Ethnobotanical surveys reveal the crucial role of medicinal plants in the primary healthcare system of the Shan people in Myanmar.

ETHNOPHARMACOLOGICAL RELEVANCE: The Shan people of Myanmar live under conditions of longtime social instability and public medical resources inadequate, which tend to strengthen the reliance on local traditional primary healthcare system. The documentation of this kind of resource, however, was rarely and inadequate to support any kind of dynamic trend evaluation. Being an ethnobotanical study, we conducted field survey in the Southern Shan State of Myanmar and aimed to 1) document the local plant species that adopted for primary healthcare purpose, 2) clarify how these species collectively address the broad range of primary medication needs for local people, and 3) lay foundation for dynamic trend evaluation of the role of local medicinal plants under this kind of social and cultural context. MATERIAL AND METHODS: Field surveys were conducted with 124 informants in eight villages. We collected 1259 use reports and documented all the plant species used for treating all the mentioned ailment types. The ailments were translated into their emic meaning and then classified into common disease categories. The top ranked and newly recorded plants or ailment types were analyzed based on historical records from the region. RESULTS: Totally 156 plant species were used for treating 91 ailments belonging to 16 disease categories, with skin problems and digestive tract were the top cited diseases, and with Fabaceae and Lamiaceae were the top cited plant families. A total of 19 newly recorded plant species were suggested as new member of Myanmar medicinal plant list. Besides, we filled the gaps (for 24 species) and enriched the types (for 83 species) of applicable ailments for known Myanmar medicinal plants. CONCLUSION: Our study revealed that the Shan people in Southern Shan State used rich plant species for various therapeutic purposes. Our findings indicate the crucial role of local plant resources for local people's primary healthcare needs and support further study about cultural or regional comparation or historical dynamic trend of the medicinal plants uses in areas facing longtime official or public medical resource inadequate.

Overexpression of microRNA-205-5p promotes cholangiocarcinoma growth by reducing expression of homeodomain-interacting protein kinase 3.

The microRNA miR-205-5p has diverse effects in different malignancies, including cholangiocarcinoma (CCA), but its effects on CCA progression is unclear. Here we investigated the role and function of miR-205-5p in CCA. Three CCA cell lines and human serum samples were found to have much higher expression levels of miR-205-5p than seen in typical cholangiocyte cell lines and healthy controls. Inhibition of miR-205-5p suppressed CCA cell motility, invasion and proliferation of KKU-213B whereby overexpression of miR-205-5p promoted cell proliferation and motility of KKU-100 cells. Bioinformatics tools (miRDB, TargetScan, miRWalk, and GEPIA) all predicted various miR-205-5p targets. Experiments using miR-205-5p inhibitor and mimic indicated that homeodomain-interacting protein kinase 3 (HIPK3) was a potential direct target of miR-205-5p. Overexpression of HIPK3 using HIPK3 plasmid cloning DNA suppressed migration and proliferation of KKU-100 cells. Notably, HIPK3 expression was lower in human CCA tissues than in normal adjacent tissues. High HIPK3 expression was significantly associated with longer survival time of CCA patients. Multivariate regression analysis indicated tissue HIPK3 levels as an independent prognostic factor for CCA patients. These findings indicate that overexpression of miR-205-5p promotes CCA cells proliferation and migration partly via HIPK3-dependent way. Therefore, targeting miR-205-5p may be a potential treatment approach for CCA.

Lower Plasma Selenoprotein P Levels in Regularly Exercising Young Adults.

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.

Seroprevalence and associated risk factors of Toxoplasma gondii infection among slaughterhouse workers in Yangon Region, Myanmar: A cross-sectional study.

