Serum Zinc Levels in Cirrhotic Patients Attending General and Specialty Hospitals, Yangon

Cirrhosis of liver is one of the common medical problem in daily clinical practice and one of the leading causes of morbidity and mortality. Zinc is an essential trace elements for human and plays in many biological roles in the body. Among them, zinc deficiency is thought to be involved in metabolism of ammonia and causes hyperammonia that worsen hepatic encephalopathy. This study aimed to find out the severity of cirrhosis of liver was by Child Turcotte Pugh score and to investigate the associations between serum zinc level and severity of cirrhosis. A hospital-based cross-sectional descriptive study was performed on 78 patients with different underlying causes of cirrhosis of liver at the Medical Units of Yangon General Hospital and Yangon Specialty Hospital. Among the study population, Child grade A was found to be 28.21%, Child grade B was 30.77% and Child grade C was 41.03%. Regarding result of serum zinc level, 62.8% were low level, 28.2% were within normal level and 8.9% were high level. Mean value of serum zinc level in grade A was 0.68 mg/l, grade B was 0.54 mg/l and grade C was 0.48 mg/l (p=0.00). It was found out that there was a high prevalence of zinc deficiency in severe cirrhotic patients. The zinc level was significantly lowest among patients with Child-Pugh C as compare to those with Child-Pugh B and C. Severity of zinc deficiency should be requested for supplementation therapy in cirrhotic patients as to prevent complications such as hepatic encephalopathy, hepatocellular carcinoma and liver failure. Screening for zinc deficiency may need in these patients with more advanced cirrhosis because it seems to be a marker of advanced liver disease and it can be deducted that awareness of serum zinc level among cirrhotic patients is very important in clinical practice.

Relationship between Insulin Sensitivity and Body Fat Composition, and Leptin Sensitivity in Non-Obese and Overweight/Obese Adults

Both insulin and leptin are major contributors for the body energy balance. Obesity is a state of energy imbalance and is also associated with changes in both insulin sensitivity and leptin sensitivity. The aim of this study was to find out the relationship between insulin sensitivity and body fat composition, and leptin sensitivity in non-obese and obese adults. A total of 86 adults participated: 42 non-obese and 44 over-weight/obese. Body fat (BF) percent was determined by skinfold method. Fasting plasma glucose was analyzed by glucose oxidase-phenol and 4 aminophenazone (GOD-PAP) method using spectro-photometer, fasting serum insulin and leptin concentrations by direct sandwich ELISA method and resting energy expenditure (REE) by indirect calorimetry. Leptin sensitivity index and insulin sensitivity were expressed as REE : Leptin ratio and homeostatic model assessment-insulin resistance (HOMA-IR), respectively. It was found that median value of HOMA-IR was significantly higher [2.93 vs 1.72, p<0.01] and leptin sensitivity was significantly lower [116.76 vs 265.66, p<0.001] in the overweight/obese adults than the non-obese adults, indicating that insulin sensitivity and leptin sensitivity were markedly reduced in overweight/obese adults in compare to non-obese adults. There was a moderate degree of positive relationship between HOMA-IR and BF only in the overweight/obese (ρ=0.509, n=44, p<0.001) and all adults (ρ=0.39, n=86, p<0.001). Similarly, a weak negative relationship between leptin sensitivity index and HOMA-IR was found in the overweight/obese (ρ=-0.328, n=44, p<0.05) and all adults (ρ=-0.35, n=86, p<0.01). It can be concluded that the insulin sensitivity was adiposity dependent, but, it did not depend on leptin sensitivity.

Fetal Hemoglobin, Serum Total Cholesterol, Plasma Phosphate and Serum Calcium Levels in Patients with Leukemia and Lymphoma

In this study, fetal hemoglobin (HbF), blood total cholesterol, phosphate and calcium levels of leukemia and lymphoma cases in Mandalay were determined. It was a cross-sectional, comparative study. Thirty adult cases of leukemia and lymphoma and equal number of control subjects of comparable age (14 to 80 yrs) and sex were studied. Mean HbF of leukemia group (n=9), acute myeloid leukemia (AML) subgroup (n=6) and controls (n=30) were 2.72±0.47%, 3.17±0.69% and 1.39±0.25% of total Hb, respectively. The HbF levels of leukemia group and AML were significantly higher than that of controls (p<0.02). Mean serum total cholesterol levels of leukemia group, AML subgroup and controls were found to be 126.5±17.38 mg%, 137.96±24.66 mg% and 177.18±7.68 mg%, respectively. Cholesterol levels of leukemia group and AML were lower than that of controls. Mean plasma phosphate levels of leukemia and lymphoma cases (n=30), leukemia group (n=9) and lymphoma group (n=21) were 1.21±0.07 mmol/l, 1.33±0.17 mmol/l and 1.15±0.06 mmol/l, respectively. Mean phosphate level of controls was 0.94 mmol/l. Plasma phosphate levels of the whole cases and individual case groups were significantly higher than that of controls (p<0.001). Mean serum calcium levels of the whole cases, leukemia group and lymphoma group were 10.16±0.36 mg%, 10.03±0.75 mg% and 10.21±0.45 mg%, respectively. Mean serum calcium level of controls was 8.55±0.14 mg%. Serum calcium levels of the whole cases and individual case groups were found to be significantly higher than that of controls (p<0.01). The study showed that not only raised HbF but also hypocholesterolaemia might be the diagnostic clues in leukemia cases. Recognition of blood phosphate and calcium changes leads to appropriate therapy and a reduction of morbidity.

