Gaps and challenges to integrating diabetes care in Myanmar.

In common with other low-income countries, diabetes is a growing challenge for Myanmar. Gaps and challenges exist in political commitment, policy development, the health system, treatment-seeking behaviour and the role of traditional medicine. National policies aimed at prevention – such as to promote healthy food, create a healthy environment conducive to increased physical activity, restrict marketing of unhealthy food, and initiate mass awareness-raising programmes – need to be strengthened. Moreover, existing initiatives for prevention of noncommunicabledisease (NCD) are channelled vertically rather than being horizontally integrated. Primary health care is traditionally orientated more towards prevention of infectious diseases and staff often lack training in prevention and control of NCDs. Capacitybuilding activities have been modest to date, and retaining trained health workers in diabetes-oriented activities is a challenge. The World Health Organization Package of Essential Noncommunicable (PEN) disease interventions for primary health care in low-resource settings has been piloted in Yangon Region and countrywide expansion awaits ministerial approval. Recently, the Myanmar Diabetes Care Model was proposed by the Myanmar Diabetes Association, with the aims of both bridging the gap in diabetes care between rural and urban areas and strengthening care at the secondary and tertiary levels. However, implementation will require policy development for essential drugs and equipment, capacity-strengthening of health-care workers, and an appropriate referral and health-information system.

In vitro antimicrobial activity of the leaves of KAT-SE-NAE Plant (Urena lobata Linn) against some strains of micro-organisms causing skin infections.

The objective of the study was to evaluate scientifi cally the in-vitro antimicrobial activity of leaves of Kat-Se-Nae plant (Urena lobata Linn). Dried powder of the leaves of Kat-Se-Nae (Urena lobata Linn) was obtained by extracting with water, petroleum ether and ethyl acetate. Screening for antimicrobial activity of all the extracts were done by Agar Disc Diffusion Technique on seven control strains: Escherichia coli (0157) and American Type Culture Collections (ATCC): Bacillus cereus, Bacillus subtilis, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, and Candida albicans which are common causal agents for skin infections. Ciprofl oxacin and Norfl oxacin were used as control antibiotics. Petroleum ether extract showed small zone of inhibition on Escherichia coli (0157) (11 ± 1.000 mm) and Staphylococcus aureus (13 ± 1.732 mm) but no signifi cant activity on other tested organisms. Ethyl acetate extract showed signifi cant zone of inhibition (20 ± 2.000mm) against Staphylococcus aureus comparable to that of control drug (Ciprofl oxacin) (15 mm) but had no activity on other tested organisms. Watery extract had no antimicrobial activity on any of the tested organisms. Minimum Inhibitory Concentration (MIC) of the active extracts already shown to have antimicrobial activity on Staphylococcus aureus, and Escherichia coli (0157) was done by Tube Dilution Method. MIC of petroleum ether extract on Staphylococcus aureus and Escherichia coli was more than 5 mg/mL and that of ethyl acetate extract on Staphylococcus aureus was more than 1.25 mg/mL. Acute toxicity studies of the watery extracts were performed by using the albino mice. The results indicated that there was no lethality up to 8 g/kg body weight. The phytochemical analysis of watery extracts and dried leaves powder of Kat-Se-Nae (Urena lobata Linn) showed that they have alkaloid, steroid, saponin, tannin, carbohydrate, glycoside, reducing sugar, fl avonoid and amino acid, but lack of cyanogenic glycoside and polyphenol. Based on the above fi ndings, it can be concluded that ethyl acetate extract of the leaves of Kat-Se-Nae (Urena lobata Linn) may have useful antimicrobial activity in skin infections caused by Staphylococcus aureus.

Calcium Intake among Myanmar Residing in Bago, Kayin, and Yangon Areas

A cross-sectional survey combined with 24-hour dietary recall and food diary was undertaken to assess the calcium intake of the Myanmar population. The study was conducted from November 2003 to October 2005. A total of 886 subjects of both sexes aged above 2 years from three States and Divisions (Bago, Kayin, and Yangon) of Myanmar were included in the study. The major measures were mean daily calcium intake (mg/day) and major sources of calcium in the diet. Overall mean calcium intake was 197+13mg/day (2-9 years), 421+2mg/day (10-19 years), 399+21 mg/day (20-49 years), and 383+25mg/day (>50 years) for males, while the corresponding values for females were 207+17 mg/day, 366+19 mg/day, 387+16 mg/day, and 327 +19 mg/day. Calcium intake was less than 80% of the recommended dietary allowances (RDA) for Myanmar for ages 2-9 years and 10-29 years in all the study areas, and for the 50 years and above age group in Yangon. Fish paste was found to be the major source of calcium. Milk and milk products contributed very little to total calcium intake, contributing 2.1% for residents in Yangon, 5.1% in Pa-an and none in Bago. Consumption of calciumrich foods, particularly milk and milk products, should be encouraged among the Myanmar people. Towards this end, appropriate nutrition education materials should be developed for promotional purposes.

