Lepra reactions in new leprosy cases at diagnosis: a study of 50 Pakistani patients

2020 ◽  
pp. 1-14
Author(s):  
Rabia Ghafoor ◽  
Muhammad Irfan Anwar ◽  
Mutaher Zia ◽  
Admin
Keyword(s):  
Disease Transmission ◽  
Early Recognition ◽  
Initial Diagnosis ◽  
Female Ratio ◽  
Pakistani Population ◽  
Erythema Nodosum Leprosum ◽  
Male Female Ratio ◽  
Medical Histories

Abstract Objective: To determine the occurrence and characteristics of the two types of lepra reactions, in new leprosy cases at initial diagnosis, in a Pakistani population. Methods: This retrospective descriptive study was done at MALC Karachi .All new leprosy cases who were registered at MALC during a two-and-a-half year period were enrolled. Their medical records were checked and selected all cases who had presented with a lepra reaction, at initial diagnosis. A total of 50 such cases were identified. Data was then collected from their medical histories, physical examination records and laboratory investigation reports. Results: Out of the total 50 cases in this study, 2 (4%) were children and 48 (96%) were adults. Male-female ratio was 4.6:1. 30 (60%) cases presented with a type 1 reaction and 20 (40%) with type 2. 30 (60%) cases were classified as borderline lepromatous (BL). Among these 17 (57%) had a type 2 reaction. Inflamed plaques were the main feature, in 27 (90%) cases of type 1. Crops of painful, erythematous nodules were seen in 19/20; 95% cases of type 2. Ulnar nerves were the most commonly enlarged nerves, in those with type 1 (73%) and common peroneal in type 2 (65%). Conclusion: Lepra reactions can be a presenting feature in a significant number of new leprosy cases, at initial diagnosis. Early recognition and management of these reactions can help prevent disease transmission, lifelong  deformities and disabilities. Keywords: Leprosy, Lepra reactions, type 1 (reversal) reaction, type 2 erythema nodosum leprosum (ENL) reaction.

Unusual non-trophic ulcerations in leprosy: A case series of 17 patients

2021 ◽  
pp. 004947552199849
Author(s):  
Prakriti Shukla ◽  
Kiran Preet Malhotra ◽  
Parul Verma ◽  
Swastika Suvirya ◽  
Abir Saraswat ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Case Series ◽  
Lepromatous Leprosy ◽  
Sweet Syndrome ◽  
Erythema Nodosum Leprosum ◽  
Leprosy Patients ◽  
Atypical Presentations ◽  
Neuropathic Ulcers

Non-neuropathic ulcers in leprosy patients are infrequently seen, and atypical presentations are prone to misdiagnosis. We evaluated diagnosed cases of leprosy between January 2017 and January 2020 for the presence of cutaneous ulceration, Ridley–Jopling subtype of leprosy, reactions and histologic features of these ulcerations. Treatment was given as WHO recommended multi-bacillary multi-drug therapy. We found 17/386 leprosy patients with non-neuropathic ulcers. We describe three causes – spontaneous cutaneous ulceration in lepromatous leprosy (one nodular and one diffuse), lepra reactions (five patients with type 1; nine with type 2, further categorised into ulcerated Sweet syndrome-like who also had pseudoepitheliomatous hyperplasia, pustulo-necrotic and necrotic erythema nodosum leprosum) and Lucio phenomenon (one patient). Our series draws attention towards the different faces of non-neuropathic ulcers in leprosy, including some atypical and novel presentations.

scholarly journals Clinical study of herpes zoster in 109 patients in central referral hospital, Gangtok

2019 ◽  
Vol 5 (4) ◽  
pp. 849
Author(s):  
Rukma L. Sharma ◽  
Rekha Sharma
Keyword(s):  
Herpes Zoster ◽  
Dorsal Root ◽  
Skin Lesions ◽  
Age Group ◽  
Female Ratio ◽  
Varicella Zoster ◽  
Single Nerve ◽  
Male Female Ratio ◽  
The Common

