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Annual Report 2009.Pdf DEPARTMENT OF MEDICAL RESEARCH Annual Report 2009 BOARD OF DIRECTORS Dr. Khin Pyone Kyi - Chairperson Dr. Kyaw Min - Membern Dr. Khin Myat Tun - Member Dr. Kyaw Moe - Member Dr. Thaw Zin - Member Dr. Khin Nwe Oo - Member Dr. San Shwe - Member Annual Report 2009 Dr. Ye Htut - Secretary Department of Medical Research (Lower Myanmar) PUBLISHED BY Department of Medical Research (Lower Myanmar) No.5, Ziwaka Road, Dagon P.O. Yangon 11191 i Annual Report 2009 ONTENTS C Highlights of Research Findings iv Organization Profile Department of Medical Research (Lower Myanmar) Layout Plan viii Organizational Structure ix Executive Board x Division Activities and Research Findings Bacteriology Research Division 1 Biochemistry Research Division 7 Biological Toxicology Research Division 13 Blood Programming Division 16 Blood Research Division 19 Chemical Toxicology Research Division 23 Clinical Research Division 26 Clinical Research Unit (Haematology) 31 Clinical Research Unit (HIV/AIDS) 33 Clinical Research Unit (Malaria-NOGH) 35 Clinical Research Unit (Malaria-No.2 DSMH) 36 Clinical Research Unit (Medical Oncology) 38 Clinical Research Unit (Traditional Medicine) 41 Clinical Research Unit (UM2) 42 Epidemiology Research Division 45 Experimental Medicine Research Division 51 Health Systems Research Division 55 Immunology Research Division 60 Medical Entomology Research Division 65 Medical Statistics Research Division 71 Nuclear Medicine Research Division 75 Nutrition Research Division 78 Parasitology Research Division 82 Pathology Research Division 90 Pharmaceutical Toxicology Research Division 93 Pharmacology Research Division 104 Physiology Research Division 113 Radiation Toxicology Research Division 118 Virology Research Division 121 ii Annual Report 2009 Supporting Divisions Central Biomedical Library 126 Computer Division 129 Instrumentation Division 131 Laboratory Animal Services Division 133 Publication Division 136 Administrative Department General Administrative Division 138 Budget and Accounts Division 140 Procurement, Stores and Distribution Division 140 Research Students 141 Consultants/Advisors to DMR (Lower Myanmar) 150 International Seminars/Workshops/Meetings 152 International Fellowships and Training Courses 154 Local Seminars/Workshops/Short Training Courses 155 List of Publications 162 List of Papers Presented 166 Institutional Ethical Review Committee 175 DMR External Grant Reviewing Committee 175 Academic Committee 175 Scientific Groups Scientific Group on Malaria Research 175 Scientific Group on Traditional Medicine Research 176 Scientific Group on Snakebite Research 176 Scientific Group on HIV/STD Research 176 Scientific Group on Liver and Gastroenrology Research 176 Scientific Group on Growth Fitness and Nutrition 177 Scientific Group on Arboviral Diseases Research 177 Scientific Group on Nuclear Medicine Research 177 Scientific Group on Molecular Biology 177 Scientific Group on Health and Social Medicine Research 178 Scientific Group on TB and Respiratory Tract Infection 178 Scientific Group on Poison Research 178 Scientific Group on Blood Research 178 Scientific Group on Information Technology 179 Myanmar Health Sciences Research Journal 179 DMR Bulletin 179 iii Annual Report 2009 HIGHLIGHTS OF RESEARCH FINDINGS In the year 2009, DMR (LM) has completed 151 out of 171 research projects: 49 on communicable diseases mainly malaria, tuberculosis and HIV/AIDS and other infections such as diarrhea, hepatitis B and C, respiratory tract infections, Japanese Encephalitis, reproductive tract infections (RTI), dengue haemorrhagic fever (DHF), influenza, and leprosy; 25 on non communicable diseases such as snake-bite, diabetes mellitus, hypertension, cancer, nutrition, leukaemia; 20 on traditional medicine; 11 on environmental health; 41 on Health Systems Research and 5 on technology development. Malaria Therapeutic efficacy and safety studies on uncomplicated Plasmodium falciparum malaria reported Day 3 parasitaemia as the indicator of slow parasite clearance, and applicable in monitoring of artemisinin resistance. Enhancing role of pfmdr186 mutation was found in increasing in-vitro dihydroartemisinin sensitivity of Plasmodium falciparum. Molecular tools were applicable in relation to in-vitro test for monitoring of CQ resistant vivax malaria. Tuberculosis MDR-TB was found in 65.9% isolates from HIV-TB co-infected patients at the Specialist Hospital, Waibargi. Pyrazinamide resistance was found in 41.4% of isolates. Kanamycin is a safe and effective drug for use in MDR-TB treatment in Myanmar DHF Sentinel surveillance of dengue in endemic regions revealed isolations of DENV-2 from Hinthada General Hospital, DENV-3 from Bago General Hospital and DENV- 4 and DENV-1 viruses from