Myanmar Oxford Clinical Research Unit

Protocol (2023): https://doi.org/10.1002/14651858.CD015234.

This article explores applying regenerative development approaches in an Amsterdam-based university course on “Education and International Development” during the COVID-19 pandemic. A transnational team examined possibilities and challenges in virtual/hybrid learning, focusing on co-creative pedagogies to enhance engagement and mutual learning. The study uses auto-ethnographic narratives, reflection questions, and student insights to reflect on critical, transgressive, decolonising, and contemplative pedagogies. Findings highlight three design premises for regenerative approaches to higher education: paradigm shifting for purpose-driven education; living system thinking for co-creative pedagogy; and holistic developmental learning for being-education. This research contributes to innovative educational practices in international fields of study and invites readers in a reflective reading experience.

AimsResistance to the artemisinins and the artemisinin‐based combination therapy (ACT) partner drugs has developed in Southeast Asia, and artemisinin resistance has also emerged in eastern Africa. Triple ACTs (triple artemisinin‐based combination therapies, TACT), consisting of two partner drugs with different mechanisms of action and similar pharmacokinetic profiles, combined with an artemisinin derivative can help to delay or prevent artemisinin resistance and prolong the useful lifetime of the partner drugs. This study aims to characterize the pharmacokinetic properties of a recommended TACT, artemether‐lumefantrine plus amodiaquine, using data from two large clinical trials.MethodsWe analysed data from two randomized, controlled intervention trials conducted between 2015 and 2020 in one African country and two Southeast Asian countries, in which artemether‐lumefantrine was administered alone (n = 443) or together with amodiaquine (n = 442) to patients with uncomplicated P. falciparum malaria. Both studies included a sub‐cohort with dense pharmacokinetic sampling, combined with sparse data in the other patients. Concentration–time data of artemether, dihydroartemisinin, lumefantrine, desbutyllumefantrine, amodiaquine and desethylamodiaquine were analysed using nonlinear mixed‐effects modelling.ResultsPharmacokinetic models were developed for all drugs and demonstrated good predictive performance and goodness‐of‐fit diagnostics. Coadministered amodiaquine was not a significant covariate on pharmacokinetic properties of artemether‐lumefantrine. Model‐predicted Cmax and AUC (median [95% confidence interval, CI]) for artemether were 256 (159–407) ng/mL and 2850 (1820‐4920) h·ng/mL for artemether‐lumefantrine alone, and 230 (123–391) ng/mL and 2800 (1570‐4570) h·ng/mL for artemether‐lumefantrine‐amodiaquine. For dihydroartemisinin, values were 135 (54.5–214) ng/mL and 1870 (813–3015) h·ng/mL for artemether‐lumefantrine alone, and 116 (40.8–186) ng/mL and 1580 (547–2680) h·ng/mL for artemether‐lumefantrine‐amodiaquine. For lumefantrine, values were 15.2 (2.90–31.3) μg/mL and 600 (275–1230) h·μg/mL for artemether‐lumefantrine alone, and 14.1 (2.72–31.4) μg/mL and 586 (269–1070) h·μg/mL for artemether‐lumefantrine‐amodiaquine. Day 7 concentrations of lumefantrine were 452 (215–1240) and 438 (204–1030) μg/mL for artemether‐lumefantrine alone and artemether‐lumefantrine‐amodiaquine, respectively. All geometric mean ratios (GMRs) for the drug–drug interaction (DDI) effect on key pharmacokinetic parameters of artemether, dihydroartemisinin and lumefantrine fell within the 0.80–1.25 range, with the majority of the corresponding 90% CI also contained within this range. This indicates no clinically relevant DDIs between artemether‐lumefantrine and amodiaquine.ConclusionsThe DDI effect of amodiaquine on the pharmacokinetics of artemether‐lumefantrine is expected to be minimal, the based on the current analysis. However, further large‐scale clinical trials are needed to confirm this finding.

Combat-related liver injuries are among the most challenging abdominal traumas due to the high risk of massive hemorrhage, complex associated injuries, and limitations in battlefield medical resources. Rapid surgical intervention remains the cornerstone of management, particularly when non-operative management is not feasible. In this case series, two soldiers with liver injuries underwent emergency laparotomy with direct repair, both later complicated by biloma formation. These were successfully treated with ultrasound-guided pigtail drainage, avoiding reoperation and facilitating recovery. Both patients were discharged in stable condition following structured multidisciplinary care. The cases underscore the critical role of timely surgical intervention, vigilant imaging surveillance, and minimally invasive drainage techniques in reducing morbidity. The integration of damage control principles, early resuscitation, and vigilant postoperative care has significantly improved survival in recent years. A notable complication in liver injuries is the development of bilomas, which may prolong recovery and increase morbidity if not promptly addressed. Minimally invasive approaches, such as ultrasound-guided pigtail catheter drainage, have proven highly effective in managing these collections, avoiding the need for reoperation and reducing patient burden. The application of such adjunctive techniques, alongside critical care support and early mobilization, reflects the evolving standards of combat trauma management. Lessons drawn from these experiences emphasize the importance of multidisciplinary collaboration, adaptability in resource-limited settings, and the translation of combat trauma strategies to civilian practice. Article Details