Screening of Glucose-6-Phosphate Dehydrogenase Deficiency in Neonatal Hyperbilirubinaemia at 300-Bedded Pyin Oo Lwin General Hospital

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common human enzyme deficiencies in the world. It is particularly common in populations living in malaria-endemic areas, affecting more than 400 million people worldwide. This hospital- and laboratory-based, cross-sectional descriptive study was conducted with the aim of determining the prevalence of G6PD deficiency among 200 newborns at 300-bedded Pyin Oo Lwin General Hospital during January to March 2017. The participants were 103 girls (58.5%) and 97 boys (41.5%). Both qualitative and quantitative measurements by using Brewer's method and G-SIX kit method were applied for diagnosis of G6PD deficiency. Total serum bilirubin level was measured by Bilirubinometer. Of the 200 newborns, 21(10.5%) were G6PD deficient. The overall prevalence of G6PD deficiency was 10.5% (21/200) and male was predominant than female (17.5% vs 3.9%). Out of 10.5% (21/100)G6PD deficient newborns, 5(23.8%) and 16(76.2%) were mild and moderate G6PD deficiency, respectively. Regarding hyperbilirubinaemia, 9(42.9%), 3(14.3%), 2(19.0%) and 5(23.8%) were severe, moderate and mild hyperbilirubinaemia and normal bilirubin, respectively. This study showed that a significant correlation between the severity of hyperbili- rubinaemia and G6PD activity (p <0.05). Taking into consideration of the above results, the high prevalence can be useful for providing appropriate prevention and early treatment of complications in routine neonatal screening in this area.

Influenza B Lineages Circulating among Children Attending Yangon Children’s Hospital

Influenza B viruses have also caused a considerable number of paediatric deaths although they are generally less prevalent than influenza A viruses. This cross-sectional study aimed to determine trends in prevalence of influenza B lineages among children attending Out Patient Department of Yangon Children’s Hospital. Nasopharyngeal swabs were collected from 316 children with influenza-like illness (ILI) during January 2016 to October 2018. Influenza A and influenza B viruses were detected by conventional reverse transcription-polymerase chain reaction (RT-PCR) targeting matrix gene. Lineages of influenza B virus were identified by conventional RT-PCR targeting haemagglutinin gene. Influenza B virus accounted for 6.5% (10/153), 1.5% (1/68) and 2.1% (2/95) of all ILI cases and 45.5% (10/22), 8.3% (1/12) and 25% (2/8) of influenza virus positive ILI cases in 2016, 2017 and 2018 (up to October), respectively. Age and sex preponderance were not seen among influenza B virus-infected children. Fever, cough and rhinorrhoea were found as main but non-specific symptoms. Majority of influenza B virus-infected children were seen in June, July and August suggesting timing for influenza vaccination. All ten cases of influenza B virus detected in 2016 and the only case in 2017 were of B/Victoria lineage whereas both cases in 2018 were of B/Yamagata lineage highlighting the changing epidemiology of influenza B/lineages in the recent years. This study generated information useful for assessment of influenza B outbreaks, timing for influenza vaccination and selection of influenza vaccine for use in subsequent years in Myanmar.

Usefulness of Thiocyanate as a Biological Marker for Discrimination of Smoking Status

Smokers have increased risk of death more than non-smokers due to its association with cancer, vascular and respiratory diseases, and tuberculosis. Epidemiological research has generally relied upon self-report information concerning smoking status but the validity is limited. Biochemical markers have been used in research on smoking are based on thiocyanate, nicotine, cotinine and carbon monoxide. Among them, thiocyanate is chosen as biomarker of smoking because of its long half-life. The aim of the study was to demonstrate the suitability of urinary, blood and salivary thiocynates (SCN‾) as indicators of smoking and to investigate the correlation among its content in salivary, serum and urinary SCN‾, and duration and amount of smoking. Thiocyanate levels were determined by spectrophotometric method in saliva, serum and urine samples to compare in smokers, passive smokers and non-smokers. The median saliva thiocyanate concentration of smokers [43.79(8.14-187.59 mg/ml)] was significantly higher (p<0.001) as compared to that of passive smokers [26.26(7.95-80.04 mg/ml)] and non-smokers [25.00(5.23-69.96 mg/ml)]. The salivary thiocyanate levels significantly correlated with duration of smoking in years (r=0.366) and number of cigarette smoking per day (r=0.316). Among three types of body fluids, saliva thiocyanate is the best biological marker for discrimination of smoking status. Heavy smokers can be distinguished from passive smokers and non-smokers by determination of thiocyanate level in saliva.

