Author: "Maung, Than" / Topic: medicine.disease - Searchworks@Jio Institute Digital Library Search Results

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533 results on '"Maung, Than"'

1. Palbociclib in combination with aromatase inhibitors in patients ≥ 75 years with oestrogen receptor-positive, human epidermal growth factor receptor 2 negative advanced breast cancer: A real-world multicentre UK study

Author: Richard Simcock, Yatri Shah, Thomas Pigott, Maung Maung Myat Moe, Simon Dixon, Alicja Synowiec, Pavel Bezecny, Bilal A Tahir, Kirsty Balachandran, Salma El Badri, Catherine Harper-Wynne, Marianna Theodoulou, Fiona Britton, Anna Stansfeld, Karen Desouza, Andrew Proctor, Anshu Wadhawan, M. Davies, Daniel Hills, Mark Verrill, and Caroline Wilson
Subjects: Oncology, medicine.medical_specialty, Pyridines, Receptor, ErbB-2, Breast Neoplasms, Palbociclib, Neutropenia, Piperazines, Breast cancer, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, medicine, Cost analysis, Humans, RC254-282, Aged, Retrospective Studies, Toxicity, business.industry, Aromatase Inhibitors, Incidence (epidemiology), Cancer, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Retrospective cohort study, General Medicine, medicine.disease, Frail elderly, United Kingdom, Tolerability, Receptors, Estrogen, Real-world, Treatment efficacy, Surgery, Female, Original Article, business, Febrile neutropenia
Abstract: Background Breast cancer incidence increases with age and real-world data is essential to guide prescribing practices in the older population. The aim of this study was to collect large scale real-world data on tolerability and efficacy of palbociclib + AI in the first line treatment of ER+/HER2-advanced breast cancer in those aged ≥75 years. Methods 14 cancer centres participated in this national UK retrospective study. Patients aged ≥75 years treated with palbociclib + AI in the first line setting were identified. Data included baseline demographics, disease characteristics, toxicities, dose reductions and delays, treatment response and survival data. Multivariable Cox regression was used to assess independent predictors of PFS, OS and toxicities. Results 276 patients met the eligibility criteria. The incidence of febrile neutropenia was low (2.2%). The clinical benefit rate was 87%. 50.7% of patients had dose reductions and 59.3% had dose delays. The 12- and 24- month PFS rates were 75.9% and 64.9%, respectively. The 12- and 24- month OS rates were 85.1% and 74.0%, respectively. Multivariable analysis identified PS, Age-adjusted Charlson Comorbidity Index (ACCI) and number of metastatic sites to be independent predictors of PFS. Dose reductions and delays were not associated with adverse survival outcomes. Baseline ACCI was an independent predictor of development and severity of neutropenia. Conclusion Palbociclib is an effective therapy in the real-world older population and is well-tolerated with low levels of clinically significant toxicities. The use of geriatric and frailty assessments can help guide decision making in these patients., Highlights • Palbociclib is a safe and effective treatment in patients ≥75 years. • Higher rates of treatment discontinuation and dose reductions were noted. • Dose delays and reductions were not associated with a worse survival outcome. • ACCI is a predictor of PFS and also for development and severity of neutropenia.
Published: 2021

2. Characteristics and significance of 'green snake' bites in Myanmar, especially by the pit vipers Trimeresurus albolabris and Trimeresurus erythrurus

Author: Mohammad Afzal Mahmood, Sam Alfred, Sai Sein Lin Oo, David A. Warrell, Aung Zaw, Julian White, Myo Thant, Khin Thida Thwin, Chen Au Peh, Scott A. Weinstein, Myat Thet Nwe, Myat Myat Thein, Caitlyn Rogers, and Khin Maung Gyi
Subjects: medicine.medical_specialty, Trimeresurus albolabris, biology, business.industry, Antivenom, Colubridae, Trimeresurus, Snake Bites, Myanmar, Toxicology, biology.organism_classification, medicine.disease, Dermatology, Snake bites, Viperidae, biology.animal, Animals, Humans, Medicine, Crotalinae, business, Trimeresurus erythrurus
Abstract: Snakebite is an important problem in Myanmar. Regionally, bites by Eastern Russell's vipers, Daboia siamensis (Viperidae, Viperinae), and monocled cobras, Naja kaouthia are considered medically important, but those categorised as “green snake” bites are not. However, these may include bites by green pit vipers, Trimeresurus spp. (Viperidae, Crotalinae) for which no antivenom is available in Myanmar. Elsewhere in Southeast Asia, these snakes are reported to cause local and systemic envenoming. As part of the Myanmar Snakebite Project, prospective case data were collected over 3 years from five hospitals in the Mandalay region. These included 3803 snakebite cases reported from Mandalay region. Of these, 355 were listed as bites by a witnessed green-coloured snake. In 22 cases, the snakes responsible were retained and preserved, then expertly identified; 21 were medically important white-lipped pit vipers (Trimeresurus albolabris), and one as an Asian vine snake, Ahaetulla prasina (Colubridae, Ahaetuliinae) which is not of medical importance. Among confirmed Trimeresurus albolabris bites, 15/21 developed swelling of the bitten limb, and 3/21 coagulopathy, defined as a positive 20-min whole blood clotting test (20WBCT). None developed necrosis, blistering, thrombocytopenia or acute kidney injury (AKI). Of the remaining 333 patients bitten by green snakes that were not specifically identified, 241 (72%) developed swelling of the bitten limb, and 62 (19%) coagulopathy. AKI occurred in 21/333 patients, but only one required dialysis. At least 10/21 of the cases with AKI in this study were more likely to represent bites from Trimeresurus spp. than D. siamensis because the snake responsible was brought into the hospital, examined and described by the treating physician as “green-coloured”. This study describes a previously unpublished case of AKI from envenoming by T. erythrurus in Yangon, and reviews cases of AKI following bites by this species and T. albolabris in Myanmar. This confirms that, at least on rare occasions, Trimeresurus spp. envenoming can cause AKI. This has important implications for snakebite management in Myanmar as the finding of local swelling, coagulopathy and AKI is generally considered pathognomonic of D. siamensis envenoming. Further collection of confirmed Trimeresurus spp. bites is required in Myanmar in order better to define the syndrome of envenoming and to assess the possible need for antivenom against Trimeresurus spp. in this country.
Published: 2021

3. Increased mortality with resuscitative endovascular balloon occlusion of the aorta only mitigated by strong unmeasured confounding: An expanded analysis using the National Trauma Data Bank

Author: Kevin M. Schuster, George C. Linderman, Winston Lin, Bishwajit Bhattacharya, Kimberly A. Davis, Adrian A. Maung, and Robert D. Becher
Subjects: medicine.medical_specialty, Resuscitation, business.industry, medicine.medical_treatment, Acute kidney injury, Absolute risk reduction, Retrospective cohort study, Critical Care and Intensive Care Medicine, medicine.disease, Balloon, Traumatic injury, Amputation, Internal medicine, Propensity score matching, Cardiology, Medicine, Surgery, business
Abstract: BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is being increasingly adopted to manage noncompressible torso hemorrhage, but a recent analysis of the 2015 to 2016 Trauma Quality Improvement Project (TQIP) data set showed that placement of REBOA was associated with higher rates of death, lower extremity amputation, and acute kidney injury (AKI). We expand this analysis by including the 2017 data set, quantifying the potential role of residual confounding, and distinguishing between traumatic and ischemic lower extremity amputation. METHODS This retrospective study used the 2015 to 2017 TQIP database and included patients older than 18 years, with signs of life on arrival, who had no aortic injury and were not transferred. Resuscitative endovascular balloon occlusions of the aorta placed after 2 hours were excluded. We adjusted for baseline variables using propensity scores with inverse probability of treatment weighting. A sensitivity analysis was then conducted to determine the strength of an unmeasured confounder (e.g., unmeasured shock severity/response to resuscitation) that could explain the effect on mortality. Finally, lower extremity injury patterns of patients undergoing REBOA were inspected to distinguish amputation indicated for traumatic injury from complications of REBOA placement. RESULTS Of 1,392,482 patients meeting the inclusion criteria, 187 underwent REBOA. After inverse probability of treatment weighting, all covariates were balanced. The risk difference for mortality was 0.21 (0.14-0.29) and for AKI was 0.041 (-0.007 to 0.089). For the mortality effect to be explained by an unmeasured confounder, it would need to be stronger than any observed in terms of its relationship with mortality and with REBOA placement. Eleven REBOA patients underwent lower extremity amputation; however, they all suffered severe traumatic injury to the lower extremity. CONCLUSION There is no evidence in the TQIP data set to suggest that REBOA causes amputation, and the evidence for its effect on AKI is considerably weaker than previously reported. The increased mortality effect of REBOA is confirmed and could only be nullified by a potent confounder. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
Published: 2021

4. A 1-Year Investigation of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolated from Bovine Mastitis at a Large-Scale Dairy Farm in Japan

Author: Takako Taniguchi, Khin Maung Latt, Hiroyuki Sato, Tomoya Minamino, Naoaki Misawa, Fusae Yano, and Elpita Tarigan
Subjects: Microbiology (medical), Pharmacology, biology, medicine.drug_class, Klebsiella pneumoniae, medicine.medical_treatment, Immunology, Cephalosporin, biology.organism_classification, medicine.disease_cause, Antimicrobial, medicine.disease, Microbiology, Mastitis, Antibiotic resistance, Staphylococcus aureus, Beta-lactamase, medicine, Staphylococcus
Abstract: In a large-scale dairy farm, it is important to take countermeasure of prevention against mastitis of dairy cows, and it is especially important to establish hygiene and risk management to prevent the emergence and spread of antibiotic-resistant bacteria. In this study, we have performed bacteriological testing of clinical and subclinical mastitis and investigation of antimicrobial resistance bacteria in a large-scale farm for 1 year. The bacteria isolated most frequently from 1,549 samples of 952 cow, including cows with recurring mastitis were Staphylococcus non-aureus (SNA) (27.6%), followed by Escherichia coli (18.9%), Klebsiella pneumoniae (12.3%). Although Staphylococcus aureus was isolated at 7.7% from milk sample, no methicillin-resistant S. aureus was found. The incidence of extended-spectrum β-lactamase (ESBL)-producing E. coli was 1.4% and ESBL-producing K. pneumoniae was 1.4% of all samples, even though third- and fourth-generation cephalosporins were not used for antimicrobial treatment of mastitis in this farm. Although these genotypes of ESBL-producing E. coli and K. pneumoniae were mainly composed of CTX-M-15 and TEM-1 and CTX-M-2 and TEM-116, respectively, there was no spread and persist of predominant clonal type. Appropriate farm management, such as segregation and culling of infected animals and monitors of trends in antimicrobial resistance among mastitis pathogens, may have contributed these results.
Published: 2021

5. The blood glucose lowering effect of Malaysian Tinospora crispa in rats

Author: Suryawati Suryawati, Nilar Aung, Maung Maung Cho, Norsidah Kuzaifah, Sarah Firdausa, and Khin Maung Maung
Subjects: Vitamin, Glucose lowering, business.industry, Blood sugar, Pharmacology, Body weight, medicine.disease, chemistry.chemical_compound, General Energy, chemistry, Diabetes mellitus, Potency, Medicine, tinospora crispa (tc), fasting blood glucose, body weight, business, lcsh:Science (General), Normal control, Tinospora crispa, lcsh:Q1-390
Abstract: Diabetes is defined as a chronic hyperglycemia which should be countered by the effective, safe and readily available hypoglycemic agents. Herbal is among alternatives that has been used by society for years but lacks of documented evidences. Tinospora crispa (TC) is enriched by phytochemicals which potentially reduce blood glucose thus is useful for diabetic patients. This study aimed to investigate the potency of TC inreducing blood sugar and body weight. It involved 30 healthy rats divided into 5 groups namely: normal control, normal fed with TC extract, diabetic, TC-treated diabetic (dose 500 mg/kg w/w), and vitamin E-traeted diabetic rats (60 IU). The body weight and fasting blood glucose were measured each week for 1 month. The administration of TC extract 500 mg/kg (w/w) helps to maintain body weight in diabetic rats and reduce the fasting blood glucose. TC is highly potent as hypoglycemic agents therefore needed to be explored further.
Published: 2020

6. APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

Author: Gregory Cheng, Rino Alvani Gani, Ji Dong Jia, Diana A. Payawal, Guo Feng Chen, Khin Maung Win, Simone I. Strasser, Zhen Wen Liu, Hasmik Ghazinian, Saeed Hamid, Tony Mok, Tanwandee Tawesak, Jer Ming Chang, Ann-Lii Cheng, Shiv Kumar Sarin, Jin Lin Hou, Rosmawaiti Mohamed, Pierce K. H. Chow, Grace Lai-Hung Wong, Masashi Mizokami, Patrick Lau, Woon Leung Ng, George Lau, Teerha Piratvisuth, Oidov Baatarkhuu, A. Kadir Dokmeci, Ming-Lung Yu, Alexander J. Thompson, Masao Omata, and Joong-Won Park
Subjects: Hepatitis B virus, medicine.medical_specialty, APASL, Hepatitis B reactivation, Guidelines, Guideline, Antiviral Agents, Hepatitis B, Chronic, Internal medicine, Humans, Medicine, Intensive care medicine, Hepatitis, Hepatitis B Surface Antigens, Hepatology, business.industry, Liver failure, Hepatitis B, medicine.disease, Clinical Practice, Immunosuppressive therapy, Virus Activation, business, Immunosuppressive Agents
Abstract: Background & Aim Hepatitis B reactivation related to the use of immunosuppressive therapy remains a major cause of liver-related morbidity and mortality in hepatitis B endemic Asia-Pacific region. This clinical practice guidelines aim to assist clinicians in all disciplines involved in the use of immunosuppressive therapy to effectively prevent and manage hepatitis B reactivation. Methods All publications related to hepatitis B reactivation with the use of immunosuppressive therapy since 1975 were reviewed. Advice from key opinion leaders in member countries/administrative regions of Asian-Pacific Association for the study of the liver was collected and synchronized. Immunosuppressive therapy was risk-stratified according to its reported rate of hepatitis B reactivation. Recommendations We recommend the necessity to screen all patients for hepatitis B prior to the initiation of immunosuppressive therapy and to administer pre-emptive nucleos(t)ide analogues to those patients with a substantial risk of hepatitis and acute-on-chronic liver failure due to hepatitis B reactivation.
Published: 2021

7. Anti-hepatitis B activities of Myanmar medicinal plants: a narrative review of current evidence

Author: Ye Htut Linn, Lwin Mon Mon Myint, Khin Maung Lwin, and Win Win Ei
Subjects: Hepatitis B virus, HBsAg, Cirrhosis, business.industry, Drug discovery, Review Article, Hepatitis B, medicine.disease, Bioinformatics, medicine.disease_cause, Infectious Diseases, Clinical research, Virology, Hepatocellular carcinoma, medicine, business, Medicinal plants
Abstract: Hepatitis B is one of the major burdens for health services and is the leading cause of morbidity and mortality from cirrhosis of liver and hepatocellular carcinoma. Current treatment strategies using nucleos(t)ide analogue reverse-transcriptase inhibitors or interferons are targeted for the long-term suppression of hepatitis B DNA. However, functional cure of hepatitis B infection (HBsAg clearance) was difficult to attain with such treatments. Therefore, new treatment strategies or innovative treatments are urgently needed. The new treatments should focus on the potential therapeutic targets such as covalently closed circular DNA which may be important for the HBsAg clearance. Plant based medicines have been used in different traditional medicine practices and these natural products/compounds serve as a good source of information or clues for use in drug discovery and design. Many natural products were found to be effective against hepatitis B virus and some even have better therapeutic activities than currently used compounds. This review summarizes the current evidence of Myanmar medicinal plants in basic and clinical research which shows promising potential for the development of novel therapeutic agents for the treatment of hepatitis B.
Published: 2021

8. A survey of visual impairment and blindness in children attending eight schools for the blind in Myanmar: An update

Author: Naw Marina Thapaw, Soe Hlaing, Sonia Huang, Michelle T. Sun, James Muecke, Robert J Casson, Andy Griffiths, Cesar Carrillo, Tin Maung Win, Ashwin Mallipatna, Than Aung, Yi Fan Tang, Ye Win, Khine Nweni, Martin Holmes, and Naing Lin
Subjects: medicine.medical_specialty, Pediatrics, Visual acuity, genetic structures, Visual impairment, Optic Disk, Vision Disorders, visual impairment, Vision, Low, Myanmar, Measles, Cataracts, Acquired immunodeficiency syndrome (AIDS), Blind schools, Epidemiology, medicine, Humans, Child, Schools, business.industry, Childhood blindness, Retinal Detachment, Optic Nerve, RE1-994, childhood blindness, medicine.disease, eye diseases, Ophthalmology, Education, Special, Commentary, Original Article, medicine.symptom, Abnormality, business, Visually Impaired Persons, blindness
Abstract: Purpose: To determine the causes of visual impairment (VI) and blindness among children in schools for the blind in Myanmar; to identify the avoidable causes of VI and blindness; to provide spectacles, low-vision aids, and ophthalmic treatment where indicated; to provide an update of the 2007 survey performed and identify any major epidemiological changes. Methods: Two hundred and ninety children under 16 years of age from all eight schools for the blind in Myanmar were examined and the data entered into the World Health Organization Prevention of Blindness Examination Record for Childhood Blindness. Results: In total, 271 children (93.4%) were blind (visual acuity [VA]
Published: 2021

9. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Luxia Zhang, Young-Ho Khang, Ellina Rakhimova, Kairit Mikkel, Tiina Vlasoff, Eruke E. Egbagbe, Sidsel Graff-Iversen, Ilona Nenko, Magdalena Klimek, Mathilde Savy, Sanjib Kumar Sharma, Alfonso Siani, Luís Lopes, Vanina Bongard, Gregor Jurak, Jacqueline F. Price, Christina-Paulina Lambrinou, Maria Lc Iurilli, Rainford J. Wilks, Bontha V. Babu, Fereidoun Azizi, Harunobu Nakamura, Marialaura Bonaccio, Angela Döring, Zhenyu Zhang, Naser Ahmadi, Jolanta Słowikowska-Hilczer, Ana Paula Carlos Cândido, Clive Osmond, Thirunavukkarasu Sathish, Robert J. Adams, Themistoklis Tzotzas, Reina Engle-Stone, Atul Trivedi, Shoichiro Tsugane, Niels Møller, Jorge Bezerra, Dénes Molnár, Muhammad Fadhli Mohd Yusoff, Badreya Al-Lahou, J. Jaime Miranda, Bahram Mohajer, Sigmund A. Anderssen, Lital Keinan Boker, Eero Kajantie, Martin Gulliford, Maties Torrent, Sumit Bharadwaj, Toshiharu Ninomiya, Zbigniew Gaciong, Nayu Ikeda, Li Juan Wu, Adrian Richter, Licia Iacoviello, Marc J. Gunter, Wenbin Wei, Norsyamlina Che Abdul Rahim, Eman Aly, Ambady Ramachandran, Nils Lehmann, Soile E. Puhakka, Giovanni Veronesi, Hongsheng Bi, Eiji Oda, Jia Li Duan, Per Tynelius, José María Huerta, Janne Schurmann Tolstrup, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Hanno Ulmer, Shukri F. Mohamed, Anthony Kafatos, Suyeon Park, Mohsen Ibrahim, Hamed Pouraram, Bin Zhou, May Soe Aung, Lars Bo Andersen, Erfan Ghasemi, René Charles Sylva, Himanshu K. Chaturvedi, Luc Dauchet, Ahmad Ali Zainuddin, Angela Chetrit, Dan Zhu, Valérie Deschamps, Ko Ko Zaw, Peter Vollenweider, Tomas Vega, Yves Martin-Prével, Mahfuzar Rahman, Dorja Vočanec, Roman Topor-Madry, Vinay Nangia, Herculina S. Kruger, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Aleksander Giwercman, Elżbieta Dziankowska-Zaborszczyk, Cecilia Björkelund, Tatjana Hejgaard, Maria Puiu, Maria Benedetta Donati, Andrew Wong, Carlos P. Boissonnet, Santosh K. Bhargava, Patrick Kolsteren, Dermot O'Reilly, Bahareh Kheiri, Wolfgang Kratzer, Susanne R. de Rooij, H. Bas Bueno-de-Mesquita, Günther Fink, José R. Banegas, Michele Monroy-Valle, Drude Molbo, Mahmudur Rahman, Hynek Pikhart, Rafael N. Pichardo, Massimo Salvetti, Hui Cai, Sarah Filippi, Georg Posch, Hung-Kwan So, Yonghua Hu, Katsuyasu Kouda, Joana Carvalho, Gailute Bernotiene, Hannu Uusitalo, Thein Thein Htay, Felix Kaducu, Maigeng Zhou, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Michel Joffres, Sabina Zambon, Ronald D. Gregor, Vayia Rarra, Seyed Mohammad Hashemi-Shahri, Loreto Santa Marina, Galina Obreja, Rudolf Kaaks, Aya Mostafa, Maria do Carmo Franco, Beata Gurzkowska, Chien-Jen Chen, Marie Moitry, Nizal Sarrafzadegan, Xiangjun Wang, Diego Giulliano Destro Christofaro, Imperia Brajkovich, Fangfang Chen, Francesco Panza, Ling Yang, Holly E. Syddall, Cecily Kelleher, Michael Tornaritis, Ningli Wang, Lutgarde Thijs, Marjolein Visser, Angelika Schaffrath Rosario, María José Tormo, Jostein Steene-Johannessen, Norbert Amougou, Emmanuella Magriplis, Mar Alvarez-Pedrerol, Jingli Gao, Stig E. Bojesen, Giuseppe Grosso, Seongjun Ha, Lauren Lissner, Mikhail Benet, Anastasia Markaki, Sanjay Rampal, Antônio Augusto Moura da Silva, Maria Lorenza Muiesan, Angelique Chan, Yvonne T. van der Schouw, Annamari Lundqvist, Philippe Amouyel, Kristyna Zejglicova, Charalambos Hadjigeorgiou, João Breda, Jørgen Meisfjord, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Vilma Irazola, Leng Huat Foo, Óscar Lopes, Dickman Gareta, Flavio Nervi, Imre Janszky, Ruzena Kubinova, Terho Lehtimäki, Mario V. Capanzana, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Shuohua Chen, Arvind Pandey, Luigi Palmieri, Roya Kelishadi, Srinivasan Kannan, Jie Mi, Robert Beaglehole, Liliana Dacica, Jyrki K. Virtanen, Mohan Deepa, Peter Ueda, Isti Ilmiati Fujiati, Hermann Pohlabeln, Morten Sodemann, Jytte Halkjær, Zbigniew Kułaga, Sophie Visvikis-Siest, Farshad Farzadfar, Mohsen Azimi-Nezhad, Henry Völzke, Karolina Milkowska, Zahra Mohammadi, Belgin Ünal, Magda Gasull, George S. Stergiou, Marshall K. Tulloch-Reid, Seppo Koskinen, James E. Bennett, Marcela González-Gross, Virginija Dulskiene, Idris Guessous, Assembekov Batyrbek, Kamarul Imran Musa, Jeannette Lee, Josep Redon, Bihungum Bista, Luisa M Macieira, Johan Sundström, Andres Metspalu, Lariane M Ono, Flora A. Ukoli, Salar Rahimikazerooni, Andrea Gualtieri, Trevor S. Ferguson, Félicité Tchibindat, Eliza Cinteza, Ha Tp Do, Tajana Zeljkovic Vrkic, Tuyen D Le, Alison J. Hayes, Abdul Basit, Chandini Nekkantti, Teresa Norat, Eunice Ugel, Gulmira Aitmurzaeva, Mariachiara Di Cesare, Abdul Hamid Zargar, Vincenzo Solfrizzi, Garry L. Jennings, Aline Meirhaeghe, Kaare Christensen, Päivi Mäki, Xu Lin, Ali Esmaeili, Joanna Baran, Aneta Grajda, Renata Cifkova, Alexandre C. Pereira, Martin Bobak, Iuliia A Rusakova, Keiu Nelis, Damian K Francis, Guansheng Ma, Axel C. Carlsson, Alejandro Diaz, Alireza Ansari-Moghaddam, N Capkova, Zumin Shi, Maria Turley, Imelda A. Agdeppa, Helena I. S. Nogueira, Marcia Scazufca, Katharina Maruszczak, Natascia Rinaldo, Paulo A. Lotufo, Nuno Lunet, Thor Aspelund, Caroline H.D. Fall, Antonio Cabrera de León, Ahmad Faudzi Yusoff, Holger Theobald, Beatriz D'Agord Schaan, Pedro Marques-Vidal, William A. Neal, Mihai Gafencu, Tandi E. Matsha, Ana B. Crujeiras, Ahmad Reza Dorosty, Alain Morejon, Weili Yan, Dominique Hange, Bekbolat Zholdin, Frédéric Gottrand, Jorge Mota, Jana Námešná, Stevo Popovic, Louise Eriksen, Line Lund Kårhus, Cihangir Erem, Juergen Breckenkamp, Mathilde Kersting, Yi Song, Martin McKee, Aleksandra Gomula, Rafaela Rosário, Enzo Manzato, S. Goya Wannamethee, Sounnia Mediene Benchekor, Azim Nejatizadeh, Krishna Kumar Aryal, Juan P. González-Rivas, Vedrana Sember, Stephen T. McGarvey, Jukka T. Salonen, Patrick Pasquet, Patricia Varona-Pérez, Amelia C. Crampin, Ramin Heshmat, Violeta Iotova, Juvenal Soares Dias-da-Costa, Oye Gureje, Aletta E. Schutte, João Luiz Bastos, Anelise Reis Gaya, Konrad Jamrozik, Dalia Luksiene, Amina Barkat, Maria Paula Santos, José Camolas, Azli Baharudin, Diego Vanuzzo, Doris Stöckl, Rosalynn Siantar, Jouko Saramies, Albertino Damasceno, Davood Khalili, Simona Bo, Martina Müller-Nurasyid, Dominique Cottel, Markku Peltonen, Fikru Tullu, Ana Isabel Rito, Angélica Ochoa-Avilés, Annette J. Dobson, Christopher T. Cowell, Charumathi Sabanayagam, Rildo de Souza Wanderley Júnior, Oanh T. H. Trinh, Farahnaz Joukar, Mostafa K. Mohamed, Mostafa Qorbani, Jeongseon Kim, Helmut Schröder, Machi Suka, Natasja M. van Schoor, Jussi Kauhanen, Teresa Haugsgjerd, Goodarz Danaei, M. Fernanda Lima-Costa, Yong Tao, Elisabetta L. Romeo, Grazyna Jasienska, Victor Guillermo Sequera, Kazem Mohammad, Yanina Zócalo, Fernanda Cunha Soares, Jianfeng Wu, Mohammad Esmaeel Motlagh, María Elena Díaz-Sánchez, Monika Zuziak, Eldridge Ferrer, Anette Varbo, Leila Beltrami Moreira, Jeremy M. Jacobs, Kenneth James, Elena Sacchini, Pascal Bovet, Mahboubeh Parsaeian, Tania Lopez, Ya Xing Wang, Wojciech Drygas, Jody C Miller, Svetlana A. Shalnova, Maria Elisa Zapata, Chung T Nguyen, Nimmathota Arlappa, Edwige Landais, Thorkild I. A. Sørensen, Jeannette Klimont, Amirabbas Momenan, Erik J. Timmermans, Mari-Liis Tammesoo, Jost B. Jonas, Stefania Toselli, Maria Teresa Anselmo Olinto, Bahman Cheraghian, Kouamelan Doua, Esteban Carmuega, Marjeta Mišigoj-Duraković, Bo Werner, M. Arfan Ikram, Breige A. McNulty, Christa Meisinger, Clara Homs, Namuna Shrestha, Alina Kerimkulova, Youcef Laid, Claes Ohlsson, Alicia Matijasevich, Alison J Price, Ala'a Alkerwi, Kristine H. Allin, Lorenza Pilotto, Mohannad Al Nsour, Ingunn Holden Bergh, Marianna Noale, Heba Fouad, Vilnis Dzerve, Novie O. Younger-Coleman, Peter Willeit, Andrea R. V. R. Horimoto, Freda Pitakaka, Habiba Ben Romdhane, Savvas C. Savva, Rajeev Gupta, Jennifer Servais, Cristina Padez, Sarah P. Garnett, Maria del Cristo Rodriguez-Perez, Michala Lustigová, Tien Yin Wong, Rosa Haghshenas, Jonathan Giovannelli, Christina Howitt, Marleen E. Hendriks, Fadia AlBuhairan, Huashuai Chen, Gretchen A Stevens, Luís B. Sardinha, David Goltzman, Jenny M. Kindblom, Karina Mary de Paiva, Yousef Khader, Eric Monterrubio-Flores, Rajendra Pradeepa, Yi-Ting Lin, Martin Neovius, Juan Francisco Miquel, Ellis Owusu-Dabo, Anil Poudyal, Marzieh Katibeh, Tanja Stocks, Veronica Mocanu, Ulla Roggenbuck, Robespierre Ribeiro, Gabriele Eiben, Mary Simon, Christine Cameron, Hamid Hakimi, Kamel Ajlouni, Jakub Stokwiszewski, Iulia Jurca Simina, Pietro Amedeo Modesti, Frederick C. W. Wu, Peter Kristensen, Charles Mondo, Felix Gutzwiller, Mariana Sbaraini, Martijn Huisman, Betina H. Thuesen, Queenie Chan, Antonisamy Belavendra, Artur Mazur, Ulf Ekelund, Laura A. Rodríguez-Villamizar, Marcos André Moura-dos-Santos, Jean Ferrières, Farhad Zamani, Shina Avi, Yves Kameli, Luis Paulo Gomes Mascarenhas, Aluísio J D Barros, Thomas Meinertz Dantoft, Hossein Poustchi, Farid Najafi, Giovanni de Gaetano, Azaliia M Tuliakova, Vera Lanska, Tint Swe Latt, Matthias Bopp, Abbas Rezaianzadeh, Rod Jackson, Johan Van der Heyden, Reecha Sofat, Koen Van Herck, Allan G. Hill, Con Burns, Emanuela Pettenuzzo, Ming-Dong Wang, Stela McLachlan, Ulrike Gehring, Ranko Stevanovic, Nagalla Balakrishna, Lekhraj Rampal, Marjolijn C. E. Bragt, Saeid Eslami, Napoleón Pérez-Farinós, G. K. Mini, Viktoria Anna Kovacs, Rosemarie Martin, Nahla Hwalla, Wei Zheng, Hoang Van Minh, Edward D Janus, Laetitia Huiart, Farhad Pourfarzi, Sudha Ramachandra Rao, Fred Paccaud, Marcia Makdisse, Aye Aye Sein, Enrique Gutiérrez-González, Yang Yang, Anneke Blokstra, Henrike Galenkamp, Jaume Marrugat, Nazan Yardim, Wan Nazaimoon Wan Mohamud, Jesús Ibarluzea, Julio Zuñiga Cisneros, Laura Lauria, Argyro Karakosta, Dragana P Jovic, Jun Hata, Elio Riboli, Piotr Bandosz, Xun Tang, Parvina Mukhtorova, Jean Dallongeville, Jean-Bernard Ruidavets, Anne Tjønneland, Guillermo Frontera, Rahul Malhotra, Thomas Ferrao, Aleksandra Piwońska, Dusan Grafnetter, Mette Rasmussen, Daniel Weghuber, Sherali Rakhmatulloev, Martine Vrijheid, Johann Willeit, Motahareh Kheradmand, Małgorzata Mossakowska, Lechaba Tshepo, Dongfeng Gu, Hyeon Chang Kim, Vilmundur Gudnason, Maria Forsner, Peter Bjerregaard, Leon A. Simons, Rachael McLean, Japhet Killewo, Ramón Suárez-Medina, Y Nikitin, Eng Joo Tan, Jean Claude Mbanya, Aroor Bhagyalaxmi, Renata Kuciene, Kairat Davletov, Jose Eugenio Lozano, Afshin Ostovar, Niloofar Peykari, Guy De Backer, Soheir H Ahmed, Nicholas J. Wareham, Sai Yin Ho, Constanta Huidumac Petrescu, Maria Hassapidou, Iris Pigeot, Myriam Galfo, Susana Cararo Confortin, Blanca Sandra Ruiz-Betancourt, W. M. Monique Verschuren, Catterina Ferreccio, Fabio Galvano, Leila Houti, Daniel Bia, Annika Rosengren, Marcin Rutkowski, Biruta Velika, Joana Araújo, Fernando Rigo, Angela Spinelli, Scott B. McLean, Shirin Djalalinia, Marie Kunešová, Boban Mugoša, Sania Nishtar, Mangesh S. Pednekar, Shahla AlDhukair, Helle-Mai Loit, Antonis Zampelas, Altan Onat, Maciej Banach, Shohreh Naderimagham, Hajer Aounallah-Skhiri, Maja Bæksgaard Jørgensen, Yin Guo, Ewelina Czenczek-Lewandowska, Parasmani Dasgupta, Elvis Oa Wambiya, Inge Huybrechts, Raimund Erbel, Jari Jokelainen, Ana P. Ortiz, Stefan Kiechl, Emmanuel Cohen, Caleb Ochimana, Shynar Abdrakhmanova, Laura Censi, Iqbal Bata, Geetha R Menon, Snehalatha Chamukuttan, Pedro Plans-Rubio, Domenico Palli, Ana Azevedo, Slawomir Koziel, Benoît Salanave, Parinaz Mehdipour, Shu Ti Chiou, Lela Sturua, Lubica Ticha, Felipe Vogt Cureau, Jin Soo Moon, Ming-Hui Zhao, Urho M. Kujala, Nathalie Michels, Ertugrul Celikcan, Jaakko Tuomilehto, Judith Benedics, Tobias F. Rinke de Wit, Agnès Le Port, Reza Homayounfar, Andrea Rodriguez-Martinez, Tai Hing Lam, Yn-Tz Sung, Jürgen König, Kodavanti Mallikharjuna Rao, Hazzaa M. Al-Hazzaa, Karen Morgan, Bogdan Wojtyniak, Cynthia M. Pérez, Ilse Khouw, Manoli Garcia-de-la-Hera, Dong Wook Shin, Genc Burazeri, Ausra Petrauskiene, Charles Sossa Jérome, Kenisha Russell Jonsson, José Boggia, Daniela Galeone, Alice Bonilla-Vargas, Han Cg Kemper, Rahman Shiri, Stefaan Demarest, Else Karin Grøholt, San-Lin You, Adelheid Weber, Juha Auvinen, Aida Pilav, Sibel Gogen, Suzanne N Morin, Wan Mohamad Wan Bebakar, Viviane Cunha Cardoso, Kavumpurathu Raman Thankappan, Hana Zamrazilová, Frank Claessens, Karien Stronks, Helen Gonçalves, Tahir Aris, Luis Revilla, Sérgio Viana Peixoto, Zhamilya Battakova, Jing Liu, Eliza Markidou Ioannidou, Leticia Hernandez Cadena, Priscilla Duboz, Sandjaja, Tiina Laatikainen, Rafel Ramos, Sareh Eghtesad, Judith Simons, Orn Olafsson, E. Shyong Tai, Louise A. Baur, Nihal Thomas, Aung Soe Htet, Bente Sparboe-Nilsen, Paul Elliott, Soon-Woo Park, Angel R. Gonzalez, Ying-Wei Wang, Rob M. van Dam, Ryutaro Ohtsuka, Ludmila Sevcikova, Suhaila Abdul Ghaffar, Lynell V Maniego, Fariborz Mansour-Ghanaei, Maria Dorobantu, Giovanni Viegi, Xiaoguang Yang, Honor Bixby, Prakash C. Gupta, Ofra Kalter-Leibovici, Eugene Sobngwi, Ričardas Radišauskas, Jurate Medzioniene, Roy A Wong-McClure, Kim F. Michaelsen, Antonia Trichopoulou, Tania Tello, Francesco Branca, Johanna Gunnlaugsdottir, Els Clays, Wei-Yen Lim, Suzanne C. Ho, Toomas Veidebaum, Rebecca Goldsmith, Margot González-León, Matthias Nauck, Alibek Mereke, Marta Buoncristiano, Jakob Tarp, Rosalba Rojas-Martínez, Maya Tanrygulyyeva, Reza Malekzadeh, Abdonas Tamosiunas, Dimitrios Poulimeneas, Pedro Ordunez, Isabelle Herter-Aeberli, Khanh Le Nguyen Bao, Anne Juolevi, Vassilis Zafiropulos, Emanuela Gualdi-Russo, Jordi Sunyer, Manu Raj, Chaoqiang Jiang, Sofia Malyutina, Efthymios Kapantais, Maria Lazo-Porras, Maung Maung Than Htike, Michael Hobbs, Ranjit Mohan Anjana, Merike Liivak, Johan G. Eriksson, Margarita Samoutian, Andreia N. Pizarro, Mohammed Rasoul Tarawneh, Jean Woo, Kaspar Staub, Maria Teresa Menzano, Mojtaba Farjam, Adroaldo Cesar Araujo Gaya, Mohammad El-khateeb, Zulfiqar A Bhutta, Mukharram M. Bikbov, Hsien-Ho Lin, Oscar Noboa, Thomas Waldhör, Garry Brian, Simona Costanzo, Frank Tanser, Nor Azwany Yaacob, Michelle Cilia, Ivo Rakovac, Bill Stavreski, Ioannis Pagkalos, Ivan Pećin, Carlo M. Barbagallo, Abla M. Sibai, Yuna He, Matsuda Fumihiko, Bharathi Viswanathan, Ali Reza Safarpour, Wei Cheng Lo, Abdullatif Husseini, Jiang He, Liv Elin Torheim, Nipa Rojroongwasinkul, Aicha Soumare, Astrid Petersmann, Tomasz Grodzicki, Davide Noto, Panayiotis K. Yiallouros, Kelias P. Msyamboza, William R. Tebar, Yingfeng Zheng, Eha Nurk, Bhawesh Koirala, Ana Jelakovic, Suhad Bahijri, Freja B Kampmann, Qi Sheng You, Marika Ferrari, María-Elena González-Villalpando, Aline Wagner, Olfa Saidi, Anwar Batieha, Eduardo Capuano, Coimbatore Subramaniam Shanthirani, Dong Wook Kim, Albina A Fakhretdinova, Tom Wilsgaard, Maria Avdicova, Moesijanti Soekatri, Chiara Donfrancesco, Salim Mohanna, Paola Russo, Uruwan Yamborisut, Rafael dos Santos Henrique, Martin Nankap, Allan Linneberg, Khairil Si-Ramlee, Kirsten Mehlig, Christina Mavrogianni, Raluca Pop, Lèlita Santos, Graziella Bruno, Valentina Peterkova, Iná S. Santos, Georg Lappas, Alberto Palloni, Malay K. Mridha, Andrzej Pajak, Marta García-Solano, Stefaan De Henauw, Daniel Ferrante, Rute Santos, Anders Grøntved, Lucjan Szponar, Mihaela Vladulescu, Chien-An Sun, Jan A. Staessen, Paula Duarte de Oliveira, Norazizah Ibrahim Wong, Maria Nordendahl, Elaine M. Dennison, Jeonghee Lee, Diego Salmerón, Ida Maria Schmidt, Gao Pei, Noushin Mohammadifard, Igor Spiroski, Fernando Rodríguez-Artalejo, Xu Ma, Elin Pettersen Sørgjerd, Valéria Regecová, Cláudia S. Minderico, Johanna A. Otero, Jamila Abubakar Garba, Vesselka Duleva, Rui Ornelas, Ilpo Huhtaniemi, Cesar G. Victora, Lijuan Liu, Rody G. Sy, Mahmood Moosazadeh, Ali Ahmadi, Antonio Pedro Graça, Natalia Nowak-Szczepanska, Miao Li Chee, Michael Sjöström, Charles Agyemang, Shiqi Zhen, Xiu-Hua Guo, Pawel Kurjata, Jardena J. Puder, Mehrdad Azmin, Neil Murphy, Kaosar Afsana, Alireza Sadjadi, Johanna M. Geleijnse, Prashant Mathur, Elysée Claude Bika Lele, Raphael Mendes Ritti-Dias, Yannis Manios, Majid Shirani, Rosemary B. Duda, Liis Nelis, Jurate Klumbiene, Zhengming Chen, Wichai Aekplakorn, Alun Evans, Andrzej Wiecek, Lars Lind, Denise Eldemire-Shearer, Bernardo L. Horta, Macia Enguerran, Seyed Rasoul Zakavi, Daniel Fernández-Bergés, Kumiko Ohara, Ursula Kiechl-Kohlendorfer, Hermann Brenner, Przemyslaw Slusarczyk, Espen Bjertness, Jutta Stieber, Augusto Di Castelnuovo, Joel G. R. Roy, Aryeh D. Stein, Ruth Frikke-Schmidt, Vera Musil, Amaneh Shayanrad, Marcel Goldberg, Ramon O. Jimenez, Mohammad Reza Fattahi, Jolanda Hyska, Amir Houshang Mehrparvar, Elin Kolle, Mohamed Bamoshmoosh, Michelle Holdsworth, Felipe F. Casanueva, Børge G. Nordestgaard, Niels Wedderkopp, Eva Corpeleijn, Elias F. Gudmundsson, Antonio Mistretta, Daniel Lemogoum, Larissa Pruner Marques, Slavica Sović, Olli T. Raitakari, Marco Aurélio Peres, Alexandra Cucu, Gregorio Varela-Moreiras, Janine Clarke, Andrea Gazzinelli, Mieczysław Litwin, Sara Schramm, Xenophon Theodoridis, Harshpal Singh Sachdev, Mohammad Reza Mirjalili, Dimitrios Papandreou, Peter T. Katzmarzyk, Benjamin Acosta-Cazares, Ben Schöttker, Prabhdeep Kaur, Norlaila Mustafa, Shariq Rashid Masoodi, Sadaf G. 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Duante, Sheikh Mohammed Shariful Islam, Quang Ngoc La, Ricky Eddie, Petra Rust, Daniela Rodrigues, Dirk De Bacquer, Karen Sparrenberger, Agneta Sjöberg, Thet Thet Mu, Katarzyna Dereń, Cora L. Craig, Jorge Motta, Janina Petkeviciene, Boyd Swinburn, Paibul Suriyawongpaisal, Visnja Djordjic, Ramón Alberto Rascón-Pacheco, Pradeep Joshi, Daan Kromhout, Marius B. Bjertness, Stefano Marventano, Juel Jarani, Alireza Khosravi, Eva Martos, David De Ridder, Lizzy M. Brewster, Nico Dragano, Liam Smeeth, Kenji Shibuya, Emma Ruiz Moreno, Hashem Jaddou, Grzegorz Sobek, Dimitrios Trichopoulos, Marvin Cervantes-Loaiza, Abu Am Hanif, Elaine M. Murtagh, Carlos A. Aguilar-Salinas, Graziella D'Arrigo, Kyungwon Oh, Heiner Boeing, Regina Heidinger-Felso, André Luiz Sena Guimarães, Balkish M. Naidu, Avula Laxmaiah, Ana M. B. Menezes, Marie Eliasen, Francesco Pistelli, Yuan He, Dusko Bjelica, José A. 