Leprosy is a skin disease that accounts for serious deformities and disabilities, leading to stigmatization and psychosocial suffering. It is included in “The Neglected Tropical Diseases”. Not surprisingly, its management is increasingly reported as a function of Dermatology Departments, with a strong community-orientated bias. Prompt and accurate diagnosis of leprosy is crucial in the control of leprosy. Its management requires a multidisciplinary team of skilled physicians, laboratory staff, and nurses. All members of the health sectors should remain vigilant to combat this battle against leprosy.

If you had horrible back or stomach pain, you’d get yourself to a doctor (or emergency room!), immediately, right? Yet, when the pain is emotional—for instance, feeling persistently worried, sad or hopeless—people are likely to resist seeking help for months or even years. In a survey by SELF in conjunction with Discovery Health and Mental Health America in Alexandria, Virginia, 53 percent of women say they’ve felt intense worry for weeks—a sign of anxiety—and 54 percent say they’ve been consistently sad or hopeless, hallmarks of depression. Yet only 35 percent have received an official diagnosis of anxiety or depression. It takes, on average, six years for people to get treated for mood disorders, according to a survey by the pharmaceutical company Eli Lilly. While suffering in silence is never a good idea, failing to seek help for anxiety or depression is downright dangerous, because the longer you wait, the worse things can get. In fact, increasing numbers of women are being diagnosed with a combination of anxiety and depression, because untreated anxiety can turn into depression and vice versa. This may be why two out of three depressed people also have symptoms of anxiety, according to Mental Health America.

Whether you doubt that your sadness warrants treatment (as 43 percent of women do), are embarrassed to talk to a professional (as 23 percent admit) or simply feel too apathetic or lethargic to make a visit, getting a diagnosis is first step to feeling like yourself again. Ask your physician for a referral to a psychologist or a psychiatrist or call your insurer for a list of mental health providers—you’ll be glad you did. If you aren’t struggling emotionally but suspect a friend is, tell her you sense that she’s feeling down and offer to assist her in finding a doctor. Thanks to your help, she’s likely to eventually start feeling better instead of worse. It may take a while to decide on the right course of treatment, whether it’s for you or your loved one, but in the meantime, making a few changes to your everyday habits can upgrade your outlook. Try the changes below to lift your mood, and to learn more about anxiety, depression and other emotional afflictions.

Sweat away sadness

We all know someone who says they exercise for their mental health, and guess what? Research proves they’re right! It turns out that working out may be as effective at relieving mild to moderate depression as the antidepressant Zoloft, because it stimulates the release of the feel-good chemical dopamine in your brain, according to a study from Duke University in Durham, North Carolina. And you don’t need to train for a triathlon to reap the benefits. Just 30 minutes of walking a day can improve your mood. If you’d rather stretch than stride, even taking a yoga class has been proven to boost levels of a neurotransmitter called gamma-aminobutyric acid that helps keep depression at bay.

Eat good food

Fish that contains omega-3 fatty acids enhances areas of the brain that affect your mood, so aim to eat a low-mercury swimmer, like wild salmon, arctic char or sardines twice a week. Have a baked spud on the side for a dose of vitamin B6, which lowers your depression risk. And foods rich in folate, such as spinach, beans and oranges, are filled with blues-busting serotonin—dig in, feel better!

Have sweet dreams

It’s not just beauty sleep—it’s happy sleep! Logging a solid seven to eight hours of rest is one of the most important things you can do for your emotional health. People who have insomnia are five times more likely to develop depression compared with those who are well-rested, a study from the University of North Texas in Denton finds. To make it easier to drift off, skip late-night TV and web surfing, jot down your worries on a notepad so you can rest with a clear mind and try soothing stretches before turning in.

Claim some quiet time

Something to contemplate: Frequent meditation is as effective as medicine at reducing bouts of depression, according to research. Yoga is a great way to clear your mind, but if you’re not the oming type, try setting aside 10 minutes in the morning to do deep breathing. Or, if you’re like me and prefer to stay in motion, try this “walking meditation:” Stride slowly for 20 minutes sans iPod. Stare at the ground 6 feet ahead and focus on the soles of your shoes lifting and dropping.

See the light

Depressed people who were exposed to a bright light for an hour upon waking up in the morning for five weeks experienced a 54 percent improvement in symptoms, according to a study from Wesleyan University in Middletown, Connecticut. Try flicking on an energy light, such as the Philips goLITE BLU ($199), as you read your morning paper or answer your email.  Spending more time outside can also lift your spirits and tame stress, according to research. Read a book on a park bench during your lunch break or bike to run your errands. Stuck inside? Try to sit near a window.

