Mr. Thesis

Influenza A(H9N2) Virus, Myanmar, 2014–2015

Routine surveillance of influenza A virus was conducted in Myanmar during 2014–2015. Influenza A(H9N2) virus was isolated in Shan State, upper Myanmar. Whole-genome sequencing showed that H9N2 virus from Myanmar was closely related to H9N2 virus of clade 4.2.5 from China.

To cite: Lin TN, Nonthabenjawan N, Chaiyawong S, Bunpapong N, Boonyapisitsopa S, Janetanakit T, Mon PP, Mon HH, Oo KN, Oo SM, Win MM. Influenza A (H9N2) Virus, Myanmar, 2014–2015. Emerging infectious diseases. 2017 Jun;23(6):1041.

Surgical Mask vs N95 Respirator for Preventing Influenza Among Health Care Workers

Abstract

Context: Data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse. Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing the effectiveness of the surgical mask is of public health importance.

Objective: To compare the surgical mask with the N95 respirator in protecting health care workers against influenza.

Design, Setting, and Participants: Noninferiority randomized controlled trial of 446 nurses in emergency departments, medical units, and pediatric units in 8 tertiary care Ontario hospitals.

Intervention: Assignment to either a fit-tested N95 respirator or a surgical mask when providing care to patients with febrile respiratory illness during the 2008-2009 influenza season.

Main Outcome Measures: The primary outcome was laboratory-confirmed influenza measured by polymerase chain reaction or a 4-fold rise in hemagglutinin titers. Effectiveness of the surgical mask was assessed as noninferiority of the surgical mask compared with the N95 respirator. The criterion for noninferiority was met if the lower limit of the 95% confidence interval (CI) for the reduction in incidence (N95 respirator minus surgical group) was greater than −9%.

Results: Between September 23, 2008, and December 8, 2008, 478 nurses were assessed for eligibility and 446 nurses were enrolled and randomly assigned the intervention; 225 were allocated to receive surgical masks and 221 to N95 respirators. Influenza infection occurred in 50 nurses (23.6%) in the surgical mask group and in 48 (22.9%) in the N95 respirator group (absolute risk difference, −0.73%; 95% CI, −8.8% to 7.3%; P = .86), the lower confidence limit being inside the noninferiority limit of −9%.

Conclusion: Among nurses in Ontario tertiary care hospitals, use of a surgical mask compared with an N95 respirator resulted in noninferior rates of laboratory-confirmed influenza.

To cite:
Loeb M, Dafoe N, Mahony J, John M, Sarabia A, Glavin V, Webby R, Smieja M, Earn DJ, Chong S, Webb A. Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. Jama. 2009 Nov 4;302(17):1865-71.

Effect of misoprostol on the pharmacokinetics of sustained release diclofenac in Myanmar healthy male volunteers
Htet Htet Aung, Aye Soe, Nu Nu Aye

Abstract
Background: Sustained release diclofenac (diclofenac SR) is the commonly used non-steroidal anti-inflammatory drug for chronic inflammatory conditions such as rheumatoid arthritis.Misoprostol, prostaglandin analogue, is the agent that enhances gastrointestinal mucosal defense. Concomitant administration of misoprostol with diclofenac SR can prevent the gastrointestinal side effects of diclofenac SR.
Objective: The purpose of the study was to explore the effect of misoprostol on the pharmacokinetics of diclofenac SR in healthy volunteers.
Methods: Crossover study was evaluated in 14 male volunteers. Single oral dose of 100 mg diclofenac SR was concomitantly administered with 200 µg misoprostol with one-week wash out period. Plasma concentrations at 0, 0.5, 1, 1.5, 2, 3, 6 and 10 hrs were determined by high performance liquid chromatography (HPLC). Pharmacokinetic parameters such as area under concentration-time curve (AUC0-∞), peak plasma concentration (Cmax), time to achieve peak plasma concentration (Tmax), absorption half-life (T½(ab)), elimination half-life (T1/2(el)), absorption rate constant (Kab), and elimination rate constant (Kel) were determined.
Results: With misoprostol, the mean AUC0-∞ of diclofenac SR was significantly reduced from 12.11±5.25µg/mL×hr to 4.17±2.72µg/mL×hr (p0.05). The mean Kab were almost the same 1.43±0.54hr-1 and 1.43±0.48hr-1. The mean T1/2(el) was decreased from 3.68±1.64hr to 3.03±1.08hr (p>0.05). The mean Kel was increased from 0.21±0.09hr-1 to 0.25±0.09hr-1 (p>0.05).
Conclusion: There was a significant reduction in the extent of absorption of diclofenac SR when concomitantly administered with misoprostol. Therefore, the dose of diclofenac SR may need to be increased to avoid therapeutic failure of diclofenac SR or concurrent use with misoprostol may need to be changed to other gastroprotective agents.

To cite: Aung HH, Soe A, Aye NN. Effect of misoprostol on the pharmacokinetics of sustained release diclofenac in Myanmar healthy male volunteers. Siriraj Medical Journal. 2017 Mar 24;69(2):75-9.