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In recent days, Lumpy Skin Disease (LSD) has been portrayed as a terrifying threat to cattle in Southeast Asia. A lump like nodules in the external skin and mucus membrane with fever and swollen lymph nodes are the preliminary noticeable signs for this devastating disease. It is commonly an arthropod-borne contagious illness, correspondingly the non-vector spreading through body discharge and infected fomites. A pronounced socio-economic collapse is driven by reduced quantity and quality of milk, udder infection, low quality hides, loss of draught power, abortion, infertility, limitation to meat ingestion, higher morbidity, etc. Animals of any age and gender are susceptible to disease. The morbidity rate varies accordingly immune status of animal and frequency of mechanical vectors. Primarily the disease was endemic in most Sub-Saharan regions of Africa, consequently extent to Middle-East, Europe, and Asia. In the South-Eastern part of Asia, the disease has first been introduced in Bangladesh in July 2019 followed by China, India, Nepal, Bhutan, Vietnam, Hong Kong and Myanmar. Bangladesh recorded the maximum attack rate in Chattagram whereas at Cuttack in India. Particular vulnerable locations of other countries are yet to be confirmed. There is no epidemiological proceeding considering the present LSD situation report from rest of Asia. Strict quarantine, vector control, and prophylactic vaccine might be the best remedy for limiting the disease risk factors. However, validated future studies for measuring true disease burden and profound factors in the perspective of geographic distributions are indispensable. [ J Adv Biotechnol Exp Ther 2021; 4(3.000): 322-333]

Breastand reductions mastopexies continue to rank among the most frequently performed plastic surgical procedures worldwide. While there exists a consensus on several aspects of the procedure, a plethora of controversies remain. This study aims to compare the most relevant peri- and intra-operative factors on an international level to standardize this common procedure according to evidence-based guidelines. A questionnaire was sent to over five thousand surgeons in 77 countries. The survey was divided into three categories according to the volume of removed breast tissue (50–500 g, 500–1000 g, and > 1000 g) and inquired about standard practices, secondary procedures, use of new technologies, current controversies, and surgeon demographics. The results were evaluated and correlated with evidence-based literature. A total of 1431 surveys were gathered, corresponding to a response rate of 29%. It was found that specific surgical approaches and standard practices prevail on an international basis. Still, there exist controversies that seem to be linked to geographic locations. For instance, irrespective of resection weight, in the majority of countries, a superior or superomedial pedicle is used most frequently, while in North America and South East Asia, the inferior-based pedicle is preferred. We identified common traits in several aspects of breast reduction surgery. However, in this study, it became apparent that international practice patterns remain incoherent. Seen from a global perspective, plastic surgeons would thus still benefit from high-quality studies to further establish evidence-based, standardized, and universally applicable practice guidelines. Level of Evidence: Not gradable

Dhat syndrome is a culture-bound syndrome, mostly prevailed in South East Asia that has been systematically defined approximately six decades ago. Assessment of the published literature would help to identify the research density as well as the gaps. We aim to do a bibliometric analysis of published global scientific literature on dhat syndrome. The Scopus database was systematically searched by using the keywords “Dhat syndrome”, “Semen loss syndrome”, “Semen loss anxiety” from inception to 11th August 2021. A total of 89 articles on dhat syndrome were found in the Scopus database. Most of the articles were from India and were published in the Indian Journal of Psychiatry and Asian Journal of Psychiatry. The majority (>58%) of research on dhat syndrome was published in the last decade. The PGIMER (Chandigarh), AIIMS (New Delhi) & KGMU (Lucknow) are the leading institutes in dhat syndrome research. The year 2004 had the highest number of total citations (n = 135), while the year 1975 had the highest number of citations per article (60 citations per article). This bibliometric review identified that despite dhat syndrome is a common condition in the South East Asian countries, research on the condition is limited.

Aims: Early clinical data indicate that both the susceptibility to infection and the outcomes (e.g., death) of COVID-19 are strongly associated with pre-existing clinical conditions and diseases, especially cardiovascular disease (CVD). A preliminary epidemiological study, based on five months of diagnosed cases for COVID-19, for the beginning of the pandemic, January to 06 June 2020, was undertaken for the six major global regions: Europe, The Americas, Western Pacific, Eastern Mediterranean, South-East Asia and Africa, covering 173 infected countries. Methods: Pre-existing medical conditions that were considered to affect the number of infections by SARS-CoV-2 virus, and death by COVID-19 were the prevalence of CVD, diabetes mellitus (DM), Human Immunodeficiency Virus (HIV) and Tuberculosis (TB). A comparison was done to establish correlation, if any, between the prevalence of these four comorbid diseases and the observed number of COVID-19 cases (infections) and deaths, by Pearson correlation analysis Findings: The global prevalence of the four pre-existing diseases is: CVD (1 332,1 million, 17,2%) > DM (686,4 million, 8,9%) > HIV (37,9 million, 0,8%) > TB (6,2 million, 0,08%), and is ranked as follows per region (% of global): CVD: Western Pacific 29,05% > South-East Asia 26,26% > America 16,65% > Europe 14,32% > Eastern Mediterranean 8,32% > Africa 6,31%; DM: South East Asia : 27,32% > Western Pacific: 24,42% > Eastern Mediterranean: 15,51 > The Americas (14,94) > Europe: 9,08 > Africa: 8,73%; HIV : Africa (74,9) > The Americas (10,3) > Europe (6,6) > Western Pacific (5,4) > Eastern Mediterranean (1,5) > South-East Asia (1,30); TB : Africa (39,5%) > Western Pacific (31,0) > Eastern Mediterranean(13,1%) > South-East Asia (7,6%) > The Americas (4,7%) > Europe (4,1%). The most common comorbid conditions for COVID-19 patients are, in decreasing prevalence: CVD > DM > HPT > Chronic Obstructive Pulmonary Disease > HIV > cerebrovascular disease/obesity > cancer/smoking/chronic kidney disease > TB. Within regions: for The Americas, there was a significant correlation between deaths due to underlying DM. Four regions had a significant correlation for underlying CVD: Europe: Infection due to CVD; Eastern Mediterranean: Infection due to CVD; South-East Asia: Deaths due to CVD and TB; Western Pacific: Deaths due to CVD; Africa: Infection due to HIV. Across regions: South-East Asia: ranked first as having a significant correlation for deaths due to CVD and TB, followed by Western Pacific: deaths due to CVD, Americas: deaths due to DM, Europe: infection due to CVD, Africa: infection due to HIV, and the Eastern Mediterranean: infection due to CVD. The global COVID-19 CFR, based on total deaths and cases, at 16 August 2020, is 3,58%. The approximate CFR for COVID-19 patients with comorbidity is: 10,6% ± 1,1 for CVD, 9,4% ± 5,6 for DM and 6,0% ± 0 for HPT. The South-East Asia region appeared to have a significant correlation, for all 4 co-morbid conditions, and risk of infection by SARS-CoV-2, and deaths by COVID-19, in decreasing rank: deaths vs TB/CVD > deaths/cases vs DM > deaths vs HIV. Conclusions: The common global diseases (CVD, DM, HIV, TB) are also risk factors for SARS-CoV-2 infection and deaths by COVID-19, in decreasing rank: CVD > DM > HIV > TB. Continents, and countries, with currently high proportional mortality due to non-communicable diseases, (CVD and DM), like South-East Asia, appear to be at higher risk for infection and death by COVID-19, compared to those with higher proportionality due to communicable diseases (HIV, TB), like Africa. The high number of case infections and death due to COVID-19 in the Western Cape appears to be similar to that for The Americas, where DM appears to be a significant comorbid condition.

