Modalities of treatment for sleep disordered breathing

Sleep disordered breathing is a spectrum of diseases that includes snoring,upper airway resistance syndrome and obstructive sleep apnea.It occurs more in obese males, resulting in hypertension and cardiac complications if untreated.There are various treatments,conservatively and surgically,starting from simple tonsillectomy to multilevel surgeries and multi dicipline.Literature review was carried out on the pathophysiology,clinical presentation , complications ,diagnosis and various treatments,using internet Google,search PubMed.Additional information was obtained by cross referencing,using text and journals in the medical libraries

Evaluation of tumor markers for the detection of hepatocellular carcinoma in Yangon General Hospital, Myanmar.

Levels of alpha-fetoprotein (AFP), its glycoforms AFP-L3 and AFP-P4, and proteins induced by vitamin K absence or antagonist-II (PIVKA-II) were determined in sera obtained from patients in Yangon General Hospital (20 with hepatocellular carcinoma (HCC), 29 with chronic liver diseases, including 3 with chronic hepatitis and 26 with cirrhosis of the liver, and 9 with other hepatobiliary diseases). Forty-five percent of the patients with HCC had serum AFP levels above 10,000 ng/ml, indicating that nearly half of the HCC patients were at an advanced stage of the disease. Thus, the AFP sensitivity was as high as 70% with 100% specificity for a cutoff level of 200 ng/ml. The sensitivity of AFP-L3 was 75% and a specificity 90% for a cutoff level of 15%. AFP-P4 showed a higher sensitivity of 80% and a similar specificity of 86% for a cutoff level of 12%. Combined evaluation of AFP-L3 and/or AFP-P4 increased the sensitivity to 90% with the same specificity of 86%, indicating that AFP-L3 and AFP-P4 are useful as adjuncts for diagnosis of HCC in the present population. PIVKA-II had a high sensitivity of 90%, although the specificity was lower than 45%, probably due to the low cutoff level, as some cholestatic patients were included in the control group.</p

Assessing the Viability of the 2005 Protocol to the Convention for the Suppression of Unlawful Acts against the Safety of Maritime Navigation

The terrorist attack on the Achille Lauro prompted the international community to adopt the Convention for the Suppression of Unlawful Acts against the Safety of Maritime Navigation (SUA) 1988, which established a legal basis for prosecuting maritime violence that did not fall within the piracy framework of the United Nations Convention on the Law of the Sea 1982. To extend the range of offences covered by the Convention, it was amended by the 2005 Protocol. The Protocol, however, has been the subject of much criticism. One of the most serious criticisms of the Protocol is directed at its Article 8bis, which authorizes a state party to visit a ship flying the flag of another state party without prior authorization from the flag state on the ground of failure to respond within four hours. In fact, this provision is in conflict with the exclusive jurisdiction of a flag state over a ship flying its flag on the high seas. This is the reason why although the 2005 Protocol entered into force on 28 July 2010, until present, there are only 22 States parties, most of which are not major maritime countries. The main objective of this paper therefore is to identify shortcomings of the 2005 Protocol and assess its viability. It is suggested that the 2005 Protocol needs to be revised to cure its deficiencies in order to attract more states to become parties to it

Fortifying horn of Africa with the Djibouti code of conduct in combating piracy and armed robbery against ships: myth or reality

obally, the Djibouti Code of Conduct is the second regional agreement in combating piracy and armed robbery against ships in the Western Indian Ocean and the Gulf of Aden after the ReCAAP. Although it has great potential to contribute in suppressing these maritime crimes in the region, it does not fully address the problem due to its non-binding nature, lack of serious cooperation among Participants, narrow definition of maritime crimes, limitations in information sharing system and poor capacity building. Thus, there is an urgent need to evaluate the efficacy of the Djibouti Code of Conduct. Accordingly, the author intents to analyse its shortcomings and proposes viable solutions. In this paper, Participants are suggested to render binding legal effect to the Djibouti Code of Conduct as soon as possible for the effective suppression of increasing maritime violence crimes. It is also proposed to widen the scope of maritime crimes and include maritime terrorism. It is preferable to remove the two ships requirement from the piracy definition and include the phrase “Exclusive Economic Zone of a State Party” into the definition of armed robbery against ships. All Participants are advised to allow the hot pursuit in their territorial waters in arresting or seizing culprits and cooperate with the requesting Participant. All ships passing through the waters in the region are recommended to notify the flag state, the nearest national focal point of a Participant and the information exchange centre when any incident takes place. All information exchange centres and national focal points should also be well equipped with advanced technologies

