2015年にミャンマー国で発生したデング熱流行の臨床、ウイルス学、疫学解析

Hospital-based surveillance was conducted at two widely separated regions in Myanmar during the 2015 dengue epidemic. Acute phase serum samples were collected from 332 clinically diagnosed dengue patients during the peak season of dengue cases. Viremia levels were measured by quantitative real-time PCR and plaque assays using FcγRIIA-expressing and non-FcγRIIA-expressing BHK cells to specifically determine the infectious virus particles. By serology and molecular techniques, 280/332 (84・3%) were confirmed as dengue patients. All four serotypes of dengue virus (DENV) were isolated from among 104 laboratory-confirmed patients including two cases infected with two DENV serotypes. High percentage of primary infection was noted among the severe dengue patients. Patients with primary infection or DENV IgM negative demonstrated significantly higher viral loads but there was no significant difference among the severity groups. Viremia levels among dengue patients were notably high for a long period which was assumed to support the spread of the virus by the mosquito vector during epidemic. Phylogenetic analyses of the envelope gene of the epidemic strains revealed close similarity with the strains previously isolated in Myanmar and neighboring countries. DENV-1 dominated the epidemic in 2015 and the serotype (except DENV-3) and genotype distributions were similar in both study sites.長崎大学学位論文 学位記番号:博(医歯薬)甲第984号 学位授与年月日:平成29年9月20日Author: A. K. KYAW, M. M. NGWE TUN, M. L. MOI, T. NABESHIMA, K. T. SOE, S. M. THWE, A. A. MYINT, K. T. T. MAUNG, W. AUNG, D. HAYASAKA, C. C. BUERANO, K. Z. THANT and K. MORITACitation: Epidemiology & Infection, 145(9), pp.1886-1897; 2017Nagasaki University (長崎大学)課程博

Retention and mortality outcomes from a community-supported public–private HIV treatment programme in Myanmar

Introduction: There is a growing interest in the potential contribution the private sector can make towards increasing access to antiretroviral therapy (ART) in low- and middle-income settings. This article describes a public–private partnership that was developed to expand HIV care capacity in Yangon, Myanmar. The partnership was between private sector general practitioners (GPs) and a community-based non-governmental organization (International HIV/AIDS Alliance). Methods: Retrospective analysis of 2119 patient records dating from March 2009 to April 2015 was conducted. Outcomes assessed were immunological response, loss to follow-up, all-cause mortality, and alive and retained in care. Follow-up time was calculated from the date of registration to the date of death, loss to follow-up, transfer out, or if still alive and known to be in care, until April 2015. Cox proportional hazards model was used to identify predictors of loss to follow-up and mortality. Kaplan–Meier survival analysis was used to estimate survival function of being alive and retained in care. Results: The median number of patients for each of the 16 GPs was 42 (interquartile range (IQR): 25–227), and the median follow-up period was 13 months. The median patient age was 35 years (IQR: 30–41); 56.6% were men, 62 and 11.8% were in WHO Stage III and Stage IV at registration, respectively; median CD4 count at registration was 177 cells/mm3; and 90.7% were on ART in April 2015. The median CD4 count at registration increased from 122 cells/mm3 in 2009 to 194 cells/mm3 in 2014. Among patients on ART, CD4 counts increased from a median of 187 cells/mm3 at registration to 436 cells/mm3 at 36 months. The median time to initiation of ART among eligible patients was 29 days, with 93.8% of eligible patients being initiated on ART within 90 days. Overall, 3.3% patients were lost to follow-up, 4.2% transferred out to other health facilities, and 8.3% died during the follow-up period. Crude mortality rate was 48.6/1000 person-years; 42% (n=74) of deaths occurred during the pre-ART period and 39.8% (n=70) occurred during the first six months of ART. Of those who died during the pre-ART period, 94.5% were eligible for ART. In multivariate regression, baseline CD4 count and ART status were independent predictors of mortality, whereas ART status, younger age and patient volumes per provider were predictors of loss to follow-up. Probability of being alive and retained in care at six months was 96.8% among those on ART, 38.5% among pre-ART but eligible patients, and 20.0% among ART-ineligible patients. Conclusions: Effectively supported private sector GPs successfully administered and monitored ART in Myanmar, suggesting that community-supported private sector partnerships can contribute to expansion of HIV treatment and care capacity. To further improve patient outcomes, early testing and initiation of ART, combined with close clinical monitoring and support during the initial periods of enrolling in treatment and care, are required

