Fw: Ref.: (LML) Detection of nerve damage in leprosy and timely treatment

 

 

 
Leprosy Mailing List – December 8,  2021

 

Ref.:  (LML) Detection of nerve damage in leprosy and timely treatment

 

From:  Zhaudat Umerov, Moscow and Antalya

 

 

Dear Pieter & colleagues,

 

Dr. Naafs expressed the most painful problem - the prevention and treatment of nerve damage in HD (LML, November 29, 2021). Successes in this area are associated with careful monitoring of changes in the functional state of peripheral nerves. The list of procedures for persons engaged in HD, proven by many years of successful experience, is presented. I believe this is an invaluable gift from Dr. Naafs to a new generation of fighters for «0» patients of HD in the world. The implementation of these recommendations can be timely for taking neuroprotective actions and this is the main goal. 

This stage of the fight against HD can become even more effective in the early diagnosis of the disease. In various countries with endemic foci, there are examples of an effective organization of the logistics chain for combating HD. One of these countries is Russia (before the collapse into separate sovereign states). 

In endemic areas, early diagnosis of HD was combined with primary medical care. Doctors of all specialties received short-term training in the diagnosis of characteristic signs of HD in order to identify persons with suspected HD. The number of tests was much smaller than that presented by Dr. Naafs and consisted of examining open areas of the skin to identify pigmented, burn spots, hair loss of eyebrows, eyelashes, facial muscle asymmetry with grimaces, thickening of the nerve trunks of the upper extremities, the large ear nerve.

Tactile sensitivity was determined by touching the cotton tail on a skin spot and the patient repeated with his eyes closed. To determine discriminative sensitivity, the skin spot was touched alternately with the sharp or blunt end of a sterile syringe needle. The result was evaluated by the patient's response. The indication of temperature sensitivity was evaluated by the reliability of the patient's responses to touching test tubes with hot and cold water. The strength of the muscles of the hands by the force of compression in the fist of the doctor's fingers.

Usually, this volume of research with minimal tools does not take much time and allows you to control a lot of the population visiting doctors of various profiles in polyclinics.

At the next stage, these persons are sent to specialized medical HD departments for in-depth diagnostics (including bacterioscopy, microscopy of biopsied material, Electroneuromyography, etc. ) and collegial diagnosis and appointment of a course of therapy. These could be leprosy colonies, dispensaries of skin diseases. After effective treatment in the leprosarium, patients are discharged for outpatient observation with the continuation of the necessary chemo- and physiotherapy. Often in leprosy colonies, people who have completely recovered from HD, deep helpless invalids end their lives. All costs for the treatment and maintenance of such patients were provided by the state.

As the analysis showed many years later, such a logistical form of organizing the fight against leprosy is quite effective and has allowed to reduce the number of registered patients per year (!965-1970) from 250 patients to 1-2-3 patients in 2 years (1995 to date).

Unfortunately, not everything is so joyful - until now we have not learned how to overcome leprosy neuropathy and the recovered disabled people still look at us reproachfully.

 

Don't worry Ben, all is not lost yet.

 

Best regards,

 

Zhaudat

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

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

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

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