Biomedical subjects
R Ganapati
Publications and source records attributed to R Ganapati.
Field application of combined therapy for infectious leprosy cases. A feasibility study in Bombay.
The practical problems related to dapsone monotherapy for a prolonged period to infectious leprosy patients are well known to the scientific community and combined treatment of dapsone with clofazimine, rifampicin or prothionamide has been successfully carried out by several workers in hospitalised leprosy patients. The application of polytherapy in field condition was hindered by the cost of the drugs and fear of side effects. 42 infectious leprosy patients attending 5 field leprosy clinics in the slums of Bombay city were put on combined drug schedule. The drug compliance of these patients was judged along with their regularity in attendance at clinics by the persons in charge and periodic and frequent check up of urines. 27 (65%) were regular in treatment from the beginning, 8(19%) who were initially irregular after motivation and 7(17%) remained irregular through out the period. The urine samples collected from leprosy patients on monotherapy and attending the same centres revealed 31% irregularity in drug consumption. The study indicates that advocating combined therapy in field conditions by paramedical workers is quite feasible. The patients on multiple drugs are more regular in drug consumption as compared to monotherapy group. The frequent check up of urine for drug content and advice to patients who are irregular in treatment improve their regularity in drug consumption.
Dapsone compliance in an urban field project.
Available reports both from rural and urban leprosy centres prove beyond any doubt that dapsone is not being consumed regularly by all those who show regular clinic attendance. No reports are available from urban field projects where SET programme is being operated. In this study surprise urine samples of 294 patients of all types (smear positive 53%) mainly on dapsone monotherapy attending (1) leprosy treatment centres in slum clinics situated in the field areas adopted for SET work by Bombay Leprosy Project and (2) general hospital clinics situated predominantly outside the project area were analysed for dapsone/creatinine ratio to judge the extent of drug compliance. 201 out of 294 (68%) were regular and 82 out of 294 (28%) were irregular in consuming DDS as judged by urine examination. 67% of smear positive cases were regular. No difference was found in regularity between patients living within the project area (intensive follow up is done in this group to remind about treatment) and outside project area patients (no reminder followup is done). Similarly no difference was observed in regularity amongst the patients attending slum clinics and general hospital clinics. It could be stated that facilities for treatment offered at general hospitals or dispensaries and encouraging voluntary reporting could be quite fruitful and economical for obtaining better drug compliance in urban areas.
Leprosy surveys in urban slums-possibilities for epidemiological investigations.
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Integration of leprosy into general health services in an urban area--a feasibility study.
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Prevalence of leprosy among in-patients in general hospitals--a survey in Bombay.
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Associated cases in the families of school children with leprosy.
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Study of urinary nitrogenous constituents in reactions of leprosy.
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Assessment of school surveys as a method of case detection in an urban area endemic for leprosy.
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Regularity of dapsone intake by leprosy patients attending urban treatment centre.
Dapsone/Creatinine in urine ratios were determined in statistically randomised samples of 965 leprosy patients attending out-patient department of Acworth Leprosy Hospital and 44 inmates of the Hospital. The percentage of irregularity in DDS treatment was found in 43 and 22.6 respectively in out-patients and inmates of the Hospital. The need to assess the possible response for irregularity in treatment is stressed and the hazard of infectious cases remaining without treatment or with incomplete treatment is pointed out.
Leprosy endemicity in Bombay: an assessment through surveys of municipal schools.
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Leprosy among school children in Greater Bombay: clinical features.
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A study of mono-neuritic lesions in a leprosy clinic.
An analysis of 11,581 leprosy patients registered at the Acworth Leprosy Hospital clinic showed that 494 cases (4.3%) had primary polyneuritic leprosy and 143 (1.2%) localised cutaneous anaesthetic lesions (or non-visible anaesthetic lesions), accounting for 5.5% who had no evidence of obvious skin lesions.
Classification of leprosy from the clinical point of view.
While, according to some, classification of leprosy is primarily clinical, there should be no objection to the application of the advances made in the last decade in understanding the immunological and histopathological aspects of the disease, provided thereby the clinical classification can be made with more accuracy. Unlike most other diseases, the bulk of the process of attempts at diagnosis and classification of this disease is still in the hands of para-medical personnel in the field, and hence it is important that at the same time, an easily understood, uniformly accepted clinical classification should be recommended for field workers. While tuberculoid and lepromatous leprosy of the polar types can be diagnosed with accuracy even under field conditions, confusion generally arises with reference to the diagnosis or indeterminate maculoanaesthetic and borderline forms, and to identify some reacting lesions. Certain terminologies in vogue add further to the confusion. Reacting lesions are confused with active lesions. The importance of recognition of varieties of reacting lesions is stressed since the therapeutic management in such cases is entirely different. It is suggested that the early forms of leprosy characterised by paucity of cardinal features of the disease should be separated from the more established types and grouped under the term indeterminate leprosy. The diagnostic points to be taken into consideration in these lesions are discussed. The importance of investigating thoroughly before classifying patients who report rarely with neuritic symptoms without any evidence of skin lesion is stressed.
Some interesting disease combinations--report on two cases.
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Childhood leprosy--study of prevalence rates and clinical aspects through surveys in Bombay.
This paper summarises the experience gained through extensive surveys of school children carried out in Greater Bombay over the past five years. The strikingly high proportion of children of 6 to 14 years age group suffering from leprosy attending the Acworth Leprosy Hospital and its peripheral clinic prompted these surveys. While surveys of 10% of child population attending randomly selected municipal schools revealed a general prevalence rate of 3 per 1000, there existed pockets of endemicity of the order of 10.8 per 1000, in some schools situated in the northern suburbs of the city. Even private schools catering to the not-so-poor sections of the community showed prevalence rates of over 6 per 1000, confirming the hyperendemicity of leprosy in Bombay city, with no socioeconomic or age group immune from exposure. Clinical observations of 1265 leprosy cases identified in the course of the above surveys covering a total population of nearly 1.8 lakhs of school children are presented. 24.7% of the cases had either the potential to develop into progressive forms of leprosy in view of the multiplicity of lesions or were already in an advanced stage of the disease. Polyneuritic leprosy together with intermediate and lepromatous types representing 5.8% of all cases (24 cases were confirmed to be smear positive) belonged to the groups posing therapeutic as well as public health problems. Analysis of 953 cases with single lesions revealed greater frequency of distribution (58.4%) of patches in parts of the body which are generally covered. It is striking that 26.4% of the solitary lesions was found in the gluteal regions and thighs, emphasising the need for thorough examinations of these parts during surveys.