Artemisinin resistance (AR) emerged in South East Asia 13 years ago and the identification of the resistance conferring molecular marker, Plasmodium falciparum Kelch 13 (Pfk13), 7 years ago has provided an invaluable tool for monitoring AR in malaria endemic countries. Molecular Pfk13 surveillance revealed the resistance foci in the Greater Mekong Subregion, an independent emergence in Guyana, South America, and a low frequency of mutations in Africa. The recent identification of the R561H Pfk13 AR associated mutation in Tanzania, Uganda and in Rwanda, where it has been associated with delayed parasite clearance, should be a concern for the continent. In this review, we provide a summary of Pfk13 resistance associated propeller domain mutation frequencies across Africa from 2012 to 2020, to examine how many other countries have identified these mutations. Only four African countries reported a recent identification of the M476I, P553L, R561H, P574L, C580Y and A675V Pfk13 mutations at low frequencies and with no reports of clinical treatment failure, except for Rwanda. These mutations present a threat to malaria control across the continent, since the greatest burden of malaria remains in Africa. A rise in the frequency of these mutations and their spread would reverse the gains made in the reduction of malaria over the last 20 years, given the lack of new antimalarial treatments in the event artemisinin-based combination therapies fail. The review highlights the frequency of Pfk13 propeller domain mutations across Africa, providing an up-to-date perspective of Pfk13 mutations, and appeals for an urgent and concerted effort to monitoring antimalarial resistance markers in Africa and the efficacy of antimalarials by re-establishing sentinel surveillance systems., Graphical abstract Image 1, Highlights • Indigenous Pfk13 resistance associated mutations have been identified in Africa • Currently, only 4 African countries have reported 6 (M476I, P553L, R561H, P574L, C580Y and A675V) of the 10 validated artemisinin resistance associated mutations • The 6 mutations though identified at low frequencies are an early warning signal for Africa, since a rise in frequency and their spread to other countries could be catastrophic for malaria control • Africa needs a concerted and systematic approach to monitoring Pfk13 mutations (beyond the few research studies published across Africa) and antimalarial efficacy through a re-establishment of sentinel surveillance platforms

The aquatic macrophyte Ipomoea aquatica Forssk. is widely distributed in many countries of Asia, Africa, North America, and Australia. It is found in the wild as well as cultivated and consumed as a vegetable in South and South East Asia. When I. aquatica was exposed to low concentrations (0.01–2 mg L− 1) of Cr (VI) for a 15 day period, it was observed that concentrations as low as 0.01 mg L− 1 could cause reductions in protein and carbohydrate content in leaf, upper and lower stem of the plant. Cr (VI) could also increase catalase activity in leaf and lower stem at 1–2 mg Cr (VI) L− 1, though the increments in the upper stem were not statistically significant. Induction of proline occurred in leaf and upper stem at 1–2 mg Cr (VI) L− 1. On the other hand, the induction of proline in lower stem occurred at 0.01 mg Cr (VI) L− 1 on 15 d. Thus, the study revealed that Cr (VI) could cause toxic effects on I. aquatica at relatively low and environmentally relevant concentrations, though the plant mitigated these effects through enhanced activities of anti-oxidant enzymes such as catalase and increased accumulation of the non-enzymatic anti-oxidant proline.