<p class="abstract"><strong>Background:</strong> Herpes zoster results from the reactivation of varicella-zoster virus lying dormant in the dorsal root ganglia following an earlier primary infection (chickenpox), usually in childhood. The reactivation occurs due to multifactorial causes leading to decreased immunity.</p><p class="abstract"><strong>Methods:</strong> This study was conducted on 109 cases of herpes zoster. Patient’s particulars were noted. A detailed history was recorded; morphology, the site and side of skin lesions were recorded. Any other associated diseases were noted.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 109 patients 66 were male and 43 were female. The total of 53 (48.6%) patients were under the age of 40 years and 56 (51.4%) patients above 40 years. Bhutias were affected in highest number (18.4%) followed by Sharma community (15.6%). The ophthalmic division of trigeminal nerve was the most commonly affected single nerve with 13.8% followed by T10 and T7 dermatome at 9.17% and 7.3% respectively. Thoracic nerves the most commonly involved thoracic nerves with 44 cases. Single dermatomal eruptions were found in 55 patients. The dissemination of herpes zoster was although very rare but was present in three patients. Type 2 diabetes mellitus was the common associated systemic illness with 10.09% of patients.</p><p class="abstract"><strong>Conclusions:</strong> From this study it was revealed that both young adults and older age group people were affected almost equally. The male: female ratio was 1.5:1 with Bhutia community being mostly affected. Thoracic dermatome was the most common dermatome involved and in half the patients some form of associated disease noted.</p>

Painful and non-painful diabetic neuropathy, diagnostic challenges and implications for future management

Brain ◽  
2021 ◽  
Author(s):  
Troels S Jensen ◽  
Pall Karlsson ◽  
Sandra S Gylfadottir ◽  
Signe T Andersen ◽  
David L Bennett ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Trials ◽  
Diabetic Neuropathy ◽  
Randomized Clinical Trials ◽  
Early Recognition ◽  
Sensory Profile ◽  
Research Perspectives ◽  
Distal Symmetric Polyneuropathy

Abstract Peripheral neuropathy is one of the most common complications of both type 1 and type 2 diabetes. Up to half of patients with diabetes develop neuropathy during the course of their disease, which is accompanied by neuropathic pain in to 30–40% of cases. Peripheral nerve injury in diabetes can manifest as progressive distal symmetric polyneuropathy, autonomic neuropathy, radiculo-plexopathies, and mononeuropathies. The most common diabetic neuropathy is distal symmetric polyneuropathy, which we will refer to as DN, with its characteristic glove and stocking like presentation of distal sensory or motor function loss. DN or its painful counterpart, painful DN, are associated with increased mortality and morbidity; thus, early recognition and preventive measures are essential. Nevertheless, it is not easy to diagnose DN or painful DN, particularly in patients with early and mild neuropathy, and there is currently no single established diagnostic gold standard. The most common diagnostic approach in research is a hierarchical system, which combines symptoms, signs, and a series of confirmatory tests. The general lack of long-term prospective studies has limited the evaluation of the sensitivity and specificity of new morphometric and neurophysiological techniques. Thus, the best paradigm for screening DN and painful DN both in research and in clinical practice remains uncertain. Herein, we review the diagnostic challenges from both clinical and research perspectives and their implications for managing patients with DN. There is no established DN treatment, apart from improved glycemic control, which is more effective in type 1 than in type 2 diabetes, and only symptomatic management is available for painful DN. Currently, less than one third of painful DN patients derive sufficient pain relief with existing pharmacotherapies. A more precise and distinct sensory profile from patients with DN and painful DN may help identify responsive patients to one treatment versus another. Detailed sensory profiles will lead to tailored treatment for patient subgroups with painful DN by matching to novel or established DN pathomechanisms and also for improved clinical trials stratification. Large randomized clinical trials are needed to identify the interventions, i.e. pharmacological, physical, cognitive, educational, etc, which leads to the best therapeutic outcomes.

