Elective incisional hernia repair: lower risk of postoperative wound infection with laparoscopic versus open repair

INTRODUCTION@#The superiority of laparoscopic repair over open repair of incisional hernias (IHs) in the elective setting is still controversial. Our study aimed to compare the postoperative outcomes of laparoscopic and open elective IH repair in an Asian population.@*METHODS@#This retrospective study was conducted in an acute general hospital in Singapore between 2010 and 2015. Inclusion criteria were IH repair in an elective setting, IHs with diameter of 3-15 cm, and location at the ventral abdominal wall. We excluded patients who underwent emergency repair, had recurrent hernias or had loss of abdominal wall domain (i.e. hernia sac containing more than 30% of abdominal contents or any solid organs). Postoperative outcomes within a year such as recurrence, pain, infection, haematoma and seroma formation were compared between the two groups.@*RESULTS@#There were 174 eligible patients. The majority were elderly Chinese women who were overweight. Open repair was performed in 49.4% of patients, while 50.6% underwent laparoscopic repair. The mean operation time for open repair was 116 minutes (116 ± 60.6 minutes) and 139 minutes (136 ± 64.1 minutes) for laparoscopic repair (P = 0.079). Within a year after open repair, postoperative wound infection occurred in 15.1% of the patients in the open repair group compared to 1.1% in the laparoscopic group (P = 0.0007). Postoperative pain, recurrence and haematoma/seroma formation were comparable.@*CONCLUSION@#Elective laparoscopic IH repair has comparable outcomes with open repair and may offer the advantage of reduced postoperative wound infection rates.

Academy of Medicine, Singapore clinical guideline on endoscopic surveillance and management of gastric premalignant lesions

Gastric cancer (GC) has a good prognosis, if detected at an early stage. The intestinal subtype of GC follows a stepwise progression to carcinoma, which is treatable with early detection and intervention using high-quality endoscopy. Premalignant lesions and gastric epithelial polyps are commonly encountered in clinical practice. Surveillance of patients with premalignant gastric lesions may aid in early diagnosis of GC, and thus improve chances of survival. An expert professional workgroup was formed to summarise the current evidence and provide recommendations on the management of patients with gastric premalignant lesions in Singapore. Twenty-five recommendations were made to address screening and surveillance, strategies for detection and management of gastric premalignant lesions, management of gastric epithelial polyps, and pathological reporting of gastric premalignant lesions.

Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting

INTRODUCTION@#In Singapore, non-anaesthesiologists generally administer sedation during gastrointestinal endoscopy. The drugs used for sedation in hospital endoscopy centres now include propofol in addition to benzodiazepines and opiates. The requirements for peri-procedural monitoring and discharge protocols have also evolved. There is a need to develop an evidence-based clinical guideline on the safe and effective use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting.@*METHODS@#The Academy of Medicine, Singapore appointed an expert workgroup comprising 18 gastroenterologists, general surgeons and anaesthesiologists to develop guidelines on the use of sedation during gastrointestinal endoscopy. The workgroup formulated clinical questions related to different aspects of endoscopic sedation, conducted a relevant literature search, adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and developed recommendations by consensus using a modified Delphi process.@*RESULTS@#The workgroup made 16 recommendations encompassing 7 areas: (1) purpose of sedation, benefits and disadvantages of sedation during gastrointestinal endoscopy; (2) pre-procedural assessment, preparation and consent taking for sedation; (3) Efficacy and safety of drugs used in sedation; (4) the role of anaesthesiologist administered sedation during gastrointestinal endoscopy; (5) performance of sedation; (6) post-sedation care and discharge after sedation; and (7) training in sedation for gastrointestinal endoscopy for non-anaesthesiologists.@*CONCLUSION@#These recommendations serve to guide clinical practice during sedation for gastrointestinal endoscopy by non-anaesthesiologists in the hospital setting.

