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PubMed2002

Chronic pancreatitis: Asia-Pacific consensus report.

Current knowledge about chronic pancreatitis (CP) is limited and there is a particular dearth of information about the entity known as tropical pancreatitis. A consensus working party was convened by the Trustees of the Journal of Gastroenterology and Hepatology Foundation to conduct a systematic investigation into available evidence about the epidemiology, etiopathogenesis, diagnosis and management of CP. A literature search and formal survey of international experts in the field were used to assemble reliable evidence about these issues. The present review summarizes the results of the working party's findings and presents a series of practice guidelines to improve diagnosis, investigation and treatment of patients with CP, particularly those in the Asia-Pacific region. Areas for further research have also been identified.

Asia↗
PubMed2003

Can a non-invasive strategy for managing young dyspeptics be safely implemented in Asia?

Dyspepsia is a common problem in the Asia-Pacific region, with a prevalence rate ranging from 10-20%. It constitutes 2-5% of consultations with primary-care physicians and forms a major part of the gastroenterologists' workload. Although upper gastrointestinal endoscopy (UGIE) is the investigation of choice, no serious disease is present in the majority of patients and various other ways have been suggested, mainly in the West, to reduce the demand on the finite resources of UGIE services. The alternative methods to UGIE have been based on non-invasive detection of Helicobacter pylori in patients with dyspepsia, as the organism has been shown to be associated with most peptic ulcers and even gastric cancer. A positive H. pylori test in a patient with dyspepsia may not necessarily indicate serious disease, but H. pylori eradication eliminates the propensity for developing peptic ulcers and perhaps even cancer (not proven). In high-risk populations, non-invasive screening for H. pylori can even be considered a 'cancer test', as it can help target investigations in a selected group of patients.

Age Factors↗
PubMed2003

Non-alcoholic steatohepatitis: what is it, and why is it important in the Asia-Pacific region?

Non-alcoholic steatohepatitis (NASH), is a critical link in the chain of metabolic fatty liver disorders that spans steatosis to cryptogenic cirrhosis. It is the hepatic manifestation of the insulin resistance (or metabolic) syndrome, and provides a clue to understanding fibrotic progression of other chronic liver diseases, particularly hepatitis C. Non-alcoholic steatohepatitis is often the first clinical indication of insulin resistance, with its complications of high blood pressure, coronary heart disease and type 2 diabetes. Among those with risk factors, NASH is common: present in at least 20% of obese adults or children with or without type 2 diabetes, and at least 5% of those overweight. With emerging urbanization, increasing affluence and behavioral changes of physical inactivity and high fat/energy-excessive diet, type 2 diabetes has become common in Asia and the western Pacific rim. The rates range from 7-40%, which in countries like Japan represents a 3-20-fold increase (depending on age) over the last 20 years. The increase is associated with central adiposity, insulin resistance, hepatic steatosis and NASH. After cancer, cirrhosis from NASH is now the second most common age-related cause of death in type 2 diabetes. Reversing these trends must become a public health priority; the first awakenings were evident in Taiwan at the time of this meeting. In order to stimulate clinicians to think more about the importance of metabolic liver disease for development of cirrhosis, this review will cover clinical and laboratory features, natural history and an approach to diagnosis and management of NASH. Some emerging concepts on pathogenesis will be mentioned briefly, but the emphasis will be on the potency of lifestyle adjustments (physical activity and diet) to prevent or reverse fatty liver disorders.

Asia↗
PubMed2003

Smokeless tobacco and health in India and South Asia.

South Asia is a major producer and net exporter of tobacco. Over one-third of tobacco consumed regionally is smokeless. Traditional forms like betel quid, tobacco with lime and tobacco tooth powder are commonly used and the use of new products is increasing, not only among men but also among children, teenagers, women of reproductive age, medical and dental students and in the South Asian diaspora. Smokeless tobacco users studied prospectively in India had age-adjusted relative risks for premature mortality of 1.2-1.96 (men) and 1.3 (women). Current male chewers of betel quid with tobacco in case-control studies in India had relative risks of oral cancer varying between 1.8-5.8 and relative risks for oesophageal cancer of 2.1-3.2. Oral submucous fibrosis is increasing due to the use of processed areca nut products, many containing tobacco. Pregnant women in India who used smokeless tobacco have a threefold increased risk of stillbirth and a two- to threefold increased risk of having a low birthweight infant. In recent years, several states in India have banned the sale, manufacture and storage of gutka, a smokeless tobacco product containing areca nut. In May 2003 in India, the Tobacco Products Bill 2001 was enacted to regulate the promotion and sale of all tobacco products. In two large-scale educational interventions in India, sizable proportions of tobacco users quit during 5-10 years of follow-up and incidence rates of oral leukoplakia measured in one study fell in the intervention cohort. Tobacco education must be imparted through schools, existing government health programmes and hospital outreach programmes.

