Intravenous Iron Therapy: Re-administration after Prior Adverse Reaction / 가정의학회지

Background@#Intravenous (IV) iron therapy is performed in community practices and hospitals with modern formulations when oral administration becomes impractical. Effective replacement of iron is important for the treatment of iron deficiency and anemia. Can IV iron be rechallenged in individuals with a history of adverse reactions? This review is to explore the challenge of this, when clinically indicated. @*Methods@#After performing a literature search, five studies (combined total sample number=1,006) for re-exposure of IV iron to individuals with a history of past reactions were identified, observed, and analyzed. Re-exposure included reactions ranging from mild to moderate and few cases of severe type. @*Results@#The majority (>80%) of IV iron rechallenges were tolerable, safe, and successful without major serious incidents. There were no reports of major reactions (severe hypersensitivity reactions or anaphylaxis) in these re-exposures. @*Conclusion@#Re-administration of IV iron therapy in patients with a previous adverse reaction is plausible, with benefit and risk stratification. A rechallenge would depend on the nature and degree of the adverse reaction and use of alternative formulations. Rechallenge to a previous severe hypersensitivity reaction or anaphylaxis with the same product has not been reported in these studies. Evidence on the benefit of premedication use is conflicting and requires further studies.

Protocol paper: kainic acid excitotoxicity-induced spinal cord injury paraplegia in Sprague-Dawley rats

BACKGROUND: Excitotoxicity-induced in vivo injury models are vital to reflect the pathophysiological features of acute spinal cord injury (SCI) in humans. The duration and concentration of chemical treatment controls the extent of neuronal cell damage. The extent of injury is explained in relation to locomotor and behavioural activity. Several SCI in vivo methods have been reported and studied extensively, particularly contusion, compression, and transection models. These models depict similar pathophysiology to that in humans but are extremely expensive (contusion) and require expertise (compression). Chemical excitotoxicity-induced SCI models are simple and easy while producing similar clinical manifestations. The kainic acid (KA) excitotoxicity model is a convenient, low-cost, and highly reproducible animal model of SCI in the laboratory. The basic impactor approximately cost between 10,000 and 20,000 USD, while the kainic acid only cost between 300 and 500 USD, which is quite cheap as compared to traditional SCI method. METHODS: In this study, 0.05 mM KA was administered at dose of 10 µL/100 g body weight, at a rate of 10 µL/min, to induce spinal injury by intra-spinal injection between the T12 and T13 thoracic vertebrae. In this protocol, detailed description of a dorsal laminectomy was explained to expose the spinal cord, following intra-spinal kainic acid administration at desired location. The dose, rate and technique to administer kainic acid were explained extensively to reflect a successful paraplegia and spinal cord injury in rats. The postoperative care and complication post injury of paraplegic laboratory animals were also explained, and necessary requirements to overcome these complications were also described to help researcher. RESULTS: This injury model produced impaired hind limb locomotor function with mild seizure. Hence this protocol will help researchers to induce spinal cord injury in laboratories at extremely low cost and also will help to determine the necessary supplies, methods for producing SCI in rats and treatments designed to mitigate post-injury impairment. CONCLUSIONS: Kainic acid intra-spinal injection at the concentration of 0.05 mM, and rate 10 µL/min, is an effective method create spinal injury in rats, however more potent concentrations of kainic acid need to be studied in order to create severe spinal injuries.

