Profile of various idiopathic inflammatory myopathies at two university hospitals in Yangon, Myanmar

@#Objective: to determine the distribution of various idiopathic inflammatory myopathies (IIM) and their profile at the largest university hospitals in Yangon, Myanmar. Method: It was a hospital based prospective study recruiting IIM patients admitted to Neurology and Rheumatology ward over a 1.5 year period from September 2017 to February 2019. Results: Among total 51 IIM patients recruited, 62.7% presented to Neurology ward and 37.3% to Rheumatology ward. Overlap myositis (OM) was the commonest (43%), followed by immune-mediated necrotizing myopathy (IMNM) 27%, dermatomyositis (DM) 24%, polymyositis (PM) 6%. Among OM, anti-synthetase syndrome (ASS) was 23%, and among IMNM, anti-SRP positive was 79%. IMNM and PM patients presented more to neurologists while OM/ASS and DM more to rheumatologists; 82% were females (F:M= 4.6:1). Mean age of onset of myositis was 40.2 + 17.8 years, and duration of symptoms before presentation was 10-3,600 days (shortest in anti-SRP and longest in anti-HMGCR myopathy). Myositis antibodies were positive in 67%. CK range was 40-25,690 U/l, highest in IMNM and lowest in DM. Associated connective tissue diseases among OM in order of descending frequency were 47% systemic lupus erythematosus, 24% Sjogren syndrome, 41% scleroderma and 12% rheumatoid arthritis. Associated cancer identified were one lung cancer in DM, one breast cancer in OM, one buccal cancer in IMNM cases. Conclusions: With recent availability of myositis antibody panel and MHC staining in Myanmar, we have applied current updated classification to describe the first Myanmar data on IIM cases.

Reaction and attitude of medical and paramedical lady students towards womanhood, menstruation, and reproductive events

To explore the reaction and attitude of preclinical lady students towards certain aspects of female reproduction, custom-made questionnaires were group-administered to two batches of Second MBBS students (mean age + or - SD: 20.3 + or - 0.5 yr; n=443) of Yangon Institutes of Medicine, and to the First and Second Year students (19.9 + or - 1.0 yr; n=114) of Yangon Institutes of Pharmacy and Paramedical Sciences. Menarche alarmed or upset about half (47.03

) of therespondents while 42.9

reported indifference. Almost 80

of the respondents hadprior knowledge about menarche. The proportion of respondents who accepted menstrual periods as natural (32.9

) was about the same as those distressed by the periods (32.7

). Those expressing positive attitudes towards marriage, childbearing and womanhood outnumbered those expressing negative ones (30

vs 12.2

, 43.6

vs 11.1

, 41.4

vs 20.8

respectively). Certain differences in the responses amongthese groups of Myanmar students and a group of Japanes students (n=28, exposed to the same question-naires) were highlighted and the implications discussed.

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.

Role of guardians in adolescents'reproductive health behaviors in rural area

A cross-sectional community-based study was undertaken in Taikkyi Township during July 1997, to explore the guardians' attitudes and practices relating to adolescents' reproductive health behavior. Altogether 102 guardians who have adolescents between 10 to 19 years of age involved in the study. Majority of the guardians did not favor their adolescents on choosing their fiancees by themselves and having more than one fiancee. While 52 per cent thought adolescents should know about contraceptives before their marriage, 38.2 per cent thought they should not. Most of the guardians approved that dissemination of messages about sex education for the adolescents through mass media was an appropriate way. It was found that most did not allow their teens to discuss such things either in front of them or with others. But some of them (36.3 per cent) said they would respond about those things willingly if or when they were asked. By knowing sex education and reproductive health, about 48 per cent (46.2 per cent of the mothers and 53.6 per cent of the fathers) said adolescents will gain benefits. Regarding information on Reproductive Health, this study highlights the needs for proper education and counselling for guardians, especially on adolescents.

Tracheal Papillomatosis Causing Upper Airway Obstruction / 결핵

Tracheal papillomatosis is rare. When the disease starts during childhood, it usually appears to be self-limiting if properly managed. In adults, however, the disease sometimes rims a more protracted course with a higher risk of developing cancer. The tumors are derived from the tracheal surface epithelium and tracheal mucous glands and usually grow exophytically. Treatment has traditionally been with repeated endoscopic resection. However, in view of its viral origin, attempts have been made to control the disease with interferon. A67 years-old man was presented with exertional dyspnea. He was treated for bronchial asthma at another hospital. There was no improvement in his symptom. lie was referred to this hospital, and a bronchoscopic biopsy showed tracheal papillomatosis. lie was undergone bronchoscopic laser therapy with symptomatic improvement.

