FW: (LML) ENL and pregnancy

 

 

Leprosy Mailing List – December 11,  2019 

Ref.:    (LML) ENL and pregnancy

From:  Ben Naafs, Munnekeburen, the Netherlands

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Dear Pieter,

Concerning the remark of Wim Theuvenet about antacid's when clofazimine and prednisolone are prescribed. It is always wise when one prescribes prednisolone for a longer time to prescribe antacid's too, for the reason he presents. Concerning Clofazimine this gives according to me enteric irritation due to deposition of the crystals. I doubt know whether antacid's will be helpful here.

Whether there is specific damage to the gastric mucosa I do not know.

Thanks for the mentioning of the risk of occult bleeding when prescribing prednisolone, whether the use of clofazimine for the stomach needs it I do not know.

Regards,

Ben

Dermatologist and leprologist

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

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

Contact: Dr Pieter Schreuder  editorlml@gmail.co

 

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FW: (LML) Identification of authors of LML postings

 

Leprosy Mailing List – December 11,  2019 

Ref.:   (LML) Identification of authors of LML postings

From:  Joel Almeida, London and Mumbai

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Dear Pieter and colleagues,

Thanks to Prof. Frankel and Dr. Deepak for their thoughtful contributions. (LML 3 and 7 Dec 2019). The reflections below might be relevant.

I believe it can be helpful to hear from people who have experienced Hansen's Disease (HD). Similarly, from front-line workers in endemic countries who see exactly how the rubber hits the road. Not everyone with valuable insights has qualifications or titles, and not everyone with qualifications or titles gets the right end of the stick. 

 

Conventional notions of prestige are not always a good indicator of reliability. A notable example is Einstein, who was employed in a patent office as he developed the special theory of relativity. HD bacilli do not respect our notions of prestige. In the end, only the truth works. I once visited and learnt from the largely illiterate village women health workers (shashto shebikas) in Bangladesh that the key to high cure rates in TB was to minimise the delay between a missed dose and corrective action. They were bold, and justifiably proud of their high success rate. They said to patients: "Come to me and you will be cured. Go to the urban doctors and you will die." Observed cure rates showed that this was not entirely an exaggeration. Nobody is too humble to be believed, nor too grand to be questioned. 

 

It can be useful also to hear from highly talented people from endemic countries. They are over-represented among the CEOs of major corporations (such as Microsoft, Mastercard, Adobe etc). However, they are often under-represented in various global HD committees, and not always due to lack of knowledge or ability. It has sometimes taken decades or more for mind-sets to shift, and for world-class researchers in endemic countries to gain global prestige and financing commensurate with their contributions. The hard-nosed major corporations have been quicker to shift their mind-sets, and have been reaping the benefits (which they measure in dollars). If we invested core funding in the great population-based field programmes in endemic countries plus local high-tech facilities, we too would probably attract more top-notch talent into HD and reap the benefits (which we measure in DALYs saved per dollar invested - meaning less suffering among the people we all strive to serve, and a quicker end to HD).

 

Endemic countries can be a useful source of top-notch young talent. In order to attract new faces, it can help to foster an environment that gives greater weight to the merits of what is said than to who is saying it. Otherwise we might lack a critical mass of talent participating in HD work. Then, healthy discussion could be replaced by a "country club" approach where we merely reaffirm errors among ourselves and sometimes end up swimming against the tide of scientific knowledge. That might lead to stagnation, or worse, in the incidence rate of HD. It is better to keep learning from unexpected successes and failures. A field programme with dramatic positive impact is like a lighthouse that indicates a safe harbour. Whereas unexpected failures are like signals marking the location of dangerous rocks.

Reliability of contributions here (as elsewhere) can often be assessed from the quality of evidence and logical analysis. A contribution can be viewed together with dissenting voices, if any. The quality of evidence and logical analysis in each can be weighed. LML enables that process to happen openly and rapidly among nearly all of the world's knowledgeable HD experts. Errors tend to have a short half-life on LML. This boosts our chances of success.

 

However, there remains a good reason for examining authorship: to identify conflicts of interest, declared or undeclared. Our shared interest is to do what is best for the people we are all trying to serve. There can be other interests. It is good to remain alert to those, so that we can understand the context, and assess views appropriately.

