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Review of the Minimus Complex of Anopheles, main malaria vector in Southeast Asia: from taxonomic issues to vector control strategies.

BACKGROUND: The Minimus Complex of Anopheles subgenus Cellia is composed of two sibling species, A and C, on the Southeast Asian mainland, and a third allopatric species E that occurs in the Ryukyu Archipelago (Japan), a malaria-free region. Anopheles minimus s.l. is considered to be one of the main malaria vector in the hilly forested regions of Southeast Asia. Despite a large number of studies over its range of distribution, it is difficult to have a global view of the ecological and bionomical characteristics of the individual species as different identification methods were used, generally without specific identification of the sibling species. OBJECTIVES: (1) To review the main malaria studies on An. minimus s.l.; (2) to discuss recently published data on the biology and ecology of each sibling species; and (3) to identify gaps in our understanding of the Minimus Complex. REVIEW RESULTS: Major biological and ecological trends are addressed, such as the high plasticity of trophic behaviour and the sympatry of species A and C over the Southeast Asian mainland. Despite the availability of rapid molecular identification methods, we still lack important information concerning the biological characteristics of each sibling species. These gaps must be filled in the future because An. minimus species A and C may exhibit different abilities to transmit malaria. CONCLUSION: We expect that entomological surveys will employ molecular methods to clearly identify these two species, and thus elucidate the biological characteristics of each species. As a consequence, current vector control strategies will be improved by targeting the most efficient vectors.

Animals↗

Clinical and molecular characteristics of hereditary non-polyposis colorectal cancer families in Southeast Asia.

Lee S-C, Guo J-Y, Lim R, Soo R, Koay E, Salto-Tellez M, Leong A, Goh B-C. Clinical and molecular characteristics of hereditary non-polyposis colorectal cancer families in Southeast Asia. Hereditary non-polyposis colorectal cancer (HNPCC), predominantly due to germline MLH1/MSH2 mutations, is the commonest form of hereditary colorectal cancer (CRC), but data in Asians are sparse. We sequenced the MLH1/MSH2 coding and promoter core regions in CRC patients diagnosed below age 40, and/or with multiple primary cancers or familial cancer clustering suggestive of HNPCC, and correlated deleterious mutations with clinical and tumour features. Forty-six Chinese, Malay and Indian kindreds participated. Of the 153 cancers reported in the 46 kindreds, stomach (14%) and urogenital cancers (13%) were the most common extracolonic cancers, whereas endometrial cancer comprised only 7%. Eleven different MLH1 and 12 MSH2 mutations were identified, including nine novel and four recurring mutations in the Chinese. One Indian was a compound heterozygote for an MLH1 and MSH2 mutation. The MLH1/MSH2 mutation data in the Malays and the Indians represents the first in these ethnic groups. Factors strongly associated with deleterious mutations were the Amsterdam criteria, family history of stomach or multiple primary cancers, and MSI-high tumours, whereas family history of endometrial cancer and young cancer age alone correlated poorly. Distinct clinical and molecular characteristics were identified among Asian HNPCC kindreds and may have important clinical implications.

Adaptor Proteins, Signal Transducing↗

Management guidelines for uninvestigated and functional dyspepsia in the Asia-Pacific region: First Asian Pacific Working Party on Functional Dyspepsia.

Dyspepsia is most optimally defined as pain or discomfort centred in the upper abdomen. The symptom complex may be caused by peptic ulcer disease, gastro-oesophageal reflux, or gastric cancer but is most often due to functional (or non-ulcer) dyspepsia. While upper endoscopy is the method of choice to determine the underlying cause of dyspepsia, it is expensive. A more pragmatic approach is needed in the Asia Pacific region where health services are limited. A detailed treatment algorithm is given for managing patients presenting with new-onset dyspepsia and documented functional dyspepsia after endoscopy, and evidence to support this approach is reviewed. Prompt endoscopy is recommended for patients with alarm features. In patients without alarm features, treatment for 2-4 weeks with an empirical anti-secretory or prokinetic agent, followed by investigation using non-invasive Helicobacter pylori testing and treatment for patients who do not respond or relapse, is recommended. Trials of management strategies are now needed to establish the efficacy and cost-effectiveness of the approaches recommended.

