Zar Ni Htet Aung - Academia.edu (original) (raw)

Papers by Zar Ni Htet Aung

Research paper thumbnail of WCN24-671 Association Between Blood Mycophenolic Acid Level and Graft Function in Renal Transplant Recipients in Early Post-Transplant Period

Kidney international reports, Apr 1, 2024

Research paper thumbnail of WCN24-1495 Relationship Between Living-Donor Kidney Volume and Recipient Body Weight Ratio on Outcome of Kidney Transplant Recipient Patients

Kidney international reports, Apr 1, 2024

Research paper thumbnail of Detection of the Omicron Variant among SARS Cov-2 Positive Cases In No. (1) Defence Services General Hospital, Myanmar

Research paper thumbnail of Efficacy of Convalescent Plasma Therapy (CPT) plus Remdesivir versus Standard Therapy (Remdesivir) In Patients with Severe or Critical COVID-19 Infection in Second and Third Wave of Epidemics in Myanmar: Non-Randomized Interventional Study

SunText review of virology, 2022

Research paper thumbnail of Effectiveness of 4 doses of COVID-19 vaccine in patients on maintenance hemodialysis in 5th wave of COVID-19 infection in Myanmar: Do we need 5 doses?

Zenodo (CERN European Organization for Nuclear Research), Dec 13, 2022

Background: Patients on maintenance hemodialysis (MHD) are at high risk of contracting SARS-CoV-2... more Background: Patients on maintenance hemodialysis (MHD) are at high risk of contracting SARS-CoV-2 and developing severe COVID-19 infection because they have low innate immunity as well as poor antibody response to COVID-19 vaccine. This study aimed to assess the effectiveness of 4 doses of COVID-19 vaccine in preventing 5 th wave of COVID-19 infections in patients on maintenance hemodialysis in Myanmar. Methods: A hospital-based descriptive study was conducted in July 2022 to November 2022 among patients on MHD who received COVID-19 vaccine 4 doses; last dose was 2 weeks ago. Data were collected by using standardized forms and analysis was done. Results: A total of 61 patients on maintenance hemodialysis (MHD) who had 4 doses of COVID-19 vaccination more than 2 weeks were included. Nasopharyngeal swab PCR was taken twice a week to all patients (if they did not have symptoms) and it was repeated if they had symptoms suggestive of COVID-19 infection or they had history of contact with patients having COVID-19 infection. Their signs and symptoms were analyzed; chest radiograph and blood tests were taken if indicated. Then, the severity of COVID-19 infection was determined according to WHO criteria and they were given treatment according to hospital guideline. They were followed up till 28 days. The base line characteristics were as follows: mean age was 51.15 ± 12.85 years; male to female ratio was 4:6; mean BMI was 19.93 ± 2.83 kg/m 2 ; 16.4%(10/61) had diabetic nephropathy; 9.8%(6/61) had cerebrovascular accident; 24.6%(15/61) had coronary heart disease; and one fifth of them were current smokers. Sixty six percent had past history of COVID-19 infection; duration from last infection was 404 days. Thirty three percent of cases had shortest duration of hemodialysis (6 months) and 23% were over 3 years. Mean duration from last vaccination was 39 days. Thirty six percent (22/61) had confirmed COVID-19 infection and 64% (39/61) of them were not infected till the end of 5 th wave. All infected cases were mild form according to WHO criteria; none of them required oxygen therapy. One case having multiple comorbidities (lymphoma, coronary heart disease, hypertension and malignant cachexia) had sudden death due to pulmonary embolism.

Research paper thumbnail of Initial presenting symptoms andseverity of SARS-CoV-2 Wild type, theDelta variant and the Omicron variant infected cases in early fourth wave ofepidemics in Myanmar

Research paper thumbnail of WCN24-675 Acute Diarrhea in Living Kidney Transplant Recipients in Early Post-Transplant Period at Two Transplant Centers in Myanmar: Any Relation with Blood Tacrolimus Level?

Kidney international reports, Apr 1, 2024

Research paper thumbnail of Is Thiamine Administration Effective in Sepsis or Not? A Randomized Controlled Trial

International Journal Of Medical Science And Clinical Research Studies

Background: Sepsis is the first leading cause of death in Myanmar and complications are also diff... more Background: Sepsis is the first leading cause of death in Myanmar and complications are also difficult to solve. This study aimed to detect the effect of thiamine on lactate clearance and mortality in patients with sepsis. Method: A randomized controlled trial done in No.(1) Defence Services General Hospital, Yangon from October 2020 to June 2022. All patients > 18 years old admitted with suspected or documented infection and qSOFA score 2 or 3 were included but alcohol related cases were excluded. Total 80 patients were assigned 1:1 by block randomization. Intervention group was given IV thiamine 100 mg 6 hourly for 3 days. Primary outcome was lactate clearance and secondary outcomes, mSOFA score (both were assessed in day 1, day 3 and day 7), and mortality within 7 days. Intention to treat analysis with worst data imputation in missing value for expired cases. Results: Significant lactate clearance was seen in intervention group compared with control group, in day 3, [23.53% (3...

Research paper thumbnail of Sepsis and Septic Shock: Are Initial mSOFA Score, Point-of-Care Lactate, Neutrophil-Lymphocyte Ratio and Platelet Count Good Predictors for Mortality?

