Leprosy: Why does it persist among us?

Despite a substantial reduction in its global prevalence since 1990s, leprosy transmission continues unabated and remains a significant public health problem. The causes for its persistence are multi-factorial, ranging from the lack of implementation of contact tracing, the skill-dependent diagnostic method with over reliance on clinical recognition; to its strong linkages to social inequality and inequity. Leprosy control and elimination is still an enormous challenge for governments and scientists and the answer for this complex problem needs to be multifaceted, which includes higher research investments to identify risk areas, novel and better diagnostics and therapeutic tools and a reduction of social inequalities

Spatiotemporal clustering, social vulnerability and risk of congenital syphilis in northeast Brazil: an ecological study

Background To investigate the spatial distribution of congenital syphilis (CS) and its association to social vulnerability indexes in northeast Brazil. Methods This was an ecological study referring to all cases of CS and CS deaths recorded in the northeast region of Brazil from 2008 to 2015. Data were obtained from three Brazilian information systems. We examined statistical correlations between CS indicators by state and municipality and their socioeconomic and social vulnerability characteristics. We used Bayesian empirical local models to identify fluctuations of the indicators. Spatial statistical tests were used to identify spatial clusters and the municipalities at high risk of CS. Results The incidence of CS ranged from 2.1 cases/1000 live births (LB) in 2008 to 6.9/1000 LB in 2015, with an annual increase of 19.9% (p < 0.001). The mortality coefficient of CS ranged from 2.9/1000 LB in 2008 to 6.5/1000 LB in 2015, resulting in an annual increase of 15.1% (p < 0.001). Nine spatial clusters were identified. Cases of congenital syphilis occurred in well-defined spatiotemporal clusters and in areas with high levels of social vulnerability. Conclusions CS incidence is associated with social vulnerability. CS control programmes should target spatial clusters and populations with high levels of social vulnerability

Leaf and Root Extracts from Campomanesia adamantium (Myrtaceae) Promote Apoptotic Death of Leukemic Cells via Activation of Intracellular Calcium and Caspase-3

Phytochemical studies are seeking new alternatives to prevent or treat cancer, including different types of leukemias. Campomanesia adamantium, commonly known as guavira or guabiroba, exhibits pharmacological properties including antioxidant, antimicrobial, and antiproliferative activities. Considering the anticancer potential of this plant species, the aim of this study was to evaluate the antileukemic activity and the chemical composition of aqueous extracts from the leaves (AECL) and roots (AECR) of C. adamantium and their possible mechanisms of action. The extracts were analyzed by LC-DAD-MS, and their constituents were identified based on the UV, MS, and MS/MS data. The AECL and AECR showed different chemical compositions, which were identified as main compounds glycosylated flavonols from AECL and ellagic acid and their derivatives from AECR. The cytotoxicity promoted by these extracts were evaluated using human peripheral blood mononuclear cells and Jurkat leukemic cell line. The cell death profile was evaluated using annexin-V-FITC and propidium iodide labeling. Changes in the mitochondrial membrane potential, the activity of caspases, and intracellular calcium levels were assessed. The cell cycle profile was evaluated using propidium iodide. Both extracts caused concentration-dependent cytotoxicity only in Jurkat cells via late apoptosis. This activity was associated with loss of the mitochondrial membrane potential, activation of caspases-9 and -3, changes in intracellular calcium levels, and cell cycle arrest in S-phase. Therefore, the antileukemic activity of the AECL and AECR is mediated by mitochondrial dysfunction and intracellular messengers, which activate the intrinsic apoptotic pathway. Hence, aqueous extracts of the leaves and roots of C. adamantium show therapeutic potential for use in the prevention and treatment of diseases associated the proliferation of tumor cell.Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Mato Grosso do Sul (FUNDECT)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Instituto Nacional de Pesquisa do Pantanal - INPPFundação de Amparo e Desenvolvimento da Pesquisa FadespFed Univ Grande Dourados, Res Grp Biotechnol & Bioprospecting Appl Metab, Dourados, BrazilUniv Fed São Paulo, Dept Biochem, São Paulo, BrazilUniv Braz Cubas, Fac Pharm, Mogi Das Cruzes, BrazilUniv Mogi das Cruzes, Interdisciplinary Ctr Biochem Invest, Mogi Das Cruzes, BrazilUniv Fed São Paulo, Dept Pharmaceut Sci, São Paulo, BrazilUniv Fed Mato Grosso do Sul, Lab Nat Prod & Mass Spectrometry, Campo Grande, MS, BrazilUniv Fed São Paulo, Dept Biochem, São Paulo, BrazilUniv Fed São Paulo, Dept Pharmaceut Sci, São Paulo, BrazilWeb of Scienc

Risk factors for physical disability in patients with leprosy: a systematic review and meta analysis

Abstract Importance: The World Health Organization (WHO) 2016–2020 Global Leprosy Strategy aims to reinvigorate efforts to control leprosy and avert leprosy disability to less than one per million population. Objective: This study aimed to identify systematically clinical factors associated with physical disability in patients with leprosy. Data source: Searches were performed in Scopus, PubMed and Web of Science databases to identify studies published up to May 2018, using the keywords leprosy and physical disability and related terms. Study selection: We included studies that evaluated patients using the WHO leprosy disability grading and reported the number of patients with and without disability by clinical characteristics. Data Extraction and Synthesis: The study was conducted following the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) statement. We used the odds ratio (OR) as a measure of association between the clinical features and physical disability. Summary estimates were calculated using random-effects models. Main Outcome(s) and Measure(s): Our primary outcome was physical disability according the WHO disability classification. We evaluated the association between clinical features and physical disability. Results: Thirty-two studies were included in the systematic review. Males were more likely to have physical disability than females (pooled OR: 1.66; CI95% 1.43-1.93). Multibacillary (MB) leprosy were 4-fold more likely to have physical disability than paucibacillary (PB) leprosy 4 patients (pooled OR 4.32; CI95% 3.37-5.53). Patients having leprosy reactions were more likely to have disability (pooled OR 2.43, CI95% 1.35-4.36). Patients with lepromatous leprosy experienced 5- to 12-fold higher odds of disability. Conclusion and Relevance: This systematic review and meta-analysis confirms the strong association between the presence of physical disabilities and male gender, MB leprosy, leprosy reactions and lepromatous presentation. These findings can guide the development of targeted interventions to identify early individuals at greater risk of developing physical disabilities and education campaigns to promote early consultation to institute treatment for leprosy reactions and to prevent physical disability