Treatment Of Leprosy Research Articles

An exploration into the psychological impact of leprosy in Sirajganj, Bangladesh

Objectives: Leprosy is a neglected tropical disease still prevalent in the world today. In addition to dealing with the physical complications associated with the condition, people affected by leprosy often also face poor mental health. This study sets out to explore the psychological impact of leprosy by looking at experiences of mental health, and perceptions of the disease and disability, in a community in Bangladesh. Methods: Mixed methods including PHQ-9 and GAD-7 questionnaires and semi-structured interviews (SSI) were used. 30 adult participants were recruited through systematic sampling, with a purposive approach taken to select a sub-group of 6 for a focus group discussion (FGD), prioritising those who recorded severe markers of anxiety, depression and disability level during the SSI/questionnaire. Results: 53% of participants experienced moderate to severe depression and 44% mild depression. 37% experienced severe anxiety and 37% moderate anxiety. Underlying issues for poor mental health included high levels of disability, being a woman, low educational levels, and economic dependence. Participants identified ways to recover from mental distress such as engaging with non-affected people, increased public awareness, strengthened education and restoring their ability to financially sustain themselves. Conclusion: These findings add to the growing body of literature that evidences the high mental distress associated with leprosy. Despite anxiety, depression and suicidal ideation being common challenges people with leprosy experience, leprosy treatment rarely includes provision for mental health care.

Hematological alterations in lepromatous leprosy: A cross-sectional observational study

BackgroundDapsone has been the mainstay for the treatment of leprosy since its discovery in the 1940s. However, hematological disturbances are not uncommon in leprosy patients on daily dapsone therapy. Hence, the present study was conducted to document the hematologic alterations observed in lepromatous leprosy patients treated with Dapsone 100 mg daily. MethodologyA cross-sectional observational study was conducted amongst 32 lepromatous leprosy patients treated with Dapsone 100 mg daily. A complete hemogram was conducted for all the study recruits. The test results were compared against the standard average values for adults for the given variables. The one sample t-test was employed to compare the difference between the study values and the standard normal values for adults. The statistical significance was considered at p < 0.05. ResultsThe study reveals a marked decrease in hemoglobin concentration in patients on dapsone, 100 mg daily. Other hematological alterations found were reduced platelet count, reduced mean platelet volume, reduced Hematocrit, reduced Mean Corpuscular hemoglobin, reduced Mean Corpuscular hemoglobin concentration. (p < 0.05). ConclusionTreatment of lepromatous leprosy with 100 mg daily Dapsone therapy may lead to hematological alterations. These findings are suggestive of dapsone-induced hemolysis.

Knowledge on leprosy and its management among primary healthcare providers in two districts of Bangladesh

BackgroundIn 2013, Lepra Bangladesh (a non-government organization) and the National Leprosy Programme of the Directorate General of Health Services under the Ministry of Health and Family Welfare, Bangladesh implemented a 3 years project entitled “2015 and Beyond: Poverty Reduction through Strengthened Health Systems”. The aims of this Health System Strengthening (HSS) project were to improve quality of leprosy services through service delivery, capacity development, curriculum development, improved collaboration, coordination, operational research and knowledge sharing to identify and treat leprosy in order to contribute to strengthen existing health systems. We evaluated the changes in knowledge of primary and community level healthcare providers about cardinal signs, course of leprosy treatment, and drug use for paucibacillary (PB) and multibacillary (MB) leprosy cases.MethodsWe conducted two surveys using purposive sampling technique in two pilot districts: Bogra and Moulvibazar. The first survey was conducted before implementing the HSS project from March to June 2014 among 98 providers. The end-line survey was conducted in November 2015 and included 49 providers. The interview was conducted using the same pre-tested structured questionnaire. Descriptive statistics followed by further analysis was done including proportions, 90% confidence intervals, and p values were calculated for the selected variables.ResultsThe primary and community level healthcare providers demonstrated significant increases in knowledge on one cardinal sign (definite loss of sensation in a pale -hypopigmented- or reddish skin patch), doses and courses for the adult PB and MB cases and duration of Multi-Drug Therapy (MDT) course at the end line compared to the beginning of the project. All the providers except TB and Leprosy Control Assistants demonstrated statistically significant decreases in knowledge at the end-line compared to the baseline about supportive counseling.ConclusionsHSS activities including training and capacity building of the providers recorded significant increase of knowledge on types of leprosy, one cardinal sign, courses of MDT and drug use for the adult PB and MB cases and use MDT for leprosy treatment among the service providers at the end-line. Any health systems strengthening project should incorporate a capacity building approach within the programme all through.

