Top Ten Tips Palliative Care Clinicians Should Know about Multiple Sclerosis

Multiple sclerosis (MS) is a chronic, immune-mediated, neurodegenerative condition of the central nervous system, with distinct challenges due to its heterogeneous presentation, prognostic uncertainty, and variable clinical course of neurological and non-neurological symptoms and disability. Although there have been significant advances in management of MS, many patients experience disability progression. Despite MS being a frequent cause of neurological disability, particularly in young persons, involvement of palliative care physicians in the care of patients with MS has been limited. This article provides ten tips for palliative clinicians for caring for patients with MS and their care partners.

The underlying mechanism between compulsory citizenship behaviors and employee innovative work behaviors and knowledge sharing: A moderated mediation model

Purpose

This paper draws on conservation of resources theory to advance the literature on extra-role performance behaviors among academics, particularly innovative work behaviors and knowledge sharing, through the lens of work stressors.

Methods

We develop a moderated-mediated model based on multi-source, multi-timed, and multi-level data from a sample of 207 academics and 137 direct supervisors in five higher education institutions in the United Arab Emirates (UAE).

Findings

Results show that academics' compulsory citizenship behaviors positively influence negative affectivity, which, in turn, negatively impacts academics' innovative work behavior and knowledge sharing. The detrimental effect of compulsory citizenship behaviors on negative affectivity is then positively moderated by passive leadership, which amplifies this relationship. The combined effect of compulsory citizenship behaviors and negative affectivity exerted on innovative work behavior and knowledge sharing are magnified amid the elevated presence of passive leadership, while gender does not significantly influence this association.

Originality

This is a pioneering study in the context of UAE to look into the counterproductive impact of CCB on employee innovative work behaviors and knowledge sharing.

Implications

Pertinent theoretical and managerial implications are discussed.

Supply chain transparency for sustainability – an intervention-based research approach

Purpose

The COVID-19 pandemic has impacted all manufacturing sectors from basic products to luxury goods including the automobile industry. This has necessitated a new line of research on competency building, transparency, and sustainability in automotive supply chains. In this study, the authors examine the competencies required to improve the automotive supply chain routine operations to address the parts supply crisis from multitier suppliers in the post-COVID-19 environment. The authors also propose a list of competencies required in the automotive supply chains to deploy the transparency for sustainability (TfS) framework on a long-term basis.

Design/methodology/approach

The authors have adapted a cross-case study process using intervention-based research and a design science approach for use in this study and used multiple sources for data collection such as published literature, operational experience, and critical opinions of original equipment manufacturer representatives. The research design includes interviews with global OEMs practitioners as one of the relevant sources of information.

Findings

The impact of the COVID-19 pandemic outbreak on automotive manufacturing operations and global supply chains is unprecedented. The TfS framework cycle has been validated using the real-world semiconductor supply crisis which deals with multitier sustainable supply chain management (MTSSCM), and the authors found that there are competency gaps when compared with existing literature. The list of key competencies identified along with the formulation of design propositions to facilitate both the supply crisis and collaboration among automotive firms to enhance their business performance were also presented.

Research limitations/implications

The COVID-19 pandemic is impacting the automobile sector significantly. This situation has created many opportunities and obstacles, but this paper only considers the automotive semi-conductor shortage situation, which may be resolved in the near future when there are more installed capacities. Therefore, it is unclear whether the proposed responses will result in long-term solutions. Further adjustments may be needed to revisit the TfS framework. The research paper only addresses the automotive side of the current supply crisis, but more sustainability issues may arise in the future, which need to be dealt with separately.

Practical implications

Research findings may prove particularly interesting to global automotive vehicle manufacturers, suppliers and policy makers who are seeking to understand multitier supply networks to resolve the current challenges associated with the post-COVID-19 pandemic situation.

Originality/value

In addition to contributing to developing competency requirements, this study enhances the evolving research stream of MTSSCM by linking it to wider research applications of intervention-based research coupled with design science.

