Treatment Of Leprosy Research Articles

The Flow of Social Environmental Determinants of Disabilities on Lepers in Tuban City

Background: Leprosy is a neglected tropical disease considered rare in most areas despite having a relatively high incidence in some countries. Objective: Analyze the flow of determinants of the social environment that can affect the occurrence of disability in lepers and their impacts. Method: Research using a qualitative approach. The research was conducted in Tuban Regency, East Java Province. The informant selection technique uses a purposeful sampling technique. Data analysis uses triangulation techniques. Results: The frequency of leprosy in Tuban Regency tended to decrease from 2014-2019. Leprosy distribution occurred in 18 sub-districts; Lepers were found every month in 2019 with various characteristics of lepers that cause the emergence of leprosy and disability in leprosy. The total number of informants in this study was seven informants. Determinants of disability in lepers include informant characteristics and social environment, including knowledge, contact history, family support, self-confidence, and impact. Conclusion: In this study, the social environment that most impact the occurrence of disability in lepers is the informant knowledge factor. Informant knowledge is influenced by education, a large network of friends, and technological literacy. Education will show the type of informant work, and the type of work will determine the income of the informant; income determines economic status. Economic status contributes to food intake, medication seeking, and the home's physical condition. The duration of leprosy treatment will affect the worsening of the disability if good self-care is not carried out and always use PPE when doing activities.

Metformin as adjunctive therapy in combination with multidrug treatment for multibacillary leprosy: A protocol for a randomized double-blind, controlled Phase 2 trial in Indonesia (MetLep Trial)

Background: The clinical management of leprosy is complicated by leprosy reactions (LR) causing irreversible nerve damage and disabilities. LR often require long-term use of corticosteroids causing serious side effects. Adjunct host-directed therapy (HDT) is a potentially attractive strategy in leprosy to prevent LR and associated immunopathology, modulate immunological memory that protects against recurrence, and thereby reduce nerve damage, disability and corticosteroid-associated morbidities. Metformin, a well-tolerated, safe and cheap anti-hyperglycaemic drug, is repurposed as HDT in auto-immune and infectious diseases, like tuberculosis (TB). Metformin use in people with diabetes is associated with reduced risks of TB-infection, progression to active TB, treatment failure and TB-mortality. Given the similarities both mycobacteria share, we hypothesize that among persons with multibacillary (MB) leprosy, adjunctive metformin may prevent/mitigate LR. Methods: We will perform a double-blind controlled proof-of-concept trial in which people with newly diagnosed multibacillary leprosy will be randomized (1:1) to metformin hydrochloride 1000mg extended release once daily versus placebo for 24 weeks in addition to standard-of-care WHO MB multidrug therapy (MDT) during 48 weeks. We aim to enrol 166 participants aged between 18 and 65 years, across five clinical sites in two leprosy endemic areas in Indonesia. Primary endpoints are the proportion of participants experiencing a LR and the frequency of (serious) adverse events. Secondary endpoints are the severity and time to first LR, the number of LR, the cumulative corticosteroid usage, and quality of life. The total study follow-up is 48 weeks. Discussion: LR signify the most important cause of irreversible nerve damage leading to anatomical deformities and disabilities, imposing a social and financial burden on those affected. Our study aims to evaluate the efficacy, tolerability and safety of adjunct metformin added to MDT in persons with multibacillary leprosy, and explore its effects on clinical and immunological endpoints. ClinicalTrials.gov registration: NCT05243654 (17/02/2022)

The leprosy reaction is associated with salivary anti-Porphyromonas gingivalis IgA antibodies

The aim of the study was to evaluate the association between salivary anti-Porphyromonas gingivalis IgA antibodies and the leprosy reaction. The levels of salivary anti - P. gingivalis IgA antibodies, together with salivary flow and pH were measured in individuals diagnosed with leprosy and associated with the development of the leprosy reaction. Saliva was collected from 202 individuals diagnosed with leprosy at a reference leprosy treatment center, 106 cases with the leprosy reaction and 96 controls without the leprosy reaction. Anti - P. gingivalis IgA was evaluated by indirect immunoenzyme assay. Non-conditional logistic regression analysis was employed to estimate the association between antibody levels and the leprosy reaction. There was a positive statistically significant association between the levels of anti - P. gingivalis IgA and the presence of the leprosy reaction, controlling for confounders: age, sex, level of education and alcoholic beverage consumption: ORajusted: 2.55; IC 95%: 1.34–4.87. Individuals with leprosy who had high levels of salivary anti - P. gingivalis IgA had approximately twice as many chances of developing the leprosy reaction. The findings suggest a possible relationship between salivary anti - P. gingivalis IgA antibodies and the leprosy reaction.