Effectiveness of Crop Residues Mulching on Water Use Efficiency and Productivity under Different Annual Cropping Patterns of Magway

Water availability in dryland crop production is influenced by the quantity of rainfall and soil ability for holding it. To improve dryland agricultural productivity, understanding of crop water use through the growing season as affected by different residue management is necessary. Two- consecutive seasons field experiments (monsoon and postmonsoon seasons of 2015-2016) were conducted at the Oilseed Crop Research Center, Magway. The experimental design was RCB factorial arrangements with three replications. Crop residue mulching at the rate of 5 t ha-1 (M) and non-mulching (NM) were tested with five levels of cropping patterns: sesame-green gram (SS-GG), sesame-groundnut (SS-GN), groundnut-green gram (GN-GG), groundnut-groundnut (GN-GN) and groundnut-sorghum (GN-SG). The objectives of the present study were to determine the grain yield and biomass production and water use efficiency of individual crops in the cropping patterns; and to investigate appropriate cropping sequences for better harvested monetary benefit per unit rainfall under rainfed condition. Crop residue mulching proved its potential to improve crop production through crop yield, biomass production and WUE in both seasons. High profit and the best harvested monetary benefit were obtained using crop residue mulching. Among the postmonsoon season crops, green gram was short duration crop and capable to produce optimal yield with limited amount of soil moisture under unfavorable weather condition. The groundnut crop in GN-GN with mulching gave the highest yield, biomass, WUE and harvested monetary benefit in monsoon seasons. The green gram in SS-GG and GN-GG with mulching and groundnut in SS-GN with mulching gave higher yield and WUE in postmonsoon seasons among all cropping patterns. Therefore, crop residue mulching should be practiced to protect soil deterioration and improve soil water in sandy soil and eventually sustain agricultural productivity

Assisted Education for Specialized Medicine: A Sustainable Development Plan for Neurosurgery in Myanmar.

BACKGROUND With only 4 active certified neurosurgeons for a population of 50 million, neurosurgical care was seriously underdeveloped in Myanmar in 2012. Together with the local neurosurgical community, Swiss Neurosurgeons International started a program of assisted education with the aim of increasing the neurosurgical capacity to 60 active neurosurgeons by 2023. METHODS Our program included a fully sponsored fellowship at an academic hospital in Switzerland for every Myanmar neurosurgeon in training to observe contemporary neurosurgery and the organization of regular workshops, lectures, and educational surgeries in Myanmar. Halfway through the program, we performed a survey to assess its benefits and shortcomings. RESULTS In 2019, the number of active neurosurgeons in Myanmar had increased to 20, with 50 more in training. Intracranial pressure monitoring, cervical spine surgery, transsphenoidal surgery, and intraoperative electrophysiology have become established procedures. Our survey showed an increased interest by the residents in tumor and vascular surgery and a new interest in spinal surgery. The overall rating of the fellowship was "very good," with language barriers, cultural differences, and coping with inclement weather reported as the greatest difficulties. CONCLUSIONS Since the start of our project in 2013, a series of contemporary neurosurgical technologies and procedures have been introduced to Myanmar with the help of Swiss Neurosurgeons International. Our survey results have shown the strong points of the ongoing educational program and the weaknesses to be addressed. Midway through our 10-year project, with an expanded and improved education program, our goal of 60 active neurosurgeons in Myanmar by 2023 seems well within reach

In Vitro Regeneration of Selected Rice Genotypes (Oryza sativa L.) through Anther Culture

