Characterizing Helicobacter pylori cagA in Myanmar

BACKGROUND/AIMS: Differences in the Helicobacter pylori infection rate are not sufficient to clarify the dissimilarity of gastric cancer incidence between Myanmar and its neighboring countries. To better understand this trend, the H. pylori virulence gene cagA was characterized in Myanmar. METHODS: Glutamate-proline-isoleucine-tyrosine-alanine (EPIYA) patterns and CagA multimerization (CM) motifs of cagA genotypes were examined by performing polymerase chain reactions and DNA sequencing. RESULTS: Of 69 tested H. pylori strains, cagA-positive patients had significantly more severe histological scores in their antrum than cagA-negative patients. Sequence analysis revealed that 94.1% of strains had Western-type cagA containing an EPIYA motif (92.6%) or EPIYT motif (6.4%). The intestinal metaplasia scores in the antral of patients infected with the ABC and ABCC types of cagA were significantly higher than those of patients with AB-type cagA. Interestingly, in patients infected with H. pylori, 46.3% of strains with three EPIYA motifs contained two identical Western-typical CM motifs, and these patients showed significantly higher antrum inflammation scores than patients infected with two identical nontypical-CM motif strains (p=0.02). CONCLUSIONS: In Myanmarese strains, Western-type cagA was predominant. The presence of CM motifs and the proportion of multiple EPIYA-C segments might partially explain the intermediate gastric cancer risk found in Myanmar.

Single Nucleotide Polymorphism at +276 g>T of the Adiponectin gene and Plasma Adiponectin Level in Myanmar Type 2 Diabetic Patients / Journal of the ASEAN Federation of Endocrine Societies

Objective@#The aim of the study was to investigate the association between single nucleotide polymorphisms (SNP) at rs 1501299 (SNP+276 G>T) of the adiponectin gene and plasma adiponectin levels in type 2 diabetes mellitus (T2DM) patients in Myanmar.@*Methodology@#One hundred T2DM patients and 104 non-diabetic subjects were included in this cross-sectional analytical study. Genotype frequencies were determined by polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) method. Plasma adiponectin level was measured by enzyme-linked immunosorbent assay (ELISA). @*Result@#Genotype frequencies (GG, GT, TT) of SNP+276 in diabetic patients were 39%, 48% and 13%, respectively. The GT and TT genotypes were more frequent in T2DM patients (OR 1.98, 95% CI, 1.10-3.55; p=0.02 and OR 4.07, 95% CI, 1.34-12.3; p=0.01), respectively. The T allele of SNP+276 was significantly associated with T2DM (OR 1.96, 95% CI, 1.27-3.01; p=0.002). Mean plasma adiponectin level was significantly lower than in T2DM patients (27.41±16.7 μg/mL) compared to non-diabetic subjects (37.19±26.77 μg/mL) (p=0.002)@*Conclusion@#SNP+276 at rs 1501299 of the adiponectin gene was associated with type 2 diabetes and low plasma adiponectin levels in this Myanmar population.

Molecular prevalence and genetic diversity of bovine Theileria orientalis in Myanmar.

Theileria orientalis is a causative agent of benign theileriosis in cattle and distributed in mainly Asian countries. In the present study, we examined the prevalence of T. orientalis infection by PCR based on the major piroplasm surface protein gene (MPSP) sequences in cattle in Myanmar, followed by phylogenetic analysis of the MPSP genes. The MPSP gene was amplified in 258 of 713 (36.2%) cattle blood DNA samples collected from five cities in different geographical regions of Myanmar. Phylogenetic analysis of MPSP sequences from 54 T. orientalis-positive DNA samples revealed the presence of six allelic genotypes, including Types 1, 3, 4, 5, 7, and N-3. Types 5 and 7 were the predominant types detected. Sequences of the MPSP genes detected in Myanmar were closely related to those from Thailand, Vietnam or Mongolia. These findings suggest that movement of animals carrying T. orientalis parasites between Southeast Asian countries could be a reason for the similar genotype distribution of the parasites in Myanmar.

Morphological and molecular characterization of Explanatum explanatum from cattle and buffaloes in Myanmar.

