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Background: Coronavirus disease 2019 (COVID-19) has been threatening the world for more than 2 years. Breakthrough COVID-19 infection has clinical and public health significance. The health care workers have been working in front line; thus, acquiring greatest risks. Their family members are also at high risk being close contact to them. This study aimed to assess the prevalence and the severity of breakthrough COVID-19 infection (BTI) in fourth wave among health care workers (HCW) and their family members, and the protective effect of C OVID-19 vaccine in Myanmar. Methods: A cross-sectional descriptive study was conducted among health care workers (HCW) and their family members who developed confirmed COVID-19 infection either by rapid test or PCR test at least 14 days after receiving COVID-19 vaccine during the fourth wave from January 2022 to May 2022. Data were collected by using standardized forms and analysis was done. Results: A total of 1013 participants were included in this study; 227 HCW and 786 family members. Less than half of HCW 44.4% (101/227) and 17.1% (135/786) of family members suffered BTI in fourth wave. Among them, 95% (96/101) of HCW and 57% (76/135) of family members had at least 3 doses of vaccine. The the chances of getting BTI after taking 3 doses, 4 doses and 5 dose were 47.4%, 36.1% and 10% respectively in HCW; and, 32.8%, 22.4% and 1% respectively in the family members. The mean duration of last dose of vaccine to symptom onset was 45.9 ± 40.6 days in HCW and 60.7 ± 66.6 days in the family members. The proportion of different types of vaccine received by HCW were Covaxin 88%, Sinopharm 70%, Covishield 34% and Sputink V 30% whereas the proportion in their family members were Covaxin 27%, Sinopharm 68%, Covishield 56% and Sputink V 13%. Comorbid status was noted in 15% of HCW and 45% of family members. The prevalence of breakthrough hospitalization was 3 (3.1) HCW and 8 (6.4%) family members. The survival rate was 100% in HCW and 97% in family members. Non survivors were over 65 years and they had multiple comorbidities. Half of them received only 2 doses of vaccine; one was unvaccinated. Conclusions: The majority of cases with BTI in fourth wave was mild. The prevalence of breakthrough hospitalization was 3-6% in HCW and family members; showing the protective effect of vaccine from severe manifestation. Non-survivors were elderly, having multiple comorbidities and incomplete vaccination or unvaccinated. The chance of BTI was decreasing if they obtained 4 doses compared to 3 doses. The possibility of BTI after taking 3 doses of vaccine was 50% in HCW and 33% in family members; it dropped to 36% and 22% respectively after 4 doses of vaccine. Therefore, 3 doses of COVID-19 vaccine could protect 50-67 percent; the protective efficacy increased to 65-87 percent with 4 doses. Therefore, 4 doses of COVID-19 vaccine are recommended for prevention of fifth wave in Myanmar.

Background: Maintenance hemodialysis has been the commonest Renal Replacement Therapy (RRT) in Myanmar. The equity is questionable in Myanmar, a developing country, as developed countries reported inequities of dialysis in various aspects. Methods: A cross-sectional descriptive study was conducted in selected Hemodialysis Centers (HDC) which are under the care of government of Myanmar in August 2022. Data were collected by using standardized forms and analysis was done. Results: A total of 168 cases from 5 HDC situated in Yangon (lower part of Myanmar), Nay Pyi Taw (central part of Myanmar), Aung Ban (Eastern part of Myanmar), Lashio (North eastern part of Myanmar) and Kyaing Ton (near Golden Triangle) were included. The age range was 21-79 years; old age was not excluded for maintenance hemodialysis. Male to female ratio was 1:1.2 revealing accessibility of both sex to maintenance hemodialysis. The proportion of ethnic groups was Burmese (139/168), Rakhine (8/168), Karen (7/168), Shan (6/168), Danu (2/168), Paoh (1/168), Chin (1/168), Kachin (1/168), inlay (1/168), Lesue (1/168) and Larhu (1/168); it was in accordance with normal ethnic distribution in Myanmar. Regarding religion, the majority were Buddhist (158/168); Nine patients were Christian. One patient was Islam. It was proportionate with percentage of population by religion in 2014 Census. Only 38 patients were graduates and four patients were illiterate; therefore, illiterates were accessible to maintenance hemodialysis. Ninety-eight percent of patients had comorbidities; and, 5% had 5 comorbid diseases revealing patients with multiple comorbid status were not left behind. Half of the patients were unemployed pointing that the jobless were not excluded for hemodialysis. Median travel time to HD center was 45 minutes (IQR 26-120 minutes). The maximum was 3 hours (180 minutes) in 3 patients. Half of the patients required 60 minutes travel time to HDC. Fifty percent of patients had booster vaccination to COVID-19. Most of the patients, over 90%, were doing their daily routine activity without assistance. Ninety-eight percent of patients were satisfied with treatments in their corresponding HDC. Conclusion: There was no difference in age, sex, race, religion, comorbidity, employment status, underlying etiology and education in terms of accessibility to maintenance hemodialysis. Although they were dealing with long travel time of more than one hour in 50% of cases, their attitude was positive. As half of the patients had travel time of more than an hour, we need new HDC in Aung Ban. Resource allocation to renal replacement therapy should be encouraged at ministry level.

