Dawn of Theranostics in Myanmar (Dream, Reality, and Constraint) / 대한핵의학회잡지

Prostate cancer is third common malignancy in men of old age (average 65 years) in Myanmar. Currently, serum PSA and bone scan are the markers of choice. Because of the evidence-based, promising success of ⁶⁸Ga-PSMA PET-CT and 177Lu-PSMA theranostics in prostate cancer worldwide, (99m)Tc-PSMA SPECT-CT imaging and ¹⁷⁷Lu-PSMA therapy has launched as a stepping-stone of theranostics in Myanmar with the available facilities. Twelve cases of prostate cancer patients were imaged with 600 MBq of (99m)Tc-PSMA I+S SPECT-CT. Four metastatic castration resistant prostate cancer (MCRPC) patients with abnormal result were treated with ¹⁷⁷Lu-PSMA. The protocol consists of 6–8 GBq of ¹⁷⁷Lu-PSMA, three successive doses at interval of 4–6 weeks. Post-therapy SPECT-CT imaging was done. All treated patients were improved by free of bone pain, and fall/rise in serum PSA level. Two patients with extensive skeletal metastases succumbed to complications. The results are well documented and present at the multidisciplinary conferences for clinical awareness. Theranostics in prostate cancer with available facilities is an additional boon to our health care professionals to upgrade cancer management in Myanmar. This paper provides the technology with cost effectiveness and benefit to prostate cancer patients of Myanmar.

Dawn of Theranostics in Myanmar (Dream, Reality, and Constraint) / 대한핵의학회잡지

Prostate cancer is third common malignancy in men of old age (average 65 years) in Myanmar. Currently, serum PSA and bone scan are the markers of choice. Because of the evidence-based, promising success of ⁶⁸Ga-PSMA PET-CT and 177Lu-PSMA theranostics in prostate cancer worldwide, (99m)Tc-PSMA SPECT-CT imaging and ¹⁷⁷Lu-PSMA therapy has launched as a stepping-stone of theranostics in Myanmar with the available facilities. Twelve cases of prostate cancer patients were imaged with 600 MBq of (99m)Tc-PSMA I+S SPECT-CT. Four metastatic castration resistant prostate cancer (MCRPC) patients with abnormal result were treated with ¹⁷⁷Lu-PSMA. The protocol consists of 6–8 GBq of ¹⁷⁷Lu-PSMA, three successive doses at interval of 4–6 weeks. Post-therapy SPECT-CT imaging was done. All treated patients were improved by free of bone pain, and fall/rise in serum PSA level. Two patients with extensive skeletal metastases succumbed to complications. The results are well documented and present at the multidisciplinary conferences for clinical awareness. Theranostics in prostate cancer with available facilities is an additional boon to our health care professionals to upgrade cancer management in Myanmar. This paper provides the technology with cost effectiveness and benefit to prostate cancer patients of Myanmar.

EPIDEMIOLOGICAL STUDY OF INFLUENZA VIRUS INFECTIONS IN YANGON, MYANMAR

Although influenza is a highly contagious acute respiratory illness of global importance, little is known about the disease in tropical countries. An influenza survey was conducted in three sentinel sites in Yangon, Myanmar from September 2003 to December 2004. Throat or nasal swabs were collected from 616 patients with influenza-like symptoms and tested using rapid diagnostic test kits and virus isolation. Influenza B virus was detected in 6 patients from September to October, 2003. Influenza A viruses were detected in 133 patients from June to September, 2004, and the 51 influenza A viruses isolated from 72 specimens were all A⁄H3N2. Influenza virus infections occurred mainly in the rainy season in Yangon, Myanmar, but continuous ongoing influenza surveillance is needed.

Comparative study of effectiveness of different dihydro-artemisinin (Cotecxin)tablet regimens in uncomplicated falciparum malaria

Dihydroartemisinin, one of the artemisinin derivatives is getting into ferquent use for its lower price and higher efficacy.In this study 32 and 21patients with uncomplicated falciparum malaria were treated with dihydroartemisinin tablet produced as Cotecxin, 480 mg over 3 days and 480 mg over 7 days respectively. The initial cure rates in both treatment groups were 100

but 34.37

recurred in 3 day treatment group and 19.05

in 7 day treatment. The resistance was only at R1 level and the recrudescence rates in both groups were not significantky different (P=0.37). The paarasite clearance times PCTs were 29.1-+1 hours in 3 day treatment and 26.62-+ 12.77 hours in 7 day treatment. All patients in both groups were free of side effects. The results support the previous findings that shorter course of artemisinin derivatives brung higher recrudescence.

