March -2012 -Newsletter

Dr. Shein MyintM.B.,B.S, M.HSc. (New Zeland), Consultant (Audiology)

American Speech, Language and Hearing Association, the American Academy of Paediatrics and American Academy of Otolaryngology recommend audiological evaluation for neonates manifesting any risk factors. The following are the risk factors for neonates (0 - 28 days) and infants (29 days to 2 years).Neonates (0 - 28 days)1. Admission to a Neonatal Intensive Care Unit (NICU) for greater than 48 hours.2. Stigmata or evidence of a syndrome associated with a hearing loss.3. Family history of hearing loss.4. Craniofacial abnormalities, including those with morphological abnormalities of the pinna and ear canal.5. In Utero infection such as CMV, rubella, toxoplasmosis, herpes. Following are additional risk factors for infants (29 days to 2 years)Infants (29 days - 2 years)1. Parental or caregiver concern regarding hearing, speech, language, and or developmental delay.2. Family history of permanent childhood hearing loss.3. Stigmata or other ndings associated with a syndrome known to include a sensorineural or conductive hearing loss or Eustachian tube dysfunction.4. Postnatal infections associated with sensorineural hearing loss including bacterial meningitis.5. In utero infections such as cytomegalovirus, herpes, rubella, syphilis and toxoplasmosis.6. Neonatal indicators - speci cally hyperbilirubinaemia at a serum level requiring exchange transfusion, persistent pulmonary hypertension of the newborn associated with mechanical ventilation, and conditions requiring the use of extracorporeal membrane oxygenation (ECMO).7. Syndromes associated with progressive hearing loss such as neurofibromatosis, osteopetrosis, and Usher’s syndrome.8. Neurodegenerative disorders, such as Hunter syndrome, or sensory motor neuropathies, such as Friedreich’s ataxia and Charcot - Marie - Tooth syndrome.9. Head trauma.10. Recurrent or persistent otitis media with effusion for at least 3 months.

Editorial Board

Dr. Myint Lwin

Dr. Shwe Baw

Dr. Zay Ya Aye

Dr. Tin Moe Phyu

Dr. Khin Than Htay

Dr. Thidar Oo

Dr. Nyein Moe Thaw

Dr. Hnin Thuzar Aung

Advisory Group

Contact UsNo-60, G-1,

New Parami Road, Mayangone Tsp,

Yangon, Myanmar.Tel : 651674, 660083, 657228 to 657232

info@paramihospital.

Free DistributionThe contents of the

newsletter are not to be reproduced in any form

without prior written approval of theeditorial board.

Prof. U Thein Aung

Prof. U Khin Maung Aye

Dr. Tin Nyunt

Prof. U Saw Win

Prof. Daw Mya Thidar

Prof. U Ne Win

NEWS L E T T ER

Holistic, Compassionate and Quality Healthcare

Issue 8 March, 2012

HIGH RISK FACTORS FOR CONGENITAL HEARING LOSSHIGH RISK FACTORS FOR CONGENITAL HEARING LOSS

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Parami General Hospital

Page - 4

Not common, but not rare

Dr. Phyu Phyu KhaingM.B.,B.S, M.Med.Sc (Paed:)

A 1year and 7 months old boy from Thamandaw Sanpya Village, Tontae Township was admitted to Parami General Hospital on 1:25 pm (4.3.2012) with loose motion and vomiting for 2 days and low grade fever for 1 day duration.

He passed loose stool for more than 10 times a day,which was watery but did not contain blood nor mucus and he could not tolerate any feeding at all.On Examination The child was febrile (100.F) and signs of dehydration was also present. The following investigations were carried out on admission: The routine examination of stool and reducing substance showed no signi cant features. Blood for complete picture, c-reactive protein and malaria parasite were done. Mild leucocytosis with neutrophilia was the only abnormal nding. He was treated as Acute Gastroenteritis with moderate dehydration. His loose motion persisted inspite of giving proper rehydration therapy with oral antibiotics, ulix P, metro and lactose-free milk.

Therefore stool culture and sensitivity, blood urea and electrolytes were proceeded. Presence of hypokalaemia was corrected with parenteral KCl. Stool Culture report came back as : Moderate growth of Vibrio cholerae isolated. The culture was done at Parami General Hospital Laboratory. The isolate was sent to National Health Laboratory for con rmation and serotyping. Finally the report came back as - Organism isolated: Vibrio cholerae

O1, Ogawa. The antibiotics such as Ciprofloxacin,Gentamicin, Tetracycline, Chloramphenicol and nor oxacin were sensitive.

According to guidelines of communicable diseasesthe patient was transferred to Waibargi Hospital. He was discharged from Waibagi Hospital after a few days.

Reason for Reporting this Case

Cholera is uncommon at the age of 2 years or under but we are always on the alert of its occurance at any age; and rehydration is the mainstay of treatment. It is also oneof the noti able disease as well as one of the categories of DUNS (Diseases under National Surveillance), so early detection is very important to prevent outbreak in the community.

Diarrhoeal disease is the second leading cause of death in children under ve, and is responsible for killing1.5 million children every year. It can be caused by a variety of bacterial, viral and parasitic organisms. Rotavirus and Escherichia coli are the two most common causes of diarrhoea in developing countries. Cholera is not common in under two and it is an often forgotten disease affecting the world’s forgotten people. When a large cholera outbreak occurs, the disease appears brie y on the radar of public attention. Isolation of Vibrio cholerae in stool culture is not easy but medical laboratory of PGH has achieved in doingit. Reasons for presenting the case are to raise the public awareness on cholera and not to forget the possibility of cholera in under two.

