Monday, March 7, 2016

(LML) 19th International Leprosy Congress Beijing 2016

Leprosy Mailing List – March 7,  2016

 

Ref.:  (LML) 19th International Leprosy Congress Beijing 2016 

 

From:  Hemanta Kumar Kar, New delhi, India


 

Dear Pieter,

 

 

Referring to the LML letter by Geeske Zijp of March 6, 2026:

 

Nerve involvement was kept as a factor to classify leprosy into PB and MB leprosy (WHO, Leprosy Elimination Group (2000). Presently in India, the number of nerves involved is taken into consideration along with skin lesion count while categorizing the patients into PB and MB as per the criteria laid down under NLEP of Govt, of India, which are similar to  ILEP.

 

      PB cases are those who are having one to five skin lesions including single nerve lesion if present or having only one nerve lesion even without having any skin lesion.

 

      MB are cases  those who are having six and above skin lesions with or without nerve lesions or more than one nerve lesions irrespective of number of skin lesions  or skin smear  positive at any site.

 

 

IAL Textbook of LEPROSY, 2nd edition, 2016, edited by Bhushan Kumar and Dr Hemanta Kumar Kar.

 

Regards,

 

Dr Kar

 

Dr. Hemanta Kumar Kar

Professor in Dermatology,North Delhi Municipal Corporation Medical College Delhi -110007

Former Director, Dean and Med. Superintendent

P.G.I.M.E.R. and Dr Ram Manohar Lohia Hospital, New Delhi-110001


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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(LML) Voluntary Organizations

Leprosy Mailing List – March 7,  2016

 

Ref.:  (LML) Voluntary Organizations

 

From:  Joel Almeida, Mumbai and London


 

 

Dear Pieter,

 

Voluntary organizations have long been at the forefront of innovation for better health outcomes. This is important now.

 

We have largely eliminated leprosy services and the world has prematurely forgotten leprosy. Meanwhile, the incidence rate of new cases with visible deformity has been increasing in India (40% increase between 2008/9 and 2014/5). This more robustly indicates the underlying trend in the incidence rate of leprosy than changes in the annual new case detection rate. Since the former automatically standardizes for delay in detection and accompanying self-healing.

 

How can we help transform health outcomes?

 

1) Emphasize the 40% increase in the incidence rate of new leprosy cases with visible deformity since 2008/9, in India. That will help restore funding for leprosy services and research. 

 

2) Measure and report the number of persons with visible deformity 2 years after the start of MDT. That will help focus our attention on regular monitoring of nerve function and prompt anti-inflammatory treatment when necessary. 

 

3) Protect polar lepromatous patients against re-infection: for their own sake and for the sake of others. That requires recognition of polar lepromatous patients at diagnosis. Otherwise all our attention to contacts of new patients could prove futile.  

 

Voluntary organizations led the transformation of TB services during the 1980s, after premature self-congratulation had largely eliminated TB services.  Governments eventually learnt from the best practices in voluntary projects, and scaled them up. Now voluntary organizations can transform the scenario in leprosy, by demonstrating best practices that protect the limbs and eyes of populations at risk. That's what matters to ordinary people today.  It's no comfort to them that, for decades, we have mistakenly predicted and promised freedom from leprosy.  Instead of freeing people from leprosy, we have merely withdrawn the skilled, mobile leprosy workers who could help save their limbs and eyes from permanent damage.

 

Now voluntary organizations can show the way forward.

 

 

Regards,

 

Joel Almeida


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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Re: (LML) 19th International Leprosy Congress Beijing 2016

Dear Schreuder,

As per the question by Geeske Zip, in clinical Leposy you classify base on skin lesions and major nerver trunk invovment. If an individual patient has 5 skin lesions or less with one major nerve trunk invovment or none you classify as PB. If an individual has more than five skin lesions you classify as MB or if he has more than one nerve involvment even if he has less than 6 skin lesions you classify as MB as per the WHO guideline.

Dr Tahir Dahiru

On Sun, Mar 6, 2016 at 9:52 AM, Pieter Schreuder <editorlml@gmail.com> wrote:

Leprosy Mailing List – March 6,  2016

Ref.:  (LML) 19th International Leprosy Congress Beijing 2016 

From:  Geeske Zijp, Mongo, Chad


 

Dear Dr. Schreuder,

Ben Naafs (LML February 4, 2016) asked us to come with questions on clinical leprosy.

