Motor Function and Manual Ability in Children with Cerebral Palsy: A Primary Report

Abstract This descriptive study aims to describe the motor type, topographical distribution and motor function of lower limbs, and the manual ability of upper limbs. Cerebral Palsy (CP) describes a group of disorders in the development of movement and posture in the developing brain. This study was carried out during 2015 on 60 CP children. Multiple sources of assessment were used, including medical records of patients at the Physical Medicine Department in 550 Bedded Mandalay Children’s Hospital. Children were grouped according to motor type, topographical pattern, Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) scales. During the study period, 60 CP children (29 males and 31 females) aged 4-12 years were observed, with a mean (SD) age of 7.7 (3.7) years. In this study, spastic CP was the most common type (80%) and more specifically, bilateral CP (70%) was more common than unilateral (10%). With respect to the GMFCS classification, level II (30%), and to the MACS classification, level II (38.3%), was the most common. This study is only a hospital based, descriptive study and therefore there are many limitations. We are trying to establish a neuro-clinic, as well as a development clinic, with few resources and man power. This research team is in the first few steps of developing a coordinated, multidisciplinary team to help children with cerebral palsy and developmental delay. The significance of the study results will help to educate the community about the role of early intervention, the earlier the better, for children with cerebral palsy

Host and parasite immunopathogenesis of Malaria

Malaria is a major health problem in various parts of the world especially affecting the tropical countries. It affects the vital organs causing severe complicated malaria. Clinical syndromes like severe cerebral malaria, anaemia, coagulation abnormalities, respiratory distress and severe anaemia can increase the mortality of malaria infected cases. Variation in individual susceptibility and severity and type of clinical presentations of malaria raises the need for Study of both the parasite and host immune reactions as well as the contribution of inflammatory cytokines in malaria pathogenesis. This study explored the immunopathological basis and advances of severe malaria and their importance in pathogenesis of malaria and its complications. Previous and ongoing studies indicate that changes in endothelium during the sequestration of parasites in organs causes disruption of endothelial barrier function leading to serious effects of malaria. Parasite and host factors contribute to disturbance of cytokine regulation and escape of parasites from the immune system of the host. Disturbance of cytokine regulation and escape of parasites from the immune system of the host also contribute to pathogenesis of severe malaria. Immunopathological changes and dysregulation of cytokine production play central role in pathogenesis and disease severity in malaria

Focusing health equality, efficiency and health maximization policy review

With economic growth and significant technological advances in the health sector, many countries have developed aggregate outcomes in terms of both health services and individual well-being. Life expectancy has seen a remarkable increase of more than fifty per cent between 1950 and 2009. Achievement is uneven, however, and some groups are better able to access health services than others. In our review, we explore the need and how to maximize health equity, efficiency and effectiveness. Methodology is the review and web surfing on public health, social science, humanity and development literature. The increasing gap in health inequality, however, calls for further reform of the health system to achieve both equity and efficiency. Health is essential for survival and human capability. Good health enables people to participate in society. A new approach to efficient and cost-effective health service provision is community participation in health development. Participation can increase the skills and knowledge of local people, thus providing opportunities to improve their lives (empowerment). Analysis suggests four functional changes to achieve equity and efficiency in maximizing health outputs: reforms targeting universal coverage to achieve universal access to health; people-centred service delivery through concentrating on health services based on need; public policy change targeting integrated and multi-system health planning; and collective health system and community response to achieve health for all

Survival analysis of hospitalized COVID-19 patients in New Yangon General Hospital by prognostic indicators

Background: Coronavirus disease (COVID-19) is an infectious disease of the SARS-CoV-2 virus and it can infect anyone resulting in serious illness and death. Methods: A retrospective cohort study was conducted in New Yangon General Hospital (NYGH), Yangon between September and November, 2022. Previous records of COVID-19 in-patients admitted to NYGH from 1st June to 31st October, 2021, were reviewed. COVID-19 in-patients who tested positive by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) or rapid diagnostic test (RDT) were included in this study. Multivariate analysis by Cox proportional-hazards (CPH) model was used to identify the prognostic indicators associated with the survival of COVID-19 inpatients. Results: Of (460) COVID-19 positive patients, there were 133 (28.9%) deaths with mortality rate of 16.9 per 1000 person-days. Then, 97 (72.9%) deaths occurred within 21 days of symptom onset, with median survival time of 28 (95% CI: 25-36) days. The results of the CPH model showed that the abnormal chest X-ray (CXR) [aHR=3.8, 95% CI: (1.1, 12.6), p=0.032], SpO2 level below 92% [aHR=3.7, 95% CI: 2.3, 5.9, p<0.001)], serum creatinine level more than 133 µmol/L [aHR=1.9, 95% CI: 1.1, 3.2, p=0.025] and C-reactive protein level (CRP) more than 10 mg/L [aHR=3.9, 95% CI: 1.2, 12.9, p=0.027] were the prognostic indicators of COVID-19 death among inpatients in NYGH. Conclusions: Patients with abnormal CXR result, low SpO2 level, high serum creatinine level, and high CRP level may have increased risks of death among COVID-19 inpatients in NYGH. Thus, close monitoring of the hospitalized COVID-19 inpatients by using these prognostic indicators should be emphasized

