Leprosy Diagnosed via Teledermatology in a U. S. Urban Academic Health Center Highlights Potential Benefits and a Pitfall of Existing Telemedicine Services.

Purpose: Teledermatology has emerged as an important tool to extend the reach of dermatologists. As utilization of teledermatology services increases, careful attention should be given to the design of the system for consulting dermatologists. Methodology: In this case study, we report how access to a patient's entire medical history in a teledermatology consultation was vital for an accurate diagnosis. Results: This case emphasizes the importance of full access to patients' medical records for improving diagnostic accuracy. We believe that full-access systems will lower the risk of misdiagnosis and will help to maximize the potential of teledermatology.

Boletín de la Cooperación Técnica, Enero-Febrero de 2019

[Prefacio] Actividades de la Cooperación técnica de OPS/OMS de enero a abril del 2016, resaltando algunas de las principales actividades de este período como fue la realización en Cuba de la Reunión Subregional de Gerentes de Centro América, República Dominicana, Cuba y México y el II Congreso Internacional de Promoción de la Salud y el X Taller Regional de Promoción y Educación para la Salud en el ámbito escolar y universitario.

Hanseníase e atenção primária: um estudo avaliativo sob a ótica do médico / Leprosy and primary care: an evaluation study from a medical perspective / La lepra y la atención primaria: un estudio evaluativo desde la óptica médica

RESUMO Objetivo Avaliar a presença e extensão dos atributos essenciais e derivados da atenção primária em saúde no programa de controle da hanseníase, sob a ótico médica. Métodos Trata-se de um estudo de avaliação de programas de saúde, com foco na hanseníase, tendo como púbico alvo os médicos atuantes nas ações de controle do programa de hanseníase nas unidades de saúde da atenção primária. Foi utilizado um questionário, elaborado e validado em outro estudo, para medir a presença e a extensão dos atributos da atenção primária à saúde no controle da doença. Os dados foram inseridos em um banco de dados e posteriormente receberam uma análise estatística e descritiva. Esse estudo foi aprovado sob o parecer CEP n° 1.128.385. Resultados Na análise dos escores gerais e dos atributos essenciais observou-se que o município do estudo apresentou alta orientação para as ações de controle da han-seníase. Os atributos acesso, orientação comunitária e orientação profissional receberam médias abaixo do ponto de corte, demonstrando fragilidades existentes nos itens que compõe esse atributo. Conclusão Apesar das fragilidades identificadas, o município de estudo apresenta alta orientação para o desenvolvimento das ações de controle da hanseníase, segundo a avaliação dos médicos atuantes na atenção primária.(AU)

ABSTRACT Objective To assess the presence and extent of essential attributes derived from primary health care in a leprosy control program. Materials and Methods This is an assessment of health programs, focused on leprosy and targeted at doctors working on control actions in a leprosy program of primary health care units. A questionnaire developed and validated in another study was used to measure the presence and scope of primary health care attributes in disease control. Data were entered into a database and statistical and descriptive analysis was carried out. This study was approved within the framework of CEP No. 1.128.385. Results Overall scores and essential attributes of leprosy control actions showed a high exposure to leprosy control actions in the studied city. Community's access, orientation and guidance attributes averaged below the cutoff point, demonstrating the existing weaknesses in the items that make up these attributes. Conclusion Despite the weaknesses identified, the study showed high orientation towards the development of leprosy control actions, according to the assessment made by doctors working in primary care.(AU)

RESUMEN Objetivo Evaluar la presencia y alcance de los atributos esenciales derivados de la atención primaria de la salud en el programa de control de la lepra, desde la óptica médica. Métodos Se trata de una evaluación de los programas de salud, centrados en la lepra, teniendo como público objetivo los médicos que trabajan en las acciones de control de la lepra en el programa de las unidades de salud de atención primaria. Se utilizó un cuestionario desarrollado y validado en otro estudio, para medir la presencia y alcance de los atributos de la atención primaria de salud en el control de la enfermedad. Los datos se introdujeron en una base de datos y más tarde se realizó el análisis estadístico y descriptivo. Este estudio fue aprobado en el marco del CEP N°. 1.128.385. Resultados Las puntuaciones globales y los atributos esenciales de las acciones de control de la lepra tuvieron una puntuación alta, en la ciudad del estudio. Los atributos de acceso, orientación y guía de la comunidad tuvieron un promedio por debajo del punto de corte, lo que demuestra las deficiencias existentes en los elementos que componen estos atributos. Conclusión A pesar de las debilidades identificadas, el estudio mostró una alta orientación en el desarrollo de acciones de control de la lepra, de acuerdo con la evaluación de los médicos que trabajan en atención primaria.(AU)

[Leprosy and primary care: an evaluation study from a medical perspective]. / Hanseníase e atenção primária: um estudo avaliativo sob a ótica do médico.

