Treatment Of Leprosy Research Articles

Dermoscopy in Leprosy: A Clinical and Histopathological Correlation Study

Leprosy, an insidious infectious granulomatous disease, is diagnosed traditionally through clinical examination coupled with skin smears and histopathology. It has myriad clinical presentations that pose diagnostic challenges. Lately, dermoscopy has emerged as a rapid, noninvasive diagnostic modality for many dermatoses. We evaluated the dermoscopic findings of various manifestations of leprosy and correlated them with clinical and histopathological features. This prospective, cross-sectional study was conducted in our skin outpatient department for a period of 1 year. Patients newly diagnosed as having leprosy or those undergoing leprosy treatment for less than 6 months were included. The most representative lesion was dermoscopically evaluated and later biopsied. We included 73 patients in the study. Results indicated an obvious correlation between dermoscopic findings and histopathology. We noted orangish yellow and white structureless areas, steadily throughout the spectrum, depicting dermal granuloma. Additionally, we observed focal vascular structures such as branching, linear, and crown vessels that result from the pressure of granuloma pushing the dilated vessels upwards. The relative absence of skin appendages aided in differentiating leprosy from other granulomatous disorders. Novel findings of our study were the detection of a branch-like pattern of clofazimine-induced pigmentation on dermoscopy and orange globules on onychoscopy. Other unique findings included violaceous structureless areas, characteristic large telangiectatic vessels, follicular plugging, star-shaped silvery-white scaling, and white globules in type 1 reaction; white shiny steaks were observed in patients with borderline lepromatous leprosy, and central white dots and keratotic plugs were observed in patients with histoid leprosy. Dermoscopy, as a noninvasive modality, could aid in the quick diagnosis of leprosy and should be used as a handy tool to complement other investigative tools for this disease.

Leprosy Screening Based on Artificial Intelligence: Development of a Cross-Platform App.

BackgroundAccording to the World Health Organization, achieving targets for control of leprosy by 2030 will require disease elimination and interruption of transmission at the national or regional level. India and Brazil have reported the highest leprosy burden in the last few decades, revealing the need for strategies and tools to help health professionals correctly manage and control the disease.ObjectiveThe main objective of this study was to develop a cross-platform app for leprosy screening based on artificial intelligence (AI) with the goal of increasing accessibility of an accurate method of classifying leprosy treatment for health professionals, especially for communities further away from major diagnostic centers. Toward this end, we analyzed the quality of leprosy data in Brazil on the National Notifiable Diseases Information System (SINAN).MethodsLeprosy data were extracted from the SINAN database, carefully cleaned, and used to build AI decision models based on the random forest algorithm to predict operational classification in paucibacillary or multibacillary leprosy. We used Python programming language to extract and clean the data, and R programming language to train and test the AI model via cross-validation. To allow broad access, we deployed the final random forest classification model in a web app via shinyApp using data available from the Brazilian Institute of Geography and Statistics and the Department of Informatics of the Unified Health System.ResultsWe mapped the dispersion of leprosy incidence in Brazil from 2014 to 2018, and found a particularly high number of cases in central Brazil in 2014 that further increased in 2018 in the state of Mato Grosso. For some municipalities, up to 80% of cases showed some data discrepancy. Of a total of 21,047 discrepancies detected, the most common was “operational classification does not match the clinical form.” After data processing, we identified a total of 77,628 cases with missing data. The sensitivity and specificity of the AI model applied for the operational classification of leprosy was 93.97% and 87.09%, respectively.ConclusionsThe proposed app was able to recognize patterns in leprosy cases registered in the SINAN database and to classify new patients with paucibacillary or multibacillary leprosy, thereby reducing the probability of incorrect assignment by health centers. The collection and notification of data on leprosy in Brazil seem to lack specific validation to increase the quality of the data for implementations via AI. The AI models implemented in this work had satisfactory accuracy across Brazilian states and could be a complementary diagnosis tool, especially in remote areas with few specialist physicians.

