41 research outputs found
Grounds of Difference
No full textBu çalismada Rogers Brubaker'in Farklilik Zeminleri kitabi incelenmistir. Bu kitap Gav Perspektif tarafindan 2020 yilinda basilmistir. Modern toplumda uygulanan güncel farklilik politikalari, küresellesme, dijital dünya esitsizlikleri daha görünür hale getirmistir. Irk ve etnisite biyolojiden ayrilip esitsizlik için nasil bir etkisi oldugu yazar tarafindan ele alinmistir. Esere göre günümüz dünyasinda kültürel farkliliklarin sosyal ve politik olarak farklilastigi en önemli alanlar dil ve dindir. Yazarin dilin ve dinin benzerligini sorgulamasi eserde tartisma çizgisizidir. Ele aldigimiz bu eserin birinci bölümünde yazar Charles Tilly’in esitsizlik teorisinden yola çikarak etnisitenin esitsizligini ele almaktadir. Bu bölümde esitsizligi yaratan unsurlar ele alinip, esitsizligin ne oldugunun kimin neye sahip oldugundan bagimsiz olacagi nedenleri içermektedir. Ikinci bölümde biyolojinin farklilik politikalarindaki belirleyiciligi sorgulanmistir. Üçüncü bölümde dil ve dinin kültürel farklilik noktasindaki yeri, kültürel sermayenin önemi ve Pierre Bourdieu’nun dil anlayisi tartisilmistir. Dördüncü bölümde din ve milliyetçilik arasindaki iliskiyi irdelenmektedir. Bu bölümde yazar, milliyetçiligi özünde seküler görür ve milliyetçiligin düsüsünü dine baglar. Besinci bölüm, diaspora kavrami ve dünyada kültürel farkliligin sosyal örgütlenmesi üzerindeki etkisi ele alinmistir. Altinci bölümde ise sinir-ötesi milliyetçilik biçimleri, ulus devlete üyelik ve aidiyet politikalari açiklanmistir. Son bölüm olan yedinci bölümde ise yazar, etnisite ve milliyetçilik üzerine modern bakis açisina odaklanmaktadir.This study analyzes Rogers Brubaker's book Grounds of Difference. This book was published by Gav Perspective in 2020. The current politics of difference in modern society, globalization and the digital world have made inequalities more visible. The author discusses how race and ethnicity are separated from biology and how they have an impact on inequality. According to the work, the most important areas where cultural differences are socially and politically differentiated in today's world are language and religion. The author's questioning of the similarity of language and religion is a line of discussion in the work. In the first chapter of this work, the author discusses the inequality of ethnicity based on Charles Tilly's theory of inequality. In this section, the elements that create inequality are discussed and the reasons for what inequality is will be independent of who owns what. In the second section, the determinant role of biology in the politics of difference is questioned. The third chapter discusses the place of language and religion in cultural difference, the importance of cultural capital and Pierre Bourdieu's understanding of language. The fourth chapter examines the relationship between religion and nationalism. In this chapter, the author sees nationalism as essentially secular and attributes the decline of nationalism to religion. The fifth chapter deals with the concept of diaspora and its impact on the social organization of cultural difference in the world. In the sixth chapter, cross-border forms of nationalism and the politics of membership and belonging to the nation-state are explained. In the last chapter, chapter seven, the author focuses on the modern perspective on ethnicity and nationalism
The clinical utility of the urine-based lateral flow lipoarabinomannan assay in HIV-infected adults in Myanmar: an observational study
No full textBackground: The use of the point-of-care lateral flow lipoarabinomannan (LF-LAM) test may expedite tuberculosis (TB) diagnosis in HIV-positive patients. However, the test's clinical utility is poorly defined outside sub-Saharan Africa. Methods: The study enrolled consecutive HIV-positive adults at a tertiary referral hospital in Yangon, Myanmar. On enrolment, patients had a LF-LAM test performed according to the manufacturer's instructions. Clinicians managing the patients were unaware of the LF-LAM result, which was correlated with the patient's clinical course over the ensuing 6 months. Results: The study enrolled 54 inpatients and 463 outpatients between July 1 and December 31, 2015. On enrolment, the patients' median (interquartile range) CD4 T-cell count was 270 (128-443) cells/mm3. The baseline LF-LAM test was positive in 201/517 (39%). TB was confirmed microbiologically during follow-up in 54/517 (10%), with rifampicin resistance present in 8/54 (15%). In the study's resource-limited setting, extrapulmonary testing for TB was not possible, but after 6 months, 97/201 (48%) with a positive LF-LAM test on enrolment had neither died, required hospitalisation, received a TB diagnosis or received empirical anti-TB therapy, suggesting a high rate of false-positive results. Of the 97 false-positive tests, 89 (92%) were grade 1 positive, suggesting poor test specificity using this cut-off. Only 21/517 (4%) patients were inpatients with TB symptoms and a CD4 T-cell count of < 100 cells/mm3. Five (24%) of these 21 died, three of whom had a positive LF-LAM test on enrolment. However, all three received anti-TB therapy before death - two after diagnosis with Xpert MTB/RIF testing, while the other received empirical treatment. It is unlikely that knowledge of the baseline LF-LAM result would have averted any of the study's other 11 deaths; eight had a negative test, and of the three patients with a positive test, two received anti-TB therapy before death, while one died from laboratory-confirmed cryptococcal meningitis. The test was no better than a simple, clinical history excluding TB during follow-up (negative predictive value (95% confidence interval): 94% (91-97) vs. 94% (91-96)). Conclusions: The LF-LAM test had limited clinical utility in the management of HIV-positive patients in this Asian referral hospital setting.Swe Swe Thit, Ne Myo Aung, Zaw Win Htet, Mark A. Boyd, Htin Aung Saw, Nicholas M. Anstey, Tint Tint Kyi, David A. Cooper, Mar Mar Kyi and Josh Hanso
Investigating potential transmission of antimicrobial resistance in an open-plan hospital ward: a cross-sectional metagenomic study of resistome dispersion in a lower middle-income setting
No full textBackground: Antimicrobial resistance (AMR) represents a profound global health threat. Reducing AMR spread requires the identification of transmission pathways. The extent to which hospital wards represent a venue for substantial AMR transmission in low- and middle-income countries settings is poorly understood. Methods: Rectal swabs were obtained from adult male inpatients in a “Nightingale” model general medicine ward in Yangon, Myanmar. Resistome characteristics were characterised by metagenomic sequencing. AMR gene carriage was related to inter-patient distance (representing inter-patient interaction) using distance-based linear models. Clinical predictors of AMR patterns were identified through univariate and multivariate regression. Results: Resistome similarity showed a weak but significant positive correlation with inter-patient distance (r = 0.12, p = 0.04). Nineteen AMR determinants contributed significantly to this relationship, including those encoding β-lactamase activity (OXA-1, NDM-7; adjusted p < 0.003), trimethoprim resistance (dfrA14, adjusted p = 0.0495), and chloramphenicol resistance (catB3, adjusted p = 0.002). Clinical traits of co-located patients carrying specific AMR genes were not random. Specifically, AMR genes that contributed to distance-resistome relationships (OXA-1, catB3, dfrA14) mapped to tuberculosis patients, who were placed together according to ward policy. In contrast, patients with sepsis were not placed together, and carried AMR genes that were not spatially significant or consistent with shared antibiotic exposure. Conclusions: AMR dispersion patterns primarily reflect the placement of particular patients by their condition, rather than AMR transmission. The proportion of AMR determinants that varied with inter-patient distance was limited, suggesting that nosocomial transmission is a relatively minor contributor to population-level carriage.Anushia Ashokan, Josh Hanson, Ne Myo Aung, Mar Mar Kyi, Steven L. Taylor, Jocelyn M. Choo, Erin Flynn, Fredrick Mobegi, Morgyn S. Warner, Steve L. Wesselingh, Mark A. Boyd, and Geraint B. Roger
The clinical characteristics of adults with rheumatic heart disease in Yangon, Myanmar: An observational study
No full textThe Safety of a Conservative Fluid Replacement Strategy in Adults Hospitalised with Malaria.
