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A case of a 32-year-old patient who presented with vaginal bleeding 2 years after undergoing laparoscopic radical trachelectomy and vaginal cerclage was noted to have Mersilene tape erosion. Subsequent management includes the removal of displaced Mersilene tape and a repeat cerclage through a new technique of laparoscopic abdominal cerclage to avoid repeat tape erosion. The novel technique of laparoscopic abdominal cerclage to lower the incidence of preterm delivery among pregnant patients who underwent laparoscopic radical trachelectomy for early-stage cervical cancer is described.

Objective: Staphylococcus aureus (S. aureus) is a zooanthroponotic, nosocomial, and communi¬ty-associated pathogen that threatens livestock management and even public health. The goal of this investigation was to clarify the role of S. aureus in zoonotic illnesses. Besides that, a novel trial was conducted in the current Egyptian study using oil extracts such as cactus oil, tea oil, geranium oil, and thyme oil to demonstrate the susceptibility of methicillin-resistant S. aureus (MRSA) iso¬lates to these organic oils in response to the alarming global concern regarding the decreased sus¬ceptibility of S. aureus to known antibiotics, which exacerbates control and treatment protocols. Material and Methods: A total of 110 samples (45 raw cattle milk samples, 35 Karish cheese samples, and 30 human sputum samples) were collected. The bacterium was identified via traditional culturing methods, Gram staining, and the application of several biochemical tests. After that, various kinds of known commercial antibiotics were used to detect the antimicrobial susceptibility (AMS) of the obtained isolates. Furthermore, conventional polymerase chain reaction (PCR) testing was performed to identify S. aureus (nuc gene) and MRSA (mecA gene), with further application of multiplex PCR for screening of all the obtained isolates for vancomycin resistance via targeting vanA, vanB, and vanC genes. Finally, the agar gel diffusion method was performed to assess the antibacterial activity of four plant extracts (cactus oil, tea oil, geranium oil, and thyme oil) against the obtained MRSA. Results: The culturing method revealed S. aureus positivity in raw cattle milk (13.33%), in Karish cheese (28.57%), and in human samples (20%). The obtained isolates showed mainly resistance to amoxicillin-clavulanic and ampicillin antibiotics, while the dairy samples showed further resis¬tance against ceptaxime and an intermediate reaction against erythromycin. On the molecular side, PCR positivity was present in human samples (10%), raw cow milk (13.33%), and Karish cheese (14.29%). Nine of the fourteen PCR isolates were methicillin-resistant S. aureus (MRSA) isolates. Comparing the four oil extracts against the acquired MRSA isolates, cactus oil extract proved to be the most effective. Conclusion: The study's results are highly promising as they support the notion that certain essential oils possess strong antimicrobial properties against zoonotic S. aureus, thereby reducing the excessive use of antibiotics in veterinary and medical settings. [J Adv Vet Anim Res 2024; 11(2.000): 306-316]

Most sediment disasters are caused by surface failures, mostly induced by rainfall, and many of them cause extensive damages. Assessment of the risk of such disasters is crucial for the safety and security of society. This is becoming increasingly important in the era of global warming when torrential rains and localized heavy rains are on the increase. Instead of the index such as accumulated rainfall amount, we attempted to make a risk assessment using the soil moisture deficit, i.e., the remained capacity of the soil column to accept rainwater. First, a numerical model was developed to calculate soil moisture deficit in any or all tertiary meshes with existing routine data. The model was then applied to 446 tertiary meshes in Niigata Prefecture within which failures occurred during a period from 2010 to 2011. The model showed that the soil moisture deficit near the failure occurrence became smaller, i.e., the soil column was closer to complete saturation. This suggests that soil moisture deficit could be a good indicator of the risk. Furthermore, a probability distribution model was constructed from the minimum soil moisture deficit data near the failure occurrence. With this probability model, the threshold of soil moisture deficit to put an area on alert, corresponding to the disaster coverage ratio, can be easily calculated. The possibility of early warning is also demonstrated by combining the soil moisture deficit at a certain time with a short-time rainfall forecast for several hours in the future.

