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© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. Methods: We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)—a composite of life expectancy, education, and income measures—into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. Findings: Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24–51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34–69) and the youngest in the low HDI tier (median 28 years, IQR 20–38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6–32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55–5·2) and high HDI tier (2·26, 1·23–4·15), but not the low HDI tier (1·66, 0·61–4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17–2·49). Interpretation: Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. Funding: National Institute for Health Research Global Health Research Group.

Myeloproliferative neoplasms (MPNs) are a group of clonal haematopoietic stem cell disorders characterized by the proliferation of one or more myeloid cell lineages. According to WHO classification, the Janus associated kinase 2 (JAK2) V617F mutation is one of the major diagnostic criteria in BCR-ABL1 negative myeloproliferative neoplasms. The aim of this study is to detect the JAK2 (V617F) mutation in patients with myeloproliferative neoplasms to get accurate diagnosis and proper management. A total of 90 clinically diagnosed MPN patients attending to Department of Clinical Haematology, Yangon General Hospital were enrolled in this study. The mean age was 53.4 ± 14 years which ranged from 16 to 81 years old and male and female ratio was 2.4:1. The identification of JAK2 (V617F) point mutation was found to be positive in 44/90 MPN patients (48.9%). According to MPN subtypes, the JAK2 mutation positivity was found in 19 out of 46 polycythemia vera patients (41.3%), 17 out of 25 essential thrombocythemia patients (68%), 8 out of 15 primary myelofibrosis patients (53.3%), 0 of 4 others myeloproliferative neoplasms (0%). Confirmation of each of nine JAK2 mutation positive and negative samples was done by Sanger sequencing. The arterial or venous thrombotic attack was found in 32/44 JAK2 mutation positive cases (72.7%) and 12/44 JAK2 mutation negative cases (27.3%). The association between thrombotic attack and presence of JAK2 mutation was statistically significance with p = 0.000. The diagnosis of myeloproliferative neoplasms mainly relies on the molecular genetics according to WHO classification. The Allele specific PCR reaction is sensitive, simple test and relatively cost-effective. Therefore, the identification of JAK2 (V617F) somatic point mutation by AS-PCR should be implemented as a routine diagnosis procedure for patients with chronic and suspected myeloproliferative neoplasms.

Men who have sex with men (MSM) in Thailand have high HIV prevalence. This analysis used three years of data from the Behavioral Surveillance Survey (BSS) to examine the behaviors and biomedical interventions among MSM in Bangkok. Percent MSM with an HIV or STI test in the past 12 months decreased from 50.8% to 29.8%, and 42.2% to 33.0%, respectively. The frequency of HIV/STI testing was higher among those who had university-level education, as well as among those who reported higher AIDS knowledge, and had utilized prevention services. Additionally, awareness of PrEP peaked in 2017 (74.1%). The study found an increasing trend of men who had sex without a condom the last time they had anal sex with a man, and/or with multiple partners. Nearly two-thirds of the sample were reached by HIV prevention interventions. One-third had correct AIDS knowledge. These findings suggest that, after an increase of sex behavior risk, a decrease in PrEP awareness, and unknown HIV status, HIV prevalence among MSM in Bangkok may have begun to increase again. Intensified prevention interventions are urgently needed to reduce HIV behavioral risk for MSM since that is a major driver of the HIV epidemic in Thailand.

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.

Tunnels are important structures in hydropower projects as they reduce the length of the water conductor system. However, tunnels also pose the possibility of collapse during construction which may cause significant time and cost overruns. Moreover, collapsing tunnels pose threats to workers and machinery. Systematic control and understanding of tunnel physics is key to preventing these dangers. In this paper, we explore the most effective means for constructing tunnels for hydropower projects.HYDRO Nepal JournalJournal of Water, Energy and EnvironmentIssue: 19Page: 31-37

Experience from a variety of disciplines suggests that improving healthcare, particularly in resource-poor environments, can benefit from a systems approach. However, putting this into practice is challenging, especially in the context of an international institutional health partnership. In this article, we outline how a systems approach to the improvement of trauma care has informed both clinical improvement and academic collaboration as part of an ongoing partnership involving Cambridge University Hospitals NHS Foundation Trust, the University of Cambridge, and Cambridge Global Health Partnerships in the UK, and Yangon General Hospital, University of Medicine 1, and the Tropical Health and Education Trust (THET) in Myanmar. Improving and researching trauma care is an exemplar of a systems problem, requiring an understanding of the relevant people, equipment, processes, institutions, and power structures that result in the delivery of care at all points of the patient’s journey from injury to rehabilitation. Exploring this in the explicit context of traumatic brain injury is one of the research themes of the NIHR Global Health Research Group on Neurotrauma, allowing systems research to directly inform efforts at practical improvement.

