Biomarkers to individualise adjuvant systemic therapy in early breast cancer patients

Background Adjuvant chemotherapy, endocrine therapy, anti-HER2 therapy and radiotherapy significantly improve recurrence free and overall survivals in early breast cancers. Indications for a particular therapy have been well defined. Examples include oestrogen receptor positivity for endocrine therapy; HER2/Neu protein overexpression for anti-HER2 therapy; young age group, lymph node positivity, nuclear grade 3 and triple negativity (ie, ER/PR/HER2 negative) etc for chemotherapy; lumpectomy, > 5 cm tumour size, > 4 lymph nodes involvement etc for radiotherapy. Compared to no chemotherapy adjuvant chemotherapy can reduce the 10 years breast cancer mortality risk by one third although the absolute benefit depends on the absolute risk before the adjuvant chemotherapy as the risk reduction is proportional. The absolute risk depends on the various clinical and histopathological risk factors such as age, nuclear grade, tumour size, lymph node involvement, oestrogen hormone and HER2 receptor expressions. Various clinical guidelines, prognostic/ predictive tools and tests have been developed to calculate the absolute breast cancer specific survival risks and chemotherapy benefits to help in making the decision of “potential benefit outweighs the potential treatment toxicities” to recommend the adjuvant chemotherapy on individual basis. This principle aims to identify patients with very good prognosis for whom the toxic chemotherapy could be safely omitted and also patients with prognosis poor enough to justify offering toxic chemotherapies. However, no studies have specifically focussed on identifying patients in whom the chemotherapy could not deliver the expected benefit. Analysing molecular biomarker proteins that are functionally important in the cancer biology and chemotherapy cell killing mechanism using readily available and relatively inexpensive immunohistochemistry (IHC) method might be able to identify this Biomarkers to individualise adjuvant systemic therapy in early breast cancer Page 5 group of patients and find the targets against which novel therapy could be developed to improve their survival outcomes

Prevalence and Risk Factors of Eye Problems among Older People in Central Tropical Region, Naypyitaw Union Territory, Myanmar

Purpose:Vision is essential one and it is proximately linked with their quality of life. In the meantime, older populations are increasing rapidly in the whole world and thus, age-related macular degeneration, glaucoma, cataract and diabetic retinopathy are becoming common. Hot and dusty environment, inadequate access to water and poor facial hygiene are risk factors for blindness. Design: Lewe Township was purposively selected due to its high prevalent on eye problems. This cross-sectional study was conducted and simple random sampling was applied to achieve desired sample size. The structured questionnaires were used to collect data including screening of eye problems from 414 older population. Frequency, percentage, mean, SD and other descriptive analysis were determined and chi-square test for associations was constructed. Findings: Cataract was the highest prevalence rate with 40.8% followed by refractive error (27.3%) and pterygium (12.8%) among older people population in research area. While knowledge level indicated good level (88.4%), good attitude level (21.3%) and good practice level (27.1%) were noticeably low among older people. In the meantime, there were significantly associations between age (p=0.003) and education level (p=0.001) with knowledge level of older people while age (p=0.001), education level (p=<0.001), occupation (p=0.038) showed statistically association with attitude level. Originality:The study noticed that higher prevalence of eye problems while relatively poor level of eye care seeking practice and unawareness on risk factors in targeted community. Knowledge and awareness for changing attitude about eye problems, eye care seeking behavior and preventive practices should be accomplished more

The public procurement of information systems: dialectics in requirements specification

When acquiring information systems, public entities face a dilemma. On the one hand, they want to procure the system that best suits their needs, which often requires lengthy dialogues with vendors. At the same time, they are restricted by government regulations that mandate limited dialogue in the interests of transparency and equal opportunities for all vendors. To examine how public entities deal with this, we followed three procurement projects in Norway. We show that this dilemmamanifests itself as a dialectic between the thesis of getting the systemrequirements right and the antithesis of strictly adhering to regulations. Public entities search for a resolution of this dialectic through two syntheses: selecting an appropriate tendering procedure, and learning how to specify requirements through networks of peer public entities. Our findings reveal that the syntheses are possible because the dialectic is actually complimentary, both the thesis and the antithesis are needed to create the joint outcome that satisfies both. The resolution of the dialectic unfolds differently over time. Our study contributes to the relatively neglected stream of IS research on dialectics that explicitly searches for a synthesis while revealing the complementarity of the dialectic. We show how time plays a nuanced role in the resolution of the dialectic situation