Asia↗
PubMed2004

Molecular epidemiology of viral gastroenteritis in Asia.

Acute gastroenteritis is one of the most common diseases in humans, and continues to be a significant cause of mortality and morbidity worldwide. Recently the estimates of mortality associated with diarrhea declined, however the majority of deaths still occur in developing countries and thus urgent intervention is needed for the prevention of these diseases. In Asian countries it is very important to study the distribution, transmission and characteristics of prevalent viruses in order to produce viral vaccines. The viruses which cause gastroenteritis are primarily from four distinct families - group A rotaviruses, caliciviruses, enteric adenoviruses and astroviruses. Rotavirus is a common virus that causes severe gastroenteritis in children <5 years of age. The reassortant viruses with animal virus, or directly animal viruses are isolated in humans. The future development of a safe and effective vaccine against rotavirus, along with the expansion of understanding of the distribution of types in Asia and an availability of rapid diagnostic tests, could reduce mortality and might be able to prevent severe gastroenteritis. Calicivirus is a causative virus of acute gastroenteritis in children and has been known to contaminate food causing viral outbreaks affecting people of all ages. Recently, the understanding of calicivirus and the improvement of detection techniques has increased the total frequencies of diarrheal viruses. For the future control and prevention of diarrheal diseases it is necessary to examine the molecular epidemiology of caliciviruses as well as rotaviruses.

Adenoviruses, Human↗
PubMed2000

Patterns of male-specific inter-population divergence in Europe, West Asia and North Africa.

We typed 1801 males from 55 locations for the Y-specific binary markers YAP, DYZ3, SRY10831 and the (CA)n microsatellites YCAII and DYS413. Phylogenetic relationships of chromosomes with the same binary haplotype were condensed in seven large one-step networks, which accounted for 95% of all chromosomes. Their coalescence ages were estimated based on microsatellite diversity. The three largest and oldest networks undergo sharp frequency changes in three areas. The more recent network 3.1A clearly discriminates between Western and Eastern European populations. Pairwise Fst showed an overall increment with increasing geographic distance but with a slope greatly reduced when compared to previous reports. By sectioning the entire data set according to geographic and linguistic criteria, we found higher Fst-on-distance slopes within Europe than in West Asia or across the two continents.

Africa, Northern↗
PubMed2003

Nephrology in South East Asia: fact and concept.

The developing countries of South East Asia lie within the tropics. Renal disease in this region represents the interaction between the kidney and the environment abetted by low levels of socioeconomic development in many areas. Together with genetic susceptibility to some diseases, there are widespread infectious diseases and prominently encountered plant and animal toxins. Chronic renal failure, most commonly the outcome of chronic glomerulonephritis and frequently to persistent nephrolithiasis as well as acute renal failure due to a variety of stimuli, are among the most common renal problems encountered. Renal replacement therapy is both a clinical and economic problem. The epidemiology of renal disease in the region is poorly understood, and workforce and treatment facilities are not adequate for the caseload in a number of countries in the region. Many people with chronic renal disease simply cannot afford the necessary treatment. The principle focus for the future must be on prevention strategies and the provision of appropriate health services within the current economic and technological restraints.

Asia, Southeastern↗
PubMed2001

Monogeneans from Pangasiidae (Siluriformes) in Southeast Asia: I. Five new species of Thaparocleidus Jain, 1952 (Ancylodiscoidinae) from Pangasius pangasius, P. kinabatanganensis, P. rheophilus and P. nieuwenhuisii.

The examination of gill parasites from Pangasius pangasius (Hamilton, 1822); P. kinabatanganensis Roberts & Vidthayanon, 1991; P. rheophilus Pouyaud & Teugels, 2000 and P. nieuwenhuisii (Popta, 1904) (Siluriformes, Pangasiidae) in Southeast Asia revealed the presence of six species of Thaparocleidus Jain, 1952 (Monogenea, Ancylodiscoidinae). One has been previously described from P. pangasius: T. pangasi (Tripathi, 1957). The other five are new species: T. chandpuri n. sp. from P. pangasius; T. bahari n. sp. and T. sabanensis n. sp. from P. kinabatanganensis; T. redebensis n. sp. from P. rheophilus and T. mahakamensis n. sp. from P. nieuwenhuisii.

Animals↗
PubMed2002

Monogeneans from Pangasiidae (Siluriformes) in Southeast Asia: IV. Five new species of Thaparocleidus Jain, 1952 (Ancylodiscoididae) from Pangasius krempfi, P. kunyit, P. mekongensis and P. sabahensis.

