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artificial_finger_for_leprosy.pptx | |
File Size: | 787 kb |
File Type: | pptx |
AVR studio
Arduino
Please click here
AtMega8
Servo moter
10K resistor quarterwatt carbon film
LED
10uf electrolytic capacitor
16Mhz crystal
PCB copper clad
28 PIN ic base DIL
Acclerometer
10Kpot
feCl3
1mm drill bit
bug connectors
Battery lead acid 1.3AHr
Jumper wire
Charger
7805
Arduino
Please click here
AtMega8
Servo moter
10K resistor quarterwatt carbon film
LED
10uf electrolytic capacitor
16Mhz crystal
PCB copper clad
28 PIN ic base DIL
Acclerometer
10Kpot
feCl3
1mm drill bit
bug connectors
Battery lead acid 1.3AHr
Jumper wire
Charger
7805
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leprosy.docx | |
File Size: | 72 kb |
File Type: | docx |
Abstract:
Leprosy is best understood as two conjoined diseases. The first is a chronic mycobacterial infection that elicits an extraordinary range of cellular immune responses in humans. The second is a peripheral neuropathy that is initiated by the infection and the accompanying immunological events. The infection is curable but not preventable, and leprosy remains a major global health problem, especially in the developing world, publicity to the contrary notwithstanding. Mycobacterium leprae remains noncultivable, and for over a century leprosy has presented major challenges in the fields of microbiology, pathology, immunology, and genetics; it continues to do so today. This review focuses on recent advances in our understanding of M. leprae and the host response to it, especially concerning molecular identification of M. leprae, knowledge of its genome, transcriptome, and proteome, its mechanisms of microbial resistance, and recognition of strains by variable-number tandem repeat analysis. Advances in experimental models include studies in gene knockout mice and the development of molecular techniques to explore the armadillo model. In clinical studies, notable progress has been made concerning the immunology and immunopathology of leprosy, the genetics of human resistance, mechanisms of nerve injury, and chemotherapy. In nearly all of these areas, however, leprosy remains poorly understood compared to other major bacterial diseases.
Leprosy is best understood as two conjoined diseases. The first is a chronic mycobacterial infection that elicits an extraordinary range of cellular immune responses in humans. The second is a peripheral neuropathy that is initiated by the infection and the accompanying immunological events. The infection is curable but not preventable, and leprosy remains a major global health problem, especially in the developing world, publicity to the contrary notwithstanding. Mycobacterium leprae remains noncultivable, and for over a century leprosy has presented major challenges in the fields of microbiology, pathology, immunology, and genetics; it continues to do so today. This review focuses on recent advances in our understanding of M. leprae and the host response to it, especially concerning molecular identification of M. leprae, knowledge of its genome, transcriptome, and proteome, its mechanisms of microbial resistance, and recognition of strains by variable-number tandem repeat analysis. Advances in experimental models include studies in gene knockout mice and the development of molecular techniques to explore the armadillo model. In clinical studies, notable progress has been made concerning the immunology and immunopathology of leprosy, the genetics of human resistance, mechanisms of nerve injury, and chemotherapy. In nearly all of these areas, however, leprosy remains poorly understood compared to other major bacterial diseases.
Introduction:
Leprosy is best understood as two conjoined diseases. The first is a chronic mycobacterial infection that elicits an extraordinary range of cellular immune responses in humans. The second is a peripheral neuropathy that is initiated by the infection and its accompanying immunologic events, but whose course and sequelae often extend many years beyond the cure of the infection and may have severely debilitating physical, social, and psychological consequences. Both aspects must be considered by clinicians, researchers, and policymakers who deal with persons affected by this disease.
Leprosy is not going to disappear anytime soon. Effective multidrug regimens are now used worldwide, and the infection in individuals is curable. However, although the reported number of registered cases worldwide has declined in the last two decades, the reported number of new cases registered each year has remained the same (at 500,000 to 700,000) over the same interval. In some countries where leprosy is endemic the number of new cases actually appears to be increasing, while in others decreasing trends are reported. Great caution must be used in reaching conclusions from these observations, however, because they are based entirely on operational data which reflect the intensity of ongoing work more than the extent of any given problem. Mathematical modeling of the potential decline in leprosy incidence and prevalence, using various premises regarding efficacy of treatment and prevention, suggests that the disease will remain a major public health problem for at least several decades.