Formulation and evaluation of herbal ointment using leaves of Acacia nilotica (L.) Delile extract

Diseases have co-existed with life, the study of diseases and their treatment is important part of our ancient plant worldwide. Herbal plants are wonderful origin of traditional & modern medicine, useful for primary health care system. Herbal medicine prepare various part of plant are used. Instead off an herbal drug is design as the alternative formulation for the external use in the form of ointment. For the medicinal use the herbal ointment apply externally on human body. The main aims of this research are preparation of herbal ointment from the Acacia nilotica (L.) Delile plants the antibacterial activity. Under this research work, it is design as herbal ointment with the help of ethanolic extract of Acacia nilotica (L.) Delile determines the anti-bacterial capacity on it. In vitro study the antibacterial activity of the ethanolic extracts of dried leaves of Acacia nilotica (L.) Delile are determine by using the Agar cup plate method versus different bacteria such as Staphylococcus aureus, Bacillus subtilis, Escherichia coli and Pseudomonas aeruginosa etc. By blending the ethanolic extract of Acacia nilotica (L.) Delile (10 % w/w) into aqueous cream we formulated herbal ointment. The emulsifying agent and simple ointment bases are added in above herbal ointment for increase the antibacterial effectiveness during in vitro evaluation. Acacia nilotica (Family Leguminosae) are broadly used in traditional system of medicine throughout different part of India, Africa & America. It is used in the treatment of diarrhea, dysentery, cough, tuberculosis and leprosy. The current study deals with the determination of formulation and evaluation of herbal ointment using Acacia nilotica (L.) leave extract.

Improving treatment outcomes for leprosy in Pernambuco, Brazil: a qualitative study exploring the experiences and perceptions of retreatment patients and their carers

BackgroundBrazil has a high leprosy burden and poor treatment outcomes (TOs), manifesting in high relapse rates. Pernambuco, an impoverished Brazilian state suffering notable geographical health inequalities, has ‘hyperendemic’ leprosy. Although current literature identifies barriers and facilitators influencing leprosy treatment compliance, inadequate investigation exists on other factors influencing TOs, including carers’ roles and psycho-dermatological impact. This qualitative study explores experiences and perceptions of leprosy patients and their carers in Pernambuco, Brazil; to identify location-specific factors influencing TOs, and consequently inform future management.Methods27, semi-structured, in-depth interviews were conducted with 14 patients and 13 carers. Participants were recruited using maximum variation and snowball sampling from three clinics in Petrolina, Pernambuco. Transcripts and field notes from both participant groups were separately analysed using conventional thematic and deviant case analysis. The University of Birmingham Internal Research Ethics Committee and Instituto Lauro de Souza Lima provided ethical approval.ResultsTwo homologous sets of four, primary, interdependent themes influencing leprosy TOs emerged: ‘personal factors’; ‘external factors’; ‘clinical factors’; and ‘the healthcare professional (HCP)-patient-carer relationship’. Poor participant knowledge and lack of symptomatic relief caused patients to distrust treatment. However, because participants thought HCP-led interventions were vital for optimal TOs, patients were effectively persuaded to adhere to pharmaceutical treatments. High standard patient and population education facilitated treatment engagement by encouraging evidence-based medicine belief, and dispelling health myths and stigma. Healthcare, on occasions, was perceived as disorganised, particularly in resource-scarce rural areas, and for those with mental health needs. Participants additionally experienced incorrect/delayed diagnoses and poor contact tracing. Leprosy’s negative socio-economic impact on employment – together with stigma, dependency and changing relationships – caused altered senses of identity, negatively impacting TOs. Better dialogue between patients, HCPs and carers facilitated individualised patient support.ConclusionThis study highlights the importance of: effective evidence-based leprosy education; communication between HCPs, patients and carers; state-funded support; and healthcare resource distribution. These findings, if prioritised on governmental scales, provide the valuable insight needed to inform location-specific management strategies, and consequently improve TOs. Future research should evaluate the effectiveness of these implementations. Failure to address these findings will hinder regional elimination efforts.

Towards the elimination of leprosy in Yunnan, China: A time-series analysis of surveillance data.