Rice is one of the most important cereal crops in the world. Anther culture, one of the double hap-loid techniques, is simple and efficient for rice breeding. The present study was carried out to evaluate callus induction ability of the selected rice genotypes on the media supplemented with two different car-bon sources and to investigate suitable Benzylaminopurine (BAP) concentrations on plant regeneration of anther-derived calli. The selected 19 rice genotypes (14 indica and 5 tropical japonica) were used in the experiment. Anthers of each genotype were cultured on Chu (N6) medium supplemented with two types of carbon sources (4% maltose and 4% sucrose), 2mg.L-1 2,4-Dichlorophenoxyacetic acid (2,4-D) and 0.5 mg.L-1 kinetin for callus induction. Anther-derived calli were transferred to Murashige and Skoog (MS) medium supplemented with (0, 0.5, 1) mg.L-1 BAP, 1 mg.L-1 1-Naphthaleneacetic acid (NAA) and 1 mg.L-1 l kinetin for regeneration. The seventeen out of 19 rice genotypes produced callus on media supplemented with maltose while only 13 genotypes produced callus on media supplemented with sucrose due to genotype dependency. Tropical japonica had more callus induction from anther than indica among the tested genotypes. Callus induction varied from 0 to 19.22%. Paw San Taung Pyan Hmwe (tropical japonica) had the highest callus induction (19.22%) among the tested all. Yebaw Sein depicted the highest callus induction (6.78%) among the tested indica rice genotypes. Plant regeneration from callus varied from 0 to 25.15%. In tropical japonica genotypes, Bay Kyar Taung Pyan gave the highest value (25.15%) in green plants regeneration, while Hnan Kar gave the highest value (13.33%) among indica genotypes. In this experiment, both MS media supplemented with 0.5mg.L-1 BAP and 1mg.L-1 BAP showed maximum green plant regeneration although maximum green spot formation oc-curred only on media supplemented with 1mg.L-1 BAP

Therapeutic efficacy of chloroquine for uncomplicated Plasmodium vivax malaria in southeastern and western border areas of Myanmar

BackgroundIn the Greater Mekong Subregion of Southeast Asia, Plasmodium vivax malaria is endemic and causes significant morbidity. In this study, the efficacy of chloroquine for treating uncomplicated P. vivax malaria at the eastern and western borders of Myanmar was investigated.MethodsA total of 197 participants with microscopically confirmed P. vivax infection were enrolled from three townships of the southeastern (Thanbyuzayat and Kawthoung) and western (Kyauktaw) borders of Myanmar. Patients were treated with chloroquine according to the national malaria treatment guidelines and followed for 28 days.ResultsAmong the 197 enrollments, 172 completed the 28-day follow-up. Twelve recurrent P. vivax infections, all occurring in the third and fourth week, were detected, resulting in an overall cumulative rate of recurrence of 4.7% [95% confidence interval (CI) 1.5-7.8]. The incidence rate of recurrence varied among the three sites. In Thanbyuzayat township, no patients had recurrent parasitemia between days 7 and 28. In contrast, Kyauktaw township had a day 28 cumulative incidence rate of recurrence of 7.2% (95% CI 0.6-13.9%) compared to 6.9% (95% CI 0.6-13.2) in Kawthoung township.ConclusionWhile this study confirmed the relatively high clinical efficacy of chloroquine for treating P. vivax in Myanmar with modest rates of recurrent infections within 28 days of the treatment, it also revealed considerable geographical heterogeneity of chloroquine efficacy, which warrants continuous surveillance efforts

Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair

OBJECTIVE Although rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to neurosurgeons and plastic reconstructive surgeons. Especially when faced with limited infrastructure and resources, establishing reliable and safe surgical techniques is of paramount importance. The authors present a case series in order to evaluate a previously proposed concise approach for meningoencephalocele repair, with a focus on sustainability of internationally driven surgical efforts. METHODS Between 2001 and 2016, a total of 246 patients with frontoethmoidal meningoencephaloceles were treated using a 1-stage extracranial approach by a single surgeon in the Department of Neurosurgery of the Yangon General Hospital in Yangon, Myanmar, initially assisted by European surgeons. Outcomes and complications were evaluated. RESULTS A total of 246 patients (138 male and 108 female) were treated. Their ages ranged from 75 days to 32 years (median 8 years). The duration of follow-up ranged between 4 weeks and 16 years (median 4 months). Eighteen patients (7.3%) showed signs of increased intracranial pressure postoperatively, and early CSF rhinorrhea was observed in 27 patients (11%), with 5 (2%) of them requiring operative dural repair. In 8 patients, a decompressive lumbar puncture was performed. There were 8 postoperative deaths (3.3%) due to meningitis. In 15 patients (6.1%), recurrent herniation of brain tissue was observed; this herniation led to blindness in 1 case. The remaining patients all showed good to very good aesthetic and functional results. CONCLUSIONS A minimally invasive, purely extracranial approach to frontoethmoidal meningoencephalocele repair may serve well, especially in middle-and low-income countries. This case series points out how the frequently critiqued lack of sustainability in the field of humanitarian surgical missions, as well as the often-cited missing aftercare and dependence on foreign supporters, can be circumvented by meticulous training of local surgeons

