Study of drug resistant cases among new pulmonary tuberculosis patients attending a tuberculosis center, Yangon, Myanmar.

A cross-sectional descriptive study was carried out at a tuberculosis center, Yangon, Myanmar from October 2003 to July 2004 to analyze the drug susceptibility of new sputum smear positive pulmonary tuberculosis patients. A total of 202 Mycobacterium tuberculosis isolates were tested for resistance to isoniazid, streptomycin, rifampicin and ethambutol. Resistance to at least one anti-tuberculosis drug was documented in 32 (15.8%) isolates. Monoresistance (resistance to one drug) was noted in 15 (7.4%) isolates and poly-resistance (resistance to two or more drugs) was noted in 17 (9.4%) isolates, including 8 (4.0%) multi-drug resistant isolates (resistance to at least isoniazid and rifampicin). Total resistance to individual anti-tuberculosis drugs were: isoniazid (29, 14.3%), streptomycin (11, 5.4%), rifampicin (10, 4.9%) and ethambutol (1, 0.5%). The demographic data and possible contributing factors of drug resistance were evaluated among the drug resistant patients. Poly-resistant cases had significantly longer intervals between symptom appearance and achieving effective anti-tuberculosis treatment than mono-resistant cases (p = 0.015).

Effect of sunlight in decontamination of coliforms and faecal coliforms from drinking water

Drinking water samples were collected during December 1997 to March 1998 from Mingalar market, Nyaungbinlay market, Thaketa, Pazundaung, Botataung, Lanmadaw, Anawrahta, Ahlone, Sanchaung and Papedan Townships, Yangon. The presumptive coliform and faecal coliform counts were tested on all water samples. The pH and temperature were also recorded during the experiment. The coliforms and faecal coliforms were identified by multiple tube method and the count of coliforms ranged from 17 to > 2400 MPN/100 ml and faecal coliform count ranged from <2 to 140 MPN/100 ml. The temperature ranged from 40 to 47C during the experiment. There was no association between coliform counts and temperature variation. Forty percent and 90 percent of the samples became free of coliforms after exposure to sunlight for six hours and seven hours, respectively. When exposed to sunlight, 33 percent and 77.8 percent of the samples became free of faecal coliforms after four and six hours respectively. Coliforms and faecal coliforms were totally absent after exposure for 12 hours. It was effective by using clear transparent plastic bottles but the opaque plastic bottles were not. After exposure to sunlight for 12 hours; regrowth of coliforms and faecal coliforms were not observed up to three months, provided that the exposed bottles were tightly closed.

Alpha fetoprotein in Myanmar patients with chronic liver diseases

In patients with chromic liver diseases, the measurement of serum alpha fetoprotein level is an invaluable laboratory investigation to assess the disease progress and to detect early diagnosis of hepatocellular carcinoma. A total of 150 sera samples were collected from normal individuals, hepatitis B surface antigen carriers, patients with hepatomagaly, fatty liver, chronic hepatitis, cirrhosis and hepatocellular carcinoma. The sera were examined for serum alpha fetoprotein levels by radia-immunoassay technique, one of the most sensitive methods available. The results showed that the sera alpha fetoprotein levels correlate with the severity of the liver diseases as all of normal individuals, hepatitis-B surface antigen carriers, hepatomegaly and fatty liver patients showed normal levels and 5-17 percent of chronic hepatitis and liver cirrhosis patients were low positive. Also 73 percent of hepatocellular carcinoma patients were positive with 50 percent of them revealing high levels of alpha fetoprotein.

