1) A 1 year 7 month old boy was admitted with diarrhea and vomiting for 2 days and fever for 1 day. Stool culture revealed moderate growth of Vibrio cholerae. 2) Cholera is uncommon in children under 2 years old but can occur. Early detection is important to prevent outbreaks. 3) The case is presented to raise public awareness of the possibility of cholera in young children and of its potential to cause large outbreaks if not contained.

1. (To Page - 3 _____)>
be in icted as much as in open surgery. The hardware and
better care for the majority of women requiring gynaecological
trainees perform procedures on real patient. It is essential to a reality sooner than later. minimal or atraumatic surgery because excessive trauma can
procedures represent an unsurpassed opportunity to provide
occur more. These complications do occur only when those training laboratories, I wish my fantasy will become limitations. Like every MAT, MIGS cannot be equated with
practice is always questioned by some critics. Whether MAT
curve’. During this learning period complications tend to with endoscopic surgery can be signi cantly reduced by been associated with some problems and has its
The place of MIGS in current gynaecological
However there is always problems associated with ‘learning years of practising MIGS. As the complications associated Minimal Access Gynaecological Surgery as MIGS has also
Obstetricians and Gynaecologists.
advances and innovations require new skills to be mastered. facilities in our country has always been my dream through It is important not to over-estimate the bene ts of
specialist training curriculum of Royal College of
It is important to remember that technological every gynaecologist and is already incorporated in the hydrosalpinx - a blocked fallopian tube
Laparoscopic Training Laboratory cost-effectiveness and safety. gynaecological oncology. It becomes an essential skill for Picture ( 1 ) Laparoscopic repair of
Picture ( 3 ) verify each approach individually very much depend on its reconstructive surgery for pelvic floor prolapse and
gynaecological problems is considerable, but the need to its role onto infertility surgery, incontinence surgery,
potential for MIGS as a better treatment for many and benign ovarian cysts. Laparoscopic approach also extend
large entry point remains to be proven in many areas. The and sterilization, ectopic pregnancy, surgery for endometriosis
However, the effectiveness of the procedures that avoid a Laparoscopic approach is recommended for tubal surgery
The bene ts of avoiding a laparotomy incision are clear. as well as investigation of pelvic pain and for tubal patency.
investigation for post-menopausal bleeding and laparoscopy
growing in favor of MIGS but much more needs to be done.
gynaecological problems. Hysteroscopy is a standard
hospital stay and shorter recovery. The evidence base is accurate tissue repair.
MIGS becomes “Gold standard” in a number of
laparoscopic approach is associated with less pain, shorter pathology, more precise removal of diseased tissue and more
aware of the role of MIGS in gynaecology. For diagnosis
short term. No matter what operation is performed, the reduces risk of infection, better display of anatomy and
Some Gynaecologists in our country may not be
procedures produced patient-friendly bene ts, at least in the cadavers or on animal subject. its almost ‘closed and no-touch’ operative approach which
diathermy injuries.
modalities clearly demonstrates that uncomplicated MIGS laboratories, and advanced surgical skills training on human complications such as entry related complications and
advantages of MIGS for gynaecological surgeons include
in 23 randomised clinical trials of ve different treatment operating theatre, fully equipped laparoscopic training times are well recognised by the health care providers. The Patients undergoing MIGS procedures may be at risk of new
evidence-based assessment. The evidence from 2195 patients micro-surgery operating microscopes, an endoscopic costs as a result of shorter hospital stay and quicker recovery associated with learning curve also needs to be considered.
been subject to a significant amount of prospective, interventional human anatomy, virtual reality simulation, quicker recovery. The bene ts of reduced inpatient and social and training facility, duration of training and problems
The ideal custom-built facility would include Due to the abore reasons MIGS techniques have morbidity, less visible scarring, less operative pain and high. As it is a new skill to develop availability of training
considerable time to come. The claimed bene ts of patient include reduced equipment are expensive so initial investment cost is usually
direction and nature of gynaecological surgery for some laparotomy for the patients, the providers and the surgeons.
challenging question. The results could determine the through open surgery. Minimal Access Gynaecological Surgery (MIGS) provides signi cant bene ts compared with
Many departments have begun to try to answer this technology enables a gynaecologist to perform almost all operations endoscopically which previously were carried out
Endotrainer Setting answer for future gynaecological practice. MAT generally aims to avoid morbidity associated with access trauma and claims quicker recovery time. Advanced
Picture ( 2 )
an important question that requires an urgent and clear
Dr.Med.Sc (OG) Professor, Dept. of O & G, University of Medicine (Mdy)
more expensive equipment to achieve inferior results. It is
M.B.,B.S, M.Med.Sc (OG), MRCOG (UK), D.F.F.P (UK),
surgery or they are merely more complex ways of using
Professor Saw Kler Ku
new MIGS surgical skills with zero complication. Gynaecological Surgery (Page - 2)
establish the centre designs to facilitate achievement of the Continued from Minimal Access Therapy (MAT) and
Minimal Access Therapy (MAT) and Gynaecological Surgery
Parami Hospital - Yangon, Newsletter Page - 3
Page - 3 Issue - 8, March 2012 Parami Hospital - Yangon, Newsletter Page - 2 Issue - 8, March 2012
Issue - 8, March 2012 Page - 4 Parami Hospital - Yangon, Newsletter
Not common, but not rare O 1 , Ogawa. The antibiotics such as Ciprofloxacin,
yg&rDtaxGaxGa&m*gukaq;½Hk
SPECIAL CASE REPORT Gentamicin, Tetracycline, Chloramphenicol and nor oxacin Parami G eneral Hospital
were sensitive.
