The quality of life of Hansen's disease clients with disabilities compared to clients without disabilities in Trinidad and Tobago

OBJECTIVE: This study aims to assess the quality of life of persons who have Hansen’s disease-related disabilities in Trinidad and Tobago, compared to persons with the disease who do not have a disability. DESIGN AND METHODS: The study was quantitative, cross-sectional, comparative in design, conducted in the Hansen’s Disease Dermatology Clinics of Trinidad and Tobago, between February 2014 and April 2014. It was a convenience sample of the 122 respondents, 26 were Hansen’s Disease clients with disabilities, 51 had the disease but without disabilities, while 45 were clients with other Dermatological conditions. The WGO Quality of Life (WHOQOL-BREF) questionnaire was interviewer-administered after consent. RESULTS: The largest group of persons who rated their quality of life as good or very good was the persons with Hansen’s Disease that had no disability (30%), only 12% of persons with Hansen’s Disease-related disability rated their quality of life as good or very good. The mean quality of life scores (and standard deviations) for Hansen’s Disease clients without disability was 78.61 (9.6), Non-Hansen’s clients was 72.23 (11.8) and Hansen’s Disease clients with disability was 67.40 (13.9). CONCLUSIONS: The quality of life of the Hansen’s Disease clients with disabilities was found to be lower than the other two groups of clients.

Leprosy - knowledge, attitudes and practices among clinic attenders

OBJECTIVE: To investigate the knowledge, attitudes and practices among leprosy clinic attendees and to review the epidemiology of leprosy in Trinidad. DESIGN AND METHODS: A cross-sectional study was undertaken utilizing an interviewer administered structured questionnaire. All leprosy clinic attendees over the age of 18 years who attend 3 of the 5 leprosy clinics in Trinidad were included. Data were collected from April to July 2014. RESULTS: All 21 responders who were invited to participate agreed, giving a response rate of 100%. Fifty-two percent (52%) were unaware of how the disease is contracted. Most patients (81%) believed that educating the public would help eradicate leprosy-related stigma. Ninety percent (90%) reported that they were compliant with taking their medication and 86% reported that they attended all clinic appointments. The majority (76%) felt self-conscious about their disease and 50% have experienced negative feelings after diagnosis. CONCLUSION: Patients appear to be aware of signs and symptoms of leprosy but less so about transmission. There appears to be a need for educating patients about their illness as well as the public to reduce stigma associated with the illness. There was also a need for counselling of patients to minimize the reported distress, sadness and worry they experience after being diagnosed.

Investigation of wound healing activity of Lantana camara L. in Sprague dawley rats using a burn wound model.

Summary: Lantana camara is used in herbal medicine for the treatment of skin itches, as an antiseptic for wounds, and externally for leprosy and scabies. The objective of our study is to investigate burn wound healing activity of the leaf extract of L.camara in rats. The animals were divided into two groups of 6 each. The test group animals were treated with the ethanol extract of L. camara (100 mg kg-1 day-1) topically and the control group animals were left untreated. Healing was assessed by the rate of wound contraction, period of epithelialization. Antimicrobial activities of the extract against the specific microorganisms were assessed. The extract showed antimicrobial activity against Staphylococcus aureus, Klebsiella Pneumoniae and E.coli. Extract treated wounds were healed in about 21 days which is not distinct from the controls. Our data suggest that L.camara has antimicrobial activity but not wound healing promoting activity on burn wound. Industrial relevance: Extensive work has been done on the L. camara and demonstrated the antimicrobial and fungicidal activity of its chemical constituents. Lantana oil is used for the treatment of skin itches and as an antiseptic for wounds. It has been used in folk medicine for the treatment of cancers, chicken pox, measles, ulcers, swellings, eczema. Our earlier work showed the healing activity on excision wound model. However, there is no data to support the wound healing activity of L. camara on burn wound. Hence, we have conducted the present study to explore the wound healing activity and the antimicrobial activities of L. camara against the specific microorganisms which generally infect burn wound.