 

We are all human, fallible, and we all make mistakes. There is no shame in that. We are all also capable of great things. We can keep helping and encouraging one another to correct errors, awaken our best selves, and get back on track, so that we can devise and implement programmes with excellent outcomes. Each of us can keep our minds open to valuable insights regardless of the authors. It's worth getting all this right because Shandong and Uele showed that 17 to 20% annual decline in incidence rate of HD is achievable. We understand the critical elements in those dramatically successful programmes. Therefore, we too can devise and implement programmes that succeed. Imagine a 20% decline per year in the incidence rate of new HD patients, as in Shandong. Wouldn't that be wonderful?

 

Regards, appreciation and gratitude to all,

Joel Almeida


PS. For those curious enough, the following paper illustrates some of my previous work in HD. Almeida, JG. A Quantitative Basis for Sustainable Anti-Mycobacterium leprae Chemotherapy in Leprosy Control Programs. Int J Lepr (1992) 60(2):255-268. Anyone who would like to know more is welcome to write to me through the LML editor.

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

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

Contact: Dr Pieter Schreuder  editorlml@gmail.co

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FW: (LML) ENL and pregnancy

 

Leprosy Mailing List – December 11,  2019 

Ref.:   (LML) ENL and pregnancy

From:  Wim Theuvenet, the Netherlands; Narang Tarun, India

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Dear Pieter,

In reply to the comments by Dr Ben Naafs:

When combining higher doses of Clofazamine in combination with corticosteroids, we prescribed antacids and used to monitor for occult gastrointestinal blood loss! Is that still advisable?

 

Best regards, 

 

 

Wim Theuvenet

Plastic Surgeon, Apeldoorn, the Netherlands

Formerly Reconstructive Surgeon, Anandaban Leprosy Hospital, Nepal

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Dear Pieter,

 

I would also like to point out here that methotrexate is also contraindicated during pregnancy, although azathioprine can be an option as it has been used in pregnant females with pemphigus.

 

However, the most important aspect of management of ENL is identifying the triggering factors and taking care of these.

 

Regards,

 

Narang Tarun

Chandigarh, India

(Note Editor: we would prefer, but we leave it up to you how and what, when writing a letter to LML to spell your complete name, your (previous) position and/or profession, and where you are stationed in order that others understands your background and your point of view in the discussion better)

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

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

Contact: Dr Pieter Schreuder  editorlml@gmail.co

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FW: (LML) ENL and pregnancy

 

 

Leprosy Mailing List – December 10,  2019

 

Ref.:   (LML) ENL and pregnancy

 

From:  Roberta Romero, Manila, Philippines

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Dear Pieter,

 

Thalidomide is an established teratogen and is banned in pregnant women.  I feel that there is no way around this caveat, hence, my belief is that it is unethical to give it to women who are not on double or triple contraceptives and/or who can not be relied upon to abstain.

 

There are reported newer biologicals that are anti tumor necrosis factor alpha, and appear safer than thalidomide to use in pregnancy.  I have no experience with these except in psoriasis.  I also think they are very expensive but may be obtained for compassionate use.

 

Best regards.

 

Dr Roberta Romero, FPDS

Director, Tropical Disease Foundation

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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: (LML) ENL and pregnancy

 

Leprosy Mailing List – December 10,  2019

Ref.:   (LML) ENL and pregnancy

From:  Ben Naafs, Munnekeburen, the Netherlands

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Correction: Ben wrote in his letter of December 9, 2019 to increase Dapsone from 50 to 100 mg daily. That was a mistake - it should have been Clofazimine from 50 to 100 mg daily. Please note!

Dear Pieter,

 

Dr. Ramesh Sharma (LML, December 6, 2019) puts forward a difficult and ethical question. It is scientifically difficult because we have few parameters to tell what will be the future. We assume that it will continue. What is her BI? Does she already have objective nerve involvement.

 

The one who has studied it was Elisabeth Duncan. I was with her in Alert. One thing she noticed was that patients on higher dose of clofazimine did better than the ones on Dapsone only, and the birthweight of the baby was higher. Give clofazimine 100mg daily instead of 50 and try to give prednisolone high dose only when the ENL is active and to down to zero within a month. When it starts again (even in the time you went down) you give the dose that suppressed ENL and go down again. Take care of the side effects of steroids. Medium dose steroids does not prevent a new ENL.

 

MTX would be a safer option than thalidomide. It is already after 3 months and I do not know the weight of the lady but I suspect low. So, 7,5 mg once a week with Folic acid not on the day that MTX is given may be added as maintenance to the intermittent steroids. But try steroids alone first.

 

The ethical question I have no solution. I think from the results of Duncan it is possible to keep the pregnancy. But when you consider the thalidomide the most crucial episode is already passed.