The examination of gill parasites from Pangasius krempfi Roberts & Vidthayanon, 1991; P. kunyit Pouyaud et al., 1999; P. mekongensis Gustiano et al., in press and P. sabahensis Gustiano et al., in press (Siluriformes, Pangasiidae) in Southeast Asia revealed the presence of six species of Monogenea, all belonging to the genus Thaparocleidus Jain, 1952 (Monogenea, Ancylodiscoididae) as defined by Lim (1996) and Lim et al. (2001). One has been previously described (T. vietnamensis Pariselle et al., 2002), five are considered as new species: T. humerus n. sp. and T. culter n. sp. on P. kunyit; T. mehurus n. sp. and T. culteroides n. sp. on P. sabahensis; and T. phuongi n. sp. on the four studied host species. The latter one, due to slight morphometric differences linked to geographical origin of hosts, is described as made up of three sub-species: T. phuongi phuongi n. sub-sp., T. phuongi malaysiensis n. sub-sp. and T. phuongi indonesiensis n. sub-sp.

Animals↗
PubMed2005

Monogeneans from Pangasiidae (Siluriformes) in Southeast Asia: VIII. Four new species of Thaparocleidus Jain, 1952 (Ancylodiscoididae) from Pangasius polyuranodon and P. elongatus.

The examination of gill parasites from Pangasius polyuranodon Bleeker, 1852 and P. elongatus Pouyaud, Gustiano & Teugels, 2002 (Siluriformes, Pangasiidae) in Southeast Asia revealed the presence of four new species of Monogenea all belonging to Thaparocleidus Jain, 1952 (Monogenea, Ancylodiscoididae) as defined by Lim (1996) and Lim et al. (2001): T. furcus n. sp., T. infundibulus n. sp., T. sudartoi n. sp. and T. turbinatio n. sp.

Animals↗
PubMed2005

Monogeneans from Pangasiidae (Siluriformes) in Southeast Asia: IX. Two new species of Thaparocleidus Jain, 1952 (Ancylodiscoididae) from Pangasius mahakamensis.

The examination of gill parasites from P. mahakamensis Pouyaud, Gustiano & Teugels, 2002 (Siluriformes, Pangasiidae) in Southeast Asia revealed the presence of three species of Monogenea. One (Thaparocleidus caecus (Mizelle & Kritsky, 1969)) had been previously described. The other two, belonging to Thaparocleidus Jain, 1952 (Monogenea, Ancylodiscoididae) as defined by Lim (1996) and Lim et al. (2001), are considered new species: T. pouyaudi n. sp. and T. teugelsi n. sp.

Animals↗
PubMed1999

Factors influencing recruitment and retention of academic staff in South-East Asia.

South-East Asia has a number of developing and developed countries. The economic standings of these countries are different and influence the number of staff in each academic department. The quantum of clinical work they are expected to perform and the remuneration vary enormously. The retirement age, facilities for research and criteria for promotion are different. The health care delivery system, the financial status and outlook of the universities also differ. These factors operate differently in the South-East Asian countries and determine the recruitment and retention of academic staff.

Asia, Southeastern↗
PubMed2007

Perspectives on the nutritional management of renal disease in Asia: people, practice, and programs.

The high prevalence of end-stage renal disease (ESRD) in many Asian countries is attributed to diabetes and hypertension. Health care expenditure in relation to per capita income and government share of this expenditure vary among Asian countries and are affected by large populations and the poverty factor. The impact of ESRD on nutritional management in Asia reveals the need for clinicians to balance the requirements for higher standards of dietetic practice as they implement optimal care algorithms with the goal of improving outcomes, against the backdrop of staffing limitations, limited expertise in renal nutrition practice, and cultural diversity among Asian people. This paper discusses current aspects of dietetic practice and the likelihood that a change in practice is required if dietitians are to play an active role in preventing or slowing down ESRD.

Asia↗
PubMed2002

Aortic surgery in Asia.

Aortic Surgery in Asia is in markedly different stages of development. We assessed the approximate state in some Asian countries. Personal communications are sought from Asian surgeons known to have interest in aortic surgery.

Aortic Aneurysm, Abdominal↗
PubMed2004

Case-finding for familial hypercholesterolemia in the Asia-Pacific region.

It is estimated that in the Asia-Pacific region, more than 5.2 million persons are suffering from familial hypercholesterolemia (FH). This means that more than half of the estimated world total of 10 million FH patients are living in this part of the world, of which the vast majority is not aware of their dangerous condition, let alone being adequately treated. Obviously, an intensive case-finding program to identify patients and subsequent clinical management are required to prevent premature cardiovascular disease and death caused by the consequences of inherited hypercholesterolemia. This article describes the current situation concerning FH and the initiatives and actions undertaken in Australia to contribute to actively identifying patients with FH in that country.