The World Health Organization (WHO) set targets for a 90% reduction in the incidence of syphilis and gonorrhoea between 2018 and 2030. We review trends in sexually transmitted infections in the WHO South-East Asia Region to assess the feasibility of reaching these targets. Myanmar, Sri Lanka and Thailand reported 90% or greater reductions in the incidence or prevalence of syphilis and/or gonorrhoea between 1975 and 2005. Evidence suggests that smaller, more recent reductions in trends in sexually transmitted infections in India have driven regional declines. In other countries, sexually transmitted infections remain high or are increasing or data are not reliable enough to measure change. Sri Lanka and Thailand have strong control programmes for sexually transmitted infections that ensure universal access to services for these infections and targeted interventions in key populations. India and Myanmar have implemented targeted control efforts on a large scale. Other countries of the region have prioritized control of human immunodeficiency virus, and limited resources are available for other sexually transmitted infections. At national and subnational levels, data show rapid declines in sexually transmitted infections when targeted promotion of condom use and sexually transmitted infection services are scaled up to reach large numbers of sex workers. In contrast, recent outbreaks of sexually transmitted infections in underserved populations of men who have sex with men have been linked to rising trends in sexually transmitted infections in the region. A renewed and focused response to sexually transmitted infections in the region is needed to meet global elimination targets.L'Organisation mondiale de la Santé (OMS) a fixé des objectifs pour réduire à 90% l'incidence de la syphilis et de la gonorrhée entre 2018 et 2030. Nous avons étudié les tendances en matière d'infections sexuellement transmissibles dans la Région d'Asie du Sud-Est de l'OMS afin d'évaluer la faisabilité de ces objectifs. Le Myanmar, le Sri Lanka et la Thaïlande ont signalé une diminution de 90% ou plus dans l'incidence ou la prévalence de la syphilis et/ou de la gonorrhée entre 1975 et 2005. Les données semblent indiquer une tendance à la baisse plus récente et moins significative des infections sexuellement transmissibles en Inde, entraînant une décrue régionale. Dans d'autres pays, soit le nombre d'infections sexuellement transmissibles demeure élevé ou continue sa progression, soit les informations disponibles ne sont pas suffisamment fiables pour en mesurer l'évolution. Le Sri Lanka et la Thaïlande ont établi de solides programmes de lutte contre les infections sexuellement transmissibles, permettant d'accéder à des services spécialement conçus pour leur prise en charge et prévoyant une intervention ciblée au sein des populations clés. De leur côté, l'Inde et le Myanmar ont déployé des efforts à grande échelle afin de mener des actions ciblées. D'autres pays de la région ont privilégié la lutte contre le virus de l'immunodéficience humaine; pour les autres infections sexuellement transmissibles, leurs ressources sont limitées. Aux niveaux national et infranational, les données révèlent un rapide déclin des infections sexuellement transmissibles lorsque la promotion ciblée pour encourager l'usage du préservatif et les services dédiés à la prise en charge de telles affections sont renforcés afin de toucher un plus grand nombre de travailleurs du sexe. En revanche, les épidémies d'infections sexuellement transmissibles observées dernièrement au sein de populations défavorisées d'hommes ayant des relations sexuelles avec d'autres hommes ont entraîné une hausse dans la région. Il est donc indispensable d'apporter une réponse remaniée et ciblée face aux infections sexuellement transmissibles dans la région en vue d'atteindre les objectifs mondiaux d'élimination.La Organización Mundial de la Salud (OMS) fijó como objetivo una reducción del 90% en la incidencia de la sífilis y la gonorrea entre 2018 y 2030. Revisamos las tendencias de las infecciones de transmisión sexual en la Región del Sudeste Asiático de la OMS para evaluar la viabilidad de alcanzar estos objetivos. Myanmar, Sri Lanka y Tailandia informaron de reducciones del 90% o más en la incidencia o prevalencia de sífilis y/o gonorrea entre 1975 y 2005. Los datos sugieren que las reducciones más pequeñas y recientes en las tendencias de las infecciones de transmisión sexual en la India han impulsado los descensos regionales. En otros países, las infecciones de transmisión sexual siguen siendo elevadas o están aumentando, o los datos no son lo suficientemente fiables como para medir el cambio. Sri Lanka y Tailandia tienen sólidos programas de control de las infecciones de transmisión sexual que garantizan el acceso universal a los servicios para estas infecciones e intervenciones específicas en poblaciones clave. India y Myanmar han implementado esfuerzos de control específicos a gran escala. Otros países de la región han dado prioridad a la lucha contra el virus de la inmunodeficiencia humana y disponen de recursos limitados para otras infecciones de transmisión sexual. A nivel nacional y subnacional, los datos muestran un rápido descenso de las infecciones de transmisión sexual cuando se amplía la promoción del uso del preservativo y los servicios para las infecciones de transmisión sexual para llegar a un gran número de profesionales del ámbito sexual. Por el contrario, los recientes brotes de infecciones de transmisión sexual en poblaciones desatendidas de hombres que tienen relaciones sexuales con otros hombres se han relacionado con las tendencias al alza de las infecciones de transmisión sexual en la región. Se necesita una respuesta renovada y centrada en las infecciones de transmisión sexual en la región para alcanzar los objetivos mundiales de eliminación.وضعت منظمة الصحة العالمية (WHO) أهدافًا لخفض بنسبة 90% في الإصابة بالزهري والسيلان بين عامي 2018 و2030. نحن نقوم بمراجعة الاتجاهات في الأمراض المنقولة جنسيًا في منطقة جنوب شرق آسيا التابعة لمنظمة الصحة العالمية، لتقييم جدوى الوصول إلى هذه الأهداف. أعلنت كل من ميانمار وسري لانكا وتايلند عن انخفاضات بنسبة 90% أو أكبر في الإصابة بالزهري و/أو السيلان، وانتشارهما بين عامي 1975 و2005. وتشير الدلائل إلى أن الانخفاضات الأصغر والأحدث في اتجاهات الإصابة بالأمراض المنقولة جنسيًا في الهند قد حفزت حدوث انخفاضات إقليمية. في بلدان أخرى، تظل الأمراض المنقولة جنسياً مرتفعة، أو متجهة للازدياد، أو أن البيانات غير موثوقة بشكل كاف لقياس التغيير. يوجد لدى كل من سري لانكا وتايلند برامج قوية لمكافحة الأمراض المنقولة جنسياً والتي تضمن الوصول الشامل إلى خدمات هذه الأمراض والتدخلات المستهدفة في الفئات السكانية الرئيسية. قامت كل من الهند وميانمار بتنفيذ جهود المكافحة المستهدفة على نطاق واسع. منحت بلدان أخرى في المنطقة الأولوية لمكافحة فيروس نقص المناعة البشرية، مع توفير موارد محدودة للأمراض الأخرى المنقولة جنسياً. على المستويين الوطني ودون الوطني، توضح البيانات انخفاضًا سريعًا في الأمراض المنقولة جنسياً عندما يتم توسيع نطاق الترويج المستهدف لاستخدام الواقي الذكري، وخدمات الأمراض المنقولة جنسياً للوصول إلى أعداد كبيرة من المشتغلين بالجنس. في المقابل، فإن الحالات الحديثة لتفشي الأمراض المنقولة جنسياً بين فئات السكان المحرومين من الخدمات من الرجال الذين يمارسون الجنس مع الرجال، قد ارتبطت بالاتجاهات المتزايدة في الأمراض المنقولة جنسياً في المنطقة. هناك حاجة إلى استجابة متجددة ومركزة للأمراض المنقولة جنسياً في المنطقة، وذلك بهدف تلبية الأهداف العالمية للقضاء على الأمراض.世界卫生组织 (WHO) 制定了目标，计划在 2018 年至 2030 年期间将梅毒和淋病发病率降低 90%。我们回顾了 WHO 东南亚地区性传播感染的趋势，以评估实现这些目标的可行性。缅甸、斯里兰卡和泰国报告在 1975 年至 2005 年期间梅毒和/或淋病的发病率或患病率下降了 90% 以上。有证据表明，印度性传播感染趋势近期出现较小幅度的降低，这一结果推动了地区性疾病的减少。在其他国家，性传播感染仍居高不下，或者正在增加，或者数据不足以衡量变化。斯里兰卡和泰国针对性传播感染制定了强有力的控制计划，确保普及针对这些感染的服务，并在关键人群中采取针对性干预措施。印度和缅甸大规模实施了有针对性的防控工作。该地区的其他国家已将人类免疫缺陷病毒的控制列为优先工作事项，用于其他性传播感染的资源有限。数据显示，在国家和国家以下各级层面，当有针对性地推广使用避孕套和扩大针对性传播感染的服务，以便可以惠及大量性工作者时，性传播感染率迅速下降。相比之下，最近在医疗资源不足地区的男男性行为者中爆发的性传播感染，与该地区性传播感染的上升趋势有一定的联系。为了实现全球消除目标，需要针对该地区的性传播感染侧重点重新制定新的应对措施。.Всемирная организация здравоохранения (ВОЗ) определила цели по снижению заболеваемости сифилисом и гонореей на 90% в период с 2018 по 2030 год. Авторы анализируют тенденции распространения инфекций, передаваемых половым путем, в регионе Юго-Восточной Азии ВОЗ, чтобы оценить возможность достижения этих целей. Мьянма, Таиланд и Шри-Ланка сообщили о сокращении заболеваемости или распространенности сифилиса и (или) гонореи в период с 1975 по 2005 год на уровне 90% или выше. Факты свидетельствуют о том, что недавнее не такое масштабное снижение тенденций инфекций, передаваемых половым путем в Индии, привело к снижению на региональном уровне. В других странах число инфекций, передаваемых половым путем, остается высоким или продолжает расти либо данные недостаточно надежны для измерения изменений. В Таиланде и Шри-Ланке действуют сильные программы по борьбе с инфекциями, передаваемыми половым путем, которые обеспечивают всеобщий доступ к услугам по лечению этих инфекций и адресным мероприятиям для ключевых групп населения. В Индии и Мьянме были предприняты широкомасштабные адресные усилия по борьбе с этими инфекциями. Другие страны региона уделяют приоритетное внимание борьбе с вирусом иммунодефицита человека, а на борьбу с другими инфекциями, передаваемыми половым путем, выделяются ограниченные ресурсы. На национальном и субнациональном уровнях данные свидетельствуют о быстром сокращении инфекций, передаваемых половым путем, когда адресное продвижение использования презервативов и услуг по борьбе с инфекциями, передаваемыми половым путем, расширяется с целью охвата большего числа работников секс-индустрии. И наоборот, недавние вспышки инфекций, передаваемых половым путем, среди не охваченных услугами групп мужчин, имеющих половые контакты с мужчинами, были связаны с тенденциями регионального роста инфекций, передаваемых половым путем. Для достижения глобальных целей по ликвидации инфекций, передаваемых половым путем, в регионе необходимы обновленные и целенаправленные ответные меры.

The question of whether small non-government organizations with comparatively small budgets can make a substantial contribution to sustainable improvement in health care in low- and middle-income countries is crucial to funding global surgical projects. The Royal Australasian College of Surgeons and its Fellows have partnered with local organizations and clinicians to deliver a wide range of projects in South East Asia. These projects have proved sustainable and have increased healthcare capacity in these nations. This provides strong evidence that small non-government organizations such as the Royal Australasian College of Surgeons can make a major contribution to global surgeryI.

The present review aims at gathering refocus on access to handwashing in South East Asia. It is because, here nearly half of the households, schools and about one fourth of the health care centers lack the basic handwashing facility and that too at the time when about one third of global new COVID-19 positive cases are getting reported from this region these days. Data on access to, handwashing device having soap and water availability, in South Asia is mainly based on the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF JMP) Joint Monitoring Programme for Water Supply, Sanitation, and Hygiene (WHO/UNICEF JMP 2020). In addition various relevant research and review papers were reviewed using the key words such as handwashing, South East Asia, Hand hygiene, and COVID-19. There is a high need to reaccess the factor of hand hygiene in South East Asia in relation to COVID-19 for the control of the present pandemic and other such challenges, particularly in South East Asia.