A robust molecular marker is needed for discrimination of amphistome species, because identification based on morphology alone requires specialized knowledge and techniques. In this study, we performed morphological and molecular characterization of Explanatum explanatum, a species that causes severe liver damage in definitive host species. Fifty-five adult amphistomes were collected from cattle and water buffaloes in Myanmar. Eighteen of the amphistomes, arbitrarily chosen, were morphologically identified as E. explanatum using sagittal sections. All of the 55 amphistome isolates had identical second internal transcribed spacer (ITS2) of ribosomal DNA sequences; these sequences differed at 7 nucleotide sites from those of the closest species, Paramphistomum leydeni. Our data indicate that the ITS2 sequence could be a useful molecular marker for epidemiological studies on E. explanatum.

A summary of the clinical practice guidelines for the management of patients with Peripheral Arterial Disease in Myanmar / Journal of the ASEAN Federation of Endocrine Societies

@#Peripheral artery disease (PAD) broadly encompasses vascular diseases caused primarily by atherosclerosis and thromboembolic pathophysiologic processes that alter the normal structure and function of the aorta, its visceral arterial branches, and the arteries of the lower extremity. The aims of the Myanmar clinical practice guidelines for the management of patients with PAD are to assist physicians in selecting the best management strategies for an individual patient with peripheral artery disease with main focus on lower extremity artery disease (LEAD) due to atherosclerosis, to help the physician to make decisions in their daily practice, and to aid in appropriate referrals to specialists. Early detection and treatment guidelines for the treatment of PAD are important to reduce the morbidity and mortality of patients with vascular problems in Myanmar.

Characterization of Fasciola spp. in Myanmar on the basis of spermatogenesis status and nuclear and mitochondrial DNA markers.

Fasciola spp. in Myanmar were characterized on the basis of spermatogenesis status and DNA markers of nuclear internal transcribed spacer 1 (ITS1) and mitochondrial NADH dehydrogenase subunit 1 (nad1). We collected 88 adult flukes from Yangon, Lashio, and Myitkyina. Spermatogenesis status was analyzed by the presence of sperm in the seminal vesicles, and 8 aspermic and 80 spermic flukes were detected. The flukes were identified on the basis of spermatogenesis status and ITS1 types which were analyzed by a PCR-RFLP method, and 80 spermic flukes were identified as F. gigantica. A very low detection rate of aspermic Fasciola sp. indicated that they are not established in Myanmar. In phylogenetic analyses, the 7 aspermic Fasciola sp. from Myitkyina displayed a haplotype in nad1 sequence, which was identical to that of aspermic Fasciola sp. from other Asian countries including China. Therefore, they were probably introduced from China through an infected domestic ruminant. On the other hand, 17 nad1 haplotypes detected in F. gigantica belonged to 2 clades unique to Myanmar, each with a distinct founder haplotype in a network analysis. This indicated a unique history of F. gigantica introduction into Myanmar involving ancient artificial movements of domestic ruminants.

Scenario of the twins with suspected congenital rubella syndrome (CRS) in Yangon, Myanmar

Rubella is a common cause of childhood rash and fever. Congenital rubella syndrome (CRS) can lead to deafness, heart disease, cataracts, and a variety of other permanent manifestations. In order to identify the disease burden of rubella infection, CRS surveillance among infants in Yangon was conducted for two consecutive years from December 2000 to December 2002, as a WHO-funded study. Among the 13 participating hospitals, the Special Care Baby Unit of the Central Women‘s Hospital in Yangon reported 17 infants with suspected CRS. Interestingly, three sets of twins with suspected CRS were reported. One ml of blood was collected from each infant after obtaining informed consent, then tested for the presence of rubella antibody (Immunoglobulin M and G) by the ELISA method, and for the presence of rubella viral RNA by the RT-PCR method. Furthermore, nucleotide sequencing and genotype identification of samples from two cases with positive rubella RNA were performed. All 3 sets of twins were IgM negative. However, rubella RNA was detected by RT-PCR in twin 1A who showed no obvious clinical signs, and in twin 2B who had patent ductus arteriosus, splenomegaly and hepatomegaly. Nucleotide sequences of PCR positive cases revealed genotype Ia sequences. Twin 2B was identified as having deafness of the left ear on audiometry assessment conducted at 5 years and 4 months of age. Both twins of twin set-2 were IgG positive at age 12 days, but turned out to be negative by the age of 9 months. Both twins of twin set-3 presented with splenomegaly and died before 2 months of age, probably due to other infections. Our findings revealed the different scenario of twins with suspected CRS. It is expected to serve as a valuable addition to the medical literature as there were very few reports on twins with CRS.

