Background Renal transplant is an effective treatment option for end-stage kidney disease and tacrolimus is one of the most commonly used immunosuppressant drugs in renal transplant patients. Tacrolimus is a substrate of cytochrome P450 3A5 (CYP3A5), and a narrow therapeutic index and large inter-individual variability. The objective of this study was to determine the frequency of CYP3A5*3 polymorphism and its effect on the pharmacokinetics of tacrolimus in post-renal transplant patients at Mandalay General Hospital. Methods Three different genotypes of CYP3A5 were determined by polymerase chain reaction-restriction fragment length polymorphism in 54 post-renal transplant recipients. Tacrolimus trough concentrations (C trough ) were measured by enzyme multiplied immunoassay technique following method validation. The apparent clearance (CL/F) was calculated from measured C trough . Results The frequency of CYP3A5*1 allele was 0.24 and that of CYP3A5*3 allele was 0.76 in the study sample. There were a total of 33 CYP3A5 non-expressors (patients with CYP3A5*3/*3 genotype) and 21 CYP3A5 expressors (patients with CYP3A5*1/*1 or CYP3A5*1/*3 genotype), respectively. CL/F was significantly lower in the non-expressor group than in the expressor group (mean±standard deviation, 12.53±5.28 vs. 21.22±5.95 L/hr; P<0.001). The mean C trough and concentration dose ratio (C/D) for tacrolimus in CYP3A5 non-expressors were significantly higher than those in CYP3A5 expressors (C trough , 7.14±2.56 vs. 5.92±1.76 ng/mL; C/D, 6.92±4.11 vs. 2.89±1.85 ng/mL/mg), respectively (P<0.05). Conclusions In this study, 76% of the Myanmar renal transplant recipients carried the CYP3A5*3 allele that was associated with lower functional activity of the CYP3A5 enzyme a lower CL/F of tacrolimus in these Thus, CYP3A5 polymorphism influences the pharmacokinetics of tacrolimus, which may affect the pharmacological response to tacrolimus
Background: Drug utilization studies are important elucidation tools for prescribing habits in particular therapeutic field and they play a key role in helping the healthcare personnel to understand, interpret and improve the prescribing, administration and use of medications. Objectives: This study was undertaken to identify amount of antibacterial drugs used and utilization patterns of antibacterial drugs in medical wards of Magway Regional Hospital. Methods: This study is a hospital-based, cross-sectional, descriptive study and was carried out for a period of four months. Data regarding antibacterial prescription during hospital stay were collected from medical record files of patients. The data were evaluated by Microsoft Excel software. Results: In this study, the most common indications for antibacterials were respiratory tract infections (43.34%) followed by gastrointestinal tract infections (16.27%). Out of 879 patients, 52.10% were prescribed by single antibacterial agent and in 47.90%, combination of antibacterials was necessary to be given. Antibacterials were prescribed by oral route in 29.58% and parenteral route were prescribed in 29.35% while 41.07% patients received antibacterials by both oral and parenteral routes. Antibacterials were prescribed with generic name in 64% and trade name in 36%. Cephalosporins were the most commonly prescribed drugs, 68.26%, followed by penicillin groups and quinolones, 53.58% and 16.27% respectively. In this study, 13 drugs included in DU90% segment were amoxicillin and β-lactamase inhibitor combination (22.26%), ceftriaxone (16.05%), cefuroxime (8.26%), levofloxacin (7.67%), amoxicillin and flucloxacillin combination (7.27%), metronidazole (6.89%),clarithromycin (4.74%), cefixime (4.68%), co-trimoxazole (4.24%), ceftazidime (2.6%), azithromycin (2.46%), cefoperazone and β-lactamase inhibitor combination (1.65%) and clindamycin (1.64%). Conclusions: The findings from this study will provide the documentary evidence regarding antibacterial utilization patterns in treatment of a variety of infections and antibacterial drugs include in DU90% segment. This information generally contributes data for making decision of purchasing medicines or preparing drug budgets.
