Myanmar Medical Journal
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Item Basic medical emergency.(Myanmar Medical Association, 2012-12-01) Than Than AyeItem Emergency medicine: new specialty in Myanmar.(Myanmar Medical Association, 2012-12-01) Zaw Wai Soe; Maw OoItem Role of clinicians and general practitioners in public health activities.(Myanmar Medical Association, 2012-12-01) Than SeinItem Assessment of knowledge perception of general practitioners on continuous quality improvement programme in Myanmar.(Myanmar Medical Association, 2012-12-01) Tin Tin Hla; Tin Myo Han; Win Zaw; Tin AyeItem Study of plasma nitric oxide, plasma malondi-aldehyde and serum uric acid concentration in normal and preeclamptic pregnant women.(Myanmar Medical Association, 2012-12-01) Tun Nay Oo; Myat Thandar; Yi Yi Myint; Zaw Lin TheinItem Enhancing the role of clinicians and general practitioners in public health,(Myanmar Medical Association, 2012-12-01) Myo OoItem GIST in small intestine.(Myanmar Medical Association, 2014-12-01) Tint Zaw Lin63 years old man was referred to surgical ward of Monywa General Hospital on 26-7-2012 for recurrent attack of passing melaena stool. Patient received 5 units of blood for severe anemia in preoperative period. Emergency operation was done on 28-7-2012 after he had undergone US abdomen and upper GI endoscopy. At operation, there was a large mass arising from jejunum. Tumor was resected and histology of tumor revealed Gastrointestinal stromal tumor [GIST]. Patient wasdischarged with no further bleeding.Item Propranolol therapy in infantile haemangioma cases.(Myanmar Medical Association, 2014-12-01) Htoo Han; Nyo Nyo Win; Mya Mya HlaingItem Rabies control / elimination and vaccination.(Myanmar Medical Association, 2014-12-01) Tint Tint KyiItem Study on the utilization pattern of the emergency ambulance Service of the Myanmar Medical Association.(Myanmar Medical Association, 2014-12-01) Aung Lin; Thar Htet Aung; Ko Lay; Aung Kyaw; Wai Phyo Aung; Thet Hlaing Win; Tin Zaw MaungEmergency 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.Item Study of serum gamma-glutamyl transferase and ferritin levels in normotensive and hypertensive Monks.(Myanmar Medical Association, 2014-12-01) Moe Phyu Phyu Aung; Aye Mya Mya Thwin; Myat ThandarThe main objective of the study is to determine the serum gamma-glutamyl transferase (GGT) and ferritin levels in normotensive and hypertensive monks and to fi nd out whether blood pressure is correlated with serum GGT and ferritin levels in these groups. Normotensive and hypertensive monks age between 40 and 60 years (n=50 each) had participated in the study. Serum GGT was measured by kinetic colorimetric method and serum ferritin level by enzyme-linked immunosorbent assay. The mean serum GGT level of the hypertensive monks was found to be signifi cantly higher than that of the normotensive monks (60.42 ± 25.93 versus 25.32 ± 5.30 U/L) (p < 0.001). The mean serum ferritin level of the hypertensive monks was also found to be signifi cantly higher than that of the normotensive monks (116.87 ± 46.68 versus 37.03 ± 18.79 ng/ml) (p < 0.001). A significant positive correlation between blood pressure (systolic blood pressure, diastolic blood pressure and mean arterial pressure) and serum GGT level was found in hypertensive monks (r = 0.691, p < 0.001; r = 0.482, p < 0.001; r = 0.610, p < 0.001 respectively). No signifi cant correlation between blood pressure and serum ferritin level was found in both groups. An increase in both serum GGT and ferritin levels in the hypertensive group suggested that oxidative stress is involved in the pathophysiology of essential hypertension, and they might rather act as prooxidants in hypertension.Item Health hazards, job satisfaction and quality of life of health professionals working at government hospitals in Mandalay City, Myanmar.(Myanmar Medical Association, 2014-12-01) Win Myint Oo; Thin Thin HtunHealth professionals play a vital role in improving and restoring health status of the community. Quality of care, patient safety and patient satisfaction depend on their performance. Job dissatisfaction, poor quality of life and they themselves being unhealthy have signifi cant impact on performance and commitment of health professionals. Therefore a cross-sectional study was conducted to determine health hazard, job satisfaction and quality of life of Myanmar health professionals during the period of February and March, 2014. Altogether 142 subjects (97 medical doctors and 45 nurses) working in government hospitals situated in Mandalay City were recruited after getting informed consent. This study found out that overall, very few health professionals were regular smokers (2.1%) and betel chewers (1.4%). There were no regular alcohol drinkers. However, among the male medical doctors12% and 8% were found to be regular smokers and betel nut chewers, respectively. Reading (58.5%) and watching movie (43.9%) are the most common recreational activities. About half (45.8%) of the subjects reported to have encountered injury either during an operation or while giving injections to patients. Such injury was reported in spite of 92.8% of all the respondents reporting to have followed universal safety precaution measures. In addition 67.6% reported that they did not have enough income and 21.1% reported not to be having adequate sleeping hours. In general 53% did not