The Safety of a Conservative Fluid Replacement Strategy in Adults Hospitalised with Malaria

BackgroundA conservative approach to fluid resuscitation improves survival in children with severe malaria; however, this strategy has not been formally evaluated in adults with the disease.MethodsAdults hospitalised with malaria at two tertiary referral hospitals in Myanmar received intravenous fluid replacement with isotonic saline, administered at a maintenance rate using a simple weight-based algorithm. Clinical and biochemical indices were followed sequentially.ResultsOf 61 adults enrolled, 34 (56%) had Plasmodium falciparum mono-infection, 17 (28%) Plasmodium vivax mono-infection and 10 (16%) mixed infection; 27 (44%) patients were at high risk of death (P. falciparum infection and RCAM score ≥ 2). In the first six hours of hospitalisation patients received a mean 1.7 ml/kg/hour (range: 1.3–2.2) of intravenous fluid and were able to drink a mean of 0.8 ml/kg/hour (range: 0–3). Intravenous fluid administration and oral intake were similar for the remainder of the first 48 hours of hospitalisation. All 61 patients survived to discharge. No patient developed Adult Respiratory Distress Syndrome, a requirement for renal replacement therapy or hypotension (mean arterial pressure < 60mmHg). Plasma lactate was elevated (> 2 mmol/L) on enrolment in 26 (43%) patients but had declined by 6 hours in 25 (96%) and was declining at 24 hours in the other patient. Plasma creatinine was elevated (> 120 μmol/L) on enrolment in 17 (28%) patients, but was normal or falling in 16 (94%) at 48 hours and declining in the other patient by 72 hours. There was no clinically meaningful increase in plasma lactate or creatinine in any patient with a normal value on enrolment. Patients receiving fluid replacement with the conservative fluid replacement algorithm were more likely to survive than historical controls in the same hospitals who had received fluid replacement guided by clinical judgement in the year prior to the study (p = 0.03), despite having more severe disease (p < 0.001).ConclusionsA conservative fluid resuscitation strategy appears safe in adults hospitalised with malaria

Observational study of adult respiratory infections in primary care clinics in Myanmar: understanding the burden of melioidosis, tuberculosis and other infections not covered by empirical treatment regimes.

BACKGROUND: Lower respiratory infections constitute a major disease burden worldwide. Treatment is usually empiric and targeted towards typical bacterial pathogens. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms. METHODS: A prospective observational study in peri-urban communities of Yangon, Myanmar was conducted between July 2018 and April 2019. Sputum specimens of 299 adults presenting with fever and productive cough were tested for Mycobacterium tuberculosis (microscopy and GeneXpert MTB/RIF [Mycobacterium tuberculosis/resistance to rifampicin]) and Burkholderia pseudomallei (Active Melioidosis Detect Lateral Flow Assay and culture). Nasopharyngeal swabs underwent respiratory virus (influenza A, B, respiratory syncytial virus) polymerase chain reaction testing. RESULTS: Among 299 patients, 32% (95% confidence interval [CI] 26 to 37) were diagnosed with tuberculosis (TB), including 9 rifampicin-resistant cases. TB patients presented with a longer duration of fever (median 14 d) and productive cough (median 30 d) than non-TB patients (median fever duration 6 d, cough 7 d). One case of melioidosis pneumonia was detected by rapid test and confirmed by culture. Respiratory viruses were detected in 16% (95% CI 12 to 21) of patients. CONCLUSIONS: TB was very common in this population, suggesting that microscopy and GeneXpert MTB/RIF on all sputum samples should be routinely included in diagnostic algorithms for fever and cough. Melioidosis was uncommon in this population

Species Composition and Monthly Occurrence of Bird Species in Pyu-Kan Lake and its Environs, Tada-U Township, Mandalay Region, Myanmar

