Epidemiology of extrapulmonary tuberculosis in Brunei Darussalam: a retrospective cohort study.

OBJECTIVES: We reported the incidence and associated factors of extrapulmonary tuberculosis (EPTB). DESIGN: A retrospective cohort study. SETTING: Brunei Darussalam, an intermediate tuberculosis (TB)-burden country with stagnating annual TB rates. PARTICIPANTS: All active TB cases identified in the country between January 2001 and December 2018 (18 years). PRIMARY AND SECONDARY OUTCOME MEASURES: Annual proportions of EPTB (overall and specific) were calculated. Multiple logistic regression was done to investigate factors associated with developing EPTB, when compared with pulmonary TB (PTB). Χ2 trend test was used to determine any trends during the 18-year study period. RESULTS: We identified 3916 TB cases, among which 743 (19.0%) were EPTB cases. Lymphatic (44.8%) and pleural (19.4%) EPTB were most common. The main modes of diagnosis were tissue biopsy (73.6%) and radiological assessment (18.3%). Treatment success and mortality rate were 79.7% and 7.0%, respectively. Associations with specific EPTB types varies with age-group and gender. Younger age-group (adjusted OR (aOR)≥1.94) and women (aOR: 2.45 (95% CI: 1.94 to 3.11)) had higher adjusted odds of developing lymphatic EPTB, but had lower adjusted odds of developing pleural EPTB (younger age-group (aOR≤0.54) and women (aOR: 0.41 (95% CI: 0.17 to 0.90)). When compared to foreign residents, locals had higher adjusted odds of skeletal (aOR: 4.44 (95% CI: 2.04 to 11.69)), gastrointestinal (aOR: 3.91 (95% CI: 1.84 to 9.66)) and other types of EPTB (aOR: 3.42 (95% CI: 1.53 to 9.14)). No significant trend differences were observed for overall and specific EPTB types. CONCLUSION: Despite being generally non-infectious and less recognised than PTB, understanding EPTB epidemiology is important as it also contributes to the overall TB burden in a country. Examining EPTB cases by their specific anatomical site would provide more information on risk factors. Raising public awareness on the EPTB symptoms and that TB affects lungs and other parts of the body could promote early health seeking behaviour and early EPTB diagnosis.

PvT Properties and Thermodynamic Property Correlations for the Low Global Warming Potential Hydrofluoroolefin Refrigerant R-1132a (1,1-Difluoroethene).

R-1132a is increasingly being considered as a low global warming potential component in alternative mixtures to R-23 in specialized low temperature and ultra-low temperature refrigeration systems. Though the thermodynamic properties of R-1132a were investigated in several studies up to 2018, reinvestigations have been carried out in recent years. In order to contribute toward these renewed measurements, the critical parameters of R-1132a were experimentally re-determined. Thirty-two vapor pressures from 240 K to the critical temperature, fifteen saturated vapor and six saturated liquid densities above 254 K and the PvT properties in both the vapor phase (98 points) and liquid phase (34 points) from densities of 50 kg·m-3 to 760 kg·m-3 were also measured. Specific correlations for each of these properties were optimized and compared to previously available data from the literature. Additionally, the Peng-Robinson equation of state was used to represent the aforementioned properties and further utilized to determine the enthalpy and entropy of R-1132a. Supplementary Information: The online version contains supplementary material available at 10.1007/s10765-023-03184-4.

A literature review exploring how health systems respond to acute shocks in fragile and conflict-affected countries.

Understanding how health systems respond to shocks has become a pressing need to strengthen response efforts. With already fragmented and disrupted health services, fragile and conflict affected [FCA] countries are more vulnerable to shocks. Previous studies have focused more on conceptualizing health system resilience rather than how health systems [especially in FCA countries] respond to or are resilient to acute shocks. To understand how health systems in FCA countries respond to the shocks and what influence their responses, we conducted a review of the literature published between January 2011 and September 2021 on health system responses to acute shocks in FCA countries. We searched Medline, Embase, Scopus, Jester and Google Scholar - 60 empirical studies in FCA countries on response to sudden, extreme, and unanticipated shocks were included in the review. We found that health systems in FCA countries responded to acute shock using absorptive, adaptive, or transformative capacities. These capacities were mediated by four dimensions of context; knowledge, uncertainties, interdependence, and legitimacy. In addition, we identified the cross-cutting role of community involvement [and its self-evolving nature], frontline workers, and leadership capacity. To our knowledge, this is among the first reviews that focus on FCA country health systems responses to acute shock. By highlighting enabling and constraining factors to each type of capacity, this study provides important lessons and practical strategies from FCA countries on how to absorb, adapt and transform in response to acute shocks - thus promoting health system resilience globally.

Contact investigation of tuberculosis in Brunei Darussalam: Evaluation and risk factor analysis.

