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Monday, August 27, 2018

(LML) Patient with severe adverse effects due to steroids

Leprosy Mailing List – August 27,  2018 

Ref.:    (LML) Patient with severe adverse effects due to steroids

From:  Ben Naafs, Munnekeburen, the Netherlands


 

Dear Pieter,

I advise too, if dr Ramesh has access to it, to use cyclosporin.

Otherwise he could use azathioprine but that has to be combined with a low dose of steroids, thus less side effects.

Some described effects from MTX. Clinical Infectious Diseases, Volume 45, Issue 1, 1 July 2007, Pages e7–e9, https://doi.org/10.1086/518699 .

According to me the one who advised to use clofazimine for type I reaction was dr Imkamp from South- Africa. In the seventies in ALERT, Addis Ababa, Ethiopia, we tried it and it had no effect. That time only dapsone monotherapy was used and we explained our lack of effect when giving clofazimine to an effective treated patient who was not dapsone resistant, while Imkamp may have treated dapsone resistant patients. After that time occasional reports appeared but non convincing.

With regards,

Ben

 

Note editor:

May be it has not been made clear, but also regarding the Google Group Leprosy Mailing List all questions, comments, messages should be directed to the editor Pieter Schreuder editorlml@gmail.com  It is not possible for the members of the Google Group LML to post email messages directly to the Google Group. All has to pass through the editor.


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

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

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


Sunday, August 26, 2018

(LML) Misusing leprosy as a metaphor for harmful stereotypes

Leprosy Mailing List – August 26,  2018

Ref.:   (LML) Misusing leprosy as a metaphor for harmful stereotypes

From:  Alice Cruz, Guayaqui, Ecuator


Dear Pieter,

This year is the 70th anniversary of the Universal Declaration of Human Rights, adopted by the UN on 10 December 1948. The Universal Declaration – translated into a world record 500 languages – is rooted in the principle that "all human beings are born free and equal in dignity and rights." It remains relevant to everyone, every day. In honour of the 70th anniversary of this extraordinarily influential document, and to prevent its vital principles from being eroded, we are urging people everywhere to Stand Up for Human Rights: www.standup4humanrights.org

Political leaders must stop misusing leprosy as a metaphor for harmful stereotypes, says UN expert 

GENEVA (16 August 2018) – Politicians must stop misusing the word leprosy to convey harmful stereotypes because its widespread use as a metaphor for all that is loathsome contributes to violations of the human rights of persons affected by leprosy, says a UN expert.

"Within the past two months we have witnessed several such incidents, and just recently there have been two discriminatory remarks by high-level political leaders," said Alice Cruz, the UN Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members.

The two senior politicians who made the reference to leprosy are the Portuguese Prime Minister, António Costa, and the Bangladeshi Shipping Minister, Shajahan Khan. On separate occasions, both used the word leprosy while referring to opposition parties.

"The use of leprosy as a pejorative metaphor derives from long-lasting stigmatising connotations produced by different cultural traditions, social rules and legal frameworks," Cruz said.

"The historical symbolism of leprosy as being negative is deeply ingrained and triggers use of the word unthinkingly. This erases from history those persons affected by leprosy, and nourishes the structural violence that makes them invisible as citizens.

 

"Using it as a metaphor leads to wrongful stereotyping that fuels public stigma, everyday discrimination, and impairs the enjoyment of human rights and fundamental freedoms by persons affected and their families," the Special Rapporteur stressed.  

"Leprosy is not a disease of the past. It is still with us now and is deeply associated with social inequities that affect thousands of millions of people worldwide, not only in countries where it is endemic, but also in others where it had already been eliminated but has since re-emerged with foreign-born cases."

Leprosy is a curable disease and most people (around 95 percent) who are in contact with the disease do not contract it. However, if not detected early and treated, leprosy can cause irreversible damage to the skin, nerves, limbs and eyes, leading to disfigurement, blindness, loss of sensation, chronic wounds and neuropathic pain.

Public stigma is one of the major barriers to early diagnosis and it intersects with other discriminatory factors that include gender, age, race, issues arising from migration, which increase the vulnerability of already disadvantaged groups to physical impairment, disability and social exclusion.

"Stigmatisation, discriminatory laws, legal and public policies, discrimination in the administration of goods and services of the State, and the prevalent gap between law in theory and law in action is an everyday reality for persons affected by leprosy and their family members," said Cruz.

The Special Rapporteur urged political leaders to note that leprosy strongly affects children and the consequences of harmful stereotypes and public stigma may be exacerbated for the development and wellbeing of children. Even more alarming is the fact that many of these children are denied the right to education because of leprosy which undermines the possibility they may have to break the cycle of discrimination and marginalization, she said.

