ObjectiveThe first is to estimate the prevalence of dyslipidaemia (hypercholesterolaemia, hypertriglyceridaemia, high low-density lipoprotein (LDL) level and low high-density lipoprotein (HDL) level), as well as the mean levels of total cholesterol, triglyceride, LDL and HDL, in the urban and rural Yangon Region, Myanmar. The second is to investigate the association between urban-rural location and total cholesterol.DesignTwo cross-sectional studies using the WHO STEPS methodology.SettingBoth the urban and rural areas of the Yangon Region, Myanmar.ParticipantsA total of 1370 men and women aged 25–74 years participated based on a multistage cluster sampling. Physically and mentally ill people, monks, nuns, soldiers and institutionalised people were excluded.ResultsCompared with rural counterparts, urban dwellers had a significantly higher age-standardised prevalence of hypercholesterolaemia (50.7% vs 41.6%; p=0.042) and a low HDL level (60.6% vs 44.4%; p=0.001). No urban-rural differences were found in the prevalence of hypertriglyceridaemia and high LDL. Men had a higher age-standardised prevalence of hypertriglyceridaemia than women (25.1% vs 14.8%; p<0.001), while the opposite pattern was found in the prevalence of a high LDL (11.3% vs 16.3%; p=0.018) and low HDL level (35.3% vs 70.1%; p<0.001).Compared with rural inhabitants, urban dwellers had higher age-standardised mean levels of total cholesterol (5.31 mmol/L, SE: 0.044 vs 5.05 mmol/L, 0.068; p=0.009), triglyceride (1.65 mmol/L, 0.049 vs 1.38 mmol/L, 0.078; p=0.017), LDL (3.44 mmol/L, 0.019 vs 3.16 mmol/L, 0.058; p=0.001) and lower age-standardised mean levels of HDL (1.11 mmol/L, 0.010 vs 1.25 mmol/L, 0.012; p<0.001). In linear regression, the total cholesterol was significantly associated with an urban location among men, but not among women.ConclusionThe mean level of total cholesterol and the prevalence of hypercholesterolaemia were alarmingly high in men and women in both the urban and rural areas of Yangon Region, Myanmar. Preventive measures to reduce cholesterol levels in the population are therefore needed.
This paper examines the situation of rurally rooted cross-border migrant workers from Myanmar during the Covid-19 pandemic. It looks at the circumstances of the migrants prior to the global health emergency, before exploring possibilities for a post-pandemic future for this stratum of the working people by raising critical questions addressed to agrarian movements. It does this by focusing on the nature and dynamics of the nexus of land and labour in the context of production and social reproduction, a view that in the context of rurally rooted cross-border migrant workers necessarily requires interrelated perspectives on labour, agrarian, and food justice struggles. This requires a rethinking of the role of land, not as a factor in either production or social reproduction, but as a central component in both spheres simultaneously. The question is not ‘whether’ it is necessary and desirable to forge multi-class coalitions and struggles against external capital, while not losing sight of the exploitative relations within rural communities and the household; rather, the question is ‘how’ to achieve this. It will require a messy recursive process, going back and forth between theoretical exploration and practical politics.
Background: Doxorubicin is the most preferred cytotoxic agent to be incorporated in chemotherapy regimens for breast cancer. However, its use is limited by cardiotoxicity which cannot be predicted using currently available methods. Plasma deoxyribonucleic acid topoisomerase 2b level (DNA Top 2b) is potential to be an early predictor of anthracycline-induced cardiotoxicity. Aim of the study is to assess the implications of plasma DNA Top 2b level in breast cancer patients receiving a doxorubicin-based chemotherapy regimen. Methods: All newly diagnosed breast cancer patients, who were going to receive a new course of doxorubicin-based chemotherapy was recruited over 12 months and assessed comprehensively in No. (2) Military Hospital (500-Bedded). After informed consent, eligible patients received six cycles of doxorubicin-based chemotherapy with serial serum troponin I and LVEF assessments on the day after each cycle. LVEF <50% or 10% decline from baseline was regarded as indication to stop doxorubicin-based chemotherapy.Results: Among fifty-one patients, mean age was 48.78 years. While mean plasma Top 2b level was 0.43 ng/lg, about a quarter of patients (25.5%) expressed 0.5 ng/lg. There was no significant association between plasma Top 2b level and each baseline clinical characteristics (age, hypertension, diabetes, dyslipidaemia and clinical staging). Throughout chemotherapy, no positive result of serum troponin I was observed while 16 patients had significant LVEF decline. There was significant association between higher Top 2b level ( 0.5 ng/lg) and LVEF decline (P ¼ 0.001). Mean plasma Top 2b level was higher in patients with LVEF decline [0.74 ng/lg (S.D 60.70)] than those without decline [0.29 ng/lg (S.D 60.30)] (P < 0.05). Log-rank test showed that patients expressing higher Top 2b level ( 0.5 ng/lg) had higher propability of LVEF decline over time (p ¼ 0.001). Conclusions: LVEF decline is associated with higher plasma DNA Top 2b level in breast cancer patients receiving doxorubicin-based chemotherapy. Given no association with other cardiovascular risk factors, plasma DNA Top 2b is a potential independent biomarker to predict cardiac risk of anthracycline in cancer patients. Legal entity responsible for the study: Defence Services Medical Academy. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.24P Prognostic nomograms for predicting overall and cancer-specific survival in breast cancer patients not achieving pathological complete response after neoadjuvant chemotherapy
Introduction: With the evolution of healthcare needs for the community and the changing trends in medical education in the 21st century, medical educators need to be prepared for their tasks in the coming decades. Medical educator training is crucial but other factors can also affect the development of their competency. This study aims to measure the impact of the medical educators’ training course and find out the key challenges encountered by the medical educators in Myanmar. Methods: A retrospective quantitative design was conducted on 45 respondents by four levels of Kirkpatrick’s model assessment consisting of 39 statements and 9 items of key challenges, using five-point Likert scale. The item scores were analysed as mean and standard deviation, ‘t’ test and ANOVA were used for relationship between impact of training and demographic background. Results: There was significant association between the impact of training and the educational background (p=0.03), job position (p=0.02), and academic year attended (p=0.03). The respondents distinctly agreed that the training increased their knowledge and attitudes and that they could apply the learnt lessons practically in their workplace (minimum 3.750.60 and maximum 4.280.50). Regarding the key challenges, respondents viewed that their institution needed to support more scholarship opportunities and academic recognition; encourage networking and strengthen ICT-based medical education system (minimum 2.550.84 – maximum 4.170.71). Conclusion: This study indicates that enhancing the competency of medical educators with medical educator training programs is effective and useful; but inadequacy of institutional support for faculty development and internet facilities posed challenges in the overall faculty development.
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