Tuesday, March 29, 2016

Re: (LML) Over-optimism and the antidote

That is true. The cost ebenfit ratio of this idea needs to be seriously looked at.

Tahir

On Sun, Mar 27, 2016 at 12:26 PM, Pieter Schreuder <editorlml@gmail.com> wrote:

Leprosy Mailing List – March 27,  2016

Ref.:   (LML)  Over-optimism and the antidote

From:  Joel Almeida, Mumbai and London


 

Dear Pieter,

 

 

Every new prediction in leprosy can make us over-optimistic.

 

In 1991 we predicted the elimination of leprosy by MDT.  Instead, we merely eliminated leprosy services. Meanwhile, the incidence rate of new cases with visible deformity increased by 40% in India, between 2008/9 and 2014/15. The price is being paid by Indians who still needlessly suffer devastating permanent damage to their nerves, limbs and eyes.

 

What is the antidote to over-optimistic predictions?  A healthy "what if" analysis.  

 

What if our predictions and hopes are mistaken?  That approach can help us establish a safety net to protect trusting people from visible deformity. We can do this by appointing the skilled, mobile leprosy workers who can monitor nerve function regularly.  Then we can ensure anti-inflammatory treatment in time to prevent visible deformity.

 

Cuba has tried chemoprophylaxis of contacts and BCG, without denting the incidence rate of leprosy.  Micronesia has tried repeated mass chemoprophylaxis, but merely delayed the occurrence of new cases. The incidence rate returned to its former level. A randomised controlled trial of chemoprophylaxis among contacts showed a higher incidence rate of leprosy in the treated group 2 to 4 years later, although the numbers were too small for this difference to attain statistical significance.  

 

What if our hopes and predictions about chemoprophylaxis are over-optimistic?  What if chemoprophylaxis merely postpones the signs of leprosy?  What if the main sources of leprosy infection are, in fact, re-infected polar lepromatous patients after release from MDT?  Of course we hope for the best. However, we need to be prepared for the worst: a mere postponement of new cases instead of a dramatic reduction in the incidence rate.

 

If the worst happens, then the skilled, mobile leprosy workers will be a safety net that protects people from visible deformity. When it comes to the limbs and eyes of ordinary people, we need "safety first."  Then we can try whatever we want. 

 

It would seem ethically sound to include post-chemoprophylaxis surveillance, prompt MDT, nerve monitoring and prompt anti-inflammatory treatment in projects of chemoprophylaxis. Otherwise chemoprophylaxis might lead to the same kind of over-optimism, complacency and avoidable visible deformity as we have seen in the past.

 

Given our history of relying on over-optimistic predictions, we would do well to appoint skilled, mobile leprosy workers for nerve function monitoring. We would also do well to identify polar lepromatous patients at diagnosis, and to protect them from re-infection.

 

Regards,

 

Joel Almeida


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com


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Sunday, March 27, 2016

(LML) Over-optimism and the antidote

Leprosy Mailing List – March 27,  2016

Ref.:   (LML)  Over-optimism and the antidote

From:  Joel Almeida, Mumbai and London


 

Dear Pieter,

 

 

Every new prediction in leprosy can make us over-optimistic.

 

In 1991 we predicted the elimination of leprosy by MDT.  Instead, we merely eliminated leprosy services. Meanwhile, the incidence rate of new cases with visible deformity increased by 40% in India, between 2008/9 and 2014/15. The price is being paid by Indians who still needlessly suffer devastating permanent damage to their nerves, limbs and eyes.

 

What is the antidote to over-optimistic predictions?  A healthy "what if" analysis.  

 

What if our predictions and hopes are mistaken?  That approach can help us establish a safety net to protect trusting people from visible deformity. We can do this by appointing the skilled, mobile leprosy workers who can monitor nerve function regularly.  Then we can ensure anti-inflammatory treatment in time to prevent visible deformity.