SPECIAL CASE REPORTSPECIAL CASE REPORT

Issue - 8, March 2012 Parami Hospital - Yangon, NewsletterPage - 4Page - 3

Continued from Minimal Access Therapy (MAT) and Gynaecological Surgery (Page - 2)

surgery or they are merely more complex ways of using

more expensive equipment to achieve inferior results. It is

an important question that requires an urgent and clear

answer for future gynaecological practice.

Many departments have begun to try to answer this

challenging question. The results could determine the

direction and nature of gynaecological surgery for some

considerable time to come.

Due to the abore reasons MIGS techniques have

been subject to a significant amount of prospective,

evidence-based assessment. The evidence from 2195 patients

in 23 randomised clinical trials of ve different treatment

modalities clearly demonstrates that uncomplicated MIGS

procedures produced patient-friendly bene ts, at least in the

short term. No matter what operation is performed, the

laparoscopic approach is associated with less pain, shorter

hospital stay and shorter recovery. The evidence base is

growing in favor of MIGS but much more needs to be done.

The bene ts of avoiding a laparotomy incision are clear.

However, the effectiveness of the procedures that avoid a

large entry point remains to be proven in many areas. The

potential for MIGS as a better treatment for many

gynaecological problems is considerable, but the need to

verify each approach individually very much depend on its

cost-effectiveness and safety.

It is important to remember that technological

advances and innovations require new skills to be mastered.

However there is always problems associated with ‘learning

curve’. During this learning period complications tend to

occur more. These complications do occur only when

trainees perform procedures on real patient. It is essential to

establish the centre designs to facilitate achievement of the

new MIGS surgical skills with zero complication.

The ideal custom-built facility would include

interventional human anatomy, virtual reality simulation,

micro-surgery operating microscopes, an endoscopic

operating theatre, fully equipped laparoscopic training

laboratories, and advanced surgical skills training on human

cadavers or on animal subject.

facilities in our country has always been my dream through

years of practising MIGS. As the complications associated

with endoscopic surgery can be signi cantly reduced by

those training laboratories, I wish my fantasy will become

a reality sooner than later.

Picture (2)Endotrainer Setting

Picture (3)

Laparoscopic Training Laboratory

Issue - 8, March 2012 Parami Hospital - Yangon, Newsletter Page - 3 Issue - 8, March 2012 Parami Hospital - Yangon, Newsletter

Professor Saw Kler Ku

M.B.,B.S, M.Med.Sc (OG), MRCOG (UK), D.F.F.P (UK),

Dr.Med.Sc (OG) Professor, Dept. of O & G, University of Medicine (Mdy)

MAT generally aims to avoid morbidity associated with access trauma and claims quicker recovery time. Advanced

technology enables a gynaecologist to perform almost all operations endoscopically which previously were carried out

through open surgery. Minimal Access Gynaecological Surgery (MIGS) provides signi cant bene ts compared with

laparotomy for the patients, the providers and the surgeons.

The claimed bene ts of patient include reduced

morbidity, less visible scarring, less operative pain and

quicker recovery. The bene ts of reduced inpatient and social

costs as a result of shorter hospital stay and quicker recovery

times are well recognised by the health care providers. The

advantages of MIGS for gynaecological surgeons include

its almost ‘closed and no-touch’ operative approach which

reduces risk of infection, better display of anatomy and

pathology, more precise removal of diseased tissue and more

accurate tissue repair.

It is important not to over-estimate the bene ts of

Minimal Access Gynaecological Surgery as MIGS has also

been associated with some problems and has its

limitations. Like every MAT, MIGS cannot be equated with

minimal or atraumatic surgery because excessive trauma can

be in icted as much as in open surgery. The hardware and

equipment are expensive so initial investment cost is usually high. As it is a new skill to develop availability of training and training facility, duration of training and problems associated with learning curve also needs to be considered. Patients undergoing MIGS procedures may be at risk of new complications such as entry related complications and diathermy injuries.

Some Gynaecologists in our country may not be aware of the role of MIGS in gynaecology. For diagnosis MIGS becomes “Gold standard” in a number of gynaecological problems. Hysteroscopy is a standard investigation for post-menopausal bleeding and laparoscopy as well as investigation of pelvic pain and for tubal patency. Laparoscopic approach is recommended for tubal surgery and sterilization, ectopic pregnancy, surgery for endometriosis and benign ovarian cysts. Laparoscopic approach also extend its role onto infertility surgery, incontinence surgery, reconstructive surgery for pelvic floor prolapse and gynaecological oncology. It becomes an essential skill for every gynaecologist and is already incorporated in the specialist training curriculum of Royal College of Obstetricians and Gynaecologists.

The place of MIGS in current gynaecological practice is always questioned by some critics. Whether MAT

procedures represent an unsurpassed opportunity to provide

better care for the majority of women requiring gynaecological (To Page - 3 _____>)

Picture (1) Laparoscopic repair of hydrosalpinx - a blocked fallopian tube

Page - 2

Minimal Access Therapy (MAT) and Gynaecological Surgery Minimal Access Therapy (MAT) and Gynaecological Surgery