"The enforcement of equality and non-discrimination for people affected will not be possible without addressing harmful stereotypes and wrongful stereotyping, as clearly stated in the Principles and guidelines for the elimination of discrimination against persons affected by leprosy and their family members, endorsed in 2010, at the General Assembly. Such efforts should be embraced as a collective human rights responsibility by all opinion-makers, including political leaders and the media," urged Cruz.   

Ms Alice Cruz, the UN Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members, is external Professor at the Law School of University Andina Simón Bolívar – Ecuador. Her doctoral work in sociology focuses on the biosocial dimensions of leprosy and identifies, in countries where leprosy is an endemic neglected disease and in countries where it is an imported and rare disease, the different barriers to access to early diagnosis and to high quality care by persons affected by leprosy, as well as their social, economic, familiar and personal life conditions.

The Special Rapporteurs are part of what is known as the Special Procedures of the Human Rights Council. Special Procedures, the largest body of independent experts in the UN Human Rights system, is the general name of the Council's independent fact-finding and monitoring mechanisms that address either specific country situations or thematic issues in all parts of the world. Special Procedures experts work on a voluntary basis; they are not UN staff and do not receive a salary for their work. They are independent from any government or organization and serve in their individual capacity. 

For more information and media requests, please contact:
Mr. Stefano Sensi (+41 22  917 9237 /
 ssensi@ohchr.org )

For media inquiries related to other UN independent experts please contact:
Mr. Jeremy Laurence, UN Human Rights – Media Unit (+41 22 917 9383 /
jlaurence@ohchr.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


Saturday, August 25, 2018

(LML) Patient with severe adverse effects due to steroids

Leprosy Mailing List – August 25,  2018

Ref.:    (LML) Patient with severe adverse effects due to steroids

From:  Richard Franakel, Hawai, USA


 

Dear Dr. Schreuder.

 

We reported a single patient treated with cyclosporine with good results.  A lot has changed since then but it might be a consideration, depending on specific patient factors.

 

Int J Lepr Other Mycobact Dis. 1992 Mar;60(1):8-12.

Resolution of type 1 reaction in multibacillary Hansen's disease as a result of treatment with cyclosporine.

Frankel RI1, Mita RTKim RDann FJ.

 

Kind regards.

 

Richard I. Frankel, M.D., M.P.H.

Emeritus Professor of Medicine

University of Hawai'i John A. Burns School of Medicine

 


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

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

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


Friday, August 24, 2018

(LML) Patient with severe adverse effects due to steroids

Leprosy Mailing List – August 24,  2018

Ref.:    (LML) Patient with severe adverse effects due to steroids

From:  John Prestigiacomo, Baton Rouge, USA


Dear Pieter,


Dr. Ramesh Sharma could try using Methotrexate dosed once a week with concomitant administration of Folic Acid 1mg po q day to control his patient's Type 1 reaction.

High dose clofazimine will eventually help but it will take up to three months for its anti-inflammatory action to take effect.  His patient may have constipation issues at higher Clofazimine doses.

 

John F. Prestigiacomo, MD, MBA

Medical Officer

National Hansen's Disease Programs

1770 Physicians Park Drive

Baton Rouge, LA 70816

Ph #:  (225) 756-3709

Ph #:  (800) 642-2477

Fax #: (225) 756-3706

E-Mail:  jprestigiacomo@hrsa.gov

NHDP Web Site:  http://www.hrsa.gov/hansens-disease/

Online Course:  "Awareness of Hansen's Disease in the US"

http://www.hrsa.gov/hansens-disease/onlinecourseawareness.html

 

 


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

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

Conta


(LML) Patient with severe adverse effects due to steroids

 

Leprosy Mailing List – August 24,  2018

Ref.:    (LML) Patient with severe adverse effects due to steroids

From:  John Prestigiacomo, Baton Rouge, USA


Dear Pieter,


Dr. Ramesh Sharma could try using Methotrexate dosed once a week with concomitant administration of Folic Acid 1mg po q day to control his patient's Type 1 reaction.

High dose clofazimine will eventually help but it will take up to three months for its anti-inflammatory action to take effect.  His patient may have constipation issues at higher Clofazimine doses.