The full genome of M. leprae was among the first to be sequenced, and this new knowledge is beginning to bear fruit. Molecular microbiology has begun to explain, for example, M. leprae's fastidious nature and predilection for an intracellular lifestyle. Similarly, recent human genetic studies have been highly informative, indicating that immunity to M. leprae is controlled at two fundamental levels: first, genetic determinants of overall susceptibility and resistance to this organism have now been described, and second, a range of HLA-D-related immune responses have been demonstrated among individuals who are infected.
Leprosy is best understood as two conjoined diseases. The first is a chronic mycobacterial infection that elicits an extraordinary range of cellular immune responses in humans. The second is a peripheral neuropathy that is initiated by the infection and its accompanying immunologic events, but whose course and sequelae often extend many years beyond the cure of the infection and may have severely debilitating physical, social, and psychological consequences. Both aspects must be considered by clinicians, researchers, and policymakers who deal with persons affected by this disease.
Leprosy is not going to disappear anytime soon. Effective multidrug regimens are now used worldwide, and the infection in individuals is curable. However, although the reported number of registered cases worldwide has declined in the last two decades, the reported number of new cases registered each year has remained the same (at 500,000 to 700,000) over the same interval. In some countries where leprosy is endemic the number of new cases actually appears to be increasing, while in others decreasing trends are reported. Great caution must be used in reaching conclusions from these observations, however, because they are based entirely on operational data which reflect the intensity of ongoing work more than the extent of any given problem. Mathematical modeling of the potential decline in leprosy incidence and prevalence, using various premises regarding efficacy of treatment and prevention, suggests that the disease will remain a major public health problem for at least several decades.
The full genome of M. leprae was among the first to be sequenced, and this new knowledge is beginning to bear fruit. Molecular microbiology has begun to explain, for example, M. leprae's fastidious nature and predilection for an intracellular lifestyle. Similarly, recent human genetic studies have been highly informative, indicating that immunity to M. leprae is controlled at two fundamental levels: first, genetic determinants of overall susceptibility and resistance to this organism have now been described, and second, a range of HLA-D-related immune responses have been demonstrated among individuals who are infected.
Aim of study:
Leprosy presents a wide range of clinical and histopathological manifestations. This great diversity puzzled and frustrated clinicians and investigators until it was appreciated that this diversity was based on the ability of the host to develop a cellular immune response to M. leprae. The first full formulation of this concept was described by Skinsnes as an “immunopathological spectrum” in 1964. Soon thereafter, a practical classification scheme based on the same principles was proposed by Ridley and Jopling, enabling a degree of global uniformity in clinical practice that gave renewed impetus to research on this disease. In the same decade, the discovery by immunologists of functionally and phenotypically distinct T- and B-lymphocyte subsets and their respective roles in cell-mediated and antibody-mediated immune responses revolutionized immunology. Scientists rapidly developed an entirely new set of tools and simultaneously discovered leprosy as a challenging human disease that appeared to be an ideal model with which to examine theories and methods related to cellular immunity in humans. The convergence of these and other factors prompted an extraordinary burst of research on leprosy during the last three decades of the 20th century.
Leprosy presents a wide range of clinical and histopathological manifestations. This great diversity puzzled and frustrated clinicians and investigators until it was appreciated that this diversity was based on the ability of the host to develop a cellular immune response to M. leprae. The first full formulation of this concept was described by Skinsnes as an “immunopathological spectrum” in 1964. Soon thereafter, a practical classification scheme based on the same principles was proposed by Ridley and Jopling, enabling a degree of global uniformity in clinical practice that gave renewed impetus to research on this disease. In the same decade, the discovery by immunologists of functionally and phenotypically distinct T- and B-lymphocyte subsets and their respective roles in cell-mediated and antibody-mediated immune responses revolutionized immunology. Scientists rapidly developed an entirely new set of tools and simultaneously discovered leprosy as a challenging human disease that appeared to be an ideal model with which to examine theories and methods related to cellular immunity in humans. The convergence of these and other factors prompted an extraordinary burst of research on leprosy during the last three decades of the 20th century.
