Lower plasma selenoprotein P levels in regularly exercising young adults / Journal of the ASEAN Federation of Endocrine Societies

Objective@#Physical exercise can provide many health benefits in humans. Exercise-induced reactive oxygen species (ROS) formation and its downstream signaling cascades are reported to induce mitochondrial biogenesis in exercising tissues. Selenoprotein P (SELENOP) is the antioxidant hepatokine whose hypersecretion is associated with various metabolic diseases. It was reported to impair exercise-induced reactive oxygen species signaling and inhibit subsequent mitochondrial biogenesis in mice. However, the relationship between selenoprotein P and mitochondrial dynamics in humans has not yet been reported. While reduction of plasma selenoprotein P becomes an attractive therapeutic target for metabolic diseases, the role of regular exercise in this regard is still unknown. This study aimed to analyze the influence of regular habitual exercise on plasma selenoprotein P levels and its association with leucocyte mitochondrial DNA copy number in healthy young adults.@*Methodology@#Plasma selenoprotein P levels and leucocyte mitochondrial DNA copy numbers were compared in 44 regularly exercising subjects and 44 non-exercising controls, and the correlation between the two parameters was analyzed. Plasma selenoprotein P levels were measured by Enzyme-linked Immunosorbent Assay, and leucocyte mitochondrial DNA copy numbers were measured using the qPCR method.@*Results@#The regular-exercise group had lower plasma selenoprotein P levels with higher leucocyte mitochondrial DNA copy numbers than the non-exercise group. There was a tendency of negative correlation between the two variables in our studied population.@*Conclusion@#Regular habitual exercise has a beneficial effect on reducing plasma selenoprotein P levels while raising mitochondrial DNA copy numbers.

Evaluation of the disinfectant concentration used on livestock facilities in Korea during dual outbreakof foot and mouth disease and high pathogenic avian influenza

Background@#A nationwide outbreak of foot-and-mouth disease (FMD) in South Korea caused massive economic losses in 2010. Since then, the Animal and Plant Quarantine Agency (QIA) has enhanced disinfection systems regarding livestock to prevent horizontal transmission of FMD and Avian influenza (AI). Although the amount of disinfectant used continues to increase, cases of FMD and AI have been occurring annually in Korea, except 2012 and 2013. @*Objectives@#This study measured the concentration of the disinfectant to determine why it failed to remove the horizontal transmission despite increased disinfectant use. @*Methods@#Surveys were conducted from February to May 2017, collecting 348 samples from disinfection systems. The samples were analyzed using the Standards of Animal Health Products analysis methods from QIA. @*Results@#Twenty-three facilities used inappropriate or non-approved disinfectants. Nearly all sampled livestock farms and facilities—93.9%—did not properly adjust the disinfectant concentration. The percentage using low concentrations, or where no effective substance was detected, was 46.9%. Furthermore, 13 samples from the official disinfection station did not use effective disinfectant, and—among 72 samples from the disinfection station—88.89% were considered inappropriate concentration, according to the foot-and-mouth disease virus guidelines; considering the AIV guideline, 73.61% were inappropriate concentrations. Inappropriate concentration samples on automatic (90.00%) and semi-automatic (90.90%) disinfection systems showed no significant difference from manual methods (88.24%). Despite this study being conducted during the crisis level, most disinfectants were used inappropriately. @*Conclusions@#This may partially explain why horizontal transmission of FMD and AI cannot be effectively prevented despite extensive disinfectant use.

Development of a smartphone application for providing disinfectant information on livestock industry / 대한수의학회지

It is important to select the correct disinfectants and to use them appropriately in order to prevent the initial spread of highly infectious livestock disease, such as foot-and-mouth disease or highly pathogenic avian influenza. This study describes a smartphone application developed to enable livestock workers to observe information related to disinfectants for the prevention of livestock disease in the domestic market, regardless of time and location, through a Linux-based Android mobile platform. This application (Konkuk-Disinfectant Information Database) provides information on disinfectant names, components, license and use; it was designed to enable the user to share disinfectant information through social media.