Background The South-East Asia regional programme to eliminate lymphatic filariasis (LF) was launched in 2000. This study presents the progress and impact of the programme in the region. Methods Mass drug administration (MDA) and morbidity management data were accessed from the WHO preventive chemotherapy databank. The status of the programme in the nine South-East Asia countries was reviewed and progress was assessed. The impact of the programme on LF disease burden was estimated on the basis of the effectiveness of the MDA drugs against microfilaraemia and chronic disease. Results Under the MDA programme, 8.1 billion treatments were delivered in nine countries and 5.7 billion treatments were consumed by the target population during 2001–2018. Three of nine countries eliminated LF. Bangladesh is poised to reach its elimination goal by 2021. In the other five countries, 38–76% of intervention units completed intervention and surveillance is in progress. The MDA programme prevented or cured 74.9 million infections, equivalent to an 84.2% reduction. Close to 1 million lymphoedema patients and 0.5 million hydrocele patients were reported and are being provided with the minimum package of care. Conclusions The South-East Asia region's LF elimination programme reduced the burden of LF appreciably and is moving towards achieving the elimination goal in the next 8–10 y.

Malaysia recorded its first case of COVID-19 on January 24th, 2020 with a stable number of reported cases until March 2020, where there was an exponential spike due to a massive religious gathering in Kuala Lumpur. This caused Malaysia to be the hardest hit COVID-19 country in South East Asia at the time. In order to curb the transmission and better managed the clusters, Malaysia imposed the Movement Control Order (MCO) which is now in its fourth phase. The MCO together with targeted screening have slowed the spread of COVID-19 epidemic. The government has also provided three economic stimulus packages in order to cushion the impact of the shrinking economy. Nonetheless, early studies have shown that the MCO would greatly affect the lower and medium income groups, together with small and medium businesses.

Background: Psychiatric disorders have been identified as an important risk factor for suicide. However, different psychological autopsy studies have revealed different prevalences at different times and places. Objective: We aimed to see the distribution of psychological autopsy studies and the prevalence of mental disorders among suicides and identify major risk factors in Southeast Asian countries. Method: We scrutinized psychological autopsy studies published in the World Health Organization (WHO) South-East Asia (SEA) region countries. We also searched the available bibliographies to identify the studies in the region so that all the possible articles could be included. Results: Out of the 11 countries, 14 psychological autopsy studies were identified in five SEA countries (Bangladesh [1], India [9], Indonesia [1], Nepal [1], and Sri Lanka [2]). Seven studies (50%) used a case-control study design, and eight (57.1%) were carried out in urban settings. The prevalence of psychiatric disorders in case-control studies was from 37% to 88%. Stressful life event was identified as a major risk factor in all the case-control studies. Conclusion: Psychological autopsy studies have not been conducted in 6 out of 11 countries of the SEA region. The presence of pre-existing psychiatric morbidity and stressful life events were the two most common risk factors noted across settings, even though there is wide heterogeneity in samples, study design, instruments, and study settings.

Malaria is amongst the most prevalent and epidemiologically relevant global parasitic protozoan infections. It is infecting millions of people annually, especially in south east Asia and sub Saharan Africa. Its morbidity and mortality still cannot be controlled entirely and elimination is still far away. Children and pregnant women are among the most vulnerable group in the population. Its pathobiology have related to cause direct or indirect deleterious effect on the patient’s skeletal muscle, named rhabdomyolysis. Eventhough it is very rare, but potentially fatal and lethal. Three mechanism of malaria related rhabdomyolysis are very intense inflammatory response, extensive red cells sequestration in muscle capillaries due to severe anemia and the parasite toxin’s, will lead to or add risks of complication. Derangement of specific type of muscle, named the skeletal and cardiac, is amongst the earliest sign of severe malaria. Further study need to be conducted in the future, especially on important topics about mechanism and its effect, signaling pathways, best practice on laboratory approach and management strategy best practice.

Thalassemia is an autosomal recessive disease. According to the WHO data, there are 269 million carriers of thalassemia worldwide, out of which 40 million are in South East Asia. This study was conducted with the primary objective to assess physiological and mental health condition of patients with thalassemia at a tertiary care hospital. It has been noticed by the study that there are frequent chances of diseases among thalassemia patients as the assessment found 20% of study patients jaundice manifested at least one time on their lifetime, 19% cardio-vascular disease, 18% hepatic diseases, 15% fever, 12% respiratory problems, 10% kidney disease and 6% diarrhoea. According to age category our study found that 18 to 25 years age category had 15.4% chances of having diseases, 26 to 30 years age category had 14.3% chances, 31 to 35 and 36 to 40 years age category had 24.6% and 42% chances of having diseases. It clearly indicates that increase in age increases the chances of disease occurrence. In our study, 57.5% patients with thalassemia manifested depression comprising 19.5% chronic depression, 20.3% minimal depressed, 8.5% mild and 9.1% moderately depressed. This study found that patients with thalassemia face mental health problems which requires planning of authorities and experience consultants to educate the life skill and to survive in a healthful manner.

Background: Adolescence represents a real opportunity to make a difference in lifelong patterns. There are 1.2 billion adolescents in the world, 85% of them live in developing countries. The adolescent population constitutes about 18 to 25% of the total population of the South East Asia Region.Objective: To assess the knowledge of Adolescents about the dietary behaviour & its consequences.Material and Methods: The present observational cross-sectional study was carried out in Department of Community Medicine, Santosh Medical College, Ghaziabad & Urban area of district Ghaziabad. The unit of the study was selected adolescent students studying in randomly selected schools of Ghaziabad city. Adolescents aged 10 to 19 years studying in the selected schools of urban Ghaziabad were included for the study. The period of study was from November 2011 to October 2012.Results: 253 (67.5%) male and 192 (51.2%) female had knowledge about healthy diet. about half of the female 193 (51.5%) preferred homemade food while about two-third 252 (67.2%) of boys preferred outside food. Males 162 (43.2%) ate junk food daily, 183 (48.8%) ate weekly and 30 (8.0%) ate occasionally while in females 108 (28.8%) ate junk food daily, 218 (58.1%) ate weekly and 49 (13.1%) ate occasionally. 270 (72.0%) male and 265 (70.7%) female had knowledge that consuming junk food regularly can harm health. 209 (55.7%) male and 224 (59.7%) female were encouraged from surrounding to eat outside or junk food.Conclusions: Considering the large no. of adolescents in our country, the study thus evokes an urgent need to stimulate an action to identify those at risk and those who need treatment and prevention of progression of the health risk behaviors, among the adolescents.

Introduction and objective: Craniosynostosis is a pathological condition resulting from premature closure of cranial sutures. Open cranial vault reconstruction has been the standard of care for isolated non-syndromic craniosynostosis. The current centre introduced the endoscopic craniosynostosis surgery in 2015. The aim of the study is to compare safety outcomes of endoscopic versus open surgery in craniosynostosis within the context of a developing healthcare system, with a focus on anterior synostosis. Methods: This was a retrospective study of all patients undergoing surgery for anterior craniosynostosis from 2012 to 2018 at a single institution. Data on age at surgery, demographics, sutures, surgery duration and complications, including follow up information was obtained. We excluded syndromic patients and patients with pan-synostosis. Statistical analysis was undertaken with P value set at

Purpose There was numerous articles that discussed about anterior cruciate ligament (ACL). There was no study that wrapped up all about ACL in South-east asia country. This study aims to apply bibliometric tools to orthopaedics publications on ACL in South-east asia country. Methods We searched English full text with keyword “ACL” OR “Anterior Cruciate Ligament” AND “injury” OR “tear” OR “rupture” that published from January 1st, 2010 to December 31st, 2019 on PubMed, EMBASE, and Cochrane Library. We included article with at least has one author affiliation in the South-east asia country. Results A total of 12,570 articles were analyzed, and 64 articles were included. Study type analysis revealed that clinical research (n = 28; 43.7%) was the most frequent study type. The journal of knee surgery, sports traumatology, arthroscopy (KSSTA) and Orthopaedic Journal of Sports Medicine had the highest number of publications in general (n = 6; 9.4%). Sholahuddin Rhatomy (n = 4) was the top author with highest number in the first author order and Lingaraj Krishna (n = 12) was the top author with highest number of published article. Most of studies (n = 32; 50.0%) were published in high index journal with impact factor >1.0. Conclusion ACL articles in South-east asia had high quality publication that proved by high impact journal publisher. There has been a steady increase in the article number since 2010 in South-east asia. This article quantifies the increased interest and could act as a baseline for future studies to compare., Highlights • Summarized the ACL publication in South-East Asia Country over the past 10 years. • There was high number of publication among knee surgeon in South-East Asia. • High impact factor journal publisher.

