The Application of Biomedical Engineering Techniques to the Diagnosis and Management of Tropical Diseases: A Review <s> Leprosy <s> Leprosy is best understood as two conjoined diseases. The first is a ::: chronic mycobacterial infection that elicits an extraordinary range of ::: cellular immune responses in humans. The second is a peripheral ::: neuropathy that is initiated by the infection and the accompanying ::: immunological events. The infection is curable but not preventable, and ::: leprosy remains a major global health problem, especially in the ::: developing world, publicity to the contrary notwithstanding. ::: Mycobacterium leprae remains noncultivable, and for over a ::: century leprosy has presented major challenges in the fields of ::: microbiology, pathology, immunology, and genetics; it continues to do ::: so today. This review focuses on recent advances in our understanding ::: of M. leprae and the host response to it, especially ::: concerning molecular identification of M. leprae , knowledge of ::: its genome, transcriptome, and proteome, its mechanisms of microbial ::: resistance, and recognition of strains by variable-number tandem repeat ::: analysis. Advances in experimental models include studies in gene ::: knockout mice and the development of molecular techniques to explore ::: the armadillo model. In clinical studies, notable progress has been ::: made concerning the immunology and immunopathology of leprosy, the ::: genetics of human resistance, mechanisms of nerve injury, and ::: chemotherapy. In nearly all of these areas, however, leprosy remains ::: poorly understood compared to other major bacterial ::: diseases. <s> BIB001 </s> The Application of Biomedical Engineering Techniques to the Diagnosis and Management of Tropical Diseases: A Review <s> Leprosy <s> Leprosy is a curable disease with well-defined etiology, but lacks better diagnostic tools, preventive and therapeutic strategies. The continued application of the Ridley–Jopling clinical classification that recognizes the natural diversity of the immune response has provided the basis for understanding leprosy, and this review proposes its implementation in all Reference Centers in order to standardize the diagnostic resources, aiming at the improvement of the disease control. Due to the broad bioepidemiological aspects of infection its eradication is difficult, and proper diagnosis of the disease and the correct clinical classification are required to ensure proper treatment. Tools and markers for diagnosis and prognosis, and the novel use of nanotechnology, as well as strategies for disease control and monitoring populations at higher risk are still continuous challenges, which will be specifically reviewed with additional insights. The use of the current diagnostic tools, such as ELISA and PCR has a very limited approach for leprosy that has been considered as a marginal disease; therefore, the current diagnostic tools must be applied extensively in the routine to accumulate clinical experience in order to improve their precise application, like what has been done in many other infectious diseases. Since a vaccine for leprosy presents an unpredictable future, the proposed chemoprophylaxis of contacts (healthy carriers and/or with subclinical infection) must also be employed in referral centers of endemic countries not only to evaluate its efficacy, but also because of the favorable cost–benefit ratio, given that there is no other available approach, besides the multi-drug therapy of patients. This strategy should readily be applied as a public health policy, and may lead to a substantial breakage of the transmission chain aiming a world without leprosy. <s> BIB002 </s> The Application of Biomedical Engineering Techniques to the Diagnosis and Management of Tropical Diseases: A Review <s> Leprosy <s> Leprosy has been a major burden on humanity over thousands of years. Perhaps no other disease in the history of mankind has been associated with such a strong social stigma as leprosy. Failure in early detection often leads to severe disability in spite of eradication of mycobacteria at a later date. Untreated the disease is progressive and results in permanent damage to the skin, nerves, limbs and eyes. Objectives: To study the pattern of neurological manifestations among adult Sudanese leprosy patients seen in Khartoum Dermatology Hospital in the period from March 2006 to August 2006. Methodology: This is a prospective cross-sectional hospital-based study. Seventy adult Sudanese leprosy patients were studied using simple, direct, standardized questionnaire including history and neurological examination, during the period from March to August 2006. Results: The most common age group affected was 18- 27 years. Male to female ratio was 3:1. Numbness was the most common neurological symptom seen in 77.14%. Each of visual disturbance, headache and bilateral ulnar sensory impairment was detected in 7.14%. Half of the patients had upper limbs sensory nerve dysfunction while 42.86% exhibited sensory nerve dysfunction in the lower limbs. "Gloves and stoking" sensory impairment was the most common finding (30%) while bilateral lateral popliteal sensory impairment was seen with the same percentage. Bilateral median and unilateral posterior tibial sensory impairment were found in 1.43% each. Unilateral radial cutaneous sensory impairment was seen in 2.86%. Approximately half (48.57%) of the patients had upper limbs motor dysfunction. Bilateral ulnar distribution motor affection was seen in 40%. A significant number (41.43%) had upper limbs muscle wasting. Impaired olfaction was the most common cranial nerve sign seen in 12.86%. Leprosy reactions were detected in 21.43%; type 2 reaction in 14.29% while type 1 reaction in 7.14%. Conclusion: Numbness and limbs weakness were the most common neurological symptoms in leprosy patients. Peripheral nerve sensory impairment was found in half of the patients with "Gloves and stokes" peripheral sensory neuropathy being the most common sensory disturbance. Motor dysfunction was found in 48.57%. Ulnar and median nerves motor affection was the most common motor dysfunctions. Signs related to cranial nerves involvement were less common. Leprosy reactions were present in one-fifth of the patients. Keywords: Mycobacterium leprae, granulomatous, numbness, popliteal <s> BIB003
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The cause of the disease was identified in 1873 by G.H.A. Hansen and is also known as Hansen's disease  . It remains a public health problem and transmission continues, although prevalence has been reduced in the past half century. Never the less leprosy remains as a leading infectious disease causing disabilities. At the beginning of 2011, the global registered prevalence of leprosy from 130 territories stood around 192,000 cases, while during 2010 the number of newly detected cases was about 228,000 [9] . The primary external sign of leprosy is skin lesions that if left untreated, can be progressive and cause permanent damage to the limbs, eyes, nerves and skin. Thus early diagnosis and treatment is essential BIB003 . Mycobacterium leprae cannot be cultured in the laboratory, hence scientists are using innovative techniques to measure the interaction of host cells with Mycobacterium leprae, however there still is no primary method for prevention of leprosy nor a means of diagnostic and prognostic testing that is practical in routine clinical care BIB001 . Problems with diagnosis of leprosy are related to its insidious nature with sometimes conflicting immunological, clinical and pathological manifestations even though there is minimal genetic variation among Mycobacterium leprae isolates worldwide. An effective diagnosis method for all stages of the diseases is electroneuromyography (ENMG). ENMG is a technique where the muscle nerve under study is stimulated with electric current. The effectiveness is demonstrated by the presence of electroneuromyographic alterations among 98% of leprosy confirmed patients, especially in the diagnosis of pure neural leprosy BIB002 .