Dying with Parkinson's Disease: Healthcare Utilization and Costs in the Last Year of Life

BACKGROUND

The end-of-life period is associated with disproportionately higher health care utilization and cost at the population level but there is little data in Parkinson's disease (PD).

OBJECTIVE

The goals of this study were to 1) compare health care use and associated cost in the last year of life between decedents with and without PD, and 2) identify factors associated with palliative care consultation and death in hospital.

METHODS

Using linked administrative datasets held at ICES, we conducted a retrospective, population-based cohort study of all Ontario, Canada decedents from 2015 to 2017. We examined demographic data, rate of utilization across healthcare sectors, and cost of health care services in the last year of life.

RESULTS

We identified 291,276 decedents of whom 12,440 (4.3%) had a diagnosis of PD. Compared to decedents without PD, decedents with PD were more likely to be admitted to long-term care (52% vs. 23%, p < 0.001) and received more home care (69.0 vs. 41.8 days, p < 0.001). Receipt of palliative homecare or physician palliative home consultation were associated with lower odds of dying in hospital (OR: 0.24, 95% CI: 0.19- 0.30, and OR: 0.38, 95% CI: 0.33- 0.43, respectively). Mean cost of care in the last year of life was greater for decedents with PD ($68,391 vs. $59,244, p < 0.001).

CONCLUSION

Compared to individuals without PD, individuals with PD have higher rates of long-term care, home care and higher health care costs in the last year of life. Palliative care is associated with a lower rate of hospital death.

End-of-life and hospice care for neurologic illness

Systems for end of life care around the world vary in availability, structure, and funding. When available, most end of life care is in the hospice model with an interdisciplinary team approach to care of people who are expected to die within months and whose primary goal is to maximize quality of life. Symptom management near the end of life is guided by prognosis and individual priorities. People dying with neurologic disease are likely to have impaired communication or mobility that adds to the complexity of prognostication and symptom management. Neurologic specialists have important roles to play in end of life care due to their unique understanding of disease prognosis as well as end of life symptom burden and management. Neurologic specialists need to become strong advocates for the importance of end of life care by being actively involved in the hospice movement and by addressing current disparities in access to care.

Supply chain resilience and business responses to disruptions of the COVID-19 pandemic

Purpose

At its peak, the COVID-19 pandemic has created disruption to food supply chains in the UK and for the entire world. Although societal changes created some resilience within the supply chains, high volatility in demand creates supply, logistics and distribution issues. This is reflected in the economic instability of businesses and small and medium enterprises (SMEs). In this paper, the authors explore factors behind this initial disruption in the supply chains and offer suggestions to businesses based on the established practices and theories.

Design/methodology/approach

The authors use mixed methods research. First, the authors conducted an exploratory study by collecting data from published online sources. Then, the authors analysed possible scenarios from the available information using regression. The authors then conducted two interviews with UK retail sector representatives. These scenarios have been compared and contrasted to provide decision-making points to businesses and supply chain players to tackle current and any future potential disruptions.

Findings

The findings from the current exploratory study inform the volatility of supply chains. The authors suggested some possible responses from businesses, during and after the pandemic.

Originality/value

The regression model provides a decision-making approach to help supply chain businesses during the pandemic outbreak. Once a complete data set of COVID-19 is available, the authors can create a resilience model that can help businesses and supply chains.

Key factors of carbon footprint in the UK food supply chains: a new perspective of life cycle assessment

Purpose

The purpose of this paper is to empirically identify key factors of UK food supply chains (SCs) that significantly contribute to CO2 emissions (CO2e) taking into account the life cycle assessment (LCA). The UK food supply chain includes imports from other countries.

Design/methodology/approach

This research develops a conceptual framework from extant literature. Secondary data obtained from ONS and FAOSTAT covering from 1990 to 2014 are analysed using Multilinear Regression (MLR) and Stochastic Frontier Analysis (SFA) to identify the factors relating to CO2 emissions significance, and the efficient contributions that are being made to their reduction in the UK food supply chains.

