Some factors associated with outcome of hospitalized russell's viper bite patients

Most of the Russell's viper patients with severe envenomation development oliguric acute renal failure. Majority of these patients failed to respond to conservative medical treaatment and required peritoneal dialysis (PD) for their survial. Some of them expired even after peritoned dialysis. In this study,some factors associated with development of acute renal failure, PD requirement and final outcomes i.e. recovered or expired, in the proven Russell's viper bitevictims admitted to the Thingangyun Sanpya Hospital were determined. It was found that the prognosis of these patients was apparently related to the time intervals between: the bite and receiving anti-venom, the bite and hospitalization, and the bite and treatment with peritoneal dialysis. It is suggested that antivenom should be administered within 2 hours and the victims hospitalized within 24 hours after the bite. Besides, peritoneal dialysis should be regarded as a lifesaaving measure for Russell's viper bite patients with oliguric acute renal failure and instituted as early as possible i.e. within 4 days after the bite.

Situation analysis of plasma collected for the production of DMR Hepatitis B vaccine

The Department of Medical Research (DMR) has been producing a safe and effective plasma derived hepatitis B (HB) vaccine since 1997 to meet the criteria of quality control tests recommended by the WHO. The production of this HBvaccine requires the HBs antigen (Ag) pasitive blood as raw material which has been collected from blood banks of the various hospitals in Yangon area. Among these collected blood bottles, only those with high HBsAg titre were pooled and purified for further manufacturing process. In this study, HBsAg titre of the blood bottles collected during the year 1992, 1993,1999 and 2000, and those used for production of various batches of HB vaccine were determined and compared. It was found that the quantities of blood bottles available for HB vaccine production and their HBsAg titres have been apparently reduced in the last two years. This may affect the production capacity of the vaccine. This could be one of the major obstacles ofr the large scale production of the plasma-derived HB vaccine tho meet the requirement of Extended Program of Immumization (EPI) in the near future. To fulfil this requirement, several solutions have been considered and discussed in this study.

Studies on the stability of DMR hepatitis B vaccine

The stability of the DMR hepatitis B vaccine at 4C and room temperature has been followed over a period of one year by monitoring its physical, chemical and biological characteristics bimonthly starting from February 1996. The pH and protein content of the vaccine did not change for both storage conditions throughout the study. The vaccines were found to be sterile and free from pyrogens and passed the general safety test on mice. The HBsAg titer started to decline after eight months of storage at 4C and after 10 days of storage at room temperature. However, the HBsAg adsorption rate to the adjuvant remained over 95 per cent for both storage conditions.

Effectiveness of sodium bisulfite on the stability of Russell's viper (Daboia russelli siamensis) venom toxoid under various storage conditions

Crude Russell's viper venom toxoid was prepred by slow and step-wise formalinization to a final concentration of 0.8 per cent formalin. Then 35 per cent sodium bisulfite was added to half volume of the toxoid. Two types of toxoid were stored at different storage temperatures. At two monthoy interval, the immunogenicity of these toxoid were tested in mice. The antibody levels in immunized mice were measured by ELISA. The toxoid with sodium bisulfite was more immunogenic than the toxoid without it. Therefore the reversion of formaldehyde lindage during storage was less in toxoid which contained sodium bisulfite.

Role of intramuscular anti-snake venom administration as a first-aid measure in the field

Effectiveness of intramuscular (i.m) anti-snake venom (ASV) administration immediately after bite as a first-aid measure in the field followed by standard hospital treatment in the management of Russell's viper bite patients was studied in 12 victims and was compared with that of standard hospital management alone in 82 victims. there was a marked reduction in the number of patients with systemic envenomation ie. disseminated intravascular coagulation (DIC), clinical proteinuria, oliguric acute renal failure (ARF), systemic bleeding, hypotension and fatality rate of Russell's viper bite victims who received initial i.m ASV prior to the hospitalization compared with those who did not. It is recommended that i.m ASV could be administered to the Russell's viper bite patients at the site of incident as a first-aid method in places where no facility for giving intravenous ASV therapy prior to hospitalization.

Clinical trial to determine the hypouricaemic potential of Zizyphus jujuba kernel

Clinical trial to determine the therapeutic efficacy of a traditional herbal drug, Zizyphus jujuba kernel reputed for anti-gout action was carried out on 20 healthy volunteers. Using a cross-over design, the subjects were divided into two groups. Group I received standard hypouricaemic drug, allopurinol and Group II was administered Z. jujuba dernel for 14 days. after a wash-out period of another 7 days, the drugs were crossed over between the two groups in which Group I was administered Z. jujuba kernel and Group II was administered allopurinol for further 14 days again. Blood and urine samples of these subjects were taken at 5 days' intervals throughout the study period for determination of uric acid, creatinine and liver function tests. It was found that Z. jujuba shows no abnormalities on kidney and liver function tests. It also possesses neither hypouricaemic nor uricosuric actions.

Clinical trial of intramuscular anti-snake venom administration as a first aid measure in the field in the management of Russell's viper bite patients.

Efficacy of intramuscular anti-snake venom administration immediately after bite as a first aid measure in the field followed by standard hospital management versus standard hospital management alone in the therapy of Russell's viper bite patients was studied. There was a definite reduction in the number of patients with systemic envenomation, complications following disseminated intravascular coagulation and in fatality rate of Russell's viper bite victims who had received first aid intramuscular anti-snake venom prior to hospitalization when compared with those who had not.

