AB0390 ASSOCIATION BETWEEN INITIAL SERUM “TUMOR NECROSIS FACTOR-LIKE WEAK INDUCER OF APOPTOSIS” (TWEAK) LEVEL AND TREATMENT RESPONSE IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) NEPHROPATHY

Background:

SLE is a chronic inflammatory immunologic abnormalities disease which produce a number of antinuclear antibodies. The SLE renal involvement is clinically apparent in approximately 50% patients (Norby et al., 2017). It is very important to introduce the prompt treatment to prevent the permanent end stage renal disease.

Objectives:

This study aimed to identify the serum biomarkers that correlate with pretreatment disease activity in patients with SLE nephropathy and predict the treatment outcome so that we may identify the unresponsive cases and switch to the other biologic agents like anti-TWEAK monoclonal antibody in the future.

Methods:

This was a hospital-based prospective analytical study conducted from January 2018 to November 2019 in Rheumatology Department, Yangon Specialty Hospital. 88 SLE nephropathy patients with 24-hour urinary protein above 0.5g/day planned to have 6 months course of IV cyclophosphamide were enrolled. The paired serum sample of each patient was analyzed by ELISA twice to get the mean serum TWEAK value. Pretreatment SLE disease activity was assessed by the SLEDAI 2k. After the completion of 6 months of aggressive treatment, the treatment response was assessed by measuring the 24 hour urinary protein.

Results:

Among the 88 patients, 63 patients (71.6%) had completed total 6-months course and 25 patients (28.4%) had not completed:11 patients (12.5%) expired and 2 patients (2.27%) had been changed to other DMARD and 12 patients (13.63%) did not attend the follow up clinic. The mean serum TWEAK level was 856 ± 77 pg/ml in 88 patients. According to the range of serum TWEAK level, most of the patients had serum TWEAK level of 601-900 pg/ml (53.4% of the study population). There was positive correlation between pre-treatment SLEDAI 2k score and pretreatment serum TWEAK level (r=0.464 and P <0.001). When the SLEDAI 2k score was grouped into mild, moderate, high and very high disease activity, the serum TWEAK level also had positive association with the different levels of disease activity (p<0.001). Among 63 treatment completed patients, 55 patients (87.3%) were the treatment responders but 8 patients (12.7%) were treatment non-responders. There was significant difference in the pretreatment SLEDAI 2k in terms of disease activity between treatment responder and treatment non-responder (p<0.001). There was significant difference in the pretreatment SLEDAI 2k in terms of reduction in 24-hours urinary protein between treatment responder and treatment non-responder (p<0.001). There was no significant difference in the level of pretreatment serum TWEAK level between treatment responders and treatment non responders (p=1.000). There was also no significant difference in the pretreatment serum TWEAK level between treatment responders and treatment non-responders in terms of reduction in 24 hours urinary protein (p=0.804).

Conclusion:

Although the pretreatment serum TWEAK level had a positive correlation with pretreatment disease activity of SLEDAI 2k, it did not reflect the outcome of the responsiveness to the intensive therapy.

References:

[1]Norby, et al (2017) Outcome in biopsy-proven lupus nephritis: evaluation of biopsies from the Norwegian kidney biopsy registry.Lupus; 26:88

Acknowledgments:

Prof.Chit Soe, Prof.Hlaing Mya Win

Disclosure of Interests:

None declared

Predictive Factors for Death After Snake Envenomation in Myanmar

INTRODUCTION

Factors predictive for death from snake envenomation vary between studies, possibly due to variation in host genetic factors and venom composition. This study aimed to evaluate predictive factors for death from snake envenomation in Myanmar.

METHODS

A prospective study was performed among adult patients with snakebite admitted to tertiary hospitals in Yangon, Myanmar, from May 2015 to August 2016. Data including clinical variables and laboratory parameters, management, and outcomes were evaluated. Multivariate regression analysis was performed to evaluate factors predictive for death at the time of presentation to the hospital.

RESULTS

Of the 246 patients with snake envenomation recruited into the study, 225 (92%) survived and 21 (8%) died during hospitalization. The snake species responsible for a bite was identified in 74 (30%) of the patients; the majority of bites were from Russell's vipers (63 patients, 85%). The independent factors predictive for death included 1) duration from bite to arrival at the hospital >1 h (odds ratio [OR]: 9.0, 95% confidence interval [CI]: 1.1-75.2; P=0.04); 2) white blood cell counts >20 ×103 cells·μL-1 (OR: 8.9, 95% CI: 2.3-33.7; P=0.001); and 3) the presence of capillary leakage (OR: 3.7, 95% CI: 1.2-11.2; P=0.02). A delay in antivenom administration >4 h increases risk of death (11/21 deaths).