Findings

The study results suggest that Transportation and Sales/Distribution are the two key factors of CO2 emissions in UK food supply chains. This is confirmed by two multivariate methods, MLR and SFA. MLR results show that transportation increases UK CO2 emissions by 10 tonnes of CO2 emissions from one tonne of fruits and vegetables imports from overseas to the UK Sales and Distribution reduces the UK CO2 emissions by 1.3 tonnes of CO2 emissions due to improved, technological operation activities in the UK. In addition, the SFA results confirm that the key factors are sufficient to predict an increase or decrease in CO2 emissions in the UK food supply chains.

Research limitations/implications

This study has focused on the LCA of the UK food supply chain from limited data. Future studies should consider Sustainability Impact Assessment of the UK food supply chain, identifying the social, economic, regulatory and environmental impacts of the food supply chain using a re-defined LCA (all-inclusive assessment) tool.

Practical implications

This research suggests that food supply chain professionals should improve efficiency, e.g. the use of solar energy and biogas, and also integrate low-carbon policies and practices in food supply chain operations. Furthermore, governments should encourage policies such as mobility management programmes, urban redevelopment and privatisation to enhance better transportation systems and infrastructure to continuously reduce CO2e from the food trade.

Originality/value

Although logistics play a major role in CO2 emissions, all logistics CO2 emissions for other countries are not included in the ONS data. This research reveals some important insights into the UK food supply chains. Logistics and other food supply chain processes of importing countries significantly contribute to CO2 emissions which are yet to be considered in the UK food SCs.

A holistic approach of quality: a case of UK chocolate manufacturing

Purpose

This research is elucidating quality control theories to reduce variation in chocolate manufacturing process in the UK food company that will help maintain the processes stable and predictable. The purpose of this paper is to reduce defects of the output; to identify the root causes of variation; to establish and implement solutions to this variation problem; and to establish a control system to monitor and report any variation in the process.

Design/methodology/approach

The authors use experimental case study of a chocolate company to achieve the objective. In this paper, the authors predominantly use established theory define–measure–analyse–improve–control, customised to the case of the chocolate factory to reduce variations in production processes.

Findings

The results confirm that customised-traditional theoretical quality models will support manufacturing companies to maintain customer satisfaction while enhancing quality and reliability.

Practical implications

Implementation of customised approach reduced the rate of defect from 8 to 3.7 per cent. The implications of reduced variation are improved product quality; reprocessing elimination; and a more stable process that support sustainability and reliability in producing chocolates to meet customer needs.

Social implications

The authors used an experimental-based case study approach to test with one company. Testing in multiple case companies may help to generalise results.

Originality/value

The research study experimentally tested quality approach with a real case company and hence the findings of this study can be applied to other cases working in similar settings.

Moderating roles of customer characteristics on the link between service factors and satisfaction in a buffet restaurant

Purpose

– In service sector, measuring quality of services is generally acknowledged to be difficult as it involves many psychological features. Hence, identifying the determinants of service quality and linkages with customer satisfaction is a challenging research topic. In this study, the authors take up a research study to address this challenge. The purpose of this paper is to examine the importance of factors influencing customer satisfaction in the context of a Chinese buffet restaurant in the UK.

Design/methodology/approach

– The authors use a questionnaire based on the SERVQUAL instrument for the purpose. Using exploratory and confirmatory factor analyses, the authors have found that service quality could be grouped into four main factors – service, food, ambience and price.

Findings

– Using multiple-regression analysis, the authors have found that food is the most significant factor influencing customer satisfaction, followed by price, ambience and service, respectively. Using a multi-group analysis, the authors have found interesting moderating roles of age, gender and annual income on the influence of the four factors on satisfaction: ambience is considered significant by male customers while it is not significant for female customers; the influence of price on satisfaction is much higher for female customers than for male customers; food and service factors are important for younger customers while price is important for older customers; price is important for customers with lower levels of income but not important for high-income customers.

Practical implications

– These results are useful to restaurant managers in allocating appropriate levels of resources to different factors based on their contributions to customer satisfaction in order to maximize customer satisfaction efficiently and effectively.

