(LML) Where are training courses provided for training in basic leprosy and leprosy microscopy?

Leprosy Mailing List – August 28,  2014 

Ref.:   (LML) Where are training courses provided for training in basic leprosy and leprosy microscopy?

From:  John F. Prestigiacomo, Baton Rouge, Louisiana, USA

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Dear Dr. Schreuder,

To continue with the theme of Leprosy education begun by Dr. Napit’s E-mail I would ask that you also post the following:

The National Hansen’s Disease Programs in the USA has two online courses that health professionals interested in Leprosy care can take.  Both are free of charge.  USA healthcare workers can obtain Continuing Education Credit for taking one or both of these courses.

The first is:  “Awareness of Hansen’s Disease in the United States: Basic Diagnosis, Treatment & Management of Complications”

http://www.hrsa.gov/hansensdisease/onlinecourseawareness.html

The first part of this course covers the occurrence of Hansen’s Disease in the USA. Later sections of the lectures cover diagnosis, basic and advanced treatment based in NHDP recommendations and management of reactions.  Several clinical cases are also presented. 

 

The second is: “Comprehensive Management of the Neuropathic Foot”

http://www.hrsa.gov/hansensdisease/onlinecourseleap.html

The well-known seminar entitled, “The Carville Approach to Management of the Neuropathic Foot” has been modified for online instruction. The material presented includes principles and protocols that can be used to prevent amputation of the lower extremity due to neuropathy. There are six modules which provide the background theory as well as practical evaluation and treatment tools.

This course will enable the health care provider to assess and treat the patient with a neuropathic foot. This course is designed to reduce injuries and amputations associated with lower extremity neuropathy.

 

The National Hansen’s Disease Programs also holds seminars each year:

Seminar #1

Hansen’s Disease in the United States:  Diagnosis & Treatment

Location:

Gillis W Long Center

5445 Point Clair Rd

Carville, LA  70721

USA

http://www.hrsa.gov/hansensdisease/trainingunitedstates.html

This seminar is held once each year.  This year it will be held November 17 and 18, 2014

 

Seminar #2

Comprehensive Management of the Neuropathic Foot

Location:

1770 Physicians Park Drive

Baton Rouge, Louisiana

USA

Phone: 1-800-642-2477

Phone:  1-225-756-3761

Fax: (225) 756-3760

E-mail: mtemplet@hrsa.gov

http://www.hrsa.gov/hansensdisease/trainingneuropathicfoot.html

 

This seminar is held twice each year.  This year it will be held September 10, 11 and 12, 2014

 

 

John F. Prestigiacomo, MD, MBA

Medical Officer

National Hansen's Disease Programs

1770 Physicians Park Drive

Baton Rouge, LA 70816

Ph #:  (225) 756-3709

Ph #:  (800) 642-2477

Fax #: (225) 756-3706

E-Mail:  jprestigiacomo@hrsa.gov

NHDP Web Site:  http://www.hrsa.gov/hansensdisease/

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(LML) Where are training courses provided for training in basic leprosy and leprosy microscopy?

Leprosy Mailing List – August 26,  2014 

Ref.:    (LML) Where are training courses provided for training in basic leprosy and leprosy microscopy?

From:  Indra B. Napit, Lalitpur, Nepal

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Dear Pieter,

Greetings from Leprosy Mission Nepal!

 

Could you please post this email with 2 pdf attachments to LML about following 2 training courses.

 

1. Basic Leprosy Training Course (Nov 2-7, 2014) - for doctors working in Leprosy field

2. International Reconstructive Surgery Workshop (Nov 9-14, 2014) -for surgeons and physiotherspists/OTs

 

Venue: Anandaban Hospital, Leprosy Mission Nepal, Kathmandu

 

Contact: Dr. Indra B. Napit, Medical Director, Anandaban Hospital, Leprosy Mission Nepal

               email:indran@TLMnepal.org

 

With regards,

Dr. Indra

 

Dr. Indra B. Napit, MBBS, MS (Ortho)
Orthopaedic & Reconstructive Surgeon
Medical Director, Anandaban Hospital
The Leprosy Mission Nepal
Tika Bhairav, Lele-9, Lalitpur
P. O. Box 151, Kathmandu, Nepal
Cell phone: (+977)-9851136027

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(LML) WHO Goodwill Ambassador's Newsletter No.69, August 2014

Leprosy Mailing List – August 25,  2014 

Ref.:  (LML)  WHO Goodwill Ambassador's Newsletter No.69, August 2014

From:  Hiroe Soyagimi, Sasakawa Memorial Health Foundation, Japan

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Dear Dr. Schreuder and Friends,

 

 

We have corrected a miscalculation in the e-mail sent to you previously.

