Shigellosis among children attending the paediatric wards of hospitals in suburban areas

A total of 55 cases of children with dysentery admitted to the Defence Services Obstetric, Gynaecology and Children Hospital and North Okkalapa General Hospital were included in this study. It was found that 49.1 per cent of the children were suffering from shigella bacillary dysentery. The Shigella spp. isolated were: Shigella flexneri (44.4 per cent), Shigella dysenteriae (29.6 per cent), Shigella boydii (22.2 per cent) and Shigella sonnei (3.7 per cent). the distribution of Shigella spp. among the different age groups were 42.9 per cent in the age group of less than 6 months, 40 per cent in 6 to 12 months, 55 per cent in 13 to 24 months and 66.7 per cent in 25 to 60 months. Antibiotic susceptibility test revealed that these shigellae were resistant to ampicillin (84 per cent), chloramphenicol (76 per cent), streptomycin (84 per cent), tetracycline (64 per cent) and septrin (72 per cent); were fully sensitive to amikacin, gentamycin, netilmicin, norfloxacin and were less sensitive to cephalothin (76 per cent) and furazolidone (72 per cent).

The association of enteropathogenic Escherichia coli (EPEC) and gastroenteritis

A total of 619 cases of adults with gastroenteritis admitted to Yangon General Hospital, Workers' Hospital and Infectious Diseases Hospital were included in this study. It was observed that 33 percent were suffering from gastroenteritis due to enteropathogenic Escherichia coli (EPEC). The most prominent EPEC sero-groups encoutered were 01, 026, 055, 086, 0114, 0125 and 0128. The antibiotic sensitivity pattern showed that 87 percent of enteropathogenic Escherichia coli (EPEC) were resistant to ampicillin, 58 percent to chloramphenicol, 49 percent to streptomycin, 55 percent to benzyl penicillin, 44 percent and 21 percent respectively to tetracyclline and septrin. They were all sensitive to nalidixic acid but 97 percent to gentamicin, 96 percent to sisomycin and 95 percent to tobramycin respectively.

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.

Endemic goitre in Pindaya and Falam Townships (1991-1992)

Baseline field studies including clinical and biochemical assessments on goitre had been conducted in Pindaya Township, Shan State and Falam Township, Chin State during November 1991 and March 1992. The subjects were school children of both sexes between the age of 5 to 14 years from both urban and rural areas. Clinical assessment was done on 1553 subjects from Pindaya Township and 1224 subjects from Falam Township. Moreover, 135 urine samples from Pindaya and 90 samples from Falam had been collected for laboratory analysis of iodine. 55.4 percent and 62.5 percent total goitre rates were observed in Pindaya and Falam respectively and the mean urinary iodine excretion indicated that the subjects were moderately deficient in iodine.

Clinicopathological study of post russell's viper bite renal failure patients

Six patients returning due to various symptoms between 2 months to 11 months after recovering from acute renal failure following Russell's viper bite were investigated. Urine RE, C & S, Blood urea, electrolyte, creatinine, cholesterol, serum protein, were estimated. Ultrasound abdomen and renogram were performed. Renal biopsy was performed if suggestive of renal involvement. Autopsied tissue from four patients in the acute stage were included. Biopsy was taken from five patients with nocturia of 2-4 times. Three patients with proteinuria, (trace to ++). One patient with hypertension of 170/100 mm Hg discovered 8 months after recovery. The glomerular changes consisted of mild degrees of glomerular necrosis. Fluid collection and adhesion between the glomeruli and the Bowman's capsule were seen in all the cases but more marked in the ones who expired. Ballooning of the capillary loops with thickening of the basement membrane were seen only in three biopsied cases who presented with proteinuria and nocturia. Mild to moderate tubular degeneration was noted in all the cases. Interstitial fibrosis occurred in two of the biopsied cases presenting with nocturia. Thus changes in both the glomeruli and tubules and interstitium persist even after 11 months following Russell's bite and may manifest as nocturia, proteinuria and occasionally hypertension.