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Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Eleonora d'Orsi, Irene G. M. van Valkengoed, Anna Fijałkowska, Wen-Harn Pan, Gregor Starc, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Abdullah Alkandari, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Saeed Dastgiri, Lien Braeckevelt, Nasheeta Peer, Radka Taxová Braunerová, Mohamed M. Ali, Steiner Krokstad, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Silvana Donoso, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Felix K. Assah, Juan A Rivera, Peter H. Whincup, Oana-Florentina Gheorghe-Fronea, Cassiano Ricardo Rech, Paul Ferdinand M. Reganit, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Dianna J. Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paola Nardone, Alberto Barceló, Tomi-Pekka Tuomainen, Francesco Gianfagna, Stefania Maggi, Mohammad Hossein Somi, Behrooz Hamzeh, Miquel Porta, Vesna Jureša, Alexander D. Deev, David Faeh, Antonio Bernabe-Ortiz, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Anjani Kumar Jha, Thamara Hubler Figueiró, Jana Kratenova, Claudia M. Hormiga, Maria Tsigga, Zivka Dika, Indrapal I. Meshram, Ei Ei K. Nang, Ian Rouse, Rusidah Selamat, Paul Korrovits, Grethe S. Tell, Julie Taylor, Anabela Mota-Pinto, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Frank J Rühli, Shelly R. McFarlane, Sara Santos Sanz, Edyta Łuszczki, Maria G. Stathopoulou, Tara Coppinger, Karin De Ridder, Lucie Viet, Anna Bugge, Mehdi Yaseri, Safiah Md Yusof, Sandra C. Fuchs, Muhammad Islam, Irfan Nuhoglu, Rui Providência, Bernard Maire, Leandra Abarca-Gómez, Sinead Brophy, Maria Ruiz-Castell, Daniela Pierannunzio, Cristina Taddei, Gowri Mahasampath, Gustavo Velasquez-Melendez, Hanna Tolonen, Sudhir Kowlessur, Bagher Larijani, Laura Torres-Collado, Susi Kriemler, Ali Akbar Shayesteh, Cynthia Robitaille, Jorge Escobedo-de la Peña, Yufang Bi, Chinh Nguyen Huu, Line Tang Møllehave, Vincent Jr DeGennaro, Noor Ani Ahmad, Anar Dushpanova, Agustinus Soemantri, Susana Sans, Ionela Pascanu, Gwenaëlle Le Coroller, Inger Ariansen, Kodanda R Kanala, Gert B. M. Mensink, Abhijit Sen, Sergej M. Ostojic, Hanan F. Abdul Rahim, Hélène Delisle, Francisco J. Félix-Redondo, Yadlapalli S. Kusuma, Michael Knoflach, Moein Yoosefi, Tanja G. M. Vrijkotte, Wolfgang Ahrens, Osvaldo Santos, Bethlehem D. Solomon, Erik Lykke Mortensen, Nikhil D. 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Chan School of Public Health, Middlesex University [London], Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Montpellier Interdisciplinary center on Sustainable Agri-food systems (Social and nutritional sciences) (UMR MoISA), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut de Recherche pour le Développement (IRD)-Centre International de Hautes Etudes Agronomiques Méditerranéennes - Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Interactions Gène-Environnement en Physiopathologie Cardio-Vasculaire (IGE-PCV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Wellcome TrustEuropean Commission, Clinical Developmental Psychology, APH - Mental Health, Sociology, The Social Context of Aging (SoCA), Nutrition and Health, Iurilli, Maria LC [0000-0003-0409-1635], Zhou, Bin [0000-0002-1741-8628], Ezzati, Majid [0000-0002-2109-8081], Apollo - University of Cambridge Repository, Epidemiology and Data Science, APH - Aging & Later Life, APH - Societal Participation & Health, Public and occupational health, APH - Health Behaviors & Chronic Diseases, VU University medical center, APH 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Medical Research Center, Luxembourg Institute of Health, Bispebjerg and Frederiksberg Hospital, Barcelona Institute for Global Health CIBERESP, World Health Organization Regional Office for the Eastern Mediterranean, Bombay Hospital and Medical Research Centre, Research Center for Social Determinants of Health, UMR CNRS-MNHN 7206 Eco-anthropologie, University of Lille, Lille University Hospital, Western Norway University of Applied Sciences, Norwegian School of Sport Sciences, Madras Diabetes Research Foundation, Zahedan University of Medical Sciences, National Institute of Public Health, Institute of Public Health of the University of Porto, Norwegian Institute of Public Health, University of Massachusetts Amherst, Abt Associates, University of Iceland, University of Yaoundé1, Federal University of Pelotas, University of Medicine 1, Oulu University Hospital, Banska Bystrica Regional Authority of Public Health, Tel- Aviv University, Hebrew University of Jerusalem, University of Porto 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Huiart , Constanta Huidumac Petrescu , Martijn Huisman , Abdullatif Husseini , Chinh Nguyen Huu , Inge Huybrechts , Nahla Hwalla , Jolanda Hyska , Licia Iacoviello , Jesús M Ibarluzea , Mohsen M Ibrahim , Norazizah Ibrahim Wong , M Arfan Ikram , Violeta Iotova , Vilma E Irazola , Takafumi Ishida , Muhammad Islam , Sheikh Mohammed Shariful Islam , Masanori Iwasaki , Jeremy M Jacobs , Hashem Y Jaddou , Tazeen Jafar , Kenneth James , Kazi M Jamil , Konrad Jamrozik , Imre Janszky , Edward Janus , Juel Jarani , Marjo-Riitta Jarvelin , Grazyna Jasienska , Ana Jelakovic , Bojan Jelakovic , Garry Jennings , Anjani Kumar Jha , Chao Qiang Jiang , Ramon O Jimenez , Karl-Heinz Jöckel , Michel Joffres , Mattias Johansson , Jari J Jokelainen , Jost B Jonas , Jitendra Jonnagaddala , Torben Jørgensen , Pradeep Joshi , Farahnaz Joukar , Dragana P Jovic , Jacek J Jóźwiak , Anne Juolevi , Gregor Jurak , Iulia Jurca Simina , Vesna Juresa , Rudolf Kaaks , Felix O Kaducu , Anthony Kafatos , Eero O Kajantie , Zhanna Kalmatayeva , Ofra Kalter-Leibovici , Yves Kameli , Freja B Kampmann , Kodanda R Kanala , Srinivasan Kannan , Efthymios Kapantais , Argyro Karakosta , Line L Kårhus , Khem B Karki , Marzieh Katibeh , Joanne Katz , Peter T Katzmarzyk , Jussi Kauhanen , Prabhdeep Kaur , Maryam Kavousi , Gyulli M Kazakbaeva , Ulrich Keil , Lital Keinan Boker , Sirkka Keinänen-Kiukaanniemi , Roya Kelishadi , Cecily Kelleher , Han Cg Kemper , Andre P Kengne , Maryam Keramati , Alina Kerimkulova , Mathilde Kersting , Timothy Key , Yousef Saleh Khader , Davood Khalili , Kay-Tee Khaw , Bahareh Kheiri , Motahareh Kheradmand , Alireza Khosravi , Ilse Msl Khouw , Ursula Kiechl-Kohlendorfer , Stefan Kiechl , Japhet Killewo , Dong Wook Kim , Hyeon Chang Kim , Jeongseon Kim , Jenny M Kindblom , Heidi Klakk , Magdalena Klimek , Jeannette Klimont , Jurate Klumbiene , Michael Knoflach , Bhawesh Koirala , Elin Kolle , Patrick Kolsteren , Jürgen König , Raija Korpelainen , Paul Korrovits , Magdalena Korzycka , Jelena Kos , Seppo Koskinen , Katsuyasu Kouda , Viktoria A Kovacs , Sudhir Kowlessur , Slawomir Koziel , Jana Kratenova , Wolfgang Kratzer , Susi Kriemler , Peter Lund Kristensen , Steinar Krokstad , Daan Kromhout , Herculina S Kruger , Ruzena Kubinova , Renata Kuciene , Urho M Kujala , Enisa Kujundzic , Zbigniew Kulaga , R Krishna Kumar , Marie Kunešová , Pawel Kurjata , Yadlapalli S Kusuma , Kari Kuulasmaa , Catherine Kyobutungi , Quang Ngoc La , Fatima Zahra Laamiri , Tiina Laatikainen , Carl Lachat , Youcef Laid , Tai Hing Lam , Christina-Paulina Lambrinou , Edwige Landais , Vera Lanska , Georg Lappas , Bagher Larijani , Tint Swe Latt , Laura Lauria , Maria Lazo-Porras , Gwenaëlle Le Coroller , Khanh Le Nguyen Bao , Agnès Le Port , Tuyen D Le , Jeannette Lee , Jeonghee Lee , Paul H Lee , Nils Lehmann , Terho Lehtimäki , Daniel Lemogoum , Naomi S Levitt , Yanping Li , Merike Liivak , Christa L Lilly , Wei-Yen Lim , M Fernanda Lima-Costa , Hsien-Ho Lin , Xu Lin , Yi-Ting Lin , Lars Lind , Allan Linneberg , Lauren Lissner , Mieczyslaw Litwin , Lijuan Liu , Wei-Cheng Lo , Helle-Mai Loit , Khuong Quynh Long , Luis Lopes , Oscar Lopes , Esther Lopez-Garcia , Tania Lopez , Paulo A Lotufo , José Eugenio Lozano , Janice L Lukrafka , Dalia Luksiene , Annamari Lundqvist , Robert Lundqvist , Nuno Lunet , Charles Lunogelo , Michala Lustigová , Edyta Łuszczki , Guansheng Ma , Jun Ma , Xu Ma , George Ll Machado-Coelho , Aristides M Machado-Rodrigues , Luisa M Macieira , Ahmed A Madar , Stefania Maggi , Dianna J Magliano , Sara Magnacca , Emmanuella Magriplis , Gowri Mahasampath , Bernard Maire , Marjeta Majer , Marcia Makdisse , Päivi Mäki , Fatemeh Malekzadeh , Reza Malekzadeh , Rahul Malhotra , Kodavanti Mallikharjuna Rao , Sofia K Malyutina , Lynell V Maniego , Yannis Manios , Jim I Mann , Fariborz Mansour-Ghanaei , Enzo Manzato , Paula Margozzini , Anastasia Markaki , Oonagh Markey , Eliza Markidou Ioannidou , Pedro Marques-Vidal , Larissa Pruner Marques , Jaume Marrugat , Yves Martin-Prevel , Rosemarie Martin , Reynaldo Martorell , Eva Martos , Katharina Maruszczak , Stefano Marventano , Luis P Mascarenhas , Shariq R Masoodi , Ellisiv B Mathiesen , Prashant Mathur , Alicia Matijasevich , Tandi E Matsha , Christina Mavrogianni , Artur Mazur , Jean Claude N Mbanya , Shelly R McFarlane , Stephen T McGarvey , Martin McKee , Stela McLachlan , Rachael M McLean , Scott B McLean , Breige A McNulty , Sounnia Mediene Benchekor , Jurate Medzioniene , Parinaz Mehdipour , Kirsten Mehlig , Amir Houshang Mehrparvar , Aline Meirhaeghe , Jørgen Meisfjord , Christa Meisinger , Ana Maria B Menezes , Geetha R Menon , Gert Bm Mensink , Maria Teresa Menzano , Alibek Mereke , Indrapal I Meshram , Andres Metspalu , Haakon E Meyer , Jie Mi , Kim F Michaelsen , Nathalie Michels , Kairit Mikkel , Karolina Milkowska , Jody C Miller , Cláudia S Minderico , G K Mini , Juan Francisco Miquel , Mohammad Reza Mirjalili , Daphne Mirkopoulou , Erkin Mirrakhimov , Marjeta Mišigoj-Durakovic , Antonio Mistretta , Veronica Mocanu , Pietro A Modesti , Sahar Saeedi Moghaddam , Bahram Mohajer , Mostafa K Mohamed , Shukri F Mohamed , Kazem Mohammad , Zahra Mohammadi , Noushin Mohammadifard , Reza Mohammadpourhodki , Viswanathan Mohan , Salim Mohanna , Muhammad Fadhli Mohd Yusoff , Iraj Mohebbi , Farnam Mohebi , Marie Moitry , Drude Molbo , Line T Møllehave , Niels C Møller , Dénes Molnár , Amirabbas Momenan , Charles K Mondo , Michele Monroy-Valle , Eric Monterrubio-Flores , Kotsedi Daniel K Monyeki , Jin Soo Moon , Mahmood Moosazadeh , Leila B Moreira , Alain Morejon , Luis A Moreno , Karen Morgan , Suzanne N Morin , Erik Lykke Mortensen , George Moschonis , Malgorzata Mossakowska , Aya Mostafa , Anabela Mota-Pinto , Jorge Mota , Mohammad Esmaeel Motlagh , Jorge Motta , Marcos André Moura-Dos-Santos , Malay K Mridha , Kelias P Msyamboza , Thet Thet Mu , Magdalena Muc , Boban Mugoša , Maria L Muiesan , Parvina Mukhtorova , Martina Müller-Nurasyid , Neil Murphy , Jaakko Mursu , Elaine M Murtagh , Kamarul Imran Musa , Sanja Music Milanovic , Vera Musil , Norlaila Mustafa , Iraj Nabipour , Shohreh Naderimagham , Gabriele Nagel , Balkish M Naidu , Farid Najafi , Harunobu Nakamura , Jana Námešná , Ei Ei K Nang , Vinay B Nangia , Martin Nankap , Sameer Narake , Paola Nardone , Matthias Nauck , William A Neal , Azim Nejatizadeh , Chandini Nekkantti , Keiu Nelis , Liis Nelis , Ilona Nenko , Martin Neovius , Flavio Nervi , Chung T Nguyen , Nguyen D Nguyen , Quang Ngoc Nguyen , Ramfis E Nieto-Martínez , Yury P Nikitin , Guang Ning , Toshiharu Ninomiya , Sania Nishtar , Marianna Noale , Oscar A Noboa , Helena Nogueira , Teresa Norat , Maria Nordendahl , Børge G Nordestgaard , Davide Noto , Natalia Nowak-Szczepanska , Mohannad Al Nsour , Irfan Nuhoglu , Eha Nurk , Terence W O'Neill , Dermot O'Reilly , Galina Obreja , Caleb Ochimana , Angélica M Ochoa-Avilés , Eiji Oda , Kyungwon Oh , Kumiko Ohara , Claes Ohlsson , Ryutaro Ohtsuka , Örn Olafsson , Maria 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Siantar, Rosalynn, Sibai, Abla M, Silva, Antonio M, Silva, Diego Augusto Santo, Simon, Mary, Simons, Judith, Simons, Leon A, Sjöberg, Agneta, Sjöström, Michael, Skodje, Gry, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobek, Grzegorz, Sobngwi, Eugène, Sodemann, Morten, Söderberg, Stefan, Soekatri, Moesijanti YE, Soemantri, Agustinu, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sørensen, Thorkild IA, Sørgjerd, Elin P, Jérome, Charles Sossa, Soto-Rojas, Victoria E, Soumaré, Aïcha, Sovic, Slavica, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Spinelli, Angela, Spiroski, Igor, Staessen, Jan A, Stamm, Hanspeter, Stathopoulou, Maria G, Staub, Kaspar, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D, Stergiou, George S, Stessman, Jochanan, Stevanovic, Ranko, Stieber, Jutta, Stöckl, Dori, Stocks, Tanja, Stokwiszewski, Jakub, Stoyanova, Ekaterina, Stratton, Gareth, Stronks, Karien, Strufaldi, Maria Wany, Sturua, Lela, Suárez-Medina, Ramón, Suka, Machi, Sun, Chien-An, Sundström, Johan, Sung, Yn-Tz, Sunyer, Jordi, Suriyawongpaisal, Paibul, Swinburn, Boyd A, Sy, Rody G, Syddall, Holly E, Sylva, René Charle, Szklo, Moyse, Szponar, Lucjan, Tai, E Shyong, Tammesoo, Mari-Lii, Tamosiunas, Abdona, Tan, Eng Joo, Tang, Xun, Tanrygulyyeva, Maya, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarp, Jakob, Tarqui-Mamani, Carolina B, Braunerová, Radka Taxová, Taylor, Anne, Taylor, Julie, Tchibindat, Félicité, Tebar, William R, Tell, Grethe S, Tello, Tania, Tham, Yih Chung, Thankappan, KR, Theobald, Holger, Theodoridis, Xenophon, Thijs, Lutgarde, Thomas, Nihal, Thuesen, Betina H, Tichá, Lubica, Timmermans, Erik J, Tjonneland, Anne, Tolonen, Hanna K, Tolstrup, Janne S, Topbas, Murat, Topór-Madry, Roman, Torheim, Liv Elin, Tormo, María José, Tornaritis, Michael J, Torrent, Matie, Torres-Collado, Laura, Toselli, Stefania, Touloumi, Giota, Traissac, Pierre, Tran, Thi Tuyet-Hanh, Trichopoulos, Dimitrio, Trichopoulou, Antonia, Trinh, Oanh TH, Trivedi, Atul, Tshepo, Lechaba, Tsigga, Maria, Tsugane, Shoichiro, Tuliakova, Azaliia M, Tulloch-Reid, Marshall K, Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L, Twig, Gilad, Tynelius, Per, Tzotzas, Themistokli, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ukoli, Flora AM, Ulmer, Hanno, Unal, Belgin, Usupova, Zhamyila, Uusitalo, Hannu MT, Uysal, Nalan, Vaitkeviciute, Justina, Valdivia, Gonzalo, Vale, Susana, Valvi, Damaskini, van Dam, Rob M, Van der Heyden, Johan, van der Schouw, Yvonne T, Van Herck, Koen, Van Minh, Hoang, Van Schoor, Natasja M, van Valkengoed, Irene GM, Vanderschueren, Dirk, Vanuzzo, Diego, Varbo, Anette, Varela-Moreiras, Gregorio, Varona-Pérez, Patricia, Vasan, Senthil K, Vega, Toma, Veidebaum, Tooma, Velasquez-Melendez, Gustavo, Velika, Biruta, Veronesi, Giovanni, Verschuren, WM Monique, Victora, Cesar G, Viegi, Giovanni, Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesu, Virtanen, Jyrki K, Visser, Marjolein, Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vladulescu, Mihaela, Vlasoff, Tiina, Vocanec, Dorja, Vollenweider, Peter, Völzke, Henry, Voutilainen, Ari, Voutilainen, Sari, Vrijheid, Martine, Vrijkotte, Tanja GM, Wade, Alisha N, Wagner, Aline, Waldhör, Thoma, Walton, Janette, Wambiya, Elvis OA, Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, de Souza Wanderley Júnior, Rildo, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nichola, Weber, Adelheid, Wedderkopp, Niel, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Md Yusof, Safiah, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassili, Zainuddin, Ahmad A, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antoni, Zamrazilová, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Ko Zaw, Ko, Zdrojewski, Tomasz, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Cisneros, Julio Zuñiga, Zuziak, Monika, Ezzati, Majid, Filippi, Sarah, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Université Paris Cité (UPCité), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, and Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)
Subjects: Population -- Health aspects, Leanness, Baixo peso/Underweight, none, Double burden, alipainoisuus, tulotaso, global health, systematic analysis, Sedentary behaviors, RC1200, Prospective associations, 0302 clinical medicine, underweight, nälänhätä, Biology (General), skin and connective tissue diseases, Children, ComputingMilieux_MISCELLANEOUS, Body mass index, Human Nutrition & Health, education.field_of_study, Humane Voeding & Gezondheid, ylipaino, General Medicine, kansainvälinen vertailu, 3. Good health, World health, Medicine, A100 Pre-clinical Medicine, Population distribution, medicine.medical_specialty, QH301-705.5, Science, Socio-culturale, Nursing, Social sciences, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Thinness, SDG 3 - Good Health and Well-being, BMI, epidemiology, obesity, None, Humans, Obesidade/Obesity, SDG 2 - Zero Hunger, education, VLAG, US adults, Omvårdnad, body mass index, malnutrition, obesity, underweight, nutritional and metabolic diseases, medicine.disease, terveellisyys, Obesity, Faculdade de Ciências Sociais, Body Mass Index, Prevalence, Risk Factors, General Biochemistry, WIAS, lihavuus, RA, Demography, N.A, double burden, Settore MED/09 - Medicina Interna, alueelliset erot, Nutrition and Disease, Animal Nutrition, [SDV]Life Sciences [q-bio], Medizin, 030204 cardiovascular system & hematology, 0601 Biochemistry and Cell Biology, Change distribution of body mass index, RA0421, Voeding en Ziekte, Epidemiology, Medicine and Health Sciences, Global health, Índice de massa corporal/Body Mass Index, 030212 general & internal medicine, Underweight, painoindeksi, 2. Zero hunger, General Neuroscience, aliravitsemus, elintarvikkeet, health, Public Health, Global Health, Social Medicine and Epidemiology, Diervoeding, 3142 Public health care science, environmental and occupational health, purl.org/pe-repo/ocde/ford#3.01.03 [https], Chinese adults, pooled analysis, medicine.symptom, Diet quality, B120 Physiology, Research Article, trends, purl.org/pe-repo/ocde/ford#1.06.03 [https], prevalence, Population, Mothers, Genetics and Molecular Biology, 3121 Internal medicine, medicine, Life Science, ddc:610, 3125 Otorhinolaryngology, ophthalmology, kehonkoostumus, Nutrition, Australian adults, General Immunology and Microbiology, purl.org/pe-repo/ocde/ford#3.01.04 [https], Ciências sociais, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, Epidemiology and Global Health, sense organs, Estilos de Vida e Impacto na Saúde
Abstract: From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions., Wellcome Trust, Medical Research Council, peer-reviewed
Published: 2021