BACKGROUND: Toxoplasmosis, having the significant consequences affecting mortality and quality of life, is still prevalent in various places throughout the world. The major gap in surveillance for Toxoplasma gondii infection among high-risk population, slaughterhouse workers, is an obstacle for the effective policies formulation to reduce the burden of toxoplasmosis in Myanmar. Therefore, this study aimed to assess the seroprevalence of toxoplasmosis and associated factors of seropositivity among slaughterhouse workers in Yangon Region, Myanmar. METHODS: A cross-sectional study that was conducted from June to November 2020 included 139 slaughterhouse workers involving at five main slaughterhouses under Yangon City Development Committee, Myanmar. The presence of IgG and IgM anti-T. gondii antibodies in serum was detected using the OnSite Toxo IgG/IgM Combo Rapid Test. A face-to-face interview was also performed using pretested structured questionnaires to obtain the detail histories: sociodemographic characteristics, level of knowledge, occupational factors, and environmental factors related to T. gondii infection. Bivariate logistic regression was used to determine the factors associated with T. gondii infection. RESULTS: Of all participants, the overall seroprevalence of anti-T. gondii was 43.9% (95% CI: 35.5-52.5%), of whom 98.4% (95% CI: 91.2-100.0%) were reactive only for IgG antibody and 1.6% (95% CI: 0.0-8.8%) were reactive for IgG and IgM antibodies. The significant factors associated with the seropositivity of T. gondii antibodies were blood transfusion history (OR: 5.74, 95% CI: 1.17-28.09), low level of knowledge (OR: 2.91, 95% CI: 1.46-5.83), contact with animal organs, muscles or blood (OR: 14.29, 95% CI: 1.83-111.51), and animals most frequently slaughtered (cattle) (OR: 3.22, 95% CI: 1.16-8.93). CONCLUSIONS: A high seroprevalence of toxoplasmosis was detected among slaughterhouse workers in Yangon Region and it raises a significant public health concern. Therefore, providing health education regarding toxoplasmosis, enforcement of personal hygiene practices in workplaces, the establishment of training for occupational hygiene, and commencement of the risk assessment and serological screening for toxoplasmosis are crucial to curtail the prevalence of T. gondii infection among slaughterhouse workers.

Validation of MyDiagnostick tool to identify atrial fibrillation in a multi-ethnic Asian population.

Introduction: MyDiagnostick is an atrial fibrillation (AF) screening tool that has been validated in the Caucasian population in the primary care setting. Methods: In our study, we compared MyDiagnostick with manual pulse check for AF screening in the community setting. Results: In our cohort of 671 candidates from a multi-ethnic Asian population, AF prevalence was found to be 1.78%. Of 12 candidates, 6 (50.0%) had a previous history of AF and another 6 (50.0%) were newly diagnosed with AF. Candidates found to have AF during the screening were older (72.0 ± 11.7 years vs. 56.0 ± 13.0 years, P < 0.0001) and had a higher CHADSVASC risk score (2.9 ± 1.5 vs. 1.5 ± 1.1, P = 0.0001). MyDiagnostick had a sensitivity of 100.0% and a specificity of 96.2%. In comparison, manual pulse check had a sensitivity of 83.3% and a specificity of 98.9%. Conclusion: MyDiagnostick is a simple AF screening device that can be reliably used by non-specialist professionals in the community setting. Its sensitivity and specificity are comparable and validated across various studies performed in different population cohorts.

Co-occurrence of behavioural risk factors for non-communicable diseases among 40-year and above aged community members in three regions of Myanmar.