International Journal Of Medical Science And Clinical Research Studies

Background: Sepsis is a common life threatening medical problem and first leading cause of death ... more Background: Sepsis is a common life threatening medical problem and first leading cause of death in Myanmar. This study was aimed to determine the predictive values of initial mSOFA score, point-of-care lactate, neutrophil-lymphocyte ratio and platelet count for mortality in patients with sepsis and septic shock. Method: A hospital based prospective observational study done in No.(1) Defence Services General Hospital, Yangon, from January 2021 to October 2022. All patients above 18 years old admitted with sepsis and qSOFA ≥ 2 were enrolled and sample size was 121 patients. The predictors were mSOFA score, point-of-care lactate, neutrophil-lymphocyte ratio and platelet count, which were assessed within 24 hour of admission and the mortality was observed for 28 days. Logistic regression was used to find out the predictive value and the predictors were compared by receiver operating characteristic curve analysis.

Research paper thumbnail of Is Thiamine Administration Effective in Sepsis or Not? A Randomized Controlled Trial

INTERNATIONAL JOURNAL OF MEDICAL SCIENCE AND CLINICAL RESEARCH STUDIES, 2022

Background: Sepsis is the first leading cause of death in Myanmar and complications are also diff... more Background: Sepsis is the first leading cause of death in Myanmar and complications are also difficult to solve. This study aimed to detect the effect of thiamine on lactate clearance and mortality in patients with sepsis. Method: A randomized controlled trial done in No.(1) Defence Services General Hospital, Yangon from October 2020 to June 2022. All patients > 18 years old admitted with suspected or documented infection and qSOFA score 2 or 3 were included but alcohol related cases were excluded. Total 80 patients were assigned 1:1 by block randomization. Intervention group was given IV thiamine 100 mg 6 hourly for 3 days. Primary outcome was lactate clearance and secondary outcomes, mSOFA score (both were assessed in day 1, day 3 and day 7), and mortality within 7 days. Intention to treat analysis with worst data imputation in missing value for expired cases. Results: Significant lactate clearance was seen in intervention group compared with control group, in day 3, [23.53% (34.37) vs 16.67% (43.30), z =-2.353, p = 0.019] and day 7, [53.85% (28.90) vs 30.22% (38.61), z =-3.186, p = 0.001]. Lactate clearance over time was well observed in the intervention group, [X 2 (2) = 29.356, p < 0.001] but not in the control group, [X 2 (2) = 3.152, p = 0.207]. Significant mSOFA score reduction over time was also observed in the intervention group, [X 2 (3) = 39.330, p < 0.001]. All-cause mortality within 7 days was not different, [X 2 (1) = 0.949, p = 0.330, OR 0.949, 95% CI (0.51-7.12)]. Conclusion: Thiamine supplementation in sepsis patient was benefit in lactate clearance starting from day 3 and reduction of mSOFA score starting from day 7. But it did not show the mortality benefit within 7 days period.

Research paper thumbnail of A case of Scrub Typhus presenting with high fever, eschar, septic shock, ARDS, acute kidney injury, thrombocytopenia, hypoalbuminemia and transaminitis in 50-year-old man coming back from Delta region of Myanmar

Journal of Clinical and Medical Images, Case Reports

A 50-year-old gentle man, coming back from Delta region, presented with, septic shock, ARDS and a... more A 50-year-old gentle man, coming back from Delta region, presented with, septic shock, ARDS and acute kidney injury following 8 days history of high fever. Eschar was noted on right forearm. His temperature was 105°F; very ill and toxic with SaO2 90% on air. He was hypotensive (80/50 mmHg), tachycardic (128/ min), tachypneic (respiratory rate 32/min) with low SaO2 (90% on air); crackles were audible in both lungs. Chest radiograph showed patchy opacities in both lungs. He had low Platelet count (34 x 109/mm3), raised serum creatinine (160 μmol/L), raised liver enzymes (SGOT 121 U/L & SGPT 86 U/L) and low serum albumin (22 mg%). Rapid test for Scrub Typhus IgM was positive. The patient recovered with oxygen therapy, fluid replacement, inotropes, cefopyrazone/salbactam and doxycycline.

Research paper thumbnail of Equity of Maintenance Hemodialysis in Myanmar: Cross-Sectional Descriptive Study

Journal of Biomedical Research & Environmental Sciences

Background: Maintenance hemodialysis has been the commonest Renal Replacement Therapy (RRT) in My... more Background: Maintenance hemodialysis has been the commonest Renal Replacement Therapy (RRT) in Myanmar. The equity is questionable in Myanmar, a developing country, as developed countries reported inequities of dialysis in various aspects. Methods: A cross-sectional descriptive study was conducted in selected Hemodialysis Centers (HDC) which are under the care of government of Myanmar in August 2022. Data were collected by using standardized forms and analysis was done. Results: A total of 168 cases from 5 HDC situated in Yangon (lower part of Myanmar), Nay Pyi Taw (central part of Myanmar), Aung Ban (Eastern part of Myanmar), Lashio (North eastern part of Myanmar) and Kyaing Ton (near Golden Triangle) were included. The age range was 21-79 years; old age was not excluded for maintenance hemodialysis. Male to female ratio was 1:1.2 revealing accessibility of both sex to maintenance hemodialysis. The proportion of ethnic groups was Burmese (139/168), Rakhine (8/168), Karen (7/168), S...