Kenneth Harrison Uttley (1901-1972). Historian to the diseases of Antigua, British West Indies

Dr. Kenneth Uttley (1901-1972) served as Chief Medical Officer in Antigua, British West Indies, from 1955 until 1966. During this time, Dr. Uttley personally reviewed and tabulated an island-wide governmental demographic database of all births, deaths and causes of death during the preceeding 100 years. This database was the result of a Compulsory Birth and Death Registration Ordinance enacted as one of several Colonial Poor Laws in 1856. His efforts resulted in the publication of a total of 30 papers in American and British medical journals. Many of these papers reviewed historical demographic trends in births, fertility rates, neonatal deaths, infant mortality and early childhood mortality rates. Others focused on the historical epidemiology of specific diseases such as neonatal tetanus, leprosy, tuberculosis and malaria. This is the first complete bibliographical account of Uttley's contributions to the history of diseases in the West Indies in general and Antigua in particular. Dr. Uttley also served as an ordained priest in the Anglican Church and, upon retirement from the Colonial Medical Services, returned to England to serve as the Vicar of Purton, Oxfordshire. (AU)

Relapse rates following Leprosy multidrug therapy

This is a retrospective study of relapses among leprosy patients who received multiple drug therapy in Trinidad and Tobago between January 1982 and Decembe 1994. The results of the study reveal a relapse of 0.65 percent for multibacillary cases and 1.5 percent for paucibacillary cases. These results are comparable to the relapse rates reported by the World Health Organisation.(Au)

An assessment of the disability trends within the Hansen's disease control programme in Jamaica. 1982-1996

Even with the constant decline in the incidence of Hansen's disease in Jamaica and declared elimination status in 1981, there is still a high percentage of patients being registered with multibacillary type of Hansen's disease and with disabilities at the time of diagnosis. The increase is noted, at a time when the global focus is on Hansen's disease eradication by the year 2000. Young adults are the group most at risk for Hansen's disease and its complications. Delayed diagnoses have resulted in an increase in deformities. Men are more prone to disabilities and the severe type of the disease (RR=1.00). Children have been diagnosed with the multibacillary type of the disease. A retrospective study was conducted, over the period 1982 to 1996, in order to analyse the disability trends and what it means for the Hansen's disease control programme in Jamaica. It was demonstrated that among the 88 patients graded 42 percent had disability, of which the most common was that of the hand (OR=5.33 P=0.03). These findings indicate that there is an urgent need for active case finding of Hansen's disease patients in Jamaica. Early case finding must be seen as the key to an effective 'prevention of disability' programme (AU)

T cells and the skin

In addition to its role as a mechanical barrier, the skin plays an important role in temperature regulation, vitamin D synthesis and absorption of ultraviolet radiation. The importance of the skin as an immunological organ was not fully appreciated until the advent of immunosuppressive agents such as cyclosporin and tacrolimus, which have a predominant action against T lymphocytes and have been found to be effective in the management of common skin diseases such as atopic eczema and psoriasis. T lymphocytes are of fundamental importance to the immune system. Access from the vascular compartment into the skin is facilitated by adhesion molecules located on the endothelial of dermal blood vessels. Selective upregulation of adhesion molecules occurs in various inflammatory skin diseases and specific skin homing T lymphocytes preferentially enter the skin rather than other organs. T cell have recently been classified into Th1 and Th2 cells based on their cytokine profile. Th1 cells produce interleukin 2 (IL-2) and interferon gamma, important in macrophage activation and cytotoxity, and Th2 cells produce IL-4 and IL-5, important in B cell maturation and humoral immunity. Contact dermatitis and psoriasis are characterised by Th1 cells and atopic dermatitis by Th2 cells. The Th1/Th2 profile is also important in infectious diseases such as leprosy in which polarisation towards tuberculoid or lepromatous disease depends on a predominance of Th1 or Th2 cells, respectively. Future management of diseases affecting the skin is likely to depend on a greater understanding of the infiltrating T cell subsets and appropriate modulation of the Th1 and Th2 profile.(AU)

An assessment of the disability trends within the Hansen's disease control programme in Jamaica 1982-1996

