Treatment for type 2 lepra reaction gifs,incidence and prevalence of type 2 diabetes in australia 2013,m-56 bomber - Test Out

The widespread use of Multiple Drug Therapy (MDT) in leprosy control programmes has resulted in a great reduction in worldwide prevalence.
It is recognized that there is more blindness in multibacillary (MB) patients with leprosy than in other people of the same age. Because of the success in reducing the prevalence of leprosy, governments are not prepared to continue to allocate money previously given to leprosy control programmes. Some of the problems and opportunities associated with integration of leprosy care into Primary Health Care were identified at the Workshop.
Under these circumstances it may be attractive for leprosy relief agencies to direct some support to general eye care programmes. The setting in which the decision to treat will be made in India will be the Primary Health Centre (PHC), under the supervision of the PHC Medical Officer (PHC MO). Paucibacillary (PB) leprosy, 6 months treatment: seen at 3 and 6 months, at the same time as patient checked for ulnar nerve involvement and foot ulcers. MB leprosy, 1-2 years treatment: patient seen at least every 6 months, or more frequently if required by the Prevention of Disability Programme.
All patients will be educated about possible eye complications, instructed in self-care, and told to return if any adverse events occur. We need to improve the type of surgery, and obtain evidence as to what is the best procedure. In the past, because of small pupils, synechiae, iris atrophy, and the demonstration of the presence of leprosy bacteria in the iris even after a full course of MDT, Ophthalmologists have been reluctant to insert IOLs after cataract surgery.
The gradual change-over from vertical leprosy programmes to an integrated programme for leprosy sufferers increases the responsibility on the staff of the eye care programmes to ensure that the patients are examined and operated on at the right time, and that general health workers are trained in leprosy eye care. This workshop was run by LEPRA (British Leprosy Relief Association) and sponsored by members of the International Federation of Anti-Leprosy Associations, Christian Blind Mission and the International Centre for Eye Health. There is a mixed picture from country to country, so that there is still a high incidence of newly diagnosed cases in some regions, for example in northern Brazil and parts of India. This has been confirmed in a longitudinal study of leprosy (LOSOL) in India (301 patients recruited over 7 years) and the Philippines (289 patients).
It will be necessary to reduce the recommended tasks and technology to the minimum essentials. In sub-Saharan Africa, prevention of blindness due to leprosy will, in practice, only survive within the general eye care programme.
Each centre may only see 5-10 new patients a year, of whom only one may have lagophthalmos.
The visual acuity will be taken by any paramedic, and the patient inspected by the PHC MO if anything is found.


There is no agreement as to the best procedure, whether tarsorrhaphy, or horizontal lid shortening, including reconstructing the canthus. This is changing, and very good results with posterior chamber IOLs were reported at this Workshop.
Unless otherwise stated, all content is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. At the beginning of 2000 there were approximately 640,000 cases registered for treatment with MDT, and around 680,000 had been newly detected in 1999.1 More than 10 million previous leprosy patients have been released from treatment (RFT), and removed from registers. In consequence, specialised leprosy programmes are being closed and leprosy workers are being phased out or re-deployed.
For those Primary Health Care workers still in training, we must ensure that teaching about eyes in leprosy is included. The reorganisation required as a result of the Vision 2020 initiative is an ideal opportunity to think how eye care in leprosy could be integrated. If the lid gap is 5mm or less and there is a recent history, systemic prednisolone should be started; if not recent, the patient is counselled in self-care. Apart from the improved optical results, IOLs avoid the problem of wearing aphakic spectacles when the bridge of the nose has collapsed, or the problem of handling them with deformed hands. This was due to cataract in 90%, the other main causes being lagophthalmos (failure to close the eyelids) leading to corneal opacity, and uveitis. Tamil Nadu is the first state in India in which leprosy control has become fully integrated into the general health services; other countries are following the same pattern. In some countries community rehabilitation workers may be involved in long term follow-up of RFT patients. When a skin patch is pale, the patient receives counselling; if red and raised, steroids should be started and the patient seen every month.
Some surgeons use frequent topical steroid drops or systemic steroids post-operatively to reduce the risk of post-operative inflammation.
In countries such as China and South Korea, there are many elderly people with disabilities, some still living in leprosy settlements or colonies.
Under these conditions there is a real danger that new cases will be missed, and disabilities will not be adequately dealt with. Therefore, guidelines for the responsibilities and training of general health workers must be rapidly developed.



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