Rapid Staining Using the Shorr Method for Intraoperative Peritoneal Washing Cytology in Advanced Gastric Cancer: a Pilot Study from a Single Institution

PURPOSE: Intraoperative peritoneal washing cytology (PWC) is used to determine treatment strategies for gastric cancer with suspected serosal invasion. However, a standard staining method for intraoperative PWC remains to be established. We evaluated the feasibility of a rapid and simple staining method using Shorr's stain for intraoperative PWC in advanced gastric cancer. MATERIALS AND METHODS: Between November 2012 and December 2014, 77 patients with clinical T3 or higher gastric cancer were enrolled. The sensitivity, specificity, and concordance between the Shorr staining method and conventional Papanicolaou (Pap) staining with carcinoembryonic antigen (CEA) immunohistochemistry (IHC) were analyzed. RESULTS: Intraoperative PWC was performed laparoscopically in 69 patients (89.6%). The average time of the procedure was 8.3 minutes, and the average amount of aspirated fluids was 83.3 mL. The average time for Shorr staining and pathologic review was 21.0 minutes. Of the 77 patients, 16 (20.7%) had positive cytology and 7 (9.1%) showed atypical findings; sensitivity and specificity were 73.6% and 98.2% for the Shorr method, and 78.9% and 98.2% for the Pap method with CEA IHC, respectively. Concordance of diagnosis between the 2 methods was observed in 90.9% of cases (weighted κ statistic=0.875) and most disagreements in diagnoses occurred in atypical findings (6/7). In overall survival, there was no significant difference in C-index between the 2 methods (0.459 in Shorr method vs. 0.458 in Pap with CEA IHC method, P=0.987). CONCLUSIONS: Shorr staining could be a rapid and reliable method for intraoperative PWC in advanced gastric cancer.

Underweight prevalence among young adults from rural areas, Salin Towinship, Magwe Region.

Maintaining a normal body mass index (BMI) throughout the life-span of a person may reduce occurrence as well as the burden of non-communicable diseases (NCDs), in terms of years lived with disability and premature death. Lifestyle and socioeconomic factors like physical activity and availability of healthy or unhealthy food may contribute to both extremes of BMI, namely underweight and overweight/obesity. The aim of the present cross-sectional study was to estimate the prevalence of underweight and overweight/obesity and selected lifestyle factors in a cluster randomized sample of 335 young adults aged 18-35 years from rural communities residing at SalinTownship, Magwe Region. In addition, it also aims to investigate the association between selected socioeconomic and lifestyle factors with underweight. Data were collected by carrying out face to face interviews with the individuals selected in the sample in 2011 using semi-structured questionnaires and measuring of their weight and height. SPSS version 16 and STATA version 11 were used for data entry and analysis respectively. Based on WHO criteria, participants were classified according to their BMI into underweight (BMI < 18.5); normal weight (BMI 18.5 - 24.99); and overweight/obese (BMI > 25). Individuals with normal BMI was found in 72% (95% confi dence interval (CI): 67.1 - 77.0) and the prevalence of underweight was found in 28% (23.0 - 32.9). The majorities of respondents were illiterates, of monastic and primary schooling, and working as farmers and manual workers. Nearly 84% of the respondents were able to have 3 meals per day, and the same proportion consumed vegetables daily. The prevalence of current smokers was 11% and all were found to be males. Seventy-two percent were physically active on a daily basis. Out of these respondents, three-fourths of them were physically active at least two hours per day. A total of 64% reported to sleep during the day and 71% reported less than 8 hours of sleeping during the night. Logistical regression analysis showed that underweight was significantly associated with lower age as compared to higher age (OR = 0.54: CI 0.32 - 0.92). There was no significant association between sex, education, occupation and lifestyle factors.

Knowledge and perception towards Ebola virus disease among nursing students in University of Nursing, Yangon.

An analytical cross-sectional study of knowledge and perception towards Ebola Virus Disease (EVD) among nursing students was conducted in University of Nursing (UON), Yangon in October 2014. A total of 170 nursing students were interviewed. Subjects were selected by simple random sampling method and the survey was conducted using self-administered questionnaire.The general objective of the study was to find out the knowledge and perception towards Ebola Virus Disease among nursing students. The study showed that the nursing students have received general information about EVD via TV, radio, internet news and peer groups. The minimum knowledge score was 7 while maximum score was 40. It was observed that 54.7% of the respondents had good knowledge about Ebola disease and 45.3% had poor knowledge (Mean ± SD = 28.51 ± 5.144). Regarding perception about the disease, the minimum perception score was 32 while the maximum score was 48. Similar to what was found regarding knowledge about the disease, 55.3% had favorable perception and 44.7% had unfavorable perception towards EVD (Mean ± SD = 43.73 ± 3.645). The academic year was found to be associated with the knowledge level (p < 0.001) and also with the perception level (p = 0.033) of the respondents. Total years of service in the government sector was also found to be associated with a higher knowledge level of EVD (p = 0.040). A signifi cant association was also observed between knowledge level and perception level (p = 0.019). The study showed that there is an urgent need to improve knowledge and perception levels of the nurses regarding the epidemiology of EVD and prevention activities.

