"Risk factors for tuberculosis among close IGRA-negative contacts of persons with infectious tuberculosis in Singapore".

BACKGROUND: Contacts of infectious TB cases testing positive on Interferon-Gamma Release Assay (IGRA) are followed up to exclude active disease. However, factors that predispose IGRA-negative contacts to TB could improve screening and follow-up strategies in a medium TB burden country like Singapore. METHODS: We conducted a retrospective study of IGRA-negative contacts aged ≥2 years identified during contact investigation between January 2014 and December 2022. We examined the risk factors associated with developing active TB among contacts previously testing IGRA-negative, using univariate and multivariable logistic regression and odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Of 60,377 IGRA-negative contacts, 150 developed TB disease and half were notified within 23 months of index diagnosis. IGRA-negative contacts of a smear-positive index were more likely to develop TB. Independent risk factors for TB were being over 50, Malay, having Diabetes or End-Stage Renal Failure, a "family" relationship with the index or exposure in a dormitory or nursing home. CONCLUSION: Certain risk factors could help optimize follow-up strategies and preventive treatment in IGRA-negative individuals. The incidence of TB in this group was 150/100,000 population, substantially higher than in the community, with a median 92 weeks to develop disease. Findings suggest that follow-up be extended to 24 months for contacts with these risk factors.

The yield of tuberculosis contact investigation on relapsed TB patients and analysis of associated risk factors: Singapore's experience.

The yield of contact investigation on relapsed tuberculosis (TB) cases can guide strategies and resource allocation in the TB control programme. We conducted a retrospective cohort study to review the yield of contact investigation in relapsed TB cases and identify factors associated with TB infection (TBI) among close contacts of relapsed TB cases notified between 2018 and 2022 in Singapore. TB infection positivity was higher among contacts of relapsed cases which were culture-positive for Mycobacterium tuberculosis complex compared to those who were only polymerase chain reaction (PCR)-positive (14.8% vs. 12.3%). On multivariate analysis, after adjusting for age and gender of the index, gender, and existing comorbidities of contacts, factors independently associated with TBI were culture and smear positivity of the index (AOR 1.41, 95%CI 1.02-1.94), higher odds with every 10 years of increase in age compared to contacts below aged 30, contacts who were not Singapore residents (AOR 2.09, 95%CI 1.46-2.97), and household contacts (AOR 2.19, 95%CI 1.44-3.34). Although the yield of screening was higher for those who were culture-positive compared to only PCR-positive relapsed cases, contact tracing for only PCR-positive cases may still be important in a country with moderate TB incidence, should resources allow.

Change in Values of Illegal Miners and Inhabitants and Reduction in Environmental Pollution after the Cessation of Artisanal and Small-Scale Gold Mining: A Case of Bunikasih, Indonesia.

Artisanal and small-scale gold mining (ASGM) harms the environment and human health, because it requires mercury (Hg). Therefore, this study uses a questionnaire survey to identify the effects of the medical checkup findings, group discussion, and educational seminar on the values of illegal miners and residents in Bunikasih, Indonesia, regarding the environmental and health effects of Hg. Transdisciplinary communities of practice (TDCoP) were formed to pursue alternative livelihoods than illegal ASGM. Environmental pollution after ASGM closure was assessed. The questionnaire showed that respondents changed their views on Hg's effects and were willing to stop ASGM practices. In an environmental impact assessment study, tea leaf samples were obtained between the ASGM activity location and village housing in two periods during ASGM closure to identify the concentrations of Hg, lead, and arsenic. Their mean concentration values in Period 1 (2) were 0.54 ± 0.14, 0.66 ± 0.09, and 0.34 ± 0.12 mg kg-1 (0.08 ± 0.04, 0.34 ± 0.14, and 0.07 ± 0.06 mg kg-1), respectively, indicating a decrease in environmental pollution. In conclusion, the government-driven cessation of ASGM in the study area shows a reduction in environmental pollution, and the change in the perception of the participants regarding the ASGM and TDCoP approaches help to make these changes permanent.