Changes in serum aldosterone levels in response to malnutrition and diarrhoea

The study included 31 children (age 1 to 5 years) who were hospitalized for malnutrition, malnutrition with diarrhoea and acute diarrhoea of less than 48 hrs duration. The controls, consisted of 6 children from the same locality as patients, were apparently healthy and in the same age group. Serum chloride tend to increase in the patients and the increase was more pronounced in the group suffering from both malnutrition and diarrhoea. On the other hand, serum potassium tend to decrease and the decreases were significant in the groups having malnutrition. Serum aldosterone levels were raised in all the three groups of patients namely malnutrition, diarrhoea and malnutrition associated diarrhoea when compared with the control. The increase was still observed even after exclusion of the subjects whose ages lied within the first 1 year of the life for whom the serum aldosterone levels were found to have a sharp rise.

Effect of cholera toxin on intestinal lysosomal enzymes in the suckling rat

Lysosomal function, namely lysosomal enzyme activities and lysosomal membrane integrities were investigated in suckling rats which received cholera toxin intragastrically and in shamoperated controls suing two typical Lysosomal enzymes, acid phosphatase and cathepsin D. It was found that the maximal specific activities of both the enzymes were decreased in the infected group when compared with the control suggesting a reduction in the ability of intracellular digestion by lysosome. On the other hand, the value of the ratio between maximal and basal activity (an expression of the degree of retention of enzyme by lysosome or lysosomal membrane stability ) of acid phosphatase was significantly increased suggesting lesser extent of leakage of the enzyme into cytoplasm when compared with the control. However, there was no difference in the lysosomal membrane stability when measured in terms of cathepsin D. This discrepancy between the two enzymes was explained by their latencies.

Effect of dietary iron defiency on some enzyme levels in growing rats

Primary derangement in the levels of iron enzymes in iron deficiency have been reported by various workers. The present study was undertaken to deternime whether secondary derangements in the levels of other non-iron enzymes could accompany in the primary derangement. Three groups of rats were fed synthetic diet for 85 days. Group I received the iron deficient diet ad libitum, group II was pair fed with group I but received supplemented iron and group III received the iron supplemented diet ad libitum. The following were the mean values of some biological data at time of sacrifice. Body weight of group I, II and III were 82.5 g, 96.5 g, 108.5 g and haemoglobin , 7.2 g

, 14,1 g

and 14.8 g

respectively. Enzyme levels were measured in different tissues of the three groups of rats. The levels of hepatic iron enzyme, catalase, as well as non-iron enzymes, glucose 6 phosphate dehydrogenase (G6PD), glutamate dehydrogenase (GD) and malate dehydrogenase (MD) were significantly decreased in the iron deficient group. The decrease was more pronounced in the levels of catalase. However, lactate dehydrogenase did not show any significant changes. The enzymes were unaffected in kidneys and spleen except catalase, which decreased in group I.

Effect of enterotoxingenic Escherichia coli heat labile toxin on intestinal enzymes in rat

Differential study of the maker enzyme level for intracellular organelles in intestinal mucosa and muscularis layer following E. coli labile toxin (LT) administration to rat revealed that there were no changes in the enzyme levels in mucosa but some changes (a degree of acid phophatase and an increase of proteinase) in muscularis layer. The results suggest that the LT, being a high molecular weight toxin, may not be easily invaginated into intestinal epithelial cells and interact with the subcellular particles. The changes in the enzyme activities observed in the muscularis layer could be the abnormal metabolic consequences of prolonged hypersecretion produced by LT.

Normal levels of SGO-T and SGP-T in healty Burmese adults

A variable range of normal SGO-T and SGP-T and activities have beenreported by various authors. With the colorimetric method of Reitman and Frankelthe normal levels of SGO-T and SGP-T in 120 Burmese adults were studied. Specimens for analysis were obtained from healthy active blood donors and factory workers. The results were analysed statistically. The mean SGO-T was 23.6+-4.6R-F units, with a normal range of 14.4 to 32.8 R-F units, while that of the SGP-T was 18.6+-1.4 R-F units, with a normal range of 9.8 to 27.4 R-F units. Although the sex difference in SGO-T shows statistical significance,no significant difference was found between the two sexes in SGP-T. The correlation coefficients show thatthere is no relation of age either to SGO-T activity or SGP-T activity. Both distributions of SGO-T and SGP-T follow a normal distribution.

Nitrogen partition in urine of Burmese subjects

The present study aims at establishing a standard of reference on the different constitutents of urinary nitrogen for Burmese subjects. Twenty-foru-hour urine samples of 100 Burmese subjects were collected and analysed for volume, specific gravity, pH, titratable acidity, total nitrogen, urea nitrogen, uric acid, ammonia nitrogen, aminoacid nitrogen and creatinine. Creatinine coefficient and the undertermined nitrogen were also calculated. The age, body weight and height of the subjects were recorded and their body-surface area measured. The total nitrogen, urea nitrogen and the urea nitrogen as percentage of total nitrogen was much lower than those of Europeans and Americans but paralleled those of Indians. This may be due to the greater protein intake by the Europeans and Americans than by the Indians and the Burmese.