No abstract

Every year, approximately 5.6% of patients with MB who have completed MDT can be expected to develop new ocular complications of leprosy, which often (3.9%) are potentially vision threatening. Because many of these complications cannot be detected without slit lamp examination, periodic monitoring, particularly of older patients and those with other disability, is recommended, in order to detect and treat ocular complications satisfactorily.

SummaryThe histological findings and their correlation with biochemical functions of the liver in 240 leprosy patients are presented. In 21% with tuberculoid leprosy and in 62% with lepromatous leprosy leprous granulomata were found in the liver. A significant prevalence of granulomatous lesions in the liver among patients with tuberculoid and borderlinetuberculoid leprosy of less than one year's duration suggests that bacillaemia occurs early in all forms of leprosy.There was a direct correlation between bacterial index and the presence of acid-fast bacilli in the liver. Of 50 patients with negative skin smears seven had acid-fast bacilli at liver biopsy. From none of these liver homogenates were acid-fast bacilli grown on culture in Lowenstein-Jensen medium.The alterations in liver functions were more consistently seen when acid-fast bacilli were associated with the presence of leprous granulomatous lesions. The acid-fast bacilli were found to persist even after one to five years of specific antileprosy therapy and after the bacilli in the skin had cleared up. This may explain the relatively frequent recrudescence or relapse of the bacillated types of leprosy when specific antileprosy therapy is stopped soon after bacterial negativity is attained on skin smears.

Aim: To evaluate the incidence of and risk factors for ocular complications in multibacillary (MB) leprosy patients during their 2 year, fixed duration, multidrug therapy (MDT). Methods: Periodic eye examinations were conducted prospectively on a cohort of 301 consecutive newly diagnosed MB patients every 6 months during their 2 year course of MDT. Incidence of ocular pathology was calculated as the number of events per person year of event free follow up of patients who did not have the specific finding at baseline. Results: 292 (97%) patients had one or more follow up visits. The incidence of lagophthalmos was 1.2%/patient year (95% CI 0.5% to 2.8%); corneal opacity was 7.4%/patient year (95% CI 5.1% to 10.6%); uveal involvement was 5.1%/patient year (95% CI 3.3% to 7.8%), and cataract that reduced vision to 6/18 or less was seen in 4.3%/patient year (95% CI 2.7% to 6.9%) of patients. Overall, 23 individuals (5.8%/patient year, 95% CI 3.9 to 8.8) developed leprosy related potentially blinding pathology during the 2 years of MDT. Conclusions: Approximately 20% of patients with MB leprosy can be expected to develop ocular complications of leprosy during a 2 year course of MDT, many (11%) of which are potentially vision threatening. Ophthalmological monitoring to detect and treat ocular complications at defined intervals during MDT is indicated. L eprosy is a chronic infection that can be classified clinically into paucibacillary leprosy (PB), in which patients have a relatively intact cellular immune function against Mycobacterium leprae and consequently low bacillary loads, and multibacillary leprosy (MB), in which patients have markedly impaired cellular immunity and high bacillary loads.Antileprosy multidrug therapy (MDT), given until recently as a standard regimen of 2 years' duration, has revolutionised the management of leprosy worldwide. While there are indications that the incidence of leprosy may be declining, the number of people taking MDT worldwide remains large (407 791 in 2004).1 Accompanying the reduction in prevalence there has been a gradual shift in the proportion of the type of leprosy from the PB to the MB form, as well as a shift to an older age at diagnosis of disease.2 The expansion of MDT programmes at a global level has given rise to hopes that disability and the other complications of leprosy need not occur as long as a person completes the required duration of therapy. However, monitoring of disability rates following diagnosis and treatment has been problematic because of the changes in definitions, particularly for ocular disabilities in leprosy patients. In particular, the extent to which complications of leprosy continue to occur during MDT has been unclear. Our previous work demonstrated that at the time of leprosy diagnosis, about 11% of MB leprosy patients have one or more significant leprosy related eye complications.5 These complications were more common with increasing age, a short duration between onset and diagnosis, and when a previous reaction involving the face had been ...

Trends in intra-uterine growth (IUG) of newborns from 1969-1973 to 1989-1993 were studied among rural and urban communities. Yerushalmy's five group classification of IUG was used. The percent preterm low birthweight (LBW) declined from 7 to 3 in rural and from 5 to 2 in urban areas. The percent of newborns with retardation of IUG declined from 20 to 11 in rural and from 13 to 8 in urban areas. Possible factors contributing to such changes are discussed.