Development of a smartphone application for providing disinfectant information on livestock industry

It is important to select the correct disinfectants and to use them appropriately in order to prevent the initial spread of highly infectious livestock disease, such as foot-and-mouth disease or highly pathogenic avian influenza. This study describes a smartphone application developed to enable livestock workers to observe information related to disinfectants for the prevention of livestock disease in the domestic market, regardless of time and location, through a Linux-based Android mobile platform. This application (Konkuk-Disinfectant Information Database) provides information on disinfectant names, components, license and use; it was designed to enable the user to share disinfectant information through social media.

Prevalence Of Stress And Its Associated Factors Among Medical Students In Sabah, Malaysia Borneo

@#Stress is accepted as the accumulation of unpleasant state of physical, mental and emotion on a person. Medical education has been known as one of the most stressful academic curriculum. Hence, medical students may subjected to multiple psychological changes and challenges throughout the years of medical education. The aim of this study was to determine the prevalence of stress and its associated factors among medical students. This cross sectional study was conducted from April to May 2018 in medical school in Sabah. It involved 396 medical students through universal sampling. Self-administered questionnaires were used as an instrument for data collection. The questionnaires included were Sociodemographic Questionnaire, Depression, Anxiety and Stress Scales 21 (DASS-21) and Medical Student Stressors Questionnaire (MSSQ). Bivariate analysis (Chi Square test, Fisher’s Exact Test, Independent T test and Man-Whitney U test) were used to analyse the association. The response rate was 90.2%. The prevalence of stress among medical students were 33.3%. Significant associated factors include financial support inadequacy (p=0.010) and all categories of medical student stressors. The mean score of the academic related stressors was found to be at 2.117 (±0.758) which was the highest mean score among medical student stressors assessed by MSSQ. The result of this study can be used as a basis for implementation of preventive measures such as provision of comprehensive, integrated and responsive mental health care services in university-based settings.@*@#

Divergence insufficiency, thyroid disease

@#Dengue viruses are single-stranded RNA viruses of the Flavivirus genus. It is a common viral infection worldwide, especially in tropical regions. Various neurological manifestations such as encephalitis, encephalopathy, meningitis, acute disseminated encephalomyelitis (ADEM) acute viral myositis, Guillain–Barré syndrome and others are increasingly reported. However, acute haemorrhagic encephalitis is a very rare presentation. Currently, there are only few previous case reports

Gaps and challenges to integrating diabetes care in Myanmar.

In common with other low-income countries, diabetes is a growing challenge for Myanmar. Gaps and challenges exist in political commitment, policy development, the health system, treatment-seeking behaviour and the role of traditional medicine. National policies aimed at prevention – such as to promote healthy food, create a healthy environment conducive to increased physical activity, restrict marketing of unhealthy food, and initiate mass awareness-raising programmes – need to be strengthened. Moreover, existing initiatives for prevention of noncommunicabledisease (NCD) are channelled vertically rather than being horizontally integrated. Primary health care is traditionally orientated more towards prevention of infectious diseases and staff often lack training in prevention and control of NCDs. Capacitybuilding activities have been modest to date, and retaining trained health workers in diabetes-oriented activities is a challenge. The World Health Organization Package of Essential Noncommunicable (PEN) disease interventions for primary health care in low-resource settings has been piloted in Yangon Region and countrywide expansion awaits ministerial approval. Recently, the Myanmar Diabetes Care Model was proposed by the Myanmar Diabetes Association, with the aims of both bridging the gap in diabetes care between rural and urban areas and strengthening care at the secondary and tertiary levels. However, implementation will require policy development for essential drugs and equipment, capacity-strengthening of health-care workers, and an appropriate referral and health-information system.