No full textBACKGROUND:A conservative approach to fluid resuscitation improves survival in children with severe malaria; however, this strategy has not been formally evaluated in adults with the disease. METHODS:Adults hospitalised with malaria at two tertiary referral hospitals in Myanmar received intravenous fluid replacement with isotonic saline, administered at a maintenance rate using a simple weight-based algorithm. Clinical and biochemical indices were followed sequentially. RESULTS:Of 61 adults enrolled, 34 (56%) had Plasmodium falciparum mono-infection, 17 (28%) Plasmodium vivax mono-infection and 10 (16%) mixed infection; 27 (44%) patients were at high risk of death (P. falciparum infection and RCAM score ≥ 2). In the first six hours of hospitalisation patients received a mean 1.7 ml/kg/hour (range: 1.3-2.2) of intravenous fluid and were able to drink a mean of 0.8 ml/kg/hour (range: 0-3). Intravenous fluid administration and oral intake were similar for the remainder of the first 48 hours of hospitalisation. All 61 patients survived to discharge. No patient developed Adult Respiratory Distress Syndrome, a requirement for renal replacement therapy or hypotension (mean arterial pressure 2 mmol/L) on enrolment in 26 (43%) patients but had declined by 6 hours in 25 (96%) and was declining at 24 hours in the other patient. Plasma creatinine was elevated (> 120 μmol/L) on enrolment in 17 (28%) patients, but was normal or falling in 16 (94%) at 48 hours and declining in the other patient by 72 hours. There was no clinically meaningful increase in plasma lactate or creatinine in any patient with a normal value on enrolment. Patients receiving fluid replacement with the conservative fluid replacement algorithm were more likely to survive than historical controls in the same hospitals who had received fluid replacement guided by clinical judgement in the year prior to the study (p = 0.03), despite having more severe disease (p < 0.001). CONCLUSIONS:A conservative fluid resuscitation strategy appears safe in adults hospitalised with malaria
Malaria incidence in Myanmar 2005–2014: steady but fragile progress towards elimination
No full textBackground: There has been an impressive recent reduction in the global incidence of malaria, but the develop-ment of artemisinin resistance in the Greater Mekong Region threatens this progress. Increasing artemisinin resist-ance is particularly important in Myanmar, as it is the country in the Greater Mekong Region with the greatest malaria burden. If malaria is to be eliminated in the region, it is essential to define the spatial and temporal epidemiology of the disease in Myanmar to inform control strategies optimally.Results: Between the years 2005 and 2014 there was an 81.1 % decline in the reported annual incidence of malaria in Myanmar (1341.8 cases per 100,000 population to 253.3 cases per 100,000 population). In the same period, there was a 93.5 % decline in reported annual mortality from malaria (3.79 deaths per 100,000 population to 0.25 deaths per 100,000 population) and a 87.2 % decline in the proportion of hospitalizations due to malaria (7.8 to 1.0 %). Chin State had the highest reported malaria incidence and mortality at the end of the study period, although socio-economic and geographical factors appear a more likely explanation for this finding than artemisinin resistance. The reduced malaria burden coincided with significant upscaling of disease control measures by the national government with support from international partners. These programmes included the training and deployment of over 40,000 com-munity health care workers, the coverage of over 60 % of the at-risk population with insecticide-treated bed nets and significant efforts to improve access to artemesinin-based combination treatment. Beyond these malaria-specific programmes, increased general investment in the health sector, changing population demographics and deforesta-tion are also likely to have contributed to the decline in malaria incidence seen over this time.Conclusions: There has been a dramatic fall in the burden of malaria in Myanmar since 2005. However, with the rise of artemisinin resistance, continued political, financial and scientific commitment is required if the ambitious goal of malaria elimination in the country is to be realize
The prognostic utility of bedside assessment of adults hospitalized with malaria in Myanmar: a retrospective analysis
No full textThe clinical characteristics of adults with rheumatic heart disease in Yangon, Myanmar: Anobservation a lstudy
No full textBackgroundRheumaticheartdisease(RHD)is a majorcauseof prematuredeathin lowandmiddle-incomecountries.Thegreatestbarrierto RHDcontrolis neglectof thediseasein nationalhealthpoliciesanda lackof prevalencedatathatmightinformcontrolefforts.Myanmarismakingremarkableprogressagainstmanyinfectiousdiseases,buttherearealmostnodatato definetheclinicalburdenof RHDin thecountry.Thisprospective auditwasperformedinanadultmedicalwardof a tertiary-referralhospitalin Yangon,to gainaninsightintotheprevalenceof RHDin Myanmar.PrincipalfindingsAllpatientsadmittedto thewardbetweenMay1, 2016andApril30,2017wereeligibleforenrolment.RHDwasconfirmedin 96patientswhowereadmittedon134occasions,repre-senting1.1%of the12,172adultmedicaladmissionsduringthestudyperiod.Thiscom-paredwith410(3.4%)admissionswithHIVand14(0.1%)withmalaria.PatientswithRHDhada medianageof 44years(interquartilerange:35–59);70(73%)werefemale.Onlyonepatienthadeverhadsurgerydespite79(82%)meetingcriteriaforintervention;54(56%)patientswerenotreceivinganyregularclinicianreview.Priorto hospitalisationonly18(19%)patientswerereceivingregularpenicillin.Only8 (19%)of the42women<50yearswereusingcontraception.Of49patientswhohadbeenhospitalisedpreviously,22(45%)werereceivingnoregulartherapy.Duringthestudythree(3.1%)patientsdied,and28(29%)werelostto follow-up.Ofthe65(68%)aliveandretainedin care,21(32%)werestillexperiencingmoderate-severeRHD-relatedsymptomsat thestudy’send.ConclusionsThereis a significantandunmetclinicalburdenof RHDin Myanmar.A nationalRHDprogram-mewouldimprovepatientcare,reducingmorbidityandmortalityfromthispreventabledisease