Originality/value

– Analysis and findings of this research are based on the customers’ survey data of a Chinese buffet restaurant in the UK. The authors have found an interesting ranking of the importance of service factors: food followed by price, ambience and service. The results on the moderating role of customer characteristics provide newer insights in the literature on service quality. The research findings can help the hotel management to improve their service levels to attain maximum customer satisfaction.

Evaluation of an intermittent six-month regimen in new pulmonary tuberculosis patients with diabetes mellitus

BACKGROUND

The treatment of tuberculosis (TB) with category I regimen of the Revised National Tuberculosis Control Programme (RNTCP) for patients with diabetes mellitus (DM) needs evaluation.

OBJECTIVE

To assess the cure and relapse rates in 3 years, among the new smear-positive TB patients with Type-2 DM (DMTB) treated with CAT-I regimen (2E3H3R3Z3/4R3H3) of RNTCP.

METHODOLOGY

TB suspects attending the diabetology units and the TB research centre (TRC) Chennai, were investigated. Eligible DMTB cases were enrolled. Baseline estimation of cardiac, renal, liver function tests and glycosylated-HBA1c were undertaken. All patients received 2E3H3R3Z3/4R3H3 under supervision at TRC. Clinical and sputum (smear and culture) examinations and monitoring of diabetic status were undertaken every month up to 24 months, then once in 3 months up to 36 months.

RESULTS

Of 100 patients admitted, 7 were excluded for various reasons from analysis. Of 93 patients, 87 (94%) had a favourable response at the end of treatment. Pre and post treatment mean glycosylated-HBA1c were 9.7% and 8.4% (>7% poor control). During follow-up period, 6 died and one lost to follow-up. Of the remaining, four relapsed.

CONCLUSION

Category-I regimen, recommended for all the new smear-positive patients in the Indian TB programme, is effective in the treatment of DMTB patients, despite poor control of diabetes.

Risk of development of tuberculosis in HIV-infected patients

OBJECTIVE

To estimate the rate of development of active tuberculosis (TB) in a cohort of human immunodeficiency virus (HIV) positive patients, and to identify the characteristics of these patients.

DESIGN

A total of 175 HIV-positive individuals were recruited from clinics for sexually transmitted diseases and followed up for 31 +/- 6.8 months. Clinical examination, chest X-ray, sputum smear for acid-fast bacilli and culture for mycobacteria and HIV serology were performed at the time of registration and repeated periodically.

RESULTS

Seventeen patients had TB at intake and another 24 developed TB during follow-up, giving a breakdown rate of 6.9/100 person-years (p-y) (95% confidence interval [CI] 4.1-9.6). The attack rates were similar in tuberculin positive (7.1/100 p-y, 95%CI 3.4-10.8) and negative (6.7/100 p-y, 95%CI 2.6-10.8) patients. There was a trend towards higher mortality in patients who developed TB (10.5/100 p-y, 95%CI 4.8-15.2) compared to those who did not (6.1/100 p-y, 95%CI 3.2-8.8).

CONCLUSIONS

The results of this study provide information regarding the high risk of development of active tuberculosis and its associated mortality in HIV-infected persons. The risk of developing TB appears to be equally high in tuberculin positive and negative individuals, suggesting that new infections could play a major role in this susceptible population.

A sequential study of circulating immune complexes, complement and immunoglobulins in borderline tuberculoid leprosy patients with and without reactions

Sequential estimates of the levels of circulating immune complexes (CIC), complement catabolic fragment C3d, complement-mediated immune complex solubilization (CMS) and immunoglobulins were made in 24 newly diagnosed with borderline tuberculoid leprosy over a 20 month period after initiation of chemotherapy. Fourteen of these patients had not suffered from reversal reactions either at the time of presentation or during the follow-up. The levels of CIC were evaluated in them from the third to the eleventh month after starting chemotherapy and immunoglobulin G (IgG) levels were evaluated up to eight months. The concentrations of C3d and immunoglobulins A (IgA) and M (IgM) were normal in these patients. The other ten patients had reversal reaction at the time of diagnosis which subsided by the third month after starting treatment. They did not have reversal reactions later. The levels of CIC and IgG were elevated and those of CMS were depressed throughout the study period. Serum C3d level was initially elevated but came down to normal by the third month while IgA and IgM levels were within normal limits. The relevance of these findings to the genesis of reversal reaction is discussed in this communication.