Knowledge, attitude and practice on safety measures against occupational hazards among constructional workers at Bayint Naung Bridge construction site in Yangon Region.

A cross sectional analytic study was carried out to assess the knowledge, attitude and practice on safety measures against occupational hazards and their inter-relationships, among Bayint Naung New Bridge Construction workers during 2014. Altogether 184 workers were selected by simple random sampling. Face to face interview method was used to collect the necessary data. Among respondents, only 4.3% (95% CI = 2%, 8.1%) had good knowledge, but all respondents had favorable attitude and 77.7% (95% CI = 71.3%, 83.3%) had good practice. There were statistically significant associations between age (P = 0.040), educational status (P = 0.001), type of work (P = 0.013), type of worker (P = 0.016), attending skill training (P = 0.002) and knowledge. However, no statistically significant associations were found between knowledge and attitude, knowledge and practice, attitude and practice of respondents on safety measures against occupational hazards. Although attitude and practice among workers are satisfactory, knowledge of respondents needs to be improved. The information gained from this study may be helpful in prevention against occupational hazards.

Hand washing and occurrence of diarrhoea and acute respiratory tract infection.

This cross-sectional study done in 2014 explored the hand-washing practice and its relation with the occurrence of acute diarrhoea and acute respiratory tract infection (ARI) among grades 9 and 10 students from No.1 Basic Education High School, North Okkalapa Township, Yangon Region. Altogether 380 students were selected: inclusive of 190 students from ninth grade and the same number of students from tenth grade by using multistage sampling procedure. Anonymous self-administered questionnaires were used in data collection. Results indicated that only 19.7% (95% CI = 15.9%, 24.1%) of students reported proper handwashing practices. The occurrence of acute diarrhoea and ARI among students within last three months were reported as 40.8% (95% CI = 35.9%, 45.8%) and 98.2% (95% CI = 96.2%, 99.2%), respectively. There were statistically significant associations between age (p = 0.002), gender (p =0.002), grade (p = 0.001), socio-economic status (p = 0.05) and practice of hand-washing. Moreover,proper hand-washing practice significantly influenced the occurrence of acute diarrhoea (p =0.001) and occurrence of ARI (p = 0.004) among students. Therefore, the enabling environment for hand-washing should be created for children at school as well as in their home settings. This may lead the children to adopt and sustain proper hand washing-practice in regular manner.

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.

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.

Health hazards, job satisfaction and quality of life of health professionals working at government hospitals in Mandalay City, Myanmar.

Health professionals play a vital role in improving and restoring health status of the community. Quality of care, patient safety and patient satisfaction depend on their performance. Job dissatisfaction, poor quality of life and they themselves being unhealthy have signifi cant impact on performance and commitment of health professionals. Therefore a cross-sectional study was conducted to determine health hazard, job satisfaction and quality of life of Myanmar health professionals during the period of February and March, 2014. Altogether 142 subjects (97 medical doctors and 45 nurses) working in government hospitals situated in Mandalay City were recruited after getting informed consent. This study found out that overall, very few health professionals were regular smokers (2.1%) and betel chewers (1.4%). There were no regular alcohol drinkers. However, among the male medical doctors12% and 8% were found to be regular smokers and betel nut chewers, respectively. Reading (58.5%) and watching movie (43.9%) are the most common recreational activities. About half (45.8%) of the subjects reported to have encountered injury either during an operation or while giving injections to patients. Such injury was reported in spite of 92.8% of all the respondents reporting to have followed universal safety precaution measures. In addition 67.6% reported that they did not have enough income and 21.1% reported not to be having adequate sleeping hours. In general 53% did not have job satisfaction. The reasons given for this were low salary (66.7%) and overwork (61.3%). However, most of the subjects (about 80%) fell into average levels of compassion satisfaction, burnout and secondary traumatic stress. Only 1% of the respondents were at low level of compassion satisfaction and high level of secondary traumatic stress. No respondent was at high level of burnout scale. Insuffi cient income was found to be major determinant of job satisfaction and quality of life of Myanmar health professionals (p < 0.01). There was significant relationship between job satisfaction and quality of life, especially burnout (p = 0.008). There is urgent need to address the problem of lacking job satisfaction through giving enough income and increasing manpower to reduce workload in hospitals. Strict adherence to universal precaution by health professionals should be reviewed and reinforced.

