Strengthening of primary health care: Key to deliver inclusive health care.

Inequity and poverty are the root causes of ill health. Access to quality health services on an affordable and equitable basis in many parts of the country remains an unfulfilled aspiration. Disparity in health care is interpreted as compromise in 'Right to Life.' It is imperative to define 'essential health care,' which should be made available to all citizens to facilitate inclusivity in health care. The suggested methods for this include optimal utilization of public resources and increasing public spending on health care. Capacity building through training, especially training of paramedical personnel, is proposed as an essential ingredient, to reduce cost, especially in tertiary care. Another aspect which is considered very important is improvement in delivery system of health care. Increasing the role of 'family physician' in health care delivery system will improve preventive care and reduce cost of tertiary care. These observations underlie the relevance and role of Primary health care as a key to deliver inclusive health care. The advantages of a primary health care model for health service delivery are greater access to needed services; better quality of care; a greater focus on prevention; early management of health problems; and cumulative improvements in health and lower morbidity as a result of primary health care delivery.

Tuberculoid granuloma in a clinically normal looking skin.

A case of tuberculoid leprosy showing well defined tuberculoid granuloma in the skin without any morphological changes is reported.

Multidrug therapy in hospitalised leprosy cases.

Fifty eight cases including 44 paucibacillary and 14 multibacillary leprosy diagnosed at Command Hospital SC Pune were hospitalised for the entire period of multidrug therapy. 76% cases belonged to high endemic states of India. Reactions occurred in 13 cases during treatment, type I in 10 and type II in three. 7 Multibacillary cases experienced reaction. 69% reaction patients developed reaction within two months of starting MDT and all of them were multibacillary. Usually it took 3-6 months for majority (61.5%) of reactions subside completely. In 65.5% paucibacillary patients activity subsided within twelve months, however 70.5% paucibacillary cases took more than six months to exhibit subsidence of activity. In 13 multibacillary cases activity subsided by 18 months though bacteriological negativity was obtained from fourth to twelve months.

Leprosy with pellagroid features (a case report).

A case of leprosy with pellagroid features is presented. Diagnosis of leprosy was confirmed by bacteriological and histopathological examination. A therapeutic trial with nicotinic acid did not result in any improvement. Occurrence of scaling in leprosy is discussed.

A study of palmar ridge malformation in leprosy.

Palmar ridge malformation of 150 male leprosy patients (50 multibacillary and 100 paucibacillary) were compared with matched controls. Significantly high incidence of ridge malformation was found on the palms of multibacillary leprosy patients. The acquired ridge atrophy was found in 32% multibacillary leprosy, 4.5% paucibacillary leprosy and 0% controls. The congenital ridge dissociation was found in 46% multibacillary leprosy, 20% paucibacillary leprosy and 22% controls. The difference is statistically significant.

An evaluation of palmar flexion creases and dermatoglyphics in leprosy.

The palmar flexion creases and dermatoglyphics of 150 male leprosy patients (100 paucibacillary and 50 multibacillary leprosy) were compared with 50 matched controls. Among palmar dermatoglyphics a significantly high frequency (P less than 0.001) of palmar pattern in thenar/1st interdigital area was noticed on left palm of multibacillary leprosy patients. Slight increase in frequency of distal axial triradii (t' and t'') was also seen on palms of leprosy patients. No difference in values of atd angle and C-line types were observed between patients and controls. Among palmar flexion creases a significantly high frequency of Single Radial Base Crease (SRBC) and lower frequency of Double Radial Base Crease (DRBC) was noticed on palms of leprosy patients as compared to controls (P less than 0.001). The difference mainly exist on left palm. A significantly high frequency of Simian Crease was also observed on palms of multibacillary leprosy patients (P less than 0.001) and paucibacillary leprosy patients (P less than 0.05) as compared to controls.

Study of finger print patterns in leprosy.

Finger print patterns of 150 male leprosy patients (100 paucibacillary and 50 multibacillary leprosy) were compared with 50 matched controls. Significant differences were found in finger print patterns of multibacillary leprosy patients and controls. No differences in dermatoglyphic patterns were observed between paucibacillary leprosy and controls. The total finger ridge count (TFRC) in both types of leprosy was slightly lower than controls. A significant difference in individual finger ridge count on digit 1 of right hand was noted in paucibacillary leprosy cases as compared to controls.

Quantification of thermal sensory loss in follow up of progress in leprosy.

Thermal sensory perception quantitatively was studied in follow up of 10 lesions (4 TT, 3 BT and 1 Indeterminate case) of cases put on poly therapy as per WHO regime, for 6 months. Significant thermal sensory improvements was noticed in 4 lesions after 4 months of therapy. Within 2 months of therapy, 3 cases showed improved perception of heat sensation but 1 showed deterioration. Recovery of sensations did not correspond to other clinical parameters of improvement in all the cases. The utility of quantitative evaluation of thermal sensory perception in follow up of leprosy cases is discussed.

Inoculation leprosy developing after tattooing--a case report.

A case of Inoculation Leprosy following tattooing in a soldier is being reported. Escape of infection in one tattoo and occurrence of disease in another when tattooing was done simultaneously, is of interest. Possible mechanism for such occurrence is discussed.

Quantification of thermal sensory perception in leprosy (a preliminary report).

An instrument called 'Thermosense' was designed and developed for quantitative assessment of thermal sensory perception. Preliminary testing on 20 healthy adult males showed that 39 degrees C was perceived as hot in 19 individuals on the forearm and arm. The perception on the finger tips was less than forearms. In 5 cases of leprosy (BT 4, TT 1) testing showed detectable difference in thermal perception within the lesion, in the skin, in the vicinity of the lesion and the uninvolved skin.

Epidemiological and clinical aspects of leprosy in Indian armed forces.

Epidemiological and clinical aspects of leprosy in 1911 cases of the disease in armed forces personnel were studied. Typewise distribution of cases was Tuberculoid 53.53%, Lepromatous 20.57%, Indeterminate 8.74%, Borderline 11.67% and Polyneuritic 5.49%. Maximum leprosy cases occurred in those belonging to Uttar Pradesh 17.11%. Maximum number of cases were detected (88.55%) in age group 20-39 years. Incidence of leprosy increased with increased years of service. 11.82% patients were illiterate. 89.85% patients earned Rs. 200 to 499 per month. 56.08% patients had no landed property. Houses of 47.29% cases were located in congested areas. 68.23% patients had to support larger families. In 95.94% cases no family members were examined for leprosy. Diet, smoking and alcohol appear to have had no relation to disease in cases studied. Clinical presentation of cases was classical and typespecific. Skin eruption and loss of sensation were the commonest symptoms. Leprosy lesions were detected on almost all parts of body. Thermal sensation was the commonest modality lost. Ulnar, lateral popliteal and greater auricular were the frequently affected nerves. Amongst complications paralytic deformities were common (16.09%). 545 complications were detected in 1911 cases. While 84.29% patients had put in more than 4 years of service, the source of infection was known only in 0.57% positively (intrafamilial).

Inoculation leprosy subsequent to dog bite. A case report.

Development of leprosy lesion at the site of inoculation or injury is described by many workers off and on. An interesting case of indeterminate leprosy developing at the site of dog bite is being reported.

Absence of triradius d on the palm of a leprosy patient.

An extremely rare finding of absence of digital triradius d in a case of borderline tuberculoid leprosy from Maharashtra is reported with review of literature.