Am. J. Trop. Med. Hyg., 68(6), 2003, pp. 754
Copyright © 2003 by The American Society of Tropical Medicine and Hygiene
CD-ROM REVIEW
CABI PUBLISHING'S TOPICS IN INTERNATIONAL HEALTH: Trachoma
Ann Freeland Fisher, MD
University of Texas Medical Branch
Department of Internal Medicine
Division of Infectious Diseases
301 University BLVD. R. 0435
Galveston, TX 77555
affisher{at}utmb.edu
Trachoma, caused by Chalmydia trachomatis is a serious disease in the poorer sections of the globe that causes significant disability and blindness. It is reported that over 500 million people may be affected, and that Trachoma is the most common etiology of preventable blindness. Trachoma can be readily diagnosed with a clinical exam and assessing environmental factors, thus making screening and treatment possible in many settings where advanced medical facilities may not be available. It is in just such settings that trachoma is endemic, making it imperative that screening and treatment are more widely practiced.
The CD-ROM "Trachoma" by the Wellcome Trust addresses these issues in a concise and readily usable format. The CD-ROM is divided into four interactive tutorials. The first tutorial is entitled "Clinical signs and grading." This section introduces the user to the disease, and then leads into a series of interactive pages regarding eye anatomy. The user learns how to properly examine the eye, with a quiz to assess understanding of key points. "Clinical signs" is an excellent section with very sharp photos illustrating the different stages of trachoma. The WHO grading system is thoroughly reviewed again with interactive pages, succinct definitions, and photos to carefully delineate the separate grades of the disease. At the end of this section the user will be adept at clinical staging. Finally a short section on differential diagnosis discusses differentiation of trachoma versus vernal conjunctivitis.
The second tutorial, entitled "Community assessment and control," begins by addressing the public health issues allowing this disease to perpetuate. The spread of infection by flies and family members, and the environmental factors leading to disease are reviewed. The environmental section has handy interactive mnemonics. The tutorial addresses the important issue of community assessment by offering advice on a community approach, and again utilizing the WHO grading system for triage. Community participation is encouraged with broad categories of simple and readily implemented suggestions utilizing schools, parents, children and local support groups. The section on the control of trachoma goes into great depth on the medical therapy available for each stage of the disease. It discusses medication, including use and contraindications, as well as alternatives and therapies on the horizon.
The third and fourth sections address trichiasis surgery. "Trichiasis surgery, part I" discusses indications and contraindications for surgery. The eye exam is briefly reviewed, this time focusing on factors that triage different surgical candidates. From this point on the tutorials are tailored to those healthcare providers who will be doing surgical intervention within the community. Sterilization/high level disinfection techniques are thoroughly reviewed with multiple reminders regarding the need for aseptic technique. "Trichiasis surgery, part II" guides the practitioner step-by-step through the surgical technique. Difficulties during surgery and post surgical complications are addressed. This CD-ROM has extra features, such as a notepad within the program so the user may jot down things as the tutorial is in session. Also available is a glossary of terms, which for the most part contained all relevant terms. The program itself is simple to operate, although one must scroll back page by page if a mid-tutorial review is desired. This is only a minor inconvenience as the sections are short.
This CD-ROM has a broad audience. The first two tutorials are a quick review or basic learning tool for medical students and clinicians. The public-health professional would also find it useful in planning programs within their areas of operation. The third and fourth tutorials are really for local healthcare providers, already trained in surgical techniques, which wish to implement community-based surgical trachoma treatment. The photographs and drawings are excellent. It is a useful for those involved in health care in areas where trachoma is a problem, as well as an instructive tool for education.
