Intravenous Iron Therapy: Re-administration after Prior Adverse Reaction / 가정의학회지

Background@#Intravenous (IV) iron therapy is performed in community practices and hospitals with modern formulations when oral administration becomes impractical. Effective replacement of iron is important for the treatment of iron deficiency and anemia. Can IV iron be rechallenged in individuals with a history of adverse reactions? This review is to explore the challenge of this, when clinically indicated. @*Methods@#After performing a literature search, five studies (combined total sample number=1,006) for re-exposure of IV iron to individuals with a history of past reactions were identified, observed, and analyzed. Re-exposure included reactions ranging from mild to moderate and few cases of severe type. @*Results@#The majority (>80%) of IV iron rechallenges were tolerable, safe, and successful without major serious incidents. There were no reports of major reactions (severe hypersensitivity reactions or anaphylaxis) in these re-exposures. @*Conclusion@#Re-administration of IV iron therapy in patients with a previous adverse reaction is plausible, with benefit and risk stratification. A rechallenge would depend on the nature and degree of the adverse reaction and use of alternative formulations. Rechallenge to a previous severe hypersensitivity reaction or anaphylaxis with the same product has not been reported in these studies. Evidence on the benefit of premedication use is conflicting and requires further studies.

Factors Associated With Food Safety Knowledge And Practice Among Street Food Vendors In Taunggyi Township, Myanmar: A Cross-Sectional Study

@#Food safety is a growing public health concern worldwide. Street foods are an integral part of many cultures and offer at affordable prices. However, it is associated with food safety issues, especially in developing countries. Therefore, it is essential that street food vendors understand and implement food safety practices to prevent outbreaks of food-borne illnesses. This cross-sectional study investigated the food safety knowledge and practices as well as their associated factors among street food vendors in Taunggyi Township, Myanmar. Validated structured questionnaires were used to interview 158 street food vendors, and a set of observational checklists was used to inspect the sanitary conditions of vending sites and vendors’ food hygiene practices. The association between food safety knowledge and practices was assessed using a chi-squared test. Our results revealed that most vendors had a high level of food safety knowledge and that 58.9% scored equal to or lower than the median value in food safety practices, whereas 41.1% scored higher than the median value (median=15). Sex and education level were significantly associated with participants’ food safety knowledge (p < 0.001). Similarly, education, race and monthly income were significantly associated with their food safety practices (p < 0.001), whereas food safety training attendance had no association. Additionally, participants with better knowledge scores were more likely to have better practice scores. Food safety training given to vendors should be more detailed and comply with standard guidelines, especially with regard to street food safety practices.

Patient barriers to implantable cardioverter defibrillator implantation for the primary prevention of sudden cardiac death in patients with heart failure and reduced ejection fraction

<p><b>INTRODUCTION</b>Device therapy is efficacious in preventing sudden cardiac death (SCD) in patients with reduced ejection fraction. However, few who need the device eventually opt to undergo implantation and even fewer reconsider their decisions after deliberation. This is due to many factors, including unresolved patient barriers. This study identified the factors that influenced patients' decision to decline implantable cardioverter defibrillator (ICD) implantation, and those that influenced patients who initially declined an implant to reconsider having one.</p><p><b>METHODS</b>A single-centre survey was conducted among 240 patients who had heart failure with reduced ejection fraction and met the ICD implantation criteria, but had declined ICD implantation.</p><p><b>RESULTS</b>Participants who refused ICD implantation were mostly male (84%), Chinese (71%), married (72%), currently employed (54%), and had up to primary or secondary education (78%) and monthly income of < SGD 3,000 (51%). Those who were more likely to reconsider their decision were aware that SCD was a consequence of heart failure with reduced ejection fraction, knowledgeable of the preventive role of ICDs, currently employed and aware that their doctor strongly recommended the implant. Based on multivariate analysis, knowledge of the role of ICDs for primary prophylaxis was the most important factor influencing patient decision.</p><p><b>CONCLUSION</b>This study identified the demographic and social factors of patients who refused ICD therapy. Knowledge of the role of ICDs in preventing SCD was found to be the strongest marker for reconsidering ICD implantation. Measures to address this information gap may lead to higher rates of ICD implantation.</p>

Singapore rhabdomyosarcoma (RMS) experience: shall we change our practice?