There was an outbreak of pneumonia in the month of December 2019 in Wuhan, China that spread with a rapid rate throughout the country and shook the world by spreading across the globe causing many deaths due This disease is confirmed by means of molecular method as a novel coronavirus and was named as 2019 novel coronavirus (2019-nCoV) in its initial stage;however, on February 11, 2020, World Health Organization (WHO) renamed this disease COVID-19, which means corona virus disease COVID-19 has impacted nearly the entire world, affecting more than 100 countries including India The Coronavirus Study Group consisting of the International Committee on Taxonomy of Viruses renamed this virus, which was provisionally named 2019-nCoV, as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) This nomenclature is based on taxonomy, phylogeny, and established practice As on March 2020, WHO has confirmed 692,575 number of cases of COVID-19 with 33,099 deaths, which are distributed across the globe: Western Pacific region with 103,775 confirmed cases with 3,649 deaths;European region with 392,757 number of confirmed cases with 23,962 deaths;South East Asia region with 4,084 confirmed cases with 158 deaths;Eastern Mediterranean region with 46,392 confirmed cases with 2,813 number of deaths;America region with 142,081 confirmed cases with 2,457 deaths;African region with 3,486 confirmed cases with 60 deaths This paper focuses on these areas and regions and tries to find establish the relationship between numbers of deaths and number of cases with respect to the temperature This paper takes the study of specific areas around the world and also the case study of India to study the effect of temperature on the rise of and death due to COVID-19 virus © 2020 IGI Global All rights reserved

Clonorchis sinensis, an important fish-borne zoonotic trematode, is widely distributed in South-East Asia, especially in China. Infections from human and animal reservoir hosts occur due to the consumption of raw or undercooked fish with C. sinensis metacercariae. This study aimed to evaluate the prevalence of C. sinensis metacercariae in fish in South-East Asia via systematic review and meta-analysis. We searched PubMed, ScienceDirect, China National Knowledge Infrastructure, Wanfang and Chongqing VIP databases for studies published between 1976 and 2020 that are related to the prevalence of C. sinensis metacercariae in fish. Studies were screened with keywords based on inclusion and exclusion criteria. Seventy-one eligible articles were identified, covering three countries: China, Korea and Vietnam. The pooled prevalence of C. sinensis metacercariae in fish from South-East Asia was 30.5%, with 35.1% in China, 29.7% in Korea and 8.4% in Vietnam. In subgroup analyses of climate, season, water source and publication date, the highest prevalence was identified in the Dwb climate type (43.3%), summer (70.2%), river (34.5%) and pre-2001 publications (38.9%), respectively. In comparison, the lowest prevalence was found in the Dfa climate type (14.5%), winter (19.5%), lake (8.0%) and post-2001 publications (23.8%). Meta-regression results indicated that country (p = .009), the published time (p = .035) and water source subgroups (p = .003) may be the source of heterogeneity. Overall, our study indicates that a high prevalence of C. sinensis infections occurs in fish in China, Korea and Vietnam, illuminating a significant public health concern in these countries.

MERS-CoV was emerged for the first time in KSA; 2012 followed by a lot of new registered cases in the Middle East, European, American and African countries. The goal of this paper is to make a comparison between the partial spike-glycoprotein reference gene (NC_019843.3; genome region: 23864-24909 with 1046bp) with similar Sudanese camel sequences; using the NCBI data base. Creations of phylogenetic tree for those who were selected as reference genes from Middle East countries (Qatar, UKE, and KSA), south East Asia and African countries (Ethiopia, Egypt, Nigeria, Burkina Faso) with Sudanese sequences using ViPR website was done. This study revealed that most of the Sudanese sequences descending from each other’s with a lot of mutations area which mainly concentrated at positions; 155, 156, 158, 242, 840, 876 at nucleotide levels and to explain these more in-depth studies are recommended.

Atopic dermatitis (AD) is a chronic, recurrent skin inflammatory disease that commonly affects children. There is an increasing prevalence of AD in South East Asia and this creates a high economic burden in addition to reducing patients’ and family quality of life. Correct understandings of the disease and its management are very important for family or caregiver of children with AD. Nevertheless, misunderstandings, lack of information and adherence to therapy and poor self-management are the main reasons of dissatisfaction with treatment. Parents often mistook food allergy as the cause of DA and this lead to unnecessary avoidance of certain food. This potentially leads to nutritional problems in children. This educational intervention activity aimed to increase parent and teachers’ knowledge regarding the cause and symptoms of AD, as well as appropriate diagnostic and therapeutic approach for children with AD. This activity was delivered in the form of lecture and discussion, and 75 parents and teachers participated in this event. Almost half of the participants (34 people) had not heard about AD previously. Based on the analysis of pretest (median 5.00) and posttest (median 8.00) results, we found a significant improvement of knowledge on AD among participants (p < 0.01). Pretest scores were associated with participants’ age, while posttest scores were associated with participants’ education level. In conclusion, this educational intervention had been successfully improved participants’ knowledge of AD.

Background Surveillance of AEFI is fundamental for improving safety and maintaining public support for vaccination. In SEAR, billions of doses of vaccine are given annually. The objective of the 2019 SEAR AEFI training workshop was to further strengthen in-country vaccine safety, assess capacity compared to 2014 and to better integrate communication into the AEFI causality assessment program. Methods A 3 ½ day workshop with AEFI experts from all 11 SEAR countries. Participants outlined each county’s AEFI data, critiqued their AEFI program, reviewed and critiqued causality assessment of 23 anonymized serious AEFI cases and proposed communication plans for each. Results Between 2016 and 2018, over 2.9 billion doses of vaccine were given in SEAR. Compared to 2014, AEFI detection and causality assessment skills had improved. AEFI experts’ communication planning skills markedly improved during the workshop. Good concordance was found between country causality assessment findings and the workshop critiques. A list of targeted recommendations (country, regional and global levels) arose from the workshop. Conclusions SEAR countries have much improved their AEFI detection and causality assessment expertise since 2014. Given the high volume of doses administered and the AEFI technical expertise, SEAR countries can well monitor safety of regionally produced vaccines. Integration of AEFI communication into AEFI causality assessment can help mitigate potential negative impacts of serious AEFIs.

Objective:To make a tentative assessment of the consumption of cassava in three countries in South-east Asia and the cyanogenic potential (CNp) of the crop as a possible food safety issue.Design:We used data from the Ministry of Health in Vietnam and Statistics Authorities in Indonesia and Philippines (mean household consumption per province) to assess cassava consumption. Conversions of units were needed to facilitate the comparison of cassava consumption between countries. The most up-to-date data available regarding both cassava consumption and the CNp of cassava grown in the respective countries were assessed.Settings:Vietnam, Indonesia and Philippines.Participants:Respondents from provinces in Vietnam (nineteen), Indonesia (thirty-three) and Philippines (eighty-one) were asked to complete a recall questionnaire detailing either the previous 24-h’ or the 7-d’ cassava consumption.Results:Among the three countries, available data indicated that the highest median cassava-consumption figurespercapitawere from Indonesia and the Philippines (9·01 and 7·28 g/capita per d, respectively), with Vietnam having the least (1·14 g/capita per d). Published information regarding the CNp of cassava in the three countries was limited.Conclusions:While the findings of the present study are somewhat limited by a lack of available information regarding both the extent of cassava consumption and the CNp of cassava consumed in the three countries, it appears likely that cyanogen intake arising from cassava consumption among the three countries exceeds the FAO/WHO Provisional Maximum Tolerable Daily Intake, although any risk to public health appears limited to a minority of provinces in each country.

