Indian Journal of Leprosy
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Item Risk Factors for Erythema Nodosum Leprosum: A Case Control Study in a Tertiary Hospital of Western Odisha, India(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-03) Nayak, D; Padhi, T; Marandi, P; Mishra, AKErythema nodosum leprosum (ENL) is a serious, often recurring and disabling, immunologically mediated reaction occurring in leprosy which often requires hospitalization. There are published several studies of ENL, but systematic studies regarding the risk factors associated with ENL in the post elimination era are few. The aim of the study was to determine the risk factors associated with ENL in a tertiary care centre in Western Odisha. This is a case control study involving 292 patients of leprosy who attended the Dermatology OPD of this tertiary care centre. These constituted 97 patients with ENL and 195 patients without ENL who attended the OPD during this period. Detailed history, clinical examination, slit skin smears were done. These included gender details, age, area of residence (rural/urban), education and socioeconomic status. The most common subtype of leprosy observed in ENL was lepromatous leprosy followed by borderline lepromatous type. Patients diagnosed with initial high BI and lepromatous leprosy were found to be significant risk factors for development of ENL. Skin diseases, Anaemia and Diabetes Mellitus were found to be more prevalent in ENL patientsItem Prevalence, Characteristics and Socio-Demographic Correlates of Self-Stigma among Leprosy Affected Persons - A Case Study(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-03) Bhat, L; Khan, N; Vaida, N; Hassan, I; Banday, M, TariqThis study has determined the prevalence of self-stigma, its characteristics in terms of alienation, stereotype endorsement, perceived discrimination and social withdrawal and stigma resistance among leprosy-affected persons and its relationship and extent of this relationship with various socio-demographic features. This has been done by carrying out a cross-sectional survey of 120 active people affected by leprosy during 2020-21. An internationally validated and standardised instrument (ISMI) was used to measure self-stigma. Statistical techniques such as independent t-test, Pearson’s and point biserial correlation and regression analysis were used for data analysis. The study found significant correlations between ISMI self-stigma scores and socio- demographic variables with moderate to minor deviation across the four components of the ISMI scale. The high to low correlation of various components of the ISMI scale found is discrimination experience, followed by stigma resistance, stereotype endorsement and alienation. Overall, the highest self-stigma was found in disabled people affected by leprosy, followed by those whose age was less than 40 years, followed by unemployed and male people affected by leprosy. It was concluded that alienation was maximum among people affected by leprosy who were either disabled, aged less than 40 years or were males. Discrimination experience was reported mainly by unemployed, disabled, males and younger people affected by leprosy. The findings indicate that proper methodology and components of Cognitive Behavioural Therapy may help reduce self-stigma among leprosy-affected personsItem A Rare Case Report of Leprous Macrocheilia in Borderline Tuberculoid Leprosy with Type 1 Reaction(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-06) Gupta, I; Chakraborty, D; Dayal, S; Khichi, DIt is well known that Mycobacterium leprae tends to target the cooler parts of the body and can involve the oral cavity. Despite this, macrocheilia - a condition where the lips become enlarged - caused by leprosy is rarely documented. There are few reported cases of leprous macrocheilia in India. We present a unique case of an elderly woman with borderline tuberculoid leprosy in type I reaction who developed leprous macrocheilia.Item Versatile Use of Mycobacterium indicus pranii (MIP) Vaccine(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-03) Thangaraju, P; Sajitha, V; Sree, Sudha, TY; Sudheer, D; Pamidimarri, VN; Balasubramanian, V; Babu, SMycobacterium indicus pranii (MIP) earlier known as Mw is a soil-borne, non-pathogenic, saprophytic and rapidly growing strain of mycobacteria. MIP is approved as a vaccine/ immunomodulator for various indications including mycobacterium infections like leprosy in humans. Its administration has resulted in satisfactory clinical improvement, accelerated bacillary clearance, and increased immune responses to Mycobacterium leprae antigens, thereby shortening the full recovery time of the patients. It also shares its antigens with M.tuberculosis. In the last decade, RCTs have been done establishing immunotherapeutic properties of MIP in the treatment of leprosy, tuberculosis, warts and experimently in leishmaniasis. Through its immune inducing and cytotoxic property, it has also proved beneficial for human use especially in treating lung cancer. The beneficial role of it is also being explored in breast, cervical, oral, liver, and bladder