Identification of <i>JAK2</i>(V617F) Mutation in Myeloproliferative Neoplasms by Using Allele Specific Polymerase Chain Reaction (AS-PCR)

Myeloproliferative neoplasms (MPNs) are a group of clonal haematopoietic stem cell disorders characterized by the proliferation of one or more myeloid cell lineages. According to WHO classification, the Janus associated kinase 2 (JAK2) V617F mutation is one of the major diagnostic criteria in BCR-ABL1 negative myeloproliferative neoplasms. The aim of this study is to detect the JAK2 (V617F) mutation in patients with myeloproliferative neoplasms to get accurate diagnosis and proper management. A total of 90 clinically diagnosed MPN patients attending to Department of Clinical Haematology, Yangon General Hospital were enrolled in this study. The mean age was 53.4 ± 14 years which ranged from 16 to 81 years old and male and female ratio was 2.4:1. The identification of JAK2 (V617F) point mutation was found to be positive in 44/90 MPN patients (48.9%). According to MPN subtypes, the JAK2 mutation positivity was found in 19 out of 46 polycythemia vera patients (41.3%), 17 out of 25 essential thrombocythemia patients (68%), 8 out of 15 primary myelofibrosis patients (53.3%), 0 of 4 others myeloproliferative neoplasms (0%). Confirmation of each of nine JAK2 mutation positive and negative samples was done by Sanger sequencing. The arterial or venous thrombotic attack was found in 32/44 JAK2 mutation positive cases (72.7%) and 12/44 JAK2 mutation negative cases (27.3%). The association between thrombotic attack and presence of JAK2 mutation was statistically significance with p = 0.000. The diagnosis of myeloproliferative neoplasms mainly relies on the molecular genetics according to WHO classification. The Allele specific PCR reaction is sensitive, simple test and relatively cost-effective. Therefore, the identification of JAK2 (V617F) somatic point mutation by AS-PCR should be implemented as a routine diagnosis procedure for patients with chronic and suspected myeloproliferative neoplasms.

Different challenges,different approaches and related expenditures of communitybased tuberculosis activities by international non-governmental organizations in Myanmar

Background:International non-governmental organizations(INGOs)have been implementing community-based tuberculosis(TB)care(CBTBC)in Myanmar since 2011.Although the National TB Programme(NTP)ultimately plans to take over CBTBC,there have been no evaluations of the models of care or of the costs of providing CBTBC in Myanmar by INGOs.Methods:This was a descriptive study using routinely-collected programmatic and financial data from four INGOs during 2013 and 2014,adjusted for inflation.Data analysis was performed from the provider perspective.Costs for sputum examination were not included as it was provided free of charge by NTP.We calculated the average cost per year of each programme and cost per patient completing treatment.Results:Four INGOs assisted the NTP by providing CBTBC in areas where access to TB services was challenging.Each INGO faced different issues in their contexts and responded with a diversity of strategies.The total costs ranged from US$140754 to US$550221 during the study period.The cost per patient completing treatment ranged from US$215 to US$1076 for new cases and US$354 to US$1215 for retreatment cases,depending on the targeted area and the package of services offered.One INGO appeared less costly,more sustainable and patient oriented than others.Conclusions:This study revealed a wide variety of models of care and associated costs for implementing CBTBC in diverse and challenging populations and contexts in Myanmar.Consequently,we recommend a more comprehensive evaluation,including development of a cost model,to estimate the costs of scaling up CBTBC country-wide,and cost-effectiveness studies,to best inform the NTP as it prepares to takeover CBTBC activities from INGOs.While awaiting evidence from these studies,model of CBTBC that have higher sustainability potential and allocate more resources to patient-centered care should be given priority support.