Psychosocial aspects of deformed leprosy patients undergoing surgical correction

A psychosocial study was conducted on 25 randomly selected leprosy patients undergoing corrective surgical procedures for their deformities. High anxiety and depression levels found preoperatively, reduced significantly after operation. Psychiatric assistance is needed for these patients in order to clear their psychic aberrations, create awareness, boost morale and to give self-confidence. Only 50-75% of preoperative expectations were satisfied but that was only in 40% of patients. This calls for a preoperative counselling session with the patients to help them reach the realistic goals that they can achieve. They should be told what benefits surgery can offer them and be made aware of the problems which will persist after operation, such as anaesthesia and analgesia.

Persistent reduced solubilization of immune complexes in lepromatous leprosy patients with reactions

It is held that immune complexes (IC) play a vital role in the pathogenesis of some of the reactions in leprosy. The complement system is known to solubilize and render IC innocuous. We have previously shown that patients undergoing lepra reactions had lowered complement-mediated IC solubilization (CMS). We, therefore, undertook a prospective study of untreated multibacillary leprosy patients and monitored their CMS levels sequentially while on therapy. In addition, the concentrations of the complement component C3d, immunoglobulins G, A and M, and circulating immune complexes (CIC) were also estimated. A total of 26 patients were included in the study and were investigated at 3-month intervals for 3 years. Thirteen of the 14 patients who did not develop reactions at all had normal CMS values, although all of them showed elevated CIC. From the inception of treatment, 10 of the 12 patients who developed lepra reactions had low CMS values which remained below normal levels even after evidence of complement activation disappeared and long after the subsidence of reaction. It is suggested that this defective CMS acts as a predisposing cause of lepra reactions.

Effect of chemotherapy on viability of Mycobacterium leprae as determined by ATP content, morphological index and FDA-EB fluorescent staining

Viable bacterial populations were estimated in bacilli purified from 105 biopsies from 40 untreated and 65 multibacillary leprosy patients treated with multidrug therapy (MDT) for varying periods. The bacilli were purified and viability was determined by ATP content, morphological index (MI), and fluorescein diacetate-ethidium bromide (FDA-EB) staining. Viable populations were calculated, taking 3.58 x 10(-15) g/solid bacillus as the mean ATP content of a viable unit of Mycobacterium leprae. The proportion of viable bacilli was also estimated in the same specimens using solid-staining (MI) and green-staining bacilli by the FDA-EB method. In the untreated cases, the positive viability by ATP assay was 100%, 92% by MI, and 100% by FDA-EB. ATP content per solid bacillus was relatively constant, which was not the case with ATP content per green-staining bacillus. While the MI was zero in all cases, viable bacilli could still be detected by ATP estimations in 5 of the 32 (16%) patients after 2 years of MDT and in 1 of the 20 (5%) patients after 3 years of MDT. No viable bacilli could be detected even by this method beyond 3 years of MDT. On the other hand, green-staining bacilli were demonstrable in 7/32 (22%) of cases after 2 years of MDT, 2/20 (10%) after 3 years of MDT, and 1/13 (8%) after more than 3 years of treatment, indicating that the FDA-EB staining and ATP assay did not detect the same populations. A determination of the ATP content of M. leprae could be used as a reliable and sensitive tool for determining viability of the bacilli.

