Search

Objective: Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries. The rates of polypharmacy and psychotropic drug load were also analyzed. Methods: The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≤ 2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method. Results: Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1,619 (80.8%) patients received mood stabilizers, 1,644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40. Results varied widely between countries. Conclusion: Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≤ 80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment. [ABSTRACT FROM AUTHOR]

Photovoltaic (PV) cell technology has made great progress over the past few decades, bringing the PV energy cost down to a point where it is competitive to conventional electricity prices. While monofacial panels have historically dominated the market, recent developments in the manufacturing of bifacial panels (collecting light from both faces) have made them accessible for commercial applications. It is therefore imperative to define the design principles so that the steeply expanding market of bifacial modules and PV farms stays on an efficient path. In this paper, we will discuss physics-based models for these next-generation bifacial PV farms for analyzing yield and costs. Besides the conventional farm configurations, tracking systems are gaining market shares aiming to enhance the yield at a lower cost. Within latitudes, we predict a 20%-30% energy gain for fixed-tilt bifacial over monofacial modules and an additional 20%–40% gain for single-axis bifacial tracking. Compound systems such as agrophotovoltaics and floating PV applications may be the possible future for a sustainable merger of food-water-energy systems. We show a competing relation between active light collection on crops and energy yield in an agrophotovoltaics system vs panel density—the final design will be decided by the crop yield or light usage efficacy constraint. The output reliability in terms of soiling and module degradation is also explained in this paper. Solar farms are expected to see 2%–5% loss in revenue in Asia and the Middle East even after optimal cleaning. Additionally, the bifacial modules degrade ∼0.5%–0.6%/year. While there have been several physics-based degradation analyses, the bifacial technology lacks a large enough data set of long-term degradation studies for accurate predictions. The combined economics of reliability against yield will decide the viability of the next generation bifacial PV industry. [ABSTRACT FROM AUTHOR]

Foot and mouth disease (FMD) is a highly contagious viral infection in cloven hoofed domestic and wild animals and endemic in many countries of the world including Bangladesh. Clinical investigation was carried out to identify natural cases of FMD and characteristics signs of FMD like salivation, ulceration in oral and pedal tissues and lameness was seen. The specific serotypes of FMD viruses involved in infected cattle were, therefore, identified using reverse transcriptase polymerase chain reaction (RT-PCR). Samples (N=97) from oral lesions was collected from infected cattle from seven divisions of Bangladesh during May to December, 2013. Viral RNA was extracted from the infected oral tissues and FMD virus specific uniplex RT-PCR was designed to detect FMD viruses. Multiplex RT-PCR was adapted to detect serotype specific amplicons. Out of 97 samples tested in uniplex and multiplex RT-PCR, 92 and 90 samples showed amplification reaction for FMD virus and viral serotypes respectively. Among the 90 FMD virus specific positive identification, single infectivity due to FMD viral Serotypes O, A and Asia 1 were seen in 56 (62.2%), 13 (14.4%) and 16 (17.8%) cases respectively. Three cattle (3.3%) were co-infected with FMD viral Serotypes O and Asia 1 and two (2.2%) with FMD viral Serotypes O and A. FMD viral serotype O was dominating all over the country followed by Asia1 and A. Cattle of Bangladesh were infected with FMD viral serotype O, A and Asia 1 alone or in combination. The RT-PCR protocols designed and adapted successfully detected FMD viruses and viral serotypes in a fraction of the time required for virus isolation and serological detection. These RT-PCR protocols can be used for rapid serotyping of FMD viruses from filed infectivity and selection of vaccine viruses. [ABSTRACT FROM AUTHOR]

This article investigates whether economic variables have explanatory power for share returns in South Asian stock markets. In particular, using data for four South Asian emerging stock markets over the period 1998–2012, the article examines the influence of a selection of local, regional and global economic variables in explaining equity returns; most previous studies that have examined this issue have tended to focus on only local and/or global factors. Important factors are identified by distilling the macroeconomic variables into principal components. Economic activities, real interest rates, real exchange rates and the trade balance represent local factors. Regional factors are represented by interregional trade and regional economic activity while global factors are represented by world financial asset returns and world economic activity. The vector autoregression results suggest that the South Asian markets examined are not efficient. Both local and regional factors can directly and indirectly explain Bangladeshi, Pakistani and Sri Lankan stock returns while the lagged returns of the Pakistani stock market and world economic activity can explain Indian stock returns. [ABSTRACT FROM PUBLISHER]