Antiemetics↗

Cardiovascular risk in the Asia-Pacific region from a nutrition and metabolic point of view: lipid.

Hypercholesterolemia. especially low-density lipoprotein cholesterol, is well-known as a risk factor for coronary heart disease. The prevalence of hyperlipidemia in the Asia-Pacific regions, although not as high as in the North American and European regions, in adults and children varied from country to country. The 'Cardiovascular Risk Factor of Chiang Mai children (CARFACC)' study has shown the small 'n' and capital 'N' phenomenons, where in some individuals, blood lipid levels were tracked from childhood to adulthood. The new concept of programming by early nutrition on later adult health has now been accepted. The prevention of dyslipidemia during childhood should receive more attention.

Adolescent↗

Diet and hypertension in the Asia-Pacific region: a brief review.

In this paper, the possible reasons for the prevalence of hypertension in the Asia-Pacific region are examined, along with its likely dietary, nutritional and sociocultural causes. This brief survey indicates the need for more comprehensive blood pressure monitoring and surveillance throughout the region. Findings from research conducted in the region and elsewhere suggest that a variety of aetiological factors predict the occurrence of hypertension, most of which are similar to those observed in western populations. However, several lines of research suggest that obesity, abdominal obesity and a number of dietary constituents, in addition to salt. may play relatively greater roles than in western populations. It is argued that hypertension may be prevented via a combination of individual, community and governmental approaches which promote social capital, environmentally sustainable food production and the public health.

Asia↗

Cardiovascular epidemiology in the Asia-Pacific region.

By 2020, non-communicable diseases including cardiovascular diseases (CVD) are expected to account for seven out of every 10 deaths in the developing countries compared with less than half this value today. As a proportion of total deaths from all-causes, CVD in the Asia Pacific region ranges from less than 20% in countries such as Thailand, Philippines and Indonesia to 20-30% in urban China, Hong Kong, Japan, Korea and Malaysia. Countries such as New Zealand, Australia and Singapore have relatively high rates that exceed 30-35%. The latter countries also rank high for coronary heart disease (CHD) mortality rate (more than 150 deaths per 100,000). In contrast, death from cerebrovascular disease is higher among East Asian countries including Japan, China and Taiwan (more than 100 per 100,000). It is worth noting that a number of countries in the region with high proportions of deaths from CVD have undergone marked declining rates in recent decades. For example, in Australia, between 1986 and 1996, mortality from CHD in men and women aged 30-69 years declined by 46 and 51%, respectively. In Japan. stroke mortality dropped from a high level of 150 per 100,000 during the 1920s-1940s to the present level of approximately 100 per 100,000. Nonetheless, CVD mortality rate is reportedly on the rise in several countries in the region, including urban China, Malaysia, Korea and Taiwan. In China, CVD mortality increased as a proportion of total deaths from 12.8% in 1957 to 35.8% in 1990. The region is undergoing a rapid pace of urbanization, industrialization and major technological and lifestyle changes. Thus, monitoring the impact of these changes on cardiovascular risks is essential to enable the implementation of appropriate strategies towards countering the rise of CVD mortality.

Adult↗

Video assisted thoracoscopic surgery (VATS) in Asia--its impact and implications.

BACKGROUND: Within a short period of time, video assisted thoracoscopic surgery (VATS) has revolutionised the practice of thoracic surgery. Most of the existing literature, however, is concentrated on the technical aspects. AIMS: We examined the impact of VATS on our practice and its implications. METHODS: We reviewed our thoracic case load two years before and two years after the introduction of VATS in our hospital. RESULTS: We have witnessed a rapid and progressive increase in our thoracic case load since the introduction of VATS. With increased experience, proportionally more cases were performed using VATS compared to conventional surgical access. The increased case load covered a wide range of thoracic diseases with the majority for spontaneous pneumothorax and pleural diseases. CONCLUSIONS: The higher case load is due to increased referrals which at least partly reflect earlier acceptance by both the patients and their physicians for surgical intervention. The changing indications for surgery and the high cost associated with VATS, however, could place extra demand on the healthcare, especially for some countries in Asia. Cost containment is therefore a high priority here. More research is greatly needed in this area.

