Back pain in an elderly patient - A case report

ABSTRACT Low back pain (LBP) secondary to the degenerative spinal disorder is a very common medical condition that presents in elderly people and rarely indicates a serious illness. We would like to report a case of 83 years old gentleman with a history of chronic degenerative back pain with the change in the nature of back pain, which triggered us to arrange further investigations and diagnosed Psoas abscess(PA) secondary to septic vertebral arthritis. It was treated with CT-guided drainage and sensitive antibiotics. This case report highlights the atypical presentation of diseases in elderly patients, and the common pitfalls of missing serious pathologies, which increases morbidity and mortality. Keywords: low back pain, septic arthritis, Psoas absces

Transfusion-Associated Graft-Versus-Host Disease in Two Patients at Yangon General Hospital

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare complication&nbsp;of blood transfusion. Two male patients admitted to the Department of Clinical Haematology,&nbsp;Yangon General Hospital (YGH) diagnosed to have TA-GVHD in 2011 and in 2016 are presented. Both of the patients received blood donation from close relatives where&nbsp;neither leukoreduction nor irradiation was done. Both patients had fever, skin rashes,gastrointestinal symptoms, raised liver enzymes and pancytopenia. Skin biopsies of both patients showed characteristic histological changes. Unlike graft-versus-host disease that&nbsp;occurred after haemopoeitic stem cell transplantation, TA-GVHD involves the recipient&rsquo;s&nbsp;bone marrow leading to bone marrow aplasia</p

Barrier Curvature Dependent Transmission Probabilities for 16O+12C, 16O+58Ni, 16O+154Sm Systems

The transmission probabilities through the Coulomb barrier for reactions having difference barrier curvatures have been calculated. We have chosen three heavy-ion fusion reactions with a fixed projectile and three targets in different mass region, namely, 16O+12C, 16O+58Ni, 16O+154Sm systems. The transmission probability for each system is evaluated by using parabolic approximation of potential barrier. It is found that the variation of transmission probability depends on the different curvature of Coulomb barriers of colliding systems. For lighter systems, the transmission probability is closer to that of classical result. As the system becomes heavier, the curvature of the barrier becomes larger and consequently the deviation from the classical limit becomes significant. Thus, the quantum effect in transmission probability is found to be larger in heavy-ion fusion reactions with heavy target than those of lighter ones

Pre-operative pseudothrombocytopenia: terrifying but innocuous

An isolated thrombocytopenia was found in a 47-year old man during pre-operative&nbsp;work-up for his closed radial bone fracture on left forearm after a fall. His platelet count&nbsp;was as low as 14 x 103/&mu;L, but there was no active bleeding and past history of bleeding&nbsp;disorder. The clue to true diagnosis started from careful blood film examination - platelet&nbsp;clumps in blood film. Repeat full blood count tests were requested not only with the usual&nbsp;anticoagulant EDTA (Ethylene diamine tetra-acetic acid) but also with heparin as well as with&nbsp;citrate. EDTA-dependent pseudothrombocytopenia was diagnosed which can be confused&nbsp;with other life-threatening platelet disorders. The operation was successfully done without&nbsp;unusual bleeding.</p

Hyperhemolysis with hemoglobin H disease

Hyperhemolysis syndrome is one of serious and potentially life-threatening complications of red blood cell transfusion, and is well described in sickle cell disease as well as in thalassaemias and other anaemias. It also is a great diagnostic and management challenge to laboratory scientists and attending physician taking care of patients with such kinds of diseases. A Myanmar patient with hemoglobin H disease presenting with acute hyperhemolysis syndrome was diagnosed timely and successfully treated with intravenous immunoglobulin (IV Ig) and methylprednisolone. A high index of suspicion allowing early diagnosis and prompt management can save lives of patients with hyperhemolysis syndrome.</p

Adverse Drug Reactions in Selected Wards of the Yangon General Hospital and Yangon Specialty Hospital During the First Quarter of 2019 : An Active Pharmacovigilance Study in Myanmar

Previous studies in Europe and the USA have reported a high prevalence of adverse drug reactions (ADRs), but data on local ADRs in Myanmar are sparse. Our objective was to study ADRs in patients admitted to selected wards of Yangon General Hospital (YGH) and Yangon Specialty Hospital (YSH), Myanmar. This was a prospective observational study in three hospital wards during the first quarter of 2019. Suspected ADRs were carefully investigated in a face-to-face interview with each patient and via review of clinical records. Patients transferred to other wards or discharged were followed-up by the researchers until day 28 after admission. ADRs were divided into those that (1) led to the admission and (2) occurred during the hospital stay or after discharge (up to day 28 after admission). A total of 65 ADRs were identified, with 47 (29.4%) of 160 patients experiencing at least one ADR. Among these, 16 (24.6%) had led to hospital admission and 49 (75.4%) occurred in 31 patients during their hospital stay. Of 160 patients, 21 had taken at least one herbal remedy and six of these developed an ADR. Five ADR-drug associations (hypokalaemia with methylprednisolone, increased transaminase levels with standard antituberculosis drugs, upper gastrointestinal bleeding with nonsteroidal anti-inflammatory drugs, constipation with tramadol, and increased transaminase levels with herbal remedies) represented 18 (27.7%) of the 65 ADRs in this study. According to the Schumock and Thornton preventability scale, more than half of these ADRs (35 [53.9%]) were preventable. The present study highlights the existence of ADRs among patients attending these hospitals. The implementation of active pharmacovigilance in hospitals could be a helpful first step to improving the awareness of unwanted effects of medicines and patient safety, as well as a way to strengthen the national pharmacovigilance system in countries such as Myanmar. The online version of this article (10.1007/s40801-020-00180-0) contains supplementary material, which is available to authorized users

Feasibility and readiness to implement Robson classification to monitor caesarean sections in public hospitals in Myanmar: Formative research.

Recent years have demonstrated an increase in caesarean section (CS) in most countries worldwide with considerable concern for the potential consequences. In 2015, WHO proposed the use of Robson classification as a global standard for assessing, monitoring and comparing CS rates. Currently, there is no standardized method to assess CS in Myanmar. The aim of this study was to explore health provider's perceptions about the feasibility, acceptability and readiness to implement the Robson classification in public hospitals across Myanmar. Ten maternities were purposively chosen, including all five teaching hospitals (tertiary referral hospital-level) affiliated to each medical university in Myanmar, which provide maternal and newborn care services, and district/township hospitals. Face-to-face in-depth interviews (IDI) with healthcare providers and facility administrators were conducted using semi-structured discussion guides. Facility and medical records systems were also assessed. We used the thematic analysis approach and Atlas.ti qualitative analysis software. A total of 67 IDIs were conducted. Most participants had willingness to implement Robson classification if there were sufficient human resources and training. Limited human resources, heavy workloads, and infrastructure resources were the major challenges described that may hinder implementation. The focal person for data entry, analysis, or reporting could be differed according to the level of facility, availability of human resources, and ability to understand medical terms and statistics. The respondents mentioned the important role of policy enforcement for the sustainability of data collection, interpretation and feedback. The optimal review interval period could therefore differ according to the availability of responsible persons, and the number of births. However, setting a fixed schedule according to the specific hospital for continuous monitoring of CS rate is required. In Myanmar, implementation of Robson classification is feasible while key barriers mainly related to human resource and training must be addressed to sustain

Qualitative interview guide.

(DOCX)</p

S1 Checklist -

(PDF)</p

Characteristics of the respondents (n = 67).

Characteristics of the respondents (n = 67).</p