BackgroundThis study reviews the progress of leprosy elimination in Yunnan, China, over the past 30 years and identifies the challenges for the next stage of the program.Methodology/Principal findingsData were collected from the Leprosy Management Information System in China (LEPMIS). The progress made in the elimination of leprosy between 1990 and 2019 was measured. We defined two time periods, time period 1 (1990–2003) and time period 2 (2004–2019), because multidrug therapy (MDT) was launched for the treatment of leprosy in 1990 and a special fund from the central government was established for leprosy in 2004. During the past 30 years, the number of newly detected leprosy patients in Yunnan has steadily declined. In total, 703 newly detected leprosy patients were reported in 1990, and 353 and 136 cases were reported at the end of 2003 and 2019, respectively. At the end of 1990, 90.7% (117/129) of counties in Yunnan Province were identified as leprosy-endemic counties (>1 case per 100,000 population). By the end of 2003 and 2019, 39.3% (46/117) and 85.5% (100/117) of the leprosy-endemic counties, respectively, had dropped below the elimination threshold. The main challenges are the remaining leprosy-endemic counties, the high rate of cases with a contact history, insufficient early detection, and leprosy cases resulting in physical disability.Conclusions/SignificanceA multifaceted strategy for leprosy elimination in Yunnan Province has been successfully implemented, and remarkable progress has been made in the elimination of leprosy in this area. The priorities for leprosy elimination in the next stage are securing sustainable support and investment from the government, establishing an effective surveillance system, ensuring prompt early detection, providing treatment with MDT, preventing transmission of M. leprae, preventing disability, providing health education, and preventing recurrence of the epidemic situation of leprosy.

Phytochemical Analysis and Anti-Tuberculosis Activity of Extracts of Detarium senegalense Bark and Root

Tuberculosis [TB] remains one of the major global health threats leading to morbidity and mortality. Detarium senegalense J. F. Gmelin belongs to a group of medicinal plants that are used by traditional medicine healers for the treatment of venereal diseases, urogenital infections, hemorrhoids, rheumatism, stomach-ache, intestinal worms, diarrhea, bronchitis, tuberculosis, convulsion, malaria and leprosy. The present study was aimed to investigate the in vitro anti-tuberculosis effect of different solvent extracts of Detarium senegalense bark and root against attenuated strain of Mycobacterium bovis [BCG]. The crude extracts [n-hexane, ethyl-acetate, methanol] of the plant parts were successively extracted and tested in vitro by broth microdilution technique against M. bovis. The result shows that the crude extracts inhibited the growth of M. bovis at concentrations ranging from 7.8 – 250 μg/mL. The ethyl-acetate extract of Detarium Senegalense bark was the most effective in inhibiting the growth of M. bovis with a minimum inhibitory concentration [MIC] of 7.8 µg/mL while the ethyl-acetate and methanol extract of the plant’s root had MICs of 250 µg/mL. This study demonstrates the efficacy of extracts of Detarium senegalense bark and root as potential agents in the management of the tuberculosis disease.

A REVIEW ON AGENTS FOR THE TREATMENT OF LEPROSY INFECTION

Leprosy is an ancient disease which is caused due to bacterial infection while curable but endures to be a substantial health problem in numerous parts across the world. It is an extremely contagious disease that is caused by any of 3 strains of bacteria such as Mycobacterium tuberculosis; Nontuberculous Mycobacterium; and Mycobacterium leprae. In several regions of Brazil, leprosy is a health issue which is still an endemic. Mainly skin, peripheral nerves, eyes, and mucosa of the upper respiratory tract are affected due to this chronic infection. As per the data shared by WHO across 159 countries globally, there were around 208,619 new leprosy cases reported. The global prevalence of leprosy is overcome with the aid of multidrug therapy which remains to be the chiefly targeted for treatment. The multidrug therapy gets attention as they show tremendous potential in fighting this disease. This review briefs about the different drugs and strategies which are used in treatment and superintendence of leprosy.

Reviewing the therapeutic management of leprosy in primary care: demand case series referred to a University Hospital in the Midwest region of Brazil

BackgroundLeprosy still represents a negleted public health problem in Brazil. Early and adequate treatment of leprosy, carried out in a primary health network is essential to reduce morbidity and sequelae. ObjectiveTo analyze the therapeutic management of leprosy patients referred from primary healthy services to a specialized service. MethodsAn analytical retrospective study using medical records and the Notifiable Diseases Information System. Patients diagnosed with leprosy, referred to a specialized outpatient clinic, between 2016 and 2017, in Goiás state, were included. The treatment carried out in the primary health services was compared to the Ministry of Health guidelines. ResultsTwo-hundred twenty-five leprosy patients were included, of whom 33.3% were referred by leprosy reactions, 27.1% by sequelae, and 10.2% by suspected recurrence or reinfection. Reviewing the therapeutic management, 123 (54.7%) were considered inadequate, 92 (40.9%) adequate, and 10 (4.4%) inconclusive. Of the 200 multibacillary patients, 39.5% had adequate management. In contrast, 12 (85.1%) out of 14 paucibacillary patients had adequate management (χ2 = 11.43 and p < 0.001). Regarding the leprosy reactions and sequelae management, 56.9% and 19.5% were considered inadequate, respectively. There was no difference between the percentage of adequate or inadequate management when considering the Goiás health macroregions (χ2 = 7.23; 4 degrees of freedom; p = 0.12). Study limitationsUse of recorded data, with incomplete medical records and lack of patient follow-up. ConclusionsThe study demonstrated the equivocal multibacillaryleprosy management conducted in healthy primary care, with an emphasis on leprosy reactions and sequelae. Training and monitoring the medical staff in the primary healthy services could reduce the morbidity and sequelae of leprosy.