Abstract Background Palliative care lower medical expenses and enhances quality of life, but misconception with euthanasia delays timely care and makes inappropriate patient management. Objective To examine the magnitude of misconceptions between palliative care and euthanasia among Thai general practitioners, explore the association with knowledge, attitudes, and practical experience, and assess the association between misconception and confidence in practicing and referring patients to palliative care centers. Methods All 144 general practitioners who were going to start residency training at Maharaj Nakorn Chiang Mai Hospital in 2021 participated in this observational cross-sectional study. A chi-square test was utilized to examine the relationship between misconception and knowledge, attitude, practical experience, confidence to practice, and confidence to refer patients. Multivariable logistic regression was carried out while controlling for age, sex, knowledge, attitude, and experience to examine the relationship between misconception and confidence to practice and refer patients for palliative care. Statistical significance was defined at p

Abstract Introduction Drinking during pregnancy is the leading cause of birth defects and child developmental disorders in Europe. The adverse effects of drinking during pregnancy may include physical, behavioural and cognitive problems, known collectively as fetal alcohol spectrum disorders (FASD). Evidence-based comprehensive recommendations at the European level on how to implement preventive and treatment policies to reduce alcohol-exposed pregnancies are needed. FAR SEAS, a tendered service contract (number 20,187,106) awarded by the European Commission, aimed at developing guidelines to respond to this knowledge gap. Methods FAR SEAS recommendations were built on (1) a two-phase review of interventions, (2) an international expert consultation, and (3) a pilot study on prevention of FASD conducted in the Mazovia region of Poland. The review of interventions included nineteen electronic open access databases, several repositories of grey literature and a key informant consultation covering most European Union (EU) countries and an additional guidelines search. After triangulating sources, 94 records were collected. Experts contributed in the design of the research questions, addressing the gaps in the literature and reviewing the recommendations formulated. The Polish pilot added nuances from real world practice to the formulated recommendations, resulting in the final set of guidelines for dissemination. Results The FAR SEAS Guidelines comprise 23 recommendations grouped into different topics areas of policies, communication strategies, screening, brief intervention and referral to treatment, treatment and social services. The recommendations highlight the need to respect women’s autonomy and avoid discrimination and stigmatization; using universal screening for women of childbearing age, including detection of other psychosocial risks (such as domestic violence); and individualized, comprehensive and multidisciplinary supportive interventions for those who require it, such as those with alcohol use disorders, including women’s partners. Policies to prevent FASD should be multicomponent, and public health communication should combine information about the risks together with self-efficacy messages to promote changes. Conclusions The FAR SEAS guidelines are a tool to support policy-makers and service managers in implementing effective programmes to reduce prenatal alcohol exposure among general and at-risk population groups. FASD prevention has to involve comprehensive and multi-level evidence-based policies and practice, with services and activities tailored to the needs of women at differing levels of risk, and with due attention to reducing stigma.

We propose an on-chip gyroscope based on nonlinear multiresonant optics in a thin film χ (2) resonator that combines high sensitivity, compact form factor, and low power consumption simultaneously. We theoretically analyze a novel holistic metric – Fisher Information capacity of a multiresonant nonlinear photonic cavity – to fully characterize the sensitivity of our gyroscope under fundamental quantum noise conditions. Leveraging Bayesian optimization techniques, we directly maximize the nonlinear multiresonant Fisher Information. Our holistic optimization approach orchestrates a harmonious convergence of multiple physical phenomena – including noise squeezing, nonlinear wave mixing, nonlinear critical coupling, and noninertial signals – all encapsulated within a single sensor-resonator, thereby significantly augmenting sensitivity. We show that ∼470× $\sim 470{\times}$ improvement is possible over the shot-noise limited linear gyroscope with the same footprint, intrinsic quality factors, and power budget.

The melting phenomenon plays a critical role in optimizing the performance of power storage, electronic cooling, and semiconductor devices. The present study aims to analyze the melting effect on the flow of Carreau fluid over a stretchable cylinder, with special consideration given to the impact of quadratic thermal radiation. Similarity variables and the homotopy analysis method are used to simplify and determine the semi-analytical homotopic solutions of the governing equations. The present findings reveal that the melting parameter increases the heat transfer rate by more than 10% for both fluids, water (Pr = 0.71), and polymer (Pr = 10). However, as the temperature ratio due to quadratic radiation increases, the local Nusselt number for water has been reduced by 25%, and an even more substantial reduction is observed for the polymer. The present study offers valuable insights into achieving optimal efficiency in electronic devices.