Modeling surface water quality using artificial intelligence-based models is essential in projecting suitable mitigation measures. However, it remains a challenge and requires further research to enhance the modeling accuracy. For this aim, this article presents a methodology to optimize the modeling inputs and reduce the associated complexity. The proposed approach employs Random Forest for modeling surface water salinity in terms of electrical conductivity (EC) and total dissolved solids (TDS) in the upper Indus River basin, one of the major rivers in Asia. Various water quality parameters measured monthly over a historical 30-year period were utilized in the modeling process. Various statistical indicators were used to evaluate the model performance. Random Forest process is suitable technique to simulate the salinity of surface water bodies, and effective tool in minimizing the modeling complexity and elaborating proper management and mitigation measures. [ABSTRACT FROM AUTHOR]

There is increased recognition of non-typhoidal Salmonella (NTS) as a major cause of severe febrile illness in sub-Saharan Africa. However, little is known about community-based incidence of NTS in Asia. In a multicentre, community-based prospective Salmonella surveillance study, we identified a total of six NTS cases: three in Karachi, Pakistan, one in Kolkata, India, and two in North Jakarta, Indonesia. No NTS cases were identified in Hechi, People’s Republic of China, and Hue, Viet Nam. Three cases were in children under 3 years, and one case was in a child aged 10 years and one in a child aged 15 years. Only one case was an adult (29 years). The highest incidence of NTS infection was in Karachi (7.2 culture-proven NTS cases per 100 000 person years in age group of 2–15 years). However, in comparison with sub-Saharan Africa, the NTS burden in Asia appears rather limited. [ABSTRACT FROM AUTHOR]

Emergency contraception (EC) has been around for decades, but the first serious introduction and scale-up efforts started in the mid 1990's. This paper reviews programmatic experiences that sought to expand access to emergency contraceptive pills (ECP) in Africa, Asia and Latin America over the last decade. This multiregional review identifies the individual phases of the introductory processes as well as facilitators and barriers to successful scale-up of ECP service provision. Characteristics of successful projects included conduction of multi-sector diagnostic assessments; careful consideration of legal and policy issues; collaborative advocacy and technical assistance for inclusion in public family planning programs by national and international institutions; as well as attention to programmatic areas such as capacity-building, supply-chain and awareness-raising. Lessons learned from varied developing country experiences are discussed as is the need for increased attention to evaluating and disseminating project results. [ABSTRACT FROM AUTHOR]

Focuses on hepatology and gastroenterology issues in some Asian countries. Seroepidemiology of hepatitis B in Bangladesh; Examination of primary biliary cirrhosis in China; Effectiveness and coverage of vaccination in Mongolia.

The author reflects on the importance for medical institutions to adopt proactive strategies for the prevention and management of peripheral vascular disease (PVD) in Asia. It outlines the risk factors PVD, which could lead to life threatening emergency, prompting physicians to implement appropriate interventions to reduce morbidity ad mortality. The author also recognizes the forecast regarding the major disease burden in the continent and calls for appropriate preventive measures.

Abstract: Conventional tilled transplanting, a widely practiced method of rice (Oryza sativa L.) establishment in puddled soils in rice–rice and rice–wheat (Triticum aestivum L.) systems in Asia, requires a large amount of labor and water, which are becoming scarce and expensive. Growing more food with the same production costs or even reduced costs and sustaining the quality of the natural resource base are a major concern. On-farm trials were conducted in Chuadanga District of Bangladesh during the wet season as monsoon rice (aman) and during the dry season as winter rice (boro) in 2006–07 to evaluate the effects of establishment methods with improved crop management on productivity, resource (land, water, and labor) use, and economic return. Rice was established by sowing in line with a drum seeder on conventional tilled puddled soils (CT-DrumR) and by transplanting in line on the day of CT-DrumR (CT-TPR1) and 30 and 35 days after CT-DrumR (CT-TPR2) in aman and boro seasons, respectively. Farmers’ usual transplanting time corresponds to the day of CT-TPR2. Grain yields in CT-DrumR and CT-TPR2 were similar but the crop occupied the main field 22–24 days longer in CT-DrumR than in CT-TPR2, resulting in lower productivity (45kggrainha−1 day−1 vs. 55kggrainha−1 day−1) in both seasons. Drum-seeded rice matured earlier by 8 and 11 days, received 12% and 6% less irrigation water, saved 19 and 24person-daysha−1, and gave higher gross margins of 6% and 4% but input costs increased by 20% and 12% than CT-TPR2 in aman and boro seasons, respectively. There is a need to examine these benefits of drum-seeded rice in relation to the feasibility of adoption by farmers. [Copyright &y& Elsevier]