Efficacy of two different short coure regimens of artemether plus mefloquine in acute uncomplicated falciparum malaria

One of the factors affecting the compliance in chemotherapy i duration of therapy. It is sseen in treatment of malaria with quinine in which its long course and side effects limit the patient's compliance. In this study two different short courses of artemether mefloquine were deployed. 27 patients in Group 1 received oral artemether 320 mg stat dose followed by mefloquine 750 mg after 24hours. In Group 2,28 patietns received same dose of Artemether followed by mefloquine 750 mg and 500 mg after 24 and 30 hours. Short parasite clearance times were observed a 28.74 + or - 15.16 hours in Group land 35.82 + or - 23.62 hours in Group 2. The cure rates were 74.07 per cent in firt group and 92.86 per cent in the latter. (p=0.06.Firsher xact test) The short course brought no side effects.

Efficacy of two different short course regimens of artemether plus mefloquine in acute uncomplicated falciparum malaria

One of the factors affecting the compliance in chemotherapy is duration of therapy. It is seen in treatment of malaria with quinine in which its long course and side effects limit the patient's compliance. In this study two different short courses of artemether mefloquine were deployed. 27 patients in Group 1 received oral artemether 320 mg stat dose followed by mefloquine 750 mg after 24 hours. In Group 2, 28 patients received same dose of Artemether followed bymefloquine 750 mg and 500 mg after 24 and 30 hours. Short parasite clearance times were observed as 28.74 + or - 15.16 hours in Group 1 and 35.82 + or - 23.62 hours in Group 2. The cure rates were 74.07

in first group and 92.86

in the latter. (P=0.06. Firsher exact test) The short course brought no side effects.

Comparative study of effectiveness of different dihydroartemisinin (cotecxin) tablet regimens in uncomplicated falciparum malaria

Dihydroartemisinin, one of the artemisinin derivativesis getting into frequent use for its lower price and higher efficacy. In this study 32 and 21 patients eith uncomplicated falciparum malaria were treated with dihydroartemisinin tablet produced as Cotecxin, 480 mg over 3 days and 480 mg over 7 days respectively. The initial cure rates in both treatment groups were 100 per cent but 34.37 per cent recurred in 3 day treatment group and 19.05 per cent in 7 day treatment. The resistance was only at R1 level and the recrudescence rates in both groups were not significantly different (P=0.37). The parasite clearance times PCTs ere 29.1 + or - 1hours in 3 day treatment and 26.62 + or - 12.77 hours in 7 day treatment. All patients in both groups ere free of side effects. The results support the previous findings that shorter course of artemisinin derivatives bring higher recrudescence.

A preliminary study of CD4+ T-lymphocyte count in tuberculosis patients

We evaluated the CD4+ T cell count in tuberculosis patients, whether it may be a supportive indicator reflecting the immune status of the patient. A total of 55 patients and 50 controls were included. Patients were within the age range of 19-65 years with a mean of 42.836 + or - 16.24 SD. These included 43 male and 12 female subjects with pulmonary and extrapulmonary tuberculosis. Age and sex matched subjects were included as controls. CD4+ T-lymphocyte count was determined manually with Coulter Manual CD4 Count Kit. A significant reduction in mean CD4 count against control subjects was observed (p=0.004, d.f. 103). A correlation coefficient of 0.546 was observed between CD4 count and percentage of differential lymphocyte count from the peripheral blood. the results indicate that measurement of CD4 count using above method is worthwhile for tuberculosis patients as an adjunct to clinical parameters for the assessment of the immune status of the patient.

Rapid and efficient removal of immature Aedes aegypti in metal drums by sweep net and modified sweeping method.

