(LML) SW monofilaments and ball point pen

Leprosy Mailing List August 12,  2013 

Ref.:    (LML) SW monofilaments and ball point pen

From:  Jaison Barreto, Bauru, São Paulo, Brazil

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Dear Pieter,

Regarding the use of ball pen for the diagnosis of leprosy, Brazilian Ministry of Health conducted a validation study, on 2005, in all the Brazilian states's references. The methodology was based on three steps:

1. It was called recent diagnosed (few months after diagnosis) leprosy patients, whose were evaluated by two leprologists, independently, in order to confirm or exclude the disease. When available, laboratory assays were also evaluated.

2. It was tested a trade mark of ball pen - 6g weight BIC pen (see attached file) - inside and outside the lesion. 

3. After this, all the patients were also undergone to the thermal sensitivity testing (heat and cold), insulin needle prick testing and SW testing, inside and outside the lesion. Correlation between this two methodology was done.

 

The results, roughly, and which were unfortunately not published, were the following:

 

1. As many as 70% of leprosy patients could not be diagnosed by testing ball pen inside the lesion alone, and most of them were in the lepromatous range of leprosy spectrum, or had early (indeterminate) leprosy.

2. It was confirmed a logical fact, always known by every good leprologist: thin or protective nerve fibers (non myelinated) can not be assessed by a toll that is able to test only thick (myelinated tactile or motor) fibers.

 

After that, our Brazilian Ministry of Health recommended to diagnose leprosy by testing first the protective sensitivity (thermal and pain), autonomic function (histamine testing) and also motor function (Portaria 3125), and the use of the pen is recommended only to write.

 

It is important to all LML readers to know that SW monofilaments are fundamental for the follow up (graduation) of neural situation during neuritis, a common condition in leprosy reactions, as well as to evaluate the initial condition (disability grade) of the sensitivity in hands and foots.

 

Brazilian Ministry of Health recommends the SW monofilaments for the evaluation of initial and final situation of disability degree,  and also every time when the patient has reaction. In the latter, this evaluation must be done, at least, once every two months, or monthly, if possible, in order to assess the possibility to diminish the dose of corticosteroids. 

 

Regards

 

Jaison

 

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com