A young renal transplant recipient received living kidney from his father; the Centers for Disease Control and Prevention (CDC) cross match was all negative. He had oliguria 5 hours after transplant with fever and neutrophil leukocytosis. Doppler ultrasonogram revealed increased cortical echo with increased Resistive Index suggesting acute rejection or acute tubular necrosis. Renal transplant biopsy revealed acute T cell mediated rejection (acute TCMR) Grade IIA. Trough level of Tacrolimus blood level done on Day 5 was very low; therefore, Tacrolimus dose was increased. Therapeutic level achieved after giving 6 mg twice a day with addition of erythromycin. Escalating antibiotics, increasing steroids and Tacrolimus dose saved the transplant kidney.

Background: Coronavirus disease 2019 (COVID-19), emerged in China at the end of 2019, became a major threat to health around the world as it caused significant morbidity and mortality. SARS-CoV-2 infection induces a cytokine storm due to dose-dependent production of IL-6 from bronchial epithelial cells; therefore, Tocilizumab, a monoclonal antibody against the interleukin-6 receptor, is one of the recommended drugs for treatment of COVID-19 infection. It may result in better outcomes in patients with severe Covid-19 infection. The efficacy and timing of Tocilizumab therapy in severe COVID-19 infection in Myanmar was not known clearly. Methods: A hospital based interventional study design (Randomized controlled trial) was conducted in COVID-19 treatment centers in Myanmar -Yangon and Nay Pyi Taw, from February 2020 to August 2021. Supervised treatment was done; and, both clinical and laboratory data were collected by using standardized forms and analysis was done. We conducted a double-blind, randomized, placebo-controlled trial of intravenous Tocilizumab in adults who were hospitalized with severe COVID-19 infection. Patients were randomly assigned to receive either Tocilizumab or placebo for within 5 days. The primary outcome was the time to recovery, defined by either discharge from the hospital or hospitalization for infection-control purposes only. Results: A total of 105 patients (55 in Tocilizumab group and 50 in Standard treatment group) with severe COVID-19 infection were included. Baseline characteristics in Tocilizumab group and Standard treatment group were as follows: (1) mean age 64.4 ± 11.9 years and 59.9 ± 15.8 years; (2) BMI 24.3 ± 3.0 and 23.9 ± 5.0; (3) mean duration of symptom onset to hospital admission was 9.5 ± 4.4 days and 6.5 ± 3.8; (4) mean duration of symptom onset to treatment was 12.8 ± 3.8 days and 7.1 ± 3.8 days; (6) mean duration of hospital stay was 20.1 ± 16.5 days and 11.4 ± 4.8 days; (7) associated co-morbidities was 88% and 70%; and, (8) mean CXR severity score by Braxia was 12.0 ± 2.0 and 9.6 ± 3.4 respectively. The survival rate in early treatment receiving group was 80% in Tocilizumab group and 65.5% in Standard treatment group; that of median treatment receiving group was 40% and 62.5% respectively. The survival rate in late treatment receiving group reduced to 36% in Tocilizumab group; however, no one survived in Standard treatment group. Inflammatory markers (Ferritin, LDH, D dimer and CRP) dropped significantly at 24 hours and 72 hours after Tocilizumab treatment; the difference was noticeable between survivors and non-survivors. Absolute lymphocyte count, liver enzymes (AST and ALT) and procalcitonin levels became normal by 2 weeks. No significant changes were seen in serum creatinine and blood urea level. Both clinical observation and questioning on experienced side effects from patients on recovery revealed that Tocilizumab therapy was tolerable and safe. Conclusions: Tocilizumab treatment was associated with a lower risk of mortality than Standard treatment group among patients with severe COVID-19 infection. The chance of survival was 36% if Tocilizumab treatment was given late- more than 15 days of symptom onset unlike Standard treatment. The significant inflammatory markers which could predict survival within 24 to 72 hours were serum ferritin, LDH, D dimer and CRP. Tocilizumab treatment in severe COVID-19 infection was safe and effective particularly it was given early.

