Purpose Our study aimed to describe the clinical profile of endogenous endophthalmitis, focusing on patient demographics, infection sources, microbial profiles, clinical outcomes, and factors affecting the final visual outcome. Methods A retrospective review was performed on data from 68 eyes of 60 patients diagnosed with endogenous endophthalmitis and hospitalized in two tertiary hospitals on the East Coast of Peninsular Malaysia from January 2011 to December 2020. The analysis encompassed evaluating patient age, gender, laterality, risk factors, infection origins, presenting and final visual acuity, microbial results, treatment responses, and factors affecting final visual outcomes. Results The average age of the patient cohort was 54.9 ± 13.3 years. Females were more likely to have endogenous endophthalmitis than males (33, 55.0% vs. 27, 45.0%). Twenty-seven patients (45.0%) presented with endogenous endophthalmitis in the left eye, while 25 patients (41.7%) had it in the right eye, and eight patients (13.3%) had bilateral involvement. Most patients had underlying predisposing conditions, predominantly diabetes mellitus (53, 88.3%). Infection sources were identified in 42 patients (70.0%), out of which urinary tract infections account for the majority (11, 18.3%). Klebsiella species(14, 22.7%) were the leading pathogens and were significantly associated with liver abscess cases. In this series, the majority of patients had poor presenting and final visual acuity of worse than 3/60 (56, 82.4% and 53, 77.9%, respectively). Thirty-six eyes (52.9%) underwent vitrectomy, resulting in only four eyes (11.11%) achieving final visual acuity better than 6/12. Presenting visual acuity was identified as the factor contributing to the blind final visual outcome (r = 0.707, p < 0.001). Conclusion Females were found to be more commonly affected by endogenous endophthalmitis than males. Klebsiella species were the most commonly isolated microorganisms and were typically associated with liver abscesses. Urinary tract infection was the most common predisposing factor. A majority of the patients had poor presenting and final visual acuity, in which poor visual acuity is a significant indicator of blind visual outcomes.

BACKGROUND: For healthcare delivery to be optimally effective, health systems must possess adequate levels and we must ensure a fair distribution of human resources aimed at healthcare facilities. We conducted a scoping review to map the current state of human resources for health (HRH) in India and the reasons behind its shortage.
METHODS: A systematic search was conducted in various electronic databases, from the earliest available date till February 2024. We applied a uniform analytical framework to all the primary research reports and adopted the \"descriptive-analytical\" method from the narrative paradigm. Inductive thematic analysis was conducted to arrange the retrieved data into categories based on related themes after creating a chart of HRH problems.
RESULTS: A total of 9675 articles were retrieved for this review. 88 full texts were included for the final data analysis. The shortage was addressed in 30.6% studies (n = 27) whereas 69.3% of studies (n = 61) addressed reasons for the shortage. The thematic analysis of data regarding reasons for the shortage yielded five kinds of HRH-related problems such as inadequate HRH production, job dissatisfaction, brain drain, regulatory issues, and lack of training, monitoring, and evaluation that were causing a scarcity of HRH in India.
CONCLUSIONS: There has been a persistent shortage and inequitable distribution of human resources in India with the rural expert cadres experiencing the most severe shortage. The health department needs to establish a productive recruitment system if long-term solutions are to be achieved. It is important to address the slow and sporadic nature of the recruitment system and the issue of job insecurity among medical officers, which in turn affects their other employment benefits, such as salary, pension, and recognition for the years of service.

While the importance of mental health and its impact on overall health and well-being has been widely recognized, there continue to be ongoing barriers to accessing mental health services. This is particularly poignant in countries in Southeast Asia (SEA) where there may be further stigma in accessing mental health services. As no reviews have been undertaken on this topic, this review aims to outline the barriers and enablers to access and utilization of mental health care services in SEA. Searches were undertaken in commercially produced and gray literature sources. Two independent reviewers screened the results. The data were then independently extracted, which was then collated and synthesized, using the Health Belief Model (HMB) as a framework. Twelve studies were included in the review. Under the HBM, barriers were grouped into: stigma, poor health literacy, internalized reasons, cultural beliefs, lack of training of health professionals, quality of service, and poor distribution of resources. Enablers included: social support, outreach services, structural stigma, self-awareness, resources and information, accessibility and affordability, and positive attitudes and beliefs about health professionals. Those accessing mental health care in SEA are confronted by complex barriers and few enablers. Ongoing stigma and a distinct lack of resources pose the greatest challenges, which are even more amplified for those in rural areas and minority groups. A multifaceted strategy that improves the structures, processes, and outcomes of mental health is required within these communities.

