Certain aspects of dapsone metabolism in leprosy patients as studied by high performance liquid chromatography (HPLC) and qualitative screening tests

Dapsone (DDS) in urine of 250 leprosy patients collected on surprise visits were screened by simple paper spot, tile tests and sensitive Enzyme linked immunosorbent assay (ELISA) and Haemagglutination inhibition (HI) tests. The urinary DDS concentration as well as DDS/C ratios were also studied. Simultaneously, 50 microliter of blood was collected from each of these patients and its dapsone content was estimated by HPLC. Urine samples with means of 25 to 30 micrograms/ml DDS and 55-64 micrograms/mg DDS/C ratios were found to give positive tests by any of the above screening procedures, while their mean blood DDS concentration was found to be 0.91 microgram/ml. The corresponding values for those specimens giving negative tests were 3.8 to 5.7 micrograms DDS per ml and 9 to 13 micrograms/mg DDS/C ratio. The blood DDS concentration in this group was ranging from 0.16 to 0.18 micrograms/ml. The findings are discussed in relation to their metabolic significance and their application in a leprosy control programme.     

Pattern of drug compliance in leprosy patients attending urban centres--a longitudinal study

The pattern of drug compliance in 485 leprosy patients attending urban leprosy centres in Bombay was studied for 2 years. The study subjects included 113 patients with paucibacillary leprosy under dapsone monotherapy, 241 patients with paucibacillary leprosy under multidrug therapy and 131 patients with multibacillary leprosy under multidrug therapy. Their urine samples had been checked at least 6 times during the 2 years by DDS tile test at the time of their clinic attendance. The urine test results were not disclosed to the patients, but patients showing negative results were counselled about the need for regular drug intake. 35% of the patients were "Regular through out", 13% were "Irregular through out" and the other 52% who "Tended to be irregular" in their drug intake became "Regular" after counselling. Regularity in drug compliance was better in patients on multidrug therapy than in those on monotherapy. It is suggested that periodic testing of urine for checking for regularity of drug intake and subsequent counselling of patients should be made a routine practice to maintain drug compliance at a high level.     

Pharmacokinetic observations on dapsone in dermatitis herpetiformis

The pharmacokinetics of dapsone (DDS) and monoacetyldapsone (MADDS) following an oral dose of 150 mg DDS were studied in sixteen patients with dermatitis herpetiformis and seven normal subjects. No differences in DDS disposition were observed between the two groups. The maintenance dose of DDS for individual patients was not significantly correlated with jejunal biopsy morphology, DDS or MADDS half-lives, or the area under the plasma concentration-time curves for DDS or MADDS. DDS plasma protein binding was normal in patients and did not apparently determine the concentration of DDS in skin biopsies, for which the skin/plasma DDS concentration ratio was approximately unity. There was no undue representation of acetylator phenotype in the patient group and no correlation between maintenance dose and MADDS/DDS ratio was noted. The determinants of the maintenance DDS dose have not been found. This may relate to pharmacodynamic differences, but alternatively the concentration of oxidative metabolites rather than DDS or MADDS could be responsible for the therapeutic activity in dermatitis herpetiformis.     

Absenteeism in leprosy patients in a rural area in Tamil Nadu

Of the 3382 leprosy patients taking treatment in Hemerijckx Rural Centre Area, 150 randomly selected patients, who were irregular for treatment, were matched with 150 patients who were regular for treatment, by age, sex and type of disease. The characteristics and the reasons for regularity/irregularity in treatment of these 300 patients were studied. There were more Lepromatous patients (20%) among regulars. A greater proportion of irregulars belonged to backward (54%) and scheduled castes (35%). The proportion of irregulars were more (32%) in the initial phase of the disease. There were more irregular patients among the illiterate group (61%). The knowledge of the irregular patients about early sign, causation, spread, curability and duration of treatment were found to be lacking. The clinic timing was unsuitable for 33% of irregular patients. 23% of irregulars experienced some intolerance to DDS. When 94% of regulars attended clinic in order that they may be 'cured', 63% of irregulars stayed away because of 'work'.     

Measuring treatment compliance of men with non-gonococcal urethritis receiving oxytetracycline combined with low dose phenobarbitone.

