BackgroundLeprosy Type 1 reactions are a major cause of nerve damage and the
preventable disability that results. Type 1 reactions are treated with oral
corticosteroids and there are few data to support the optimal dose and
duration of treatment. Type 1 reactions have a Th1 immune profile: cells in
cutaneous and neural lesions expressing interferon-γ and interleukin-12.
Methylprednisolone has been used in other Th1 mediated diseases such as
rheumatoid arthritis in an attempt to switch off the immune response and so
we investigated the efficacy of three days of high dose (1 g) intravenous
methylprednisolone at the start of prednisolone therapy in leprosy Type 1
reactions and nerve function impairment.ResultsForty-two individuals were randomised to receive methylprednisolone followed
by oral prednisolone (n = 20) or oral prednisolone
alone (n = 22). There were no significant differences
in the rate of adverse events or clinical improvement at the completion of
the study. However individuals treated with methylprednisolone were less
likely than those treated with prednisolone alone to experience
deterioration in sensory function between day 29 and day 113 of the study.
The study also demonstrated that 50% of individuals with Type 1
reactions and/or nerve function impairment required additional prednisolone
despite treatment with 16 weeks of corticosteroids.ConclusionsThe study lends further support to the use of more prolonged courses of
corticosteroid to treat Type 1 reactions and the investigation of risk
factors for the recurrence of Type 1 reaction and nerve function impairment
during and after a corticosteroid treatment.Trial RegistrationControlled-Trials.comISRCTN31894035
This is the first study to examine the expression of TLR2 and TLR4 in vivo in individuals experiencing leprosy Type 1 reactions. The data support the possibility of an important role for TLR2 and TLR4 in the pathogenesis of this important complication of leprosy.
Introduction: Childhood wasting although well studied elsewhere, it has not been well understood about in slum area of Nepal. This study aimed to assess effect of socio-demographic factors and child feeding practice in the determination of wasting among the children under five years of age in slum area of Nepal.Methods: A community based cross-sectional study was performed among 150 children under five years of age from the slum area of Nepal between 1st January and 28th February 2013 using simple random sampling techniques. Multivariate analyses were performed to determine factors associated with wasting controlling the potential confounders.Results: In a total of 150 under five years children, the prevalence of wasting was 56 (37.33%). The current study demonstrated that children of mothers from dalit (Adjusted Odds Ratio (OR) 11.5; 95% CI: 03.1 – 41.3), aadibasi/janajati (AOR 4.6; 95% CI: 1.2 – 17.0), illiterate mothers (AOR 3.6; 95% CI: 1.1 – 13.6), laborer mothers (AOR 2.1; 95% CI: 1.1-9.4), child age group 25-36 months (AOR 2.8; 95% CI: 1.5-5.3), multiple child birth order (AOR 10.0; 95% CI: 2.5-25.0), children who were not fed colostrums (AOR 15.0; 95% CI: 1.25-10.0)) were more likely to develop wasting compared to their counterparts.Conclusions: As incremental childhood wasting is associated with maternal socio-demographic factors and child feeding practice, health promotion strategies should focus maternal socio-demographic factors, age of children and early initiation of breast feeding for the improved child nutrition in slum area of Nepal.Keywords: socio-demographic factors; urban slum; under five children; wasting. [PubMed]
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