Enterically transmitted Non-A,Non B, hepatitis immunity in Rhesus Cynomolgus monkeys (Macaca mulatta & Macaca fascicularis)

An exoerimental model of enterically transmitted non-A, non-B hapatitis was established in rhesus and cynomolgus monkeys (Macaca mulatta and Macaca fascicularis). Two monkeys previously infected with 10 per cent pooled stool suspensions of Myanmar patients with well-defined enterically transmitted non-A, non-B, hepatitis and three virgin control monkeys were infected simultaneously with pools of stool suspensions from the first-passage. None of the two previously infected monkeys developed signs of hepatitis. All the control virgin monkeys exhibited hepattis as evident by sharp rise in serum aminotransfrases and pathological changes of acute hepatitis in liver biopsies. These findings document the establishment of immunity after infection with enterically transmitted non-A, non-B hepatitis virus in rhesus and cynomolgus monkeys.

A study of glucose and insulin profiles in acute viral hepatitis patients

Oral glucose tolerance tests, with 75 gm of glucose load were carried out on 25 patients suffering from acute viral hepatitis including 15 pregnant women and on 25 apparently normal subjects. the mean fasting blood glucose level of hepatitis patients (62.3 - 2.6 mg/dl) was found to be significantly (p<0.01)lower than that of normal subjects (73.6 - 2.0mgdl). After drinking the glucose solution hepatitis patients generally had higher blood glucose levels compared to normal sbjects. Blood glucose and plasma insulin concentration were measured in another 35 acute viral hepatitis patients after an overnight fast, to study the relation between these values and the parameters of liver Function Test. The fastion blood glucose level was found to be inversely correlated to SGOT and SGPT level in these patients.

Experimental transmission of Non A, Non B hepatitis to rhesus monkey; (a preliminary report)

Two rhesus monkeys (M.mulatta) were injected intravenously with 10 per cent (wt/wt) pooled-stool suspensions obtained from Non-A, Non-B hepatitis patients in Rangoon. One control monkeys was injected phosphate-buffered saline only. Serial monitoring of transminase levels showed significantly raised SGOT and SGPT levels in one of the stool-injected monkey (CY-2) 4 weeks after injection. Liver biopsy was taken at the peak of transminase levels. Histologic changes suggestive of acute hepatitis were detected. EM and IEM studies for detection of virus like particles are in progress. Non-A, Non-B hepatitis was first recognized as a form of post transfusion hepatitis (Alter, HS et al 1978). However a number of reports from Burma (Khin Maung Tin and Myint Myint Khin 1977, Hla Myint 1985) India (Tandon, BN 1982), Nepal (Kane, MA 1984) and Japan (Yamandi, MA 1983), confirmed the existence of foeco-oral form of epidemic Non-A, Non-B hepatitis. Moreover there are also studies indicating sporadic form of Non-A, Non-B hepatitis (Kuroo, MS et al 1983, Nogato, A et al 1985). In Burma there are both epidemic and sporadic Non-A, Non-B hepatitis. At the present time there are no accepted serologic tests for Non-A, Non-B hepatitis in spite of several supposedly definitive antigenantibldy systems. In this study sporadic Non-A, Non-B hepatitis was transmitted to locally available rhesus monkeys.

Study on relative values of history physical examination and investigations in final diagnosis of medicial in patients in Mandalay General Hospital

A study was done on 84 newly admitted medical cases, at Mandalay General Hospital from 3.8.76 to 3.9.76. In 71 (88.7 per cent) out of 84 patients, the diagnosis after history taking was the same as that of the Final Diagnosis. In 66(82.5 per cent), the "diagnosis made after history alone was not changed after the completion of physical examination. In only 5 cases was the diagnosis changed after physical examination. 266 investigations were done in 84 cases. 84.89 per cent of the test done were found to be abnormal. Thus, (1) history alone can give a diagnosis accurate enough to stand confirmation by investigations in 88.7 per cent of cases usually reinforced by physical examination after which the accuracy rate went up to 93.8 per cent and (2) help given by investigations in arriving at Final Diagnosis is negligible.

Chromomycosis (Case report)

A 56 year old male with a warty skin involvement of the right leg by a case of Chromomycosis (Chromoblastomycosis) of about 10 years duration, had improved greatly under a combination of bed rest with elevation of the involved leg, surgery and achromycin, systemically and topically.