PERILAKU SEHAT PENDERITA KUSTA DENGAN KEPATUHAN KONSUMSI MDT DI PUSKESMAS LIMO KOTA DEPOK JAWA BARAT

Leprosy is a disease caused by the bacterium Mycobacterium leprae, will attack the skin and peripheral nerves, and is transmitted through the upper respiratory tract. Management of leprosy requires patient patience in treatment, because it takes a long time. Patient compliance in the treatment process determines the success of treatment. Healthy behavior in the management of leprosy treatment requires discipline in taking leprosy medication. Poor treatment management can have permanent damage to the limbs of the patient, which is the occurrence of disability. The purpose of this study was to determine the main factor dimensions of healthy behavior that affect leprosy compliance in consuming Multi Drug Therafi (MDT) of leprosy. The research design used cross sectional descriptive, the sampling technique used was a total sampling of 15 people. The research instrument used a questionnaire containing statements of compliance and healthy behavior consisting of dimensions of knowledge, attitudes and psychomotor, and analyzed using multiple linear regression. The results obtained that the factors of knowledge, attitudes, and psychomotor have a positive and significant effect on patient compliance consuming MDT (p value

Evaluation of antibody detection against the NDO-BSA, LID-1 and NDO-LID antigens as confirmatory tests to support the diagnosis of leprosy in Yunnan province, southwest China

Although multidrug therapy (MDT) has been widely used for the treatment of leprosy for nearly 40 y, the disease remains a public health concern in some areas. The early detection of leprosy cases is vital to interrupt Mycobacterium leprae transmission, but currently diagnosis is typically achieved during the recognition of clinical symptoms by professional staff performing physical examinations in conjunction with microbiological assessment of slit skin smears (SSSs) and histopathology. In the last 10 y, serum antibody detection tests have emerged to aid leprosy diagnosis. Here we evaluated the ability of antigens NDO-BSA and LID-1 (ML0405 and ML2331) and the conjugate of these, NDO-LID, to detect antibodies in the sera of 113 leprosy patients and 166 control individuals in Yunnan province in southwest China. We found that each antigen was readily detected by sera from multibacillary (MB) patients, with sensitivities of 97.3%, 97.3% and 98.6% for NDO-BSA, LID-1 and NDO-LID, respectively. Even among paucibacillary (PB) patients the antigens detected antibodies in 74.4%, 56.4% and 69.2% of serum samples, respectively. Receiver operating characteristics (ROC) curve analysis indicated that, irrespective of the leprosy case classification as MB or PB, the detection efficiency obtained with NDO-LID was better than that obtained with the other two antigens (with LID-1 being a slightly better than NDO-BSA). Our results indicate the utility of NDO-LID in assisting in the diagnosis of PB and MB leprosy patients and that these antibody detection assays represent powerful diagnostic tools. We suggest that could be implemented into the procedures of local health centres in leprosy-endemic regions to assist in earlier diagnosis.