Comparison between lymecycline with multidrug therapy and standard multidrug regimen (WHO-MDT) in the treatment of multibacillary leprosy patients: a retrospective cohort study.

Hansen's disease or leprosy is a chronic, infectious disease that has locally and globally afflicted all populations. Despite standard treatment with multidrug therapy (WHO-MDT), the incidence of drug resistance has been an increasingly prevalent global problem in leprosy management. This study compared the effectiveness between lymecycline with WHO-MDT and standard WHO-MDT in leprosy treatment. The research is a retrospective cohort study at a tertiary hospital from January 2011 to July 2021. Pre- and post-treatment bacillary index, presence of new lesions, nerve function impairment, and leprosy reactions were obtained through chart review. The results showed a significant difference in bacteriological index (BI) in both groups at the end of the treatment. However, a higher reduction in BI was noted for the lymecycline group. For the group that took WHO-MDT alone, BI decreased by 0.7 (P < 0.001) whereas patients who took lymecycline and WHO-MDT had a BI difference of 3 (P < 0.001) upon completion of treatment. A significant decrease in the recurrence of lesions (P = 0.006) and nerve function impairment (P = 0.038) was also noted in the lymecycline group whereas there was no significant difference in leprosy reactions between the two groups. Lymecycline 600 mg daily for 3 months can be used as an adjunct in cases of leprosy resistance and treatment failure among multibacillary patients. Lymecycline significantly reduced bacillary index, recurrence of skin lesions, and nerve function impairment through its possible immunomodulatory, antiapoptotic, and neuroprotective effects.

The efficacy of a whole foods, plant-based dietary lifestyle intervention for the treatment of peripheral neuropathic pain in leprosy: a randomized control trial protocol.

Despite effective treatment of leprosy via WHO-approved multi-drug therapy (MDT), patients still suffer from debilitating neuropathic sequelae, including peripheral neuropathic pain (PNP), and continue to develop intercurrent etiologies (such as diabetes), and progressive existing neuropathy over time. Strategies seeking to improve physiological and metabolic wellness, including those that reduce systemic inflammation and enhance immune responsiveness to neurotoxic factors may influence underlying neuropathic etiologies. A whole food plant-based diet (WFPBD) has been shown to be effective in the management of neuropathic pain due to diabetes, limiting severity and relevant symptomology. Diabetes remains a significant sequela of leprosy, as up to 50% of patients in reaction requiring corticosteroids, may develop a biochemical diabetes. As nutritional interventions may modulate both leprosy and diabetes, a specific exploration of these relationships remains relevant. (1) To demonstrate the effect of a WFPBD lifestyle intervention, on neuropathic pain variables in leprosy; and (2) To contextualize the significance of diet in the treatment of chronic sequelae in leprosy by evaluating tolerability and side effect profile. A prospective, randomized, controlled, single-blind, multicentre interventional trial is described. Weekly one-hour dietary counseling sessions promoting a WFPBD emphasizing vegetables, fruits, whole-grains, nuts, and legumes, omitting animal products, and limiting fat intake over a six-month duration will be implemented. Participants will be 70 age and sex-matched individuals experiencing active or treated "cured" leprosy and PNP, randomized to either intervention or control groups. Primary outcome measures include efficacy via visual analog scale, subjective questionnaire and objective quantitative sensory testing, as well as safety, tolerability, and harms of a WFPBD on PNP in leprosy. This study will be initiated after Research Ethics Board (REB) approval at all participating sites, and in advance of study initiation, the trial will be registered at ClinicalTrials.gov. It is hypothesized that WFPBDs will mitigate progression and severity of PNP and potentially reduce the adverse events related to standard corticosteroid treatment of leprosy reactions, thereby reducing disease severity. By examining the effects of WFPBDs on PNP in leprosy, we hope to illuminate data that will lead to the enhanced therapeutic management of this neglected tropical disease.

