Fw: Ref.: (LML) Detection of nerve damage in leprosy and timely treatment

 

Leprosy Mailing List – December 2,  2021

 

Ref.:  (LML) Detection of nerve damage in leprosy and timely treatment

 

From:  Wim Theuvenet, Apeldoorn, the Netherlands

 

Dear Pieter,

Thank dr. Naafs so much for his valuable comments  (LML, November 29, 2021) and perhaps of these his most important recommendations:

"Record everything carefully. You can use a ready-made form or mention the deviations in your notes. All this can be done in 5-10 minutes. When he/she comes in, talk to the patient after you have prepared by reviewing your notes about the patient. Talk not only about the disease but about his or her family, work and problems too. Take personal notes (these are private between you and the patient). In this way, an increase in nerve damage can be detected early and the action is timely. The patient can get better instead of worse under your care, what happens too often nowadays" .

Also because of these holistic observations he is one of the most appreciated leprologists within our global horizon!!

 

On a more technical level;

• For the Neurosensory Testing with the Semmes Weinstein Monofilaments:

    In my personal practise I daily use the Semmes Weinstein Monofilants as supplied by North Coast Medical (https://www.ncmedical.com/live_search.php?q=semmes)

    When using these please take into consideration that temperature and humidity can strongly influence the bending force of each filament, this far more than the age of the set.

 

   (https://www.researchgate.net/publication/51451043_Semmes-Weinstein_Monofilaments_Influence_of_Temperature_Humidity_and_Age)

 

 

• For the Neurosensory Testing in an even more advanced way (research setting) with the PSSD as developed by Prof. Lee Dellon: (https://tucsonfoot.com/wp-content/uploads/2019/02/neuro_testing.pdf)

 

• For the Intrinsic Muscle Strength Assessment dr. Ton Schreuders has developed an impressive apparatus called the RIHM (https://pubmed.ncbi.nlm.nih.gov/15043908/)

 

• Extrinsic Muscle Strength Testing should fall within the routine skills of every Physiotherapist, Occupational therapist and anyone who deals with peripheral neuropathies.

 

Peripheral Muscle Nerve Testing is an important part of "The Surgical and Physiotherapy Training Courses" in leprosy that  dr. Ton Schreuders, dr. Indra Napit and myself regularly conduct abroad, but which are also routinely given in e.g., many TLM Centres in India, Nepal etc. 

 

In these courses we always start with a section on the early detection, prevention and treatment of nerve function loss.

 

In the field leprosy budgets are limited, one will have to deal with limited resources, but with proper training it indeed should be possible to improve on the prevention of nerve damage in leprosy!

 

And indeed, we advocate as recommend that one starts with:

 

"Talk not only about the disease but about his or her family, work and problems too! "

 

 

With Best regards, and please stay healthy,

 

"Worried too!"

 

Wim Theuvenet 

 

Willem J.Theuvenet, M.D., Ph.D

Plastic, Reconstructive and European Certified Hand Surgeon

Consultant for TLMI and the NLR

 

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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Fw: Ref.: (LML) Detection of nerve damage in leprosy and timely treatment

 

 

 
Leprosy Mailing List – December 2,  2021

 

Ref.:  (LML) Detection of nerve damage in leprosy and timely treatment

 

From:  Marcos Virmond, Bauru, Brazil

 

Dear Pieter

 

I am quite happy with the message by dr. Benn Naafs regarding the relevance of sensory testing in a disease that is primarily a peripheral nerve disorder. I read Dr. Naafs' message as a necessary and a timely warning to health professionals on the need to use monofilaments as a clinical tool in the diagnosis and, most of all, in the follow-up of cases of leprosy with clear sensory nerve compromise. 

 

It is also very interesting and important to have the testimony of Mr. Anthony Nicoll, from SORRI-Bauru, on the history of this famous and widely used (in Brazil) Pocket Monofilaments Set - a real achievement of Mr. Nicoll and this team. I recall the success of this pocket set when Mr. Nicoll presented it during the 2nd Congress of the College of Hansenology of The Endemic Countries held in Baton Rouge-USA in 1985. He offered some 50 sets ( I cannot recall the exact number) and it was sold out after less than half an hour!