Detailed Pharmacognostical and Phytochemical Screening of Stem and Stem Bark of Ficus semicordata Buch.-Ham. Ex sm. - An Extra Pharmacopoeial Drug of Ayurveda

Introduction: Stem bark of Bhumi udumbara (Ficus semicordata Buch.-Ham. ex Sm.) is used traditionally in the treatment of leprosy, ulcer, dysentery, wound, pregnancy, complaints of gastric, liver, bladder and various disorders. In present study, stem and stem bark of F. semicordata are explored for their microscopic including powder microscopy, physiochemical and preliminary phytochemical aspects. Materials and Methods: Stem and stem bark of the plant, after proper authentication by BSI Kolkata, were evaluated following standard procedures. Results: Stem is hard, cylindrical, cut pieces measures about 10 - 25cm in length and 0.4 – 0.8 cm in diameter. Diagrammatic transverse section of stem shows outer cork followed by wide parenchymatous cortex with prismatic and rhomboidal crystals, starch grains and tannin content. Powder light brown in colour; odour woody; taste tasteless to astringent; texture fibrous. Stem bark is hard, single quilled after drying, outer dark reddish brown in colour with presence of lenticels, longitudinal cut fibres, rough in surface. Diagrammatic section, of the bark, shows outer several layered cork followed by cortical region along with medullary rays. Powder tortilla(brown) in colour; odour slightly aromatic; taste astringent; texture fibrous. Loss on drying at 110°C was found to be 7.41% and 8.60% of stem and stem bark respectively. HPTLC results shows 3 peaks and 0 peak at 254 and 366 nm of stem and 3 peaks at 254 and 366 nm of stem bark respectively. Discussion and Conclusion: Woody stem and presence of brown content, tannin, rhomboidal and prismatic crystals in stem and stem bark are the diagnostic characters.

A systematic review on Piper longum L.: Bridging traditional knowledge and pharmacological evidence for future translational research

Piper longum, commonly referred as 'Pippali', has found its traditional use in India, Malaysia, Singapore and other South Asian countries as an analgesic, carminative, anti-diarrhoeic, immunostimulant, post childbirth to check postpartum hemorrhage and to treat asthma, insomnia, dementia, epilepsy, diabetes, rheumatoid arthritis, asthma, spleen disorder, puerperal fever, leprosy etc. AIM OF THE REVIEW: This review offers essential data focusing on the traditional use, phytochemistry and pharmacological profile of Piper longum thereby identifying research gaps and future opportunities for investigation on this plant. This systematic survey was accomplished as per the PRISMA guidelines. The information was collected from books, and electronic search (PubMed, Science Direct, Lilca and Scielo) during 1967-2019. Many phytochemicals have been identified till date, including alkaloids as its major secondary metabolites (piperine and piperlongumine), essential oil, flavonoids and steroids. These exhibit a wide range of activities including anti-inflammatory, analgesic, anti-oxidant, anti-microbial, anti-cancer, anti-parkinsonian, anti-stress, nootropic, anti-epileptic, anti-hyperglycemic, hepatoprotective, anti-hyperlipidemic, anti-platelet, anti-angiogenic, immunomodulatory, anti-arthritic, anti-ulcer, anti-asthmatic, anthelmintic action, anti-amebic, anti-fungal, mosquito larvicidal and anti-snake venom. Amongst various activities, bioscientific clarification in relation to its ethnopharmacological perspective has been evidenced mainly for anti-amebic, anthelminthic, anti-tumor and anti-diabetic activity. However, despite traditional claims, insufficient scientific validation for the treatment of insomnia, dementia, epilepsy, rheumatoid arthritis, asthma, spleen disorder, puerperal fever and leprosy, necessitate future investigations in this direction. It is also essential and critical to generate toxicological data and pharmacokinetics on human subjects so as to confirm its conceivable bio-active components in the body.