Asia↗

Distributions of exotic plants in eastern Asia and North America.

Although some plant traits have been linked to invasion success, the possible effects of regional factors, such as diversity, habitat suitability, and human activity are not well understood. Each of these mechanisms predicts a different pattern of distribution at the regional scale. Thus, where climate and soils are similar, predictions based on regional hypotheses for invasion success can be tested by comparisons of distributions in the source and receiving regions. Here, we analyse the native and alien geographic ranges of all 1567 plant species that have been introduced between eastern Asia and North America or have been introduced to both regions from elsewhere. The results reveal correlations between the spread of exotics and both the native species richness and transportation networks of recipient regions. This suggests that both species interactions and human-aided dispersal influence exotic distributions, although further work on the relative importance of these processes is needed.

Asia↗

The impact of the Gulf war on migration and remittances in Asia and the Middle East.

The author discusses the impact of the 1990 Gulf war on the migrant worker populations in the region, with a focus on migration and remittances in Asia and the Middle East. Both immediate and long-term effects are considered. "From the perspective of foreign migrant communities living in the Gulf...the war...was much more of a disaster for Arabs than for Asians....Arab migrant populations...were dramatically affected by the Gulf crisis. In contrast, the Asian migrant community was largely concentrated in Saudi Arabia and the [United Arab Emirates] and remained relatively less affected by the crisis. Subsequent polarization in the Arab world gives Asian labor-exporting countries an unexpected opportunity to increase their share of Gulf labor markets still further in the coming years." (SUMMARY IN FRE AND SPA)

Asia↗

Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography.

BACKGROUND: The incidence of postsurgical venous thromboembolism is thought to be low in Asian ethnic populations. OBJECTIVE: We studied the incidence of deep-vein thrombosis (DVT) in Asian patients undergoing major orthopedic surgery of the lower limbs. PATIENTS/METHODS: We performed a prospective epidemiological study in 19 centers across Asia (China, Indonesia, South Korea, Malaysia, Philippines, Taiwan, and Thailand) in patients undergoing elective total hip replacement (THR), total knee replacement (TKR) or hip fracture surgery (HFS) without pharmacological thromboprophylaxis. The primary endpoint was the rate of DVT of the lower limbs documented objectively with bilateral ascending venography performed 6-10 days after surgery using a standardized technique and evaluated by a central adjudication committee unaware of local interpretation. RESULTS: Overall, of 837 Asian patients screened for this survey, 407 (48.6%, aged 20-99 years) undergoing THR (n = 175), TKR (n = 136) or HFS (n = 96) were recruited in 19 centers. DVT was diagnosed in 121 of 295 evaluable patients [41.0%, (95% confidence interval (CI): 35.4-46.7)]. Proximal DVT was found in 30 patients [10.2% (7.0-14.2)]. Total DVT and proximal DVT rates were highest in TKR patients (58.1% and 17.1%, respectively), followed by HFS patients (42.0% and 7.2%, respectively), then THR patients (25.6% and 5.8%, respectively). DVT was more frequent in female patients aged at least 65 years. Pulmonary embolism was clinically suspected in 10 of 407 patients (2.5%) and objectively confirmed in two (0.5%). CONCLUSIONS: The rate of venographic thrombosis in the absence of thromboprophylaxis after major joint surgery in Asian patients is similar to that previously reported in patients in Western countries.

Adult↗

Oral lesions of HIV and AIDS in Asia: an overview.

The magnitude of HIV infection in the Asian region is increasing dramatically. Oral disease represents an important health problem for HIV-infected individuals, because of its diagnostic, prognostic and therapeutic implications. The documentation and reporting of HIV infection and AIDS in most of the Asian countries has been superficial. Though the epidemiology of HIV infection in Asia has been studied by many investigators, few attempts have been made to summarise the data and assess the magnitude of the problem, the mode of transmission, the spread of infection and clinical pattern of illness. A review of the literature shows that there is hardly any published data on oral manifestations of HIV infection or AIDS from the Asian region. However, some preliminary information is available on the type of lesion presenting in patients from India and Thailand. These observations suggest that oral manifestations are common in HIV-infected and AIDS patients. The pattern of occurrence of various lesions reported appears to show variation from those reports from other parts of the world, but no definitive conclusion can be drawn from these preliminary observations. Further epidemiological studies are necessary to substantiate the present understanding of the nature of oral lesions found in Asian countries.