Of 62 men with non-gonococcal urethritis who entered a study to assess compliance with treatment with oxytetracycline, only 33 could be evaluated. Traditional methods (interview and the absence of oxytetracycline in the urine) showed incomplete compliance in nine. Use of low dose phenobarbitone as a pharmacological marker showed incomplete compliance in a further five patients. In addition, phenobarbitone concentrations gave information on the extent to which individual patients had omitted treatment and provided direct, as opposed to circumstantial, evidence of good compliance by most (18) of those studied. Only three of the 33 patients whose compliance was assessed had evidence of continuing infection at follow up, and there was evidence of incomplete compliance in only one of these patients.     

Behavior modification obtained by sun protection education coupled with removal of a skin cancer

The 1042 people in this study who had a nonmelanoma skin cancer surgically removed received repetitive and interactive oral and written education in forms of sun protection. One year after these educational efforts, the subjects responded to a questionnaire that measured their compliance. Sixty-two percent complied with starting to use sunscreens and 56% changed their habits of outdoor activities. The portion of behavioral change attributable to surgery alone vs surgery plus education was unable to be determined. Despite intensive educational efforts, the noncompliance was 38%. This study identifies a health risk-taking pattern of behavior among those who were noncompliant. Those over age 65 years tended to be less compliant. When the data were analyzed by the transtheoretical model of behavior change, those already acting on some form of sunscreen use prior to this study achieved 100% compliance with increasing to a sunscreen with a sun protection factor of 15 or greater. It is hoped that with more educational efforts those in precontemplative and contemplative phases of behavior can be recruited to take action, and those who acted by acquiring one sun protective behavior will add other behaviors.     

DDS-induced photosensitivity with reference to six case reports

Photosensitivity as an adverse reaction to DDS was recognized in 6 patients of our hospital during the summer of 1988. The clinical manifestations and also the management of those patients are given in detail. All doctors and health workers involved with leprosy need to be aware of such a problem and to take correct decisions after weighing the risk of photosensitivity against the potential benefit of DDS.     

尿动力学检测在前列腺增生患者中的意义

目的：分析前列腺增生症患者的尿动力学参数,为个性化治疗前列腺增生症提供依据。方法：2011年1月至2013年1月我科收治800名前列腺增生症患者,经直肠指诊、泌尿系彩超,膀胱镜等初步诊断为前列腺增生,对所有患者进一步行尿动力学检查。结果：本组800例患者中,无梗阻8例;可疑梗阻89例,其中逼尿肌收缩无力23例,逼尿肌收缩乏力66例;膀胱出口明显梗阻（BOO）703例,患者中伴不稳定膀胱132例,低顺应性膀胱486例,不稳定膀胱合并低顺应性膀胱18例。平均最大尿流率（8.2±1.5〕mL/s,平均残余尿量（82.6±75.6）mL,急迫尿意时膀胱容量（280.6±171.3）mL,与同期体检中心健康者正常值比较有差异（P〈0.05）。顺应性（24.4±16.5）mL/cmH2O,与同期体检中心健康者正常值比较无差异（P〉0.05）。结论：尿流动力学检测对前列腺增生症患者具有重要意义。     

Why do patients with atopic dermatitis refuse to apply topical corticosteroids?

BACKGROUND: The number of patients with atopic dermatitis who refuse to use topical corticosteroids because of personal fears seems to be increasing. However, studies on this subject are scarce. Consequently, we have investigated this issue further. METHODS: A cross-sectional study based on a questionnaire. Between September 1998 and January 1999, a questionnaire was distributed to patients who responded to an announcement and to those attending 18 hospitals or clinics and 11 self-help groups throughout Japan to identify what makes patients resistant to applying topical corticosteroids. RESULTS: Patients who are reluctant to use topical corticosteroids often experienced: ineffective or short-lasting results, adverse side effects and feelings of distrust towards their physician. These feelings of distrust were found to be significantly stronger among patients who were reluctant to apply topical corticosteroids than among patients who accepted the treatment with little or no feelings of resistance. External influences such as those from family members, acquaintances, mass media (television, newspapers and magazines), alternative 'nondoctor' therapists and self-help groups were not found to be a significant factor between both groups. However, the influence of the physician was found to be significant and directly related to the patients' lack of trust. CONCLUSIONS: Patients with atopic dermatitis who refuse to use topical corticosteroids attribute their feelings of resistance to personal experiences rather than to information from external sources. Information or warnings about associated side effects from physicians may help to reduce these fears and ultimately benefit the physician-patient relationship.     