Factors affecting treatment adherence among leprosy patients: Perceptions of healthcare providers

BackgroundTreatment adherence is a vital aspect in the management of chronic diseases like leprosy; however, most studies on treatment adherence focus on patients. This study aims to examine the perceptions of healthcare providers on factors that can promote or prevent patients from adhering to treatment. MethodsWe conducted three focus group discussions (FGDs) with healthcare providers who have at least one year experience in managing leprosy in three large leprosy case-holding hospitals in Metro Manila, Philippines. We audio-recorded, transcribed, translated the FGD proceedings, and analyzed the transcripts thematically to identify patient-intrinsic and patient-extrinsic enablers and barriers to treatment adherence of leprosy patients. ResultsPatient-intrinsic motivators to complete treatment include innate desire to be cured, fear of infecting family and friends, fear of disability, good knowledge about the disease, need for medical clearance to be considered fit to work, and experiencing leprosy reactions. Patient-extrinsic motivators to complete treatment include free treatment, immediate and sufficient counselling, flexibility in treatment, follow-up and motivation of healthcare workers, and presence of Hansen’s Club and support groups. Patient-intrinsic barriers to good treatment adherence include distance between residence and hospital, financial and opportunity costs, adverse drug reactions, misconceptions about being cured, disabilities and presence of leprosy reactions, stubbornness and/or laziness, and undergoing clinical depression. Patient-extrinsic barriers to good treatment adherence include poor availability of MDT, transfer to other leprosy treatment facilities without informing current facility, and stigma. ConclusionHealthcare providers perceive that patient-intrinsic and patient-extrinsic factors influence the treatment adherence of leprosy patients through different mechanisms. We highlight the role of healthcare provider attitudes, stigma, and support groups in promoting treatment adherence.

H15 A treatment for leprosy developed on the edge of Europe: Vincent Barry (1908–1975)

Abstract Leprosy is the prototype of a biblical disease. Without an effective cure, it was deemed a ‘curse’ for millennia. It is an infection caused by Mycobacterium leprae and Mycobacterium lepromatosis. With an affinity for peripheral skin (due to lower temperatures), a rash is a common presenting feature. A tropism to infiltrate neural tissue causes a reduction in sensation leading to repeated injury, infection and disfigurement. Affected individuals were often shunned from society and sent to leper colonies. Treatment for leprosy only became effective in the mid-20th century. Initial treatment for leprosy was with promin and dapsone. Clofazimine and rifampicin were later added in the 1960s–70s. Treatment for leprosy consists of a multidrug therapy regime of rifampicin, dapsone and clofazimine for 6–12 months. This was first recommended by the World Health Organization (WHO) in 1981 and remains the recommended treatment. Clofazimine was developed in a laboratory in Trinity College Dublin by Vincent Barry and his scientific team. Vincent Barry was born in Cork, Ireland, and later graduated in chemistry from University College Dublin. He became associate professor of chemistry in Galway where he lectured bilingually in Irish and English and co-authored the first Irish-language textbook for chemistry (Ceimic). Barry spent time working in and observing leper colonies in both Zimbabwe and India. In 1943, he was given a fellowship by the Medical Research Council of Ireland to carry out research on the chemotherapy of tuberculosis (TB). However, as TB became more curable, he focused his attention on leprosy. His team were given laboratory space in Trinity College Dublin, and in 1957, they developed compound B663, clofazimine. Intended as an anti-TB medication, clofazimine showed more effectiveness against leprosy. The product was launched in 1969 after several clinical trials in Nigeria. In 1974, they devoted the patents of the drug to India to allow it to be produced in a more cost-effective manner. The team was not interested in fame or fortune; their goal was simply to make the drug available in the developing world. They received the Boyle Award from the Royal Dublin Society in 1969, and the UNESCO Science prize in 1980 ‘for their work on the synthesis of an anti-leprosy agent, B-633’. The achievements of Mr Barry and his team, seldom discussed, have led to millions of lives being saved. Clofazimine is part of the WHO Model list of Essential Medicines.

