1
|
Saravanabavan S, Kazi M, Murugan J, Vispute T, Vijayakumaran P, Desouza A, Saklani A. Outcomes of extended total mesorectal excision in patients with locally advanced rectal cancer. Colorectal Dis 2023. [PMID: 37246309 DOI: 10.1111/codi.16606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/09/2023] [Accepted: 04/25/2023] [Indexed: 05/30/2023]
Abstract
AIM Extended total mesorectal excision (eTME) is a complex procedure involving en bloc resection of the structures surrounding the various quadrants of the rectum. This study, presenting the largest series so far of patients undergoing eTME, aimed to assess the surgical and survival outcomes of patients following treatment with eTME and to compare these outcomes with historical data on pelvic exenteration. METHOD The study is a retrospective review of all patients with locally advanced rectal cancer requiring an eTME (2014-2020). The database includes the demographic profile, operative details, histopathological features and follow-up. RESULTS One hundred and sixty three patients who underwent eTME were analysed. The overall Clavien-Dindo complication rate of > IIIa was 21.1%. The anterior quadrant was the most common anatomical site resected (68.5%). The R1 resection rate was 10.4%. After a median follow-up of 28 months, there were 51 recurrences in the study and twenty two deaths were recorded. The local recurrence rate was 7.3% among the study population. The disease-free survival (DFS) and overall survival were 66.7% and 80.4%, respectively, at 3 years. The majority of the recurrences were distant metastasis (84.3%). In univariate analysis, the quadrant involved did not affect survival. In multivariate analysis, signet ring histology, metastatic presentation, inadequate tumour response and R1 resection affected DFS. CONCLUSION The recurrence pattern, R1 resection rate and survival outcomes of patients in the present study were comparable with those for patients undergoing an exenteration. Therefore, eTME is probably a safe alternative to pelvic exenterations when R0 resection is achievable and when the procedure is performed in high-volume specialist tertiary care centres.
Collapse
Affiliation(s)
- Srivishnu Saravanabavan
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Mufaddal Kazi
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Janesh Murugan
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Tejas Vispute
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Preeti Vijayakumaran
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Ashwin Desouza
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
2
|
Kazi M, Vijayakumaran P, Saklani A. Postoperative short-duration nonsteroidal anti-inflammatory drugs reduce colorectal anastomotic leaks and recurrences - correlation or causation? Colorectal Dis 2022; 24:877-878. [PMID: 35426218 DOI: 10.1111/codi.16105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Mufaddal Kazi
- Division of Colorectal Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Preeti Vijayakumaran
- Division of Colorectal Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Avanish Saklani
- Division of Colorectal Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
3
|
Anjum V, Vijayakumaran P. Presence of an index case in households of newly registered leprosy patients: experience from a leprosy referral centre in South India. LEPROSY REV 2015; 86:383-386. [PMID: 26964435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The global leprosy burden in terms of new case detection does not seem to show a declining trend. India continues to be one of the major contributors to the leprosy burden. It is well known that the presence of an index case is a risk factor for leprosy among household contacts. The Blue Peter Health and Research centre (BPHRC), a leprosy referral centre in South India, observed the presence of an index case in 27.6% of leprosy patients newly diagnosed during 2009-2013. A majority of the index cases were either parents or siblings. Early case detection is recommended in global and national strategies, but active contact screening is not in the purview of integrated leprosy services in India. Active contact screening may be considered as one of the major activities to further reduce the leprosy burden.
Collapse
|
4
|
Anjum V, Vijayakumaran P. Presence of an index case in households of newly registered leprosy patients: experience from a leprosy referral centre in South India. LEPROSY REV 2015. [DOI: 10.47276/lr.86.4.383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
5
|
Madhavan K, Vijayakumaran P, Ramachandran L, Manickam C, Rajmohan R, Mathew J, Krishnamurthy P. Sustainable leprosy related disability care within integrated general health services: findings from Salem District, India. LEPROSY REV 2007; 78:353-361. [PMID: 18309709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The main focus of leprosy control has been case detection and treatment delivery with relative neglect of prevention of disability. Absence of reliable data and lack of research have added to the problem. This raised concerns about the capacity of the general health system to address the needs of people living with leprosy-related disabilities. In this prospective study appropriate services for people living with leprosy-related disabilities were introduced in the form of self-care training, guidance and monitoring by the general health staff facilitated by a non-governmental organisation leprosy centre in a district in south India with a population of 3.1 million (estimated in 2005). The staff identified 1232 people with leprosy-related disabilities and trained them in self-care. Follow-up assessments indicated that 86% were found to be practising self-care regularly and all the 239 general health workers were found to be actively involved. The most heartening outcome was the healing of plantar ulcers in 70% of people at the 1-year follow up. This intervention is sustainable because of the simplicity of the procedures and the involvement of all health staff including supervisors.
