Clinico-Epidemiological Profile of New Leprosy Cases Detected in Leprosy Case Detection Campaign in North Maharashtra during 2018–2020

Leprosy is a leading cause of disability in India. The percentage of disability and deformity can be reduced by diagnosing leprosy at an early stage. In order to detect the hidden leprosy cases, leprosy case detection campaigns, on line with Pulse Polio Campaign have been introduced specifically for high endemic districts, by the Central Leprosy Division. Records of cases from 2018 to 2020 were evaluated retrospectively to study the trend of new cases. The present study denotes the presence of hidden undiagnosed cases in the community and will require an intensification of leprosy control activities through contact tracing and active case detection. Continued quality surveillance is required for early detection, timely management, and prevention of the spread of the disease.

COVID-19 in Singapore - a case series from primary care

As the COVID-19 pandemic worsens, early case detection is vital to limiting community spread. We describe our experiences with four COVID-19 cases at the polyclinics in January and February 2020. This retrospective case series highlights the challenges primary care clinicians face in the early identification of suspect cases based on clinical criteria only. To improve case detection, clinicians can sharpen their clinical acumen by keeping abreast with the latest COVID-19 developments and by maintaining a high state of vigilance.

Assessment of case detection performance of tuberculosis patients registered for treatment in tuberculosis units of Satara district, Maharashtra

Background: Tuberculosis is a chronic, communicable, infectious disease caused by mycobacterium tuberculosis bacilli usually affecting lungs primarily resulting in pulmonary tuberculosis. Objective: The objective of this study was to evaluate the Revised National Tuberculosis Control Program (RNTCP) through the assessment of case detection performance of the patients registered for treatment under RNTCP in tuberculosis units (TUs). Materials and Methods: The present record-based, observational cross-sectional study was carried out under district tuberculosis centre, Satara, involving all the 10 TUs. District tuberculosis centre is located in the campus of District Hospital, Satara. The functioning of RNTCP under district tuberculosis centre at the level of TUs was studied from 2012 to 2014. Fifty slides of sputum smear positive and 50 slides of sputum smear negative for tuberculosis were selected randomly. Results: Tuberculosis suspect rate was found consistently increasing from 2012 to 2014 in majority of TUs except Umbraj TU. Sputum positive rate was also consistently low in Umbraj TU. Sputum positive smear rate was higher in Bel-Air TU consistently from 2012 followed by Satara TU. Annualized new smear-positive case detection rate was higher in Satara and Bel-Air TUs in 2012; however, it was within the range of 68–83% in 2012 which rose to 86.9% in 2013 at Koregaon and 89.5% at Wai TU in 2014. Conclusion: Tuberculosis suspect rate is consistently low at both Umbraj and Bel-Air TU. Sputum smear-positive rate is consistently higher at Satara and Bel-Air TU.

Leprosy Case Detection Campaign (LCDC): An Approach to Accelerate Progress to Achieve Leprosy Free India

The Elimination of Leprosy at National level was achieved in the month of December, 2005, by India. Afterward it was observed that trend of two important indicators of NLEP i.e. Annual New Case Detection Rate (ANCDR) and Prevalence Rate (PR) are almost static since 2005–2006, whereas the percentage of Grade II disability (G2D) amongst new cases detected showed a rising trend, which indicated delayed detection of cases and quantum of cases lying undetected/ hidden in the community. Hence, in order to address the issues being faced by programme an innovative approach for hidden case detection i.e., Leprosy Case Detection Campaign (LCDC) was introduced by Central Leprosy Division (CLD), Directorate General of Health Services (Dte.GHS), Ministry of Health & Family Welfare (MoHFW), Govt of India. This novel concept is first of its kind in the world as it has various unique features i.e., institutional framework at various administrative levels for planning, implementation and concurrent review of LCDC, formulation and training of search teams, Micro plan preparation, IEC activities, supervision and monitoring by identified supervisors and report submission. The activity was piloted in the limited areas of 50 districts of 7 states during March-April 2016 and in September, 2016 it was expanded to 163 districts of 20 States/ UTs to cover around 360 million population. During 2017, it was implemented in 255 districts of 23 States/ UTs to cover population of around 390 million. These efforts have yielded the desired result which is evident from the fact that approximately 67000 new leprosy cases were detected during the LCDCs in these 2 years (2016-17 & 2017-18) and number of G2D cases per million population also declined by more than 25%, from 4.48 cases per million in 2014-15 to 3.34 cases per million in 2017-18. In addition to the above, the benefits achieved through LCDCs are generation of large number of trained manpower who can suspect, identify leprosy cases and can carry out focussed IEC regarding leprosy.

