Backward logistic regression analysis of the determinants of the hand function among patients with leprosy: A cross-sectional study.

Introduction: The hands are the most common site of disability in leprosy. Hand dysfunction could result in difficulty performing activities of daily living. Therefore, hand function should be regularly assessed to ensure that any decrease in hand function could be diagnosed earlier. Methods: This study included 110 patients with leprosy from Likupang and Lembata, Indonesia. Hand function was assessed using the modified Jebsen test to measure hand function respective of the dominance. The grip and pinch strength were used as objective measures of clinical arm function. The World Health Organization (WHO) hand disability grade were used to determine the degree of impairment. Other factors such as age, sex and the type of leprosy were also considered. All factors were analysed using backward logistic regression. Results: Among the 110 participants, a decrease in the dominant (48.2%) and non-dominant (50.9%) hand functions were found. Pinch strength (OR: 3.39; 95% CI: 1.13-10.19) and age (OR: 4.91; 95% CI: 1.72-14.03) were significantly associated with hand function irrespective of the dominance. Conversely, the WHO hand disability grade (OR: 2.97; 95% CI: 1.10-8.04) and type of leprosy (OR: 0.34; 95% CI: 0.12-0.97) were significantly associated with only function of the dominant hand. Conclusion: There is a significant association of age and pinch strength with hand function regardless of the hand dominance. In contrast, the WHO hand disability grade and type of leprosy are significantly associated with the function of the dominant hand only.

Catastrophic ocular complications in leprosy: a case report.

Leprosy is a chronic, granulomatous infectious disease commonly affecting the skin, nerves, mucosa and eyes. The stigma associated with the disease frequently leads to delay in presentation to health professionals. Treated patients, though considered cured presumptively, many continue to live with physical disabilities and deformities. Intact visual acuity prevents humans from trauma and any reduction in visual acuity, especially in leprosy, increases the risk of getting injured by many folds. Here, we present a case of leprosy with complete loss of vision due to bilateral anterior staphyloma secondary to keratitis and his physical deformities preventing him to take care of his eyes. This paper aims to emphasize on the importance of a baseline ophthalmology consultation in all newly diagnosed leprosy patients and repeat examination at onset of any new symptoms of the eye.

Leprosy Scenario in Ahmedabad District (Gujarat).

BACKGROUND: In India, leprosy still continues to be one of the major public health problems and demands a continuous awareness for its eradication. The reduction of the load of infection is the cornerstone of leprosy control. AIMS: The aim of the present study was to enumerate the epidemiology of leprosy in the Ahmedabad district of Gujarat. METHODS: Three hundred new cases of leprosy (multidrug therapy cases) and patients who had completed antileprosy treatment and developed new signs and symptoms after that during the period from June 2010 to December 2012 were included in the study. A detailed history, clinical examination, and relevant tests were done. RESULTS: Out of a total of 300 patients, male-to-female ratio was 2.1:1. Family history was positive in 4.3% of patients. Lepromatous leprosy was seen in 27.3%, pure neuritic leprosy occurred in 12 (3.9%), and smear positivity was seen in (44.6%). Thirty (10%) patients developed type 1 reaction and 32 (10.6%) patients had type 2 reaction. Nearly 1.3% of the cases were relapsing cases. LIMITATIONS: The study had geographical limitation and the study did not cater the whole population but only the cases who reported to the hospital. Hence, the social stigma factor associated with leprosy could not be annulled. CONCLUSIONS: Leprosy still prevails and adequate knowledge and clinical skills, sensitive diagnostic tools and proper supply of medicines from the medical end and early reporting of symptoms, compliance regarding medicine intake, and social awareness to null social stigma associated with it from the patient's end may bring the country as a whole to the target of leprosy elimination.

Lessons From Leprosy: Peripheral Neuropathies and Deformities in Chronic Demyelinating Diseases.

In light of the World Health Organization's push to accelerate progress toward a leprosy-free world by 2020, it is fitting to look back on the evolution of progress in treating lepromatous neuropathy and limb deformities. To date, no surgeon has had as great an impact on the understanding and treatment of this disease as Dr Paul Brand. Before Dr Brand's accomplishments, few surgeons participated in the management of the deformed leprous patient. By challenging conventional beliefs, Dr Brand revealed that many of the deformities associated with leprosy were in fact caused by nerve damage and subsequent limb anesthesia. His pioneering work centered on tendon transfers to provide hand and foot mobility to leprous patients, revolutionizing the surgical management of this patient population and restoring functionality to the lives of otherwise stigmatized and functionally handicapped individuals. In the process, he provided us with the surgical principles and techniques that we still apply today. Because of its predilection for the peripheral nervous system, leprosy also provides an excellent opportunity to investigate mechanisms of demyelination and chronic nerve degeneration in nonacute peripheral neuropathies. Processes underlying demyelination of infectious, traumatic, and genetic etiologies overlap and precede the onset of acute neuronal derangement. Glial pathology has been shown to be a common pathological element in leprosy, Charcot-Marie-Tooth type I, multiple sclerosis, and chronic nerve compression injury. The aim of this article is to provide an overview of lepromatous neuropathy with its subsequent deformities as it relates to the pathophysiology, surgical management, and potential therapeutic targets of other modern peripheral neuropathies.

