Leprosy Mailing List – September 6, 2019
Ref.: (LML) Seeking a group or NGO who would be interested in safekeeping a large reservoir of loose graded Monofilaments for sensory testing and disseminating packets of them from such a reservoir to those practitioners in need
From: Robert Jerskey, Carlsbad, USA
Requesting you to post this request along with appendix for LML readers.
With the 20th International Leprosy Congress around the corner and having read several recent LML postings of interest that pertain to the critical importance of assessing and monitoring Nerve Function/Nerve Function Impairment [NFI], be it known to any interested readers that I have quite a large supply of loose Semmes-Weinstein monofilaments [MF] I would like to distribute en masse.
Below are some of the year 2019 LML postings that have prompted me to reflect and then ultimately take this action. My individual thanks out to the authors for their posts.
In the past, for example while attending previous Congresses, e.g., Belgium, Beijing, or when otherwise traveling overseas, I would distribute sizable batches of the 6 grades of loose MF to individuals addressing NFI, including those in NGOs overseeing their use.
As my traveling over the years has curtailed considerably, and I will not be attending the Congress in Manila [though I plan to continue to travel overseas to India yearly], it occurred to me that it is positively time for me to turn over all the MF I have to a group/NGO familiar with the methodology of the MF who would have the resources to deliver the MF and incorporate their use in nerve function assessment/monitoring with the necessary training---including following up, which I have learned first-hand is so paramount.
If there are any interested LML readers, they are welcome to contact me via the LML or directly via my email address below. My hope is that these would be disseminated without any cost whatsoever to those in the field, whether in high endemic or low endemic countries/regions, as has been my practice since receiving these from the late Judy Bell-Krotoski, an ardent proponent for the MF.
Closing here with friendly greetings to all LML readers, and with much gratitude for LML --and its moderators-- being such a resource as it is world-wide,
Robert Jerskey, LOTR, consultant for prevention and management of impairments, disabilities, and multiple morbidities
Below are selected extracts from 4 LML postings, with permission of the LML moderators, which I have chosen to highlight the value I see in the MF towards reducing the burden of impairment, disability, and morbidity. Each includes a brief comment of mine within brackets regarding the relevance and utility of the MF.
For those who have not read these postings in their entirety, I highly recommend! The posted dates are listed for easy reference to the full submission.
1. Leprosy Mailing List – August 24, 2019
Ref.: (LML) Epidemiology of Hansen's Disease for interruption of transmission
From: Joel Almeida, London and Mumbai
' 85% of nerve function impairment in South Asia occurs without any signs or symptoms of reaction ("silent neuritis / silent neuropathy / quiet nerve damage") (8). '
[I see the MF having an integral role in identifying ---and monitoring--- such a pervasive manifestation of NFI. I did not realize such a large percentage are involved!]
2. Leprosy Mailing List – August 20, 2019
From: Pieter AM Schreuder, Maastricht, the Netherlands
"High occurrence of disabilities caused by leprosy: census from a hyperendemic area in Brazil's savannah region". By Kathrin Haefner et al. Lepr Rev (2017) 88, 520 – 532
… "At diagnosis, 142/629 (22·6%) had Grade1 disability (G1D), and 28/629 (4·5%) had Grade 2 disability (G2D). At the time of the study, 178/910 (19·6%) presented with G1D, and 84/910 (9·2%) with G2D." ….
[As in much of Brasil, MF were aptly used for sensory assessment, and for determining G1D.]
Leprosy Mailing List – May 16, 2019
Ref.: (LML) Chronic aspects of leprosy
From: Diana Lockwood, London, UK
I have recently published a review on the chronic aspects of leprosy that I would like to share with readers of LML. Trans R Soc Trop Med Hyg 2019; 00: 1–5. Chronic aspects of leprosy—neglected but important
…. "Nerve damage is caused by inflammation in leprosy-affected nerves. Patients with nerve damage of<6-mo duration need treatment with steroids. About 66% of multibacillary patients will develop nerve damage. Plastic graded monofilaments can be used to detect nerve damage in leprosy and diabetic clinics. Assessing nerve damage and treating patients with steroids in leprosy programmes needs to be strengthened."
[I believe the aforementioned plastic graded monofilaments are the same [nylon] MF I am referring to in this posting.]
Leprosy Mailing List – February 17, 2019
Ref.: (LML) Zero Disability
From: Linda Lehman, Belo Horizonte, Brazil
…."We have had the S-W monofilaments around for a long time and there have been studies by Manoel Villarroel, Jose Antonio Garbino and others demonstrating the S-W monofilaments are a good tool for the field to detect and monitor nerve impairments early if lighter filaments are used and not only one or two filaments (10g) or two (4g and 10g) for protective sensory loss. Protective sensory loss is NOT early nerve function impairment, it is late and usually by the time there is a protective sensory loss, motor fibers are involved indicating even more severe nerve impairment. Is the limited nerve function impairment improvement because we waited until there was protective loss (10g or touch with ball point pen)?
I remember Job's work showed us by the time we see "clinical evidence (sensory and motor changes) 30% of the nerve fibers are already involved, so imagine how many nerve fibers are involved if we wait and only treat with anti-inflammatory when there is a big loss of 4 or 10g. Looking back on my supervision documents and other records, I see that even 2g is late, as motor function impairment is frequently present by this time. " …..
[Among the highlights I draw from here: 1. Graded (i.e., multiple) MF 2. Not only are the MF of utility to identify Grade 1 Disability, but also the identifying and treating early NFI within the Grade 0 range is emphasized here, before there is loss of protective sensation-- perhaps irreversible by then.]
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << email@example.com