Abstract Background Stroke is a leading cause of death in the world, and the burden of stroke is higher in low- and middle-income countries. Understanding the risk factors, complications, and outcomes of stroke are useful for healthcare planning and resource allocation. Little information on stroke is available for many low- and middle-income Asian countries; including Myanmar, which is the focus of this study. Methods A review was conducted of medical records for stroke admissions during 2017 in a tertiary hospital in Myanmar. The final diagnoses, risk factors, clinical features, complications, and outcomes were systematically collected from computer- and paper-based medical records. Results Of 908 cases analysed, haemorrhagic stroke was the most common type (49%), followed by ischaemic stroke (43%). Unimproved cases were 32%. Identified risk factors of unimproved cases were ‘haemorrhagic stroke’ [adjusted odds ratio (aOR): 1.73], ‘having fever during hospitalization’ [aOR: 2.49], ‘Glasgow Coma Scale (GCS) at the admission between 9 and 14’ [aOR: 4.33], and GCS less than 9 [aOR: 42.86]. Conclusion This study is based on hospital medical records to assess stroke types, risk factors, clinical features, and outcomes in a tertiary hospital, in Nay Pyi Daw, Myanmar. The findings indicated that early case admission, improved hospital care management, and increased awareness of the modifiable risk factors within populations are crucial for preventing stroke incidents.

Abstract Background Guidelines about febrile neutropenia in paediatric patients are not homogeneous; the best empiric treatment of this condition should be driven by local epidemiology. The Weighted-Incidence Syndromic Combination Antibiogram (WISCA) addresses the need for disease-specific local susceptibility evidence that could guide empiric antibiotic prescriptions based on outcome estimates of treatment regimens obtained as a weighted average of pathogen susceptibilities. This study developed a WISCA model to inform empirical antibiotic regimen selection for febrile neutropenia (FN) episodes in onco-haematological paediatric patients treated at two Italian paediatric tertiary centres. Methods We included blood cultures from patients with a bloodstream infection and neutropenia admitted to the Paediatric Haematology-Oncology wards in Padua and Genoa Hospitals from 2016 to 2021. WISCAs were developed by estimating the coverage of 20 antibiotics as monotherapy and of 21 combined regimens with a Bayesian probability distribution. Results We collected 350 blood cultures, including 196 g-negative and 154 g-positive bacteria. Considering the most used antibiotic combinations, such as piperacillin–tazobactam plus amikacin, the median coverage for the pool of bacteria collected in the study was 78%. When adding a glycopeptide, the median coverage increased to 89%, while the replacement of piperacillin–tazobactam with meropenem did not provide benefits. The developed WISCAs showed that no monotherapy offered an adequate coverage rate for the identified pathogens. Conclusions The application of WISCA offers the possibility of maximizing the clinical utility of microbiological surveillance data derived from large hospitals to inform the choice of the best empiric treatment while contributing to spare broad-spectrum antibiotics.

Abstract Background Internet use has both positive and negative effects on mental health. However, few studies have examined the association between internet use and mental health among older adults in developing countries. This study aimed to investigate the association between Internet use and depressive symptoms among older adults in two regions of Myanmar. Methods Data based on a visit to 1,200 older adults in urban and rural Myanmar were obtained through stratified random sampling using the cross-sectional baseline survey of the longitudinal study titled “Healthy and Active Aging in Myanmar.” Our analysis included 1,186 participants. The dependent variable was depressive symptoms, and the 15-item version of the Geriatric Depression Scale (GDS) was used as a continuous variable; the higher the score, the more likely a person was to be depressed. Internet use (one of the questions about household property ownership) was used as an independent variable. After confirming the absence of multicollinearity, we adjusted for age, gender, educational background, activities of daily living, residential area, and frequency of meeting friends, and stratified by subjective economic status (above or below average). We also examined the interaction between internet use and subjective economic status. A linear regression analysis was performed. Results Among the 1,186 participants included in the analysis (women: 59.5%; median age: 68 years old), 202 (17.0%) were Internet users (95% Confidential Interval [CI]: 0.15, 0.19), and they had significantly lower GDS scores than the participants who did not use the Internet (B: -1.59, 95% CI: -2.04, -1.13).GDS showed a negative association with Internet use even in the multivariate analysis (B: -0.95, 95% CI: -1.41, -0.50). However, the interaction term for GDS between Internet use and subjective economic status was not significantly associated (B: 0.43, 95% CI: -1.11, 1.98). Conclusions Internet use and depressive symptoms were associated especially among the older adults. However, there were no significant interaction between Internet use and subjective economic status for GDS.