 

Cuba has tried chemoprophylaxis of contacts and BCG, without denting the incidence rate of leprosy.  Micronesia has tried repeated mass chemoprophylaxis, but merely delayed the occurrence of new cases. The incidence rate returned to its former level. A randomised controlled trial of chemoprophylaxis among contacts showed a higher incidence rate of leprosy in the treated group 2 to 4 years later, although the numbers were too small for this difference to attain statistical significance.  

 

What if our hopes and predictions about chemoprophylaxis are over-optimistic?  What if chemoprophylaxis merely postpones the signs of leprosy?  What if the main sources of leprosy infection are, in fact, re-infected polar lepromatous patients after release from MDT?  Of course we hope for the best. However, we need to be prepared for the worst: a mere postponement of new cases instead of a dramatic reduction in the incidence rate.

 

If the worst happens, then the skilled, mobile leprosy workers will be a safety net that protects people from visible deformity. When it comes to the limbs and eyes of ordinary people, we need "safety first."  Then we can try whatever we want. 

 

It would seem ethically sound to include post-chemoprophylaxis surveillance, prompt MDT, nerve monitoring and prompt anti-inflammatory treatment in projects of chemoprophylaxis. Otherwise chemoprophylaxis might lead to the same kind of over-optimism, complacency and avoidable visible deformity as we have seen in the past.

 

Given our history of relying on over-optimistic predictions, we would do well to appoint skilled, mobile leprosy workers for nerve function monitoring. We would also do well to identify polar lepromatous patients at diagnosis, and to protect them from re-infection.

 

Regards,

 

Joel Almeida


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com


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Sunday, March 13, 2016

(LML) Basic Dermatology Course for Medical Doctors

Leprosy Mailing List – March 13,  2016
Ref.: (LML)  Basic Dermatology Course for Medical Doctors
From:  Gopal Gurung, Pokhara, Nepal


Dear Dr. Pieter,

Please circulate the attached BIKASH Nepal training announcement to all readers of LML.
Basic Dermatology Course for Medical Doctors
Course prerequisite: Medical background with competence in written and spoken English
Dates: 3rd to 8th April 2016

Venues: BIKASH Nepal Training Centre, Pokhara, Nepal

Thank you!

Gopal
====
Gopal Gurung
Program Manager
BIKASH Nepal
Green Pastures Complex
Pokhara, Kaski, Nepal
Ph: 00977 61 430562
Fax: 00977 61 430940



LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder << editorlml@gmail.com

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Thursday, March 10, 2016

Re: (LML) 19th International Leprosy Congress Beijing 2016

Dear Mr Schreuder,

Yes I was but I had a problem with my old e mail address. I was using tahirdahirutahir@yahoo.com which was hacked. I now use drtahirdahiru@gmail.com. I work for the Netherlands Leprosy Relief as a Medical Adviser in Nigeria. Our postal adress is P.O. Box 759 Bukuru Jos Plateau State Nigeria.

Best regards.

Dr Tahir Dahiru.

On Tue, Mar 8, 2016 at 10:30 AM, Pieter Schreuder <editorlml@gmail.com> wrote:

Leprosy Mailing List – March 8,  2016

Ref.:  (LML) 19th International Leprosy Congress Beijing 2016 

From:  Tahir Dahiru, India


 

Dear Schreuder,

 

As per the question by Geeske Zip (LML, March 6, 2016), in clinical Leprosy you classify base on skin lesions and major nerve trunk involvement. If an individual patient has 5 skin lesions or less with only one major nerve trunk involvement or none you classify as PB. If an individual has more than five skin lesions you classify as MB or if he has more than one nerve involvement even if he has less than 6 skin lesions you classify as MB as per the WHO guideline.

 

Dr Tahir Dahiru


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com


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(LML) 19th International Leprosy Congress Beijing 2016

Leprosy Mailing List – March 10,  2016

Ref.:   (LML) 19th International Leprosy Congress Beijing 2016 

From:  Indropo Agusni, Surabaya, Indonesia


 

Dear Pieter,

I am of the same opinion as Dr. Jaison Barreto (LML, March 9, 2016)). During reversal reaction many leprosy cases develop some new small skin lesions (" flare up”) at sites that previously looked like normal skin. It indicates that actually some of leprosy bacilli or antigen are already present in the tissue, without any previous sign or symptom. Soon after the start of MDT or type 1 reaction, the immune system detects the invaders, immune cells are recruited and inflammation occurs, manifested as “flare up" of skin lesions.