Background: The World Health Organization (WHO) regions of Africa and South-East Asia are the epicentres of the global tuberculosis (TB) epidemic. This study aimed at examining the trend and determ...

Burning and stabbing pain in the feet and lower limbs can have a significant impact on the activities of daily living, including walking, climbing stairs and sleeping. Peripheral neuropathy in particular is often misdiagnosed or underdiagnosed because of a lack of awareness amongst both patients and physicians. Furthermore, crude screening tools, such as the 10‐g monofilament, only detect advanced neuropathy and a normal test will lead to false reassurance of those with small fiber mediated painful neuropathy. The underestimation of peripheral neuropathy is highly prevalent in the South‐East Asia region due to a lack of consensus guidance on routine screening and diagnostic pathways. Although neuropathy as a result of diabetes is the most common cause in the region, other causes due to infections (human immunodeficiency virus, hepatitis B or C virus), chronic inflammatory demyelinating polyneuropathy, drug‐induced neuropathy (cancer chemotherapy, antiretrovirals and antituberculous drugs) and vitamin deficiencies (vitamin B1, B6, B12, D) should be actively excluded., Diabetic neuropathy has a major impact on morbidity and mortality. However, the diagnosis and management of diabetic neuropathy is South‐East Asia is limited. Clear guidance is required to diagnose and manage patients with diabetic and other neuropathies.

Background: Being ranked second among countries with the highest estimated number of people living with HIV in South East Asia, 28.8% of PWIDs in the country are HIV–infected. Despite the UNAIDS 90...

This study aimed to investigate air pollutant exposure at five primary schools in Terengganu, Malaysia and to assess chromosomal damage among primary school children. The study involved 176 children aged 10–11 years living close to industries (the exposed group) and those living far away from the industries (the comparative group). The parameters for the indoor air monitoring included suspended particulate matter, gaseous pollutants (NO2 and SO2), and physical variables (temperature, relative humidity, and air velocity). Respiratory symptoms were assessed through questionnaires (n = 176), and a micronucleus assay was conducted on the buccal epithelial cells of 91 children. The findings showed that the levels of air pollutants at the schools of the exposed group were significantly higher (p < 0.05) than those of the comparative group. The highest concentration of PM1, PM2.5 and PM10 recorded at the exposed schools were 43.30, 44.83, and 60.83 µg m-3, respectively. Cough is the most significant recurring respiratory symptom among children with 2.52 odd ratio (p < 0.05). Children in the exposed group had an average micronuclei frequency of 5.02 ± 3.43 per 1000 cells, while those in the comparative group had 2.00 ± 1.56. This study strongly suggests that exposure to industrial air pollutants significantly influence micronuclei formation and increase the prevalence of respiratory symptom among children living in proximity to the industrial area after controlling all possible confounding factors. This study serves as baseline data for genotoxic damage among children in the vicinity of industrial area in South East Asia specifically.

Highlights • Foreign body located in the lower urinary tract is uncommon, with bladder being the most common site. • Most of them are self-inserted via the urethra as the result of psychometric problems, or sexual curiosity. • Treatment of foreign bodies is determined by their size, location, shape, and mobility. • In most cases, minimally invasive procedures are recommended to prevent bladder and urethral injuries. • Surgical treatments are necessary if endoscopic removal fails or further injuries take place., The lower urinary tract's foreign body is an uncommon condition, with the bladder being the most common site. Most foreign bodies are self-inserted via the urethra due to exotic impulses, psychometric problems, or sexual curiosity. We present a case of a 39 years old male with a lower urinary tract and abdominal pain. An abdominal CT Scan showed a sharp metal in the bladder. The patient underwent a successful extraction of a foreign body with biopsy forceps transurethrally. Foreign bodies in the bladder represent a urological challenge that requires prompt management. Treatment is determined by size, location, and shape. Minimally invasive procedures are recommended to prevent bladder and urethral injuries. However, surgical treatment should be performed if further injuries are expected. The suspected history and presenting symptoms are crucial and could lead to further investigations. Extraction should be carefully performed to minimize bladder and urethral injury. Gentle endoscopic management is the primary treatment with a high success rate. This case report aims to describe a case of the longest 12 cm sharp metal foreign material inserted to the bladder in South East Asia along with the management and subsequent condition to provide a better insight in managing future unusual cases.

Background: With targeted management of neonatal hyperbilirubinaemia in high-income countries, there has been a dras- tic drop in both the prevalence and mortality. On the contrary, over two-thirds of the global burden of neonatal hyperbiliru- binaemia is in Sub-saharan Africa and South East Asia with a high mortality risk of 16-35%. Neonatal hyperbilirubinaemia is not a leading global cause of neonatal mortality, however leads to irreversible neurological damage and death when managed poorly. Three-quarters of the babies admitted to the national referral hospital in Uganda had significant hyperbilirubin- aremia; 16.6% of these babies died. We aimed at determining the prevalence, treatment outcome and describing factors associated with hyperbilirubinaemia in neonates admitted to St Francis hospital, Nsambya. Methods: A cross sectional study was carried out. A total of 242 files of babies with a preliminary diagnosis of hyperbiliru- binaemia were retrieved retrospectively. Relevant data was extracted from the files and analysed using STATA version 14.0. Results: The prevalence of significant hyperbillirubinaemia was 22.7% (55/242). Seventy-seven percent of the babies ad- mitted did not require treatment for hyperbilirubinaemia. No factors were found to be significantly associated with sig- nificant hyperbilirubinaemia. The case fatality for severe hyperbilirubinaemia was 20% (6/30); half of these babies had haemolytic disease of the newborn. Conclusion: Establishment of local guidelines will prevent unnecessary admissions and ensure timely treatment is admin- istered. Longitudinal studies are required to discover factors associated with neonatal hyperbilirubinaemia in this region. Keywords: Neonatal jaundice; hyperbilirubinaemia; phototherapy; exchange transfusion.

Good quality urine samples play a crucial role in establishing an early and accurate diagnosis of urinary tract infection in infants. Invasive methods are more reliable but cause pain and discomfort in infants as well as anxiety in clinicians and parents. The current available non-invasive methods are less efficient and produce low quality urine samples being less apprehensive in infants and parents. To date, no studies have been conducted in South East Asia, including Malaysia, to identify the most feasible non-invasive urine sampling method. This literature review aimed to compare various non-invasive urine sample collection methods (bladder stimulation techniques, standard clean-catch urine, urine collection pads and urine bags) which could be more feasible for a district hospital setting in Malaysia. In total, 17 studies were included and reviewed. This review concluded that bladder stimulation techniques are potentially good and feasible alternatives to the current common practices in Malaysia (standard clean-catch urine and catherization) due to its high success rate, fast collection and low contamination rate. There is a higher likelihood to implement these techniques in a tertiary setting if further research on bladder stimulation techniques is found feasible in a less resourceful district hospital setting.

