Lactose intolerance in the Burmese

Lactose intolerance was tested for in 50 adult patients aged 17 to 60 years and 47 children aged 1 to 5 years who had been admitted to hospital for disorders unrelated to the gastro-intestinal tract. The total of 97 patients were all Burmese and included 25 women none of whom were pregnant or lactating. Lactose intolerance was tested for by determining the rise in blood glucose level 30 minutes after an oral dose of lactose 1 g/kg body weight and of glucose 0.5 g/kg body weight on two consecutive days respectively. Symptoms such as abdominal pain and diarrhoea were also noted. Out of 31 adults who showed a rise in blood glucose of more than 20 mg/l00 ml after oral glucose 29 (93 per cent) failed to show a similar rise after lactose, therefore indicating intestinal lactase deficiency. 34 out of 50 (68 per cent) developed abdominal pain and diarrhoea of 2-10 times after the lactose dose but none after 8 oz of cow's milk. Out of 17 children who showed a rise in blood glucose of more than 20 mg/l00 ml after oral glucose II (64 per cent) did not show a similar rise after lactose, indicating lactose deficiency. 3 out of 47 children (6 per cent) developed diarrhoea after lactose but none after 8 oz of cow's milk.

Iron balance in young Burmese women

Hb determination, packed cell volume, serum iron and total iron-binding capacity, menstrual iron loss and dietary iron intake were determined in 109 healthy young Burmese nurses. The mean Hb concentration was 12.8 g/100 ml, the mean serum iron 112.5 ug/100 ml, the mean menstrual blood loss 34.5 ml/per period, the mean menstrual iron loss 14.3 mg/per period, and the average dietary iron intake per head per day was 30mg by the food composite analysis method. When grouped according to amount of menstrual iron loss it was found that the mean Hb concentration did not differ but that the serum iron showed a statistically insignificant trend towards lower values in those with a higher loss. The 24-hour urinary excretion of iron after desferrioxamine injection was below 5oo u/g in 4 out of 7on whom it was done.

Serum, whole blood and red cell folate levels (L.casei) in some Burmese population groups

Serum, whole blood and red cell folate (L. casei activity) was determined in 63 normal and 45 anaemic subjects from some Burmese population groups. The mean serum folate values are 5.2 + or - SD 2.87 ng/ml and 10.3 + or - SD 4.5 ng/ml in 2 groups of normals, the mean whole blood folate values are 81.7 + or - SD 40.4 ng/ml and 84.2 + or -SD 26.7 ng/ml, and the mean red cell folate values are 173.7 + or - SD 101.5 ng/ml and 175.7 + or - SD 49.7 ng/ml. In normals 0-16 per cent have serum folate levels less than 3 ng/ml, and 8-25 per cent have red cell levels less than 100 ng/ml. The mean serum, whole blood and red cell folate levels and the proportion with deficient serum and red cell folate values in all anaemics combined is not significantly different from their respective controls.

Urinary coproporphyrin excretion in battery workers

Determination of urinary coproporphyrin excretion and haematological examination were done on 53 battery workers and 24 healthy control subjects. It was found that (1) the 24-hour urinary coproporphyrin excretion of battery workers (524.5 g S.D. 403.9) was significantly higher than that of the controls (77.61 g S.D. 35.20.p<0.001) ; and (2) the incidence of anaemia appears to be more prevalent in the group with higher coproporphyrin excretion.

Amaemia in two Burmese villages

A mass haemoglobin (Hb) survey was done on a total of 1, 961 subjects from two villages: Shan-te-gyi in Insein district and Tu-ywin-bo in Myingyan district. 90 per cent and 80 per cent respectively of the population was covered. Blood film : mean corpuscular Hb concentration : serum iron; serum protein; serum, whole blood and red cell folates; Hb electrophoresis and osmotic resistance tests were done on adults with Hb less than 11g per cent. Stool examination for helminthic infestation and a dietary survey were done in both villages. The mena Hb value if 520 adult males was 14.08 g per cent (S.D.1.81) and that of 648 adult females was 12.335 g per cent (S.D.1.79). 50 per cent of the males, 34 per cent of the females and 55 per cent of the 793 children below 15 years were anaemic according to WHO criteria. Pregnancy and lactation are significant factors in lowering the mean Hb; the mean Hb of the pregnant group and lactating group being 10.86 g per cent (S.D.1.60) and 12.13g per cent (S.D.1.92) respectively, both of which are significantly lower than the mean Hb of the 12.58g per cent (S.D.1.67) of the non-pregnant, non-lactating group. However, the percent anaemic according to WHO criteria is 28 per cent and 42 per cent respectively in the pregnant and lactating group versus 33 per cent in the non-pregnant, non-lactating group. 47.1 per cent of the anaemic females and 28.60 per cent of the anaemic males had serum iron values below 50g per cent. There were only 4 cases of Thalassemia-E disease among the 117 anaemic adults tested. The stool survey on adults showed that only 4 out of 74 anaemics (5 per cent) and 5 out of 54 non-anaemic controls (9 per cent) had hookworm ova in Shan-te-gyi. Of 54 anaemics and 28 non-anaemic controls tested in Tu-ywin-bo, none had hookworm ova. In the village the iron intake was adequate according to the Interdepartmental Committee on Nutrition for National Defense (ICNND) standards.