Relapses in paucibacillary patients after treatment with three short-term regimens containing rifampin

Three multidrug regimens all containing rifampin and dapsone have been tried for the treatment of 278 cases of paucibacillary leprosy. Regimen I was the one recommended by the WHO Study Group. Regimen II was the same as Regimen I with depsone alone continued for a further 6 months. Regimen III was the same as Regimen II but rifampin was given daily for the first 7 days. The patients were comparable with regard to disease classification, lepromin status, bacteriological status, and number of lesions. As reported earlier, the disease inactivity rates by 1 year of treatment were much greater with Regimens II and III than with Regimen I (94% and 97% vs 76%). Early reaction was seen in 6% of those in Regimen III and in none in Regimens I and II. Late reaction was observed in 9% of those in Regimen I and none in Regimens II and III. During 3 1/2 years of follow up, 13% of the cases in Regimen I, 1% in Regimen II, and 2% in Regimen III relapsed. Since the patients in the three regimens were otherwise comparable, it is concluded that the high inactivity rate, low relapse rate (1%-2%), and no early or late reaction as observed in Regimen II patients were because of adequate treatment.

Results of a modified WHO regimen in highly bacilliferous BL/LL patients

A regimen consisting of 600 mg of rifampin once a month, 100 mg of clofazimine on alternate days, and 100 mg of dapsone daily was used in 56 untreated, highly bacillated borderline lepromatous/lepromatous (BL/LL) patients with an average bacterial index (BI) of 4.45. Treatment was continued until skin-smear negativity. After 2 years of therapy, none of the patients had become smear negative and the average BI was 2.56. There was no growth on inoculation of skin-tissue biopsies in the normal mouse foot pad after 6 months of therapy. Bacillemia was still detectable in 11/50 patients, and significant ATP levels were detected in Mycobacterium leprae from skin-tissue biopsies in 16% of the cases. After 3 years of therapy, three patients had become smear negative. The average BI was 1.30. None of the patients had detectable bacillemia, and 5% of the cases showed detectable ATP levels in M. leprae from tissue biopsies. After 4 years of therapy, 41.7% of the patients had become smear negative. The average BI was 0.66, and no ATP was detected in any of the purified bacillary suspensions. The fall in BI was accelerated, and more patients on continued treatment became negative earlier compared to those having treatment for a limited duration, as reported by others.

Pyrazinamide as a part of combination therapy for BL and LL patients--a preliminary report

Pyrazinamide in a dose of 1500 mg was given to 63 borderline lepromatous (BL) and lepromatous (LL) leprosy patients on different drug regimens for the initial 2 months of therapy. Fifty-one BL and LL patients were put on the same drug regimens without pyrazinamide. There was a rapid and good clinical improvement in the patients in both of the groups. At the end of 2 years, the patients who received pyrazinamide had a morphological index (MI) of zero as compared to those patients who did not receive pyrazinamide, some of whom still had solidly staining bacilli. One out of 20 (5%) scrotal (smooth muscle) biopsies of the patients who received pyrazinamide had growth in the mouse foot pad as compared to 9 out of 38 (23.7%) smooth muscle biopsies of the patients who did not receive pyrazinamide. At the end of 5 years, the patients who received pyrazinamide had slightly better results compared with the non-pyrazinamide group. Pyrazinamide appears to have some effect against persisters in multibacillary leprosy. A well-controlled, randomized trial with longer duration of pyrazinamide therapy in a larger group of patients needs to be carried out to unequivocally determine the exact role of pyrazinamide in leprosy.

Comparison of three regimens containing rifampin for treatment of paucibacillary leprosy patients

Three regimens containing rifampin have been tried in paucibacillary leprosy patients. The patients were selected according to the criteria laid down by the World Health Organization (WHO). In Regimen I, rifampin 600 mg is given once a month for 6 months with dapsone 100 mg daily. Treatment is stopped at the end of 6 months. Regimen II is the same as Regimen I, and is supplemented with an additional 6 months' treatment with dapsone 100 mg daily. Regimen III is the same as Regimen II, except that rifampin is administered daily for the first 7 days. At the end of the scheduled treatment period, 72.2% of the patients in Regimen I, 94.9% of the patients in Regimen II, and 97.1% in Regimen III became inactive. Eighteen out of the 25 active cases at the time Regimen I treatment was stopped had to be restarted on drug therapy since they showed a worsening of their disease, as indicated by an increase in their bacterial index, the appearance of new lesions, renewed activity in old lesions, an increase in the size of old lesions, or development of nerve abscesses. The remaining seven cases regressed without further treatment. All four Regimen II patients and two Regimen III patients who had evidence of activity at the time treatment was stopped did not require any further treatment. On follow-up for 1 1/2 years, three Regimen I patients and none of the Regimen II or Regimen III patients showed relapses. It is thus apparent that rifampin helps to shorten the time duration and to increase the cost effectiveness of treatment of paucibacillary leprosy cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow up of BL/LL patients on a slightly modified WHO regimen of multidrug therapy