<p><b>INTRODUCTION</b>Although rhabdomyosarcoma (RMS) constitutes nearly 4% of all children diagnosed with cancer in the ethnically diverse small island city of Singapore, it is unknown how children with RMS fare.</p><p><b>MATERIALS AND METHODS</b>This study investigated 50 children with RMS from April 1993 to December 2010 from KK Women's and Children's Hospital (KKH) and National University Hospital (NUH). They were treated either as per Intergroup Rhabdomyosarcoma Study Group (IRSG) or Société Internationale Pediatrique D'Oncologie (SIOP) regimens.</p><p><b>RESULTS</b>Median age of diagnosis was 5.1 years (range, 0.1 to 17.3 years) with a median follow-up of 3.3 years (range, 0.4 to 15.6 years). According to IRSG classifi cation, 18 (36%) were staged as low-risk (LR); 19 (38%) were intermediate-risk (IR), 12 (24%) were high-risk (HR) and it was unknown in 1 patient. Twenty-nine (58%) were of embryonal subtype, 17 (34%) were alveolar and subclassification was not available in 4. The primary sites of tumour were: head and neck region (n = 22); genitourinary (n = 19); extremity (n = 10); and abdomen/retroperitoneal (n = 5). At the time of analysis, 80% were alive with no evidence of disease, 9 were dead of disease, and 2 were alive with disease. By disease risk group, the 5-year event-free survival (EFS) for LR group disease was 81.3% (95% CI, 62.0 to 100.0), IR group was 61.4% (95% CI, 32.3 to 90.4) and HR group was 25.0% (95% CI, 0.0 to 49.5) respectively (P <0.001). The 5-year EFS for risk by chemotherapy received as per SIOP vs per IRSG revealed: LR 83.3% vs 75.0% (P = 0.787); IR 83.3% vs 43.8% (P = 0.351); HR 0.0% vs 42.9% (P = 0.336) respectively. Of 15 relapses (HR, n = 7), at median of 2 years, 4 of 6 patients treated as per SIOP regimen were dead of disease and 3 of 8 treated as per IRSG were alive.</p><p><b>CONCLUSION</b>Radiation therapy (RT) can be avoided in LR classification although those in higher risk classification need RT to local and distant metastatic disease. The outcome of children with RMS in Singapore can be further improved by coming together as a cooperative group to provide the best total care. Improved communication, multidisciplinary team collaboration, standardisation of protocols and rigorous data collection are keys.</p>

Bowel prolapse following spontaneous rupture of a femoral hernia

This case presents a rare complication of the spontaneous rupture of a femoral hernia in an elderly woman without causing much systemic effect despite the herniated bowel being necrosed and perforated, giving rise to an enterocutaneous fistula. The small bowel had also prolapsed through the fistula opening, making it a very rare and alarming presentation.

The level of knowledge, attitude and practice in relation to malaria in Oo-do village, Myanmar.

A knowledge, attitude and practice (KAP) study concerning the nature and prevention of malaria was carried out in a rural area of Myanmar. According to the findings, many (over 40%) people do not have a clear cut knowledge on the transmission of malaria. Only one fourth of them had chemoprophylaxis before going to the forest, but they do not have the proper knowledge of the chemoprophylaxis regarding the type and dosage. Although there is acceptable knowledge (about 80% of the subject knew that mosquito bite causes malaria) and positive attitude towards malaria (100% of respondents agreed that malaria was a serious health problem in this area and 97% of respondents agreed that they would like to participate in malaria control activities), it is necessary to increase the community awareness of the transmission of the disease, its consequences and ways and means to control the disease to a minimum, especially in endemic areas.

Psychiatric sequelae of female sterilization

Prior to sterilization 272 cases were subjected to assessment of their personality. Six months after the operation 190 respondents were interviewed regarding the post-sterilization sequelae at the Central Women's Hospital. Housewives were the commonest occupational group, and the socio-economic problem being the most frequent reason besides the basic medical and psychological reasons for sterilization. Belief in the rumours of post-sterilization complications was found to be insignificant contrary to our suspicion. Over half of the sterilized cases were found to suffer post-sterilization sequelae either in isolation or in multiple of symptoms, the most outstanding symptoms being that of nuchal neuromuscular tension. Unstable personality types were more prone to have post-sterilization sequelae singificantly than the stable types.

A study on the prevalence of ischaemic heart disease among individuals admitted to the medical unit of the North Okkalapa General Hospital and the distribution of risk factors

This study was conducted with the purpose to find out the prevalence of IHD among individuals admitted to the Medical Unit of NOGH, the distribution of risk factors and their correlation with IHD. It is a cross-sectional clinical study of one hundred patients with or without symptoms of IDH selected from every 10th admission of each day, aged between 35-75 years of both sexes from the period of 1st July 1991 to 30 June 1992. Among the 100 patients, 15 out of 72 males (68 percent) and 7 out of 28 females (32 percent) had IHD and the highest prevalence was found in 51 years and above age group. Hypertensive patients were found to have IHD (prevalence ratio 7.05), smokers (3.35-17.0), obesity (7.78), diabetes mellitus (3.48), hypercholestrolaemia (5.5), family history of IHD (5.78), patient with sedantary life style (2.23). In conclusion, IHD had 22 percent prevalence rate in NOGH and there was preponderance in males and older age group. Hypertension and smoking were major risk facors and also obesity is found to be a significant contributing factor in this study.

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.

