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.

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.

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.

Summary of the clinical practice guidelines for diabetes mellitus in pregnancy in Myanmar / Journal of the ASEAN Federation of Endocrine Societies

@#The aims of the Myanmar CPG for Diabetes in Pregnancy were to provide a framework to assist healthcare professionals in the management of diabetes in pregnancy and to aid primary care physicians in referrals to specialists, when necessary, in an appropriate manner. This article summarizes clinical practice guidelines developed for assisting Myanmar healthcare providers (physicians, endocrinologists, obstetricians, general practitioners) to better diagnose and effectively manage diabetes in pregnancy. It recommends a multidisciplinary approach in the management of diabetes in pregnancy in Myanmar.

The phytohemagglutinin (PHA)-induced peripheral lymphocyte blastogenic response in cancer patients

The in vitro blastogenic response of peripheral bolld lymphocytes was determined in 50 patients with various types of malignancies by quantitation of phytohaemagglutinin PHA-induced tritiated thymidine uptake. PHA-induced blastogenic response was impaired in patients with malignancy more so in patients with squamous cell carcinoma in whom there was an inverse correlation with the stage of the tumor and the reduction. No correlation was seen in patients with adenocarcinoma, lymphoma or sarcoma. these data indicate that PHA-induced blastogenic respoonse is a potentially useful assay for the detection of immunocompromized persons especially in patients suffering from squamous cell carcinoma.

The peripheral lymphocyte mitogenic responses of apparently healthy Myanmar blood donors

The responses of peripheral lymphocytes to mitogens namely, phytohemagglutinin (PHA) and lipopolysaccharide (LPS) were determined in 50 apparently healthy blood donors. The stimulation indexes of PHA and LPS of male and female donos were calculated. Though there was a singificant difference (p < 0.001) between the sexes to PHA response, no significant difference was found in LPS response. Also the mitogen responses had no correlation with the age and the number of T and B lymphocytes in the peripheral blood.

Immunophenotyping of acute leukaemia

Immunophenotyping of peripheral blood mononuclear cells from 36 patients (Male 23, female 13; age range 3-80 yrs) newly diagnosed as acute leukaemia were done during May 1991 to November 1992. All cases were diagnosed as acute leukaemias based on clinical features and peripheral blood and bone marrow findings under light microscopy. Using the indirect immunofluorescent method immunophenotypes of the leukaemic blasts were identified on peripheral blood mononuclear cells using monoclonal antibodies (CD13 as myeloid marker; CD3, CD10 and CD19 as lymphoid markers). Out of 36 patients, 19 were myeloid and 14 were lymphoid leukaemias and 3 were non-reactive with monoclonals used. The study showed a significant positive correlation between morphological diagnosis and immunophenotyping. It had established the diagnosis in 3 cases where morphology alone was unable to do it. Discrepancy between morphological diagnosis and immunophenoltyping was observed in 4 cases. The present study showed that it will be of great diagnostic as well as therapeutic value if an appropriate and wider panel of monoclonal antibodies can be used.