A 58 year old man was brought to hospital in state of deep coma following severe headache for one day. His GCS was 3/15 and had flaccid all 4 limbs with equivocal planter response on both sides on arrival. NECT head showed acute subdural haemorrhage with surrounding cerebral oedema, mid-line shift and corning of brain stem. After giving mannitol and dexamethasone, four hours later, he became fully conscious and orientated; his motor power returned to normal. He was on warfarin 3mg daily for rheumatic mitral valvular heart disease with atrial fibrillation and his INR on arrival was 3.5. He had intractable hiccups once he regained consciousness. Both pharmacological and non-pharmacological measures were tried for distressing hiccups; there was no therapeutic success. His hiccups disappeared completely only after removing the haematoma by burr hole surgery.

A young man presented with abdominal pain and vomiting after eating Naphthalene Mothball. He had dyspnea, central cyanosis (SaO2 on air was 67% on air), marked pallor, deep jaundice and dehydration. His urine color was black; and, his plasma in clotted blood sample was brownish. He was treated as methemoglobinemia due to suicidal Naphthalene Mothball poisoning with fluid and electrolyte replacement, ascorbic acid, N-acetylcystine and exchange transfusion twice with four units of whole blood. Dramatic improvement in central cyanosis immediately following exchange transfusion. Psychiatric consultation and counselling were done; he admitted the main reason for committing suicide was socioeconomic stress due to COVID-19.

Background:Sepsis is a common life threatening medical problem and first leading cause of death in Myanmar. This study was aimed to determine the predictive values of initial mSOFA score, point-of-care lactate, neutrophil-lymphocyte ratio and platelet count for mortality in patients with sepsis and septic shock. Method:A hospital based prospective observational study done in No.(1) Defence Services General Hospital, Yangon, from January 2021 to October 2022. All patients above 18 years old admitted with sepsis and qSOFA ≥ 2 were enrolled and sample size was 121 patients. The predictors were mSOFA score, point-of-care lactate, neutrophil-lymphocyte ratio and platelet count, which were assessed within 24 hour of admission and the mortality was observed for 28 days. Logistic regression was used to find out the predictive value and the predictors were compared by receiver operating characteristic curve analysis. Results:The initial mSOFA score, point-of-care lactate and neutrophil-lymphocyte ratio of non survivors were significantly higher than survivors (mSOFA score 9 vs 4), (blood lactate 3.3 mmol/L vs 2 mmol/L), (neutrophil-lymphocyte ratio 13.4 vs 8.3). Platelet count was significantly lower in non-survivors than survivors (175 x 10^9/L vs 290 x 10^9/L). The mortality was 33.1%. The mSOFA score and lactate were strongly correlated (rho= 0.650,p< 0.001). The adjusted odds ratio of mSOFA score was 1.350 (1.135 – 1.606) with adjusted R20.478 and accuracy 80.2%. The adjusted odds ratio of lactate was 1.819 (1.168 – 2.834); NLR, 1.108 (1.023 – 1.200); platelet 0.992 (0.987 – 0.998) with adjusted R20.616 and accuracy 86.8%. Each predictor had moderate prognostic value (AUC > 0.7) and the combinations of mSOFA score and/or lactate with NLR and platelet count, good prognostic value (AUC > 0.8). Conclusion:The mSOFA score, lactate, NLR and platelet count had predictive value for mortality assessment in patients with sepsis or septic shock. Lactate level was strongly correlated with disease clinical severity of the sepsis, mSOFA score. The combination of mSOFA score and/or lactate with NLR and platelet count had better predictive value.

Background:Sepsis is the first leading cause of death in Myanmar and complications are also difficult to solve. This study aimed to detect the effect of thiamine on lactate clearance and mortality in patients with sepsis. Method:A randomized controlled trial done in No.(1) Defence Services General Hospital, Yangon from October 2020 to June 2022. All patients > 18 years old admitted with suspected or documented infection and qSOFA score 2 or 3 were included but alcohol related cases were excluded. Total 80 patients were assigned 1:1 by block randomization. Intervention group was given IV thiamine 100 mg 6 hourly for 3 days. Primary outcome was lactate clearance and secondary outcomes, mSOFA score (both were assessed in day 1, day 3 and day 7), and mortality within 7 days. Intention to treat analysis with worst data imputation in missing value for expired cases. Results:Significant lactate clearance was seen in intervention group compared with control group, in day 3, [23.53% (34.37) vs 16.67% (43.30), z = -2.353,p= 0.019] and day 7, [53.85% (28.90) vs 30.22% (38.61), z = -3.186,p= 0.001]. Lactate clearance over time was well observed in the intervention group, [X2(2) = 29.356,p< 0.001] but not in the control group, [X2(2) = 3.152,p= 0.207]. Significant mSOFA score reduction over time was also observed in the intervention group, [X2(3) = 39.330,p< 0.001]. All-cause mortality within 7 days was not different, [X2(1) = 0.949, p = 0.330, OR 0.949, 95% CI (0.51 – 7.12)]. Conclusion:Thiamine supplementation in sepsis patient was benefit in lactate clearance starting from day 3 and reduction of mSOFA score starting from day 7. But it did not show the mortality benefit within 7 days period.