Alternate careers for medical graduates and house officers in Malaysia

@#Introduction: In recent years, many unresolved issues pertaining to house officers in Malaysia have led to a longer waiting time and a ‘glut’ of medical graduates with a surprising 20% dropout amongst those who join the housemanship programme. This appears to reflect the changing times, mindsets and work expectations of millennials who comprise this cohort reflecting a need to consider possibilities of career shifts especially so in these uncertain times. This study explores the perceptions, awareness and interest in alternative career options amongst recent graduates and house officers. Materials and Methods: This was a study done between 2018 and 2019 using a questionnaire which was shared on various social platforms. Data analysis was done using Excel spreadsheet. Results: A total of 450 house officers and 657 medical graduates responded. Expectedly 66.8% claimed lifelong passion whilst another 12.1% claimed family influence as their reason to do medicine. Most were aware of their career challenges and 40% of them were keen to consider career change and reskilling indicating a possible shift from traditional expectations of a medical career. Conclusion: Whilst medicine is often considered a true calling, current challenges will require mental and emotional flexibility to explore other career opportunities. Thus, engagement programmes should be directed at medical graduates and house officers to identify and support those open to career transitions. This will help address current issues of internship bottleneck and rising dropout rates amongst internees. Early career change engagements will give them insight into their true career goals whilst opening up opportunities for those who wish to change.

Factors Associated With Pressure Ulcer Risk Among Spinal Cord Injury Adults in Kuala Lumpur, Malaysia: A Community-based Study

@#Introduction: Pressure ulcers (PUs) are a leading health problem among spinal cord injury(SCI) patients. Therefore, this comprehensive study was aimed at determining the association between potential factors and the occurrence of PUs among SCI adults in community settings. Methods: A cross-sectional study was conducted among adults with SCI aged 18 years and above from five selected locations in Kuala Lumpur, Malaysia. The study was carried out through interviews based on validated questionnaires such as the Dietary History Questionnaire (DHQ), Spinal Nutrition Screening Tool (SNST), Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), Barthel Index for Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL). Estimated weight and height were obtained using recumbent formula. The stages of their PUs were assessed based on National Pressure Ulcer Advisory Panel (NPUAP) grading system. Results: A total of 40 subjects participated in the study, 25% of whom were having PUs. Their nutritional inadequacies were identified, whereby 90%, 70% and 85.5% of them were receiving below their daily requirement of energy, carbohydrate and protein, respectively. The fat and sodium intakes of 55% of them were above the Malaysian Recommended Nutrient Intakes(RNI). It was successfully found that physical activity could decrease the risk of PUs(R2=0.654, OR=0.310, p<0.05). Conclusion: Overall, 25% of the subjects had PUs that were associated with physical inactivity. The majority of the subjects did not meet their nutrient requirements. Therefore, there is a need for increased physical activity and improved nutrient intake in order to reduce the risk of pressure ulcers among SCI adults in communities.

Prevalence of Insulin Receptor Substrate-1 Gene (G972R) Polymorphism, Insulin Resistance, and Determination of β-Cell Function among overweight and obese persons with Type 2 Diabetes Mellitus / Journal of the ASEAN Federation of Endocrine Societies

Background@#Type 2 diabetes mellitus (T2DM) is the most common metabolic disorder and its pathogenesis is characterized by a combination of peripheral insulin resistance and impaired insulin secretory capacity of pancreatic β cell. Genetic predisposition interacts with environmental factors including diet, physical activity, and age leading to the development of diabetes.@*Objective@#To determine the proportion of overweight and obese persons with type 2 diabetes and to compare the fasting blood sugar, fasting serum insulin, insulin resistance and β-cell function in G972R carrier and non-carrier overweight and obese persons with type 2 diabetes.@*Methodology@#One hundred overweight and obese patients with T2DM were recruited from persons with diabetes attending the Diabetes Outpatient Department of Yangon General Hospital. History taking and physical examination were done and blood samples were collected. Plasma glucose level was determined by the glucose oxidase method and fasting serum insulin was measured by enzyme linked immunoassay (ELISA) kit method. Polymerase chain reaction and Restriction Fragment Length Polymorphism were done for genetic polymorphism.@*Results@#Among 100 overweight and obese subjects with T2DM, 81 patients were of homozygous (G/G) genotype, 18 patients were of heterozygous (G/A) and only one patient of homozygous (A/A) genotype. There was no statistically significant difference in the proportion of genotypes between overweight and obese subjects with T2DM.There was no significant difference in fasting blood sugar (FBS), fasting serum insulin, HOMA-IR, β-cell function, lipid parameters between IRS-1 (G972R) carriers and non-carriers. There is significant negative correlation between insulin resistance and TG level (r2=0.0529, p=0.01).@*Conclusion@#It was concluded that IRS-1 G972R polymorphism was not important in insulin resistance, β-cell function and lipid parameters in overweight and obese T2DM. There could be a number of candidate genes in the pathophysiology of diabetes mellitus, genetic sequencing of IRS-1 and other genes in the insulin signaling pathway, and finding out the alteration in their genetic patterns would provide clues for the association of the site-specific polymorphisms of these genes with insulin resistance in T2DM.

