Tuesday, April 23, 2019

(LML) Treatment for neuropathic pain

Leprosy Mailing List – April 23,  2019

Ref.:   (LML) Treatment for neuropathic pain

From:  Francine Brandão, Rio de Janeiro, Brazil


 

 

Dear Pieter,

 

In my master study I noted that there were many patients with re-entrant neuropathy, making use of corticosteroids for more than 6 years. Those were patients who were already discharged from polychemotherapy.

 

Dr. Didier Bouhassira, a neurologist at Ambroise-Paré Hospital in Boulogne-Billancourt, told me recently that in France they use a capsaicin-based patch for the treatment of neuropathic pain in diabetes. Is anybody aware of this treatment and has this been tried in leprosy?

 

It seems that long time steroids are still used for the treatment of neuropathic pain in leprosy at least in Brazil. What would be the most effective anti-neuropathic (pain) treatments not using steroids?

 

 

Sincerely,

 

Francine Brandão


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

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

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

 


(LML) Learning from unexpected success






Leprosy Mailing List – April 23,  2019

Ref.:  (LML)   Learning from unexpected success

From:  Joel Almeida, London and Mumbai


Dear Pieter,


Evidence about the endemic is revealing.





Figure 1. Analysis of number of newly detected people with MB reported globally, by year of detection. (Almeida, based on data from: WHO, Weekly Epidemiological Records)


The average decline in newly detected people with MB is calculated to be less than 0.5% per year. Transmission continues, including to children. More people with MB were newly detected in 2017 than in 1985, although this is partly due to altered definitions of MB.


Contrast this global picture with Shandong Province.




Figure 2. Analysis of number of newly detected people with MB in Shandong Province by year of detection. (Almeida, based on data from: Li et al, Int J Lepr (1985) 53(1): 79-85)


The decline in newly detected people with MB is calculated to be about 15% per year in Shandong Province. The decline has continued relentlessly, through to near-zero transmission. (3)


What explains the enormous difference in decline between the global situation (Fig. 1) and Shandong (Fig. 2)?


The disease is initiated by bacilli. Bacilli infect hosts according to the infectious dose 50 (ID50, the inoculum required to infect 50% of a population). Hosts with genetically-linked anergy innately tend to have a much smaller ID50 than do others. Further, unprotected persons with anergy (LLp) can harbour and shed more bacilli than do hundreds of thousands of persons with a well-defined single small skin patch but no other signs of disease. A single well-defined small patch is often a sign of a healthy immune response, typically resulting in zero infectiousness and self-healing without sequelae. The bacilli have a better chance of prolonged survival outside hosts than within such self-healing persons who have a healthy immune response.


The whole of India reports about 130,000 newly detected patients each year, including many with excellent innate immunity. So, the number of bacilli that can be shed by even one unprotected person with anergy can play a hugely disproportionate and critical role in maintaining the endemic. (The lack of protection, incidentally, is not the fault of the person with anergy.) The demonstrated viability of bacilli in shaded Indian environments, for at least 5 months (4), aggravates the situation. The greater the environmental concentration of viable bacilli, the greater the risk that an unprotected person with genetically-linked anergy will be infected or re-infected. The endemic is therefore probably kept alive largely by transmission from one genetically anergic person to another, including via the environment.


Shandong Province ensured prolonged anti-microbial protection for persons with anergy. By contrast, we currently allow re-infection of persons with anergy (LLp) after withdrawal of MDT. This can, to an important extent, explain the differing rates of decline in Shandong (Fig. 2) and globally (Fig. 1).


Did BCG, too, aid the observed decline of Hanseniasis in Shandong Province? Not very much. BCG was introduced to Shandong in only about 1978.

Was the decline attributable entirely to an increase in per capita GDP? Not entirely. Compare the per capita GDPs, over time, of China and India:







Figure 3. Comparison of GDP per capita in China (top) and India (bottom) over time. (Almeida, based on data from World Bank)


Both countries achieved a USD500 GDP per capita in the 1980s. India has well over half of the world's newly detected patients, and made a dominant contribution to Figure 1 data.


The observed difference can be explained, to an important extent, by prolonged anti-microbial protection for persons with LLp in Shandong province. Therefore, anti-microbial protection for LL patients after the standard duration of MDT is likely to be, by far, the most effective and important form of chemoprophylaxis.  It protects persons with anergy against re-infection (5), and ensures that they cannot contribute to the environmental pool of bacilli. That decreases the reproductive ratio of LLp patients, the number of LLp patients arising as a consequence of one index LLp patient. Once this reproductive ratio falls and stays below one, the endemic begins its terminal decline. Shandong's success illustrates this process.