 

John F. Prestigiacomo, MD, MBA

Medical Officer

National Hansen's Disease Programs

1770 Physicians Park Drive

Baton Rouge, LA 70816

Ph #:  (225) 756-3709

Ph #:  (800) 642-2477

Fax #: (225) 756-3706

E-Mail:  jprestigiacomo@hrsa.gov

NHDP Web Site:  http://www.hrsa.gov/hansens-disease/

Online Course:  "Awareness of Hansen's Disease in the US"

http://www.hrsa.gov/hansens-disease/onlinecourseawareness.html

 

 


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

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

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

Thursday, August 23, 2018

(LML) Google Group Leprosy Mailing List

 

Leprosy Mailing List – August 23,  2018

Ref.:    (LML) Google Group Leprosy Mailing List

From:  Pieter Schreuder, Maastricht, the Netherlands


Dear Colleagues,

 

Yesterday we sent the first LML message through Google Group Leprosy Mailing List. Actually, twice the same message was sent. The reason was that I could not find this message back in my inbox. I thought that I had done something wrong. Then my son advised me to look in the SPAM box, and there it was.

We have about 520 subscribers at this moment, from about 15 the email address bounced. That means that most of you should have received the August 22 communication. If not, please look into your SPAM box.

If there are still questions or remarks, please contact me.

 

Best wishes,

 

Pieter AM Schreuder

Editor LML


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

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

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

Wednesday, August 22, 2018

(LML) Patient with severe adverse effects due to steroids

Leprosy Mailing List – August 22,  2018

Ref.:    (LML) Patient with severe adverse effects due to steroids

From:  Wim Theuvenet, Apeldoorn, the Netherlands


Dear Pieter,

 

 

Thanks to Dr. Sharma you for sharing this problem (LML, August 19, 2018).

 

Please allow for some questions and suggestions:

 

1. Dr. Sharma mentions BT and type 1 reaction. 

 

Q: is there also a type II component?

 

2. In my experience one can try tapering off the Prednison while keeping an umbrella of Clofazimine 100 mg TDS.

 

Suggestion: The combination of Prednison and Clofazimine creates an increased risk of gastrointestinal erosions/bleeding. Therefore, it is advisable to be very hesitant in adding analgesics that also have an anti-inflammatory component, any how it is wise to prescribe anti-acids to protect the stomach, and to check Hb and the faecal occult blood test once a week!  Trust that is already in your protocol?

 

3. Type 1 frequently causes enlargement of (painful) nerves and nerve function loss.

   

Suggestion: When this is the case please consider a nerve decompression of the affected nerves to strongly reduce the pain and hopefully restore nerve function! This may also help in reducing the type 1 reaction symptoms and thus the need for high dosages of the above discussed drugs?

  

When in any doubt you can always seek the advice of Dr Indra Napit, of Anandaban Leprosy hospital.

 

From Dr Wim Brandsma there is a suggestion that I to visit GP Hospital early November, this prior to the Surgical Course at Anandaban. Perhaps there will be an opportunity to see some patients together, learn from each other, and perhaps do some surgery?

 

With best regards,

 

Willem Theuvenet

 


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

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

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

 

 

 

Tuesday, August 21, 2018

(LML) InfoNTD monthly e-newsletter onNTDs and cross-cutting issues – August 2018

Leprosy Mailing List – August 21 ,  2018

Ref.:    (LML) InfoNTD monthly e-newsletter onNTDs and cross-cutting issues – August 2018

From:  Ilse Egers, Amsterdam, the Netherlands


Dear all,

This newsletter provides you with a selection of news items and recent publications on cross-cutting issues in NTDs. Our starting point is to add articles covering a wide variety of issues. Unfortunately, this is not always possible due to a limited diversity in and shortage of articles on cross-cutting issues and NTDs.

Feel free to contact us with any questions or to receive the PDF if a link to the full text is not included.
Our document delivery service is free!

Ilse Egers
InfoNTD Information officer

infontd@leprastichting.nl
 

 


 

News


Neglected tropical diseases and disability—what is the link?
There are many parallels between neglected tropical diseases (NTDs) and disability. Both affect approximately one billion people. Both are more common in the poorest parts of the world, and among the poorest people. There is also a direct link as NTDs are frequently disabling. Almost all of the 17 main NTDs can cause disabilities.
Read more

Blog – Unfinished Business: Human Rights and the Future of NTD Control and Elimination
By Joseph J. Amon and David G. Addiss
Read more
 
WHO outlines criteria to assess elimination of sleeping sickness.
18 July 2018 | Geneva – The latest data released by the World Health Organization (WHO) confirm a sustained decrease in the number of new cases of human African trypanosomiasis (HAT, also known as sleeping sickness), firming up projections that the target to eliminate the disease as a public health problem (1) by 2020 is achievable.
Read more

Tsetse.org 
Relaunch of the website tsetse.org designed to provide programmes and information to assist in the planning and implementation of tsetse control operations in endemic countries.
 