Collapse
|
6
|
Govinda KR, Vijayakumaran P, Krishnamurthy P, Bevanur MS. Effective participation of TB sanatoria in Revised National TB Control Programme (DOTS) in a metropolitan city. Indian J Tuberc 2007; 54:30-5. [PMID: 17455421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Revised National TB Control Programme has been implemented since 1998 in Bangalore metropolitan city which has several big general hospitals, including two TB sanatoria which attract a large number of respiratory symptomatic and TB patients. Till recently there was significant loss of patients for follow up because of lack of mechanism to reach the patients, good recording practices and linkage with district TB control office. OBJECTIVE To establish an effective referral mechanism between TB sanatoria and peripheral health institutions of the government for providing un-interrupted supervised treatment (DOT) to all newly detected TB patients. METHOD TB sanatoria remain as "islands" when Reyised National TB Control Programme (RNTCP) with DOTS strategy is implemented. Damien Foundation India Trust (DFIT) provided a Technical Support Team (one medical consultant and three supervisors) to assist in implementation of RNTCP in the district. DFIT liaised with both partners and established procedures for recording correct address, informing health institutions and Senior TB Supervisors (STS) and monitoring referrals. Referral slip and a copy of treatment card were given to patients. One copy of treatment card was sent to respective health facility. Initially the number of STS was not adequate to follow up the patients. The supervisors of Technical Support Team ensured that they were treated in peripheral health institutions or near patients' residence. All STS were in position one year after initiation of this effort. RESULTS The referral system is functional. Case holding improved from about 50% to 85% during 2002-2005 by effective transfer through referrals. CONCLUSION Interfacing of NGO between district TB control office and TB sanatoria enabled the establishment of effective collaboration. Initial reluctance was replaced by complete participation in the TB control programme.
Collapse
Affiliation(s)
- K R Govinda
- Technical Support Team - RNTCP, Bangalore Urban district
| | | | | | | |
Collapse
|
7
|
Shivakumar M, Prabhakarareddy B, Rajaprasannakumar A, Vijayakumaran P, Krishnamurthy P. Repeated sputum microscopy is not essential for monitoring tuberculosis treatment response. Int J Tuberc Lung Dis 2006; 10:1296-8. [PMID: 17131792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
SETTING This study was conducted in two districts in India where DOTS has been implemented. There are 39 microscopy centres in Anantpur district and 34 in Nellore district (one per 100,000 population), each with a trained microscopist. Periodic follow-up sputum microscopy is performed for all tuberculosis (TB) patients on treatment, with two sputum specimens examined on each follow-up. Results are recorded in a laboratory register. OBJECTIVE To determine whether examining two sputum specimens for follow-up is useful for assessing treatment outcome. DESIGN A retrospective study using data from laboratory registers of all microscopy centres for 2002 in Anantpur and 2003 (January-June) in Nellore. RESULTS Of 5086 follow-up examinations done in Anantpur and 1028 in Nellore, 8% were acid-fast bacilli positive. One additional positive result was obtained on examination of a second sputum specimen. This result did not significantly add to the assessment of treatment outcome. CONCLUSION The yield of a second on-the-spot sputum specimen is negligible, provided that the first smear is from an overnight specimen. From the data available, it is evident that repeated follow-up smears are not essential for documenting treatment outcome.
Collapse
Affiliation(s)
- M Shivakumar
- Technical Support Team, Anantpur, Andra Pradesh, India
| | | | | | | | | |
Collapse
|
8
|
Vijayakumaran P, Prasad B, Krishnamurthy P. Trends in new case-detection leprosy in Bihar, India. Indian J Lepr 2006; 78:145-51. [PMID: 16927849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Multi-drug therapy (MDT) has been successfully implemented in all leprosy endemic countries. Prevalence of leprosy has declined remarkably after the introduction of MDT. Detection of new cases did not show expected decline in many endemic and low endemic situations. Bihar in India started implementing MDT in 1993. The Damien Foundation India Trust (DFIT) supported the leprosy control programme in Bihar by providing a district technical support team (DTST) for each district assigned to DFIT. Effective coverage was achieved in 1996-98. Data for the period 1996-2004 from 10 districts are presented in this paper. The total population in these districts was 29.4 million. Deformity among newly detected leprosy patients declined to 1% indicating effective early case-detection. Intensive new case-detection activities were in vogue contributing to high new case-detection rate (NCDR). The NCDR remained high during the 9-year period reported here and did not show any declining trend.