INTRODUCTION: We evaluated the yield of tuberculosis (TB) contact investigation in Brunei Darussalam, and identified the associated factors for latent TB infection (LTBI) diagnosis, as well as for initiating and completing LTBI treatment. METHODS: Data were extracted and digitalised for all close contacts of pulmonary TB (PTB) cases at the National TB Coordinating Centre from January 2009 to December 2018. Generalising estimating equations logistic regression models were used to determine the associated factors. Manual matching against electronic health records system was done to identify contacts who had progressed to active TB disease. RESULTS: Among 10 537 contacts, 9.9% (n=1047) were diagnosed as LTBI, out of which 43.0% (n=450) initiated LTBI treatment. Among those who initiated, 74.0% (n=333) completed LTBI treatment. Contact factors associated with LTBI diagnosis include being male (adjusted OR (aOR)=1.18 (95% CI 1.03 to 1.34)), local (aOR=0.70 (95% CI 0.56 to 0.88)) and a household contact (aOR=1.59 (95% CI 1.26 to 1.99)). Contacts of index cases who were <60 years old and diagnosed as smear positive PTB (aOR=1.62 (95% CI 1.19 to 2.20)) had higher odds of being diagnosed with LTBI. Local LTBI cases had higher odds of initiating LTBI treatment (aOR=1.86 (95% CI 1.26 to 2.73)). Also, LTBI cases detected from local (aOR=2.32 (95% CI 1.08 to 4.97)) and smear positive PTB index cases (aOR=2.23 (95% CI 1.09 to 4.55)) had higher odds of completing LTBI treatment. Among 1047 LTBI cases, 5 (0.5%) had progressed to active PTB within 1-8 years post-LTBI diagnosis. DISCUSSION: LTBI burden is disproportionately high towards foreign nationals, with higher odds of LTBI diagnosis but lower odds of treatment initiation. Determining the reasons of not initiating LTBI treatment will be useful to help improve LTBI treatment uptake. Establishing digital databases and building TB laboratory capacity for molecular typing would be useful to determine the contribution of LTBI or reactivation towards TB incidence in Brunei.

Hypokalemia-Induced Arrhythmia: A Case Series and Literature Review.

Electrolyte imbalances, particularly potassium disorders, are common in clinical practice. Potassium homeostasis plays a key role in regulating cell membrane excitability. Hypokalemia usually presents with cardiovascular and neuromuscular abnormalities. Hypokalemia can lead to clinically significant life-threatening arrhythmia. Typical electrocardiographic (ECG) features of hypokalemia include widespread ST depression, T wave inversion, and prominent U waves. However, hypokalemia may present with different types of arrhythmia, such as premature ventricular contractions, ventricular fibrillation, atrial fibrillation, and torsade de pointes. Thus, clinicians should be familiar with ECG manifestations of potassium disorders that may warrant timely diagnosis and effective management. Herein, we report three patients with arrhythmia who were found to have typical ECG characteristics of hypokalemia after resolution of arrhythmia and later proved to have low serum potassium levels.

Rurally rooted cross-border migrant workers from Myanmar, Covid-19, and agrarian movements.

This paper examines the situation of rurally rooted cross-border migrant workers from Myanmar during the Covid-19 pandemic. It looks at the circumstances of the migrants prior to the global health emergency, before exploring possibilities for a post-pandemic future for this stratum of the working people by raising critical questions addressed to agrarian movements. It does this by focusing on the nature and dynamics of the nexus of land and labour in the context of production and social reproduction, a view that in the context of rurally rooted cross-border migrant workers necessarily requires interrelated perspectives on labour, agrarian, and food justice struggles. This requires a rethinking of the role of land, not as a factor in either production or social reproduction, but as a central component in both spheres simultaneously. The question is not 'whether' it is necessary and desirable to forge multi-class coalitions and struggles against external capital, while not losing sight of the exploitative relations within rural communities and the household; rather, the question is 'how' to achieve this. It will require a messy recursive process, going back and forth between theoretical exploration and practical politics.

Prevalence and associated factors of diabetes mellitus among tuberculosis patients in Brunei Darussalam: A 6-year retrospective cohort study.

OBJECTIVES: To determine the prevalence and associated factors of diabetes mellitus (DM) among tuberculosis (TB) cases in Brunei Darussalam. METHODS: We conducted a retrospective cohort study among all TB patients registered between 2013 and 2018. Collected data include sociodemographics, comorbidities, and information related to their TB diagnosis and treatment outcomes. Associated factors of having DM among TB patients were investigated using logistic regression analyses. RESULTS: We identified a total of 1362 TB patients, among which 462 (33.9% [95%CI: 31.4%,36.5%]) also have DM. 70.6% (n = 326) were diagnosed with DM at least six months prior to their TB diagnosis. The incidence of newly diagnosed DM among TB patients was 74.2 per 1000 population. Significant factors of having TB and DM comorbidity were age (adjusted OR (adj. OR) = 1.04 [95%CI: 10.3,1.05]), classified as smear-positive pulmonary TB (adj. OR = 5.77 [95%CI: 3.71,9.22]), having the following underlying conditions: hypertension/heart disease (adj. OR = 24.05 [95%CI: 5.80,100.05]), renal disease (adj. OR = 7.34 [95%CI: 2.88,20.22]) and chronic obstructive pulmonary disease/asthma (adj. OR = 0.38 [95%CI: 0.22,0.64]). CONCLUSION: About one-third of TB cases in Brunei were also diagnosed with DM. Bi-directional screening could be a good strategy to facilitate early detection and treatment of both diseases.