We have so far omitted the critical step that can help interrupt transmission: prolonged anti-microbial protection for persons with LLp. It would be good to provide this critically important intervention, including by identifying persons with LL at diagnosis. Slit skin smears are very helpful for such classification at diagnosis.


Funders interested in showing similar success could usefully sponsor one or more demonstration projects in endemic countries. Demonstration projects allow us to succeed, or to learn why not.


Wouldn't it be great more effectively to save human nerves, eyes, limbs, minds, livelihoods and relationships? Wouldn't it be wonderful to defeat the bacillus? Shandong succeeded. So, probably, can all of us.


शान्दोंग प्रांत ने LLpolar वाले व्यक्तियों को लंबे समय तक एंटी माइक्रोबियल सुरक्षा प्रदान की। इसके विपरीत, वैश्विक नीति ने MDT के बाद LLpolar वाले व्यक्तियों के पुन: संक्रमण की अनुमति दी। इसके कारण, शान्दोंग में बीमारी की गिरावट वैश्विक औसत से लगभग 30 गुना अधिक तेजी से हुई। शान्दोंग ने लगभग शून्य संचरण हासिल किया। हम भी शायद इस तरह से सफल हो सकते हैं।


A província de Shandong forneceu proteção antimicrobiana prolongada para pessoas com LLpolar / anergia. Pelo contrário, a política global permitiu a re-infecção de pessoas com LLpolar após a PQT. Devido a isso, o declínio da doença em Shandong foi quase 30 vezes mais rápido que a média global. Shandong conseguiu quase zero transmissão. Nós também provavelmente podemos ter sucesso dessa maneira.


La province du Shandong a fourni une protection antimicrobienne prolongée aux personnes atteintes de LLpolar / anergy. Au contraire, la politique mondiale a permis la réinfection des personnes atteintes de LLpolar après la PCT. Pour cette raison, le déclin de la maladie dans le Shandong a été presque 30 fois plus rapide que la moyenne mondiale. Le Shandong a réalisé une transmission presque nulle. Nous aussi pouvons probablement réussir de cette façon.


Joel Almeida


References

1. WHO. Weekly Epidemiological Records, various. 1997-2018

2. Li Huan-Ying, Pan Yu-Lin, and Wang Yang. Leprosy Control in Shandong Province, China,1955-1983; Some Epidemiological Features. Int J Lepr (1985) 53(1): 79-85.

3. Shumin Chen, Yunchun Zheng, Min Zheng, Demin Wang. Rapid survey on case detection of leprosy in a low endemic situation, Zhucheng County, Shandong Province, The People's Republic of China. Lepr Rev (2007) 78, 65–69.

4. Desikan KV, Sreevatsa. (1996) Extended studies on the viability of Mycobacterium leprae outside the human body. Lepr Rev 66(4):287-95 

5. Stefani MMA, Avanzi C, Bührer-Sékula S et al. Whole genome sequencing distinguishes between relapse and reinfection in recurrent leprosy cases. PLoS Negl Trop Dis (2017) 11(6): e0005598.


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, April 19, 2019

(LML) InfoNTD monthly e-newsletter on NTDs and cross-cutting issues - April 2019

Leprosy Mailing List – April 19,  2019

Ref.:  (LML)  InfoNTD monthly e-newsletter on NTDs and cross-cutting issues - April 2019

From:  Roos Geutjes, Amsterdam, the Netherlands


Dear colleagues,

This month, InfoNTD was present during the NNN Disease Management Disability and Inclusion (DMDI) working group spring meeting. Besides delivering a presentation on the future plans of InfoNTD, it was a great opportunity to learn more on stigma and mental wellbeing which was a topic extensively discussed. In this newsletter you will find two relevant publications on this important topic.  

Additionally, our partner CBM has launched a new Community Mental Health Initiative which aims to promote meaningful participation in communities, improve the quality of life, and broaden the choices for care available for people with psychosocial disabilities. Good luck with this great initiative CBM! 

Primary prevention, control of NTDs and management of NTD-related disabilities relies heavily on access to safe water, sanitation, and hygiene (WASH). Building on the need for better coordination between WASH and NTD interventions, you will find no less than seven WASH related articles. 

If you have certain information requests, do not hesitate to contact us. Should you come across interesting publications or have you published an interesting article on any of the cross-cutting NTD issues yourself, we would appreciate receiving your input for sharing. Together we learn. 