Biochemical, Cardiovascular Parameters and Weight Status among a Rural Population in Mandalay Division, Myanmar

Overweight and obesity are increasing public health problems recognizedworldwide and rural population is not less affected. Early detection of overweight andobesity as well as cardiovascular and biochemical data are important for rural populationsto prevent and control of obesity related cardio-metabolic diseases. This study aimed todetermine biochemical, cardiovascular parameters and weight status among a ruralpopulation in Mandalay Division. This cross-sectional study of 263 subjects, age ranging from18-86 years, was conducted at Pin-Tee village in Pyin-Oo-Lwin Township in 2015.Anthropometry, cardiovascular and biochemical parameters were determined. Weightstatus was assessed by Body Mass Index (BMI) and classified according to WHO adult AsianBMI criteria. There were 110 males (41.8%) and 153 females (58.2%), respectively, withmean age was 44.8 ± 16.0 years. Current smoking and current betel chewing were found inmales (58.2% and 34.6%) and females (4.6% and 4.6%), respectively. Current alcoholdrinking was observed in males (41.8%). Overweight (16.4% males; 19.6 % females) andobesity (10.9% males; 29.4 % females) were found in this study. Existence of hypertension,hypertriglyceridemia, hyperglycemia (Fasting Blood Glucose≥126mg/dl) andelectrocardiographic abnormalities were detected in 39.9%, 32.3%, 9.5 % and 30.8%,respectively, among all respondents. Hypertension, abnormal electrocardiography,dyslipidemia and high alkaline phosphatase levels were significantly associated withincrease in BMI. The magnitude of obesity was quite high in this study population. Most ofthe cardio-metabolic risk factors were more common in females. Hypertension andhypertriglyceridemia were more frequent in this rural community.

Profile of various idiopathic inflammatory myopathies at two university hospitals in Yangon, Myanmar

@#Objective: to determine the distribution of various idiopathic inflammatory myopathies (IIM) and their profile at the largest university hospitals in Yangon, Myanmar. Method: It was a hospital based prospective study recruiting IIM patients admitted to Neurology and Rheumatology ward over a 1.5 year period from September 2017 to February 2019. Results: Among total 51 IIM patients recruited, 62.7% presented to Neurology ward and 37.3% to Rheumatology ward. Overlap myositis (OM) was the commonest (43%), followed by immune-mediated necrotizing myopathy (IMNM) 27%, dermatomyositis (DM) 24%, polymyositis (PM) 6%. Among OM, anti-synthetase syndrome (ASS) was 23%, and among IMNM, anti-SRP positive was 79%. IMNM and PM patients presented more to neurologists while OM/ASS and DM more to rheumatologists; 82% were females (F:M= 4.6:1). Mean age of onset of myositis was 40.2 + 17.8 years, and duration of symptoms before presentation was 10-3,600 days (shortest in anti-SRP and longest in anti-HMGCR myopathy). Myositis antibodies were positive in 67%. CK range was 40-25,690 U/l, highest in IMNM and lowest in DM. Associated connective tissue diseases among OM in order of descending frequency were 47% systemic lupus erythematosus, 24% Sjogren syndrome, 41% scleroderma and 12% rheumatoid arthritis. Associated cancer identified were one lung cancer in DM, one breast cancer in OM, one buccal cancer in IMNM cases. Conclusions: With recent availability of myositis antibody panel and MHC staining in Myanmar, we have applied current updated classification to describe the first Myanmar data on IIM cases.