新发和复发麻风患者中麻风菌的氨苯砜、利福平耐药基因的检测

目的：检测麻风菌的氨苯砜、利福平耐药基因，以了解复发与耐药的关系。方法：在PCR扩增出麻风菌的氨苯砜耐药基因fol P1、利福平耐药基因rpoB靶片段的基础上，采用直接测序和异源双链分析确定相应基因是否有突变。结果：在7例复发病例中，发现2例为DDS耐药菌株，但未发现有：RFP，耐药菌株。在35例新病人中，有22例和31例分别扩增出fol P1和rpoB基因，但均未发现有DDS、RFP基因突变。结论：结合2例DDS耐药病例的临床病史分析提示，fol P1基因不同突变，可能导致不同程度的DDS耐药。虽然本研究未发现有RFP耐药菌株，但是对复发病例开展DDS、RFP耐药检测却是十分必要的。     

氨苯砜在皮肤科的应用

氨苯砜（dapsone, DDS）曾被广泛应用于诸多感染性和炎症性皮肤病的治疗，但随着对其致死性药物不良反应-氨苯砜超敏反应综合征（dapsone hypersensitivity syndrome, DHS）的认识，DDS逐步退出临床，目前仅用于麻风的治疗。随着DHS风险因子HLA-B*13:01的发现和转化应用，DDS的应用前景一片光明。本文从DDS的药代学、药效学和就DDS在皮肤科应用做一综述。     

氨苯砜超敏反应综合征5例临床分析

目的探讨氨苯砜超敏反应综合征的临床特征和治疗方法。方法回顾分析5例氨苯砜超敏反应综合征临床资料。结果5例氨苯砜超敏综合征用药潜伏期较长,为20～42天,均以发热或皮疹为首发症状,皮疹呈多形性,为麻疹样型、多形红斑型和红皮病型,所有患者均有浅表淋巴结肿大,肝肿大,1例脾肿大,并伴有血液学异常和肝功能受损,治疗时间平均58天,4例痊愈出院,1例死于肺部感染。结论氨苯砜超敏综合征表现为发热、皮疹、黄疸、淋巴结肿大、肝损害和溶血性贫血。根据DDS用药史,排除微生物感染和其他发疹性疾病可诊断本病,治疗应遵循重症药疹治疗原则。     

Clinical analysis of multibacillary leprosy patients after 1-year fixed World Health Organization recommended multidrug therapy at Yangon General Hospital, Myanmar

This study included 200 randomly selected multibacillary leprosy cases who had completed 1 year of fixed World Health Organization recommended multidrug therapy (WHO-MDT) without prior dapsone (DDS) monotherapy. The time interval after release from treatment varied from a few months to 8 years. All cases were clinically reviewed in 2006 by comparison with their old clinical records. Reactions, particularly reversal reactions, occurred frequently among patients who had completed MDT within the last 3 years. It was difficult to distinguish relapse cases and late reversal reactions in skin smear-negative multibacillary cases. Based on bacteriological and histological analyses, one patient was confirmed to have relapsed 1 year after release from treatment. The overall relapse rate was 0.5%. No drug resistance mutations were detected by polymerase chain reaction or dot blot hybridization. The present study indicates that it is important to follow up patients for several years after completion of MDT in order to detect possible lepra reactions and relapses.     

Patients with psoriasis and their compliance with medication.

BACKGROUND: Poor compliance with treatment advice in chronic conditions, such as psoriasis, represents a major challenge to health care professionals. Previous research suggests that the rate of noncompliance in chronic conditions may be as high as 40%. OBJECTIVE: This study was designed to examine self-reported compliance in patients with psoriasis. METHODS: We undertook an anonymous postal survey sent to consecutive patients with psoriasis attending a tertiary psoriasis specialty clinic. RESULTS: Thirty-nine percent of participants reported that they did not comply with the treatment regimen recommended. The noncompliant group had a higher self-rated severity of psoriasis (t = -2.16, P =. 03), were younger (t = 3.28, P =.001), and had a younger age at onset (t = 2.35, P =.02) than those who were compliant. The noncompliant group reported that psoriasis had a greater impact on daily life (t = -2.23, P =.028), but general well-being was not significantly different from those who complied (t =.47, P = not significant). CONCLUSION: Patients who reported intentional noncompliance with treatment advice were more likely to believe that both psoriasis and its treatment interfered with their quality of life but not overall well-being. The impact of treatment on daily life highlights the importance of joint decision making in planning treatment.     