 

I hope this helps. Otherwise come back to me.

 

Regards and wisdom,

 

Ben

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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: (LML) Infolep monthly overview of new publications on leprosy, December 2019

 

Leprosy Mailing List – December 10,  2019

Ref.:   (LML) Infolep monthly overview of new publications on leprosy, December 2019

From:  Jiske Erlings, Amsterdam, the Netherlands

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Dear Pieter,

We are excited to announce the launch of the renewed Infolep website! What's new? More user-friendly design and navigation and improved search functionality.  Take a look and experience how navigating through 29,000 publications on leprosy has become much easier. We welcome any feedback for further improvements.   The portal is constantly updated with new content. Every month we send you an overview of (scientific) publications on leprosy recently added to the Infolep website. To search the full collection, please visit www.leprosy-information.org. With warm regards, Jiske Erlings Infolep Coordinator j.erlings@infolep.org

 

 

Highlighted publications

 

 

IASC Guidelines, Inclusion of Persons with Disabilities in Humanitarian Action, 2019. Inter-Agency Standing Committee, 2019.  Download report  Discussion paper: The gender dimensions of Neglected tropical diseases. The Access and Delivery Partnership, 2019. Download report

 

 

New publications

 

 

Reflections on the 201th International Leprosy Congress held in Manila, from Sept 10th to 13th, 2019 Leprosy review. 2019; 90 (4) : 482–486. Download PDF    Spatial distribution and temporal trends of leprosy in Uganda, 2012–2016: a retrospective analysis of public health surveillance data.  Aceng FL, Kawuma H, Majwala R, et al. BMC Infect Dis. 2019;19: 1016. Download PDF   Causes of death among persons affected by leprosy in Korea, 2010-2013. Ahn YH, Park H, Kweon SS. Am J Trop Med Hyg. 2019. Read abstract   Differential expression of IFN-γ, IL-10, TLR1, and TLR2 and their potential effects on downgrading leprosy reaction and erythema nodosum leprosum. Antunes DE, Goulart IMB, Lima MIS, et al.J Immunol Res. 2019;2019:3405103. Published 2019 Nov 7.  Download PDF   MicroRNAs in mycobacterial infection: Modulation of host immune response and apoptotic pathways. Agarwal RG, Sharma P, Nyati KK. Immune Netw. 2019 Sep 18;19(5):e30. Download PDF   Community stigma and desired social distance towards people affected by leprosy in Chandauli District, India. Ballering V B, Peters R, Waltz M, et al. Leprosy review. 2019 Download PDF   Leprosy Reactions In Childhood: A Prospective Cohort Study In The Brazilian Amazon. Bandeira SS, Pires CA, Quaresma JAS. Infect Drug Resist. 2019;12:3249–3257.  Download PDF   Leprosy post-exposure prophylaxis with single-dose rifampicin: toolkit for implementation.  Barth-Jaeggi T, Cavaliero A, Aerts A, et al. Lepr rev. 2019; 90(4). Download PDF   An exploration into the psychological impact of leprosy in Sirajganj, Bangladesh. Bow-Bertrand A, Pahan D, Mangeard-Lourme J. Leprosy review. 2019; 90 (4) : 399–417. Download PDF   Lepromatous leprosy, melanoma, and basal cell carcinoma: clinical-histopathologic association. Braghiroli CS, Parise-Fortes MR, Marques MEA, et al. An Bras Dermatol. 2019;94(5):586–589.  Download PDF   Levels of disability and relapse in Bangladeshi MB leprosy cases, 10 years after treatment with 6m MB-MDT.  Butlin C, Aung K, Withington S, et al. Leprosy review. 2019; 90 (4) : 388–398. Download PDF   What neglected tropical diseases teach us about stigma. Chang AY, Ochoa MT. Cutis. 2019;104(4):202–203.  Download PDF   Case-control study measuring the association between HLA-B*13:01 and dapsone hypersensitivity syndrome in Indian patients.  Chiramel M, George R, Daniel D, et al. Leprosy review. 2019; 90 (4) : 371–377. Download PDF   Odontogenic infections and leprosy reactions: A case-control study. Cortela D, Nogueira M, Junior A. Leprosy review. 