Scenarios warranting modified treatment regimens in leprosy: A 5-year retrospective study from a tertiary care center

Objectives: To study the scenarios warranting modified treatment regimens in leprosy. Materials and Methods: A 5-year retrospective study was carried out in a tertiary care center by analyzing the data collected from national leprosy eradication program (NLEP) records. Results: During the 5-year study period, 171 patients received treatment for leprosy from our center. Thirtyone patients (31/171, 18.1%) required substitution of standard multidrug therapy (MDT) with alternate drugs or required alternate treatment regimens. The patients who required modified treatment included 18 men (18/31, 58.1%) and 13 women (41.9%). Male/female ratio was 1.4:1. Indications for treatment modification were adverse drug reactions to standard MDT (ADR) (21/31, 67.7%) and lack of response to standard MDT (10/31, 32.3%). The most common scenario that warranted a modification of standard MDT was dapsone-induced hemolysis (12/31, 38.7%). Seven (7/31, 22.6%) and two (2/31, 6.5%) patients needed a change in treatment due to drug-induced hepatitis and drug-induced maculopapular rash, respectively. Limitations: Retrospective study design, study conducted in single tertiary referral center and small sample size were the limitations. Conclusion: Nearly one-fifth of patients with leprosy required modifications in standard MDT. The most common indication (in two-third of patients who needed a modified treatment) for modification of treatment regimen was adverse drug reactions.

Ocular Manifestations of Lepromatous Leprosy

This study was done during the study period November 2020 to September 2022, during which 47 patients of leprosy were examined of whom 36 were Lepromatous leprosy in Ophthalmology department if Rajah Muthiah Medical College and Hospital. In our study 80.06% of Lepromatous leprosy patients had ocular manifestations, of whom maximum prevalence was present in 61-75 age group. The major ocular manifestations present were Madarosis (61.11%), Iridocyclitis (50%), Lagophthalmos (11.11%), corneal anesthesia (22.22%), corneal Hypoesthesia (16.67%), exposure keratitis (8.33%) and corneal opacity (8.33). BCVA- 3/60 to PL (U/L) – 18.06% BCVA- 3/60 to PL (B/L)- 2.8% Most of the patients of Lepromatous leprosy had Bilateral Polyneuropathy. The most common nerve affected in Lepromatous leprosy was found to be ulnar nerve and Radial cutaneous nerve. The ocular symptoms occurred more in patients of WHO grade 2 Disability than grade 2 or grade 1. Ocular symptoms occurred mostly in patients who completed Leprosy treatment. Keywords: Lepromatous leprosy, ocular manifestations, leprosy.

Effectiveness of population-wide screening and mass drug administration for leprosy control in Kiribati: the COMBINE protocol

IntroductionProgress towards leprosy elimination is threatened by increasing incidence in ‘hot-spot’ areas where more effective control strategies are urgently required. In these areas, active case finding and leprosy prevention limited...

Lucio phenomenon or necrotic erythema nodosum leprosum in an untreated case of leprosy?? A diagnostic dilemma…

Lucio phenomenon (LP) or erythema necroticans is a rare reaction pattern seen in untreated or partially treated lepromatous (LL) or borderline lepromatous (BL) leprosy cases. Necrotic Erythema Nodosum Leprosum (nENL), although seen in the same spectrum of leprosy, is seen in cases already undergoing treatment for leprosy and rarely in untreated cases. A 33-year-old male, a serving soldier presented to the medical clinic, in a remote area in the Northeast part of India with complaints of tender violaceous rash over previously normal looking skin, for 10 days along with myalgia and arthralgia, followed by low grade fever for 5 days. Cutaneous examination showed the presence of hyperpigmented to erythematous, irregularly shaped, discrete as well as coalescing purpuric macules and a few papules, with the presence of angular superficial ulcerations and haemorrhagic crusting, located over the trunk, abdomen, bilateral upper and lower extremities, including the palms and soles. He was started on systemic antibiotics by the physicians. Unfortunately, despite the treatment, the patient succumbed to the illness. A post-mortem biopsy sent from various parts of the body showed diffuse infiltration in the dermis with macrophages and lympho-histiocytic cells, numerous foam cells, panniculitis and necrotizing vasculitis. Fite-Faraco stain showed numerous cigar shaped bacilli arranged in the form of globi within macrophages. The cutaneous features were suggestive of LP, but the systemic features and histopathology favoured nENL, even though the patient had not been on any multibacillary therapy for leprosy, and showed no nodular eruptions preceding the haemorrhagic crusting.