National sample survey to assess the new case disease burden of leprosy in India.

A national sample survey of leprosy was undertaken in partnership with Indian Council of Medical Research (ICMR) institutions, National Leprosy Eradication Programme (NLEP), Panchayati Raj members, and treated leprosy patients to detect new cases of leprosy in India. The objectives of the survey were to estimate the new leprosy case load; record both Grade 1 and Grade 2 disabilities in the new cases; and to assess the magnitude of stigma and discrimination prevalent in the society. A cluster based, cross-sectional survey involving all States was used for the door-to-door survey using inverse sampling methodology. Rural and urban clusters were sampled separately. The population screened for detecting 28 new cases in rural and 30 in urban clusters was enumerated, recorded and analyzed. Data capture and analysis in different schedules were the main tools used. For quality control three tiers of experts were utilized for the confirmation of cases and disabilities. Self-stigma was assessed in more than half of the total new patients detected with disabilities by the approved questionnaire. A different questionnaire was used to assess the stigma in the community. A population of 14,725,525 (10,302,443 rural; 4,423,082 urban) was screened and 2161 new cases - 1300 paucibacillary (PB) and 861 multibacillary (MB) were detected. New case estimates for leprosy was 330,346 (95% Confidence limits, 287,445-380,851). Disabilities observed in these cases were 2.05/100,000 population and 13.9 per cent (302/2161) in new cases. Self-stigma in patients with disabilities was reduced, and the patients were well accepted by the spouse, neighbour, at workplace and in social functions.

Case for diagnosis

Hansen's disease is a chronic infecto-contagious disease caused by Mycobacterium leprae. The bacillus prefers low-temperature areas and the nose is usually the initial site of lesions. Transmission of the bacilli occurs by nasal and oropharyngeal secretions, and through solutions of continuity of the skin and/or mucosae. Nasal manifestations are found in the later stages of the disease.

Análise da qualidade de vida em pacientes com incapacidades funcionais decorrentes de hanseníase / Analysis of the quality of life in patients with disabilities caused of hansen’s disease

A hanseníase é uma doença infecciosa, causada pelo Mycobacterium leprae, micro-organismo que acomete principalmente a pele e os nervos. É considerada no Brasil como um problema de saúde pública, por causar incapacidades e deformidades que podem levar a alterações da qualidade de vida. Objetivou-se, neste trabalho, analisar a qualidade geral da vida dos indivíduos com hanseníase. Foi realizado um estudo transversal com 100 pacientes submetidos a tratamento no Centro de Referência Dona Libânia, independente do sexo e com idade superior a 18 anos. Foram aplicados 02 questionários: qualidade de vida SF-36 e outro abordando aspectos epidemiológicos, socioeconômicos e característica da doença. Os resultados mostraram que a metade era do sexo masculino (n=54). A média de idade de 39,2 ± 12,57, com maior prevalência entre 26 a 45 anos (n=44). Dos entrevistados, 51 tinham o primeiro grau incompleto e 91 apresentavam renda familiar de 1 a 3 salários mínimos. Na qualidade de vida, os domínios que apresentaram valores baixos foram limitação por aspecto físico, dor e aspecto emocional, quando comparado aos demais (p<0,05). Ao classificar a média dos domínios, a capacidade funcional, aspecto social e saúde mental foram enquadrados como “muito bom”. Entretanto, limitação por aspecto físico, dor, estado geral de saúde, vitalidade e aspecto emocional obtiveram perfil “bom”. Pode-se concluir que a hanseníase interfere na qualidade de vida dos pacientes, por ser uma patologia que gera incapacidades funcionais, acarretando a diminuição da atividade laboral e restrição da vida social.

Leprosy is an infectious disease caused by Mycobacterium leprae, micro-organism that primarily affects the skin and nerves. It is considered in Brazil as a public health problem, causing disabilities and deformities that can lead to changes in quality of life. The objective of this study was to analyze the overall quality of life of people with leprosy. A cross-sectional study of 100 patients undergoing treatment in a Reference Center, regardless of sex and age over 18 years was conducted. 02 questionnaires were applied: SF-36 quality of life and addressing other epidemiological, socioeconomic and characteristic of the disease. The results showed that half were male (n = 54). The mean age was 39.2 ± 12.57, with higher prevalence among 26-45 years (n = 44). Of those interviewed, 51 had incomplete first degree and 91 had a family income 1-3 times the minimum wage. Quality of life, areas that had low values ​​were limited by physical aspect, pain and emotional aspect when compared to the others (p <0.05). By classifying the average of the areas, functional capacity, social aspects and mental health they were classified as "very good". However, limited by the physical aspect, pain, general health, vitality and emotional aspect obtained Profile "good." It can be concluded that leprosy interfere with the quality of life of patients to be a condition which generates functional disability, leading to reduction in working activity and restriction of social life.