Background:Patients on maintenance hemodialysis (MHD) are at high risk of contracting SARS-CoV-2 and developing severe COVID-19 infection because they have low innate immunity as well as poor antibody response to COVID-19 vaccine. This study aimed to assess the effectiveness of 4 doses of COVID-19 vaccine in preventing 5thwave of COVID-19 infections in patients on maintenance hemodialysis in Myanmar. Methods:A hospital-based descriptive study was conducted in July 2022 to November 2022 among patients on MHD who received COVID-19 vaccine 4 doses; last dose was 2 weeks ago. Data were collected by using standardized forms and analysis was done. Results:A total of 61 patients on maintenance hemodialysis ( MHD) who had 4 doses of COVID-19 vaccination more than 2 weeks were included. Nasopharyngeal swab PCR was taken twice a week to all patients (if they did not have symptoms) and it was repeated if they had symptoms suggestive of COVID-19 infection or they had history of contact with patients having COVID-19 infection. Their signs and symptoms were analyzed; chest radiograph and blood tests were taken if indicated. Then, the severity of COVID-19 infection was determined according to WHO criteria and they were given treatment according to hospital guideline. They were followed up till 28 days. The base line characteristics were as follows: mean age was 51.15 ± 12.85 years; male to female ratio was 4:6; mean BMI was 19.93 ± 2.83 kg/m2; 16.4%(10/61) had diabetic nephropathy; 9.8%(6/61) had cerebrovascular accident; 24.6%(15/61) had coronary heart disease; and one fifth of them were current smokers. Sixty six percent had past history of COVID-19 infection; duration from last infection was 404 days. Thirty three percent of cases had shortest duration of hemodialysis (6 months) and 23% were over 3 years. Mean duration from last vaccination was 39 days. Thirty six percent (22/61) had confirmed COVID-19 infection and 64% (39/61) of them were not infected till the end of 5thwave. All infected cases were mild form according to WHO criteria; none of them required oxygen therapy. One case having multiple comorbidities (lymphoma, coronary heart disease, hypertension and malignant cachexia) had sudden death due to pulmonary embolism. Conclusions:The protection rate of four doses of COVID-19 vaccine in patients on MHD was not good as 36% of them were infected in the 5thwave of epidemic in Myanmar. However, all the infected cases were mild form and they did not need oxygen therapy showing that booster vaccination prevented morbidity and mortality. Therefore, the protection rate of four doses of COVID-19 vaccine in patients on MHD was nearly 65%; it reduced the severe form of infection and death. Fifth dose of COVID-19 vaccine is necessary along with personnel protective measures.

Background: In COVID-19 pandemic, the diagnosis and treatment must be as early as possible to save the life of each patient. Moreover, screening of asymptomatic carriers, close contacts or healthy subjects must not be delay to prevent transmission to publics. For confirmation of diagnosis of SARS-CoV-2 infection, nasopharyngeal swab must be tested either by real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests or Rapid Antigen Test (RAT). RAT is faster, easier and cheaper; thus, it is suitable for health service in developing country. Objectives: The aim of this study was to assess the diagnostic accuracy of Roche SARS-CoV-2 Rapid Antigen Test (RAT) in diagnosing SARS-CoV-2 infection. Methods: Hospital based exploratory study was done in out-patient department and fever clinic, and molecular laboratory of No. (1) Defence Services General Hospital. Nasopharyngeal swabs were taken, and the Roche SARS- CoV-2 RAT was conducted in parallel with RT-PCR test (reference standard). Results: Among the 932 patients/subjects recruited, RT-PCR was positive in 468 individuals, corresponding to a prevalence of 50.2%. The RAT was positive in 363 patients (60.4%), false positive in 120 patients; it was negative in 569 individuals (39.6%), false negative in 225 patients. The overall sensitivity of the RAT was 51.9% (95% Confidence Interval [CI] 47.29-56.53) and, the specificity was 74.1% (95% CI 69.9-78.07); positive predictive value was 66.9% and negative predictive value was 60.5%. The sensitivity varied with Ct value; 78% in clinical samples with Ct values < 20, 57.5% in those with Ct values between 21 and 25, 41.8% in samples with Ct values between 26 and 30, and, 36.4% in samples with Ct value > 30. Conclusion: The accuracy of the SARS-CoV-2 Roche RAT in diagnosing SARS-CoV-2 infections was inferior to RT-PCR and manufacturer’s data. The sensitivity was with low Cycle threshold values < 20 which were inversely related to the viral load. RAT test should be used in association with clinical impression of physicians. In hospital setting especially in emergency department, the role of RAT should be reconsidered in those patients presenting with anosmia and some cases of dyspnoea, late symptoms in the course of disease, as the RAT results would be false negative. Other errors may arise if the operator for RAT has to handle more than recommended tests per hour especially in the peak of epidemics.