 


 


 


 


 

New publications

 


 

Mycetoma: a clinical dilemma in resource limited settings.
Emmanuel P, Dumre SP, John S, et al. Ann. Clin. Microbiol. Antimicrob. 2018; 17(1):35.
Abstract An overview of the clinical presentation of mycetoma in the early and late phases, clues to distinguish eumycetoma from actinomycetoma in the field and the laboratory, differential diagnosis and a suggested diagnostic algorithm that may be useful in making diagnosis amidst the differential diagnosis of mycetoma is given. Additionally, a proposed preventive measures which may be helpful in the community is also provided.
Download PDF


Lymphoedema management in podoconiosis.
Brooks J, Ersser S, Matts P, et al. Lancet Glob Health. 2018; 6(9):e962.
Download PDF


Lymphoedema management in podoconiosis - Authors reply.
Molla M, Ngari M, Berkley JA, et al. Lancet Glob Health. 2018; 6(9):e963.
Download PDF


Drug therapy for mycetoma.
Scolding P, Fahal A, Yotsu RR. Cochrane Database Syst Rev. 2018; (7):14.
Abstract This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To assess the effects of drug therapy for mycetoma, including eumycetoma and actinomycetoma.
Download PDF


Structural equation modeling of health related quality of life of lymphatic filariasis patients.
Harichandrakumar KT, Kumaran M. Int J Health Sci Res. 2018; 8(7):245-258.
Abstract Health Related quality of Life (HRQoL) assess the perceived well being of the individuals in their physical, mental and social well being of their daily life. The items in the HRQoL measures are interrelated and the relationship between them is complex in nature and the domains, which are the constructs of the HRQoL cannot be observed or measured directly. One of the major challenges in the modeling of HRQoL is related to the complexity and collinearities of the relationships among the variables, which cannot be unraveled by standard statistical analysis.
Download PDF


Access to health for persons with disabilities.
Shakespeare T, Bright T, Kuper H. OHCHR. 2018:56.
Download PDF


Mass drug administration and the sustainable control of schistosomiasis: an evaluation of treatment compliance in the rural Philippines.
Inobaya MT, Chau TN, Ng S-K, et al. Parasit Vectors. 2018; 11(1):441.
Abstract Preventive chemotherapy is the current global control strategy for schistosomiasis. The WHO target coverage rate is at least 75% for school-aged children. In the Philippines, the reported national coverage rate (43.5%) is far below the WHO target. This study examined the factors associated with non-compliance to mass drug administration.
Download PDF


A call to action for mycetoma.
Beer KD, Blaney DD, Kadzik M, et al. Curr Fungal Infect Rep. 2018:1-6.
Abstract Here, we discuss the current needs and priorities for mycetoma control and prevention, highlight lessons learned from leprosy and podoconiosis, and motivate an urgent need to accelerate progress toward reducing the burden of mycetoma in endemic areas.
Read more


Determinants for not utilizing trachomatous trichiasis surgery among trachomatous trichiasis patients in Mehalsayint District, North-East Ethiopia.
Meshesha TD, Senbete GH, Bogale GG. PLoS Negl Trop Dis. 2018; 12(7):e0006669.
Abstract Globally, trachoma is the leading cause of infectious blindness. In Ethiopia, the overall Trachomatous Trichiasis (TT) surgical coverage is 41%. Identifying determinants for not utilizing TT surgery among TT patients is important to design and monitor effective intervention programs. Therefore, this study aimed to identify determinants for not utilizing TT surgery among TT patients in Mehalsayint District, North East Ethiopia.
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Understanding perceptions on 'Buruli' in northwestern Uganda: A biosocial investigation.
Pearson G. PLoS Negl Trop Dis. 2018; 12(7):e0006689.
Abstract Taking an inductive approach and drawing on long-term ethnographic fieldwork in 2013-14, this article presents perspectives on this affliction of people living and working along the River Nile in northwest Uganda. Little is known biomedically about its presence, yet 'Buruli', as it is known locally, was and is a significant affliction in this region. Establishing a biosocial history of 'Buruli', largely obscured from biomedical perspectives, offers explanations for contemporary understandings, perceptions and practices.
Download PDF