Development of a novel loop-mediated isothermal amplification assay for rapid detection of Mycobacterium leprae in clinical samples.

Sensitive and definitive diagnostic tests are required for timely treatment of leprosy and to control its transmission. In the present study, we report the development of loop-mediated isothermal amplification assay using six primers targeting the RLEP gene sequence uniquely present in Mycobacterium leprae. Tissue punch samples (n = 50) and slit aspirates (n = 50) from confirmed cases of leprosy (M. leprae positive by quantitative polymerase chain reaction), reporting at the Department of Dermatology, Safdarjung Hospital, New Delhi, were analyzed using newly developed closed tube loop-mediated isothermal amplification assay. The sensitivity and specificity; positive predictive value, negative predictive value and accuracy were calculated using MedCalc statistical software. The loop-mediated isothermal amplification assay specifically amplified M. leprae genomic DNA with an analytical sensitivity of 100 fg. About 47 Out of the 50 quantitative polymerase chain reactions confirmed M. leprae positive tissue samples, 47 were positive by loop-mediated isothermal amplification assay (sensitivity 94%; 95% confidence interval 83.5%-98.8%) while only 31/50 were positive by histopathology (sensitivity 62%; 95% confidence interval 47.2%-75.4%) . Using slit aspirate samples of these 50 patients, 42 were positive by both quantitative polymerase chain reaction and loop-mediated isothermal amplification assay (sensitivity 84%; 95% confidence interval 70.9%-92.8%) while only 23/50 (sensitivity 46%; 95% confidence interval 31.8%-60.7%) were positive by microscopy. In the present study, the leprosy patient cohort was not uniform, as it comprised a lower number of paucibacillary cases (22%) compared to multibacillary (78%) cases. Loop-mediated isothermal amplification assay established here provides a rapid and accurate diagnostic test for leprosy in terms of sensitivity and specificity. The assay is simple to perform in comparison with other molecular techniques (polymerase chain reaction/quantitative polymerase chain reaction) and has potential for field applicability.

Clinical study to relook into the case definition and treatment of leprosy

Introduction: The statistical elimination of leprosy in India is something to cheer about but the steady appearance of newer cases still haunt us. It is sad to note that countries with high prevalence of Leprosy administer once a month of rifampicin while developed nations administer daily rifampicin. Materials and Methods: We have done a retrospective analysis of all the leprosy cases seen in the department of Dermatology, Belagavi Institute of Medical Sciences, India. A total of 64 cases were analyzed using the case records and various parameters were recorded. Results: Out of 64 cases, 13 were treated as out patients and 51 were treated as in patients. The most common age group was 21-40. Males outnumbered the females. There were 62 cases of multibacillary and only 2 cases of paucibacillary. Of 64, 30 were newly detected, 19 were receiving treatment and 15 cases had completed treatment but had one or more complications. Family h/o leprosy was noted in 4.The most common presenting complaints were: Multiple painful, reddish raised skin lesions – 24; Spontaneous blisters/Ulcers on the hand/feet – 21; Hypopigmented patches – 13. As per the clinical criteria of WHO, only 37 patients had anaesthetic patches, 52 had nerve thickening and only 11 demonstrated bacilli in the slit skin smear. Discussion: A good number of patients are being seen with lepra reactions or complications. Conclusions: It is quite evident that the presentation of leprosy is changing. This is a paradigm shift in the initial presentation and needs a relook into the existing diagnostic criteria. Keywords: Leprosy, Multidrug therapy, Leprosy elimination.