Research paper thumbnail of Acute coronary syndrome with cardiogenic shock due to occlusion of right coronary artery in a young physician caring patients with COVID-19 infection: a case report

Journal of medicine and therapeutics, 2020

Research paper thumbnail of The Prevalence, Clinical Characteristics, Predicting Factors and Impact of Long COVID Syndrome Following Third Wave of Epidemic in Myanmar: Prospective Study

International Journal Of Medical Science And Clinical Research Studies

Background: Coronavirus disease 2019 (COVID-19), emerged in China at the end of 2019, became a ma... more Background: Coronavirus disease 2019 (COVID-19), emerged in China at the end of 2019, became a major threat to health around the world by causing acute COVID-19 infection. After recovery, a significant number of patients experience prolonged symptoms, long COVID syndrome. The prevalence of long COVID syndrome, its symptoms, severity and relation between clinical parameters and long COVID syndrome, and its impact were not studied in Myanmar. Methods: A prospective study was conducted via telecommunication to patients with positive SARS COV 2 PCR from nasopharyngeal swab during the third wave from end of May to August 2021. Data were collected by using standardized forms and analysis was done. A chi-square test of independence was performed to examine the relation between age groups, gender, body mass index (BMI), vaccination status, comorbidity status, severity of initial symptoms, oxygen requirement status, and symptoms of long covid syndrome. Results: Though initial recruitment inc...

Research paper thumbnail of A Case of Rupture Ectopic Pregnancy Diagnosed 10 Days After Hospital Stay In A 22-Year-Old Girl Presented With Symptoms of Anemia Without Abdominal Pain and Amenorrhea: Lessons Learned

International Journal Of Medical Science And Clinical Research Studies

A 22-year-old unmarried Myanmar girl presented with symptoms of anemia: fatigue, exertional dyspn... more A 22-year-old unmarried Myanmar girl presented with symptoms of anemia: fatigue, exertional dyspnea and fainting attack. There was no abdominal pain or amenorrhea. The hemodynamic status was stable except sinus tachycardia. Anemia was refractory to blood transfusion; thus, the differential diagnosis were autoimmune hemolytic anemia and occult blood loss. Blood film, bone marrow examination, Comb tests, Anti-nuclear antibody profile and PNH screen tests excluded autoimmune hemolytic anemia. Presence of fibrous strands in free fluids of abdominal cavity with normal uterus and ovary mislead the diagnosis of tuberculosis. Blood tap in ascitic fluid aspiration made all the answer- rupture ectopic pregnancy. The symptoms resolved after right salpingectomy and blood transfusion. The clerking on sexual exposure to Myanmar single is not acceptable in our culture; it is regarded as “social insult”. Atypical presentation and not asking sexual history caused delay in diagnosis; diagnosed 10 day...

Research paper thumbnail of Combined effect of low dose atorvastatin, aspirin, clopidogrel and cessation of smoking for one year on totally occluded left anterior descending coronary artery in 39-year-old obese physician: a case report

Research review, Mar 30, 2022

A 39-year-old physician had severe central chest pain and cardiogenic shock due to acute inferior... more A 39-year-old physician had severe central chest pain and cardiogenic shock due to acute inferior myocardial infarction one year ago; bare metal stent was inserted into occluded right coronary artery, culprit artery. Left anterior descending artery (LAD) was found to be totally occluded too, planned for future procedure. He had multiple risk factors: high BMI 28, heavy smoking, high cholesterol 220 mg% and sedentary life style. He quit smoking after the event. He has been taking atorvastatin 10 mg, aspirin 75 mg and clopidogrel 75 mg in addition to diuretics and low dose ramipril. He could not do exercise as his effort tolerance was poor. One year later, recheck coronary angiogram revealed a good flow in right coronary artery; moreover, there was distal flow in totally occluded LAD. Therefore, bare metal stent was inserted after dilatation. Blood tests were almost the same. In this patient, spontaneous flow in totally occluded LAD was due to combined effect of low dose atorvastatin, aspirin, clopidogrel and cessation of smoking for one year; not due to exercise or weight reduction. Low dose statin and smoking cessation had effect on atheromatous plaque on LAD.

Research paper thumbnail of COVID-19 and Gastrointestinal Manifestation: A Case Report on Colonic Perforation in 91-year- old man with Severe COVID-19 Infection