Relationship between plasma adiponectin level and corrected QT interval in smoker and non-smoker adult male subjects / Journal of the ASEAN Federation of Endocrine Societies

@#Objective. This study determined the relationship between plasma adiponectin level and corrected QT interval (QTc) in smokers and non-smokers. Methodology.This cross-sectional analytical study was undertaken in 30 smokers and 30 non-smokers. Plasma adiponectin level was determined by enzyme-linked immunosorbent assay (ELISA). The QT interval was measured by routine 12-lead ECG with Lead II rhythm and QTc was calculated. Results. Mean plasma adiponectin level was significantly lower in smokers (27.89±15 μg/ml) than that of non-smokers (52.13±21.57μg/ml) (p<0.001). Mean QTc interval was significantly longer in smokers than that of non-smokers (415.37±29.9 versus 395.63±26.13 ms, p<0.01). Higher risk of low adiponectin level (odds ratio [OR],8.1; 95% confidence interval [CI],1.61-40.77) and QTc interval prolongation (OR,6; 95%CI,1.17-30.73) were observed in smokers. There was weak significant negative correlation between plasma adiponectin level and QTc interval in the study population (n=60, r=-0.407, p=0.001). Moreover, low plasma adiponectin level was significantly associated with prolonged QTc interval in the study population (n=60, Fisher's exact p value<0.05). Risk of QTc interval prolongation was 4.3 times higher in subjects with low plasma adiponectin level (OR,4.27; 95% CI,1.05-17.46). Conclusion. Smokers have greater risk for low plasma adiponectin level and prolonged QTc interval. There is a relationship between plasma adiponectin level and QTc interval.

Attitudes towards vasectomy and its acceptance as a method of contraception among clinical-year medical students in a Malaysian private medical college

INTRODUCTION@#This study explored attitudes towards vasectomy and its acceptance as a method of contraception among clinical-year medical students, and determined the association between their demographic characteristics, and attitudes and acceptance.@*METHODS@#A cross-sectional survey was conducted among clinical-year medical students from a Malaysian private medical college using a self-administered questionnaire.@*RESULTS@#There were 330 participants with a female preponderance and a mean age of 22.0 ± 1.1 years. The largest proportion of respondents were from Year 3. The vast majority were ethnically Malay (91.8%) and followed Islam (92.4%). Overall, 60.9% of participants had a positive attitude towards vasectomy and 76.0% showed good acceptance. Gender, academic year, ethnicity and religion variables were not associated with attitudes and acceptance (p > 0.05). A significantly higher proportion of male respondents thought that vasectomy was religiously forbidden and would give a bad impression. A significantly higher proportion of Year 5 students agreed to the statement 'I would recommend vasectomy to relatives, friends and people close to me' compared to Year 3 and 4 students.@*CONCLUSION@#Students' perception of vasectomy as a contraceptive method was encouraging. Our results suggest that their knowledge improved as medical training progressed, and attitudes evolved for the better irrespective of their traditional, cultural and religious beliefs - highlighting the importance of providing students with evidence-based learning about male sterilisation, which is more cost-effective and is associated with lower morbidity than female sterilisation. A qualitative study involving students from different ethnicities and religions would provide a better understanding of this subject.

Alcohol consumption among adult males in urban area of Thanlyin Township, Yangon Region, Myanmar.

