Factors affecting functional outcome of surgical correction of claw hand in leprosy.

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.

Evaluation of narrow-band UVB phototherapy in 150 patients with vitiligo.

BACKGROUND: Very few studies have been performed to evaluate the efficacy and safety of narrow-band ultraviolet B (NBUVB) therapy in Indian patients with vitiligo and are of small sample size. AIMS: The purpose of this study is to know the efficacy and safety of NBUVB in 150 vitiligo patients of various age groups. METHODS: One hundred fifty patients (69 males, 81 females), aged 3-70 years, with vitiligo were treated twice weekly with NBUVB. The starting dose was 250 mJ/cm2 in adults and 150 mJ/cm2 in children, with 20% dose increments at each subsequent visit given for a maximum period of 1 year and were followed-up for 6 months for stability of repigmentation. Statistical methods were employed to establish the relation between the response and the number of exposures, duration of treatment, cumulative dose and the compliance. RESULTS: Analysis of our study showed that a majority of our cases, about 73, achieved 25-75% repigmentation, with an average of 51+/-19 exposures, 51 had <25% repigmentation, with an average of 19+/-11 exposures and 26 had >75% repigmentation, with an average of 74+/-24 exposures. Good response to therapy was directly associated with good compliance, more number of exposures and increasing cumulative dose, which was statistically significant (P<0.01). Adverse effects were minimal. Only three patients developed depigmentation of repigmented sites during follow-up. CONCLUSION: Our study proves that NBUVB therapy is an effective and safe tool in the management of vitiligo, with good stability of repigmentation and cosmetic appearance.

Acropigmentation of dohi.

A 9-year-old girl with multiple hyperpigmented and hypopigmented macules over the hands and neck since childhood is reported.

Nerve abscess in leprosy: a retrospective study.

Nerve abscesses occur, both in tuberculoid and lepromatous leprosy. We studied 20 patients who had undergone surgery for nerve abscess in mixed peripheral and cutaneous nerves. Details of these cases and the controversial question as to how long the question PB regimen should be continued are discussed.

Nutritional status of children of urban leprosy patients staying at preventoria based on biochemical parameters.

Measurements of nutritionally relevant biochemical and endocrine variables were made on 60 apparently healthy children (group A) whose parents suffered from leprosy and who had been separated at the age of 4 years and brought up in preventoria. Most of the measurements were also made on a comparison group of healthy children from the same poor socio-economic class (group B). In both groups the serum concentrations of cholesterol and triglycerides were well below those found in Western populations. Almost all the children in both groups were anaemic, but serum iron and ferritin levels were satisfactory. Folate and vitamin B12 levels were measured in group A only and were low in a significant proportion. Deficiency of these water-soluble vitamins may be a cause of the anaemia. Low albumin levels were found in 40% of group A children, compared with 2% in group B. The concentrations of calcium and magnesium were lower and that of phosphate higher in group A than in B. In both groups one-third of the children had low levels of serum zinc. Fifteen per cent of group A children had biochemical evidence of vitamin A deficiency, but none were deficient in vitamin E. Levels of total T3 and total T4 were below the lower limit of normal in a substantial proportion of children in both groups. Concentrations of parathyroid hormone were increased in parallel with the low values for serum calcium. Radiological studies of ossification centres in 57 group A children showed delayed maturation in 11 cases. The relevance of these findings to previous studies of the children of lepers in India is discussed.

Surgical correction of claw fingers in Hansen's disease by palmar plate shortening and pulley advancement.

A simple technique has been used to correct the clawing of fingers in patients with Hansen's disease. The distal part of the palmar plate is excised and the remaining portion is advanced and sutured with a single horizontal mattress suture to prevent hyperextension of the metacarpophalangeal joint. A pulley advancement is also done. One hundred five claw hands were corrected in 99 patients from December 1985 to September 1988. Follow-up period varied from 6 months to 3 1/2 years. The results were assessed for correction of deformity, power grip, motion, and function. Out of 94 hands that were followed up after operation, power grip remained static in most cases. Correction of deformity was satisfactory in 85 hands, motion and function of the fingers were satisfactory in 63 hands, and correction of the clawing was statistically significant in two fingers (p less than 0.01).

A study on nutrition, growth and development of a high-risk group of children of urban leprosy patients.