Acquired Immunodeficiency Syndrome↗

Penicilliosis marneffei: another AIDS defining illness in Southeast Asia.

Penicilliosis marneffei, a common mycosis among AIDS patients living in Southeast Asia, has been recently suggested for inclusion in the AIDS surveillance case definition. Infections with Penicillium marneffei were rare in the past, but infections with this dimorphic fungus have increased with the endemic of AIDS in the region. The reservoir of P. marneffei in nature is still unknown, although it seems likely that inhalation may be the route of entry of the organism leading to infection in humans. P. marneffei can cause two clinical types of the disease; focal and fatal progressive, disseminated infections, characterized by a variety of symptoms which can mimic those of other diseases. Oral P. marneffei lesions usually occur in patients with disseminated infections, presenting as shiny papules, as erosions or as shallow ulcers covered with whitish yellow, necrotic slough which may be found on the palate, gingiva, labial mucosa, tongue and oropharynx. Biopsy and culture provide definitive diagnoses, while serologic tests for both antibody and antigen are useful in rapid presumptive diagnoses as well as in surveillance studies of the prevalence and latency of the infection. Penicilliosis marneffei is a treatable disease, but late diagnosis and treatment may be fatal. Itraconazole and ketoconazole are the drugs of first choice for mild to moderately severe forms of the disease, whereas parenteral therapy with amphotericin B may be required for seriously ill patients. Recurrence of the disease is common, therefore maintenance is recommended. As reported, prophylaxis generating resistant strains are likely to develop.

AIDS-Related Opportunistic Infections↗

HLA-DR2 haplotypic diversity in populations of South-East Asia, northern China, Melanesia and Australian aborigines using PCR-RFLP for DRB1, DRB5, DQA1 and DQB1. A novel DRB1 allele: DRB1*16022.

The polymorphism of the human leucocyte antigen HLA-DR2 and the heterogeneity of HLA-DR2 class II-related haplotypes (HLA-DRB1-DRB5-DQA1-DQB1) were investigated in four populations of east and south-east Asia (SEA) and five Melanesian populations using TaqI restriction fragment length polymorphism (RFLP) analysis, and the polymerase chain reaction (PCR) amplification-based techniques PCR-RFLP and sequence-specific oligonucleotide (SSO) typing. The haplotype DRB1*1502-DRB5*0101-DQA1*0102-DQB1*0601 was common in Malaysians, Javanese, Thursday Islanders, Madang, Goroka and the Australian Aborigines, while DRB1*16021-DRB5*0101-DQA1*0102-DQB1*0502 was common in the Thai and Thursday Islanders. DRB1*1501-DRB5*0101-DQA1*0102-DQB1*0602 was present at a high frequency in Northern Chinese, Goroka, Watut and Australian Aborigines. The study describes four rare or unusual haplotypes: HLA-DRB1*1501-DRB5*0101-DQA1*0101-DQB1*0601, DRB1*1502-DRB5*0101-DQA1*0101-DQB1*0502, DRB1*1502-DRB5*0102-DQA1* 0102-DQB1*0502 and DRB1*1501-DRB5*0101-DQA1*0101/2-DQB1*0503; the latter two were confirmed by segregation in two Javanese families. A new DR2 allele, initially detected by PCR-RFLP and confirmed by DNA sequencing as DRB1*16022 (previously designated DRB1*16Madang), was seen in a Madang individual. A new HLA-DR2 TaqI RFLP subtype, locally designated as DR15U, is also described. This RFLP subtype segregated in a Javanese family and correlated with a typically SEA haplotype, DRB1*1502-DRB5*0102-DQA1*0101-DQB1*0501. The allele HLA-DR16Thai, determined by TaqI DRB RFLP, was found by PCR-RFLP and SSO typing to correlate with a unique SEA haplotype, HLA-DRB1*16021-DRB5*0101-DQA1*0102-DQB1*0502, and was observed in the Thai, Malaysian, Thursday Islander, Javanese and Northern Chinese populations.

