Determinants of patients’ delay with disability in the diagnosed leprosy cases in the three major states of India: A case-control study

Background: Skin lesions are the most common early symptoms of leprosy, often ignored by patients at an early stage and misdiagnosed as other dermatological diseases by healthcare personnel, leading to delay in diagnosis and treatment of leprosy precipitating permanent neurological deficit, deformities and serious disabilities. Aims: The objective is to evaluate the duration of delay and factors responsible for the delay in reporting of patients, among the newly detected leprosy cases (Grade 1 and Grade 2 disability patients). Methods: A case-control study was conducted during 2014–2016 in three major states of India (Delhi, Gujarat and West Bengal) in 140 randomly recruited newly registered adult leprosy patients (aged 18 years and above) with Grade 2/1 disabilities (cases) and 140 Grade 0 disability patients (controls) in each of these Indian states. Results: It is established that the major contributors for the delay in the early diagnosis of leprosy have been patient-related factors. The median patient delay in the three states of Delhi, Gujarat and West Bengal were five months (0.7–1.8), 2.8 months (2–14) and 12 months (2–24), respectively. Limitations: The study design is case-control and has an inbuilt reporting bias due to the retrospective nature of data collection but the data collection was carried with caution to reduce the recall bias. As the study is carried out in three states, generalisation of interpretation was cautiously executed. The matching ratio of cases and controls was 1:1 in this study, but we could not increase the controls due to operational feasibility during the conduct of the study. Conclusion: Patient delay is a crucial factor responsible for the disability among new leprosy cases. A higher patient delay in these three states reflects that the community is not aware about the signs and symptoms of leprosy. Reducing patient delay is very important for reducing disabilities in the newly diagnosed cases.

Expression of annexin-A1 in blood and tissue leukocytes of leprosy patients

Abstract INTRODUCTION In leprosy, immune system mediators that regulate the infectious process act in a complex manner and can lead to several clinical outcomes. To understand the behavior of these mediators we quantified the expression of annexin-A1 (ANXA1) in the peripheral blood and plasma as well as tissue leukocytes in all clinical forms of leprosy and compared with healthy controls. METHODS Seventy healthy controls and 70 patients with leprosy, tuberculoid (TT) (n = 13), borderline tuberculoid (BT) (n = 15), borderline borderline (BB) (n = 13), borderline lepromatous (BL) (n = 15), and lepromatous leprosy (LL) (n = 14), were selected. Phenotyping of the lymphocyte cells and the intracellular expression of ANXA1 in leukocytes was performed by immunofluorescence. Plasma protein levels were determined by enzyme-linked immunosorbent assay. RESULTS Histiocytes and CD4+ and CD8+ T cells in the skin of BL and LL patients had higher ANXA1 expression. ANXA1 expression was also high in circulating polymorphonuclear, monocytes, and CD4+ and CD8+ T cells in the blood of LL patients compared to those of TT, BT, BB, and BL patients, and these levels were similar to those in healthy controls. Plasma ANXA1 levels indicate an increase in paracrine release in patients with LL. CONCLUSIONS The data indicate that ANXA1 expression is enhanced in the leukocytes and plasma of patients with LL, and may contribute to the inhibition of leukocyte action, leading to inadequate functioning of the immune system and thus contributing to the spread of M. leprae infection.

Anatomical Study Of Superficial Palmar Arch And Its Variations With Clinical Significance

Background: Superficial Palmar Arch (SPA) is an arterial arcade usually formed by the continuation of ulnarartery and the superficial branch of radial artery. Variations can occur in the vessels contributing to the formationof SPA. Knowledge of such variations will be very much helpful to microvascular surgeons, plastic surgeons andorthopaedicians to bring a better outcome in their surgical procedures. Also, it will be useful to the cardiovascularsurgeons to carryout radial artery harvesting procedures for the purpose of Coronary Artery Bypass Grafting. Themain objective is to study the different patterns of formation of the superficial palmar arch with an emphasis ontheir clinical importance.Materials and methods: This study was done in 40 upper limb specimens from 20 embalmed human adultcadavers at the Institute of Anatomy, Madras Medical College, Chennai. In every upper limb specimen, the palmwas dissected as per the steps described in the Cunningham’s Manual of Practical Anatomy. The SuperficialPalmar Arch was exposed and the vessels taking part in its formation were studied. Variations in the formationof Superficial Palmar Arch were noted and analysed.Results: Out of 40 specimens, the Superficial Palmar arch was found to be complete in 29 specimens (72.5%) andincomplete in 11 specimens (27.5%).Conclusion: Information about the different patterns in the formation of the Superficial Palmar Arch will beextremely useful for hand surgeons, microvascular surgeons, plastic surgeons and orthopaedicians to bring outa successful and beneficial postoperative outcome. Awareness about these variations will also help in appropriateinterpretation of investigations prior to radial artery harvesting for the purpose of Coronary Artery BypassGrafting.

Study on the Morphologic Variations in Colic Branches of Superior Mesenteric Artery.

Superior mesenteric artery arises from the abdominal aorta and supplies the derivatives of Midgut. Knowledge of the normal and anomalous arterial supply is important in modern abdominal surgical techniques like liver transplants, laparoscopic surgery, splenectomies, intestine transfers, penetration injuries of abdomen, resections of the small and large intestines, in radiological diagnosis and radiological abdominal interventions. A total number of 50 superior mesenteric arteries were studied in the different age group and sex by Dissection, Angiogram pictures and Surgeries. The colic branches were studied for variations in origin, course and pattern of supply.

Surgical Anatomy Of Dorsal Root Entry Zone of Cervical Spinal Nerves – Cadaveric Study.

Background: The main purpose of this study is to determine the detailed morphometric data of Dorsal Root Entry Zone (DREZ) of cervical spinal nerves. This knowledge is necessary for diagnosis, treatment and surgical management of pain due to many conditions like brachial plexus avulsion injury, post-herpetic neuralgia, phantom pain and cancer pain involved in cervical myelo-radiculopathy. There are fewer studies reported in this field of DREZ. Materials and Methods: Twenty five adult formalin fixed cadavers are taken for this study. Conventional Spinal cord dissection is followed as per Cunningham’s Dissection Mannual. Findings: The parameters included are Number of dorsal rootlets, Longitudinal Length of DREZ, Distance between two successive DREZ, Length of dorsal rootlets, Distance between right and left DREZ, Distance between DREZ and Ligamentum denticulatum, Cranial angles of Superior & inferior rootlets. Results: Results were noted for all the parameters and are compared with the previous studies. The significant observations are obtained. Conclusion: Surgical anatomy of Dorsal Root Entry Zone (DREZ) of cervical spinal nerves will be useful for the neurosurgeons doing Drezotomy procedure, in which the nociceptive fibres alone are specifically severed with preservation of other sensations.