Can baseline ML Flow test results predict leprosy reactions? An investigation in a cohort of patients enrolled in the uniform multidrug therapy clinical trial for leprosy patients in Brazil

Background:The predictive value of the serology to detection of IgM against the Mycobacterium leprae-derived phenolic glycolipid-I/PGL-I to identify leprosy patients who are at higher risk of developing reactions remains controversial.Whether baseline results of the ML Flow test can predict leprosy reactions was investigated among a cohort of patients enrolled in The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil(U-MDT/CT-BR).Methods:This was a descriptive study focusing on the main clinical manifestations of leprosy patients enrolled in the U-MDT/CT-BR from March 2007 to February 2012 at two Brazilian leprosy reference centers.For research purposes,753 leprosy patients were categorized according to a modified Ridley-Jopling(R&J)classification and according to the development of leprosy reactions(reversal reaction/RR and erythema nodosum leprosum/ENL),and whether they had a positive or negative bacillary index/BI.Results:More than half of the patients(55.5%)reported leprosy reaction:18.3%(138/753)had a RR and 5.4%(41/753)had ENL.Leprosy reactions were more frequent in the first year following diagnosis,as seen in 27%(205/753)of patients,while 19%(142/753)developed reactions during subsequent follow-up.Similar frequencies of leprosy reactions and other clinical manifestations were observed in paucibacillary(PB)and multibacillary(MB)leprosy patients treated with U-MDT and regular MDT(R-MDT)(P=0.43 and P=0.61,respectively).Compared with PB patients,leprosy reactions were significantly more frequent in MB patients with a high BI,and more patients developed RR than ENL.However,RR and neuritis were also reported in patients with a negative BI.At baseline,the highest rate of ML Flow positivity was observed in patients with a positive BI,especially those who developed ENL,followed by patients who had neuritis and RR.Among reaction-free patients,81.9%were ML Flow positive,however,the differences were not statistically significant compared to reactional patients(P=0.45).Conclusions:MB and PB patients treated with R-MDT and U-MDT showed similar frequencies of RR and other clinical manifestations.Positive ML Flow tests were associated with MB leprosy and BI positivity.However,ML Flow test results at baseline showed limited sensitivity and specificity for predicting the development of leprosy reactions.

情感区三角和印堂治疗失眠:个案报道

Insomnia prevalence may reach up to 30%of the population considering at least one of the following criteria:difficulty in falling asleep,difficulty in remaining asleep,waking up too early,not repairing sleep or bad sleep quality,followed by daily consequences of lack of sleep such as lack of attention or stress.Several studies have reported the use of acupuncture as a therapeutic alternative for insomnia treatment showing important results such as anxiety decrease,improvement of sleep quality,decrease of daily consequences of insomnia,among others.The aim of this project was to use acupuncture as treatment for insomnia using the points Shenmen(神门HT7),Taiyuan(太渊LU9),Neiguan(内关PC6)and Yintang(印堂EX-HN3).After the signing of the TCLE,the patient answered a questionnaire during sessions 1,5 and10.The patient received insomnia treatment through puncture of the following points:HT7,LU9,PC6 and EX-HN3.The patient reported a significant improve in the sleep quality after the first sessions and absence of the symptoms after the tenth session.Therefore we conclude that the stimulation of these acupoints is useful in the insomnia treatment.