Rehabilitation awareness and needs in patients with disability due to leprosy / 中国康复理论与实践

@#ObjectiveTo determine the rehabilitation awareness and needs in patients with disability due to leprosy.Methods4353 patients in 23 fields of 7 provinces were surveyed by interview and questionnaire.Results80% of patients knew general knowledge of disability prevention and rehabilitation, and believed that the self-care could prevent disability; but they seldom carried out the daily self-care practice.90% of patients lacked awareness in early manifestation of leprosy, treatment of the disease, basic cause of disability, and the way to prevent such as plantar ulcers. For needs of rehabilitation education, teaching by medical staff(86%), booklet(81%), video tape(70%) and recording(52%) had been selected.ConclusionThe awareness of rehabilitation and the practice must be combined together. Rehabilitation education should be carried out in advance systemically through different ways.

Interactions of the human T-cell leukemia virus type-II integrase with the conserved CA in the retroviral long terminal repeat end.

Retroviral integrases (INs) interact with termini of retroviral DNA in the conserved 5'-C(A/G)T. For most integrases, modifications of critical moieties in the major and minor grooves of these sequences decrease 3'-processing. However, for human immunodeficiency virus type-2 (HTLV-2) IN, the replacement of the guanine with 6-methylguanine or hypoxanthine not only reduced 3'-processing, but also promoted cleavage at a second site. This novel cleavage activity required an upstream ACA, unique to the HTLV-2 U5 end. 3'-Processing assays with additional isosteric modifications at Gua and filter binding experiments revealed that the mechanism of the second site cleavage differed among the major groove, minor groove, and mismatch modifications. Importantly, the decrease in 3'-processing activity noted with the minor groove and mismatch modifications were attributed to a decrease in binding. Major groove modifications, however, decreased the level of 3'-processing, but did not affect binding. This suggests that integrase binds the viral end through the minor groove, but relies on major groove contacts for 3'-processing. Several modifications were also examined in strand transfer and disintegration substrates. HTLV-2 IN showed reduced activity with strand transfer and disintegration substrates containing major groove, but not minor groove modifications. This suggests major groove interactions at guanine also provide an important role in these reactions.

Final report about Stage II Collaboration Project on Leprosy Rehabilitation.

OBJECTIVE: To undertake the pilot experiments of prevention of disability (POD) in 14 different geographical areas to serve as examples for future development of rehabilitation work in China and in Asia. METHODS: According to the principles and national criterion, 27 000 people affected by leprosy were selected and assessed using disability record forms at beginning and followed up regularly for observing changes of different indicators. RESULTS: A total of 197 neuritis cases were detected and treated with prednisolone out of 1 407 new or active cases. Self-care training of eyes, hands and feet were conducted for 10 500 disabled people affected by leprosy. Comprehensive therapy was given to 1 804 cases having complicated ulcers of which 1 055 cases have got their ulcers healed. Out of 706 prostheses, 613 were given to patients with satisfactory results. Surgical treatment was given to 269 cases and 251 have shown good progress. CONCLUSION: Most of patients have got benefit from the project in function or appearance which is very helpful for their going back to the society and agreed by foreign experts during the final evaluation. The experiences from the project can be implemented in the whole country.

Sensory testing with monofilaments in Hansen's disease and normal control subjects.

Sensory testing with Semmes-Weinstein filaments was conducted on: 112 normal subjects to determine the effects of age, gender and occupation on threshold perception, 27 Hansen's disease (HD) patients to determine inter-observer and intra-observer reliability of testing, and 101 patients with HD and a history of hand and/or foot ulceration to identify thresholds for injury risk. Filament thresholds were found related to age (p < 0.002) and occupation (p < 0.001) but not gender (p > 0.1). Inter-observer and intra-observer reliability was found to be high (intraclass correlation coefficient = 0.88-0.93). The 4.93 (7.0-7.7 g) filament had 97% sensitivity and 100% specificity for identifying a history of foot injuries, and the 4.17 (1.2-1.6 g) filament had 100% sensitivity and 100% specificity for identifying hand injuries.

Leprosy neuropathy: correlation of clinical and electrophysiological tests.

This report describes the neurological and electrophysiological examination of 35 subjects with leprosy (average duration of symptoms 3.4 years, average time since diagnosis 7.5 months). Clinical examination in the distribution of non-dominant median and ulnar nerves was performed with the following clinical methods: touch sensation with 0.05 gm. Monofilament nylon, thermal sensation with a thermal sensitivity testing device, voluntary muscle testing and nerve palpation. At least one abnormality was found in 22 ulnar and 13 median nerves (63% and 37%, respectively). Nerve palpation was the most frequent clinical abnormality, while the other methods had similar frequencies of abnormality. Electrophysiological studies were performed on the ipsilateral side of the leprosy subjects and on 32 age-matched normal subjects. Electrophysiological responses from the leprosy subjects were evaluated by criteria established from normal subject data. Abnormal or absent responses were found in 21/35 ulnar sensory, 12/35 ulnar motor, 9/35 median sensory and 6/35 median motor responses among the leprosy subjects. The most important electrodiagnostic findings were: (i) low sensory amplitudes and (ii) drops in amplitude and NCV over the across-elbow segment of the ulnar nerve. Both clinical and nerve conduction abnormalities were positively associated with duration of leprosy symptoms. The four clinical methods were compared for concordance with nerve conduction data by cross-tabulation. The two sensory measures, monofilaments and the thermal sensitivity device, had the highest concordances. Usefulness of clinical tests for nerve damage in leprosy may vary depending on whether the purpose is for diagnosis, patient education or clinical follow-up.

Manual muscle strength testing: intraobserver and interobserver reliabilities for the intrinsic muscles of the hand.

The reliability of manual muscle strength testing of the intrinsic muscles of the hand is reported. The muscle strengths of 28 patients who had neuropathies of the ulnar nerve or the ulnar and median nerves were graded by two physiotherapists to determine intraobserver and interobserver reliabilities. Muscle strength was graded using the numeric scale developed by the Medical Research Council (grades 0 to 5). Reliabilities were established for nine muscles or muscle groups. Intraobserver reliabilities ranged from 0.71 to 0.96 and interobserver reliabilities from 0.72 to 0.93. It is difficult to isolate, and hence grade, most of the intrinsic muscles of the hand. Therefore, it is suggested that specific movements be tested and graded when assessing and evaluating muscle or nerve function.