2019; 90 (4) : 378– 387. Download PDF    The challenge of health-seeking: recollections of leprosy inpatients in post-elimination Nepal. Engelbrektsson U, Subedi M, Nicholls P. Leprosy review. 2019; 90 (4) : 433–443. Download PDF   Análise das incapacidades físicas por hanseníase em uma cidade do interior do Maranhão, Brasil / Analysis of physical disabilities by hanseníase in a city of the interior of Maranhão, Brazil.  Façanha, ATF et al. Research, Society and Development, Itabira, v. 9, n. 2, p. e75922055, jan. 2020. Download PDF   Genetics of leprosy: today and beyond.  Fava VM, Dallmann-Sauer M, Schurr E. Hum Genet. 2019 Nov 11. Read abstract   Mortalidade por hanseníase em contextos de alta endemicidade: análise espaço-temporal integrada no Brasil [Mortality from leprosy in highly endemic contexts: integrated temporal-spatial analysis in Brazil Mortalidad por lepra en zonas de alta endemicidad: análisis espacio-temporal integrado en Brasil]. Ferreira AF, de Souza EA, Lima MDS, et al. Rev Panam Salud Publica. 2019;43:e87.  Download PDF   Validation of a cross-NTD toolkit for assessment of NTD-related morbidity and disability. A cross-cultural qualitative validation of study instruments in Colombia. Fischer J, Jansen B, Rivera A, et al. PLoS One. 2019;14(12):e0223042.  Download PDF   Leprosy in the North and Northeast regions of Brazil: an integrated spatiotemporal approach. Fuentes Ferreira A, Amorim de Sousa E, Soledad Márdero García G, et al. Trop Med  Int Health. 2019 Nov 12. Read abstract   Scoping review: Community programs for people with leprosy. Gema MC, Carmen VC, Diana GG. Trop Med Int Health. 2019 Nov 12.  Read abstract   Knowledge on leprosy and its management among primary healthcare providers in two districts of Bangladesh. Kabir H, Hossain S. BMC Health Serv Res. 2019 Nov 4;19(1):787. Download PDF   Ultrasonography versus clinical examination in detecting leprosy neuropathy.  Kumaran M, Thapa M, Narang T, et al. 2019; 90 (4) : 364– 370. Download PDF   Current status of neglected tropical diseases (NTDs) in the Philippines. Leonardo L, Hernandez L, Magturo TC, et al. Acta Trop. 2019;105284.  Read abstract   PGL-1 and LID-1 antibody levels in HIV-infected and HIV-uninfected individuals in a Hansen's disease (leprosy) endemic area of Brazil. Madureira BP, de Carvalho FM, Pessolani MC, Immunobiology. 2019;S0171-2985(19)30282-7.  Read abstract   Quantitative PCR for leprosy diagnosis and monitoring in household contacts: A follow-up study, 2011-2018. Manta FSN, Barbieri RR, Moreira SJM, et al. Sci Rep. 2019 Nov 13;9(1):16675. Download PDF   Desenvolvimento de uma cartilha para a promoçao do autocuidado na hanseníase./ Development of a booklet for self-care promotion in leprosy. Martins R, Dias Í, Sobreira C, et al. Revista de Enfermagem UFPE on line. Revista de Enfermagem, UFPE Online. 2019. Download PDF   Ulcers in leprosy patients, an unrecognized clinical manifestation: a report of 8 cases.  Miyashiro D, Cardona C, Valente, NYS. et al. BMC Infect Dis. 2019; 19: 1013. Download PDF   Trends and patterns of leprosy over a decade in a tertiary care hospital in Northern India: A retrospective analysis. Mushtaq S, Dogra N, Dogra D, Faizi N. Indian J Dermatol Venereol Leprol. 2019 Nov 14. Download PDF   Protocol, rationale and design of PEOPLE (Post ExpOsure Prophylaxis for LEprosy in the Comoros and Madagascar): a cluster randomized trial on effectiveness of different modalities of implementation of post-exposure prophylaxis of leprosy contacts.  Ortuno-Gutierrez, N., Younoussa, A., Randrianantoandro, A. et al. BMC Infect Dis. 2019;19, 1033. Download PDF    Epidemiological, clinical and immune factors that influence the persistence of antiphospholipid antibodies in leprosy. Ribeiro SLE, Pereira HLA, Boechat AL, et al. Adv Rheumatol. 2019;59(1):52. Published 2019 Nov 28.  Download PDF   Leprosy in children: a Cuban experience on leprosy control. Ruiz-Fuentes JL, Rumbaut Castillo R, Hurtado Gascón LC, et al. BMJ Paediatr Open. 019;3(1):e000500.  Download PDF   Diagnostic test using monofilament compared to electroneuromyography (ENMG) for detection of peripheral neuropathy in leprosy at Sanglah General Hospital, Bali-Indonesia.  