Indian journal of leprosy最新文献

Leprosy, major public health problem in Satara District with prevalence rate of 61/10000 population in 1990. With a view to eliminate Leprosy, Government of India launched National Leprosy Eradication Programme (NLEP) in Satara district during July 1990 to overcome the burden of Leprosy with Multi-Drug Treatment and subsequently Modified Leprosy Elimination Campaign and Block Leprosy Awareness Campaign. The objective of the study is to assess the differential trend of Leprosy in rural and urban area of Satara district. Record based retrospective time series study was conducted in Urban Leprosy Control Units and Primary Health Centers of Satara district on NLEP evaluation indicators; prevalence rate, new case detection rate, percentage of cases released from treatment, proportion of female cases among new cases, proportion of multi bacillary cases among new cases, proportion of grade-II disability among new cases and proportion of child cases among new cases. Leprosy elimination was achieved in rural area i.e. prevalence rate < 1/10000 population but disease was still endemic in urban area of Satara district i.e. prevalence rate of leprosy was 1.3/10000 population in March 2007-08. Not a single case of grade-II disability was reported in both urban and rural area since March 2006-07 onward. New case detection rate was decreased to 0.7/10000 population in rural area but upward trend was recorded in urban area from 0.1/10000 population to 1.1/10000 population since March 2006-07 and trend was statistically significant (chi2 trend = 37.26, p < 0.001*). Proportion of female cases among new cases decreased from 63% to 46.7% in rural area but reverse trend was observed in urban area from 39.6% to 52.8% with significant difference (chi2 trend = 5.42, p = 0.01*). Proportion of multi bacillary cases among new cases showed little fluctuation in rural area from 57% to 55.2% but proportion was decreased in urban area from 59.1% to 44.4% and trend was statistically significant (chi2 trend = 29.82, p < 0.001*). Proportion of child cases among new cases decreased from 23.7% to 10.4% in rural but reverse trend was observed in urban area from 7% to 22.2% since March 2005-06 and proportion was significant (chi2 trend = 15.90, p = 0.0001*). More than 90% cases were released from treatment in rural area but proportion was low in urban area and trend was statistically significant (chi2 trend = 19.38, p < 0.001*). The National Leprosy Eradication Programme showed favorable impact in rural area as compared to urban area in Satara District of Maharashtra.

Medial nerve and Ulnar nerve palsy are still very common in spite of MDT. While most surgeons are concerned with the function of the hand, few have paid attention to the aesthetics of it. However 'white-collar' patients are concerned about the appearance of their hands -besides the function, therefore they would like us to do something for the muscular wasting which is so common. We propose here a new technique, used for the last 10 years, and demonstrate its results.

Leprosy causes not just physical disabilities but mental and psycho social problems which are further more enhanced in women due to their submissive and secondary role in an Indian culture. This is reflected in their reluctance and delay in seeking hospitalization and generates great anxiety while admitted as inpatients. Appropriate nursing care can relieve much anxiety and help in faster healing. This paper presents the findings from such research carried out at a leprosy referral hospitalin north India. Adult female leprosy patients newly admitted for the first time in a leprosy referral hospital were interviewed in depth using Hamilton Anxiety Rating Scale and observed before and after implementing a customized nursing care plan. On admission, out of 40 women admitted more than 80% showed moderate or severe anxiety. After well planned nursing interventions only 2 continued to have severe anxiety, and a majority in all age groups showed significant reductions in anxiety levels, and responded well to leprosy care at the hospital. Well planned nursing care reduces or minimizes anxiety levels of female leprosy patients admitted first time in the hospital, and should become a standard practice in all hospital admissions.

The objective of this paper is to study the results and the factors that impact the results of claw hand surgery in leprosy. 110 patients who underwent claw hand correction between 2002 and 2006 were followed up and studied. Brand's criteria for objective assessment and a visual analog scale for subjective assessment were used. The factors studied were age, sex, clinical, duration of paralysis, long flexor tightness, degree of contracture and type of surgery. Objective assessment showed Excellent or Good results in 76.6%, Fair in 20% and Poor in 3.4%. Subjective assessment showed that 80.8% were fully satisfied or satisfied. Regression analysis showed that age, degree of contracture,duration of paralysis and long flexor contracture were seen as significant factors impacting results of claw hand correction.

The objective of this study was to determine the knowledge, beliefs and attitudes regarding leprosy in school students of Jaipur district. A cross-sectional study was conducted from August 2010 to February 2011 on 1199 students (rural and urban) studying in class 10th and above. The findings of this study showed fair knowledge in students about cause, signs and symptoms of leprosy but less knowledge about prevention and treatment of the disease. Myths and beliefs were more prevalent in rural students as compared to urban ones. Both the groups showed positive attitude toward leprosy with 30-50% students showing neutral approach but negative reaction was more in rural students. In conclusion the study highlights to emphasize on health education in students and improving knowledge to develop positive attitude towards leprosy.