A hospital-based cross-secti onal analyti cal study was carried out on 53 patientswith haemophilia A at the Department of Clinical Haematology, Yangon General Hospitalduring the period of October 2014 to September 2016. Haemophilia Joint Health Score (HJHS) and Functi onal Independence Score in Haemophilia (FISH) were used to assessthe pati ents’ physical well-being. All pati ents were males with a mean age of 23.18 ±10.2 years (r = 12-55). Twenty-four pati ents (45.3%) disconti nued their educati on and among them 66.7% disconti nued due to pain with recurrent bleeding in the joints and33.3% disconti nued due to other reasons. Seventeen pati ents (32.08%) in this study werestudents, while another 17 pati ents (32.08%) were workers/employed and 19 pati ents(35.85%) disconti nued working. Out of 19 pati ents who disconti nued working, 84.21%disconti nued due to severity of the disease and 15.79% disconti nued due to personaland religious reasons.

The diet of Pteropus giganteus from three roosts in Mandalay Region, central Myanmar was investigated for over two years by examining feeding remains in and around two villages. It consists of 24 species of fruits, six species of flowers and three of leaves. Of these, 13 species of fruits are eaten by the local people, three of which are also marketed. Two are used in traditional medicine and one for stuffing pillows. Most dietary plants are native, mangoes are seasonally superabundant and are eaten in large numbers. Interviews revealed no evidence of conflict between bats and villagers.

Hyperhemolysis syndrome is one of serious and potentially life-threatening complications of red blood cell transfusion, and is well described in sickle cell disease as well as in thalassaemias and other anaemias. It also is a great diagnostic and management challenge to laboratory scientists and attending physician taking care of patients with such kinds of diseases. A Myanmar patient with hemoglobin H disease presenting with acute hyperhemolysis syndrome was diagnosed timely and successfully treated with intravenous immunoglobulin (IV Ig) and methylprednisolone. A high index of suspicion allowing early diagnosis and prompt management can save lives of patients with hyperhemolysis syndrome.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare complicationof blood transfusion. Two male patients admitted to the Department of Clinical Haematology,Yangon General Hospital (YGH) diagnosed to have TA-GVHD in 2011 and in 2016 are presented. Both of the patients received blood donation from close relatives whereneither leukoreduction nor irradiation was done. Both patients had fever, skin rashes,gastrointestinal symptoms, raised liver enzymes and pancytopenia. Skin biopsies of both patients showed characteristic histological changes. Unlike graft-versus-host disease thatoccurred after haemopoeitic stem cell transplantation, TA-GVHD involves the recipient’sbone marrow leading to bone marrow aplasia

An isolated thrombocytopenia was found in a 47-year old man during pre-operativework-up for his closed radial bone fracture on left forearm after a fall. His platelet countwas as low as 14 x 103/μL, but there was no active bleeding and past history of bleedingdisorder. The clue to true diagnosis started from careful blood film examination - plateletclumps in blood film. Repeat full blood count tests were requested not only with the usualanticoagulant EDTA (Ethylene diamine tetra-acetic acid) but also with heparin as well as withcitrate. EDTA-dependent pseudothrombocytopenia was diagnosed which can be confusedwith other life-threatening platelet disorders. The operation was successfully done withoutunusual bleeding.

Myanmar has high prevalence of important haemoglobinopathies: a- thalassaemia -10% to 56.9%, HbE -1 to 28.3%, B thalassaemia -0.54 to 4.07%, accounting for 1 to 4.9 births per 1000 infants with a major haemoglobinpathy.