IL-23/IL-23R Promote Macrophage Pyroptosis and T Helper 1/T Helper 17 Cell Differentiation in Mycobacterial Infection

Pathogen-induced epigenetic modifications can reshape anti-infection immune processes and control the magnitude of host responses. DNA methylation profiling has identified crucial aberrant methylation changes associated with diseases, thus providing biological insights into the roles of epigenetic factors in mycobacterial infection. In this study, we performed a genome-wide methylation analysis of skin biopsies from patients with leprosy and healthy controls. T helper 17 differentiation pathway was found to be significantly associated with leprosy through functional enrichment analysis. As a key gene in this pathway, IL-23R was found to be critical to mycobacterial immunity in leprosy, according to integrated analysis with DNA methylation, RNA sequencing, and GWASs. Functional analysis revealed that IL-23/IL-23R-enhanced bacterial clearance by activating caspase-1/GSDMD-mediated pyroptosis in a manner dependent on NLRP3 through signal transducer and activator of transcription 3 signaling in macrophages. Moreover, IL23/IL-23R promoted T helper 1 and T helper 17 cell differentiation and proinflammatory cytokine secretion, thereby increasing host bactericidal activity. IL-23R knockout attenuated the effects and increased susceptibility to mycobacterial infection mentioned earlier. These findings illustrate the biological functions of IL-23/IL-23R in modulating intracellular bacterial clearance in macrophages and further support their regulatory effects in T helper cell differentiation. Our study highlights that IL-23/IL-23R might serve as potential targets for the prevention and treatment of leprosy and other mycobacterial infections.

AN UPDATE TREATMENT OF ERITEMA NODOSUM LEPROSUM

Leprosy, also called Morbus Hansen, is a contagious skin disease caused by the bacterium Mycobacterium Leprae. It takes 2–5 years for the disease to show up, and it takes 2–3 weeks for the cells to divide. Leprosy reaction is a sudden event that happens during the long-term course of the disease. It causes skin sores to become very red and swollen. This disease can show up before, during, or after treatment for leprosy, and it can happen to 30–50% of people with leprosy. Reactions to leprosy happen when both cellular and humoral immune responses go wrong. Type 2 or Eritema Nodosum Leprosum (ENL) reactions have a clinical picture of the appearance of nodules in the skin. This reaction occurs in leprosy patients with very large numbers of bacteria, namely the multibacillary type. In contrast to the reversal reaction, the humoral immune response plays an important role in the pathogenesis of ENL. Large amounts of bacterial antigen concentrations in tissues will increase IgM and IgG titers in multibacillary leprosy patients. Th2 cell activation will stimulate the production of IL-4 and IL-10, thereby increasing the humoral immune response and increasing the production of B lymphocytes. The goals of the treatment are to control the inflammation, ease the pain, and stop new cases from happening. In weak cases of ENL, the best way to treat it is to rest and take anti-inflammatory drugs. Most of the time, people take aspirin, which is an anti-inflammatory drug. Other drugs have also been tried, including nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, oral zinc, pentoxifylline, and chloroquine. But each of the current treatment options has its own downsides and limitations, and the best one must be carefully chosen for each case.

Clofazimine pKa Determination by Potentiometry and Spectrophotometry: Reverse Cosolvent Dependence as an Indicator of the Presence of Dimers in Aqueous Solutions.

The weakly basic antibiotic and anti-inflammatory drug, clofazimine (CFZ), was first described in 1957. It has been used therapeutically, most notably in the treatment of leprosy. However, the compound is extremely insoluble in aqueous media, and, indeed, there is poor consensus about what its intrinsic solubility is since the reported values range from 0.04 to 11 ng/mL. To understand the speciation and solubilization of CFZ as a function of pH, it is of paramount importance to know the true aqueous pKa. However, there is also poor consensus about the value of the pKa (reported measured values range from 6.08 to 9.11). In the present study, we report the determination of the CFZ ionization constant using two independent techniques. A state-of-the-art potentiometric analysis was performed, drawing on titration data in methanol-water solutions (46-75 wt % MeOH) of CFZ, using the bias-reducing consensus of two different procedures of extrapolating the apparent psKa values to zero cosolvent to approximate the true aqueous pKa as 9.43 ± 0.12 (25 °C, I = 0.15 M reference ionic strength). In parallel, spectrophotometric UV/vis titration data were acquired (250-600 nm at different pH) in 10 mM HEPES buffer solutions containing up to 54 wt % MeOH. The alternating least squares (ALS) method was used in the analysis of the absorbance-pH spectra. Uncharacteristically, the cosolvent UV/vis data in our study showed reverse cosolvent dependence (apparent pKa values increased with increasing cosolvent) which could be explained by a dimerization of the free base. The analysis of UV/vis data obtained from 54 wt % MeOH-water solution containing 20 μM CFZ yielded the apparent pKa 9.51 ± 0.17 (I ≈ 0.005 M). To assess whether self-assembly of CFZ was energetically feasible, density functional theory (DFT) calculations were used to study the putative CFZ dimers in aqueous and methanol media. The DFT-optimized geometries and infrared spectra of CFZ dimers using water and methanol as solvents were calculated and analyzed. Based on the lack of negative frequencies in calculated infrared spectra, it was confirmed that optimized geometries correspond to the true energetic minima. Visual analysis of optimized structures indicates the presence of stacking interactions between two CFZ molecules. The protonation site (the imine nitrogen atom) was determined by 1H NMR spectroscopy.