Asia↗
PubMed2004

High dose antipsychotic use in schizophrenia: findings of the REAP (research on east Asia psychotropic prescriptions) study.

BACKGROUND: High-dose antipsychotic regimes (defined as the prescription of more than 1000 chlorpromazine-equivalents milligrams of antipsychotic per day) in the management of patients with schizophrenia are not uncommon, but most reports are from western countries. Recent functional neuroimaging studies have found that the previous notion concerning the use of antipsychotic medication, especially in high doses, was unsupported and untenable. METHODS: This international study examined the use of high dose antipsychotic medication and its clinical correlates in schizophrenia patients within six East Asian countries/territories. RESULTS: Within the study group (n = 2399), 430 patients (17.9%) were prescribed high dose antipsychotics. Antipsychotic use varied significantly between countries, with Japan, Korea, and Singapore using higher doses than the other countries. High dose antipsychotic use was associated with younger age in Japan (p < 0.001), longer duration of admission (p < 0.001), duration of illness (p < 0.001, particularly in Korea and Taiwan), positive psychotic symptoms (p < 0.001, particularly in Japan and Korea), and aggression (p < 0.05, particularly in Japan), and also with a higher likelihood of extrapyramidal and autonomic adverse effects (p < 0.05, particularly in China). Country, younger age, the presence of delusions and disorganized speech, polypharmacy, and receiving depot medication but not atypical antipsychotic drugs were important predictors of high antipsychotic use. CONCLUSIONS: This survey revealed that high antipsychotic dosing is not an uncommon practice in East Asia. It behooves the prescribing clinicians to constantly reevaluate the rationale for such a practice.

Adult↗
PubMed2004

[Tsutusgamushi fever after travel to Southeast Asia].

HISTORY AND CLINICAL FINDINGS: A 49-year-old travel guide fell ill during his return from a 6-week-stay in Vietnam, Myanmar and Thailand. He developed high fever and severe headache. On admission, the body temperature was at 39.5 degrees C with relative bradycardia. A black, crusted skin lesion of approximately 5 mm diameter was noted on the chest wall and was interpreted as an insect bite. INVESTIGATIONS: CRP and liver enzymes were elevated. Total leucocyte count was normal but the differential count showed a left shift and aneosinophilia. Imaging procedures revealed splenomegaly and small pleural effusions on both sides. TREATMENT AND COURSE: The patient was treated with a parenteral quinolone based on the initial suspicion of typhoid fever. Failure of this treatment and negative blood cultures raised concerns about the possibility of Tsutsugamushi fever, based on travel history and a re-evaluation of the skin lesion as an eschar. Tsutsugamushi fever was suspected on epidemiological and clinical grounds and was confirmed by the detection of specific IgM to Orienta tsutsugamushi and by seroconversion of IgG antibodies during follow-up. Even before immunodiagnostic confirmation was available, a course of doxycycline was started. This led to rapid improvement of the patient's condition. CONCLUSION: In febrile travellers returning from Southeast Asia, Tsutsugamushi fever has to be considered in the differential diagnosis. The causative agent, Orienta tsutsugamushi is transmitted by larvae of trombiculid mites (chiggers). Leading symptoms are fever continua, cephalgia, and a primary lesion (eschar) at the site of cutaneous inoculation. The Eschar is easily overlooked and has to be searched carefully. Diagnosis is confirmed by the detection of specific antibodies. However, serology may be negative in the beginning. Therefore, treatment with doxycycline should be initiated on clinical grounds.

Anti-Bacterial Agents↗
PubMed2006

Rapid Asia-Europe-North America geographic dispersal of earliest Eocene primate Teilhardina during the Paleocene-Eocene Thermal Maximum.

True primates appeared suddenly on all three northern continents during the 100,000-yr-duration Paleocene-Eocene Thermal Maximum at the beginning of the Eocene, approximately 55.5 mya. The simultaneous or nearly simultaneous appearance of euprimates on northern continents has been difficult to understand because the source area, immediate ancestors, and dispersal routes were all unknown. Now, omomyid haplorhine Teilhardina is known on all three continents in association with the carbon isotope excursion marking the Paleocene-Eocene Thermal Maximum. Relative position within the carbon isotope excursion indicates that Asian Teilhardina asiatica is oldest, European Teilhardina belgica is younger, and North American Teilhardina brandti and Teilhardina americana are, successively, youngest. Analysis of morphological characteristics of all four species supports an Asian origin and a westward Asia-to-Europe-to-North America dispersal for Teilhardina. High-resolution isotope stratigraphy indicates that this dispersal happened in an interval of approximately 25,000 yr. Rapid geographic dispersal and morphological character evolution in Teilhardina reported here are consistent with rates observed in other contexts.

Animals↗