An assessment of the reported impact of the COVID-19 pandemic on leprosy services using an online survey of practitioners in leprosy referral centres.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to governments implementing a variety of public health measures to control transmission and has affected health services. Leprosy is a communicable neglected tropical disease caused by Mycobacterium leprae and is an important health problem in low- and middle-income countries. The natural history of leprosy means that affected individuals need long-term follow-up. The measures recommended to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can create barriers to health services. We evaluated the impact of the COVID-19 epidemic response on leprosy services and disease management. METHODS: We conducted a cross-sectional online survey with healthcare professionals in leprosy referral centres. RESULTS: Eighty percent of leprosy diagnostic services were reduced. All respondents reported that multidrug therapy (MDT) was available but two reported a reduced stock. Clinicians used alternative strategies such as telephone consultations to maintain contact with patients. However, patients were not able to travel to the referral centres. DISCUSSION: This study highlights the effects of the initial phase of the SARS-CoV-2 pandemic on leprosy services in a range of leprosy-endemic countries. Many services remained open, providing leprosy diagnosis, MDT and leprosy reaction medications. Centres developed innovative measures to counter the negative impacts of the COVID-19 pandemic

Methotrexate and prednisolone study in erythema nodosum leprosum (MaPs in ENL) protocol: a double-blind randomised clinical trial.

INTRODUCTION: Erythema nodosum leprosum (ENL) is an immunological complication of leprosy. ENL results in morbidity and disability and if it is not treated can lead to death. The current treatment consists of thalidomide or high doses of oral corticosteroids for prolonged periods. Thalidomide is not available in many leprosy endemic countries. The use of corticosteroids is associated with morbidity and mortality. Identifying treatment regimens that reduce the use of corticosteroids in ENL is essential. Methotrexate (MTX) is used to treat many inflammatory diseases and has been used successfully to treat patients with ENL not controlled by other drugs, including prednisolone and thalidomide. We present the protocol of the 'MTX and prednisolone study in ENL' (MaPs in ENL) a randomised controlled trial (RCT) designed to test the efficacy of MTX in the management of ENL. METHODS AND ANALYSIS: MaPs in ENL is an international multicentre RCT, which will be conducted in leprosy referral centres in Bangladesh, Brazil, Ethiopia, India, Indonesia and Nepal. Patients diagnosed with ENL who consent to participate will be randomly allocated to receive 48 weeks of weekly oral MTX plus 20 weeks of prednisolone or 48 weeks of placebo plus 20 weeks of prednisolone. Participants will be stratified by type of ENL into those with acute ENL and those with chronic and recurrent ENL. The primary objective is to determine whether MTX reduces the requirement for additional prednisolone. Patients' reported outcome measures will be used to assess the efficacy of MTX. Participants will be closely monitored for adverse events. ETHICS AND DISSEMINATION: Results will be submitted for publication in peer-reviewed journals. Ethical approval was obtained from the Observational/Interventions Research Ethics Committee of the London School of Hygiene & Tropical Medicine (15762); The Leprosy Mission International Bangladesh Institutional Research Board (in process); AHRI-ALERT Ethical Review Committee, Ethiopia; Ethics Committee of the Managing Committee of the Bombay Leprosy Project; and The Leprosy Mission Trust India Ethics Committee; the Nepal Health and Research Council and Health Research Ethics Committee Dr. Soetomo, Indonesia. This study is registered at www.clinicaltrials.gov. This is the first RCT of MTX for ENL and will contribute to the evidence for the management of ENL.Trial registration numberNCT 03775460

A core outcome set for pre‐eclampsia research: an international consensus development study

Objective To develop a core outcome set for pre‐eclampsia. Design Consensus development study. Setting International. Population Two hundred and eight‐one healthcare professionals, 41 researchers and 110 patients, representing 56 countries, participated. Methods Modified Delphi method and Modified Nominal Group Technique. Results A long‐list of 116 potential core outcomes was developed by combining the outcomes reported in 79 pre‐eclampsia trials with those derived from thematic analysis of 30 in‐depth interviews of women with lived experience of pre‐eclampsia. Forty‐seven consensus outcomes were identified from the Delphi process following which 14 maternal and eight offspring core outcomes were agreed at the consensus development meeting. Maternal core outcomes: death, eclampsia, stroke, cortical blindness, retinal detachment, pulmonary oedema, acute kidney injury, liver haematoma or rupture, abruption, postpartum haemorrhage, raised liver enzymes, low platelets, admission to intensive care required, and intubation and ventilation. Offspring core outcomes: stillbirth, gestational age at delivery, birthweight, small‐for‐gestational‐age, neonatal mortality, seizures, admission to neonatal unit required and respiratory support. Conclusions The core outcome set for pre‐eclampsia should underpin future randomised trials and systematic reviews. Such implementation should ensure that future research holds the necessary reach and relevance to inform clinical practice, enhance women's care and improve the outcomes of pregnant women and their babies

I Foro de Ministras y Viceministras de Agricultura de las Américas “Las Mujeres al frente de la Transformación de los Sistemas Agroalimentarios”

Moderadora: Karla Iberia Sánchez.El objetivo del Foro es resaltar el papel de las mujeres que, desde el nivel más alto de la función pública, trabajan por el desarrollo sostenible de los sistemas agroalimentarios, generando un espacio de diálogo e intercambio de información en el que se compartirán valiosas experiencias de gestión

II Foro de Ministras y Viceministras de Agricultura y Altas Funcionarias de las Américas

Laura Suazo, Secretaria de Estado en los Despachos de Agricultura y Ganadería de Honduras; Laura Bonilla, Ministra de Agricultura y Ganadería de Costa Rica; Jewel Bronaugh, Subsecretaria de Agricultura del USDA; Samantha Marshall, Ministra de Agricultura, Pesca y Asuntos de Barbuda de Antigua y Barbuda; Joyce Boye, Directora General de la Subdivisión de Ciencia y Tecnología de Agricultura y Agroalimentación de Canadá; Carolina Gainza, Subsecretaria de Ciencia, Tecnología, Conocimiento e Innovación de Chile; Kyra Paul,Secretaria Permanente del Ministerio de Economía Azul y Verde, Agricultura y Seguridad Alimentaria Nacional de Dominica; Fernanda Maldonado, Directora General de Secretaría del Ministerio de Ganadería, Agricultura y Pesca de Uruguay; Rocío Valerio, Viceministra de Agricultura y Ganadería de Costa Rica; Londa Schiebinge, Directora del proyecto Innovaciones con Perspectiva de Género en Ciencia, Salud y Medicina, Ingeniería y Medio Ambiente de la Universidad de Stanford; la científica argentina Raquel Chan; y el Director General del IICA, Manuel Otero.El encuentro, organizado por el Instituto Interamericano de Cooperación para la Agricultura (IICA), en colaboración con el gobierno de Honduras, reunió a mujeres con importantes lugares de toma de decisión en el sector agrícola del continente. Y marcó la continuidad del Foro que fue constituido en julio de 2021, en ocasión de la Pre-Cumbre de la ONU sobre Sistemas Alimentarios, en Roma, con la misión perfeccionar políticas públicas y visibilizar el lugar protagónico que las mujeres cumplen en el desarrollo rural, favoreciendo el reconocimiento pleno de sus derechos. Las autoridades participantes llevaron adelante un rico intercambio de experiencias e hicieron un repaso de la amplia gama de políticas públicas que se están implementando en los países de las Américas y están rompiendo con los estereotipos de género que tradicionalmente han obstaculizado el acceso de las mujeres a los puestos más altos tanto en el ámbito público como en el privado