CONCLUSIONS

Patients who present with these independent predictive factors should be recognized and provided with early appropriate intervention to reduce the mortality rate among adults with snake envenomation in Myanmar.

Rabies in Myanmar: Prevalent, Preventable but not Prioritized

Despite the availability of proven measures to prevent the disease, rabies now kills more people in Myanmar than malaria. Although there are challenges in controlling rabies in such a large and culturally diverse country, Myanmar's successful National Malaria Control Program demonstrates what can be achieved with sufficient political, financial, and scientific commitment. Presently, however, Myanmar lacks a comparable program to coordinate the multifaceted approach that is necessary to control rabies. The national government has invested heavily in improving access to postexposure prophylaxis, but there should also be an emphasis on other, more cost-effective strategies, particularly mass canine vaccination, which has been an essential component of successful rabies elimination programs in other countries. Continued health system strengthening is also required to improve primary health care, while decentralization of laboratory diagnostic services is needed to facilitate more timely, rational, and cost-effective use of postexposure prophylaxis.

Clinical and laboratory parameters associated with acute kidney injury in patients with snakebite envenomation: a prospective observational study from Myanmar

Background

Snakebite-related acute kidney injury (AKI) is a common community-acquired AKI in tropical countries leading to death and disability. The aims of this study were to (1) determine the occurrence of snakebite-related AKI, (2) assess factors at presentation that are associated with snakebite-related AKI, and (3) determine the outcomes of patients with snakebite-related AKI.

Methods

We conducted a prospective observational study of patients with snake envenomation at the three academic tertiary care hospitals in Yangon, Myanmar between March 2015 and June 2016. Patient data including baseline characteristics, clinical and laboratory findings, hospital management, and outcomes were recorded in a case report form. A stepwise multivariate logistic regression analysis using a backward selection method determined independent factors significantly associated with AKI.

Results

AKI was observed in 140 patients (54.3%), the majority of whom were AKI stage III (110 patients, 78.6%). AKI occurred at presentation and developed during hospitalization in 88 (62.9%) and 52 patients (37.1%), respectively. Twenty-seven patients died (19.3%), and 69 patients (49.3%) required dialysis. On multivariate logistic regression analysis, (1) snakebites from the Viperidae family (odds ratio [OR]: 9.65, 95% confidence interval [CI]: 2.42–38.44; p = 0.001), (2) WBC >10 × 10³ cells/μL (OR: 3.55, 95% CI: 1.35–9.34; p = 0.010), (3) overt disseminated intravascular coagulation (OR: 2.23, 95% CI: 1.02–4.89; p = 0.045), (4) serum creatine kinase >500 IU/L (OR: 4.06, 95% CI: 1.71–9.63; p = 0.001), (5) serum sodium <135 mmol/L (OR: 4.37, 95% CI: 2.04–9.38; p < 0.001), (6) presence of microscopic hematuria (OR: 3.60, 95% CI: 1.45–8.91; p = 0.006), and (7) duration from snakebite to receiving antivenom ≥2 h (OR: 3.73, 95% CI: 1.48–9.37; p = 0.005) were independently associated with AKI. Patients bitten by Viperidae with normal renal function who had serum sodium <135 mmol/L had a significantly higher urine sodium-to-creatinine ratio than those with serum sodium ≥135 mmol/L (p < 0.001).

Conclusions

Identifying factors associated with snakebite-related AKI might help clinicians to be aware of snakebite patients who are at risk of AKI, particularly patients who demonstrate renal tubular dysfunction after Viperidae bites.

Electronic supplementary material

The online version of this article (doi:10.1186/s12882-017-0510-0) contains supplementary material, which is available to authorized users.

Malaria incidence in Myanmar 2005-2014: steady but fragile progress towards elimination

Background

There has been an impressive recent reduction in the global incidence of malaria, but the development of artemisinin resistance in the Greater Mekong Region threatens this progress. Increasing artemisinin resistance 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 community 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 deforestation 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 realized.