Comparative study on the dietary behaviour, and serum/urinary electrolytes levels of hypertensive males in Thonegwa Township

This study was a cross-sectional, hospital hased, comparative study. It was conducted on 31 pairs of the hypertensive and apparently healthy males between 25-59 years. At the time of hospital admission, dietary bahaviour was interviewed by means of the structured questionnaires.The blood pressure was measured at the time of admission and dischange.Serum sodium and potassium levels and urinary excretion of them were also measured.Family history of hypertension was strongly associated with the hypertensives (p<0.05).Hypertensive subjects consumed palm oil two times (old ratio=2.2) more than normotensive subjects. a significant association of hypertension and daily consumption of soda rich snacks was found in the cases (p<0.05). Tthe mean serum sodium level of the cases was significantly higher than that of the controls (p<0.03) but 24 hour urinary sodium excretion of them was not significantly lower. Thus, increased salt consumption with imparired renal handling of sodium homeostasis would be responsible for higher prevalence of hypertension in Thonegwa Township.

Comparative study on the dietary behaviour and serum/urine electrolyte levels of hypertensive males in thonegwa township

This study was a cross-sectional, hospital based, comparative study. It was conducted on 31 pairs of the hypertensive and apparently health males between 25-59 years. At the time of hospital admission, dietary bahaviour was interviewed by menas of the structured questionnaires. The blood pressure was measured at the time of admission and discharge. Serum sodium and potassium levels and urinary excretion of them were also measured. Family history of hypertension was strongly associated with the hypertensives (P<0.05). Hypertensive subjects consumed palm oil two times (odd ratio=2.2) more than normotensive subjects. A significant association of hypertension and daily consumption of soda rich snacks was found in the cases (p<0.05). The mean serum sodium level of the cases was significantly higer than that of the controls (P<0.03) but 24 hour urinary sodium excretion of them was not significantly lower. Thus, increased salt consumption with impaired renal handling of sodium homeostasis would be responsible for higher prevalence of hypertension in Thonegwa Township.

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.

Hormone levels in Russell's viper bite follow-up patients

Studies of cliniccal features of hypopituitarism and/or any endocrine daficiency and hormone levels were carried out in systemic envenomed Russell's viper bite victims of more than one year duration. Eighteen follow-up patients with history of post viper bite ranging from one to seven years were studied. Serum cortisol were assayed in all but serum ACTH, HGH and urinary cortisol and HGH were made in four patients. Eight were found to have clinical evidence of endocrine deficiency and their hormone levels were on the low side, although statistically not significant. Symptomless patients also have abnormal pituitary function. Chronic ill-health with vague clinical presentation in post viper bite cases should always raise the possibility of chronic pituitary dysfunction.

Circulating and urinary cortisol, ACTH & HGH levels of normal Myanmar subjects

Cortisol, adrenocorticotropic hormone (ACTH), human growth hormone (HGH), overnight urinary cortisol and HGH levels were measured in 31 apparently normal healthy volunteers (21 males and 10 females) at the Thayawady Township Hospital. Measurement of circulating hormonal levels was performed by using commercial radioimmunoassay kits. All volunteers were admitted to the hospital for a period of 48 hours and cortisol, ACTH, HGH were measured four times in 24 hours (9:00 hr, 12 noon, 18 hr and 24 hr) consecutively for 48 hours. Overnight urinary cortisol and HGH levels were also measured after a protein load was given on the second night. Serum ACTH level was 15.82 uU/L (range 0.02 to 150.0 uU/L) and the average 24 hour serum HGH level was 7.55 mU/L (range 0.01 to 37.0 mU/L). Serum cortisol was found to be in the range of 21.0 nmol/L to 700.0 nmol/L with a 24 hr average of 227.95 nmol/L. Overnight urinary cortisol and HGH ranged from 0.089 to 27.7 ug and 4.0 to 230 uU respectively.

Clinical trial of intramuscular anti-snake venom administration as a first aid measure in the field in the management of Russell's viper bite patients.