Use of WONCA global standards to evaluate family medicine postgraduate education for curriculum development and review in Nepal and Myanmar.

Family medicine is an integral part of primary care within health systems. Globally, training programmes exhibit a great degree of variability in content and skill acquisition. While this may in part reflect the needs of a given setting, there exists standard criteria that all family medicine programmes should consider core activities. WONCA has provided an open-access list of standards that their expert community considers essential for family medicine (GP) post-graduate training. Evaluation of developing or existing training programmes using these standards can provide insight into the degree of variability, gaps within programmes and equally as important, gaps within recommendations. In collaboration with the host institution, two family medicine programmes in Nepal and Myanmar were evaluated based on WONCA global standards. The results of the evaluation demonstrated that such a process can allow for critical review of curriculum in various stages of development and evaluation. The implications of reviewing training programmes according to WONCA standards can lead to enhanced training world-wide and standardisation of training for post-graduate family medicine.

A novel integrated thermal-/membrane-based solar energy-driven hybrid desalination system: Concept description and simulation results.

In this paper, a hybrid desalination system consisting of vacuum membrane distillation (VMD) and adsorption desalination (AD) units, designated as VMD-AD cycle, is proposed. The synergetic integration of the VMD and AD is demonstrated where a useful effect of the AD cycle is channelled to boost the operation of the VMD process, namely the low vacuum environment to maintain the high pressure gradient across the microporous hydrophobic membrane. A solar-assisted multi-stage VMD-AD hybrid desalination system with temperature modulating unit is first designed, and its performance is then examined with a mathematical model of each component in the system and compared with the VMD-only system with temperature modulating and heat recovery units. The total water production and water recovery ratio of a solar-assisted 24-stage VMD-AD hybrid system are found to be about 21% and 23% higher, respectively, as compared to the VMD-only system. For the solar-assisted 24-stage VMD-AD desalination system having 150 m(2) of evacuated-tube collectors and 10 m(3) seawater storage tanks, both annual collector efficiency and solar fraction are close to 60%.

On the thermodynamics of refrigerant + heterogeneous solid surfaces adsorption.

This Article presents a theoretical framework for the understanding of pressurized adsorption systems using the statistical rate methodology. Utilizing results from the statistical rate theory, basic thermodynamic variables including enthalpy (h(a)), entropy (s(a)), and the specific heat capacity (c(p,a)) of the adsorbed phase are derived using the thermodynamic requirements of chemical equilibrium, Gibbs law, as well as Maxwell relations. A built-in constant (K) describes the adsorbed molecular partition function (q(s)), and it captures the heterogeneous properties of the adsorbent + adsorbate pair at equilibrium states. Improved adsorbed-phase volume considerations were incorporated in the formulations of these variables where they could be utilized with relative ease for analyzing the energetic performances of any practical adsorption system. In this Article, we have demonstrated how derived thermodynamic quantities can bridge the information gap with respect to the states of adsorbed phase, as well as resolved some theoretical inconsistencies that were found in previously derived quantities. Experimentally, the adsorption isotherms of propane (refrigerant) on activated carbon powder (Maxsorb III) for temperatures from 5 to 75 °C and pressures up to 8 bar are presented, and they are used to illustrate the behaviors of the adsorbed-phase during uptakes, temperatures, and pressure excursions or changes.

Metabolic Syndrome in obese and normal weight Myanmar children / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#To estimate the frequency of Metabolic Syndrome (MS in Myanmar obese children and to determine the risk factors associated with MS in obese children comparing with normal weight children. @*Methodology@#A cross-sectional study was conducted to compare the risk factors for metabolic syndrome between normal and obese children by using the pediatric definition for metabolic syndrome [International Diabetes Federation (IDF), 2007]. Twenty-three obese children (BMI, ≥ 97th percentile) and 23 normal weight children (BMI, < 85th percentile) aged 5-12 years were included in the study. Blood pressure, body weight, height, waist circumference (WC), fasting triglycerides, HDL-cholesterol, total cholesterol and glucose concentrations were determined. @*Results@#Based on the IDF pediatric criteria, 9 obese children (39.1%) had metabolic syndrome while no normal weight child had metabolic syndrome. Ten (43.5%) normal weight children and 3 (13.0%) obese children had at least one risk factor for the metabolic syndrome. Central obesity (WC ³ 90th percentile for age and sex), the most common risk factor, was observed in 25 children (54.4% of the total population). @*Conclusion@#This study highlights the need for early recognition of risk factors for metabolic syndrome in all children to halt the progression of type 2 diabetes and cardiovascular diseases (CVD) in later life.