Role of the Whole Body Vibration Machine in the Prevention and Management of Osteoporosis in Old Age: A Systematic Review

A literature search of related articles was carried out in electronic data sources. Initially, 276 randomised controlled trials related to the title were collected, after which 44 were selected using the keywords. Overlapping articles, articles with a study duration of less than six months, and studies involving young participants were removed from the list. The remaining 20 articles were checked for entitlement using the PEDro scale. A total of nine eligible articles with 1486 participants were analysed. Seven trials used dual-energy x-ray absorptiometry (DXA) to measure bone mineral density (BMD). The six trials published from 2005 to 2013 found a significant increase in BMD. In the remaining one trial, there was no significant increase in BMD. One study published in 2013 reported a significant increase in BMD measured with peripheral qualitative computed tomography, whereas another trial published in 2014 stated that there was a reduction in calcaneal bone density measured by peripheral qualitative ultrasound. From these findings it can be concluded that the whole body vibration machine is a good adjunctive therapy for the prevention and management of osteoporosis in postmenopausal women. However, further investigations are necessary before the same can be recommended for elderly men.

Review on the comparison of effectiveness between denosumab and bisphosphonates in post-menopausal osteoporosis

OBJECTIVE: Osteoporosis is a rapidly rising cause of concern for elderly patients. Various classes of drugs are available in the market. Bisphosphonates are considered as a first-line therapy for the prevention and treatment. Denosumab is an antiresorptive agent which is a RANK ligand inhibitor. There is a scarcity of comparison between these two classes of drugs. The aim of this study is to compare efficacy of Bisphosphonates and Denosumab in various parameters. MATERIALS AND METHODS: Literature search was done for randomized controlled trials (RCTs) comparing bisphosphonates with denosumab. RCTs with a treatment period of at least one year with a baseline bone mineral density (BMD) and bone turnover markers (BTM) and follow up values at one year were included in the study. All included studies were also analysed for complications. The study has also been registered in PROSPERO International prospective register of systematic reviews. RESULTS: A total of five RCTs were identified providing data on 3751 participants. In all five studies, the BMD changes at both hip and spine were statistically significant in favour of denosumab. Result was similar in three studies that studied BMD changes at the wrist. Denosumab also produced significant reduction in BTM as early as one month, but at one year there was no difference compared to the bisphosphonates. There was no statistically significant differences in the complication rates. CONCLUSION: Though both bisphosphonates and denosumab were effective with similar side effects, the latter was statistically superior in increasing the BMD and reducing the BTM.

The efficacy of sequential treatment for Helicobacter Pylori eradication.

Myanmar is a high prevalence area of H pylori infection with sero-prevalence rate of 69%. The clarithromycin-based triple therapy is commonly used as empiric first line treatment for H pylori infection in Myanmar. However, the efficacy of sequential treatment for Myanmar patients with H pylori infection has not been investigated. The objective of the present study is to determine the efficacy and safety of sequential treatment for Helicobacter pylori eradication in dyspeptic patients. A total of 100 dyspeptic patients aged > 18 years with proved Helicobacter pylori infection were randomly assigned to receive either 10 day sequential therapy or 10 day triple therapy. After completion of treatment, compliance and side effects were assessed. The outcomes of the eradication therapy were assessed 4 weeks after treatment by the 13C urea breath test. The success rate of H pylori eradication between the sequential therapy and the triple therapy was not significant (85.7% Vs 95.1%, p = 0.147). The triple therapy had 66.7% relative risk reduction (RRR), 9.4% absolute risk reduction (ARR) and 11 number need to treat (NNT). The adverse events between two study groups did not differ significantly (23.8% Vs 31.7%, P = 0.422). Good compliance was achieved in all patients of two study population. The result of this study could not prove that the efficacy of sequential treatment was superior to that of triple treatment for H pylori eradication in Myanmar dyspeptic patients.