The photovoltaics (PV) industry is poised to capture most of the energy sector within the next few decades. As the installed PV capacity increases, even the smallest improvements on the system and operations of the solar farms can accumulate to a significant gain in revenue. One such scope is efficient mitigation of dust accumulation on panels or soiling. While installed capacities are two of the highest in Asia and around US deserts, these locations are also dust prone. The Middle East and North Africa (MENA) regions having good insolation are also highly potential candidates for PV farms with the added complexity of soiling losses. Therefore, while soiling may not be an issue in many locations over the globe, it is in fact relevant to the majority of the PV installation sites. The analysis of the effects of soiling losses on energy yield and economics are of great importance for these locations. In this work, we have extended the empirical soiling model found in the literature to include the effects of temporal variation on soiling and insolation. Our study on variation in revenue with unoptimized cleaning intervals estimates the soiling loss, which can particularly interest PV farms with accessibility issues such as agrophotovoltaic systems. We analyze the optimal cleaning cycle and corresponding normalized revenue (cash inflow normalized to the rated clean farm revenue). A numerical model is used to explain the effects under seasonal and sudden (e.g., sand storm or rain) variations in soiling and insolation. Our closed-form analytical expressions can predict the cleaning cycle and normalized revenue within 0.1% of the numerical results by using the soiling and insolation data averaged over the seasons. Finally, we discuss these results in a global scenario using our estimated world-map for soiling rates. This predicts the worldwide revenue loss under location-specific optimal cleaning cycles, assuming one of the lowest cleaning costs seen globally. In Asia and MENA regions, for example, median revenue loss due to soiling is 2.5% even after optimal cleaning every 5–6 days. This loss is 1.5% in the US for 12 days of cleaning interval. Considering region-specific cleaning costs, the revenue loss of optimally cleaned PV farm is 2%–5% for Asia, MENA, North America, and Europe. • Analytical and numerical model to predict cleaning cycle and normalized revenue. • Global overview of the effects of soiling based on data from 132 locations. • Global prediction on cleaning cycle and normalized revenue in PV farms. • Globally, 1–2.5% revenue loss after optimal cleaning for moderate cleaning cost. • Globally, >2% revenue loss (optimally cleaned) for region-specific cleaning cost. [ABSTRACT FROM AUTHOR]

We reconstruct the rise of a segment of the southern flank of the Himalaya-Tibet orogen, to the south of the Lhasa terrane, using a paleoaltimeter based on paleoenthalpy encoded in fossil leaves from two new assemblages in southern Tibet (Liuqu and Qiabulin) and four previously known floras from the Himalaya foreland basin. U-Pb dating of zircons constrains the Liuqu flora to the latest Paleocene (ca. 56 Ma) and the Qiabulin flora to the earliest Miocene (21-19 Ma). The proto-Himalaya grew slowly against a high (~4 km) proto-Tibetan Plateau from ~1 km in the late Paleocene to ~2.3 km at the beginning of the Miocene, and achieved at least ~5.5 km by ca. 15 Ma. Contrasting precipitation patterns between the Himalaya-Tibet edifice and the Himalaya foreland basin for the past ~56 m.y. show progressive drying across southern Tibet, seemingly linked to the uplift of the Himalaya orogen. [ABSTRACT FROM AUTHOR]