An Evaluation of Active Case Detection in Malaria Control Program in Kiyuni Parish of Kyankwanzi District, Uganda

Malaria remains one of the leading health burdens in the developing world, especially in several sub-Saharan Africa countries; and Uganda has some of the highest recorded measures of malaria transmission intensity in the world. It is evident that the prevalence of malaria infection, the incidence of disease, and mortality from severe malaria remain very high in Uganda. Although the recent stable political and economic situation in the last few decades in Uganda supported for a fairly good appreciation of malaria control, the declines in infection, morbidity, and mortality are not sufficient to interrupt transmission and this country is among the top 4 countries with cases of malaria, especially among children under 5 years of age. In fact, Uganda, which is endemic in over 95% of the country, is a representative of challenges facing malaria control in Africa. In this study, we evaluated an active case detection program in 6 randomly selected villages, Uganda. This program covered a potential target population of 5,017 individuals. Our team screened 12,257 samples of malaria by active case detection, every 4 months, from February 2015 to January 2017 in the 6 villages (a total of 6 times). This study assessed the perceptions and practices on malaria control in Kiyuni Parish of Kyankwanzi district, Uganda. Our study presents that the incidence of malaria is sustained high despite efforts to scale-up and improve the use of LLINs and access to ACDs, based on the average incidence confirmed by RDTs.

Rendimiento diagnóstico de la baciloscopía en sintomáticos respiratorios usuarios de establecimientos de salud del primer nivel en un distrito de Lima Metropolitana / Diagnostic performance of sputum smear microscopy in respiratory symptomatics users of primary care level facilities of a district of Lima Metropolitana

Objetivo: Determinar el rendimiento de la baciloscopía en sintomáticos respiratorios (SR) que acuden a cuatro establecimientos de salud del primer nivel de atención de un distrito de Lima Metropolitana. Métodos: Se realizó un estudio de fuentes secundarias de tipo observacional y corte transversal. Se utilizó el Libro de Registro de Sintomáticos Respiratorios del año 2012 de cuatro establecimientos de salud del distrito de Santa Anita. Se determinó el porcentaje de baciloscopía positivas para los SR registrados en el libro de registros, además se calcularon tres indicadores operacionales incluidos en la Norma Técnica de Salud para el Control de la Tuberculosis (NTSCTB). Resultados: Se analizó los datos de 4 845 sintomáticos respiratorios identificados (SRI) en el libro de registro, de los cuales 4 726 fueron SR examinados (SREx) según la NTSCTB. Del total de SREx, 2,4% fueron casos de tuberculosis (TB) pulmonar con frotis positivo. La proporción de SREx entre los SRI fue del 97,5%; la proporción de baciloscopía con diagnóstico positivo entre el total de baciloscopía de diagnóstico fue de 2,0% y el promedio de baciloscop¡a entre los SREx fue de 1,9. Conclusiones: El rendimiento de la baciloscopía entre SR es menor a lo reportado en otros estudios. Si bien algunos indicadores operacionales se encuentran cercanos a la meta que establece la NTSCTB, la proporción de baciloscopía con diagnóstico positivo entre el total de baciloscopía realizadas reflejan posibles fallas en el proceso de identificación de los SR en el primer nivel de atención.

Objective: To determine the yield of smear sputum within symptomatic respiratory (SR) that assists to four primary health levels setting of a Lima Metropolitana district. Methods: A cross sectional study of secondary data was performed. The percentage of positive smears between SR registered in the Symptomatic register book was calculated. Also were calculated three indicators included in the Health Technical Standard for the Control of Tuberculosis. Results: 4 845 identified symptomatic respiratory (ISR) were in the register books of which 4 726 were examined symptomatic respiratory (ESR). 2,4% of ESR was tuberculosis smear positive. The proportion of ESR between ISR was 97,5% ; the proportion of positive smears within the total of smears performed was 2,0% and the mean of the smears between ESR was 1,9%. Conclusions: The yield of sputum smear between ESR is lesser that reported in other studies. Although some operational indicators are close to the goal established by technical standard, the proportion of positive smears within total of smears performed reflects possible failures in the identification process of symptomatic respiratory at the primary health level.

Private pharmacists and tuberculosis control: a survey of case detection skills in Osogbo, South Western, Nigeria.