OBJECTIVE: To assess the presence and extent of essential attributes derived from primary health care in a leprosy control program. MATERIALS AND METHODS: This is an assessment of health programs, focused on leprosy and targeted at doctors working on control actions in a leprosy program of primary health care units. A questionnaire developed and validated in another study was used to measure the presence and scope of primary health care attributes in disease control. Data were entered into a database and statistical and descriptive analysis was carried out. This study was approved within the framework of CEP No. 1.128.385. RESULTS: Overall scores and essential attributes of leprosy control actions showed a high exposure to leprosy control actions in the studied city. Community's access, orientation and guidance attributes averaged below the cutoff point, demonstrating the existing weaknesses in the items that make up these attributes. CONCLUSION: Despite the weaknesses identified, the study showed high orientation towards the development of leprosy control actions, according to the assessment made by doctors working in primary care.

Prevalência e controle de hanseníase: pesquisa em uma ocupação urbana de São Luís, Maranhão, Brasil / Prevalence and control of Hansen's disease: a research in an urban occupation area of São Luis, Maranhão state, Brazil / Prevalencia y control de la lepra: investigación en una ocupación urbana de São Luís, Maranhão, Brasil

Objetivo: Investigar a prevalência de incapacidades em pacientes com Hanseníase em três Unidades Básicas de Saúde (UBS) de São Luís no Maranhão e discutir preliminarmente possíveis modos de controle da doença. Métodos: Foi realizado estudo retrospectivo descritivo por meio dos prontuários de todos os pacientes hansenianos (n=57) cadastrados nas UBS, no período correspondente aos anos de 2008 a 2009. As variáveis coletadas foram: idade, sexo, aspectos e situação clínica dos pacientes (GIF- Grau de incapacidade física, classificação operacional e forma clínica). Resultados: Foram encontrados 57 prontuários de pacientes hansenianos, dos quais 24 continham alguma alteração quanto ao grau de incapacidade dos pacientes. Entre aqueles que tinham algum grau de incapacidade física, 8 (33,3%) encontravam-se entre 21 e 30 anos, 2 (8,3%) tinham menos de 10 anos, 1 paciente (4,1%) tinha mais de 60 anos. Com relação ao sexo, 15 eram homens (62,5%) e 9 eram mulheres (37,5%). Quanto à classificação operacional da doença, três casos eram paucibacilares e 21 multibacilares. Dos 57 casos estudados, 33 usuários apresentaram GIF 0; 17 pacientes, GIF I; e 7 pacientes, GIF II. A prevalência de incapacidades físicas em pacientes com hanseníase neste estudo foi de 42,1%, correspondendo a 24 pacientes. Conclusão: O percentual de 12,28% para GIF II sugere que são necessárias medidas de tratamento e reabilitação com uma abordagem mais específica e foco nos serviços de atenção primária, para se evitar o agravamento da enfermidade e permitir o controle das incapacidades.

Objective: To study the prevalence of patients with disability owing to leprosy in three Primary Healthcare Centres (PHC) in São Luis, Maranhão state and to discuss possible ways of disease control. Methods: A retrospective descriptive study based on medical records of all leprosy patients (n=57) registered in these PHCs between 2008 and 2009. The following variables were analyzed: age, sex, aspect and clinical status (DPD - Degree of Physical Disability, operational classification and clinical form). Results: Fifty-seven medical records of patients with leprosy were found, and 24 of them contained some alteration in the DPD of patients. Among those who presented some degree of disability, eight patients (33.3%) were between 21 and 30 years old, 2 (8.3%) were under than 10 years of age, and 1 patient (4.1%) was over 60 years old. Regarding sex, 15 were men (62.5%) and 9 were women (37.5%). With respect to the operational classification of disease, 3 cases were paucibacillary and 21 were multibacillary. Of the 57 cases, 33 patients presented DPD 0; 17 patients showed DPD I; and 7 patients presented DPD II. The prevalence of physical disabilities in leprosy patients in this study was 42.1%, corresponding to 24 patients. Conclusion: The prevalence of 12.28% of DPD II patients suggests that treatment and rehabilitation measures are needed, with a more specific approach and focus on primary care services to prevent the worsening of this disease and allow the control of its disabilities.

Objetivo: Investigar la prevalencia de las discapacidades en los pacientes con lepra en tres Unidades Básicas de Salud (UBS) de São Luís de Maranhão, y preliminarmente discutir posibles formas de controlar la enfermedad. Métodos: Se realizó un estudio retrospectivo descriptivo a través de los historiales clínicos de todos los pacientes con lepra (n=57) registrados en las UBS, en el período correspondiente a los años que van de 2008 a 2009. Las variables recogidas fueron: edad, sexo, aspectos y estado clínico de los pacientes (GDF - Grado de discapacidad física, clasificación operativa y forma clínica). Resultados: Se encontraron 57 registros médicos de pacientes con lepra, de los cuales 24 contenían alguna alteración relacionada con el grado de discapacidad de los pacientes. Entre los que tenían algún grado de discapacidad física, 8 (33,3%) tenían entre 21 y 30 años, 2 (8,3%) tenían menos de 10 años, y 1 paciente (4,1%) tenía más de 60 años. Con respecto al sexo, 15 eran hombres (62,5%) y 9 eran mujeres (37,5%). En cuanto a la clasificación operativa de la enfermedad, tres casos fueron paucibacilares y 21 multibacilares. De los 57 casos estudiados, 33 usuarios presentaron GIF 0; 17 pacientes GIF I; y 7 pacientes GIF II. La prevalencia de las discapacidades físicas en pacientes con lepra en este estudio fue del 42,1%, que corresponde a 24 pacientes. Conclusión: El porcentaje de 12,28% para GIF II sugiere que se necesitan medidas de tratamiento y rehabilitación con un enfoque más específico y focalizado en los servicios de atención primaria, para impedir el empeoramiento de la enfermedad y permitir el control de las discapacidades.

