Disabilities in leprosy: an open, retrospective analyses of institutional records

Abstract Background and objectives: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. Material and methods: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. Results: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. Limitation of study: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. Conclusion: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.

Efficacy of TENS versus Conservative Pain Control Measures in Post Herpetic Neuralgia: A Retrospective Observational Study.

Abstracts: Background & Objective: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in treatment of post herpetic neuralgia (PHN) compared with conservative pain control measures. Methodology: A retrospective institution based observational study was conducted evaluating the records of patients visiting the dermatology OPD during last 6 consecutive months for herpes zoster and PHN. 152 out of 6240 new cases had herpes zoster and 50 of these patients had PHN which was defined as persistence of pain at the involved site one month after subsidence of rash. Pain was quantitatively noted in these patients on a visual analogue scale (VAS) from 0-10.Three treatment groups were compared: only TENS therapy, TENS with analgesics (most commonly NSAIDS) and tab gabapentin along with tab amitriptyline as tricyclic antidepressant. ANOVA test was applied to study the statistical difference in treatment response between the three groups. Results: Mean baseline VAS in the groups was 6.6, 7.06 and 6.78 respectively. At the end of treatment the mean VAS was 2.1, 2.39 and 2.86 respectively. We found that there was 68.1%, 66.1% and 57.8% improvement in VAS in the individual groups respectively. The improvement was found to be statistically significant (p<0.05) in all the three treatment groups. Intergroup analysis, however, did not reveal any statistically significant difference between the groups. Conclusion: TENS is a safe and effective measure for pain control in post herpetic neuralgia patients. However, its efficacy over conventional pain control measures like NSAIDs and tab gabapentin and tricyclic antidepressants could not ascertained. Our study also revealed that initiation of antiviral therapy within 72 hours did not affect the severity of PHN.