After Myanmar eliminated leprosy in 2003, the prevention of disability (POD), as well as prevention of worsening disabilities (POWD) and rehabilitation became a new agenda, which is one of three national strategies of leprosy control beyond 2005. Since the training needs for income generation for youths living in leprosy villages were not well known, a small-scale survey was conducted in May 2005. This study found that the youths in Mayanchaung village, Yangon Division, were eager to receive training on income generation. After training they wanted to practice and improve their skills with the resources available, because they perceived that a short training course would not enable them to get a proper job. Although they were fully aware of income generation skills, they found it difficult to adequately consider issues such as resources for practicing skills after training, social marketing, and seeking job opportunities. They also felt that mediators could be helpful between villagers and external customers/retailers. On the other hand, the elders, most of whom had disabilities, wanted the youths to stay in the village to take care of them. A basic sewing and stitching training course that was planned to match the study results was produced in January 2006. After 11 months it was observed that a newly opened sewing workshop was busy operating 12 sewing machines because of a big order of making primary school uniforms. How effective the needs assessment was still unknown, but it was found that prior need assessment activities followed by a training course upon the real needs might promote the proper processes of social rehabilitation of youths in a leprosy village of Myanmar.

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This reports a long-term follow-up study on clinical effects of ofloxacin (OFLX)-combined therapy to 14 leprosy patients with various types and stages. Combined drugs were diaminodiphenyl sulfone(DDS), rifampicin (RFP) and clofazimine. Clinical evaluation of the treatment after OFLX-combined therapy was remarkable improvement 10 cases, improvement 3 and re-exacerbated after improvement 1 to whom clofazimine and minocycline were prescribed. The evaluation during the follow-up was remarkable improvement 10, improvement 1; three cases died of traffic accident or complications not related to chemotherapy and none of them showed relapse of leprosy. Bacterial negativity after onset of OFLX-combined therapy was achieved in about the same periods as RFP-combined therapy. OFLX-combined therapy was effective and safe. This follow-up study supports the efficacy of clinical guideline for the use of new quinolones published by Japanese leprosy Association.

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Prevention of Disability (POD) service needs to be expanded for future reducing the leprosy burden. Tibialis Posterior Transfer Surgery (TPT) is an established procedure and relatively easy to do at district level general hospitals. It can protect further damages of affected foot and consequently reduce patient's social burden as well. Totally 70 TPT surgeries were done during a joint project of JICA¹ on leprosy control and basic health service in Myanmar for training purpose (Jan/2002-Jan/2006). A follow-up assessment was done for exploring the effectiveness of foot drop surgery, in Nov/2006 at 9-selected townships in Mid-Myanmar. 33 cases (Male 22, Female 11) were reviewed and the mean of follow up period was 29.1 months (SD=7.1, 10-48 months). Total results were; good: 25 cases (76%), fair: 4 cases (12%) and poor: 4 cases (12%). In good and fair cases, patients were satisfied with the results and TPT improved the QOL of patients. In almost all cases (32/33, 97%) after TPT, patients are free from plantar ulcer. Most serious complication of operation (4 cases, 12%) identified was inversion deformity due to loosed tension of lateral tail of grafted TP tendon sutured to Extensor Digitorum Longus. From the results of TPT surgery follow-up, it can benefit much to the patients if resources permit to make it as a routine service in more places.

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We have performed a questionnaire to survey the present conditions of the slit skin smear test, a method to diagnose leprosy.
The answer was obtained from 40 (93.0%) out of 43 clinics, department of dermatology of university and other hospitals and leprosy sanatoriums. Slit skin smear test was carried out in most institutions. However, when inspection frequency was low, a laboratory technician performed Ziehl-Neelsen staining or its variation using a normal slide glass. A few institutions carried out fluorescence staining. Both physician and technician examined the slides in most cases, however, in more than half of the leprosy sanatoriums, technician was the only person examined. Bacterial index was evaluated in most institutions, while only for the presence of bacteria was examined 5 institutions.
Slit skin smear test is simple and easy, but accuracy is different with skills, glass slides to be used and methods for staining and inspection. Supply of the glass slide with a marker, the spread of staining methods, technical improvement of an inspection are demanded in future.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Although Mycobacterium shinshuense and M. leprae infections are relatively rare in the fields of dermatology, an early diagnosis is one of the important prognostic factors of these infections. Applications of the genetical examinations such as PCR and 16S rDNA sequencing are helpful in early diagnosis with culture nagative cases. Short target PCR tests are available to detect DNA of M. shinshuense or M. leprae from clinical specimens including formalin fixed-paraffin embedded samples. A partial 16s rDNA sequencing is functional with enough intact bacterial DNA. A similarity search based on the partial 16S rDNA sequences using RIDOM database is an easy and powerful tool to estimate the species of mycobacteria, however, it is not enough for the identification in some cases. For instance, a clinical isolate of M. shinshuense is clearly discriminated from M. leprae (92.75% sequence identity), however, difficult to be identified from M. marinum and M. ulcerans (99.77% sequence identity). The phylogenetic tree based on 16S rDNA sequences is illustrating that both M. leprae (closely related to M. haemophilum) and M. shinshuense (closely related to M. marimum and M. ulcerans, and also M. tuberculosis) are relatively related species and distantly related to rapidly growing species among 30 species of pathogenic mycobacteria which have been isolated in Japan.

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As the number of whole genome sequences available continues to increase rapidly, the raw scale of the sequence data being used in analysis is the first hurdle for comparative genome analysis. When performing whole genome alignments, large-scale rearrangements make it necessary to first find out roughly which short well-conserved segments correspond to what other segments (termed anchors). Successful results have been achieved by adapting tools like BLAT and BLASTZ on a problem-to-problem basis, but the work required to perform a single alignment is considerable. Recently, new programs such as Mauve and Pattern-Hunter can handle slightly larger inputs, but the memory/time requirements for sequences like Human and Chimp X chromosomes are prohibitive for most computational environments.
Our novel algorithm, which we have implemented in a program called Murasaki (available at http://murasaki.dna.bio.keio.ac.jp), makes it possible to identify anchors of multiple large sequences on the scale of several hundred megabases (e. g. three mammal chromosomes) in a matter of minutes. We also demonstrate an application of Murasaki to the comparative analysis of multiple mycobacteria genomes.

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