Background: Risky behaviours such as smoking, alcohol consumption, physical inactivity and inadequate consumption of fruits and vegetables are known contributing factors for non-communicable diseases (NCDs) which account for 74% of global mortality. Such behavioural risk factors co-occur frequently resulting in synergistic action for developing NCD related morbidity and mortality. This study aims to assess the existence of multiple risk behaviours and determine the socio-economic and demographic factors associated with co-occurrence of behavioural risks among Myanmar adult population. Method: Data were collected, in the context of the SUNI-SEA project (Scaling Up NCD interventions in Southeast Asia), from 660 community members aged 40 years and above of both sexes, residing in selected urban and rural areas from Ayeyawaddy, Yangon and Mandalay regions of Myanmar. The co-occurrence of behavioural risk factors was presented as percentage with 95% CI and its determinants were identified by multinomial logistic regression. Results: The co-occurrence of two risk behaviours and three or four risk behaviours were found in 40% (95% CI: 36.2%, 43.9%) and 10.8% (95% CI: 8.5%, 13.4%) respectively. Urban residents, men, participants without formal schooling and unemployed persons were more likely to exhibit co-occurrence of two risk behaviors and three or four risk behaviours. Conclusion: The current study shows high prevalence of co-occurrence of behavioural risk factors among Myanmar adults in the study area. NCD prevention and control programs emphasizing management of behavioural risks should be intensively promoted, particularly directed towards multiple behavioural risk factors, and not focused on individual factors only.

Risky behaviours such as smoking, alcohol consumption, physical inactivity and inadequate consumption of fruits and vegetables are known contributing factors for non-communicable diseases (NCDs) which account for 74% of global mortality. Such behavioural risk factors co-occur frequently resulting in synergistic action for developing NCD related morbidity and mortality. This study aims to assess the existence of multiple risk behaviours and determine the socio-economic and demographic factors associated with co-occurrence of behavioural risks among the Myanmar adult population. Data were collected from 660 community members aged 40 years and above of both sexes, residing in selected urban and rural areas from Ayeyawaddy, Yangon and Mandalay Regions of Myanmar. The current study shows substantial proportion of study adults had co-occurrence of behavioural risk factors (at least two risk factors), contributing to 50.8%. Urban residents, men, participants without formal schooling and unemployed persons were more likely to present co-occurrence of two risk behaviors and three or four risk behaviours, compared with their counterparts. Based on the study findings, the research team highly recommends that NCD prevention and control programs emphasizing management of behavioural risks should be intensively promoted, particularly directed towards multiple behavioural risk factors, and not focused on single risk factor only.

Continuum of care of mothers and immunization status of their children: A secondary analysis of 2015-2016 Myanmar Demographic and Health Survey.

Objective: To assess the association between the continuum of care of mothers and the immunization status of their 12-23 months old children. Study design: A secondary data analysis using the Myanmar Demographic and Health Survey (2015-16) data, a cross-sectional, household-based, nationally representative survey conducted during 2015-2016. Methods: We included 1669 pairs of mothers and their children in this analysis. We categorized the children into fully immunized and no/not fully immunized children and define a continuum of care (CoC) of the mother if women received antenatal care ≥ four times, delivered with skilled birth attendances, and received postnatal care within 48 h after delivery. We used the multivariable binary logistics regression using STATA version 15.1 with the survey command (svy) and reported the results by adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: The mother's CoC prevalence was 42.5%, and that of fully immunized children was 33.5%. However, only one-fifth of mothers and their children received the continuum of care services altogether. The children of mothers who received CoC were more likely to be fully vaccinated than those who did not (aOR = 1.60, 95%CI: 1.21, 2.13, P < 0.001). The child's birth order, employment status, and wealth status of the households are independent predictors of the full immunization of children. Conclusions: We concluded that receiving the CoC in mothers influenced their children's vaccination status. Hence, integrating maternal health programs and immunization programs is essential to achieving sustainable development goals in Myanmar.

An Unusual Presentation of Adrenocortical Carcinoma (ACC): Panic Attacks and Psychosis.