The serodiagnosis of amoebiasis by enzyme-linked immunosorbent assay

We attempt to detect antibodies against Entamoeba histolytica in sera obtained from both healthy individuals and hospitalized patients by an enzyme-linked immunosorbent assay (ELISA). The limiting value for ELISA-positive was established on the basis of serologic results of 1869 healthy persons living in a non-endemic area (Japan)> The ELISA then was applied to 61 patients in 5 hospitals in Myanmar who were suspected of having amoebiasis. The ELISA results were compared with those of stool examinations, and evaluated for sensitivity. Using the llimiting value for the ELISA, there was an 83 Percent agreement of positivity between the ELISA tests and microscopic examinations. Specific anti-E-histolytica IgM was observed in the sera of 44 patients; IgG in all of the 61 patients. Since high titers of specific IgM were not observed in both stool-positive and stool-negative patients, we judged that patients with early stages of amoebic infections were not included in this population. In our ELISA, the sera of the patients did not exhibit crosss-reactions betweeen antigens prepared from the HK-9 strain of E. histolytica and antigens prepared from Trichomonas vaginalis and Giardia lamblia. On the basis of these results, we suggest that it is necessary to do two or more different examinations in order to make a definite diagnosis of amoebic infection.

Detection of Entamoeba histolytica antigen in stool samples by enzyme-linked immunosorbent assay using monoclonal antibodies

An enzyme-linked immunosorbent assay (ELISA), using monoclonal antibodies, was applied for the detection of Entamoeba histolytica antigen in stool samples obtained from 148 patients with gastrointestinal symptoms, and the results are compared with microscopic findings. Ninety nine positives by microscopy generally had high ELISA OD values. Ninety one stool samples of asymptomatic cyst passers were also investigated by ELISA, and most were found to be positive. Although false positives were observed in both symptomatic and asymptomatic cases, the ELISA appears to be useful for the detection of amoebic antigen(s). However, our results suggest that both immunological methods and microscopic examination are needed for an accurate diagnosis of intestinal amoebiasis.

The drug sensitivity patterns of Plasmodium falciparum in Myanmar (1990)

During 1990, sensitivity of P. falciparum to antimalarials was conducted in Mawlamyaing, Lashio and Seik Phyu townships. There were 40 successful in vitro test in Mawlamyaing, 39 in Lashio, 26 in Seik Phyu township. Chloroquine was found to be highly resistant (95 to 100 Percent) in Mawlamyaing and Lashio areas but 31 Percent sensitivity was detected in Seik Phyu township. Amodiaquine was found to be much more sensitive (38 to 67 Percent) than chloroquine. Effective concentration (EC99) for chloroquine varies from 7.4 to 8.4 U mol/L and EC99 for amodiaquine varies from 0.58 to 1.6 U mol/L. In all the areas studied sulfadoxine/pyrimethamine sensitivity was seen in 65 to 80 Percent. All the isolates from the three areas were 100 Percent sensitive to mefloquine and were also highly sensitive (93 to 100 Percent) to quinine. EC99 of quinine varies from 1.35 to 2.7 U mol/L and EC99 of mefloquine varies from 1.5 to 2.2 U mol/L in the areas.

A rapid diagnosis of malaria parasites by acridine orange staining method

The study was designed to find out the diagnostic value of Acridine orange staining method in detection of malaria parasite (Plasmodium falciparum) in comparison with the conventional thick and thin blood films. Thirty two P. falciparum and two P. vivax malaria cases were included in thestudy and the thick blood film and acridine orange staining methods were found to be more sensitive in detecting asexual and sexual parasites (gametocytes) than the thin film. It needs 2-4 weeks time to train a technician to beable to detect the parasites in thick and thin film methods, but acridine orange staining method can be transferred within an hour. Another advantage of acridine orange staining method is the shortest examination time, lasting only 45 seconds whereas the thick and thin blood films need 5 to 10 minutes. Hence, it is concluded that the acridine orange staining method is useful for quick diagnosis of malaria although accessary eauipment is required.