Background: Coronavirus Disease 2019 (COVID-19), emerged in China at the end of 2019, became a major threat to health around the world. Breakthrough infection following COVID-19 vaccine has clinical and public health significance. The highest groups at risk of infection during the COVID-19 pandemic is health care workers; the physicians are the frontline workers. This study aimed to assess the prevalence of breakthrough COVID-19 infection and their clinical presentation, co-morbidities and outcome among physicians who were fully vaccinated, working in COVID-19 treatment centers in Myanmar. Methods: A cross-sectional descriptive study was conducted among physicians, at least 14 days after receiving second dose, working at COVID-19 treatment centers in Myanmar, during the third wave from end of May to August 2021. Data were collected by using standardized forms and analysis was done. Results: Among 410 physicians, 98.2% (221/225) received two dose of vaccination: Covaxin 90.0%, Covishield 9.5% and Sputink V 0.5%. They received first dose of vaccine in January/February 2021 and second dose in March/April 2021. In Myanmar, third wave started in end of May; the largest pandemic surge had reached its peak in July, 2021. In the third wave, most of them 72.9% (161/221) did not experience no infection. The prevalence of fully vaccinated break through infection was 27.1% (60/221); the majority 78.3% (47/60) were mild symptomatic infection. Severe infection was seen in 10% of physicians with breakthrough infection who required hospital admission and oxygen therapy. The common presenting symptoms in order of frequency were body aches and pain 62.6%, sneezing 56.6%, headache 53.5%, cough 52.5%, sore throat 45.5%, anosmia 33.3%, runny nose 23.2% and loose motion 27.3%. The uncommon symptoms were dyspnoea 9.1%, vertigo 6.1%, skin rash 5.1%, vomiting 5.1%, petechiae 3.0%, tinnitus 3.0% and silent hypoxia 3.0%, and non-per-os 1%. Most of them did not have any significant comorbidities. One out of six physicians having severe infection had diabetes mellitus and two were obese. The mean duration of hospital stay was 7 days. None of the cases was fatal. Conclusions: In this study, over 98% of physicians were fully vaccinated; majority with Covaxin. One in four physicians had breakthrough infection in third wave; mainly mild form. Nearly half of them had possible delta symptoms; aches and pain, sneezing, runny nose, headache, cough, and sore throat. Awareness of rare but important symptoms like Non-per-Os and vertigo should be highlighted both to public and health care personnel. Ten percent of physicians with breakthrough infection were severe. Mortality rate was zero.

The “severe acute respiratory syndrome coronavirus type 2” (SARS-CoV-2) is also known as “coronavirus disease 19” (COVID-19). It originated in Wuhan, Hubei province, People’s Republic of China, in December 2019; and, it spread worldwide causing a global pandemic. Genetic variants of SARS-CoV-2 have been emerging and circulating around the world throughout the COVID-19 pandemic. The original (wild-type) SARS-CoV-2 coronavirus that causes COVID-19 has been changing; and, it has reproduced several new variants- the original (wild-type), the Alpha variant, the Beta variant, the Delta variant, the Gamma variant and the Omicron. the Omicron variant was first detected in South Africa in late November; and, it was found in Myanmar in January 2022 (Pyar, 2022).