Alleles↗

A cooperative study of sarcoidosis in Asia and Africa: descriptive epidemiology.

An eight-nation cooperative epidemiological study revealed the Asian and African features of sarcoidosis. Almost every country reported from several to less than 30 cases, except for Japan which had already collected over 3,000 cases. Not a single case was found in the mass x-ray surveys conducted by several countries on a large scale (Tables 1 and 2). Although the number of the cases included in this study were small, this information is the first of this kind for Asia and Africa.

Africa↗

Thalassemia in southeast Asia: determination of different degrees of severity of anemia in thalassemia.

beta (0)-Thalassemia/Hb E in Southeast Asia varies greatly in severity, with hemoglobin levels ranging from 2.5 to 13.5 g/dl, averaging 7.7 g/dl. Results of systematic investigations to find out what determines different levels of severity are reviewed. Concomitant inheritance of alpha-thalassemia significantly decreases the severity. Different degrees of severity in the majority of cases, however, is not due to alpha-thalassemia. Concordance of hemoglobin levels among patients who are sibs prevails, suggesting polygenic factor determinants. Potential factors ruled out as determinants for different levels of severity are discriminating fetal hemoglobin production, erythrocyte superoxide dismutase activity, reticulo-endothelial function, and failure of erythropoiesis compensation. Red cell survival and globin synthesis studies indicate that different degrees of excess of alpha-chains leading to different red cell pathology and survival are responsible for variable severity. Degrees of excess of alpha-chains in this circumstance are probably mainly determined by erythrocyte proteolytic activity. The relationship between the hemoglobin levels and erythrocyte cytosol proteolytic activity in 15 beta(0) -thalassemia/Hb E disease patients in whom a deletional type of alpha-thalassemia had been ruled out by DNA mapping is striking, with a correlation coefficient of 0.78. This finding suggests that modulation of erythrocyte proteolysis is another approach for treatment of thalassemia.

Asia, Southeastern↗

Cerebrovascular pathology and dementia in autopsied Honolulu-Asia Aging Study participants.

Clinicopathologic data from 285 autopsies were analyzed. The decedents were long-standing participants in the Honolulu-Asia Aging Study, a prospective epidemiologic investigation of stroke, neurodegenerative diseases, and aging. We assessed the prevalence at death of four primary neuropathologic processes using specific microscopic lesions as indicators. An algorithm was developed to assign each decedent to one of six subsets, corresponding to pathologic dominance by microvascular lesions (14% of decedents), Alzheimer lesions (12%), hippocampal sclerosis (5%), cortical Lewy bodies (5%), codominance by two or more primary processes (9%), or without a dominant pathologic process recognized (55%). Definite or probable dementia had been identified in 118 of the decedents. The proportions of men in each subset identified as demented were (in the same order) 57%, 53%, 79%, 57%, 76%, and 25%. In this autopsied panel of older Japanese-American men, the importance of microvascular lesions as a likely explanation for dementia was nearly equal to that of Alzheimer lesions. The cerebrovascular lesion type most essentially and inclusively related to dementia was multiple microinfarction.

Aged↗

Latest Homo erectus of Java: potential contemporaneity with Homo sapiens in southeast Asia.

Hominid fossils from Ngandong and Sambungmacan, Central Java, are considered the most morphologically advanced representatives of Homo erectus. Electron spin resonance (ESR) and mass spectrometric U-series dating of fossil bovid teeth collected from the hominid-bearing levels at these sites gave mean ages of 27 +/- 2 to 53.3 +/- 4 thousand years ago; the range in ages reflects uncertainties in uranium migration histories. These ages are 20,000 to 400,000 years younger than previous age estimates for these hominids and indicate that H. erectus may have survived on Java at least 250,000 years longer than on the Asian mainland, and perhaps 1 million years longer than in Africa. The new ages raise the possibility that H. erectus overlapped in time with anatomically modern humans (H. sapiens) in Southeast Asia.

Africa↗