- Volume 70 , Number 4
- Page: 3–372
Abstracts of Congress for Papers and Posters
PPOD 63
MAGNITUDE, TRANSCENDENCE AND VULNERABILITY OF THE LATE REACTION IN LEPROSY PATIENTS: IMPLEMENTATION OF A SPECIFIC CARE PROGRAM
Goulart, I.M.B.; Rodrigues. A.L.P.; Rodrigues. B.F.
Centro de Referência Estadual em Hanseníase/Dermatologia Sanitária Faculdade de Medicina / Universidade Federal de Uberlândia. Av. Pará 1720. CEP 38400-902 - Uberlândia-MG, Brasil. Fax: +55-32182349: E-mail: imhgoular@ufu.hr.
The leprosy, cronical infection disease, is a large public health problem. If not diagnosed and treated, it may cause physical disabilities in Hansen's diseased patients, due mainly to reaction episodes. The leprosy reaction and its grievance, may happen before, during and after multidrug therapy treatment. The aim was to evaluate the magnitude, transcendence and vulnerability of late reactions; calculate the epidemiological and operational control indicators; implement action for monitoring the patients after treatment, through the analysis of charts of 335 leprosy patients in the Jaraguá Health School Center (CSE - Jaraguá) and 256 leprosy patients in the Clinical Center of the University Hospital (HC-UFU). A total of, 84 patients (25%) attended in CSE - Jaraguá and 66 patients (25.7%) attended in HC-UFU. due to reactive episodes after treatment. In terms of transcendence, the disability grade 1 was found in 21.2% and grade 2 in 25.8% of patients that presented reaction after treatment in the HC-UFU. In the CSE - Jaraguá the disability grade I was found in 15.5%, grade 2 in 6% and grade 3 in 2.5%. About the vulnerability, the implementation of the Associated Macroregional Referral Center in UFU, involving both the CSE - Jaraguá and HC-UFU, was able to subsidize the implementation of a specific leprosy control program for follow up of these leprosy patients after treatment in city district and region.
PPOD 64
MANAGEMENT OF LAGOPHTHALMOS
Dr. A.K. Mohapatra
Resident Surgeon, Surgical Unit, LEPRA India, Hoina Leprosy Research Trust, Muniguda, Dist-Rayagada, Orissa, India.
205 Leprosy cured persons with ocular complications were treated in Surgical Unit, HOINA Leprosy Research Trust. Muniguda. Orissa, between 1997 July to Aug' 2001. They were reffered from different Projects of LEPRA India viz. Koralep, Junlep, Bolep, HOINA and Mayurlep. Out of 205, 56 persons had Lagophthalmos. 36 had bilateral and 10 had unilateral. 10 cases were unlit for operation due to other ocular complications. In total 62 eyes were operated for Lagophthalmos giving benefit of doubt to 10 persons having one eye incomplete paralysis. The patients operated were predominately males and elderly age group (40-50 Yrs.). 52 were MB cases. 60 operations of TMT-2T (Johnson's method) were done and 2 lateral tarsorraphy in rest 2 cases. The maximum period of follow up was +3 Yrs.. Results were analysed after last follow up. Integration was good in all cases. Think blink was fair in maximum number of cases. Only 2 cases needed retightening of suture and one patient had opening problem. It can be concluded that TMT-2T Johnson's method is a very effective procedure for correction of Lagophthalmos by a skilled and experienced surgeon.
PPOD 65
MEDIAL PLANTAR ARTERY ISLAND FLAP FOR CHRONIC HEEL ULCERATION
Richard Schwarz
Green Pastures Hospital & Rehabilitation Centre, INF-RELEASE, PO BOX 28. Pokhara, Nepal.
Green Pastures Hospital, run by the International Nepal Fellowship, is one of three tertiary referral centres in Nepal to which people affected by leprosy are admitted for reconstructive surgery.
Chronic heel ulcers can be a difficult problem for the leprosy patient, necessitating many admissions to hospital with resulting loss of time at work. The risk of subsequent squamous cell carcinoma is also present in chronic ulcers.
To correct the defect and prevent continuing ulceration both removal of underlying bone spurs and coverage with healthy sole skin with underlying fat pad are often indicated. We report nine patients with chronic ulcers of the heel or carcinoma who underwent medial plantar artery island Rap from the instep to the heel. Operations were carried out between 1997 and 2001. The average size of the ulcer was 3.5 em and the average duration was 6.8 years. Eight of the patients had an associated bone spur excised. There was one minor post-operative wound infection and one minor dehiscence, both of which healed without further intervention. Follow-up tit an average of 14.5 months demonstrated no recurrence of ulceration.
We would recommend this flap as suitable in the treatment of recurrent or chronic heel ulcers as it removes the ulcer with the associated scar tissue and restores lull padding to the heel.
PPOD 66
MEDIAN NERVE REPAIR USING MUSCLE GRAFT IN LEPROSY
T.S. Narayanakumar; J.H. Pereira; D.D. Palande; A. Subramanian
Sacred Heart Leprosy Centre. Kumbakonam, Tamil-nadu. India.
Median nerve paralysis results from segmental (localized) lesions in leprosy. Nerve repair could not be successfully done in these hands as the nerves used conventionally as grafts were also affected by the disease. In this study, denatured autologous muscle, established as graft in the surgery of peripheral nerve injuries was used to repair leprosy affected median nerves in selected hands, primarily to restore sensibility in the palm.< br> At Sacred Heart Leprosy Centre, autologous muscle was used as graft to repair median nerves in 10 hands with total irreversible paralysis due to leprosy, during the period between 1989 and 1994. Objective sensory assessments with graded nylon filaments, weighted pins and biothesiometry and subjective assessments were thine prior to surgery and at six monthly intervals thereafter.
Follow-up data were available for 9 hands, for periods ranging from 7 years to 11.5 years (mean 8.25 years) and were analyzed. For grading the results, both objective and subjective sensory assessments were used as criteria. Results were successful in 5 hands. Grade I in 2 and Grade II in 3. This study showed that the technique of using muscle as graft works in nerves affected by leprosy and remaining part of the nerve including distal sensory apparatus remains viable.
PPOD 67
METHODS TO PREVENT NERVE FUNCTION IN LEPROSY BY DETECTING EARLY SENSORY NEUROPATHY - AN OVERVIEW
S Kingsley; V.V. Pai; R. Ganapati
Bombay Leprosy Project. Sion-Chunabhatli. Mum bai 400 022. India.
Although the early detection and prompt treatment has considerably minimized die proportion of disability among new cases, in variably certain number of cases develops neuropathy leading to deformity and disability. It is mandatory for instituting special intervention as well as to monitor the response to such interventions to evaluate the nerve function status of individual patients. Since the earliest manifestation of nerve damage in leprosy is mainly sensory neuropathy, it is important to detect and treat before it becomes irreversible. The availability of different methods to evaluate the nerve function loss to judge the actual neuropathy status can be misleading. The reliability and reproducibility of sensory testing is dependent upon a standard method of application. Studies on the use of SWM Filament to detect the early sensory changes indicate dial it is sensitive and reliable. However the limitations of such tests have made it difficult to incorporate these modalities in a routine leprosy control programme. Efforts have been made to device a standard tool to make the sensory testing more sensitive and reliable. There is no uniform pattern of sensory neuropathy and the severity of loss in terms of duration and extent is always uncertain. It is also necessary to differentiate whether the sensory loss is directly a consequence of the peripheral neuropathy or due lo other factors.
