(LML) Manifest against the implementation of U-MDT

Leprosy Mailing List – July 26,  2018

Ref.:    (LML) Manifest against the implementation of U-MDT

From:  Ajit P, Mumbai, India

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Dear Pieter,

 

I, as a dermatologist just want all members to ask themselves few of these questions!!!

Heavens forbid, but if you or your child or parent or partner or sibling gets leprosy, then???

I would request members to ask themselves these few hypothetical questions, regarding leprosy, considering the affected patient is you yourself or your child or parent, partner or sibling???

 

Would you get a slit skin smear and repeat it every year?

Would you get a skin biopsy?

Hematoxylin eosin only or also fite faraco stain method?

Would get a g6pd prior to therapy?

And would that g6pd be qualitative or quantitative?

What kind of regimen would you prefer?

WHO MDT for one year or two years or up to smear negativity or life long?

Daily rifampicin or monthly rifampicin?

Would you give newer regimens with multiple bactericidal agents like monthly moxifloxacin minocycline rifampicin?

If yes, for how long??? Six, twelve, twenty-four months, till smear negativity or life long?

Would you use U-MDT?

How often would you monitor while on therapy (Routine blood tests)?

How would you treat ENL? Thalidomide or steroids?

(Note- Sometimes ENL are accompanied by neuritis ....in this case steroids are also a must even if one is using thalidomide)

Considering the patient is a diabetic hypertensive male, what would be the drug of choice for ENL? Thalidomide or steroids?

How would you classify for treatment purposes?

Lesion counting alone (note: all erudite members must be definitely aware that there are not so small number of cases where number of lessons is less than five, but they are smear positive)

Lesion counting, and smears?

Lesion counting, smears, clinical assessment and histology (including file faraco) ?

Would you simply give U-MDT U and not bother to classify at all?

If the diagnosis is histoid leprosy or lepromatous leprosy, would give 

U-MDT U?

What would be your criteria before giving PB MDT??

 

 

What if you had financial constraints?

Would you use what you knew to be an inferior but CHEAP regimen? Or beg borrow steal, but give the best treatment?

What would be your philosophy for goals of treatment?

(Would you be very concerned about the reports of adverse effects? Or would you say "Damn the torpedoes! Full speed ahead!")?

Would you have Zero tolerance for relapse? Or relapse can be ok??

Would you have a philosophy of absolute cure, nothing but a cure and only a cure?

And finally, considering you are a dermatologist with a good experience and expertise in leprosy, on what would the above decisions be primarily based on?

Only guidelines?

Only published data??

Published data plus your own expertise and experience?

If there is contradiction in the published studies and your experience (that is that despite loads of evidence, your vast experience says something else?). Then would you go by guidelines or published data or give precedence to your genuine expertise……

 

Thanx

Dr Ajit

Dermatologist

Bandra Mumbai India

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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