How can the private practitioners support leprosy elimination in India.

The private providers especially private practitioners are the first contact points for any types of ailments both in the urban and rural situations. From 2001 onwards, the services for National Leprosy Eradication changed to integrated system involving general healthcare system. Special emphasis is laid on correct diagnosis of leprosy cases before declaring and putting them under multidrug therapy. The government doctors were provided repeated training for this capacity building to diagnose and manage all diagnosed cases. Government of India also arranged practice of giving orientation programme to the private practitioners through IMA in the year 2004-05. The private practitioners can support the programme through case diagnosis, continuation of treatment and spreading awareness.

Experience of involvement of IMA members in leprosy elimination after CME conducted during 2004-2005.

Leprosy can affect all age groups. In 1991 the World Health Assembly took major initiative towards global elimination of the disease. It was possible to achieve 90% reduction in leprosy cases all over the world. India is not lagging behind to eliminate leprosy as Government of India, various NGOs and IMA have joined hands to fight the menace aggressively. During the year 2004-05 the IMA organised training workshops on leprosy for private practitioners, who are mostly members of IMA. After the completion of workshops a wrap-up workshop was organised in each state. It was a treat opportunity for the IMA to mobilise its resources to contribute to the national cause.

Clinical diagnosis of leprosy cases.

The principle of leprosy control is based on secondary prevention with early detection of all cases and treatment with multidrug therapy. Eradication of leprosy warrants detection of all cases. Hence diagnosis of leprosy is of paramount importance to eradicate the cases. History taking gives all important information about the patient. Presenting complaint and contacts in family give useful guidelines to clinicians to arrive at the diagnosis. The objective of clinical examination is to elicit cardinal signs of leprosy through a systemic examination. Sensory testing, examination of nerves and examination of hands, feet and eyes are helpful in establishing diagnosis. Laboratory examination is not essential. Slit-skin smear examination for acid-fast bacilli shows positive results in a few cases. Diagnosis is complete once the clinical signs are established through clinical examination.

[Doctor Eyvind Kraft--halfway around the world in the 1880s]. / Lege Eyvind Kraft--jorden halvveis rundt i 1880-årene.

More than every second Norwegian 19th century physician made one or more study trips abroad. Some of them were probably more inspired by love of adventure than by the prospect of gaining new medical insight. This was probably also true of my great-grandfather, Eyvind Kraft. Shortly after completing medical school in 1879, he left Norway on the "Musca", an emigrant vessel, bound for Hawaii. He returned home approximately six years later to establish a sanatorium. In the meantime he worked as a ship's doctor, made a contribution to the understanding of the contagiousness of leprosy, and was among the founding members of the first medical society in the state of Wisconsin. Back in Norway he worked at the sanatorium, but also as a general practitioner and among fishermen during the seasonal fisheries. He had to travel to the Continent in an attempt to cure his "nerve disease". Eyvind Kraft's life tells an exciting story of exotic places and of the view of disease in his time.

Hansen's disease. Practice tips for management.

The author highlights some of the critical features of general practice diagnosis and management of Hansen's disease in First World primary care practice. These features are often not obvious or emphasised in most texts because they are designed for a Third World scenario, where primary care is delivered without the luxury of medically trained practitioners and therefore without the option of emergency steroid therapy.

The private GP and leprosy: a study.

In urban and rural areas alike, people in India tend to prefer private medical care to the existing government health services. Nevertheless, the large private health care sector has hitherto been virtually alienated from activities of public health importance including priority disease control programmes. This study of 106 private general practitioners (GPs), practising in low socioeconomic areas of Bombay, shows a gross lack of knowledge and awareness among private doctors about leprosy and also about the National Leprosy Control Programme. The possible reasons are discussed. Effective involvement of GPs in the National Leprosy Control Programme should facilitate both integration and better implementation of leprosy control activities. The study also highlights some areas for future interventions at both primary and secondary health care levels and the need for a strategy, based on larger studies, to train and make private doctors participate in controlling diseases of major public health concern like leprosy.

Diagnosis of leprosy in Victoria--a non-endemic area of Australia.

There have been at least 70 cases of leprosy in Victoria since 1950; the occurrence of 40 of these in the last seven years indicates that the disease is no longer rare in this State. The diagnosis was delayed in most patients, the average period of time between development of symptoms and diagnosis being 28 months. The most common presentations among these patients emphasize the point that a diagnosis of leprosy should be considered in patients who are suffering either from chronic skin diseases which are atypical and have not responded to therapy, of from localized disturbances of skin sensation.