cancers. Various studies on MIP have shown that it has immune-modulating properties in humans. The curiosity of the human mind has led to it being tried in Covid treatment trials. The results have shown that administering MIP has lowered inflammatory markers in Covid 19 patients, promising us for it to be a potential treatment option. More RCTs with a larger sample size should be done to establish this. Cytokine storm seen in bacterial sepsis is also decreased with MIP administration. Considering the encouraging results in hastening recovery in various diseases it appears that MIP is perhaps not being exploited to its fullest potentialItem Spatial Distribution of Leprosy Cases Notified in a Reference Center in the Municipality of Várzea Grande – MT, Brazil(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-03) Duarte, VMS; Machado, LMG; Santos, ESD; Damazo, ASThe spatial distribution can be mapped and analyzed for a better understanding of any disease’s involvement with any/ Brazilian population. The objective of this study was to analyze the spatial distribution of leprosy cases reported in a reference center in the city of Várzea Grande - MT from 2016 to 2019. This is an observational and descriptive epidemiological study, with an ecological distribution nature. The information was extracted from the SINAN form. For the epidemiological profile, annual leprosy detection rates and proportions were calculated according to clinical form, neighborhood, mode of entry, smear, operational classification, number of affected nerves and skin lesions and degree of disability. In the spatial analysis, the empirical Bayesian model of global smoothing was used, established with the aid of the software GeoDa 1.20. A municipal detection rate of 38.4 per 100 thousand inhabitants was observed, with a predominant borderline clinical form with 70.8%, 62.4% cases with more than 6 skin lesions, 45.2% without neural involvement, 36.3% with disability degree 0, 85.4% were new cases registered and 50.7% did not undergo smear microscopy. The spatial distribution of leprosy cases in Várzea Grande has been associated with a low population quality of life, which includes basic sanitation and access to basic unitsItem Analysis of the Incidence of Leprosy in the Northeast Region of Brazil: 2011 to 2021(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-03) Kramer, DG; Sousa, AM; Lins, MLBCLeprosy is a pathology known to mankind for centuries. The clinical manifestations of leprosy depend on the patient’s immune reaction against Mycobacterium leprae, ranging from small hypochromic lesions and hypoesthesia to progressive and diffuse infiltrations of the skin, involvement of upper airway mucosa and involvement of cutaneous as well as nerve trunks. In some cases, and especially during reactions there are several manifestations and signs and symptoms of systemic involvement. The objective of the present study was to analyse the incidence of leprosy and the epidemiological parameters in the period from 2011 to 2021, in the Northeast of Brazil. The Notifiable Diseases Information System-SINAN of Brazil was consulted and is being reported on the detected cases of leprosy. The various parameters being discussed in the present study include sociodemographic aspects, types of injuries, clinical form, treatment regimen, degree of disability and clinical evolution. We were all during a global pandemic in 2020-21. The 2020-21 global pandemic of COVID-19 compromised the monitoring and recording of several diseases, which were left in the background. This fact may have contributed to the drop in the number of leprosy cases registered between 2020 and 2021 in the present study. There were 168,848 reported cases, of which 55.57% were males 62.87% were multiracial, most with low education level, until primary education, 35.63% had multiple skin lesions, 68.51% received treatment for the multibacillary type of disease, 26.83% (24.468) had neuronal impairment and, 71.74%, were considered cured. Despite the drop in the global number of cases observed in the region, several factors are still worrying, these require actions that contribute to the eradication of leprosy in the region, and these include programs that eradicate poverty, implementation of health programs that favour early diagnosis and treatment of leprosy cases, reduction of stigma and social exclusion of affected patients.Item Histoid Leprosy Presenting with Borderline Tuberculoid Leprosy in Type 1 reaction: An Uncommon Shift of Spectrum(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-03) Dhattarwal, N; Sharma, R; Divyashree, RHistoid leprosy is an uncommon variant of leprosy with characteristic clinical, immunological and bacteriological features and is considered to be a polar variant of lepromatous leprosy. Coexistence of other immunologically diverse forms of leprosy in histoid end of spectrum is very rare. We report a rare case of histoid leprosy on multi-drug therapy for last 7 months shifting to borderline tuberculoid spectrum in type 1 reaction or Wade’s contamination, spectral shiftItem Sole, An Uncommon Location of Borderline Tuberculoid Hansen’s