Background: Despite progress, under-five mortality remains high, especially in Sub-Saharan Africa and South Asia, where around 13,400 children die daily. Environmental pollutants, including PM2.5 from outdoor air and household air pollution, significantly contribute to these preventable deaths., Methods: This cross-country study combined satellite data with 113 surveys from the IPUMS-DHS dataset (1998-2019) to examine under-five child mortality in 41 developing countries. The integration of Global Annual Particulate Matter with a diameter of 2.5 micrometres or less (PM2.5) Grids from Socioeconomic Data and Applications Center (SEDAC) and geospatial data from the DHS Program enabled a focused analysis of the association between indoor and outdoor air pollution, particularly PM2.5, and child mortality rates using both logistic and multilevel logistic regression models, as well as estimating Population Attributable Fractions (PAF) to quantify the mortality burden attributable to these pollutants., Results: Outdoor air pollution, measured by a one standard deviation increase in PM2.5, significantly increased the risk of child mortality (Odds Ratio [OR]: 1.14; 95% Confidence Interval [CI]: 1.10-1.18; p < 0.001). Moderate and high household air pollution exposure also heightened this risk, with increases of 37% (OR: 1.37; 95% CI: 1.24-1.53; p < 0.001) and 40% (OR: 1.40; 95% CI: 1.26-1.56; p < 0.001), respectively, compared to no exposure. Multilevel models (Models 5a and 10a) produced similar estimates to standard logistic regression, indicating robust associations. Additionally, Population Attributable Fraction analysis revealed that approximately 11.9% of under-five mortality could be prevented by reducing ambient PM2.5 exposure and 12.0% by mitigating household air pollution. The interaction between indoor and outdoor pollution revealed complex dynamics, with moderate and high household exposure associated with a reduction in mortality risk when combined with PM2.5. Geographical disparities were observed, with stronger correlations between outdoor air pollution and child mortality in Africa compared to Asia, and more pronounced impacts in low-income countries. However, household air pollution had stronger association with child mortality in Africa and lower- and middle-income countries., Conclusions: Our findings could serve as a guide for policy development aimed at reducing under-five mortality, ultimately contributing to the attainment of the Sustainable Development Goal (SDGs)., (© 2024. The Author(s).)

This paper aims to measure the impact of environmental provisions in free-trade agreements on pollution levels in 40 Asian economies for the period 1990-2019. Following the failure of WTO negotiations, there has been a rapid proliferation of preferential trade agreements incorporating various types of environmental clauses. We exploit such changes to assess their influence on pollution emissions. We use a DOLS approach that considers the potential endogeneity of environmental clauses. Further, panel vector error correction models (VECM) are employed for examining the presence of a cointegration relationship among the variables studied. Overall, our findings indicate that these environmental clauses have heterogenous effects on CO 2 emissions. We do not find significant effects of environmental clauses on pollution. However, this result is driven by environmental provisions that are not legally enforceable. We do find a positive effect of environmental clauses with a higher level of legalism on the environmental quality. These results show that the inclusion of environmental provisions in trade agreements is not sufficient by itself. Such provisions should incorporate a legally enforceable framework to effectively address environmental concerns. These findings have significant policy implications for Asian countries., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Continuous economic growth and the rise in energy consumption are linked with environmental pollution. Demand for health care expenditure increased after the COVID-19 pandemic. This study is interesting in modeling the nexus between public and private health expenditure, carbon dioxide emissions, and economic growth. To this end, the present study analyzed the nexus between public and private health care expenditure, economic growth, and environmental pollution for 36 Asian countries for the period 1991-2017. FMOLS, GMM, and quantile regression analysis confirm the EKC hypothesis in Asia. Besides, FMOLS and quantile regressions reached the reducing effects of government and private health expenditures on CO 2 emissions. While quantile regression results show that public and private health expenditures can mitigate CO 2 emissions; however, these results differ for various levels of CO 2 . Findings of quantile regression show a significant impact of both public and private health expenditures in reducing CO 2 at the 50 th and 75 th quantiles but results are insignificant for the 25 th quantile. Overall, the paper concludes that both government and private health sectors' expenditures caused CO 2 emissions to decrease in Asia and that the negative impact of the private health sector on CO 2 emissions is greater than that of the government health sector. The concluding remark is that the higher the health spending, the higher the environmental quality will be in Asia. Hence, the health administrators need to increase public and private health expenditures with an effective cost-service and energy-efficient management approach to reach sustainable health services and a sustainable environment in Asia., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Prevalence rates for diabetes mellitus continue to rise, which, coupled with increasing costs of complications, has appreciably increased expenditure in recent years. Poor glycaemic control including hypoglycaemia enhances complication rates and associated morbidity, mortality and costs. Consequently, this needs to be addressed. Whilst the majority of patients with diabetes have type-2 diabetes, a considerable number of patients with diabetes require insulin to help control their diabetes. Long-acting insulin analogues were developed to reduce hypoglycaemia associated with insulin and help improve adherence, which can be a concern. However, their considerably higher costs have impacted on their funding and use, especially in countries with affordability issues. Biosimilars can help reduce the costs of long-acting insulin analogues thereby increasing available choices. However, the availability and use of long-acting insulin analogues can be affected by limited price reductions versus originators and limited demand-side initiatives to encourage their use. Consequently, we wanted to assess current utilisation rates for long-acting insulin analogues, especially biosimilars, and the rationale for patterns seen, across multiple Asian countries ranging from Japan (high-income) to Pakistan (lower-income) to inform future strategies., Methodology: Multiple approaches including assessing utilization and prices of insulins including biosimilars among six Asian countries and comparing the findings especially with other middle-income countries., Results: Typically, there was increasing use of long-acting insulin analogues among the selected Asian countries. This was especially the case enhanced by biosimilars in Bangladesh, India, and Malaysia reflecting their perceived benefits. However, there was limited use in Pakistan due to issues of affordability similar to a number of African countries. The high use of biosimilars in Bangladesh, India and Malaysia was helped by issues of affordability and local production. The limited use of biosimilars in Japan and Korea reflects limited price reductions and demand-side initiatives similar to a number of European countries., Conclusions: Increasing use of long-acting insulin analogues across countries is welcomed, adding to the range of insulins available, which increasingly includes biosimilars. A number of activities are needed to enhance the use of long-acting insulin analogue biosimilars in Japan, Korea and Pakistan.