Infection control measures among interns / house surgeons in teaching hospitals under University of Medicine (1), Yangon.

Health care workers are responsible for prevention and control of communicable diseases in the hospital environment. This study aimed to focus on infection control measures among house officers. A cross-sectional descriptive study was conducted in 2010 at three teaching hospitals in Yangon City by introducing anonymous self-administered questionnaires to randomly selected 150 respondents. SPSS version 16.0 was used for analysis. Over half of the respondents had high knowledge and perception but the practice was poor. Infection control messages acquired through health talks, seminars and media were infl uencing factors on knowledge while training programs signifi cantly infl uenced both knowledge and perception. Senior house offi cers had significantly higher mean perception scores than their juniors (p=0.005). Their hand washing practice was signifi cantly infl uenced by newspapers and magazines (p=0.003) and poster and pamphlet(p=0.056). Compliance on utilization of surgical mask as a precautionary measure for airborne transmission was associated with knowledge (0.020), adequate supply in wards (p=0.001) and donation from medical product company (p=0.042). They bought gloves for handling infectious materials (p=0.000), and needle recapping practice before discarding was related to knowledge (p=0.05). Knowledge, perception and practice of house offi cers were interrelated to each other. Further education and training of house surgeons, resource allocation and continuous monitoringwere necessary for proper infection control and safe hospital environment.

Proper hand washing practice among mothers and occurrence of diarrhoea among family members.

A cross-sectional analytic study was done to determine the self-reported prevalence of proper hand washing practice among mothers and its relationship with the occurrence of diarrhoea among family members in Mandalay during 2011. Altogether 829 mothers (one from each household) from Chan-Aye-Tharzan and Mahar-Aung-Myay townships were selected by using systematic random sampling procedure. Face to face interview method was used to collect the necessary data. The prevalence of proper hand washing practice as reported among mothers was almost 80% (95% CI = 76.6%, 82.1%) but the occurrence of diarrhoea reported among her family members including herself within past one year was 18.2% (95% CI = 15.7%, 20.9%). Family income (p = 0.006) and education status (p = 0.048) were found to have significant effects on reported practices of proper hand washing. Moreover, proper hand washing practice by mothers was found to have significant effect on the occurrence of diarrhoea among all family members including herself (p < 0.001). It was apparent that if the mother washed her hands properly, the annual occurrence of diarrhoea would be reduced among the whole family (48% of current occurrence), among other family members (53%) and herself (50%). Although proper hand washing practice among mothers is satisfactory, habit of this hygienic behavior should be promoted in the whole country to prevent episodes of diarrhoea especially giving priority to low income households and mothers with low education status.

Selected health-risk behaviors among middle and high school students in Chan-Aye-Tharzan township of Mandalay city and their determinants.