The effect of chloroquine chemoprophylaxis on workers in Kazunma area

The study was conducted in November 1990 in the Kazunma village area of the Seikphyu Township. The study included 300 villagers of the Kazunma village as the control and the 315 workers of the Kazunma camps. The workers were on chloroquine chemoprophylaxis for more than three months. Among the villagers of the Kazunma village 16

were infected with malaria, P. falciparum 64.8

and P. vivax 31.3

. The malaria infection rate of the workers from the northern and the base camps were similar to the villagers. The workers from the southern camps have higher level of parasitaemia (26

) inspite of the chemoprophylaxis. Though the chemoprophylaxis has no effect on the parasite rate, it seems to have some effect on the parasite density of the workers of the northern and the base camps. The in vitro sensitivity of P. falciparum isolates were 30,8

sensitive to chloroquine and 55.6

sensitive to amodiaquine.

Heparin therapy in Russell's viper bite victims with disseminated intravascular coagulation: a controlled trial.

A controlled clinical trial of low dose heparin was carried out in confirmed cases of Russell's viper bite. Twenty patients with systemic envenoming were included in the study. They were randomized 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 unit 3 kg/hour 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 values. No significant difference was observed in the outcome among two groups, the recovery rate from the clotting defect being similar in both. The mean serum creatinine values of the two groups were also not statistically different. The results indicated that there is no beneficial effect of adding heparin to the standard treatment by antivenom.

The effect of antimalarials on the development of Plasmodium Falciparum trophozoites

The effect of different antimalarials (Artemether, Quinine, Chloriquine, Amodiaquine and Sulphadoxine/ Pyrimethamine) on the in vivo development of a sexual parasites during the treatment of falciparum malaria was studied on 29 patients. Maturation of trophozoites from tiny to large ring forms were noted on blood films taken every 6 hourly. The shortest clearance time of tiny forms and fastest parasite clearence rate was detected in the artemether treated group than other antimalials. The parasite clearance time also does not depend on the disappearance time of tiny ring forms, though it does on small and large forms. The drug resistant cases showed longer durationof clearence time of small and large forms in both the sulphadoxine/pyrimethamine and artemether treated groups. The possible early interpretation of resistant cases and application of the methods for the documentation of the action of the antimalarial was discussed.

In vitro and in vivo antimalaial activities of artesunate

Artesunate, a derivative of Quinghaosu (Artemisinine) was test for antimalarial activities against four isolates of Plasmodium falciparum in vitro and Plasmodium berghei- mouse model in vivo. The minimum inhibitory concentration of Artesunate in vitro was 6.0 p Mol per well whereas in vivo ED 90 was 1.4 mg/kg day.

Inhibition of Plasmodium falciparum merozoites invasion by immune sera from malaria infected subjects

The study was conducted on sera samples of 92 subjects from malaria endemic areas. All 92 subjects have experienced either previous or present infection with different parasitaemia levels of Plasmodium falciparum. The relationship between frequency of malaria infection, parasite densities and immunofluorescence malaria antibody titres of P. falciparum were studied. There was no significant correlation between IFA titres and parasitaemia levels or frequency of malarial infection. The serum inhibition to invasion of P. falciparum merozoites in vitro was found to vary according to the sera obtained from subjects with various malarial immune status. Parasite inhibitory antibody was not evident in sera from acutely infected subjects but was significantly observed in sera from convalescent subjects with an inhibition of P.falciparum merozoite invasion up to 85 per cent.

Drug Resistance in Falciparum Patients Treated with Mefloquine-sulphadoxine-pyrimethanine in Myanmar

3 out of 32 P. falciparum malaria patients treated with Mefloquine-Sulfadoxig-Pyrimethamine combinations at Tharrawaddy Township Hospital, Myanmar failed to respond to the drug. One of the patients was regarded as R2 and another two as R1 resistance to the drug. One of them was also resistance to Mefloquine and Quinine in in-vitro studies. We conclude that there are patients who failed to respond to Mefloquine-Sulfadoine-Pyrime-thamine even in areas where Mefloquine had never been used.