10. Psychopathic personalities and developmental systems

Author: Hane Htut Maung
Subjects: dynamic interactionism, causal parity, Developmental systems theory, philosophy of biology, 05 social sciences, Psychopathy, 06 humanities and the arts, 0603 philosophy, ethics and religion, medicine.disease, Personality psychology, 050105 experimental psychology, Developmental psychology, Philosophy, Philosophy of biology, 060302 philosophy, medicine, 0501 psychology and cognitive sciences, Psychology, developmental systems theory, Applied Psychology
Abstract: Is psychopathy born or made? Contemporary psychopathy research shows that there is much wrong with this question. It is increasingly accepted that the development of psychopathy is dependent on multiple causal factors interacting with one another. However, there remains the major theoretical challenge of understanding the relations between these multiple causal factors in the developmental process. In this paper, I argue that the conventional picture of gene-environment interactionism does not offer an adequate account of psychopathy development. Instead, I propose that a theoretical framework from the philosophy of biology, namely developmental systems theory, can facilitate a better understanding of psychopathy development that captures the contingent and dynamic relations between multiple causal factors. Some practical implications of a developmental systems theory approach to psychopathy are also explored.
Published: 2021

11. Polyoma BK Virus in Kidney Transplant Recipients: Screening, Monitoring, and Management

Author: Melanie L R Wyld, Germaine Wong, Brian J. Nankivell, Kathy Kable, Chanel H Y Chong, and Thida Maung Myint
Subjects: medicine.medical_specialty, medicine.medical_treatment, Viremia, medicine.disease_cause, law.invention, Nephropathy, chemistry.chemical_compound, Randomized controlled trial, law, Internal medicine, medicine, Humans, Dialysis, Kidney transplantation, Polyomavirus Infections, Transplantation, business.industry, Immunosuppression, medicine.disease, Kidney Transplantation, Transplant Recipients, BK virus, Tumor Virus Infections, chemistry, BK Virus, Polyomavirus, business, Cidofovir
Abstract: Polyomavirus BK virus (BKPyV) infection is an important complication of kidney transplantation and allograft failure. The prevalence of viremia is 10-15%, compared with BK associated nephropathy (BKPyVAN) at 3-5%. Given that there are no effective anti-viral prophylaxis or treatment strategies for BKPyVAN, active screening to detect BKPyV viraemia is recommended, particularly during the early post-transplant period. Immunosuppression reduction to allow viral clearance may avoid progression to severe and irreversible allograft damage. The frequency and duration of screening are highly variable between transplant centers because the evidence is reliant largely on observational data. Whilst the primary treatment goals center on achieving viral clearance through immunosuppression reduction, prevention of subsequent acute rejection, premature graft loss and return to dialysis remain as major challenges. Treatment strategies for BKPyV infection should be individualised to the recipient's underlying immunological risk and severity of the allograft infection. Efficacy data for adjuvant therapies including intravenous immunoglobulin and cidofovir are sparse. Future well-powered and high-quality randomized controlled trials are needed to inform evidence-based clinical practice for the management of BKPy infection.
Published: 2021

12. Observational study of adult respiratory infections in primary care clinics in Myanmar: understanding the burden of melioidosis, tuberculosis and other infections not covered by empirical treatment regimes

Author: Alistair R. D. McLean, Chitmin Ko Ko, David A. B. Dance, Yee Yee Aung, Kaung San Linn, Mo Mo Win, Ni Ni Tun, Clare E. Warrell, Yadanar Aung, Aung Pyae Phyo, Kyaw Thu Soe, Myo Maung Maung Swe, Wanitda Watthanaworawit, Htet Naing Lin, Frank Smithuis, Cho Zin Waing, Elizabeth A. Ashley, and Ne Myo Aung
Subjects: Adult, medicine.medical_specialty, Burkholderia pseudomallei, Melioidosis, Tuberculosis, Population, Myanmar, Sensitivity and Specificity, respiratory infection, Internal medicine, Drug Resistance, Bacterial, Humans, Medicine, AcademicSubjects/MED00860, education, Respiratory Tract Infections, Tuberculosis, Pulmonary, education.field_of_study, GeneXpert MTB/RIF, Primary Health Care, Respiratory tract infections, business.industry, Sputum, Public Health, Environmental and Occupational Health, Respiratory infection, Mycobacterium tuberculosis, General Medicine, medicine.disease, AcademicSubjects/MED00290, Infectious Diseases, tuberculosis, Respiratory virus, Original Article, Parasitology, medicine.symptom, influenza, business
Abstract: Background Lower respiratory infections constitute a major disease burden worldwide. Treatment is usually empiric and targeted towards typical bacterial pathogens. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms. Methods A prospective observational study in peri-urban communities of Yangon, Myanmar was conducted between July 2018 and April 2019. Sputum specimens of 299 adults presenting with fever and productive cough were tested for Mycobacterium tuberculosis (microscopy and GeneXpert MTB/RIF [Mycobacterium tuberculosis/resistance to rifampicin]) and Burkholderia pseudomallei (Active Melioidosis Detect Lateral Flow Assay and culture). Nasopharyngeal swabs underwent respiratory virus (influenza A, B, respiratory syncytial virus) polymerase chain reaction testing. Results Among 299 patients, 32% (95% confidence interval [CI] 26 to 37) were diagnosed with tuberculosis (TB), including 9 rifampicin-resistant cases. TB patients presented with a longer duration of fever (median 14 d) and productive cough (median 30 d) than non-TB patients (median fever duration 6 d, cough 7 d). One case of melioidosis pneumonia was detected by rapid test and confirmed by culture. Respiratory viruses were detected in 16% (95% CI 12 to 21) of patients. Conclusions TB was very common in this population, suggesting that microscopy and GeneXpert MTB/RIF on all sputum samples should be routinely included in diagnostic algorithms for fever and cough. Melioidosis was uncommon in this population.
Published: 2021

13. Serological evidence indicates widespread distribution of rickettsioses in Myanmar

Author: Htun Linn, Ni Ni Zaw, Thin Thin Nwe, Myat Myat Moe, Ni Ni Tun, Thel K. Hla, Frank Smithuis, Yin Yin Htwe, Stuart D. Blacksell, Ampai Tanganuchitcharnchai, Aung Pyae Phyo, Win May Thein, Kyaw Thu Soe, Htet Naing Lin, Elizabeth A. Ashley, Alistair R. D. McLean, Wei Yan Aung Htay, Wai Mon Kyaw, Myo Maung Maung Swe, and Philip N. D. Elders
Subjects: Adult, Male, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, 030106 microbiology, Seroprevalence, Enzyme-Linked Immunosorbent Assay, Myanmar, Scrub typhus, Murine typhus, Article, Immunoglobulin G, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, 0302 clinical medicine, Seroepidemiologic Studies, Internal medicine, medicine, Humans, lcsh:RC109-216, 030212 general & internal medicine, Rickettsial infections, biology, business.industry, Rickettsia Infections, General Medicine, Odds ratio, Middle Aged, bacterial infections and mycoses, medicine.disease, Antibodies, Bacterial, humanities, Spotted fever, Infectious Diseases, Spotted fever group, biology.protein, Female, business, Typhus
Abstract: Highlights • Diagnosis of rickettsial infections is difficult in low-resource settings; this leads to delays in receiving appropriate treatment. • Before this study, the distribution of rickettsioses in Myanmar was not known. • This serosurvey shows that rickettsioses are widespread in Myanmar. • Particularly high prevalence of scrub typhus was found in central and northern regions., Background Little research has been published on the prevalence of rickettsial infections in Myanmar. This study determined the seroprevalence of immunoglobulin G (IgG) antibodies to rickettsial species in different regions of Myanmar. Methods Seven hundred leftover blood samples from patients of all ages in primary care clinics and hospitals in seven regions of Myanmar were collected. Samples were screened for scrub typhus group (STG), typhus group (TG) and spotted fever group (SFG) IgG antibodies using enzyme-linked immunosorbent assays (ELISA). Immunofluorescence assays were performed for the same rickettsial groups to confirm seropositivity if ELISA optical density ≥0.5. Results Overall IgG seroprevalence was 19% [95% confidence interval (CI) 16–22%] for STG, 5% (95% CI 3–7%) for TG and 3% (95% CI: 2–5%) for SFG. The seroprevalence of STG was particularly high in northern and central Myanmar (59% and 19–33%, respectively). Increasing age was associated with higher odds of STG and TG seropositivity [per 10-year increase, adjusted odds ratio estimate 1.68 (p < 0.01) and 1.24 (p = 0.03), respectively]. Conclusion Rickettsial infections are widespread in Myanmar, with particularly high seroprevalence of STG IgG antibodies in central and northern regions. Healthcare workers should consider rickettsial infections as common causes of fever in Myanmar.
Published: 2021

14. When a storm showers the blood clots: a case of thyroid storm with systemic thromboembolism

Author: Ying Ying Chua, May Anne Cheong, Daphne Su-Lyn Gardner, and Aye Chan Maung
Subjects: Adult, Male, medicine.medical_specialty, endocrine system, endocrine system diseases, Endocrinology, Diabetes and Metabolism, animal diseases, 030209 endocrinology & metabolism, January, Thrombophilia, lcsh:Diseases of the endocrine glands. Clinical endocrinology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Internal Medicine, medicine, Thyroid storm, Thyroid, Singapore, Past medical history, lcsh:RC648-665, business.industry, Asian - Filipino, Atrial fibrillation, Sequela, Unique/Unexpected Symptoms or Presentations of a Disease, medicine.disease, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Cardiology, Propylthiouracil, Complication, business, medicine.drug
Abstract: Summary Thyroid storm is a rare but potentially life-threatening complication of excessive thyroid hormone action. It is associated with a hypercoagulable state and reported to increase the risk of thromboembolism. However, the role of anticoagulation in thyroid storm still remains controversial and inconclusive. A 22-year-old male with no significant past medical history presented with acute severe generalised abdominal pain. He was found to be profoundly thyrotoxic on arrival at our institution and subsequently diagnosed with thyroid storm secondary to newly diagnosed Graves’ disease. Extensive thromboses of the splanchnic, iliac, femoral veins and pulmonary arteries were subsequently demonstrated on CT scan. He had prolonged bowel ileus as a sequela of mesenteric ischaemia requiring total parenteral nutrition and non-oral forms of anti-thyroid drugs for management of hyperthyroidism. He was in sinus rhythm throughout his inpatient stay, and there was no personal history of prothrombotic conditions. His thrombophilia screen was normal. He eventually required jejunectomy due to jejunal ischaemia from extensive involvement of portal and mesenteric veins. He underwent radioiodine ablation for definitive treatment. He is currently hypothyroid and receiving thyroxine replacement. Thyroid storms are hypercoagulable states and can be associated with extensive thromboembolism even in the absence of atrial fibrillation. To our knowledge, this is the first report of severe extensive thromboembolism complicated by severe mesenteric ischaemia and bowel ileus in the setting of a thyroid storm. Routine prophylactic anticoagulation should be considered in those presenting with thyroid storms. Learning points: Prolonged use of rectal propylthiouracil (PTU) for managing hyperthyroidism was effective in a patient who cannot take oral anti-thyroid drugs. Hyperthyroidism is a hypercoagulable state due to an imbalance between coagulation and fibrinolytic factors. Thyroid storm can be associated with extensive thromboembolism even in the absence of atrial fibrillation; routine prophylactic anticoagulation should be considered in the setting of thyroid storms.
Published: 2021

15. Antifungal efficacy of isavuconazole and liposomal amphotericin B in a rabbit model of Exserohilum rostratum meningoencephalitis: A preclinical paradigm for management of CNS phaeohyphomycosis

Author: Patriss W. Moradi, Aspasia Katragkou, Vidmantas Petraitis, Laura L. Kovanda, Ethan Naing, Bo Bo Win Maung, Malcolm Finkelman, Gittel E Sussman-Straus, Thomas J. Walsh, and Ruta Petraitiene
Subjects: rabbits, Antifungal Agents, Pyridines, Triazole, Microbial Sensitivity Tests, Pharmacology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Ascomycota, Central Nervous System Diseases, In vivo, Amphotericin B, Amphotericin B deoxycholate, Nitriles, medicine, Animals, Humans, liposomal amphotericin B, 030212 general & internal medicine, experimental CNS phaeohyphomycosis, 0303 health sciences, 030306 microbiology, business.industry, isavuconazole, Exserohilum rostratum, Micafungin, Disease Management, Meningoencephalitis, General Medicine, Triazoles, medicine.disease, In vitro, Disease Models, Animal, Phaeohyphomycosis, Infectious Diseases, chemistry, AcademicSubjects/SCI00960, Original Article, Drug Therapy, Combination, Female, AcademicSubjects/MED00010, business, medicine.drug
Abstract: Treatment options for Exserohilum rostratum meningoencephalitis and other causes of phaeohyphomycosis of the central nervous system (CNS) are limited, while mortality and morbidity remain high. We therefore evaluated isavuconazole, a new antifungal triazole in comparison to liposomal amphotericin B (LAMB), in vitro and in the rabbit model of Exserohilum rostratum meningoencephalitis. We hypothesized that isavuconazole alone or in combination with LAMB or micafungin may be alternative options for treatment of CNS phaeohyphomycosis. We therefore investigated the in vitro antifungal activity of isavuconazole alone or in combination with amphotericin B deoxycholate (DAMB) or micafungin and efficacy of treatment with isavuconazole and LAMB in a rabbit model of experimental E. rostratum meningoencephalitis. Combination checkerboard plates were used to determine the minimum inhibitory concentrations, minimal lethal concentrations, fractional inhibitory concentration indices, and Bliss surface analysis of isavuconazole and amphotericin B deoxycholate (DAMB), either alone or in combination. As there were no in vitro synergistic or antagonistic interactions for either combination of antifungal agents against the E. rostratum isolates, in vivo studies were conducted with isavuconazole and LAMB as monotherapies. Rabbits were divided in following groups: treated with isavuconazole at 60 mg/kg/d (ISAV60), LAMB at 5.0 (LAMB5), 7.5 (LAMB7.5), and 10 mg/kg/d (LAMB10), and untreated controls (UC). In ISAV60-, LAMB5-, LAMB7.5-, and LAMB10-treated rabbits, significant reductions of fungal burden of E. rostratum in cerebral, cerebellar, and spinal cord tissues (P
Published: 2020

16. Incidence and Characteristics of Delayed Injection Site Reaction to the mRNA-1273 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccine (Moderna) in a Cohort of Hospital Employees

Author: Zaw Maung, Colin Hart, Adam Zakaria, Erin Amerson, Marlys S. Fassett, Timothy H. McCalmont, and Mark A. Jacobson
Subjects: Microbiology (medical), Adult, Male, Emergency Use Authorization, Pediatrics, medicine.medical_specialty, COVID-19 Vaccines, injection site reaction, 030226 pharmacology & pharmacy, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, adverse effect, vaccine, Injection site reaction, medicine, Humans, 030212 general & internal medicine, Adverse effect, business.industry, SARS-CoV-2, Incidence (epidemiology), Incidence, COVID-19, Sequela, Middle Aged, medicine.disease, Hospitals, United States, Vaccination, Infectious Diseases, Cohort, Female, business, Cohort study, 2019-nCoV Vaccine mRNA-1273
Abstract: Background mRNA SARS-CoV-2 vaccines are administered to 2 million individuals per day in the United States under US Food and Drug Administration emergency use authorization. Methods Observational cohort study of hospital employees who received their first SARS-CoV-2 mRNA vaccination between 14 December 2020 and 8 January 2021, including employees who reported onset of an injection site reaction ≥48 hours after administration of their first or second dose to an employee hotline. Results Thirteen female employees who received the mRNA-1273 vaccine (Moderna) during the first 3 weeks of the SARS-CoV-2 vaccine rollout at San Francisco General Hospital reported a pruritic rash at the injection site appearing 3 -9 days after receipt of their initial dose. Five had milder or similar reactions with earlier onset after the second dose. One additional female employee reported this delayed reaction only after the second dose. None reported serious adverse events or had symptoms severe enough to seek medical attention. These cases represented 1.1% of the 1275 female employees who received their first mRNA-1273 dose and 2.0% of the 557 who were aged 31 -45 years during this initial vaccine rollout. None of 675 males who initiated mRNA-1273 or 3612 employees of any sex who initiated BNT162b (Pfizer) vaccination during this period reported delayed-onset reactions. Conclusions These results suggest that delayed-onset, injection site pruritic rashes after mRNA-1273 SARS-CoV-2 vaccine administration, lasting up to 1 week, occur commonly in females, do not lead to serious sequela, and should not deter receipt of the second vaccine dose.
Published: 2022

17. Muliple Sclerosis, Corpus Callosum & Epilepsy

Author: Khin Maung Bo
Subjects: medicine.medical_specialty, Epilepsy, nervous system, business.industry, medicine, food and beverages, Audiology, medicine.disease, business, Corpus callosum
Abstract: There is a difference in prevalence of Epilepsy in General population & MS patients. Interical Epileptiform Discharges (IED) positivity in EEG is also different in the above two populations. Demyelination slows down the conduction speed of axons and author is proposing that different speed of conduction in adjacent axons can generate re-entrant circuits. If the reentrant circuits involve Corpus callosum (CC) fibers, seizure activities of MS can be triggered. DBS applied to CC can terminate the seizure attack of MS like Vagal Nerve Simulator (VNS) in terminating seizure in general population.
Published: 2021

18. High sustained virologic response in genotypes 3 and 6 with generic NS5A inhibitor and sofosbuvir regimens in chronic HCV in myanmar

Author: Soe Thiha Maung, Aung Hlaing Bwa, Sithu Lin, Sithu Sein Win, Naomi Khaing Than Hlaing, Moe Zaw Maung, Khin Thuzar Myint, K. Rajender Reddy, A. Mi Mi Kyaw, Khin Maung Win, Gayatri Nangia, Kyaw Thet Tun, and Bao-Li Loza
Subjects: Adult, Male, medicine.medical_specialty, Pyrrolidines, Cirrhosis, Daclatasvir, Genotype, Sustained Virologic Response, Sofosbuvir, Hepacivirus, Myanmar, Antiviral Agents, Heterocyclic Compounds, 4 or More Rings, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Virology, Internal medicine, Ribavirin, medicine, Humans, 030212 general & internal medicine, Adverse effect, Aged, Hepatology, business.industry, Imidazoles, Valine, Hepatitis C, Chronic, Middle Aged, medicine.disease, Clinical trial, Regimen, Infectious Diseases, chemistry, Drug Therapy, Combination, Female, 030211 gastroenterology & hepatology, Carbamates, business, medicine.drug
Abstract: Exclusive HCV therapy clinical trials with genotype 6 patients in high prevalence areas have been sparse. We analysed the safety and efficacy of two generic, pangenotypic NS5A/NS5B combination oral DAA regimens, primarily in genotypes 3 and 6, in a real-world setting: (a) daclatasvir/sofosbuvir (DCV/SOF) ± ribavirin (RBV) and (b) Velpatasvir/sofosbuvir (VEL/SOF ± RBV). Between December 2015 and November 2017, data from 522 patients were analysed, 311 of whom were treated with DCV/SOF ± RBV for 12/24 weeks (genotype 3: n = 193, genotype 6: n = 89) and 211 were treated with VEL/SOF ± RBV for 12/24 weeks (genotype 3: n = 83, genotype 6: n = 77). Overall SVR rates were high for both DCV/SOF ± RBV (96.1%, n = 299/311) and VEL/SOF ± RBV (95.3%, n = 201/211), and there was a good adverse event profile. Treatment naïve status and inclusion of RBV (in advanced fibrosis/cirrhosis) were significant independent predictors of achieving SVR12, while type of DAA regimen was not predictive. In this large cohort of genotypes 3 (n = 276) and 6 (n = 166; n = 127 unique subtype of 6c-l), high SVR rates of 94.9% (n = 262/276) and 95.2% (n = 158/166), respectively, were noted. In conclusion, generic and pangenotypic DCV/SOF and VEL/SOF ± RBV regimens were highly effective and safe, in genotypes 3 and 6 chronic HCV in Myanmar. These efficacious pangenotypic regimens suggest that baseline genotype testing can be eliminated moving forward. While RBV may still be needed for those with advanced fibrosis/cirrhosis, in a global elimination strategy it would not be practical even if it does compromise SVR in a minority with difficult to treat characteristics.
Published: 2019

19. Strategy and Efficacy of Generic and Pan-genotypic Sofosbuvir/Velpatasvir in Chronic Hepatitis C Virus: A Myanmar Experience

Author: Aung Hlaing Bwa, Rajender Reddy, Bao Li Loza, Gayatri Nangia, Khin Maung Win, Khin A.W. Han, Wint W. Ko, Soe Thiha Maung, Julia Palecki, Su S. Htar, Moe P. Oo, Lei Y. Wine, Naomi Khaing Than Hlaing, and Si T.S. Win
Subjects: medicine.medical_specialty, Hepatology, Sofosbuvir, business.industry, Hepatitis C virus, Ribavirin, Hepatitis C, medicine.disease_cause, medicine.disease, Sofosbuvir/velpatasvir, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, chemistry, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Internal medicine, Genotype, medicine, Original Article, 030211 gastroenterology & hepatology, business, Adverse effect, medicine.drug
Abstract: Background In resource-constrained areas, generic direct-acting antivirals (DAAs) have considerably reduced the cost of hepatitis C virus (HCV) therapy while there remain significant costs related to the baseline and follow-up virologic assays. Aim The aim was to assess the efficacy and safety of HCV therapy in Myanmar with pan-genotypic generic DAA sofosbuvir/velpatasvir (SOF/VEL) and with and without the baseline genotype testing, while the duration of treatment and use of ribavirin (RBV) was dictated by cirrhosis and prior treatment failure. Methods Between September 2016 and June 2017, data from the 359 participants who completed treatment with SOF/VEL (± RBV) for 12–24 weeks were analyzed. Two hundred one patients did not have the baseline HCV genotype tested. Results Regimens included SOF/VEL for 12 weeks (n = 43), SOF/VEL/RBV for 12 weeks (n = 275), or SOF/VEL/RBV for 24 weeks (n = 41). The mean age was 52 years, 44% were men (n = 159), 41 (11.4%) had a history of previous DAA therapy, 7 (1.9%) had a history of hepatocellular carcinoma, and 55 (15.3%) had cirrhosis. Overall, the sustained viral response (SVR)12 rate was 98.6% (354/359) and with a good adverse event profile. SVR rates were similar to those with and without baseline genotype testing and also across all genotypes in those who had genotype tested. Conclusions In Myanmar, generic and pan-genotypic SOF/VEL ± RBV is a highly effective and safe treatment for HCV, regardless of the HCV genotype, and therefore, the requirement for the baseline genotype can be eliminated. Future strategies should include elimination of treatment and end of treatment HCV RNA testing to enhance treatment uptake and further reduce cost.
Published: 2019

20. Dawn of Theranostics in Myanmar (Dream, Reality, and Constraint)

Author: Kyin Myint, Win Maung, Thiri Kyi Phyu, and Tin Maung Thein
Subjects: Oncology, medicine.medical_specialty, PET-CT, Cost effectiveness, business.industry, Castration resistant, urologic and male genital diseases, Malignancy, medicine.disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Prostate cancer, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, Perspective, Cancer management, Health care, medicine, Radiology, Nuclear Medicine and imaging, medicine.symptom, business, Bone pain
Abstract: Prostate cancer is third common malignancy in men of old age (average 65 years) in Myanmar. Currently, serum PSA and bone scan are the markers of choice. Because of the evidence-based, promising success of (68)Ga-PSMA PET-CT and (177)Lu-PSMA theranostics in prostate cancer worldwide, (99m)Tc-PSMA SPECT-CT imaging and (177)Lu-PSMA therapy has launched as a stepping-stone of theranostics in Myanmar with the available facilities. Twelve cases of prostate cancer patients were imaged with 600 MBq of (99m)Tc-PSMA I+S SPECT-CT. Four metastatic castration resistant prostate cancer (MCRPC) patients with abnormal result were treated with (177)Lu-PSMA. The protocol consists of 6–8 GBq of (177)Lu-PSMA, three successive doses at interval of 4–6 weeks. Post-therapy SPECT-CT imaging was done. All treated patients were improved by free of bone pain, and fall/rise in serum PSA level. Two patients with extensive skeletal metastases succumbed to complications. The results are well documented and present at the multidisciplinary conferences for clinical awareness. Theranostics in prostate cancer with available facilities is an additional boon to our health care professionals to upgrade cancer management in Myanmar. This paper provides the technology with cost effectiveness and benefit to prostate cancer patients of Myanmar.
Published: 2019

