Health-related quality of life associated with erythema nodosum leprosum in Purulia, West Bengal, India

Objectives: To determine the impact of erythema nodosum leprosum (ENL) on healthrelated quality of life (HRQoL) of persons affected by leprosy compared to individuals without ENL using the Medical Outcomes Study: 36-Item Short Form Survey (SF-36). Methods: Individuals with a diagnosis of leprosy completed the Bengali version of the SF-36. The responses to the items of the surveys were coded, summed and transformed into a score for each of the eight domains. A lower score reflects a worse HRQoL. Results: 290 individuals with a median age of 32 years (Range 14–82) participated. Individuals with ENL and those with isolated neuritis had significantly lower mean scores in all domains compared with individuals without reaction or neuritis except the domain of physical functioning in those with ENL. Conclusions: This study demonstrates an association of reduced HRQoL with ENL compared to individuals without reaction or neuritis

AZALEP a randomized controlled trial of azathioprine to treat leprosy nerve damage and Type 1 reactions in India: Main findings.

BACKGROUND: Leprosy Type 1 reactions are difficult to treat and only 70% of patients respond to steroid treatment. Azathioprine has been used as an immune-suppressant and we tested its efficacy in treating leprosy T1R. METHODOLOGY: Randomised controlled trial adding azathioprine to steroid treatment for leprosy reactions. This trial was conducted in four leprosy hospitals in India. Patients with a new leprosy Type 1 reaction affecting either skin or nerve were recruited. They were given a 20 week course of oral prednisolone either with placebo or azathioprine 50mg for 24, 36 or 48 weeks. Outcomes were measured using a verified combined clinical reaction severity score (CCS) and the score difference between baseline and end of study calculated. An intention to treat analysis was done on the 279 patients who had an outcome. PRINCIPAL FINDINGS: 345 patients were recruited, 145 were lost due to adverse events, loss to follow up or death. 36% needed extra steroids due to a recurrence of their skin and/or nerve reaction. 76% of patients had improvements in their CCS the end of the study, 22% had no change and 1.1% deteriorated. Adding azathioprine to steroid treatment did not improve CCS. So the improvements were attributable to treatment with steroids. We analysed the skin, sensory and motor scores separately and found that skin improvement contributed most with 78.9% of patients having skin improvement, azathioprine treatment for 48 weeks improved sensory scores it also improved motor scores but so did treatment with prednisolone alone. We identified significant adverse effects attributable to steroid treatment. When azathioprine and Dapsone were given together significant numbers of patients developed significant anaemia. CONCLUSIONS: Azathioprine is not recommended for the treatment of leprosy reactions and does not improve steroid treatment. Recurrent reactions are a major challenge. We have also identified that 65% of patients with sensory and 50% with motor nerve damage do not improve. Future studies should test giving azathioprine in the treatment of nerve damage and giving a higher dose for 48 weeks to patients. These findings highlight the difficulty in switching off leprosy inflammation and the need for better treatments for reactions and nerve damage. There is also a research need to identify patients who have recurrences and optimize treatments for them. Patients with recurrences may benefit from combined treatment with steroids and azathioprine. We have also shown that significant numbers of patients treated with steroids develop adverse effects and this needs to be highlighted in leprosy programmes. Research is needed to identify patients who do not respond to steroid treatment and develop alternative treatments for them. TRIAL REGISTRATION: ClinicalTrials.gov This trial was registered with the Indian Council of Medical research clinical Trial register as a clinical trial Number-REFCTRI/2016/12/007558

Quality of life of persons affected by leprosy in an endemic district, West Bengal, India

Introduction: Leprosy still remains a public health problem in India. Stigma and associated psychosocial problems are common in leprosy and may affect the quality of life (QoL). This study aimed to assess the QoL of the person affected by leprosy living in Purulia district, West Bengal. Methods: A cross-sectional study was conducted among 358 persons affected by leprosy above the age of 18 years and who were reporting at tertiary leprosy referral hospital, Purulia, West Bengal, from April to July 2017. The World Health Organization QoL (WHOQOL-BREF) scale was used to measure the QoL and the scale had four domain; physical health, psychological health, social relationship, and environmental health. Results: Of the 358 respondents, 41% were female, 60% were aged between 18 and 45 years, and 58% were literate. Half of the participants (55%) were farmer and labor, and 75% of the participants' family income was below Rs. 5000 per month. One hundred and forty-four (40%) participants had physical disability. There was a highly significant difference seen among the person affected by leprosy between those with visible deformity and no deformity in four domains. The participants with visible deformity had lower QoL than the person without deformity. Conclusion: The study observed that the person affected by leprosy with visible deformity had lower QoL. Early detection and management would prevent the deformity and might improve the QoL of persons affected by leprosy

The effect of 8-week warm-ups, static and dynamic stretching of hip flexors on flexibility, agility, and dynamic balance in junior field hockey players: a randomized controlled trial

Abstract Background Hockey players mostly lack flexibility in the hips due to prolonged flexion during competition and overuse of hip extensors and external rotators. The lack of flexibility or dysfunction in the hips can negatively impact the dynamic balance and biomechanics of the lower extremities. Objective This study aimed to investigate the effect of adding dynamic stretching to the standard warm-ups and static stretching of hip flexors in junior field hockey players’ balance, flexibility, and agility. Methods In this randomized controlled trial, 30 junior field hockey players were randomly assigned into experimental (n = 15) and control groups (n = 15). The control group performed warm-ups, static stretching, and placebo-like stretching exercises. The experimental group performed the same warm-ups, static stretching exercises plus dynamic stretching to hip flexors. The exercise program was performed by alternating between the right and left lower limbs in both groups. The modified Thomas test, Illinois Agility Test, and modified star excursion balance test were used to measure hip muscle flexibility, agility, and dynamic balance after 8 weeks of interventions in both groups. Results In comparison with the post-test score of both the groups, the experimental group shows a highly statistically significant value in all three measurements of the modified Thomas test (right limb: Cohen’s d = 2.1, P < 0.001, left limb: Cohen’s d = 1.5, P < 0.001) Illinois Agility Test (Cohen’s d = 2.3, P < 0.001) modified star excursion balance test (composite score: right limb Cohen’s d = 1.3, P < 0.001, left limb Cohen’s d = 1.53, P < 0.001) respectively. Conclusion The findings of this study revealed that adding dynamic stretching of hip flexors in routine warm-ups and static stretching has significantly increased hip extension range of motion, agility, and dynamic balance in both the right and left limbs among junior field hockey players

Additional file 1 of Accessibility and availability of maternal and reproductive health care services: ensuring health equity among rural women in Southern India

Supplementary Material