METHODS: CLHIV were considered to have lipid or glucose abnormalities if they had total cholesterol ≥200 mg/dL, high-density lipoprotein (HDL) ≤35 mg/dL, low-density lipoprotein (LDL) ≥100 mg/dL, triglycerides (TG) ≥110 mg/dL, or fasting glucose >110 mg/dL. Factors associated with lipid and glucose abnormalities were assessed by logistic regression.
RESULTS: Of 951 CLHIV, 52% were male with a median age of 8.0 (interquartile range [IQR] 5.0-12.0) years at ART start and 15.0 (IQR 12.0-18.0) years at their last clinic visit. 89% acquired HIV perinatally, and 30% had ever used protease inhibitors (PIs). Overall, 225 (24%) had hypercholesterolemia, 105 (27%) low HDL, 213 (58%) high LDL, 369 (54%) hypertriglyceridemia, and 130 (17%) hyperglycemia. Hypercholesterolemia was more likely among females (versus males, aOR 1.93, 95% CI 1.40-2.67). Current PIs use was associated with hypercholesterolemia (current use: aOR 1.54, 95% CI 1.09-2.20); low HDL (current use: aOR 3.16, 95% CI 1.94-5.15; prior use: aOR 10.55, 95% CI 2.53-43.95); hypertriglyceridemia (current use: aOR 3.90, 95% CI 2.65-5.74; prior use: aOR 2.89, 95% CI 1.31-6.39); high LDL (current use: aOR 1.74, 95% CI 1.09-2.76); and hyperglycemia (prior use: aOR 2.43, 95% CI 1.42-4.18).
CONCLUSION: More than half and one-fifth of CLHIV have dyslipidemia and hyperglycemia, respectively. Routine paediatric HIV care should include metabolic monitoring. The association between PIs use and dyslipidemia emphasizes the importance of rapidly transitioning to integrase inhibitor-containing regimens.
METHODS: The online survey was conducted in seven Asian countries from April to August 2021. Two sets of online questionnaires were developed, one set for the chairs/secretaries and another set for the REC members.The REC profiles obtained from the REC members are descriptive in nature. Data from the chairs/secretaries were compared between the RECs with external quality assessment (SIDCER-Recognized RECs, SR-RECs) and non-external quality assessment (Non-SIDCER-Recognized RECs, NSR-RECs) and analyzed using a Chi-squared test.
RESULTS: A total of 688 REC members and 197 REC chairs/secretaries participated in the survey. Most RECs have standard operating procedures (SOPs), and have experience in reviewing all types of protocols, but 18.1% had no experience reviewing COVID-19 protocols. Most REC members need specific training on reviewing COVID-19 protocols (93%). In response to the outbreak, RECs used online reviews, increased meeting frequency and single/central REC. All SR-RECs had a member composition as required by the World Health Organisation ethics guidelines, while some NSR-RECs lacked non-affiliated and/or layperson members. SR-RECs reviewed more COVID-related product development protocols and indicated challenges in reviewing risk/benefit and vulnerability (0.010), informed consent form (0.002), and privacy and confidentiality (P = 0.020) than NSR-RECs.
CONCLUSIONS: Surveyed RECs had a general knowledge of REC operation and played a significant role in reviewing COVID-19-related product development protocols. Having active networks of RECs across regions to share updated information and resources could be one of the strategies to promote readiness for future public health emergencies.
METHODS: The GYTS covered a total of 2,242 Bangladeshi, 1,444 Nepalese and 1,377 Sri-Lankan youths aged 13-15 years. They represented response rates of 88.9%, 94.6%, and 85.0% for the three countries, respectively. Socioeconomic, environmental, motivating, and programmatic predictors of TC were examined using cross tabulations and logistic regressions.
RESULTS: Prevalence of TC was 6.9% (9.1% in males, 5.1% in females) in Bangladesh, 9.4% (13.2% in males, 5.3% in females) in Nepal and 9.1% (12.4% in males, 5.8% in females) in Sri Lanka. The average tobacco initiation age was 9.6, 10.24 and 8.61 years, respectively. Cross tabulations showed that gender, smoking among parents and friends, exposure to smoking at home and public places, availability of free tobacco were significantly (P < 0.001) associated with TC in all three countries. The multivariable analysis [odds ratio (95% confidence interval)] indicated that the common significant predictors for TC in the three countries were TC among friends [1.9 (1.30-2.89) for Bangladesh, 4.10 (2.64-6.38) for Nepal, 2.34 (1.36-4.02) for Sri Lanka], exposure to smoking at home [1.7 (1.02-2.81) for Bangladesh, 1.81 (1.08-2.79) for Nepal, 3.96 (1.82-8.62) for Sri Lanka], exposure to smoking at other places [2.67 (1.59-4.47) for Bangladesh, 5.22 (2.76-9.85) for Nepal, 1.76 (1.05-2.88) for Sri Lanka], and the teaching of smoking hazards in schools [0.56 (0.38-0.84) for Bangladesh, 0.60 (0.41-0.89) for Nepal, 0.58 (0.35-0.94) for Sri Lanka].