Ethnobotanical uses, phytochemistry and biological activity of the genus Euclea: A review.

Euclea (Ebenaceae) is a genus of flowering shrubs and trees widely distributed in Africa, the Comoro Islands, and Arabia. This review aimed to evaluate the ethnobotanical uses, phytochemistry, and biological activities of the genus Euclea on available research reports. This was achieved through PubMed, Medline, Google Scholar, Science Direct, Taylor and Francis Online, Wiley Online Library which provides access to scientific and medical research. The extensive literature survey revealed that plants that belong to this genus are used as folkloric medicine for the treatment of diabetes mellitus, toothache, diarrhea, cancer, malaria, leprosy, and genital and oral diseases in the case of HIV/AIDS-related diseases. To date, more than 40 secondary metabolites have been isolated and identified from these plants, especially from E natalensis and E. divinorum. Among these, naphthoquinones, terpenes, and flavonoids are potential secondary metabolites with profound biological activities. Euclea plant extracts and their bioactive compounds possess outstanding pharmacological properties, especially antimalarial, antidiabetic, anticancer, antimicrobial, and antioxidant properties.

An Overview of Biological Importance, Pharmacological Aspects, and Analytical Techniques of Bavachin from Psoralea corylifolia Linn.

Background: Psoralea corylifolia Linn belongs to Leguminosae family is commonly known as ‘Bakuchi’ in Ayurvedic system of medicine. P. corylifolia is an important medicinal herb used for the treatment of Leucoderma, psoriasis and leprosy. P. corylifolia seed contain psoralen, psoralidin, isopsoralen, neobavaisoflavone, corylin, bavachin, and bavachalcone. P. corylifolia has been used for the treatment of asthma, vitiligo, nephritis, calvities and cough. Bavachin is a pure phytochemical, found to be present in the seeds and fruit of P. corylifolia. Methods: In order to know the medicinal properties and therapeutic benefit of bavachin in the medicine, numerous scientific research data have been collected from different literature sources and analyzed. Medicinal importance and pharmacological activities of bavachin has been investigated through literature data analysis of different scientific research works. Scientific research data has been collected from databases such as PubMed, Google, Google Scholar, Science Direct, and Scopus using words Psoralea corylifolia and bavachin. Further maximum scientific article of bavachin with respect to its pharmacological activities, medicinal importance, and analytical data of has been collected from these databases and presented here with proper citation. Results: Data analysis of scientific research works of bavachin revealed the biological importance of bavachin in the medicine. Bavachin showed anti-inflammatory, anticancer, anti-bacterial, lipid-lowering and cholesterol-reducing properties in the medicine. Bavachin has multiple pharmacological activities including platelet aggregation, α-glucosidase activities and antibacterial potential. Bavachin has a potential estrogen supplement for estrogen replacement therapy. Present work summarized biological potential of bavachin on inflammatory disorders, articular cartilage degeneration, cardiovascular disease, hyperglycemia, Parkinson's disease, Alzheimer's disease, apoptosis, melanin synthesis, estrogen Receptor, UDP-glucuronosyltransferase 1A1 and various form of pathogenic infection. Analytical data revealed the significance of an HPLC-UV, HPLC, HPLC-ECD, HPLC-DAD, IT-MS, HPLC, HPLC/TOF-MS, LC-MS/MS and ILUAE techniques for separation, identification and quantification of bavachin in different samples. Conclusion: Literature data analysis revealed the biological importance and therapeutic potential of bavachin in the medicine for the treatment of various form of human disorders.