Clinical Profile of COVID-19 Patients Admitted at a Private Hospital During Three Surges in Mandalay, Myanmar.

Introduction During the coronavirus disease 2019 (COVID-19) pandemic, private hospitals in Mandalay started to manage COVID-19 infections according to national treatment guidelines since February 2021. Variations of clinical characteristics and their outcomes in different surges could be evaluated in the private hospital. This study aimed to assess the clinical profile and outcomes of COVID-19 patients admitted at a private hospital during three surges in Mandalay. Methods This study is a retrospective record review of the case series of COVID-19 patients admitted at City Hospital, Mandalay. The study was conducted from January to December 2022. All of the hospital records of COVID-19 patients admitted during the second wave from February 2020 to 26 May 2021, the third wave from 27 May 2021 to 27 January 2022, and the fourth wave from 28 January to April 2022 were included in the study. Results A total of 1606 admitted cases were included in the study. The mean with standard deviation (SD) of age was 55.7±18.5, and males were 778 (48.4%). The mean duration of hospital stay in days was 10.8±5.94, 10.6±6.11, and 7.3±2.88 in second, third, and fourth waves, respectively. The mean duration of hospital stay was shortened in the fourth wave. Comorbid conditions with hypertension and/or diabetes diseases were mostly observed in three waves of COVID-19 infection. Fever was the most presented symptom in three waves. Cough, sore throat, and rhinorrhea were observed more in the fourth wave compared with previous waves. Complication with pneumonia (71.3%), liver dysfunction (21.0%), acute respiratory distress syndrome (10.0%), thrombocytopenia (6.2%), acute kidney injury (5.5%), bleeding (3.9%), and pulmonary embolism (2.9%) were investigated. Antiviral treatment such as remdesivir or molnupiravir was used more in the patients of third and fourth waves than those of the second wave. Oxygen therapy (59.9%), prone position (35.5%), non-invasive ventilation (9.5%), invasive ventilation (0.5%), inotropes (4.6%), and renal replacement therapy (1.1%) were recorded in serious cases. Only 7.9% and 9.4% died in the hospital in second and third waves. No mortality was observed in the fourth wave. Conclusions The study recommended that COVID-19 patients with comorbid conditions of hypertension or diabetes and ages 65 and older should be taken with intensive care support at the hospital. This study also concluded that a private hospital in Mandalay could tackle with COVID-19 severe cases in line with national treatment guidelines since the second wave and could provide better management in the fourth wave. Antiviral treatment should be used in severe COVID-19 cases for further emergency management. In conclusion, private hospital involvement in the COVID-19 pandemic is supportive of the healthcare provision in Myanmar in an emergency situation.

Molecular Epidemiological Characterization of Staphylococcus aureus and Staphylococcus argenteus Clinical Isolates from a National Tertiary Care Hospital in Myanmar: Co-Isolation of Multiple Clones and Identification of Novel Staphylocoagulase Genotype.

Spread of antimicrobial resistance and virulence factors among Staphylococcus aureus/Staphylococcus argenteus poses a potential public health concern in Myanmar. In this study, a total of 226 clinical isolates of S. aureus (n = 211) and S. argenteus (n = 15) collected in Yangon General Hospital during a two-year period were analyzed for their antimicrobial susceptibility and genetic features. Methicillin-resistant S. aureus (MRSA) accounted for 19% of S. aureus isolates, associated with mostly staphylococcal cassette chromosome mec (SCCmec) type IV, or V. Panton-Valentine leukocidin (PVL) genes were detected in methicillin-susceptible S. aureus (MSSA) at significantly higher rate (39%) than in MRSA (22%). Among MRSA, ST361 (clonal complex [CC] 361), ST772 (CC1), and ST239 (CC8) were frequently identified, while the most common clone in MSSA was ST2990 (CC1), followed by ST121 and CC8 comprising five STs. Novel coagulase gene genotype XVI was identified in four MSSA isolates. All the S. argenteus isolates were assigned to ST2250 and mecA negative, including only one PVL-positive isolate. MSSA and S. argenteus were co-isolated from two patients, while two different MSSA clones were simultaneously identified in eight patients. This study revealed clonal diversity and genetic characteristics of current MRSA/MSSA/S. argenteus clinical isolates in the national tertiary care hospital in Myanmar.