56 lepromatous leprosy patients with an initial average BI of 4.45 were administered once a month 600 mg of Rifampicin, 100 mg of Clofazimine on alternate days and 100 mg of Dapsone daily. None of these patients became smear negative in 2 years, and the same regimen was continued further. Two patients have become negative in 3 years and treatment has been stopped in them. The study indicates that highly bacilliferous LL/BL patients are likely to need 3 years or more of MDT for achieving bacterial negativity.

Dermatoglyphics in leprosy (II Metric analysis of palms)

A group of 100 leprosy patients consisting of 50 lepromatous (BL/LL) and 50 tuberculoid (BT/TT) were investigated for metric analysis of the patterns present on their palms. Hundred normal persons were also selected from the families of patients to serve as controls. BT/TT patients and controls did not show any significant difference in their palmar patterns. On the other hand, significant differences were observed in the patterns between BL/LL patients and controls.

Chemotherapeutic trials with different regimens containing rifampicin in paucibacillary type of leprosy cases--a preliminary report

Different regimens containing Rifampicin have been tried in treating paucibacillary leprosy patients. In our study we have studied three regimens. Regimen I consists of treating patients with Rifampicin 600 mg once a month for six months combined with Dapsone 100mg daily and treatment is stopped at six months. Regimen II is same as regimen I except that instead of stopping treatment at the end of six months the treatment was continued with dapsone 100 mg daily for another six months and treatment was stopped at one year. Regimen III is the same as recommended by I.A.L. in which treatment is started with Rifampicin 600 mg daily for seven days in the first month to be followed by Rifampicin 600 mg once a month for five more months. This is combined with dapsone 100mg daily for one year. Treatment in this group is also stopped at one year. Eighty one patients in Regimen I, thirty five patients in Regimen II and sixty three patients in Regimen III completed the six month treatment. It was found that the inactivation index in all the three regimens was nearly the same.

Dermatoglyphics in leprosy (I. Finger patterns)

Finger dermatoglyphic patterns were studied in leprosy families selecting patients and controls from each family. A total of 100 leprosy cases (50 of TT/BT types and 50 of BL/LL types) and 100 control subjects were investigated. While a statistically significant association was noted with some finger patterns (loop ulnar, loop radial, loop twin and loop central pocket) in the lepromatous type, no such association was observed with the finger patterns in the tuberculoid type.

Attitude of doctors to working in leprosy

A study was conducted to assess the attitude of Doctors to working in leprosy. 35 subjects were studied using a questionnaire to tap the various areas of leprosy work. The results indicated that although a majority of the doctors were interested in the specialty and considered that they had been trained well there was evidence of inadequate knowledge in 33% of them. Fears of being socially stigmatised and facing poor job prospects while working in this field were also revealed. It is suggested that training in the under-graduate and, post-graduate levels and improving job prospects would remove the disincentives which hamper anti-leprosy work.

Solid, fragmented and granular index as one of the parameters in drug trials

A bacteriological study of the skin smears of 108 bacteriologically positive cases of leprosy, 30 of them untreated, has been undertaken. In each case solid, fragmented and granular (SFG) index, bacteriological index (BI) and morphological index (MI) of skin smears from 4 sites were calculated. The results show that SFG index together with BI can be used as one of the parameters in drug trials. The importance of SFG index in research and as a routine laboratory procedure in leprosy control units undertaking multi drug therapy is discussed.