Phone a pal

Not surprisingly, lonely folks are more likely to be depressed, research from the University of Chicago suggests. To feel your happiest, aim to strengthen bonds with at least three close pals. Make buddy dates by automating them—agree to meet at the gym twice a week, or gather for a night of takeout and movie watching the first Friday of each month. You’ll keep your spirits high with a little help from your friends!

What’s your stress style? Take the quiz on Self.com to find out, and learn how to cope better with anything.

A. Pre-exposure Measures

1. The most effective preventive measure is the avoidance of high-risk exposure (i.e. wading in floods and contaminated water, contact with animal body fluids).
2. If high risk exposure is unavoidable, appropriate protective measures include wearing boots, goggles, overalls, and rubber gloves.
3. Pre-exposure antibiotic prophylaxis is NOT ROUTINELY RECOMMENDED. However, in those individuals who intend to visit highly endemic areas AND get exposed, pre-exposure prophylaxis may be considered.

Pre-exposure prophylaxis regimen for non-pregnant, non-lactating adult: Doxycycline 2 capsules of 100 mg/ capsule once weekly, to begin 1 to 2 days before exposure and continuing through the period of exposure Currently, there is NO recommended pre-exposure prophylaxis that is safe for pregnant and lactating women.

B. Post-Exposure Measures

1. Antibiotic prophylaxis in the prevention of leptospirosis is NOT 100% effective.
2. Factors that may affect prophylactic effectiveness include the quality of the drug, timing of intake of the antibiotic, drug interaction, the presence or absence of skin wounds, and degree and extent of exposure.
3. Antibiotic prophylaxis of leptospirosis may be achieved by administration of doxycycline depending on the risk category of exposure.
1. LOW RISK is defined as those individuals with a single history of wading in flood or contaminated water but with absence of wounds, cuts or open lesions of the skin.

2. Doxycycline (hydrochloride or hyclate) at 2 capsules of 100 mg/capsule single dose within 24 to 72 hours of exposure. MODERATE RISK is defined as those individuals with a single history of wading in flood or contaminated water and the presence of wounds, cuts, or open lesions of the skin, OR accidental ingestion of contaminated water.

3. Doxycycline (hydrochloride or hyclate) at 2 capsules of 100 mg/capsule once a day for 3-5 days to be started immediately within 24 to 72 hours of exposure. HIGH RISK is defined as those individuals with continuous exposure (i.e., those with more than a single exposure; those exposed for several days, e.g., residents in flooded areas, rescuers and relief workers). People who wade in flooded or contaminated water everyday – with or without wounds, cuts or open lesions of the skin; those who swim in flooded water and ingest contaminated water are also considered high risk.

Doxycycline (hydrochloride or hyclate) at 2 capsules of 100 mg/capsule once weekly until the end of exposure
4. The use of such prophylaxis REQUIRES PRIOR CONSULT WITH A PHYSICIAN. It should not be taken unless prescribed and fully explained by a physician, including common side-effects and contraindications.
5. SINCE ANTIBIOTIC PROPHYLAXIS IS NOT 100% EFFECTIVE, INDIVIDUALS SHOULD CONTINUE TO MONITOR THEMSELVES FOR FEVER AND OTHER FLU-LIKE SYMPTOMS.

C. Algorithm on the Risk Category and Prophylactic Regimen

ANNEX
Doxycycline8-10

Contraindications

* Do not use this medication if you are pregnant. It could cause harm to the unborn baby, including permanent discoloration of the teeth later in life.
* Do not take this medication without telling your doctor if you are breast-feeding a baby. Doxycycline passes into breast milk and may affect bone and tooth development in a nursing baby.
* Do not give doxycycline to a child younger than 8 years old. Doxycycline can cause permanent yellowing or graying of the teeth, and it can affect a child’s growth
* Do not use this medication if you are allergic to doxycycline, or to similar medicines such as demeclocycline, minocycline, or tetracycline.

Precautions

* Before taking doxycycline, tell your doctor if you have liver or kidney disease. You may not be able to take doxycycline, or you may need a dose adjustment or special tests during treatment
* Doxycycline can make birth control pills less effective. Use a second method of birth control while you are taking doxycycline to keep from getting pregnant.
* Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Doxycycline can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.
* Do not take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking doxycycline
* Store this medication at room temperature away from moisture and heat
* Throw away any unused doxycycline when it expires or when it is no longer needed. Do not take any doxycycline after the expiration date printed on the bottle. Expired doxycycline can cause a dangerous syndrome resulting in damage to the kidneys.

