Pneumocystis carinii infection among human immunodeficiency virus (HIV) infected Myanmar patients.

A total of 60 HIV infected patients complaining of dry cough for at least two weeks and attending the Out-patient Department of the Specialist Hospital, Waibargi, were screened for Pneumocystis carinii. Induced sputum samples were examined with Giemsa and Gomori silver methenamine stains. P. carinii were detected in 18 patients (30%) with silver stain and 13 patients (21.7%) with Giemsa stain. The sensitivity and specificity of the Giemsa stain were 72.2% and 95.2%, respectively. The range of CD4 counts in P. carinii-positive patients was found to be 0-562/microl, and the mean CD4 count was 132.3/microl. Out of 18 P. carinii-positive cases, CD4 counts of 15 cases (83.3%) were <200/microl and those of 3 cases were >200/microl. Clinically, P. carinii-positive cases were associated with fever in 55.5%, with tightness of the chest in 38.9%, and with cyanosis and tightness of the chest in 11.1%. Co-infection with tuberculosis was found in 16.7%. Anti-pneumocystic prophylaxis is recommended for those patients with a CD4 count <200/microl. Giemsa staining could be used as an alternative diagnostic method for detecting P. carinii. This study documented the existing prevalence of P. carinii among HIV-infected Myanmar patients.

Assessing HIV and AIDS information needs of the General public using a telephone hotline in Yangon

To reduce the further spread of HIV infection and its impact on the society through the dissemination of correct information about HIV transmission and prevention in a confidential and anonymous discussion over the telephone and to assess information needs of people calling the hotline, a hotline number was advertised in three major journals and in one news paper for December 1, World AIDS day. the counsellors took note of demographic characteristics and reason for calling the hotline. A simple questionnaire was filled up by the counsellors to reflect demographic characteristics as well as behaviour risk of callers. The data gathered was analyzed using the software EpiInfo 6. Only calls during World AIDS Day were analyzed. Out of 74 calls on world AIDS Day, most of the callers were males and the mean age of female callers was 26.32 years, while males was 31.52 years, Majority of the callers were in their 20's (47 per cent) and 30's (21 per cent). Most of the callers were single. Regarding the risk practices, (26 per cent) admitted risk behaviour of whom 52 per cent said that they had multiple sexual partners, while nearly a quarter of callers said they injected drugs (21 per cent) and a quarter said they had sexual partners who had multiple sexual partners (26 per cent). When they talk about condom use, most of the young male callers asked about how to use condom properly. Regarding HIV/AIDS knowledge more than half of the callers had misconception about the basic information about HIV/AIDS. More than two thirds of the callers wanted to know how HIV is transmitted and prevented. Some of the callers expressed concern about their feelings towards the disease and some were concerned about their own personal behaviours that could put them at risk for infection. almost a quarter asked about the HIV/AIDS services available in Yangon. At least one hotline service should be established to disseminate the HIV AIDS information and also for the people who are worried about their risks. The anonymity of the conversations in the hotline might encourage people to discuss freely their sexual activities.

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.

Electrocardiographic effect of quinine and quinidine in the treatment of falciparum malaria

Quinidine has been suggested as an acceptable alternative to quinidine in the treatment of falciparummalaria. To compare the electrocardiographic effects of quinine and quinidine in falcaparum malaria, sixty patients with more than 2 per cent of parasitized red cells were chosenand paired as closely as possible. The study was double-blind. 15 mg/kg quinine or quinidine was given as a loading dose infused over 4 hours followed by 2 doses of 7.5 mg/kg base at 8 hourly intervals. Oral quinine or quinidine as 7.5 mg/kg base 3 times/day was then continued till day 7. Satisifactory 12 lead electrocardiograms were obtained from 58 patients on day 0, after 24 hours, on day 3 and on day 7. Overall there was no significant change in PR interval or ORS duration. The pretreatment QTc was 443+ or -30 msec in the quinine group (n=30) and 438+ or -25 msec in the quinidine group (n=28) with no significant difference. MAximum QTc prolongation occured on the third day in both groups being 481+ or -28msec in the quinine group and this was significantly less than 532+ or -55 msec seen in the quinidine group. QTc > 550 msec was found in 46.6 per cent in the quinidine group but in only one in the quinine group.T wave flattening occurred in 62 per cent in the quinidine group but in only 25 per cent in the quinine group. No dysrhythmias were recorded in this study but because of the excessive prolongation of the Qtc caused by quinidine, we conclude that we should be cautious about the use of quinidine for falciparum malaria.

Clinical presentation of H.I.V positive intravenous drug abusers

Of 45 persons who were tested for the presence of HIV antibodies at Wards 1 & 2 , Yangon General Hospital from April 1989 to November 1989, all 26 HIV positive cases were male intravenous drug abusers (ELISA and Western blot tests positive). Mean age was 29.4 years . Pulmonary tuberculosis was the commonest presentation with 6 cases followed by infective endocarditis in 4 cases and seroconversion illness in 4. Other clinical presentations included septicaemia (3), viral hepatitis (2), drug overdose (3), malaria (3) and pneumonitis (1). Overall mortality was high nearly 40 per cent even though none of the cases had features of AIDS as defined by CDS/WHO.

Ruptured sinus of valsalva : A case report with description of echocardiographic features

A patient with right sinus of valsalva aneurysm which had ruptured into the right ventricle is described. The diagnosis was confirmed at cardiac catheterization and angiography. Echocardiographic findings are discussed and these are compared with those given by others. Detection of a continuous murmur over the precordium during clinical examination alerts one to the diagnosis of patient ductus arteriosus. However, one should also consider aorto-pulmonary window, ruptured sinus of valsalva and coronary arteriovenous fistula among other rarer conditions in the differential diagnosis, Rupture of the sinus of Valsalva is usually thought to present with sudden onset of symptoms 1,2 and the patient may have sudden chest pain, syncope, rapidly progressive cardiac failure or even sudden death. We describe a patient with ruptured sinus of Valsalva who was completely asymptomatic at the time of diagnosis and whose abnormality was first suspected during a routine check-up.