Review of literature:
A small survey was carried out in two areas of northern Bangladesh to assess and compare the level of knowledge, attitude and practice toward leprosy and tuberculosis (TB) among two communities that differed widely in the amount of health education received about these diseases. The results indicate that without a health education program levels of knowledge about the cause of treatability of the diseases are poor, worse for leprosy than TB, with correspondingly negative attitudes. Only 16% of the respondents in the "uninformed" area mentioned "skin patch" in a question about what they knew about leprosy; and only 44% mentioned "cough" as a symptom of TB. In the area that had received health education, 90% mentioned, respectively, "skin patch" and "cough." Seventy-eight percent of the respondents would not buy goods from a shopkeeper known to have leprosy, 76% if he had TB in the uninformed area; but in the community which had received health education the proportions were reversed, with three-quarters agreeing to purchase from a diseased shopkeeper. The implications of these findings for the Danish Bangladesh Leprosy Mission and national health education programs are discussed.
This article reports the outcome of a Special Action Project for the Elimination of Leprosy (SAPEL), including the implementation of multidrug therapy (MDT) in difficult situations in Akwa Ibom state in Nigeria. Twenty-two fishing villages and 5 communities in areas of gully erosion participated in the project from August 1996 to September 1997. Seven new cases were detected and treated with MDT. Twenty-one out of 22 defaulters examined resided in the mainland part of the project area and not in the fishing villages. Considerable difficulties were encountered with regard to the exorbitant cost of transport, physical attacks on the teams and the lack of reliable information on population figures for the project area. The discussion includes attention to the cost-effectiveness of the SAPEL approach under the conditions described and the need to develop better monitoring of treatment and community participation in poorly accessible areas.
In this review, we present the correlation between clinical manifestations and the immunological alterations on the clinical spectrum of leprosy and the importance of the specific treatment on the clinical, immunological and epidemiological controls. Related are the more important aspects, especially results of immunological investigation to understand better the pathophysiologic mechanisms on the leprosy evolution. There are presented also the therapeutic plan for reactional episodes and the multidrug therapy efficacy on leprosy control and the low frequency of relapses.
A small survey was carried out in two areas of northern Bangladesh to assess and compare the level of knowledge, attitude and practice toward leprosy and tuberculosis (TB) among two communities that differed widely in the amount of health education received about these diseases. The results indicate that without a health education program levels of knowledge about the cause of treatability of the diseases are poor, worse for leprosy than TB, with correspondingly negative attitudes. Only 16% of the respondents in the "uninformed" area mentioned "skin patch" in a question about what they knew about leprosy; and only 44% mentioned "cough" as a symptom of TB. In the area that had received health education, 90% mentioned, respectively, "skin patch" and "cough." Seventy-eight percent of the respondents would not buy goods from a shopkeeper known to have leprosy, 76% if he had TB in the uninformed area; but in the community which had received health education the proportions were reversed, with three-quarters agreeing to purchase from a diseased shopkeeper. The implications of these findings for the Danish Bangladesh Leprosy Mission and national health education programs are discussed.
This article reports the outcome of a Special Action Project for the Elimination of Leprosy (SAPEL), including the implementation of multidrug therapy (MDT) in difficult situations in Akwa Ibom state in Nigeria. Twenty-two fishing villages and 5 communities in areas of gully erosion participated in the project from August 1996 to September 1997. Seven new cases were detected and treated with MDT. Twenty-one out of 22 defaulters examined resided in the mainland part of the project area and not in the fishing villages. Considerable difficulties were encountered with regard to the exorbitant cost of transport, physical attacks on the teams and the lack of reliable information on population figures for the project area. The discussion includes attention to the cost-effectiveness of the SAPEL approach under the conditions described and the need to develop better monitoring of treatment and community participation in poorly accessible areas.
In this review, we present the correlation between clinical manifestations and the immunological alterations on the clinical spectrum of leprosy and the importance of the specific treatment on the clinical, immunological and epidemiological controls. Related are the more important aspects, especially results of immunological investigation to understand better the pathophysiologic mechanisms on the leprosy evolution. There are presented also the therapeutic plan for reactional episodes and the multidrug therapy efficacy on leprosy control and the low frequency of relapses.