Declines in the global extent and condition of tropical forests have reduced carbon storage potential and caused biodiversity loss. However, the magnitude of these problems within individual countries may depend on the extent of the reserved forest estate, and the particular rules put in place to manage resource use in these areas. To test this hypothesis, aboveground carbon stocks and indices of tree diversity were derived for two reserved (highly regulated) sites and a protected public (less regulated) site in the mixed deciduous forests of Myanmar. Aboveground tree carbon stocks were around three times higher in the reserved forests than in the public forest, a difference driven by the near absence of trees >40 cm DBH at the public forest site. The species composition of large (≥20 cm DBH) trees differed substantially between all three sites. In contrast, the species composition of small (

Thalassaemia intermedia (TI) patients are extremely diverse in phenotypic expressionand there is a wide variation in clinical complications1. Thromboembolic events areamong the clinical complications of TI that were found to occur at a higher rate than in patients with thalassaemia major (TM)2, 3.Hb E beta-thalassaemia disease is the commonest of the thalassaemia syndromes presenting with clinical symptoms of anaemia in Myanmar4, 5.The incidence of thromboembolic events in Myanmar Hb E beta - TI patients hasnever been reported.

“Safety through Community in High Schools” started out as the result of a long-time fascination with the educational system in the United States and the contradictions that exist within it. One such contradiction is the attempted inclusion of the greater community within the physical realm of the school—through the allowed use of an auditorium, for example—while simultaneously advocating for physical barriers and checkpoints which foster an air of distrust. Another contradiction on a smaller scale relates to a premise that students function best when exposed to natural sunlight. However, the need for security—elevated by the increase of mass shootings—has influenced many public schools to build with small windows, which restrict natural light and often make for an oppressive environment. This thesis aims to bring forth a design which arises out of thoughtful explorations of such contradictions between community, security, and stimulating learning environment.

Recent studies have shown the importance of Myanmar for the conservation of bat diversity. In March–April, 2003, twenty-five localities in Kachin and Shan States and Mandalay and Sagaing Divisions in Upper Myanmar were surveyed using mist nets and harp traps. Of the twenty-three bat species collected, thirteen were recorded from two localities in Kachin State, one of which has already been described as a new species, Kerivoula kachinensis, and a further two (a Rhinolophus and a Kerivoula) are putative new species. Murina tubinararis, Murina cyclotis and Rhinolophus shameli were recorded for the first time in Myanmar for over 65 years, while our records of Rhinolophus stheno and Rhinolophus malayanus are the most northern localities for these species in Myanmar. Species are discussed individually with external, cranial and dental measurements summarised. We also present descriptive statistics for echolocation calls recorded from five taxa. This represents the first bat survey of northern Myanmar forests for nearly 70 years. Kachin is already known to support high biodiversity and these recent records confirm the importance of its forests for the conservation of Myanmar's mammal fauna.

Ore derived a sufficient condition for a graph to contain a Hamiltonian cycle. We obtain a sufficient condition, similar to Ore's condition, for a graph to contain a Hamiltonian cycle and a 1-factor which are edge disjoint.

A graphG has toughnesst(G) ift(G) is the largest numbert such that for any subsetS of the vertices ofG, the number of vertices inS is at leastt times the number of components ofG on deletion of the vertices inS, provided that there is then more than one component. Ak-tree of a connected graph is a spanning tree with maximum degree at mostk. We show here that if\(t(G) \geqslant \frac{1}{{(k - 2)}}\), withk ≥ 3, thenG has ak-tree. The notion of ak-tree generalizes the casek = 2 of a hamiltonian path, so that this result, as we discuss, may be of some interest in connection with Chvatal's conjecture that, for somet, every graph with toughness at leastt is hamiltonian.

An outbreak of plague occurred in Hlegu Town, Burma in February and March 1977. Altogether 14 bubonic plague cases, with 2 deaths were reported, mostly children under 15 years of age. Twice as many males as females were affected. A retrospective investigation showed that a rat fall took place in the last week of January. Only 9.5% of the rodents which died in the epizootic were found to be infected with Y. pestis; this apparent low infection rate probably resulted from the inclusion in the survey of some dead rats which died of other causes. 14.5% out of 48 trapped rodents were found to be serologically positive. The general flea and cheopis indices were rather high, perhaps because fleas were found to be partially resistant to DDT and also because spraying of insecticide did not effect fleas on the hosts. The cheopis index in Hlegu Town was 1.17, and less than 0.5 in Hlegu suburb (Yankin-Yat) where no epizootic was reported. An active case search revealed 76 suspected plague cases out of which 11 were found to have bubonic plague. A field trial showed that plague vaccination during the outbreak did not result in a rise of detectable antibodies in persons inoculated.