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This paper describes the use of a neonatal sphygmomanometer cuff as a simple, inexpensive pinch meter. Normal values for key pinch, pulp pinch and side pinch in the dominant hand of healthy Nepali people are provided. The pinch meter was also used to test pinch strength in hands affected by leprosy and normal hands. Some patients with leprosy who have no objective weakness on voluntary muscle testing (VMT) have less pinch strength than people without leprosy. The pinch meter is a useful tool for the early detection of motor function loss.

In the correction of lagophthalmos due to leprosy neuritis temporalis muscle transfer (TMT) is used to provide a motor to assist in lid closure. This study of TMT in 51 eyes was carried out to assess the effectiveness of TMT in achieving lid closure and corneal protection. The average lid gap preoperatively on light closure was 7.3 mm which was reduced to 3.2 mm on final follow-up. The average lid gap pre-operatively on tight closure was 5.3 mm which was reduced to 0.4 mm at final follow-up. It is possible to train patients with partial or total anesthesia of the cornea in a visual THINK-BLINK reflex. The common complications encountered were ectropion in 6 eyes (12%) and ptosis in 3 eyes (6%).

Squamous cell carcinoma (SCC) of the foot is a rare sequelae of chronic ulceration secondary to leprosy neuropathy. Most of the tumours are relatively slow growing and tend to metastasize late. Survival after local excision is generally good. In this series of 17 patients so far there have been 3 deaths attributable to SCC, all of whom presented with locally advanced tumours and lymph node metastasis.

In the correction of footdrop due to leprosy neuritis the tibialis posterior muscle is re-routed and used to provide dorsiflexion of the foot. This study of tibialis posterior transfer was carried out to compare the results of the circumtibial and interosseous routes. There is no significant difference in the range of motion between either route through the range of the interosseous route is more functional (better dorsiflexion). The interosseous route is preferable as this results in a significantly lower incidence of recurrent inversion deformity of the foot at long-term follow-up when compared with the circumtibial route.

Many leprosy patients treated with multidrug therapy (MDT) had previously received dapsone (DDS) monotherapy for many years. We report here 2 such patients treated with modified paucibacillary MDT composed of rifampicin and DDS who subsequently relapsed with multibacillary leprosy 5 and 6 years after release from treatment. Isolates of Mycobacterium leprae from both patients were resistant to DDS but sensitive to rifampicin, suggesting that the relapses were caused by rifampicin sensitive 'persister' organisms. The implications of this for surveillance of patients released from treatment (RFT) and the management of relapsed patients is discussed.

This study assessed the causes, duration and site of hand wounds seen among patients in order to try and improve the delivery of self-care teaching to patients with anaesthetic hands. Seventy-seven patients with 102 affected hand surfaces were assessed. The commonest cause was a burn from a tea glass. The average duration of the wound was 2 weeks. Most patients had a single current wound and 62% of wounds were on the palmar surface.

This study was carried out to assess the role PGL-1 antibodies may have to play in assisting with early diagnosis in close contacts of leprosy patients. Blood samples were collected from patients and contacts. It was found that 6.9% of index cases and 1% of healthy contacts were positive for PGL-1 antibody. None of the healthy contacts developed clinical leprosy and all had become seronegative at follow-up. We conclude that screening for PGL-1 antibodies has a limited role in the screening of healthy contacts and may not be of use in low endemic areas.