We made an attempt to review different sensory testing methods published in literature to compare their merits and adaptability in routine leprosy control programmes. The advantages and efficacy of various studies will be analyzed and presented with a suitable recommendation.
PPOD 68
MR IMAGING OF NEUROPATHIC FEET IN LEPROSY PATIENTS SUSPECTED FOR OSTEOMYELITIS
M.Maas; E.Slim; AF Hoeksma; AJ van der Kley; GJ den Heeten; WR Faber
Department of Radiology. Dermatology and Surgery Academic Medical Center.
Dept of Rehabilitation Jan van Breemen Institute. Amsterdam. The Netherlands. E-mail: m.maas@amc.uva.nl
The MRI of 12 leprosy patients with 18 events of suspected osteomyelitis were retrospectively analysed.
All patients had longstanding neuropathic feet with neuro-osteoarthropathy. All patients underwent contrast enhanced MRI with Two Point Dixon Chemical Shift Imaging as fat suppression technique. For the analysis of osteomyelitis primary and secondary MRI signs known from diabetic feet literature were used. Golden standard for the diagnosis osteomyelitis was a positive culture and/or histopathology. Clinical outcome after 6 months, using a combination of clinical criteria, was retrospectively evaluated when the golden standard was not available or not conclusive.
MRI was positive for osteomyelitis in 17 of 18 events and negative in I event. Com pared to the golden standard and/or clinical outcome there was agreement in 16 of 17 events positive for osteomyelitis and in I of I event negative for osteomyelitis.
We conclude that MRI can serve as a one step diagnostic strategy to diagnose osteomyelitis in leprosy patients with a longstanding neuropathic foot and neuro-osteoarthropathy suspected for osteomyelitis.
PPOD 69
MRI IN CLINICALLY ASYMPTOMATIC NEU-ROPATH1C LEPROSY FEET
M. Maas1; E.J. Slim3; E.M. Akkerman1; W.R. Faber2
1. Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
2. Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands.
3. Department of Rehabilitation, Jan van Breemen Institute, Amsterdam, The Netherlands.
Correspondence: M. Maas, E-mail: m.maas@zamc.uva.nl
MRI examination was performed in clinically asymptomatic neuropathic feet of leprosy patients. Ten adult leprosy patients with normal or nearly normal shaped neuropathic feet, without a history of osteomyelitis or clinical symptoms of inflammation at the time of MRI were analysed. All patients underwent the MRI protocol with the inclusion of Two Point Dixon Chemical Shift Imaging as fat suppression sequence.
In 90% of the patients MRl-abnornialities were found in the MTP I region. Abnormalities ranged from degradation and interruption of the subcutaneous fat, plantar fascia, and small fistula to effu-sion/synovitis in the MTP I. Bone marrow enhancement was seen in 3 patients.
Our study reveals significant MRI findings, which may possibly be related to the development of ulcerations. We conclude that with the use of MRI important changes are found in clinically asymptomatic neuropathic feet of leprosy patients. The consequence of this study could be that more attention is paid to the clinical examination and longitudinal follow up of leprosy patients with asymptomatic neuropathic feet.
PPOD 70
NASAL RECONSTRUCTION IN LEPROSY
Richard Schwarx; Mark McDonald; Jo McDonald; Ruth Murphy.
Green Pastures Hospital & Rehabilitation Centre, INF-RELEASE, PO BOX 28, Pokhara, Nepal.
Green Pastures Hospital, run by the International Nepal Fellowship, is one of three tertiary referral centres in Nepal to which people affected by leprosy are admitted for reconstructive surgery.
Destruction of the nasal septum and nasal bones by mycobacterium leprae and subsequent infection is still regularly seen in leprosy endemic areas. The social stigma associated with this deformity is significant in many countries. Different procedures have been developed to reconstruct the nose.
Patients operated on at Anandaban Hospital (Kathmandu, Nepal) and Green Pastures Hospital (Pokhara Nepal) between 1986 and 2001 were reviewed. There were 49 patients with an average age of 47.5 years, operated by 6 different surgeons. Deformities were mild (14). moderate (23) and severe (12). Bone grafting with skin flaps was done in 14 cases, bone grafting alone in 10 cases, flaps alone in 7 cases and cartilage grafting in 10 cases. In 3 patients a prosthesis was inserted and in 3 patients a gullwing forehead flap was performed. Grafting with conchal cartilage was associated with the best cosmetic results and had minimal complications. Bone grafting either with or without flaps was associated with a 509} complication rate, of infection or graft resorbtion. In mild to moderate deformities cartilage grafting is recommended while for more severe deformities cone grafting with fixation and skinflaps is recommended. In very severe cases reconstruction with a forehead flap gives good results. These procedures should only be carried out by an experienced surgeon and peri-operative antibiotics must be used.
PPOD 71
NEED FOR REHABILITATION OF LEPROSY PATIENTS
Abdulbhai K. Chauhan. Dr. P.V. Dave
District Panchayat, Bharuch. Helth Department. Government of Gujarat - India.
As in other diseases or conditions associated with disability and/or deformity, rehabilitation services are also needed for leprosy patients. The introduction of effective methods of treatment-medical, surgical and physical has brightened the prospects of cure of the disease. As a result, rehabilitation of a leprosy patients has now become practicable. Cure of the disease does not have much meaning for the patient if he still remains socially and economically dislocated.
The general principles of rehabilitation of leprosy handicapped persons are no doubt the same as those for other handicapped persons. However, there are two significant and vital differences. First, while other handicapped persons do not carry any stigma and/or are not socially dislocated, leprosy is unfortunately associated with a stigma and patients suffering or having suffered from this disease are apt to be socially ousted and considered as out casts from society.
In other diseased, the question of rehabilitation is considered alter the treatment of the patient has been completed, but in leprosy the process of rehabilitation should start as soon as a diagnosis of the disease has been made. Because of the immense difficulties in rehabilitation after he has been socially and economically dehabilitated or dislocate, efforts should be made to prevent dehabilition.
There are vast numbers of leprosy patients representing an enormous waste of human resources who are disabled physically, socially, spiritually, vocationally or economically. We are to prevent this from occurring in the first place.
PPOD 72
NEW CONCEPT IN FOOT WEAR FOR LEPROSY PATIENTS WITH PLANTAR ULCER
K.Udaya Kiran
Hansen's Information and treatment centre, Hyderabad.A.P. India.500028.
Custom made Microcellular rubber foot wear with rigid sole has established their importance in healing plantar ulcers and prevent reccurence.
Arch support has the important role of increasing weight bearing area and scooping is helpful in making the ulcer to take less weight.
Our concept incorporates till the above plus use of silicone gel inside the arch support and scooping is done on the bottom side rather than the foot contact side of the MCR.
The silicone gel is incorporated in the area of scooping and the soie.That is in between the insole and the sole. This help in creating a water bed like effect in the areas where it is required.This has the positive effect of decreasing the friction effect as well as reducing the weight bearing.Such effect is given where ever it is required.
The criteria involved,methods,patient acceptance and the benefits will be discussed.
As seen in 500 patients will he discussed.