Collapse
Affiliation(s)
- P Vijayakumaran
- The Damien Foundation India Trust, 14 Venugopal Avenue, Spurtank Road, Chetpet, Chennai 600 031, India.
| | | | | |
Collapse
|
9
|
Rao TP, Krishnamurthy P, Vijayakumaran P, Mishra RK, Samy MSA. "Instant" new leprosy case-detection: an experience in Bihar State in India. Indian J Lepr 2003; 75:9-15. [PMID: 15253390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The National Leprosy Eradication Programme (NLEP) is based on survey, education and treatment, including coverage of all the registered cases with multi-drug therapy (MDT). The Government of India introduced MDT in all leprosy endemic districts through a vertical set-up, and through mobile leprosy treatment units in low endemic districts. Anti-leprosy work has not been uniform in all the states and needed push-start in some, such as Bihar. There have been spurts of leprosy elimination activities and the entire populations of the regions have not been covered because of various administrative reasons and logistic problems. In Singhbhum district of Bihar, a successful attempt was made to cover the maximum population by campaign approach. The strategy was to involve all the field workers of the leprosy programme in the district, supported by a small group of experienced personnel. The campaign, lasting for 39 working days, resulted in detecting leprosy cases equivalent to 64% of cases detected during the previous one full year. The entire operation helped the local staff to gain experience that would be useful for the future of the NLEP, and also provide an insight into working practices. Similar campaign approach can be used in situations where case-detection activities are feeble and the implementation of MDT is slow. If such campaigns are repeated at appropriate intervals, it will be a great support to achieving the goal of leprosy elimination.
Collapse
Affiliation(s)
- T Prabhakar Rao
- Damien Foundation India Trust (DFIT), 27, Venugopal Avenue, Spur Tank Road, Chetpet, Chennai 600 031, India
| | | | | | | | | |
Collapse
|
10
|
Vijayakumaran P, Krishnamurthy P, Rao P, Declerq E. Chemoprophylaxis against leprosy: expectations and methodology of a trial. LEPROSY REV 2000; 71 Suppl:S37-40; discussion S40-1. [PMID: 11201885 DOI: 10.5935/0305-7518.20000065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Because of the great efficacy of multidrug therapy (MDT), it had been hoped that the widespread use of MDT would bring about a rapid decrease of the incidence of leprosy. To the present, a decrease of incidence has not been observed, possibly because of the long incubation period of the disease, and because general implementation of MDT is still recent. Other reasons, such as environmental sources of infection or the role of healthy carriers in transmitting Mycobacterium leprae, cannot be excluded. Therefore, one must seek alternative or supplementary strategies, such as chemoprophylaxis. Household contacts of leprosy patients are at greater risk of developing leprosy than is the general population. Therefore, a randomized, controlled trial of chemoprophylaxis, using a single 10 mg/kg dose of rifampicin, or a placebo, is planned in nine projects in India, among the household contacts of newly detected leprosy patients. Based upon assumptions of a protective efficacy of the chemoprophylaxis of 50%, an annual incidence of 2 per 1000 contacts, a desired power of the study of 90%, and a level of significance of 95%, 15,000 household contacts will be allocated randomly by household to each arm of the study, and followed for 5 years. Considered as household contacts will be all persons living in the same household as an index case and sharing the same kitchen. Pregnant women and infants will be excluded. To be certain that transmission of the organisms from the index case cannot occur once the prophylaxis is administered, rifampicin will be administered 2 months after diagnosis of the index case. Diagnosis of leprosy will be clinical, and confirmed independently. Although household contacts usually constitute only a small proportion of the new patients detected in a control programme, their high-risk status makes them particularly appropriate for a study of the potential effect of chemoprophylaxis. Following the trial, one could evaluate the usefulness and feasibility of using the same strategy in other population-groups, based on the number of persons necessary to treat to prevent one case.