Efficacy of intramuscular anti-snake venom administration immediately after bite as a first aid measure in the field followed by standard hospital management versus standard hospital management alone in the therapy of Russell's viper bite patients was studied. There was a definite reduction in the number of patients with systemic envenomation, complications following disseminated intravascular coagulation and in fatality rate of Russell's viper bite victims who had received first aid intramuscular anti-snake venom prior to hospitalization when compared with those who had not.

Drug resistance pattern in sputum positive treatment failure cases admitted to Aung San TB Hospital

One hundred and thirty five sputum positive failure patients admitted to Aung San Tuberculosis Hospital during October 1994 to January 1995 were studied for drug resistance pattern, probable associated clinical, social, demographic factors and sputum negative rate on retreatment. Ninety three cases were able to proceed resistance testing to isoniazid, rifamppicin and streptomycin. The result revealed resistant to one drug (31.2 percent); resistant to 2 drugs (37.7 percent) and resistant to 3 drugs (15.1 percent). Multidrug resistant cases were 22 (23. 7 percent). No significant association was observed between drug resistance and cavity lung lesions, number of drugs previously exposed. An analysis of risk factor for drug resistance revealed no significant differences between age, sex, race, ethnic groups, area of localisation. Alcoholism, tobacco abuse, drug users, overcrowding in living conditions were common demographic characteristics. Inappropriate administration of drugs is commonly observed in patients. Sputum negative rate by short-course chemotherapy and 12-month regimen at the end of initial 3 months were 54.7 percent and 38 percent respectively.

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.

Heparin therapy in Russell's viper bite victims with impending dic (a controlled trial).

A controlled clinical trial of low-dose heparin was carried out in confirmed cases of Russell's viper bite. Twenty-eight patients with coagulable blood and serum FDP levels (more than 80 micrograms/ml) were included in the study. They were randomised to receive low-dose heparin in an initial dose of 50 units/kg body weight intravenously immediately after antivenom followed by a continuous infusion of 10 units/kg/hr in isotonic saline for 24 hours, or antivenom alone. Response to treatment was assessed clinically as well as by serial measurements of coagulation factors and biochemical variables. No features of systemic envenoming developed in any patient after treatment, but one patient in each group developed microscopic haematuria. No systemic bleeding or acute renal failure occurred in any patient. Recovery rate from the clotting defect was similar in the two groups, but in patients with initially very low fibrinogen levels there was a tendency for the heparin to restore fibrinogen faster than in comparable patients who did not receive heparin.

Comparative trial of different dose schdules of monospecific antivenom for Russell's viper

An open comparative trial of two different dose schedules of Myanma Pharmaceutical Industry (MPI) monospecific Russell's viper venom (ASV) was carried out in 45 confirmed cases of Russell's viper envenoming. Patients included in the study were randomised by drawing lots and divided into two groups. Group one received an initial bolus dose of 40 ml of ASV (intravenous over 10 minutes) and if blood remains incoaguable 6 hours after the initial dose another dose of 40 ml was given. Group two received a bolus dose of 80 ml (intravenous over 20 minutes). Response to treatment was assessed clinically and serial measurements of blood venom antigen, coagulation factors and biochemical variables. 40 ml was found to be adequate in 48

of envenomed patients without systemic bleeding or heavy proteinuria. For patients with these features 40 ml is usually not adequate to correct the coagulation defect. In these patients the venom antigen was cleared significantly more rapidly if 80 ml was given as a single bolus dose. Therefore a single bolus dose of 80 ml is recommended in these patients. But development of acute renal failure was not prevented by increasing the dose to 80 ml.

Patterns of acute renal failure in Russell's viper bite patients

Fifty-two patients with acute renal failure due to Russell's viper bite were studied. 34 patients had oliguric and 18 had non-oliguric types of acute renal failure. There was a higher incidence of complications such as gastrointestinal bleeding, renal angle tenderness and facial oedema in patients with oliguria. These patients also had a higher serum creatinine, fractional excretion of sodium and renal failure index when compared to polyuric patients. Mortality rate was about 32 per cent inpatients with oliguria in spite of peritoneal dialysis in 8 patients. No patients in the polyuric group needed dialysis and none died. The difference may be due to more severe renal lesions in patients with oliguric acute renal failure.