Background: Alcohol consumption is a major cause of morbidity and mortality worldwide. It is frequently related to health and behavioural problems as well as socio-economic hardship. Therefore, this study was conducted to determine the prevalence and risk factors of alcohol consumption among adult males residing in urban area of Thanlyin Township, Yangon Region. Methods: A cross-sectional study was conducted among 380 adult males. Multi-stage random sampling was applied. Data entry and analysis was done using Stata 11.0 statistical package. Results: The prevalence of current alcohol drinking, ex-drinking and never drinking were 20.5%, 9.0% and 70.5%, respectively. There was a significant decreasing trend of alcohol consumption across the levels of age-group. Age, education status and practicing other health-risk behaviours such as smoking and betel chewing were detected as significant risk factors of alcohol consumption. Ever smokers and ever betel chewers were about 4 times more likely to be ever alcohol user compared to their counterparts even if age and education level were adjusted. By controlling smoking and betel chewing habits, 79.2% and 76.6% of existing prevalence of alcohol consumption among respondents would be reduced, respectively. Conclusions: There is an urgent need to curb the habit of alcohol consumption among adult males living in urban area, especially young adults. Alcohol and tobacco control policies in Myanmar should be strengthened or reinforced. Tobacco control program also needs to be intensified. Health education and health promotion activities should be enhanced in order to reduce alcohol consumption in the country.

Catastrophic expenditure for health care in Myanmar.

Protecting households from the catastrophic health care expenditure is important for every health system because it can prevent some people from seeking care and result in impoverishment. Therefore, this cross-sectional study was done in 2014 to determine the magnitude of the catastrophic health care expenditure and its relationship with income, expenditure, residence, and receiving an in-patient care. Altogether 437 households from both urban and rural areas of 1 State and 5 Regions including Nay-Pyi-Taw territory were included in the study. Two thresholds that cover the 10% of total expenditure and 40% of non-food expenditure were used to estimate the catastrophic health care expenditure for one year period in randomly selected households. The estimates of catastrophic health care expenditure were 37.1% and 32.9% for thresholds of 10% of total annual expenditure and 40% of annual non-food expenditure, respectively. The catastrophic health care expenditure was significantly related to both annual household income (p = 0.012) and expenditure (p = 0.009). The estimate of catastrophic expenditure for health care was highest in households of lowest income (quintile) group (42.3%) whereas this estimate was lowest in households with highest income (21.2%), (p = 0.008). The similar trend was detected in the expenditure quintile groups (p = 0.013). The catastrophic expenditure for health care was significantly higher among households residing in the rural area compared to those of urban area (p = 0.001). Similarly, households experiencing hospitalization of any of its members was more likely to have the catastrophic expenditure than those who did not (p = 0.001). This study highlighted the urgent need to promote health, strengthen the strategic approach to universal health care coverage and also to seek ways to improve household income, especially for the rural poor. The establishment of nationwide health insurance system should also be considered.

Rectus sheath haematoma after laparotomy.

Case (1) - A 32 years old, P2+1 lady was referred to Central Women's Hospital (CWH), Yangon with shock for 18 hours following laparotomy for ruptured ectopic pregnancy at Tike Gyi Hospital. Resuscitated measures were carried out. The urgent re-laparotomy was done with the diagnosis of intra-abdominal bleeding. The operative findings were rectus sheath haematoma (about 100ml), haemoperitoneum (about 300 ml) and intact left tubal ligation stump. The source of bleeding was from inferior epigastric vessels. The bleeding point was secured and abdominal and sub-rectus sheath drains were inserted. At post operative period, her condition deteriorated and she had acute renal failure (ARF) and disseminated intravascular coagulopathy (DIC). She was referred to renal medical unit on post-operative day 2 for peritoneal dialysis. However, she expired on the next day. Case (2) - A 28years old, G2 P1+0 lady was admitted to CWH, Yangon for previous one scar with twins pregnancy at 37 week gestation. Elective Caesarean Section was done at 38 week gestation with the indication of previous one scar with twins pregnancy. At 4 hours after operation, she had shock with clinical features of intra-abdominal bleeding and abdominal wound haematoma. Urgent laparotomy was undertaken and the operative findings revealed the 9x10 cm right sub-rectus sheath haematoma with active bleeding from right inferior epigastric vessels and 1000 ml of haemoperitoneum. Her post-operative period was uneventful and she was discharged on post-operative day 10.