21. Clinical importance of the Mandalay spitting cobra (Naja mandalayensis) in Upper Myanmar – Bites, envenoming and ophthalmia

Author: Myat-Myat-Thein, Myat-Thet-Nwe, Mohammad Afzal Mahmood, David A. Warrell, Sai-Sein-Lin-Oo, Myo-Thant, Du-Wun-Moe, Chen Au Peh, Aye-Zarchi-San, Than-Aye, Mark O’Shea, Mi-Mi-Khine, Khin-Maung-Gyi, Julian White, Pyae-Phyo-Aung, Oakkar-Kyaw-Khant, and Htay-Aung
Subjects: medicine.medical_specialty, Naja mandalayensis, Naja, Antivenom, Snake Bites, Cobra, Myanmar, Toxicology, complex mixtures, medicine, Animals, Naja kaouthia, Elapidae, computer.programming_language, Elapid Venoms, Endophthalmitis, biology, Antivenins, business.industry, biology.organism_classification, medicine.disease, Dermatology, Snake bites, Spitting cobra, business, computer
Abstract: Examination of 18 cobras brought to three hospitals in the Mandalay Region by patients bitten or spat at by them distinguished 3 monocled cobras (Naja kaouthia) and 15 Mandalay spitting cobras (N. mandalayensis), based on their morphological characteristics. We confirm and extend the known distributions and habitats of both N. mandalayensis and N. kaouthia in Upper Myanmar. Clinical symptoms of local and systemic envenoming by N. mandalayensis are described for the first time. These included local swelling, blistering and necrosis and life-threatening systemic neurotoxicity. More information is needed about the clinical phenotype and management of bites by N. mandalayensis, the commoner of the two cobras in Upper Myanmar. Since the current cobra antivenom manufactured in Myanmar has lower pre-clinical efficacy against N. mandalayensis than N. kaouthia, there is a need for more specific antivenom therapy.
Published: 2020

22. The effect of anticoagulation on outcomes after liver and spleen injuries: A research consortium of New England centers for trauma (ReCONECT) study

Author: Jon D. Dorfman, Sandra Mackey, Kimberly A. Davis, Reza Askari, Alexander Ruditsky, Stephen R. Odom, George Kasotakis, George C. Velmahos, Adrian A. Maung, Michael S. Rosenblatt, Ahmed I Eid, Bishwajit Bhattacharya, Ahmed E Elsharkawy, and Barbara U. Okafor
Subjects: medicine.medical_specialty, Spleen, Wounds, Nonpenetrating, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, New england, Trauma Centers, New England, Internal medicine, Humans, Medicine, Retrospective Studies, General Environmental Science, Liver injury, 030222 orthopedics, business.industry, Anticoagulants, 030208 emergency & critical care medicine, Mean age, Retrospective cohort study, Middle Aged, medicine.disease, medicine.anatomical_structure, Liver, General Earth and Planetary Sciences, business
Abstract: Liver and spleen injuries are the most commonly injured solid organs, the effects of anticoagulation on these injuries has not yet been well characterized.Multicenter retrospective study.During the 4-year study period, 1254 patients, 64 (5%) on anticoagulation (AC), were admitted with liver and/or splenic injury. 58% of patients had a splenic injury, 53% had a liver injury and 11% had both. Patients on AC were older than non-AC patients (mean age 60.9 vs. 38.6 years, p 0.001). The most common AC drug was warfarin (70%) with atrial fibrillation (47%) the most common indication for AC. There was no significant difference in AAST injury grade between AC and non-AC patients (median grade 2), but AC patients required a blood product transfusion more commonly (58 vs 40%, p = 0.007) particularly FFP (4 vs 19%, p 0.01). Among those transfused, non-AC patients required slightly more PRBC (5.7 vs 3.8 units, p = 0.018) but similar amount of FFP (3.2 vs 3.1 units, p = 0.92). The two groups had no significant difference in the rates of initial non-operative management (50% (AC) vs 56% (non-AC), p = 0.3)) or failure of non-operative management (7 vs 4%, p = 0.16). AC patients were more likely to be managed initially with angiography (36 vs 20%, p = 0.001) while non-AC patients with surgery (24% vs 13%, p = 0.04). There was no significant difference in LOS and mortality.The use of anticoagulation did not result in a difference in outcomes among patients with spleen and/or liver injuries.
Published: 2020

23. Vitamin D in COVID - 19: Dousing the fire or averting the storm? – A perspective from the Asia-Pacific

Author: Chandran, Manju, Chan Maung, Aye, Mithal, Ambrish, and Parameswaran, Rajeev
Subjects: 0301 basic medicine, medicine.medical_specialty, Pediatrics, lcsh:Diseases of the musculoskeletal system, 030209 endocrinology & metabolism, Disease, Article, vitamin D deficiency, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Case fatality rate, Epidemiology, medicine, Vitamin D and neurology, Vitamin D, Acute respiratory tract infection, Vitamin D supplementation, SARS-CoV-2, business.industry, COVID-19, Outbreak, medicine.disease, Coronavirus, 030101 anatomy & morphology, lcsh:RC925-935, business
Abstract: COVID-19, the acute respiratory tract infection (RTI) caused by the Coronavirus, Sars-CoV-2, has swept around the world. No country has been spared from its onslaught. Treatments that can reduce the risk of infection and mortality from the disease are desperately needed. Though high quality randomized controlled trials are lacking, some observational and interventional studies that explore the link between vitamin D and RTIs exist. Vitamin D modulates both innate as well as adaptive immunity and may potentially prevent or mitigate the complications associated with RTIs. Evidence linking vitamin D to COVID-19 include that the outbreak occurred in winter in the northern hemisphere at a time when vitamin D levels are lowest in resident populations, that blacks and minority ethnic individuals who are known to have lower levels of vitamin D appear to be disproportionately affected and have more severe complications from the disease, that vitamin D deficiency has been shown to contribute to acute respiratory distress syndrome and that case fatality rates increase with age and in populations with comorbid conditions such as diabetes, hypertension, and cardiovascular disease, all of which are associated with lower vitamin D levels. This narrative review summarizes the current knowledge about the epidemiology and pathophysiology of COVID-19, the evidence linking vitamin D and RTIs, especially COVID-19, the mechanistic reasons behind the possible protective effect of vitamin D in COVID-19, and the evidence with regard to vitamin D supplementation in RTIs. It concludes with some recommendations regarding supplementation of vitamin D in patients with COVID-19.
Published: 2020

24. Traumatic Brain Injury in Myanmar: Preliminary Results and Development of an Adjunct Electronic Medical Record

Author: Aung Thurein Win, Kee B. Park, Zayya Naung, Thet Maung Maung, Karam Asmaro, Su Myat Mo, Aye Mya Phyu, Nang Saw Myat Hnin Aye, Kyi Hlaing, Win Myaing, Ai Ai Khaing, Thint Myat, Jack Rock, and Tyler Prentiss
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Databases, Factual, Traumatic brain injury, Neurosurgery, Myanmar, Proof of Concept Study, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Brain Injuries, Traumatic, medicine, Electronic Health Records, Humans, Developing Countries, Aged, Aged, 80 and over, business.industry, Medical record, Mortality rate, Online database, Glasgow Coma Scale, Internship and Residency, Middle Aged, medicine.disease, Neurosurgeons, Computers, Handheld, 030220 oncology & carcinogenesis, Etiology, Female, Surgery, Neurology (clinical), Medical emergency, business, 030217 neurology & neurosurgery
Abstract: The treatment of traumatic brain injury (TBI) in Myanmar is a major health issue. Comprehensive appreciation of the pathology is limited given the lack of granular metadata available. In this proof-of-concept study, we analyzed demographic data on TBI generated from a novel, prospective, online database in a lower-middle income country.Neurosurgery residents were given an electronic tablet for data entry into an online database. Metadata-driven data capture was carried out prospectively by trained residents, and the information was reviewed weekly by the supervising team in the United States.Complete data were available on 242/253 (96%) patients. Age at admission was 37 years (range 16-85), and length of stay was 3.53 days (1-21). Etiologies included motorcycle accidents, falls, assaults, pedestrian vehicular injuries, and industrial accidents. Dispositions were primarily to home (211). Average Glasgow Coma Scale score at admission was 12.97. There was a 68% mortality rate of patients directly admitted to the North Okkalappa General and Teaching Hospital with a Glasgow Coma Scale score8 versus 75% for patients transferred in from other facilities. Surgery was performed on 30 patients (12.4%).Despite a lack of formal training in electronic medical records or research, the resident team was able to capture the majority of admissions with granular-level data. This helped shed light on the etiology and severity of TBI in Myanmar. As a result, more effective transport systems and access to trauma care must be achieved. Accessible regional trauma centers with investment in intensive care units, operative care, anesthesia, and imaging resources are necessary.
Published: 2020

25. Efficacy and tolerability of artemisinin-based and quinine-based treatments for uncomplicated falciparum malaria in pregnancy: a systematic review and individual patient data meta-analysis

Author: Blaise Genton, Michael Nambozi, Elizabeth A. Ashley, Anupkumar R. Anvikar, François Nosten, Norah Mwebaza, Neena Valecha, Khin Maung Lwin, Aung Pyae Phyo, Myaing M. Nyunt, Steven R. Meshnick, Jean-Louis A Ndiaye, Kanlaya Sriprawat, Nicholas J. White, Irene Kuepfer, Harry Tagbor, Rose McGready, Marcus J. Rijken, Patrice Piola, Rashid Mansoor, Dominic Mosha, Halidou Tinto, Moo Kho Paw, Linda Kalilani-Phiri, Victor Mwapasa, Umberto D'Alessandro, Mary Ellen Gilder, Innocent Valea, Jacher Wiladphaingern, Miriam K. Laufer, Makoto Saito, Elizabeth Juma, Philippe J Guerin, Bernhards Ogutu, Sunil Parikh, Kasia Stepniewska, Lauren M. Cohee, Daniel Chandramohan, Mupawjay Pimanpanarak, Kalynn Kennon, Joel Tarning, and Obstetrics and Gynaecology
Subjects: Amodiaquine/therapeutic use, Anti-Bacterial Agents/therapeutic use, Antimalarials/adverse effects, Antimalarials/therapeutic use, Artemisinins/therapeutic use, Artesunate/therapeutic use, Atovaquone/therapeutic use, Clindamycin/therapeutic use, Drug Combinations, Drug Therapy, Combination, Female, Humans, Malaria, Falciparum/drug therapy, Mefloquine/therapeutic use, Pregnancy, Pregnancy Complications, Parasitic/drug therapy, Proguanil/therapeutic use, Pyrimethamine/therapeutic use, Quinine/adverse effects, Quinine/therapeutic use, Quinolines/therapeutic use, Sulfadoxine/therapeutic use, medicine.medical_specialty, business.industry, 030231 tropical medicine, Cochrane Library, medicine.disease, Article, Clinical trial, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Systematic review, Tolerability, Meta-analysis, Internal medicine, medicine, 030212 general & internal medicine, Artemisinin, business, Malaria, Cohort study, medicine.drug
Abstract: Background: Malaria in pregnancy affects both the mother and the fetus. However, evidence supporting treatment guidelines for uncomplicated (including asymptomatic) falciparum malaria in pregnant women is scarce and assessed in varied ways. We did a systematic literature review and individual patient data (IPD) meta-analysis to compare the efficacy and tolerability of different artemisinin-based or quinine-based treatments for malaria in pregnant women. Methods: We did a systematic review of interventional or observational cohort studies assessing the efficacy of artemisinin-based or quinine-based treatments in pregnancy. Seven databases (MEDLINE, Embase, Global Health, Cochrane Library, Scopus, Web of Science, and Literatura Latino Americana em Ciencias da Saude) and two clinical trial registries (International Clinical Trials Registry Platform and ClinicalTrials.gov) were searched. The final search was done on April 26, 2019. Studies that assessed PCR-corrected treatment efficacy in pregnancy with follow-up of 28 days or more were included. Investigators of identified studies were invited to share data from individual patients. The outcomes assessed included PCR-corrected efficacy, PCR-uncorrected efficacy, parasite clearance, fever clearance, gametocyte development, and acute adverse events. One-stage IPD meta-analysis using Cox and logistic regression with random-effects was done to estimate the risk factors associated with PCR-corrected treatment failure, using artemether-lumefantrine as the reference. This study is registered with PROSPERO, CRD42018104013. Findings: Of the 30 studies assessed, 19 were included, representing 92% of patients in the literature (4968 of 5360 episodes). Risk of PCR-corrected treatment failure was higher for the quinine monotherapy (n=244, adjusted hazard ratio [aHR] 6·11, 95% CI 2·57–14·54, p Interpretation: Efficacy and tolerability of artemisinin-based combination therapies (ACTs) in pregnant women are better than quinine. The lower efficacy of artemether-lumefantrine compared with other ACTs might require dose optimisation.
Published: 2020

26. Factors associated with breast cancer screening behaviors in a sample of Jamaican women in 2013

Author: Byron C. Jaeger, Huifeng Yun, Nora Balas, Pauline E. Jolly, and Maung Aung
Subjects: Adult, Health Knowledge, Attitudes, Practice, Jamaica, Black People, Breast Neoplasms, Sample (statistics), Logistic regression, Article, 03 medical and health sciences, Breast cancer screening, 0302 clinical medicine, Breast cancer, Regional health authority, Surveys and Questionnaires, medicine, Humans, Mass Screening, Breast screening, Mammography, 030212 general & internal medicine, Early Detection of Cancer, Aged, Retrospective Studies, Aged, 80 and over, 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, business.industry, Age Factors, Breast Self-Examination, Mean age, General Medicine, Middle Aged, medicine.disease, Health Surveys, Cross-Sectional Studies, Female, business, Demography
Abstract: In this study authors aimed to investigate the barriers to participation of a sample of Jamaican women in mammography screening. The data were obtained from a previous survey that was conducted in Jamaica from June to August 2013 in the four parishes (Hanover, St. James, Trelawny, and Westmoreland) served by the Western Regional Health Authority (WRHA). WRHA served four hospitals, five non-randomized health centers, and five sites of community events. The sample consisted of women ranging in age between 35 and 83 years, with the mean age of 50.2 (SD = 10.6). The authors used a logistic regression to determine the extent to which variables were associated with breast cancer screening. The level of significace was 0.1 for the bivariate and multivariable analysis. The main factors associated with the lack of breast cancer screening among the women were: being less than 50 years old, single, never thought about breast cancer screening, in need of childcare, and having more than three children. We identified significant barriers to participation in mammography screening experienced by a sample of Jamaican women. Our results suggest that it is necessary to increase the awareness of the importance of breast screening importance among the women who may never have thought about mammography.
Published: 2020

27. Effect of Astragalus membranaceus extract on IgA nephropathy: a case of renal function improvement during one-and-a-half-year follow-up

Author: Khin Maung Lwin, Ye Htut Linn, and Yamin Kyaw Swar Dee
Subjects: medicine.medical_specialty, Renal function, 01 natural sciences, Gastroenterology, Nephropathy, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Hepatitis, Proteinuria, biology, business.industry, Glomerulonephritis, medicine.disease, biology.organism_classification, 030205 complementary & alternative medicine, 0104 chemical sciences, 010404 medicinal & biomolecular chemistry, Astragalus, Losartan, Complementary and alternative medicine, medicine.symptom, business, Kidney disease, medicine.drug
Abstract: Immunoglobulin A nephropathy is one of the most common type of primary glomerulonephritis globally. Its pathogenesis remains unclear. It is a slowly progressive disease that may eventually lead to end-stage renal disease. Although the angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and immunosuppressive drugs are regarded as the standard treatments, the optimal approach to the treatment of IgA nephropathy is still uncertain. Astragalus membranaceus has been widely used in traditional Chinese medicine for cardiovascular disorder, kidney disease, hepatitis, and some skin diseases. It had been widely used in treating various renal diseases including IgA nephropathy. In this case report, we present a 34-year-old Myanmar female of Karen ethnic with IgA nephropathy. She was treated with Astragalus membranaceus together with losartan and other integrative medicines. Her renal function and proteinuria improved during the one-a-half-year follow-up. This case report highlights the improvement effect of Astragalus membranaceus in integrative way for the treatment of IgA nephropathy.
Published: 2020

28. A pivotal role for Interferon-α receptor-1 in neuronal injury induced by HIV-1

Author: Ricky Maung, Hina Singh, Rohan Shah, Daniel Ojeda-Juárez, Amanda J. Roberts, and Marcus Kaul
Subjects: MAPK/ERK pathway, Male, Cell signaling, AIDS Dementia Complex, Immunology, Central nervous system, Receptor, Interferon alpha-beta, Neurotransmission, HIV Envelope Protein gp120, Microgliosis, lcsh:RC346-429, Cellular and Molecular Neuroscience, Mice, Interferon, medicine, Animals, Receptor, lcsh:Neurology. Diseases of the nervous system, Mice, Knockout, Neurons, business.industry, General Neuroscience, Research, Neurotoxicity, Brain, medicine.disease, Cell biology, medicine.anatomical_structure, Neurology, HIV-1, Female, business, medicine.drug
Abstract: Background HIV-1 infection remains a major public health concern despite effective combination antiretroviral therapy (cART). The virus enters the central nervous system (CNS) early in infection and continues to cause HIV-associated neurocognitive disorders (HAND). The pathogenic mechanisms of HIV-associated brain injury remain incompletely understood. Since HIV-1 activates the type I interferon system, which signals via interferon-α receptor (IFNAR) 1 and 2, this study investigated the potential role of IFNAR1 in HIV-induced neurotoxicity. Methods We cross-bred HIVgp120-transgenic (tg) and IFNAR1 knockout (IFNAR1KO) mice. At 11–14 months of age, we performed a behavioral assessment and subsequently analyzed neuropathological alterations using deconvolution and quantitative immunofluorescence microscopy, quantitative RT-PCR, and bioinformatics. Western blotting of brain lysates and an in vitro neurotoxicity assay were employed for analysis of cellular signaling pathways. Results We show that IFNAR1KO results in partial, sex-dependent protection from neuronal injury and behavioral deficits in a transgenic model of HIV-induced brain injury. The IFNAR1KO rescues spatial memory and ameliorates loss of presynaptic terminals preferentially in female HIVgp120tg mice. Similarly, expression of genes involved in neurotransmission reveals sex-dependent effects of IFNAR1KO and HIVgp120. In contrast, IFNAR1-deficiency, independent of sex, limits damage to neuronal dendrites, microgliosis, and activation of p38 MAPK and restores ERK activity in the HIVgp120tg brain. In vitro, inhibition of p38 MAPK abrogates neurotoxicity caused similarly by blockade of ERK kinase and HIVgp120. Conclusion Our findings indicate that IFNAR1 plays a pivotal role in both sex-dependent and independent processes of neuronal injury and behavioral impairment triggered by HIV-1.
Published: 2020

29. Triple artemisinin-based combination therapies versus artemisinin-based combination therapies for uncomplicated Plasmodium falciparum malaria: a multicentre, open-label, randomised clinical trial

Author: Rob W van der Pluijm, Rupam Tripura, Richard M Hoglund, Aung Pyae Phyo, Dysoley Lek, Akhter ul Islam, Anupkumar R Anvikar, Parthasarathi Satpathi, Sanghamitra Satpathi, Prativa Kumari Behera, Amar Tripura, Subrata Baidya, Marie Onyamboko, Nguyen Hoang Chau, Yok Sovann, Seila Suon, Sokunthea Sreng, Sivanna Mao, Savuth Oun, Sovannary Yen, Chanaki Amaratunga, Kitipumi Chutasmit, Chalermpon Saelow, Ratchadaporn Runcharern, Weerayuth Kaewmok, Nhu Thi Hoa, Ngo Viet Thanh, Borimas Hanboonkunupakarn, James J Callery, Akshaya Kumar Mohanty, James Heaton, Myo Thant, Kripasindhu Gantait, Tarapada Ghosh, Roberto Amato, Richard D Pearson, Christopher G Jacob, Sónia Gonçalves, Mavuto Mukaka, Naomi Waithira, Charles J Woodrow, Martin P Grobusch, Michele van Vugt, Rick M Fairhurst, Phaik Yeong Cheah, Thomas J Peto, Lorenz von Seidlein, Mehul Dhorda, Richard J Maude, Markus Winterberg, Nguyen Thanh Thuy-Nhien, Dominic P Kwiatkowski, Mallika Imwong, Podjanee Jittamala, Khin Lin, Tin Maung Hlaing, Kesinee Chotivanich, Rekol Huy, Caterina Fanello, Elizabeth Ashley, Mayfong Mayxay, Paul N Newton, Tran Tinh Hien, Neena Valecha, Frank Smithuis, Sasithon Pukrittayakamee, Abul Faiz, Olivo Miotto, Joel Tarning, Nicholas P J Day, Nicholas J White, Arjen M Dondorp, Nguyen T Thuy-Nhien, Neena Valeche, Nicholas PJ Day, Infectious diseases, AII - Infectious diseases, APH - Aging & Later Life, APH - Global Health, APH - Quality of Care, and Intensive Care Medicine
Subjects: medicine.medical_specialty, Amodiaquine, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, parasitic diseases, medicine, Humans, 030212 general & internal medicine, Artemether, Artemisinin, Malaria, Falciparum, Intention-to-treat analysis, biology, business.industry, Mefloquine, Plasmodium falciparum, General Medicine, Articles, medicine.disease, biology.organism_classification, Artemisinins, Malaria, Tolerability, business, medicine.drug
Abstract: Summary Background Artemisinin and partner-drug resistance in Plasmodium falciparum are major threats to malaria control and elimination. Triple artemisinin-based combination therapies (TACTs), which combine existing co-formulated ACTs with a second partner drug that is slowly eliminated, might provide effective treatment and delay emergence of antimalarial drug resistance. Methods In this multicentre, open-label, randomised trial, we recruited patients with uncomplicated P falciparum malaria at 18 hospitals and health clinics in eight countries. Eligible patients were aged 2–65 years, with acute, uncomplicated P falciparum malaria alone or mixed with non-falciparum species, and a temperature of 37·5°C or higher, or a history of fever in the past 24 h. Patients were randomly assigned (1:1) to one of two treatments using block randomisation, depending on their location: in Thailand, Cambodia, Vietnam, and Myanmar patients were assigned to either dihydroartemisinin–piperaquine or dihydroartemisinin–piperaquine plus mefloquine; at three sites in Cambodia they were assigned to either artesunate–mefloquine or dihydroartemisinin–piperaquine plus mefloquine; and in Laos, Myanmar, Bangladesh, India, and the Democratic Republic of the Congo they were assigned to either artemether–lumefantrine or artemether–lumefantrine plus amodiaquine. All drugs were administered orally and doses varied by drug combination and site. Patients were followed-up weekly for 42 days. The primary endpoint was efficacy, defined by 42-day PCR-corrected adequate clinical and parasitological response. Primary analysis was by intention to treat. A detailed assessment of safety and tolerability of the study drugs was done in all patients randomly assigned to treatment. This study is registered at ClinicalTrials.gov, NCT02453308, and is complete. Findings Between Aug 7, 2015, and Feb 8, 2018, 1100 patients were given either dihydroartemisinin–piperaquine (183 [17%]), dihydroartemisinin–piperaquine plus mefloquine (269 [24%]), artesunate–mefloquine (73 [7%]), artemether–lumefantrine (289 [26%]), or artemether–lumefantrine plus amodiaquine (286 [26%]). The median age was 23 years (IQR 13 to 34) and 854 (78%) of 1100 patients were male. In Cambodia, Thailand, and Vietnam the 42-day PCR-corrected efficacy after dihydroartemisinin–piperaquine plus mefloquine was 98% (149 of 152; 95% CI 94 to 100) and after dihydroartemisinin–piperaquine was 48% (67 of 141; 95% CI 39 to 56; risk difference 51%, 95% CI 42 to 59; p
Published: 2020