BACKGROUND Adrenocortical carcinoma (ACC) is a very rare disease, with an incidence of 1.02 per million population per year. The most commonly secreted hormone in ACC is cortisol, often presenting as a rapidly progressive Cushing syndrome (CS). We describe a case of ACC with an unusual presentation, mainly with psychiatric manifestations, including panic attacks and hallucinations. CASE REPORT A 52-year-old woman presented with episodes of acute anxiety, hallucinations, palpitations, hot flashes, gastrointestinal upset associated with paroxysmal hypertension, tachycardia, and flushing for 1 week. The initial workup was aimed at ruling out causes of acute psychosis and/or anxiety such as substance use, and organic diseases such as pheochromocytoma (PCC). Our initial suspicion of PCC was ruled out based on the negative serum and urinary metanephrines (MN) and normetanephrines (NMN). Recurrent metabolic alkalosis and hypokalemia despite fluid and potassium supplementation prompted us to work up for hyperaldosteronism. Her renin level was elevated and the aldosterone level was appropriately suppressed. Elevated cortisol, positive dexamethasone (DXM) suppression test, low adrenocorticotropic hormone (ACTH), imaging revealing an adrenal mass, and postoperative histology confirmed the diagnosis of cortisol-producing ACC. CONCLUSIONS It is essential to recognize psychiatric presentations of CS to achieve early diagnosis and prevent mortality and morbidity. Panic attacks, a common presentation of CS, can present with features mimicking pheochromocytoma (PCC), including palpitations, sweating, tachycardia, and paroxysmal hypertension. A comprehensive workup is warranted to reach a diagnosis, with a combination of hormonal levels, imaging, and histology.

Dissecting the roles of Haspin and VRK1 in histone H3 phosphorylation during mitosis.

Protein kinases that phosphorylate histones are ideally-placed to influence the behavior of chromosomes during cell division. Indeed, a number of conserved histone phosphorylation events occur prominently during mitosis and meiosis in most eukaryotes, including on histone H3 at threonine-3 (H3T3ph). At least two kinases, Haspin and VRK1 (NHK-1/ballchen in Drosophila), have been proposed to carry out this modification. Phosphorylation of H3 by Haspin has defined roles in mitosis, but the significance of VRK1 activity towards histones in dividing cells has been unclear. Here, using in vitro kinase assays, KiPIK screening, RNA interference, and CRISPR/Cas9 approaches, we were unable to substantiate a direct role for VRK1, or its paralogue VRK2, in the phosphorylation of threonine-3 or serine-10 of Histone H3 in mitosis, although loss of VRK1 did slow cell proliferation. We conclude that the role of VRKs, and their more recently identified association with neuromuscular disease and importance in cancers of the nervous system, are unlikely to involve mitotic histone kinase activity. In contrast, Haspin is required to generate H3T3ph during mitosis.

Residual malaria among migrant workers in Myanmar: why still persistent and how to eliminate it?

BACKGROUND: Residual malaria is probably an important source for the re-emergence of malaria infection in the elimination era. Assessment to identify the factors influencing residual malaria in high-risk groups is needed to develop evidence-based decisions by stakeholders and policymakers. METHODS: This study was conducted to explore the factors influencing the residual malaria infection among migrant workers in two sentinel sites (endemic vs. pre-elimination areas) in Myanmar using the mixed-model method. RESULTS: A total of 102 migrant respondents (65 in Bamauk and 37 in Shwegyin) were included for the quantitative assessment using pretested questionnaires during household visits. Although 87.3% of them had insecticidal bed nets (ITNs/LLINs), only 68.3% of the migrants in Bamauk and 57.9% in Shwegyin used it regularly. The use of any bed net was high (79.9% in Bamauk vs. 91.0% in Shwegyin). The mean LLINs in their families were 1.64 (95%CI: 1.48-1.81) in Bamauk and 2.89 (95%CI: 2.67-3.11) in Shwegyin. Most of them received no health information for malaria prevention within the last year and their knowledge about malaria was low. Their working nature was a challenge for control measures against malaria in migrants. CONCLUSION: The strategy for distributing LLINs and health promotion activities for mobile/migrant populations should be reviewed, and an appropriate action plan should be developed for the specific migrant group. Moreover, health promotion activities for behavior change communication should be strengthened in the migrant population in Myanmar.

Evaluation on Antidiabetic Properties of Medicinal Plants from Myanmar.

