Wednesday, April 25, 2018

(LML) Are there any systematic reviews or evaluations of toolkits for challenging stigma?

Leprosy Mailing List – April 25,  2018

Ref.:    (LML)  Are there any systematic reviews or evaluations of toolkits for challenging stigma?

From:  Bassey Ebenso, Leeds, UK


Dear Pieter,

Dr Bassey mentioned the growing interest in toolkits for challenging stigma.  He himself was instrumental in producing the "Toolkit for understanding and challenging leprosy-related stigma" which was developed in 2016 for the EU-Funded CREATE project in partnership with The Leprosy Mission (TLM Trust India and TLM England & Wales).

No systematic review has yet been conducted of the impact or effectiveness of this toolkit, although we have plenty of anecdotal evidence from its use in 4 different Indian States that it is a helpful tool and appreciated by a range of different stakeholders who have used it.  CREATE project is hoping to present about this toolkit and its impact at the NNN in Ethiopia on 24-26 September and the CREATE project will undergo a formal external end of project evaluation in early 2019, at which point there should be some more rigorous evidence about the value of this toolkit.

I hope this is of some help to your enquiry.  Mathanraj (CCd above), the Research & Training Officer for CREATE project may be able to give more specific examples of how, when and where this toolkit has already been used and with what impact, if required.

With thanks

Gareth.

 

Gareth Shrubsole

Senior Programme Manager

Goldhay Way
Orton Goldhay
Peterborough 
PE2 5GZ

+44 (0)1733 404879

 


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

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

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

 


Tuesday, April 24, 2018

(LML) Are there any systematic reviews or evaluations of toolkits for challenging stigma?

Leprosy Mailing List – April 28,  2018

Ref.:    (LML)  Are there any systematic reviews or evaluations of toolkits for challenging stigma?

From:  Bassey Ebenso, Leeds, UK


Dear Pieter,

There is abundant literature on interventions and approaches for tackling/reducing health-related stigma. There is also a growing body of systematic reviews that document the effectiveness of specific stigma-reduction interventions. However, literature on toolkits for challenging stigma, is limited.

The term toolkit is used broadly to describe the packaging of a combination of materials such as templates, guidelines, instruction sheets, videos, posters, intended to: i) fill knowledge gaps, ii) inform dialogue, and ii) improve behaviours for diverse audiences including, health workers, patients, community and health organizations, policy makers, and for the public.

Recently, the development of toolkits for challenging the stigma of specific conditions (e.g. TB, HIV, leprosy, gender-based violence etc.) is becoming popular. However, little is known about effectiveness of toolkits for changing behaviour and reducing stigma.

Do members know of empirical evaluations and/or systematic reviews of toolkits in the field of health, disability, gender, and international development that they can share? Thank you in advance for your help.

Regards,

Bassey

Dr Bassey Ebenso

Research Fellow

Nuffield Centre for International Health and Development

Leeds Institute of Health Sciences

University of Leeds

Room 10.28,  Worsley Building

Clarendon Way,

Leeds, LS2 9NL

 

Tel:  + 44 (0) 113 343 9642

Email: B.E.Ebenso@leeds.ac.uk ; Skype: bassey.ebenso ;

ResearchGate: https://www.researchgate.net/profile/Bassey_Ebenso

University Profile: https://medhealth.leeds.ac.uk/profile/600/1113/bassey_ebenso/3

Twitter: @B_Ebenso 

 


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

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

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

 


Monday, April 23, 2018

(LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

Leprosy Mailing List – April 23,  2018

Ref.:  (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy 

From:  Atul Shah, Mumbai; VP Shetty, Mumbai; Wim van Brakel, Amsterdam


 

Dear sir,

 

The basic question of role of nerve biopsy to rule in or rule out leprosy has not been addressed. Need more clarification on this as well as the site of biopsy.

 

Whether only electrical methods can conclusively define the DM as the aetiology particularly when all limbs show decreased sensory conduction and one upper limb also has partial motor affection grade 3+ . 

 

Hope to get an insight in these interesting cases.

 

Thanks. Best regards,

 

Dr. Atul Shah

Plastic surgeon

President, The Research Society,

Grant Medical College and Sir J J Group of Hospitals, Mumbai


Dear Pieter,

In our experience doing a biopsy of an involved sensory cutaneous nerve and histopathology is the most reliable in diagnosis of suspected pure neural cases of leprosy.

We also find doing a nerve conduction velocity study prior to biopsy helps in selecting the right nerve for biopsy. Sural nerve is the most frequently involved nerve in pure neural cases.

With regards,

VP Shetty


 

Dear Pieter,

Perhaps to add to what Dr Theuvenet has already written:

·       In diabetic neuropathy deep vibration sense is often lost (tuning fork or vibrometer on a bony prominence at the ankle or wrist). In our experience in leprosy, the deep sensation was usually intact.

·       In diabetic small fibre neuropathy, cold sensation is affected before warm sensation; our findings in the INFIT cohort study showed that, in persons affected by leprosy, warm detection thresholds were affected more often and earlier than cold sensation.

With kind regards,

Wim van Brakel

----------------------

Wim van Brakel, MD MSc PhD

Head Technical Department

Netherlands Leprosy Relief (NLR)

Wibautstraat 137k

1097DN Amsterdam

Netherlands

Tel. +31 20 5950529

Email: w.v.brakel@leprastichting.nl

URL: www.leprosyrelief.org

 

 


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

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

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


Sunday, April 22, 2018

(LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

Leprosy Mailing List – April 22,  2018

Ref.:    (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

From:  Eric Slim, Utrecht, the Netherlands


 

 

Dear Peter,

 

I agree with Wim important remarks concerning the difference between Diabetes andLeprosy related neuropathy (LML, April 21, 2018)

However, I would like to add some remarks.