Transdisciplinary Communities of Practice to Resolve Health Problems in Southeast Asian Artisanal and Small-Scale Gold Mining Communities.

Artisanal and small-scale gold mining (ASGM) has been a major part of people's livelihood in the rural areas of many developing countries, including those in Southeast Asia (SEA). Nevertheless, because of the use of mercury, ASGM activities have significant local and global adverse impacts on the environment and ASGM community health. Although there have been many monodisciplinary projects by academic researchers and governments to solve the environmental and health problems in SEA ASGM communities, they have not been sufficient to solve the complex socioeconomic problems. This review first outlines the nature of the SEA ASGM activities and the consequent environmental, community health, and socioeconomic problems and then introduces an approach using transdisciplinary communities of practice that involves both academic and nonacademic participants to relieve these wicked ASGM problems and to improve the environmental governance and community health in ASGM communities in SEA.

Mercury Pollution from Artisanal and Small-Scale Gold Mining in Myanmar and Other Southeast Asian Countries.

Mercury (Hg) is one of the most harmful metals and has been a public health concern according to the World Health Organization (WHO). Artisanal and small-scale gold mining (ASGM) is the world's fastest-growing source of Hg and can release Hg into the atmosphere, hydrosphere, and geosphere. Hg has been widely used in ASGM industries throughout Southeast Asia countries, including Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, and Thailand. Here, 16 relevant studies were systematically searched by performing the PRISMA flow, combining the keywords of "Hg", "ASGM", and relevant study areas. Mercury concentrations exceeding the WHO and United States Environmental Protection Agency guideline values were reported in environmental (i.e., air, water, and soil) and biomonitoring samples (i.e., plants, fish, and human hair). ASGM-related health risks to miners and nonminers, specifically in Indonesia, the Philippines, and Myanmar, were also assessed. The findings indicated severe Hg contamination around the ASGM process, specifically the gold-amalgamation stage, was significantly high. To one point, Hg atmospheric concentrations from all observed studies was shown to be extremely high in the vicinity of gold operating areas. Attentions should be given regarding the public health concern, specifically for the vulnerable groups such as adults, pregnant women, and children who live near the ASGM activity. This review summarizes the effects of Hg in Myanmar and other Southeast Asian countries. In the future, more research and assessment will be required to investigate the current and evolving situation in ASGM communities.

Fending off Delta - Hospital measures to reduce nosocomial transmission of COVID-19.

OBJECTIVES: Following the emergence of the Delta variant of SARS-CoV-2 in Singapore, our hospital experienced a Delta-linked ward cluster. In this study, we review the enhanced strategies in preventing nosocomial transmission of COVID-19 following widespread community transmission of the Delta variant. METHODS: We conducted a cohort study on exposures to unexpected COVID-19 cases for which contact tracing was initiated from June 2021 to October 2021. Strategies evaluated included upgraded personal protective equipment (PPE) and rostered routine testing (RRT) for staff and patients, surveillance of staff with acute respiratory illness (ARI), and expanded quarantining and testing for contacts of identified cases. RESULTS: From 193 unexpected COVID-19 exposures, 2,573 staff, 542 patients, and 128 visitor contacts were traced. Four staff contacts subsequently had SARS-CoV-2 infection. Two were likely from exposure in community settings, whereas 2 had exposure to the same COVID-19 positive staff in the hospital, forming the only hospital cluster. One inpatient had a nosocomial infection, possibly from visitors. The SARS-CoV-2 detection rate among staff was 0.3% (of 11,200 staff) from biweekly RRT and 2.5% (of 3,675 staff) from ARI surveillance. CONCLUSION: Enhanced hospital measures, including upgraded PPE and RRT for staff and patients, staff sickness surveillance, and more rigorous management of contacts of COVID-19 cases, were likely to have reduced nosocomial transmission amid the Delta variant.

