Evaluation of tuberculin response after BCG vaccination:by gestation and by age at immunization

Tuberculin response following BCG vaccination was evaluated in 3 groups of babies. One hundred and sixteen full term babies (Group I) were vaccinated with BCG at birth; 89 full term babies (Group II) received BCG at the end of third month of life and Group III was made up of 48 preterm babies (32-36 weeks) given BCG vaccination at birth. The sizes of PPD induration area [mm] (6.3+/-3.1 Vs 2.5+/-3.0; P< 0.00001) and BCG scar diameter (3.7+/-1.5 Vs 2.7+/-1.3; P< 0.0001) were significantly larger in full term than preterm babies all of whom were vaccinated at birth, whereas no significant difference was observed between full term babies who were vaccinated at different age. The complications of BCG vaccine were not observed in all study groups. This study suggests that tuberculin responses are equivalent at birth and at third month of age in full term babies. Although immune response is not fully developed in preterm babies (32 to 36 weeks of gestation), they can be safely immunized with BCG at birth.

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 ).

Etiologic agents, clinical and laboratory characteristics of acute versus persistent diarrhoea in children who attended the Yangon Children's Hospital

To identify the etiologic agents, clinical and laboratory characteristics of acute and persistent diarrhoea in children less than 12 years of age, a hospital based prospective study was carried out for 18 months in Yangon Children's Hospital. A total of 487 children, 327 with acute and 160 with persistent diarrhoea participated in the study. Intestinal pathogens including bacterial agent 31 per cent, viral agent 6.3 per cent and protozoa 33 per cent were detected in 71 per cent of persistent diarrhoea cases, whereas in acute diarrhoea cases intestinal pathogens were identified in 64 per cent, among which bacterial, viral and protozoal agents were 28 per cent, 11.5 per cent and 25 per cent respectively. More than one enteric pathogen was detected in 13.7 per cent and 16.5 per cent of persistent and acute diarrhoea cases respectively. male children who suffered from diarrhoea were more than females and peak incidence of acute and persistent diarrhoea occurred in the 2-11 month age group. fever and vomiting were found more frequent in persistent than acute diarrhoea during second week of illness and differences were statistically significant. Shigella species, ETEC and e. histolytica were equally isolated from both acute and persistent diarrhoea whereas rota virus was found more ofter in acute than persistent diarrhoea. The presence of leucocytes and reducing substances in the stool was equally frequent.

Histopathological severity of antral gastritis in relationship to Helicobacter pylori colonisation

The association between Helicobacter pylori (HP) colonisation in gastric antrum and the degree of severity and activity of gastritis and the concomitant relationship with gastric atrophy and intestinal metaplastic changes were studied. A total of 204 pieces of endoscopic biopsy tissues were collected from the outpatient endoscopy unit of New Yangon General Hospital in 1994. Routine Haematoxylin and Eosin stain as well as special stains such as modified Giemsa and Carbol fuchsin stains were used for bacterial identification and quantitative analysis. a significant correlation (P value <0.001) was obtained between density of HP colonisation and severity of gastritis as well as its activity (p value <0.001). However, no significant degree of atrophic changes and intestinal metaplastic changes were noted in these biopsies. a continuation for a better understanding of the pathogenesis of HP and its consequences is necessary.

Cryptosporidiosis among children with diarrhoea and dysentery from Yangon Children's Hospital

Cryptosporidiosis among children who attended Yangon Children's Hospital from March to October 1996 was studied. A total of 396 stool samples were collected after admission to the hospital. Simultaneously, a set of questions was filled to ascertain the duration and motion of diarrhoea of children. Stool characteristics were also recorded. Cryptosporidium oocysts were detected by staining with Kinyoun's acid modified method by Haley and Standard 1973. Random samples of 238 male and 158 female children of ages ranging from one month to ten years old were included in this study. It was found that the duration of diarrhoea ranged from one to 150 days. Number of motions also ranged from one to 40 times per day. Diarrhoea with either blood or mucous (dysentery) was found in 61 cases (15.4 per cent). cryptosporidium oocysts were found in 5 cases (1.3 per cent) of children; three were from watery diarrhoea cases and two from dysentery cases. From the cases detected, the age range was from 10 months to five years and the duration of illness was from 3 to 30 days. Four cases were with moderate degree of dehydration and one case was associated with HIV infection.