Coir slides os the whole procedure will be shown.
PPOD 73
NOSE RECONSTRUCTION IN LEPROSY
Tuli Neder Meyer
Sanatórios Santa Fé and Santa Izabel. FHEMIG, Três Coracoes. MG Brazil.
Among the many deformities caused by leprosy, facial ones are the most evident and stigmatizing, as they are easily seen. Patients with facial deformities, even when bacterially cured, see themselves, and are seen by other people, as still being sick. Leprosy causes loss of eyebrows, excessive facial wrinkling, eyelid paralysis, ear and nose deformities. These last ones are ugly ami mark their bearers. They are caused by direct bacillary destruction of nasal lining and framework, generally sparing the skin. Surgical reconstruction includes a new lining for the nasal cavity and a new framework. The author presents nine cases of nose reconstruction in leprosy. Lining reconstruction was achieved by nasolabial (Farina's) Maps. A new bone support was built either with ulnar, tibial or skull grafts. A complete sequence of surgical techniques illustrates this presentation. Before and after pictures are exhibited. One complicated case is also detailed. Nose deformities, which are very stigmatizing, can be satisfactorily corrected through the Utilization of presented techniques. Surgical reconstruction must be a part of leprosy patients' rehabilitation.
PPOD 74
ORTHOTIC INTERVENTION IN NEUROPATHIC FOOT OF LEPROSY AND OTHER DISEASES
Dr. V. H. Jadhav; Dr. V. N. Kulkarni; A. Day; Dr. J. M.Mehta
Dr. Bandorwala Leprosy Hospital. Kodhawa. Pune 411048, Maharashtra. India.
Total of 124 patients of leprosy (65 with ulcers. 52 with callosities. 5 with knee and calf pain and 2 with corns) and 26 non-leprosy patients (9 with rheumatoid arthritis. 4 each of polio and diabetes mellitus, 6 with corns and I each with tabes dorsalis. calcaneous spur and pain at first metacarpal head) were assessed clinically and radiologically. Harris mat footprints were taken. Customs made orthotic devices were prepared from MCR. Harris footprints were taken with orthosis in place. These devices were fitted in appropriate footwear. Patients were followed up six monthly for one and half year. They were reassessed and given new orthotic devices and footwear at every follow up. Clinical photographs were taken periodically lo record the findings. In leprosy group ulcers showed healing in 55 patients, improvement in 6 patients and development of new ulcer due lo nail injury in I patient. All showed reduction in callosities. Size of corns was reduced and patients were relieved of pain. Non-leprosy patients were relieved of pain and could walk comfortably. Patient of tabes dorsalis could walk with stability and with minimum support. Those with corn showed reduction in size. Diabetic ulcers showed complete healing and were free from recurrence. The benefits obtained from orthotic devices are attributable to redistribution of planter pressure achieved.
PPOD 75
PAUTAS DE INTERVENCIÓN DEL EQUIPO DE PREVENCIÓN DE INCAPACIDADES Y REHABILITACIÓN EN LA ENFERMEDAD DE HANSEN
Dras Silvia Paredes; Cristina Cuello; Cristina Vaca Cardoso
Programa de Dermatología Sanitaria. Lucha Antileprosa.; Hospital Protomédico. Santa Fe. Argentina.
La lepra es una enfermedad discapacitante e invalidante al presentar un compromiso específico de los nervios periféricos denominado "neuropatía hanseniana", al ser las células de Schwan el blanco específico del Mycobacterium Leprae.
Esto implica que la persona que lo padece tiene un alto riesgo de presentar disfunciones sensitivas- motoras y vegetativas que comprometen su autonomía.
La patología neurítica responsable de la mayoría de los casos de la discapacidad, requiere de control y seguimiento permanente por parte del médico y de la intervención precoz, del equipo de Prevención de las incapacidades y rehabilitación (PIR).
El objetivo principal de este equipo es "mantener las capacidades funcionales intactas a fin de evitar la pérdida de independencia de la persona".
Para el logro de este objetivo se implementan pautas de intervención específica que se desarrollan a través de cuatro programas
- de educación
- de prevención
- de recuperación funcional
- de reeducación funcional.
Se desarrollan en este trabajo los mismos y se evalúan los resultados de 7 años de actividades inherentes a esta propuesta.
PPOD 76
POST OPERATIVE OUTCOME OF CATARACT EXTRACTION WITH POSTERIOR CHAMBER INTRA OCULAR LENS IMPLANTATION IN LEPROSY PATIENTS AS COMPARED TO NON-LEPROSY PATIENTS
Taffessework Girma
All Africa Leprosy and Tuberculosis Rehabilitation and Training Center. E-mail: leprosyth@sparrow.telecom.net.et
A retrospective analysis of the post operative outcome of a sample number of leprosy and non leprosy patients who underwent cataract extraction with posterior chamber intra ocular lens implantation over three years in the eye unit of ALERT will be presented. Sample groups will be studied with respects to age sex and type of leprosy. Postoperative outcome will be divided into visual outcome and postoperative complications
PPOD 77
PRELINIMARY PROBE ON 1NVOLVENENT OF GRASS-ROOTS LEVEL HEALTH DOCTORS IN POD AND REHABILITATION FOR PALS
LIN Shengzhi
Yining County Epidemic Prevention .Station, Guangxi Province. China.
PURPOSE: To probe the feasibility of involving the grass-roots level health doctors in the prevention of disability (POD) and rehabilitation for the persons affected by leprosy (Pals).
Method: Taking the advantage of the opportunity supplied by Handicap International Organization's project, to reain the health doctors while involving them in the POD and rehabilitation for the Pals from community.
Result: Totally 108 pals have been assessed about the disability, 15 Pals have been found with disability grade 2. which covers 13.998 of the total number, 16 Pas with disability grade 1, covers 14.89% The situation of all of the pals with disability have been proven to be much more better than before.
Conclusion: The active involvement of the grassroots level health doctors will be surely favorable to POD and rehabilitation for Pals. Reinforcement of the doctors training and a mechanism to improve the doctors' motivation is essential for our work in the future.
[Key words] the health doctor POD and Rehabilitation for Pals
PPOD 78
PREVENÇÃO DE INCAPACIDADES
Ana Cristina Costa Augusto1; Ana Maria Chagas Sette Câmara1,2; Ana Paula Azeredo Teixeira1; Cynthia Rossetti Portela1,3; Jacqueline Farnese Rezende1; Luciana Miranda Barbosa Melo1,3; Nadja Paulino1,4
1. Universidade Federal de Minas Gerais - Departamento de Fisioterapia. Av. Presidente Antônio Carlos,6627, Bairro Liberdade - Cep 31270-000 - Belo Horizonte - MG -Brasil.