Physiological background:
It was 1873, and Dr. Armauer Hansen of Norway had astounding news for the world: leprosy was caused by a bacterium (Mycobacterium leprae). Until then, the disease was thought to be from a curse or sinful ways.
Leprosy, known as Hansen's disease, still exists. According to the World Health Organization (WHO), the global registered prevalence of leprosy at the beginning of 2008 stood at 212,802 cases, while the number of new cases detected during 2007 was 254,525 (excluding the small number of cases in Europe).
It was 1873, and Dr. Armauer Hansen of Norway had astounding news for the world: leprosy was caused by a bacterium (Mycobacterium leprae). Until then, the disease was thought to be from a curse or sinful ways.
Leprosy, known as Hansen's disease, still exists. According to the World Health Organization (WHO), the global registered prevalence of leprosy at the beginning of 2008 stood at 212,802 cases, while the number of new cases detected during 2007 was 254,525 (excluding the small number of cases in Europe).
Signs and Symptoms of Leprosy:
The earliest sign of leprosy is commonly a spot on the skin that may be slightly redder, darker, or lighter than the person's normal skin. The spot may lose feeling and hair. In some people, the only sign is numbness in a finger or toe. If left untreated, leprosy can progress to cause serious effects on the body, including:
The earliest sign of leprosy is commonly a spot on the skin that may be slightly redder, darker, or lighter than the person's normal skin. The spot may lose feeling and hair. In some people, the only sign is numbness in a finger or toe. If left untreated, leprosy can progress to cause serious effects on the body, including:
- Hands and feet - Leprosy bacteria attack the nerves in the hands and feet and cause them to become numb. A person may get cuts or burns on the numb parts and not know it, leading to infections which cause permanent damage. Fingers and toes may be lost to infection. Serious infections in the feet may require amputation. Paralysis may cause the fingers and toes to curl up permanently.
- Eyes - Leprosy bacteria attack the nerves around the eyes, causing the loss of blinking reflex (which protects the eye from injury and moistens the surface). The eyes become dry and infected, and blindness may result. Because of numbness of the eye, the person cannot feel debris in or scratches on the eye.
- Face - Damage to the internal lining of the nose causes scarring and eventual collapse of the nose.
Principle:
Leprosy is caused by a slow-growing type of bacteria called Mycobacterium leprae (M. leprae). Leprosy is also known as Hansen's disease, after the scientist who discovered M. leprae in 1873.
Leprosy is defined by the number and type of skin sores you have. Specific symptoms and treatment depend on the type of leprosy you have. The types are:
Tuberculoid. A mild, less severe form of leprosy. People with this type have only one or a few patches of flat, pale-colored skin (paucibacillary leprosy). The affected area of skin may feel numb because of nerve damage underneath. Tuberculoid leprosy is less contagious than other forms.
Lepromatous. A more severe form of the disease. It has widespread skin bumps and rashes (multibacillary leprosy), numbness, and muscle weakness. The nose, kidneys, and male reproductive organs may also be affected. It is more contagious than tuberculoid leprosy.
Borderline. People with this type of leprosy have symptoms of both the tuberculoid and lepromatous forms.
Leprosy is caused by a slow-growing type of bacteria called Mycobacterium leprae (M. leprae). Leprosy is also known as Hansen's disease, after the scientist who discovered M. leprae in 1873.
Leprosy is defined by the number and type of skin sores you have. Specific symptoms and treatment depend on the type of leprosy you have. The types are:
Tuberculoid. A mild, less severe form of leprosy. People with this type have only one or a few patches of flat, pale-colored skin (paucibacillary leprosy). The affected area of skin may feel numb because of nerve damage underneath. Tuberculoid leprosy is less contagious than other forms.
Lepromatous. A more severe form of the disease. It has widespread skin bumps and rashes (multibacillary leprosy), numbness, and muscle weakness. The nose, kidneys, and male reproductive organs may also be affected. It is more contagious than tuberculoid leprosy.
Borderline. People with this type of leprosy have symptoms of both the tuberculoid and lepromatous forms.