Assessing the accuracy of respiratory rates at different counting periods and methods

The respiratory rates of 198 children (aged 2-59 months) suffering from acute respiratory infections (ARI) were monitored by observation, palpation and auscultation (Gold standard). Two 30-second and one 60-second counts were obtained. The difference among respiratory rate counts determined simultaneously by observation, palpation and auscultation in relation to their mean count was analyzed for 60-second counting period, 30 plus 30-second period and 30-second doubled. The variability among the different counting methods and counting periods was not significantly different whether the children were feeding, sleeping, resting and awake or awake but not resting. The data from the study suggest that respiratory rate counting either by observation or palpation are similar in accuracy and one minute's counting either at a stretch or 30-second doubled or two blocks of 30-second intervals are also similarly accurate.

Is oral rice-based electrolyte solution superior to glucose electrolyte solution in acute chidhood diarrhoea?

In a controlled trial of oral rehydration therapy, the efficacy and safety of rice-based electrolyte solution was compared with standard WHO oral rehydration solution. Ninety eight male children aged 4 months to 10 years presenting with watery diarrhoea of less than 72 hours prior to hospitalization were studied. 48 were treated with standard WHO oral rehydration solution (ORS) and 50 patients with an improved formulation which contained 100 gm of rice (instead of glucose) with 25 mg of amylase in addition to electrolytes. The clinical characteristics of the two groups on, admission were comparable. Although there was a consistent trend towards reduction in stool volume and better gain in body weight in children with cholera treated with rece-based ORS, significant difference was noted only in 6-12 hour stool output and in the first 6 hour weight gain. Stool volume was significantly reduced during the 24 to 48 hour perild in all diarrhoeal patients receiving rice-based ORS. Thus, amylyte digested rice-based ORS is as effective as the Standard WHO ORS and have some therapeutic advantage in the treatment of acute childhood diarrhoea.

Assessment of the erythrocyte protoporphyrin test for screening of iron deficiency anaemia

A total of 84 apparently healthy children between ages of 1-12 years were screened for iron deficiency with the erythrocyte protoporphyrin (EP) test. Serum iron, total iron binding capacity in serum, percent transferrin saturation, haematocrit and haemoglobin values were also determined together with the screening test. Comparing the relationship between EP and percent transferrin saturation, using a percent transferrin saturation value < 10 percent as the criterion of iron deficiency, the optimal cut off limit for the EP test appears to be 80 ug/dl of rbcs. At this level, this screening test showed a sensitivity of 74 percent and specificity of 95 percent and the positive and negative predictive values were 82 percent and 93 percent respectively. thus EP assay which is less expensive and easy to perform can be used as a screening test for the detection of iron deficiency.

Comparative study on detection of urease activity by CLO Test Kit and Microtiter Biopsy Urease Test Kit for evaluation of Helicobacter pylori

A Microtiter Biopsy Urease Test (MBUT) for the detection of Helicobacter pylori was evaluated in the drug trial study conducted in the Endoscopy Department of New Yangon General Hospital. The MBUT was compared with commercially available urease test (CLO Test). Both CLO test and MBUT were performed on antral and fundal gastric tissues biopsied from 35 subjects who underwent upper gastrointestinal endoscopy. 29 (83 percent) cases were positive for Helicobacter pylori when tested by CLO test and MBUT. Thus the sensitivity and specificity of MBUT relative to CLO test was both 100 percent respectively. Tested by MBUT, the urease reaction was positive in 83 percent of cases within 2 hours and 90 percent within 3 hours. Tested by CLO test, it was positive in 60 percent of cases within 2 hours and 67 percent within 3 hours. the accuracy of MBUT was thus similar to that of CLO test for the detection of Helicobacter pylori. Moreover, MBUT is not expensive, can be prepared locally, packed in test kit form and can be supplied to gastroenteroscopy units for diagnostic and treatment purposes.

Applicability of WHO criteria by community health workers for diagnosis of acute lower respiratory infections

Applicabiligy of simple clinical signs (WHO, 1990 ARI classification) by community health workers (CHWs) for the diagnosis of Acute Lower Respiratory Infections (ALRI) especially pneumonia, were evaluated in ort-patient department of Yangon Children's Hospital from November 1990 to February 1991. 944 under-five children presenting with Acute Respiratory Infection related symptoms of less than 7 days duration were included in the study. The percentage agreement of diagnosis status by CHWs with reference to project Medical Officers (gold standard) were Kappa 0.5126 (p<0.001) in less than 2 months old infants and Kappa 0.5442 (p<0.001) in children aged 2 months to 5 years. CHWs were able to detect important cllinical sings like chest indrawing in percentage agreement of 85.1 Percent. However, perecentage agreement in respiratory rate was found to be 60.2 Percent and there was incorrectness in counting the respiratory rate as the rate increased. Divverences in the level of agreement on these important clinical signs misclassified the disease category resulting in low percentage agreement in discriminating the disease severity.