 

Leprosy bacilli seems to be “tolerated " by human body or having a "mask" in their face, so the immune system does not recognized the enemy. They live happily and multiply in human body without any opponent. That is why leprosy should be treated early and not to wait until the presence of skin lesions.

Best regards,

Indropo Agusni


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

 


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(LML) 19th International Leprosy Congress Beijing 2016

Leprosy Mailing List – March 10,  2016

Ref.:  (LML) 19th International Leprosy Congress Beijing 2016 

From:  Marco Andrey Cipriani Frade, Ribeirão Preto, Brazil


Dear Pieter,

 

Dr Jaison (LML, March 9, 2016) touched exactly an uncomfortable point about leprosy classification and he has my complete agreement.  

 

According the simple scheme, considering just the number of lesions and neglecting the nerve impairment, we are losing the chance to do an early diagnosis and the correct treatment of leprosy and really cure these patients before disabilities and incapacity. 

 

Nowadays, the number of patients with borderline profile and with small number of skin lesions, many almost imperceptible, but with restrict neural branches impairment with islet of sensitivity alteration(s) (tactile, pain and/or hot), and/or sympathetic alteration. Sympathetic alteration defined as restricted areas (islet) with no vasomotor reflex to endogenous or exogenous histamine stimulus and/or sweat dysfunction defined by (the absence of) natural beads of sweat or using lugol test. None of these details and detailed peripheral nerve clinical exam are described in routine protocols. 

 

With MDT leprosy became a simple disease to treat, but its diagnosis continues or became more complex. Sure, we should think strongly about it and propose a more elaborated continuous educational program in leprosy clinic mainly in these early neural signs preventing the advance and the consequent notoriety of stigmas that both committed leprosy patients. 

 

 

Best regards

 

Marco Andrey C. Frade

President of Brazilian Society of Leprology            

 

Prof. Dr. Marco Andrey Cipriani Frade

Professor Associado (Livre Docente)

Coordenador Residência Médica de Dermatologia HCFMRP-USP

Coordenador Centro de Referência em Dermatologia Sanitária - Hanseníase - HCFMRP-USP

[(http://lattes.cnpq.br/9103136155056414)]

Divisão de Dermatologia - Departamento de Clínica Médica

Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo

Av. Bandeirantes, 3900 - Monte Alegre - Ribeirão Preto -SP - Brasil

CEP: 14.049.900 - Tel: 55-16-36022441 (Sala) - 36022447 (Sec.) - FAX: 55-16-36021522


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

 


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Wednesday, March 9, 2016

(LML) 19th International Leprosy Congress Beijing 2016

Leprosy Mailing List – March 9, 2016
Ref.:  (LML) 19th International Leprosy Congress Beijing 2016 
From:  Rajeev B Dudhalkar, Mumbai, India