Even with the constant decline in the incidence of Hansen's disease in Jamaica and declared elimination status in 1981, there is still a high percentage of patients being registered with multibacillary type of Hansen's disease and with disabilities at the time of diagnosis. This increase is noted, at a time when the global focus is on Hansen's eradication by the year 2000. Young adults are the group most a risk for Hansen's disease and its complications. Delayed diagnoses have resulted in an increase in deformities. Men are more prone to disabilities and the severe type of the disease (RR=1.00). Children have been diagnosed with the multibacillary type of disease. A retrospective study was conducted, over the period 1982 to 1996, in order to anlayse the disability trends and what it means for the Hansen's disease control programme in Jamaica. It was demonstrated that among the 88 patients graded 42 percent had disability, of which the most common was that of the hand (OR=5.33 p=0.03). These findings indicate that there is an urgent need for active case finding of Hansen's disease patients in Jamaica. Early case finding must be seen as the key to an effective "prevention of disability" programme.(AU)

La eliminacion de la lepra de las mericas: situacion actual y perspectivas / Eliminating leprosy from the Americas: current situation and future perspectives

Leprosy, a disease that used to be shrouded in darkness and fear, can now be cured thanks to a multidrug treatment schedule with rifampicin, clofazimine, and dapsone which has been in use since 1981. In 1991 the World Health Assembly, encouraged by the efficacy of this treatment regimen, established the goal of eliminating the disease as a public health problem globally and nationally by the year 2000. This goal, which calls for reducing disease prevalence to less than one case per 10 000 inhabitants, should not be confused with the goal of eradicating the disease, which implies a complete interruption of its transmission. Eliminating leprosy is an attainable goal which will depend on the forceful and massive use of the multidrug treatment regimen. This paper describes and discusses the various initiatives that have been launched in Latin America for the purpose of achieving this goal and the results obtained so far. It also explores the factors that impact on the feasibility of eradicating the disease (AU) (AU)

Human T cell lymphotropic virus (HTLV-1): cutaneous manifestations

Skin manifestations are a common feature of HTLV-1 associated disorders and of HTLV-1 infection itself. These include the lymphomatous skin infiltrates in adult T-cell lymphoma/leukaemia, most commonly manifesting as persistent, generalised papules, nodules and plaques with later ulceration, acquired ichthyosis and xeroderma in HAM/TSP, infective dermatitis of children, dermatomyositis, crusted (Norwegian) scabies, psoriasiform rashes which may precede one of the more serious disease associations, and possibly also seborrhoeic dermatitis. Disorders typically associated with immunosuppression such as disseminated herpes zoster, and ulcerative non-healing herpes simplex may also be seen occasionally both in ATK as well as in other wise asymptomatic HTLV-1 infection (AU)

Surgical aspects of the infective granulomata in St. Vincent - abstract

This retrospective study assesses the infective granulomata which were managed by a single surgeon in St. Vincent from January, 1964 to November, 1994. The data were obtained from the author's clinical and operative records, library of clinical photographs, X-ray films and private pathological museum. The total number of cases was 37, distributed as follows: bacterial-22 (syphilis 12, tuberculosis 5, yaws 3, leprosy 2); mycotic 4 (actinomycosis 4, mycetoma 1 viral-11 (lymphogranuloma venereum 9, granuloma inguinale 2). Syphilis presented as primary, secondary and tertiary lesions, the latter constituting two-thirds of the cases. There was one case of abdominal tuberculosis four of bone and joint. The three cases of yaws and two of leprosy were late manifestations of both diseases. The cases of actinomycosis were facial, cervico-facial and abdominal, the teeth and appendix being the sources of infection. Diagnosis of the single case of mycetoma was long delayed and amputation was eventually necessary. Lymphogranuloma venereum presented in its early acute and late fibrotic forms with anorectal structure in four patients requiring defunctioning colostomy. Granuloma inguinale manifested itself as beefy-red ulcers on the penis and perineum. This study indicates that the infective granulomata, though relatively few in number, were nevertheless of clinical and surgical interest (AU)