Lashio General Hospital. The unexpected finding of mitochondrial pseudogenes in the nuclear genome of Aedes aegypti resulted in restricted use of mtDNA in future studies. Significantly low level of genetic differentiation among populations indicated some restricted contemporary gene flow between populations even over the smallest spatial distances up to 5 km. Hepatitis C Anti HCV seropositivity among the commercial sex workers attending the sexually transmitted infections (STI) clinic, Yangon General Hospital was 6.5%. Among the Injecting Drug Users (IDUs), the highest prevalence was 86.9% seen among the IDUs attending the registered Drug Treatment Center in Myitkyina. RTI C. trachomatis was most frequently associated with ectopic pregnancy and PCR on tubal samples was more sensitive diagnostic method than cervical PCR and chlamydial IgM. iv Annual Report 2009 Leprosy The FTA® elute card can be substituted for 70% ethanol tube and was a suitable medium for collecting, transporting and storing single stranded skin samples for molecular detection of Mycobacterium leprae. Hypertension Increasing age, history of hypertension and stroke in first degree relatives, Body Mass Index, waist-hip ratio ≥ 0.8 in women, serum creatinine >1.3 mg% were found as potential risk factors for hypertension in Pintaya township. Cancer The positivity of malignant HPV genotypes was 33.79%. Of these, 67% of HPV- 16, 4.08% of HPV-18, and 12.24% of HPV-31 was observed. In acute myeloid leukemia, as a prognostic marker, AML1-ETO positivity was found in 23.8% of AML patients. Traditional Medicine Crude extracts and dry powder forms of Derris elliptica Benth (pyg;v i farT;) were as effective as the synthetic insecticide, deltamethrin in killing the mosquitoe larvae. Hydrocotyle umbellanata, various parts of Premna intigrifolia especially stem barks and Premma integrifolia Linn showed lowering of blood glucose levels in adrenaline induced hyperglycemia rat model. In vivo and vitro testing of Myanmar medical plant Cuminum, 80% ethanolic extract of cumin seeds has a significant antidiarrhoea activity and antibacterial activity agaist Shigella fexneri. A multi-center clinical trial of traditional medicine on 50 MDR-TB patients (32 Cat II failure cases and 18 Cat IV failure cases) had been recruited from various chest clinics, Htan-Ta-Pin TB Hospital, Thin-Gan-Gyun Sanpya Hospital and Aung-San TB hospital. Treatment outcome indicated sputum conversion to negativity in 27 out of 32 Cat II failure cases (84.4%) after 3 to 6 months of treatment, and 6 out of 18 Cat IV failure cases (33.3%) after 6 to 8 months of treatment. It can be rationally concluded that traditional medicine may have a potential in the treatment of MDR-TB patients in future. However, follow-up of 2 years is necessary before valid conclusions can be drawn. Environmental Health Assessment of pesticide residues in the ecosystem around Inlay lake area was conducted. Persistent levels of pesticides (Aldrin, Heptachlor, Endrin, δ-BHC, pp’-DDT) as high as 0.048mg/kg in fish and 0.0002mg/L in water were detected but none in drinking water sources in Inlay lake, Southern Shan State. However, the levels were below the permissible limits in the environment. Grilled meat samples from street vendors identified Escherichia coli and detected verotoxin production (VETC strain). v Annual Report 2009 Health Systems Research Previous practices of most general practitioners’ for treatment and referral of TB were not in line with NTP guidelines. Proper advocacy for PPM-DOTS was crucial for success of future activities. The ecosystem management interventions based on ecology, biology and social context of dengue vectors in 6 clusters of North Dagon and Insein (600 households) compared to 6 control clusters (600 households) pointed out the adequate coverage by volunteers and lowering of entomological indices by targeting most productive water containers such as metal drums, cement tanks, ceramic jars and ceramic bowls for worshipping spirits. Strengthened active links/partnerships between multi-stakeholder groups and households were effective for intervention delivery. Disability among new leprosy cases in Ayeyarwaddy Division revealed the needs to disseminate information about the nature of disease, accessibility of health facilities and treatment taking to both patients and midwives from the study area. Prevention of defaulters among new pulmonary TB patients required effective, complete pre-treatment health education, Basic Health Staff (BHS) guideline, conducting initial home visit for every TB patients, motivating BHS for effective DOT and enhancing early missed dose tracing. A study on knowledge translation intervention of stake holder groups in Myeik township pointed out that reducing
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