Background: Breast cancer is the most common cancer among females in Myanmar but patients often receive treatment rather late. Delays in seeking treatment of breast cancer for a period longer than 3 months, is associated with lower survival. Hence it is important to find out the causes of the delays so that necessary measures may be implemented with a view to improving treatment outcome. Aim: To explore the delays and barriers to early diagnosis and treatment among the breast cancer patients in Yangon. Methods: A mixed method design. All breast cancer patients (total 104) participated in the structured interview and (16) in the Focus Group Discussion (FGD) sessions. Site at Shwe Yaung Hnin Si Cancer Foundation's Charity clinic from September 2017 to February 2018. Results: Some 32.4% had (patient delay - consulted a medical personnel more than 3 months after noticing signs and symptoms), 19.4% had (general practitioner (GP) delay- to refer to cancer specialist) and 44.4% had (hospital or system delay –i.e., treatment delay after first consultation with specialists). Reasons for patient delay were not knowing that painless small breast lump could be serious (37.5%), socioeconomic constraints (18.8%), too busy working (9.4%) too scared (7.8%) and too shy (4.7%). People living in Yangon had 3.8 times less delay than those living outside (OR 3.8, χ2 = 7.4, P < 0.004); those unemployed were 2.4 times less delay than used (OR 2.4, χ2 = 3.77, P < 0.02); negative attitude toward breast lump and being worried had 8 times less chance of patient delay (OR= 8, χ2=19.9, P ≤ 0.0001). Those who perceived that a painless breast lump was serious are 8.8 times less likely to have patient delay (OR 8.8, χ2 = 3.08, P < 0.001). The odds of having GP delay are 3.2 times higher among those having patient delay (OR=3.2, χ2=5.6, P < 0.02). By FGD most of the survivors revealed reasons for delay which were limited information, economic, use of traditional medicine and sociocultural issues. Conclusion: Lack of knowledge was the highest cause of the patient delay, followed by perception, socioeconomic factors and accessibility to health care and so these need to be overcome. The GP delay and system delay need to be further explored to ascertain the exact causes.
Background: Doxorubicin is the most preferred cytotoxic agent to be incorporated in chemotherapy regimens for breast cancer. However, its use is limited by cardiotoxicity which cannot be predicted using currently available methods. Plasma deoxyribonucleic acid topoisomerase 2b level (DNA Top 2b) is potential to be an early predictor of anthracycline-induced cardiotoxicity. Aim of the study is to assess the implications of plasma DNA Top 2b level in breast cancer patients receiving a doxorubicin-based chemotherapy regimen. Methods: All newly diagnosed breast cancer patients, who were going to receive a new course of doxorubicin-based chemotherapy was recruited over 12 months and assessed comprehensively in No. (2) Military Hospital (500-Bedded). After informed consent, eligible patients received six cycles of doxorubicin-based chemotherapy with serial serum troponin I and LVEF assessments on the day after each cycle. LVEF <50% or 10% decline from baseline was regarded as indication to stop doxorubicin-based chemotherapy.Results: Among fifty-one patients, mean age was 48.78 years. While mean plasma Top 2b level was 0.43 ng/lg, about a quarter of patients (25.5%) expressed 0.5 ng/lg. There was no significant association between plasma Top 2b level and each baseline clinical characteristics (age, hypertension, diabetes, dyslipidaemia and clinical staging). Throughout chemotherapy, no positive result of serum troponin I was observed while 16 patients had significant LVEF decline. There was significant association between higher Top 2b level ( 0.5 ng/lg) and LVEF decline (P ¼ 0.001). Mean plasma Top 2b level was higher in patients with LVEF decline [0.74 ng/lg (S.D 60.70)] than those without decline [0.29 ng/lg (S.D 60.30)] (P < 0.05). Log-rank test showed that patients expressing higher Top 2b level ( 0.5 ng/lg) had higher propability of LVEF decline over time (p ¼ 0.001). Conclusions: LVEF decline is associated with higher plasma DNA Top 2b level in breast cancer patients receiving doxorubicin-based chemotherapy. Given no association with other cardiovascular risk factors, plasma DNA Top 2b is a potential independent biomarker to predict cardiac risk of anthracycline in cancer patients. Legal entity responsible for the study: Defence Services Medical Academy. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.24P Prognostic nomograms for predicting overall and cancer-specific survival in breast cancer patients not achieving pathological complete response after neoadjuvant chemotherapy
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