Dear Pieter,
I would like get clarification looking at the present field situation on some of the following issues to MB/PB grouping of cases.
1.       Counting of lesions
a.       Skin lesions (patches) and nerve lesions (trunk nerves) though nerve palpation remains an issue.
b.      Skin lesion: patch with the satellite lesion/s (including feeding cutaneous nerve involvement) to be counted as one lesion.
c.       Irrespective size of the patch, even though it may big/ very large in size counted as one lesion.
- Morphology of the skin lesion: margin (well defined/ill-defined), satellite lesion/s, distribution(symmetrical/asymmetrical), number, consistency, texture indicates or gives clue for the immunological status of the case on Ridley&Jopling classification so the MB and PB grouping on the basis of number of lesions.
- Patches with sensory loss can be easily diagnosed and counted to be grouped as PB.
- But cases with many or innumerable patches and patches seen with characteristics suggestive of BB and BL which may be diagnosed with bacteriological examination only and difficult to diagnose in field condition confirmation of sensory loss by testing a sensation. These cases may not be diagnosed and grouped into MB in the absence of skin smear facility though they confirm bacteriologically positive. These bacteriologically positive case means infectious cases which may give setback to the whole purpose of early case detection to curtail the source of infection in the community.
 2.       Bacteriological examination (skin smear)
a.       Availability of skin smear facility within the programme.
b.      Detection of the cases without skin patches (Lepromatous cases) that is cases with change in skin texture namely smooth, oily, shiny and thickened skin, suspects with nodules, suspects with patches without sensory loss (BB & BL) and macular lepromatous. As these cases are considered to be source of infection being bacteriologically positive and cases of consequences.
All these in mind I have shared a chart ‘A simple guide to diagnose leprosy’ published by ALERT-INDIA, where the basis for MB and PB grouping is attempted to explained based on the clinical and bacteriological features with the help of Ridley&Jopling classification. Which I would like share again.
With best regards,
Rajeev B. Dudhalkar
Mumbai, India

LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder << editorlml@gmail.com

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(LML) 19th International Leprosy Congress Beijing 2016

Leprosy Mailing List – March 9,  2016

Ref.:  (LML) 19th International Leprosy Congress Beijing 2016 

From:  Jaison Barreto, Bauru, Brazil


Dear Pieter,

About pseudo-classifications, it is important to remind some points:

1. If a patient has only one visible leproma, even if infiltration is not easily seen, it is not a PB leprosy.
2. If a patient has only one visible honeycomb like plaque, with ill-defined borders, this patient has mid borderline leprosy, and this is not PB leprosy.
3. If a patient has only one plaque, even with well-defined borders, but several nerve trunks affected, i.e., disseminated disease, this patient has borderline tuberculoid leprosy, and this is not PB leprosy.

PB or MB are NOT forms of leprosy, but schemes of treatment.

Patients with several visible lesions have disseminated disease, but the opposite is not true, unfortunately.

Subclinical involvement of skin or nerves, or other organs like testis, kidneys or liver, is seen, in many instances, only after the beginning of MDT. We call this manifestations as reactions.

Regards,

Jaison


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com


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Tuesday, March 8, 2016

(LML) INFOLEP's monthly Choice list - February 2016

Leprosy Mailing List – March 8,  2016

Ref.: (LML) INFOLEP’s monthly Choice list - February 2016

From:  Jiske Erlings, Amsterdam, the Netherlands


Dear Pieter, 

 

Greetings from Infolep!

Below you will find a selection of recent publications on leprosy and related subjects. Feel free to contact me to receive the full text versions if a link to the full text is not included.

On International Women’s Day you might want to check out our Leprosy & Gender collection: http://www.leprosy-information.org/category/subject/gender.

Keep sending us your publications on leprosy or material on leprosy in your language to include in the portal.


With kind regards,

Jiske Erlings

INFOLEP Information specialist

Follow Infolep on Facebook or Twitter

To subscribe/unsubscribe to this service, please send an email to: infolep@leprastichting.nl


Some NTD publications


de Vlas SJ, Stolk WA, le Rutte EA, Hontelez JA, Bakker R, Blok DJ, Cai R, Houweling TA, Kulik MC, Lenk EJ, Luyendijk M, Matthijsse SM, Redekop WK, Wagenaar I, Jacobson J, Nagelkerke NJ, Richardus JH.
Concerted Efforts to Control or Eliminate Neglected Tropical Diseases: How Much Health Will Be Gained? in: PLoS Negl Trop Dis. 2016 Feb 18;10(2):e0004386. Full text: http://www.leprosy-information.org/resource/concerted-efforts-control-or-eliminate-neglected-tropical-diseases-how-much-health-will-be

Hotez PJ, Pecoul B, Rijal S, Boehme C, Aksoy S, et al. (2016) Eliminating the Neglected Tropical Diseases: Translational Science and New Technologies. in: PLoS Negl Trop Dis 10(3): e0003895. Full text online: http://www.leprosy-information.org/resource/eliminating-neglected-tropical-diseases-translational-science-and-new-technologies