scholarly journals Host-Related Laboratory Parameters for Leprosy Reactions

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuqian Luo ◽  
Mitsuo Kiriya ◽  
Kazunari Tanigawa ◽  
Akira Kawashima ◽  
Yasuhiro Nakamura ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Clinical Symptoms ◽  
Type I ◽  
Leprosy Reactions ◽  
Erythema Nodosum Leprosum ◽  
Precise Diagnosis ◽  
Reversal Reaction

Leprosy reactions are acute inflammatory episodes that complicate the course of a Mycobacterium leprae infection and are the major cause of leprosy-associated pathology. Two types of leprosy reactions with relatively distinct pathogenesis and clinical features can occur: type 1 reaction, also known as reversal reaction, and type 2 reaction, also known as erythema nodosum leprosum. These acute nerve-destructive immune exacerbations often cause irreversible disabilities and deformities, especially when diagnosis is delayed. However, there is no diagnostic test to detect or predict leprosy reactions before the onset of clinical symptoms. Identification of biomarkers for leprosy reactions, which impede the development of symptoms or correlate with early-onset, will allow precise diagnosis and timely interventions to greatly improve the patients' quality of life. Here, we review the progress of research aimed at identifying biomarkers for leprosy reactions, including its correlation with not only immunity but also genetics, transcripts, and metabolites, providing an understanding of the immune dysfunction and inflammation that underly the pathogenesis of leprosy reactions. Nevertheless, no biomarkers that can reliably predict the subsequent occurrence of leprosy reactions from non-reactional patients and distinguish type I reaction from type II have yet been found.

Cutaneous ulceration as a presenting feature of type 1 lepra reaction: A case report

2022 ◽  
pp. 004947552110686
Author(s):  
Pallavi Hegde ◽  
Deepti Jaiswal ◽  
Varsha M Shetty ◽  
Kanthilatha Pai ◽  
Raghavendra Rao
Keyword(s):  
Case Report ◽  
Erythema Nodosum ◽  
Immunological Response ◽  
Lepromatous Leprosy ◽  
Multidrug Therapy ◽  
Cutaneous Lesions ◽  
Erythema Nodosum Leprosum

Reactions in leprosy represent sudden shift in the immunological response and are seen in 11–25% of affected patients. It can be seen before, during or after the completion of multidrug therapy (MDT). 1 Two types of reactions are recognized; Type 1 reaction (T1R), seen in borderline leprosy, affecting mainly skin and nerves; type 2 reaction (T2R) or erythema nodosum leprosum (ENL), seen in lepromatous leprosy, characterized by systemic features in addition to cutaneous lesions. Trophic ulcers and ulcerating ENL are well known entities while cutaneous ulceration in T1R is extremely rare; we describe an immune-competent woman with cutaneous ulceration as a presenting feature to highlight the need to recognize this entity at the earliest opportunity.

scholarly journals Common Malocclusion Problems and their Management: A Hospital based study

2018 ◽  
Vol 10 (1) ◽  
pp. 22-25
Author(s):  
Helal Uddin ◽  
Ziauddin Ahmed ◽  
Nitish Krishna Das ◽  
Arup Kumar Saha ◽  
Mohammad Rakibul Islam Babu ◽  
...  
Keyword(s):  
Young Women ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Female Ratio ◽  
Functional Efficiency ◽  
Lip Seals ◽  
Bangladeshi Population ◽  
Type 3

