Background In Vietnam, a rapid decline of P . falciparum malaria cases has been documented in the past years, the number of Plasmodium falciparum malaria cases has rapidly decreased passing from 19.638 in 2012 to 4.073 cases in 2016. Concomitantly, the spread of artemisinin resistance markers is raising concern on the future efficacy of the ACTs. An evaluation of the clinical impact of the artemisinin resistance markers is therefore of interest. Methods The clinical effectiveness of dihydroartemisinin-piperaquine therapy (DHA-PPQ) has been evaluated in three districts characterized by different rates of ART resistance markers: K13(C580Y) mutation and delayed parasite clearance on day 3 (DPC3). Patients were stratified in 3 groups a) no markers, b) one marker (suspected resistance), c) co-presence of both markers (confirmed resistance). In the studied areas, the clinical effectiveness of DHA-PPQ has been estimated as malaria recrudescence within 60 days. Results The rate of K13(C580Y) ranged from 75.8% in Krong Pa to 1.2% in Huong Hoa district. DPC3 prevalence was higher in Krong Pa than in Huong Hoa (86.2% vs 39.3%). In the two districts, the prevalence of confirmed resistance was found in 69.0% and 1.2% of patients, respectively. In Thuan Bac district, we found intermediate prevalence of confirmed resistance. Treatment failure was not evidenced in any district. PPQ resistance was not evidenced. Confirmed resistance was associated to the persistence of parasites on day 28 and to 3.4-fold higher parasite density at diagnosis. The effectiveness of malaria control strategies was very high in the studied districts. Conclusion No treatment failure has been observed in presence of high prevalence of ART resistance and in absence of PPQ resistance. K13(C580Y) was strongly associated to higher parasitemia at admission, on days 3 and 28. Slower parasite clearance was also observed in younger patients.
The curriculum in teaching anatomy is under increasing pressure to transform from traditional to interdisciplinary integration, from cadaver-based to multimodal instruction with a system-based approach. Educational technologies are becoming critical and urged to be integrated into teaching medicine. At the College of Health Sciences, VinUniversity, the block of Human Body Structure and Function (HBSF) within the undergraduate medical training program was designed to teach anatomy with relevant basic medical sciences based on the principles of the system-based integrated structure. To support students in achieving the intended learning outcomes, multiple innovative technological platforms have been introduced into the curriculum using the moderation of the Adaptation – Standardization – Integration – Compliance (ASIC) framework over four key terms: adaptation, standardization, integration, and compliance. In this paper, the process for curriculum development is presented with an illustration of the selected technological platforms and the lessons learned using the ASIC model.
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