Preparation, Characterization of Silver-Nanoparticles from Seed Coat Exudates of Celastrus paniculatus Willd. and Their Bactericidal and Biofilm Inhibition Effects

We are reporting a novel approach for preparing silver nanoparticles with seed coat exudates of Celastrus paniculatus Willd, a medicinal plant traditionally used for the treatment of skin diseases, fever, leprosy and neurological disorders. HPTLC study revealed that aqueous, soluble seed coat exudates contain phenolics, alakaloids and flavonoids. The formation, crystalline nature and morphology of the nanoparticles were identified by UV–Vis spectroscopy, X-ray Diffraction (XRD) analysis, Transmission Electron Microscopy (TEM) and selected-area electron diffraction (SAED). Functional group stretching of aqueous soluble extracts was identified by using FTIR. Results revealed that nanosilver particles are spherical, range in size from 10 to 82 nm and crystalize in face-centered cubic structures. Surface-enhanced Raman spectra analysis showed that AgNP are capped with bioactive molecules from exudates and that they may act as precursors of the reduction of silver nitrate from the metallic state (Ag+) to the atomic state (Ag0). We also examined the minimal inhibitory concentration for bacteria Escherichia coli and Bacillus subtilis using a resazurin color assay. Nanosilver strongly inhibited the bacterial growth, leading to MIC values of 40µg/ml and 60µg/ml for the bacteria, respectively. The colony screening method and inhibition kinetics of biofilm formation in the Klebsiella pneumoniae strain were also studied using the tube method and a quantitative microplate assay. SEM analysis and quantification of the EPS revealed a fivefold decrease in concentration in treated compared to untreated. The inhibition response was duly reflected in SEM images.

Ethno-medicinal Species of Cassia (C. fistula, C. siamea, C. tora): Documentation and Metabolites Estimation

Different species of Cassia found in Jharkhand are consumed as daily vegetables have high nutritional value. Most of them are underutilized and display varied ethenomedicinal values. The work was carried out with an aim to document three ethno medicinal properties of three different species of Cassia, Cassia fistula, Cassia siamea and Cassia tora. The documentation was done among 100 tribal people residing in the area near Morabadi, Ranchi. The knowledge revealed that the three plants were used in almost every tribal houses as a dietary supplement and various medicinal uses. According to the Munda Vaidya’s the plant Cassia is of pitta nature and its different part have different uses. The root is used against tuberculosis glands, diabetes, as a tonic, the root and bark paste mixed in equal amount is used against snake bite. traditionally it is used as laxative, for the treatment of leprosy and various skin disorders. the present study aimed to screen and quantify primary and secondary metabolite by quantitative and qualitative method. The pigments (chlorophyll and carotenoid) were characterised by UV visible spectroscopy. Concentration of chlorophyll-a, chlorophyll-b and carotenoid was calculated by Arnon method (80% acetone extract). The spectrophotometric study of the different pigment of the three species of Cassia, Cassia fistula (chl-a 254.516, chl-b 305.741, total chl 533.7 carotenoid 10.6), Cassia siamea (chl-a 257.88, chl-b 393.16, total chl 630.2 carotenoid 9.395), Cassia tora (chl-a 266.36, chl-b 271.96, total chl 538.32 carotenoid 16.3). The result revealed that chl-a was highest in Cassia tora followed by Cassia siamea and Cassia fistula. Chl-b pigment followed C. siamea&gt; C. fistula&gt;C. tora pattern, total chl C. siemea&gt;C. tora&gt;C. fistula and the carotenoid amount C. tora &gt; C. fistula &gt; C. siamea. In screening of secondary metabolites tannin, saponins alkaloids, terpenoids, resin Phyto-sterols were carried out on the aqueous extract showed +ve test for all except phyto-sterols and on the powdered specimen gave –ve result in aqueous, ethanol as well as acetone extract.&#x0D; Int. J. Appl. Sci. Biotechnol. Vol 7(3): 387-394&#x0D;

Geographic and socioeconomic factors associated with leprosy treatment default: An analysis from the 100 Million Brazilian Cohort.