Intranasal octenidine for methicillin-resistant Staphylococcus aureus (MRSA) carriers and universal octenidine bathing reduced MRSA acquisition in an acute-care general ward.

In this quasi-experimental before-and-after study in a methicillin-resistant staphylococcus aureus (MRSA) high-prevalence acute-care dermatology ward from August 2016 to November 2018, patients admitted during intervention period who received additional topical intranasal octenidine were 63% less likely to acquire MRSA than those receiving universal daily octenidine bathing alone during baseline period (aOR, 0.37; 95% CI, 0.14-0.98).

Transdisciplinary Online Health Assessment of an Artisanal and Small-Scale Gold Mining Community during the COVID-19 Pandemic in the Mandalay Region of Myanmar.

Artisanal and small-scale gold mining (ASGM) has a known negative effect on the community's health; therefore, assessment to monitor community health is essential to detect any issues and enable early treatment. Because ASGM-related health issues are complex and cannot be addressed effectively with a traditional one-time health assessment alone, both long-term and regular health assessments using a transdisciplinary approach should be considered. In response to this need, we designed an online health assessment tool as a reference for a future long-term health assessment system. An online video interview was conducted with 54 respondents living in the ASGM area of Chaung Gyi Village, Thabeikkyin Township, Mandalay Region, Myanmar, via a social networking service application. The tool was used to evaluate community health during the coronavirus 2019 pandemic, including mercury intoxication symptoms, mining-related diseases, and other diseases. Results show that persons working in mining versus non-mining occupations had a greater prevalence of pulmonary diseases, such as pulmonary tuberculosis, silicosis, and bronchial asthma, in addition to malaria. Based on these findings, online health assessment using a transdisciplinary approach can be recommended as an effective tool for sustainable and long-term health assessment of ASGM-related disease and should be performed regularly following physical health surveys.

Molecular phylogeny of the genus Muntiacus with special emphasis on the phylogenetic position of Muntiacus gongshanensis.

Muntjac deer (Cervidae: Muntiacus) are often cited as an excellent model for the study of vertebrate evolution due to their fast rate of change in chromosome number among vertebrates. However, the phylogenetic relationships within Muntiacus generally, and the taxonomic status of Muntiacus gongshanensis specifically, remain unclear. Here, the phylogenetic relationships within Muntiacus were studied using mitochondrial genome (mitogenome) and cytochrome b (cyt b) segments. Our results recognize 12 species within Muntiacus and support the controversial species M. gongshanensis, M. putaoensis, and M. malabaricus. Furthermore, Bayesian inference (BI) and maximum-likelihood (ML) approaches revealed M. gongshanensis and M. crinifrons to be closely related species, with M. feae as their sister species, and M. putaoensis and M. truongsonensis to be closely related, with M. rooseveltorum as their sister species. The distribution range of M. gongshanensis was also confirmed in southwest China (Namdapha, Modong, Zayu and Gongshan) and northern Myanmar (Putao). The results of this study provide insight into the evolution of Muntiacus and further provide a molecular basis for the taxonomic evaluation of the genus in the future and fundamental data for the conservation of M. gongshanensis.

Health Impact Assessment of Artisanal and Small-Scale Gold Mining Area in Myanmar, Mandalay Region: Preliminary Research.

Increasing artisanal and small-scale gold mining (ASGM) in developing countries has raised health concerns in mining communities. A preliminary health survey was conducted in Thabeikkyin Township, Mandalay Region, Myanmar, in February 2020 to assess the health conditions of an ASGM community. Respiratory function and other clinical assessments were evaluated in miners and non-miners, and participants' hair was analyzed for heavy metals. Respiratory function of miners was similar to that of non-miners. However, miners' respiratory function declined with longer mining activity duration. In total, 3 out of 18 miners showed neurological signs and symptoms of chronic mercury intoxication. The median concentration of the hair mercury was significantly higher in miners than non-miners (P = 0.01), and 9 out of 18 miners and 2 out of 11 non-miners showed the warning level of mercury. We found that, despite an association between declining respiratory function and length of time mining, only a minority of miners showed clinical features of chronic mercury intoxication. Further clinical surveys with a larger sample size are necessary to determine the broader health status of this community. In addition, clinical indicators such as pulmonary function tests are recommended as additional criteria for the diagnosis of mercury intoxication.