Drug Interactions

* Drug interactions: antacids; minerals such as iron, zinc, calcium, magnesium, and over-the-counter vitamin and mineral supplements cholesterol-lowering medications such as cholestyramine or colestipol; isotretinoin; tretinoin; product that contains bismuth subsalicylate; warfarin; penicillin antibiotic such as amoxicillin, penicillin, dicloxacillin, oxacillin (Bactocill), and others.

Adverse Reactions

* Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
* Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Other alarming side effects:

* severe headache, dizziness, blurred vision; fever, chills, body aches, flu symptoms; severe blistering, peeling, and red skin rash; urinating less than usual or not at all; pale or yellowed skin, dark colored urine, fever, confusion or weakness; severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate; loss of appetite, jaundice (yellowing of the skin or eyes); or easy bruising or bleeding, unusual weakness.

Less serious side effects may include:

* swollen tongue, trouble swallowing; mild nausea, vomiting, diarrhea, or stomach upset; white patches or sores inside your mouth or on your lips; sores or swelling in your rectal or genital area; or vaginal itching or discharge.

How to Reduce Doxycycline Side Effects

* Ensure that your physician is aware of all medications and over-the-counter vitamin supplements or herbal remedies that you are taking. Antacids and certain vitamins and minerals are known to interfere with doxycycline absorption.
* Take doxycycline with food or following a meal. If you have taken doxycycline on an empty stomach before and gotten away with it, the next time may be different. Doxycycline induced nausea is quite unpleasant and more serious stomach irritation can occur.
* Don’t lie down for an hour following doxycycline intake to prevent one of the most formidable doxycycline side effects, esophageal damage. If reclined, the medication may dissolve in the esophagus instead of the stomach. If this doxycycline side effect occurs, a patient may gag on something as innocuous as sips of water. Treatment may take days for this condition to abate, depending on the extent of the irritation or damage.
* Avoid, if possible, taking doxycycline along with other medications that are known to bother the stomach. Space out the medications accordingly and add more food intake if needed. Pain medications and NSAIDs (e.g., ibuprofen) combined with doxycycline may cause significant stomach distress.
* Talk to your physician about the benefits of acid reducers, rather than antacids, as these may be helpful in reducing or eliminating some doxycycline side effects.
* Discuss any recommended treatments for yeast infection should these occur. Some patients find lactobacillus helpful in preventing yeast infections. This healthy bacteria is found in some foods, including yogurt and cheese. It is also available as a supplement in capsule form.
* Take doxycycline 100 mg capsule BID if 200 mg OD is not tolerated.

References

1. San Lazaro Hospital Guideline on Prophylaxis for Leptospirosis 2009
2. DOH- Health Emergency Management Staff Manual on Treatment Protocols of Common Communicable Diseases and other Ailments During Emergencies and Disasters
3. Mandell’s Principles and Practice of Infectious Diseases 2005 6th ed chapter 237:2789-2795
4. Mandell’s Principles and Practice of Infectious Diseases 2009 7th ed
5. New England Journal of Medicine Feb 23, 1984 Volume 310 (8):497-500
6. Int J Antimicrob Agents 2000 Feb; 13 (4): 249-55. Randomized controlled trial of doxycycline prophylaxis against leptospirosis in an endemic area
7. Revista do Instituto de Medicina Tropical de Sao Paulo 1998; 40: 59-61. Use of doxycycline for leptospirosis after high-risk exposure in Sao Paulo, Brazil
8. http://health.yahoo.com/infectiousdisease
medications/doxycycline/healthwised00037a1.html#d00037a1-drugs
9. http://www.drugs.com/pro/doxycycline.html.
10. http://www.ehow.com/how_2165217_avoid-doxycycline-side-effects.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art

Task Force Committee
Marissa M. Alejandria, MD
Rhona G. Bergantin, MD
Manolito L. Chua, MD
Raul P. Destura, MD
Raquel Victoria M. Ecarma, MD
Ma. Cecilia S. Montalban, MD
Mario M. Panaligan, MD
Minette O. Rosario, MD
Paul Salandanan, MD
Rontgene M. Solante, MD
Maria Fe R. Tayzon, MD
Dionisio M. Tiu, MD
Catherine Yu, MD