A total of 70 bird species belonging to 40 families and 14 orders were recorded from Pyu-Kan Lake and its environs during the study period from September 2017 to April 2018. Among them, 46 species were terrestrial birds and 24 species were waterbirds. Among 14 orders, Passeriformes was the largest order containing 30 species (42.86%) and next to this was order Pelecaniformes containing nine species (12.86%), Coraciiformes six species (8.57%), Gruiformes five species (7.14%), Anseriformes and Charadriiformes four species (5.71%) in each, Accipitriformes and Columbiformes three species (4.28%) in each and Podicipediformes, Ciconiiformes, Falconiformes, Psittaciformes, Cuculiformes, Strigiformes one species (1.43%) in each respectively. Myanmar’s endemic species: Pericrocotus albifrons (Jerdon’s Minivet), Mirafra microptera (Burmese Bushlark), Pycnonotus blanfordi (Irrawaddy Bulbul), and Turdoides gularis (White- throated Babbler) were also recorded in the Pyu-Kan Lake and its environs. Four Near Threatened species of Threskiornis melanocephalus (Black-headed Ibis), Vanellus vanellus (Northern Lapwing), P. albifrons (Jerdon’s Minivet) and Ploceus hypoxanthus (Asian Gloden Weaver) and one Vulnerable species of Aythya ferina (Common Pochard) were recorded at Pyu-Kan Lake and its environs during the study period. Therefore, this wetland area is very important for bird conservation because a great number of waterbirds species, Near Threatened and Vulnerable species still exist in this area. It is therefore necessary to maintain the environment friendly for the birds to thrive

Estimation of Strong Ground Motion Parameters in Amarapura Township, Mandalay Region

Amarapura Township, Mandalay Region is located very closed to the most active dextral Sagaing Fault in Myanmar. In the historical record, several earthquakes happened in and around Mandalay, Amarapura, Innwa, Sagaing region from the beginning of the year of 1400. Even a moderately strong earthquake may cause great loss of lives and property damage. An evaluation of the seismic risk of urban areas cannot neglect the variability of the ground vibration due to site amplification and the induced effects, such as soil liquefaction etc. We conducted 21-sites of microtremor measurement to gain a representative determination of the underground structures and predominant frequency in Amarapura Township. These parameters are required for seismic resistant design of structures. The very highest potential zone of seismic hazard mainly locates the western marginal part of Amarapura Township, in the proximal portion to the dextral Sagaing Fault

Checklist of Bird Species in Mandalay University Campus

A total of 36 bird species belonging to 26 families and 11 orders were recorded from Mandalay University Campus during the study period from June 2017 to May 2018. Among them, 34 species were terrestrial birds and two species were waterbirds. Of these, 11 orders, Passeriformes was the largest order containing 20 species (55.56%) and followed by order Columbiformes and Coraciiformes containing three species in each (8.33%), Psittaciformes and Cuculiformes, two species in each (5.56%), Anseriformes, Accipitriformes, Gruiformes, Strigiformes, Caprimulgiformes and Piciformes one species in each (2.78%), respectively. Two Myanmar’s endemic species of Pycnonotus blanfordi (Irrawaddy Bulbul) and Turdoides gularis (White- throated Babbler) were recorded in the Mandalay University Campus. Of these 36 species, two Winter Visitors of Lanius cristatus (Brown Shrike) and Motacilla alba (White Wagtail), one Near Threatened species of Psittacula eupatria (Alexandrine Parakeet), three migrant species of P. eupatria (Alexandrine Parakeet), Upupa epops (Common Hoopoe) and Passer flaveolus (Plain-backed Sparrow), and 26 residents species were recorded in the Mandalay University Campus. It is proof that Mandalay University Campus is a good habitat for long-term survival of birds including terrestrial and waterbirds

Response in plasma creatinine to the conservative fluid strategy (includes only patients with an elevated plasma creatinine (>120 μmol/L) on enrolment).

<p>The data points represent the mean and the error bars the standard error of the mean.</p

Formula used to calculate weight-based fluid infusion rate [21].

<p>Formula used to calculate weight-based fluid infusion rate [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0143062#pone.0143062.ref021" target="_blank">21</a>].</p

Survival rate of patients receiving conservative fluid therapy in 2014–15 compared with controls receiving standard fluid therapy at the same hospitals in 2013.

<p>(Results stratified by malaria species and RCAM score). No patient died in 2014–5; no patient with P.vivax mono-infection died in either time period.</p