A Survey of Medicinal Plants Used by Folk Medicinal Practitioners in Daulatpur Upazila of Kushtia District, Bangladesh

The present paper focused on medicinal plants used by traditional practitioners in Daulatpur Upazila of Kushtia district, Bangladesh from October 2018 to September 2019. The information about medicinal plants uses of traditional practitioners was collected through interview. A total of 45 medicinal plant species under 43 genera and 33 families have been documented which are used for the treatment of 48 categories diseases. These medicinal plants are used by the traditional practitioners for the treatment of various diseases like asthma, anemia, burning sensation, blood pressure, constipation, cough, diarrhea, diabetes, dysentery, eczema, fever, headache, heart disease, jaundice, leprosy, toothache, ulcer, skin disease, snake-bite, wound, and others. All these plants need to be evaluated through phyto and pharmaco-chemical investigations to discover their potentiality and may help in discovering effective drugs for human health care.

Aspectos epidemiológicos da Hanseníase no Município de Caxias, do Estado do Maranhão

A hanseníase é uma doença infecciosa crônica. Sua causa é o Mycobacterium leprae, uma bactéria ácido-alcoólica francamente gram-positiva e resistente que pode infectar os nervos periféricos. Este estudo teve como objetivo descrever os aspectos epidemiológicos da hanseníase no município de Caxias-MA. Trata-se de um estudo documental, descritivo, retrospectivo e quantitativo, realizado no período de 2013 a 2017, utilizando dados do Sistema de Informação de Agravos de Notificação (SINAN) do Ministério da Saúde. Este estudo avaliou 349 casos de hanseníase no período de 2013 a 2017 no município de Caxias do estado do Maranhão. Os coeficientes mais elevados foram registrados no ano de 2013 (6,15/10000) e 2015 (5,03/10000), Quanto ao perfil dos pacientes identificados houve prevalência do sexo masculino com 191 (54,7%) dos casos, em que houve predominância da faixa etária de 50 a 59 ano (18,6%), a avaliação da classificação operacional mostra que a forma multibacilar foi a mais frequente (74,5%); quanto ao percentual de lesões cutâneas em decorrência da hanseníase o maior índice são de duas a cinco lesões com 151 (43,3%) dos casos, e com relação ao esquema terapêutico, 260 (74,5%) receberam tratamento poliquimioterápico multibacilar (PTQ/MB) de 12 doses. A hanseníase ainda é considerada uma doença negligenciada, apesar de existir politicas púbicas voltadas para erradicação da mesma, ainda estamos numa longa e lenta trajetória para eliminação da doença. Mas muitas ações e atividades de rastreamento veem se intensificando para o diagnóstico e tratamento precoce da hanseníase com objetivo de reduzir as altas taxas de casos multibacilares.

A systematic review and meta-analysis of studies on the diagnostic accuracy and screening of tests to detect antimicrobial resistance in leprosy

Although multidrug therapy is considered an effective treatment for leprosy, antimicrobial resistance is a serious concern. We performed a systematic review of studies on the diagnostic accuracy and screening of tests for antimicrobial resistance in leprosy. This review was registered in PROSPERO (CRD42020177958). In April 2020, we searched for studies in the PubMed, EMBASE, Web of Science, Scopus, Scielo, and LILACS databases. A random effects regression model was used for the meta-analysis. We included 129 studies. Molecular tests for dapsone resistance had a sensitivity of 78.8% (95% confidence interval [CI] = 65.6–87.9) and a specificity of 97.0% (95% CI = 94.0–98.6). Molecular tests for rifampicin resistance had a sensitivity and specificity of 88.7% (95% CI = 80.0–93.9) and 97.3% (95% CI = 94.3–98.8), respectively. Molecular tests for ofloxacin resistance had a sensitivity and specificity of 80.9% (95% CI = 60.1–92.3) and 96.1% (95% CI = 90.2–98.5), respectively. In recent decades, no increase in the resistance proportion was detected. However, the growing number of resistant cases is still a clinical concern.

Mutation of Gyra Gene Found In Mycobacterium Leprae From Leprosy Patient In West Papua and Papua, Indonesia