Background:Coronavirus disease 2019 (COVID-19), emerged in China at the end of 2019, became a major threat to health around the world by causing acute COVID-19 infection. After recovery, a significant number of patients experience prolonged symptoms, long COVID syndrome. The prevalence of long COVID syndrome, its symptoms, severity and relation between clinical parameters and long COVID syndrome, and its impact were not studied in Myanmar. Methods:A prospective study was conducted via telecommunication to patients with positive SARS COV 2 PCR from nasopharyngeal swab during the third wave from end of May to August 2021. Data were collected by using standardized forms and analysis was done. A chi-square test of independence was performed to examine the relation between age groups, gender, body mass index (BMI), vaccination status, comorbidity status, severity of initial symptoms, oxygen requirement status, and symptoms of long covid syndrome. Results:Though initial recruitment included 18,709 patients with PCR confirmed COVID-19 infection, only 853 patients with recovery were analyzed. Long COVID syndrome was recorded in nearly 40% (333/853) of them; sixty percent of them (520/853) did not experienced symptoms following recovery. The common presenting symptoms in order of frequency were fatigue 58.9% (196/333), insomnia 27.3% (91/333), palpitation 17.1% (57/333), poor concentration 15.6% (52/333), anxiety 8.7% (29/333), myalgia 6.6% (22/333), chest pain 5.1% (17/333), persistent cough 4.2% (14/333), rash 3% (10/333), headache 2.7% (9/333), diarrhea 1.8% (6/333), anosmia 1.5% (5/333), sensory symptoms 0.9% (3/333) and dyspnea 0.9% (3/333). The majority 70% described as mild- not disturbing daily activity or job; however, 3% had severe symptoms- disturbing daily activity or job. Minority of cases 3% (10/333) required oxygen therapy for 2 months. Age, sex and BMI were not related with long COVID syndrome. However, initial multiple symptoms more than 2, co-morbidity, vaccination and initial oxygen requirement had significantly relationship with development of long COVID syndrome. Conclusions:In this study, the prevalence of long COVID syndrome among survivors was 40%; the common presenting symptoms in order of frequency were fatigue, insomnia, palpitation and poor concentration. Most of the cases had mild symptoms- not disturb job or daily routine activity. Nearly 80% of them admitted that their health status was not back to pre-COVID condition. Not only the patients with COVID-19 infection having initial multiple symptoms, co-morbidity, no vaccination and initial oxygen requirement but also their care givers should be warned about possible long COVID syndrome; and the necessary for follow up. Vaccination may prevent long COVID syndrome; it should be prioritized to those with comorbidity. It highlighted the need for systematic follow-up after hospitalisation with COVID-19 with multi-disciplinary team, rehabilitation and further investigation.

Background: In COVID-19 pandemic, the diagnosis and treatment must be as early as possible to save the life of each patient. Moreover, screening of asymptomatic carriers, close contacts or healthy subjects must not be delay to prevent transmission to publics. For confi rmation of diagnosis of SARS-CoV-2 infection, nasopharyngeal swab must be tested either by real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests or Rapid Antigen Test (RAT). RAT is faster, easier and cheaper; thus, it is suitable for health service in developing country. Objectives: The aim of this study was to assess the diagnostic accuracy of Roche SARS-CoV-2 Rapid Antigen Test (RAT) in diagnosing SARS-CoV-2 infection.

PCA3 is one of the most prostate cancer-specific genes described to date. Of note, PCA3 expression is detectable at high level in the urine of prostate cancer (PCa) patients. Accordingly, PCA3 is an ideal biomarker for PCa diagnosis. Several techniques for the measurement of this biomarker in urine have been developed but there are still some drawbacks. In this study, magnetic nanoparticle-based PCR coupled with streptavidin-horseradish peroxidase and a substrate for colorimetric detection was established as a potential assay for urinary PCA3 detection. The method provided a high specificity for PCA3 gene in LNCaP prostate cancer cell line. Additionally, this technique could detect PCA3 at femtogram level which was approximately 1,000-fold more sensitive than the conventional RT-PCR followed by agarose gel electrophoresis. The effectiveness of the method was assessed by PCA3 detection in clinical specimens. The relative PCA3 expression of PCa patients determined by this assay was significantly greater than that of benign prostatic hyperplasia (BPH) patients and healthy controls. The results of our test were comparable with the results of qRT-PCR. The proposed method is promising to distinguish between cancerous and non-cancerous groups. Altogether, this simple assay is practicable and useful for prostate cancer diagnosis., EXCLI Journal;Vol. 19 2020

A 22-year-old unmarried Myanmar girl presented with symptoms of anemia: fatigue, exertional dyspnea and fainting attack. There was no abdominal pain or amenorrhea. The hemodynamic status was stable except sinus tachycardia. Anemia was refractory to blood transfusion; thus, the differential diagnosis were autoimmune hemolytic anemia and occult blood loss. Blood film, bone marrow examination, Comb tests, Anti-nuclear antibody profile and PNH screen tests excluded autoimmune hemolytic anemia. Presence of fibrous strands in free fluids of abdominal cavity with normal uterus and ovary mislead the diagnosis of tuberculosis. Blood tap in ascitic fluid aspiration made all the answer- rupture ectopic pregnancy. The symptoms resolved after right salpingectomy and blood transfusion. The clerking on sexual exposure to Myanmar single is not acceptable in our culture; it is regarded as “social insult”. Atypical presentation and not asking sexual history caused delay in diagnosis; diagnosed 10 days after hospital stay. She recovered uneventfully.