A cross-sectional study was done during 2010 to determine the self-reported prevalence of health-risk behaviors such as smoking, alcohol drinking and betel chewing among young students in Mandalay and examine their determinants. Six hundred students from grade six to eleven from a randomly selected Basic Education High School were recruited into the study by systematic random sampling. Data were collected by anonymous self-administered questionnaire and were analyzed by SPSS version 17.0 software. The prevalence of current smoking, alcohol drinking and betel chewing habits among middle and high school students were 2.3%, 1.2% and 6.7% respectively. Those who reported ever smoking, drinking and betel chewing were 5.7%, 3% and 10.3% respectively. The mean ages of initiating smoking, alcohol drinking and betel chewing were 13.1, 14.3 and 13.2 years respectively. These health-risk behaviors were significantly associated not only with students’ characteristics such as age (p < 0.001), sex (p < 0.001) and education level or grade (p < 0.001) but also among each other (p < 0.001). The students whose fathers smoked were more likely to report smoking (p = 0.052). Similarly, drinking (p = 0.004) and betel chewing (p = 0.005) habits of students were significantly associated with similar behaviors of their fathers. This study created the composite variable reflecting the concurrent multiple health-risk behaviors based on the smoking, drinking and betel chewing habits of fathers. The greater the number of risk behaviors of fathers, the more likely the students to become smokers (p < 0.001), drinkers (p = 0.024), and betel chewers (p = 0.002). If their fathers were currently unemployed, school children were more likely to be smokers (p = 0.002) and betel chewers (p = 0.012). Although the prevalence of smoking and drinking among high school students in Chan-Aye-Tharzan township, Mandalay were lower than that of neighboring countries, the existing tobacco and alcohol control programs require intensification to reduce the extent of health-risk behaviors. Fathers seemed to play a vital role in controlling these health-risk behaviors of students that posed threat to their health. Therefore, fathers should be encouraged to join the effective risk reduction program of high school students to avoid smoking, alcohol drinking and betel chewing.

Metabolic Syndrome in obese and normal weight Myanmar children / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#To estimate the frequency of Metabolic Syndrome (MS in Myanmar obese children and to determine the risk factors associated with MS in obese children comparing with normal weight children. @*Methodology@#A cross-sectional study was conducted to compare the risk factors for metabolic syndrome between normal and obese children by using the pediatric definition for metabolic syndrome [International Diabetes Federation (IDF), 2007]. Twenty-three obese children (BMI, ≥ 97th percentile) and 23 normal weight children (BMI, < 85th percentile) aged 5-12 years were included in the study. Blood pressure, body weight, height, waist circumference (WC), fasting triglycerides, HDL-cholesterol, total cholesterol and glucose concentrations were determined. @*Results@#Based on the IDF pediatric criteria, 9 obese children (39.1%) had metabolic syndrome while no normal weight child had metabolic syndrome. Ten (43.5%) normal weight children and 3 (13.0%) obese children had at least one risk factor for the metabolic syndrome. Central obesity (WC ³ 90th percentile for age and sex), the most common risk factor, was observed in 25 children (54.4% of the total population). @*Conclusion@#This study highlights the need for early recognition of risk factors for metabolic syndrome in all children to halt the progression of type 2 diabetes and cardiovascular diseases (CVD) in later life.

The use of parasite lactate dehydrogenase isoenzyme-based visual test for the speciation of Plasmodium Falciparum and Plasmodium vivax infections

Parasite specific lactate dehydrogenase (LDH) isoenzyme coated OptiMAL test strips were used to diagnose Plasmodium falciparum and p. vivax infections in one hundred clinically suspected malaria patients attending the Clinical Research Unit for Malaria, Defence Services General Hospital, Mingaladon during May to September 1999. Traditional microscopic examination was carried out in parallet to observe the sensitivity and specificity of the LDH-based OptiMAL test. the interpretation of the results by LDH-based test strips took only five minutes, whereas microscopic examination took thrity minutes. The sensitivities and specificities of pLDH-based OptiMAL test were 89.47 per cent and 100.0 per cent for P. falciparum; 100.0 per cent and 96.43 per cent for P.vivax respectively. Due to the rapid detection and speciation, prompt treatment was made without any delay.

A study on knowledge regarding HIV/AIDS, opinon on prevalence of HIV infection in the locality and sexual practice among trishawmen in Mandalay

Myanmar Medical Association (Mandalay Branch), general Practitioners'Section Myanmar Medical Association/Japan/s Grass Root Grant Assistance cosponsored an Anti HIV/AIDS project in Mandalay for fifteen months, conducted by General Practitioners' Section of Myanmar Medical Association (Mandalay Branch), the projection being 20,000 persons belonging to four high risk groups. Trishawmen of five townships in Mandalay were one of these high risk groups. Out of them 111 were randomly selected for a cross-sectional study. This study covered their educational status, their knowledge, attitude, practice and behaviour regarding HIV/AIDS, condom usage and sexual exposure to commercial sex workers which will be reported in details.