Primary Biliary Cirrhosis and Mitral Stenosis: A Rare Association.

Primary biliary cirrhosis is a rare cause of chronic liver disease in Myanmar. It usually presents with pruritus and fatigue in a middle-aged female before the appearance of jaundice. This case illustrates a woman presenting with 15 years of pruritus and 5 years of intermittent jaundice. She had no risk factors for viral hepatitis and was a non-drinker. Multiple consultations were done and treated as a chronic liver disease without probing further for the etiology. Persistently high alkaline phosphatase of biliary origin prompted us to test for anti-mitochondrial antibodies which were positive for M2 subtype. Furthermore, she was found to have clinical and echocardiographic evidence of mitral stenosis (MS). MS is usually a consequence of post-streptococcal rheumatic carditis. Molecular mimicry is the common mechanism in the pathogenesis of both conditions. Her symptoms improved after ursodeoxycholic acid treatment.

Two different presentations of fracture zygoma in clinical practice.

Two types of fracture zygoma were treated successfully with surgery by temporal reduction and the patients were able to recover fully from their injuries without any further additional treatment.

Study on the utilization pattern of the emergency ambulance Service of the Myanmar Medical Association.

Emergency Ambulance Service was initiated by the Myanmar Medical Association in October 2012. It aims to provide free ambulance service in the City of Yangon on a 24 hour basis. It mainly caters to road traffi c accident (RTA) victims and poor patients in need of emergency care and hospitalization. On each ambulance, basic life saving equipment has been installed and it is staffed with a medical doctor, a paramedic and a driver cum fi rst aid worker. Since the launch of this service a total of 1,214 cases have been provided emergency ambulance services. Over the past 2 years, an average of around 60 patients a month has been cared for. At present, patients utilizing this service are mainly from the downtown area of Yangon (40.9%) followed by residents from East Yangon (28.3%) and West Yangon (21.0%). Among patients utilizing the services, medical emergencies comprises 51.8% of all cases followed by road traffi c accident cases (11.8%) and surgical emergencies (10.5%). Due to traffi c jams in Yangon along with poor communication systems, only 65-75% of road traffi c accidents victims can be reached within 10 minutes (golden hour). In terms of overall cases, during the fi rst 6 months 32.08% of all cases were reached within the stipulated 10 minutes and this proportion improved during the subsequent 6 monthly periods. During the last 6 months (April-September 2014), this proportion reached 41.1%. Similar improvements were also observed in the 6 monthly period with regards to the time taken to transport the patient from the site of pick-up to hospital. There were no deaths reported during transportation of the patients to the hospital. In conclusion, with increasing public awareness and improved communication systems the utilization of this free ambulance service is projected to increase especially in the peri-urban areas of Yangon. As a result of proper emergency care provided at the site of pick-up and also during transportation to the hospital, this emergency ambulance service has been able to reduce unnecessary loss of lives.