Background:Coronavirus disease 2019 (COVID-19) has been a major threat to health around the world as it causes significant morbidity and mortality. SARS-CoV-2 infection induces severe inflammation in lungs and multi-organs; therefore, the Janus kinase (JAK) inhibitor known as baricitinib was proposed as a treatment for COVID-19 because of its anti-inflammatory and potential antiviral effects. It may improve survival in patients with severe Covid-19 infection. The efficacy and safety of Baricitinib therapy in severe COVID-19 infection in Myanmar was not known clearly. Methods:A case control study was conducted in COVID-19 treatment centers in Myanmar- Yangon and Nay Pyi Taw, from June to October 2021. Baricitinib 4 mg daily for 14 days was given to the patients with severe COVID-19 infection as an add on therapy to Standard treatment group (Remdesivir). The primary outcome was survival status; survive or non-survive. The secondary outcome was duration of hospital stay, the requirement for oxygen therapy at Day 7 (improved or not), changes in chest radiograph at Day 14 (improved, same or worse), and changes in inflammatory markers (CPR and LDH). Patient data were stratified by age, sex, body weight, co-morbidities and immune status (immunocompromised or normal immune status). Data were collected by using standardized forms and analysis was done. Results: A total of64 patients with severe COVID-19 infection were enrolled. Base line characteristics in both groups, Baricitinib group (n =32) and Standard treatment group (n = 32), were comparable. Nearly 53% of patients in Baricitinib group and 59% of patients in Standard treatment group survived; however, mean duration of hospital stay was shorter in Baricitinib group (15.53 ± 6.83 days versus 22.25 ± 11.17 days; p < 0.001). Improvement in oxygen supplementation, radiological changes and changes in inflammatory markers were not different in both groups. Minor side effects like giddiness, appetite loss and insomnia were noted in Baricitinib group. Conclusions: In treating patients with severe COVID-19 infection, the survival rate was not different between Baricitinib group (Baricitinib plus Remdesivir) and Standard treatment group (Remdesivir). In survivors, those in Baricitinib group had shorter duration of hospital stays; quick recovery time and accelerating improvement in clinical status

Background: Coronavirus Disease 2019 (COVID-19), emerged in China at the end of 2019, became a major threat to health around the world. Breakthrough infection following COVID-19 vaccine has clinical and public health signifi cance. The highest groups at risk of infection during the COVID-19 pandemic is health care workers; the physicians are the frontline workers. This study aimed to assess the prevalence of breakthrough COVID-19 infection and their clinical presentation, co-morbidities and outcome among physicians who were fully vaccinated, working in COVID-19 treatment centers in Myanmar. Methods: A cross-sectional descriptive study was conducted among physicians, at least 14 days after receiving second dose, working at COVID-19 treatment centers in Myanmar, during the third wave from end of May to August 2021. Data were collected by using standardized forms and analysis was done. Results: Among 410 physicians, 98.2% (221/225) received two dose of vaccination: Covaxin 90.0%, Covishield 9.5% and Sputink V 0.5%. They received fi rst dose of vaccine in January/February 2021 and second dose in March/April 2021. In Myanmar, third wave started in end of May; the largest pandemic surge had reached its peak in July, 2021. In the third wave, most of them 72.9% (161/221) did not experience no infection. The prevalence of fully vaccinated break through infection was 27.1% (60/221); the majority 78.3% (47/60) were mild symptomatic infection. Severe infection was seen in 10% of physicians with breakthrough infection who required hospital admission and oxygen therapy. The common presenting symptoms in order of frequency were body aches and pain 62.6%, sneezing 56.6%, headache 53.5%, cough 52.5%, sore throat 45.5%, anosmia 33.3%, runny nose 23.2% and loose motion 27.3%. The uncommon symptoms were dyspnoea 9.1%, vertigo 6.1%, skin rash 5.1%, vomiting 5.1%, petechiae 3.0%, tinnitus 3.0% and silent hypoxia 3.0%, and non-per-os 1%. Most of them did not have any signifi cant comorbidities. One out of six physicians having severe infection had diabetes mellitus and two were obese. The mean duration of hospital stay was 7 days. None of the cases was fatal. Conclusions: In this study, over 98% of physicians were fully vaccinated; majority with Covaxin. One in four physicians had breakthrough infection in third wave; mainly mild form. Nearly half of them had possible delta symptoms; aches and pain, sneezing, runny nose, headache, cough, and sore throat. Awareness of rare but important symptoms like Non-per-Os and vertigo should be highlighted both to public and health care personnel. Ten percent of physicians with breakthrough infection were severe. Mortality rate was zero.