Evaluation of the use of calendar blister packaging on patient compliance with STD syndromic treatment regimens

BACKGROUND: Good compliance with antibiotic therapy is critical for successful management of sexually transmitted diseases (STDs). GOAL OF THIS STUDY: To evaluate the use of user-friendly drug packaging as a means of improving patient compliance with STD therapy and the acceptability of the packaging. STUDY DESIGN: Compliance of patients with STDs with treatment regimens for three different STD syndromes, using antibiotics packed in standard medicine packaging (SP), was compared to that of patients using calendar blister packaged drugs. Compliance was measured by counting the remaining pills at two return visits. Questionnaires were used to evaluate acceptability of the packs. RESULTS: Compliance was significantly better among patients using the calendar blister packs than among those using standard packs, irrespective of dosing frequency. The degree of poor compliance increased with increasing dosing frequency. There was a high level of satisfaction with the blister pack among patients and health care workers. CONCLUSION: Compliance can be improved by the introduction of user-friendly drug packaging, especially for more complex dosing regimens.     

Dapsone drug compliance study among leprosy patients: a comparison between qualitative and quantitative methods

The methods currently employed to monitor self-administration of dapsone have been evaluated by comparing the results of the qualitative spot test and quantitative DDS/creatinine ratio test. Random urine samples of 242 leprosy patients, periodically attending the Leprosy Clinic were tested. Although a good correlation between the results of the two tests was evident, the DDS/creatinine ratio technique appeared to be more sensitive than the spot test. The concentration of DDS and its metabolites in urine specimens found to be negative by the spot test, ranged from 3.32-12.37 micrograms of DDS/mg creatinine. The spot test was found to be more specific and stays to be the method of choice, when rapidity and reproducibility are the prime objectives, and sensitivity can be marginally compromised. Acidification of urine prior to the spot test was found to be desirable to rule out false negative and false positive reactions.     

氨苯砜综合征8例临床分析

目的:探讨氨苯砜(DDS)综合征的临床特点。方法:回顾分析8例DDS综合征患者的临床资料。结果:8例患者均在服用DDS21～40d后起病,以皮损或发热为首发症状,都伴有皮肤或巩膜黄染;均有浅表淋巴结增大,6例有肝大,3例脾大;3例有胸腔或腹腔积液;血常规示6例嗜酸性粒细胞升高,2例出现异形淋巴细胞,3例单核细胞增多;8例均有肝功能异常和贫血。结论:DDS综合征的临床特征为发热、皮损、黄疸、淋巴结增大、贫血及肝脏损害等,其治疗遵循重症药疹的治疗原则。开始要足量使用糖皮质激素,减量不宜过快。     

Armadillo as a model for studying chemotherapy of leprosy: preliminary studies

In order to determine the suitability of the armadillos as a model of human leprosy for chemotherapeutic studies, especially in evaluating newer anti-leprosy drugs, uninfected Armadillos were used to study the metabolic disposition of DDS. Serum DDS levels ranged from 500 ng/ml at 3 hours to 13 ng/ml at 96 hours after intravenous administration of DDS (1 mg/kg). In an ad libitum feeding trial of DDS it was found that the level of serum DDS varied according to the dose of DDS, and even at a dose of 0.0001%, the animals maintained MIC of DDS against M. leprae. Finally, it was demonstrated that armadillos acetylate DDS to MADDS and 7-9% of DDS is acetylated by armadillos.     

护理干预对艾滋病患者药物依从性及生存质量的影响初探

目的：探讨综合护理干预对艾滋病患者治疗依从性及生存质量的影响。方法：随机选取240名艾滋病患者,并将研究对象随机分为对照组和干预组,每组各120名。对干预组患者在常规护理的基础上,针对其护理需求制定干预措施,实施综合性护理干预。利用自制《抗病毒药物依从性调查表》和《世界卫生组织生存质量测定量表（WHOQOL-100）》收集患者的基线资料、干预3个月后的评估资料并进行对比分析。结果：护理干预后的治疗依从性和生存质量高于干预前,干预组高于对照组。结论：本文设计的综合护理干预方案是合理有效的,能明显提高艾滋病病人的治疗依从性和生存质量,为艾滋病病人的治疗与护理及相关政策的制定提供依据。