Influencing factors for cholera and diarrhoea: Water sanitation and hygiene in impoverished rural villages of Beluran District, Sabah, Malaysia

The lower percentage of water, sanitation and hygiene are the root causes of diarrhoea and cholera. Cholera is a sudden onset of acute watery diarrhoea which can progress to severe dehydration and death if untreated. The current pandemic, Vibrio Cholera O1 started in 1961. This study explores water, sanitation, hygiene and cholera and diarrhoea in three affected villages of Beluran District, Sabah Malaysia to support effective and timely public health intervention. This cross sectional study uses purposive sampling. All (114) households were interviewed and household water samples collected. The study reported lower coverage improved sanitation facilities (35.3% to 52.3%), no latrine at home (37% to 63%), improved water supply (52% to 60%), and prevalence of hand washing after toilet (57% - 74%). For water quality, Ecoli was present in household water (32% to 37%) but Vibrio cholerae was not isolated in any of the water samples tested. Statistically significant associations were found for; 1) occupation−non-agriculture and unimproved sanitation facility and 2) house ownership and correct knowledge of ORS preparation. Predictors for household water quality were: latrine at home, and improved household toilet. Aggressive strategies to improve water supply, sanitation and hygiene−hand washing after toilet−were recommended for future prevention of cholera and diarrhoea in the affected area

Island health review, progress and the way forward in the Western Pacific Region

Island health differs from other health care systems, particularly in that there are limited resources and referral faculties available. With globalisation and climate change, island populations have become increasingly vulnerable to natural disasters and global pandemics. This study will identify, explore, compare and report on island health issues facing in the western Pacific, before making appropriate recommendations. A review of selected health indicators in Pacific islands was collected from the World Health Organization (WHO) and other publicly available resources. In the Pacific region, 15 islands saw lower health expenditure (<US $500), one physician and two to six nurses per 1,000 people (fall below WHO recommendation), lower life expectancy (60-70 years), higher fertility rates (2.5 to 6.4 children per women, excepting Palau), and higher adolescent fertility rates (23 to 88 children per 1,000 girls, excepting Tonga). Island populations also suffer a higher disease burden per 100,000 people, with TB, malaria, and non-communicable diseases contributing to elevated mortality rates throughout much of the region. This article highlights four areas: the sustainable development of the health workforce, improved maternal and antenatal health care provisioning, and selective communicable and non-communicable disease control. However, there are some limitations especially under reporting of maternal health data and generalization effect of reported data

Myanmar dengue outbreak associated with displacement of serotypes 2, 3, and 4 by dengue 1

Published version is free to read on publisher website In 2001, Myanmar (Burma) had its largest outbreak of dengue—15,361 reported cases of dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), including 192 deaths. That year, 95% of dengue viruses isolated from patients were serotype 1 viruses belonging to two lineages that had diverged from an earlier, now extinct, lineage sometime before 1998. The ratio of DHF to DSS cases in 2001 was not significantly different from that in 2000, when 1,816 cases of DHF/DSS were reported and dengue 1 also was the most frequently isolated serotype. However, the 2001 ratio was significantly higher than that in 1998 (also an outbreak year) and in 1999, when all four serotypes were detected and serotypes 1, 2, and 3 were recovered in similar numbers. The large number of clinical cases in 2001 may have been due, in part, to a preponderance of infections with dengue 1 viruses

Regulation of Brain Primary Cilia Length by MCH Signaling: Evidence from Pharmacological, Genetic, Optogenetic, and Chemogenic Manipulations