Development stages:
Leprosy may briefly be defined as a chronic, potentially disabling disease, mainly affecting the nerves, skin, and eyes, caused by a bacillus, Mycobacterium leprae, which microscopically resembles the organism of tuberculosis. However, a better understanding of this complex disease calls for attention to (i) the long incubation period (usually 2–5 years); (ii) the remarkable diversity of clinical findings, apparently related to the level of immunity of different individuals; (iii) the frequency of adverse (damaging) immunological reactions, based on either cell-mediated or humoral (antigen–anitbody) mechanisms (iv) its propensity to produce disability and deformity, which in some cases may be severe and widespread, affecting eyes, face, or limbs; and (v) the social and psychological consequences of leprosy for the patient, the family, and the community, sometimes leading to outright stigmatization and rejection.
Leprosy is generally believed to have originated in Asia. From India, it probably spread to China in about 500 bc and then to Japan. It may have been carried from India in the fourth century bc by returning soldiers and camp followers of the Greek wars of conquest in Asia. In Europe, leprosy was active between the tenth and fifteenth centuries and then, for reasons largely unknown, steadily declined. Fear, stigma, and awareness of the disease also declined, but reappeared a few centuries later when the imperialist and colonialist activities of the countries in Western Europe revealed large numbers of cases in Africa, Asia, and Polynesia. Chaulmoogra (hydnocarpus) oil was introduced as treatment in the nineteenth century, but its beneficial effects were short-lived and it was not until the 1940s that effective chemotherapy became available. Dr G. H. Faget of the National Leprosarium at Carville, Louisiana, US, showed that a sulphone, ‘Promin’ (glucosulphone sodium) was effective intravenously in the treatment of leprosy, and this led to the use of dapsone (di-amino di-phenyl sulphone), given as tablets by mouth, on a wide scale.
The number of registered cases in the world has decreased from 5.4 million in 1985 to 700 000 recently. They are mainly in South and Cental America, Africa and the Far East. These remarkable changes have come about largely as a result of the widespread implementation of regimens of multiple drug therapy for all cases of leprosy as recommended by (WHO) in 1982. The enormous success of these regimens led to the establishment by WHO in 1994 of an Action Programme for the Elimination of Leprosy, aimed at reducing the prevalence of leprosy worldwide to less then one case per 10 000 of the population, and thus eliminating the disease as a public health problem.
Leprosy may briefly be defined as a chronic, potentially disabling disease, mainly affecting the nerves, skin, and eyes, caused by a bacillus, Mycobacterium leprae, which microscopically resembles the organism of tuberculosis. However, a better understanding of this complex disease calls for attention to (i) the long incubation period (usually 2–5 years); (ii) the remarkable diversity of clinical findings, apparently related to the level of immunity of different individuals; (iii) the frequency of adverse (damaging) immunological reactions, based on either cell-mediated or humoral (antigen–anitbody) mechanisms (iv) its propensity to produce disability and deformity, which in some cases may be severe and widespread, affecting eyes, face, or limbs; and (v) the social and psychological consequences of leprosy for the patient, the family, and the community, sometimes leading to outright stigmatization and rejection.
Leprosy is generally believed to have originated in Asia. From India, it probably spread to China in about 500 bc and then to Japan. It may have been carried from India in the fourth century bc by returning soldiers and camp followers of the Greek wars of conquest in Asia. In Europe, leprosy was active between the tenth and fifteenth centuries and then, for reasons largely unknown, steadily declined. Fear, stigma, and awareness of the disease also declined, but reappeared a few centuries later when the imperialist and colonialist activities of the countries in Western Europe revealed large numbers of cases in Africa, Asia, and Polynesia. Chaulmoogra (hydnocarpus) oil was introduced as treatment in the nineteenth century, but its beneficial effects were short-lived and it was not until the 1940s that effective chemotherapy became available. Dr G. H. Faget of the National Leprosarium at Carville, Louisiana, US, showed that a sulphone, ‘Promin’ (glucosulphone sodium) was effective intravenously in the treatment of leprosy, and this led to the use of dapsone (di-amino di-phenyl sulphone), given as tablets by mouth, on a wide scale.