Collapse
|
11
|
Deenabandhu DA, Babu CR, Vijayakumaran P. Study of the problem of hidden cases of leprosy among "inaccessible" section of urban population in Madras City. Indian J Lepr 2000; 70 Suppl:79S-82S. [PMID: 10992870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A questionnaire survey was conducted amongst 1300 general practitioners (GPs) of Madras city to assess the magnitude of leprosy problem amongst the upper middle class and upper class populations who are getting treatment from these GPs. A total of 2944 leprosy patients were being treated by 200 GPs. One third of these patients belonged to the upper middle/upper class section of the population living in the city of Madras.
Collapse
Affiliation(s)
- D A Deenabandhu
- Schieffelin Leprosy Research & Training Centre, Karigiri, Tamil Nadu
| | | | | |
Collapse
|
12
|
Vijayakumaran P, Rao TP, Krishnamurthy P. Pace of leprosy elimination and support teams in Bihar state, India. LEPROSY REV 1999; 70:452-8. [PMID: 10689827 DOI: 10.5935/0305-7518.19990049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite the extensive implementation of multiple drug therapy (MDT) in most leprosy-endemic countries world-wide since 1982, bringing about a remarkable reduction in prevalence, there are still regions at the sub-national level where the implementation of MDT remains difficult. The state of Bihar (population 86.3 million) in India is a good example of such a region. Previously rated as one of the most highly endemic states, it still contributes about 21% of the total caseload in India and about 12% of the global caseload. For various reasons, case-finding and drug treatment have lagged behind the progress made in most other states in the country and in 1996, the Damien Foundation India Trust (DFIT) volunteered technical support to increase the pace of elimination. Sixteen out of the 39 districts in the state were allocated, with a population of 41.8 million. Support teams, including a Medical Advisor and a Non-Medical Supervisor, both with over 10 years experience of leprosy work and control programmes, were provided to assist and work alongside government staff in case detection, treatment delivery, case-holding and discharge in their respective areas of operation. New case detection by intensive survey increased by 394% and total new case detection by 226% during the year 1996-1997, with similar trends in the following year. Striking improvements were also observed in MDT coverage, treatment regularity, monitoring and discharge of patients and in the training of local staff. This collaboration between a non-government agency (DFIT) and the staff of the National Leprosy Eradication Programme in 16 out of 39 districts in the State of Bihar has clearly been extremely successful. Similar approaches in the remaining districts of Bihar, and in other parts of India, where the infrastructure is available but inadequate, may contribute significantly to achieving the elimination goal at national and sub-national levels.
Collapse
|
13
|
Vijayakumaran P, Jesudasan K, Mozhi NM, Samuel JD. Does MDT arrest transmission of leprosy to household contacts? Int J Lepr Other Mycobact Dis 1998; 66:125-30. [PMID: 9728444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The multidrug therapy program with the World Health Organization (WHO)-recommended treatment (WHO/MDT) regimens has given the hope of early case detection and rendering a leprosy patient, especially a multibacillary (MB) patient, noninfectious within a short period of time. Hence, the duration of exposure for household contacts to infection is expected to be remarkably less when compared to exposure to MB leprosy patients on dapsone monotherapy. A total of 1661 household contacts of skin-smear-positive leprosy patients were recorded from 1984 to 1994. Follow up of these individuals [8403 person-years at risk (PYR)] revealed that the incidence of leprosy was 7.7 per 1000 PYR, which was 8 times more than that of the general population. The risk was more if there was a coprevalent case in the family. The incidence of leprosy declines from the third year of surveillance onward, and declines more so in children. Although disease transmission should have been arrested as soon as the index case was started on MDT, the incidence of leprosy among the household contacts was still high when compared to that of the total population. Effective intervention needs to be introduced to reduce the risk of contacts developing leprosy.