Mitochondria are present in all mammalian cells except matured red blood cells. Mitochondria consist of several metabolic pathways for glucose, fatty acids, amino acids, and bioenergetic pathways for ATP synthesis, membrane potential, and reactive oxygen production. In the liver, hepatic mitochondria play a key role in hepatic steatosis because mitochondrial metabolism produces acetyl-CoA which is the building block for synthesis of lipids and cholesterol. Mitochondria inner membrane is impermeable of metabolites, reducing equivalents, and small molecules such as phosphate, and sulfate. Thus, mitochondrial shuttles and carriers function as the routes of influx and efflux of these metabolites and molecules across the inner membrane. The signal regulation of these shuttles and mitochondrial enzymes could play a key role in coordinating the mitochondrial metabolism to adapt the cytosolic part of metabolic pathways in liver metabolic stress. Intriguingly, the interaction of mitochondria protein SH3 domain-binding protein 5 (SAB/SH3BP5) and c-Jun N-terminal kinase (JNK) was found as a pivotal role in sustained activation of JNK and phosphorylated-JNK (P-JNK) mediated activation of lipogenic pathway in nutritional excess. Knockout or knockdown of SAB prevented or reversed the hepatic steatosis, inflammation, and fibrosis, and improved metabolic intolerance and energy expenditure. Moreover, blocking the SAB peptide prevents palmitic acid-induced P-JNK interaction with SAB and inhibition of mitochondrial bioenergetics, implying the P-JNK effect on mitochondrial metabolism. This review focuses on the flow of mitochondrial metabolites in metabolic stress conditions and the contribution of mitochondria and mitochondrial stress signals in hepatic steatosis.

Spinal cord injury (SCI) often causes loss of sensory and motor function resulting in a significant reduction in quality of life for patients. Currently, no therapies are available that can repair spinal cord tissue. After the primary SCI, an acute inflammatory response induces further tissue damage in a process known as secondary injury. Targeting secondary injury to prevent additional tissue damage during the acute and subacute phases of SCI represents a promising strategy to improve patient outcomes. Here, we review clinical trials of neuroprotective therapeutics expected to mitigate secondary injury, focusing primarily on those in the last decade. The strategies discussed are broadly categorized as acute-phase procedural/surgical interventions, systemically delivered pharmacological agents, and cell-based therapies. In addition, we summarize the potential for combinatorial therapies and considerations.

Nonhuman primates living in proximity to humans increase risks for sylvatic arbovirus transmission. We collected serum samples from nonhuman primates in Hlawga National Park near Yangon, Myanmar, and detected antibodies against chikungunya (33%) and Japanese encephalitis (4%) viruses. Buffer zones between primate and human communities might reduce cross-species arbovirus transmission.

Background: Postpartum depression (PPD) is non-psychotic depressive illness after childbirth, and PPD affects the health and social status of mothers and their children. This study aims to identify the prevalence of suspected PPD and associated factors among women in Yangon, Myanmar. Methods: This is a cross-sectional study of 552 women at 6–8 weeks postpartum who visited at North Okkalapa General and Teaching Hospital for postnatal care from September to October 2022. Socio-demographic factors, obstetric and infant factors, family support, and medical history were collected using a structured questionnaire. Myanmar version of the Edinburgh Postnatal Depression Scale (EPDS) was used for screening PPD, and all women were divided into suspected PPD (EPDS ≥10) and non-suspected PPD (EPDS