1. Leprosy related neuropathy involves (more) often (significant) motor function impairment compared to diabetes related neuropathy.

2. Concerning Wim's comment:  "DM neuropathy will manifest itself after a much longer duration after the onset of the disease":

I would like to add: Diabetes often is diagnosed (to) late and neuropathy is already present at time of diagnose in a huge amount of diabetes patients (up to 60%).

3. Nerve enlargement can also be seen in diabetes related neuropathy but structural differences between diabetes and leprosy nerve impairment can be seen on ultrasound.

4. Neuropathy related muscle atrophy can be seen in both diabetes and leprosy and may result in both cases also in loss of strength. The distribution may differ (symmetrical versus asymmetrical) but also a symmetrical pattern can also be found in leprosy patients. However, significant motor function impairment is less found in diabetes (as mentioned in remark 1). 

5. I don't have much experience with tendon transfers in leprosy nor in diabetes but the risk of complication may be higher in patient with both diseases. This emphasizes the importance of an adequate diagnosis. However, the work done by dr Dellon suggests that also in diabetes, nerve repair and transplantation in the neuropathic foot is optional.  

 

6. Concerning the neuropathic foot: for ulcer prevention, treatment, use of orthoses and footwear, the expertise of both leprosy and diabetes is both applicable

 

With regards,

 

Erik Slim

 

MD, PhD, Physical Medicine and Rehabilitation.

St Antonius Hospital Nieuwegein/Utrecht The Netherlands.

 


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, April 21, 2018

(LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

Leprosy Mailing List – April 21,  2018

Ref.:    (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

From:  Wim Theuvenet, Apeldoorn, the Netherlands


 

Dear Pieter,

 

Thanks to Dr. Sharma for sharing this dilemma (LML, April 20, 2018).

 

There may be a few considerations to assist in the differential diagnosis:

1. DM peripheral neuropathy will in general be more symmetrical/bilateral;

2. DM neuropathy tends to affect the lower extremities far more often /much earlier than the upper limbs;

3. DM neuropathy will manifest itself after a much longer duration after the onset of the disease;

4. With ultrasound you may see the (a)symmetry of the nerve enlargement;

5. A cytological needle aspiration of enlarged nerves, when showing AFB's will set the diagnosis of leprosy;

6. When still inconclusive I would treat as MB leprosy seeing the extend of the nerve involvement;

7. When not done yet would suggest to have a full PT function assessment and when there are serious functional problems to present the patient to Dr. Indra Napit, Anandaban Hosptal, for possible reconstructive surgery/ tendon transfers?

 

With very best wishes

 

Willem J.Theuvenet M.D, Ph.D

Plast.Rec. Surgeon and Consultant for TLMI and the NLR.

 


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

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

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


Friday, April 20, 2018

(LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

Leprosy Mailing List – April 20,  2018

Ref.:    (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

From:  Ramesh Sharma, Pokhara, Nepal


Dear Pieter, 

 

This is Dr. Ramesh Sharma, Dermatologist, working in Greenpastures' Hospital, Pokhara, Nepal which is a leprosy mission hospital. 

 

We come across some confusing cases regarding pure neuritic leprosy. We, at present, have a patient in our ward who has uncontrolled diabetes (HbA1c: 10.3) and subjective nerves enlargement with sensory loss of the hands and feet and motor atrophy of the muscles of the hands only. 'Nerve enlargement' in this patient could only be a subjective finding. It's been difficult for us to distinguish between peripheral neuropathy of diabetes and pure neuritic leprosy. 

 

1. Is there any point as to differentiate between diabetic and pure neural neuropathy?

2. Can we differentiate them by the atrophy of muscles (in Hansens disease) along with sensory loss?

3. We have not yet done a nerve biopsy (its on our plan). But, if we do a nerve biopsy, can it be taken as conclusive to rule in or rule out a pure neuritic leprosy?

 

Looking forward to your reply.

 

Regards,

 

Ramesh.


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

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

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


Thursday, April 19, 2018

(LML) Invitation to LRI e-survey on Research Priorities

 

 

Leprosy Mailing List – April 19,  2018

Ref.:   (LML) Invitation to LRI e-survey on Research Priorities

From:  Nienke Veldhui,zen


Dear colleagues,

 

At the LRI (Leprosy Research Initiative), we are currently evaluating our research priorities and with this e-mail we would like to invite you to participate.

In this study, we are using a combination of key informant interviews, focus group discussions (FGD), an e-survey and finally we will use a so-called Delphi panel to rank the research topics according to their priority. The current invitation is for the e-survey.

We realize that some of you have already participated in other parts of this study. If so - you may still choose to participate in this e-survey. Moreover, we are distributing this e-survey via various ways and apologize if you may receive this invitation more than once.

We are hoping to reach many different stakeholders with this e-mail who are involved in leprosy care, control or research as well as persons affected by leprosy. You may also forward this invitation to others whom you think would be important to include.

Please note that you are only asked to complete the survey once.

In this e-survey, which will take approximately 10-15 minutes of your time, we would like to ask your opinion on how important different research topics are according to you. Furthermore, we would like to know if you think there are some important research topics missing from the list.

If you choose to participate, would you be so kind to complete the survey before May 15th?

You can use this link to access the e-survey:  Complete the survey

If you have any questions concerning this project or the e-survey, please contact Zahra Khazai at: z.khazai@leprosyresearch.org.

Your input is very valuable to this study and will contribute to a comprehensive list of current research priorities. We would like to thank you in advance for your contribution to this study!

 

Nienke Veldhuijzen  

The Leprosy Research Initiative

 www.leprosyresearch.org

Info@leprosyresearch.org

 


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

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

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