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Sequence comparison of the capsid region of hepatitis E viruses isolated from Myanmar and China.

Hepatitis E viruses (HEVs) were isolated during epidemics, one from Myanmar (formerly called Burma) and one from China and were partially sequenced. Another HEV Myanmar strain from sporadic hepatitis was previously sequenced by us. A cDNA sequence comparison was performed among them in the 3'-terminal region, approximately 750-base long. This region contained at least two immunological epitopes and was considered to correspond to the structural protein. The nucleotide sequence identity was 97.2% between the two Myanmar strains and 93.3 and 92.5% between the two Myanmar and the China strain. The deduced amino acid sequence identity ranged from 98.4 to 100.0% among the three strains. Thus this segment was well conserved on the amino acid level among the different strains isolated from these two Asian countries, although the China strain diverged more from the Myanmar strains on the nucleotide sequence level. This data may provide important information for the development of a vaccine and for identification of the virological link between different geographical locations.

Amino Acid Sequence

Male cross-gender behavior in Myanmar (Burma): a description of the acault.

Cross-gender behavior in Myanmar (formerly Burma) is reported. Western concepts of transsexualism, gynemimesis, transvestism, and homosexuality are not distinct categories by the Burmese. Males with cross-gender behavior are referred to as acaults. Although Myanmar is a profoundly Buddhist society, the people still have strong animistic beliefs with an elaborate system of 37 nats (spirit gods). One of these nats is a female named Manguedon who may take possession of males and impart femininity on them. The cross-gender status of the acaults is sanctioned by their spiritual marriage to Manguedon. The acaults, while not envied, are respected for their roles as shamans and seers.

Adult

Development of a simple indirect enzyme-linked immunosorbent assay for the detection of immunoglobulin M antibody in serum from patients following an outbreak of chikungunya virus infection in Yangon, Myanmar.

During 1984, 1548 children were admitted to the Yangon [Rangoon] Children's Hospital in Myanmar [Burma] with haemorrhagic fever. No evidence of recent dengue infection was found in 577 of the 803 children from whom paired sera were obtained, raising the possibility of reappearance of Chikungunya virus infection in Myanmar. An enzyme-linked immunosorbent assay (ELISA) for the detection of anti-Chikungunya virus immunoglobulin M (IgM) antibody was prepared and standardized using only reagents which are commercially available or which could be prepared without the use of sophisticated equipment. While there was 90% agreement between haemagglutination inhibition (HI) tests and the IgM ELISA in the diagnosis of acute Chikungunya virus infections, 12 additional patients with stationary anti-Chikungunya virus HI antibody titres could be identified as having acute Chikungunya infections using the ELISA. Furthermore, the ELISA could identify twice as many patients (31/103) at the time of admission to hospital as the HI test (15/103). There was no false positive IgM reaction with the ELISA which could be attributed to the presence of rheumatoid factor. Using the test, 103 of a sample of 163 children who presented to the Yangon Children's Hospital with fever/haemorrhagic fever were diagnosed as Chikungunya patients, 4 had possible dual Chikungunya and dengue infections, 16 had dengue, 30 had neither Chikungunya nor dengue infections, and a definitive diagnosis could not be made for 10 patients. Routine use of the ELISA would alert authorities to future outbreaks of Chikungunya virus infection and avoid admission to hospital of patients with a non-life-threatening viral disease.

Antibodies, Viral

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.

Adolescent

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.

Abortion, Induced

Carriage of enteric bacterial pathogens by house flies in Yangon, Myanmar.

The carriage of enteric bacterial pathogens by house flies, caught from different places of human habitation and at different seasons, was quantitatively determined in the town of Tamwe, Yangon, Myanmar. A total of 186 fly-pools, each containing 10 live flies, were caught in entomological cages by random sampling regarding season, month, frequency and place of collection. A 10% suspension of each homogenised fly-pool in sterile normal saline was prepared on the day of collection and was cultured to isolate pathogens using standard microbiological methods. Escherichia coli, Vibrio cholerae non-O1, and species of Salmonella and Shigella were isolated from 76.3%, 45.7%, 11.8% and 4.8% respectively from all the fly-pools. Enteric bacterial pathogens were isolated more frequently in flies from refuse dumps and animal pens and least commonly in flies from kitchens. Of the E. coli isolates, one pool each from flies trapped in animal pens (n = 30 fly-pools), latrines (n = 32) and refuse dumps (n = 34) produced enterotoxins (ETEC). These ETEC isolates were obtained in the months of June and July. The rates of isolation of pathogens were highest in the hot-wet season. The faecal coliform counts in the fly-pools also increased in this season compared with those in cool-dry and hot-dry seasons. These data suggest that flies may be an important carrier of enteric infections in Myanmar.

Animals

Bites by Russell's vipers (Daboia russelii siamensis) in Myanmar: effect of the snake's length and recent feeding on venom antigenaemia and severity of envenoming.