BackgroundAlthough leprosy is largely curable with multidrug therapy, incomplete treatment limits therapeutic effectiveness and is an important obstacle to disease control. To inform efforts to improve treatment completion rates, we aimed to identify the geographic and socioeconomic factors associated with leprosy treatment default in Brazil.Methodology/Principal findingsUsing individual participant data collected in the Brazilian national registries for social programs and notifiable diseases and linked as part of the 100 Million Brazilian Cohort, we evaluated the odds of treatment default among 20,063 leprosy cases diagnosed and followed up between 2007 and 2014. We investigated geographic and socioeconomic risk factors using a multivariate hierarchical analysis and carried out additional stratified analyses by leprosy subtype and geographic region. Over the duration of follow-up, 1,011 (5.0%) leprosy cases were observed to default from treatment. Treatment default was markedly increased among leprosy cases residing in the North (OR = 1.57; 95%CI 1.25–1.97) and Northeast (OR = 1.44; 95%CI 1.17–1.78) regions of Brazil. The odds of default were also higher among cases with black ethnicity (OR = 1.29; 95%CI 1.01–1.69), no income (OR = 1.41; 95%CI 1.07–1.86), familial income ≤ 0.25 times Brazilian minimum wage (OR = 1.42; 95%CI 1.13–1.77), informal home lighting/no electricity supply (OR = 1.53; 95%CI 1.28–1.82), and household density of > 1 individual per room (OR = 1.35; 95%CI 1.10–1.66).ConclusionsThe findings of the study indicate that the frequency of leprosy treatment default varies regionally in Brazil and provide new evidence that adverse socioeconomic conditions may represent important barriers to leprosy treatment completion. These findings suggest that interventions to address socioeconomic deprivation, along with continued efforts to improve access to care, have the potential to improve leprosy treatment outcomes and disease control.

Study of elcetrophysiological changes in clinically uninvolved nerves in Leprosy

Introduction: The present day classification of leprosy depends on the number of nerves affected [WHO]. Detection of changes in clinically uninvolved nerves can have a major impact on diagnosis, classification and treatment of leprosy patients. Aim: Study of nerve conduction parameters in a segmental manner in commonly involved peripheral nerves and detection of electrophysiological changes in clincally uninvolved nerves. Method: Leprosy was clinically diagnosed on the basis of criteria put forward by WHO. Segmental electrophysiological studies were done in 30 cases and 30 controls after obtaining informed consent. Both ulnar nerves, common peroneal nerves and posterior tibial nerves were studied. Sensory and motor parameters were studied. Observation: Thirty patients and controls were studied. 60 nerves were clinically involved. 180 clinically uninvolved nerves were also studied. Clinically uninvolved nerves were compared with the same nerves in normal persons having no peripheral neuropathy. Results: Segmental demyelination and axonal degeneration were observed in clinically uninvolved nerves. Conclusion: Clinically uninvolved nerves showed changes in electrophysiological studies. Detection of involvement of clinically uninvolved nerves can modify diagnosis, classification and treatment of leprosy.

Alternative Leprosy Treatment Using Rifampicin Ofloxacin Minocycline (ROM) Regimen – Two Case Reports

Abstract Introduction. Leprosy is a disease that predominantly affects the skin and peripheral nerves, resulting in neuropathy and associated long-term consequences, including deformities and disabilities. According to the WHO classification, there are two categories of leprosy, paucibacillary (PB) and multibacillary (MB). The standard treatment for leprosy employs the use of WHO MDT (Multi Drug Treatment) regimen, despite its multiple downsides such as clofazimine-induced pigmentation, dapsone-induced haematological adverse effects, poor compliance due to long therapy duration, drug resistance, and relapse. Multiple studies and case reports using ROM regimen have reported satisfactory results. Nevertheless, there are still insufficient data to elucidate the optimum dosage and duration of ROM regimen as an alternative treatment for leprosy. Previous experience from our institution revealed that ROM regimen given three times weekly resulted in a satisfactory outcome. Case Reports. We report two cases of leprosy treated with ROM regimen from our institution. The first case was PB leprosy in a 64-year-old male who presented with a single scaly plaque with erythematous edge on the right popliteal fossa. Sensibility examination showed hypoesthesia with no peripheral nerve enlargement. Histopathological examination confirmed Borderline Tuberculoid leprosy. ROM regimen was started three times weekly for 6 weeks and the patient showed significant clinical improvement at the end of the treatment with no reaction or relapse until after 6 months after treatment. The second case was MB leprosy in a 24-year-old male patient with clawed hand on the 3rd-5th phalanges of the right hand and a hypoesthetic erythematous plaque on the forehead. Histopathology examination confirmed Borderline leprosy. The patients received ROM therapy 3 times a week with significant clinical improvement after 12 weeks. Conclusion. ROM regimen given three times weekly for 6 weeks in PB leprosy and 12 weeks in MB leprosy resulted in a significant clinical improvement. Thus, ROM regimen could be a more effective, safer, faster alternative treatment for leprosy.