Summary: Background: Cardiovascular diseases (CVD) remains a leading cause of mortality in Myanmar. Despite the burden, CVD preventive services receive low government and donor budgets, which has led to poor CVD outcomes. Methods: We conducted a cost-effective analysis and a budget impact analysis on CVD prevention strategies recommended by the WHO. A Markov model was used to analyse the cost and quality-adjusted life year (QALY) from healthcare provider and societal perspectives. We calculated transition probabilities from WHO CVD risk data and obtained treatment effects and costs from secondary sources. Subgroup analysis was performed on different sex and age groups. We framed the budget impact analysis from a healthcare provider perspective to assess the affordability of providing CVD preventive care. Findings: The most cost-effective strategy from the healthcare provider perspective varied. The combination of screening, primary prevention, and secondary prevention (Sc-PP-SP) (incremental cost-effectiveness ratio [ICER]: US$1574/QALY) is most cost-effective at the three times gross domestic product (GDP) per capita threshold, while at one time the GDP per capita threshold, secondary prevention is the most cost-effective strategy (ICER: US$160/QALY). Sc-PP-SP is the most cost-effective strategy from the societal perspective (ICER: US$647/QALY). Among age groups, intervention at age 45 years appeared to be the most cost-effective option for both men and women. The budget impact revealed the Sc-PP-SP would avert 55,000 acute CVD events and 28,000 CVD-related deaths with a cost of US$157 million for the first year of CVD preventive care. Interpretation: A combination of screening, primary prevention, and secondary prevention is cost-effective to reduce CVD-related deaths in Myanmar. This study provides evidence for the government and development partners to increase investment in and support for CVD prevention. These findings not only provide a basis for efficient resource allocation but also underscore the importance of adopting a total cardiovascular risk approach to CVD prevention, in alignment with global health goals. Funding: Pilot grant from Duke Global Health Institute, USA.

Water is a fundamental element of life and a critical resource for ecosystems, agriculture, industry, and human consumption. Most of the water sources on this earth are not safe to use. A group of researchers from the Faculty of Civil Engineering have taken the initiative to treat water in Bukit Gemilang. Treated water is stored in a clean water storage tank before being distributed for use. However, there is still no system or device to ensure that the water stored in the storage tank is safe for use. Therefore, the Sistem Pemantauan Kualiti Air (PeKA) was developed to monitor and measure the quality of water stored in storage tanks. The PeKA system is based on IoT devices and the PeKA web. This IoT device is equipped with three types of sensors, namely TDS Sensor, pH Sensor, and Turbidity Sensor as a tool to measure the level of water quality that has been treated. The PeKA system is developed based on HTML and PHP for system interface development. C++ programming language is used to develop IoT devices while MySQL is used as a database for data storage. The prototype methodology is used for the development of the PeKA System. This is because IoT device prototypes need to be built first to make the system evaluation phase. This system can make it easier for users who are water treatment researchers to monitor and measure the level of water quality that has been treated. Among the advantages of this system is in terms of the administration of the system which is self-administered by the water treatment researchers, the web-based implementation of the PeKA System allows the system to be accessed online. Subsequently, users will receive a warning notification of extreme changes in water quality.

Summary: The genetic mechanisms of reproductive isolation have been widely investigated within Asian cultivated rice (Oryza sativa); however, relevant genes between diverged species have been in sighted rather less. Herein, a gene showing selfish behavior was discovered in hybrids between the distantly related rice species Oryza longistaminata and O. sativa. The selfish allele S13l in the S13 locus impaired male fertility, discriminately eliminating pollens containing the allele S13s from O. sativa in heterozygotes (S13s/S13l). Genetic analysis revealed that a gene encoding a chromatin-remodeling factor (CHR) is involved in this phenomenon and a variety of O. sativa owns the truncated gene OsCHR745, whereas its homologue OlCHR has a complete structure in O. longistaminata. CRISPR-Cas9-mediated loss of function mutants restored fertility in hybrids. African cultivated rice, which naturally lacks the OlCHR homologue, is compatible with both S13s and S13l carriers. These results suggest that OlCHR is a Killer gene, which leads to reproductive isolation.

Every child deserves the opportunity to play during their preschool-age towards optimal development of physical, intellectual, social and emotional. However, parents or caregivers from the remote villages in Myanmar have not raised awareness of the play with their preschoolers. There was no preschool program in these remote villages in Myanmar. Therefore, this study aims to support parents and caregivers to nurture the social and emotional development of preschool children using play. This study shows them how they can create an environment for their preschoolers to improve the social and emotional development and the empirical evidence of the children development using play. Drawing on a pre-test-post-test control group design, a total of 90 preschool children involving 45 children in the experimental group and 45 children in the control group were observed before, during, and after the play program by using social and emotional development surveys. The descriptive and inferential data analysis results revealed that there was an effect of play program on preschool children's social and emotional development. The program helps preschool children to optimize their social and emotional development. Implications of the results for the development and implementation of the play program are discussed.