Epidemiological trends of leprosy elimination in CLTRI rural field operation area, Tamil Nadu, India.

The analysis of computerized data of patients in our Rural Field Operation Area (Kunrathur Taluk, Kancheepuram District, Tamil Nadu) from the start of MDT in 1986 has shown a decrease of leprosy prevalence from 275/10000 in 1986 to 0.7/10000 in 2005. Leprosy has been eliminated as a public health problem after 19 years of MDT implementation. Although the control programme was started in 1962, MDT implementation began only in 1986. The new case-detection rate has declined significantly from 27.3 in 1987 to 2.4/10000 in 2005 (y = -1.6x + 2325.1, p = < 0.05). The age-specific cumulative detection rates calculated showed highest case-detection at 10-14 years for total, 10-14 years for PB, 50-54 for MB, and 10-14 for both males and females. MB percentage was more among new cases in the last three years as compared to the initial three years, and this difference was found to be statistically significant, but there was no significant difference between the first three and the last three-year periods in child, male and disability rates (grade +/-2) among new cases. Thus, the declining trend in NCDR has not reflected any change in sex and age-groups of new cases. This analysis strengthens the hypothesis of sub-clinical cases possibly transmitting the disease and MB cases accruing after long incubation period.

Protective role of vitamin E on the oxidative stress in Hansen's disease (Leprosy) patients.

BACKGROUND: A constellation of reactive oxygen species (ROS) capable of damaging cellular constituents generated in excess during the chronic, inflammatory, neurodegenerative disease process of leprosy. The consequences of this leads to enhanced oxidative stress and lower antioxidant status. Enzymatic antioxidants provide first line defense against ROS. We have measured the levels of oxidative stress indices like lipid peroxidation (LPO), protein carbonyls together with enzymatic antioxidants in the blood samples of control and leprosy patients. Nutritional rehabilitation by way of exogenous supplementation of functionally efficient antioxidants like vitamin E reactivates the enzymatic antioxidant system and guards against the insult caused by ROS during the pathogenesis of the disease and antileprosy chemotherapy. DESIGN: Untreated leprosy patients were selected on the basis of clinical examination and skin smear. All diagnosed untreated leprosy patients received multi drug therapy (MDT) consisting of rifampicin, dapsone and clofazimine as recommended by World Health Organization. A small number of untreated cases were selected for co-supplementation of vitamin E along with MDT. Oxidative stress indices, enzymatic and nonenzymatic antioxidant status were assayed in untreated, MDT treated and those supplemented vitamin E along with MDT. STATISTICAL METHODS: We have compared the significance in the mean+/-s.d. values of the oxidative stress indices and the levels of antioxidants using one way analysis of variance (ANOVA) between control, untreated, MDT treated and those supplemented vitamin E with MDT and the results were significant at P < 0.05. Statistical analysis of the results suggests that oral administration of vitamin E lowers oxidative stress and augments antioxidant status in affected individuals. RESULTS: Enhanced oxidative stress as evidenced by increased LPO and protein carbonyl in leprosy cases lowers the antioxidant status. Treatment with MDT has a limited impact on increased oxidative stress and decreased antioxidant status. Coadministration of vitamin E along with MDT decreases oxidative stress and activate the antioxidant status. DISCUSSION: The excess production of ROS as seen in leprosy cases could lead to degeneration of tissues and derangement of internal organs. The possible reason for the decreased antioxidant status in leprosy cases may be increased production of ROS, deranged liver function, and the free radical producing ability of drugs used in MDT of leprosy. Intervention with antioxidant supplementation like vitamin E prevents oxidative stress mediated through ROS and activates the net antioxidant status during the chronic course of the disease and antileprosy chemotherapy.

Mediastinal haematoma in Ehlers-Danlos syndrome.

A patient with Ehlers-Danlos syndrome presented acutely with clinical and radiological features suggestive of aortic dissection. Further investigations including computerised tomography and aortography showed mediastinal haematoma with no evidence of aortic dissection. He was treated conservatively with no complications. The typical clinical and radiological features are reviewed and an emphasis is made on accurate diagnosis to allow prompt, appropriate management.

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.

Foot pressure measurement in leprosy and footwear design.

Leprosy patients deprived of sensory feedback allow excessive pressures to be applied to feet, thereby cause foot ulcers. Quantitative knowledge of the pressure distribution under leprotic feet is helpful to prevent further damage to foot by designing suitable footwear. This paper describes barographic technique for measurement of pressures under the leprotic feet and the design of special footwear for prevention of foot ulcers.

Cauliflower growths in trophic ulcers of leprosy--a 10 year study.

A 10 year study of cauliflower growths in trophic ulcers of leprosy patients was done. Seventy five cases were seen, out of which seventy two were in foot and three in hand. Eventhough appearance was like that of malignancy, malignant change was seen only in four cases and in other seventy one cases it was pseudoepitheliomatous hyperplasia. Various surgical procedures were done. Wide excision appears to be the procedure of choice where feasible as per our studies.

Ulnar nerve decompression by medial epicondylectomy of the humerus and a method of assessing muscle power status by totalling the muscle grading.

This paper advocates the principle of ulnar nerve decompression by medial epicondylectomy of the humerus in leprosy patients presenting with ulnar nerve neuritis and early muscle weakness of ulnar nerve supplied muscles. 16 medial epicondylectomies were done on 14 patients and a follow up showed relief of nerve tenderness and an improvement in the motor power status of the muscles as shown by total grading.