Roos Geutjes,

InfoNTD Coordinator
www.InfoNTD.org
info@InfoNTD.org

New publications

A major hurdle in the elimination of urogenital schistosomiasis revealed: Identifying key gaps in knowledge and understanding of female genital schistosomiasis within communities and local health workers.
Kukula V, Macpherson EE, Tsey I, Stothard RJ, Theobald S, Gyapong M. PLoS neglected tropical diseases. 2019; 13(3):e0007207.
Abstract Urogenital schistosomiasis is endemic throughout Ghana with elevated infection levels in certain areas e.g. Lake Volta Region. While the primary focus of the national control program is on mass drug administration of praziquantel to school-aged children, Female Genital Schistosomiasis (FGS), a disease-specific affliction of girls and women, has been largely overlooked. To better focus future actions, our study investigated the perceptions, knowledge and understanding of FGS amongst community members and health providers.
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Neglected tropical diseases and disability-what is the link?
Kuper H. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2019.
Abstract Neglected tropical diseases (NTDs) are a diverse group of infectious conditions that vary in their epidemiology, impact and control. Many NTDs have long-term consequences, such as visual and physical impairments. As a result, people with NTDs may have difficulties in carrying out activities or participating in society-in other words, NTDs can cause disabilities. Additionally, NTDs are often strongly linked to stigma and can have mental health consequences. It is therefore important to incorporate rehabilitation within NTD programmes. Without incorporating disability within NTD programmes, the quality of life of people with NTDs will suffer and global targets for elimination and management of NTDs will not be met.
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Report of the Interregional meeting on leishmaniasis among neighbouring endemic countries in the Eastern Mediterranean, African and European regions, Amman, Jordan, 23–25 September 2018.
WHO
Regional Office for the Eastern Mediterranean; 2019. Licence: CC BYNC-SA 3.0 IGO.
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Editorial Perspectives: we need innovation for water, sanitation, and hygiene (WASH) in developing communities
Guest JS. Environmental Science: Water Research & Technology. 2019.
Download PDF
 


Primary health care nurses attitude towards people with severe mental disorders in Addis Ababa, Ethiopia: a cross sectional study.
Sahile Y, Yitayih S, Yeshanew B, Ayelegne D, Mihiretu A. International Journal of Mental Health Systems. 2019; 13(26).
Abstract Negative attitude and discriminatory behavior of health professionals constitute a major obstacle in psychiatric care and have been pointed out as a key issue in working with mental illness. Understanding about the attitude of nurses is crucial for quality and holistic care of psychiatric services and essential for the successful integration of mental health into primary health care. However, there is a paucity of study to examine the attitude of primary health care nurses towards severe mental disorder in Ethiopia. Therefore, this study aimed to assess the attitude of primary health care nurses and its associated factors towards people with severe mental illness in Addis Ababa.
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The paediatric participation scale measuring participation restrictions among former Buruli Ulcer patients under the age of 15 in Ghana and Benin: Development and first validation results.
Beeres DT, Horstman J, van der Tak P, Phillips RO, Abass KM, van der Werf T, et al.. PLoS neglected tropical diseases. 2019; 13(3):e0007273.
Abstract Buruli Ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Former BU patients may experience participation restrictions due to physical limitations, stigmatization and other social factors. A scale that measures participation restrictions among children, who represent almost half of the affected population, has not been developed yet. Here, we present the development of a scale that measures participation restrictions in former BU paediatric patients, the psychometric properties of this scale and the scales' results.
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Estimating the current burden of Chagas disease in Mexico: A systematic review and meta-analysis of epidemiological surveys from 2006 to 2017.
Arnal A, Waleckx E, Rico-Chávez O, Herrera C, Dumonteil E. PLoS neglected tropical diseases. 2019; 13(4):e0006859.
Abstract Our analysis suggests a disease burden for T. cruzi infection higher than previously recognized, highlighting the urgency of establishing Chagas disease surveillance and control as a key national public health priority in Mexico, to ensure that it does not remain a major barrier to the economic and social development of the country's most vulnerable populations.
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Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally.
Naslund JA, Shidhaye R, Patel V. Harvard review of psychiatry. 2019.
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Challenges and opportunities for control and elimination of soil-transmitted helminth infection beyond 2020.
Freeman MC, Akogun O, Belizario V, Brooker SJ, Gyorkos TW, Imtiaz R, et al.. PLoS neglected tropical diseases. 2019; 13(4):e0007201.
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Risk factors for infection with soil-transmitted helminths during an integrated community level water, sanitation, and hygiene and deworming intervention in Timor-Leste.
Vaz Nery S, Clarke NE, Richardson A, Traub R, McCarthy JS, Gray DJ, et al.. International journal for parasitology. 2019.
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WASH in health care facilities: global baseline report 2019. Geneva: World Health Organization and the United Nations Children's Fund (UNICEF), 2019. Licence: CC BY-NC-SA 3.0 IGO
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WASH from the START: Water, Sanitation and Hygiene Education in Preschool
Wagner JT, Pramling Samuelsson I. International Journal of Early Childhood. 2019. 31273131137124425(4611101448).
Read abstract
 