Moisturizing emulsion with Attalea speciosa (babassu) oil as an alternative treatment for cutaneous xerosis in leprosy

This study investigated the moisturizing action of a topical emulsion containing babassu coconut almond oil in xerotic skin volunteers treated or undergoing leprosy treatment. A total of 20 volunteers (16 men and 4 women, with a mean age of 52.2 ± 15.3) with cutaneous xerosis performed the tests after signing the informed consent form. The research subjects were instructed to use the product under investigation (Attalea speciosa almond oil gel-cream formulation) 1 (one) once a day, in two 15-day cycles: first with the gel-cream formulation with babassu oil (treatment A) and the second with the gel-cream formulation without babassu oil (treatment B). The moisturizing emulsion did not significantly alter (p&gt; 0.05) the xerotic skin pH of the volunteers, treatment A (11.6 ± 0.1), treatment B (8.8 ± 0.2) and control (11.4 ± 0.2) at week W7, when compared to week W15, treatment A (11.0 ± 0.4), treatment B (11.6 ± 0.1) and control (11.4 ± 0.2). Clinical evaluations showed the efficacy and good tolerability of topical emulsion in the hydration of xerotic skin. The biophysical evaluation of the moisturizing emulsion proved the significant improvement of skin moisture.

The unbreakable journey: using photovoice to raise awareness and fight leprosy stigma in Papua, Indonesia.

In preparation of an ongoing trial to improve the treatment of leprosy (MetLep, clinicaltrials.gov: NCT05243654), we conducted a photovoice project among persons affected by leprosy in eastern Indonesia. Photovoice is a participatory visual method in which photographic images are used to explore community health and social issues among disadvantaged populations. This project generated opportunities to visualize stigma and misunderstandings people with leprosy face, and the social and mental burden that this puts on them and those around them.

Leprosy orientation for final year medical students

An orientation in leprosy was undertaken for final year medical students by Schieffelin Institute of Health – Research, Leprosy Centre (SIH-RLC), Karigiri with the objective of transferring knowledge and skills related to the diagnosis and treatment of leprosy and its complications, so that these would be useful later when they have to deal with patients affected by leprosy, especially in the Primary Health Centres. The Leprosy orientation program was of one-day duration and was organised in three Government Medical Colleges every year between 2016 to 2018. Pre and post-test questionnaires were used to assess leprosy knowledge before and after the orientation. During the orientation the facilitators transferred knowledge and skills required for management of leprosy through interactive and practical sessions. Each participant was followed up two years later when a simple questionnaire was sent to them to assess the impact of the leprosy orientation in diagnosis and management of leprosy in their respective work areas. The questionnaire was sent as a link to the medical student’s mobile phones for their responses. The pre and post test scores showed significant improvements. This difference was statistically significant. The follow-up questionnaire showed that students who underwent this leprosy training were able to diagnose and treat leprosy in their work area. Leprosy orientation also helped them to identify and treat leprosy complications/or refer patients to appropriate centres for further management. Selective and targeted training of final year medical students helped to improve their knowledge and skills to diagnose and treat leprosy and its complications later in their work situations, especially in the Government Primary Health Centres (PHC).

Clofazimine for the treatment of tuberculosis.

Shorter (6-9months), fully oral regimens containing new and repurposed drugs are now the first-choice option for the treatment of drug-resistant tuberculosis (DR-TB). Clofazimine, long used in the treatment of leprosy, is one such repurposed drug that has become a cornerstone of DR-TB treatment and ongoing trials are exploring novel, shorter clofazimine-containing regimens for drug-resistant as well as drug-susceptible tuberculosis. Clofazimine's repurposing was informed by evidence of potent activity against DR-TB strains in vitro and in mice and a treatment-shortening effect in DR-TB patients as part of a multidrug regimen. Clofazimine entered clinical use in the 1950s without the rigorous safety and pharmacokinetic evaluation which is part of modern drug development and current dosing is not evidence-based. Recent studies have begun to characterize clofazimine's exposure-response relationship for safety and efficacy in populations with TB. Despite being better tolerated than some other second-line TB drugs, the extent and impact of adverse effects including skin discolouration and cardiotoxicity are not well understood and together with emergent resistance, may undermine clofazimine use in DR-TB programmes. Furthermore, clofazimine's precise mechanism of action is not well established, as is the genetic basis of clofazimine resistance. In this narrative review, we present an overview of the evidence base underpinning the use and limitations of clofazimine as an antituberculosis drug and discuss advances in the understanding of clofazimine pharmacokinetics, toxicity, and resistance. The unusual pharmacokinetic properties of clofazimine and how these relate to its putative mechanism of action, antituberculosis activity, dosing considerations and adverse effects are highlighted. Finally, we discuss the development of novel riminophenazine analogues as antituberculosis drugs.