East Yangon General Hospital

Tigecycline is one of the last-resort antibiotics for treating serious infections caused by multidrug-resistant pathogens. This is the first report of clinical isolates of tigecycline-resistant Escherichia coli harbouring tet(X4) in Myanmar. Two E. coli isolates were obtained from two patients at two hospitals in Myanmar from November 2023 to May 2024. They were identified using MALDI-TOF MS, and minimum inhibitory concentrations (MICs) were determined using the broth microdilution method. Genomic DNA was extracted and sequenced using next generation sequencing. Drug resistance factors were determined, and the genetic environments surrounding tet(X4) and blaNDM-5 were analysed. Conjugation rates of plasmids harbouring tet(X4) and blaNDM-5 were calculated. One strain, TGH62, was resistant to tigecycline (MIC 8 µg/mL) and meropenem (MIC 128 µg/mL), whereas the other, YGH433, was resistant to tigecycline (MIC 4 µg/mL). Whole-genome sequencing revealed that both strains harboured tet(X4) on plasmids and TGH62 also harboured blaNDM-5 on a plasmid. The plasmids carrying tet(X4) in TGH62 and YGH433 belonged to the IncI and IncFII incompatibility groups, respectively. The plasmid carrying blaNDM-5 belonged to the IncFIA incompatibility group. The conjugation efficiencies of the plasmids harbouring tet(X4) in YGH433 and blaNDM-5 in TGH62 were relatively high, whereas that harbouring tet(X4) in TGH62 was low. Tigecycline-resistant Enterobacteriaceae harbouring tet(X4) may spread in hospitals in Myanmar. Further studies are needed to detect tet(X4) conferring tigecycline resistance in hospitals as well as environmental settings in Myanmar.

Pemphigus vulgaris (PV) is a chronic autoimmune disease causing painful oral erosions and fragile skin blisters, severely impacting quality of life. This case report presents a 69-year-old female patient in Myanmar with PV complicated by diabetes, hypertension, and thromboembolic conditions. Her extensive skin involvement, severe pain, and recurrent infections emphasized the need for a multidisciplinary approach to management. Palliative care interventions focused on holistic, patient-centered strategies, including effective pain relief with pre-procedural analgesia, meticulous wound care, and strict infection control. Psychological support significantly improved her mental well-being and daily functioning. The case highlights the urgent need for enhanced patient education, continuous follow-up, and structured psychosocial support to optimize treatment outcomes. By implementing these measures, healthcare providers can ensure a more comprehensive approach, improving long-term care and patient satisfaction for individuals living with PV.

Abstract Introduction - Traumatic brain injury (TBI) poses a significant global health challenge, particularly in low- and middle-income countries (LMICs), where the disease burden is exacerbated by limited resources and preventative measures. This study revisits the ‘VENTILatOry strategies in patients with severe traumatic brain injury’ (VENTILO) survey, focusing on ventilatory management practices among healthcare professionals in LMICs. Methodology - A cross-sectional online survey, VENTILOMICS, was conducted using the original VENTILO survey questionnaire, developed following a review of literature on respiratory management in TBI patients, captured demographics of participants, type of hospital/specialty and available neuromonitoring tools; protocols for mechanical ventilation and weaning, and respiratory management strategies. Descriptive statistics were computed for all study variables. We analyzed data based on the geographical location of the LMICs and their economic status. Results – There were 204 respondents from 28 LMICs. Our results indicate that 55-70% of respondents recommend tidal volumes (VT) of 6-8 ml/kg for patients with high or medium PaO2/FiO2 (P/F) ratios, while VT of 4-6 ml/kg is preferred for those with low P/F ratios. For patients with intracranial hypertension, lower positive end-expiratory pressure (PEEP) levels were utilized. Access to neuromonitoring tools was notably better in neuro-critical care units compared to general ICUs, with significant geo-economic disparities in practices and resource availability. Most respondents advocated for early tracheostomy, though preferences varied by region, particularly in Sub-Saharan Africa. Conclusion - The findings are suggestive of a consistent approach to lung-protective ventilation across LMICs, with notable variations influenced by local resources and economic status. This study highlights the necessity for tailored research and guidelines to address the specific challenges faced in TBI management within LMICs, thereby, advocating improved access to neuromonitoring techniques and standardized protocols.

BackgroundPostpartum 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. MethodsThis 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 <10). Chi-square and Fisher's exact tests were used to compare the characteristics of women between suspected PPD and non-suspected PPD. Logistic regression analysis was preformed to identify the factors associated with suspected PPD. ResultsThe mean age of the 552 women was 27.9 years and 176 women (31.9 %) were categorized into suspected PPD. Factors associated with suspected PPD were living in a nuclear family (adjusted odds ratio (AOR) = 2.04, 95 % confidence interval (CI) 1.10–3.77), feeling insufficient income (AOR = 2.15, 95 % CI 1.09–4.25), unplanned pregnancy (AOR = 2.76, 95 % CI 1.47–5.16), less than eight ANC visits (AOR = 3.29, 95 % CI 1.74–6.23), low birth weight of the last baby (AOR = 5.69, 95 % CI 1.17–27.71), insufficient support from partners (AOR = 11.28, 95 % CI 5.62–22.63), parents (AOR = 3.83, 95 % CI 2.08–7.04), and parents-in-law (AOR = 2.00, 95 % CI 1.06–3.76), and depressive symptoms during the last pregnancy (AOR = 3.08, 95 % CI 1.52–6.26). ConclusionThe prevalence of suspected PPD was 31.9 % among 6-8-week postpartum women in Yangon. Strengthening maternal health programs and providing education about postpartum psychiatric problems is essential to improve maternal psychological well-being.

Hepatocellular carcinoma (HCC) constitutes the majority of liver cancers and significantly impacts global cancer mortality. While ultrasound (US) with or without alpha-fetoprotein is the mainstay for HCC surveillance, its limitations highlight the necessity for more effective surveillance tools. Therefore, this review explores evolving imaging modalities and abbreviated magnetic resonance imaging (MRI) (AMRI) protocols as promising alternatives, addressing challenges in HCC surveillance. This comprehensive review delves into the evaluation and challenges of HCC surveillance tools, focusing on non-contrast abbreviated MRI (NC-AMRI) and contrast-enhanced abbreviated MRI protocols. It covers the implementation of AMRI for HCC surveillance, patient preferences, adherence, and strategies for optimizing cost-effectiveness. Additionally, the article provides insights into prospects for HCC surveillance by summarizing meta-analyses, prospective studies, and ongoing clinical trials evaluating AMRI protocols. The opinions underscore the transformative impact of AMRI on HCC surveillance, especially in overcoming US limitations. Promising results from NC-AMRI protocols indicate its potential for high-risk patient surveillance, though prospective studies in true surveillance settings are essential for validation. Future research should prioritize risk-stratified AMRI protocols and address cost-effectiveness for broader clinical implementation, alongside comparative analyses with US for optimal surveillance strategies.