Pneumocystis carinii infection among human immunodeficiency virus (HIV) infected Myanmar patients.

A total of 60 HIV infected patients complaining of dry cough for at least two weeks and attending the Out-patient Department of the Specialist Hospital, Waibargi, were screened for Pneumocystis carinii. Induced sputum samples were examined with Giemsa and Gomori silver methenamine stains. P. carinii were detected in 18 patients (30%) with silver stain and 13 patients (21.7%) with Giemsa stain. The sensitivity and specificity of the Giemsa stain were 72.2% and 95.2%, respectively. The range of CD4 counts in P. carinii-positive patients was found to be 0-562/microl, and the mean CD4 count was 132.3/microl. Out of 18 P. carinii-positive cases, CD4 counts of 15 cases (83.3%) were <200/microl and those of 3 cases were >200/microl. Clinically, P. carinii-positive cases were associated with fever in 55.5%, with tightness of the chest in 38.9%, and with cyanosis and tightness of the chest in 11.1%. Co-infection with tuberculosis was found in 16.7%. Anti-pneumocystic prophylaxis is recommended for those patients with a CD4 count <200/microl. Giemsa staining could be used as an alternative diagnostic method for detecting P. carinii. This study documented the existing prevalence of P. carinii among HIV-infected Myanmar patients.

The effect of antimalarials on reticulocyte count of patients with falciparum malaria

One hundred and eleven adult patients who attended North Okkalapa General Hospital for uncomplicated falciparum malaria were chosen for the study. They were treated with dihydroartemisinine (Cetexin), quinine, artesunate tablets and artemether injection. Fifty nine adult male and female without malaria were chosen as controls. They were treated with sulfadoxine-pyrimethamine, quinine and artesunate. Thick and thin blood films were taken from the patients daily and were stained and counted for malaria parasites. Packed cell volume (PCV), WBC count and reticulocyte count were also done. Among the patients treated with drugs, there was a significant fall in the mean reticulocyte count (number concentration and number fraction) at day 3. But the reticulocytes were raised back to normal at days 7 and 14. There was no significant changes in the mean packed cell volume (PCV) and mean level of total WBC count of the patients in all 4 groups. Among normal controls treated with artesunate tablets, there was also a significant fall in the mean reticulocyte count at day 3 but the mean reticulocytes count was also raised back to normal at days 7 and 14. Among normal controls treated with quinine and sulfadoxine-pyrimethamine tablets, there was no significant fall in the mean reticulocyte count. And there was no significant changes in PCV and WBC count in all 3 groups of controls. The fall in reticulocyte counts can be due to part of the disease malaria as well as to the drug including quinine and not singly to artemisinine therapy alone.

Comparison of the effect of combinations of parentral artemisinin derivatives (I/M artemether, I/V artesunate) plus oral mefloquine with intravenous quinine plus oral tetracycline on patients with cerebral malaria: A multicentre trial (Preliminary Report)

In order to find out the best drug combination for treatment of cerebral malaria at less equipped hospitals, 105 cases of cerebral malaria belonging to Mawlamyine, Pyin Oo Lwin and North Okkalapa hospitals were studied in a controlled trial of three regimens. (1) Intramuscular artemether total dose 480 mg plus mefloquine 750 mg in a single dose given through nasogastric tube at day 0. (2) Intravenous artesunate total dose 240 mg plus mefloquine 750 mg as in regimen 1. (3) Intravenous quinine dighdrochloride 600 mg in 180 ml infusion of dextrose saline given over 4 hours. The dose is repeated every 8 hours until the patient can swallow the tablets. Then oral quinine sulphate tablets were given 600 mg 8 hourly. Total period of quinine therapy is 7 days. Tetracycline 250 mg capsules were given 6 hourly for 7 days (started via nasogastric tube while the patient is unconscious). There was no significant difference in overall mortality rate, mean parasite clearance time, mean fever clearance time and mean time to regain consiousness between the three groups. Thus quinine-tetracycline (if necessary to supplement with artemether-mefloquine at 48 hours if the patient failed to respond to initial treatment) is suggested, as the drug of first choice for the management of cerebral malaria in Myanmar.

The Effect of oral artesunate versus quinine on patients who are resistant to chloroquine and sulfadoxine pyrimethamine

The patients who attended the out patients cllinic of Thayarwaddy Civil Hospital and North Okkalapa General Hospital were treated with chloroquine (600 mg base at days 0 and 1 and 300 mg base at day 2). To those who failed to clear the parasites at 72 hours were treated with 3 tablets of sulfadoxine pyrimethamine (each containing 500 mg sulfadoxine and 25 mg pyrimethamine). To those who failed again to clear the parasites at 72 hours were treated with one of the following drugs at alternate sequence. (1) 50 mg Artesunate tablets were given twice a day for 5 days orally. The initial dose was double. (2) Quinine sulphate tablets 600 mg 3 times per day given orally for 7 days. Total 60 patients were studied.In both groups of patients parasites were cleared at 72 hours and at day 4. The parasite clearance time and fever clearance time of the patients treated with the two different drugs were not statistically different. All patients treated with artesunate can tolerate the drug and were free from side effects that can be related to the drug. Out of 18 patients who were followed till day 28,6 patients recrudesced at days between 21 and 28. Among the patients treated with quinine 50 percent failed to complete the drug course. Out of 10 patients who were followed till day 28, one patient recrudesced at day 21. We conclude that Artesunate or quinine alone are effective but may not be useful for treatment of drug resistant malaria.

The effect of cardiac risk factors in coronary heart disease (CHD) among diabetic patients

To compare the effect of 4 cardiac risk factors namely, hypertension, smoking, hypercholestrolaemia and obesity on coronary heart disease among diabetic patients, a retrospective study was carried out between August 1991 and September 1992. A total of 60 patients with diabetes mellitus were studied. 40 patients had CHD and 20 did not. The average age of the study group was 54.04 years. It was found that in diabetics who had hypertension, hypercholesterolaemia or smoked, had a two-fold risk of developing CHD compared to those who did not have the above risk factors. There was no difference found between those patients who were obese and those who were not.