Issues and Developments in Medicine and Medical Research Vol. 7, 2022

Thus, he was treated as a case of severe Covid-19 infection with oxygen 10L/min, imipenem, azithr... more Thus, he was treated as a case of severe Covid-19 infection with oxygen 10L/min, imipenem, azithromycin, dexamethasone, low molecular weight heparin, vitamins and dexamethasone. Convalescent plasma therapy was given on Day 12 symptom onset. He made gradual improvement over one weeks. His symptoms improved on Day 14 symptom onset. Absolute lymphocyte count decreased to 1.5 X 10 9 /l and Chest Xray too Clinical presentation A-91-year old man had fever, cough with dyspnoea for 7 days and was brought to hospital. He was previously healthy and lived with caring family. He did not have dementia and was ambulating well. He was not diabetics nor hypertensive. His nasopharyngeal swab for Covid-19 PCR was positive. His SaO2 on air was 83% and respiratory rate was 28/minutes. Chest Xray was consistent with severe pneumonia as patchy opacities occupied more than 50% of lung parenchyma on both sides (Figure 1(a)). His total WBC was 31.6 X10 9 /l and absolute lymphocyte count was 2.2 X10 9 /l. He had high LDH Case summary A-91-year old man had severe Covid-19 infection (bilateral pneumonia, SaO2 85% on air). He was treated with antibiotics, oxygen, dexamethasone and convalescent plasma therapy. On day 28 symptom onset, he noticed abdominal distension without abdominal pain. CT abdomen revealed pneumoperitoneum. An area of perforation at colon with mucosal haemorrhage was seen in laparotomy. Right hemicolectomy was done. Histology showed mucosal oedema, infi ltration with infl ammatory cells mainly polymorphs and lymphocytes, congested vessels with areas of haemorrhage in the mucosa.

Research paper thumbnail of Infective endocarditis involving native aortic valve due to Burkholderia cepacia presenting as refractory heart failure in immunocompetent host: A case report

Journal of Clinical Images and Medical Case Reports, 2021

A 44-year-old previously healthy gentle man presented with dyspnoea for three weeks which was mor... more A 44-year-old previously healthy gentle man presented with dyspnoea for three weeks which was more severe over 7 days. He had anaemia, sinus tachycardia, wide pulse pressure of 100 mmHg, heaving displaced apex beat, and features of aortic regurgitation with occasional crackles over both lung base. Echocardiogram revealed vegetations at aortic valve. He was initially treated as a case of infective endocarditis and left ventricular failure with amoxicillin, gentamycin and anti-failure treatment. However, heart failure was very refractory and even worsening; he expired five days after arrival to our hospital. Blood culture obtained after his death showed a growth of unusual organism Burkholderia cepacia. Keywords: infective endocarditis; aortic regurgitation; refractory heart failure; Burkholderia cepacia.

Research paper thumbnail of Colonic perforation in 91- year- old man with severe Covid-19 infection

Journal of Clinical Microbiology and Biochemical Technology, 2020

Thus, he was treated as a case of severe Covid-19 infection with oxygen 10L/min, imipenem, azithr... more Thus, he was treated as a case of severe Covid-19 infection with oxygen 10L/min, imipenem, azithromycin, dexamethasone, low molecular weight heparin, vitamins and dexamethasone. Convalescent plasma therapy was given on Day 12 symptom onset. He made gradual improvement over one weeks. His symptoms improved on Day 14 symptom onset. Absolute lymphocyte count decreased to 1.5 X 10 9 /l and Chest Xray too Clinical presentation A-91-year old man had fever, cough with dyspnoea for 7 days and was brought to hospital. He was previously healthy and lived with caring family. He did not have dementia and was ambulating well. He was not diabetics nor hypertensive. His nasopharyngeal swab for Covid-19 PCR was positive. His SaO2 on air was 83% and respiratory rate was 28/minutes. Chest Xray was consistent with severe pneumonia as patchy opacities occupied more than 50% of lung parenchyma on both sides (Figure 1(a)). His total WBC was 31.6 X10 9 /l and absolute lymphocyte count was 2.2 X10 9 /l. He had high LDH Case summary A-91-year old man had severe Covid-19 infection (bilateral pneumonia, SaO2 85% on air). He was treated with antibiotics, oxygen, dexamethasone and convalescent plasma therapy. On day 28 symptom onset, he noticed abdominal distension without abdominal pain. CT abdomen revealed pneumoperitoneum. An area of perforation at colon with mucosal haemorrhage was seen in laparotomy. Right hemicolectomy was done. Histology showed mucosal oedema, infi ltration with infl ammatory cells mainly polymorphs and lymphocytes, congested vessels with areas of haemorrhage in the mucosa.

Research paper thumbnail of A Case of Rupture Ectopic Pregnancy Diagnosed 10 Days After Hospital Stay In A 22-Year-Old Girl Presented With Symptoms of Anemia Without Abdominal Pain and Amenorrhea: Lessons Learned

A 22-year-old unmarried Myanmar girl presented with symptoms of anemia: fatigue, exertional dyspn... more A 22-year-old unmarried Myanmar girl presented with symptoms of anemia: fatigue, exertional dyspnea and fainting attack. There was no abdominal pain or amenorrhea. The hemodynamic status was stable except sinus tachycardia. Anemia was refractory to blood transfusion; thus, the differential diagnosis were autoimmune hemolytic anemia and occult blood loss. Blood film, bone marrow examination, Comb tests, Anti-nuclear antibody profile and PNH screen tests excluded autoimmune hemolytic anemia. Presence of fibrous strands in free fluids of abdominal cavity with normal uterus and ovary mislead the diagnosis of tuberculosis. Blood tap in ascitic fluid aspiration made all the answer-rupture ectopic pregnancy. The symptoms resolved after right salpingectomy and blood transfusion. The clerking on sexual exposure to Myanmar single is not acceptable in our culture; it is regarded as "social insult". Atypical presentation and not asking sexual history caused delay in diagnosis; diagnosed 10 days after hospital stay. She recovered uneventfully.