Neglected Tropical Disease NGDO Network: Reflections on accomplishments in the prevention, treatment and management of consequences of NTDs - Special NNN2016 issue of Int. Health (2016) 8 Full text online: http://inthealth.oxfordjournals.org/content/8/suppl_1.toc

Combating NTDs: Lessons from India. PLOST NTDs Collection: http://collections.plos.org/india?#_=_


New Leprosy publications

Andrade PR, Jardim MR, da Silva AC, Manhaes PS, Antunes SL, Vital R, Prata RB, Petito RB, Pinheiro RO, Sarno EN. Inflammatory Cytokines Are Involved in Focal Demyelination in Leprosy Neuritis. in: J Neuropathol Exp Neurol. 2016 Feb 17. Full text online: http://www.leprosy-information.org/resource/inflammatory-cytokines-are-involved-focal-demyelination-leprosy-neuritis

de Sousa JR, de Sousa RP, de Souza Aarão TL, Dias LB Jr, Carneiro FR, Fuzii HT, Quaresma JA. In situ expression of M2 macrophage subpopulation in leprosy skin lesions. in: Acta Trop. 2016 Jan 28. Abstract: http://leprosy-information.org/resource/situ-expression-m2-macrophage-subpopulation-leprosy-skin-lesions

De Matos HJ, Blok DJ, De Vlas SJ, Richardus JH. Leprosy New Case Detection Trends and the Future Effect of Preventive Interventions in Pará State, Brazil: A Modelling Study. in: PLoS Negl Trop Dis. 2016  10(3): e0004507. Full text online: http://www.leprosy-information.org/resource/leprosy-new-case-detection-trends-and-future-effect-preventive-interventions-par-state

Dimri D, Gupta A, Singh AK. Leprosy Continues to Occur in Hilly Areas of North India. in: Dermatol Res Pract. 2016;2016:7153876. Full text online: http://www.leprosy-information.org/resource/leprosy-continues-occur-hilly-areas-north-india

Fava VM, Manry J, Cobat A, Orlova M, Van Thuc N, Ba NN, Thai VH, Abel L, Alcaïs A, Schurr E; Canadian Lrrk2 in Inflammation Team (CLINT). A Missense LRRK2 Variant Is a Risk Factor for Excessive Inflammatory Responses in Leprosy. in: PLoS Negl Trop Dis. 2016 Feb 4;10(2):e0004412. Full text online: http://www.leprosy-information.org/resource/missense-lrrk2-variant-risk-factor-excessive-inflammatory-responses-leprosy

Ganesan V, Mandal J. Primary oral tuberculosis in a patient with lepromatous leprosy: Diagnostic dilemma. in: Int J Mycobacteriol. 2016 Mar;5(1):102-5. Abstract: http://www.leprosy-information.org/resource/primary-oral-tuberculosis-patient-lepromatous-leprosy-diagnostic-dilemma

Júnior IA, Gresta LT, Noviello ML, Cartelle CT, Lyon S, Arantes RM. Leprosy classification methods: a comparative study in a referral center in Brazil.
in: Int J Infect Dis. 2016 Feb 26. ull text online: http://www.leprosy-information.org/resource/leprosy-classification-methods-comparative-study-referral-center-brazil

Lambert SM, Nigusse SD, Alembo DT, Walker SL, Nicholls PG, Idriss MH, Yamuah LK, Lockwood DN. Comparison of Efficacy and Safety of Ciclosporin to Prednisolone in the Treatment of Erythema Nodosum Leprosum: Two Randomised, Double Blind, Controlled Pilot Studies in Ethiopia. in: PLoS Negl Trop Dis. 2016 Feb 6;10(2): e0004149. Full text online: http://www.leprosy-information.org/resource/comparison-efficacy-and-safety-ciclosporin-prednisolone-treatment-erythema-nodosum-leprosum