An improved enzyme immunoassay technique (EIA) was used in the diagnosis of 311 suspected Russell's viper bite cases in Myanmar [Burma], 181 of whom (58%) had systemic envenoming. Russell's viper venom was detected in the sera of 175 (56.3%), cobra or green pit viper venoms in 4 (1.3%), and no venom in the remaining 132 (42.4). Among 175 of these patients who failed to bring the dead snake, EIA achieved a specific diagnosis of Russell's viper envenoming in 101 (58%). The serum venom antigen concentration was higher in patients with systemic envenoming than in those with local or no envenoming and it increased with the development of coagulopathy. Stomach contents were examined in 101 Russell's vipers responsible for bites. The presence of prey, usually a rodent, in the snake's stomach, indicating that it had eaten recently, did not influence the severity of envenoming, the initial venom level, or the percentage circumference increase and the extent of local swelling in the bitten limb. One hundred and fifty-five Russell's vipers responsible for bites showed a bimodal distribution of total lengths. The smaller snakes had probably been born that year. Longer snakes were responsible for more severe envenoming, a shorter interval between the bite and the detection of incoagulable blood, and more extensive local swelling with a greater percentage circumference increase of the bitten limb; but their bites were not associated with higher initial venom antigenaemia or a greater risk of developing acute renal failure.

Adult

Control of Culex quinquefasciatus in Myanmar (Burma) and India: 1960-1990.

During the past 30 years three major programmes of research have been carried out in Myanmar (Burma) and India on the ecology and control of Culex quinquefasciatus. To differing degrees the programmes have employed environmental, chemical, biological and genetic control strategies, but none has been an unqualified success. Results have been good when well-trained staff with substantial resources were employed, but much poorer when less-well-equipped general health workers took over the programmes. Overall, it would seem most cost-effective for health workers to concentrate their efforts on the elimination of the limited number of larval habitat categories which commonly contribute a large fraction of the adult population. Insecticides and biological control agents should serve as supplements, not as alternatives, to environmental management. Genetic control strategies have currently no place in C. quinquefasciatus programmes.

Animals

An epidemiologic study of 70 oral cancer cases at the Institute of Dental Medicine, Yangon, Myanmar, 1985-1988.

This study shows that in Myanmar, South-East Asia, the prevalence of oral cancers is a serious fact as they rank fifth among all cancers being known there. On the 70 oral cancer cases reported at the Institute of Dental Medicine, Yangon, the findings stressed that most patients, male or female, came from the metropolitan division (Yangon), had smoking and chewing habits. Also most of these patients came to hospital only at the severe and late stage. It confirms us in our opinion that early diagnosis and prompt treatment are a necessity.

Adolescent

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.

Ambulatory Care

Bites by the king cobra (Ophiophagus hannah) in Myanmar: successful treatment of severe neurotoxic envenoming.

Three patients bitten by the world's largest species of venomous snake, the king cobra (Ophiophagus hannah), were observed in Myanmar (Burma). All three were involved in the famous snake dance in Yangon (Rangoon) Zoological Gardens. One patient showed no signs of envenoming despite a sustained bite, another developed only signs of local envenoming, but in a third there was severe neurotoxic envenoming requiring mechanical ventilation for 64 1/2 hours, episodes of hypotension and massive swelling of the bitten limb. This patient showed some signs of recovery before delayed treatment with specific antivenom. It is possible that all three patients had some immunity to king cobra venom resulting from traditional 'immunization' achieved by scratching venom into the skin. The literature on king cobra bites is reviewed and recommendations given for antivenom and ancillary treatments.

Adult

Bacteriologic studies of food and water consumed by children in Myanmar: 1. The nature of contamination.

To isolate major bacterial pathogens from children's food and drinking water, a 3-month study was conducted in a suburban community in Yangon, Myanmar. From the morning meals and stored drinking water of 208 randomly selected children, 775 food and 113 water samples were collected and were cultured using standard methods. Escherichia coli, Vibrio cholerae non-01, and Salmonella were isolated from 505, 28 and 6 food samples respectively, and E. coli and V. cholerae non-01 were isolated from 29 and 5 water samples respectively. Among the E. coli isolates, 8 produced heat-stable toxin (ST) and 3 were enteroinvasive. Nine V. cholerae non-01 produced cholera-like toxin. Of the 29 E. coli isolates from the samples of drinking water, 3 produced ST. All water samples were negative for Salmonella. The study underscores the importance of bacterial contamination of children's food and drinking water and stresses the need to improve environmental sanitation.

Bacterial Toxins

Bacteriologic studies of food and water consumed by children in Myanmar: 2 Lack of association between diarrhoea and contamination of food and water.

The association between contamination of morning samples of food and water of 208 children aged 6-29 months and the incidence of diarrhoea was investigated for 3 months in Yangon, Myanmar. Contamination of the samples was determined by isolation of faecal coliforms (FC) by standard methods. The children were divided into three groups, high, medium and low, according to the proportion of food and water samples found to be contaminated. The incidence of diarrhoea was recorded by weekly recall. Of the 779 food samples, 504 (65%), and of the 860 drinking water samples, 187 (22%) were positive for FC. The association between food and water contamination and the incidence of diarrhoea was assessed by comparing the cumulative incidences in the high and medium groups with that in the low group which served as reference. Diarrhoea risk ratios (RR) for children in the medium and high contamination groups (food, RR = 1.04 in medium and 0.78 in high vs 1 in low; water, RR = 0.73 and 0.73 vs 1) were not significantly different from those who were in the low-contamination group even after controlling for the confounding variables.