 

Please refer to slight word change hilighted in red below.

 

 

With best regards,

Sasakawa Memorial Foundation

 

 

Dear Dr. Schreuder and Friends,

 

Warm greetings from Sasakawa Memorial Health Foundation in Tokyo.

 

We have uploaded our latest edition of WHO Goodwill Ambassador's Newsletter No.69, August  2014" to our website. 

Please visit http://www.smhf.or.jp/e/ambassador/index.html to obtain electronic version of this issue. 

In this issue we feature articles about ...

Message from the Goodwill Ambassador- Compassionate Concern

Report-Case-finding in Brazil - Results from targeted leprosy surveillance in the Amazon region indicate the task at hand

Speech-Why This Museum Matters - Culion resident underlines why preserving the past is a source of strength for the future

Viewpoint-The Pope and “Leprosy” - Why does this champion of the marginalized favor an unfortunate metaphor?

Ambassador's Journal-Visit to Mayanchaung - The Goodwill Ambassador calls at a leprosy resettlement village in Myanmar

News-Culion’s Place in History - Philippine island’s past as leprosy colony recognized with official historical marker

We hope you enjoy our latest Newsletter!

Hiroe Soyagimi

Sasakawa Memorial Health Foundation

*********************************************

Sasakawa Memorial Health Foundation

Nippon Zaidan Bldg., 1-2-2, Akasaka

Minato-ku, Tokyo, 107-0052, Japan

TEL: +81-3-6229-5377

FAX: +81-3-6229-5388

Our websight: http://www.smhf.or.jp/e/

Our blog: http://blog.canpan.info/hansenbyo/ 

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(LML) WHO Goodwill Ambassador's Newsletter No.67, April 2014

Leprosy Mailing List – August 25,  2014 

Ref.:  (LML)  WHO Goodwill Ambassador's Newsletter No.67, April  2014

From:  Hiroe Soyagimi, Sasakawa Memorial Health Foundation, Japan

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Dear Dr. Schreuder and Friends,

 

 

Warm greetings from Sasakawa Memorial Health Foundation in Tokyo. We have uploaded our latest edition of "WHO Goodwill Ambassador's Newsletter No.67, April  2014" to our website. Please visit http://www.smhf.or.jp/e/ambassador/index.html to obtain electronic version of this issue. 

In this issue we feature articles about ...

Message from the Goodwill Ambassador- Compassionate Concern

Report-Case-finding in Brazil - Results from targeted leprosy surveillance in the Amazon region indicate the task at hand

Speech-Why This Museum Matters - Culion resident underlines why preserving the past is a source of strength for the future

Viewpoint-The Pope and “Leprosy” - Why does this champion of the marginalized favor an unfortunate metaphor?

Ambassador's Journal-Visit to Mayanchaung - The Goodwill Ambassador calls at a leprosy resettlement village in Myanmar

News-Culion’s Place in History - Philippine island’s past as leprosy colony recognized with official historical marker

 

We hope you enjoy our latest Newsletter!

 

Hiroe Soyagimi

Sasakawa Memorial Health Foundation

*********************************************

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(LML) WHO disability grading and the term anaesthesia

Leprosy Mailing List – August 20,  2014 

Ref.:    (LML)   WHO disability grading and the term anaesthesia

From:  Dinkar Palande, Pondicherry, India

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Dear Pieter,

 

 

I endorse the suggestion by Dr. Wim Theuvenet. (LML August 12, 2014). I hope that there is a discussion on this topic and positive suggestions. It is time that we bring a new deformity grading and start using it. This will help a lot in reducing the incidence of new deformities and worsening of present ones. Hope agencies like ILEP and WHO help in bringing  out the required change. 

 

What we need to recognise is presence or absence of protective sensation. The one from Linda Lehman is an excellent communication (LML August 15, 2014). I endorse it fully especially that a proper training program is essential for the success of any new method. Ball point pen, or better a similar calibrated devise, has an advantage that it tests wider surface than a nylon filament. Wherever possible I would also recommend Texture recognition.