Lymphatic filariasis control in Tanzania: infection, disease perceptions and drug uptake patterns in an endemic community after multiple rounds of mass drug administration.
Derua YA, Kisinza WN, Simonsen PE. Parasit Vectors. 2018; 11(1):429.
Abstract Lymphatic filariasis (LF) control in most countries of sub-Saharan Africa is based on annual mass drug administration (MDA) with a combination of ivermectin and albendazole, in order to interrupt transmission. However, attaining and maintaining high treatment coverage has been a challenge in many LF control programmes. This study was designed to elucidate reasons for continued transmission of LF in an endemic area of Tanga, northeastern Tanzania, where control activities based on MDA had been in place for eight years by the time of this study in 2012.
Download PDF


Monitoring equity in universal health coverage with essential services for neglected tropical diseases: an analysis of data reported for five diseases in 123 countries over 9 years.
Fitzpatrick C, Bangert M, Mbabazi PS et al. Lancet Glob Health. 2018.
Abstract A service coverage index has recently been proposed to monitor progress towards universal health coverage (UHC), and baseline results for 2015 are available. However, evidence on equity in that progress is scarce. The service coverage index did not consider services for neglected tropical diseases (NTDs), a group of preventable diseases defined by WHO member states on the basis of the disproportionate burden they place on their poorest, remotest, and otherwise most marginalised communities.
Download PDF


Global "worming": Climate change and its projected general impact on human helminth infections.
Blum AJ, Hotez PJ. PLoS Negl Trop Dis. 2018; 12(7):e0006370.
Download PDF


Vulnerability to snakebite envenoming: a global mapping of hotspots.
Longbottom J, Shearer FM, Devine M, et al. The Lancet. 2018:12.
Abstract Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed.
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Identifying residual transmission of lymphatic filariasis after mass drug administration: Comparing school-based versus community-based surveillance - American Samoa, 2016.
Sheel M, Sheridan S, Gass K, et al. PLoS Negl Trop Dis. 2018; 12(7):e0006583.
Abstract Under the Global Programme to Eliminate Lymphatic Filariasis (LF), American Samoa conducted seven rounds of mass drug administration (MDA) from 2000-2006. The World Health Organization recommends systematic post-MDA surveillance using Transmission Assessment Surveys (TAS) for epidemiological assessment of recent LF transmission. We compared the effectiveness of two survey designs for post-MDA surveillance: a school-based survey of children aged 6-7 years, and a community-based survey targeting people aged ≥8 years.
Download PDF


Impact of a national deworming campaign on the prevalence of soil-transmitted helminthiasis in Uganda (2004-2016): Implications for national control programs.
Adriko M, Tinkitina B, Arinaitwe M, et al. PLoS Negl Trop Dis. 2018; 12(7):e0006520.
Abstract Soil-transmitted Helminths and Anemia potentially reduce and retard cognitive and physical growth in school-age children with great implications for national control programs in Africa. After years of deworming programs, a study was undertaken to evaluate the impact of a national deworming campaign on the prevalence and intensity of soil-transmitted helminthic infections in school-age children in Uganda.
Download PDF


An overview of the treatment of Mycobacterium ulcerans infection (Buruli ulcer).
Meher-Homji Z, Johnson PDR. Curr Treat Options Infect Dis. 2018.
Abstract Buruli ulcer is a major cause of morbidity in the regions where it is endemic across 33 countries. The treatment of the disease has changed drastically over the last 15 years with a move away from reliance on wide surgical excision, increased confidence in the efficacy of antibiotics and a better understanding of the pathogenesis of Mycobacterium ulcerans infections.
Read more


The threat of lymphatic filariasis elimination failure in Pasaman Barat District, West Sumatra Province.
Ikawati B, Wijayanti T, Jastal. Ind. Jour. of Publ. Health Rese. & Develop. 2018; 9(6):446-451.
Read more


Patterns and epidemiology of acute poisoning in Ethiopia: systematic review of observational studies.
Chelkeba L, Mulatu A, Feyissa D, et al. Arch Public Health. 2018; 76:10.
Abstract Acute poisoning is a common reason for emergency department visit and hospitalization worldwide with major morbidity and mortality. The burden of poisoning exposures in Africa is a significant public health concern, but only 10 of 58 countries have poisons information centers (PICs). The primary intention of our current review is to explore and summarize the published evidence on the patterns and epidemiology of poisoning in Ethiopia.
Download PDF


 


 

Call for proposals

The African Research Network for Neglected Tropical Diseases (ARNTD) is being supported by the U.S. Agency for International Development (USAID) and UK aid from the UK government (UKaid) through the Coalition for Operational Research on Tropical Medical (COR-NTD) to run the ARNTD African Researchers' Small Grants Program.

The deadline for submission of proposals is September 10, 2018.

 



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

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

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