2. Coordenadora.
3. Colaboradora.
4. Subcoordenadora.
A hanseníase representa um grave problema de saúde pública no Brasil. A cada ano. são registrados no país cerca de 40 mil novos casos da doença. Trata-se de uma patologia intecto-contagiosa crônica causada pelo bacilo de Hansen. A transmissão acontece via contato direto e prolongado com pacientes bacilíferos não tratados. O bacilo apresenta afinidade pela pele e nervos periféricos, o que pode levar a alterações sensitivas, motoras e autonômicas que predispõem a incapacidades físicas severas. Dessa forma, ressalta-se a importância das técnicas de prevenção, controle e tratamento das incapacidades físicas na hanseníase. O projeto de extensão "Prevenção de Incapacidades" tem como objetivo facilitar o acesso dos acadêmicos de fisioterapia às ações de controle das incapacidades físicas em hanseníase. São desenvolvidas atividades no Centro de Saúde Jardim Montanhês (CSJM) e no Anexo de Dermatologia do Hospital das Clínicas da UFMG (ADE/HC7UFMG). No CSJM, além do acompanhamento dos pacientes, tem-se a proposta de treinamento dos funcionários e agentes comunitários de saúde, sensibilizando-os para a busca ativa de casos novos e acompanhamento dos pacientes em tratamento e pós-alta. O ADE/HC/UFMG constitui um serviço de referência do programa de controle da hanseníase em Minas Gerais.
Nas ações de prevenção de incapacidades físicas em hanseníase a fisioterapia pode atuar precocemente através da avaliação neurológica periódica dos olhos, membros superiores e membros inferiores; acompanhamento das reações e/ou neurites; orientação quanto às atividades de auto-cuidados; e abordagem das alterações da função neural durante o tratamento e após a alta. Uma das formas de avaliação da efetividade das ações de controle em hanseníase é o registro do grau de incapacidades físicas, que tem corno objetivo traçar um perfil epidemiológico da população assistida.
Com a ação integrada dos participantes do projeto e da equipe de saúde dos serviços pretende-se contribuir com o Programa Nacional de Controle da Hanseníase do MS na tentativa de erradicação da doença.
PPOD 79
PREVENTION AND MANAGEMENT OF DISABILITY ANGOLA
Jean Pierre Brechet. MD
SOLE - ALM, CP 5968, Luanda - Angola.
Disability has been measured for the last 4 years in leprosy patients. The National Leprosy Control Program has trained health workers to recognise and treat leprosy with MDT It is noted that as the number of newly detected cases rise, the proportion of patients with Grade II disability tends to gradually drop.
On the other hand patients with open ulcers on hands and feet continue to give a horrible image of the disease. Neuritis and reactions are present in approximately 20 % of patients. Prevention of disability is part of the training health staff receive when trained in leprosy care.
Care of ulcers in the Health Centres is frequently forgotten for lack of dressings and dressing instruments. Instrument and dressing Kits have been introduced into 56 Health Centres in 9 Provinces. The impact is measured in the number of ulcers found and the time ulcers take to heal. After one year the number of ulcers has reduced by 50 % and health education has encouraged patients suffering from ulcers to develop self-care groups.
By the end of 2002 it will be possible to manage ulcers and prevent disability in all 18 Provinces of Angola.
PPOD 80
PROBLEMS RELATED TO PHYSICAL REHABILITATION AMONGST PALS AFTER RELEASE FROM TREATMENT
Yamin Hasibuan
Netherlands Leprosy Relief Jakarta, Wisma Bayuadji Kamar 3.06. Jalan Gandaria Tengah III No.44. Jakarta Selatan 12130, Indonesia
A study was conducted to assess problems related to physical rehabilitation in Subang district. West Java, in 2001. In 8 Health Centres 53 PALs were identified, of which 43 participated in this study. The results show that 37.2% are young adults, presenting as having the highest priority for physical rehabilitation. The majority of PALs are poor with a low level of education, work in heavy manual jobs and walk long distances to works. Of the 43 examined. 9 PALs had additional disability grades while the others had remained 3 years after RET. Of the 43 interviewed. 38 PALS presented with great hopes of finding help at the HC's. The performance of HC's are poor in physical rehabilitation, the district general hospital doesn't cater for leprosy and isn't actively involved in physical rehabilitation for PALs. The level of knowledge about physical rehabilitation amongst the PAL's was as follows: 74.4% had heard about the possibility of rehabilitative surgery. 65.8% said the result of surgery must be good. 65.1% said that surgery must be very expensive. Of the 43 interviewed, 22 are ready to undergo surgery, under the conditions of: free of charge (100% ). hospital must be close to their homes (72.7%). a preference for Subang general hospital (63.6%). The remaining 21 tire not ready for the reasons: fear of operation (25.6%). no indication as they only have G-1 disability (16.3%). a feeling of hopelessness (2.3%). have adapted with the presence of deformities (2.3%), must earn a living for the family (2.3%). Currently most patients' needs are physical rehabilitation with ulcer care, septic surgery including protective shoes. Many PALs present with recurring ulcers, but 79.1% have never been referred to the hospital, as the referral system is not working well.
PPOD 81
PROTECTION OF FOOT FROM DEVELOPING THE FIRST ULCER
Dr. J.S. Revannawar; Dr. V.V. Dongre
Gandhi Memorial Leprosy Foundation. Ramnagar, WARDI1A-442 001 (Maharashtra Slate) INDIA.
Plantar Ulceration is a common complication in leprosy due to peripheral nerve damage causes impairment of sensory, motor and sudo-motor function of the hands and feet, may occur in all types of Leprosy often the ulcer become infected with micro organisms that produce recurrent episodes of cellulitis of the surrounding tissues, osteomyelitis and destruction of bones results in deformities.
In our hospital out of 108 patients admitted during the year 2000. 63 were admitted for ulcers and most of which were plantar ulcers. As we see ordinarily, ulcers will not be so common, if the patient takes care of his feet. But once the patient allows an ulcer to form in his foot, the foot becomes more prone to develop a recurrent ulcer. Thus it becomes necessary to take all precautions to prevent the formation of the first ulcer, this is what Paul Brand refers to as "The Doctrine of the first ulcer".
Anaesthetic foot patient should take some steps like avoiding long walks and fast walking. Wearing MCR chappal. trimming his toenails, everyday hydrotherapy and oil therapy for 15-20 minutes and most important is patient should examine his feet everyday to see whether any fissure or break in the skin has occurred etc.
Rest is the most important thing in the treatment of ulcers of foot. Depending upon the severity of ulceration the treatment should be followed. What ever may be the intervention advocated to treat the phuitar ulcers, the ideal intervention is to emphasis more on selfcare.
PPOD 82
QUANTIFICAÇÃO DO GRAU DE MELHORA DA FORCA DE PREENSÃO EM PACIENTES PORTADORES DE HANSENÍASE SUBMETIDOS Â NEURÓLISE DOS NERVOS ULNAR E MEDIANO: APRESENTAÇÃO DE CASO
Prof Ms. Demóstenes Moreira; Prof Dr Rosicler Rocha de Aiza Alvarez; Prof Dr Guilhotino Moneada; Dr Renata Nascimento
Universidade de Brasília - UnB. Campus Darcy Ribeiro - Asa Norte - Brasília/DF - CEP. 70910-900.
Introdução: Nos últimos anos, as doenças do punho vêm merecendo destaque na literatura científica, com progressivo aumento do número de trabalhos clínicos e experimentais. Na avaliação dos resultados dos pacientes hansenianos submetidos à neurólise, são utilizados vários parâmetros clínicos, entre os quais destacamos a força de preensão palmar.
Objetivos.: Avaliar o grau de melhora após neurólise em um paciente hanseniano com seqüelas motoras da mão.