Disease(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-03) Nair, S; Phiske, M; Someshwar, SLeprosy a chronic granulomatous infection, frequently affects areas with relatively low temperature and which are trauma prone. Areas like scalp, palms and soles, groins, genitalia, axillae, eyelids, and perineum, have been described as “immune” to development of leprosy. But clinic-pathological and bacteriological evidence of involvement of these so-called “immune zones” has rarely been documented. Palmoplantar involvement is uncommon in leprosy and could be easily misdiagnosed. We report here a case of 65-year-old male who had a single, well defined, round, 5*5 cm, dull erythematous to hyperpigmented plaque with central clearing over medial aspect of left foot extension as single, erythematous, roundish 2*2cm, plaque with central clearing over medial aspect of left foot just below ankle, for 3 months. There was decreased sensation to hot and cold temperature and to fine touch and pain over the lesions. Sensory examination elsewhere on the body was normal. There was no motor loss, no thickened nerves, no deformities, trophic ulcers or evidence of reaction. Histopathology of sole lesion suggested borderline tuberculoid Hansen’s disease. Stain for AFB was negative. Slit skin smear was negative. Good response to MDT was seen at end of 4 months. Such presentation needs to be kept mind for diagnosis of leprosy for instituting timely and appropriate treatmentItem Histoid Leprosy: Are We Still Harbouring Potential Community Menace? A Case Series from North-East India(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-06) Sharma, L; Pathania, V; Singh, A; Agarwal, RLeprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Histoid leprosy is considered an uncommon multibacillary form of leprosy characterized by presence of histoid lepromas which present as erythematous round or oval shaped glistening nodules. Most commonly this form of leprosy is seen in patients on irregular therapy with MDT. In this series we report a total of three cases with their clinical, histopathological and dermoscopic findings.Item A Case of Lepromatous Leprosy with Laryngeal Involvement Presenting as Dysphonia(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-03) Handal, A; Awake, P; Kulkarni, D; Khobragade, SInvolvement of larynx is a uncommon manifestation but could be the first time when the patient may be reporting to a specialist. This is the case report of a 65-year-old man who presented with dysphonia, was evaluated and was diagnosed as lepromatous leprosy with laryngeal involvement. On clinical examination the patient was found to have signs of leprosy – leonine face, nodular involvement of ears, madarosis, oedema of hands and feet, trophic ulcer on right foot. Bilateral greater auricular nerves were found to be enlarged. Video laryngoscopy revealed pale edematous epiglottis, arytenoid and aryepiglottic folds, with nodules on epiglottis. Biopsy from aryepiglottic fold and skin both was done. The diagnosis of lepromatous leprosy was confirmed with histopathology of biopsy from both skin and epiglottic fold. MRI imaging of the neck with contrast showed diffuse hyperintensity in the glottic-supraglottic larynx with asymmetry in the aryepiglottic fold and vocal cord. This experience shows that clinical suspicion is most critical element in reaching the diagnosis of leprosyItem Hansen’s Disease: Still a Burden in Post Elimination Era(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-06) Praveena, C; Anupama, YG; Anushree, LS; Dadapeer, HJDespite the multidrug regimen, Hansen’s disease still remains a public health scourge. The present study aims to study the epidemiological and clinical trends of Hansen’s disease in a tertiary care center for a period of 1 year. A cross sectional study was carried out in the outpatient department of the institute for a period of 1 year from July 2020 to June 2021 and all leprosy cases were included in the study. The patients were examined thoroughly, and the diagnosis was done using WHO criteria. The nerves involved, lepra reactions were identified and disability was graded using WHO grading. Out of 62 patients, maximum number of patients (15 patients) were in the 21-30 years age group (24.2%). The most common type of leprosy was borderline lepromatous leprosy (32.25%) and nerve enlarged was the ulnar nerve (63.9%). As per WHO classification, 51(82.25%) cases were classified as MB and 11(17.7%) cases as PB. Among these 62 patients 25 ( 40%) were slit skin smear positive for AFB). A total of 18 patients (29.03%) presented with lepra reactions of which 10 presented with type 1 and 8 with type 2 reactions. A total of 25 patients (40.32%) presented with deformities which shows delayed diagnosis and inadequate timely treatment of disease and its complications. Our data shows that only 13% of cases reported within one year of noticing the symptoms. Community based studies are required to understand the reasons for such a situation in this area. Efforts must be made to prevent its spread, promote early detection, ensure proper treatment, and maintain patient follow-upItem