 

Besides skin involvement, nerve damage is the real threatening feature of leprosy and health teams must be prepared to cope with this.

 

I wish to thank dr. Naafs for his opportune message.

 

Marcos Virmond MD, PhD

former director ILSL-Bauru

 

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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Fw: Ref.: (LML) Announcement Call for Proposals 2023 - Leprosy Research Initiative

 

 
Leprosy Mailing List – December 2,  2021

 

Ref.:  (LML) Announcement Call for Proposals 2023 - Leprosy Research Initiative

 

From:  Nicole Dinnissen, Amsterdam, the Netherlands

 

 

Dear colleagues,

The Leprosy Research Initiative (LRI) is pleased to announce a call for proposals for funding commencing in 2023. LRI funds research with a focus on leprosy – including research applications combining leprosy with other neglected tropical diseases (NTDs) or other diseases that share cross-cutting issues with leprosy.

• Para a versão do edital em português, favor clicar aqui!
• Pour une version française de l'appel à propositions, cliquez ici!
• ¡Para obtener una versión en español de la convocatoria de proyectos, haga clic aquí!

Eligibility criteria:

• The main topic of the study must fall within one of the agreed priority areas (www.leprosyresearch.org). This budget round preference will be given to research applications addressing the following topics:
         i) cost-efficient case finding strategies
         ii) development and validation of lab or field-based assays for leprosy diagnosis.
  Proposals can address these two research topics in combination or individually.
• Research results must be directly applicable to leprosy services or to the wellbeing of persons affected by leprosy.
• Preference will be given to proposals from or in close collaboration with institutions or organisations in endemic countries.
• Project duration must not exceed four years (48 months).
• There is no budget ceiling for the current call. By way of guidance: projects LRI has funded in the past years had an average annual budget of €30,000 (ranging from €10,000 to €75,000) – although in exceptional cases higher annual budgets have been accepted (with a maximum of four years).

 
Researchers interested to apply for funding by the LRI are invited to complete and submit a Letter of Intent (LoI), giving an outline of the intended research. The LoIs should be submitted using the LRI Grant Application portal – which can be accessed via https://leprosyresearch.flexigrant.com/. The online portal will open on December 1st, 2021.
 
LoIs should be submitted by January 28th, 2022 at 23:59 (Amsterdam date and time) after which the application portal will be closed. We strongly advise you to take sufficient time to enter all the required data in the system. Only applications in English will be considered.
 
LoIs will be screened by the LRI Steering Committee (SC). Applicants will be informed about the outcome of the LoI on March 14th 2022. If the feedback by the SC is positive, the applicants will be invited to submit a full proposal before the next deadline (May 2nd, 2022).

 

Leprosy Research Initiative

 

Submit Letter of Intent

 

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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Fw: Ref.: (LML) Closing the gaps in protection for LL HD patients in endemic areas

 

 Leprosy Mailing List – December 1,  2021

 

Ref.:  (LML) Closing the gaps in protection for LL HD patients in endemic areas

From:  Joel Almeida, London and Mumbai

 

Note editor: several centres in the (leprosy) world are giving prolonged anti-micro bacterial protection of anergetic LLp patients against reinfection. We would like to request them to react and inform the LML readers about their opinion and experience.

 

 

Dear Pieter and colleagues,

 

It is useful to understand why some programs in low-income areas showed good epidemiological impact while other areas experience stagnation in the number of new cases. Many esteemed colleagues at the front lines are concerned about the accumulating number of previously treated LL HD patients who require re-treatment. They have an important point.

Best,

 

Joel Almeida

 

- - - - - -

 

Closing the gaps in protection for LL HD patients in endemic areas

 

Patients at the lepromatous pole (LLp) lack an effective immunological response against the HD (leprosy) bacilli. Anergy among LLp patients appears to be genomically related (1-5) and is long-lasting, while fixed duration MDT (multi-drug therapy) offers only temporary protection against reinfection. That is why fixed duration MDT is inadequate for genomically anergic LLp patients who live in endemic areas. A rapid decline in incidence rate of MB (multibacillary) HD has been achieved, but only when prolonged anti-microbial protection was ensured among LLp patients. (6-8)