H. pylori infection among Buddhist monks in the selected regions of Myanmar.

Background: The prevalence of H. pylori infection is different in various regions of Myanmar, and the results of studies are contradictory regarding incidence of H. pylori infection. The infection rate of H. pylori among the monks could reflect the prevalence of the particular region studied. Objectives: The present study was aimed to determine the Helicobacter pylori status among asymptomatic Buddhist monks in Myanmar, and to observe the efficacy of clarithromycin based first line therapy by using C14 Urea Breath Test (PY test). Method: The Buddhist monks 17 years of age and above from the monasteries of both middle and lower Myanmar were selected by purposive sampling method. After filling out the questionnaire,H.pylori infection was detected by 14C-UBT (PY test, microCOUNTLite Liquid Scintillation Counter). H.pylori positive subjects were treated with 10 days' course of clarithromycin containing standard triple therapy as a first line.14C-UBT test was repeated at week 4 to check for H.pylori eradication status. Results: A total of 399 monks (from Bago and Mandalay city) were enrolled in this study. The mean age was 23.51+/ 8.907 years (range: 18 - 97). Urea breath test was positive in 65.4% of the monks. The prevalence of H. pylori infection was radically similar in different monasteries of different cities: Bago and Mandalay (67.52% ν 63.18%, p = 0.33). Among H. pylori infected monks, 67.7% achieved eradication with clarithromycin containing standard triple therapy. Conclusion: High H. pylori infection rates were found in asymptomatic Buddhist Myanmar monks and the standard triple therapy had moderate efficacy.

Aspirations and attitudes towards medical professionalism and awareness of medical ethics among Final Part 2 MBBS students in Myanmar Medical Universities.

The cross-sectional descriptive study being conducted in 2012 explored the aspirations and attitudes of the Final Part 2 MBBS students towards medical professionalism and their awareness of medical ethics. A total of 920 students from four Medical Universities in Myanmar responded to the self-administered questionnaire. Less than 65% of their parents were graduates and nearly half (48.5%) of them earned their living by own business. Sixty five percent of students admitted their career ambition during high school period as becoming a medical doctor. They had attended the Medical University due to family influence (22.1%), high scores in Basic Education High School examination (22.8%) and their desire for monetary gains (23.5%). Almost all (90%)accepted medical profession as noble and 65.7% of respondents cited that they were fond of giving care to patients. Regarding their attitudes toward medical professionalism, more than 90% of the respondents agreed towards principles of fair distribution of finite resources, honesty with patients, a necessity to improve quality of care, ability to manage conflict of interest and professional self regulation. Only 5.5% of students disagreed that periodic recertification was desirable. Nearly half (45.8%) of them disagreed on improving an access to care regardless of patient’s ability to pay,and also on increasing scientific knowledge by encouraging their patients to participate in clinical trials (63%). For future aspiration, 40.4% of respondents intended to join the government service, of whom 71.6% expected to become clinicians. Eighty seven percent of the students agreed to teach Medical ethics as a separate subject and they preferred group discussions. So, to review and revise the existing curriculum for medical ethics is necessary to improve the professional skills of students.

Myanmar diabetes care model: Bridging the gap between urban and rural healthcare delivery / Journal of the ASEAN Federation of Endocrine Societies

@#There has been significant magnitude of problems of diabetes in Myanmar, according to the estimates of International Diabetes Federation (IDF) and the recent National Survey on the prevalence of diabetes. There has been a wide gap of equity between the urban and rural healthcare delivery for diabetes. Myanmar Diabetes Care Model (MMDCM) aims to deliver equitable diabetes care throughout the country, to stem the tide of rising burden of diabetes and also to facilitate to achieve the targets of the Global Action Plan for the Prevention and Control of NCDs (2013-2020). It is aimed to deliver standard of care for diabetes through the health system strengthening at all level. MMDCM was developed based on the available health system, resources and the country's need. Implementation for the model was also discussed.