Child, Preschool

Development of renal function abnormalities following bites by Russell's vipers (Daboia russelii siamensis) in Myanmar.

Renal function was monitored in 24 patients with systemic envenoming following proven Russell's viper bite. In all patients, blood clotted within 20 min on admission. In 15 cases severe defibrination (systemic envenoming) developed during the next 3-5 d. None of the patients received antivenom before admission but enzyme-refined monospecific antivenom was given to those who developed signs of systemic envenoming. Specific antigen was detected by enzyme immuno-assay in all 21 subjects tested. Nine patients whose renal function remained normal did not develop systemic envenoming, and recovered without any treatment even though venom antigen was detectable in their serum. Ten patients developed mild renal dysfunction and systemic envenoming, but recovered after treatment with antivenom alone. The remaining 5 patients, all of whom were oliguric from admission, developed acute renal failure despite treatment with antivenom, but some recovered after peritoneal dialysis. Serum venom antigen levels were high in the last 2 groups, but there was some overlap. Albuminuria, found only in patients who became systemically envenomed, was associated with high fractional sodium excretion in those who developed acute oliguric renal failure. Albuminuria may appear before a gross clotting defect is detectable. It is an indication for antivenom and spot measurements might prove a useful early predictor of outcome.

Acute Kidney Injury

Effect of short-term intermittent antibiotic treatment on growth of Burmese (Myanmar) village children.

To test the hypothesis that subclinical enteric infection (such as bacterial overgrowth), rice malabsorption, and growth faltering are causally linked, a field trial of low-dose, short-term, intermittent antibiotic treatment was carried out in 142 hydrogen-producing (by lactulose breath hydrogen test) Burmese village children aged 6-59 months. The children were randomly allocated treatment with metronidazole (20 mg/kg or 5 mg/kg daily), amoxycillin (25 mg/kg daily), or placebo given 1 week per month for 6 months. A cooked rice meal breath hydrogen test was done to classify the children as rice absorbers (RA) or rice malabsorbers (RM) before treatment and monthly on the day before each cycle of treatment. There were no differences between the treatment groups, so they were considered together. Factorial analysis showed that antibiotic treatment did not significantly affect the proportion of RM children. The only significant difference between antibiotic-treated and placebo-treated children's growth was in the subgroup of RM children aged 36-47 months; the antibiotic-treated children had significantly greater linear growth. In other age groups antibiotic treatment had no effect on growth.

Age Factors

Epidemiology of small bowel bacterial overgrowth and rice carbohydrate malabsorption in Burmese (Myanmar) village children.

Breath hydrogen tests were performed after a rice meal (3 g of cooked rice/kg of body weight, equivalent to 1 g of carbohydrate/kg of body weight) on 256 village children (age range 1-59 months) who were known hydrogen (H2) producers. Anthropometric measurements were made every three months and growth rates were calculated. A breath H2 excretion pattern that suggested small bowel bacterial overgrowth (SBBO), which was recognized as a transient maximum level of 10 ppm or more at 20-, 40-, or 60-min breath samples following the rice meal, was present in 53 (20.7%) children, and was more frequent in children 36-47 and 48-59 months old. This breath H2 excretion pattern was detected in 48 (33.3%) of 144 children who were rice malabsorbers (greater than 10 ppm H2 above baseline values in one of the breath samples taken between 90 and 240 min), and in only five (4.5%) of 112 rice absorbers. Children who had SBBO had a high relative risk (10.7) of being rice malabsorbers. Rice malabsorbers have a high relative risk (59.7) of having faltered growth, accompanied by a large etiologic fraction (94%). This same risk (6.68) and an etiologic fraction of 62% exist in children with untreated SBBO. These findings emphasize the need for interventions aimed at reducing the prevalence of SBBO or similar conditions as detected by the breath H2 excretion pattern to prevent rice malabsorption and growth faltering.

Bacteria

The effect of artemether plus mefloquine on Myanmar patients with complicated falciparum malaria.

The effect of artemether plus mefloquine versus quinine on 35 patients with complicated falciparum malaria including 5 patients with cerebral malaria were studied. All patients treated with the artemether-mefloquine combination survived and all were free from toxic effects of the drugs. Three patients on quinine therapy died. The mortality rate was 8.5%. The mean parasite clearance time of patients treated with artemether plus mefloquine was significantly shorter than those treated with quinine but there was no significant difference in the mean fever clearance of the two groups of patients. There was no recrudescence with artemether and mefloquine; the recrudescence rate was 5.5% with quinine. The study showed that the artemether-mefloquine combination is superior to quinine for the treatment of patients with complicated falciparum malaria, including cerebral malaria.

Antimalarials