Loss to Follow-Up (LTFU) during Tuberculosis Treatment

Loss to follow-up (LTFU) is a serious issue in the field of tuberculosis (TB) since it can lead to TB outbreaks and drug resistance. The proportion of LTFU patients differs among different countries, regions, year, and institutions. In some countries, the number of patients that were LTFU nearly reaches half of the total patients. Underlying factors such as age, gender, education, residence, financial factors, migration, and social stigma are discussed in this chapter. These factors should always be taken into consideration whenever a treatment program is designed. Suggestions have been made regarding some interventions that could potentially solve the problem of LTFU. With these points in mind, an ambitious approach should be taken to reduce the number of LTFU patients up to zero

Re-evaluation of the phylogeny based on mitochondrial cytochrome b gene in the house shrew, Suncus murinus-S. montanus species complex, with special reference to Yemen and Myanmar populations

The house shrew (Suncus murinus-S. montanus species complex) is considered to have been unintentionally introduced by humans from their original range to other regions around the　Indian Ocean and neighboring seas, but this has yet not fully been investigated. A phylogenetic tree and haplotype network were reconstructed　based on the mitochondrial cytochrome b gene nucleotide sequences (1140 bp) of 179 individuals of house shrews from 46 localities in southern East Asia, Southeast Asia, West Asia, and islands in the western Indian Ocean. There was small genetic variation among shrews in Japan (Okinawa), southern China, Vietnam, and insular Southeast Asia. However, the shrew populations in Myanmar and Sri Lanka showed of a variety of different haplotypes. In the region of the western Indian Ocean, three interesting findings were obtained. First, the shrews on Zanzibar Island (Tanzania) shared same haplotype as those in southwestern Iran, and the haplotype was close to a group in Pakistan, despite these three regions being distantly located. Second, inferring from the haplotype network, it was suggests that the shrews in Yemen might have derived from Madagascar/Comoros populations. Third, the shrews on Réunion Island were genetically different from other populations around the western Indian Ocean but closer to Malaysia and Myanmar populations. Thus, the present study demonstrates that there have been dynamic immigration/emigration processes in the house shrews, especially for those around the western Indian Ocean. In addition, the house shrews in Myanmar may include several different species

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

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

Knowledge on tuberculosis among the members of a rural community in Myanmar

Background: Myanmar, one of the high tuberculosis (TB) burden countries, is in serious need of research work to develop strategies aiming to tackle the problem. Conducting a study on the knowledge of the population will help understand the flaws in the National TB Control Program (NTP), and how to correct them, and further strategic planning to reach the goals of Sustainable Development Goals. Aims: The aim of the study was to access sociodemographic characteristics, knowledge, and behavioral practice of TB among the community members in Ngar Syu Taung Village, Hlegu Township. This is a cross-sectional descriptive study. The number of defined person was 200. Methods: Nonprobability convenience sampling method was used. Data collection method used was face-to-face interviewing method using questionnaires. They were collected by house officers as a part of the community medicine training program. Results: Less than half of the respondents were not aware of TB meningitis (41%) and TB osteomyelitis (49%) and they are not aware that diabetic patients are one of the commonly infected people (41.5%). Furthermore, less than one-third of the patients know that TB can infect the gut (23%) and cause bowel obstruction (30.5%). Conclusions: Wrong ideas should be tackled, and lacking knowledge should be enlightened. Nationwide studies using stronger study designs are also urgently needed. Implementing these evidence into NTP is necessary for Myanmar, to escape from being a TB high-burden country

Burnout Among House Officers in Myanmar: A cross-sectional study

Burnout can result in in a serious negative impact on a doctor's life, the quality of patient care, and the healthcare organization. This study aims to determine the prevalence of burnout and factors affecting burnout among the house officers in Myanmar

Y chromosome polymorphism found among house shrew populations in Myanmar

The house shrew (Suncus murinus) is a small mammalian species that is widespread in South Asia and Southeast Asia. Preceding analyses of mitochondrial DNA polymorphisms revealed two major groups among the wild populations of this species, continental and insular, and the division was inferred to lie in the central part of Myanmar. However, the wild house shrew populations in Myanmar are also known to comprise more than two groups. Considering this information, the present study attempted to further elucidate the wild population structure of house shrews in regions around Myanmar. We prepared chromosomal samples from the house shrews captured in several localities in Myanmar and compared the band patterns. The autosomal and X-chromosomal band patterns obtained from these animals resembled those of the standard suncus karyotype (continental type). In contrast, Y chromosomes revealed a considerable range of inter-individual variations. The absence of any common regionality in the distribution of Y chromosome polymorphisms suggests that the wild populations of house shrews in Myanmar are formed through a more complicated process than formerly postulated

Checklist of Bird Species in Mandalay University Campus

A total of 36 bird species belonging to 26 families and 11 orders were recorded from Mandalay University Campus during the study period from June 2017 to May 2018. Among them, 34 species were terrestrial birds and two species were waterbirds. Of these, 11 orders, Passeriformes was the largest order containing 20 species (55.56%) and followed by order Columbiformes and Coraciiformes containing three species in each (8.33%), Psittaciformes and Cuculiformes, two species in each (5.56%), Anseriformes, Accipitriformes, Gruiformes, Strigiformes, Caprimulgiformes and Piciformes one species in each (2.78%), respectively. Two Myanmar’s endemic species of Pycnonotus blanfordi (Irrawaddy Bulbul) and Turdoides gularis (White- throated Babbler) were recorded in the Mandalay University Campus. Of these 36 species, two Winter Visitors of Lanius cristatus (Brown Shrike) and Motacilla alba (White Wagtail), one Near Threatened species of Psittacula eupatria (Alexandrine Parakeet), three migrant species of P. eupatria (Alexandrine Parakeet), Upupa epops (Common Hoopoe) and Passer flaveolus (Plain-backed Sparrow), and 26 residents species were recorded in the Mandalay University Campus. It is proof that Mandalay University Campus is a good habitat for long-term survival of birds including terrestrial and waterbirds