Dapsone- gel as a novel platform for acne treatment: In vitro evaluation and In vivo performance and histopathological studies in acne infected mice

The uniqueness of dapsone, 4,4′-diaminodiphenylsulfone (DPS) is attributed to its dual antimicrobial and anti-inflammatory effects. Nevertheless, DPS limited solubility in water makes its topical use in treatment of dermatological conditions limited. This study aimed to formulate and test the activity of DPS as a gel by its inclusion into a cyclodextrin ring. The interaction between DPS and methyl β-cyclodextrin (Kleptose® Crysemb) in the solution state was investigated using phase solubility technique. Aqueous solubility of DPS increased linearly as a function of the Kleptose® Crysemb concentration with a phase diagram classified as AL-type according to Higuchi and Connors. Moreover, interaction between the drug and the used cyclodextrin molecule was further investigated using differential scanning calorimetry and X-ray diffraction. The inclusion of the drug into core of the cyclodextrin molecule disrupted the crystalline nature of the drug forming crystalline form of higher solubility. The prepared complex was further incorporated in a thermo-sensitive Pluronic F127 gel, to ease the application on the skin. To assess the prepared gel anti-acne activity, in vivo testing in acne-induced inflammation mouse model was performed. DPS gel exhibited superior anti-inflammatory and healing activities compared to reference anti-acne antibiotic Aknemycin®. Additionally, the prepared DPS gel exhibited equipotent antimicrobial effect to that of reference antibiotic Aknemycin®. Our topical DPS formulation therefore provides an efficient strategy for treatment of dermatological indications, such as acne and for alternative treatment of leprosy.

Oro-facial manifestations in lepromatous leprosy patients in Central India: clinical findings from a cross-sectional study.

To clinically evaluate the oro-facial manifestations in lepromatous leprosy patients undergoing multidrug therapy in Central India. Two hundred patients from 2 leprosy treatment centers in Central India who satisfied the diagnostic criteria set by the WHO (2006-2010) committee on leprosy were included in the study. To avoid bias, only patients who started the multi-drug treatment regimen less than 1year ago were included. All the patients were examined for the presence of oral and facial manifestations. To confirm that the oro-facial manifestations were not due to HIV co-infection, serological diagnostic tests including ELISA, Immunocomb, and Tri-dot were performed. Majority of the patients (n = 189) exhibited oral (n = 145) and/or facial (n = 147) manifestations. The most common oral lesions were found to be fissuring and depapillation of the tongue followed by fibrosis and loss of uvula. Among the facial manifestations, facial skin lesions and loss of eyebrows were most prevalent followed by sagging of facial skin and facies leonine. The facial manifestations of leprosy are quite common, readily recognizable, and relatively specific to the disease. Thus, the presence of facial manifestations, especially with co-existing oral lesions must prompt the clinician to mandate further investigations to confirm the diagnosis. As evidenced by the present study, facial manifestations and oral lesions are an integral part of leprosy. In addition to being a diagnostic parameter, facial manifestations and oral lesions could potentially be used to monitor the disease progression and treatment outcome.

WITHDRAWN: Interventions for skin changes caused by nerve damage in leprosy.

