Research Letter
Single-lesion paucibacillary leprosy: a retrospective study of 75 cases treated with the ROM scheme
Silmara Navarro Penninia,b,c,
, Josineide de Oliveira Novo Françad,e, Paula Frassinetti Bessa Rebelloc, Sinésio Talharia,b,c
Autor para correspondência
a Tropical Medicine Program, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
b Universidade do Estado do Amazonas, Manaus, AM, Brazil
c Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
d Universidade Federal do Amazonas, Manaus, AM, Brazil
e Scientific Initiation Grant, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta in Collaboration with Fundação de Amparo à Pesquisa do Estado do Amazonas, Manaus, AM, Brazil
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array:1 [ 0 => array:4 [ "autoresLista" => "Silmara Navarro Pennini, Josineide de Oliveira Novo França, Paula Frassinetti Bessa Rebello, Sinésio Talhari" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Silmara Navarro" "apellidos" => "Pennini" "email" => array:1 [ 0 => "snp.ddt18@uea.edu.br" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Josineide de Oliveira Novo" "apellidos" => "França" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 2 => array:3 [ "nombre" => "Paula Frassinetti Bessa" "apellidos" => "Rebello" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Sinésio" "apellidos" => "Talhari" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Tropical Medicine Program, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidade do Estado do Amazonas, Manaus, AM, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Universidade Federal do Amazonas, Manaus, AM, Brazil" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Scientific Initiation Grant, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta in Collaboration with Fundação de Amparo à Pesquisa do Estado do Amazonas, Manaus, AM, Brazil" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Leprosy, an infectious disease caused by <span class="elsevierStyleItalic">Mycobacterium leprae</span>, remains a public health problem in Brazil. In 2018, 28,660 new cases were recorded, corresponding to 93% of patients diagnosed in the American continent. In the same year, Brazil, India, and Indonesia contributed with 80% of the 208,619 new cases reported worldwide.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">For operational purposes, in 2009, the World Health Organization (WHO) recommended classifying leprosy according to the number of skin lesions: paucibacillary (PB) leprosy – one to five lesions; and multibacillary (MB) leprosy – more than five lesions.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Multidrug therapy (MDT), recommended by the WHO in 1982, was decisive for the global reduction in the prevalence of leprosy. PB cases are treated for six months with rifampicin and dapsone; and MB cases undergo 12 months of treatment with the same drugs associated with clofazimine.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Given the knowledge about the possibility of spontaneous cure of single skin lesions PB cases (SSL-PB), the WHO, in 1998, recommended studies with a single dose of Rifampicin - 600 mg, Ofloxacin - 400 mg and Minocycline - 100 mg, a drug combination called the ROM scheme.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">One of the first studies with the ROM scheme was carried out in India with 1,483 patients. The ROM scheme was compared with the MDT treatment for PB cases. In this randomized clinical trial, 1,381 patients completed the study, and, at the end of 18 months, 99.2% of the cases attained clinical cure. There was no difference regarding the cure rates between the patients allocated to the two regimens, either MDT or ROM.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In Brazil, from October 1997 to November 1998, a multicenter study was carried out, designed as a prospective cohort, consisting of 259 patients with SSL-PB leprosy: 75 in the state of Amazonas, 59 in Goiás, 80 in Rio de Janeiro and 45 in Rondônia. All were treated with the ROM scheme and had a median follow-up of 31 months. In the follow-up, 216 (83.4%) cases were considered to be cured.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">According to data from the world literature and the results of the Brazilian study, the Brazilian Ministry of Health (MH) in 2002 recommended the ROM scheme as an alternative treatment to be used in referral centers.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In the latest leprosy control guide (MH, 2017), there is no reference to the ROM treatment and there are no explanations about its exclusion.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> On the other hand, in the 2020 recommendations for the treatment of leprosy, the WHO continues to recommend the ROM scheme.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">This investigation aimed to assess the clinical evolution of 75 patients in the state of Amazonas allocated to the Brazilian study, mainly in relation to the occurrence of events such as reactions, neuritis, and retreatment.</p><p id="par0050" class="elsevierStylePara elsevierViewall">For this analysis, a search was carried out in the database of the Notifiable Diseases Information System (SINAN) and its medical records. Only one medical record was not found. It also aimed to rescue patients for dermatological examination through telephone contact. None were found.</p><p id="par0055" class="elsevierStylePara elsevierViewall">During the investigation of the SINAM database, no information was found on the reentry of patients due to therapeutic failure.