This paper describes a cross-sectional study of the physical development of a high-risk group of 182 socially deprived healthy children of leprosy patients ranging from preschool age to early teens. They were rescued at the age of 4 years from the distress of leprosy colonies where they were born, and brought up in Government Homes (Preventorium) under better environmental conditions. Of them 135 children could be followed clinically for 10 years for the development of childhood leprosy. Another 94 children of leprosy patients living with their parents were included for comparison. A group of 158 normal children of similar economic status and age group were included as controls. It was observed that, although better environment, food and training were provided in the Preventorium, so that the children could be brought into the national mainstream, nevertheless 5 children developed an indeterminate type of leprosy during the course of 10 years. This is the first report of growth and development of children of leprosy patients from the Indian sub-continent.

Sensory recovery in the plantar aspect of the foot after surgical decompression of posterior tibial nerve. Possible role of steroids along with decompression.

In leprosy, involvement of the posterior tibial nerve leads to sensory loss in the plantar aspect of the foot. As a result plantar ulcers are common and lead to deformity and disability. Restoration of plantar sensation can prevent ulcer formation. Posterior tibial decompression was done for the recovery of sensation in the plantar aspect of the foot. Seventy-two patients under went decompression on 84 feet, 25 received steroids pre- and post-operatively. The recovery of sensation was better if surgery was done before 6 months of onset of anaesthesia. Decompression along with steroids gave better results than decompression alone in patients with active neuritis especially in BT cases whereas in BB, BL and LL cases there was no significant improvement of sensation. The results are discussed.

Toxoplasma gondii antibody in patients of lepromatous leprosy.

Sera from 140 lepromatous leprosy patients (test group) and 120 normal persons, who showed no clinical signs of acute or chronic toxoplasmosis (control group), were studied for the presence of Toxoplasma gondii antibody by indirect hemagglutination and indirect-immunofluorescent antibody tests. Both tests showed a high incidence of Toxoplasma antibody in the test group in comparison with the control group. IgM and IgG classes of antibody responses were observed in both the groups, which signified recent as well as past infections in them.

Undernutrition in lepromatous leprosy. V. Severe nutritional deficit in lepromatous patients co-infected with pulmonary tuberculosis.

We have compared the nutritional status of patients with lepromatous leprosy coinfected with pulmonary tuberculosis (18 cases) with that of lepromatous leprosy (239 cases) and of pulmonary tuberculosis (21 cases) and with that of healthy controls. There was a severe weight loss and reduction of skinfold thickness in the patients with pulmonary tuberculosis as well as in lepromatous patients with associated pulmonary tuberculosis, but not in patients with lepromatous leprosy. Levels in sera of diet-dependent proteins, such as albumin, prealbumin and retinol binding protein, were significantly decreased in all three groups of patients; on the other hand, levels of the diet-independent proteins, such as the immunoglobulins, were raised in all the groups, particularly in the pulmonary tuberculosis patients as compared with healthy controls. Serum transferrin levels were decreased only in the tuberculosis patients with or without lepromatous leprosy, but not in patients with leprosy alone. While haemoglobin levels decreased in all patient groups, serum iron concentrations were reduced most in lepromatous patients concomitantly infected with pulmonary tuberculosis. Serum ferritin levels increased in the sera of pulmonary tuberculosis and lepromatous leprosy patients, but was severely reduced in lepromatous patients with associated pulmonary tuberculosis. Mean serum zinc and calcium levels were decreased in all three groups of patients, while the serum copper concentration was increased in all of them compared with healthy controls. Also, inorganic phosphorus was elevated in tuberculosis and lepromatous patients coinfected with pulmonary tuberculosis, but not in lepromatous patients. Serum calcitonin levels were increased in all patient groups indicating an inverse correlation between serum calcium and calcitonin levels. This is the first comparative report describing the status of macro- and micronutrients in two most important mycobacterial diseases of the third world countries.

Nutrition: an essential element of primary health care.