More than three million persons are disabled by leprosy worldwide. The main complication of sensory nerve damage is neuropathic ulceration, particularly of the feet. In this review we explored interventions that can prevent and treat secondary damage to skin and limbs. To assess the effects of self-care, dressings and footwear in preventing and healing secondary damage to the skin in persons affected by leprosy. We searched the Cochrane Skin Group Specialised Register (April 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2008), MEDLINE (from 2003 to April 2008), EMBASE (from 2005 to April 2008), CINAHL (1982-2006) and LILACS (1982- April 2008 ) as well as online registers of ongoing trials (April 2008). Randomised controlled trials involving anyone with leprosy and damage to peripheral nerves treated with any measures designed to prevent damage with the aim of healing existing ulcers and preventing development of new ulcers. Two authors assessed trial quality and extracted data. Eight trials with a total of 557 participants were included. The quality of the trials was generally poor. The interventions and outcome measures were diverse. Although three studies that compared zinc tape to more traditional dressings found some benefit, none of these showed a statistically significant effect. One trial indicated that topical ketanserin had a better effect on wound healing than clioquinol cream or zinc paste, RR was 6.00 (95% CI 1.45 to 24.75). We did not combine the results of the two studies that compared topical phenytoin to saline dressing, but both studies found statistically significant effects in favour of phenytoin for healing of ulcer (SMD -2.34; 95% CI -3.30 to -1.39; and SMD -0.79; 95% CI -1.20 to 0.39). Canvas shoes were not much better than PVC-boots, and double rocker shoes did not promote healing much more than below-knee plasters. One study suggested that topical ketanserin is more effective than clioquinol cream or zinc paste. Topical phenytoin (two studies) may be more effective than saline dressing regarding ulcer healing. For the other dressings the results were equivocal. Canvas shoes were a little better than PVC-boots, but not significantly, and the effect of double rocker shoes compared to below-knee plasters was no different in promoting the healing of ulcers. No side effects were documented.There is a lack of high quality research in the field of ulcer prevention and treatment in leprosy. New trials should follow the current standards for design and reporting of randomised controlled trials.

Experimental dapsone administration induces infertility in male Wistar rats: Mechanisms and clinical implications

Dapsone (4, 4′-diaminodiphenylsulfone, DDS) is a potent anti-inflammatory and antibacterial compound which has been used in the treatment of leprosy, vasculitis and dermatitis herpetiformis, lupus erythematosus profundus and even as an antimalarial in combination with proguanil. This study investigated the effect of the administration of dapsone on the reproductive activities of male rats using in vivo and in vitro techniques. In the in vivo study, dapsone was administered orally to male Wistar rats for 5 days or 6 weeks after which their body weight, relative reproductive organ weights, sperm parameters and reproductive hormones were determined while testicular and epididymal histology were also assessed. Data were compared using analysis of variance and Students-Newman-Keuls multiple comparison test. For the in vitro study, Sertoli cells were cultured and treated with varying doses of dapsone at different durations, thereafter Sertoli cell viability and nuclei integrity were determined. Also, the genetic expressions of Glial cell line-derived neurotrophic factor (GDNF) and transferrin were assessed. The results obtained from the in vivo study showed a duration-dependent significant decrease in body and reproductive organ weights, sperm parameters and serum testosterone concentration. Testicular and epididymal histology also showed duration-dependent degenerative changes. However, all these changes were restored towards control values in the recovery experiment. The viability and deoxyribonucleic acid (DNA) integrity of the treated Sertoli cells showed dose and duration-dependent adverse effects while GDNF and transferrin showed normal genetic expressions. These results suggest that dapsone could induce male reproductive stress by affecting testicular and epididymal structure and function.

