Does nerve examination improve diagnostic efficacy of the WHO classification of leprosy?

BACKGROUND: In the year 1998 WHO proposed that the clinical criteria of counting skin lesions alone should decide whether a patient receives Multibacillary (MB) or Paucibacillary (PB) MDT. There is a concern that a significant number of patients may be incorrectly treated under these guidelines. AIMS: This study aims to determine whether the sensitivity and the specificity of the latest WHO criteria, can be enhanced by the addition of nerve examination in the place of slit skin smears. METHODS: 150 patients of untreated leprosy reporting at a TLM Hospital in Delhi from January to December 2006 were registered for the study. After physical examination, the number of skin lesions and nerves involved were counted and slit skin smears performed. Two groups were created, those with > 5 skin lesions, and those with 5 or less skin lesions. The diagnostic efficacy of the current WHO classification was calculated with and without the addition of nerve examination. RESULTS: The sensitivity and the specificity of the current WHO operational classification are 76.6%, and 73.7% respectively, using slit skin smear as a standard. When the number of nerves was added to the diagnosis, the sensitivity increased to 94.4%, for more than 5 lesions and to 90.9%, for five or less than five lesions. CONCLUSIONS: Nerve examination can significantly improve the sensitivity of the WHO criterion in determination of MB versus PB leprosy.

Prevention of disability in leprosy.

Leprosy is curable now-a-days if initiatives are taken for prevention of disability along with complete and regular chemotherapy. Common disabilities encountered in leprosy are: Claw hand, foot drop, lagophthalmos, plantar ulcers and depressed bridge of nose. Objectives of prevention of disabilities are preservation of nerve function, preservation of vision, to regain functional ability and self-esteem. Measures to prevent disabilities include early diagnosis and treatment with effective chemotherapy, to train leprosy cases to perform self-care practices, providing them with protective aids and referring the cases for surgery if indicated. Lepra reactions are episodes of sudden increase in the activity of the disease. Lepra reactions are treated by bed rest, analgesics rest to affected nerve by splints and a suggested course of prednisolone. Besides, leprosy-affected persons should be encouraged for self-care practices. Counselling and holding care and concern camps (POD camps) are very much integrated wtih the prevention of disabilities.

Cambios histopatológicos por intoxicación de mercurio en cobayos / Histopathological response to mercury intoxication in Guinea pigs

En el presente trabajo de investigación se observaron cambios histopatológicos de importancia en órganos como el cerebro, corazón, hígado y riñón de los cobayos, como consecuencia de la intoxicación experimental por mercuio. Las lesiones de mayor importancia aparecieron en el sistema nervioso como fue el daño neuronal avanzado con pérdida total de la sustancia de Nissl, acidofilia intensa, retracción del citoplasma y picnosis; en el riñón se observó tumefacción de los citoplasmas y numerosos cilindros intraluminales así como necrosis tubular aguda; en el corazón existió un incremento de la cidofilia del carcoplasma y pérdida focal de las estriaciones. En el hígado se observó alteración de los hepatocitos de la región centro lobulillar, caracterizados por balonización y esteatosis

Leprosy deformities. I. An epidemiological study in a rural area of Rajasthan.

Leprosy deformities have been the cause of dehabilitation, destitution and social ostracism. Present study was planned and conducted in a rural area situated in eastern districts of Rajasthan. Out of 426 cases of leprosy, ninety cases were found suffering with deformities. The influences of various host factors and disease factors, in causation of deformities have been discussed.