30. Epidermal growth factor receptor variants in patients from Myanmar with lung adenocarcinoma

Author: Aye Aye Nyunt, Aye Aye Myint, Nitar Khine, May Phyo Maung, Myint Myint Naing, Hnin Hnin Aye, Nway Nway Htike, and Khine San Yin
Subjects: 0301 basic medicine, Lung, biology, business.industry, Geography, Planning and Development, Management, Monitoring, Policy and Law, medicine.disease, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Cancer research, biology.protein, medicine, Adenocarcinoma, In patient, Epidermal growth factor receptor, business
Abstract: Background Epidermal growth factor receptor (EGFR) sequence variants in patients from Myanmar have not yet been reported. Objectives To describe the molecular epidemiology of EGFR variants in patients from Myanmar with lung adenocarcinoma. Methods Histological diagnosis and categorization of biopsies collected from 66 patients (28–78 years) with lung cancer was conducted using a panel of antibodies including those to: TTF1, P40, synaptophysin, CK7, and napsin-A. Samples from patients with confirmed adenocarcinoma were tested for EGFR variants using a cobas EGFR Mutation Test kit and cobas z 480 System (Roche). We conducted a univariate analysis of categorical factors using a χ2 or Fisher exact test. Results Histological types were adenocarcinoma (61%, 40/66), squamous cell carcinoma (24%, 16/66), neuroendocrine carcinoma (9%, 6/66), undifferentiated carcinoma (2%, 1/66), adenosquamous carcinoma (2%, 1/66), small cell anaplastic carcinoma (2%, 1/66), and pleomorphic sarcoma (2%, 1/66). EGFR variants were detected in 15 of 40 (38%) cases of adenocarcinoma. Among them, 6 patients (40%) had an exon 19 deletion, another 6 (40%) had exon 21 substitutions, 1 (7%) had exon 20 insertion S768I, and 2 (13%) had compound variations (1 of exon 21 L858R and exon 18 G719X, and 1 of exon 20 S768I and exon 18 G719X). Although limited by small sample size, no significant association was found between the variants and factors including family cancer history, age group, sex, ethnicity, or occupation. However, there was a strong significant association between never-smokers and EGFR variants (P = 0.008). Conclusion Knowledge of EGFR variants in patients from Myanmar is encouraging for their effective cancer treatment.
Published: 2020

31. Contemporary management of spontaneous retroperitoneal and rectus sheath hematomas

Author: Bishwajit Bhattacharya, Kimberly A. Davis, Adrian A. Maung, and Michael H. Warren
Subjects: Male, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Blood Component Transfusion, Shock, Hemorrhagic, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Hematoma, Humans, Medicine, International Normalized Ratio, Retroperitoneal Space, Embolization, Aged, Retrospective Studies, Aged, 80 and over, Prothrombin time, medicine.diagnostic_test, business.industry, Anticoagulant, Angiography, Warfarin, Anticoagulants, Retrospective cohort study, General Medicine, Rectus sheath, Length of Stay, Middle Aged, medicine.disease, Embolization, Therapeutic, Surgery, Rectal Diseases, medicine.anatomical_structure, Prothrombin Time, Female, Tomography, X-Ray Computed, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract: Background Retroperitoneal and rectus sheath hematomas can occur spontaneously. There is a lack of research about the disease progression, optimal treatment strategies and the need for surgical intervention. Our study investigated their outcomes and management. Study design Adult patients admitted during a one-year period with non-traumatic retroperitoneal or rectus sheath hematomas were retrospectively identified. Biographical, hospital-course, and outcome data were extracted. Results 99 patients were included; median age was 73-years (IQR 61–80). 88 patients were on an anticoagulant or antiplatelet agent. Warfarin and intravenous heparin being the most commonly utilized agents (42% and 36.4%, respectively). All 99 patients were diagnosed by CT scan. 79 patients received some sort of blood product (79.8% PRBC, 43.4% FFP, 17% platelets), and 26 patients were in hemorrhagic shock. 17 patients underwent angiography and/or angioembolization. Neither anticoagulation in general nor any specific agent was associated with the need for blood product transfusion or angiography. 13 patients died but none were attributable to the hematoma. Conclusion Both hematomas are usually self-limiting and rarely require surgical intervention. A subset may require angioembolization.
Published: 2020

32. Lung eosinophils increase vagus nerve-mediated airway reflex bronchoconstriction in mice

Author: Allison D. Fryer, David B. Jacoby, Jessica N. Maung, and Zhenying Nie
Subjects: Male, 0301 basic medicine, Pulmonary and Respiratory Medicine, Serotonin, Physiology, Bronchoconstriction, Airway hyperresponsiveness, Cell Count, Vagotomy, Bronchoalveolar Lavage, 03 medical and health sciences, 0302 clinical medicine, Bone Marrow, Physiology (medical), Reflex, Respiratory Hypersensitivity, medicine, Animals, Pulmonary Eosinophilia, Nerve function, Lung, Asthma, Receptor, Muscarinic M3, business.industry, Airway Resistance, Vagus Nerve, Cell Biology, respiratory system, medicine.disease, respiratory tract diseases, Vagus nerve, Eosinophils, Mice, Inbred C57BL, Disease Models, Animal, 030104 developmental biology, medicine.anatomical_structure, 030228 respiratory system, Immunology, Female, medicine.symptom, Airway, business, Research Article
Abstract: Eosinophils mediate airway hyperresponsiveness by increasing vagally mediated reflex bronchoconstriction. Here, we tested whether circulating or airway eosinophils change nerve function. Airway resistance in response to aerosolized 5-hydroxytryptamine (5-HT, 10–300 mM) was measured in wild-type mice or transgenic mice that overexpress IL5 in T cells (+IL5T), overexpress IL5 in airway epithelium (+IL5AE), or overexpress IL5 but are devoid of eosinophils (+IL5AE/−Eos). Inflammatory cells in bronchoalveolar lavage (BAL), blood, and bone marrow were quantified. Blood eosinophils were increased in +IL5T and +IL5AE mice compared with wild-type mice. +IL5T mice had increased eosinophils in bone marrow while +IL5AE mice had increased eosinophils in BAL. Eosinophils surrounding large airways were significantly increased only in +IL5AE mice. With intact vagal innervation, aerosolized 5-HT significantly increased airway resistance in +IL5AE mice. 5-HT-induced bronchoconstriction was blocked by vagotomy or atropine, demonstrating that it was mediated via a vagal reflex. Airway resistance was not increased in +IL5AE/−Eos mice, demonstrating that it required lung eosinophils, but was not affected by increased bone marrow or blood eosinophils or by increased IL5 in the absence of eosinophils. Eosinophils did not change M3 function on airway smooth muscle, since airway responses to methacholine in vagotomized mice were not different among strains. Eosinophils surrounding large airways were sufficient, even in the absence of increased IL5 or external insult, to increase vagally mediated reflex bronchoconstriction. Specifically blocking or reducing eosinophils surrounding large airways may effectively inhibit reflex hyperresponsiveness mediated by vagus nerves in eosinophilic asthma.
Published: 2020

33. Maternal stressful events and socioeconomic status among orofacial cleft families: A hospital-based study

Author: Ko Ko Maung, Thi Ha Myint Wei, Zayar Lin, Moe Myat Noe Phyu, and Kyaw Myo Tun
Subjects: Pregnancy, Future studies, myanmar, business.industry, lcsh:Surgery, 030208 emergency & critical care medicine, lcsh:RD1-811, 030230 surgery, Family income, medicine.disease, Hospital based study, socioeconomic status, lcsh:RK1-715, 03 medical and health sciences, Maternal stress, 0302 clinical medicine, Increased risk, maternal stress, lcsh:Dentistry, Medicine, orofacial cleft, business, Socioeconomic status, Demography
Abstract: Background and Objective: Studies have suggested that maternal stressful events are associated with an increased risk of orofacial cleft (OFC) in many populations, but none have focused on Myanmar. Socioeconomic status (SES) has been recognized as a strong predictor of pregnant mothers' perceived maternal stress. We sought to assess the SES among OFC families and determine the role of maternal stressful events during pregnancy. Materials and Methods: A cross-sectional descriptive study was performed at the New Look New Life Cleft Lip and Palate Center/Smile Train Myanmar in the Shwe Baho and Pinlon Hospital in Yangon, Myanmar, from December 2016 to December 2017. The study included 298 mothers of children under-five with OFCs. The research tool included a questionnaire used in face-to-face interviews with mothers. SES was measured with Kuppuswamy's scale. Maternal stress questions from the Kaiser Permanente/California Department of Health Study of Pregnancy and Stress were used. Results: Among the 298 families, 126 (42.28%) household heads were farmers, and the most common educational level was middle school (83, 27.85%). Two-thirds of the respondents reported a monthly family income below 180,000 Kyats (120 USD). Most OFC families (129, 43.3%) had upper lower SES. One hundred and forty-one (47%) mothers reported stressful events during pregnancy, and 106 (60%) of these mothers indicated financial-related burden as the leading cause of stress. SES was significantly related to maternal stress (P = 0.01). Conclusion: Most OFC families had low SES, which could lead to financial-related stress for pregnant mothers. Future studies need to extend the results to better understand this relationship.
Published: 2020

34. Childhood acute myeloid leukemia shows a high level of germline predisposition

Author: David M. Ross, Amanda Smith, Andreas W. Schreiber, Saumya E. Samaraweera, Hamish S. Scott, Amilia Wee, Jonathan Ellis, Christopher N. Hahn, Mark Pinese, Debora A. Casolari, Andrew J. Deans, Paul Leo, Paul Po-Shen Wang, Kyaw Ze Ya Maung, Thomas J. Gonda, Richard J D'Andrea, Anna L. Brown, Kelly Perkins, Mark J. Cowley, Ka Leung Li, Devendra K Hiwase, Andrew S. Moore, Jinghua Feng, Samaraweera, Saumya E, Wang, Paul PS, Li, Ka Leung, Casolari, Debora A, Feng, Jinghua, Maung, Kyaw Ze Ya, Scott, Hamish S, Schreiber, Andreas W, Brown, Anna L, Ross, David M, Gonda, Thomas J, Hahn, Christopher N, and D'Andrea, Richard J
Subjects: Oncology, medicine.medical_specialty, Immunology, Population, Biochemistry, Germline, Gene Frequency, Internal medicine, Genetic predisposition, medicine, Humans, Genetic Predisposition to Disease, education, Child, Exome, Germ-Line Mutation, education.field_of_study, Whole Genome Sequencing, business.industry, Childhood Acute Myeloid Leukemia, Bone marrow failure, Cancer, Cell Biology, Hematology, medicine.disease, Leukemia, Myeloid, Acute, Germ Cells, Cohort, business
Abstract: As germline variants can influence cancer patient treatment decisions, outcomes and counselling, and the level of genetic predisposition for sporadic childhood acute myeloid leukemia (AML) is not clearly established, we undertook a comprehensive analysis of rare germline variants in childhood AML. As childhood AML is rare,1 to date pan-cancer childhood cohorts have included few AML cases and often the germline panels used have not included key genes relevant to myeloid malignancy. We therefore combined data from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) program together with an Australian childhood AML cohort (Supplemental Tables 1 and 2) to identify the rare germline variants in a large panel of cancer predisposition genes (n=216) compiled from literature review, and including genes involved in familial hematological malignancies (HM) and bone marrow failure (BMF) syndromes (Supplemental Table 3). We analyzed whole genome sequencing (WGS) and whole exome sequence (WES) data available through the TARGET program (n=48) (phs000218.v22.p8.c1) and WES data for the Australian cohort (n=24). Given that damaging and disease-causing variants are predicted to have a low population prevalence we identified extremely rare, potentially deleterious germline variants [VAF >30%; MAF (gnomAD) 10] and classified these as shown in Figure 1. All variants passing initial filtering are listed in Supplemental Table 4. The distribution of germline and somatic variants is shown in Supplemental Table 5, Supplemental Figure 1. Given the small cohort size pairwise comparisons of germline variants and clinico-pathological characteristics did not reveal significant associations after applying multiple correction (Supplemental Table 6).
Published: 2021

35. Childhood TB in Myanmar: trends in notification, profile and treatment outcomes in the private sector

Author: Srinath Satyanarayana, T N Maung, Khine Wut Yee Kyaw, M K Thu, Si Thu Aung, P P Swe, Saw Thein, and Saw Saw
Subjects: Not evaluated, education.field_of_study, Tuberculosis, genetic structures, business.industry, Health Policy, 030231 tropical medicine, Treatment outcome, Population, Public Health, Environmental and Occupational Health, Original Articles, Treatment rate, Private sector, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, medicine, Observational study, 030212 general & internal medicine, education, business, Demography
Abstract: Myanmar National Tuberculosis (TB) programme (NTP).To describe 1) the trends in childhood TB (aged ⩾ 14 years) notification from 2014 to 2017 and quantify the private sector contribution to this notification; and 2) the profile and treatment outcomes of childhood TB managed in the private sector in 2016.This was an observational study involving the review of routine records and reports of the NTP public-private mix (PPM) projects managed by the Myanmar Medical Association and Population Service International.The total number of childhood TB notified has declined from 36 314 in 2014 to 28 723 in 2017 (average annual decline = 2607 cases per year). The private sector contribution to the notification remained between 17% and 19%. Of the 5616 childhood TB cases diagnosed and treated under the two PPM projects in 2016, 99% were clinically diagnosed and 5459 (97.7%) had successful treatment outcomes. Children aged ⩾10 years, males, those with bacteriologically confirmed TB, those treated in the regions or states of Mandalay, Chin and Shan had a higher risk of an unfavourable outcome (lost to follow-up, death, move to second-line treatment and not evaluated).Childhood TB notification is showing a declining trend. One of five notified childhood TB cases was diagnosed and treated in the private sector, where the successful treatment rate was high.Programme national de lutte contre la tuberculose (NTP) du Myanmar.Décrire 1) les tendances de la notification de la TB de l'enfant (⩽14 ans) de 2014 à 2017 et quantifier la contribution du secteur privé à cette notification; et 2) le profil et les résultats du traitement de la TB prise en charge dans le secteur privé en 2016.Etude d'observation impliquant une revue des registres et des rapports de routine du NTP, des projets conjoints Public-Privé (PPM) gérés par la Myanmar Medical Association et par Population Service International.Le nombre total de cas de TB de l'enfant notifiés a décliné de 36 314 en 2014 à 28 723 en 2017 (déclin annuel moyen = 2607 cas par an). La contribution du secteur privé à la notification est restée entre 17 et 19%. Sur les 5616 TB de l'enfant diagnostiquées et traitées dans le cadre des deux projets PPM en 2016, 99% ont été diagnostiqués sur la clinique et 5459 (97,7%) ont eu un bon résultat du traitement. Les enfants âgés de10 ans, de sexe masculin, ceux ayant une TB confirmés par bactériologie, ceux traités dans les régions/états de Mandalay, Chin et Shan ont eu un risque plus élevé de mauvais résultats (pertes de vue, décès, passage à un traitement de deuxième ligne et non évalués).La notification de la TB de l'enfant montre une tendance déclinante. Une TB notifiée dur cinq a été diagnostiquée et traitée dans le secteur privé et le taux de succès du traitement a été très élevé.El Programa Nacional contra la Tuberculosis (PNT) de Birmania.Describir 1) la tendencia en la notificación de la TB de los niños (14 años) del 2014 al 2017 y cuantificar la contribución del sector privado a esta notificación; y 2) el tipo de TB y el desenlace del tratamiento antituberculoso de los niños tratados en el sector privado en el 2016.Fue este un estudio observacional a partir del examen de las historias clínicas corrientes y las notificaciones del PNT, los proyectos de colaboración publicoprivada (PPM) dirigidos por la Asociación Médica de Birmania y de la organizaciónEl número total de casos de TB notificados en los niños disminuyó de 36 314 en el 2014 a 28 723 en el 2017 (promedio de disminución anual: 2607 casos). La participación del sector privado a la notificación permaneció entre 17% y 19%. De los 5616 niños con diagnóstico de TB y tratados en los dos PPM en el 2016, el 99% obtuvo un diagnóstico clínico y 5459 niños (97,7%) alcanzaron el éxito terapéutico. Los niños con el mayor riesgo de desenlace desfavorable (pérdida durante el seguimiento, muerte, cambio a fármacos de segunda línea y sin evaluación) fueron los niños de edad de ⩾10 años, los niños con confirmación bacteriológica de la TB y los que recibieron tratamiento en las regiones o estados de Mandalay, Chin y Shan.La notificación de casos de TB en los niños exhibe una tendencia hacia la baja. Uno de cada cinco casos notificados recibió el diagnóstico y el tratamiento en el sector privado y la tasa de éxito fue muy alta.
Published: 2019

36. Retroviral association with ovarian adenocarcinoma in laying hens

Author: Yvette J. Johnson, Janice M. Bahr, Maung San Myint, Matthew C. Stewart, Aya Iwai, Laura J. Kohrt, Evelyn H G Caporali, Nicholas Szigetvari, and Varsha V Ramoutar
Subjects: General Immunology and Microbiology, biology, Avian Leukosis Virus, Cancer, Endogeny, Avian leukosis, Adenocarcinoma, medicine.disease, biology.organism_classification, Virus, Andrology, Retrovirus, Cross-Sectional Studies, Food Animals, Antigen, Avian Leukosis, medicine, Animals, Animal Science and Zoology, Ovarian adenocarcinoma, Female, Flock, Chickens, Poultry Diseases
Abstract: The laying hen has been used as a model for ovarian adenocarcinoma (OAC) in women. Previous work has shown an association between expression of endogenous retroviral proteins and elevated envelope mRNA and occurrence of OAC in humans, but causality has not been demonstrated. The objective of this study was to determine whether there is a similar association between retrovirus presence and OAC in a commercial laying hen flock at the University of Illinois Poultry Research facility with a history of a high OAC prevalence in older hens. Laying hens of three age strata were randomly selected for a cross-sectional study. Blood samples were collected, and serum was tested for antigens of endogenous or exogenous avian leukosis virus (ALV) by ELISA. Birds were humanely euthanized, and spleens, ovaries, and any tissues with gross lesions were sampled. Ovaries and gross lesions were examined histologically and spleens were used for RT-PCR to detect endogenous ALV via ALV-E env mRNA expression. Overall, hens with OAC were 5.2 times more likely to be ALV positive than hens without OAC (95% C.I. 2.06-13.14). Controlled for age, OAC positive hens were 3.6 times more likely to be positive for ALV via antigen-capture ELISA (95% C.I. 1.08-11.96). Endogenous ALV-E in hens may be analogous to human endogenous retroviruses, which have also been associated with OAC in women. Further studies to establish causation are warranted to better understand the potential for laying hens to serve as a laboratory model for viral-induced ovarian tumours in humans. RESEARCH HIGHLIGHTSOAC in hens was associated with age, seropositivity for ALV, and endogenous ALV mRNA expression.Older hens with OAC were more likely to be ALV seropositive by ELISA and ALV-E mRNA-positive.Associations between OAC, age, and endogenous retrovirus expression have been reported in humans.These findings support the use of hens as models for OAC in humans.
Published: 2021

37. Revised nomenclature and SNP barcode for Mycobacterium tuberculosis lineage 2

Author: Surakameth Mahasirimongkol, Hideki Yanai, Htet Myat Win Maung, Zhezhe Cui, Yuttapong Thawornwattana, Prasit Palittapongarnpim, and Virasakdi Chongsuvivatwong
Subjects: Genetics, Whole genome sequencing, Genetic diversity, Tuberculosis, Outbreak, General Medicine, Drug resistance, Biology, medicine.disease, biology.organism_classification, Mycobacterium tuberculosis, medicine, SNP, Genotyping
Abstract: Mycobacterium tuberculosis (Mtb) lineage 2 (L2) strains are present globally, contributing to a widespread tuberculosis (TB) burden, particularly in Asia where both prevalence of TB and numbers of drug resistant TB are highest. The increasing availability of whole-genome sequencing (WGS) data worldwide provides an opportunity to improve our understanding of the global genetic diversity of Mtb L2 and its association with the disease epidemiology and pathogenesis. However, existing L2 sublineage classification schemes leave >20 % of the Modern Beijing isolates unclassified. Here, we present a revised SNP-based classification scheme of L2 in a genomic framework based on phylogenetic analysis of >4000 L2 isolates from 34 countries in Asia, Eastern Europe, Oceania and Africa. Our scheme consists of over 30 genotypes, many of which have not been described before. In particular, we propose six main genotypes of Modern Beijing strains, denoted L2.2.M1–L2.2.M6. We also provide SNP markers for genotyping L2 strains from WGS data. This fine-scale genotyping scheme, which can classify >98 % of the studied isolates, serves as a basis for more effective monitoring and reporting of transmission and outbreaks, as well as improving genotype-phenotype associations such as disease severity and drug resistance. This article contains data hosted by Microreact.
Published: 2021

