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

Gibbon population status and long-term viability: Implication for a newly established protected area management

Effective protected area management is a crucial process for biodiversity conservation, and its effectiveness can be evaluated using the status of indicator species. Monitoring changes over time in the status of indicator species is an essential tool for designing and improving management plans for protected areas. Due to the preference for pristine habitat hoolock gibbon can be considered indicator species for habitat quality. We therefore defined changes in the status of the eastern hoolock gibbon (Hoolock leuconedys) over 16 years (2005–2021) by estimating density changes and population viability in Mahamyaing Wildlife Sanctuary (MWS), a newly established protected area in western Myanmar. Using the acoustic point count method, we estimated the gibbon density to determine the impacts of selective logging and human disturbances on this species. This survey was conducted between February and March 2021 at 22 sampling sites, covering 352 km2 of evergreen and mixed deciduous forests in Mahamyaing Wildlife Sanctuary. We used distance sampling method to estimate an overall gibbon density of 0.97 groups/km2, which appeared to be dramatically lower than a previous estimate of 1.81 groups/km2 from 2005, defined using the same method. We then divided the Sanctuary into three zones and defined the minimum viable population (MVP) for gibbons in each zone to support management policies for the long-term persistence of the species. Moreover, the population viability analysis indicated that the population of eastern hoolock gibbons in the entire study area was seriously declining to lower than 1000 gibbons by the year 2055. By our estimation, around 4400 groups are needed for the long-term persistence of gibbons in Mahamyaing Wildlife Sanctuary. Our results highlight the detrimental effects of selective logging and human disturbance on gibbons, and presumably wildlife in general, in Mahamyaing Wildlife Sanctuary and the problems of inadequate protection level and management, underscoring the need to address these threats through targeted conservation efforts

Isotherme weerstandsmetingen aan amorf Fe40Ni40B20 en Fe40Ni40P20

Mechanical, Maritime and Materials EngineeringTechnische Materiaalwetenschappe

Unadjusted Kaplan-Meier curves, by first-line ART regimen.

<p>Unadjusted Kaplan-Meier curves, by first-line ART regimen.</p

Flexible parametric survival model of potential determinants for attrition among study population (N = 5,718).

<p>CI: Confidence interval; BMI: Body mass index; PI: Protease inhibitor; WHO definition of Anaemia: Haemoglobin concentration <12 g/dL in women and <13 g/dL in men.</p><p>#- not significant in univariate models.</p><p>Note: Early enrolment (1 Sep 2005 to 31 Dec 2009), and Late enrolment (1 Jan 2010 to 20 Oct 2011).</p><p>Flexible parametric survival model of potential determinants for attrition among study population (N = 5,718).</p

Prevalence percentages and odds ratios for primary outcome (death or loss-to-follow-up) from the logistic regression analysis.

<p>OR: Odds ratio; CI: Confidence interval; BMI: Body mass index; SD: Standard deviation; PI: Protease inhibitor; Anaemia: Haemoglobin concentration <12 g/dL in women and <13 g/dL in men.</p><p>Prevalence percentages and odds ratios for primary outcome (death or loss-to-follow-up) from the logistic regression analysis.</p

Clinical baseline characteristics of study population.

<p>IQR: Interquartile range.</p><p>WHO definition of Anaemia: Haemoglobin concentration <12 g/dL in women and <13 g/dL in men.</p><p>Clinical baseline characteristics of study population.</p

CONSORT diagram for analysis, with a total number of enrolled patients, number of patients for survival analysis and number of patients to estimate risk factors for attrition.

<p>CONSORT diagram for analysis, with a total number of enrolled patients, number of patients for survival analysis and number of patients to estimate risk factors for attrition.</p

Unadjusted Kaplan-Meier survival curves of non-prior ART group and prior ART group, full cohort (N = 10,223).

<p>Log-rank test for equality of survival χ2 (1 df) = 122.10; p<0.001.</p

Attrition Rate at 36-month follow up of the cohort in the public sector comparing with MSF (H) cohort.

<p>N: Number; LTF: Loss to follow up; MSF (H): Médecins Sans Frontières (Holland); DOH: Department of Health.</p><p>Attrition Rate at 36-month follow up of the cohort in the public sector comparing with MSF (H) cohort.</p