Scenario of the twins with suspected congenital rubella syndrome (CRS) in Yangon, Myanmar

Rubella is a common cause of childhood rash and fever. Congenital rubella syndrome (CRS) can lead to deafness, heart disease, cataracts, and a variety of other permanent manifestations. In order to identify the disease burden of rubella infection, CRS surveillance among infants in Yangon was conducted for two consecutive years from December 2000 to December 2002, as a WHO-funded study. Among the 13 participating hospitals, the Special Care Baby Unit of the Central Women‘s Hospital in Yangon reported 17 infants with suspected CRS. Interestingly, three sets of twins with suspected CRS were reported. One ml of blood was collected from each infant after obtaining informed consent, then tested for the presence of rubella antibody (Immunoglobulin M and G) by the ELISA method, and for the presence of rubella viral RNA by the RT-PCR method. Furthermore, nucleotide sequencing and genotype identification of samples from two cases with positive rubella RNA were performed. All 3 sets of twins were IgM negative. However, rubella RNA was detected by RT-PCR in twin 1A who showed no obvious clinical signs, and in twin 2B who had patent ductus arteriosus, splenomegaly and hepatomegaly. Nucleotide sequences of PCR positive cases revealed genotype Ia sequences. Twin 2B was identified as having deafness of the left ear on audiometry assessment conducted at 5 years and 4 months of age. Both twins of twin set-2 were IgG positive at age 12 days, but turned out to be negative by the age of 9 months. Both twins of twin set-3 presented with splenomegaly and died before 2 months of age, probably due to other infections. Our findings revealed the different scenario of twins with suspected CRS. It is expected to serve as a valuable addition to the medical literature as there were very few reports on twins with CRS.

Essential element contents of surface and artesian well water in Yangon area

A total of 91 samples of water collected from 18 townships within Yangon area comprising 31 numbers of surface wells and 60 numbers of artesian wells were chemically examined. All samples were determined for their concentrations of elements such as iodine, calcium, magnesium, iron, copper and zinc with the corresponding depths of wells. Average iodine contents of water was found to decrease as the depth of well increased. Magnesium concentration was also observed in the same manner as iodine. Calcium concentration was more in surface well water and no difference among artesian wells water. There was no relationship between calcium concentrations and the depths of the wells.

Renal involvement in viper bite

Acute renal failure in viper bite is sometimes due to prerenal causes and sometimes by renal causes per se. Some facts, however, remain in doubt with regard to renal histological findings and the precise pathogenesis of established ARF. 28 viper bite cases admitted to renal and dialysis unit, Department of Nephrology, Yangon General Hospital, over a period of two years were biopsied and their clinical and biochemical parameters evaluated. This study reveals that ARF in viper bite is attributable to a total nephron failure-a combination of glomerular, tubulointerstitial and vascular nephropathies rather than due simply to acute tubular necrosis. A combination of several different mechanisms may operate in the pathogenesis. The possible pathogenetic mechanisms are being discussed. How different mechanisms operate at different times may call for further sophisticated studies.