A modified sweeping method was developed using a cotton sweep net for control of Ae. aegypti immatures in 200 liter (44 gallon) metal drums which are major sources of breeding in Yangon. Laboratory experiments revealed that with only 4 sweeps (approximately 10 minutes duration), the mean % removal (+/- SD) of Ae. aegypti fourth stage larvae was 88.5% +/- 1.47. This was followed by a field study undertaken in Sanchaung township, Yangon. Twenty-eight drums with moderate (< 500 immatures) to high (> or = 500 immatures) Ae. aegypti density were tested in the field. It was found that with only 4 sweeps per drum, a total of 24,886 immatures were removed out of 29,155 immatures in these 28 drums, giving a mean % removal per drum of 85.36% +/- 10.74 (range = 55.54-98.62%). This sweeping method is simple, cost-effective, and readily accepted by the community. It could be an appropriate technology for control of the dengue hemorrhagic fever (DHF) vector Ae. aegypti.

Applicability of WHO criteria by community health workers for diagnosis of acute lower respiratory infections

Applicabiligy of simple clinical signs (WHO, 1990 ARI classification) by community health workers (CHWs) for the diagnosis of Acute Lower Respiratory Infections (ALRI) especially pneumonia, were evaluated in ort-patient department of Yangon Children's Hospital from November 1990 to February 1991. 944 under-five children presenting with Acute Respiratory Infection related symptoms of less than 7 days duration were included in the study. The percentage agreement of diagnosis status by CHWs with reference to project Medical Officers (gold standard) were Kappa 0.5126 (p<0.001) in less than 2 months old infants and Kappa 0.5442 (p<0.001) in children aged 2 months to 5 years. CHWs were able to detect important cllinical sings like chest indrawing in percentage agreement of 85.1 Percent. However, perecentage agreement in respiratory rate was found to be 60.2 Percent and there was incorrectness in counting the respiratory rate as the rate increased. Divverences in the level of agreement on these important clinical signs misclassified the disease category resulting in low percentage agreement in discriminating the disease severity.

Epidemiology of sports injury in Myanmar athletes

An epidemiological study of sports injury was conducted in early part of 1990. Records of five different federations, namely track and field, foot ball, volley ball, boxing and weight lifting from outpatients department of the Aung San Stadium, were collected for 1985, 1986, and 1987. An interview study was also carried out in 116 Myanmar selected athletes from the above five federations, to determine the possible causal factors of sports injury. Three year average incidence rate of sports injury in five federations was 5.5 per 100 athletes. Common sites of injury, major types of injury, type of treatment, health seeking pattern, causes of sports injury were described, and discussed.

A knowledge-preception-behaviour study on malaria in two island villages and two timber extraction camps in Tanintharyi Division

<A> malaria related knowledge-perception-behaviour study was undertaken in January 1989 in Pu-law-ton-tone (8 km from Kaw-thaung) and Pan-zin (10 km from Myeik) villages by interviewing heads ofn household, and in Han-ka-dine (western coast in Boke-pyin township) and Nam-ton (eastern border in Kaw-thaung township) timber camps by questioning the personnel concerned. In both the villages, more than 85 per cent of the respondents had none or low level of knowledge concerning biting position and breeding places of Anopheles mosquito, cause of malaria, awareness of chemoprophylaxis and chemotherapy against malaria. However, in comparison with the latter respondents, the former knew less significantly about the biting time of mosquito, and spread mof malaria; and perceived less significantly on susceptibility, severity, and controllability of malaria, benefits of selected antimalarial control measures. The greater number of people in Pu-law-ton-tone relied malaria treatment on general medical practitioners (37 per cent) and self-medication (29 per cent), while those in Pan-zin on Community Health Worker (38 per cent) and midwife (29 per cent). Similarly, the patterns of lack and difference in knowledge and perception on malaria between Han-ka-dine and Nam-ton timber workers were comparable to those seen in the two villages. The causes of dis-similarity in knowledge and perception on malaria between the villages and the camps and the facts to be emphasized in providing health education are discussed.

Chest injury and it's management

The incidence, classifications and management of chest injury are discussed. Proper recognition and treatment of abnormality produced, rather than routine employment of specific measures for specific injury, was stressed. Initial management of individual problems and further management of the patient as a whole are also discussed. During the first three decades of life, accident is the leading cause of death and it ranks fourth among causes of death overall. Since 1879, when the first person was killed in a car accident, the rate of road traffic, accidents has increased. This is accompanied by a paralled increase in severe injury of all kinds, among which chest injuries are prominent and often fatal.