 

Texture testing: we used to do it by using different surfaces for the hand to feel and identify smooth, rough, pebbled, surfaces. For the foot walking on different surfaces with eyes closed, we used roughly 2x2 feet areas covered with sands of different texture, another surface impregnated with pebbles and a smooth rubber mat. One can choose different surfaces available easily locally. We standardised by using normal controls. In the paper on ten years follow up of nerves in leprosy treated with auto muscle grafts by Jerome Pereira, Dr Narayan Kumar and others we have given details. (British Journal of Bone and joint surgery). This work was also presented at the International Leprosy congress in Hyderabad, India. For more information readers may contact Dr. Narayan Kumar <drtsnkumar@yahoo.com>

 

With best regards,

 

Dinkar

 

from dinkar d. palande

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(LML) Is there no place for Deformity or Disability in POID?

Leprosy Mailing List – August 20,  2014 

Ref.:  (LML)  Is there no place for Deformity or Disability in POID?

From:  Sathish Kumar Paul, Karigiri, Vellore, India

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Dear Editor LML,

 

My response to Dr. Jerry's mail (LML August 3, 2014).

The concept of POID came into practice specially for focusing on the prevention of early impairments and also in the prevention of worsening of disabilities in leprosy. However, the prevention of early impairments has got its share as many of the programs focus only around early diagnosis. The programs focusing on ‘contact tracing’, ‘sample surveys’ have particularly attracted funders as they had the prevention component in it.  The issue also has another dimension where the health workers in my experience being ignorant about the importance of preventing both early impairments and deformities. The health workers feel that SSO (soaking, scraping and oiling) is the only solution for the anaesthetic feet and hands to prevent worsening of the impairments and also that deformities can only be prevented by tendon transfer surgeries.

However there is a great need for special focus on the prevention of impairments (primary and secondary) by giving focused education for people who have developed impairments (primary and secondary) or who are newly diagnosed with impairments (Primary and secondary). The emphasis on the screening high pressure prone areas (hands and feet), development and the use of assistive devices, aids and appliances to offload these pressure prone areas is of great need. It is also of important at this post integration period that these are more effectively translated to the health workers so that they can carry out the work at the field in a very simple and less complicated way.    

 

Regards,

Sathish Kumar Paul

Physiotherapist & Biomedical Engineer

S.I.H.R & L.C

Karigiri

Vellore

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(LML) WHO disability grading and the term anaesthesia

Leprosy Mailing List – August 15,  2014 

Ref.:    (LML)   WHO disability grading and the term anaesthesia

From:  Linda Lehman, Belo Horizonte, Brazil

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Dear Pieter,

 

I have enjoyed the discussions.  We have come a long way in better clarifying and defining the WHO grading criteria which will hopefully produce better consistent data allowing comparisons within countries and between countries.  I agree with Wim Brandsma that the consensus on Grade 1 needed further discussion and attention.  

 

I have three observations:

 

Grade 1 - Risk of injury (protective sensory loss)

1.  Personally knowing and speaking with Dr. Paul Brand about their original work with the Disability Grading taught me that their original criteria for Grade 1 was to identify feet and hands with a "protective sensory loss" which would put them at Risk for injury.  At that time it was touching the foot or hand with a ball point pen.  

• Today this is known to be a loss of feeling 10g on the foot as Brandsma points out but is not for the hand (Bell-Krotoski).  
• Care is needed to clearly understand that feeling the touch of a ball point pen does not mean the sensation is normal, it may not be.  However, we do know the person is at lower risk for injury.  
• Early identification of a nerve problem (before it is at a level of protective loss) is ideal, so interventions can be started earlier and return the nerve to normal or near normal function in which protective sensation is preserved. This is obtained by carefully evaluating and monitoring routinely nerve function (sensory & motor)

Training & Supervision

2.  Brasil defined the WHO grades more clearly, including defining what would be Grade 1 in 1997. Extensive work was done for about 5-7 yrs to try and help people learn the criteria and use it consistently.  Extensive practical training and supervision helped to increase the percent of new cases with Disability Grading evaluated at diagnosis and now at the end of MDT.  Also the quality improved.  However one thing observed is if there is not repeated training which includes practice with patients, good supervision checking on the Grading, the quality can deteriorate and inconsistencies begin again.