Research paper thumbnail of WCN24-671 Association Between Blood Mycophenolic Acid Level and Graft Function in Renal Transplant Recipients in Early Post-Transplant Period

Kidney international reports, Apr 1, 2024

Research paper thumbnail of WCN24-1495 Relationship Between Living-Donor Kidney Volume and Recipient Body Weight Ratio on Outcome of Kidney Transplant Recipient Patients

Kidney international reports, Apr 1, 2024

Research paper thumbnail of Detection of the Omicron Variant among SARS Cov-2 Positive Cases In No. (1) Defence Services General Hospital, Myanmar

Research paper thumbnail of Efficacy of Convalescent Plasma Therapy (CPT) plus Remdesivir versus Standard Therapy (Remdesivir) In Patients with Severe or Critical COVID-19 Infection in Second and Third Wave of Epidemics in Myanmar: Non-Randomized Interventional Study

SunText review of virology, 2022

Research paper thumbnail of Effectiveness of 4 doses of COVID-19 vaccine in patients on maintenance hemodialysis in 5th wave of COVID-19 infection in Myanmar: Do we need 5 doses?

Zenodo (CERN European Organization for Nuclear Research), Dec 13, 2022

Background: Patients on maintenance hemodialysis (MHD) are at high risk of contracting SARS-CoV-2... more Background: Patients on maintenance hemodialysis (MHD) are at high risk of contracting SARS-CoV-2 and developing severe COVID-19 infection because they have low innate immunity as well as poor antibody response to COVID-19 vaccine. This study aimed to assess the effectiveness of 4 doses of COVID-19 vaccine in preventing 5 th wave of COVID-19 infections in patients on maintenance hemodialysis in Myanmar. Methods: A hospital-based descriptive study was conducted in July 2022 to November 2022 among patients on MHD who received COVID-19 vaccine 4 doses; last dose was 2 weeks ago. Data were collected by using standardized forms and analysis was done. Results: A total of 61 patients on maintenance hemodialysis (MHD) who had 4 doses of COVID-19 vaccination more than 2 weeks were included. Nasopharyngeal swab PCR was taken twice a week to all patients (if they did not have symptoms) and it was repeated if they had symptoms suggestive of COVID-19 infection or they had history of contact with patients having COVID-19 infection. Their signs and symptoms were analyzed; chest radiograph and blood tests were taken if indicated. Then, the severity of COVID-19 infection was determined according to WHO criteria and they were given treatment according to hospital guideline. They were followed up till 28 days. The base line characteristics were as follows: mean age was 51.15 ± 12.85 years; male to female ratio was 4:6; mean BMI was 19.93 ± 2.83 kg/m 2 ; 16.4%(10/61) had diabetic nephropathy; 9.8%(6/61) had cerebrovascular accident; 24.6%(15/61) had coronary heart disease; and one fifth of them were current smokers. Sixty six percent had past history of COVID-19 infection; duration from last infection was 404 days. Thirty three percent of cases had shortest duration of hemodialysis (6 months) and 23% were over 3 years. Mean duration from last vaccination was 39 days. Thirty six percent (22/61) had confirmed COVID-19 infection and 64% (39/61) of them were not infected till the end of 5 th wave. All infected cases were mild form according to WHO criteria; none of them required oxygen therapy. One case having multiple comorbidities (lymphoma, coronary heart disease, hypertension and malignant cachexia) had sudden death due to pulmonary embolism.

Research paper thumbnail of Initial presenting symptoms andseverity of SARS-CoV-2 Wild type, theDelta variant and the Omicron variant infected cases in early fourth wave ofepidemics in Myanmar

Research paper thumbnail of WCN24-675 Acute Diarrhea in Living Kidney Transplant Recipients in Early Post-Transplant Period at Two Transplant Centers in Myanmar: Any Relation with Blood Tacrolimus Level?

Kidney international reports, Apr 1, 2024

Research paper thumbnail of Is Thiamine Administration Effective in Sepsis or Not? A Randomized Controlled Trial

International Journal Of Medical Science And Clinical Research Studies

Background: Sepsis is the first leading cause of death in Myanmar and complications are also diff... more Background: Sepsis is the first leading cause of death in Myanmar and complications are also difficult to solve. This study aimed to detect the effect of thiamine on lactate clearance and mortality in patients with sepsis. Method: A randomized controlled trial done in No.(1) Defence Services General Hospital, Yangon from October 2020 to June 2022. All patients > 18 years old admitted with suspected or documented infection and qSOFA score 2 or 3 were included but alcohol related cases were excluded. Total 80 patients were assigned 1:1 by block randomization. Intervention group was given IV thiamine 100 mg 6 hourly for 3 days. Primary outcome was lactate clearance and secondary outcomes, mSOFA score (both were assessed in day 1, day 3 and day 7), and mortality within 7 days. Intention to treat analysis with worst data imputation in missing value for expired cases. Results: Significant lactate clearance was seen in intervention group compared with control group, in day 3, [23.53% (3...

Research paper thumbnail of Sepsis and Septic Shock: Are Initial mSOFA Score, Point-of-Care Lactate, Neutrophil-Lymphocyte Ratio and Platelet Count Good Predictors for Mortality?