Comparison of in vivo anti-inflammatory and antiplaque properties of Scoparia dulcis Linn. (Dan-ta-thuka) extract and chlorhexidine mouthwashes on normal and gingivitis subjects

Scoparia dulcis Linn. an indigenous Myanmar medicinal plant, which is being used as mouthwashes for the management of gingival troubles by the local people. In vivo study of the 1 percent Scoparia dulcis Linn. watery extract mouthwash on gingival inflammation and dental plaque accumulation study in comparison with standard 0.02 percent chlorhexidine mouthwash on normal and gingivitis subjects. Its antiplaque activity is similar to that of 0.02 percent chlorhexidine.

Hormonal profile comparison of women with menstrual symptoms and those without, in a population of medical students

This study was carried out on 102 medical students attending the 2nd M.B.,N.S course, inthe Institute of Medicine (1) at the Department of Physiology, between the period of April 1994 to May 1994. Out of 102 volunteers, 74.5 percent had premenstrual symptoms: PMS (+), and 25.5 percent were symptoms free: PMS(-). The mean menarcheal age of PMS(-) group was 12.8 + 0.8 yrs whereas PMS(+) was 13.1 + 1.2 yrs. Student's "t" test showed that they were not significantly different. In the PMS(+) group the commonest symptom was hritability and abdominal pain (26.4 percent and 25.2 percent, respectively). 21.9 percent presented with fullness and bloating. 13.2 percent had headaches and 13.2 percent presented with weight gain. A hormonal profile using immunometric assay kit to determine FSH, LH, PRL and Progesterone level was carried out during the follicular, peri-ovulatory and luteal phases. The levels were within the normal standard range. Mann- Whitney's test showed that there was no significant differences between the PMS(+) and PMS(-) groups. This study suggests that hormonal level differences may not be responsible for the symptoms.

Clinical trial to determine the antidiarrhoeal potential of traditional medicine formulations TMFs-16, TMF-35a and TMF-43

Clinical trial to determine the therapeutic efficacy of three Traditional Medicine Formulations, claimed to have antidiarrhoeal action, were studied on 150 acute diarrhoeal patients admitted to the Infectious Diseases Hospital, Yangon. TMF-16 was found to possess a good antidiarrhoeal action with the antidiarrhoeal index (ADI) of 28.71 percent, which is approximately equal to that of the standard drug, loparamide which had the ADI of 27.94 percent. TMF-35a also possess a mild to moderate antidiarrhoeal action (ADI = 21.5 percent), but TMF-43 showed little or no antidiarrhoeal action (ADI = 9.64 percent). The cllinical significance of the study is that both TMF-16 and loparamide were found to reduce the stool output as well as the amount of fluid replacement required. TMF-16 is well tolerated, available locally and cheaply, and thus, may prove beneficial in the symptomatic relief of non-specific acute diarrhoea.

Plasma level of quinidine in Myanmar patients with falciparum malaria

Plasma level of quinidine on 14 adult male falciparum malaria patients were studied. The patients consisted of 7 with low level of parasites in blood and 7 with high level of parasites ( > 5 percent RBC parasitised). All the patients received infusion of quinidine 15 mg/kg body weight diluted in 500 cc normal saline as initial loading dose, followed by infusion 7.5 mg/kg body weight 8 hourly for another two doses and than followed by oral quinidine 7.5 mg/kg 3 times a day for 7 days. Plasma for quinidine estimation was collected at the following hours: 0,1,2,4,6,9,12,36,48 hours and on days. 3,4 and 7 of the study period. In patients with low level of parasites, the maximum plasma quinidine level reached the peak 6.8 ug/ml onthe 4th day of treatment. After the first dose of treatment, it reached 4.3 ug/ml at 2nd hour. Among patients with high level of parasites, the maximum plasma quinidine concentration was 6.6 ug/ml and this concentration was obtained at 9th hour after the first dose. The mean plasma concentration of the 2 groups was not statistically different.