Dermatologic simulation of neglected tropical diseases for medical professionals.
Mankbadi M, Goyack L, Thiel B, Weinstein D, Simms-Cendan J, Hernandez C. MedEdPORTAL : the journal of teaching and learning resources. 2016; 1210525.
Abstract While patients with neglected tropical diseases may present for care in the United States, they are encountered so infrequently that medical professionals may have little chance of being exposed to these illnesses during training. This simulation on dermatological presentations of neglected tropical diseases was used as a teaching tool for multifaceted topics including disease management, interdisciplinary collaboration, and sociocultural issues. To achieve this goal, we created four cases with patients demonstrating clinical and dermatological presentations.
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Efectve and needed, but not used: Why do mobile phonebased health interventons in Africa not move beyond the project status?
Stephani V. Berlin: Technische Universität Berlin; 2019.
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Surgical Considerations for Pediatric Snake Bites in Low- and Middle-Income Countries.
Hernandez MC, Traynor M, Bruce JL, Bekker W, Laing GL, Aho JM, Kong VY, Klinkner DB, Zielinski MD, Clarke DL. World journal of surgery. 2019.
Abstract Snake envenomation is associated with major morbidity especially in low- and middle-income countries and may require fasciotomy. We determined patient factors associated with the need for fasciotomy after venomous snake bites in children located in KwaZulu-Natal, South Africa.
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Tropicality and abjection: What do we really mean by "Neglected Tropical Diseases"?
Shahvisi A. Developing world bioethics. 2019.
Abstract Neglected tropical diseases are defined operationally as diseases that prevail in "tropical" regions and are under-researched, under-funded, and under-treated compared with their disease burden. By analysing the adjectives "tropical" and "neglected," I expose and interrogate the discourses within which the term "neglected tropical disease" derives its meaning. First, I argue that the term "tropical" conjures the notion of "tropicality," a form of Othering which erroneously explains the disease-prevalence of "tropical" regions by reference to environmental determinism, rather than colonialism and neocolonialism. Second, I examine the way in which this Othering enables the abjection of tropical regions and their peoples, leading to neglect. I recommend that the term "neglected tropical diseases" be more carefully contextualised within health scholarship, education, and policy.
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Geographical distribution and prevalence of podoconiosis in Rwanda: a cross-sectional country-wide survey
Deribe K, Mbituyumuremyi A, Cano J, Bosco MJ, Giorgi E, Ruberanziza E, et al.. Lancet Glob. Health 2019. 
Abstract Podoconiosis is a type of tropical lymphoedema that causes massive swelling of the lower limbs. The disease is associated with both economic insecurity, due to long-term morbidity-related loss of productivity, and intense social stigma. Reliable and detailed data on the prevalence and distribution of podoconiosis are scarce. We aimed to fill this data gap by doing a nationwide community-based study to estimate the number of cases throughout Rwanda.
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Contextualizing Schistosoma haematobium transmission in Ghana: assessment of diagnostic techniques and individual and community water-related risk factors.
Kulinkina AV, Kosinski KC, Adjei MN, Osabutey D, Gyamfi BO, Biritwum N-, et al.. Acta tropica. 2019.
Abstract The study assessed associations between Schistosoma haematobium infection (presence of parasite eggs in urine or hematuria) and self-reported metrics (macrohematuria, fetching surface water, or swimming) to evaluate their performance as proxies of infection in presence of regular preventive chemotherapy. It also examined community water characteristics (safe water access, surface water access, and groundwater quality) to provide context for schistosomiasis transmission in different types of communities and propose interventions.
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Neglected tropical diseases: elimination and eradication.
Bodimeade C, Marks M, Mabey D. Clinical medicine (London, England). 2019; 19(2):157-160.
Abstract The term neglected tropical diseases (NTDs) describes a disparate group of diseases which affect populations living in poverty and are important causes of morbidity and mortality worldwide. Global programmes for the control of NTDs benefit large-scale donations made by pharmaceutical companies. A number of NTDs have internationally agreed targets for their control, elimination and eradication. Eradication is defined as the permanent reduction to zero of the worldwide incidence of infection. Elimination is defined as the reduction to zero of the incidence of infection in a specified geographic area. Considerable progress has been made towards elimination and eradication of some NTDs but unexpected new challenges have emerged which threaten the eventual achievement of these goals.
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Mapping of lymphatic filariasis in loiasis areas: A new strategy shows no evidence for Wuchereria bancrofti endemicity in Cameroon.
Wanji S, Esum ME, Njouendou AJ, et al.. PLoS neglected tropical diseases. 2019; 13(3):e0007192.
Abstract. Mapping of lymphatic filariasis (LF) caused by Wuchereria bancrofti largely relies on the detection of circulating antigen using ICT cards. Several studies have recently shown that this test can be cross-reactive with sera of subjects heavily infected with Loa loa and thus mapping results in loiasis endemic areas may be inaccurate.
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Epidemiological features of a recent zoonotic cutaneous leishmaniasis outbreak in Zagora province, southern Morocco.
El Hamouchi A, Daoui O, Ait Kbaich M, Mhaidi I, El Kacem S, Guizani I, et al.. PLoS Negl Trop Dis 2019;13(4): e0007321.
Abstract Leishmania major is an endemic vector-borne disease in Morocco that causes zoonotic cutaneous leishmaniasis (ZCL), especially in arid pre-Saharan regions where its unique vector and reservoir are Phlebotomus papatasi and Meriones shawi, respectively, and may cause epidemics. In late 2017, the Zagora province, an endemic focus for ZCL in southern Morocco, had CL outbreak. The main objective of our investigation was to analyze the epidemiological features of this latest ZCL outbreak.
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Highlighting Operational and Implementation Research for Control of Helminthiasis
Keiser J. First edition 2019 Elsevier Ltd. 2019.
Abstract Highlighting Operational and Implementation Research for Control of Helminthiasis, Volume 103 in the Advances in Parasitology series, includes medical studies of parasites of major influence, along with reviews of more traditional areas, such as zoology, taxonomy and life history, all topics which help to shape current thinking and applications. This latest release includes chapters on Helminthiasis Epidemiology and Control: Scoring Successes and Meeting the Remaining Challenges, Worms, History and Swiss TPH, Mobile Microscopy, Combination Chemotherapy, DNDi Portfolio, Pediatric Praziquantel, lessons learned, and Community and Drug Distributor Perceptions and Experiences of Mass Drug Administration for the Elimination of Lymphatic Filariasis, amongst other topics.
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Water and health: From environmental pressures to integrated responses.
Boelee E, Geerling G, van der Zaan B, Blauw A, Vethaak DA. Acta tropica. 2019; 193217-226.
Read abstract
 