Background: National Tuberculosis and Leprosy Control Program (NTBLCP) adopted Stop TB strategy in 2006 as a result of high TB burden which outlined engagement of all care providers including Private Pharmacists (PP) in TB control. However, there were no previous baseline studies done on knowledge and practices on TB control among private pharmacists needed to appraise their potential role and contribution to TB control which forms the basis of this study. Aims & Objective: To provide relevant information about tuberculosis case detection skills among private pharmacists in Osogbo, South Western Nigeria for the purpose of policy initiation, planning and decision making. Material and Methods: A cross sectional descriptive study using pre-tested structured questionnaire was conducted in November, 2007 among 47 Private Pharmacists (PP) randomly selected in Osogbo, South West, Nigeria. Verbal consent was taken before given the questionnaire. Sampling technique was a convenient sampling. Data were analyzed using SPSS v 16. Results: Almost all Private pharmacists interviewed (80.9%) were seeing TB suspects and had a good knowledge on TB etiology (100%) and air borne route of transmission (70%). Majority (90%) did not know TB treatment duration and standardized drug regimen for adult (93%) and children (97.9%). Less than half (40.4%) regarded sputum microscopy as the best test to confirm diagnosis of pulmonary tuberculosis. In addition, majority (99%) had no previous training on standard guidelines on TB control by the National Program. Conclusion: Private pharmacists were seen TB suspects with inadequate knowledge on Nigerian Guidelines on TB control. National tuberculosis and Leprosy control program (NTBLCP) must take appropriate measure to educate and train Private Pharmacists in TB management.

Glaucoma in developing countries.

Objective: To describe the background and strategy required for the prevention of blindness from glaucoma in developing countries. Materials and Methods: Extrapolation of existing data and experience in eye care delivery and teaching models in an unequally developed country (India) are used to make recommendations. Results: Parameters like population attributable risk percentage indicate that glaucoma is a public health problem but lack of simple diagnostic techniques and therapeutic interventions are barriers to any effective plan. Case detection rather than population-based screening is the recommended strategy for detection. Population awareness of the disease is low and most patients attending eye clinics do not receive a routine comprehensive eye examination that is required to detect glaucoma (and other potentially blinding eye diseases). Such a routine is not taught or practiced by the majority of training institutions either. Angle closure can be detected clinically and relatively simple interventions (including well performed cataract surgery) can prevent blindness from this condition. The strategy for open angle glaucoma should focus on those with established functional loss. Outcomes of this proposed strategy are not yet available. Conclusions: Glaucoma cannot be managed in isolation. The objective should be to detect and manage all potential causes of blindness and prevention of blindness from glaucoma should be integrated into existing programs. The original pyramidal model of eye care delivery incorporates this principle and provides an initial starting point. The routine of comprehensive eye examination in every clinic and its teaching (and use) in residency programs is mandatory for the detection and management of potentially preventable blinding pathology from any cause, including glaucoma. Programs for detection of glaucoma should not be initiated unless adequate facilities for diagnosis and surgical intervention are in place and their monitoring requires reporting of functional outcomes rather than number of operations performed.

Case detection of primary aldosteronism using the aldosterone-renin ratio (ARR): A three year experience in a tertiary hospital

BACKGROUND: Primary aldosteronism is a common, treatable and potentially curable cause of hypertension. It is a much more common cause of hypertension than was previously thought, and aldosterone excess may have deleterious effects on the cardiovascular system that are at least partly independent of blood pressure elevation. Plasma aldosterone-renin ratio is currently the most reliable available screening test for primary aldosteronism.OBJECTIVE: To determine the cases of primary aldosteronism using aldosterone-renin ratio as screening tool.METHODOLOGY: This is a retrospective, descriptive study. Seventy-two charts of patients with plasma aldosterone and renin determination done were reviewed.RESULTS: Forty-three patients had positive aldosterone-renin ratio (ARR?30). Only 23 submitted to a confirmatory test. Eighteen were females. The mean age was 40 y.o; the mean duration of onset of hypertension was 5 years prior to consult. Mean systolic and diastolic BP were 195mmHg and 100mmHg, respectively. All were hypokalemic. Fourteen showed a positive result in confirmatory saline infusion test. Computed tomography was done. Ten had unilateral adrenal nodule, 2 had adrenal limb thickening and 2 had bilateral adrenal lesions. Those with bilateral lesions underwent bilateral adrenal vein sampling, but no lateralization was demonstrated. They were given medical therapy, as well as the other 2 with adrenal limb thickening. The ten patients with unilateral adrenal lesions underwent unilateral adrenalectomy. Serum potassium normalized postoperatively; blood pressure improved but 3 patients continued to maintain on antihypertensive medication after surgery.CONCLUSIONS: Primary aldosteronism is a potentially curable disease. Hypokalemia and blood pressure improve upon treatment. Case detection using plasma aldosterone-renin ratio be done in high risk group. Confirmatory test must be pursued in those with positive ratio. CT scan is helpful in detecting the lesion and adrenal vein sampling be done to lateralize the hyperfunctioning adrenal.