Dr. Phyu Phyu Khaing
M.B.,B.S, M.Med.Sc (Paed:)
According to guidelines of communicable diseases
the patient was transferred to Waibargi Hospital. He was
NEWSLETTER
A 1year and 7 months old boy from Thamandaw discharged from Waibagi Hospital after a few days. Issue 8 March, 2012
Sanpya Village, Tontae Township was admitted to Parami
Holistic, Compassionate and Quality Healthcare
General Hospital on 1:25 pm (4.3.2012) with loose motion
and vomiting for 2 days and low grade fever for 1 day Advisory Group HIGH RISK FACTORS FOR CONGENITAL HEARING LOSS
duration. Prof. U Thein Aung Dr. Shein Myint
He passed loose stool for more than 10 times a day,
Prof. U Khin Maung Aye M.B.,B.S, M.HSc. (New Zeland), Consultant (Audiology)
which was watery but did not contain blood nor mucus and
Dr. Tin Nyunt American Speech, Language and Hearing Association, the American Academy of
he could not tolerate any feeding at all.
Reason for Reporting this Case Prof. U Saw Win Paediatrics and American Academy of Otolaryngology recommend audiological evaluation
On Examination
Cholera is uncommon at the age of 2 years or under Prof. Daw Mya Thidar for neonates manifesting any risk factors. The following are the risk factors for neonates
The child was febrile (100.F) and signs of
but we are always on the alert of its occurance at any age; Prof. U Ne Win (0 - 28 days) and infants (29 days to 2 years).
dehydration was also present.
Neonates (0 - 28 days)
The following investigations were carried out on and rehydration is the mainstay of treatment. It is also one Editorial Board
of the noti able disease as well as one of the categories of 1. Admission to a Neonatal Intensive Care Unit (NICU) for greater than 48 hours.
admission:
Dr. Myint Lwin 2. Stigmata or evidence of a syndrome associated with a hearing loss.
The routine examination of stool and reducing DUNS (Diseases under National Surveillance), so early
detection is very important to prevent outbreak in the Dr. Shwe Baw 3. Family history of hearing loss.
substance showed no signi cant features.
Dr. Zay Ya Aye 4. Craniofacial abnormalities, including those with morphological abnormalities of the
Blood for complete picture, c-reactive protein and community.
Diarrhoeal disease is the second leading cause of Dr. Tin Moe Phyu pinna and ear canal.
malaria parasite were done. Mild leucocytosis with
5. In Utero infection such as CMV, rubella, toxoplasmosis, herpes.
neutrophilia was the only abnormal nding. death in children under ve, and is responsible for killing Dr. Khin Than Htay
Following are additional risk factors for infants (29 days to 2 years)
He was treated as Acute Gastroenteritis with 1.5 million children every year. It can be caused by a variety Dr. Thidar Oo
Infants (29 days - 2 years)
moderate dehydration. His loose motion persisted inspite of of bacterial, viral and parasitic organisms. Rotavirus and Dr. Nyein Moe Thaw 1. Parental or caregiver concern regarding hearing, speech, language, and or developmental
giving proper rehydration therapy with oral antibiotics, ulix Escherichia coli are the two most common causes of Dr. Hnin Thuzar Aung delay.
P, metro and lactose-free milk. diarrhoea in developing countries. Cholera is not common
2. Family history of permanent childhood hearing loss.
Therefore stool culture and sensitivity, blood urea in under two and it is an often forgotten disease affecting Contact Us
No-60, G-1, 3. Stigmata or other ndings associated with a syndrome known to include a sensorineural
and electrolytes were proceeded. Presence of hypokalaemia the world’s forgotten people. When a large cholera outbreak
New Parami Road, or conductive hearing loss or Eustachian tube dysfunction.
was corrected with parenteral KCl. Stool Culture report occurs, the disease appears brie y on the radar of public
Mayangone Tsp, 4. Postnatal infections associated with sensorineural hearing loss including bacterial
came back as : Moderate growth of Vibrio cholerae isolated. attention. Isolation of Vibrio cholerae in stool culture is not meningitis.
Yangon, Myanmar.
The culture was done at Parami General Hospital easy but medical laboratory of PGH has achieved in doing Tel : 651674, 660083, 5. In utero infections such as cytomegalovirus, herpes, rubella, syphilis and toxoplasmosis.
Laboratory. The isolate was sent to National Health it. Reasons for presenting the case are to raise the public 657228 to 657232 6. Neonatal indicators - speci cally hyperbilirubinaemia at a serum level requiring exchange
Laboratory for con rmation and serotyping. Finally the awareness on cholera and not to forget the possibility of info@paramihospital. transfusion, persistent pulmonary hypertension of the newborn associated with mechanical
report came back as - Organism isolated: Vibrio cholerae cholera in under two. ventilation, and conditions requiring the use of extracorporeal membrane oxygenation
Free Distribution
(ECMO).
The contents of the
7. Syndromes associated with progressive hearing loss such as neurofibromatosis,
newsletter are not to be
reproduced in any form
osteopetrosis, and Usher’s syndrome.
without prior written 8. Neurodegenerative disorders, such as Hunter syndrome, or sensory motor neuropathies,
approval of the such as Friedreich’s ataxia and Charcot - Marie - Tooth syndrome.
editorial board. 9. Head trauma.
10. Recurrent or persistent otitis media with effusion for at least 3 months.