Background & Objectives: Crimean-Congo Hemorrhagic Fever Virus (CCHFV) is a vector borne pathogen, well-known for causing endemic hemorrhagic fever in Asia, Europe and Africa. There is no specific drug or vaccine available against CCHFV. The recent upsurge of Crimean-Congo Hemorrhagic Fever around the globe has made it a major health issue and this demands investigation for specific inhibitors to viral proteins. The objective of this study was to assess inhibitors that may have the potential to dock CCHFV nucleoprotein which plays an important role in viral assembly., Methods: We performed structure-based virtual screening and molecular docking by using potent inhibitors against nucleoprotein of CCHFV. Screening was performed by a webserver, MtiOpenScreen which gave 1000 drug-like molecules from PubChem. PyRx Autodock vina was utilized to dock the protein. The docking poses were observed for interaction analysis by LigPlot+. This study provided ten potential candidates capable of binding to the active site of NP of CCHFV. The selected hits were then subjected to toxicity prediction by ProTox-II., Results: Four hits were identified that specifically dock nucleoprotein at the presumed binding site. Furthermore, these compounds have less binding energy i.e., 9.7 kcal/mol, 9.8 kcal/mol and 10.4 kcal/mol and with equal toxicity measures when compared to an FDA approved drug., Interpretation & Conclusion: This study illustrates that virtual screening is an efficient in silico approach to identify target-specific inhibitors. Researchers in this area who investigate drugs or synthesize agents against CCHFV with better efficacy could utilize reported inhibitors rather than trying random compounds ambivalently., Competing Interests: None

Although Asian economies have registered strong economic growth over the last few decades, their growing pollution emissions raise concerns among the policymakers about the sustainability of this output growth. This paper tests the causal relationship between economic development, energy consumption, trade openness, financial development, FDI, government expenditures, institutional quality. and pollution emissions for 41 Asian economies from 1996 to 2015. Further, we separately test the impact of political and economic institutions on pollution emissions of the sample economies. Our estimated outcomes, based on the panel cointegration method and panel vector error correction models (VECM), substantiate the presence of a cointegration relationship among all the selected variables. While economic development, energy use, trade openness, and FDI augment environmental degradation, financial development and better economic institutions help the selected countries in reducing their pollution emissions. Moreover, better economic and political institutions also mediate the adverse impact of income, trade openness, and FDI on pollution emissions. The VECM model shows that per capita GDP is the only variable having a causal effect on pollution emissions in all the models. For all the other variables, the causal effect is significant only in a few cases. These outcomes have some important policy recommendations for the sample economies., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Nipah virus (NiV) is an emerging bat-borne zoonotic virus that causes near-annual outbreaks of fatal encephalitis in South Asia-one of the most populous regions on Earth. In Bangladesh, infection occurs when people drink date-palm sap contaminated with bat excreta. Outbreaks are sporadic, and the influence of viral dynamics in bats on their temporal and spatial distribution is poorly understood. We analyzed data on host ecology, molecular epidemiology, serological dynamics, and viral genetics to characterize spatiotemporal patterns of NiV dynamics in its wildlife reservoir, Pteropus medius bats, in Bangladesh. We found that NiV transmission occurred throughout the country and throughout the year. Model results indicated that local transmission dynamics were modulated by density-dependent transmission, acquired immunity that is lost over time, and recrudescence. Increased transmission followed multiyear periods of declining seroprevalence due to bat-population turnover and individual loss of humoral immunity. Individual bats had smaller host ranges than other Pteropus species (spp.), although movement data and the discovery of a Malaysia-clade NiV strain in eastern Bangladesh suggest connectivity with bats east of Bangladesh. These data suggest that discrete multiannual local epizootics in bat populations contribute to the sporadic nature of NiV outbreaks in South Asia. At the same time, the broad spatial and temporal extent of NiV transmission, including the recent outbreak in Kerala, India, highlights the continued risk of spillover to humans wherever they may interact with pteropid bats and the importance of limiting opportunities for spillover throughout Pteropus 's range., Competing Interests: The authors declare no competing interest., (Copyright © 2020 the Author(s). Published by PNAS.)

