Some factors associated with outcome of hospitalized russell's viper bite patients

Most of the Russell's viper patients with severe envenomation development oliguric acute renal failure. Majority of these patients failed to respond to conservative medical treaatment and required peritoneal dialysis (PD) for their survial. Some of them expired even after peritoned dialysis. In this study,some factors associated with development of acute renal failure, PD requirement and final outcomes i.e. recovered or expired, in the proven Russell's viper bitevictims admitted to the Thingangyun Sanpya Hospital were determined. It was found that the prognosis of these patients was apparently related to the time intervals between: the bite and receiving anti-venom, the bite and hospitalization, and the bite and treatment with peritoneal dialysis. It is suggested that antivenom should be administered within 2 hours and the victims hospitalized within 24 hours after the bite. Besides, peritoneal dialysis should be regarded as a lifesaaving measure for Russell's viper bite patients with oliguric acute renal failure and instituted as early as possible i.e. within 4 days after the bite.

Situation analysis of plasma collected for the production of DMR Hepatitis B vaccine

The Department of Medical Research (DMR) has been producing a safe and effective plasma derived hepatitis B (HB) vaccine since 1997 to meet the criteria of quality control tests recommended by the WHO. The production of this HBvaccine requires the HBs antigen (Ag) pasitive blood as raw material which has been collected from blood banks of the various hospitals in Yangon area. Among these collected blood bottles, only those with high HBsAg titre were pooled and purified for further manufacturing process. In this study, HBsAg titre of the blood bottles collected during the year 1992, 1993,1999 and 2000, and those used for production of various batches of HB vaccine were determined and compared. It was found that the quantities of blood bottles available for HB vaccine production and their HBsAg titres have been apparently reduced in the last two years. This may affect the production capacity of the vaccine. This could be one of the major obstacles ofr the large scale production of the plasma-derived HB vaccine tho meet the requirement of Extended Program of Immumization (EPI) in the near future. To fulfil this requirement, several solutions have been considered and discussed in this study.

Studies on the stability of DMR hepatitis B vaccine

The stability of the DMR hepatitis B vaccine at 4C and room temperature has been followed over a period of one year by monitoring its physical, chemical and biological characteristics bimonthly starting from February 1996. The pH and protein content of the vaccine did not change for both storage conditions throughout the study. The vaccines were found to be sterile and free from pyrogens and passed the general safety test on mice. The HBsAg titer started to decline after eight months of storage at 4C and after 10 days of storage at room temperature. However, the HBsAg adsorption rate to the adjuvant remained over 95 per cent for both storage conditions.

Effectiveness of sodium bisulfite on the stability of Russell's viper (Daboia russelli siamensis) venom toxoid under various storage conditions

Crude Russell's viper venom toxoid was prepred by slow and step-wise formalinization to a final concentration of 0.8 per cent formalin. Then 35 per cent sodium bisulfite was added to half volume of the toxoid. Two types of toxoid were stored at different storage temperatures. At two monthoy interval, the immunogenicity of these toxoid were tested in mice. The antibody levels in immunized mice were measured by ELISA. The toxoid with sodium bisulfite was more immunogenic than the toxoid without it. Therefore the reversion of formaldehyde lindage during storage was less in toxoid which contained sodium bisulfite.

Role of intramuscular anti-snake venom administration as a first-aid measure in the field

Effectiveness of intramuscular (i.m) anti-snake venom (ASV) administration immediately after bite as a first-aid measure in the field followed by standard hospital treatment in the management of Russell's viper bite patients was studied in 12 victims and was compared with that of standard hospital management alone in 82 victims. there was a marked reduction in the number of patients with systemic envenomation ie. disseminated intravascular coagulation (DIC), clinical proteinuria, oliguric acute renal failure (ARF), systemic bleeding, hypotension and fatality rate of Russell's viper bite victims who received initial i.m ASV prior to the hospitalization compared with those who did not. It is recommended that i.m ASV could be administered to the Russell's viper bite patients at the site of incident as a first-aid method in places where no facility for giving intravenous ASV therapy prior to hospitalization.

Clinical trial to determine the hypouricaemic potential of Zizyphus jujuba kernel

Clinical trial to determine the therapeutic efficacy of a traditional herbal drug, Zizyphus jujuba kernel reputed for anti-gout action was carried out on 20 healthy volunteers. Using a cross-over design, the subjects were divided into two groups. Group I received standard hypouricaemic drug, allopurinol and Group II was administered Z. jujuba dernel for 14 days. after a wash-out period of another 7 days, the drugs were crossed over between the two groups in which Group I was administered Z. jujuba kernel and Group II was administered allopurinol for further 14 days again. Blood and urine samples of these subjects were taken at 5 days' intervals throughout the study period for determination of uric acid, creatinine and liver function tests. It was found that Z. jujuba shows no abnormalities on kidney and liver function tests. It also possesses neither hypouricaemic nor uricosuric actions.

Clinical trial of intramuscular anti-snake venom administration as a first aid measure in the field in the management of Russell's viper bite patients.

Efficacy of intramuscular anti-snake venom administration immediately after bite as a first aid measure in the field followed by standard hospital management versus standard hospital management alone in the therapy of Russell's viper bite patients was studied. There was a definite reduction in the number of patients with systemic envenomation, complications following disseminated intravascular coagulation and in fatality rate of Russell's viper bite victims who had received first aid intramuscular anti-snake venom prior to hospitalization when compared with those who had not.