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D Porichha

Publications and source records attributed to D Porichha.

At least 19 recordsLinked to original sources
PubMed2004

Neural pathology in leprosy during treatment and surveillance.

The histological findings of 22 patients with neuritis, 14 developing pain, tenderness and swelling during treatment and 8 during surveillance are presented in this study. Seven patients' biopsies showed macrophage type and 14 had epithelioid cell type of granulomas. All biopsies showed evidence of active disease, except for two patients with macrophage granulomas where some regressive changes were evident. One biopsy showed fibrosis with lymphocytic infiltration. The histology of epithelioid cell granulomas had varied histopathological presentations ranging from non-reacting BT to those with severe type I reaction with caseation necrosis, liquefaction and calcification. Two macrophage granulomas showed partial regression though there was neuritis clinically and features of ENL in the biopsy sections. One biopsy showed histoid changes. All the biopsies showed similar histopathological features irrespective of whether neuritis appeared during treatment or surveillance. The features of reaction were severe in nerves, probably due to the adjuvant nature of lipid and myelin in the nerve tissue. The histopathological features of nerve biopsies from patients under surveillance appeared to be ongoing active disease rather than relapse.

Adolescent↗
PubMed1996

Practical problems in the management of leprosy.

The categorization of leprosy into paucibacillary or multibacillary depends on the report of slit-skin smears. Unfortunately, in many control programmes the quality of slit smears is below par. Taking the example of India, the main reasons were that the work of laboratory technicians was unrewarding as compared to serving in a general health care system. There was lack of equipment and an unrealistic patient to technician ratio. Future attempts were made by experienced workers to devise a clinical system for classifying leprosy as paucibacillary or multibacillary based on counting the number of lesions. However this method did not prove cost-effective because more paucibacillary patients were classified in the multibacillary group increasing the burden of treatment. A renewed attempt to improve slit-smear performance should be made by modifying the existing methods. This can definitely improve the situation. Patients with multiple macular lesions and those with neuritic leprosy are best treated with the MB-MDT regimen. The treatment for PB leprosy is to continue up to 6 months but in MB leprosy with a high bacterial index a longer duration of MDT may be required. Following completion of MDT many cases with deformity are accumulating and their care forms are a neglected part of many control programmes. In addition to strengthening the infrastructure, simple techniques must be imparted to those with deformities and disabilities. This involves the artful and innovative cooperation of the health worker, patient and the community. The leprosy worker should be motivated to promote such activities.

Health Services Needs and Demand↗
PubMed1993

Ambiguities in leprosy histopathology.

This paper presents the percentage of definite or suggestive evidence present in 482 biopsies from different types of leprosy. The presence of acid-fast bacilli (AFB) and nerve involvement were taken as definite features for a diagnosis of leprosy, and infiltration of the dermal appendages, neurovascular bundles and dermis by granuloma cells and lymphocytes were regarded as suggestive signs of leprosy. Using these criteria, all cases were categorized into three groups having definite, suggestive, or no signs of leprosy. The results showed definite and suggestive features in 72.2% and 14.1% of the cases, respectively. The remaining 13.7% had none of these signs. These cases were mostly healed lesions. Large, epithelioid cell granulomas without any nerve element present and healed cases proved difficult for a definite diagnosis. Emphasis is placed on searching for residual nerve elements in AFB-negative sections because this increases the certainty level of the diagnosis. Also, it is suggested that for uniformity of understanding and reporting, terminologies need to be narrowed down and restricted to only definite, suggestive, or no diagnosis of leprosy.

Biopsy↗
PubMedDate not supplied

BI of patient vs BI of individual sites.

An analysis of 200 skin smear results from multibacillary patients showed that the average bacteriological index (BI) of a patient varied considerably from his site-wise highest BI. The average BI was equal to site wise highest BI only in 17.5% of cases and in the rest, it ranged from 99% to as low as 36% of the highest site-wise BI. In follow-up smears, site-wise consistency of the highest BI was found in 96% of cases. It is suggested that for follow-up purposes, repeating smear from only one such site would be adequate.

Colony Count, Microbial↗
PubMedDate not supplied

Reaction cases treated at the Regional Leprosy Training and Research Institute, Aska, Orissa: a retrospective analysis.

This study is a retrospective analysis of 147 cases of leprosy reaction selected out of 942 cases of leprosy registered between 1992 and 2002 at the RLTRI, Aska (Orissa). The occurrence of reaction was about 16% with a slight increase over the years. There was a preponderance of males, with about 80% cases among males, and the peak occurrence of reaction was found in the age-group of 21-49 years. Reversal reaction (RR) was seen in 68.7% and ENL in 31.3% of cases. Single episode of RR and ENL reactions was seen in 61.2% and 43.5% respectively. In either type the last episode was seen even after about 32 months after RFT. There was a dissociation between nerve and skin manifestation, with both skin and nerve manifestation in 78.96%, skin lesions only in 21.1% and nerve lesions only in 50.9% of cases. About 88% of reaction was seen in MB patients, with a higher proportion of RR, because of inclusion of more borderline cases. Prednisolone was the drug of choice in both types of reaction, though in 17 cases of steroid dependency, thalidomide was proved to have an edge over steroids. Both types taken together, in half of the cases the first episode of reaction developed within 6 months of starting treatment. Multiple episodes were more common with ENL.

Adolescent↗
PubMedDate not supplied

A review of trends in new case-detection in Subarnapur district of Orissa.

Trends in new case-detection are analysed by reviewing the demographic and leprosy epidemiological data and current indicators in Subarnapur district, Orissa State and India. Population-specific new case-detection rates were calculated for analysis. The trend of skin-smear positive cases over a period of 10 years was reviewed in respect of smear positive cases of 1991. During the years 2002 to 2004, a sudden fall was noticed in the new cases detected in both India and Orissa state, whereas the decline in Subarnapur district was more gradual. The fall in the female-specific new case-detection rates is found to be rapid from 11 to 2.5 over the last three years. This also indirectly indicated the health-seeking behaviour of women in accessing health services and hence required a changed strategy. A similar rapid decline was observed in child-specific new case-detection rates. On analysiS, the decline of highly bacilliferous cases from 1991 to 2001 was found to be statistically significant. The analysis also brought out the fact that cases with bacterial index of 1+, 2+ and 3+, though small in numbers, were detected during the last three years indicating continued presence of cases with low bacterial density in the community. The review indicates a definite decline in the occurrence of new cases in all groups. Caution needs to be exercised about continued presence of cases with low bacterial index though in small numbers. The rapid decrease of cases in all groups during the years 2004 and 2005 warrants meticulous surveillance. The surveillance activities could include monitoring of population-specific new case-detection rates and skin-smear positive cases at district and state levels in order to advise on leprosy eradication programme strategies.

Adult↗