have job satisfaction. The reasons given for this were low salary (66.7%) and overwork (61.3%). However, most of the subjects (about 80%) fell into average levels of compassion satisfaction, burnout and secondary traumatic stress. Only 1% of the respondents were at low level of compassion satisfaction and high level of secondary traumatic stress. No respondent was at high level of burnout scale. Insuffi cient income was found to be major determinant of job satisfaction and quality of life of Myanmar health professionals (p < 0.01). There was significant relationship between job satisfaction and quality of life, especially burnout (p = 0.008). There is urgent need to address the problem of lacking job satisfaction through giving enough income and increasing manpower to reduce workload in hospitals. Strict adherence to universal precaution by health professionals should be reviewed and reinforced.Item Infection control measures among interns / house surgeons in teaching hospitals under University of Medicine (1), Yangon.(Myanmar Medical Association, 2014-12-01) May Soe Aung; Tin Tin Aye; Win Myint OoHealth care workers are responsible for prevention and control of communicable diseases in the hospital environment. This study aimed to focus on infection control measures among house officers. A cross-sectional descriptive study was conducted in 2010 at three teaching hospitals in Yangon City by introducing anonymous self-administered questionnaires to randomly selected 150 respondents. SPSS version 16.0 was used for analysis. Over half of the respondents had high knowledge and perception but the practice was poor. Infection control messages acquired through health talks, seminars and media were infl uencing factors on knowledge while training programs signifi cantly infl uenced both knowledge and perception. Senior house offi cers had significantly higher mean perception scores than their juniors (p=0.005). Their hand washing practice was signifi cantly infl uenced by newspapers and magazines (p=0.003) and poster and pamphlet(p=0.056). Compliance on utilization of surgical mask as a precautionary measure for airborne transmission was associated with knowledge (0.020), adequate supply in wards (p=0.001) and donation from medical product company (p=0.042). They bought gloves for handling infectious materials (p=0.000), and needle recapping practice before discarding was related to knowledge (p=0.05). Knowledge, perception and practice of house offi cers were interrelated to each other. Further education and training of house surgeons, resource allocation and continuous monitoringwere necessary for proper infection control and safe hospital environment.Item Maintaining good clinical practice with evidence based approach.(Myanmar Medical Association, 2014-12-01) Aye Maung HanItem Sticky Throat.(2015-09-01) Zin Latt Ko; Ne Myo Aung; Tint Tint Kyi; Mar Mar KyiA 46-year old woman from Hlaing Thar Yar Township presented to the medical ward of Insein General Hospital with acute onset of fever, dyspnoea and coma. She had one year history of tiredness and feeling of sticky sensation in the throat while swallowing meals. Tiredness was especially marked in the evenings and after heavy work. The feeling of sticky sensation was felt intermittently but it was more remarkably felt during dinner and after having a heavy meal. On admission, she was cyanosed, respiration was depressed and autonomic disturbances were observed. She was treated in the intensive care unit with assisted ventilation. Upon further investigation along with clinical assessment and nerve conduction studies the diagnosis was confi rmed as generalized myasthenia. This is an example of myasthenia presenting with vague signs and symptoms that fi nally lead to a health crisis. The delay in diagnosis occurred due to lack of detailed analysis of the symptoms, lack of suspicion and the unique presentation of the case with vague symptoms. The lesson to be learnt from this case is that neuromuscular disorders should always be considered in cases presenting with throat problems.Item Pulmonary Embolism.(Myanmar Medical Association, 2015-09-01) Tin Latt; Ei Ei PhyuFirst case (UTO) was a 42 year old Myanmar male who was admitted to Asia Royal Hospital on 31st December 2014 for shortness of breath and tightness of chest for duration of two days. He had a fainting attack on 30th December 2014 that lasted about one minute and recovered spontaneously. He had both long bone fractures in his right leg and POP was applied from foot to below knee. CT pulmonary angiogram (CTPA) revealed pulmonary embolism (PE) in both main pulmonary arteries and fi rst order branches. Color Doppler Vascular Ultrasound was done after removal of the POP cast in the right lower limb which revealed deep vein thrombosis. Low molecular weight (LMW) heparin (Enoxaprin) was given sub-cutaneously BID followed by oral anticoagulant, warfarin. He was discharged from hospital on 6th January 2015 with full recovery. The second case (Mr SFSW), was a 64 year old gentleman from New Zealand, residing in Yangon for over 20 years who was admitted to Asia Royal Hospital on 6th April 2015 for breathlessness and dyspnoea on exertion for three days. He had a past history of hypertension and type 2 diabetes mellitus for 15 years. He is grossly obese with a BMI of 50.99. Color Doppler ultra-sonography revealed deep vein thrombosis in the right lower limb. CT Pulmonary Angiogram (CTPA) revealed pulmonary embolism in the main pulmonary arteries on both sides extending into upper and lower lobe pulmonary arteries. He was treated with LMW heparin (Enoxaprin) sub-cutaneously BID followed by warfarin. He was also discharged on 17th April 2015 with full recovery.Item Wegener’s granulomatosis: Is it rare?