Effective policies that address both the supply and demand dimensions of access to affordable, healthy foods are required for tackling malnutrition in South East Asia. This paper presents the Protocol for the South East Asia Obesogenic Food Environment (SEAOFE) study, which is designed to analyze the retail food environment, consumers’ and retailers’ perspectives regarding the retail food environment, and existing policies influencing food retail in four countries in South East Asia in order to develop evidence-informed policy recommendations. This study was designed as a mixed-methods sequential explanatory approach. The country sites are Malaysia, Indonesia, the Philippines, and Thailand. The proposed study consists of four phases. Phase One describes the characteristics of the current retail food environment using literature and data review. Phase Two interprets consumer experience in the retail food environment in selected urban poor communities using a consumer-intercept survey. This phase also assesses the retail food environment by adapting an in-store audit tool previously validated in higher-income countries. Phase Three identifies factors influencing food retailer decisions, perceptions, and attitudes toward food retail policies using semi-structured interviews with selected retailers. Phase Four recommends changes in the retail food environment using policy analysis and semi-structured interviews with key stakeholders. For the analysis of the quantitative data, descriptive statistics and multiple regression will be used, and thematic analysis will be used to process the qualitative data. This study will engage stakeholders throughout the research process to ensure that the design and methods used are sensitive to the local context.

Aims: To identify existing interventions in South East Asian countries implemented to prevent postpartum depression (PPD) and explore the possibility of replication of such interventions in Nepal to reduce it. Methods: The paper reviewed the risk factors and preventive strategies implemented in South East Asian countries to prevent PPD. Results: Enough actions have not been taken to address PPD despite of high prevalence in the reviewed countries (Bangladesh, India, Pakistan, Srilanka and Nepal). However, some of the interventions used such as cognitive behavior therapy, education for girls, poverty alleviation program, participatory approach for empowerment and involvement of community health workers have shown positive impact on reducing PPD. Conclusions: The interventions used in South East Asian countries were simple in design intervention and mostly conducted through community health workers; it showed a possibility of replication in Nepal as it already has sufficient community workforces working in maternal and child health. Keywords: interventions, maternal depression, maternal mental health, post–partum depression, prevention, south asia, strategies

Infections with vancomycin-resistant enterococci (VRE) have limited treatment options, with linezolid the mainstay of therapy. The emergence of linezolid-resistant vancomycin-resistant enterococci (LRVRE) further restricts the therapeutic options. LRVRE isolated from clinical specimen have not previously been reported in South-East Asia. Here, we report three clinical cases of LRVRE from a teaching hospital in Malaysia. Three isolates of Enterococcus faecium were isolated from three different patients. These isolates were determined to be resistant to both vancomycin and linezolid by Etest gradient diffusion test and Vitek2 automated antibiotic susceptibility testing, respectively. Retrospective analysis of the microbiological and clinical data of the three patients was undertaken. LRVRE were isolated from from tissue and peritoneal fluid of two patients who underwent complicated abdominal surgery. Another patient with underlying acute lymphoblastic leukaemia developed neutropenia following chemotherapy. LRVRE were isolated from the blood culture. All three patients were not treated with linezolid. The possible risk factors for LRVRE acquisition are administration of multiple broad-spectrum antimicrobials and disruption of the gastrointestinal mucosa. The appearance of LRVRE in increasingly widespread geographic locations may lead to a global health threat. Judicious use of broad-spectrum antimicrobials and infection-control practices are crucial to curb its spread.

BACKGROUND Severe maternal morbidity or maternal near miss (MNM) events can have significant consequences for individuals, their families and society and the study of these events may inform practices to reduce future adverse pregnancy outcomes. AIMS To review the scope of MNM studies undertaken in Australia, New Zealand, South-East Asia and the South Pacific region. MATERIALS AND METHODS A systematic search of four online databases (MEDLINE, EMBASE, SCOPUS and CINAHL) and the World Health Organization Library was conducted to identify all relevant studies published between 1 January 2011 and 31 December 2020. The studies were reviewed and included if they assessed MNM using a composite outcome or a predefined set of indicators. RESULTS The literature search yielded 143 articles of which 49 are included in this review. There were substantial differences in the monitoring approach to MNM in the Australasian region. Overall rates of MNM in the region ranged from two to 100/1000 births and the most common aetiologies identified were direct obstetric causes such as postpartum haemorrhage, pre-eclampsia and sepsis. Multidisciplinary review indicated a substantial number of MNM cases were preventable or amenable to improved management, mostly from a provider perspective. CONCLUSIONS Assessment of MNM is an important part of the evaluation of maternity care provision. Reaching a consensus on indicators and how best to collect information will allow a more discerning assessment of MNM including longer-term health outcomes, aspects of preventability and financial implications for health services.

Meliodosis, a potentially fatal disease endemic in south east asia and northern Australia is caused by Burkholderia pseudomallei, a motile ,aerobic , non spore forming gram negative bacillus. It can present with asymptomatic infections to localized abscesses to fulminating diseases with multi organ involvement and eventual death. Mycotic aneurysm is a very rare presentation of meliodosis. Although isolation of

Antimicrobial resistance (AMR) is a critical challenge worldwide as it impacts public health, especially via contamination in the food chain and in healthcare-associated infections. In relation to farming, the systems used, waste management on farms, and the production line process are all determinants reflecting the risk of AMR emergence and rate of contamination of foodstuffs. This review focuses on South East Asia (SEA), which contains diverse regions covering 11 countries, each having different levels of development, customs, laws, and regulations. Routinely, here as elsewhere antimicrobials are still used for three indications: therapy, prevention, and growth promotion, and these are the fundamental drivers of AMR development and persistence. The accuracy of detection of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARG) depends on the laboratory standards applicable in the various institutes and countries, and this affects the consistency of regional data.Enterobacteriaceaesuch asEscherichia coliandKlebsiella pneumoniaeare the standard proxy species used for indicating AMR-associated nosocomial infections and healthcare-associated infections. Pig feces and wastewater have been suspected as one of the hotspots for spread and circulation of ARB and ARG. As part of AMR surveillance in a One Health approach, clonal typing is used to identify bacterial clonal transmission from the production process to consumers and patients – although to date there have been few published definitive studies about this in SEA. Various alternatives to antibiotics are available to reduce antibiotic use on farms. Certain of these alternatives together with improved disease prevention methods are essential tools to reduce antimicrobial usage in swine farms and to support global policy. This review highlights evidence for potential transfer of resistant bacteria from food animals to humans, and awareness and understanding of AMR through a description of the occurrence of AMR in pig farm food chains under SEA management systems. The latter includes a description of standard pig farming practices, detection of AMR and clonal analysis of bacteria, and AMR in the food chain and associated environments. Finally, the possibility of using alternatives to antibiotics and improving policies for future strategies in combating AMR in a SEA context are outlined.

Introduction Therapeutic plasma exchange (TPE) for neuroimmunological disorders has played an increasingly important role within the Southeast Asian (SEA) region. The South East Asian Therapeutic Plasma exchange Consortium (SEATPEC) was formed in 2018 to promote education and research on TPE within the region. The advent of the Covid-19 pandemic has produced challenges for the development and expansion of this service. Methodology A qualitative and semi-quantitative questionnaire-based survey was conducted by SEATPEC member countries from January to June 2020 (Phase 1) and then from July 2020 to January 2021 in (Phase 2) to assess the impact of Covid-19 on regional TPE. Objectives The study's main objectives were to explore the challenges experienced and adaptations/adjustments taken by SEATPEC countries in order to continue safe and efficient TPE during the Covid-19 pandemic. Results The pandemic was found to disrupt the delivery of TPE services in all SEATPEC countries. Contributing factors were multifactorial due to overstretched medical services, staff shortages, quarantines and redeployments, fear of acquiring Covid-19, movement restriction orders, and patient's psychological fear of attending hospitals/testing for Covid-19. All SEATPEC countries practiced careful stratification of cases for TPE (electives vs emergencies, Covid-19 vs non-Covid-19 cases). SEATPEC countries had to modify TPE treatment protocols to include careful preprocedure screening of patient's for Covid-19, use of personal protective equipment (PPE) and post-TPE sanitization of machines and TPE suites. Conclusion Based on the responses of the survey, SEATPEC countries produced a consensus statement with five recommendations for safe and effective TPE within the region.