Phenotypic and Genotypic Analysis of Anti-Tuberculosis Drug Resistance in Mycobacterium tuberculosis Isolates in Myanmar

BACKGROUND: Tuberculosis (TB) is one of the most serious health problems in Myanmar. Because TB drug resistance is associated with genetic mutation(s) relevant to responses to each drug, genotypic methods for detecting these mutations have been proposed to overcome the limitations of classic phenotypic drug susceptibility testing (DST). We explored the current estimates of drug-resistant TB and evaluated the usefulness of genotypic DST in Myanmar. METHODS: We determined the drug susceptibility of Mycobacterium tuberculosis isolated from sputum smear-positive patients with newly diagnosed pulmonary TB at two main TB centers in Myanmar during 2013 by using conventional phenotypic DST and the GenoType MTBDRplus assay (Hain Lifescience, Germany). Discrepant results were confirmed by sequencing the genes relevant to each type of resistance (rpoB for rifampicin; katG and inhA for isoniazid). RESULTS: Of 191 isolates, phenotypic DST showed that 27.7% (n=53) were resistant to at least one first-line drug and 20.9% (n=40) were resistant to two or more, including 18.3% (n=35) multidrug-resistant TB (MDR-TB) strains. Monoresistant strains accounted for 6.8% (n=13) of the samples. Genotypic assay of 189 isolates showed 17.5% (n=33) MDR-TB and 5.3% (n=10) isoniazid-monoresistant strains. Genotypic susceptibility results were 99.5% (n=188) concordant and agreed almost perfectly with phenotypic DST (kappa=0.99; 95% confidence interval 0.96-1.01). CONCLUSIONS: The results highlight the burden of TB drug resistance and prove the usefulness of the genotypic DST in Myanmar.

Challenges of smokeless tobacco use in Myanmar.

Myanmar Tobacco Control Law of 2006 covers the control of all forms of tobacco use. After 7‑year, tobacco use among adults did not see a decrease. The paper aimed to study the prevalence, details of the products, trade, legislation, tax, marketing, advertising and evidence on morbidity and mortality, and to make recommendations for policy options. Personal communications by authors and colleagues, and searches by keywords in PubMed and on Google, literature review and research from published reports, and various studies and surveys conducted in Myanmar and other countries. Smokeless tobacco use in Myanmar is the highest among ASEAN countries. A variety of SLT products used together with betel chewing poses a challenge; betel quid chewing has been accepted as a cultural norm in both rural and urban areas. Betel quid chewing usually starts at younger ages. Sale, marketing, and advertising of SLT are not under control and thus, road‑side kiosks selling betel quid with SLT are mushrooming. Considerable trade of SLT products by illegal and legal means created an increase in access and availability. Low cost of SLT product enables high volume of use, even for the poor families. Taxation for raw tobacco and tobacco products is half the values of the tax for cigarettes. Effective enforcement, amendment of the law, and action for social change are needed.

A forgotten disease of Myanmar origin.

A 16-year old student from Taungoo presented to medical ward, Insein General Hospital with one month-long fever, weight loss and multiple abscesses and ulcers at the face, limbs and trunk. Examination revealed pallor, remittent fever and hepatosplenomegaly. Imaging showed multiple splenic abscesses. Wound swab cultures from ulcers revealed gram negative coccobaccilli with characteristic of Burkholderia pseudomallei. The diagnosis was melioidosis. Defeverese time was 13 days after treatment with intravenous ceftazidime and amikacin. Recovery was uneventful. This case warrants the clinician, in case of recalcitrant septicaemia, to consider melioidosis-originally discovered in Myanmar but uncommon now.

Effect of oral calcium supplementation on lipid profile and atherogenic index of plasma / Journal of the ASEAN Federation of Endocrine Societies

Objective@#To assess the effect of oral calcium supplementation on lipid profile and atherogenic index of plasma (AIP). @*Methodology@#This study was undertaken in 28 centrally obese male subjects [age 26.4 (6.5) years], BMI 31.6 (4.7) kg/m2, WC 99.4 (6.4) cm. All participants received six tablets of CaCO3 (250 mg of elemental calcium/ capsule, for a total of 1500 md/day) for 8 weeks. Serum lipid profile including triglyceride, total cholesterol, HDL-C, LDL- C was measured at baseline and after intervention. AIP was calculated by using formula = log (TG/HDL-C). @*Results@#Oral calcium supplementation achieved a 22% (36 mg/dL, p<0.001) reduction in Triglyceride from baseline [163.4 (37.9) mg/dL] and 19.2% ( 5.8 mg/dL, p<0.001) increase in HDL-C from baseline [30.4 (7.4) mg/dL)]. There were no significant treatment effects on total cholesterol [217.1 (41.21) mg/dL vs 196.3 (46.2) mg/dL] and LDL-C [155.4 (45.1) mg/dL vs 136.3 (45.1) mg/dL]. Significant reduction in serum total cholesterol and LDL-C level was only found in dyslipidemic centrally obese subjects. AIP decreased significantly by 51% with calcium carbonate treatment [median and interquartile range; 0.35 (0.29-0.44) vs 0.17 (0.04-0.44), p<0.01]. @*Conclusion@#Eight-week calcium supplementation at 1500 mg/day led to a significant change in lipid levels and AIP.