Mayboroda OA, van Hooij A, Derks R, van den Eeden SJ, Dijkman K, Khadge S, Thapa P, Kunwar CB, Hagge DA, Geluk A. Exploratory Urinary Metabolomics of Type 1 Leprosy Reactions. in: Int J Infect Dis. 2016 Feb 25. Full text online: http://www.leprosy-information.org/resource/exploratory-urinary-metabolomics-type-1-leprosy-reactions

Mendonça JA, Provenza JR, Castro de Mattos A, Ota FS, Appenzeller S. Hansen's disease: Descriptions of novel ultrasonographic findings. in: Joint Bone Spine. 2016 Jan 27. Abstract: http://www.leprosy-information.org/resource/hansens-disease-descriptions-novel-ultrasonographic-findings

Neela VS, Devalraju KP, Pydi SS, Sunder SR, Adiraju KR, Singh SS, Mpjs A, Valluri VL. Mycobacterial r32-kDa Ag specific T cell responses correlate with successful treatment and heightened antimicrobial response in human leprosy patients. in: Int Immunol. 2016 Feb 26. pii: dxw009. Abstract: http://www.leprosy-information.org/resource/mycobacterial-r32-kda-ag-specific-t-cell-responses-correlate-successful-treatment-and


Oliveira JM, Rêgo JL, de Lima Santana N, Braz M, Jamieson SE, Vieira TS, Magalhães TL, Machado PR, Blackwell JM, Castellucci LC. The -308bp TNF gene polymorphism influences tumor necrosis factor expression in leprosy patients in Bahia State, Brazil.
in: Infect Genet Evol. 2016 Jan 29. Abstract: http://leprosy-information.org/resource/308bp-tnf-gene-polymorphism-influences-tumor-necrosis-factor-expression-leprosy-patients

Pradeep Nair S, Vidyadharan S. A study of the prevalence of smear-positive leprosy cases in a tertiary care center in the post-elimination phase of leprosy. in: Int J Dermatol. 2016 Feb 12. Abstract: http://www.leprosy-information.org/resource/study-prevalence-smear-positive-leprosy-cases-tertiary-care-center-post-elimination-phase

Ramos JM, Romero D, Belinchón I. Epidemiology of Leprosy in Spain: The Role of the International Migration. Plos Negl Trop Dis 10(3): e0004321. in: Full text online: http://www.leprosy-information.org/resource/epidemiology-leprosy-spain-role-international-migration

Roset Bahmanyar E, Smith WC, Brennan P, Cummings R, Duthie M, Richardus JH, Saunderson P, Shwe T, Rosen S, Geluk A. Leprosy Diagnostic Test Development As a Prerequisite Towards Elimination: Requirements from the User's Perspective.
in: PLoS Negl Trop Dis. 2016 Feb 11;10(2):e0004331. Full text online: http://www.leprosy-information.org/resource/leprosy-diagnostic-test-development-prerequisite-towards-elimination-requirements-users

Sen D, Satija L, Chatterji S, Majumder A, Gupta A, Kumar A. Ultrasonography and magnetic resonance imaging of ulnar nerve abscess in leprosy. in: Med J Armed Forces India. 2016 Jan;72(1):78-81. Abstract: http://www.leprosy-information.org/resource/ultrasonography-and-magnetic-resonance-imaging-ulnar-nerve-abscess-leprosy

Sharma I, Singh A, Mishra AK, Singh LC, Ramesh V, Saxena S. Is CXCL10/CXCR3 axis overexpression a better indicator of leprosy type 1 reaction than inducible nitric oxide synthase? in: Indian J Med Res. 2015 Dec;142(6):681-9. Full text online: http://leprosy-information.org/resource/cxcl10cxcr3-axis-overexpression-better-indicator-leprosy-type-1-reaction-inducible-nitric

Thomas M. A new era of diagnostic modalities for type 1 leprosy reactions: Promise for the future. in: Indian J Med Res. 2015 Dec;142(6):644-6. Full text online: http://leprosy-information.org/resource/new-era-diagnostic-modalities-type-1-leprosy-reactions-promise-future