Socio-psychological Issues of Adolescents Affected with Leprosy: A Scoping Review(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-06) Ahmad, SSkin sores, ulcers, nerve weakness, and disfigurement are a few most common leprosy complications when the diagnosis is delayed and not treated timely. The chronic nature of leprosy and the associated risks of deformities make it the most horrifying illness in human history. Although leprosy affects every segment of the population, adolescents and their highly sophisticated social life put them at additional risk and prone to severe socio-psychological problems. This study has systematically collected and reviewed published literature and arranged findings in a single report to provide a comprehensive understanding of adolescents affected by leprosy. Findings indicate that early adolescents are affected mainly compared to children (0-10 years). Household contact is the primary source of infection among adolescents, and changes in daily life, poor wellbeing, the experience of stigma, self-isolation, and reduced social mobility are prominent issues among affected adolescents. Adolescents with one or both parents affected with leprosy showed signs of anxiety, depression, poor academic performance, or dropout. Leprosy among adolescents demands extra attention due to their precarious and unsafe behavioural traits and their comparably extensive peer and social engagements. This review shows that systematic and well planned studies are required on directly or indirectly leprosy affected adolescents to further research relevant issues for defining the problems and finding solutions to various challenges so as to frame effective interventions and policiesItem Leprosy Skin Lesion Detection: An AI Approach Using Few Shot Learning in a Small Clinical Dataset(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-06) Beesetty, R; Reddy, SA; Modali, S; Sunkara, G; Dalal, J; Damagathla, J; Banerjee, D; Venkatachalapathy, MThis is an exploratory research study to check if artificial intelligence (AI) based image marker tool can aid leprosy screening to detect leprosy cases early in field situation and reduce the financial and personnel burden. We aimed to collect clinical leprosy skin lesion images and develop an AI model to identify and differentiate them. A total of 368 clinically diagnosed leprosy and 28 non-leprosy skin lesions were collected by an expert leprologist from 151 eligible patients using a multimodal imaging protocol. A Siamese-based Few Shot Learning (FSL) model was trained as it is a meta learning approach on an extremely small data set with fewer disease classes (disease conditions as categories). The number of class labels were increased by fine-grained grouping of skin lesions based on skin morphology (Nine leprosy subgroups) and further divided into train-set and test-set. An AI model was successfully developed, and the results indicated an accuracy of 91.25% and 73.12% on train-set and test-set for two-way one-shot task, respectively. The best sensitivity-specificity for the test-set were 72.39%-73.66% (two-way one-shot task). This early research data indicates that the development of AI based leprosy screening application is feasible using the skin lesion image as marker. The FSL method was successfully used in this training the small data set. However, this is a small sample size study, and more leprosy cases need to be enrolled along with an equal number of non- leprosy cases while improving model architecture to reduce overfit or bias problem. Moreover, as of now this tool cannot be used for neural leprosy (having no skin lesion) as well as lepromatous leprosy having diffuse infiltration. This tool will need further development and validation on pictures taken by different categories of common health care workers using available mobile phones.Item A Case Series of Histoid Leprosy with a Brief Comparison of the Clinical Features with that of Lepromatous Leprosy(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-06) Nair, SP; Nair, B AHistoid leprosy (HL) is a rare highly bacilliferous variant of lepromatous leprosy (LL). We are describing here a case series of HL in a tertiary care centre along with a comparison of the clinical features with cases of LL encountered in the same centre. There were 6 cases of HL in our centre for the past 10 years accounting for 1.86% of the total number of leprosy cases. HL constituted 11.54% of the total LL cases. 