The effect of intramuscular loading dose of quinine on Myanmar patients (children and adults) with falciparum malaria

The effect of three doses of intramuscular quinine followed by oral quinine on ten adults and ten children with falciparum malaria (half of each group were highly parasitised) were studied. There were no complications associated with this method of therapy. the level of serum quinine in all the adults reached above the minimal inhibitory concentration (MIC) from the 2nd hour of the drug administration. So this method of administration should be recommended for severely ill patients before referral to hospitals. Anong the children, eight responded well to the therapy and the serum quinine level rose above MIC level from the second hour as in adults. There were two patients who failed to respone to the treatment. One had persistantly high level of quinine and was misdiagnosed as a case of cerebral malaria instead of quinine toxicity. He responded well when quinine was omitted and replaced with mefloquine. Another child had persistantly low level of quinine. He developed cerebral sings and symptoms and also responded well to mefloquine. Thus it is suggested that the level of serum quinine should be monitroed in children if possible, or toxicity ot quinine should be watched.

The effect of quinine and Quinidine on patients with highly parasitised falciparum malaria ( A double blind study )

Sixty patients with high level of parasites in the blood (i.e., more than 2

of RBCs parasitised)were chosen for the study. They were paired in sex and associated complications as nearly as possible. The first group of patients was treated with drug (A) and the remaining with drug (B). Drugs (A) and drug (B) consisted fo quinine or quinidine, (injection and tablets) which is unknown to investigators. 15 mg/ kg quinine or quinidine was given as a loading dose infused over 4 hours followed by 2 doses of 7.5mg/kg base also infused over 4 hours each at 8 hours intervals. This was followed by oral therapy. The oral drugs were continued as 7.5 mg/ kg base 3 times/ day till day 7. the efficacy of the 2 drugs were compared in terms of mortality, development of complications parasite and fever clearance, time. All patients survived, significantly higher level of serum quinine was recorded, when compared to quinidine through out the study.Serum insulin of five pairs of patients and blood glucose level of 15 pairs of patients were within the normal range (in all patients) throughout the study period. Blood glucose level in patients treated with quinine is significantly lower than those treated with quinidine at the first 36 hours of treatment. Since the parasite clearance time, fever clearance time mortality rate and recrudescence rate between the 2 groups of patients were comparable, we conclude that quinidine is clinically equal but not more potent than quinine. It is probably more toxic because of more ECG changes. Quinidine may be used as alternative only if quinine is not available.

Disposition kinetics of intramuscular quinine in Myanmar adult patients with falciparum malaria

Intramuscular quinine pharmacokinetic study was made on ten Myanmar adults who attended Thayarwady Civil Hospital for the treatment of Falciparum malaria. The patients were given intramuscular quinine dihydrochloride (15 mg base/kg) body weight following by another two doses of intramuscular quinine 7.5 mg per kg and oral quinine sulphate 7.5 mg three times daily till day-7. Plasma conscentrations of quinine at various post-drug time intervals were assayed by the benzene extraction fluorescence (EF) method (1). Plasma quinine concentrations until 6 hours after the laoding dose were analysed for pharmacokinetic parameters. The level of quinine reached the minimum inhibitory concentration level within the first 1-2 hours of starting treatment. The drug was found to ge well tolerated by the patients with absence of tissue necrosis at the site of injection.

Acetaminophen (paracetamol) pharmacokinetics in contraceptive pill-using Myanmar women

Acetaminophen (paracetamol) pharmacokinetic study was made on a total of 16 healthy adult Myanmar women of reproductive age, half of whom were pretreated chronically for 6 month with an oral contraceptive steroid (OCS), namely, Combination 5. Single oral dose (930 mg) of acetaminophen showed similar extent of maximum plasma acetaminophen concentration in either group. However, the OCS causes significant effect (p<0.05) on plasma acetaminophen resulting in shortening of half-life by 21.6 per cent and augmentation of clearance by 5.9 per cent. The OCS affected predominantly the sulphate conjugation of acetaminophen. In regimen requiring repeated dosing, acetaminophen should be administered more frequently in the pill-users.

Disposition kinetics of infusion quinine in (Adult) Myanmar falciparum malaria patients

To study the pharmacokinetics of infusion quinine in Myanmar patients, 14 adults with falciparum malaria (half of them were highly parasitised i.e more than 5

of rbc parasitised with malaria parasites) were infused with Quinine dihydrochloried 15 mg/kg body weight initially, followed by 7.5 mg/kg 8 hourly for 2 doses. This was followed by oral administration of Quinine sulphate 7.5 mg/kg for 7 days. Plasma concentrations of quinine until 6 hours after the initial loading dose were analysed for pharmacokinetic parameters.