OBJECTIVES: To explore the effective and safe medicines for treating diabetes. METHODS: Hydroalcoholic extracts of 130 medicinal plants belonging to 66 families were evaluated using porcine pancreatic lipase (PPL) inhibition and glucose uptake methods together with a literature review. RESULTS: The extracts of 22 species showed the PPL inhibition activity; 18 extracts of 15 species stimulated glucose uptake in 3T3-L1 adipocytes. Among them, Mansonia gagei J.R. Drumm., Mesua ferrea L., and Centella asiatica (L.) Urb. exhibited both activities. The extracts of Caladium lindenii (André) Madison rhizomes and Azadirachta indica A. Juss. leaves presented the utmost lipase inhibitory activity with IC50 of 6.86 ± 0.25 and 11.46 ± 0.06 µg/mL, respectively. The extracts of Coptis teeta Wall. rhizomes and Croton tiglium L. seeds stimulated the maximum glucose uptake. Ten species are reported to have antidiabetic activity for the first time. Flavonoids and triterpenoids are the dominant antidiabetic compounds in selected medicinal plants from Myanmar. CONCLUSIONS: P. zeylanica, L. cubeba, H. crenulate, M. gagei, C. teeta, and M. ferrea are worthy to advance further study according to their strong antidiabetic activities and limited research on effects in in vivo animal studies, unclear chemical constitutes, and safety.

Antihypersensitivity effect of betanin (red beetroot extract) via modulation of microglial activation in a mouse model of neuropathic pain.

BACKGROUND: Neuropathic pain (NeP) medications have several side effects that affect NeP patients' quality of life. Betanin, the most common betacyanin pigment, has been shown to have potent antioxidant and anti-inflammatory properties in vivo; thus, it has potential as a healthcare treatment. In this study, we focused on betanin (red beetroot extract) as a potential therapy for NeP. METHODS: Mice model of NeP were made by chronic constriction injury (CCI), and the development of mechanical hypersensitivity was confirmed using the von Frey test. Motor coordination and locomotor activity were assessed using open field tests and rotarod tests, respectively. The expression level of glial markers in the spinal cords was analyzed by immunostaining. The direct effects of betanin on microglial cells were investigated using primary cultured microglial cells. RESULTS: In CCI model mice, repeated betanin treatment, both intraperitoneally and orally, attenuated developing mechanical hypersensitivity in a dose-dependent manner without impairing motor coordination. Betanin treatment also attenuated mechanical hypersensitivity that had developed and prevented the onset of mechanical hypersensitivity in CCI mice. Microglial activation in the spinal cord is known to play a key role in the development of NeP; betanin treatment reduced CCI-induced microglial activation in the spinal cord of model mice. Moreover, in primary microglia cultured cells, the activation of microglia by lipopolysaccharide application was suppressed by betanin treatment. CONCLUSION: Betanin treatment appears to ameliorate mechanical hypersensitivity related to CCI-induced NeP in mice by inhibiting microglial activation. SIGNIFICANCE: This article supports findings of the effect of betanin on NeP and provides a potential therapeutic candidate for NeP. Furthermore, elucidating the underlying mechanism of the effect of betanin on microglial activation could assist the development of new treatments for chronic pain.

An electrochemical sensor based on gold nanoparticles-functionalized reduced graphene oxide screen printed electrode for the detection of pyocyanin biomarker in Pseudomonas aeruginosa infection.