Métodos: Realizou-se um estudo de caso com um indivíduo jovem portador de hanseníase apresentando grau 2 de incapacidade nas mãos. O paciente foi submetido a avaliação da força de preensão na mão direita através do dinamômetro-JAMAR (posição 2), durante o pré e pós-operatório de neurólise dos nervos ulnar e mediano.
Apresentação do Caso: ANPS, 19 anos, sexo masculino, estudante, destro, procedente de Brasilinha/GO, MH Multibacilar, encontra-se na 8º dose de PQT, Q.P: dormência com paresia de musculatura in-trínsica e extrínsica na mão direita. Apresenta-se com neurite nos nervos ulnar e mediano direito há mais de 3 meses. Grau máximo de incapacidade 2 para as mãos com perda da sensibilidade protetora, garra móvel e reabsorção discreta.
Resultados: Houve melhora significativa da força de preensão palmar após a realização do procedimento cirúrgico (neurólise).
Conclusão: O uso do dinamômetro Jamar consiste em um método confiável na quantificação da preensão palmar de pacientes submetidos à neurólise dos nervos ulnar e mediano.
PPOD 83
REASONS FOR REFUSAL OF RECONSTRUCTIVE SURGERY IN LEPROSY
Dr Mannam Ebenezer; Mr Premraj Isaac
The objective of the study is to determine the reasons for refusal of surgery and to identify ways to overcome them. In this study 75 patients belonging to the leprosy control area of Schieff elin Leprosy Research and Training Centre. Karigiri with impairments requiring reconstructive surgery and who refused surgery were interviewed.. All these patients were advised to undergo surgery during their regular visits to the leprosy clinic. A significant observation is that only 23% seem to have understood the benefits and risks of surgery.
The reasons for refusal included long duration of hospitalization (42%), loss of wages (18%), both long hospitalisation and loss of wages (20%), non availability of a family member to care (14%) and fear of surgery (6%). Of the patients who refused surgery 86% said that they had adapted with their impairment to carry out ADL and their vocation although at a lower level of efficiency. The reasons for refusal of surgery were also analyzed according to age. sex, occupation, literacy, type of paralysis and bilateral involvement the major reason being long duration of hospitalization (62%).
This study brings out the need to reduce duration of hospitalization in our situation to enable patients to undergo reconstructive surgery. Alternative methods required to release joint contractures in a shorter time prior to surgery and methods to reduce postoperative period of physiotherapy for re-education needs to be explored.
PPOD 84
RECONSTRUCTIVE SURGERY FOR BACK LOG PATIENTS
H. Srinivasan FRCS., FRCSEd.
25. First Seaward Road, Chennai 600 041, India.
Worldwide implementation of multidrug therapy (MDT) has resulted in a rapid increase in the number of persons cured of leprosy over a short period. A proportion of them have WHO grade 2 disability. In India alone about ten million patients have been cured of their disease since the inception of MDT in 1982. We may expect about two million of the still living eight million among cured persons to be having grade 2 disability. Our experience shows that only a proportion of these persons are lit and willing for surgery straight away and that this proportion may be about 15% ± 5%. Thus we may have about 0.8 to 1.6 million persons who are fit and willing for surgery. The problem now is how to make surgery available to them within a reasonable period. While no systematic efforts to solve this managerial problem have been made on a large scale, various kinds of efforts have been made to tackle this issue at different places at different times and for different periods by different organizations. The experiences of various strategies are examined here. They may be broadly described as under: (i) special institutions model, (ii) sensitizing anil motivating the surgical community, (iii) sensitizing and motivating academic departments of surgical specialties, (iv) incentives to institutions and (v) camp/campaign approach. The first model has mostly outlived its utility. The next three models have had very limited success. The last model has been very successful in the State of Gujarat, but it may not be possible to replicate it in most other States. However, that model well illustrates the importance of political will and widespread participation of the medical anil paramedical professionals as whole and wide public support for a satisfactory solution of this otherwise unsolvable problem.
PPOD 85
RECONSTRUCTIVE SURGERY IN THE LEPROSY NOSE, A NEW CONCEPT
G.J. Nolst Trenite; W. Fokkens; K. Ingels; M. Virmond
The typical pathologic-anatomical findings in the leprosy nose are due to the destruction of parts of the nasal skeleton.
In particular destruction of the nasal septum and the anterior nasal spine are responsible for a saddle nose deformity and an acute nasolabial angle with lack of columellar show.
In severe cases there is also a lack of projection of the bony pyramid and vestibulur stenosis with typical vertical alar grooves due to sear tissue retraction. In the past different reconstuctive techniques were used to reconstruct the nose, from forehead (laps to implantation of iliacal bone to restore profile and form with varying success. Ideal would be to restore the normal cartilaginous skeleton. Endoscopic analysis of 40 leprosy patient in Brasil (1994) showed extensive destruction of the internal nasal framework, with makes reconstruction of the septum impossible.
From initial surgical procedures to restore function and form we learned that the soft tissue envelope could be freed and used after dissection of the scar tissues.
Depending on the severity of the deformity we were able to reconstruct the nose with autogenous material, (rib cartilage) and composite grafts from the auricle to restore the inner lining and to prevent retraction.
We classified the leprosy nose in four grades of severity of the deformity.
Depending on the severity, conchal cartilage alone (in moderate deformities) to rib cartilage combined with composite grafts (in severe deformities) were indicated for reconstruction.
From 1995 untill 2000 23 patients were operated with a follow up from 2-5 years. In all but one case there was aesthetic and functional improvement. The technique with dorsal (rib) grafts attached to a columella strut (with extention to rebuild the anterior nasal spine) showed no resorption of the dorsal auto-genus rib cartilage implant but a rather high percentage of partial resorption oflhe columella strut (rib), possibly due to the tension of the soft tissue on this graft. The composite grafts of the aurical survived in all cases.
PPOD 86
REHABILITATION IN THE EYES OF INSTITUTIONALISED LEPROSY PATIENTS
Kiskhor Landge
National Organization for Community Welfare. 8. Srinivas Colony, Eardha - 442001 (Maharastra - India)
There are thousands of leprosy patients staying in colony today and new patients are also coming to the colony for their rehabilitation. This fact is disturbing in connecting with Community Based Rehabilitation of leprosy patients. In this direction a study is undertaken to know the opinion about the rehabilitation in the eyes of institutionalized leprosy patients in mine district of Vidarbha - Maharashtra, India. A data is collected form 175 institutionalized leprosy patients and analyzed. In this study, the knowledge of the patients, their experiences in the families and with society, the reasons for their dehabilitation from normal social environment, their opinion about their rehabilitation, their educational, economical and own status in the family and society etc. such factors are studied in detail.
However, it also found that not old or deformed patients are settled in colony but the patients with no visible deformities are also coming today in colony for stay and this is disturbing. It is also found that qualified patients have more psychological problems and today on the verge of elimination the patients are facing familial, social, physical, economical, psychological and medical problems. These patients have no hope about their acceptance in the family and society as one of them and don't believe that the concept of Community Based Rehabilitation will be seen in reality in future completely
PPOD 87
REHABILITATION PROGRAM OF JICA ON LEPROSY IN MYANMAR
Dr. Yutaka Ishida; Ms. Hiroko Baba
Leprosy Control and Basic Health Services Project in Myanmar, JICA.
