 Good morning and good afternoon everybody. Today I want to give you a general picture of anti-microbial use and resistance in Laos. As a demand of the country to present current AMR situation in Laos and to identify the important gaps to inform AMR policy. We reviewed all published and great literatures related to human health, animal health, and environment in Laos language, French, and English. We just focused on battery infections for this time. We screened more than 1,300 peer-reviewed and great literatures and finally 80 of them contain information on antibiotic use and antibiotic resistance in these three sectors. Nearly 70 percent of what we have found were related to AMR in human health. The majority of the data will form epidemiological studies and case studies. Approximately 15 or 16 percent of them will form great literatures, but that contains a big data sense from a big microbiology lab in Laos as well. The most frequently described pathogens were staphylococcus or used, E. coli, carcinia, pneumonia, but during this talk I would just focus on some breast pathogens only. Our main concern is ESBL producing E. coli. As you can see here it increased dramatically during our previous decade. It increased from 7 percent here in 2004 and to 35 percent in 2016. With the more recent data from the same laboratory, the proportion of ESBL producing E. coli is much higher compared to the previous years from Brad and Julian, and if you can see that the proportion in Julian is really serious. So the first MRSA has been reported in Laos in 2002, and the first MRSA bacteria was identified in Laos in 2017. After the first case has been identified, only 16 cases have been reported recently. While you might think that this is so small compared to neighboring countries, but if you take into account that, they still won't go missing in Laos. Most hospitals in Laos do not really have a proper MRSA management program or strategy. This small proportion of MRSA may become a great problem in the near future if you don't have a proper solution, I mean appropriate solution. Well, based on 18 years broad culture data from many hospitals across the country, it seems that someone in Laos, I feel, is still have good susceptibility to the first life antibiotic treatment. Nestlea gonorrhea was fully susceptible to sceptriosone and sphectenomycin. Sceptococcus pneumonia was not commonly identified in Laos. Only three cases reported during 2003-2011, which said that reduced susceptibility to penicillin, cabapenem, lecithin, acinetobacter, bomaniae still have good susceptibility data for other tested antibiotics such as amicocin and sceptricidin. Well, the data on antibiotic use in humans and animal in Laos are so limited. Let's start with AMG in humans first. So the data showed that the proportion of hospital anti-microprescription in Laos could be as high as 70 percent. The most prescribed antibiotic-based beta lockdowns followed by metronidazone and aminocuricosine, ketriarzone accounted for more than 50 percent of them. In some settings, lack of health staff might lead to what choice of antibiotic-deducted prescribed. For example, a doctor would prefer to prescribe ketriarzone with once a day dosing over penicillin, which have to be given four times a day. The reason behind this is to reduce workload for nurses. In community level, self-medication was common. Some participants from a qualitative study said that there's no point to see a doctor every single time that they have fever or illness because they can't access antibiotics easily without the prescriptions. A heresicine behavior also showed that 80 percent of those who sell medicated access the antibiotics from pharmacies, and some of them also got antibiotics from groceries. Here is AMR and AMDU dashboard, anti-microbial consumptions, and anti-microbial use dashboard, which reduce to monitor the antibiotic use and consumptions in the country. So how about AMR and AMDU in in the most sector in Laos? AMR data on food productions in Laos mostly focused on someone in Laos Basie and E. coli in livestock and poultry. Early parts of a study from a Wally Lee Moore earlier of Laos showed that 8 percent of 252 production animal can leach ESBR producing E. coli. Another study described polystyrene-resistant E. coli in pigs and the pigs or not. The recent study also revealed polystyrene-resistant E. coli and in chicken and chicken meat. Please bear in mind that polystyrene is not available for human use in Laos. So far, we don't have any antibiotic leach assistance system for animal use in Laos, so this might be a problem fairly very soon. While data on AMDU in food production in Laos are so limited, we could only find one peer review and full grade literature during our review period, but all of them focus on domestic animal and antibiotic use for infectious disease treatment. The first available data on antibiotic use in production anymore was sorry, can you hear me? Sorry, the first available data on antibiotic use in production anymore in Laos was just released in 2021. Data showed that nearly half chicken farms and more than half a pigs farm from this survey admitted that they use antibiotic in their farms. Sorry, they use antibiotic in their farms and less than 50% claim that they use it for the growth promotion, but majority of them use it for treatment. We have not seen any data on AMR and AMDU in Laos aquaculture. Well, there is only one publication related to AMR pathogens contaminating in the environment in back home liver, but we haven't seen any information about antimicrobial juice in environment. They will give us some picture on AMR and AMDU surveillance in Laos because the data is quite sparse and yeah, I think we can do something more about it, but it helps us to identify which AMR pathogens is more critical. There are some sparse data, but it raises some hidden problems in Laos, such as cholestine-resistant bacteria, which many people believe that does not exist in Laos. Lack of guideline and proper stewardship program and training might lead to very high antimicrobial proportion. Antimicrobial prescription proportion in Laos. This will clearly show that AMR and AMDU data in food production anymore in environment sectors in Laos are so limited. What can we do from here with the results that we have to improve this situation? Suggestions could be increased coordination or collaborations within and between sectors. In Laos now, we tend to work on our own department, our own sectors, like human health separately, animal health separately. Yeah, maybe it's a time that we can work more together and then making sure that the system, the sewering system comprehensively and effectively function. Increased liquidation on antibiotic use in both sorry, in both human and animal sector, making sure that the country have access to appropriate antibiotic when needed, as well as control the use of some blood spectrum antibiotic, and lastly, such antibiotic in both human and animal sectors. We also do some interventional study now by comparing those who get, we introduce our guideline. This is the first antimicrobial juice guideline in paper-based format and in mobile format. We would like to compare these two past the stewardship training to see the change in the antimicrobial prescription in Laos. We are on the middle stage of this study. So if COVID allows, we will be able to give you more some data and discuss in the next year. Thank you very much. Thank you very much. That was great.