 

When concerning the WHO-grading, 5 or less skin patches means PB-leprosy. We do occasionally have patients with 5 or less patches but many of them have more than one enlarged nerve. Recently a new patient, having mistreated himself with traditional medicine, was detected by our team in his village with (severe) leprosy reaction on multiple nerves. The patient was put on MDT PB but we decided later on, to put him on MB treatment since he presented reaction symptoms on multiple nerves.

 

My question is, what is the guideline? What is the criteria in regard to nerve involvement (hypertrophy) for classification PB or MB (when skin patches are 5 or less?). Is there a standard answer on this?

 

NB: we are working in very basic field conditions, without the possibility to do routine laboratory work (skin smears only in the capital, nerve biopsies outside the country I believe).

With kind regards,

Geeske Zijp
TLM-programme manager for Chad


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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Sunday, March 6, 2016

(LML) In Memoriam Dr. Thomas H. Rea

Leprosy Mailing List – March 6,  2016

Ref.:  (LML) In Memoriam Dr. Thomas H. Rea

From:  PK Das, Birmingham, UK


 

Dear Dr. Schreuder,

Through Dr. Maria Ochoa (LML, March 5, 2016) I would like to express my condolence to Mrs. Mary Rea and the other family members and friends of Dr. Thomas Rea.

For the last time, I met Dr Rea  in Hyderabad during the International Congress in Leprosy and had a cup of coffee in a corner with him. Since then I had an opportunity to host Dr. Robert Modline at AMC-UvA, Amsterdam, Netherlands, who told me that among the mentors of him, Dr Rea is the number 1 for his Dermatological knowledge. During walk along the canal side of Amsterdam, myself and Robert spoke quite a bit about the enchanting and softly spoken, almost saint like personality of Dr. Rea.

In this world, every has to leave sometime, nevertheless, it is a great loss for the world of Dermatological sciences  and its practice.


With Reverence,


Pranab


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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(LML) 19th International Leprosy Congress Beijing 2016

Leprosy Mailing List – March 6,  2016

Ref.:  (LML) 19th International Leprosy Congress Beijing 2016 

From:  Geeske Zijp, Mongo, Chad


 

Dear Dr. Schreuder,

Ben Naafs (LML February 4, 2016) asked us to come with questions on clinical leprosy.

 

When concerning the WHO-grading, 5 or less skin patches means PB-leprosy. We do occasionally have patients with 5 or less patches but many of them have more than one enlarged nerve. Recently a new patient, having mistreated himself with traditional medicine, was detected by our team in his village with (severe) leprosy reaction on multiple nerves. The patient was put on MDT PB but we decided later on, to put him on MB treatment since he presented reaction symptoms on multiple nerves.

 

My question is, what is the guideline? What is the criteria in regard to nerve involvement (hypertrophy) for classification PB or MB (when skin patches are 5 or less?). Is there a standard answer on this?

 

NB: we are working in very basic field conditions, without the possibility to do routine laboratory work (skin smears only in the capital, nerve biopsies outside the country I believe).

With kind regards,

Geeske Zijp
TLM-programme manager for Chad


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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Saturday, March 5, 2016

(LML) 19th International Leprosy Congress Beijing 2016

Leprosy Mailing List – March 5, 2016

Ref.:   (LML) 19th International Leprosy Congress Beijing 2016

From:  Ruth Butlin, Nilphmari, Bangladesh


Dear Editor,

I would like to suggest a few questions to be considered for the clinical leprosy session (request Dr. Ben Naafs, LML February 4, 2016):

1. Does anyone have tried and tested (preferably evidence-based) guidelines on “managing Leprosy reactions in Children", giving appropriate dosages and durations of steroids and any evidence on incidence of adverse effects?

2. Does anyone anywhere routinely use the "clinical prediction rule" for identifying leprosy affected people at more risk of having new nerve function impairment within 24m of diagnosis, in order to give them more attention (monitoring and care) including in the 6-18m period after competing MDT? It should allow optimal use of sparse human resources for maximum benefit of patients at highest risk.

If not, why not?

3. Does anyone have guidelines for chemotherapy of highly smear positive cases with impaired liver function which contra-indicates most of first and second line anti-leprosy drugs? Is there any evidence base for managing this problem?

Thank you.