Taxonomic revision and phylogenetic position of the flying squirrel genus Biswamoyopterus (Mammalia, Rodentia, Sciuridae, Pteromyini) on the northern Indo-China peninsula.

The flying squirrel genus Biswamoyopterus (Rodentia: Sciuridae: Pteromyini) was once considered to contain three species, Biswamoyopterus biswasi from northeastern India, B. laoensis from central Laos and B. gaoligongensis from southwest China, all identified from morphological characteristics of one or two specimens. However, based on similar morphological characteristics of two samples of the genus Biswamoyopterus collected recently from northern Laos and northern Myanmar, and the small genetic distances on mitochondrial DNA and nuclear DNA between them, the results strongly support these two samples as representatives of the same species. The phylogenetic analyses strongly support Biswamoyopterus as an independent genus of Pteromyini, as a sister group to Aeromys. Biswamoyopterus biswasi is distributed in the northern Indo-China peninsula, where it is exposed to a series of threats, such as intense hunting activity, illegal trade, and rapid habitat loss; this should warrant its classification as critically endangered according to the International Union for Conservation of Nature (IUCN) Red List criteria. Here, the molecular data for genus Biswamoyopterus and two new specimen records from northern Laos and northern Myanmar are presented.

Epidemiology, vaccine effectiveness, and risk factors for mortality for pneumococcal disease among hospitalised adults in Singapore: a case-control study.

BACKGROUND: Streptococcus pneumoniae infections can lead to severe morbidity and mortality, especially in patients with invasive pneumococcal disease (IPD). This study evaluated factors associated with pneumococcal disease, pneumococcal vaccine effectiveness, and risk factors for all-cause mortality in hospitalised adults with pneumococcal disease in Singapore. METHODS: Retrospective case-control study of patients tested for pneumococcal disease with streptococcal urinary antigen testing and at least one sterile site culture, during their admission to a tertiary hospital in Singapore from 2015 to 2017. Patients were defined as cases of IPD or non-IPD, or as controls, based on laboratory results and clinical diagnoses. Multivariable models were constructed to determine factors associated with IPD/non-IPD, and risk factors for mortality from pneumococcal disease. Vaccine effectiveness against IPD/non-IPD was estimated using a variation of the test-negative design. RESULTS: We identified 496 pneumococcal disease cases, of whom 92 (18.5%) had IPD. The mean age of cases was 69.1 ± 15.4 years, and 65.5% were male. Compared with controls (N = 9181), IPD patients were younger (mean age 61.5 ± 16.3 years, vs 72.2 ± 16.1 years in controls; p < 0.001) and with less co-morbidities [median Charlson's score 1 (IQR 0-4), vs 3 (1-5) in controls; p < 0.001]. IPD patients also had the highest proportions with intensive care unit (ICU) admission (20.7%), inpatient mortality (26.1%) and longest median length of stay [9 (IQR 8-17) days]. On multivariable analysis, IPD was negatively associated with prior pneumococcal vaccination (adjusted relative risk ratio = 0.20, 95%CI 0.06-0.69; p = 0.011). Risk factors for mortality among pneumococcal disease patients were ICU admission, diagnosis of IPD, age ≥ 85 years and Charlson's score > 3. CONCLUSION: Patients with pneumococcal disease (especially IPD) were younger and had less co-morbidities than controls, but had higher risk of severe clinical outcomes and mortality. Pneumococcal vaccination effectiveness against IPD was estimated to be about 80%, and should be encouraged among high-risk patients.