From 1st. April, 2000. JICA project named Leprosy Control and Basic Health Services Project was started as a pilot project covered 48 townships (4 townships in Mandalay Division, 19 townships in Sagaing Division and 25 townships in Magway Division).
Now the government of Myanmar is devoting all its powers to eliminate leprosy according to WHO's regimen in the not too distant future. After elimination of Leprosy, it will become to be important to control ex-patients with disabilities and deformities who are unclear the number in more than 230 thousand RFTs at the present. Therefore, we were starting to carry out some programs concerning rehabilitation on Leprosy in collaboration with the government of Myanmar. This project are stating to collaborate to control them within the project sites such as Reconstructive surgical training. Sewing training. Shoe making training, Physiotherapy training and so on using Yenanthar Leprosy Training Centre that was built up in 2001 by the government of Japan. Yenanthar Leprosy Hospital to which this training centre belongs is only one national leprosy hospital in Myanmar that has a responsibility to give medical services to leprosy patients.
Reconstructive surgical training for orthopedic surgeons in the divisional hospitals and district hospitals were conducted as first step of surgical training, Shoe making training for staff of Yenanthar Leprosy Hospital and physiotherapy training for physiotherapists of Myanmar were also conducted by Japanese experts dispatched from Japan. Sewing training for leprosy patients and their members of family were carried out in collaboration with Japanese NGO that are working in Mandalay city, Myanmar.
We would like to show the above activities and evaluation concerning with the rehabilitation on leprosy that we are just starting to carry out from this year.
PPOD 88
ROLE OF POSTERIOR TIBIAL NERVE DECOMPRESSION IN PLANTAR ULCER
Arunachalam Subramanian
Sacred Heart Leprosy Centre. Karaikal Road. Sakkottai — 612401, Kumbakonam, Tamil Nadu. India.
Plantar ulcers continue to be a major problem in leprosy. For various reasons Posterior Tibial Nerve (PTN) damage is neither noticed by the patient nor managed by the doctors early. The consequence is deformities and ulcers causing physical, social, financial and psychological problems to the patients. A study to assess the effects of PTN decompression was done. Patients with sensory loss of more than one year and plantar ulcers of varying duration were operated and followed up for 2 to 16 years. Total patients 78 (Male - 59, Female - 19), Total nerves 100.
Results: Fourteen out of 16 patients with two years duration of sensory loss had good sensory recovery and there were no ulcers. Among 44 who had single or recurrent ulcer of less than six months there was no recurrence in 30 and the recurrence was less in 14. Twelve with recurrent ulcers more than one year showed poor improvement. Six patients with sensory loss and ulcer of more than three years did not show any improvement.
PTN decompression has an important role in the management of early nerve damage. If done within two years of sensory loss and ulcer recurrence, the result will be tangible. PTN decompression at a later stage is beneficial to enhance the healing and reduction of ocurrecurrence. This surgery can be done in centres with a minimal infrastructure ami trained team. By managing the PTN involvement effectively, the manpower and money spent on hospitalization and rehabilitation can be reduced to a large extent.
PPOD 89
ROLE OF SELF CARE CUM TRAINING CAMPS IN DESTIMATISING LEPROSY - AN EXPERIENCE WITH THE PATIENTS. PROVIDERS AND PEOPLE
Dr. (Mrs) K.R. Mishra; Dr. D. N. Nayak
MO LEU. Program Officer. DANLEP; Jaipur. Orissa. India.
Background: Leprosy is better known for deformity it causes to the patient, resulting in social stigma, discrimination and ostracism This is a concern for all of us but the problem is actually faced by the patients and their families in the community.
In Orissa since implementation of MDT. 794485 cases have been detected and 85% have been cured with MDT. The deformity rate has come down from nearly 17% in 1983 to 1.8% by March 2001. This looks convincing. But there is huge load of already deformed patients who needs both care and cure including community acceptance. To further worsen the situation roughly 800 cases are added each year. Inadequate vertical set up coupled with increasing disability burden calls for immediate attention of all. This is a real challenge to be faced.
Objective: To provide both curative and preventive services to the deformed patients through self care practices and counseling.
To equip the service providers with the technical knowledge and skill of disability care through learning by doing approach.
To make aware the community that leprosy is treatable, curable, and touchable and we really mean it ensuring community participation.
Strategy: Self-care practices including counseling for recently developed visible (gr-II) deformity cases.
Sell-care teachings to the General Health Care providers baseil on learning by doing exercises.
Community participation ensured.
Observations:
Conclusion: These camps provided an excellent opportunity for patients, providers and people to inlet-act with each other and enrich their know ledge and skills.
Generate a common understanding of disease and associated deformity.
PPOD 90
SENSATION TESTING OF HANDS AND FEET: EXPERIENCES WITH THE TRAFFIC LIGHT PRINCIPLE
J Wim Brandsma; Khadga Gurimg
Green Pastures Hospital & Rehabilitation Centre. INF-RELEASE. PO BOX 28, Pokhara, Nepal.
Assessment and evaluation of nerve function is important in the diagnosis and management of leprosy reactions/neuritis. Loss of sensory function is an early sign of nerve function impairment and often may precede motor function impairment.
In many projects graded monofilaments are used to (semi)-quantitate the sensory status of the nerves. Often the sensory status of the nerve is visualised by marking the selected points on the diagrams of the hands and feet with the colour that corresponds to the graded lilament.
Hands and feet have different levels of normal, diminished, and protective sensation. When interpreting the sensory status of the ulnar, median and posterior tibial nerves, the examiner has to do a mental exercise because the different colours have a different meaning for hand and feet.
A colour pattern is proposed: green, orange and red. based on the colours of a traffic light. This harmonises the interpretation and can facilitate the evaluation of the sensory status of the nerves affected in leprosy. The recording and visualisation of the sensory status respect the different levels of normal sensation of hands and feet. The advantages and disadvantages of this method of evaluating and monitoring sensory function of peripheral nerves will be discussed.
PPOD 91
SERVICES AUGMENTATION FOR INTEGRATION OF LEPROSY (SAIL) AN EPOCH MAKING VENTURE IN A DEVELOPING COUNTRY
C.S. Cheriyan; Dr. Thomas Abraham; T. Jayaraj Devadas
German Leprosy Relief Association-India. No.4, Ga-japathy Street, Shenoy Nagar, Chennai-600 030.
Introduction: The Government of India has set forth a parameter for integrating leprosy with general health care services in states where MDT is in operation for 5 years or more and where the prevalence rate has come down to less than 6 per 10,000 population. With excellent leprosy control and elimination activities carried out by the Government of Tamil Nadu during the last two decades, integration of leprosy has become a reality in the year 1997.
Objectives:
- To identify the high risk groups through the existing leprosy and public health staff in Tiruvallur, Coimbatore and Vellore districts.
- To assist in augmenting programs as an integral part of the medical campaign and to implement the field programs effectively through IEC assistance of the existing systems.