Summary of Myanmar clinical practice guidelines on the management of Dyslipidaemia in Type 2 Diabetes Mellitus / Journal of the ASEAN Federation of Endocrine Societies

@#Cardiovascular disease is a significant cause of morbidity and mortality in patients with diabetes mellitus (DM). According to the IDF Diabetes Atlas 2013, the prevalence of diabetes in Myanmar is 5.7%.(1) Diabetes is recognized as a risk equivalent for coronary heart disease. The lipid profile in patients with type 2 DM is characterized by elevated triglycerides, low high-density lipoprotein cholesterol and raised small dense low-density lipoprotein cholesterol (LDL-C) particles. This is believed to be a key factor in promoting atherosclerosis in these patients. There is ample evidence that aggressive statin therapy reduces cardiovascular end points in patients with DM in both primary and secondary prevention studies. In all persons with DM, current treatment guidelines recommend reduction of LDLC to less than 100 mg/dL, regardless of baseline lipid levels. In very high risk patients with DM and coronary heart disease lowering of LDL-C to less than 70 mg/dL may provide even greater benefits. Treatment for hypertriglyceridaemia is recommended only if TG levels is very high (>500 mg/dL).

A summary of the clinical practice guidelines for the management of patients with Peripheral Arterial Disease in Myanmar / Journal of the ASEAN Federation of Endocrine Societies

@#Peripheral artery disease (PAD) broadly encompasses vascular diseases caused primarily by atherosclerosis and thromboembolic pathophysiologic processes that alter the normal structure and function of the aorta, its visceral arterial branches, and the arteries of the lower extremity. The aims of the Myanmar clinical practice guidelines for the management of patients with PAD are to assist physicians in selecting the best management strategies for an individual patient with peripheral artery disease with main focus on lower extremity artery disease (LEAD) due to atherosclerosis, to help the physician to make decisions in their daily practice, and to aid in appropriate referrals to specialists. Early detection and treatment guidelines for the treatment of PAD are important to reduce the morbidity and mortality of patients with vascular problems in Myanmar.

Beta cell function, insulin resistance and low grade systemic inflammation in Myanmar adults with different categories of glucose tolerance / Journal of the ASEAN Federation of Endocrine Societies

Objective@#The aim of the study was to evaluate the beta cell function, insulin sensitivity and low grade systemic inflammation in different categories of glucose tolerance in Myanmar. @*Methodology@#A cross-sectional study was conducted on 202 Myanmar subjects of both sexes, aged between 45-65 years old. Fasting blood glucose, insulin, C-peptide and hs-CRP levels were measured. A 75g oral glucose tolerance test was performed. Insulin resistance and beta cell function were assessed by homeostasis-model-assessment (HOMA). @*Results@#The subjects were categorized as normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes mellitus (DM) according to WHO-2006 criteria. Fasting serum insulin, C-peptide and hs-CRP levels and insulin resistance index (HOMA-IR) progressively increased from NGT through prediabetes (IFG, IGT) to DM (p<0.01). Beta-cell function did not change significantly in any other group as compared to normal group. @*Conclusion@#After multivariate analysis, increases in fasting C-peptide, hs-CRP and HOMA-IR index were significantly associated with diabetes. It was also found that insulin resistance was a predominant feature in deterioration of the glucose tolerance in Myanmar subjects.