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.

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.