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The analysis of the medical records showed that 33 patients returned to the service: 19 with complaints not related to leprosy and 14 to have the disease reassessed. According to existing information, four patients showed signs of probable reactivation of the disease five to six years after treatment – ​​three cases reported reactivation or an increase in the size of the lesion, and one, classified as an indeterminate case, developed neuritis (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The medical records had no information about positive biopsy or bacilloscopy results. The dermatological examinations were not performed by the dermatologists involved in this research protocol. The criteria for therapeutic failure, after 20 years, were exclusively clinical and there was no definitive proof of treatment ineffectiveness.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In conclusion, it is emphasized that the ROM scheme is recommended by the WHO and should be considered as an alternative scheme for the treatment of PB cases with a single lesion, especially in referral centers.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM) – scientific initiation grant.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Silmara Navarro Pennini: design and planning of the study; critical review of the literature; collection, analysis, and interpretation of data; drafting, review and approval of the final version of the manuscript.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Josineide de Oliveira Novo França: critical review of the literature; collection, analysis, and interpretation of data; drafting and review of the manuscript.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Paula Frassinetti Bessa Rebello: design and planning of the study; critical review of the literature; analysis and interpretation of data; drafting and critical review of the manuscript.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Sinésio Talhari: Critical review of the literature; analysis and interpretation of data; drafting, critical review of the manuscript and approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-08-24" "fechaAceptado" => "2020-11-23" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow-up \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Classification \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical manifestation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Month of occurrence \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="9" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Three years<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reversal Reaction / MB histopathology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MDT-MB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neuritis (two nerves) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PRED/MDT-MB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reversal reaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MDT-PB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reversal reaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PRED/MDT-PB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increase in the number of lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MDT-PB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reversal reaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PRED/MDT-PB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reversal reaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MDT-PB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reversal reaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MDT-PB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Therapeutic failure/Enlargement of the initial lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MDT-PB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Twenty years</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Therapeutic failure/Enlargement of the initial lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MDT-PB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Therapeutic failure/Enlargement of the initial lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MDT-PB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Therapeutic failure/Neuritis (one nerve) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PRED/MDT-PB \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2872338.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Source: Rebello PF. Single-lesion paucibacillary leprosy: perspectives for implementing the single-dose multidrug therapy (Master’s Degree dissertation). Goiânia, Universidade Federal de Goiás; 2001.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Causes of single lesion leprosy retreatment after being treated with the ROM scheme in the state of Amazonas.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "World Health Organization [Internet]. Suíça: Weekly epidemiological record 2019;94:225–232. [cited 2020 Mai 06]. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 18 | 9 | 27 |
| 2024 Outubro | 143 | 64 | 207 |
| 2024 Setembro | 173 | 73 | 246 |
| 2024 Agosto | 187 | 106 | 293 |
| 2024 Julho | 123 | 106 | 229 |
| 2024 Junho | 117 | 78 | 195 |
| 2024 Maio | 86 | 63 | 149 |
| 2024 Abril | 101 | 89 | 190 |
| 2024 Março | 108 | 60 | 168 |
| 2024 Fevereiro | 92 | 81 | 173 |
| 2024 Janeiro | 67 | 48 | 115 |
| 2023 Dezembro | 52 | 56 | 108 |
| 2023 Novembro | 79 | 99 | 178 |
| 2023 Outubro | 56 | 74 | 130 |
| 2023 Setembro | 65 | 72 | 137 |
| 2023 Agosto | 46 | 30 | 76 |
| 2023 Julho | 52 | 35 | 87 |
| 2023 Junho | 60 | 40 | 100 |
| 2023 Maio | 58 | 15 | 73 |
| 2023 Abril | 38 | 22 | 60 |
| 2023 Março | 76 | 46 | 122 |
| 2023 Fevereiro | 40 | 31 | 71 |
| 2023 Janeiro | 52 | 50 | 102 |
| 2022 Dezembro | 65 | 47 | 112 |
| 2022 Novembro | 73 | 57 | 130 |
| 2022 Outubro | 150 | 54 | 204 |
| 2022 Setembro | 60 | 72 | 132 |
| 2022 Agosto | 49 | 56 | 105 |
| 2022 Julho | 85 | 80 | 165 |
| 2022 Junho | 68 | 91 | 159 |
| 2022 Maio | 111 | 83 | 194 |
| 2022 Abril | 103 | 98 | 201 |
| 2022 Março | 142 | 141 | 283 |
| 2022 Fevereiro | 44 | 61 | 105 |
| 2022 Janeiro | 55 | 56 | 111 |
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