Reflections: Evolution of PBL in the International Medical University

This paper traces the evolution of PBL in the International Medical University over a period of twenty years; since its inception in 1992 till 2012. It is a record of the reasons for the evolution, the people involved and the strategies adopted. The PBL in IMU has metamorphosed over the years from a paper-based complete case history into its present form of staggered release of information, paper-based or otherwise (videos, web-based, newspaper cuttings, debates). Strategies to improve student and facilitator buy-in, strengthening of facilitator training, adoption of PBL templates, innovations to improve student participation are discussed.

Comparative multiple-dose pharmacokinetics of chloroquine in P. vivax malaria patients and healthy volunteers

Recent evidence of the emergence of resistance of P. vivax to chloroquine in Myanmar has increased the importance and urgency of understanding the cause of resistance as well as the need for devising the strategies to limit its spread. A comparative multiple-dose pharmacokinetic study was conducted on 5 clinically healthy volunteers and 10 malaria patients with P. vivax, admitted to the No. 2 Miliysty Hospital, Yangon, with the object to study whether there is any pharmacokinetic-dynamic relationship underlying the response of patients to standard chloroquine (1500 mg given over 3 days) therapy. Serum chloroquine concentrations reached well above the MIC level in all subjects with the patients' serum concentration (both peak and trough) and the AUC being significantly (2-3 times) higher than jnormal volunteers (p < 0.02). Both the clearance and the volume of distribution were also significantly lower in the malaria patients as compared to the healthy volunteers (p < 0.05). The elimination half-life (T1/2el) was shorter in malaria patients but the difference was not statistically significant. No significant difference was seen with other pharmacokinetic parameters, between normal volunteers and patients and between patients who do and do not recrudescenced. The study supports the emergence of chloroquine-resistant P. vivax in Myanmar and also excludes the possibility of apparent resistance due to pharmacokinetic causes, especially reduced bioavailability.

Comparison between efficacy of oral artemether 480mg and combination of oral artemether 480mg and mefloquine 1000mg in acute uncomplicated p. falciparum malaria

A prospective study comparing the efficacy of Artemether capsule (160 mg. tat and 80 mg. 12 hourly for four doses with a total dose of 480 mg.) as a single drug regimen and a combination drug regimen of Artemether capsule 480 mg. as above together with oral Mefloquine two equal split doses (500 mg 6 hours apart) was carried out at the No. 2, Military Hospital, Yangon during January 1993 and September, 1993. 30 patients were included in oral Artemether single drug regimen and 35 patients were included in oral Artemether and Mefloquine combination drug regimen. The mean age of two groups were 25.82 years and 25.37 years respectively. The initial parasite counts were 13736 and 16879 per microlitre respectively. All patients cleared the parasites initially in both groups. However, 12 patients (40 percent) recrudesced as RI cases in Artemether single drug regimen and thus cure rate was 60 percent. In combination drug regimen group 2 patients (5. 71 percent) recrudesced and cure rate was 94.29 percent. The parasite clearance time (PCT), fever clearance time (FCT) and 50 percent reduction time were compared in both groups and the results were 44.85*** 19.01 hours, 26.56*** 14.14 hours, 40.25*** 16.76 hours, 23.77*** 18.69 hours and 14.28*** 10.11 hours, 12.94*** 6.86 hours respectively. Significant side effects were not noted among patients in both groups. This study showed that Artemether capsule and Mefloquine combination drug regimen has higher efficacy interms of PCT, FCT and 50 percent reduction time than Artemether capsule single drug regimen for patients with acute uncomplicated falciparum malaria in Myanmar.

Study Habits and class performance of second M.B.,B.S. Students

This study was conducted on Second M.B.B.S students (11/92 batch) of IM (1), to fulfill three objectives viz. to get students feedback on the course; to give the students an opportunity to evaluate the staff and our Department's performance and to relate study habits to class performance. Results to the first two objectives have already been reported else where (MEU Newsletter, IM (1), August, 1993), so this paper focuses on the last objective. Questionnaires were given to 220 students, of whom 98 responded. Students' achievement was assessed taking into consideration the number of distinctions gained in the Matric and First M.B.B.S class; number of times they made it to the Departmental Top-Ten list; and the number of tests passed in the three disciplines. Aspects of study habits interrogated include reading of text books; making notes; revising at weekends; number of hours of study; answering old questions. We found that there is much room for improvement in the study habits of our students.

Renal function, plasma sodium and osmolality during the menstrual cycle

In order to assess whether hormonal changes occurring during the menstrual cycle affect function, glomerular filtration rate (C cr), and proximal tubular reabsorption of sodium and water (lithium clearance; C li) were assessed in 9 healthy women in 2 phases of the menstrual cycle. Plasmar sodium and osmolality were also measured. Each subject was studied three time ("basal", "proliferative" and "luteal" phases), point on her customary sodium intake, and in a controlled (sitting) posture. There were no significance differences between the phases with respect to any of the renal variables studied. There was a significantly lower plasma sodium in the luteal phase, and a trend towards lower plasma osmolality.

Renal lithium clearance in essential hypertension

There is considerable interest in whether a defect in renal sodium handling is important in the development of essential hypertension. A recent report indicated that the proximal tubule might be involved, since fractional lithium clearance, a measure of the fraction of filtered sodium reaching the end of the proximal tubale, was reduced in hypertentive patients. However, ther were a number of objectionable points in that paper. In the present study, we measured clearances of creatinine (C cr), lithium, (C li) and sodium (C na) in 21 hypertensive patients and 21 controls matched for age, sex and ethnic background. Clearances were measured over a 4-h period during which the subject were seated. The result provide no evidence for altered proximal tubular sodium handling in essential hypertension under the conditions of the study.

Study on the energy expenditure and physical fitness of dockyard workers

The energy expenditure and physical fitness of dock workers engaged in manual labour (carrying a 711 kg rice sack) is determined. It is found that they are expending 7.62 kcal/min and working at 72.04 percent of their maximal aerobic capacity. As the work iutensity exceeded 50 percent of their maximal aerobic capacity, it is suggested that for the workers to work safely either the weight of the rice sack should be reduced or select suitable type of man fitting to the task.