ABSTRACT
CONTEXT: India accounts for 60% of the global leprosy burden. Deformities lead to a negative impact on the quality of life (QoL). There is a paucity of Indian studies evaluating the QoL in patients with leprosy. AIMS: This study was undertaken to assess QoL in leprosy patients with two different questionnaires, correlate QoL with demographic and clinical profile and evaluate the impact on health-related QoL scores. SETTINGS AND DESIGN: A cross-sectional study to evaluate the QoL was conducted in the dermatology OPD of a tertiary center in Maharashtra, India. MATERIALS AND METHODS: Demographic and clinical profile along with evaluation of QoL using DLQI and WHOQOL-BREF questionnaires was conducted in 60 leprosy patients. STATISTICAL ANALYSIS USED: Parametric test, R test, Chi-square test, Z test, Student's t-test (t), and Pearson's correlation coefficient (r) were used. RESULTS: The mean DLQI score was 8.4 ± 4.4 and 40% of patients had moderate impact on QoL, and the mean WHOQOL-BREF score was 3.13 ± 0.9. The demographic profile, type of leprosy and reactions did not have a statistically significant correlation with DLQI. Presence of deformity had significant impact on DLQI and a statistically significant impact on physical, psychological, and environmental domain in WHOQOL-BREF analysis. CONCLUSIONS: Deformities have a profound impact on QoL in leprosy patients on evaluation with DLQI and WHOQOL- BREF questionnaires. The social domain was least affected, whereas severe impact was noted in psychological domain. DLQI is a practical and simple questionnaire, whereas WHOQOL- BREF provides a comprehensive approach on all domains.
ABSTRACT
BACKGROUND: The authors wished to develop a scoring system for evaluating patients presenting with febrile thrombocytopenia for risk stratification, predicting patient outcome and optimization of care especially in resource poor countries. OBJECTIVE: 1. To decide a protocol in the management of patients with fever and thrombocytopenia. 2. To develop screening or therapeutic guidelines (early warning score-EWS) in febrile thrombocytopenic patients and decide about therapeutic interventions. METHODS: 1. To decide a protocol in the management of patients with fever and thrombocytopenia. 2. To develop screening or therapeutic guidelines (early warning score-EWS) in febrile thrombocytopenic patients and decide about therapeutic interventions. DESIGN: Retrospective study and development of a bedside scoring system based on Platelet Count, Temperature, Respiratory Rate, Blood Pressure. Pulse, CNS, Respiratory, Hematological, Hepatic and Renal complications in a central civic hospital and teaching institute in India. PARTICIPASNTS: All patients > 18 years presenting with fever and thrombocytopenia with platelet count of < 150 × 109/L. RESULTS: Number of patients requiring platelet transfusions decreases when total risk score is used for risk stratification and for transfusing platelets as against the platelet count at admission. Patients who died in our study had a platelet count at presentation between 20,000- 1,00,000 though their total risk score was 17 and 18 respectively; hence platelet count alone should not be relied upon for platelet transfusion. Irrespective of the number of platelets transfused the prognosis is poor as the total risk score increases. CONCLUSIONS: The platelet count is not the only indicator of transfusion. When we use total risk score instead of platelet count for classifying patients who need transfusions, number of patients who fall in severe risk category needing immediate transfusion reduces and haphazard use of platelets can be avoided. Patient outcome (death/survival), occurrence of complications and hematological manifestations (petechiae/purpura etc) are not dependent on platelet count at presentation. There is a significant association between risk category and patient outcome.
