Accuracy and cost-effectiveness of the Diabetic Foot Screen Proforma in detection of Diabetic Peripheral Neuropathy in Myanmar / Journal of the ASEAN Federation of Endocrine Societies

Objective@#Proper foot assessment is important for early detection and treatment of diabetic peripheral neuropathy (DPN), the main cause of diabetic foot ulcers (DFUs). This study aimed to determine the accuracy and cost-effectiveness of the locally developed Diabetic Foot Screen (DFS) proforma in detecting DPN among diabetic patients at 10 selected clinics in Yangon, Myanmar@*Methodology@#The study included 625 type 2 diabetics from 10 primary care clinics who participated in the diagnostic accuracy and cost-effectiveness analysis. They were assessed with DFS proforma and biothesiometry by two examiners independently. The cost-effectiveness analysis was conducted based on available data in the local primary care setting.@*Results@#The overall accuracy of the DFS proforma assessment was 74.76% (95% CI: 70.46%- 79.06%). The optimal cut-off DFS score was ≥1.5 (sensitivity 62%; specificity 76%) in detecting DPN. Compared to biothesiometry, the cost-effectiveness of DFS proforma assessment in DPN detection was 41.79 USD per DPN case detected.@*Conclusion@#This study supported the use of DFS proforma for DPN detection in primary care clinics. It also provided new information on the estimated costs per patient with DPN detected in Myanmar.

Some factors associated with outcome of hospitalized russell's viper bite patients

Most of the Russell's viper patients with severe envenomation development oliguric acute renal failure. Majority of these patients failed to respond to conservative medical treaatment and required peritoneal dialysis (PD) for their survial. Some of them expired even after peritoned dialysis. In this study,some factors associated with development of acute renal failure, PD requirement and final outcomes i.e. recovered or expired, in the proven Russell's viper bitevictims admitted to the Thingangyun Sanpya Hospital were determined. It was found that the prognosis of these patients was apparently related to the time intervals between: the bite and receiving anti-venom, the bite and hospitalization, and the bite and treatment with peritoneal dialysis. It is suggested that antivenom should be administered within 2 hours and the victims hospitalized within 24 hours after the bite. Besides, peritoneal dialysis should be regarded as a lifesaaving measure for Russell's viper bite patients with oliguric acute renal failure and instituted as early as possible i.e. within 4 days after the bite.

Cobra bite in Sanpya Hospital, Thingangyun

Cobra bite is the second commonest poisonous snake bite in Myanmar. This descriptive study includes definite cobra bite patients (n=10) admitted to Thingangyun Sanpya Hospital from May 1999 to January 2000. their ages ranged from 5 years to 38 years; 70 per cent were bitten in South Dagon. 40 per cent had severe local reactions requiring wound debridement and skin grafting; 10 per cent had digital amputation. All patients received antivenom and 80 per cent received prostigmine and atropine; 9 patients survived; 30 per cent required assisted ventilation. One patient, who received antisnake venom 100ml within 20 minutes, died after 30 hours on respirator. although antisnake venom and respirator are useful in the management of cobra bite, survival rate is not 100 per cent. as 40 per cent of bites occurred while sleeping, particular attention should be given to tucking and sleeping in the middle of big mosquito net. As cobra bite also occurred in suburbs of Yangon, alnd survival despite therapy is not 100 per cent, everysone should exercise snake bite preventive measures.

Hypertension among patients with glomerulonephritis in NOGH

Hypertension is an important cardiovascular disease and a recognized accompaniment of glomerulonephritis. The aim of this study is to determine the incidence of hypertension among patients with glomerulonephritis and determine the various histological types which are associated with hypertension in North Okkalapa General Hospital. The period of study is from 1 December 1992 to 25 October 1993. All patients with biopsy proven glomerulonephritis were included in the study. There were 80 patients with glomerulonephritis and (53 percent) were found to be hypertensive. (65 percent) of those patients with glomerulonephritis who were hypertensive had mesangiocapillary proliferative glomerulonephritis followed by mesangial proliferative glomerulonephritis (43 percent). Oedema, the hallmark of nephritis, was absent in (11 percent) of the hypertensive patients. There were four patients with hypertension associated with pregnancy. (75 percent) had mesangiocapillary proliferative glomerulonephritis. Mesangiocapillary glomerulonephritis is the histological type most commonly associated with glomerulonephritis. As hypertension was the sole presenting feature in (4 percent) of patients with glomerulonephritis, glomerulonephritis should be considered in all young patients with hypertension.

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.