The number of registered cases in the world has decreased from 5.4 million in 1985 to 700 000 recently. They are mainly in South and Cental America, Africa and the Far East. These remarkable changes have come about largely as a result of the widespread implementation of regimens of multiple drug therapy for all cases of leprosy as recommended by (WHO) in 1982. The enormous success of these regimens led to the establishment by WHO in 1994 of an Action Programme for the Elimination of Leprosy, aimed at reducing the prevalence of leprosy worldwide to less then one case per 10 000 of the population, and thus eliminating the disease as a public health problem.
Future scope:
Wheelchairs and ground mobility devices
Wheelchairs in developed countries often use high-technology materials like aluminium alloys, titanium and carbon fibre. The cost of such wheelchairs, however, is usually unaffordable by most users in Asian and Pacific developing countries. Non-availability of spare parts and maintenance facilities are additional drawbacks. As a result, steel is predominantly used for fabricating wheelchairs in the developing countries of the region. Aluminium alloys have recently been used for making wheelchairs in Thailand (see Box 6). These wheelchairs, however, are only suitable for movement on smooth surfaces.
NGOs in Cambodia use a wooden wheelchair (see Technical Specifications Supplement). Compared with metal wheelchairs, wooden wheelchairs are stronger and easier to repair and adapt in rural areas. They were initially cheaper as well, although this advantage has faded with rises in the price of wood.
The design of wheelchairs used in Asian and Pacific developing countries has often been based on specifications intended for people in other regions of the world. These wheelchairs are often oversized. The width and depth of the seat and the height of the armrests are unsuitable for and unacceptable to their users.
Some wheelchairs in use in the region, especially those provided free of charge to users, were designed for use in institutions, especially hospitals even though the actual use of the wheelchairs is in daily life. Such wheelchairs have many problems including:
(a) Inappropriate size
(b) Difficulty of controlling the chairs
(c) Poor facility for transferring in and out of the chairs
(d) High cost
(e) Unsuitability for rural use
(f) Lack of durability
(g) Difficulty and expense of repairs.
Orthoses
Orthoses are also known as calipers or braces. Although a brace is generally considered to be larger than a caliper, the two terms are often used interchangeably. This review uses only the more general term orthosis to avoid confusion.
Orthoses have two major purposes: first, to support or maintain a weak limb; and second, to help prevent or correct future deformities and contractures.
Only a few developing countries of the ESCAP region have paid substantial attention to the production of orthoses, in spite of large numbers requiring them. India has addressed the need for orthoses in response to the consequences of polio among many people. In those countries which produce orthoses, manufacturing capacities are not completely used.
A combination of hip knee ankle foot orthosis (HKAFO) and crutches has been used effectively by the Christian Medical College in Vellore, India, for rehabilitating paraplegic people in their own village surroundings (see Field Visit Notes in Madras Workshop Proceedings). Unlike most wheelchairs, this combination permits them to work in the field and thus remain productive members of their families, as well as allowing for regular exercise.
Metallic orthoses are the most common type of orthosis in developing countries of the ESCAP region. Conventional metal lower-limb orthoses require the use of special shoes. These shoes are user-specific, so full orthoses can only be produced at a clinic or hospital with trained prosthetic and orthotic technicians. The special leather shoes required are made in the rehabilitation workshops to suit the size and condition of the user's foot. For example, the inside height of the shoe may have to be increased to account for limb shortening.
Wheelchairs and ground mobility devices
Wheelchairs in developed countries often use high-technology materials like aluminium alloys, titanium and carbon fibre. The cost of such wheelchairs, however, is usually unaffordable by most users in Asian and Pacific developing countries. Non-availability of spare parts and maintenance facilities are additional drawbacks. As a result, steel is predominantly used for fabricating wheelchairs in the developing countries of the region. Aluminium alloys have recently been used for making wheelchairs in Thailand (see Box 6). These wheelchairs, however, are only suitable for movement on smooth surfaces.
NGOs in Cambodia use a wooden wheelchair (see Technical Specifications Supplement). Compared with metal wheelchairs, wooden wheelchairs are stronger and easier to repair and adapt in rural areas. They were initially cheaper as well, although this advantage has faded with rises in the price of wood.