LL patients, if denied anti-microbial protection against infection or reinfection, are capable of shedding as many as ten million viable bacilli per day. (9) This is sufficient to drive transmission despite all other efforts. The LLp patients are forced to serve unknowingly and unwillingly as super-spreaders. The ratio of accumulated reinfected LLp HD patients to previously untreated LL HD patients is more important than the absolute recurrence/reinfection rate among MB patients. Typically, the detection rate of previously untreated LL patients remains below 100 per million population per year, once the backlog of cases has been detected. This means that even so-called "low" recurrence/reinfection rates among previously treated LLp patients can make them important drivers of transmission. Since the incidence rate of LL HD is so low in absolute terms, the number of previously treated but reinfected LL patients could well exceed the number of newly diagnosed LL patients in endemic areas. HD transmission in endemic areas therefore could well be maintained to an important extent by reinfected previously treated LL patients. That is likely why only those projects ensuring prolonged anti-microbial protection against reinfection, for LLp patients, achieved a rapid decline in the incidence rate of MB HD. (6-8) Every endemic area can succeed similarly.

 

ENL (erythema nodosum leprosum) shows a dose-response relationship with bacillary load and shows a part response to anti-microbials (11-16). It also responds partly to anti-reaction (anti-inflammatory) drugs. (17-19) Therefore, response to "anti-reaction" medication does not in itself preclude bacillary proliferation. The use of this criterion to exclude recurrence/reinfection can underestimate the risk of recurrence/reinfection among LLp patients.

There is another important reason for continuing MDT (or other anti-microbial protection) beyond 12 months in LLp patients. A one-year MDT group in an endemic area showed a 600% increase in the risk of ENL with neuritis compared to a two-year MDT group, during months 13 to 24 after the start of MDT. (20-21) ENL with neuritis is known to be excruciatingly painful. Therefore, it would be good to continue MDT beyond 12 months in LL patients. This would help to avert a greatly multiplied risk of the painful, swollen and tender nerves found in the neuritis of ENL episodes.

Signs of reinfection can be subtle and are not easy to detect promptly. Prevention is better than surveillance because expert clinicians are not available everywhere, and experts detect signs of recurrence/reinfection in five times as many patients compared to even well trained but non-expert health workers. (10, 22) Without prolonged anti-microbial protection of anergic LLp patients against reinfection, the people of endemic areas remain trapped in transmission of HD. Reinfection of anergic LLp patients can be prevented by ensuring prolonged anti-microbial protection. It is a simple thing to do for LLp patients, and it consistently leads to a decline in the incidence rate of MB HD (Shandong vs Yunnan, ref 6, Karigiri, ref 7, Uele, ref 8). This dramatic epidemiological success can be replicated in every endemic area simply by ensuring prolonged anti-microbial protection for LLp patients, beyond 12 months of MDT. Prolonging MDT is the lowest-cost option. Monthly doses of 3 bactericidal drugs following MDT are another option if sufficient finance is available, enabling full supervision and therefore improved regularity of ingestion.

 

The evidence from successful programs is that prolonged anti-microbial protection of LL HD patients in endemic areas is critical for interrupting transmission as well as for greatly reducing the risk of painful, swollen nerves found in ENL episodes. Such protection of anergic LL HD patients after 12 months of MDT could replace anti-microbial neglect. This would respect Article 25 of the Universal Declaration of Human Rights, that enshrines the right to adequate medical care.

References

1. Chakravarti MR, Vogel F. A twin study on leprosy Georg Thieme Publishers, Stuttgart, Germany; 1973

2. Zhang FR, Huang W, Chen SM et al. Genomewide Association Study of Leprosy. N Engl J Med 2009; 361:2609-2618 DOI:10.1056/NEJMoa0903753

3. Sartori PVU, Penna GO, Bührer-Sékula S et al. Human Genetic Susceptibility of Leprosy Recurrence. Scientific Reports 2020 volume 10, Article number: 1284

4. Gaschignard J, Grant AV, Thuc NV et al. Pauci- and Multibacillary Leprosy: Two Distinct, Genetically Neglected Diseases. PLoS Negl Trop Dis. 2016 May 24;10(5):e0004345. doi: 10.1371/journal.pntd.0004345

5. Wang N, Wang Z, Wang C et al. Prediction of leprosy in the Chinese population based on a weighted genetic risk score. PLoS Negl Trop Dis. 2018 Sep 19;12(9):e0006789. doi: 10.1371/journal.pntd.0006789.