Rusyati L, Sasmita P, Adiguna M. Bali Medical Journal 8(3). Download PDF   Analysis of factors affecting self care in kusta patients in Daha Husada Kediri Hospital.  Santoso H, Nurdina N, Nurwijayanti N. Journal for Quality in Public Health . 2019.   Late reversal reaction with resistant Mycobacterium leprae: an emerging paradigm. Sardana K, Mathachan SR, Agrawal D, et al. Trop Doct. 2019 Nov 9:49475519884421.  Read abstract   Epidemiological aspects of leprosy. Sarode G, Sarode S, Anand R, et al. Disease-a-Month. 2019. Read abstract   Isolation of Mycobacterium lepromatosis and development of molecular diagnostic assays to distinguish M. leprae and M. lepromatosis. Sharma R, Singh P, McCoy R, Cet al. Clin Infect Dis. 2019 Nov 16.  Download PDF   Neuritic leprosy; An intriguing re-visit to a forbidden ailment. Shrestha BK, Ranabhat K, Pant R, et al. Kathmandu Univ Med J (KUMJ). 2019 Jan.-Mar;17(65):73-76. Download PDF   Serological and molecular detection of infection with Mycobacterium leprae in Brazilian six banded armadillos (Euphractus sexcinctus). da Silva Ferreira J, de Carvalho FM, Vidal Pessolani MC, et al. Comp Immunol Microbiol Infect Dis. 2019;68:101397.  Download PDF   Molecular characterization of environmental mycobacterial species from leprosy endemic tribal regions of North Purulia District, West Bengal. Singh V, Turankar RP, Goel A. Int J Mycobacteriol. 2019;8(4):381–389.  Download PDF   Implementation of active case detection of visceral leishmaniasis along with leprosy through female community health volunteers in Sarlahi District, Nepal. Singh VK, Joshi AB, Gurung CK, Banjara MR. Kathmandu Univ Med J (KUMJ). 2019 Jan.-Mar;17(65):40-45. Download PDF   Trend of leprosy detection rate in Brazil, 1990 to 2016. Souza CDF, Santos FGB, Leal TC, et al. An Bras Dermatol. 2019;94(5):603–607. Download PDF   Lack of evidence for the presence of leprosy bacilli in red squirrels from North-West Europe. Tió-Coma M, Sprong H, Kik M, et al. Transbound Emerg Dis. 2019 Nov 16. Read abstract   Whole blood RNA signatures in leprosy patients identify reversal reactions before clinical onset: a prospective, multicenter study. Tió-Coma M, van Hooij A, Bobosha K, et al. Sci Rep. 2019;9(1):17931. Published 2019 Nov 29.  Download PDF   Government of India initiative against leprosy-We should be aware. Venkatesan S, Thangaraju P. J Family Med Prim Care. 2019 Sep 30;8(9):3072-3073. Download PDF   Oral manifestation in leprosy: A cross-sectional study of 100 cases with literature review. Vohra P, Rahman MSU, Subhada B, et al. J Family Med Prim Care. 2019;8(11):3689–3694.  Download PDF

 

 

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Journals & Newsletters

 

 

Disability, CBR & Inclusive Development: http://dcidj.org/ Hansenologia Internationalis: http://www.ilsl.br/revista/atual.php Indian Journal of Leprosy: http://www.ijl.org.in/index.html Leprosy Review: https://www.lepra.org.uk/leprosy-review Leprosy Review Repository (1928-2001): http://leprev.ilsl.br/arquivo.php Plos Neglected 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: https://www.shf.or.jp/information/g/ambassador?lang=en

 

 

Websites & Services

 

 

WHO Global Leprosy Programme https://www.who.int/lep/en/ The Global Partnership for Zero leprosy http://zeroleprosy.org/ LML - Leprosy Mailing List - a free moderated email list that allows all persons interested in this theme to share ideas, information, experiences, and questions. https://groups.google.com/forum/#!forum/leprosymailinglist Fontilles y la lepra en España / Fontilles and leprosy in Spain http://www.cervantesvirtual.com/portales/fontilles_y_la_lepra_en_espana/ Association des Léprologues de Langue Francaise (ALFF) https://allf.medicalistes.fr/ InfoNTD - Information on cross-cutting issues in Neglected Tropical Diseases (NTDs) https://www.infontd.org/

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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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