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Volume - 93, Issue - 2

editorial
Page 95
Editorial
Pages 96 - 101
Original Papers
Pages 102 - 114
  • Correction of ulnar claw hand – A comparative study of extensor carpi radialis longus (ECRL) and flexor digitorum superficialis (FDS) as the motor unit of choice

    • Imran Sajid
    • Sabeel Ahmad
    Volume 93, Issue 2

    | Published on June 2022

    Leprosy is a chronic infectious disease caused by M. leprae, with peripheral neuropathy as its most common manifestation. Deformity of the hand is particularly debilitating and the ulnar claw hand is the most common presentation. There are various surgical options available for correcting clawing in Hansen’s disease. In the present study we have tried to identify patient-related factors favouring either Extensor Carpi Radialis Longus (ECRL) or Flexor Digitorum Superficialis (FDS) as the motor unit of choice.

    Method

    A comparative study of ECRL (Brand Procedure) and FDS (Stiles–Bunnel) motor tendon transfer in the ulnar claw of hand was carried out. Correction of clawing of fingers was done in 60 ulnar claw hands using transfer of motor units ECRL and FDS. The Z deformity was corrected by 1∕2 FPL to EPL transfer. 12 cases were lost to follow up over the course of 5 years, so 48 cases were followed for up to 2 years, for various activities of daily life and routine work.

    Conclusion

    Both the transfers gave equivalent results. No morbid deformity was seen in ECRL transfer except the scar on the donor thigh. FDS transfer is the best reconstructive tendon transfer procedure for correction of ulnar claw hand in manual labourers. For white-collar workers, ECRL transfer should be the choice.

Original Papers
Pages 115 - 130
  • Evaluation of the integrity of the facial muscles in leprosy patients using surface electromyography: a cross-sectional study

    • Marlice Fernandes de Oliveira
    • Diogo Fernandes dos Santos
    • Luciano Brinck Peres
    • Douglas Eulálio Antunes
    • Victor Herlys Gomes Braga
    • Adriano de Oliveira Andrade
    • Adriano Alves Pereira
    • Isabela Maria Bernardes Goulart
    Volume 93, Issue 2

    | Published on June 2022

    Objective

    This study sought to evaluate facial muscle integrity in clinical forms of leprosy through surface electromyography.

    Methods

    For evaluation of facial muscle integrity, 19 healthy subjects and 71 patients diagnosed with leprosy and under treatment in a National leprosy reference center were recruited. The muscles investigated, through surface electromyography, were the frontalis, orbicularis oculi, zygomaticus, masseter, and orbicularis oris. The evaluated features were Root Mean Square (RMS) and Mean frequency (Fmean). The facial muscles were analyzed jointly and separately for each leprosy clinical form and healthy individuals.

    Results

    Regarding the Fmean, there was a difference noted between the values of healthy subjects and patients of all clinical forms, except for the LL form (p = 0.986). The highest frequency values were seen in TT and BL forms, which did not present a significant difference between each other (p = 0.757). Asymmetry of the facial muscles was detected in TT (RMS) and TT, BB, and LL forms from the Fmean. RMS and Fmean indicated motor neurogenic impairment in facial muscles of all leprosy patients, except the LL form.

    Conclusions

    Surface electromyography is shown to be an auxiliary tool for the diagnosis of facial motor disorders imperceptible to clinical examination, helping to prevent impairments, which is fundamental for the social inclusion of leprosy patients.

Original Papers
Pages 131 - 137
  • Clinical profile of patients with pure neuritic leprosy: 20 years’ experience at a tertiary referral centre from North India

    • Mala Bhalla
    • Kavita Poonia
    • Surbhi Jain
    • Gurvinder Pal Thami
    • Priyanka Sharma
    Volume 93, Issue 2

    | Published on June 2022

    Introduction

    Pure neuritic leprosy (PNL) is characterized by enlargement of peripheral nerves, sensory loss without any cutaneous lesions, skin slit smear negativity and a variable lepromin test and histopathology.

    Methods

    This was a retrospective analysis of the clinical records of all the leprosy patients enrolled in the Leprosy Clinic, during the years 1999–2019. The patient records fulfilling the diagnostic criteria of PNL were considered for analysis.

    Results

    A total of 1225 patients registered leprosy cases, out of which 41 (3.3%) patients were diagnosed with PNL. Mean age was 31 years and 80% patients were male. Multiple nerves were affected in 25 (61%) patients and one nerve was found to be affected in only 16 (39%) patients. Grade 2 deformities were seen in 26 (63%) patients. All patients were treated with multi-drug therapy - 25 patients received the multibacillary regimen and 16 received the paucibacillary regimen; 27 (66%) patients completed the treatment as prescribed.

    Conclusion

    Leprosy is the most common treatable cause of peripheral neuropathy. Therefore, early detection of leprosy neuropathy is important for preventing deformities and disabilities. It may be advisable to treat all PNL cases with the multibacillary multidrug therapy in view of higher rate of deformities.

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