Background/objective: Most of the studies and registries related to cerebral venous thrombosis (CVT) are reported from European countries and the United States. The objective of the present study is to identify risk factors, presentation, and outcome of CVT in Asian patients., Methods: Asian CVT registry is a prospective multinational observational study that included patients (aged > 16 years) with symptomatic CVT., Results: Eight hundred and twelve patients (59% women) from 20 centers in 9 Asian countries were included. Mean age of the patients was 31 years. Motor weakness in limbs was present in 325 (40%) patients. One hundred and eighty (22.1%) patients had a normal Glasgow coma scale (GCS) at presentation, and another 529 patients (65%) had GCS between 11 and 14. The rest (103; 13%) had a GCS of less than 10 at presentation. Permanent risk factors were present in 264 (33%) patients, transient in 342 (42%) patients, both in 43 (5%) patients and no risk factors were found in 163 (20%) patients. Anemia was present in 51%, use of oral contraceptive pills (OCP) was present in 12% women and a hypercoaguable state was present in more than 40% of those tested. One hundred and forty-three cases (18%) were in women who were either pregnant (18; 2%) or in the puerperium (up to 6 weeks postpartum; N = 125; 15%). A total of 86 (10.5%) patients were diagnosed with infection in any part of the body. The most common MRI finding was local brain edema or ischemia (53.3%) followed by hemorrhage (26.7%). Twenty-seven patients (3.3%) died during hospital stay. The mRS score at discharge was available for 661 (81%) patients. Of these, 577 (87.3%) had good functional outcome at discharge. Motor weakness at presentation, GCS of 9 or less and mental status disorder were the strongest independent predictors of mortality at last follow-up among patients with CVT., Conclusions: Important differences were identified as compared to western data including younger age, high frequency of anemia, low use of OCP, and high frequency of hypercoaguable states. Functional outcome at discharge was good., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Asian countries are in various stages of epidemiological transition and therefore exhibit a great diversity in disease patterns. Collectively, they comprise almost two-third of the world's total mortality due to stroke. The purpose of this review is to explore existing epidemiological data on stroke, highlight the temporal trends in stroke epidemiology in various regions of Asia and predict future patterns based on these observations. Our search revealed that there is a lack of good epidemiological data from most Asian countries. Whatever data exist are not comparable due to lack of standardised methodology for ascertaining stroke and its subtypes. For this and other reasons, these estimates exhibit country-to-country variation and also within-country variability. We have also reviewed temporal trends in stroke incidence and prevalence in 12 Asian countries and the evolution of stroke subtypes over the past two decades. Important observations include a rise in stroke incidence in most Asian countries, an earlier age at onset compared with the West, a relative increase in the proportion of ischaemic strokes and a decline in haemorrhagic strokes. Among ischaemic stroke subtypes, lacunar strokes, which were once the commonest variety, are now declining. Emerging data suggest that large artery atherosclerosis and in particular that of intracranial vessels is the predominant aetiology in most Asian countries. The review also identified important gender differences in terms of stroke risk factors, prevalence and outcomes. There is need for sound epidemiological data from most countries to understand the disease better and plan policy-level interventions to decrease the burden. We identify a need for standard format or guidelines for conducting stroke epidemiological studies especially in developing Asian countries. This region must be identified as a priority region for stroke-related interventions and preventive strategies by global healthcare authorities and organisations., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: Despite an increased risk of stroke in pregnancy and puerperium, the overall incidence of the condition in this population is low. Therefore, there is limited data pertaining to these patients particularly from Asian countries. Our objective was to describe the risk factors and outcomes of 110 pregnancy-related ischemic strokes from 5 Asian countries., Methods: Data were collected by retrospective chart review in most cases and prospectively in the rest. Inclusion criteria for this subanalysis were women, pregnant or within 1-month postpartum, presenting to the study center with acute ischemic stroke (arterial or venous) confirmed by neuroimaging. Intracranial hemorrhages other than the ones associated with cerebral venous thrombosis or hemorrhagic infarct were excluded. Risk factors were diagnosed based on already published criteria. Outcomes were measured using modified Rankin score. Statistical analysis was done using Statistical Package for Social Sciences version 19.0., Results: In all, 110 women with mean age of 27.94 years presented with pregnancy-related ischemic strokes; 58.2% of the strokes occurred postpartum and 49.1% were secondary to cerebral venous thrombosis. Venous strokes were significantly more likely to occur postpartum compared with arterial strokes (P=.01), to have abnormal "hypercoagulable panel result on admission" (P<.001), less likely to have traditional stroke risk factors (P<.001), to have hemorrhagic conversion of stroke (P<.001), and to have lesser stroke severity and better functional outcome at 3 months (P<.001 for each)., Conclusion: Cerebral venous thrombosis is a significant contributor to pregnancy-related strokes in Asian women. Both traditional and pregnancy-specific risk factors should be addressed to control ischemic stroke risk in these women., (Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Complete nucleotide sequences of 19 hepatitis B virus (HBV) isolates of genotype A (HBV/A) were determined and analysed along with those of 20 previously reported HBV/A isolates. Of the 19 HBV/A isolates, six including three from Japan and three from the USA clustered with the 14 HBV/A isolates from Western countries. The remaining 13 isolates including four from The Philippines, two from India, three from Nepal and four from Bangladesh clustered with the six HBV/A isolates reported from The Philippines, South Africa and Malawi. Due to distinct epidemiological distributions, genotype A in the 20 HBV isolates was classified into subtype Ae (e for Europe), and that in the other 19 into subtype Aa (a for Asia and Africa) provisionally. The 19 HBV/Aa isolates had a sequence variation significantly greater than that of the 20 HBV/Ae isolates (2.5+/-0.3 % vs 1.1+/-0.6 %, P<0.0001); they differed by 5.0+/-0.4 % (4.1-6.4 %). The double mutation (T1762/A1764) in the core promoter was significantly more frequent in HBV/Aa isolates than in HBV/Ae isolates (11/19 or 58 % vs 5/20 or 25 %, P<0.01). In the pregenome encapsidation (epsilon) signal, a point mutation from G to A or T at nt 1862 was detected in 16 of the 19 (84 %) HBV/Aa isolates but not in any of the 20 HBV/Ae isolates, which may affect virus replication and translation of hepatitis B e antigen. Subtypes Aa and Ae of genotype A deserve evaluation for any clinical differences between them, with a special reference to hepatocellular carcinoma prevalent in Africa.