 

Yours sincerely,

C Ruth Butlin

TLM Bangladesh


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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(LML) In Memoriam Dr. Thomas H. Rea

Leprosy Mailing List – March 5,  2016

Ref.:    (LML) In Memoriam Dr. Thomas H. Rea

From:  Maria T. Ochoa, Los Angeles, USA


Dear Dr. Schreuder,

 

Please share with readers of the LML the notice, below, regarding the passing of Dr. Thomas H. Rea, previous Director for the Hansen’s Disease Program at the Los Angeles County-University of Southern California (LAC+USC) Medical Center in Los Angeles.

Maria T. Ochoa M.D.
Director Thomas H. Rea Hansen’s Disease Program at the Los Angeles County-University of Southern California (LAC+USC) Medical Center in Los Angeles

 

 

Thomas Herald Rea, MD

1929-2016

 

It is with great sadness that we report the passing of Dr. Thomas H. Rea. He passed peacefully on February 7 in the company of his family and loved ones.

 

A world renowned dermatologist and leprologist, Dr. Rea served as the Project Director for the Hansen’s Disease (HD) Program at the Los Angeles County-University of Southern California (LAC+USC) Medical Center in Los Angeles for 31 years before retiring from this role in 2012. Prior to the creation of the HD program at USC, Dr. Rea had already served as a national leader in Hansen’s Disease research and care, beginning in 1963 at Bellevue Hospital in New York.

 

For over 50 years, Dr. Rea has been a leading voice in Hansen’s Disease care. As a young faculty member in the Department of Dermatology at New York University (NYU) he developed an interest in HD, recognizing the direct influence of the immune system on the clinical presentation of the disease. With only corticosteroids and clofazimine available to combat erythema nodosum leprosum (ENL) in some of his patients, he recognized the dramatic efficacy of the controversial drug thalidomide in managing ENL and lobbied the federal FDA (Food and Drug Administration) for approval of its use.

 

Dr. Rea completed his undergraduate studies at Oberlin College and his M.D. at the University of Michigan where he also did his internship and dermatology residency at the University Hospital in Ann Arbor, Michigan. He went on to his fellowship training in the Department of Dermatology at the New York University, School of Medicine. His interests in research stem from the surrounding vibrant immunology research community at NYU, including scientists like Dr. Rudolph Baer, studying mechanisms of contact dermatitis and Dr. H. Sherwood Lawrence doing early work on immunologic memory.

 

Dr. Rea served as Chief of the Division of Dermatology at USC between 1981 and 1996. During this time, Dr. Rea began studying the immunology of HD, investigating the role of antibodies and cell-mediated immune (CMI) responses. He sought additional training (1980-1981) in CMI with Dr. John Turk at the Royal College of Surgeons in London and, while there, took advantage of the presence of Dr. Dennis Ridley to learn the complex Ridley-Jopling histopathological classification scheme for HD. His interests in research have resulted in >140 published, peer reviewed articles. Working closely with Dr. Robert Modlin, Dr. Rea helped to identify the key Th1 and Th2 cytokines at the site of disease in leprosy. These studies were published in Nature and Science, becoming landmark papers in our understanding of the immune system.

 

In 2015, the leprosy clinic at LAC+USC Medical Center was renamed the Thomas H. Rea Hansen’s Disease Clinic at LAC+USC and it currently serves more patients than any of the other 12 National Hansen’s Disease Program ambulatory care clinics in the USA. Dr. Rea was the heart and soul of this clinic. He remained very active in direct patient care until his retirement in 2015. Always soft spoken, he approached each patient with sincerity. He was a fierce advocate for those who entrusted themselves to his care.

 

As a mentor, Dr. Rea always enjoyed teaching moments with a multi-generational field of clinicians, doctors, medical students, therapists, laboratory scientists and guests. His expertise was shared across a geographical area far larger than the LA clinic. From his early days in New York he promoted the need for HD awareness in the U.S. and internationally. To this end he assisted and consulted with numerous physicians- locally, nationally and internationally.

 

Dr. Rea is survived by his wife of 51 years, Mary, his two sons, Steven and Andrew, and four grandchildren.

 

He is greatly missed.

If anyone would like to send a card to Mrs. Rea, her address is:

                Mrs. Mary Rea

                P.O. Box 1125

                La Canada, CA 91012-1125

 

 

Yours sincerely,

 

Maria T. Ochoa, M.D., Seth Vaccaro, M.D., Robert Jerskey OT, Helen Mora RN

Thomas H. Rea Hansen’s Disease Program at the Los Angeles County-University of Southern California (LAC+USC) Medical Center in Los Angeles


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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