Background: Telemedicine is a useful tool to deliver healthcare to communities in low- to high-income countries, especially in the coronavirus disease 2019 pandemic era. Guidelines on telemedicine would assist healthcare providers in delivering healthcare services based on local circumstances. Objective: To explore and compare guidelines on telehealth and telemedicine in South East Asian countries. Methods: Electronic databases such as Google, PubMed, and Cochrane reviews were searched for articles using keywords such as “telemedicine” OR “telehealth” OR “eHealth” OR “telemedis” AND “guidelines” AND “South East Asia” OR “Malaysia” OR “Singapore” OR “Indonesia” OR “Thailand” OR “Vietnam” published up to 2020. Inclusion criteria were full articles and gray materials (i.e., policy statements, advisories, blueprints, executive summaries, and circulars) related to telemedicine guidelines. No language restrictions were imposed. Only the first 100 Google searches were included for eligibility based on its relevance to telemedicine guidelines. Exclusion criteria were abstracts, duplicate publications, blogs, news articles, promotional brochures, conference proceedings, and telemedicine projects unrelated to telemedicine guidelines. Results: A total of 62,300 articles were identified through the search engines (Google 62,203, PubMed 77, and Cochrane 20) and six articles from additional sources. Sixty-eight full-text articles fulfilled the inclusion criteria, but only 24 articles contained some form of guidelines on telemedicine: Indonesia (nine), Malaysia (seven), Singapore (five), Thailand (two), and Vietnam (one). There were six laws, six advisory guidelines, five policy statements, and two circulars (regulations) issued by either the Ministry of Communication and Multimedia, Ministry of Health, or Medical Councils from the respective countries. Issues addressed were clinical governance (100%); information and communication technology infrastructure (83.3%); privacy, storage, and record-keeping (77.8%, respectively); ethics and legal (77.8%); security and safety (72.2%); definitions and applications of telemedicine (72.2%); confidentiality (66.7%); licensing (66.7%); identification (55.6%); cost of information and communication technology infrastructure (55.6%); reimbursement (16.7%); mobile applications (11.1%); and feedback and choices (5.6%). The Singapore National Telemedicine Guidelines contained the most domains compared with other guidelines from South East Asia. Conclusions: Although there can be no “one-size-fits-all” telemedicine guideline, there should be a comprehensive and universal telemedicine guideline for any country to adapt based on the local context. Details on patient-identification, data ownership, back-up, and disposal; transregional cybersecurity laws and ways to overcome the limitations of telemedicine compared with face-to-face consultations should be outlined clearly to ensure uniformity of telemedicine service and patient safety.

Background: High dietary salt intake is an avoidable cause of hypertension and associated cardiovascular diseases (CVDs). Thus, salt reduction is recommended as one of the most cost-effective interventions for CVD prevention and for achieving the World Health Organization’s (WHO) 25% reduction in premature non-communicable disease (NCD) mortality by 2025. However, current and comprehensive information about national salt reduction policies and related actions across different regions are difficult to access and impede progress and monitoring. Objectives: As an initial step to developing an online repository of salt reduction policies and related actions, and to track nation-wise progress towards the WHO’s 25 by 25 goal, we aimed to identify and assess salt reduction policies and actions in select countries from two of the top five most populous regions of the world- the South-East Asia and Latin America. Methods: We conducted a literature review to identify national and regional salt reduction policies in the selected South-East Asian and Latin American countries, from January 1990–August 2020, available in English and Spanish. We also contacted selected WHO country offices (South-East Asian region) or relevant national authorities (Latin America) to gain access to unpublished documents. Results: In both regions, we found only a few dedicated stand-alone salt reduction policies: Bhutan, Sri-Lanka and Thailand from South East Asia and Costa Rica from Latin America. Available polices were either embedded in other national health/nutritional policy documents/overall NCD policies or were unpublished and had to be accessed via personal communication. Conclusions: Salt reduction policies are limited and often embedded with other policies which may impede their implementation and utility for tracking national and international progress towards the global salt reduction target associated with the 25 by 25 goal. Developing an online repository could help countries address this gap and assist researchers/policymakers to monitor national progress towards achieving the salt reduction target.

Although several studies have already been carried out in investigating the general profile of the gut mycobiome across several countries, there has yet to be an officially established baseline of a healthy human gut mycobiome, to the best of our knowledge. Microbial composition within the gastrointestinal tract differ across individuals worldwide, and most human gut fungi studies concentrate specifically on individuals from developed countries or diseased cohorts. The present study is the first culture-dependent community study assessing the prevalence and diversity of gut fungi among different ethnic groups from South East Asia. Samples were obtained from a multi-ethnic semi-rural community from Segamat in southern Malaysia. Faecal samples were screened for culturable fungi and questionnaire data analysis was performed. Culturable fungi were present in 45% of the participants' stool samples. Ethnicity had an impact on fungal prevalence and density in stool samples. The prevalence of resistance to fluconazole, itraconazole, voriconazole and 5-fluorocytosine, from the Segamat community, were 14%, 14%, 11% and 7% respectively. It was found that Jakun individuals had lower levels of antifungal resistance irrespective of the drug tested, and male participants had more fluconazole resistant yeast in their stool samples. Two novel point mutations were identified in the ERG11 gene from one azole resistant Candida glabrata, suggesting a possible cause of the occurrence of antifungal resistant isolates in the participant's faecal sample.

Peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) is largely underutilized globally. We analyzed PD utilization, impact of economic status, projected growth and impact of state policy(s) on PD growth in South Asia and Southeast Asia (SASEA) region.The National Nephrology Societies of the region responded to a questionnaire on KRT practices. The responses were based on the latest registry data, acceptable community-based studies and societal perceptions. The representative countries were divided into high income and higher-middle income (HIHMI) and low income and lower-middle income (LILMI) groups.Data provided by 15 countries showed almost similar percentage of GDP as health expenditure (4%-7%). But there was a significant difference in per capita income (HIHMI -US$ 28 129 vs. LILMI - US$ 1710.2) between the groups. Even after having no significant difference in monthly cost of haemodialysis (HD) and PD in LILMI countries, they have poorer PD utilization as compared to HIHMI countries (3.4% vs. 10.1%); the reason being lack of formal training/incentives and time constraints for the nephrologist while lack of reimbursement and poor general awareness of modalities has been a snag for the patients. The region expects ≥10% PD growth in the near future. Hong Kong and Thailand with 'PD first' policy have the highest PD utilization.Important deterrents to PD underutilization were lack of PD centric policies, lackadaisical patient/physician's attitude, lack of structured patient awareness programs, formal training programs and affordability.

Hidradenitis suppurativa (HS) in South-East Asia and East Asia shows distinct clinical, environmental, physiological and likely genetic differences compared with the West. A male predominance is present, which may be due to differences in smoking habits. Involvement of the buttocks is common in East Asian patients, while the axillae are most commonly affected in South-East Asian patients. Metabolic comorbidities are prevalent in South-East Asian and East Asian HS patients. A family history of HS is less common than noted in Western populations. Asian ethnic subgroups deserve further study.

Tuberculosis is a highly contagious granulomatous disease which is endemic in South East Asia. Most common presentation is pulmonary tuberculosis which is spread by droplets inhalation of mycobacterium tuberculosis bacterium. Nasopharyngeal tuberculosis is a rare entity which poses a diagnostic difficulty as its presentation is greatly similar to that of nasopharyngeal carcinoma. Herein, we describe two cases of nasopharyngeal tuberculosis which mimics nasopharyngeal malignancy leading to diagnostic difficulties.