6. Li HY, Weng XM, Li T et al. Long-Term Effect of Leprosy Control in Two Prefectures of China, 1955-1993. Int J Lepr Other Mycobact Dis. 1995 Jun;63(2):213-221. reviewed and analysed further in Almeida JG. What really happened in Shandong? LML 16 Nov 2019

7. Norman G, Bhushanam JDRS, Samuel P. Trends in leprosy over 50 years in Gudiyatham Taluk, Vellore, Tamil Nadu. Ind J Lepr 2006. 78(2): 167-185. reviewed and analysed further in Almeida JG. Karigiri, India: How transmission rapidly was reduced in a low-income population. LML 29 Oct 2020

8. Tonglet R, Pattyn SR, Nsansi BN et al. The reduction of the leprosy endemicity in northeastern Zaire 1975/1989 J.Eur J Epidemiol. 1990 Dec;6(4):404-6. reviewed and analysed further in Almeida JG. Reducing transmission in poor hyperendemic areas - evidence from Uele (DRC). LML 29 Nov 2019

9. Davey TF, Rees RJ. The nasal dicharge in leprosy: clinical and bacteriological aspects. Lepr Rev. 1974 Jun;45(2):121-34.

10. Balagon MF, Cellona RV, Cruz E, Burgos JA, Abalos RM, Walsh GP, et al. 2009. Long-term relapse risk in multibacillary leprosy after completion of 2 years of multiple drug therapy (WHO-MDT) in Cebu, Philipplines.  Am. J Trop. Med. Hyg. 81(5), 895-899. reviewed and analysed further in Almeida JG. Recurrence rate among MB patients following RFT. LML 2 June 2019

11. Pocaterra L, Jain S, Reddy R, Muzaffarullah S, Torres O, Suneetha S, Lockwood DN. Clinical course of erythema nodosum leprosum: an 11-year cohort study in Hyderabad, India. Am J Trop Med Hyg (2006) 74(5):868–879.
12. Manandhar R, LeMaster JW, Roche PW. Risk factors for erythema nodosum leprosum. Int J Lepr 1999 Sep;67(3):270-8

13. Lastoria JC, deAlmeida TSC, Putlinatti MSdMA, Padovani CR. Effectiveness of the retreatment of patients with multibacillary leprosy and episodes of erythema nodosum leprosum and/or persistent neuritis: a single-center experience  An Bras Dermatol. 2018 Mar-Apr; 93(2): 181–184. doi: 10.1590/abd1806-4841.20185387

14. Narang T, Bishnoi A, Dogra S et al. Alternate Anti-Leprosy Regimen for Multidrug Therapy Refractory Leprosy: A Retrospective Study from a Tertiary Care Center in North India . Am J Trop Med Hyg. 2019 Jan; 100(1): 24–30. doi: 10.4269/ajtmh.18-0256

15. Narang T, Sawatkar GU, Kumaran MS, Dogra S. Minocycline for Recurrent and/or Chronic Erythema Nodosum Leprosum JAMA Dermatol 2015 Sep;151(9):1026-8. doi: 10.1001/jamadermatol.2015.0384.

16. Arora P, Sardana K, Agarwal A, Lavania M. Resistance as a cause for chronic steroid dependent ENL - a novel paradigm with potential implications in management. Lepr Rev (2019) 90, 201– 205

17. Kar HK, Gupta L. Comparative efficacy of four treatment regimens in Type 2 leprosy reactions (prednisolone alone, thalidomide alone, prednisolone plus thalidomide and prednisolone plus clofazimine). Indian J Lepr 2016 88(1):29–38

18. Kaur I, Dogra S, Narang T, De D. 2009. Comparative efficacy of thalidomide and prednisolone in the treatment of moderate to severe erythema nodosum leprosum: a randomized study. Australas J Dermatol 50(3):181–185.

19. Lambert SM, Nigusse SD, Alembo DT, Walker SL, Nicholls PG, Idriss MH, Yamuah LK, Lockwood DN. 2016. 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. PLoS Negl Trop Dis 10(2):e0004149.