DNA gyrase could be a crucial regulatory factor for growth and survival of Mycobacterium leprae

Leprosy, an important infectious disease in humans caused by Mycobacterium leprae (Mle), remains endemic in many countries. Notably, the pathogen cannot be cultured in vitro, except in mouse footpads in vivo. The molecular basis of these characteristics and the mechanisms remain unknown. Consequently, analysis of Mle growth and survival is urgently needed to develop novel therapies against leprosy, including rapid, simple, and specific methods to detect infection. Here, we demonstrated the functional role and contribution of Mle-DNA gyrase, which regulates DNA topology, DNA replication, and chromosome segregation to promote bacterial growth and survival, in Mle growth and survival in vitro and in vivo. The optimum temperature for Mle-DNA gyrase activity was 30 °C. When the DNA gyrB-gyrA genes in Mycobacterium smegmatis were replaced with the Mle gyrase genes by allelic exchange, the recombinants could not grow at 37 °C. Moreover, using radiorespirometry analysis for viability of Mle bacilli, we found that Mle growth was more vigorous at 25–30 °C than at 37 °C, but was inhibited above 40 °C. These results propose that DNA gyrase is a crucial factor for Mle growth and survival and its sensitivity to temperature may be exploited in heat-based treatment of leprosy.

Wanda Błeńska and the program of leprosy treatment in Uganda

Wanda Błeńska (1911-2014), a Polish physician, established a leprosy treatment center in the village of Buluba in Uganda in 1951, which lasted until 1993. Through her efforts, the village for lepers in Buluba, established in 1934, which had previously been a place of isolation conducted by the Little Sisters of St. Francis in Uganda, became such an important leprosy treatment and research center that eventually the facility was able to cooperate with similar centers in India and South Africa. It then became affiliated with research institutes in London and Amsterdam; the Borstel Research Institute near Hamburg, Germany; and the World Health Organization. Błeńska developed a working relationship with the government of Uganda and contributed to changes in the government provision of health care for lepers by creating a network of leprosy treatment stations throughout the country. Through her efforts, public health education and leprosy prophylaxis became available for thousands of people, effectively changing the national attitude toward this disease. In 1994, one of the buildings of the St. Francis hospital complex in Buluba was named in her honor (The Wanda Blenska Training Centre).

Isolation of Sesquiterpene-Amino Acid Conjugates, Onopornoids A-D, and a Flavonoid Glucoside from Onopordum alexandrinum.

Previous phytochemical investigations have revealed the presence of a variety of compounds such as pyrrolidine derivatives, flavonoids, and megastigmanes in Egyptian plants. Onopordum alexandrinum has been traditionally used by the natives for treatment of skin cancers and leprosy. In this paper the isolation of four new sesquiterpene-amino acid conjugates, onopornoids A-D (1-4), i.e., three elemanes and one germacrane, and a new acylated flavonoid glucoside (5) along with nine known compounds (6-14) from the whole aerial parts of the title plant is discussed. The structures were elucidated based on chemical and spectroscopic/spectrometric data.

ORAL IATROGENIC KAPOSI'S SARCOMA: CASE REPORT

This study presents a case of a 29-years old male patient with immunosuppression-associated Kaposi´s Sarcoma (KS) caused by the medicines for the leprosy treatment. The patient was presented to the stomatology service of the Hospital Metrolpolitano Odilon Behrens, Brazil, with a tumoral growth in the rights side of the lip commissure, with no history of local trauma. He was previously diagnosticated with borderline leprosy, cataract and glaucoma and was under regular use of 100mg prednisone for 1 year and 6 months for treatment of leprosy complication. At the clinical examination it was possible to observe an erythematous tumoral growth in the lip commissure, right side, with necrosis on the surface measuring approximately 12mm. In view of the diagnostic hypothesis of non-neoplastic proliferative lesion and neoplasia of mesenchymal origin, an incisional biopsy of the lesion was performed. Microscopic findings and immunohistochemical examination of the lesion led to a final diagnosis of KS. The patient was submitted to the rapid serology test for human immunodeficiency virus (HIV), which proved to be negative, a result confirmed by the fourth-generation test. The patient was referred for surgical evaluation of the lesions and for reevaluation of the systemic steroid dosage. Faced with the infeasibility of reducing corticoid dosage, the patient underwent surgical excision of the lesions and was free of recurrence of the disease for 2 years. So, this case shows the importance of including KS in the differential diagnosis of oral cavity lesions in patients who use chronic immunosuppressant drugs.