 

Hopefully each country will carefully give attention to the Disability Grading in their training and supervision activities so that the quality improves and is sustained.

 

3.  Further work is needed to help people understand and know how to use the results of the Disability Grading at the national program level down to the local patient care level.  Perhaps further discussion can be continued on this point.

 

Best regards.

Linda

 

 

 

Linda F. Lehman, OTR/L MPH C.Ped

Senior Advisor for Morbidity Management & Disability Prevention

 

American Leprosy Missions

One ALM Way, Greenville, South Carolina 29601 USA

R. Castelo de Alenquer 390 Apt 302  Belo Horizonte, MG 31330-050 BRASIL

BRASIL Direct:  +55 31.3476.6842  +55 31.9637.5576

USA:  +1 505 504 8749

 

llehman@leprosy.org | www.leprosy.org

 

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(LML) WHO disability grading and the term anaesthesia

Leprosy Mailing List – August 15,  2014 

Ref.:    (LML)   WHO disability grading and the term anaesthesia

From:  Grace Warren, Sidney, Australia

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Dear Pieter,

 

 

Thank you for publishing Dr Rao's paper. I must accent his comments re the altered sensory perception. There are hundreds of patients out there who have altered perception but not anaesthesia but according to WHO do not have leprosy. However, a careful examination and slit skin smear can confirm the diagnosis in many cases.

 

Is there any way of getting the WHO to modify their statement???  As I know of many patients who to me have definite leprosy but are deprived of treatment because they do not full fill the WHO definition.

 

The other fact, often missed, is that all patients need definite skin patches according to WHO criteria.  In S E Asia there are many patients with primary persistent neuritic leprosy. They present with a paralysis or anaesthetic area but no skin patch ever!   I saw a young man with a clawed hand told by a WHO Consultant in Cambodia that he did not have leprosy!!!  I knew otherwise and just palpate his nerves.  I know of patients who did not receive treatment and continue to slowly progress. We will treat such persons, but in many countries treatment is not available as they are not officially leprosy.

 

 Grace  Warren

 

Previously Adviser in Leprosy and reconstructive surgery

 for The Leprosy Mission in Asia ( 1975-1995).

 

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(LML) WHO disability grading and the term anaesthesia

Leprosy Mailing List – August 12,  2014 

Ref.:    (LML) WHO disability grading and the term anaesthesia

From:  Wim Theuvenet, Apeldoorn,The Netherlands

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Dear Pieter,

 

 

Thank to Prof. Rao for his valuable comments! Indeed the WHO disability grading for hands and feet seems rather outdated and therefore in need of redefinition!

 

A new definition could perhaps be ?:

 

Grade 0: No loss of protective sensation; sensation as measured with the SW monofilament is at least 3.61+, 

               No loss of intrinsic nor loss of extrinsic motor function, thus with a VMT grade 5

               No visible deformity or damage due to neuropathy

 

Grade 1: Loss of protective sensation; sensation as measured with the SW monofilament is less than 3.61+, 

               Loss of intrinsic and/or loss of extrinsic motor function, thus with a VMT grade less than 5

               No visible deformity or damage due to neuropathy

 

Grade 2: Visible deformity or damage due to neuropathy.

 

 

Am looking forward to hearing your, as well the comments of the other LML members,

 

with best regards,

 

Wim Theuvenet

 

Willem J.Theuvenet, M.D., Ph.D

Plastic, Reconstructive, Esthetic and Hand Surgeon (FESSH),

Regional Hospitals of Apeldoorn, Deventer and Zutphen, The Netherlands,

Consultant for TLMI and the NLR

 

 

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(LML) WHO disability grading and the term anaesthesia

Leprosy Mailing List – August 12,  2014 

Ref.:    (LML) WHO disability grading and the term anaesthesia

From:  Wim Brandsma, Hoevelaken, The Netherlands

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Dear Pieter,

 

I like to respond to Dr Narishma Rao’s invitation: WHO disability grading and the term anaesthesia.

