immunosorbent assay. RESULTS: Histiocytes and CD4+ and CD8+ T cells in the skin of BL and LL patients had higher ANXA1 expression. ANXA1 expression was also high in circulating polymorphonuclear, monocytes, and CD4+ and CD8+ T cells in the blood of LL patients compared to those of TT, BT, BB, and BL patients, and these levels were similar to those in healthy controls. Plasma ANXA1 levels indicate an increase in paracrine release in patients with LL. CONCLUSIONS: The data indicate that ANXA1 expression is enhanced in the leukocytes and plasma of patients with LL, and may contribute to the inhibition of leukocyte action, leading to inadequate functioning of the immune system and thus contributing to the spread of M. leprae infection.

Expression of annexin-A1 in blood and tissue leukocytes of leprosy patients

Abstract INTRODUCTION In leprosy, immune system mediators that regulate the infectious process act in a complex manner and can lead to several clinical outcomes. To understand the behavior of these mediators we quantified the expression of annexin-A1 (ANXA1) in the peripheral blood and plasma as well as tissue leukocytes in all clinical forms of leprosy and compared with healthy controls. METHODS Seventy healthy controls and 70 patients with leprosy, tuberculoid (TT) (n = 13), borderline tuberculoid (BT) (n = 15), borderline borderline (BB) (n = 13), borderline lepromatous (BL) (n = 15), and lepromatous leprosy (LL) (n = 14), were selected. Phenotyping of the lymphocyte cells and the intracellular expression of ANXA1 in leukocytes was performed by immunofluorescence. Plasma protein levels were determined by enzyme-linked immunosorbent assay. RESULTS Histiocytes and CD4+ and CD8+ T cells in the skin of BL and LL patients had higher ANXA1 expression. ANXA1 expression was also high in circulating polymorphonuclear, monocytes, and CD4+ and CD8+ T cells in the blood of LL patients compared to those of TT, BT, BB, and BL patients, and these levels were similar to those in healthy controls. Plasma ANXA1 levels indicate an increase in paracrine release in patients with LL. CONCLUSIONS The data indicate that ANXA1 expression is enhanced in the leukocytes and plasma of patients with LL, and may contribute to the inhibition of leukocyte action, leading to inadequate functioning of the immune system and thus contributing to the spread of M. leprae infection.

Aortic valve annular dimension in Indian population.

AIM: The Aortic Valve (AV) annular dimension with respect to the Body Surface Area (BSA) of the Indian population is compared against the standard values. Presence of discrepancies can lead to patient prosthesis mismatch during aortic valve replacement surgeries. METHODS: This study was conducted on 406 subjects. AV diameter was examined by using parasternal long axis view, where the imaging plane transects the AV in an anteroposterior direction and its x axis is aligned parallel to the long axis of aorta. Data were statistically analysed with western population. RESULTS: The AV dimension ranged from 12.2 mm to 21.2 mm in the BSA range of 0.6 to 1.9 m(2), showing a linear increase in diameter with increasing BSA. There was an increase of about 2 mm, from 0.61 - 0.7 m(2) BSA to 0.71 - 0.8 m(2) BSA. A linear increase which ranged from 0.3 to 1 mm was observed for BSA which ranged from 0.81 m(2) to 1.2 m(2). In the BSA range of 1.21 - 1.3 m(2), there was an increase of 1.5 mm. A steady increase which ranged from 0.4-1 mm was observed in the BSA which ranged from 1.31- 1.9 m(2). CONCLUSIONS: There is a significant difference between Indian and western population in the aortic dimension, in the body surface ranges of 0.61-0.7, 1.11-1.2, 1.21-1.3, 1.51-1.6, 1.61-1.7, 1.71-1.8 and 1.8-1.9 m(2). In the range of 1.21-1.3 m(2), the diameter was larger than standard, whereas in all the other ranges, AV diameter was smaller than standard values. BSA, as a good predictor of AV dimension, has also been proved.

The study of mitral valve annular dimension in relation to the body surface area in the Indian population.

OBJECTIVE: We compare the mitral valve annular dimension in relation to the body surface area of the Indian population as against the standard values. METHODS: The study was conducted between September 2004 and February 2006 on 406 subjects, out of which 252 were males and 154 were females. A spatially oriented B-mode scan echocardiogram was used, with the long-axis plane running parallel to the heart or the left ventricle, the short-axis plane being perpendicular to the long axis, and the four-chamber plane orthogonal to the other two and somewhat representing a frontal plane. Mitral valvular dimensions were recorded in early diastole. RESULTS: The mitral valve showed a steady rise in its diameter with rise in body surface area. For body surface area ranging from 0.61 to 0.7 m², the mitral valve diameter was 15.5mm. There was a sudden increase from 15.5mm to 18 mm for body surface area ranging from 0.71 to 0.8 m². After this sudden increase, the mitral valve diameter steadily increased by 0.2-0.6 mm for every 0.1 m² increase in body surface area. The values obtained from the Indian population were definitely lower than the lower end of standard deviation of the standard values, which are derived in relation to body surface area. CONCLUSIONS: Although the annular dimensions of the mitral valve increased correspondingly with body surface area, they still remained very low in the Indian population as compared with the standard values, which might cause patient-prosthesis mismatch during mitral-valve replacement surgeries.