Intestinal absorption in the Burmese

The xylose absorption test using 5g of xylose, the vitamin A absorption test, and the modified folic acid absorption test of Butterworth (1962) was performed on 55 apparently health Burmese adults, 41 subjects with recent diarrhea, and 7 subjects during diarrhoea. Among healthy Burmese (20 out of 55) 36 percent had subnormal xylose absorption (10-29 percent excretion) ; (3 out of 36) 8 percent had defective vitamin A absorption with 5 hour plasma vitamin A levels less than 150 g percent (9 out of 26) 35 percent had defective folate absorption with 5 hour urinary excretion less than 0.87 mg. Considerable variation in xylose absorption was found on repeating the test at one week intervals. Among subjects with recent diarrhoea (8 out of 41) 20 percent had abnormal xylose absorption (less than 10 percent excretion ) and (21 out of 41) 15 percent had subnormal xylose absorption (17 out of 30) 57 percent had defective vitamin A absorption ; and (20 out of 27) 74 percent had defective vitamin A absorption ; and (20 out of 27) 74 percent had defective folate absorption. The incidence of defective xylose, vitamin A and folate absorption was significantly higher in those with recent diarrheoa when compared with the healthy subjects. The incidence of impaired absorption of vitamin A and folate is higher in individuals with defective xylose absorption than in those with normal xylose absorption. Apparently, impaired small intestinal function exists in a considerable proportion of apparently healthy Burmese as revealed by defective xylose and to a lesser extent vitamin A and folate absorption. Also, that defective small intestinal function occurs during and up to one week after an acute episode of diarrheoa . The presence of predomin- antly leaf-shaped jejunal villi in Burmese subjects not suffering from diarrhoea is noted.

Effect of para-aminosalicylic acid on human erythrocyte glutathione metabolism and its relation to drug induced haemolysis

During experiments designed to discover the mechanism of haemolysis due to para-aminosalicvlic acid (PAS) it was found that PAS has no oxidative effect on intracellular reduced glutathione (G-SH) nor does it cause methaemholobin or Heinz body formation as found to be the case with other haemolytic durgs such as Primaquine.

Glucose-6-phosphate dehydrogenase deficiency in Burma

Using the Glutathione instability test of E. Beutler, a survey of G-6-PD deficiency was made among the Burmese, Karens, Kachins and Mons of Burma. 200 Burmese, 98 Karens, 125 Kachins and 76 Mons were tested, all the subjects being unrelated adult males. Determination of red cell G-6-PD enzyme activity was also performed on 22 Burmese males. The incidence of G-6-PD deficiency was found to be 9 percent in the Burmese, 14 percent in the Karens, 8 percent in the Kachins and 4 percent in the Mons. The clinical implications of G-6-PD deficiency are discussed.

The assessment of iron stores

Urianary excretion of iron after administration of the iron chelating agent, Desferrioxamine-B, was investigated as a method of assessing iron stores. The test was performed on normals and on patients with iron deficiency anaemia and on 2 subjects with possibly high iron stores. The results indicate that this method will be useful for assessment of storage of iron.

The thalassemias in Burma

A random sample of 232 adult Burmese males from among 1,886 workers was investigated for the presence of thalassemia. The methods used were peripheral blood film examination for erythrocyte morphology, red cell absolute indices using routine methods as well as the Coulter Counter, paper and starch gel electrophoresis for quantitation of Hb.A2 and Serum iron determinations. From the sample of 232 subjects 10 (4.3 per cent) were found to have the thalassemia trait of whom 2 have the beta-thalassemia trait and 8 have the alpha-thalassemia trait. The diagnostic criteria are discussed. the incidence is compared with that in other countries and the implications are discussed. Data on 25 subjects with Thalassemia Hb. E disease and 8 subjects with Hb. H disease on whom hematological and genetic studies have been completed are presented. The results of hematological, biochemical and genetic studies of an informative family having both Hb. H and Hb. E are presented. The implications as to the interaction between the thal. gene and the Hb. E gene are discussed.

Methods of detecting folate deficiency

Several of the available methods of detecting folate deficiency were investigated. The results of the qualiltative formiminoglutamic acid (FIGLU) excretion test after 15 g histidine load using conventional voltage paper electrophoresis on 8 non-anaemic Burmese subjects and 5 patients with folate deficient megaloblastic anaemia are reported. Of the 8 non-anaemic subjects, 3 gave abnormal results. Of the 5 folate deficient megaloblastic anaemia patients 3 gave abnormal results, while 1 was negative and 1 was doubtful. Microbiological assay of folate activity in serum, whole blood, and erythrocyte using Lactobacillus casei as test organism is described. Results on healthy non-anaemic Burmese adults and patients with folate deficient megaloblastic anaemia are presented. 29 of the 54 healthy non-anaemic Burmese adults and 2 of the 3 megaloblastic anaemia patients have serum level below 3ng/ml (millimicrogram per milliliter). The results of the plasma Folic Acid clearance test and urinary excretion test using both microbiological assay and radioisotope tritium labeled folic acid (H power 3 Folic Acid) on two non-anaemic Burmese adults and 3 folate deficient megaloblastic anaemic patients are presented. The usefulness of the tests in detecting folate deficiency is discussed.

Some aspects of anaemia of pregnancy in Burma

Hb. concentration was determined in 1,167 unselected pregnant women attending the ante-natal clinic of the Central Maternity Hospital, Rangoon. Hb. concentration, M.C.H.C., Hb. electrophoresis, serum iron level and iron binding capacity and serum and whole blood folate (L. casei) levels were determined in 48 anaemics and 109 non-anaemic controls from among 230 unselected, obsteretically normal, full-term pregnant women in the wards of the Central Maternity Hospital, Rangoon. Ratio of paired maternal and cord blood was also determined for Hb. serum iron, and serum folate.