Assessing the Viability of the 2005 Protocol to the Convention for the Suppression of Unlawful Acts against the Safety of Maritime Navigation

Abstract: The terrorist attack on the Achille Lauro prompted the international community to adopt the Convention for the Suppression of Unlawful Acts against the Safety of Maritime Navigation (SUA) 1988, which established a legal basis for prosecuting maritime violence that did not fall within the piracy framework of the United Nations Convention on the Law of the Sea 1982. To extend the range of offences covered by the Convention, it was amended by the 2005 Protocol. The Protocol, however, has been the subject of much criticism. One of the most serious criticisms of the Protocol is directed at its Article 8bis, which authorizes a state party to visit a ship flying the flag of another state party without prior authorization from the flag state on the ground of failure to respond within four hours. In fact, this provision is in conflict with the exclusive jurisdiction of a flag state over a ship flying its flag on the high seas. This is the reason why although the 2005 Protocol entered into force on 28 July 2010, until present, there are only 22 States parties, most of which are not major maritime countries. The main objective of this paper therefore is to identify shortcomings of the 2005 Protocol and assess its viability. It is suggested that the 2005 Protocol needs to be revised to cure its deficiencies in order to attract more states to become parties to it

High prevalence of hepatitis C in patients with thalassemia and patients with liver diseases in Myanmar (Burma).

We conducted Myanmar-Japan cooperation studies on hepatitis B and hepatitis C virus markers in patients with thalassemias and those with liver diseases. Among the 102 patients with liver diseases, 92% had a history of hepatitis B virus infection (antibody to hepatitis B core antigen positive), 35% were hepatitis B surface antigen positive, 39% were positive for anti-HCV. Among 28 patients with hepatocellular carcinoma, 46% had hepatitis B surface antigen, 21.4% had antibody to hepatitis C virus, and 7% were positive for both hepatitis B surface antigen and anti hepatitis C virus. The history of HCV infection among blood recipients at the Haematology Department of the Yangon General Hospital and at the Yangon Children's Hospital was found to be 55.5% and 46.7%, respectively, which is comparable to the history of hepatitis B infection (66.7% and 46.7%, respectively). This preliminary survey also encountered 2 cases positive for anti-HCV among 34 voluntary blood donors. This survey is the first one to report that hepatitis C is at the epidemic stage in Myanmar. As there is no effective treatment for hepatitis C in this country, a screening program for blood used in transfusion should be started immediately.</p

“Nine Dimensions”: A multidisciplinary approach for community engagement in a complex postwar border region as part of the targeted malaria elimination in Karen/Kayin State, Myanmar [version 2; referees: 2 approved]

Background: In light of growing antimalarial drug resistance in Southeast Asia, control programmes have become increasingly focused on malaria elimination, composed of mass drug administration coupled with prompt diagnosis and treatment of symptomatic cases. The key to a successful elimination programme centres on high participation rates in targeted communities, often enhanced by community engagement (CE) efforts. Social science research was conducted to develop a conceptual framework used for CE activities in the Targeted Malaria Elimination programme, as a cross-border operation in Karen/Kayin State, Myanmar. Methods: Data was collected from three main sources: (1) participant observation and semi-structured interviews of CE team members; (2) participant observation and semi-structured interviews with villagers; and (3) records of CE workshops with CE workers conducted as part of the TME programme. Results: Interviews were conducted with 17 CE team members, with 10 participant observations and interviews conducted with villagers and a total of 3 workshops conducted over the course of this pilot programme in 4 villages (November 2013 to October 2014). Thematic analysis was used to construct the nine dimensions for CE in this complex, post-war region: i) history of the people; ii) space; iii) work; iv) knowledge about the world; v) intriguing obstacle (rumour); vi) relationship with the health care system; vii) migration; viii) logic of capitalism influencing openness; and ix) power relations. Conclusions: Conducting CE for the Targeted Malaria Elimination programme was immensely complicated in Karen/Kayin State because of three key realities: heterogeneous terrains, a post-war atmosphere and cross-border operations. These three key realities constituted the nine dimensions, which proved integral to health worker success in conducting CE. Summary of this approach can aid in infectious disease control programmes, such as those using mass drug administration, to engender high rates of community participation