Collapse
Affiliation(s)
- P Vijayakumaran
- Branch of Epidemiology and Leprosy Control, Schieffelin Leprosy Research & Training Centre, Karigiri, South India
| | | | | | | |
Collapse
|
14
|
Vijayakumaran P, Reddy NB, Krishnamurthy P, Ramanujam R. Utilizing primary health care workers for case detection. Indian J Lepr 1998; 70:203-10. [PMID: 9724856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Under the National Leprosy Elimination Programme it takes at least one year for the paramedical worker to survey the allotted population for case detection. An alternative strategy in warranted for States like Bihar still having a high case load and poorly functioning leprosy programme. An intensive case finding programme using Primary Health Care (PHC) workers was organized in Bhojpur district, Bihar State, India. The whole population (3, 173, 701 in 1996) of the district was screened within a period of four days and confirmation of suspected cases was carried out in four days. During this screening procedure, 1586 new leprosy cases were detected (NCDR = 5 cases per 10,000) and all were started on MDT. The new cases constituted 26.4% of active cases existing on record before the screening. After this experience, the prevalence rate of active cases increased from 19 to 24 10,000. If such rapid screening programmes are done at least twice a year, it will greatly hasten the process of elimination of leprosy.
Collapse
Affiliation(s)
- P Vijayakumaran
- Damien Foundation India Trust Support Teams for Bihar, Manda Colony, Morabadi, Ranchi
| | | | | | | |
Collapse
|
15
|
Abraham S, Vijayakumaran P, Jesudasan K. Ulnar nerve abscess in a multibacillary patient during post-multidrug therapy surveillance. LEPROSY REV 1997; 68:333-5. [PMID: 9503870 DOI: 10.5935/0305-7518.19970042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An old borderline-lepromatous leprosy patient, treated initially with DDS monotherapy followed by MDT, 11 years later during surveillance presented with 3-month-old asymptomatic cystic swelling, arising from the right ulnar nerve without exhibiting any evidence to document relapse of the disease. It responded promptly to corticosteroid therapy. This unusual clinical presentations of ulnar nerve abscess has not been reported elsewhere.
Collapse
Affiliation(s)
- S Abraham
- Schieffelin Leprosy Research & Training Centre, Karigiri, Vellore Dt., Tamil Nadu, South India
| | | | | |
Collapse
|
16
|
Vijayakumaran P, Mahipathy PV, Misra RK, Petro TS, Ramanujan R, Karunakaran S, Abraham O. Hidden cases of leprosy (in prison). Indian J Lepr 1997; 69:271-4. [PMID: 9394177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Leprosy survey conducted in eight prisons in seven districts of Bihar State revealed a prevalence of 13.3 per 1000 which was 12 times more than the recorded prevalence of leprosy in the State. Thus this finding supports the view that prisons could form a hyperendemic pocket for leprosy. Regular NLEP services need to be extended to the inmates of the prisons.
Collapse
Affiliation(s)
- P Vijayakumaran
- Damien Foundation India Trust support teams for Bihar, Sushila Sadan, Bhahadurpur, Rajendranagar, Patna
| | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
New antimycobacterial agents and combined treatment regimens are being introduced for the treatment of leprosy. Ofloxacin is one such broad spectrum antimicrobial agent. In this study rifampicin plus ofloxacin were administered daily for 4 weeks (daily supervised dose). Two patients (and possibly a third patient who refused all investigations) out of 125 patients developed leucocytopenia during the third week of therapy. It was associated with fever, malaise, nausea and loss of appetite. They recovered after cessation of drug treatment. Patients receiving ofloxacin should be monitored for constitutional symptoms suggestive of this complication even though the risk of such complication may be minimal.
Collapse
Affiliation(s)
- P Vijayakumaran
- Schieffelin Leprosy Research & Training Centre, Karigiri, Tamilnadu, South India
| | | | | | | | | | | |
Collapse
|
18
|
Jesudasan K, Vijayakumaran P, Manimozhi N, Bushanam JD, Kanagarajan S, Rao PS. Origin of new leprosy cases during general surveys in relation to previous survey findings. LEPROSY REV 1996; 67:183-9. [PMID: 8885611 DOI: 10.5935/0305-7518.19960018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As part of the leprosy control activities in the area of Gudiyatham Thaluk, general surveys are done once every three to five years. The percentage of examination is about 90%. An analysis of all new cases registered for treatment between 1990-94 was done to study whether these cases had been examined in the previous general survey. Of the new cases detected and registered, 566 cases (32.6%) were not examined during the previous survey. The significance of these findings in relationship to cost-effectiveness of general surveys, case-detection methodology and possible continuing of transmission of leprosy are discussed.