4 cases were de novo HL and 2 cases due to relapse. Papules, plaques and nodules were the commonest primary skin lesions. The distribution was localised in HL, mainly confined to the upper and lower limbs, while in LL it was symmetrical and generalised and mainly localised to the trunk. Superciliary madarosis, ear lobe infiltration, glove and stocking type of anaesthesia were found in the majority of LL, while lacking in HL patients. Type 2 lepra reaction and Grade 2 disability was much more common in LL, than HL. A very important finding in this case series is that the mean BI and MI of HL was more than in LL. All the patients were given of MB-MDT for 12 months and in patients who had initial BI of 4+ or more were given 24 months treatment and there were no cases of relapse after release from treatmentItem Monitoring the Outcome of Leprosy Using Leprosy Neuropathy Scale: A Preliminary Study(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2023-06) Misra, UK; Chaudhary, SK; Kalita, JThe disability and progress of leprosy patients is monitored by the WHO disability grading system which has limited sensitivity in leprous neuropathy. This study aims to report the spectrum of leprosy patients at a tertiary care neurology service and compare WHO grading, modified Rankin Scale (mRS) and Leprosy Neuropathy Scale (LNS) in monitoring the treatment outcome. The patients with leprosy diagnosed as per WHO criteria were subjected to medical history and clinical examination. Their disability was graded as per WHO grading scale, modified Rankin scale (mRS) and LNS. These parameters were repeated and compared after six months of multiple drug therapy (MDT). Thirty-eight patients with leprosy, aged 40 (`5-80) years, 33 of whom were males have been evaluated. The duration of symptoms was 24 (91-120) months. Mononeuropathy was present in 14, mononeuropathy multiplex in 24, trophic ulcer in two, claw hand in 11, wrist drop in two, foot drop in four, facial palsy in one, Charcot’s joint in one and lepra reaction in seven patients. Their disability as per WHO grade 1 and 2 was in 19 patients each. After 6 months of MDT, WHO grade improved in two patients, mRS revealed improvement in seven and LNS in nine patients. LNS- a clinical scale, seems more effective and easier to use for monitoring the progress/ outcome of neuropathy in leprosy patients and may complement the WHO grading scaleItem Hansen’s disease Like Sensory Loss Following Chikungunya Infection: A Rare Manifestation(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2022-12) Nithya, S; Srinivas, CRChikungunya means “that which bends up,” indicating severe incapacitating arthritis or polyarthralgia. It is a viral infection caused by the chikungunya virus (CHIK V) belonging to the family Togaviridae and is transmitted by the mosquitoes Aedes aegypti and Aedes albopictus. It is a self-limiting condition with a high fever of up to 40°C (104°F), debilitating arthritis/polyarthralgia, and cutaneous involvement. CHIK V virus affects the joints causing tenosynovitis and enthesopathy presenting as arthralgia. Leprosy is also associated with the loss of sensation, arthritis/arthralgias including involvement of several joints and tenosynovitis specially during reactions. Apart from leprosy, numerous other conditions can present with loss of sensation, which must be ruled out while considering leprosy. We report two patients with chikungunya who presented with a loss of sensation like leprosyItem Challenges Faced by People Affected with Leprosy During the COVID-19 Pandemic: A Questionnaire Based Study(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2022-03) Narang, T; Mehta, H; Rathod, SP; Kansal, K; Gupta, SK; Chauhan, PS; Bhardwaj, A; Shilpa,; Pal, M; Kaur, S; Dogra, SThis study aims to assess the continuity of medical care, the impact on disease condition and to highlight the major challenges faced by people affected by leprosy during the pandemic. Telephonic questionnaire-based survey was conducted among previously registered patients of leprosy at referral hospitals in India. Leprosy affected people aged >18 years, either on treatment or who had completed treatment with access to phone and willingness to participate were included. The questions were asked pertaining to demographic details, baseline disease characteristics and various problems faced during lockdown relating to livelihood, finances, treatment, and mental status. A total of 196 patients consented to participate in the study. Mean age of study participants was 37.31 (13.86) years, male participants (n=123, 62.7%) were more than females (n=73, 37.2%). Overall, 101 patients (51.5%) experienced exacerbation, 21 patients (10.7%) reported improvement and 74 patients (37.8%) reported no change in disease status during the pandemic. Most common difficulty faced was the procurement of medicines (115 patients, 58.6%) followed by difficulty in diagnostic testing (61 patients, 31.1%). Course of treatment was interrupted in 16 patients. Most of the patients (n=147, 75%), agreed that teleconsultation services would aid in management of their disease. The majority of patients (88.2%) were able to continue some form of treatment. Two patients (1%) tested positive for COVID-19. Nearly all patients (n=189, 96.4%) were informed regarding the risks and preventive measures related to COVID-19. Fifty percent of the patients reported deterioration in mental health due to the pandemic. The present study highlights the gaps in healthcare delivery and social inequalities along with their impact on the health, livelihood and mental status of people affected by leprosy during the current COVID-19 pandemic.Item The Experiences of Leprosy Clients Attending Self-Care Groups During Community-Based Rehabilitation for Fulfilling Their Health