Multidrug resistant Pseudomonas aeruginosa (P. aeruginosa) is known to be a problematic bacterium for being a major cause of opportunistic and nosocomial infections. In this study, reduced graphene oxide decorated with gold nanoparticles (AuNPs/rGO) was utilized as a new sensing material for a fast and direct electrochemical detection of pyocyanin as a biomarker of P. aeruginosa infections. Under optimal condition, the developed electrochemical pyocyanin sensor exhibited a good linear range for the determination of pyocyanin in phosphate-buffered saline (PBS), human saliva and urine at a clinically relevant concentration range of 1-100 µM, achieving a detection limit of 0.27 µM, 1.34 µM, and 2.3 µM, respectively. Our developed sensor demonstrated good selectivity towards pyocyanin in the presence of interfering molecule such as ascorbic acid, uric acid, NADH, glucose, and acetylsalicylic acid, which are commonly found in human fluids. Furthermore, the developed sensor was able to discriminate the signal with and without the presence of pyocyanin directly in P. aeruginosa culture. This proposed technique demonstrates its potential application in monitoring the presence of P. aeruginosa infection in patients.

The secret of health in daily cuisine: typical healthy vegetables in local markets in central Myanmar.

BACKGROUND: Central Myanmar is located in the Indo-Burma biodiversity hotspot, and the Bamar people are the main ethnic group, which settled there over 1000 years ago. Despite being the core region of the country, central Myanmar has been ignored in previous ethnobotanical studies. Local healthy foods and knowledge are regarded as treasures for resource development and pharmaceutical drug discovery, and market surveys are a good strategy in ethnobotanical research. Thus, we collected and documented typical vegetables and local knowledge in local markets and then analysed the diversity and local knowledge of these vegetables. MATERIALS AND METHODS: Observations and interviews were used in the field study, and 10 markets and fairs were selected in central Myanmar. A total of 277 vegetable stalls or shops were visited. We compared the local knowledge we collected with selected important and typical herbal books on traditional Myanmar medicine. Quantitative analysis, including frequency of citation (FC), relative frequency of citation (RFC) and use value (UV), was used to assess the diversity and local knowledge of these vegetables. RESULTS: A total of 132 plant taxa from 47 botanical families and 116 genera were collected. Most (106 taxa, 80.3%) of these vegetables were cited by the informants as functional foods that had health benefits, while others were regarded as merely "good for health". The main health function of the vegetables was treating digestive problems. Sixty-four species were recorded in selected herbal books on traditional Myanmar medicine, and forty-seven taxa were not recorded in these books but were nonetheless used as healthy vegetables by local people. Twenty-eight species of vegetables were collected from wild places. CONCLUSION: The diversity and local knowledge of healthy vegetables in central Myanmar were rich. Nevertheless, the diversity of wild vegetables was seemingly relatively low. The possible reason was that we counted only the vegetables that were from entirely wild sources as "wild vegetables". The most frequently cited vegetables were commonly cultivated species, which reflects the fact that plants cultivated on a large scale comprise the major source of vegetables. Some lesser known vegetables could reflect the unique food culture of local people, but most of these were cited only a few times by the interviewees, which caused low UV and RFC rankings for them in the league table. In addition, future research should pay more attention to the food safety of these vegetables.

Pyrazinamide resistance and pncA mutations in drug resistant Mycobacterium tuberculosis clinical isolates from Myanmar.

Pyrazinamide (PZA) is an important anti-tuberculosis drug, which is active against semi-dormant bacilli and used as a component of first-line drugs and drug-resistant tuberculosis regimens. Mutations in pncA and its promoter region are main cause of PZA resistance. There are limited PZA susceptibility data as there is no routine drug susceptibility testing (DST) for PZA. This study was aimed to determine the proportion of PZA resistance among rifampicin-resistant tuberculosis patients and to identify mutations which are responsible for PZA resistance in pncA and its promoter region. Liquid-based DST was performed to detect PZA susceptibility on 192 culture positive rifampicin-resistant isolates collected from National Tuberculosis Reference Laboratory. Sequencing on pncA including its promoter region was performed and analysis was done on 157 isolates. Phenotypic PZA resistance was detected in 58.9% of isolates. Sixty-five different mutations were distributed in pncA or promoter region of 82 isolates. Sensitivity and specificity of pncA sequencing in detection of PZA resistance showed 89.8% and 95.6% respectively. High proportion of PZA resistance among rifampicin-resistant cases highlighted the need for effective treatment regimen development for PZA-resistant MDR-TB. It is also suggested that routine PZA susceptibility test should be incorporated to treatment monitoring regimen and National Drug Resistance surveys.