PIP: In India, major social discrepancies linger despite major advances since 1947 with the result of overeating by the rich and undernutrition of the poor. Anemia affected 65% of pregnant women in Hyderabad hospitals, and in Calcutta it hovered around 88.5-90/1% for males and 96.5-96.7% for females aged 15-44. Malnutrition accounted for 15% of hospitalizations often because of infant diarrhea. Parasitic infestations leading to anemia and subsequent malnutrition also resulted in premature births and low birth weight. Weaning practices including its late initiation and prolongation of breast feeding for up to 12 months (or 18 months in rural areas) led to growth retardation. About 25,000 children become blind annually because of vitamin A deficiency, and 55% of women also suffer from it. Almost 120-170 million people suffer from endemic goiter. Socio economic and socio cultural factors are also associated with nutritional problems. Some Brahmin communities in South India avoid garlic and onions because they are considered taboo foods. The Tridosha Theory holds the there are heat-producing foods, cooling foods, and gas-producing foods that have to be avoided. Some of these are brown sugar, eggs, tomatoes, oranges, cereals, and vegetables. In West Bengal they believe that milk and fish can cause leprosy. The population nearing 800 million is another factor, as smaller families have better nutrition. Education by nurses should include the use of exhibits, songs, and plays to teach women proper nutrition. Nurses also have to change their attitudes to avoid commercial foods, identify harmful practices, and promote nutritional education. The project of the National Institute of Nutrition involving 23 villages combated vitamin A deficiency successfully by laying stress on available vegetables and fruits. If nurses participate if such primary health care programs the objectives of Health for All by 2000 will be achieved.^ieng

Undernutrition and lepromatous leprosy. Serum vitamin A and E levels in leprosy spectrum.

Serum vitamins A and E were estimated by spectrophotocolorimetric methods in 67 leprosy patients comprising 9 BT, 10 BB, 15 BL, 27 LL, including 12 Histoid cases. These findings were evaluated in comparison to 55 normal subjects serving as controls. A significant reductions in the mean serum levels of Vitamins 'A' and 'E' were observed in the leprosy groups as compared to normal controls. These findings are of considerable importance and need to be taken note of in the light of delineating these alterations to the cause or effect of the disease. As far as we know, this is the first report describing serum levels of Vitamins 'A' and 'E' in the leprosy spectrum.

Collagen sheet and its usefulness in healing of ulcers in leprosy patients.

Collagen is a natural tissue present in the body. For healing of any part collagen is essential. Collagen has been made available in the form of sheets for clinical use, by the Central Leather Research Institute, Adyar, Madras 20. It has been tried in burns and ulcers. Plantar ulcers are common in leprosy and pose a problem in healing. Therefore, collagen was tried in our Institute on 75 patients having plantar ulcers, other type of ulcers like stasis ulcers and post operative wounds. It has been found from our study that Collagen Sheet hastens the healing of wounds.

Restoration of plantar sweat secretion in the feet of leprosy patients.

As part of the studies on nerve damage and its consequences in leprosy, the status of sweat gland function in the anaesthetic sole of the feet of leprosy patients was investigated qualitatively and semi-quantitatively, before and after surgical decompression of the posterior tibial neurovascular bundle. Sweat prints of the feet of the patients were obtained pre-operatively and postoperatively on Whatman's No. 1 filter paper. The paper was treated with one percent Ninhydrin and the intensities of the Ninhydrin positive areas were quantitated. Forty one feet of thirty six patients have been studied in this manner. Sweat print analysis of twenty normal people have also been done, and included for comparison. This operative procedure has been found to effect an improvement in the sweat gland function in the feet of more than fifty percent of leprosy patients studied so far.

Undernutrition and lepromatous leprosy. III. Micronutrients and their transport proteins.

The present report is a continuation of our earlier studies on the complex interaction between undernutrition and leprosy. Serum levels of vitamins A and E, zinc and iron were determined in healthy control subjects and lepromatous leprosy patients belonging to an eastern state of India. Results indicated a significant lowering in the two above-mentioned fat-soluble vitamins and also a remarkable hypozincaemia in the patient group. However, serum iron levels were found to be comparable in both the groups. Also concentrations of vitamin A transport proteins such as retinol binding protein and prealbumin in sera of the lepromatous patients were significantly decreased in comparison with the control subjects. Of the two zinc-binding proteins, ie, serum albumin and alpha-2 macroglobulin, only the former was significantly reduced in the patient group. Surprisingly, though serum iron, transferrin and ferritin levels were similar in both the patient and control groups, the haemoglobin levels were significantly reduced in the lepromatous patients. The implications of these findings have been discussed. This is the first report describing the serum ferritin levels in lepromatous patients.