The melanin-concentrating hormone (MCH) system is involved in numerous functions, including energy homeostasis, food intake, sleep, stress, mood, aggression, reward, maternal behavior, social behavior, and cognition. In rodents, MCH acts on MCHR1, a G protein-coupled receptor, which is widely expressed in the brain and abundantly localized to neuronal primary cilia. Cilia act as cells’ antennas and play crucial roles in cell signaling to detect and transduce external stimuli to regulate cell differentiation and migration. Cilia are highly dynamic in terms of their length and morphology; however, it is not known if cilia length is causally regulated by MCH system activation in vivo. In the current work, we examined the effects of activation and inactivation of MCH system on cilia lengths by using different experimental models and methodologies, including organotypic brain slice cultures from rat prefrontal cortex (PFC) and caudate–putamen (CPu), in vivo pharmacological (MCHR1 agonist and antagonist GW803430), germline and conditional genetic deletion of MCHR1 and MCH, optogenetic, and chemogenetic (designer receptors exclusively activated by designer drugs (DREADD)) approaches. We found that stimulation of MCH system either directly through MCHR1 activation or indirectly through optogenetic and chemogenetic-mediated excitation of MCH-neuron, caused cilia shortening, detected by the quantification of the presence of ADCY3 protein, a known primary cilia marker. In contrast, inactivation of MCH signaling through pharmacological MCHR1 blockade or through genetic manipulations — germline deletion of MCHR1 and conditional ablation of MCH neurons — induced cilia lengthening. Our study is the first to uncover the causal effects of the MCH system in the regulation of the length of brain neuronal primary cilia. These findings place MCH system at a unique position in the ciliary signaling in physiological and pathological conditions and implicate MCHR1 present at primary cilia as a potential therapeutic target for the treatment of pathological conditions characterized by impaired primary cilia function associated with the modification of its length

The potential of task shifting selected maternal interventions to auxiliary midwives in Myanmar: a mixed-method study

Background: An estimated 282 women die for every 100,000 live births in Myanmar, most due to preventable causes. Auxiliary Midwives (AMWs) in Myanmar are responsible for providing a package of care during pregnancy and childbirth to women in rural hard to reach areas where skilled birth attendants (Midwives) are not accessible. This study aims to examine the role of AMWs in Myanmar and to assess the current practices of three proposed essential maternal interventions (oral supplement distribution to pregnant women; administration of misoprostol to prevent postpartum haemorrhage; management of puerperal sepsis with oral antibiotics) in order to facilitate a formal integration of these tasks to AMWs in Myanmar. Methods: A mixed methods study was conducted in Magwe Region, Myanmar involving a survey of 262 AMWs, complemented by 15 focus group discussions with midwives (MWs), AMWs, mothers and community members, and 10 key informant interviews with health care providers at different levels within the health care system. Results: According to current government policy, AMWs are responsible for identifying pregnant women, screening for danger signs and facilitating early referral, provision of counselling on nutrition and birth preparedness for women in hard-to-reach areas. AMWs also assist at normal deliveries and help MWs provide immunization services. In practice, they also provide oral supplements to pregnant women (84%), provide antibiotics to mothers during the puerperium (43%), and provide misoprostol to prevent postpartum haemorrhage (41%). The current practices of AMWs demonstrate the potential for task shifting on selected essential maternal interventions. However, to integrate these interventions into formal practice they must be complemented with appropriate training, clear guidelines on drug use, systematic recording and reporting, supportive monitoring and supervision and a clear political commitment towards task shifting. Conclusion: With the current national government’s commitment towards one AMW in one village, this study highlights the potential for shifting specific maternal lifesaving tasks to AMWs

Determination of Oncogenic Human Papillomavirus (HPV) Genotypes in Anogenital Cancers in Myanmar

Molecular and epidemiologic investigations suggest a causal role for human papillomavirus (HPV) in anogenital cancers. This study identified oncogenic HPV genotypes in anogenital cancers among men and women in a 2013 cross-sectional descriptive study in Myanmar. In total, 100 biopsy tissues of histologically confirmed anogenital cancers collected in 2008-2012 were studied, including 30 penile and 9 anal cancers from Yangon General Hospital and 61 vulvar cancers from Central Women's Hospital, Yangon. HPV-DNA testing and genotyping were performed by polymerase chain reaction-restriction fragment length polymorphism. Overall, 34% of anogenital cancers were HPV-positive. HPV was found in 44.4% of anal (4/9), 36.1% of vulvar (22/61), and 26.7% of penile (8/30) cancers. The most frequent genotypes in anal cancers were HPV 16 (75%) and 18 (25%). In vulvar cancers, HPV 33 was most common (40.9%), followed by 16 (31.8%), 31 (22.7%), and 18 (4.6%). In penile cancers, HPV 16 (62.5%) was most common, followed by 33 (25%) and 18 (12.5%). This is the first report of evidencebased oncogenic HPV genotypes in anogenital cancers among men and women in Myanmar. This research provides valuable information for understanding the burden of HPV-associated cancers of the anus, penis, and vulva and considering the effectiveness of prophylactic HPV vaccination