UNASSIGNED: The review aimed at examining patient factors that were associated with the worldwide geographic variation in number of monkeypox cases during the 2022 outbreak.
UNASSIGNED: A systematic search was conducted using Scopus, Google Scholar, and PubMed/MEDLINE, to identify studies published in the year 2022 until 30 September on the 2022 monkeypox outbreak. Studies that described demographics and patient characteristics of the affected populations were eligible. Only countries/regions with the highest and lowest globally reported numbers were included.
UNASSIGNED: A total of 24 eligible studies reported data from the most affected countries in Europe [Spain and UK]; Americas [USA and Brazil]; and the least affected region [South East Asia]. There were no eligible studies reporting data from the Eastern Mediterranean which was allegedly the least affected region. Cases from Europe and the Americas were mostly men having sex with men [MSM], in fourth and fifth decades of life, with a substantial proportion of HIV and sexually transmitted diseases. Sporadic cases among women [sexual, household] and children [household] were identified. Sexual orientation and/or mode of transmission were not clearly stated in most studies from South East Asia.
UNASSIGNED: The 2022 monkeypox outbreak was most obvious in the western part of the globe due mainly to sexual activities among MSM. Low numbers in the east may indicate the influence of the conservative social behaviors. Co-morbidities in the form of HIV and sexually transmitted diseases were identified. Detection of the disease among women and children highlights the importance of adopting appropriate preventive public health measures.

Despite its importance in guiding public health decisions, studies on COVID-19 vaccination acceptance and its determinants in South East Asia (SEA) are lacking. Therefore, this study aims to determine the prevalence of COVID-19 vaccine acceptance and the variables influencing the vaccine\'s acceptance. This review is registered under PROSPERO CRD42022352198. We included studies that reported vaccination acceptance from all SEA countries, utilising five academic databases (Pubmed, MEDLINE, Cochrane Library, Science Direct, and Google Scholar), three Indonesian databases (the Indonesian Scientific Journal Database, Neliti, and Indonesia One Search), two pre-print databases (MedRxiv and BioRxiv), and two Thailand databases (ThaiJo and Thai-Journal Citation Index). The analysis was conducted using STATA 17.0 with metaprop commands. The prevalence for COVID-19 vaccination acceptance in SEA was 71% (95%CI 69-74; I2 99.87%, PI: 68.6-73.5). Myanmar achieved the highest COVID-19 vaccination acceptance prevalence, with 86% (95%CI 84-89), followed by Vietnam with 82% (95% CI 79-85; I2 99.04%) and Malaysia with 78% (95%CI 72-84; I2 99.88%). None of the ten determinants studied (age, sex, education, previous COVID-19 infections, smoking and marriage status, health insurance, living together, chronic diseases, and healthcare workers) were significantly associated with acceptance. This result will be useful in guiding vaccination uptake in SEA.

COVID-19 imposed unprecedented financing requirements on countries to rapidly implement effective prevention and control measures while dealing with severe economic contraction. The challenges were particularly acute for the 11 countries in the WHO South East Asia Region (SEAR), home to the lowest average level of public expenditure on health of all WHO Regions. We conducted a narrative review of peer-reviewed, grey literature and publicly available sources to analyse the immediate health financing policies adopted by countries in the WHO SEAR in response to COVID-19 in the first 12 months of the pandemic, i.e. from March 1, 2020, to March 1, 2021. Our review focused on the readiness of health systems to address the financial challenges of COVID-19 in terms of revenue generation, financial protection and strategic purchasing including public financial management issues. Twenty peer-reviewed articles were included, and web searches identified media articles (n=21), policy reports (n=18) and blog entries (n=5) from reputable sources. We found that countries in the SEAR demonstrated great flexibility in responding to the COVID-19 pandemic, including exploring various options for revenue raising, removing financial barriers to care and rapidly adapting purchasing arrangements. At the same time, the pandemic exposed pre-existing health financing policy weaknesses such as underinvestment, inadequate regulatory capacity of the private health sector and passive purchasing which should give countries an impetus for reform towards more resilient health systems. Further monitoring and evaluation is needed to assess the long-term implications of policy responses on issues such as government capacity for debt servicing and fiscal space for health and how they protect progress towards the objectives of universal health coverage.