Needs(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2022-03) Susanto, T; Bahtiar, S; Rokhmah, D; Deviantony, F; Puspitaningtyas, Z; Rif’ah, ENThe experience of leprosy clients undergoing treatment in community-based rehabilitation (CBR) needs to be identified more deeply to reduce, prevent transmission and the disability it causes because it will impact the social life of leprosy clients in the community. The non-fulfillment of the needs of leprosy clients in the community will impact the conditions of transmission and disability of leprosy clients. We explored the experiences of leprosy clients attending self-care groups during CBR for identifying their health needs. A descriptive phenomenology study was performed among leprosy clients, families, and healthcare providers. Our study included 16 leprosy clients and their families and six healthcare providers. A triangulation method was performed to compare the third source data. Thematic analysis was used to identify the phenomenon of leprosy during CBR for fulfilling their health needs. We have identified five themes, including leprosy prevention efforts, self-care process and client treatment for leprosy, the needs of clients with leprosy during self-care at CBR, medication, and therapy during the CBR family support during rehabilitation and treatment. Therefore, fulfilling the needs for self-care, medication, and therapy during the rehabilitation period for leprosy clients in the community needs to be facilitated and fulfilled to support recovery. Furthermore, CBR designs that prioritize self-care aspects and are integrated with family care need to be developed in the future. All these approaches should be developed, adapted and validated in different settings with specific needsItem Impact of Covid-19 Disease on Health Care Services of Leprosy Patients Attending a Tertiary Care Centre, Telangana(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2022-03) Indira, D; Vani, DS; Padmaja, P; T, Rajeev Singh; Prasad, JVDS; Krishna, A VenkataCovid - 19 disease was declared as a pandemic by World Health Organization in March 2020. Subsequently, a nationwide lock down for variable intensity and periods was announced in India to contain the disease. Leprosy patients faced difficulties during this pandemic owing to their long-term health care requirements and lack of access to leprosy services during covid time. This resulted in deprivation of multi - drug therapy (MDT), steroids and other drugs to leprosy patients, which is detrimental to the patients as well as to the society. This study was conducted to analyze the impact of covid-19 pandemic induced lock downs and movement restrictions on leprosy patients attending a tertiary care centre. This provides data to assess their impact on leprosy healthcare services. The study observed a marked decrease in the number of leprosy patients attending the leprosy out patient care and also a reduction in the number of new cases registered during the year 2020. Quarterly analysis showed maximum reduction of cases occurring during the lockdown period and peak covid-19 infection periods. As there is a likelihood of this pandemic continuing and similar other disruptions may occur again, there is a need to assure that MDT and health care services reach leprosy patients by various other means. Some of the modifications can be a) supplying a 3 to 6 month course at a time as A-MDT, b) home delivery of drugs by health workers c) promotion of telemedicine services for leprosy patients d) optimal utilization of social media to educate and counsel leprosy patients on both covid-19 and leprosy. It is also important that leprosy clinics and drug delivery services should be continued both in Covid and Non-covid hospitals at par with Revised National TB Control Programe (RNTPC) renamed as National Tuberculosis Elimination Programme (NTEP) and Anti-Retroviral Treatment (ART) services.Item Study of Correlation of High-Resolution Ultrasonography and Ultrasonography Guided Fine Needle Aspiration Cytology in Diagnosis of Pure Neuritic Leprosy in a Tertiary Care Hospital(Hind Kusht Nivaran Sangh (Indian Leprosy Association), 2022-12) Jena, S; Panda, S; Mohanty, P; Bisoyi, D; Pradhan, PThis study assesses the features of high-resolution ultrasonographic and ultrasound-guided FNAC of peripheral nerves and correlates the findings in clinically suspected cases of pure neuritic leprosy (PNL). As per the study protocol, clinically screened pure neuritic leprosy cases from January 2017 to June 2018 were subjected to high resonance ultrasonography and ultrasonography-guided FNAC. The aspirated material was stained with modified ZN stain for AFB. Nerves showed hypoechogenicity, loss or distorted echogenic rim, and fibrillary echotextures in ultrasonography. Epithelioid cells, epithelioid cell granuloma was found in the histopathology sections of FNAC specimens with the presence of AFB in some cases. From these findings it may be concluded that HRUS and ultrasound-guided FNAC could be incorporated as rapid and reliable diagnostic tools for PNL. It may enlighten the future path as an early indicator of neural damage and be critical and useful to prevent the disabilities.