(Myanmar Medical Association, 2015-09-01) Santara; Zaw Lynn AungA 52 year old lady was admitted with fever, productive cough and breathlessness for one month. She had past history of recurrent sinusitis. Clinically, she had bilateral sensorineural hearing impairment, nasal crusts and peripheral neuropathy apart from signs of consolidation. Vasculitic lesions appeared a day after admission. Investigations revealed multiple nodular like lesions scattered in both lungs on CXR. Blood tests revealed positive cANCA (Cytoplasmic fluorescence Antineutrophil Cytoplasmic Antibodies) and raised infl ammatory markers. She was treated with immunosuppressant and antibiotic. Clinical and radiological improvement was noted 2 weeks later.Item Current status and diagnosis of multidrug-resistant tuberculosis in Myanmar.(Myanmar Medical Association, 2015-09-01) Ti Ti.Item Effectiveness, safety and acceptability of the method of visual inspection with acetic acid (VIA) and cryotherapy based single-visit approach to cervical cancer prevention (CCP) in Kungyangon Township, Yangon Region, Myanmar.(Myanmar Medical Association, 2015-09-01) Mya Thida; Khin May Thin; Zaw Myint Thein; Yin Yin Sein; Thazin Nyunt; SandaCervical cancer is the second most frequent cancer occurring among the women in Myanmar. Being a preventable cancer, it is crucial to have an organized screening program in place that uses simple, practical and cost effective technology so as to ensure that the screening services have a wide coverage and it is universally accessible. The aim of this study is to fi nd out the effectiveness, safety and acceptability of the method of visual inspection with acetic acid (VIA) and cryotherapy based single-visit approach for use in cervical cancer prevention (CCP) programmes in Myanmar. The study is a descriptive community-based study conducted from July 2013 to October 2014. A well trained central CCP mobile team from Central Women’s Hospital (CWH) of the University of Medicine 1 visited Kungyangon Township fortnightly during the weekends to carry out the study. During the 6 visits undertaken by the team, 1,617 married women between the ages of 30 - 49 years were screened for cervical cancer using VIA method. The screening coverage achieved was 8.97%. The VIA tests were positive in 121 women and the screening positive rate was 7.5%. Cryotherapy was given to 119 eligible women after proper counseling. The treatment rate was 98.35%. Two women needed loop electrosurgical excision procedure (LEEP) surgery. Another two women had invasive cancer on screening. Watery vaginal discharge for 2 to 3 weeks after cryotherapy was the only symptoms reported at the time of one month follow-up. At the time of 1 year follow-up visit, the defaulter rate was 13.45% and 3 women had persistent VIA positive lesions. The overall cure rate was 97.09%. Twenty local basic health staff (BHS) were trained during screening visits of the Central CCP team. A local CCP team was also formed to sustain the screening program at the community level. All women that participated in the study were happy with the single-visit approach and they have been supported by their husbands in their efforts to obtain treatment. In addition, it was found that the women undergoing cryotherapy successfully adhered to home-care instructions prescribed by the CCP team. The study has shown that the screen and treat single-visit approach can be successfully implemented and expanded to other areas so that a universal coverage can be obtained to control cervical cancer in Myanmar.Item Association of mean platelet volume with glycemic control and macrovascular complications in type 2 diabetic patients.(Myanmar Medical Associaiton, 2015-09-01) Min Min; Khin Saw Than; Htun Lwin Nyein; Moe Moe SanDiabetes is a major global health problem. Vascular complications of diabetes include both macro-vascular and micro-vascular pathologies. Mean Platelet Volume (MPV) is an indicator of average size and activity of platelets. Platelet hyper-reactivity is a characteristic feature of diabetes and it plays a pivotal role in its overall prothrombotic state. A cross-sectional analytical study was carried out on 88 cases of type 2 diabetic patients presented to Yangon General Hospital and New Yangon General Hospital during 2013. Glycemic control was detected by HbA1C and MPV was measured. The subjects were interviewed and assessed for family history of diabetes, duration of diabetes, body mass index and presence of macro-vascular complications. Among the 88 patients in the study, majority of them were in the 60 - 69 years age group. Mean age was 64 years. Sex distribution was equal among the selected 88 patients. Macro-vascular complications such as cerebrovascular disease, ischaemic heart disease and peripheral vascular disease were found in 28.4%, 55.68% and 19.32% respectively. Mean MPV was 8.45 fl and it had a significant association with HbA1C (p = 0.0367). However, no signifi cant association was found between MPV and the presence of macro-vascular complications (p = 0.462).