International Journal Of Medical Science And Clinical Research Studies

Background: Sepsis is a common life threatening medical problem and first leading cause of death ... more Background: Sepsis is a common life threatening medical problem and first leading cause of death in Myanmar. This study was aimed to determine the predictive values of initial mSOFA score, point-of-care lactate, neutrophil-lymphocyte ratio and platelet count for mortality in patients with sepsis and septic shock. Method: A hospital based prospective observational study done in No.(1) Defence Services General Hospital, Yangon, from January 2021 to October 2022. All patients above 18 years old admitted with sepsis and qSOFA ≥ 2 were enrolled and sample size was 121 patients. The predictors were mSOFA score, point-of-care lactate, neutrophil-lymphocyte ratio and platelet count, which were assessed within 24 hour of admission and the mortality was observed for 28 days. Logistic regression was used to find out the predictive value and the predictors were compared by receiver operating characteristic curve analysis.

Research paper thumbnail of Is Thiamine Administration Effective in Sepsis or Not? A Randomized Controlled Trial

INTERNATIONAL JOURNAL OF MEDICAL SCIENCE AND CLINICAL RESEARCH STUDIES, 2022

Background: Sepsis is the first leading cause of death in Myanmar and complications are also diff... more Background: Sepsis is the first leading cause of death in Myanmar and complications are also difficult to solve. This study aimed to detect the effect of thiamine on lactate clearance and mortality in patients with sepsis. Method: A randomized controlled trial done in No.(1) Defence Services General Hospital, Yangon from October 2020 to June 2022. All patients > 18 years old admitted with suspected or documented infection and qSOFA score 2 or 3 were included but alcohol related cases were excluded. Total 80 patients were assigned 1:1 by block randomization. Intervention group was given IV thiamine 100 mg 6 hourly for 3 days. Primary outcome was lactate clearance and secondary outcomes, mSOFA score (both were assessed in day 1, day 3 and day 7), and mortality within 7 days. Intention to treat analysis with worst data imputation in missing value for expired cases. Results: Significant lactate clearance was seen in intervention group compared with control group, in day 3, [23.53% (34.37) vs 16.67% (43.30), z =-2.353, p = 0.019] and day 7, [53.85% (28.90) vs 30.22% (38.61), z =-3.186, p = 0.001]. Lactate clearance over time was well observed in the intervention group, [X 2 (2) = 29.356, p < 0.001] but not in the control group, [X 2 (2) = 3.152, p = 0.207]. Significant mSOFA score reduction over time was also observed in the intervention group, [X 2 (3) = 39.330, p < 0.001]. All-cause mortality within 7 days was not different, [X 2 (1) = 0.949, p = 0.330, OR 0.949, 95% CI (0.51-7.12)]. Conclusion: Thiamine supplementation in sepsis patient was benefit in lactate clearance starting from day 3 and reduction of mSOFA score starting from day 7. But it did not show the mortality benefit within 7 days period.

Research paper thumbnail of A case of Scrub Typhus presenting with high fever, eschar, septic shock, ARDS, acute kidney injury, thrombocytopenia, hypoalbuminemia and transaminitis in 50-year-old man coming back from Delta region of Myanmar

Journal of Clinical and Medical Images, Case Reports

A 50-year-old gentle man, coming back from Delta region, presented with, septic shock, ARDS and a... more A 50-year-old gentle man, coming back from Delta region, presented with, septic shock, ARDS and acute kidney injury following 8 days history of high fever. Eschar was noted on right forearm. His temperature was 105°F; very ill and toxic with SaO2 90% on air. He was hypotensive (80/50 mmHg), tachycardic (128/ min), tachypneic (respiratory rate 32/min) with low SaO2 (90% on air); crackles were audible in both lungs. Chest radiograph showed patchy opacities in both lungs. He had low Platelet count (34 x 109/mm3), raised serum creatinine (160 μmol/L), raised liver enzymes (SGOT 121 U/L & SGPT 86 U/L) and low serum albumin (22 mg%). Rapid test for Scrub Typhus IgM was positive. The patient recovered with oxygen therapy, fluid replacement, inotropes, cefopyrazone/salbactam and doxycycline.

Research paper thumbnail of Equity of Maintenance Hemodialysis in Myanmar: Cross-Sectional Descriptive Study

Journal of Biomedical Research & Environmental Sciences

Background: Maintenance hemodialysis has been the commonest Renal Replacement Therapy (RRT) in My... more Background: Maintenance hemodialysis has been the commonest Renal Replacement Therapy (RRT) in Myanmar. The equity is questionable in Myanmar, a developing country, as developed countries reported inequities of dialysis in various aspects. Methods: A cross-sectional descriptive study was conducted in selected Hemodialysis Centers (HDC) which are under the care of government of Myanmar in August 2022. Data were collected by using standardized forms and analysis was done. Results: A total of 168 cases from 5 HDC situated in Yangon (lower part of Myanmar), Nay Pyi Taw (central part of Myanmar), Aung Ban (Eastern part of Myanmar), Lashio (North eastern part of Myanmar) and Kyaing Ton (near Golden Triangle) were included. The age range was 21-79 years; old age was not excluded for maintenance hemodialysis. Male to female ratio was 1:1.2 revealing accessibility of both sex to maintenance hemodialysis. The proportion of ethnic groups was Burmese (139/168), Rakhine (8/168), Karen (7/168), S...