Operational Modalities: Advance programs were prepared to reach at the public health centres through a circuit plan drawn out and distributed among the PFICs one month in advance. These programs cover a population of over 10,000,000 in 3 districts where we had supplied over 16,000 MCR chappals and over 80,000 POD/Selfcare Kits. The services of SAIL have certainly enhanced involvement of the government health staff in
PPOD 92
"SWIFT" DISABILITY ASSESSMENT-AN NGO BASED STUDY TO OFFER EFFECTIVE POD SERVICES
Dr. Thomas Abraham; M.V. Ramana; T. Jayaraj Devadas; Shibu George
German Leprosy Relief Association-India. No.4, Ga-japathy Street, Shenoy Nagar, Chennai-600 030.
German Leprosy Relief Association (GLRA) and Swiss Emmaus Leprosy Relief Work (ALES) are two International Organisations working for leprosy in India for more than 40 years. Through the projects supported by these organisations, 34607 disability patients were registered for treatment and care.
The objective of the "SWIFF" Disability assessment was to organise systematic special campaign to carry out the quality assessment of disability on a fast pace, so that a realistic picture of the disability particulars will be available from the supported projects. It could also cover all the deserving patients suffering with deformities under the medical, surgical, physio and rehabilitation services on priority basis.
The project physio technician and the field staff of the concerned projects were utilised for this assessment under the guidance of the Technical Advisory Unit (TAU) of GLRA/ALES - India, using a specially designed format. The assessment was done in two phases, an intensive phase of one week followed by an evaluation after one month.
The result showed that some of the old registered patients were not available in the given address for assessment and the number of deserving cases for reconstructive surgery was on the higher side. The teams also could identify the right candidates for different POD services.
PPOD 93
THE ACCEPTABILITY OF PROSTHETIC REHABILITATION AMONG PERSONS AFFECTED BY LEPROSY IN NEPAL
Sharan Ruchal, Narendra Khadka and Mark Macdonald.
Anandaban Leprosy Hospital, PO Box 151, Kathmandu, NEPAL. E-mail: anandaban@mail.com.np
AIM: To review the acceptability of prosthetic limbs among users, their families and their communities.
Methods: More than 150 leprosy and non-leprosy patients have had below knee amputation (BKA) and been fitted with prosthetic limbs at Anandaban Leprosy Hospital, Nepal. Sixty-two of these patients (52 leprosy and 10 non-leprosy patients) were interviewed using a standard questionnaire. There were 48 statements divided into seven categories to assess the difficulties faced as a result of the prosthesis in areas such as personal, domestic and social activities.
Results: Over 90% of those interviewed were able to do domestic activities but indicated inability to do field work; half of them possess no lands and cattle. More than 70% were allowed to partake in family and community ceremonies; 28% refused the invitation. Ninety percent had received a positive attitude from the community. Almost all patients managed to go to the toilet with the prosthesis, but found squatting difficult. Half of those interviewed felt physically able to cany on their work efficiently. Two thirds were capable of earning, while 25% depend upon leprosy and other social organisations. The average use of a prosthesis was 8.9 hours (range: 1-16 hours); walking distance was 3 km (range: 1-10) each day.
Conclusion: There is no significant change in the social, religious and cultural lives of patients with prosthetic limbs. Social integration seems to be positive and the nuclear family appears to be strong
PPOD 94
THE ANALYSIS OF EFFECT FOR 500 CASES WITH EYE, HANDS. FOODS DISABILITIES BY SELF CARE IN 3 YEARS
Qian Jianrong; Jin Gangshi
Tongxiang Institute of Dermatology, 314500. Tongx-iang, China.
Objective: To observe the effectiveness alter the disability persons who affected by leprosy had eyes, hands and feet self-care.
Methods: The disability persons who affected by leprosy were guided lermly by staffs to have self-care, then we registered their disability situation according to uniform standard.
Results: After observing for three years, total 500 persons, their red eyes were decreased 43.57%. cracks of hands and feet were decreased 33.33%. ulcers of thenar were decreased 37.14%. the proportion of implementing self-care consciously was 81.0%.
Conclusion: Eyes, hands and feet self-care can prevent from and control leprosy disabilities effectively.
PPOD 95
THE ANALYSIS OF REHABILITATION EFFECT FOR 823 CASES WITH DISABILITIES IN 3 YEARS
Mo Yingjian; Huang Peiyong; Huang Xiuyun; Huang Ceng; Fang Xicai; Liang Jianxiu
Guangxi Institute of Dermatology. 530003. Nanning, China.
Objective: Prevent and stop disability increase, improve and recover the physiological function so to get a higher life quality.
Methods: teaching the care-self method of the Watson (eye, hand and foot care-self) to leprosy patients and treating the complex foot ulcer in a compositive measure.
Result: disability was improved obviously, the cured rate of foot ulcer is 73.5%.
Conclusion: The Watson method is a effective measure to prevent and reduce leprosy disability. It could improve patients' physiological function obviously and should be spread out.
[Key Words] Leprosy disability rehabilitation.
PPOD 96
THE APPLICATION OF THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING. DISABILITY AND HEALTH IN LEPROSY
J. Wim Brandsina. Eriedbert Herm. Wim van Brakel
Green Pastures Hospital & Rehabilitation Centre. INF-RELEASE, PO BOX 28. Bokhara. Nepal.
In 1980. the World Health Organisation (WHO) published, for trial purposes, the International Classification of Impairments. Disabilities and Handicaps (ICIDII). During the last decade many international organisations have collaborated with WHO in the development of a definitive classification. This is now called the International Classification of Functioning. Disability and Health and will be known by the acronym ICE In its 54thassembly (May 2001 ) WHO endorsed its international use. The overall aim is " to provide a unified and standard language and framework for the description of health and health related states".
The classification is divided into two parts:
1 ) Function and disability, consisting of the components a) body function and structure, and b) activities and participation.
2) Contextual factors, consisting of a) environmental and b) personal factors.
The important health-related terms impairment, disability, activity, functioning and participation are all defined. The classification shows how these are (inter) related and how the experience and evolution of 'health (problems)' is influenced by environmental and personal factors. To be able to assess the need for rehabilitation and to monitor and evaluate the effect of rehabilitative interventions, it is advised that the concept and definitions of the ICF be used.
Leprosy can affect the person in every important domain of functioning. In the past, much emphasis has been given to the assessment and treatment of impairments only. For a comprehensive or holistic rehabilitation, attention needs to be given to all domains of functioning.
Case studies will illustrate how the concepts of the ICF can be used and applied in the rehabilitation of leprosy affected persons.
PPOD 97
THE COGNITION AND DEMAND OF INPATIENTS WITH LEPROSY FOR REHABILITATION
HUANG Zhen-Ian
Guangxi Tiang-lang Leprosy Hospital, 530022, Guangxi, China.
The rehabilitation is an important part of leprosy control and also an important point of our work now and onward. In order to exploring and demanding of rehabilitation of leprosy patient, through questionnaires of leprosy patients, through questionnaires made by ourselves, making dialogue with and investigating 96 patients. The result showed that most of the patients know general knowledge of self rehabilitation but lack of deep concern, and doing apart from knowledge. The demanding rehabilitation forms are most from medical professional performance and pamphlets, watching TV and listening tape records. The discussion indicated that the knowledge and doing of rehabilitation for leprosy patties should be in step.
We recommend that the time of rehabilitation should be in advance, contents should be systematically and the forms of performance should be multiplex
[Key words] leprosy rehabilitation exploration.