Aims: Orthodontics is the branch of dentistry concerned with the prevention, interception and correction of malocclusion. The present study aimed at the common malocclusion problems and their management in Bangladeshi population. It was also aimed to align for aesthetics reason, functional efficiency and structural balance. Methods: A cross-sectional study was carried out among 120 respondents having malocclusions. Students, especially young women and urban residents were selected as the main respondents of our series which reflected its aesthetic value against malocclusion Results: Mean age of the respondents was 22.22±9.07 years with a male and female ratio of 1:3.1. Among the respondents, 37.5% were within the 11 to 20 years age group with a past (21.0%) and present (7.5%) history of finger sucking habit and abnormal over jet (71.7%) and over bite (55.8%). Mean over jet and overbite were 4.4 ±3.47 (range, -2 to 12) mm and 3.47±1.98 (range, 0 to 7) mm, respectively. Angle’s classification revealed type 1, type 2 (division 1), type 2 (division 2) and type 3 were 55.0%, 28.3%, 3.3% and 13.3%, respectively, and based on skeletal relationships, type 1, type 2 and type 3 were 64.2%, 25.0% and 10.8%, respectively. Of all patients, 66.7% had convex, 22.5% straight and 10.8% had concave face profiles. They also had 44.2% competent, 36.7% incompetent and 19.2% habitual competent anterior lip seals. Conclusions: Smile is a global language though many of our patients are deprived of both socially and economically, especially young women from this language. With growing importance imposed on preventive orthodontic treatment and proper oral health education, incidence of malocclusion can be reduced. DOI: http://dx.doi.org/10.3329/cdcj.v10i1.13827 City Dent. Coll. J Volume-10, Number-1, January-2013

scholarly journals Effects of metabolic memory on inflammation and fibrosis associated with diabetic kidney disease: an epigenetic perspective

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Wen Zheng ◽  
Jia Guo ◽  
Zhang-Suo Liu
Keyword(s):  
Kidney Disease ◽  
Environmental Factors ◽  
Diabetic Kidney Disease ◽  
Early Recognition ◽  
Epigenetic Modifications ◽  
Metabolic Memory ◽  
Diabetic Patients ◽  
Diabetic Kidney

AbstractDiabetic kidney disease (DKD) is one of the most common microvascular complication of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM), and the leading cause of end-stage renal disease (ESRD) worldwide. Persistent inflammation and subsequent chronic fibrosis are major causes of loss of renal function, which is associated with the progression of DKD to ESRD. In fact, DKD progression is affected by a combination of genetic and environmental factors. Approximately, one-third of diabetic patients progress to develop DKD despite intensive glycemic control, which propose an essential concept “metabolic memory.” Epigenetic modifications, an extensively studied mechanism of metabolic memory, have been shown to contribute to the susceptibility to develop DKD. Epigenetic modifications also play a regulatory role in the interactions between the genes and the environmental factors. The epigenetic contributions to the processes of inflammation and fibrogenesis involved in DKD occur at different regulatory levels, including DNA methylation, histone modification and non-coding RNA modulation. Compared with genetic factors, epigenetics represents a new therapeutic frontier in understanding the development DKD and may lead to therapeutic breakthroughs due to the possibility to reverse these modifications therapeutically. Early recognition of epigenetic events and biomarkers is crucial for timely diagnosis and intervention of DKD, and for the prevention of the progression of DKD to ESRD. Herein, we will review the latest epigenetic mechanisms involved in the renal pathology of both type 1 (T1DN) and type 2 diabetic nephropathy (T2DN) and highlight the emerging role and possible therapeutic strategies based on the understanding of the role of epigenetics in DKD-associated inflammation and fibrogenesis.

scholarly journals Diabetic ketoacidosis at presentation of type 1 diabetes in children in Canada during the COVID-19 pandemic

2021 ◽  
Author(s):  
Elizabeth A C Sellers ◽  
Danièle Pacaud
Keyword(s):  
Type 1 Diabetes ◽  
Chronic Illness ◽  
Diabetic Ketoacidosis ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Initial Diagnosis ◽  
Morbidity And Mortality ◽  
Time Period