Patients with MDR-TB on domiciliary care in programmatic settings in Myanmar: Effect of a support package on preventing early deaths

<div><p>Background</p><p>The community-based MDR-TB care (CBMDR-TBC) project was implemented in 2015 by The Union in collaboration with national TB programme (NTP) in 33 townships of upper Myanmar to improve treatment outcomes among patients with MDR-TB registered under NTP. They received community-based support through the project staff, in addition to the routine domiciliary care provided by NTP staff. Each project township had a project nurse exclusively for MDR-TB and a community volunteer who provided evening directly observed therapy (in addition to morning directly observed therapy by NTP).</p><p>Objectives</p><p>To determine the effect of CBMDR-TBC project on death and unfavourable outcomes during the intensive phase of MDR-TB treatment.</p><p>Methods</p><p>In this cohort study involving record review, all patients diagnosed with MDR-TB between January 2015 and June 2016 in project townships and initiated on treatment till 31 Dec 2016 were included. CBMDR-TBC status was categorized as “receiving support” if project initiation in patient’s township was before treatment initiation, “receiving partial support” if project initiation was after treatment initiation, and “not receiving support” if project initiation was after intensive phase treatment outcome declaration. Time to event analysis (censored on 10 April 2017) and cox regression was done.</p><p>Results</p><p>Of 261 patients initiated on treatment, death and unfavourable outcomes were accounted for 13% and 21% among “receiving support (n = 163)”, 3% and 24% among “receiving partial support (n = 75)” and 13% and 26% among “not receiving support (n = 23)” respectively. After adjusting for other potential confounders, the association between CBMDR-TBC and unfavourable outcomes was not statistically significant. However, when compared to “not receiving support”, those “receiving support” and “receiving partial support” had 20% [aHR (0.95 CI: 0.8 (0.2–3.1)] and 90% lower hazard [aHR (0.95 CI: 0.1 (0.02–0.9)] of death, respectively. This was intriguing. Implementation of CBMDR-TBC coincided with implementation of decentralized MDR-TB centers at district level. Hence, patients that would have generally not accessed MDR-TB treatment before decentralization also started receiving treatment and were also included under CBMDR-TBC “received support” group. These patients could possibly be expected to sicker at treatment initiation than patients in other CBMDR-TBC groups. This could be the possible reason for nullifying the effect of CBMDR-TBC in “receiving support” group and therefore similar survival was found when compared to “not receiving support”.</p><p>Conclusion</p><p>CBMDR-TBC may prevent early deaths and has a scope for expansion to other townships of Myanmar and implications for NTPs globally. However, future studies should consider including data on extent of sickness at treatment initiation and patient level support received under CBMDR-TBC.</p></div

Criteria to identify presumptive MDR-TB under programme setting who were referred to X-pert MTB/RIF testing facilities, Myanmar, 2015–16.

<p>Criteria to identify presumptive MDR-TB under programme setting who were referred to X-pert MTB/RIF testing facilities, Myanmar, 2015–16.</p

Risk factors for unfavorable treatment outcomes among patients with MDR-TB registered for treatment between January 2015 and June 2016 in 33 community-based MDR-TB care (CBMDR-TBC) project supported townships in Myanmar.

<p>Risk factors for unfavorable treatment outcomes among patients with MDR-TB registered for treatment between January 2015 and June 2016 in 33 community-based MDR-TB care (CBMDR-TBC) project supported townships in Myanmar.</p