Research paper thumbnail of Acute coronary syndrome with cardiogenic shock due to occlusion of right coronary artery in a young physician caring patients with COVID-19 infection: a case report

Journal of medicine and therapeutics, 2020

Research paper thumbnail of The Prevalence, Clinical Characteristics, Predicting Factors and Impact of Long COVID Syndrome Following Third Wave of Epidemic in Myanmar: Prospective Study

International Journal Of Medical Science And Clinical Research Studies

Background: Coronavirus disease 2019 (COVID-19), emerged in China at the end of 2019, became a ma... more Background: Coronavirus disease 2019 (COVID-19), emerged in China at the end of 2019, became a major threat to health around the world by causing acute COVID-19 infection. After recovery, a significant number of patients experience prolonged symptoms, long COVID syndrome. The prevalence of long COVID syndrome, its symptoms, severity and relation between clinical parameters and long COVID syndrome, and its impact were not studied in Myanmar. Methods: A prospective study was conducted via telecommunication to patients with positive SARS COV 2 PCR from nasopharyngeal swab during the third wave from end of May to August 2021. Data were collected by using standardized forms and analysis was done. A chi-square test of independence was performed to examine the relation between age groups, gender, body mass index (BMI), vaccination status, comorbidity status, severity of initial symptoms, oxygen requirement status, and symptoms of long covid syndrome. Results: Though initial recruitment inc...

Research paper thumbnail of A Case of Rupture Ectopic Pregnancy Diagnosed 10 Days After Hospital Stay In A 22-Year-Old Girl Presented With Symptoms of Anemia Without Abdominal Pain and Amenorrhea: Lessons Learned

International Journal Of Medical Science And Clinical Research Studies

A 22-year-old unmarried Myanmar girl presented with symptoms of anemia: fatigue, exertional dyspn... more A 22-year-old unmarried Myanmar girl presented with symptoms of anemia: fatigue, exertional dyspnea and fainting attack. There was no abdominal pain or amenorrhea. The hemodynamic status was stable except sinus tachycardia. Anemia was refractory to blood transfusion; thus, the differential diagnosis were autoimmune hemolytic anemia and occult blood loss. Blood film, bone marrow examination, Comb tests, Anti-nuclear antibody profile and PNH screen tests excluded autoimmune hemolytic anemia. Presence of fibrous strands in free fluids of abdominal cavity with normal uterus and ovary mislead the diagnosis of tuberculosis. Blood tap in ascitic fluid aspiration made all the answer- rupture ectopic pregnancy. The symptoms resolved after right salpingectomy and blood transfusion. The clerking on sexual exposure to Myanmar single is not acceptable in our culture; it is regarded as “social insult”. Atypical presentation and not asking sexual history caused delay in diagnosis; diagnosed 10 day...

Research paper thumbnail of Combined effect of low dose atorvastatin, aspirin, clopidogrel and cessation of smoking for one year on totally occluded left anterior descending coronary artery in 39-year-old obese physician: a case report

Research review, Mar 30, 2022

A 39-year-old physician had severe central chest pain and cardiogenic shock due to acute inferior... more A 39-year-old physician had severe central chest pain and cardiogenic shock due to acute inferior myocardial infarction one year ago; bare metal stent was inserted into occluded right coronary artery, culprit artery. Left anterior descending artery (LAD) was found to be totally occluded too, planned for future procedure. He had multiple risk factors: high BMI 28, heavy smoking, high cholesterol 220 mg% and sedentary life style. He quit smoking after the event. He has been taking atorvastatin 10 mg, aspirin 75 mg and clopidogrel 75 mg in addition to diuretics and low dose ramipril. He could not do exercise as his effort tolerance was poor. One year later, recheck coronary angiogram revealed a good flow in right coronary artery; moreover, there was distal flow in totally occluded LAD. Therefore, bare metal stent was inserted after dilatation. Blood tests were almost the same. In this patient, spontaneous flow in totally occluded LAD was due to combined effect of low dose atorvastatin, aspirin, clopidogrel and cessation of smoking for one year; not due to exercise or weight reduction. Low dose statin and smoking cessation had effect on atheromatous plaque on LAD.

Research paper thumbnail of COVID-19 and Gastrointestinal Manifestation: A Case Report on Colonic Perforation in 91-year- old man with Severe COVID-19 Infection