Vieira AP, Trindade MÂ, Pagliari C, Avancini J, Sakai-Valente NY, Duarte AJ, Benard G. Development of Type 2, But Not Type 1, Leprosy Reactions is Associated with a Severe Reduction of Circulating and In situ Regulatory T-Cells. Am J Trop Med Hyg. 2016 Feb 22. Abstract: http://www.leprosy-information.org/resource/development-type-2-not-type-1-leprosy-reactions-associated-severe-reduction-circulating-and


Journals  & Newsletters

Community Eye Health: http://www.cehjournal.org/wp-content/uploads/Working-with-communities-to-improve-their-eye-health.pdf

Disability, CBR & Inclusive Development: http://dcidj.org/

Leprosy Review: http://www.lepra.org.uk/Pages/FAQs/Category/volume-85

Plos Neglegted Tropical Diseases: http://journals.plos.org/plosntds/

Revista de Leprología: http://www.leprosy-information.org/resource/revista-de-leprologia

WHO Goodwill Ambassador’s Newsletter for the elimination of leprosy: http://www.leprosy-information.org/resource/who-goodwill-ambassador-s-newsletter-elimination-leprosy


Other Information Sources


You might also be interested in The Leprosy Mailing List (LML), a free moderated email list that allows all persons interested in this theme to share ideas, information, experiences and questions. http://leprosymailinglist.blogspot.nl/

The new International Leprosy Association – History of Leprosy http://leprosyhistory.org/ website.

 
Jiske Erlings

Medewerker InfoLep / Information Officer

Infolep Leprosy Information Services

Postbus / P.O. Box 95005

1090 HA Amsterdam

The Netherlands

Tel:

+31 20 5950530

Mob:

-

Email:

J.Erlings@Leprastichting.NL

Web:

www.leprosy-information.org


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

 


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(LML) 19th International Leprosy Congress Beijing 2016

Leprosy Mailing List – March 8,  2016

Ref.:  (LML) 19th International Leprosy Congress Beijing 2016 

From:  Tahir Dahiru, India


 

Dear Schreuder,

 

As per the question by Geeske Zip (LML, March 6, 2016), in clinical Leprosy you classify base on skin lesions and major nerve trunk involvement. If an individual patient has 5 skin lesions or less with only one major nerve trunk involvement or none you classify as PB. If an individual has more than five skin lesions you classify as MB or if he has more than one nerve involvement even if he has less than 6 skin lesions you classify as MB as per the WHO guideline.

 

Dr Tahir Dahiru


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com


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Monday, March 7, 2016

(LML) 19th International Leprosy Congress Beijing 2016

Leprosy Mailing List – March 7,  2016

 

Ref.:  (LML) 19th International Leprosy Congress Beijing 2016 

 

From:  Hemanta Kumar Kar, New delhi, India


 

Dear Pieter,

 

 

Referring to the LML letter by Geeske Zijp of March 6, 2026:

 

Nerve involvement was kept as a factor to classify leprosy into PB and MB leprosy (WHO, Leprosy Elimination Group (2000). Presently in India, the number of nerves involved is taken into consideration along with skin lesion count while categorizing the patients into PB and MB as per the criteria laid down under NLEP of Govt, of India, which are similar to  ILEP.

 

      PB cases are those who are having one to five skin lesions including single nerve lesion if present or having only one nerve lesion even without having any skin lesion.

 

      MB are cases  those who are having six and above skin lesions with or without nerve lesions or more than one nerve lesions irrespective of number of skin lesions  or skin smear  positive at any site.

 

 

IAL Textbook of LEPROSY, 2nd edition, 2016, edited by Bhushan Kumar and Dr Hemanta Kumar Kar.

 

Regards,

 

Dr Kar

 

Dr. Hemanta Kumar Kar

Professor in Dermatology,North Delhi Municipal Corporation Medical College Delhi -110007

Former Director, Dean and Med. Superintendent

P.G.I.M.E.R. and Dr Ram Manohar Lohia Hospital, New Delhi-110001


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com


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