UNASSIGNED: There is increasing evidence that the COVID-19 pandemic has impacted adversely on the provision of essential health services. The South East Asia region (SEAR) has experienced extremely high rates of COVID-19 infection, and continues to bear a significant proportion of communicable disease burden worldwide.
UNASSIGNED: We conducted a systematic literature review of quantitative evidence to estimate the impact of COVID-19 on the provision of essential prevention, detection, treatment, and management services for five high-burden infectious diseases across the SEAR.
UNASSIGNED: A total of 2338 studies were reviewed, and 12 studies were included in our analysis, covering six countries across the SEAR (Bhutan, Sri Lanka, Nepal, Myanmar, Thailand, and India) for three conditions of interest (HIV, TB, dengue fever). We identified significant disruption to TB testing (range=25% to 77.9%) and diagnoses (range=50% to 58%) in India, Nepal, and Indonesia; and similar disruptions were observed for screening, new diagnoses and commencing HIV treatment in India and Thailand. There was also drastically reduced case detection for dengue fever (range=75% to 90% disrupted) in Bhutan and Sri Lanka. No studies were identified for malaria nor hepatitis in any country, and nor for any service in the remaining six SEAR countries.
UNASSIGNED: We identified evidence of significant disruption to the prevention, diagnoses, treatment, and management of TB, HIV, and dengue fever due to the COVID-19 pandemic across multiple SEAR country settings. This has the potential to set back hard-fought gains in infectious disease control across the region. The lack of evidence for the impact of the pandemic on malaria and hepatitis services, and in the remaining six SEAR countries, is an important evidence gap that should be addressed in order to inform future policy for service protection and pandemic preparedness.
UNASSIGNED: This work was supported by the WHO Sri Lanka Country office.

UNASSIGNED: COVID-19 has had a profound impact on the health systems of the 11 countries of the WHO South East Asia Region. We conducted a systematic review of studies that used quantitative and comparative approaches to assess the impact of the pandemic on the service provision of four noncommunicable diseases (NCDs) (cancer, cardiovascular disease, chronic respiratory diseases, and diabetes) in the region.
UNASSIGNED: A systematic search was conducted in PubMed, Embase, MedRxiv, and WHO COVID-19 databases in December 2021. The quality of studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist and the ROBINS-I risk of bias tool. A narrative synthesis was conducted following the \'synthesis without meta-analysis\' reporting guidelines.
UNASSIGNED: Two review authors independently screened 5,397 records with 31 studies included, 26 which were cross-sectional studies. Most studies (n=24, 77%) were conducted in India and 19 (61%) were single-site studies. Compared to a pre-pandemic period, 10/17 cancer studies found a >40% reduction in outpatient services, 9/14 cardiovascular disease found a reduction of 30% or greater in inpatient admissions and 2 studies found diagnoses and interventions for respiratory diseases reduced up to 78.9% and 83.0%, respectively. No eligible studies on the impact of COVID-19 on diabetes services were found.
UNASSIGNED: COVID-19 has substantially disrupted the provision of essential health services for NCDs in the WHO South East Asia Region, particularly cancer and cardiovascular disease. This is likely to have serious and potentially long-term downstream impacts on health and mortality of those living with or at risk of NCDs in the region.
UNASSIGNED: This work was supported by the WHO Sri Lanka Country Office.

Melioidosis is a serious infection caused by the bacterium Burkholderia pseudomallei (B. pseudomallei) mostly found in endemic areas like Southeast Asia and Northern Australia. However, in non-endemic regions, such as Saudi Arabia, it remains somewhat rare and unknown to healthcare workers and the public. Herein, we present a case of melioidosis in a 59-year-old Bangladeshi man who presented with pneumonia. He recently returned from Bangladesh, was a known case of type 2 diabetes on metformin, and presented to the emergency department (ED) with a history of cough, shortness of breath, and fever for three weeks. He was initially misdiagnosed and treated as pulmonary tuberculosis in another hospital prior to his latest presentation. Melioidosis is a severe infection that can be misdiagnosed due to variable presentation and low awareness among healthcare workers of the disease. Diagnosis requires high clinical suspicion, especially in patients who are coming from endemic areas with appropriate risk factors such as diabetes mellitus. Treatment with appropriate antibiotics for a long duration, and outpatient follow-up is vital to reduce the risk of recurrence.

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