Ineffectiveness of breath methane excretion as a diagnostic test for lactose malabsorption.

BACKGROUND: In clinical and field conditions, breath gas analysis has been widely used in evaluating carbohydrate digestion. A field study was performed to determine the prevalence of lactose malabsorption in Myanmar children and to evaluate the possibility of using breath methane excretion to indicate lactose malabsorption in a field situation. METHODS: The study population consisted of 118 children aged 1 to 12 years. A hydrogen breath test after a lactose meal (2 g/kg, maximum 50 g) was used as a standard test. RESULTS: Lactose malabsorption was detected in 16.7% of children aged 1 to 2.9 years, with the prevalence increasing with age from 40.5% of those aged 3 to 5.9 years to 88.5% of those aged 6 to 8.9 years and reaching 91.7% in those aged 9 to 11.9 years. Lactose malabsorption was more prevalent when children were weaned before 4 months of age (87.2 vs. 41.1%; p < 0.01). Compared with lactose-tolerant children, those with lactose malabsorption had significantly higher concentrations of breath hydrogen excretion 60 minutes after the lactose test meal. Breath methane excretion was also significantly higher in samples at 120 minutes in children with lactose malabsorption. Breath methane excretion of greater than or equal to 2 parts per million at 180 minutes as a diagnostic test for lactose malabsorption had a sensitivity of 61.5% and a specificity of 84.6%. CONCLUSION: The breath methane test for lactose malabsorption has a lower sensitivity and specificity than the breath hydrogen test and therefore does not replace the lactose breath hydrogen test.

Serum cortisol levels in children with dengue haemorrhagic fever.

Dengue Haemorrhagic Fever (DHF) is a serious and often fatal paediatric problem in Myanmar. Acute and convalescent serum cortisol levels were measured in 62 children with dengue infection to study cortisol sufficiency in this disease. Twenty-six children with non-dengue acute viral infection were also included as controls. In acute stage, highest mean serum cortisol level (655.4 +/- 72.18 nmol/l) was observed in DHF cases presenting with shock, followed by DHF non-shock cases (640.56 +/- 74.58 nmol/l) and dengue fever cases (617.2 +/- 75.38 nmol/l). Cases with DHF had significantly higher serum cortisol level (P < 0.05) than in controls (444.41 +/- 59.71 nmol/l). In cases of DHF, mean serum cortisol level during the acute stage was found to be significantly two-fold higher than the convalescent stage. We found no cortisol insufficiency in cases of dengue haemorrhagic fever during acute and convalescent stages of illness.

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.

Comparison of glucose/electrolyte and maltodextrin/glycine/glycyl-glycine/electrolyte oral rehydration solutions in acute diarrhea in children.

Male children (N = 101) 6-35 months of age presenting with acute watery diarrhea for less than 48 h at home before hospitalization were admitted into a randomized, double-blind clinical trial. Fifty-one children were treated with standard oral rehydration solution (ORS) (World Health Organization [WHO] formulation containing citrate) and 50 were treated with an improved ORS formulation (containing, in addition to the standard formula, 20 g maltodextrin instead of glucose, and 4 g glycine and 4 g glycyl-glycine). None were given antibiotics. No i.v. infusions were given. Rotavirus was detected by enzyme-linked immunosorbent assay in stools of 43 children. Clinical characteristics of children in the two treatment groups were comparable. Improved ORS did not produce significant reduction in the volume of diarrhea stools. Children given improved ORS had greater weight gain than that observed in children treated with standard ORS, but the differences were not statistically significant except at the end of the first 24 h. Among children with rotavirus diarrhea, no significant differences were observed between the 23 children who received improved ORS and the 20 who received standard ORS.