Prevalence trend of youth smoking in 29 Townships of Bago, Magwe and Mandalay Divisions, September 1999

In 1999 September a cross-sectional analytic study was conducted in 29 townships of Mandalay. Magwe and Bago divisions of Myanmar. Randomly selected 2074 urban and 1781 rural 15-24 year old youths from 4808 households were interviewed. 5.6 per cent of females and 67.6 per cent of male youths reported as current smokers. At age 14, 37 per cent of the boys smoked. At age 17, more than half of males smoked, and, at age 22 and older, nearly 80 per cent of them were already smoking. Girls started smoking later than boys. Only 1 per cent of 15-year-old girls smoked. When the females reached age 22-24, approximately 10 per cent of them smoked. Comparing different youth cohorts, the younger started smoking earlier than the older youths. Median age of starting tobacco smoking for the 16 year old males was 16; that was approximately 3 years earlier than the median age of smoking for the 24 years old males.

A study on knowledge regarding HIV/AIDS, their sexual practices and seroprevalence of syphilis/HIV among taxi-drivers in Yangon

Aim-To study a knowledge regarding HIV AIDS, sexual practices and sero-prevalences of syphilis/HIV among taxi-drivers. A cross sectional study on 120 respondants of taxi-drivers from Yangon Division Buses Control Committee was carried out by using the systematic random sampling method with self-administered questionnaire. Majority of taxi-drivers have better knowledge on mode of transmission and little knowledge on ways which do not transmit HIV. Most of them did not know proper use of condom. No case of HIV sero-positive were detected at the time of study.

Effect of Azadirachta indica neem seed kernel extracts on Anopheles dirus mosquitoes

Neem oil (seed kernel extract) produced a strong repellent action on An. dirus mosquitoes (the major vector of malaria) in Myanmar even at concentrations as low as 0.5 and 1.0 percent. At a concentration of 2 percent no anopheles biting and the protection provided was 100 percent during 10-12 hrs periods. The larvicidal effects of neem oil on An. dirus (larvae) were determined by using 3rd instar and above. The LC90 and LC50 were found to be one percent and 0.45-0.5 percent respectively, The residual effect of neem oil under laboratory condition with 2 and 4 percent persisted ca 72+/-5 hrs. Moreover, under laboratory condition with 2 and 4 percent, the ovicidal effect was found to be 100 percent control.

The association between faecal leukocytes and pathogens present in stool of children with diarrhoea and dysentery

A total of 378 cases of children with diarrhoea and dysentery admitted to Yangon Children's Hospital from March to mid-September, 1996 were studied. The study population comprised 233 males and 145 females. Faecal leukocytes were identified under a high power field microscope by wet mounting of methylene blue staining method. Those cells clearly identified with either round nucleus or as polymorphonuclear were noted and degenerated cells that could not be clearly identified were ignored. The bacterial pathogens and protozoal pthogens were identified by standard methods. Faecal leukocytes were present in 31.2 percent of total cases (diarrhoea 28.5 percent, dysentery 45.8 percent). The association between the presence of faecal leukocytes and isolated pathogens from the stools was analysed. It was found that faecal leukocytes were seen in stools which were associated with Shigella (25 percent), Shigella and Entamoeba histolytica (71.4 percent), Entamoeba histolytica (29.6 percent), enteropathogenic Escherichia coli and Entamoeba histolytica (41.7 per cent), enteropathogenic Escherichia coli (9.8 per cent ), Klebsiella spp. (50 per cent ) and Vibrios (50 per cent ).

Importance of plasma protein binding of antituberculosis drugs on the response to shortcourse chemotherapy

