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.

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.
Genotype ; Helicobacter pylori ; Helicobacter ; Humans ; Incidence ; Inflammation ; Metaplasia ; Myanmar ; Polymerase Chain Reaction ; Sequence Analysis ; Sequence Analysis, DNA ; Stomach Neoplasms ; Virulence

Prostate cancer is third common malignancy in men of old age (average 65 years) in Myanmar. Currently, serum PSA and bone scan are the markers of choice. Because of the evidence-based, promising success of ⁶⁸Ga-PSMA PET-CT and 177Lu-PSMA theranostics in prostate cancer worldwide, (99m)Tc-PSMA SPECT-CT imaging and ¹⁷⁷Lu-PSMA therapy has launched as a stepping-stone of theranostics in Myanmar with the available facilities. Twelve cases of prostate cancer patients were imaged with 600 MBq of (99m)Tc-PSMA I+S SPECT-CT. Four metastatic castration resistant prostate cancer (MCRPC) patients with abnormal result were treated with ¹⁷⁷Lu-PSMA. The protocol consists of 6–8 GBq of ¹⁷⁷Lu-PSMA, three successive doses at interval of 4–6 weeks. Post-therapy SPECT-CT imaging was done. All treated patients were improved by free of bone pain, and fall/rise in serum PSA level. Two patients with extensive skeletal metastases succumbed to complications. The results are well documented and present at the multidisciplinary conferences for clinical awareness. Theranostics in prostate cancer with available facilities is an additional boon to our health care professionals to upgrade cancer management in Myanmar. This paper provides the technology with cost effectiveness and benefit to prostate cancer patients of Myanmar.

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.
Diabetes Mellitus, Type 2

Prostate cancer is third common malignancy in men of old age (average 65 years) in Myanmar. Currently, serum PSA and bone scan are the markers of choice. Because of the evidence-based, promising success of ⁶⁸Ga-PSMA PET-CT and 177Lu-PSMA theranostics in prostate cancer worldwide, (99m)Tc-PSMA SPECT-CT imaging and ¹⁷⁷Lu-PSMA therapy has launched as a stepping-stone of theranostics in Myanmar with the available facilities. Twelve cases of prostate cancer patients were imaged with 600 MBq of (99m)Tc-PSMA I+S SPECT-CT. Four metastatic castration resistant prostate cancer (MCRPC) patients with abnormal result were treated with ¹⁷⁷Lu-PSMA. The protocol consists of 6–8 GBq of ¹⁷⁷Lu-PSMA, three successive doses at interval of 4–6 weeks. Post-therapy SPECT-CT imaging was done. All treated patients were improved by free of bone pain, and fall/rise in serum PSA level. Two patients with extensive skeletal metastases succumbed to complications. The results are well documented and present at the multidisciplinary conferences for clinical awareness. Theranostics in prostate cancer with available facilities is an additional boon to our health care professionals to upgrade cancer management in Myanmar. This paper provides the technology with cost effectiveness and benefit to prostate cancer patients of Myanmar.
Castration ; Congresses as Topic ; Cost-Benefit Analysis ; Delivery of Health Care ; Humans ; Male ; Myanmar ; Neoplasm Metastasis ; Prostatic Neoplasms ; Theranostic Nanomedicine

Objective. This study determined the relationship between plasma adiponectin level and corrected QT interval (QTc) in smokers and non-smokers. Methodology.This cross-sectional analytical study was undertaken in 30 smokers and 30 non-smokers. Plasma adiponectin level was determined by enzyme-linked immunosorbent assay (ELISA). The QT interval was measured by routine 12-lead ECG with Lead II rhythm and QTc was calculated. Results. Mean plasma adiponectin level was significantly lower in smokers (27.89±15 μg/ml) than that of non-smokers (52.13±21.57μg/ml) (p<0.001). Mean QTc interval was significantly longer in smokers than that of non-smokers (415.37±29.9 versus 395.63±26.13 ms, p<0.01). Higher risk of low adiponectin level (odds ratio [OR],8.1; 95% confidence interval [CI],1.61-40.77) and QTc interval prolongation (OR,6; 95%CI,1.17-30.73) were observed in smokers. There was weak significant negative correlation between plasma adiponectin level and QTc interval in the study population (n=60, r=-0.407, p=0.001). Moreover, low plasma adiponectin level was significantly associated with prolonged QTc interval in the study population (n=60, Fisher's exact p value<0.05). Risk of QTc interval prolongation was 4.3 times higher in subjects with low plasma adiponectin level (OR,4.27; 95% CI,1.05-17.46). Conclusion. Smokers have greater risk for low plasma adiponectin level and prolonged QTc interval. There is a relationship between plasma adiponectin level and QTc interval.
Smokers ; adiponectin

Background: Type 2 diabetes mellitus (T2DM) is the most common metabolic disorder and its pathogenesis is characterized by a combination of peripheral insulin resistance and impaired insulin secretory capacity of pancreatic β cell. Genetic predisposition interacts with environmental factors including diet, physical activity, and age leading to the development of diabetes. Objective: To determine the proportion of overweight and obese persons with type 2 diabetes and to compare the fasting blood sugar, fasting serum insulin, insulin resistance and β-cell function in G972R carrier and non-carrier overweight and obese persons with type 2 diabetes. Methodology: One hundred overweight and obese patients with T2DM were recruited from persons with diabetes attending the Diabetes Outpatient Department of Yangon General Hospital. History taking and physical examination were done and blood samples were collected. Plasma glucose level was determined by the glucose oxidase method and fasting serum insulin was measured by enzyme linked immunoassay (ELISA) kit method. Polymerase chain reaction and Restriction Fragment Length Polymorphism were done for genetic polymorphism. Results: Among 100 overweight and obese subjects with T2DM, 81 patients were of homozygous (G/G) genotype, 18 patients were of heterozygous (G/A) and only one patient of homozygous (A/A) genotype. There was no statistically significant difference in the proportion of genotypes between overweight and obese subjects with T2DM.There was no significant difference in fasting blood sugar (FBS), fasting serum insulin, HOMA-IR, β-cell function, lipid parameters between IRS-1 (G972R) carriers and non-carriers. There is significant negative correlation between insulin resistance and TG level (r2=0.0529, p=0.01). Conclusion It was concluded that IRS-1 G972R polymorphism was not important in insulin resistance, β-cell function and lipid parameters in overweight and obese T2DM. There could be a number of candidate genes in the pathophysiology of diabetes mellitus, genetic sequencing of IRS-1 and other genes in the insulin signaling pathway, and finding out the alteration in their genetic patterns would provide clues for the association of the site-specific polymorphisms of these genes with insulin resistance in T2DM.
Insulin Resistance

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.
Peripheral Arterial Disease ; Practice Guideline ; Myanmar