A young farmer, tenth standard student, helping his grandfather during holiday, developed anuria after viper bite. Because of headache, non-enhanced CT scan head was done on admission which showed a small pituitary haemorrhage with normal ventricles. Later, he had generalized fi ts and second nonenhanced CT scan head was repeated which revealed a small pituitary haemorrhage with dilated ventricles. He also had acute kidney injury, septicaemia, cellulitis and DIC. The serum level of TSH, free T3 & free T4 were low; thus, replacement was done. Cerebrospinal fl uid study (protein, sugar, cells) including culture was normal. Renal replacement therapy (haemodialysis), platelets transfusion and antibiotics were given. He had torrential polyuria (urine output 12 liter per day) when he recovered from renal failure and it improved dramatically with desmopressin replacement. There was improvement in third nonenhanced CT scan head and fourth one was consistent with normal ventricle and reduction in size of pituitary haemorrhage.

The “severe acute respiratory syndrome coronavirus type 2” (SARS-CoV-2) is also known as “coronavirus disease 19” (COVID-19). It originated in Wuhan, Hubei province, People’s Republic of China, in December 2019; and, it spread worldwide causing a global pandemic. Genetic variants of SARS-CoV-2 have been emerging and circulating around the world throughout the COVID-19 pandemic namely the original (wild-type), the Alpha variant, the Beta variant, the Delta variant, and the Gamma variant. In third wave, the notorious variant was the Delta variant; it was well-known for quick transmissibility, causing high morbidity and mortality. In late November 2021, the Omicron variant was first detected in South Africa.

A-91-year old man had severe Covid-19 infection (bilateral pneumonia, SaO2 85% on air). He was treated with antibiotics, oxygen, dexamethasone and convalescent plasma therapy.

In the first month post-transplantation period, the degree of immunosuppression is not high enough to get opportunistic infections.

Melioidosis is a frequently fatal infectious disease caused by the Gram negative bacillus Burkholderia pseudomallei. Although it was originally discovered in Myanmar, the disease disappeared from sight for many decades. This study focuses on detection of B. pseudomallei in soil in selected sampling sites in an attempt to start to fill the gaps in the current status of our knowledge of the geographical distribution of B. pseudomallei in soil in Myanmar. This cross-sectional study consists of 400 soil samples from 10 selected study townships from two major paddy growing regions. Bacterial isolation was done using a simplified method for the isolation of Burkholderia pseudomallei from soil. In this study, only 1% (4/400) of soil samples were found to be positive, two of four were found at 90 cm depth and another two positive samples were found at 30 cm and 60 cm. This survey has confirmed the presence of environmental B. pseudomallei in Myanmar indicating that the conditions are in place for melioidosis acquisition.

A cross-sectional descriptive study was conducted among participants who attended to outpatient department Number 2 Defence Services General Hospital. The objective is to describe understanding of prescription from health care providers to patients. The study recruited participants by using simple random sampling and pre-tested questionnaire from August to September 2014. The participants were age between 17 and 77 years and the mean age was 47.27 (SD 11.67) years. Among 194 participants, 99 (51%) were male and 95 (49%) were female. The participants who came to hospital for themselves (93.3%), for husband/wife (2.1%), for their children (1%) and for parent (3.6%). The participants who went to the specialist doctors (59.3%) and medical officer (25.8%) and the remainders (14.9%) did not know which doctors treated to them. Although the participants (87.6%) could answer their diagnosis, 12.4% of participants could not answer it. The time given for explanation of prescription was between 1 and 20 minutes and the mean time was 5.5 (SD 4.26) minutes. While 68% of the participants could answer at least one pill of the prescribed drugs, 32 % of participants could not answer it. Furthermore, the participants (87.6%) knew well about dosing frequency of pills that they took. But 4.6% of participants knew about dosing frequency of one or more pills and the remainders (7.7%) did not know about it. Most of the prescribers (74.7%) did not explain adverse reaction of pills; only 25.3% of prescribers explained it. There was association between patients’ understanding of medical prescription and age group and gender. Despite the doctors and nursing staffs prescribing clearly and giving more time for explanation of prescription, some of the participants do not know it. Thus, the prescribers should ask how to take the pills after the patients had received the pills and explain well about the adverse reaction of the pills.