Recently, there has been an increasing concern over the consequences of altered plasma protein binding of drugs in disease states, malnutrition and concomittant drug use on the therapeutic efficacy and toxicity of many antituberculous drugs. The increasing awareness of the problems associated with altered plasma protein binding necessitates studying the plasma protein binding profile of drugs used in short- course therapy for tuberculosis since such a study has not been done regardless of the fact that malnutrition and multiple drug use is often unavoidable and where drug resistance and hepatotoxicity has been a major issue. A total of 5 clinically healthy volunteers and 18 smear-positive tuberculosis patients, who were undertaking a short-course chemotherapy at the Union Tuberculosis Institute, were recruited and the plasma protein level and their binding property to rifampicin, isonazid and pyrazinamide at steary-state were studied. The findings showed that although the total plasma protein level was not significantly reduced, there is decrease in the mean albumin level in relation to the globulin level in tuberculous patients. The protein binding profile showed rifampicin to be highly bound (74-87 per cent) and pyrazinamide to be moderately bound (22-40 per cent ) to plasma proteins but no significant binding was seen with isoniazid (0.7-2.4 per cent ). All 3 drugs achieved adequate serum concentration well above the MIC throughout the study accompanied by rapid clinical improment and sputum conversion to negativity in 88.9 per cent of patients within one month of treatment. No sign of hepatic toxicity was seen in the study. Two patients (11.1 per cent ) had relapse after completion of therapy. The study highlights the importance of plasma protein binding of drugs and its influence on the metabolism and interaction between drugs used concomitantly in short-course chemotherapy. The study also showed that addition of pyrazinamide in short-course chemotherapy is very effective and well tolerated but increase in dosage of pyrazinamide during the twice-weekly phase may be necessary to prevent relapse.

Shigellosis among children attending the paediatric wards of hospitals in suburban areas

A total of 55 cases of children with dysentery admitted to the Defence Services Obstetric, Gynaecology and Children Hospital and North Okkalapa General Hospital were included in this study. It was found that 49.1 per cent of the children were suffering from shigella bacillary dysentery. The Shigella spp. isolated were: Shigella flexneri (44.4 per cent), Shigella dysenteriae (29.6 per cent), Shigella boydii (22.2 per cent) and Shigella sonnei (3.7 per cent). the distribution of Shigella spp. among the different age groups were 42.9 per cent in the age group of less than 6 months, 40 per cent in 6 to 12 months, 55 per cent in 13 to 24 months and 66.7 per cent in 25 to 60 months. Antibiotic susceptibility test revealed that these shigellae were resistant to ampicillin (84 per cent), chloramphenicol (76 per cent), streptomycin (84 per cent), tetracycline (64 per cent) and septrin (72 per cent); were fully sensitive to amikacin, gentamycin, netilmicin, norfloxacin and were less sensitive to cephalothin (76 per cent) and furazolidone (72 per cent).

Comparative multiple-dose pharmacokinetics of chloroquine in P. vivax malaria patients and healthy volunteers

Recent evidence of the emergence of resistance of P. vivax to chloroquine in Myanmar has increased the importance and urgency of understanding the cause of resistance as well as the need for devising the strategies to limit its spread. A comparative multiple-dose pharmacokinetic study was conducted on 5 clinically healthy volunteers and 10 malaria patients with P. vivax, admitted to the No. 2 Miliysty Hospital, Yangon, with the object to study whether there is any pharmacokinetic-dynamic relationship underlying the response of patients to standard chloroquine (1500 mg given over 3 days) therapy. Serum chloroquine concentrations reached well above the MIC level in all subjects with the patients' serum concentration (both peak and trough) and the AUC being significantly (2-3 times) higher than jnormal volunteers (p < 0.02). Both the clearance and the volume of distribution were also significantly lower in the malaria patients as compared to the healthy volunteers (p < 0.05). The elimination half-life (T1/2el) was shorter in malaria patients but the difference was not statistically significant. No significant difference was seen with other pharmacokinetic parameters, between normal volunteers and patients and between patients who do and do not recrudescenced. The study supports the emergence of chloroquine-resistant P. vivax in Myanmar and also excludes the possibility of apparent resistance due to pharmacokinetic causes, especially reduced bioavailability.

Potential use of Kyethingha-thee (Momordica charantia L. fruit) in the treatment of maturity onset diabetes mellitus

The hypoglycemic efficacy of Kyethingha-thee dired powder capsule was conducted on five uncomplicated type II non insulin dependent diabetes mellitus patients, who were admitted to the No. 2 Military Hospital, Yangon. Preliminary study revealed that it has hypoglycaemic effect with minimum effective dose of 3 grams for each patient and the time of maximum effect was 4 to 6 hours respectively. Kyethingha-thee was found to be 79.94 percent as effective as tolbutamide and 154.53 percent as effective as TMF 32. So far no adverse side effects were observed in any of these patients.

The association of enteropathogenic Escherichia coli (EPEC) and gastroenteritis

A total of 619 cases of adults with gastroenteritis admitted to Yangon General Hospital, Workers' Hospital and Infectious Diseases Hospital were included in this study. It was observed that 33 percent were suffering from gastroenteritis due to enteropathogenic Escherichia coli (EPEC). The most prominent EPEC sero-groups encoutered were 01, 026, 055, 086, 0114, 0125 and 0128. The antibiotic sensitivity pattern showed that 87 percent of enteropathogenic Escherichia coli (EPEC) were resistant to ampicillin, 58 percent to chloramphenicol, 49 percent to streptomycin, 55 percent to benzyl penicillin, 44 percent and 21 percent respectively to tetracyclline and septrin. They were all sensitive to nalidixic acid but 97 percent to gentamicin, 96 percent to sisomycin and 95 percent to tobramycin respectively.