The study aims to examine the perceptions, causes, and treatment of diseases among the people of a few selected villages in Matlab and their relation to traditional culture and interventions made by BRAC and ICDDR,B in the form of rural development and MCH-FP programs. Four sets of villages were chosen purposively--two DSS and the other two non-DSS. In one of the DSS villages the MCH-FP program is underway, while the other does not have such programs. Likewise, one of the non-DSS villages has the rural development program of BRAC, while the other does not have any. From each village 10 respondents were selected purposively to gather information. The perception of disease is mostly defined in terms of the functions of the body. On very few occasions it is defined in terms of the action rendered by germs or the pathological condition of the body organs. The difference between the meaning and the actual diseases is often blurred. While identifying the causes, often the reference is made to invisible spirits, locally known as alga batash. The modes of treatment combine both modern and traditional elements. However, the health teaching educates them about the perception, causes, and treatment of certain diseases. In society, the elderly people, religious preachers, and traditional healers play important roles to influence the mind of the people. Sometimes gender relations and other structural features also bear on the minds of the illiterate poor. The difference between the intervention and non-intervention villages is expressed in the fact that the people of the intervention villages are constantly exposed to the agents making changes, while in the non-intervention villages it is intermittent. Traditional culture still plays an important role in the construction of disease perception and the choice of treatment, while modern approaches are combined with it. The intervention procedures widen modern approaches but could not eliminate the traditional notions altogether., (full text)