PPOD 98
THE EFFECT OF PREVENT ION FOR LEPROSY DISABILITIES
Liang Jianxiu; Huang Peiyong; Fu Zhizhi, Lu Yunqing, Huang Xiuyun; Mo Yingjian
Guangxi Institute of Dermatology, 530003, Nanning, China.
Objective: To assess the effect of actual measure for prevention from leprosy disability.
Methods: Comparing the leprosy disability rate between now and before the measure of prevention from disability by using the retrospective research in new cases and relapse patients.
Result: Since a compositive measure of prevention from leprosy disability was used in Guangxi, the rate of leprosy disability grade II has descended to average 13.02% of near this 10 years from 45.09% of before and the disability rate in new cases has been descended to average 10.95% of near this 10 years from average 23.14% of before 30 years (P<0.05).
Conclusion: It is a compositive result of many factors for the descending on leprosy disability in Guangxi, of it, measures of disability record form, early detecting and treatment for peripheral neuritis have played a key role.
[Key Words] Leprosy disability rehabilitation
PPOD 99
THE FOLLOW UP STUDY OF THE OUT COME OF INTRA OCULAR LENS IMPLANTATION AS A PART OF THE CATARACT SURGERY AMONGST THE LEPROSY SUFFERERS
Swapan K Samanta; I.S. Roy; Asim K. Dey; Amitava Chattaraj; Arpana Samanta
B.S. Medical College & Gouripore State Leprosy Hospital, Bankura. West Bengal, PIN 722101, India.
At present Cataract is the major cause of blindness amongst the leprosy sufferers of Eastern India. In most of these cases it is due to senility. Complicated cataract possibly due to leprous process is encountered in 20% of the cases. Extra Capsular Cataract Extraction (Can Opener Technique) with Intra Ocular Lens (10L) Implantation with a Peripheral Button Hole Iridectomy and Interrupted Sclero Corneal Sutures was the surgery of choice in this study. In a rapid epidemiological assessment conducted in Janu-ary,2002, out of 300 eyes of 210 MB leprosy sufferers with operable cataract, 170 eyes of 120 patients were found to underwent cataract operation with Intra Ocular Lens Implantation. The Cataract Surgical Coverage (No of operated eyes with cataract x 100 divided by Total No of eyes with Cataract + No of operated eyes with Cataract) was 36.6%. However all the 170 eyes of this series was operated by the same operative technique,surgical team,surgical atmosphere of a particular hospital with the single operation theatre and a single specific brand of vis-coelastic agents. IOL and suture material and uniform post operative care (a course of oral steroid along with local steroid and cycloplegics). The post operative follow up period varies from two and half years to three months. The mean follow up period was one year. The visual outcome following surgery after mean period was 6/12 and above in 90% of cases. Posterior Capsular Opacity resulted corrected vision upto 6/12 in 5% of the study group. 4% of the cases had vision limited to 1/60 due to corneal opacity following corneal ulceration as a result of hyposthetic cornea, associated lagophthalmos. 1 % had PL only due to blood staining of the cornea. Not a single case of post operative endophthalmitis or intractable uveitis was encountered. So Cataract Surgery with IOL implantation is a safe procedure in MB Leprosy sufferers even with the history of reaction.
PPOD 100
THE INFLUENCE OF PSYCHOLOGICAL STATUS OF LEPROSY CASES WITH DISABILITY ON REHABILITATION
ZHOU Zhiguang; WEI Guangming; Mariolein Loren; HUANG Qingping
Guangxi Institute of Dermatology, 530003. Nanning, China.
Objective: Understand and mastery the influence of psychological status of leprosy cases with disability on rehabilitation.
Methods: Studied the influences of sex. age. educational level, disability and having or not close relatives on their mind in 82 leprosy cases with disability by using the disease self—estimate table of SCL-90.
Result: The suffering levels of the study object is higher than those in healthy status ami the total mean score of psychological response was equal to 116.55 ± 47.21. The degree of disability has made a direct impact on the patient's mind. As compared with the patients living at home, the patients isolated in leprosaria without close relatives have higher scores in compulsion, depression, phobic anxiety, bigoted ideas and psychosis. The longer the disease duration, the more severe the lost and phobic feeling and hostility. The illiterate patients have more serious lost and phobic feeling. According to eight (actors in SCL-90. the most sensitive ones are interpersonal sensitivity, depression and phobic anxiety, and the next ones are compulsion, anxiety and hostility. After they (irmly believed the diagnosis, a few cases began excessively drinking, became superstitious, gamble-some, hostile and even tending to suicide. Forty-eight of the 74 cases had suicide intentions and four commited suicide themselves (without completion).
Conclusion: For the psychological health of leprosy patients with disability it will be necessary to obtain the support of the public in removing discrimination against the patients through popular health education and to find and treat the patients as early as possible in the interests of prevention of the disability.
[Key Words] Leprosy Disability Psychological Reaction SCL-90 Form
PPOD 101
THE INTRINSIC PARALYSIS THUMB; A CHALLENGE FOR SURGEONS AND PHYSIOTHERAPISTS. A SUGGESTED APPROACH.
Roland Kazen; Sahilu Zewge
ALERT. P.O. Box 165. Addis Ababa. Ethiopia.
A well functioning thumb is depending on stability in its joints to allow sufficient power in its function as an opposing linger in grips as well as sufficient joint mobility for dexterity. The ulnar nerve in its function as a metacarpophalangeal joint stabiliser also serves the first ray through the m. adductor pollicis. the m. flexor pollicis brevis deep head as well as (to some extent) through the first dorsal interosseus muscle. Paralysis of those muscles, whether due to an ulnar paralysis or a combined ulnar and median paralysis, leads to Z-ing and weakness of the thumb. Stabilising procedures, dynamic or static, encounter risks for crankshaft deformity and/or less than desired dexterity. In tin attempt to restore independent movements in the carpometacarpal, metacarpophalangeal, and interphalangeal joints 11 patients (6 with ulnar paralysis only, and 5 with combined ulnar and median paralysis) have had tendon transfers using the extensor indicis proprius routed trans-interosseus, trans-thenar, volar-ulnar to the metacarpophalangeal joint and inserted into the extensor pollicis longus on the basephallanx. The task of bringing back the skills of independent movements of the three joints present certain challenges for the physiotherapist both in terms of training as well as in terms of evaluating the result. The method and results are discussed.
PPOD 102
THE NEEDS AND COGNIZE ON REHABILITATION FOR 135 LEPROSY CASES
Xu Yaping; Zheng Jinjun; Chen Chaoqun
Zhejiang Provincial Institute of Dermatology, Wukang, 313200£¬China
Objective: to know the leprosy patients' cognizing and requirements to rehabilitation.
Methods: 135 leprosy patients were investigated by interview and questionnaire, the investigation form designed by national STD and leprosy control center was used.
Results: 60-857 patients knew normal knowledge of leprosy rehabilitation, they were kicking of deeper knowledge and can not implement rehabilitation as what they knew. About rehabilitation requirements, most of patients(72%) chose demonstration of doctors and nursesj (Jsimple books. 50-70%of them chose watching kinescopes and listening to records.
Conclusion: we ought to let leprosy patients implement leprosy rehabilitation as what they knew, which is very important It is suggested that time of rehabilitation should be earlier, contents should be systema-tism and formats should be diversification.
[Key words] Leprosy Rehabilitation Cognize