Abstract Type 1 diabetes is a common chronic illness in childhood. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes. Early recognition of symptoms of diabetes and immediate initiation of treatment are important factors in preventing DKA at first presentation. We describe the numbers of children presenting with DKA at initial diagnosis across eight Canadian paediatric centres during the COVID-19 pandemic (March 15, 2020 to July 31, 2020) and compare this to the same time period in 2019. Comparing the pre-COVID to the COVID-19 time period, presentation in DKA increased from 36.4% to 55.0% (P&lt;0.0001) and presentation in severe DKA from 37.0% to 48.3% (P=0.044). These findings are concerning and emphasize the importance of awareness of the signs and symptoms of diabetes. In addition, these findings raise concern about access to appropriate and timely care during the COVID-19 pandemic.

scholarly journals Sex Differences in Lower Extremities Amputations in Patients with Diabetes - Five Year Nationwide Follow-Up Using Drg Data in Romania

2015 ◽  
Vol 22 (1) ◽  
pp. 53-59
Author(s):  
Ioan Andrei Vereșiu ◽  
Cosmina Bondor ◽  
Silvia Ștefania Iancu
Keyword(s):  
Health Management ◽  
Regression Line ◽  
Lower Extremities ◽  
Female Ratio ◽  
National School ◽  
Patients With Diabetes ◽  
Male To Female

AbstractBackground and Aims. The present study represents the first nationwide evaluation of lower extremities amputations (LEA) in diabetes patients in Romania. Material and Methods. We used the disease related groups (DRG) data provided by the National School for Public Health, Management and Health Education, for the years 2006-2010 and stratified according to diabetes type, sex and age group. Results. There were 16873 patients with diabetes who underwent a total number of 24312 non traumatic LEA. A total of 22.55% of the patients had type 1 diabetes (T1DM) and 70.26 % had type 2 diabetes (T2DM). The rate of amputations decreased in T1DM and increased in T2DM, especially in elderly people. Male-to-female ratio of amputations was ~2:1 in T1DM and ~2.4:1 in T2DM. The predictions for the number of amputation episodes was approximated by the regression line y=286.8x-572728 r=0.97, p=0.005, d=0.95 in men, and by y=91.1x- 181511, r=0.98, p=0.004, d=0.95 in women ( where x is years and y is number of amputation episodes). Conclusions. Identifying certain age and sex groups of patients with diabetes in whom higher increase of LEA rates are observed imposes a change of strategy concerning prevention and curative measures.

scholarly journals Autoimmune pancreatitis type 1 and type 2: A report of two cases

2017 ◽  
Vol 74 (4) ◽  
pp. 361-366
Author(s):  
Irina Brcerevic ◽  
Radoje Doder ◽  
Nenad Perisic ◽  
Stanko Petrovic ◽  
Jasna Jovic ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Male Patient ◽  
Autoimmune Pancreatitis ◽  
Early Recognition ◽  
Systemic Disease ◽  
Adequate Treatment ◽  
Disease Case ◽  
Epithelial Lesions

Introduction. Autoimmune pancreatitis is a disease associated with autoimmune mechanisms, clinically manifested mostly as obstructive icterus with or with no entire or partial enlargement of the pancreas, histological lymphoplas-mocytic infiltration, fibrosis or granulocytic epithelial lesions with a favourable therapeutic response to the application of corticosteroids. Type 1 autoimmune pancreatitis is a systemic disease befalling the group of IgG4-related diseases in contrast to type 2 which is specific for pancreas disease. Case report. We presented two cases. The first one was a 64-year-old male patient with autoimmune pancreatitis complaining of abdominal pain, weight loss, weakness and exhaustion. Clinical examination showed a rare IgG4 autoimmune pancreatitis. The second one was a 37-year-old male patient complaining of abdominal pain with diarrhea. The diagnosis made revealed the presence of type 2 autoimmune pancreatitis. Following the diagnosis, immunosuppressive therapy was administered to both patients leading to the improvement of their general condition. Conclusion. Autoimmune pancreatitis is a rare disease, sometimes not easy to differ from pancreatic tumor or bile duct tumor with poor prognosis. Thus, early recognition of the disease is very important, since adequate treatment significantly increases the course and the outcomes of the disease.

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