Cases of leprosy in Indonesia are still high, especially in the provinces of West Papua, North Maluku and Papua. Drug resistance surveillance and typing strains of Mycobacterium leprae are useful molecular tools for leprosy control especially in the three Provinces. The purpose of this study was to identify mutations in the gyrA M. leprae gene obtained from leprosy patients in the provinces of West Papua and Papua on a molecular basis. M. leprae samples obtained from leprosy patients were extracted and continued with PCR and sequencing in the M. leprae gyrA gene. The sequencing results are aligned with M. leprae TN sequences to identify mutations. The phylogenetic tree was constructed using Mega 7 to get the M. leprae gyrA cluster. The RNAalifold server was employed to generate the conserved 2D structure for the gyrA MSAs. Six variants were found in the gyrA M. leprae obtained from the provinces of West Papua and Papua. The six variants are H71R, K73R, D95G, A101T, R107W, A127V. The existence of mutations in the gyrA M. leprae gene found in this study can be information in the treatment of leprosy in Papua if using Ofloxacin as an alternative treatment. Based on phylogenetic analysis found there are three distinct clusters of gyrA gene. The five variants are H71R, K73R, A101T, R107W, A127V are new variant of gyrA M. leprae. The D95G variant has been confirmed to cause resistance to Fluoroquinolone by in vitro methods, while the H71R, K73R, A101T, R107W, A127V variants are new variants whose effects on the fluoroquinolone are unknown. Thus, further analysis is needed to study the effects of the five variants on ofloxacin.

Burden of depression and anxiety among leprosy affected and associated factors-A cross sectional study from India.

BackgroundLeprosy is a Neglected Tropical Diseases (NTDs) known to cause stigma and discrimination in low-and middle-income countries. It often results in visible impairments, thus pre-disposing to poor mental health. Aim of the study was to estimate the prevalence of depression and anxiety among people affected by Leprosy and to determine the associated factors.Methodology/Principal findingsA multi-centric, cross-sectional study was carried out in four leprosy endemic states of India—Chhattisgarh, Maharashtra, West Bengal and Tamil Nadu in randomly selected blocks (a sub-unit of district), from one district in each state. From selected blocks those registered for leprosy treatment at public health or referral centres, people above the age of 18 years were interviewed with PHQ-9 and GAD-7 questionnaires for Depression and Anxiety, respectively. Disease profile like leprosy classification, deformity grade, number and site of the patches and socio-economic status were collected along with individual data.Of the total 220 respondents, prevalence of depression and anxiety symptoms was, 33% (73) and 19% (42), respectively. Presence of disability (47%) and Female gender (46%) were significantly associated with depression. Presence of disability (32%), Lower income group (27%) and low education (22%) were significantly associated with symptoms of anxiety. As the severity of disability increased, risk of developing depression and anxiety increased.ConclusionThe study indicates that more than 30% of people affected by leprosy have mental health problems, which emphasizes the importance of mental health care services in leprosy. Women, those who had lower level of education, those belonging to lower socio-economic status and those with any level of disability due to leprosy are at risk of developing depression and/or anxiety. The study concludes more attention to be paid to the categories identified to be at risk.

Factors associated with cure and abandonment of leprosy treatment: A reflective analysis

To analyze trends, and the main socioeconomic and clinical factors related to treatment abandonment and the cure of leprosy in Sergipe. For the present study, data from all new cases of cure and abandonment of leprosy treatment notified by the health centers of the municipalities to the SINAN (Information System on Notifiable Diseases) in the state of Sergipe, Brazil, from 2007 to 2017, were used. This is an ecological study of cases of cure and abandonment of leprosy treatment, rates were calculated based on the "Guidelines for surveillance, care and elimination of leprosy as a public health problem".using time-series analysis and multivariate logistic regression. Concerning multivariate regression, the young age group presents a higher risk for quitting the treatment (p = 0.429; OR = 2.75). Blacks/browns/indigenous were more likely to abandon treatment (p = 0.482; OR = 1.69), as well as multibacillary individuals (p = 0.541; OR = 2.26). Regarding the cure, the young age group has less chances of cure (OR = 0.34). The same happens for the operational classification; the multibacillary patients have a lower chance of cure (OR = 0.35). Finally, individuals with grade 2 of physical disability are less likely to be cured (OR = 0.54). Health services are noticeably weak, especially when it comes to clinical factors associated with treatment abandonment and a low proportion of cure. Multibacillary (Borderline and Lepromatous) are responsible for the active transmission of leprosy.