Extent of Household Catastrophic Health Expenditure among Urban Dwellers in Mandalay City

Self-payments (out-of-pocket payments OOP) are the principal means of financing health care throughout Myanmar. It leaves households exposed to the risk of unforeseen expenditures that absorb a large share of the household budget. The OOP expenditures may be considered as catastrophic in the sense that they absorb a large fraction of household resources. Catastrophic impact of health care costs among households in selected area of Mandalay City is measured by indices such as incidence, intensity and mean positive gap and explored the opinions of people paying for health care by conducting focus group discussion. As expected, households’ catastrophic impacts are considerably high in Mandalay. The incidence of catastrophic health care payment is 8%, 4% and 1.3% for the defined catastrophic thresholds of 10, 20 and 30 percent, respectively. The intensities are 1.62, 1.09 and 0.8 percents for the same thresholds. Mean Positive Gaps are 20.2, 27.3 and 61.5 percents for the three defined threshold levels. Because of heavy out-of-pocket health care expenditure, most of the households’ income absorbed with repeated borrowing and lending mechanisms can push these households into impoverishment. Although they pay heavily, Myanmar people do not blame anyone but their destiny because they know nothing about social protection mechanisms.

Parameters Predicting Poor Prognosis in Patients with Malignant Ascites in Yangon General Hospital

Prognosis for patients with malignant ascites is poor and median survival is only a few months. Treatment of malignant ascites ranges from simple drainage procedures to chemotherapy and debulking surgery. Careful selection of treatment modality by using clinicpathological parameters could improve not only the survival but also the quality of life of the patients. So this hospital-based prospective study aimed to find out the parameters predicting poor prognosis among patients with confirmed malignant ascites admitted to Oncology Department, Yangon General Hospital. This study included 102 patients with malignant ascites. Among them, 19(18.6%) were male patients and 83(81.4%) were female with age ranging from 15 to 73 years (mean age 46.35±12.9 years). Common cancers associated with malignant ascites were ovarian cancer (32.35%), stomach cancer (19.61%) and breast cancer (9.80%). Sixty-four percent of patients presented with stage IV. Common metastatic sites were liver (37.27%), peritoneum (16.67%) and lungs (11.76%) and 28 patients (27.45%) had more than one site of metastasis. Eight patients (7.8%) were in Eastern Cooperative Oncology Group (ECOG) per-formance status score 1 and 23 patients (22.5%) were in ECOG score 4. The time interval between first diagnosis and development of malignant ascites ranged from 0 to 120 months. Only 33 patients (32.4%) were still alive after 6-month follow- up. High serum urea level was associated with better prognosis (OR =0.19, 95% CI 0.04-0.99), however, primary advanced stage (OR=3.30, 95% CI 1.26-258.62), and high serum creatinine level (OR=9.15, 95% CI 1.71-71.21) significantly worsened the prognosis in patients with malignant ascites.

Immunoexpression of Matrix Metalloproteinase-9 in Colorectal Adenocarcinoma

Colorectal carcinoma is one of the most common malignant tumors of gastrointestinal tract and is a contributing factor of cancer mortality in Myanmar. Matrix metalloproteinase-9 is a proteolytic enzyme which breaks down extracellular matrix leading to tumor progression, contri-buting as a potential prognostic marker nowadays. The study was aimed to determine MMP-9 immunoexpression in colorectal adenocarcinoma and its association with Astler-Coller staging. A cross-sectional descrip-tive study was done on 42 specimens of colorectal adenocarcinoma. All tissue specimens were studied with haematoxylin and eosin to categorize histological types and grades. Out of 42 cases, 21.4% were well differentiated, 57.2% were moderately differentiated and 21.4% were poorly differentiated. According to Astler-Coller staging, 11.9% were found to be in stage B1, 40.5% in stage B2, 7.1% in stage C1, 33.3% in stage C2 and 7.1% in stage D. 81% (34/42) of colorectal carcinoma showed positive MMP-9 immunoexpression. Positive MMP-9 immuno-expression was seen in 91% of conventional adenocarcinoma, 40% of mucinous carcinoma and no cases signet ring carcinoma. The findings of the study pointed out that MMP-9 immunoexpression was positively associated with histological types of colorectal adenocarcinoma (p=0.001). MMP-9 immunoexpression was positive in 88.9% of well differentiated adenocarcinoma, 91.7% of moderately differentiated adenocarcinoma and 44.4% of poorly-differentiated adenocarcinoma (p=0.007). Regarding the immunoexpression of MMP-9 in different Astler-Coller staging, positive MMP-9 immunoexpression was seen in 60% of the cases in stage B1, 76.5% in stage B2, 66.7% in stage C1, 92.9% in stage C2 and 100% in stage D. The findings of the study can be extrapolated to predict prognosis and help in better management of colorectal adenocarcinoma by introducing targeted therapy against MMP-9 in future.