Giardia lamblia infection in children attending diarrhoeal unit of Yangon Children Hospital

A hospital-based study was conducted in Yangon from June to November 1994 to examine the importance of a protozoal pathogen Giardia lamblia as one of the causal organismsin acute diarrhoeal disease in children. This study was also carried out to observe the effectiveness of metronidazole on them. The stool samples were collected from diarrhoeal unit of Yangon Children Hospital. A total of 308 stool samples were examined. Giardia lamblia cysts (or) trophozoites were examined under ordinary microscope. If they were present in the stool, the patient was treated with metronidazole and the stool was rechecked again. The results were discussed in this study.

The anti-ulcerogenic activity of Plantago major Linn.

Plantago major Linn. (Ahkyaw-baung-tahtaung; Mann-sote ywet; Htaung-Khaung-pwa; Sai-Kyaw-gyi; Phar-Kyaw-ywet) has long been used in official folk medicine for various purposes. Ethnobotanic field survey in Russia has shown that P. major (Plantaginaceae) can be used in the treatment of acid-peptic gastritis. So the plant was investigated for the anti-peptic ulcer activity by the previously standardized method using cimetidine. The aqueous extract of air-dried leaves of the plant was found to have a significant anti-ulcerogenic activity against aspirin-induced ulceration in in-vivo rat model (p < 0.005). The reduced ulcer severity was seen by the ulcer index of 8.4 + 1.0 in the treated group when compared to the ulcer index of 20.6 + 3.5 in the untreated group, showing a 59 percent healing activity of the ulcers.

Clinical trial to compare the analgesic efficacy of selected Traditional Medicine Formulations (TMF-06,-24,-25) on experimentally induced pain in human subjects

Forty clinically healthy volunteers participated in the study aimed to evaluate the therapeutic efficacy of three Traditional Medicine Formulations (TMF-06, TMF-24 and TMF-25) on experimentally-induced cold compressor stimulation pain. The rationale underlying the study is that these formulations have beenproduced locally and used extensively as standard analgesics for pain relief at the Traditional Medicine Hospitals and dispensaries as well as through self-medication over-the-counter-durgs by the local community for many years but has yet received little investigative attention regarding efficacy and sefety. The study was a placebo controlled double-blind, complete cross-over single dose design using aspirin (acetyl salicylate) as positive standard and was evaluated on three basic pain response parameters namely, pain threshold, pain tolerance and pain sensitivity range. All three formulations showed a significant analgesic efficacy (p < 0.01) when compared to placebo (TMF-25 > TMF-24 > TMF-60). No, adverse effects were noted even when given at maximum recomended dose. It was concluded dose. It was concluded that the three TMFs can be used as an alternative to aspirin for the symptomatic relief of mild to moderate pain.

Anti-oedema activity of Nyctanthes arbor-tritis L.,Curcuma longa L. and Plantago major L.

Nyctanthes arbor-tritis Linn. (Seik-balu); Curcuma longa Linn. (Nanwin) and Plantago major Linn. (Ahkyaw-baung-tahtaung; Mann-sote-ywet; Htaung-khaung-pwa and Phar-kyaw-ywet) have long been used in folk medicine as anti-oedema agenta. Experimental evaluation of anti-oedema property of these plants was studied on carrageenan-induced acute oedema in in vivo method using rats. Aqueous extracts of N. arbor-tritis; C. longa and P. major showed a significant anti-oedema activity ( p < 0.005) at a dose of 3 g/kg. Anti-oedema activities of these plant extracts were observed to be 56 + 7.6 percent; 46 + 8.4 percent and 51 + 4.9 percent respectively when compared with that of the control group. Thus, this study has shown that the tested medicinal plants possess anti-oedema activity.

Anthelminthic property of Myanmar pineapple (Nanat) on experimental models

The anthelminthic property of Myanmar pineapple (Ananas sativa L.) juice was investigated by using both in vitro and in vivo test models on Ascaris suum. In the in vitro test model, the pineapple juice, at a concentration of 40-80 mg/ml was found to produce immobilization of the worms leading to death within a 2 day period. In the in vivo test model using pigs, the pineapple fruit, doses as low as 10 g ingested food were found to purge Ascaris suum within 16 hrs of ingestion. The lethal effect was assumed to be due to cuticle digestive effect of bromelain, which is present in an average of 0.29 mg percent in pineapple.