Determination of phytochemical constituents and antioxidant activity of Rasayana, Triphala and antiageing herbal plants.

Antioxidants possess the ability to protect the body from damage caused by free radical induced oxidative stress and have antiageing property. ‘Theinga Dara Thanhitar’ book, written by Ashin Nagathein described that ‘Rasayana and Triphala’ drugs have the ability to prevent ageing and illness. This study was carried out to investigate the antioxidant activities of commonly used ingredients of ‘Rasayana’ such as Streblus asper Lour. (Okhne), Cassia fistula Linn. (Ngu), Tinospora cordifolia Miers. (Sindone-Ma-Nwe), Asparagus racemosus Willd. (Shin-Matet), Boerhavia diffusa Linn. (Payan-Nawa), and ‘Triphala’ such as Phyllanthus emblica Linn. (Ze-Phyu), Terminalia chebula Retz. (Phan-Ga) and Terminalia belerica Roxb. (Thit-Saint). Their absorbances were evaluated using 1,1-diphenyl -2-picrylhydrazyl (DPPH) assay method by using spectrophotometer. Yield percents of these plants were ranging from 4.05% to 28.6%. The watery extracts of Okhne, Ngu, stem of Sindone-Ma-Nwe, tubor of Payan-Nawa, Ze-Phyu, Phan-Ga, and Thit-Saint contain phenols and tannins which have free radical scavenging activities. It was found that the bark and stem of Okhne, tubor of Payan-Nawa and ‘Triphala’ had the least IC50 value i.e. the best antioxidant potency. Therefore, the findings from this study supported the experience-based findings of antiageing activities in ‘Triphala’ and ‘Rasayana’ to be evidence-based.

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.

Threat of HIV/AIDS in children: social, education and health consequences among HIV orphans and vulnerable children in Myanmar.

Background: There is very limited information available on HIV related orphans and vulnerable children (HIV-OVC) in Myanmar. Hence, the objective of this study was to identify and compare the social, education and health consequences among HIV-OVC and children from the families not related to HIV in the same neighbourhoods (neighbouring children). Materials and Methods: A cross-sectional, comparative survey was carried out in three geographical locations. Face-to-face interviews were conducted with guardians and children using a pretested structured questionnaire including Strength and Difficulties Questionnaire (SDQ) for behavioural problems. Outcome measures were compared using Chi-squared test or 't' test or 'Rank-sum' test. Results: A total of 300 HIV-OVC and 300 neighbouring children were included. A greater number of HIV-OVC than their neighbouring children have experienced family displacement from their original homes (27% and 1%), child/sibling displacement (20% and 2.7%) and family dispersion (20.3% and 1.3%) (P < 0.001). More guardians of HIV-OVC reported that the disease affected their children's education (28.2% and 16.3%; P < 0.05). Fifteen per cent of HIV-OVC and 10.5% of neighbouring children had to work for their families (P < 0.05). Psychological condition was assessed on emotional, conduct, hyperactivity/inattention, peer relationship and prosocial behaviour. A greater number of HIV-OVC were noted in the abnormal category with regard to hyperactivity and prosocial behaviours (P < 0.05). Conclusions: Higher incidence of social and psychological consequences among HIV-OVC call for more community support programmes and creation of job opportunities to minimize social impact in the affected families. Future programmes should focus on counselling of HIV-OVC and providing psychological support.

Older age at initial presentation to human immunodeficiency virus (HIV) care and treatment at the Communicable Disease Centre (CDC) in Singapore, 2006 to 2011

