Local compression pads as a first-aid measure for victims of bites by Russell's viper (Daboia russelii siamensis) in Myanmar.

A prospective study of the efficacy of applying local pressure by compression pads in retarding spread of venom was carried out on 15 cases of bite by Russell's viper (Daboia russelii siamensis) in Myanmar. A firm rubber pad was applied with cotton bandaging over the site of bite and the limb was immobilized with a splint. Serial monitoring of venom levels by enzyme immunoassay (EIA) was carried out at 15 min intervals for 1h (2h in one case) while the pad was in place and at 15 and 30 min after its removal. A rise of 10-40ng/mL in serum venom antigen level was observed in most cases after removal of the pad. The central movement of venom antigen was retarded in 13 of the 15 cases. Mild haemostatic changes (factor V and X assays and screening tests) were observed in 10 pad-treated cases measured at the time of onset of incoagulability of blood. The side effects observed while the pads were in place were minimal, consisting of swelling, pain and tenderness, and were well tolerated by most patients (for up to 2h by one patient), except for 2 who had incisions or bruising at the site of the bite.

Thalassemia in the outpatient department of the Yangon Children's Hospital in Myanmar: basic hematological values of thalassemia traits.

The present study was conducted in the Outpatient Department (OPD) of Yangon Children's Hospital (YCH) during June to November 1990 to determine the hematological data of 133 Myanmar patients with thalassemia trait who were the parents of patients with known beta-thalassemia major or hemoglobin E (Hb E)/beta-thalassemia. The mean values of hemoglobin (Hb) concentration, packed cell volume (PCV), mean cell hemoglobin (MCH) and mean cell volume (MCV) were significantly lower than normal controls but the mean cell hemoglobin concentration (MCHC) was the same as controls. Increased osmotic resistance tested in 0.36% buffered saline was detected in 81-97% of cases depending on the cut-off point. High levels of Hb A2 (> 3.5%) were found in 93% of cases whereas Hb F was increased (> 0.8%) only in 23% of cases. Although the mean red cell count (RBC) was significantly higher than normal, only 79% of thalassemia traits were detected if the RBC count of > 5.0 x 10(12)/1 was taken as the discrimination limit. Other discrimination functions such as MCH/RBC, MCV/RBC, (MCV)2 x MCH x 0.01 and MCV-(RBC/10(12)/1)-(5 x Hb) - 3.4 or - 8.4 were tested for their utility in diagnosing thalassemia traits. All of them were found not to be superior to each of the simple tests (MCV, MCH, Hb A2 or osmotic fragility) in diagnosing thalassemia traits. The one tube osmotic fragility test is a the suitable test to be used in future thalassemia screening programs in Myanmar.

Thalassemia in the outpatient department of the Yangon Children's Hospital in Myanmar: knowledge, attitudes and practice in relation to thalassemia.

A maternal knowledge, attitudes and practice (KAP) study concerning the nature and prevention of thalassemia was carried out at the Yangon Children's Hospital in Myanmar. The KAP information was collected using a pretested schedule. Only 18 to 28% of the mothers knew at least one of the statements: thalassemia is a genetic disorder; both parents of thalassemic children carry abnormal genes; there is a 25% chance of recurrence in each subsequent pregnancy. Eighty-two per cent of the respondents decided not to have a further pregnancy for fear of recurrence and of these 62% were currently practising contraception. Oral contraception was the most commonly used method (56%). The median scores as well as the percent responses in favor of the three attitude scales relating to limiting thalassemic children, prenatal diagnosis and termination of pregnancy were high. Although there is a need to increase the community awareness of thalassemia in Myanmar, there is a possibility that prenatal diagnosis and pregnancy termination will be accepted for the prevention of thalassemia.

Thalassemia in the outpatient department of the Yangon Children's Hospital in Myanmar: cost analysis of the day-care-room services for thalassemia.

A cost analysis study for the fiscal year 1989-1990 was conducted in the day care room (DCR) for thalassemia patients at the Yangon Children's Hospital in Myanmar to provide a basis for future cost-effectiveness, cost-benefit and efficiency analyses. Two types of costs, hospital costs and costs borne by the patients' families were studied by reviewing hospital records and by interviewing family members of patients. Of the total cost of DCR services for thalassemia 74 to 75% was contributed by material costs most of which were for imported items. The cost of each transfusion visit and the annual cost per patient were Kyats 166.5 to 173.3 and Kyats 1,108.6 to 1,208.7, respectively. The median cost (range) per treatment visit and the averaged annual median cost (range) borne by the patients' families were Kyats 21 (0-302) and Kyats 107 (0-1,509), respectively.

The nephrotoxic action of Russell's viper (Vipera russelli) venom.

Sixteen rabbits were injected s.c. with 2 LD50 doses of Russell's viper venom. Kidneys from 10 rabbits that died after envenomation were examined by microdissection and light microscopy. Nephrons from five animals showed destruction of the proximal tubules with normal distal tubules. Nephrons from three animals were normal throughout, while those from two animals were destroyed. In the in vitro experiment, kidney slices from normal rabbits were incubated with varying dilutions of Russell's viper venom, Russell's viper venom and antivenom mixture, antivenom alone or saline controls, at 37 degrees C for varying time intervals. Scattered areas of tubular damage were found in kidney tissues incubated in 5 mg/ml Russell's viper venom for 2 hr. This damage was prevented by antivenom. Abnormal appearances were not seen in kidney tissues incubated with antivenom alone or saline. In the present study, direct nephrotoxic action of Russell's viper venom was observed both in the in vivo and in vitro tests, however, part of the damage in vivo could be of an ischemic nature.