Investigation of Japanese Encephalitis Virus Infection in Bogalay Township, Myanmar in 1999

An investigation was in Nyi-naung-wa village, Bogalay township for Japanese encephalitis (JE) virus infection and the possibility of a JE outbreak. JE virus antibody was determined among the pigs and the people living near the pig farms in that village and at an adjacent village as a control. The known JE virus vector Culex mosquito species were also identified in both villages. Haemagglutination inhibition (HAI) methods were used for the detectioon of JE and dengue antibodies. Homotypic or monotypic JE antibodies were detected in 33% of the pigs tested. No homotypic nor monotypic JE antibodis was detected among the villagers. Although there was no JE virus infection among the people, because of the presence of JE virus infection among the pigs and the presence of Culex mosquito vector in that area, the possibility of a JE outbreak in humans in that area, if the number of pig breeding per household increase and the mosquito density become higher is discussed

Community-based assessment of human rights in a complex humanitarian emergency: the Emergency Assistance Teams-Burma and Cyclone Nargis

<p>Abstract</p> <p>Introduction</p> <p>Cyclone Nargis hit Burma on May 2, 2008, killing over 138,000 and affecting at least 2.4 million people. The Burmese military junta, the State Peace and Development Council (SPDC), initially blocked international aid to storm victims, forcing community-based organizations such as the Emergency Assistance Teams-Burma (EAT) to fill the void, helping with cyclone relief and long-term reconstruction. Recognizing the need for independent monitoring of the human rights situation in cyclone-affected areas, particularly given censorship over storm relief coverage, EAT initiated such documentation efforts.</p> <p>Methods</p> <p>A human rights investigation was conducted to document selected human rights abuses that had initially been reported to volunteers providing relief services in cyclone affected areas. Using participatory research methods and qualitative, semi-structured interviews, EAT volunteers collected 103 testimonies from August 2008 to June 2009; 42 from relief workers and 61 from storm survivors.</p> <p>Results</p> <p>One year after the storm, basic necessities such as food, potable water, and shelter remained insufficient for many, a situation exacerbated by lack of support to help rebuild livelihoods and worsening household debt. This precluded many survivors from being able to access healthcare services, which were inadequate even before Cyclone Nargis. Aid efforts continued to be met with government restrictions and harassment, and relief workers continued to face threats and fear of arrest. Abuses, including land confiscation and misappropriation of aid, were reported during reconstruction, and tight government control over communication and information exchange continued.</p> <p>Conclusions</p> <p>Basic needs of many cyclone survivors in the Irrawaddy Delta remained unmet over a year following Cyclone Nargis. Official impediments to delivery of aid to storm survivors continued, including human rights abrogations experienced by civilians during reconstruction efforts. Such issues remain unaddressed in official assessments conducted in partnership with the SPDC. Private, community-based relief organizations like EAT are well positioned and able to independently assess human rights conditions in response to complex humanitarian emergencies such as Cyclone Nargis; efforts of this nature must be encouraged, particularly in settings where human rights abuses have been documented and censorship is widespread.</p

Clinical importance of the Mandalay spitting cobra (Naja mandalayensis) in Upper Myanmar – Bites, envenoming and ophthalmia

This is an accepted manuscript of an article published by Elsevier in Toxicon on 03/06/2020, available online: https://doi.org/10.1016/j.toxicon.2020.05.023 The accepted version of the publication may differ from the final published version.© 2020 Elsevier Ltd Examination of 18 cobras brought to three hospitals in the Mandalay Region by patients bitten or spat at by them distinguished 3 monocled cobras (Naja kaouthia) and 15 Mandalay spitting cobras (N. mandalayensis), based on their morphological characteristics. We confirm and extend the known distributions and habitats of both N. mandalayensis and N. kaouthia in Upper Myanmar. Clinical symptoms of local and systemic envenoming by N. mandalayensis are described for the first time. These included local swelling, blistering and necrosis and life-threatening systemic neurotoxicity. More information is needed about the clinical phenotype and management of bites by N. mandalayensis, the commoner of the two cobras in Upper Myanmar. Since the current cobra antivenom manufactured in Myanmar has lower pre-clinical efficacy against N. mandalayensis than N. kaouthia, there is a need for more specific antivenom therapy.Published versio