Collapse
Affiliation(s)
- K Jesudasan
- Branch of Epidemiology and Leprosy Control, Schieffelin Leprosy Research and Training Centre, NAA district, Tamil Nadu, South India
| | | | | | | | | | | |
Collapse
|
19
|
Vijayakumaran P, Manimozhi N, Ravikumar RN, Jesudasan K, Rao PS. Leprosy among inmates of a prison. Indian J Lepr 1996; 68:247-250. [PMID: 8889610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A leprosy survey carried out in a district prison revealed a gross prevalence of 20 cases per 1000, and active prevalence of 10 cases per 1000 whereas, prevalence of leprosy in the state was 1.12 per 1000. Such prisons thus form hyperendemic pockets. The inmates are a closed community and there is a risk of cases among inmates spreading infection to others inside the prison during their sojourn there and to the community when they are released from the prison. Special efforts are required to identify and eliminate all identifiable sources of infection, especially at this point of time when we are aiming at elimination of leprosy as a public health problem.
Collapse
Affiliation(s)
- P Vijayakumaran
- Branch of Epidemiology & Leprosy Control, Schieffelin Leprosy Research & Training Centre, Karigiri
| | | | | | | | | |
Collapse
|
20
|
Vijayakumaran P. Fixed duration therapy (FDT) in MB leprosy (clinicobacteriological experience). Indian J Lepr 1996; 68:297-300. [PMID: 8889617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
21
|
Vijayakumaran P. Profile of relapses after MDT in paucibacillary leprosy and subsequent management. Indian J Lepr 1996; 68:300-3. [PMID: 8889618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
22
|
Jesudasan K, Vijayakumaran P, Manimozhi N, Jeyarajan T, Rao PS. Absence of relapse within 4 years among 34 multibacillary patients with high BIs treated for 2 years with MDT. Int J Lepr Other Mycobact Dis 1996; 64:133-135. [PMID: 8690971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Thirty-four multibacillary patients with a bacterial index (BI) of 3+ or more were treated with 2 years of WHO multidrug therapy (WHO/MDT). Treatment was then stopped and the patients followed for a minimum of 4 years. The rate of fall in the BI in this group without further treatment was similar to the rate of fall in the BI in an earlier group of similar patients treated with MDT until skin-smear negativity. No relapses have been seen.
Collapse
Affiliation(s)
- K Jesudasan
- Schieffelin Leprosy Research and Training Centre, Karigiri, India
| | | | | | | | | |
Collapse
|
23
|
Jesudasan K, Vijayakumaran P, Manimozhi N, Rao PS, Samuel P. Effectiveness of MDT in multibacillary leprosy. Int J Lepr Other Mycobact Dis 1996; 64:128-32. [PMID: 8690970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The study on the use of World Health Organization multidrug therapy (WHO/MDT) under field conditions was initiated in December 1981, and included 1067 multibacillary (MB) patients treated with two MDT regimens. The first was a THELEP-recommended regimen which consisted of 600 mg of rifampin (RFP) and 600 mg of clofazimine (CLO) given under supervision on two consecutive days monthly and 225 mg of diacetyl diaminodiphenylsulfone (DADDS) bimonthly plus dapsone (DDS) 100 mg daily unsupervised. The second regimen was the conventional MDT: patients received RFP 600 mg and CLO 300 mg supervised once a month, daily 100 mg of DDS and 50 mg of CLO unsupervised. A zero relapse rate was obtained after more than 10 years (a total of 8244 person-years) of follow up. Both regimens were well tolerated with few complications and a high acceptability, even among women. The fall in the bacterial index (BI) was 0.5 - 1.0+ in positive patients. CLO discoloration began to decrease after 3 months and disappeared within 1 year after it was discontinued. Seventy-two patients (67%) developed reactions during the treatment period; a further 12 patients developed post-treatment reactions during the surveillance period. This study vindicates MDT treatment for MB patients as recommended by WHO under field conditions.
Collapse
Affiliation(s)
- K Jesudasan
- Schieffelin Leprosy Research and Training Centre, Karigiri, India
| | | | | | | | | |
Collapse
|
24
|
Vijayakumaran P, Jesudasan K, Manimozhi N. Fixed-duration therapy (FDT) in multibacillary leprosy; efficacy and complications. Int J Lepr Other Mycobact Dis 1996; 64:123-7. [PMID: 8690969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The World Health Organization (WHO) recommended a multidrug therapy (MDT) regimen for multibacillary (MB) leprosy patients in 1982 which was to be administered for a minimum period of 2 years or until a skin smear was negative for acid-fast bacilli, whichever was later. This regimen contains rifampin, dapsone and clofazimine. A single dose of rifampin was shown to effect a high degree of bacterial killing (99.9%). The combined therapy administered for 2 years may be adequate to bring about "total" bacterial killing and to prevent the emergence of drug resistance and persisters. In this study, 360 smear-positive and previously untreated MB leprosy patients were treated with WHO/MDT for 2 years; 22.8% of these MB patients developed lepra reaction during therapy and 10.7% during surveillance. The bacterial index continued to decline even after termination of fixed-duration therapy. None of these patients relapsed during 886 person-years of surveillance.
