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This single disc CD contains ten interactive tutorials covering an extensive range of topics related to clinical leishmaniasis. About 834 images used in the tutorials are provided in a separate library. Topics covered by the tutorials are: The Parasite, Vectors and Hosts, Immunology, Epidemiology, Prevention and Control, Cutaneous Leishmaniasis, Visceral Leishmaniasis and Diagnosis and Treatment. Each consists of approximately 40 or 50 separate slides. A 48-slide Overview tutorial reviews core material from the nine specialized topics. Upon opening the program, the reader is presented with a main menu, providing selections from the tutorials menu, the photo library or an extensive glossary defining terms used in the tutorials.
The tutorials are well written and appropriately illustrated. Within each tutorial, the subject matter is presented in a logical sequence and with sufficient background information to assure coherence with other tutorials. Interactive features include underlined text that can be clicked to open boxes providing greater detail on that subject. For instance, clicking on the term "Chiclero’s ulcer" opens up a box with photographs of ulcerated ears and a description of the term "Chiclero" and the clinical characteristics of this chronic, deforming type of leishmaniasis. Illustrations with yellow borders can also be clicked for commentary. Interspersed through each tutorial are self-assessment tests. Upon selection of an answer, rapid feedback is provided by means of pop-up box and a brief review of the relevant material if the incorrect answer is chosen. A menu bar on the bottom of each page provides access to a search engine, notepad, glossary and table of contents. This format is excellent for either group instruction (via an LCD projector) or for individual education on a personal PC.
This CD is clearly intended for a wide range of audiences. The overview tutorial, for instance, would be very appropriate for medical students, physicians with no previous experience with this disease or other health care professionals or lab technicians planning to work with leishmaniasis. The other nine tutorials are considerably more comprehensive for the indicated subject and seem appropriate for an audience actively involved in clinical care or research with leishmanial diseases. The Immunology tutorial, for instance, starts with a discussion of the importance of cell mediated immunity in intracellular parasitic infection, such as leishmaniasis. This leads to a discussion on T cell subsets, MHC II and MHC I restricted T cell activation and CD4+ subset differentiation along Th1 and Th2 pathways. The production and function of selected cytokines – such as IFNgamma, TNFalpha, IL-10 and IL-4 --are discussed in the context of their importance as mediators of progressive or self-resolving leishmaniasis. The tutorials on Cutaneous and Visceral Leishmaniasis are very comprehensive. The multimedia CD format lends itself well to this disease, as much of the evaluation and diagnosis is visual in nature. In this regard, this is probably the best collection of images of leishmaniasis that I’ve seen in one collection. There is also considerable attention spent on specific patterns of cutaneous disease characteristic of distinct species of leishmania. The tutorials are also up to date. For instance, the new anti-leishmanial agent miltefosine, is included in the list of available agents and is discussed in appropriate detail.
The image library is accessed through a separate main menu. There are separate frames for the illustration and a detailed figure legend, typically consisting of several paragraphs of description. A search feature allows figures to be identified by subject or keywords. Otherwise, the library can be browsed slide-by-slide using forward and reverse buttons. A gallery view option allows up to 24 images to be seen at a time for quicker browsing. Each illustration can be printed. A photodesk utility is used to view expanded versions of each illustration. Figures can also be "tagged" and saved as sets to create custom screen slideshows.
There are weaknesses with this program. For instance, the references provided at the end of each tutorial relies heavily on Leishmania-dedicated textbooks, some of which were unavailable at my institution (which has a major focus on international health) and therefore are likely also inaccessible to the average reader. Some basic content also appears to be missing. For instance, there are no references to viscerotropic leishmaniasis caused by L. tropica and observed during the Gulf War. The tutorial interface has several limitations that are likely to frustrate the student. Only one of the helper applications (glossary, notepad, etc.) can be opened at a time and the program does not allow cut and paste into the notepad. The references cannot be printed directly. This proved particularly annoying when trying to copy down the suggested references at the end of each tutorial. A pen and paper is essential as a low-technology remedy for this.
The setup for the program is relatively easy, consisting of a self-extracting utility that installs the program on the computer’s hard disk. The software is copy-protected, requiring that the CD is in the disk drive. Although listed as compatible with Windows 95, NT, 98 and 2000, I had no problems operating the program with Windows XP. However, it consistently failed to install on a PC operating with Windows 95. Unfortunately, this program is not designed for Macintosh operation, which will be a disappointment for the many academic and student communities already invested in this platform.
Despite these minor problems, I enthusiastically endorse this CD for anyone with a serious interest in the leishmaniasis, especially if they are involved in the frequent education of others in the topics covered by the tutorials.
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