This study reports detailed analysis of clinical parameters and clearance of granuloma in borderline leprosy patients treated with immunotherapy and chemotherapy. It aims to assess the additive effect of immunotherapy (Mwvaccine) with standard MDT on clinical status of untreated borderline leprosy cases and on granuloma fraction of untreated borderline leprosy cases. Patients attending the OPD were serially recruited in two groups. A total of 150 cases in one treatment (trial) group (Mw vaccine plus MDT) and 120 cases in another treatment (control) group (MDT only) of border line leprosy have been included. After the formal written consent, detailed clinical examination, charting, smear examination of all untreated borderline patients of both groups was done, biopsies were taken from the active lesions of all patients of both groups at start of therapy and every six month thereafter till the completion of therapy. The same procedure was repeated every six months during the follow-up period. Standard MDT was given to all the patients of both groups according to type of disease. Mw vaccine 0.1 ml (0.5 x 10(9) bacilli) was injected intra-dermally at the start of therapy and every six months in addition to chemotherapy to the treatment group. The BT cases were followed up after 6 doses of MDT and 2 doses of Mw vaccine, and, the BB, BL cases were followed up after 24 doses of MDT plus 5 doses of Mw vaccine. Clinically, greater and faster improvement was observed in all the clinical parameters, faster attainment of smear negativity and two episodes of lepra reaction occurred in cases treated with combined chemotherapy and immunotherapy, as compared to controls (chemotherapy alone) wherein clinical improvement was slower in all parameters, slower attainment of smear negativity in bacillary index and seven showed the occurrence of reactions, histipathologically in addition to more rapid clearance of granuloma in immunotherapy treated group, a significant finding was an increase in the epithelioid cells population in this group. This suggests a possible immunoactivation of the macrophages especially in BB/BL immunotherapy group. Overall comparison of regression induced by chemotherapy alone with that induced by combined chemotherapy and immunotherapy shows a greater reduction in clinical parameters as well as granuloma fraction in BT cases as well as in BB/BL cases. This trial shows the potential usefulness of this approach of addition of immunotherapy to standard chemotherapy in borderline leprosy cases which leads to in faster recovery from disease reduced chances of reactions and faster granuloma clearance. Such information is expected to be useful in improving the immunotherapeutic approaches for treatinggranulomatous conditions in general and in leprosy in particular.

Background and objectives: Leprosy is yet an important infectious disease in Brazil. The objective of this study was to determine the frequency of leprosy among children and adolescents in a countryside city from Legal Amazon region.

Results: there was a high frequency of Hansen's disease among children from 5 to 9 years-old, predominantly females, with multibacillary form, and dimorphous types.

Conclusion: due to late diagnosis and higher frequency of treatment abandonment leprosy is a serious public health problem among children and adolescents is this small city.

Clinical and histopathological correlative study was carried out in 171 cases of leprosy using the criteria laid down by Ridley and Jopling. There was male preponderance in the study with majority of patients (35.7%) in the age goup of 21-30 years. The overall concordance between the clinical and histopathological diagnosis was 57.3%. Maximum concordance was seen in the polar ends of the spectrum with 76.9% in LL and 75.0% in TT. The concordance rate was lower in the borderline groups with 57.3% in BT, 40.0% in BL and least concordance of 16.7% in BB. However the concordance for IL was higher than the borderline groups with 66.7%. Cases in borderline group are in continuously changing immunological spectrum. Histological classification because of its definitive features gives a better indication than clinical classification for any recent shift of a case in the spectrum. Therefore skin biopsy should be done in all cases for correct classification of leprosy.

Migration of persons affected by leprosy was hinted at as early as 1929 (Bhaskara Rao 1930). All new cases of leprosy in Isfahan Province (Iran) were found to be migrants (Asilian et al 2005). Chudasama (2007) suspected increase in leprosy cases in Surat district to migration. These suggest migration contributes to new cases. This study was done to find out 1. Extent of migration among new cases, 2. Characteristics of migrants, 3. Occupational pattern 4.Reasons for migration. 5. Place of origin of migrants 6. Assimilation of migrants into the society. Trained staff collected information regarding migration using special questionnaire from all 222 new untreated cases from the field area of Community Health department during 2004 to 2008. Migrants were 10.4%. Distribution of place of residence, age, gender, marital status, education, mode of detection, Ridley-Jopling and MB/PB classifications of migrants were not significantly different from that of nonmigrants. Grade 2 deformities were more among migrants. All migrants found occupation. Mostly men migrated for job and women for joining their husbands. The role of migration in increasing the number of new cases cannot be minimized. Enhanced efforts should be made to provide adequate medical, health and rehabilitation services for them also.