38. P186 Single centre experience of tocilizumab in COVID 19 pneumonia

Author: R Goodka, H Ghani, Sachin Ananth, Rama Vancheeswaran, M Mehta, and Y Maung Maung Myint
Subjects: medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, medicine.medical_treatment, medicine.disease, Single centre, chemistry.chemical_compound, Pneumonia, Tocilizumab, chemistry, Internal medicine, Cohort, medicine, Intubation, business, Hospital stay, Dexamethasone, medicine.drug
Abstract: P186 Table 1Clinical parameters of the COVID 19 pneumonia patients who received tocilizumab between January and February 2021Dexamethasone (Control group) Dexamethasone+ Tocilizumab p value Total 38 47 Age Median [IQR] 61.5 54 SF ratio Median [IQR] 106.67 106.67 Gender Male 21 36 Female 17 11 Ethnicity British/White 25 30 Any other white background 1 8 Asian 5 11 Others 8 6 Outcome Death 17 8 0.008 Need for NIV/HFNO 9 27 0.002 ITU admission 12 22 0.18 Need for intubation 4 13 0.06 Length of Hospital Stay Median [IQR] 6 12
Published: 2021

39. Defence Medical Services telemedicine now: a successful pilot of video consultations and instant messaging support to firm base training

Author: N Aye Maung, R J Booker, O Bartels, and Amritpal Sandhu
Subjects: Telemedicine, Situation awareness, Primary health care, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Combat Medical Technician, Medical services, Officer, 03 medical and health sciences, 0302 clinical medicine, medicine, 030212 general & internal medicine, Instant messaging, Medical emergency, Business, Medical prescription
Abstract: Introduction: Telemedicine was pioneered in the Defence Medical Services (DMS) in 1998, since then the capabilities within the DMS have not advanced in step with advances in technology. We present our findings of a pilot of remote video consultation via Skype for MODNET during an arduous course held in the UK. Method: Combat medical technician sick parades were live streamed via Skype to a Defence Primary Healthcare Medical Centre and medical officer (MO) support was delivered remotely. This process was augmented by the use of Pando for still images of wounds and infection sites in order to enhance decision making and situational awareness. Results: Over a 3-week period, 34 consultations carried out during sick parade required the input from a remote MO, of those 34% required a prescription from an MO. None of the presentations required a face-to-face consultation, and all patients received MO-led care remotely. Conclusion: We have successfully demonstrated that video telemedicine consultations are safe, while simultaneously improving patient care, augmenting the distribution of medical assets and reducing costs.
Published: 2021

40. Mass drug administration for the acceleration of malaria elimination in a region of Myanmar with artemisinin-resistant falciparum malaria: a cluster-randomised trial

Author: Arjen M. Dondorp, Elizabeth A. Ashley, Thar Tun Kyaw, Aung Kyaw Phyo, Frank Smithuis, Zay Soe Khant, Nicholas J. White, Alistair R. D. McLean, Kyaw Myo Tun, Chanida Indrasuta, Kyaw Thu Soe, Hein Aung, Ni Ni Tun, Mallika Imwong, Sai Maung Maung, James Heaton, Lorenz von Seidlein, Myo Maung Maung Swe, Nicholas P. J. Day, Thaung Hlaing, Ye Aung, and Intensive Care Medicine
Subjects: Adult, Male, medicine.medical_specialty, Primaquine, Adolescent, medicine.medical_treatment, 030231 tropical medicine, Population, Drug Resistance, Dihydroartemisinin, Myanmar, 03 medical and health sciences, Antimalarials, Young Adult, 0302 clinical medicine, Internal medicine, Piperaquine, parasitic diseases, medicine, Cluster Analysis, Humans, 030212 general & internal medicine, Artemisinin, Disease Eradication, Malaria, Falciparum, education, Mass drug administration, Child, education.field_of_study, biology, business.industry, Plasmodium falciparum, biology.organism_classification, medicine.disease, Artemisinins, Infectious Diseases, Quinolines, Mass Drug Administration, Drug Therapy, Combination, Female, business, Malaria, medicine.drug
Abstract: Summary Background To contain multidrug-resistant Plasmodium falciparum, malaria elimination in the Greater Mekong subregion needs to be accelerated while current antimalarials remain effective. We evaluated the safety, effectiveness, and potential resistance selection of dihydroartemisinin–piperaquine mass drug administration (MDA) in a region with artemisinin resistance in Myanmar. Methods We did a cluster-randomised controlled trial in rural community clusters in Kayin (Karen) state in southeast Myanmar. Malaria prevalence was assessed using ultrasensitive quantitative PCR (uPCR) in villages that were operationally suitable for MDA (villages with community willingness, no other malaria control campaigns, and a population of 50–1200). Villages were eligible to participate if the prevalence of malaria (all species) in adults was greater than 30% or P falciparum prevalence was greater than 10% (or both). Contiguous villages were combined into clusters. Eligible clusters were paired based on P falciparum prevalence (estimates within 10%) and proximity. Community health workers provided routine malaria case management and distributed long-lasting insecticidal bed-nets (LLINs) in all clusters. Randomisation of clusters (1:1) to the MDA intervention group or control group was by public coin-flip. Group allocations were not concealed. Three MDA rounds (3 days of supervised dihydroartemisinin–piperaquine [target total dose 7 mg/kg dihydroartemisinin and 55 mg/kg piperaquine] and single low-dose primaquine [target dose 0·25 mg base per kg]) were delivered to intervention clusters. Parasitaemia prevalence was assessed at 3, 5, 10, 15, 21, 27, and 33 months. The primary outcomes were P falciparum prevalence at months 3 and 10. All clusters were included in the primary analysis. Adverse events were monitored from the first MDA dose until 1 month after the final dose, or until resolution of any adverse event occurring during follow-up. This trial is registered with ClinicalTrials.gov , NCT01872702 . Findings Baseline uPCR malaria surveys were done in January, 2015, in 43 villages that were operationally suitable for MDA (2671 individuals). 18 villages met the eligibility criteria. Three villages in close proximity were combined into one cluster because a border between them could not be defined. This gave a total of 16 clusters in eight pairs. In the intervention clusters, MDA was delivered from March 4 to March 17, from March 30 to April 10, and from April 27 to May 10, 2015. The weighted mean absolute difference in P falciparum prevalence in the MDA group relative to the control group was −10·6% (95% CI −15·1 to −6·1; p=0·0008) at month 3 and −4·5% (−10·9 to 1·9; p=0·14) at month 10. At month 3, the weighted P falciparum prevalence was 1·4% (0·6 to 3·6; 12 of 747) in the MDA group and 10·6% (7·0 to 15·6; 56 of 485) in the control group. Corresponding prevalences at month 10 were 3·2% (1·5 to 6·8; 34 of 1013) and 5·8% (2·5 to 12·9; 33 of 515). Adverse events were reported for 151 (3·6%) of 4173 treated individuals. The most common adverse events were dizziness (n=109) and rash or itching (n=20). No treatment-related deaths occurred. Interpretation In this low-transmission setting, the substantial reduction in P falciparum prevalence resulting from support of community case management was accelerated by MDA. In addition to supporting community health worker case management and LLIN distribution, malaria elimination programmes should consider using MDA to reduce P falciparum prevalence rapidly in foci of higher transmission. Funding The Global Fund to Fight AIDS, Tuberculosis and Malaria.
Published: 2020

41. Rare variants in Fanconi anemia genes are enriched in acute myeloid leukemia

Author: Richard J D'Andrea, Andrew J. Deans, Anna L. Brown, James X Gray, Paula Marlton, Thomas J. Gonda, Sarah C Bray, Luen Bik To, Ian D. Lewis, Matthew A. Brown, Tran Nguyen, Debora A. Casolari, Emma L. Duncan, Paul Leo, Vinay Tergaonkar, Gökhan Cildir, Devinder Gill, Stephen Pederson, Saumya E. Samaraweera, Adam D. Ewing, Russell Saal, Mhairi Marshall, Mahmoud A. Bassal, Kyaw Ze Ya Maung, Deepak Singhal, Maung, Kyaw Ze Ya, Leo, Paul J, Bassal, Mahmoud, Casolari, Debora A, Bray, Sarah C, Singhal, Deepak, Samaraweera, Saumya E, Nguyen, Tran, Cildir, Gökhan, Tergaonkar, Vinay, Lewis, Ian, Brown, Anna L, D'Andrea, Richard J, and Gonda, Thomas J
Subjects: 0301 basic medicine, Acute Myeloid Leukemia, Myeloid, Genotype, Biology, gene variants, lcsh:RC254-282, Germline, 03 medical and health sciences, Germline mutation, Fanconi anemia, hemic and lymphatic diseases, Correspondence, medicine, Humans, Genetic Predisposition to Disease, Alleles, Genetic Association Studies, Bone marrow failure, Myeloid leukemia, Genetic Variation, Hematology, medicine.disease, mutations, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Fanconi Anemia Complementation Group Proteins, FANCB, Leukemia, Leukemia, Myeloid, Acute, 030104 developmental biology, medicine.anatomical_structure, Oncology, Mutation, Cancer research, patient
Abstract: Acute Myeloid Leukemia (AML) is an aggressive hematological malignancy caused by somatically acquired changes affecting a well-defined set of genes1. While rare high-risk variants affecting specific transcription factors account for a proportion of myelodysplastic syndrome (MDS) and AML associated with a family history, the contribution of other germline variants conferring low-intermediate risk has not yet been determined, partly because these are more difficult to identify from pedigree analysis. Here we use an Australian AML patient cohort to analyze rare, deleterious variants affecting genes involved in the rare recessive bone marrow failure syndrome Fanconi Anemia (FA). FA is caused by bi-allelic germline mutations in any of the 22 FANC genes (except for FANCB and FANCR which are X-linked and autosomal dominant), and is associated with profoundly increased risk of AML. The proteins encoded by the FANC genes participate in the removal of interstrand crosslinks (ICL) and the protection and resolution of stalled replication forks, an essential step for faithful DNA replication. Deficiency for these genes, combined with other mutations, results in pre-leukemia or leukemia in mouse models.
Published: 2018

42. Lemierre’s Syndrome in an Elderly Female Patient with Polycythemia Vera: Does Polycythemia Vera Predispose to Lemierre’s Syndrome?

Author: Chun Maung, Jacob Shani, Gerald Hollander, Sanchit V. Kundal, Vijay Shetty, Mazin Khalid, Jasmine Lee, and Zhou Ping
Subjects: Chest Pain, medicine.medical_specialty, ved/biology.organism_classification_rank.species, Chest pain, Thrombophlebitis, Polycythemia vera, Lemierre's syndrome, Fusobacterium necrophorum, Humans, Medicine, Polycythemia Vera, Aged, Neck pain, business.industry, ved/biology, Lemierre Syndrome, Articles, General Medicine, medicine.disease, Dermatology, Thrombosis, Female, Jugular Veins, medicine.symptom, business, Odynophagia
Abstract: Patient: Female, 66-year-old Final Diagnosis: Lemierre’s syndrome Symptoms: Chills • neck pain • odynophagia • rigors • trismus Medication: — Clinical Procedure: Computed tomography Specialty: Cardiology • Hematology • Infectious Diseases • General and Internal Medicine Objective: Unusual clinical course Background: Lemierre’s syndrome (LS), a potentially fatal condition, is characterized by thrombophlebitis of a head or neck vein secondary to a head or neck infection, most commonly involving Fusobacterium necrophorum. Its association with polycythemia vera (PV) is not well reported despite the predisposition to thrombogenesis. Case Report: We present the case of a 66-year-old woman with a known history of polycythemia vera (PV) who presented with 4 days of worsening right-sided neck pain and odynophagia. The physical examination revealed poor oral dentition, mild erythema of the posterior pharyngeal mucosa, and non-erythematous tonsils without exudate. A computed tomography with i.v. contrast of the neck revealed complete thrombosis of the right internal jugular vein (IJV). Treatment was initiated with i.v. antibiotics and anticoagulation, with symptoms improving rapidly within 24 h. She was eventually discharged on apixaban and clindamycin and was encouraged to follow up with her hematologist. Conclusions: PV predisposes patients to a hyper-viscous and prothrombotic state, which may warrant a stronger suspicion of Lemierre’s syndrome. In addition, lack of aspirin use for prophylaxis of thrombosis and undiagnosed oral infection are factors to consider when assessing risk factors for Lemierre’s syndrome in PV patients.
Published: 2021

43. Genetic surveillance in the Greater Mekong subregion and South Asia to support malaria control and elimination

Author: Jordi Landier, Abdullah Abu Sayeed, Seila Suon, Kim-Tuyen Nguyen, Kate Rowlands, Frank Smithuis, Chanon Kunasol, Chanaki Amaratunga, Sasithon Pukrittayakamee, Keobouphaphone Chindavongsa, Jacob Almagro Garcia, Richard D. Pearson, Mozam Ali, Xin Hui S Chan, Katie Love, Naomi Park, Pascal Ringwald, Richard J. Maude, Cristina V. Ariani, Mehul Dhorda, Marie A. Onyamboko, Daniel M. Parker, Tin Maung Hlaing, Scott Goodwin, Namfon Kotanan, Thang Ngo Duc, Gilles Delmas, Huy Rekol, Rick M. Fairhurst, Victoria Simpson, Arjen M. Dondorp, Le Thanh Dong, Bouasy Hongvanthong, Tran Tinh Hien, Rapeephan R. Maude, Thomas J. Peto, Shavanthi Rajatileka, Roberto Amato, Thanat Chookajorn, Ben Jeffery, Anna E. Jeffreys, Nicole Zdrojewski, Caterina I. Fanello, Eleanor Drury, Mihir Kekre, Myo Thant, John Sillitoe, Olivo Miotto, Aung Myint Thu, James J Callery, Subrata Baidya, Paul N. Newton, Ranitha Vongpromek, Prativa K Behera, Borimas Hanboonkunupakarn, Rob W. van der Pluijm, Jim Stalker, Anupkumar R. Anvikar, Sonexay Phalivong, Dawn Muddyman, Nguyen Thuy-Nhien, Christina Hubbart, Rithea Leang, Lorenz von Seidlein, Nicholas P. J. Day, Phrutsamon Wongnak, Jonathan Keatley, Hoa Nguyen, Cinzia Malangone, Parthasarathi Satpathi, Abul Faiz, Dysoley Lek, François Nosten, Christopher G Jacob, Rupam Tripura, Sara E. Canavati, Huynh Hong Quang, Kirk A. Rockett, Neena Valecha, Thuy Nguyen, Kimberly J. Johnson, Tran Minh Nhat, Didar Uddin, Caroline O. Buckee, Akhter ul Islam, Podjanee Jittamala, Mayfong Mayxay, Amir Hossain, Viengxay Vanisaveth, Elizabeth A. Ashley, Dominic P. Kwiatkowski, Sanghamitra Satpathi, Aung Pyae Phyo, Amar Tripura, Nguyen Hoang Chau, Sónia Gonçalves, Khin Lin, Cheah Huch, Wellcome Sanger Institute [Hinxton, Royaume-Uni], Oxford University Clinical Research Unit [Ho Chi Minh City] (OUCRU), Mahosot Hospital [Vientiane, Laos], Institute of Research and Education Development [Vientiane, Lao People’s Democratic Republic], University of Health Sciences [Vientiane, Laos] (UHS), University of Oxford [Oxford], Mahidol University [Bangkok], Harvard T.H. Chan School of Public Health, Institute of Malariology, Parasitology, and Entomology [Quy Nhon, Vietnam] (IMPE), Centre of Malariology, Parasitology, and Entomology [Vientiane, Lao People’s Democratic Republic] (CMPE), National Institute of Malariology, Parasitology and Entomology [Hanoi], National Center for Parasitology, Entomology and Malaria Control [Phnom Penh, Cambodia] (CNM), National Institute of Allergy and Infectious Diseases [Bethesda] (NIAID-NIH), National Institutes of Health [Bethesda] (NIH), Shoklo Malaria Research Unit [Mae Sot, Thailand] (SMRU), Mahidol Oxford Tropical Medicine Research Unit (MORU), University of Oxford [Oxford]-Mahidol University [Bangkok]-Wellcome Trust-University of Oxford [Oxford]-Mahidol University [Bangkok]-Wellcome Trust, Chittagong Medical College Hospital [Chittagong, Bangladesh] (CMCH), World Health Organization [Geneva], Institute of Malariology, Parasitology, and Entomology [Ho Chi Minh City, Vietnam] (IMPE), Vysnova Partners Inc [Hanoi, Vietnam] (VPI), University of Kinshasa (UNIKIN), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of California [Irvine] (UCI), University of California, Royal Society of Thailand [Bangkok, Thailand], Myanmar Oxford Clinical Research Unit [Yangon, Myanmar], The Department of Medical Research (Upper Myanmar), Defence Services Medical Research Centre [Naypyitaw, Myanmar] (DSMRC), Midnapore Medical College [Midnapur, India] (MMC), ispat general hospital [Rourkela, India] (IGH), Agartala Medical College [Agartala, India] (AMC), National Institute of Malaria Research [New Dehli, Inde] (NIMR), Indian Council of Medical Research [New Dehli] (ICMR), Ramu Upazila Health Complex [Cox’s Bazar, Bangladesh] (RUHC), The Wellcome Trust Sanger Institute [Cambridge], WorldWide Antimalarial Resistance Network [Bangkok] (WWARN), WorldWide Antimalarial Resistance Network (WWARN), Université de Washington Seattle-Université de Washington Seattle, The Wellcome Trust Centre for Human Genetics [Oxford], University of Oxford, University of Oxford-Mahidol University [Bangkok]-Wellcome Trust-University of Oxford-Mahidol University [Bangkok]-Wellcome Trust, University of California [Irvine] (UC Irvine), University of California (UC), University of Washington [Seattle]-University of Washington [Seattle], and Malbec, Odile
Subjects: Plasmodium, History, [SDV]Life Sciences [q-bio], Drug Resistance, global health, Drug resistance, Barcode, law.invention, law, Genotype, Biology (General), Aetiology, Microbiology and Infectious Disease, 0303 health sciences, Bangladesh, General Neuroscience, General Medicine, asia, 3. Good health, [SDV] Life Sciences [q-bio], Geography, Infectious Diseases, Democratic Republic of the Congo, Medicine, epidemiology, Genetic Engineering, Malaria control, Infection, Research Article, medicine.medical_specialty, South asia, Asia, QH301-705.5, Science, infectious disease, Plasmodium falciparum, malaria, Library science, Southeastern, India, General Biochemistry, Genetics and Molecular Biology, Antimalarials, 03 medical and health sciences, Rare Diseases, Simple sample, Clinical Research, Environmental health, medicine, Genetics, Humans, Animals, Disease Eradication, 030304 developmental biology, drug resistance, General Immunology and Microbiology, 030306 microbiology, Public health, microbiology, Genetic data, Genetic Therapy, medicine.disease, genetic surveillance, Compendium, Resistance monitoring, Data sharing, Vector-Borne Diseases, Epidemiology and Global Health, Good Health and Well Being, Communicable Disease Control, Antimicrobial Resistance, Biochemistry and Cell Biology, Malaria, 2.6 Resources and infrastructure (aetiology)
Abstract: Author(s): Jacob, Christopher G; Thuy-Nhien, Nguyen; Mayxay, Mayfong; Maude, Richard J; Quang, Huynh Hong; Hongvanthong, Bouasy; Vanisaveth, Viengxay; Ngo Duc, Thang; Rekol, Huy; van der Pluijm, Rob; von Seidlein, Lorenz; Fairhurst, Rick; Nosten, Francois; Hossain, Md Amir; Park, Naomi; Goodwin, Scott; Ringwald, Pascal; Chindavongsa, Keobouphaphone; Newton, Paul; Ashley, Elizabeth; Phalivong, Sonexay; Maude, Rapeephan; Leang, Rithea; Huch, Cheah; Dong, Le Thanh; Nguyen, Kim-Tuyen; Nhat, Tran Minh; Hien, Tran Tinh; Nguyen, Hoa; Zdrojewski, Nicole; Canavati, Sara; Sayeed, Abdullah Abu; Uddin, Didar; Buckee, Caroline; Fanello, Caterina I; Onyamboko, Marie; Peto, Thomas; Tripura, Rupam; Amaratunga, Chanaki; Myint Thu, Aung; Delmas, Gilles; Landier, Jordi; Parker, Daniel M; Chau, Nguyen Hoang; Lek, Dysoley; Suon, Seila; Callery, James; Jittamala, Podjanee; Hanboonkunupakarn, Borimas; Pukrittayakamee, Sasithon; Phyo, Aung Pyae; Smithuis, Frank; Lin, Khin; Thant, Myo; Hlaing, Tin Maung; Satpathi, Parthasarathi; Satpathi, Sanghamitra; Behera, Prativa K; Tripura, Amar; Baidya, Subrata; Valecha, Neena; Anvikar, Anupkumar R; Ul Islam, Akhter; Faiz, Abul; Kunasol, Chanon; Drury, Eleanor; Kekre, Mihir; Ali, Mozam; Love, Katie; Rajatileka, Shavanthi; Jeffreys, Anna E; Rowlands, Kate; Hubbart, Christina S; Dhorda, Mehul; Vongpromek, Ranitha; Kotanan, Namfon; Wongnak, Phrutsamon; Almagro Garcia, Jacob; Pearson, Richard D; Ariani, Cristina V; Chookajorn, Thanat; Malangone, Cinzia; Nguyen, T; Stalker, Jim; Jeffery, Ben | Abstract: BackgroundNational Malaria Control Programmes (NMCPs) currently make limited use of parasite genetic data. We have developed GenRe-Mekong, a platform for genetic surveillance of malaria in the Greater Mekong Subregion (GMS) that enables NMCPs to implement large-scale surveillance projects by integrating simple sample collection procedures in routine public health procedures.MethodsSamples from symptomatic patients are processed by SpotMalaria, a high-throughput system that produces a comprehensive set of genotypes comprising several drug resistance markers, species markers and a genomic barcode. GenRe-Mekong delivers Genetic Report Cards, a compendium of genotypes and phenotype predictions used to map prevalence of resistance to multiple drugs.ResultsGenRe-Mekong has worked with NMCPs and research projects in eight countries, processing 9623 samples from clinical cases. Monitoring resistance markers has been valuable for tracking the rapid spread of parasites resistant to the dihydroartemisinin-piperaquine combination therapy. In Vietnam and Laos, GenRe-Mekong data have provided novel knowledge about the spread of these resistant strains into previously unaffected provinces, informing decision-making by NMCPs.ConclusionsGenRe-Mekong provides detailed knowledge about drug resistance at a local level, and facilitates data sharing at a regional level, enabling cross-border resistance monitoring and providing the public health community with valuable insights. The project provides a rich open data resource to benefit the entire malaria community.FundingThe GenRe-Mekong project is funded by the Bill and Melinda Gates Foundation (OPP11188166, OPP1204268). Genotyping and sequencing were funded by the Wellcome Trust (098051, 206194, 203141, 090770, 204911, 106698/B/14/Z) and Medical Research Council (G0600718). A proportion of samples were collected with the support of the UK Department for International Development (201900, M006212), and Intramural Research Program of the National Institute of Allergy and Infectious Diseases.
Published: 2021