Collapse
Affiliation(s)
- P Vijayakumaran
- Schieffelin Leprosy Research & Training Center, Karigiri, South India
| | | | | |
Collapse
|
25
|
Jesudasan K, Vijayakumaran P, Mozhi NM, Rao PS. A leprosy survey in a taluk headquarters town and the role of dermatological services and active health education in its success--a preliminary report. Indian J Lepr 1996; 68:175-8. [PMID: 8835587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A report of two general surveys done in 1984 and 1987 in Gudiyatham town, is presented. The first survey covered 89.2% and the second survey 82% of the population. The new case detection rate was 3.4 per 1000. The success of the survey was due to the co-operation obtained from the public, most probably because of the intense and sustained health education, combined with leprosy services integrated with a dermatology clinic.
Collapse
Affiliation(s)
- K Jesudasan
- Branch of Epidemiology & Leprosy Control, Schieffelin Leprosy Research & Training Centre, Karigin
| | | | | | | |
Collapse
|
26
|
Vijayakumaran P, Manimozhi N, Jesudasan K. Incidence of "chance" smear positivity among MB leprosy patients after MDT. Indian J Lepr 1995; 67:249-58. [PMID: 8576604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Multidrug therapy (MDT) was introduced in 1982. Nine hundred eighty multibacillary (MB) leprosy patients had successfully completed the MDT administered for a minimum of two years or till skin smear negativity, whichever was later, as recommended by the World Health Organisation (WHO). During surveillance, 2.24% of them revealed presence of acid-fast bacilli (AFB) in the skin smear. They did not have any clinical evidence suggestive of relapse. Subsequent followup (without antileprosy chemotherapy) for periods ranging from one to eight years was uneventful. We have called this as "chance smear positivity" where a few bacilli, yet to be cleared by the immune system, were picked up by routine skin smear examination.
Collapse
Affiliation(s)
- P Vijayakumaran
- Department Branch of Epidemiology & Leprosy Control, Sehieffelin Leprosy Research & Training Centre, Karigiri
| | | | | |
Collapse
|
27
|
Vijayakumaran P, Manimozhi N, Jesudasan K. Incidence of late lepra reaction among multibacillary leprosy patients after MDT. Int J Lepr Other Mycobact Dis 1995; 63:18-22. [PMID: 7730714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Multidrug therapy (MDT) recommended by the World Health Organization (WHO) had been administered in 1982 to a cohort of multibacillary (MB) leprosy patients. Treatment was administered for a minimum period of 2 years or until skin-smear negativity for acid-fast bacilli was achieved (whichever was later). Among 980 MB leprosy patients who completed treatment, 11 patients (1.1%) experienced lepra reactions during surveillance. Probable predictive factors are discussed. The incidence of lepra reaction seemed to be three times more common in borderline (BL) leprosy than in lepromatous (LL) leprosy. The majority of these events occurred during the first 3 years of surveillance. All of these episodes were treated with steroids without antileprosy chemotherapy. None of these patients was confirmed as experiencing a relapse during the subsequent period of surveillance.
Collapse
Affiliation(s)
- P Vijayakumaran
- Branch of Epidemiology and Leprosy Control, Schieffelin Leprosy Research and Training Center, Karigiri, India
| | | | | |
Collapse
|
28
|
Jesudasan K, Vijayakumaran P, Manimozhi N, Gangadaran M. Need for peripheral nerve examination during leprosy case-detection surveys. LEPROSY REV 1994; 65:284-5. [PMID: 8942161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
29
|
Pannikar V, Jesudasan K, Vijayakumaran P, Christian M. Relapse or late reversal reaction? Int J Lepr Other Mycobact Dis 1989; 57:526-8. [PMID: 2664046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- V Pannikar
- Department of Epidemiology and Leprosy Control, Tamil Nadu, India
| | | | | | | |
Collapse
|
30
|
|