Epidemiological pattern of leprosy in an endemic area of North-East Brazil, 1996-2005: the supporting role of a Nongovernmental Organization / O perfil da hanseníase em uma área endêmica do nordeste do Brasil, 1996-2005: atividade de suporte de uma Organização Não Governamental

In an endemic area of North-East Brazil (the town of Picos, State of Piauí), a nongovernmental organization (NGO) supported the activity against leprosy in connection with governmental health organizations and local agents. The indicators of leprosy elimination were compared over time (within Picos) and across space (Picos versus Piauí). The case detection rate, above 8 per 10,000 people in the last two years of observation, increased over time in Picos (p=0.010). This finding could be due to active detection activities rather than expanding endemicity, as suggested by the reduction in leprosy in children (p=0.053) and the decrease in the proportion of new cases with grade 2 disability (p<0.001). These indicators showed a more favorable time trend in the city than in the State, suggesting that NGO activity was supportive in the battle towards leprosy control.

Para avaliar a atividade da sustentação fornecida por Organizações Não Governamentais (ONG)na luta contra a hanseníase, o perfil epidemiológico da doença em uma cidade é comparado ao perfil do todo Estado do Piauí. A tendência temporal da taxa de detecção é de aumento em Picos (p=0,010), e nos últimos dois anos de observação estava acima de 8 para 10.000 habitantes, duas vezes maior do que o limiar de hiperendemicidade (4 para 10.000). Como varia paralelamente com a redução da hanseníase nas crianças (p=0,053) e a diminuição da proporção de casos novos com grau 2 de incapacidade (p<0.001), o incremento no tempo da taxa de detecção pode ser atribuído mais à maior intensidade da atividade de detecção do que à expansão da endemicidade. Os indicadores de eliminação da hanseníase têm uma tendência no tempo mais favorável na cidade do que no Estado do Piauí, sugerindo que o ONG fosse útil na batalha para o controle da hanseníase.

Un indicador sintético (ISILOC) para valorar la calidad de la detección de casos de tuberculosis / An approach to a synthetic indicator (ISILOC) for quality assurance of tuberculosis case detection

Un proceso de detección de casos de tuberculosis efectivo es necesario para su control y eliminación. Valorar los resultados de una prueba inicial de la aplicación de un indicador sintético, para la monitorización y evaluación de la calidad de la detección de casos de tuberculosis. A partir de datos retrospectivos del sistema de vigilancia de tuberculosis de los municipios de Ciudad de La Habana y La Habana, de las variables intermedias: A= proporción de sintomáticos respiratorios detectados; B= proporción de primeras baciloscopias realizadas a ellos; G= demora entre el comienzo de los síntomas y la primera consulta con el médico (de los enfermos diagnosticados); H= demora entre el diagnóstico y el inicio del control de foco, se estimó el indicador sintético de localización de casos (ISILOC)= A+B/8 (GH) cuyas cotas van desde 0 hasta 10 (0,9-1 excelente; 07-0,89 muy bueno; 0,4-0,69 aceptable; 0,1-0,39 deficiente; 0 deplorable). Se calificó como aceptables a los municipios Habana Vieja y 10 de Octubre, mientras Marianao alcanzaba muy bueno. Con los datos obtenidos en Guanajay 2000 y 2001 se precisó una calidad excelente y muy bueno, respectivamente. Para la provincia Habana se identificaron 2 municipios como deficientes en 2000, que fueron muy bueno en 2001. Los datos sugieren que ISILOC es factible y fácil de computar e interpretar, así como discriminante en su aplicación al integrar 4 variables importantes como instrumento adicional de monitorización-evaluación en el contexto nacional.

An effective tuberculosis case detection process is needed for tuberculosis (TB) control and elimination. To assess results of an initial test for a synthetic indicator designed to monitoring and evaluating the quality of tuberculosis cases detection. Using retrospective data from the tuberculosis surveillance systems in Havana City and Havana municipalities and some intermediate variables as A= portion of respiratory symptom patients detected; B= portion of first sputum smears microscopies performed; G= length of time from onset of symptoms to first appointment of diagnosed patients with the doctor and H= length of time from diagnosis to the beginning of the focus control, the synthetic indicator of case location (ISILOC)= (A+B)/8 (GH) was estimated, its figures range 0 to 10 (0,9-1, Excellent; 07-0,89, Very Good; 0,4-0,69 Acceptable; 0,1-0,39 Poor; 0 Very poor). Habana Vieja and 10 de Octubre municipalities were rated as Acceptable whereas Marianao municipality classification was Very Good. With data collected in Guanajay municipality in 2000 and 2001, the case detection quality was Excellent and Very Good respectively. Two municipalities were rated as Poor in 2000 in Havana province but they turned out to be classified as Very Good in 2001. Collected data indicate that The Synthetic Indicator (ISILOC) seems to be feasible, easy to compute and interpret and discriminating in its application by integrating four important variables as an additional tool for monitoring and evaluation of TB case detection process nationwide.