The effect of quinine and Quinidine on patients with highly parasitised falciparum malaria ( A double blind study )

Sixty patients with high level of parasites in the blood (i.e., more than 2

of RBCs parasitised)were chosen for the study. They were paired in sex and associated complications as nearly as possible. The first group of patients was treated with drug (A) and the remaining with drug (B). Drugs (A) and drug (B) consisted fo quinine or quinidine, (injection and tablets) which is unknown to investigators. 15 mg/ kg quinine or quinidine was given as a loading dose infused over 4 hours followed by 2 doses of 7.5mg/kg base also infused over 4 hours each at 8 hours intervals. This was followed by oral therapy. The oral drugs were continued as 7.5 mg/ kg base 3 times/ day till day 7. the efficacy of the 2 drugs were compared in terms of mortality, development of complications parasite and fever clearance, time. All patients survived, significantly higher level of serum quinine was recorded, when compared to quinidine through out the study.Serum insulin of five pairs of patients and blood glucose level of 15 pairs of patients were within the normal range (in all patients) throughout the study period. Blood glucose level in patients treated with quinine is significantly lower than those treated with quinidine at the first 36 hours of treatment. Since the parasite clearance time, fever clearance time mortality rate and recrudescence rate between the 2 groups of patients were comparable, we conclude that quinidine is clinically equal but not more potent than quinine. It is probably more toxic because of more ECG changes. Quinidine may be used as alternative only if quinine is not available.

Time usage and energy expenditure of volleyball players during training

Fifteen male Myanmar national volleyball players, selected for 11th Asian Games, 1990, were studied during training. This is the first assignment of energy expenditure on Myanmar volleyball players. The average daily training period of the players was 4.23 h. They utilized 1508.8 kcal for training activities out of the 24 h energy expenditure of 3088.6 kcal. The mean + or - SD energy intake was 3965.3+ or - 469.4 kcal per cent day and was found to be sufficient for twenty four-h energy expenditure. The individual training activities belonged to heavy type of activities but the daily training period was short compared to those of other countries.

Serum cholesterol levels in elderly people

Serum total (TC) and low density lipoprotein (LDlc) cholesterol levels were measured on one hundred and sixty (68 males and 92 females) elderly people of age 60 years and older, selected from two socio-economically different wards in San-Chaung Township. Subjects from high socio-economic ward San-Chaung-North showed higher mean TC (175.5+ or - 33.2 mg/dl for male and 196.0+ or - 35.9 mg/dl for female) and LDlc (129.5+ or - 38.5 mg/dl for male and 149.0+ or - 42.5 mg/dl for female) levels than those from low socio-economic ward Wai-LU-Wun-North (Tc, 157.8+ or - 26.5 mg/dl for male and 166.4+ or - 30.6 mg/dl for female and LDlc, 117.1+ or -23.2 mg/dl for male and 123.3+ or - 33.1 mg/dl for female). Male subjects were found to have lower cholesterol levels (Tc as well asLDlc) than that of female subject in both the residential areas. Serum cholesterol levels were found to have significant direct correlation with Body mass index and sum of four skinfolds, but no association was found with smoking habit nor with daily physical activities nor with blood pressure.

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.

Controlled trial of initial slow intravenous quinine vs conventional quinine infusion in the treatment of highly parasitized falciparum malaria in adult patients.

A total of 10 patients (adults) with highly parasitized falciparum malaria were treated initially with intravenous quinine (10 mg per kg quinine diluted in 20 ml normal saline injected very slowly with a syringe taking not less than 20 minutes). Six control patients were treated with quinine infusion standard method (quinine 10 mg/kg diluted in 500 ml of normal saline given as slow drip taking 4 hours for the drug to enter the patient's body). Both two groups of patients were followed by oral quinine 10 mg/kg three times a day for 7 days.

Thyroid dysfunction following irradiation to the neck

Thyroid functions (serum T3, T4 and TSH) were studied among 35 patients who had external radiation of the neck involving the thyroid gland within the past 10 years, and 10 control patients who had radiation else where in the body but not in the thyroid region. Findings were presented, compared with previous reports and discussed. Routine TFTs one year after radiotherapy was recommended and replacement therapy for patients with raised serum TSH is encouraged.

Intestinal ascariasis in medical students and comparative evaluation of treatments

A study of the prevalence of ascariasis in the hostel students of the Institute of Medicine 2, Rangoon was undertaken. Stool from 407 students (267 males and 140 females) were examined using hypersaturated saline concentration method, The prevalence was 47.19 per cent in male students and 52.14 per cent in the female students, the mean being 48.89 per cent + and - 0.05. The efficacies of piperazine citrate as a single dose of 4 g, as a daily dose of 4 g on two consecutive days and laevo-tetramisole 120 mg as a single dose were compared. Statistical analysis showed that, the efficacy of the three methods of treatments may be the same.