Is 2030 too soon for Africa to achieve the water and sanitation sustainable development goal?
Nhamo G, Nhemachena C, Nhamo S. The Science of the total environment. 2019; 669129-139.
Abstract Water-Sanitation-Hygiene (WASH) remains vital for the 2030 Agenda for Sustainable Development, yet many countries have not localised the 17 Sustainable Development Goals (SDGs), including SDG 6, which focuses on ensuring the availability and sustainable management of water and sanitation for all.
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Project Implementation Management Modalities and Their Implications on Sustainability of Water Services in Rural Areas in Ethiopia: Are Community-Managed Projects More Effective?
Senbeta F, Shu Y. Sustainability. 2019; 1137(6).
Abstract The study examines the impact of project implementation management approaches on the sustainability outcomes of rural water services in Ethiopia. The result showed the existence of a significant difference in most of the sustainability variables among project implementation management modalities under the study. As to the findings, the community-managed project approach generated a relatively higher and statistically significant sustainability outcome as compared to the others. Nevertheless, environmental sustainability indicators lack a statistically significant relationship. Overall, the key findings suggest that, in addition to demand-driven interventions, if the communities are empowered with the management and decision-making role of constructing their water points, the benefits of continuous delivery and sustainability of services can be maximized.
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GDPR & the InfoNTD newsletter

 
New EU data protection regulations came into force on 25 May 2018. We have been reviewing our practices with regards to the GDPR, including our privacy statement and mailing list. InfoNTD sends out monthly e-mails to its subscribers with an overview of recent publications on NTDs and cross-cutting issues. The purpose of this activity is to keep subscribers up to date. InfoNTD will only process the data we have (names, email addresses) for the purpose of sending you the newsletter. We take your security seriously and will never share your contact details with anyone else. You can update your preferences or unsubscribe from this list at any time.


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

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

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