Issues and Developments in Medicine and Medical Research Vol. 7, 2022

Thus, he was treated as a case of severe Covid-19 infection with oxygen 10L/min, imipenem, azithr... more Thus, he was treated as a case of severe Covid-19 infection with oxygen 10L/min, imipenem, azithromycin, dexamethasone, low molecular weight heparin, vitamins and dexamethasone. Convalescent plasma therapy was given on Day 12 symptom onset. He made gradual improvement over one weeks. His symptoms improved on Day 14 symptom onset. Absolute lymphocyte count decreased to 1.5 X 10 9 /l and Chest Xray too Clinical presentation A-91-year old man had fever, cough with dyspnoea for 7 days and was brought to hospital. He was previously healthy and lived with caring family. He did not have dementia and was ambulating well. He was not diabetics nor hypertensive. His nasopharyngeal swab for Covid-19 PCR was positive. His SaO2 on air was 83% and respiratory rate was 28/minutes. Chest Xray was consistent with severe pneumonia as patchy opacities occupied more than 50% of lung parenchyma on both sides (Figure 1(a)). His total WBC was 31.6 X10 9 /l and absolute lymphocyte count was 2.2 X10 9 /l. He had high LDH Case summary A-91-year old man had severe Covid-19 infection (bilateral pneumonia, SaO2 85% on air). He was treated with antibiotics, oxygen, dexamethasone and convalescent plasma therapy. On day 28 symptom onset, he noticed abdominal distension without abdominal pain. CT abdomen revealed pneumoperitoneum. An area of perforation at colon with mucosal haemorrhage was seen in laparotomy. Right hemicolectomy was done. Histology showed mucosal oedema, infi ltration with infl ammatory cells mainly polymorphs and lymphocytes, congested vessels with areas of haemorrhage in the mucosa.

Research paper thumbnail of Infective endocarditis involving native aortic valve due to Burkholderia cepacia presenting as refractory heart failure in immunocompetent host: A case report

Journal of Clinical Images and Medical Case Reports, 2021

A 44-year-old previously healthy gentle man presented with dyspnoea for three weeks which was mor... more A 44-year-old previously healthy gentle man presented with dyspnoea for three weeks which was more severe over 7 days. He had anaemia, sinus tachycardia, wide pulse pressure of 100 mmHg, heaving displaced apex beat, and features of aortic regurgitation with occasional crackles over both lung base. Echocardiogram revealed vegetations at aortic valve. He was initially treated as a case of infective endocarditis and left ventricular failure with amoxicillin, gentamycin and anti-failure treatment. However, heart failure was very refractory and even worsening; he expired five days after arrival to our hospital. Blood culture obtained after his death showed a growth of unusual organism Burkholderia cepacia. Keywords: infective endocarditis; aortic regurgitation; refractory heart failure; Burkholderia cepacia.

Research paper thumbnail of Colonic perforation in 91- year- old man with severe Covid-19 infection

Journal of Clinical Microbiology and Biochemical Technology, 2020

Thus, he was treated as a case of severe Covid-19 infection with oxygen 10L/min, imipenem, azithr... more Thus, he was treated as a case of severe Covid-19 infection with oxygen 10L/min, imipenem, azithromycin, dexamethasone, low molecular weight heparin, vitamins and dexamethasone. Convalescent plasma therapy was given on Day 12 symptom onset. He made gradual improvement over one weeks. His symptoms improved on Day 14 symptom onset. Absolute lymphocyte count decreased to 1.5 X 10 9 /l and Chest Xray too Clinical presentation A-91-year old man had fever, cough with dyspnoea for 7 days and was brought to hospital. He was previously healthy and lived with caring family. He did not have dementia and was ambulating well. He was not diabetics nor hypertensive. His nasopharyngeal swab for Covid-19 PCR was positive. His SaO2 on air was 83% and respiratory rate was 28/minutes. Chest Xray was consistent with severe pneumonia as patchy opacities occupied more than 50% of lung parenchyma on both sides (Figure 1(a)). His total WBC was 31.6 X10 9 /l and absolute lymphocyte count was 2.2 X10 9 /l. He had high LDH Case summary A-91-year old man had severe Covid-19 infection (bilateral pneumonia, SaO2 85% on air). He was treated with antibiotics, oxygen, dexamethasone and convalescent plasma therapy. On day 28 symptom onset, he noticed abdominal distension without abdominal pain. CT abdomen revealed pneumoperitoneum. An area of perforation at colon with mucosal haemorrhage was seen in laparotomy. Right hemicolectomy was done. Histology showed mucosal oedema, infi ltration with infl ammatory cells mainly polymorphs and lymphocytes, congested vessels with areas of haemorrhage in the mucosa.

Research paper thumbnail of A Case of Rupture Ectopic Pregnancy Diagnosed 10 Days After Hospital Stay In A 22-Year-Old Girl Presented With Symptoms of Anemia Without Abdominal Pain and Amenorrhea: Lessons Learned

A 22-year-old unmarried Myanmar girl presented with symptoms of anemia: fatigue, exertional dyspn... more A 22-year-old unmarried Myanmar girl presented with symptoms of anemia: fatigue, exertional dyspnea and fainting attack. There was no abdominal pain or amenorrhea. The hemodynamic status was stable except sinus tachycardia. Anemia was refractory to blood transfusion; thus, the differential diagnosis were autoimmune hemolytic anemia and occult blood loss. Blood film, bone marrow examination, Comb tests, Anti-nuclear antibody profile and PNH screen tests excluded autoimmune hemolytic anemia. Presence of fibrous strands in free fluids of abdominal cavity with normal uterus and ovary mislead the diagnosis of tuberculosis. Blood tap in ascitic fluid aspiration made all the answer-rupture ectopic pregnancy. The symptoms resolved after right salpingectomy and blood transfusion. The clerking on sexual exposure to Myanmar single is not acceptable in our culture; it is regarded as "social insult". Atypical presentation and not asking sexual history caused delay in diagnosis; diagnosed 10 days after hospital stay. She recovered uneventfully.