Advances in the treatment of reactions in leprosy.

Morbidity in leprosy is almost always due to reactions. Similarly, to a great extent, deformities in leprosy are the consequence of reactions occurring both in borderline patients (type 1 or reversal reactions) and in lepromatous patients (type 2 or ENL reactions). Over the last three decades, work has centred around finding who are prone to getting the reactions, identifying the risk factors and improving the management of reactions in order to alleviate quickly the suffering and prevent and reverse nerve damage consequent to reactions. Though several new drugs have been tried and found somewhat useful, corticosteroids and thalidomide continue to be the mainstay in the management of leprosy reactions. A brief review of the current understanding is presented.

Leprosy situation in the slums of Agra City--epidemiological findings.

The present article is the result of a study of the leprosy caseload in Agra City and is based on a house-to-house survey conducted during April-July 2003 in 5 areas. During the survey 198,150 persons were examined, and 287 cases were detected, giving a prevalence rate of 14.5/10,000. A majority of them (92%) were new cases, detected and diagnosed for the first time. The patient load was found to be unevenly distributed with comparatively more number of patients in areas such as Jamuna Kinara, Shah Ganj and Lohamandi. Among the 264 newly detected cases, 14.8% were of MB type. Overall deformity of grade > or = 2 was seen in 2.8% of patients--0.4% in PB and significantly high at 18% in MB leprosy. The observations reveal that leprosy is endemic in slum areas of Agra City.

Protective sensibility--its monofilament nylon threshold equivalents in leprosy patients.

An attempt has been made to definite the levels of "protective sensibility" in terms of perception thresholds to monofilament nylon induced touch/pressure stimuli. Certain problems were observed while interpreting the observations. There appears to be a range of threshold values instead of a clear cut-off point. We suggest that a monofilament nylon stimulus two times the normal threshold value for that patient be taken as cut-off point. This will make the observations of Birke and Sims (1986) and Hammond and Klenerman (1987) reasonable without having any need to exclude the cases who defy the boundaries laid by them. Since the genesis of plantar ulcer is multifactorial, it appears logical to include all patients who have a certain degree of hypoaesthesia, for special ulcer care program. The likely problems while using monofilament nylons in the field and their possible solutions have also been outlined.

Sensory functions in limbs of normal persons and leprosy patients with peripheral trunk damage.

The threshold to touch was tested in hands and feet of normal persons using Semmes-Weinstein graded monofilament nylons. The minimum stimulus to which response could be elicited was nylon number 3.61 in palms and 4.31 in soles. These numbers relate to the logarithm of the force applied, 3.61 corresponding to 0.217 gm force and 4.31 to 2.35 gm force respectively. The area of pain insensitivity complained by the patient more or less corresponds to that revealed by objective testing. It was interesting to observe that loss of pain sensitivity was confined to a smaller area compared to touch and thermal insensibility in the part innervated by the same nerve trunk.

Bioavailability of dapsone on oral administration of Dapsomine--a comparative evaluation.

This study describes a comparative evaluation of dapsone kinetics in humans on administration of Dapsomine, a capsule containing dapsone 100 mg dispersed in oily-base suspension of clofazimine 50 mg. Seven untreated lepromatous leprosy patients were given one capsule of Dapsomine a day for seven days and the pharmacokinetics parameters in this group were compared with those from another group of seven patients who received dapsone 100 mg and clofazimine 50 mg separately. There were no statistically significant differences in parameters such as peak dapsone plasma concentration (Cmax), basal plasma level (C24h), time to peak level (tmax), absorption half-life (t1/2 alpha), elimination half-life t1/2 beta) and areas under plasma concentration-time curves (AUC0-8h) and AUC0-24h) between the two groups.

Drug compliance among self-motivated leprosy patients.

Regularity of DDS intake among 366 leprosy patients attending our out patient department voluntarily was assessed by urine spot test. It was found that only 54.6% of them had taken their last dose of drug within the previous three days. Those who kept their appointment showed better compliance than those who did not. Urinary DDS positivity was found to be unrelated to sex, occupation or the type of the disease. In the younger age group the compliance was low, as also among the patients coming from nearby places as compared to those who were residing in far off districts.

Short course treatment of paucibacillary (TT/BT) leprosy cases.

A study has been undertaken wherein (TT/BT) cases with less than 5 lesions have been given DDS for 12 months alone or in combination with steroids for initial 1 month or rifampicin for initial one week. It has been found that only about three fourths of the cases become disease inactive in 12 months period. Follow up of 15 to 21 months in the post treatment period has shown a relapse rate of 6.33 per 1000 patient months. There was no difference in number of relapses occurring in the three regimens i.e. with or without rifampicin. Half the relapses were primarily in the nerves. During the course of treatment, a slightly higher number of patient in the DDS group had nerve problems as compared to group wherein additional steroids had been given.

A study of some pharmacological actions of carbamazepine and sodium valproate.

Carbamazepine (CA) and sodium valproate (SV) were studied for their actions of central nervous system and neuromuscular junction. CA and SV given ip neither possessed analgesic nor hypothermic activity in rats, nor did they alter the pentobarbitone sleeping time in mice. The drug had no effect on the frog rectus muscle nor did they alter its responses to acetylcholine. Both CA and SV produced a dose related decrease in indirectly evoked contractions of rat diaphragm and cat gastrocnemius muscle without much altering the directly evoked responses. This effect may be due to their local anaesthetic property, which was observed in infiltration test in guinea pigs.

Anorectic effect of SK & F 38393, a new dopamine agonist in rats.

Anorectics are clinically used in the management of obesity to accept dietary restriction through decreased desire of food intake. The present study, indicates that the drug SK & F 38393 a dopamine agonist given to albino rats at the doses of 1 mg/kg and 5 mg/kg caused decreased food intake. Central side effects observed with amphetamine and other related drugs were not observed with this drug. The drug thus may be used as an anorectic agent without central side effects.