 

Indeed the term anaesthesia is cause for confusion and not officially defined.  I would like to make reference to an article, the report of a consensus meeting on the neurologically impaired foot (Brandsma et al. Lepr Rev 2001;72:254-). In this article we propose to talk about loss of protective sensation (touch) which, depending on instrument used, is defined as follows: when on two or more locations on the foot (out of a maximum of ten sites, excluding the heel) the 10gm filament is not felt or if at any one site firm pressure with a ballpoint pen is not felt.

 

Above may need revision - therefore I would like to add this to the discussion. A more recent article discusses the WHO grading: A Delphi exercise to refine the WHO three-point Disability grading for leprosy, and to develop guidelines to promote greater accuracy and reliability of WHO disability recording (Cross etal, 2014:85:18) The consensus evolved around grade-2 issues. In hindsight, a possible omission that consensus was not asked for grade 1.

 

With kind regards,

 

Wim

Wim Brandsma, PT, PhD 

Koolmeeslaan 18

3871 HG HOEVELAKEN/Netherlands

33-8447266

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(LML) WHO disability grading and the term anaesthesia

Leprosy Mailing List – August 12,  2014 

Ref.:    (LML) WHO disability grading and the term anaesthesia

From:  Cairns Smith, Aberdeen, UK

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 Pieter,

 

Leprosy Review have just published an article by Hugh Cross and his colleagues on WHO Disability Grading titled ‘A Delphi exercise to refine the WHO three-point

Disability Grading system for leprosy, and to develop guidelines to promote greater accuracy and reliability of WHO Disability recording.

 

It can be accessed at:  http://www.lepra.org.uk/platforms/lepra/files/lr/Mar14/1890.pdf

 

With best wishes,

 

Cairns Smith

ILEP Technical Commission

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(LML) PB and MB are not two forms of leprosy

Leprosy Mailing List – August 13,  2014 

Ref.:    (LML) PB and MB are not two forms of leprosy

From:  S. Noto, Verdellino, Bergamo, Italy

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Dear Pieter,

Thank you to all colleagues that have given their contribution to this important topic that is about “Staining smears for leprosy”.   Dr Barreto in his message [LML - July 25, 2014] correctly widened the terms of the problem.  He interprets sentiments widely shareable. I would like to comment that Paucibacillary (PB) Multibacillary (MB) are not two forms of leprosy but, two treatment regimens. Their use as classification system generates problems.

Diagnosis
The diagnosis of leprosy is based on the 3 cardinal signs of the disease.  One of these is: “positive slit-skin smear examination”.  The other two are "skin patches with loss of sensation" and "enlarged peripheral nerves".

Classification
Once diagnosis is done we classify and, the Ridley and Jopling (R-J) classification is a milestone in modern leprosy.  Here I recall a few years ago comment of Dr Scollard: “we can see TV or movies with many colours and therefore we do not force ourselves to see only in black and white  -- in leprosy it would be like watching in black and white if we lose the R-J system.  I add that before the work of Drs Ridley and Jopling it was the chaos in clinical leprosy.  This classification was intended mainly for research purpose but, it helps all involved in leprosy and particularly in clinical leprosy.

Treatment
Paucibacillary (PB) Multibacillary (MB) are not two forms of leprosy but, two treatment regimens.  They were thought and introduced as such, as the two regimens or protocols of the multi-drug therapy (MDT).  They are the other mile-stone of modern leprosy therapy after the introduction of dapsone.  Patients with very few bacilli (pauci) can be treated with two anti-leprosy drugs for six months; these are tuberculoid and smear negative borderline tuberculoid leprosy cases.  Patients with many bacilli (multi) can be treated with three drugs and for a longer period; these are smear positive borderline tuberculoid, mid and borderline lepromatous and lepromatous leprosy cases.

Remarks opened to discussion
Early diagnosis and timely treatment are the goal of high quality leprosy work.  Diagnosis is based on the three cardinal signs of leprosy.  Treatment is dependent upon classification of the disease and classification is based on the work of Ridley and Jopling.  PB and MB are the used treatment regimens.  The ideal duration of the MB regimen is not clear yet but, it needs to be adequate to the patient’s bacterial load.

Attachment
In attachment are a Power Point (note editor: failed to get this file downloaded) and PDF file - - - “The leprosy spectrum and the bacteriological index”.
There are reported two slides with graphs representing the R-J classification.  They are adapted, only five forms of the disease are represented.  The second slide shows the relationship between bacillary index and cell mediated immunity.

Your sincerely,

Salvatore

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