44. Extrapolating Long-term Event-Free and Overall Survival With Dapagliflozin in Patients With Heart Failure and Reduced Ejection Fraction: An Exploratory Analysis of a Phase 3 Randomized Clinical Trial

Author: M Nishino, T Shinozaki, J Lash, N Takahashi, H Kokane, Béla Merkely, F Guimaraes, T Arakawa, C Zaidman, V Bugan, A Arouni, D Precoma, L Ermoshkina, A Pandey, D Kucera, I Efremov, L Younis, H Nagashima, C Chiang, M Ogunniyi, R Nilk, D Wang, T Haddad, M Zacharias, R Nischik, S Leslie, Mikhail Kosiborod, J Castriz, K Saito, I Weigmann, A Schabauer, A Kiyosue, M Hernandes, Charlotta Ljungman, Subodh Verma, Marc S. Sabatine, Y Khaykin, C Ince, S Iskander, Mark C. Petrie, G Drelich, R Lee, J Slaby, A Nikfarjam, M Kanwar, R Smik, Y Onishi, M Gadkari, M Suzuki, A Viera, S Matsuoka, F Poór, K Egstrup, M Bennett, Y Gu, L Maia, T Lewis, D Sinha, Jonathan G. Howlett, Andrej Dukát, J Shih, L Wu, O Montaña, D Peng, V Mehta, S Higashiue, S Rassi, Junbo Ge, S Mansour, H Nguyen, J Dong, E O’Meara, S Joseph, G Cursack, L Køber, G Reis, A Naik, M Schou, R Ahuad Guerrero, V Kostenko, Silvio E. Inzucchi, Scott D. Solomon, R Robles De Medina, E Vishneva, Y Didenko, D García Brasca, A Sosa Liprandi, M Bernstein, A Hedman, K Kuwahara, A Hirohata, Y Li, Michael Böhm, D Karageorgiev, B Al-Joundi, Jan Belohlavek, P Hajek, E Noori, J Spinar, S Sinha, M Milanova, B Groenemeijer, T Hashimoto, M Najenson, M Higuchi, C Brown, V Macek, S Mahal, B Merkely, K Lindmark, F Nasser-Sharif, N Botushanov, A Costard-Jäckle, S Hiroi, D Raev, L Lin, S Suzuki, N Toursarkissian, Rudolf A. de Boer, J Hove, W Huang, O Akinboboye, T Kadokami, Y Ivanova, N Koziolova, L Kantaros, L Pawłowicz, R Kuchar, K Chang, G Hamroff, C Staniloae, K Appel, L Spinarova, N Runev, J Lampart, N Jaffrani, Dapa-Hf Investigators, S Emani, L Antalik, Y Okumura, A Pereira, K Fujii, Y Hisamatsu, N Iliev, M Sandhu, S Vizel, M Pursley, Y Momiyama, A Ezhov, R Sawant, Z Zheng, M Hominal, S Mehta, B Han, K Shah, R Ściborski, J Saraiva, R Kawamura, R Witek, A Wada, C Majul, U Stephan, L Fu, David L. DeMets, M Tokmakova, D Martinez, L Jamriskova, Tzvetana Katova, E Schmidt, X Li, Eileen O'Meara, O Mayer, W Tseng, K Fujimoto, L Bellersen, C Wu, A Japp, J Sala, Mirta Diez, F Arantes, Kieran F. Docherty, Anna Maria Langkilde, R Cheng, H Chang, M Böhm, J Londono, J Walsh, Chern-En Chiang, R Mariankowski, A Mihov, Colin J. Petrie, M Mahapekar, Y Noguchi, Y Yasaka, Robert S. McKelvie, J Albisu, D Gupta, K Seki, Pardeep S. Jhund, C Király, A Al-Zoebi, H Ueno, I Malek, M Jardula, A Kazakov, I Lieber, F Franchi, D Avino, S Pereiro Gonzalez, P Wakefield, P Pimentel, T Kasai, E Fruehling, Olof Bengtsson, P Kopylov, S Uchikawa, X Guo, J Borges, S Tereschenko, F Azzari, J Selecky, S Sassone, J Vyselaar, S Lederman, J Howlett, Committees, E Vasconcellos, J Kostis, A Czigány, G Masszi, J Izzo, Z Járai, F Neuenschwander, L Tomasova, Mikaela Sjöstrand, C De Nooijer, Felipe Martinez, H Tsutsui, I Uchida, J Patel, A Arif, W Takahashi, M Nassif, K Moritani, M Mohri, J Shilko, Tereshchenko Sn, B Paolino, Z Wang, S Tanaka, João Pedro Ferreira, Y Takagi, H Jiang, A Maltcev, Piotr Ponikowski, V Bhargava, N Komiyama, W Dong, S Verma, S Weiss, L Busak, R Sotolongo, B Foley, C Hsia, John J.V. McMurray, T Mooe, R Gardner, N Cluigt, H Swart, N Spasova, Clare Murphy, K Harada, S Srivastava, P Olexa, B Bertolet, P Andrássy, M Petrie, Inder S. Anand, L Levinson, D Rupka, N Fujimoto, S Aksentiev, Y Hata, L Krylova, N Dzhaiani, R Korzeniak, T.Z. Maung, G Hickey, F Colombo Berra, X Zhang, Q Zhao, B Chompalova, D Avramov, M Asakura, A Hershson, G Mercau, N Takeyasu, J Menon, D Pevzner, T Nunohiro, T Katova, F Syed, W French, P Rossi, C Constance, Z Paltsman, K Tsukahara, A Gogov, M Liu, K Ilieva, I Majercak, Y Zhou, Vijay K. Chopra, T Anzai, F Mody, P Jhund, V Kothiwale, M Hartleib, S Zoet Nugteren, Z Li, J Drożdż, E Krcova, Lars Køber, A Galyavich, A Dincheva, R García Durán, D Hotchkiss, V Chopra, R Manshadi, T Greene, J Taborda, A Fernandez, E Lo, Pham Nguyen Vinh, G Gislason, K Sumii, G Lewis, L Nagy, S Genth-Zotz, J Liu, A Clark, P Leaes, A Wilke, Y Hayashi, J Belohlavek, Y Liang, S Szynal, M Van Hessen, T Kakuta, T Dalcoquio, J Skopek, S Karna, Q Tang, R Vijayaraghavan, K Fukui, X Lin, J Teel, S Nani, P Liu, D Vinanska, C Ljungman, Morten Schou, P Fulop, Y Katayama, D Song, L Yao, A Kimura, M Babapulle, D Kollarova, D Ho, E Fairman, S Deleon, V Pham, C Lindholm, T Kuramochi, S Boldueva, T Cimato, Y Ueda, T Shibasaki, H Takase, S Inoue, E MirekBryniarska, J Huang, D Aizenberg, R Chehayeb, J Van Eck, Y Pesant, Brian Claggett, H Do, I Hsieh, B Mikłaszewicz, R De Boer, Y Tomobuchi, J Carda, P Fong, N Kazemi, E Manenti, Y Komura, D Singal, Jarosław Drożdż, J Cha, T Nguyen, M Berk, E Hattori, B Kolomanov, Á Motyovszki, P Miękus, V Florea, T Lin, H Meno, G Simonis, L Videbæk, Y Dong, P Poirier, C Venugopal, D Tschöpe, M Deshpande, M Kellerer, L Chandra, K Ramanathan, C Lang, D Phaneuf, S Vladeva, H Kamiya, J Javier, Masahumi Kitakaze, M Talavera, Jose C. Nicolau, J Prokopczuk, B Truong, E Perna, W Sudnik, A Paraschos, H Sugino, S Banerjee, Akshay S. Desai, A Chernyavsky, H Luquez, P Nierop, P Udgire, G Caruso, M Slovenska, and H Iseki
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Placebo, Global Health, Ventricular Function, Left, law.invention, chemistry.chemical_compound, Randomized controlled trial, Double-Blind Method, Glucosides, law, Internal medicine, Cause of Death, medicine, Humans, Prospective Studies, Dapagliflozin, Benzhydryl Compounds, Sodium-Glucose Transporter 2 Inhibitors, Original Investigation, Aged, Heart Failure, Ejection fraction, Dose-Response Relationship, Drug, business.industry, Stroke Volume, Middle Aged, medicine.disease, New York Heart Association Functional Classification, Clinical trial, Survival Rate, chemistry, Intravenous therapy, Heart failure, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Importance: Sodium glucose cotransporter 2 inhibitors reduce morbidity and mortality in patients with heart failure and reduced ejection fraction (HFrEF). Clinicians may find estimates of the projected long-term benefits of sodium glucose cotransporter 2 inhibitors a helpful addition to clinical trial results when communicating the benefits of this class of drug to patients. Objective: To estimate the projected long-term treatment effects of dapagliflozin in patients with HFrEF over the duration of a patient’s lifetime. Design, Setting, and Participants: Exploratory analysis was performed of Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF), a phase 3 randomized, placebo-controlled clinical trial conducted at 410 sites in 20 countries. Patients with an ejection fraction less than or equal to 40% in New York Heart Association functional classification II to IV and elevated plasma levels of N-terminal pro B-type natriuretic peptide were enrolled between February 15, 2017, and August 17, 2018, with final follow-up on June 6, 2019. Mean (SD) duration of follow-up was 17.6 (5.2) months. Interventions: Dapagliflozin, 10 mg, once daily vs placebo in addition to standard therapy. Main Outcomes and Measures: The primary composite outcome was time to first hospitalization for heart failure, urgent heart failure visit requiring intravenous therapy, or cardiovascular death. The trial results were extrapolated to estimate the projected long-term treatment effects of dapagliflozin over the duration of a patient’s lifetime for the primary outcome and the secondary outcome of death from any cause. Results: A total of 4744 patients (1109 women [23.4%]; 3635 men [76.6%]) were randomized in DAPA-HF, with a mean (SD) age of 66.3 (10.9) years. The extrapolated mean event-free survival for an individual aged 65 years from a primary composite end point event was 6.2 years for placebo and 8.3 years for dapagliflozin, representing an event-free survival time gain of 2.1 years (95% CI, 0.8-3.3 years; P = .002). When considering death from any cause, mean extrapolated life expectancy for an individual aged 65 years was 9.1 years for placebo and 10.8 years for dapagliflozin, with a gain in survival of 1.7 years (95% CI, 0.1-3.3; P = .03) with dapagliflozin. Similar results were seen when extrapolated across the age range studied. In analyses of subgroups of patients in DAPA-HF, consistent benefits were seen with dapagliflozin on both event-free and overall survival. Conclusions and Relevance: These findings indicate that dapagliflozin provides clinically meaningful gains in extrapolated event-free and overall survival. These findings may be helpful in communicating the benefits of this treatment to patients with HFrEF. Trial registration: ClinicalTrials.gov Identifier: NCT03036124.
Published: 2021

45. TB outcomes and mortality risk factors in adult migrants at the Thailand-Myanmar border

Author: W P P Htun, M Vincenti-Delmas, Pam Sonnenberg, B Maung Maung, François Nosten, A Carroll, and Catherine M Smith
Subjects: Adult, Transients and Migrants, Pulmonary and Respiratory Medicine, education.field_of_study, business.industry, Mortality rate, Population, HIV Infections, Myanmar, Hiv testing, Thailand, medicine.disease, Infectious Diseases, Tuberculosis diagnosis, Risk Factors, Case fatality rate, Coinfection, medicine, Humans, Tuberculosis, Vulnerable population, Hiv status, education, business, Demography
Abstract: BACKGROUND: Cross-border migrants at the Thailand-Myanmar border are an underserved and vulnerable population. We aimed to identify the causes and risk factors for TB mortality at a migrant-friendly TB programme.METHODS: Routinely collected data on TB cases, treatment outcomes and causes of death were analysed for adult TB cases diagnosed between January 2013 and April 2017. Mortality in the 6 months post-diagnosis was calculated and risk factors were identified using multivariable Poisson regression.RESULTS: Of the 1344 TB cases diagnosed, 1005 started treatment and 128 died. Case fatality rate was 9.5% and the TB mortality rate was 2.4/100 person-months. The number of pre-treatment deaths (33/128) and losses to follow-up (9.0%) were high. Among cases enrolled in treatment, the treatment success rate was 79.8%. When stratified by HIV status, case fatality was higher in HIV-positive cases not on antiretroviral therapy (ART) (90.3%) or with unknown HIV status (31.8%) than those on ART (14.3%) or HIV-negative (8.6%).CONCLUSION: This TB programme achieved high treatment success rates in a population with a substantial burden of TB-HIV coinfection. Expanding access to HIV testing and ART is crucial to reduce mortality. Striving towards same-day TB diagnosis and treatment could reduce death and loss to follow-up.
Published: 2021

46. Adipocyte-Specific Deletion of Lamin A/C Largely Models Human Familial Partial Lipodystrophy Type 2

Author: Katrina Granger, Elif A. Oral, Carolyn M. Walsh, Ziru Li, Jessica N. Maung, Hiroyuki Mori, Maria Cristina Foss de Freitas, Julie Hardij, Callie A.S. Corsa, Rebecca L. Schill, Ormond A. MacDougald, Amy E. Rothberg, Kenneth T. Lewis, Ruth D. Azaria, and Devika P. Bagchi
Subjects: medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Adipose Tissue, White, Adipose tissue, Biology, LMNA, chemistry.chemical_compound, Mice, Adipose Tissue, Brown, Bone Density, Internal medicine, Adipocyte, Internal Medicine, medicine, Hyperinsulinemia, Adipocytes, Animals, Mice, Knockout, Adipogenesis, Adiponectin, Leptin, medicine.disease, Lamin Type A, Lipodystrophy, Familial Partial, Disease Models, Animal, Endocrinology, chemistry, Steatosis
Abstract: Mechanisms by which autosomal recessive mutations in Lmna cause familial partial lipodystrophy type 2 (FPLD2) are poorly understood. To investigate function of lamin A/C in adipose tissues, we created mice with an adipocyte-specific loss of Lmna (LmnaADKO). Although LmnaADKO mice develop and maintain adipose tissues in early postnatal life, they show a striking and progressive loss of white and brown adipose tissues as they approach sexual maturity. LmnaADKO mice exhibit a surprisingly mild metabolic dysfunction on a chow diet, but on a high fat diet they share many characteristics of FPLD2 including hyperglycemia, hepatic steatosis, hyperinsulinemia, and almost undetectable circulating adiponectin and leptin. Whereas LmnaADKO mice have reduced regulated and constitutive bone marrow adipose tissue with a concomitant increase in cortical bone, FPLD2 patients have reduced bone mass and bone mineral density compared to controls. In cell culture models of Lmna deficiency, mesenchymal precursors undergo adipogenesis without impairment, whereas fully-differentiated adipocytes have increased lipolytic responses to adrenergic stimuli. LmnaADKO mice faithfully reproduce many characteristics of FPLD2 and thus provide a unique animal model to investigate mechanisms underlying Lmna-dependent loss of adipose tissues.
Published: 2021

47. Lessons of the month 3: Mosaic Klinefelter syndrome unveiled by acute vertebral fracture in a middle-aged man

Author: Aye Chan Maung, Swee Du Soon, David Carmody, and Jenny Yc Hsieh
Subjects: Male, Pediatrics, medicine.medical_specialty, business.industry, Lessons of the Month, Osteoporosis, General Medicine, Chromosome Disorder, Comorbidity, Middle Aged, medicine.disease, Broad spectrum, Klinefelter Syndrome, Phenotype, Primary hypogonadism, medicine, Humans, Spinal Fractures, Klinefelter syndrome, business, X chromosome
Abstract: Klinefelter syndrome (KS) is the most common sex chromosome disorder in males. It is the result of two or more X chromosomes in a phenotypic male. In addition to primary hypogonadism affecting male sexual development, it is associated with a series of comorbidities such as osteoporosis, psychiatric and cognitive disorders, metabolic syndromes, and autoimmune diseases. A broad spectrum of phenotypes has been described and many cases remain undiagnosed throughout their lifespan. In this case report, we describe a case of mosaic KS unmasked by acute vertebral fracture.
Published: 2021

48. The molecular and cellular basis of copper dysregulation and its relationship with human pathologies

Author: Teresita Padilla-Benavides, Lobna Elkhadragy, Monserrat Olea-Flores, Kyle M. Schachtschneider, Alyssa Carlson, May T Maung, and Napoleón Navarro-Tito
Subjects: Mitochondrial Diseases, ATP7A, Regulator, medicine.disease_cause, Biochemistry, Mitochondrial myopathy, Metabolic Diseases, Genetics, medicine, Animals, Homeostasis, Humans, Molecular Biology, Chemistry, Biological Transport, Neurodegenerative Diseases, medicine.disease, Cell biology, Copper-Transporting ATPases, Cancer cell, Menkes disease, Signal transduction, Carcinogenesis, Copper, Biotechnology
Abstract: Copper (Cu) is an essential micronutrient required for the activity of redox-active enzymes involved in critical metabolic reactions, signaling pathways, and biological functions. Transporters and chaperones control Cu ion levels and bioavailability to ensure proper subcellular and systemic Cu distribution. Intensive research has focused on understanding how mammalian cells maintain Cu homeostasis, and how molecular signals coordinate Cu acquisition and storage within organs. In humans, mutations of genes that regulate Cu homeostasis or facilitate interactions with Cu ions lead to numerous pathologic conditions. Malfunctions of the Cu+ -transporting ATPases ATP7A and ATP7B cause Menkes disease and Wilson disease, respectively. Additionally, defects in the mitochondrial and cellular distributions and homeostasis of Cu lead to severe neurodegenerative conditions, mitochondrial myopathies, and metabolic diseases. Cu has a dual nature in carcinogenesis as a promotor of tumor growth and an inducer of redox stress in cancer cells. Cu also plays role in cancer treatment as a component of drugs and a regulator of drug sensitivity and uptake. In this review, we provide an overview of the current knowledge of Cu metabolism and transport and its relation to various human pathologies.
Published: 2021

49. Acute Kidney Injury Following Eastern Russell’s Viper (Daboia siamensis) Snakebite in Myanmar

Author: Sam Alfred, David A. Warrell, Khin Maung Kyaw, Chen Au Peh, Myat Myat Thein, Mohammad Afzal Mahmood, D. J. Bates, Yan Linn Myint, Su Sint Sint San, Htar Kyi Swe, Aung Zaw, Khin Thida Thwin, and Julian White
Subjects: medicine.medical_specialty, Nephrology, business.industry, Acute kidney injury, medicine, Russell's Viper, medicine.disease, business, Dermatology
Published: 2019

50. Association of plasma leptin, pro‐inflammatory adipokines and cancer‐related fatigue in early‐stage breast cancer patients: A prospective cohort study

Author: Angie Hui Ling Yeo, Yan Xiang Gan, Maung Shwe, Alexandre Chan, Chia Jie Tan, Koon Mian Foo, Karin Olson, Pat Chu, Yi Long Toh, and Han Kiat Ho
Subjects: Leptin, 0301 basic medicine, Oncology, medicine.medical_specialty, Anthracycline, medicine.medical_treatment, Adipokine, Breast Neoplasms, cancer‐related fatigue, 03 medical and health sciences, breast cancer, 0302 clinical medicine, Breast cancer, Adipokines, Internal medicine, medicine, Humans, Prospective Studies, Prospective cohort study, Cancer-related fatigue, Fatigue, Neoplasm Staging, Chemotherapy, business.industry, Original Articles, Cell Biology, Middle Aged, medicine.disease, cytokines, C-Reactive Protein, 030104 developmental biology, 030220 oncology & carcinogenesis, biomarker, Molecular Medicine, Biomarker (medicine), Original Article, Female, medicine.symptom, business, Biomarkers, hormones, hormone substitutes, and hormone antagonists
Abstract: Cancer‐related fatigue (CRF) is subjective and has wide inter‐individual variability. Given that leptin is commonly associated with fatigue syndrome, its use as a potential biomarker for CRF is being investigated. The primary objective of this study was to evaluate the association between leptin and CRF in early‐stage breast cancer patients receiving chemotherapy. In a prospective cohort study, patients completed assessments at baseline (T1), during chemotherapy (T2) and after chemotherapy (T3). Levels of plasma leptin and adipokines were measured using a Luminex bead‐immunoassay and CRF was measured using the Multi‐Dimensional Fatigue Symptom Inventory‐Short Form (MFSI‐SF). Data were analysed longitudinally using a generalised estimating equation incorporating clinically relevant parameters and pro‐inflammatory adipokines. The analysis included 136 patients (mean age ± SD = 51.5 ± 8.8 years; 69.1% receiving anthracycline‐based chemotherapy). More patients experienced CRF at T3 (23.8%) than at T2 (13.8%) compared to baseline. An increase was observed in the median plasma leptin level at T2, followed by a decrease at T3 (T1: 4.07 ng/mL, T2: 4.95 ng/mL and T3: 3.96 ng/mL). In the multivariate model, the change in leptin levels over time was significantly associated with the total MFSI‐SF score (β = −0.15, P = 0.003) after adjusting for the tumour necrosis factor‐α (TNF‐α) level, anxiety, depression, insomnia, age, menopausal status and type of chemotherapy. This is the first study to report leptin as a biomarker that predicts the onset of CRF over time. Future studies are required to validate the findings.
Published: 2019

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