The design of wheelchairs used in Asian and Pacific developing countries has often been based on specifications intended for people in other regions of the world. These wheelchairs are often oversized. The width and depth of the seat and the height of the armrests are unsuitable for and unacceptable to their users.
Some wheelchairs in use in the region, especially those provided free of charge to users, were designed for use in institutions, especially hospitals even though the actual use of the wheelchairs is in daily life. Such wheelchairs have many problems including:
(a) Inappropriate size
(b) Difficulty of controlling the chairs
(c) Poor facility for transferring in and out of the chairs
(d) High cost
(e) Unsuitability for rural use
(f) Lack of durability
(g) Difficulty and expense of repairs.
Orthoses
Orthoses are also known as calipers or braces. Although a brace is generally considered to be larger than a caliper, the two terms are often used interchangeably. This review uses only the more general term orthosis to avoid confusion.
Orthoses have two major purposes: first, to support or maintain a weak limb; and second, to help prevent or correct future deformities and contractures.
Only a few developing countries of the ESCAP region have paid substantial attention to the production of orthoses, in spite of large numbers requiring them. India has addressed the need for orthoses in response to the consequences of polio among many people. In those countries which produce orthoses, manufacturing capacities are not completely used.
A combination of hip knee ankle foot orthosis (HKAFO) and crutches has been used effectively by the Christian Medical College in Vellore, India, for rehabilitating paraplegic people in their own village surroundings (see Field Visit Notes in Madras Workshop Proceedings). Unlike most wheelchairs, this combination permits them to work in the field and thus remain productive members of their families, as well as allowing for regular exercise.
Metallic orthoses are the most common type of orthosis in developing countries of the ESCAP region. Conventional metal lower-limb orthoses require the use of special shoes. These shoes are user-specific, so full orthoses can only be produced at a clinic or hospital with trained prosthetic and orthotic technicians. The special leather shoes required are made in the rehabilitation workshops to suit the size and condition of the user's foot. For example, the inside height of the shoe may have to be increased to account for limb shortening.
Advantage:
Highly effective in curing the disease
Reduces the period of treatment
Well accepted by patients
Easy to apply in the field
Prevents development of drug resistance
Interrupts transmission of infection
Reduces risk of relapse
Prevents disabilities
Improves community attitude
Highly effective in curing the disease
Reduces the period of treatment
Well accepted by patients
Easy to apply in the field
Prevents development of drug resistance
Interrupts transmission of infection
Reduces risk of relapse
Prevents disabilities
Improves community attitude
Limitations:
1) Recharging.
2) Minimum one finger required.
3) Third motion of ginger is missing.
1) Recharging.
2) Minimum one finger required.
3) Third motion of ginger is missing.
Conclusion:
While the elimination target has been reached in most countries, and substantial benefits (including the universal availability of MDT without charge to the patient) have occurred through the World Health Organization Leprosy Elimination Program, the available evidence suggests that the underlying trends in incidence of the disease have been only minimally affected. It is also apparent that trends in incidence differ significantly in different parts of the world, for reasons that are not understood.
Further progress toward eradicating leprosy is dependent on a better understanding of the transmission of the disease and new tools with which to interrupt it. The tools being developed at present include
(1) new diagnostic and epidemiologic tools that will be able to show which individuals in contact with the disease have been infected and the origin of the infection.
(2) better chemoprophylactic regimens, although long-term efficacy may be an elusive goal.
(3) effective immunotherapeutic/immunoprophylactic agents, which, although more costly to develop and deploy, may overcome some of the potential obstacles to a successful chemoprophylactic regimen.
While the elimination target has been reached in most countries, and substantial benefits (including the universal availability of MDT without charge to the patient) have occurred through the World Health Organization Leprosy Elimination Program, the available evidence suggests that the underlying trends in incidence of the disease have been only minimally affected. It is also apparent that trends in incidence differ significantly in different parts of the world, for reasons that are not understood.
Further progress toward eradicating leprosy is dependent on a better understanding of the transmission of the disease and new tools with which to interrupt it. The tools being developed at present include
(1) new diagnostic and epidemiologic tools that will be able to show which individuals in contact with the disease have been infected and the origin of the infection.