<p><b>INTRODUCTION</b>The incidence of newly diagnosed older patients diagnosed with human immunodeficiency virus (HIV) has increased worldwide in recent years. In this study, we compared the demographics and clinical presentation of younger and older patients in our HIV sentinel cohort.</p><p><b>MATERIALS AND METHODS</b>Among all HIV patients presenting to the Communicable Disease Centre (CDC), Singapore from 2006 to 2011, 793 were randomly included in our cohort, representing about 50% of the patients seen during that period. We collected demographic, clinical, laboratory, and outcome data from patient records to compare younger (<50 years old) and older (≥50 years old) HIV patients.</p><p><b>RESULTS</b>Older patients comprised 27.1% of our HIV cohort and presented with lower median CD4 T cell counts (65 cells/mm³, interquartile range [IQR]: 27 to 214 cells/mm³) compared to younger patients (250 cells/mm³, IQR: 74 to 400 cells/mm³; P <0.001). The median time from HIV diagnosis to initiation of antiretroviral therapy (ART) differed significantly for both age groups as well (49 days for patients <50 years old, IQR: 18 to 294 days; versus 35 days for patients ≥50 years old, IQR: 14 to 102 days; P = 0.008). More of our younger patients were single (72.2%) or homosexual (44.1%), in contrast to older patients, of whom 48.8% were married and 84.7% were heterosexual.</p><p><b>CONCLUSION</b>Upon comparison of our younger and older patients, we identified distinct differences in risk transmission and clinical presentation. Increased awareness of older patients at risk of HIV may improve time to diagnosis among this age group.</p>

Calcium Intake among Myanmar Residing in Bago, Kayin, and Yangon Areas

A cross-sectional survey combined with 24-hour dietary recall and food diary was undertaken to assess the calcium intake of the Myanmar population. The study was conducted from November 2003 to October 2005. A total of 886 subjects of both sexes aged above 2 years from three States and Divisions (Bago, Kayin, and Yangon) of Myanmar were included in the study. The major measures were mean daily calcium intake (mg/day) and major sources of calcium in the diet. Overall mean calcium intake was 197+13mg/day (2-9 years), 421+2mg/day (10-19 years), 399+21 mg/day (20-49 years), and 383+25mg/day (>50 years) for males, while the corresponding values for females were 207+17 mg/day, 366+19 mg/day, 387+16 mg/day, and 327 +19 mg/day. Calcium intake was less than 80% of the recommended dietary allowances (RDA) for Myanmar for ages 2-9 years and 10-29 years in all the study areas, and for the 50 years and above age group in Yangon. Fish paste was found to be the major source of calcium. Milk and milk products contributed very little to total calcium intake, contributing 2.1% for residents in Yangon, 5.1% in Pa-an and none in Bago. Consumption of calciumrich foods, particularly milk and milk products, should be encouraged among the Myanmar people. Towards this end, appropriate nutrition education materials should be developed for promotional purposes.

Household income, health and education in a rural area of Myanmar.

This study was to determine the relationship between a commonly used social stratification indicator, net equivalent income, and self-rated health, long-term disability, visual acuity status, death rate, birth rate, unsafe delivery and school enrollment in a rural area of Myanmar. Data were collected from 3,558 respondents in 805 households of all ages. Data analysis for various items was based on different age groups. The results from two income groups (highest and lowest) are as follows: the percent of those who self-rated their health as very good were 17.8% and 10.4% in the highest and lowest income groups, respectively (adjusted coefficient = 0.30, 95% Cl 0.11-0.50); those with an acute medical condition were found in 16.3% and 20.8% in the highest and lowest income groups, respectively (adjusted OR = 1.35, 95% Cl 1.08-1.68); those with long-term disability were found in 15.3% and 21.2% in the highest and lowest income groups, respectively (adjusted OR = 1.39, 95% Cl 1.05-1.84); and those with poor visual acuity at a distance of 13 feet were found in 8.1% and 13.5% in the highest and lowest income groups, respectively (adjusted OR = 1.64, 95% Cl 1.18-2.30). The birth rate ratio was 1.3, the death rate ratio was 1.2, and school enrollment was found in 92.8% and 83.2% in the highest and lowest income groups, respectively (adjusted OR = 0.34, 95% Cl 0.1-0.8). These results indicate that there is an urgent need to strengthen the health care infrastructure and educational system, targeting the poor in rural areas.