Introduction: Case-Based Learning (CBL) is increasingly used in modern medical schools to improve students' critical thinking and problem-solving skills. While CBL is established in Western Resource-Structured (WRS) educational settings, its use in Asian-Pacific regions like Myanmar is under explored. This research studied the integration of CBL at the Defence Services Medical Academy (DSMA) in Myanmar, focusing on the perspectives of both students and faculty involved in curriculum reforms. Methods: This study used constructivist grounded theory to gather data from 24 DSMA participants through four focus group discussions. Twelve students and twelve faculty members, were invited a subgroup of six, and after providing informed consent discussed their experiences of CBL, aiming to assess its effectiveness and relevance in their specific educational and cultural context. Result: Analysis shows that students valued CBL for enhancing group discussions, reflecting upon real-world situations, and building critical thinking abilities. Faculty members also appreciated CBL for its capacity to create realistic applications and its support for student-centered learning and interpersonal skills development. Both groups acknowledged CBL as an effective method for simulating the complexities of medical practice. Conclusion: This study found that CBL is well-regarded at DSMA for preparing students competence and confidence for clinical encounters. However, faculty indicated that the extensive time required in preparation of this teaching modality was a significant challenge for the wider adoption of CBL. These insights highlight the adaptability and potential challenges of implementing CBL in non-Western educational settings and suggest possible areas for development for its broader application in the Asia-Pacific region. Keywords: Medical Education, Case-based Learning, Perceptions, Grounded Theory, Focus Group Discussion

Pemphigus vulgaris (PV) is a chronic autoimmune disease causing painful oral erosions and fragile skin blisters, severely impacting quality of life. This case report presents a 69-year-old female patient in Myanmar with PV complicated by diabetes, hypertension, and thromboembolic conditions. Her extensive skin involvement, severe pain, and recurrent infections emphasized the need for a multidisciplinary approach to management. Palliative care interventions focused on holistic, patient-centered strategies, including effective pain relief with pre-procedural analgesia, meticulous wound care, and strict infection control. Psychological support significantly improved her mental well-being and daily functioning. The case highlights the urgent need for enhanced patient education, continuous follow-up, and structured psychosocial support to optimize treatment outcomes. By implementing these measures, healthcare providers can ensure a more comprehensive approach, improving long-term care and patient satisfaction for individuals living with PV.

Abstract This chapter grapples with the issue of power in Myanmar prisons. It is about punishment, the disciplinary system, and the ubiquity of violence. Taking point of departure in the idea that power is not pregiven or intrinsic but is produced in practice, we look at how power is exercised in everyday lived experience through practices of punishment and discipline that are laced with violence. Our orientation is to power as diffusely distributed and exercised and performed in ways that are often accepted as habitual and natural by all parties. The often-brutal structures and practices we describe conspire to generate the compliance and subjection of the prisoner and the production of an orderly prison. Our examination and delineation of these practices complete our characterisation of prisons in Myanmar as bureaucratic, martial, and violent marketplaces with authoritarian pretensions.

A 64-year-old woman presented with a 10-day history of fatigue, loss of appetite and insomnia.She received living-related kidney transplant from her son 6 years ago for end stage renal disease due to diabetes mellitus.She had tinge of jaundice, anemia and tachycardia.She had anemia, neutrophil leukocytosis, low platelet count, severe hyponatremia, transaminitis, high blood sugar and high serum creatinine.Urine culture revealed Escherichia coli sensitive to levofloxacin; she was treated accordingly.Dose reduction of mycophenolate mofetil was done.She developed frank hematuria on 'Day 10' after admission; ultrasound of graft kidney revealed echogenic foci with posterior shadowing in the calyces with elevated resistive indices.Cystoscope showed multiple hemorrhagic areas in whole bladder mucosa which easily bleed on touch.CT abdomen demonstrated swollen allograft kidney with air in the renal pelvic, subcapsular area and air along bladder wall suggestive of emphysematous pyelonephritis and cystitis.The patient deteriorated rapidly; DIC and acute kidney injury.It was followed by acute pulmonary edema, ARDS and cardiac arrest.

The G-res tool shows only a part of the climate impact of tropical hydropower reservoirs because several emission pathways are not included and it does not address the change in surface albedo.