20. Balagon MVF, Gelber RH, Abalos RM, Cellona RV. Reactions following completion of 1 and 2 year multidrug therapy (MDT) Am J Trop Med Hyg 2010 Sep;83(3):637-44. doi: 10.4269/ajtmh.2010.09-0586 reviewed and analysed further in Almeida JG. MDT duration and ENL neuritis risk. LML 7 January 2020

21. Balagon M, Saunderson PR, Gelber RH. Does clofazimine prevent Erythema Nodosum Leprosum (ENL) in leprosy? A retrospective study, comparing the experience of multibacillary patients receiving either 12 or 24 months WHO-MDT. Lepr Rev (2011) 82, 213– 221

22. Gelber RH, Balagon VF, Cellona RV. The relapse rate in MB leprosy patients treated with 2-years of WHO-MDT is not low. Int J Lepr 2004; 72: 493-500.

 

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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Fw: Ref.: (LML) Detection of nerve damage in leprosy and timely treatment

Leprosy Mailing List – November 30,  2021

 

Ref.:  (LML) Detection of nerve damage in leprosy and timely treatment

 

From:  Joel Almeida, London and Mumbai

 

 

Dear Pieter & colleagues,

 

Thanks to Dr. Naafs for the important and detailed advice that can help patients to get better (not worse) once they are diagnosed. HD patients deserve respect and quality care. This includes regular nerve function monitoring as was introduced in the Brazilian national program on the initiative of Linda Lehman and associates. SORRI-BAURU is doing a great service to the world by maintaining production of these very helpful monofilaments.

 

There is no future in confining persons with HD or its sequelae to second-class care, or simply removing them from registers and forgetting about them. They are first class human beings like everyone else. Therefore, they deserve first class care. This includes at least quarterly nerve function monitoring during the first 2 years after the start of treatment, so that anti-inflammatory treatment can be started at the first sign of sensory impairment. Their nerves and limbs depend upon it.

 

Dr. Naafs and other esteemed colleagues will be able to advise on the best practical ways of testing for impaired temperature sensation in the field. Temperature is the first sensation to be impaired, and this year's Nobel Prize in Physiology or Medicine was awarded to David Julian and Ardem Patapoutian who discovered the unique molecular bases for separate receptors of temperature and touch respectively. Of course, in HD frontline workers had long recognised (from e.g., Nauru in the early 20C or perhaps even before) that temperature was the first sensation to be impaired. There are Nobel Prizes to be had for those brilliant minds who devote at least some of their time to studying HD, even if they find their greatest satisfaction from seeing patients get better.

 

Enlightened programs have taken specialist nerve function testing to the frontlines, by providing well trained specialist health workers with transport. This allows a single worker to provide competent nerve function testing services across a wide area. Even patients who cannot afford to travel can have these competent nerve function testing services provided regularly at their doorstep. This service is highly suited to NGOs, and it is attractive to the public and other donors. Those NGOs who provide this service are likely to fare better than others.

Best,

 

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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Fw: Ref.: (LML) Viewing disruption as an opportunity to rebuild

 

Leprosy Mailing List – November 30,  2021

 

Ref.:  (LML) Viewing disruption as an opportunity to rebuild

 

From:  Claudio Salgado, Belém, Brazil

 

 

Note editor: this letter appeared earlier in the Leprosy Bulletin 106 (LML, November 29, 2021). With the permission of the author, we reprint this letter in LML.

 

Dear colleagues,

Between 1989 and 1998, the number of new cases per year of Hansen's disease (HD) in the world increased from 576,361 to 805,000. This increase occurred in the context of the World Health Assembly's 1991 resolution to "eliminate leprosy as a public health problem" by the year 2000 and associated efforts to train health professionals to facilitate HD diagnosis [1].

However, since the World Health Organization (WHO) declared achievement of "elimination as a public health problem," the number of new cases counted each year plummeted to 202,195 in 2019. The number of new cases detected worldwide plunged to 127,396 in 2020 during the SARS-CoV-2 pandemic [2], leading the HD community, persons affected by HD, and health care professionals to realize the worst moment of the last 20 years for HD control. Even before the pandemic, mathematical models indicated that we may now have more than 4 million people waiting to be diagnosed [3]. This huge reduction in the number of new cases in the last two decades can be ascribed to an untested declaration of HD "elimination." Misunderstood to mean "eradication," the "elimination" declaration is associated mainly with a loss of expertise about the disease, which has actually led to a different kind of elimination: the elimination of HD diagnosis.

