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Exploring the Utility of High-Resolution Ultrasonography and Color Doppler of Peripheral Nerves in Monitoring Response to Treatment in Leprosy Patients: A Prospective, Observational Study
Apoorva Sharma
Apoorva Sharma
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;
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Tarun Narang
Tarun Narang
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;
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Mahesh Prakash
Mahesh Prakash
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India;
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Bijaya Kumar Padhi
Bijaya Kumar Padhi
Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sunil Dogra
sundogra@hotmail.com
Sunil Dogra
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;
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Diagnosis and monitoring of nerve function impairment (NFI) presents an ongoing challenge in global leprosy control. This was a prospective, observational study in leprosy patients receiving treatment with cutaneous and neurological examinations done every 3 months for 1 year. High-resolution ultrasonography and color Doppler (HRUS-CD) was performed in all patients at baseline, completion of treatment, and anytime during the study period if a patient had deterioration of nerve function noted clinically. All peripheral nerves were assessed, and parameters studied were cross-sectional area (CSA), length of thickening, endoneural flow signals (ENFS), and distortion in fascicular symmetry. Of 54 treatment-naive leprosy patients, loss of sensation was noted in 37 (68.5%), paresthesia in 20 (37.0%), and neuropathic pain in 7 (12.9%) at baseline presentation. At end of treatment of leprosy, maximum improvement in NFI across all clinical criteria was seen in ulnar and radial nerves (P <0.05). The number of impairments on HRUS-CD decreased consistently, significantly for ulnar (P = 0.009 right ulnar, P = 0.012 left ulnar) and right radial (P = 0.025) nerves, and significant improvements in CSA and ENFS were seen across multiple nerves, which correlated with improvement in NFI as well. Abnormal HRUS-CD findings in the target nerves were significantly associated with multibacillary cases (odds ratio [OR]: 4.33; 95% CI: 0.62–30.31), those in reaction (OR: 9.42; 95% CI: 1.51–58.66), and those older than 40 years (OR: 3.14; 95% CI: 0.49–19.93). This study provides objective evidence of improvement in NFI with anti-leprosy treatment, supporting integration of HRUS-CD imaging in monitoring nerve involvement in leprosy.
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Author Notes
Disclosures: Consent for the publication of recognizable patient photographs or other identifiable material was obtained by the authors and included at the time of article submission to the journal stating that all patients gave consent with the understanding that this information may be publicly available. The study was approved by the Institute’s Ethics Committee (IEC) (INT/IEC/2021/SL-1306), PGIMER, Chandigarh, India; Clinical Trials Registry-India (CTRI) (CTRI/2022/02/039908). This study was presented at European Academy of Dermatology and Venereology (EADV) Congress, Berlin, 2023.
Current contact information: Apoorva Sharma, Tarun Narang, and Sunil Dogra, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, E-mails: apoorvasharma1112@gmail.com, narangtarun@yahoo.co.in, and sundogra@hotmail.com. Mahesh Prakash, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India, E-mail: image73@gmail.com. Bijaya Kumar Padhi, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India, E-mail: bkpadhi@gmail.com.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 937 | 937 | 937 |
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