(2) better chemoprophylactic regimens, although long-term efficacy may be an elusive goal.
(3) effective immunotherapeutic/immunoprophylactic agents, which, although more costly to develop and deploy, may overcome some of the potential obstacles to a successful chemoprophylactic regimen.
Reference:
1. Hansen GA. Causes of leprosy (Spedalskhedens aarsager). Translated and reprinted from the original Norwegian, first published in Norwegian in 1874. Int J Lepr. 1955;23:307–9.
2. Britton WJ, Lockwood DN. Leprosy. Lancet. 2004;363:1209–19. [PubMed]
3. Meima A, Gupte MD, van Oortmarssen GJ, Habbema JD. SIMLEP: a simulation model for leprosy transmission and control. Int J Lepr Other Mycobact Dis. 1999;67:215–36
1. Hansen GA. Causes of leprosy (Spedalskhedens aarsager). Translated and reprinted from the original Norwegian, first published in Norwegian in 1874. Int J Lepr. 1955;23:307–9.
2. Britton WJ, Lockwood DN. Leprosy. Lancet. 2004;363:1209–19. [PubMed]
3. Meima A, Gupte MD, van Oortmarssen GJ, Habbema JD. SIMLEP: a simulation model for leprosy transmission and control. Int J Lepr Other Mycobact Dis. 1999;67:215–36
#include <Servo.h>
Servo myservo; // create servo object to control a servo
Servo myservo1; // create servo object to control a servo
int val=0; // variable to read the value from the analog pin
int val1=0; // variable to read the value from the analog pin
int sensorValue = 0;
int tmp=0;
int i=0;
int buttonState = LOW;
void setup()
{
pinMode(19, INPUT);
myservo.attach(9); // attaches the servo on pin 9 to the servo object
myservo1.attach(10); // attaches the servo on pin 9 to the servo object
myservo.write(val); // sets the servo position according to the scaled value
myservo1.write(val1); // sets the servo position according to the scaled value
tmp=analogRead(A1);
for(i=0;i<1000;i++)
{
sensorValue = analogRead(A1);
tmp=(tmp+sensorValue)/2;
}
Serial.begin(9600);
}
void loop()
{
sensorValue = analogRead(A1);
val=abs(round((tmp-sensorValue)/3));
myservo.write(val);
delay(100); // sets the servo position according to the scaled value
buttonState = digitalRead(19);
if(buttonState==HIGH)
{
val1=val1+1;
if(val1<90)
{
myservo1.write(val1);
delay(50);
}
else
{
val1=90;
}
}
else
{
val1=val1-1;
if(val1>0)
{
myservo1.write(val1);
delay(50);
}
else
{
val1=0;
}
}
Serial.println(tmp);
Serial.println(val);
Serial.println(val1);
}
Servo myservo; // create servo object to control a servo
Servo myservo1; // create servo object to control a servo
int val=0; // variable to read the value from the analog pin
int val1=0; // variable to read the value from the analog pin
int sensorValue = 0;
int tmp=0;
int i=0;
int buttonState = LOW;
void setup()
{
pinMode(19, INPUT);
myservo.attach(9); // attaches the servo on pin 9 to the servo object
myservo1.attach(10); // attaches the servo on pin 9 to the servo object
myservo.write(val); // sets the servo position according to the scaled value
myservo1.write(val1); // sets the servo position according to the scaled value
tmp=analogRead(A1);
for(i=0;i<1000;i++)
{
sensorValue = analogRead(A1);
tmp=(tmp+sensorValue)/2;
}
Serial.begin(9600);
}
void loop()
{
sensorValue = analogRead(A1);
val=abs(round((tmp-sensorValue)/3));
myservo.write(val);
delay(100); // sets the servo position according to the scaled value
buttonState = digitalRead(19);
if(buttonState==HIGH)
{
val1=val1+1;
if(val1<90)
{
myservo1.write(val1);
delay(50);
}
else
{
val1=90;
}
}
else
{
val1=val1-1;
if(val1>0)
{
myservo1.write(val1);
delay(50);
}
else
{
val1=0;
}
}
Serial.println(tmp);
Serial.println(val);
Serial.println(val1);
}
Circuit diagram:-