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.

Rheumatology in Pathein practice

It is a prospective descriptive study on patients with rheumatological diseases who attended Shin Pa Ku private specialist clinic (SPK) and Patein General Hospital (PGH) from Dec 1998 to July 1999. Spectrum of rheumatological diseases was recorded by using proforma. Among 162 rheumatological cases, there were 6 cases of SLE and 3 cases of Systemic scleros is, and all were females. Among the seronegative diseases, 3 patients were suffering from ankylosing spondylitis, and all were suffering from ankylosing spondylitis, and all were males. In 15 cases of reactive arthritis 47

were males and 53

females. But in 9 cases ofgout, there was male preponderance (78

).Osteoarthritis accounts for 53 cases, with male 36

and 23 cases of rheumatic fever, has also female dominance(79

). Filbromyalgia affected 14 patients and all were females. Among a total of 28 casesof Rheumatoid arthritis (RA) mean age was 48.18yr (SD=15.57), Male: Female=1:4. Average duration for morning stiffness was 72.81 min (SD=2.72) and visual anologue pain score (VAPS) was 61.29 (SD=21.13). Grip power of left hand was found to be 88.57mmHg (SD=77.92) and that of right hand was 99.64mmHg (SD=6.50).Only 5.6

had renal involvement. RA occurred in patients irrespective of any educational status and occupation. Most of them had no concomitant diseases at the time of enrollment. RA is the 2nd commonest rhematological disease in this study. Moreover, it especially occurs in working age group and also greatly affects the qualtiyof life.

A case control study on the risk factors for diabetes mellitus

The development of prevention programs for non insulin dependent diabetes mellitus is greatly needed. Before such programs are implemented, proper community assessment is essential and this includes a knowledge of relevant risk factors for non insulin dependent diabetes. To determine such risk factors, a study was done on 118 cases of diabetes mellitus from Diabetic Clinic and Wards 1 & 2, Yangon General Hospital. A questionnaire of the patient's family history and drug history, smoking and alcohol history among others were noted. Statistical analysis was done by Odds ratio and 95 percent confidence interval of Odds ratio. In this study significant risk factors for diabetes were physical inactivity, family history of diabetes, especially parenteral, history of taking diuretics and dietary excesses like high carbohydrate and high fat diet. We recommend that exercise be an adjunct to proper diet and weight control for the prevention of non insulin dependent diabetes mellitus.

Knowledge, attitudes and behaviours on HIV infection/AIDS among clinical students and house surgeons in Mandalay

Data were collected to assess the current level of knowledge, attitude towards prevention and actual practices among clinical students and house surgeons in Mandalay in 1994. It was found that there were class related differences in KAP scores of medical students. In addition, they could correctly answer the difference between AIDS and HIV infection as their education advanced (Chi=45.55, p < 0.005), but there was no difference with regard to knowledge of AIDS counselling (p > 0.1) and the use of condom (p > 0.1). Only 49.5 percent would like to take care of AIDS patients in their wards. To avoid treating AIDS patients is the main reason in 38.6 percent of them. At the same time, 23 percent of students believed that AIDS should be prevented by isolating HIV infected cases. Percentage of presence of risk behaviour are nearly the same for the three different clases. 27.2 percent of students had heterosex and among them, 51.1 percent reported always using condom while 10.2 percent reported never using condom at all. It may be due to the misperception about the transmission or inability to break down the lod socio-cultural constraints or just due to the fact that information increases knowledge but does not change behaviour. An integrated and comprehensive educational programme and periodic feedback is recommended.

A comparative study of YGH index and Wayne's index in the diagnosis of thyrotoxicosis

This study was done during 1992 to 1994. the patients were in-patients of Wards 1 & 2 and those referred from the Nuclear Medicine Department of Yangon General Hospital. they all were clinically thyrotoxic patients confirmed by either high uptake of radioactive iodine or high serum T3 and T4 levels. We took proper history taking and did thorough clinical examination for all patients. Then we recorded the findings and counted the scores for each patient according to YGH index and WAYNE index for diagnosis of thyrotoxicosis. The total numberr of patients studied was 138. Mean age was 36.5 years. The sensitivity of YGHindex was 93.47 percent. The sensitivity of WAYNE index was 89.85 percent. The difference between the sensitivities of two scoring systems was not significant statistically. Therefore, both scoring systems can be applied with the nearly same sensitivity in the clinical diagnosis of thyrotoxicosis.

Association of chronic complications of diabetes mellitus and presence of risk factors

Chronic complications of diabetes are known to be associated with certain risk factors. Once complications develop, they will never regress, denoting that reduction of these factors as much as possible, is the best way to deter the complications. To determine such risk factors, a study was done on diabetic patients with a ample size of 315 from Diabetic Clinic and Ward 1 + 2, Yanton General Hospital. There were 281 NIDDM and 341 IDDM patients. The study on NIDDM patients shows that physical inactivity and age of the patients were associated with the development of retinopathy. The following factors were identified as being associated: hypertension, high serum cholesterol and age of the patient. Smoking is also associated with neruopathy. The possible risk factors for nephropathy were age of patient, hypertension, alcohol and hyper-uricaemia. Hypertension, age of the patient, male sex and pbhysical inactivity were found to be important risk factors for CVA. For IHD, contraceptive pills, physical inactivity and age of patients were possible risk factors. On the other hand, physical inactivity, hypertension, age of patient and duration of disease were important for peripheral vascular disease. Out study spotlihgted that age factor is the mainstay in the development of chronic complications in both NIDDM and IDDM. In NIDDM physical inactivity predisposes to retinopathy and atherosclerotic complications. Hypertension enhances neuropathy, nephropathy, CVA and peripheral vascular disease. However, in IDDM, the duration of diabetes and fasting blood sugar levels are significant risks in the development of retinopathy and nephropathy.