CONCLUSIONS: An understanding of the influencing factors of youth TC provides helpful insights for the formulation of tobacco control policies in the South-Asian region.
METHODS: Weekly dengue fever surveillance data from 2012 to 2020 were collected from 48 locations in four countries named Singapore (1 location), Sri Lanka (15 locations), Malaysia (9 locations), and Thailand (23 locations, with 11 locations having different study periods). The distributed lag non-linear models were built to assess the impacts of compound temperature, rainfall, and relative humidity exposures on dengue fever infection risks.
RESULTS: A total of 1,359,993 dengue fever cases were reported with 9.33%, 24.02%, 48.73%, and 17.91% cases contributed by Singapore, Sri Lanka, Malaysia, and Thailand, respectively. Compared to non-warm-non-wet, compound warm-wet was associated with an increased dengue risk (RR:1.32, 95% CI:1.21-1.44). Compared to moderate temperature-humidity, warm-wet environment was also associated with an increase in dengue risk (RR:1.37, 95% CI:1.22-1.55). In comparison to weeks with moderate temperature-rainfall, warm-wet weeks was linked to an elevated dengue risk (RR:1.39, 95% CI:1.27-1.52), whereas cold-dry weather would significantly reduce the infection risk (RR:0.70, 95% CI:0.62-0.80). Modification effects showed that the hot effect on dengue infection was more pronounced under higher humidity, while the impact of rainfall increased with warmer temperature.
CONCLUSION: Warm-wet events were associated with an increased dengue fever risk, while the infection risk would decline in cold-dry environment, and modification effects exist among exposures. Findings from this study highlight the importance of considering joint temperature, humidity, and rainfall dependency of dengue fever infection in disease prevention and control.
RECENT FINDINGS: Asia is the epicenter of diabetes. There have been marked advances with genotyping and phenotyping of the Asian patient with T2D, particularly with young onset diabetes where early beta cell failure and rapid progression of complications are more frequent. As Asians have lower muscle mass and higher adiposity, sarcopenia is increasingly associated with diabetes. Response to lifestyle and pharmacotherapy are generally similar, but unique features exist with different populations. Across Asia, use of guideline directed medical therapy for cardio-renal protection are recommended, but uptake of these newer agents are suboptimal and barriers exist with regards to standardized care.
SUMMARY: Although many similarities have been observed across Asia, due to the heterogeneity of populations within Asia, further research is required to streamline and pave the way towards precision medicine. There is an urgent need for region wide consensus to minimize barriers to diabetes care and stigma in diabetes terminology across Asia.
AIMS: The PEACH in Asia pilot study aimed to test the feasibility of a standardized protocol for investigating SCEs in anesthesia practices across Asia, evaluate the data acquisition processes, and determine the sample size for a main study.
METHODS: This multicenter pilot study involved ten institutions across nine Asian countries, including children from birth to 15 years undergoing diagnostic or surgical procedures. Data on SCEs were collected using standardized definitions. The study assessed the feasibility and estimated the sample size needed for the main study.
RESULTS: The pilot study enrolled 330 patients, with a SCE incidence of 12.4% (95% CI: 9.2-16.4%). Respiratory events were observed in 7.0% of cases, cardiovascular instability in 4.9%, and drug errors in 0.6%. Based on the SCE incidence observed in the pilot study, the estimated sample size required for the main study is at least 10 958 patients. The pilot study demonstrated the feasibility of the study protocol but identified several challenges, particularly in resource-limited settings. These challenges included a significant burden associated with data collection, technical issues with electronic case report forms (e-CRFs), variability in patient enrollment across institutions (ranging from 4 to 86 patients per site), and incomplete data acquisition (24.8% of height data and 9.7% of disposition data were missing).
CONCLUSIONS: The PEACH in Asia pilot study successfully validated a protocol for investigating SCEs in pediatric anesthesia across Asia. Addressing the challenges identified in the pilot study will be crucial for generating robust data to improve pediatric anesthesia safety in the region. Key issues to address include improving data collection methods, resolving e-CRF technical difficulties, and ensuring consistent institutional support.
METHODS AND STUDY DESIGN: The group convened and discussed evidence-based recommendations and clinical experiences in the management of malnutrition in hospitalized and community-dwelling adults, and the relevance of oral nutritional supplements in clinical practice. Supported by a literature search from January 2007-September 2017, consensus statements on key aspects of malnutrition management were developed.
RESULTS: Malnutrition management should be considered as an integral part of patient care and managed by a multidisciplinary team. Hospitalized patients and outpatients should be screened for risk of malnutrition with validated tools. Nutrition intervention, including oral, enteral, or parenteral nutrition, should be accessible and individualized to all patients who are malnourished or at risk of malnutrition. Education on nutrition care is imperative for healthcare professionals, patients and caregivers.
CONCLUSION: These consensus recommendations provide practical guidance to improve nutrition practice within healthcare in Southeast Asia. With collaborative efforts from the clinical community, professional societies and policy makers, this regional effort may also facilitate change in the nutrition practice at the institutional and national level.