A Potent Plant for Traditional Medicine System: andldquo;Achyranthes Aasperaandrdquo;

Nature has been a resource of medicinal constituents for thousands of years and an extraordinary number of modern drugs have been isolated from natural sources. India is a soil of prosperous biodiversity, the total number of lower and higher plants in India is about more than 45,000 species. The plants are potential resource of medicines since antiquity. The medicinal plants are used for treatment of various diseases because of their safety and effectiveness. Achyranthes aspera (Amaranthaceae) is an important medicinal herb found as a weed throughout India. Though almost all of its parts are used in traditional systems of medicines, seeds, roots and shoots are the most important parts which are used medicinally. Achyranthes aspera L. (Amaranthaceae) has long been used in different systems of medicine in the treatment of cancer, leprosy, asthma, wound, insect and snake bite, dandruff, hepatitis, renal disorders, dermatological disorders, gynecological disorders, gonorrhea, malaria, fever, cough, diabetes, pyorrhea, dysentery, opthalmia, rabies, hysteria, toothache etc. The plant has been used as Antimicrobial, Antiviral and Anticarcinogenic, Spermicidal, Anti-parasitic, Anti-cancerous, Hypoglycemic, Hypolipidemic, Wound Healing, Antiinflammatory, anti-arthritic and Anti-oxidant, Nephroprotective, Cardiac, Anti-depressant activity etc. The present review deals with the enormous amount of scientific research and reports available in different aspects of this plant involving phytochemistry and pharmacology.

Symplocos racemosa bark assisted copper nanoparticles and its antibacterial activity against Staphylococcus aureus and Lactobacilli species

Aim: To evaluate the antibacterial activity of copper nanoparticles using lodhra bark against Staphylococcus aureus and Lactobacillus species. Introduction: Symplocos racemosa also known as Lodhra, is a drug used by Ayurvedic practitioners. Theroot, bark and leaves of this plant is traditionally used for the treatment of diarrhoea, leprosy, uterine and liver disorders. Materials and methods: The plant extract is prepared by mixing 100 ml of distilled water, boiled and filtered using a filter paper. The copper nanoparticles are prepared by mixing copper sulphate powder to 500 ml of distilled water. Readings were taken frequently, and the synthesis of copper nanoparticles were analysed. Agar well diffusion method was used to evaluate the antimicrobial activity of both S.aureus and Lactobacilli species. Results: S.aureus showed a higher inhibition area than Lactobacillus. Conclusion: There is a future potential for these copper nanoparticles for combating pathogenic microorganisms.

Leprosy patients quality of life: a scoping review.

To explore the scientific evidence regarding the leprosy patients quality of life. Scoping review according to the Joanna Briggs Institute methodology, with articles indexed in PubMed, Cochrane, LILACS, Embase, CINAHL, Scopus, Web of Science, PsyINFO, INFOLEP, and Google Scholar databases, published in full in Portuguese, English, or Spanish. Seventy-four studies were identified, with 71 of quantitative approach and 3 with a mixed method. There was a predominance of studies published in Brazil (58.1%), with an adult population, (97.3%) and recruited in reference centers for the treatment of leprosy (52.7%). There was greater use of the WHOQOL-bref (50%) and SF-36 (18.9%) instruments to assess quality of life. The study showed that the greatest impairment in quality of life was related to the delay in the diagnosis of the disease, to leprosy reactions, physical disabilities, neuropathic pain, and stigma. Most studies were developed in endemic countries, with adults, and based on observational studies, and the worst scores obtained were associated with physical domain impairment.

Aspectos relacionados ao diagnóstico e tratamento da hanseníase: uma revisão sistemática

Objetivo: Identificar as principais formas de diagnóstico e analisar os fatores associados a adesão e abandono do tratamento da hanseníase no Brasil. Métodos: Revisão sistemática de literatura. A busca foi realizada nas bases de dados Scientific Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval System Online (Medline), sendo selecionadas publicações no período de 2010 a 2020. Utilizaram-se os descritores: saúde púbica and diagnóstico and quimioterapia combinada and hanseníase. Resultados: Verificou-se a importância do diagnóstico precoce na diminuição do processo de transmissibilidade. Sobre à adesão, foram relatadas: relevância da educação em saúde, papel da religiosidade e dos vínculos familiares para o enfrentamento do tratamento. Fatores sociodemográficos, dificuldades de compreensão das orientações da equipe de saúde, elementos físicos, discriminação, impotência diante do problema foram influenciadores do abandono do tratamento. Considerações finais: A hanseníase e os aspectos relacionados à adesão/abandono do tratamento representam um desafio a ser superado pela saúde pública Brasileira. Espera-se que o resultado dessa pesquisa seja elemento norteador para futuros trabalhos sobre o tema. Sugere-se que, futuramente, sejam realizados estudos com o intuito de investigar a realidade local, em relação aos dados sobre adesão, abandono e formas de diagnóstico da hanseníase.