Cases showing few symptoms remain undiagnosed for years, and so originate the new few classic cases still diagnosed. Asymptomatic cases are usually contacts of undiagnosed and untreated HD patients who are not correctly examined because of the lack of expertise and laboratory tools necessary to identify, classify, and define those who need early treatment for latent HD. Furthermore, among well-examined contacts of HD patients there are those positive for acid fast bacilli in slit skin smear, anti-PGL-I IgM serology or RLEP RT-qPCR, or those with nerve damage detected only by electroneuromyography or ultrasound [4], [5], [6]. A group of "healthy" contacts may even have two or more of these parameters altered. Despite these issues in diagnosis, WHO's present proposal is to give a single dose of rifampicin (SDR) to all of them [7], a policy that has polarized many of us in the HD clinical community [8].

The issues are not limited to problems of diagnosis. There are persons affected by HD receiving insufficient treatment (mostly borderline or lepromatous leprosy patients) who may need more than 24 months of multidrug therapy (MDT) and those with MDT failure, who need other drug regimens that are not available to them. These drug-related treatment issues, which are accepted for other diseases like tuberculosis [9], are not currently acknowledged by WHO.

Something good can come from the disruption wrought by the SARS-CoV-2 pandemic crisis if we rebuild the HD technical program based on the following pillars:

1. Implement mandatory surveillance that relies at least on clinics, serology, and molecular biology. Communities surrounding former colonies and hot spots based on data of the last 20 years should be the initial targets.
2. Make serology, RT-qPCR, electroneuromyography, and ultrasound available to patients and contacts for diagnosis and follow-up.
3. Develop and make available new treatment regimens using other antibiotics for when a patient does not respond properly, although MDT may continue to be used as the first line scheme to treat patients and when necessary use for longer periods. 
4. Make corticoids and thalidomide widely available for taking a patient out of a reaction crisis. For patients who require treatment for longer periods, whether for persistent reactions or worsening of nerve function signs/symptoms or pain, develop other drugs and new concepts.
5. Make surgery, orthotics, prostheses and other supportive equipment or human assistance available for patient follow-up when incapacity occurs. 

These topics should be among the new global HD targets for Neglected Tropical Diseases in the WHO roadmap 2021-2030. All the matters pointed out here may be discussed under the umbrella of human rights as well, including the right of a person affected by HD to know whether they have really been cured of this complex disease. 

 

Dr. Claudio Guedes Salgado

President, Brazil Hansen's Disease Society (SBH)
http://www.sbhansenologia.org.br/historia-sbh
Full Professor, Federal University of Pará, Brazil
https://www.linkedin.com/in/claudio-guedes-salgado
Director of Health Surveillance, Belém, Pará, Brazil

 

References:

1. C. G. Salgado, J. G. Barreto, M. B. da Silva, I. M. B. Goulart, J. A. Barreto, N. F. de M. Junior, J. A. Nery, M. A. C. Frade, J. S. Spencer, Are leprosy case numbers reliable? The Lancet Infectious Diseases. 18, 135–137 (2018), https://doi.org/10.1016/S1473-3099(18)30012-4.
2. World Health Organization (WHO), Global leprosy (Hansen disease) update, 2020: impact of COVID-19 on global leprosy control. Weekly epidemiological record. 96, 421–444 (2021),  https://www.who.int/publications/i/item/who-wer9636-42-444.
3. W. C. Smith, W. van Brakel, T. Gillis, P. Saunderson, J. H. Richardus, The Missing Millions: A Threat to the Elimination of Leprosy. PLoS Neglected Tropical Diseases. 9 (2015), https://doi.org/10.1371/journal.pntd.0003658.
4. J. G. Barreto, L. de S. Guimarães, M. A. C. Frade, P. S. Rosa, C. G. Salgado, High rates of undiagnosed leprosy and subclinical infection amongst school children in the Amazon Region. Memórias do Instituto Oswaldo Cruz. 107, 60–7 (2012), https://doi.org/10.1590/S0074-02762012000900011.
5. D. F. dos Santos, M. R. Mendonça, D. E. Antunes, E. F. P. Sabino, R. C. Pereira, L. R. Goulart, I. M. B. Goulart, Revisiting primary neural leprosy: Clinical, serological, molecular, and neurophysiological aspects. PLoS Neglected Tropical Diseases. 11 (2017), https://doi.org/10.1371/journal.pntd.0006086.
6. M. B. da Silva, W. Li, R. C. Bouth, A. R. Gobbo, A. C. C. Messias, T. M. P. Moraes, E. V. O. Jorge, J. G. Barreto, F. B. Filho, G. A. B. Conde, M. A. C. Frade, C. G. Salgado, J. S. Spencer, Latent leprosy infection identified by dual RLEP and anti-PGL-I positivity: Implications for new control strategies. PLOS ONE. 16, e0251631 (2021), https://doi.org/10.1371/journal.pone.0251631.
7. World Health Organization (WHO), Leprosy/Hansen disease: Contact tracing and post-exposure prophylaxis (ed. 1, 2020), https://apps.who.int/iris/handle/10665/336679.
8. D. N. J. Lockwood, P. Krishnamurthy, B. Kumar, G. Penna, Single-dose rifampicin chemoprophylaxis protects those who need it least and is not a cost-effective intervention. PLOS Neglected Tropical Diseases. 12, e0006403 (2018), https://doi.org/10.1371/journal.pntd.0006403.
9. A. M. Ginsberg, M. Spigelman, Challenges in tuberculosis drug research and development. Nature Medicine 2007 13:3. 13, 290–294 (2007), https://doi.org/10.1038/nm0307-290.

 

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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Fw: Ref.: (LML) Pocket Filaments Kits – Semmes-Weinstein monofilaments

Leprosy Mailing List – November 30,  2021

 

Ref.:  (LML) Pocket Filaments Kits – Semmes-Weinstein monofilaments

 

From:  Anthony Nicoll, Bauru, Brazil

 

Dear Dr Naafs,

I very much appreciated your letter to the Leprosy Mailing list (November 29, 2021).

I'm sure you will be relieved to know that yes, we are still producing the "Pocket Filament Kits" that I developed in Brazil some 35 years ago at the request of Occupational Therapist Linda Lehman, and with the help of surgeons, doctors, nurses, physiotherapists, and others working at the Lauro de Souza Lima Institute, here in Bauru and in Bambui and Belo Horizonte, in Minas Gerais State.

They are produced in a small extension to the orthopaedic workshop at SORRI-BAURU, which continues its services to benefit people with disabilities and their families in the region.

I remember having read a couple of articles of yours which mention the pioneering work of Graham Weddell  and his colleagues who published studies involving graded nylon suture filaments to monitor sensory loss in leprosy patients.

Here we have followed the specific diameters and length of mounted nylon "612" filaments as defined by Weinstein, and as reduced by Judy Bell-Krotoski to a manageable number of six graded filaments:  that she called the "Hand and Foot Set".  (That is, the five-filament hand set plus the 10 gram-force filament which became popularised by James Birke).  We still use the same colour-code defined by Judy and Linda.

Our "Kit" was recently tested in the UK and Europe, by

-       Doreen B. Pfau, Omer Haroun, Diana N. Lockwood, Christoph Maier, Marc Schmitter, Jan Vollert, Andrew S.C. Rice, Rolf-Detlef Treede. Mechanical detection and pain thresholds: comparability of devices using stepped and ramped stimuli. Pain Reports, 2020, 5.6.

And in the US, by

-        Marco Andrey Cipriani Frade, Dario Júnior de Freitas Rosa, Fred Bernardes Filho, John Stewart Spencer1, Norma T. Foss . Semmes-Weinstein monofilament: A tool to quantify skin sensation in macular lesions for leprosy diagnosis. Indian Journal of Dermatology, Venereology and Leprology, 2021, 1-9.

Most of our distribution has been restricted to Brazil, though we will also be exporting to India early next year. 

 

Anthony R J Nicholl

SORRI-BAURU, Brazil

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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