The uses of fig (Ficus) by five ethnic minority communities in Southern Shan State, Myanmar.

BACKGROUND: Most regions of Myanmar fall within the Indo-Burma Biodiversity Hotspot and are threatened with biodiversity loss. Development of a comprehensive framework for sustainable development is crucial. Figs are ecological keystone species within these regions and are also important for traditional spiritual food and health uses, which often have accompanying conservation practices. The traditional use and management of figs may offer clues to help guide the development of national policies for sustainable development. In this study, we showcase the rich ethnobotanical knowledge as well as the variety of collection and conservation practices of figs among five ethnic groups in Southern Shan State. METHODS: We performed both key informant and semi-structured interviews with 114 informants from five ethnic groups. Their uses for figs were categorized according to local practices and recipes. Informants were asked about trends in conservation status over the past 10 years and any conservation-related customs and practices. Data were analyzed quantitatively with common quantitative ethnobotany indices, the use report (UR) and use value (UV). RESULTS: Informants reported the uses of eight fig species (Ficus auricularta, F. concinna, F. geniculata, F. hispida, F. racemosa, F. religiosa, F. semicordata, and F. virens). F. geniculata and F. virens were most useful (UR = 228) and were used by all five ethnic groups, corresponding to a high use value (UV = 2). Treatments for 16 diseases were reported from seven species. Household consumption, economic and sacred uses were accompanied by sustainable practices of harvest and protection. Traditional taboos, in situ and ex situ conservation were common especially for highly demanded species (F. geniculata and F. virens) and the sacred fig F. religiosa. CONCLUSION: Findings suggest that figs are useful for food (all informants) and medicine (13.16% of the informants) in the study area. Traditional taboos, in situ and ex situ conservation practices help to maintain sustainable utilization of locally important figs. This is an early contribution to the traditional knowledge of edible figs. Although similar uses have been reported in neighboring countries for seven of the fig species, the ethnobotanical use of F. concinna is novel.

Geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar.

BACKGROUND: Diagnosis by computed tomography (CT) and magnetic resonance imaging (MRI) is important for patient care. However, the geographic distribution and utilisation of these machines in countries with limited resources, such as Myanmar, have not been sufficiently studied. Therefore, this study aims to identify the geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar. METHODS: This nationwide, cross-sectional study was conducted at 43 public hospitals in Myanmar. Data were collected retrospectively using a prepared form from 1st January 2015 to 31st December 2017 at public hospitals in Myanmar. A descriptive analysis was performed to calculate the number of CT and MRI units per million population in each state and region of Myanmar. The distribution of CT and MRI units was assessed using the Lorenz curve and Gini coefficient, which are indicators of inequality in distribution. RESULTS: In total, 45 CT and 14 MRI units had been installed in public hospitals in Myanmar by 2017. In total, 205,570 CT examinations and 18,981 MRI examinations have been performed within the study period. CT units per million population in 2017 varied from 0.30 in Rakhine State to 3.22 in Kayah State. However, MRI units were available only in public hospitals in five states/regions. The Gini coefficient for CT and MRI was 0.35 and 0.69, respectively. An upward trend in the utilisation rate of CT and MRI was also observed during the study period, especially among patients aged between 36 and 65 years. CONCLUSIONS: Throughout Myanmar, CT units were more equally distributed than MRI units. CT and MRI units were mostly concentrated in the Yangon and Mandalay Regions, where the population density is higher. The geographic distribution and utilisation rate of CT and MRI units varied among states, regions, and patients' age group. However, the utilisation rates of CT and MRI increased annually in all states and regions during the review period. The Ministry of Health and Sports in Myanmar should consider the utilisation and population coverage of CT and MRI as an important factor when there will be procurement of those medical equipment in the future.