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Hypertension remains a major problem worldwide, especially across the Asia-Pacific region, which reports high prevalence rates and slow improvements in treatment rate and blood pressure (BP) control rate. Asian patients with hypertension may also vary with regard to phenotype and the epidemiology of the complications of hypertension, especially when compared with Western patients. Given these differences, Western guidelines may not necessarily be applicable to countries in the Asia Pacific. This narrative review aims to provide a critical comparison between the recently published European Society of Hypertension (ESH) 2023 guidelines and existing local guidelines in select Asian countries, offer expert opinion on how to fill gaps in the ESH 2023 guidelines for hypertension in the Asian context, and examine the need for harmonisation of hypertension guidelines worldwide. This review focuses on the definition and diagnosis of hypertension, the treatment thresholds and targets, and recommendations on the use of pharmacotherapy.

Clinical trials with a solid strategy are indispensable for improving outcomes of rare childhood leukemias such as infant acute lymphoblastic leukemia (ALL) and ALL associated with Down syndrome, and international collaboration contributes to trial success. I am part of a group conducting an international trial of ALL associated with Down syndrome in collaboration with Asian countries. Although we are meeting enrollment targets, there have been no enrollments outside Japan. We also planned a clinical trial in unclassifiable acute leukemia, but abandoned this effort due to a lack of consensus on the choice of treatment regimen. Many elements must fit together for an international trial to succeed, including not only the study\'s concept, theme, and objectives, but also the organization, the logistics, and, ultimately, trained professionals to carry it out. At the same time, of course, there is the need for appropriate timing and luck. International trials across countries with different cultures, social organizations, and medical systems require persistent effort and negotiation skills. Professional training and infrastructure development are necessary to make this possible.

This study delves into the concept of niche conservatism (NC) and its implications for how hornets (Hymenoptera: Vespidae) and honeybees respond to climate change. Our primary objectives are threefold: firstly, to assess whether distinct environmental niche spaces (E-space) exist between 12 hornets and honeybees like Apis cerana and Apis mellifera in Asia; Secondly, to explore the degree to which Asian hornets have attained geographic equilibrium alongside honeybee species. Lastly, is to investigate how the geographic niche overlap (G-space) between hornets and honeybees could potentially change under climate change scenarios. To accomplish these goals, we employed ordination and ecological niche modeling techniques to analyze 91 pairs of hornets and honeybees in both geographic (G-space) and environmental (E-space) contexts. Then, we projected the potential impacts of climate change on the future geographic overlap between hornets and honeybees, specifically under the SSP585 climate scenario for the year 2070. Our results demonstrated that the environmental niches (E-space) of hornets and honeybees can be treated as interchangeable, indicating they have similar environmental preferences despite being unrelated taxa. We found that Vespa velutina currently exhibits a moderate geographic niche overlap (G-space) of 0.63 with both honeybee species. Meanwhile, Vespa mandarinia demonstrates an overlap of 0.46 with Apis cerana and 0.63 with Apis mellifera. The overlap of Vespa velutina with Apis cerana might potentially decrease to 0.51 and 0.56 with Apis mellifera. For Vespa mandarinia, the overlap could reach 0.41 with Apis cerana and 0.6 with Apis mellifera under a climate change scenario. This study indicates that the limited spatial overlap between honeybees and hornets across certain areas in Asia is more likely influenced by geographical barriers rather than solely environmental unsuitability for hornets. In this study, we delve into the concept of niche conservatism (NC) and its implications for how hornets (Hymenoptera: Vespidae) and honeybees respond to climate change.

BACKGROUND: Toxoplasma gondii can cause symptomatic toxoplasmosis in immunodeficient hosts, including in people living with human immunodeficiency virus (PLWH), mainly because of the reactivation of latent infection. We assessed the prevalence of toxoplasmosis and its associated risk factors in PLWH in the Asia-Pacific region using data from the TREAT Asia Human Immunodeficiency Virus (HIV) Observational Database (TAHOD) of the International Epidemiology Databases to Evaluate AIDS (IeDEA) Asia-Pacific.
METHODS: This study included both retrospective and prospective cases of toxoplasmosis reported between 1997 and 2020. A matched case-control method was employed, where PLWH diagnosed with toxoplasmosis (cases) were each matched to two PLWH without a toxoplasmosis diagnosis (controls) from the same site. Sites without toxoplasmosis were excluded. Risk factors for toxoplasmosis were analyzed using conditional logistic regression.
RESULTS: A total of 269/9576 (2.8%) PLWH were diagnosed with toxoplasmosis in 19 TAHOD sites. Of these, 227 (84%) were reported retrospectively and 42 (16%) were prospective diagnoses after cohort enrollment. At the time of toxoplasmosis diagnosis, the median age was 33 years (interquartile range 28-38), and 80% participants were male, 75% were not on antiretroviral therapy (ART). Excluding 63 out of 269 people without CD4 values, 192 (93.2%) had CD4 ≤200 cells/μL and 162 (78.6%) had CD4 ≤100 cells/μL. By employing 538 matched controls, we found that factors associated with toxoplasmosis included abstaining from ART (odds ratio [OR] 3.62, 95% CI 1.81-7.24), in comparison to receiving nucleoside reverse transcriptase inhibitors plus non-nucleoside reverse transcriptase inhibitors, HIV exposure through injection drug use (OR 2.27, 95% CI 1.15-4.47) as opposed to engaging in heterosexual intercourse and testing positive for hepatitis B virus surface antigen (OR 3.19, 95% CI 1.41-7.21). Toxoplasmosis was less likely with increasing CD4 counts (51-100 cells/μL: OR 0.41, 95% CI 0.18-0.96; 101-200 cells/μL: OR 0.14, 95% CI 0.06-0.34; >200 cells/μL: OR 0.02, 95% CI 0.01-0.06), when compared to CD4 ≤50 cells/μL. Moreover, the use of prophylactic cotrimoxazole was not associated with toxoplasmosis.
CONCLUSIONS: Symptomatic toxoplasmosis is rare but still occurs in PLWH in the Asia-Pacific region, especially in the context of delayed diagnosis, causing advanced HIV disease. Immune reconstitution through early diagnosis and ART administration remains a priority in Asian PLWH.

UNASSIGNED: The objective of this study is to conduct a temporal analysis of rheumatic heart disease (RHD) disease burden trends over a 30-year period (1991 to 2021), focusing on prevalence, deaths, and disability-adjusted life years (DALYs) in the South Asia (SA).
UNASSIGNED: In this ecological study, we analyzed data regarding burden of RHD from the Global Burden of Diseases (GBD) study spanning the years 1991 to 2021 for the SA Region. Estimates of the number RHD-related prevalence, deaths, and DALYs along with age-standardized rates (ASR) per 100,000 population and 95% uncertainty intervals (UI) were evaluated.
UNASSIGNED: The overall prevalent cases of RHD in the 2021 were 54785.1 × 103 (43328.4 × 103 to 67605.5 × 103), out of which 14378.8 × 103 (11206.9 × 103 to 18056.9 × 103) were from SA. The ASR of point prevalence showed upward trend between 1991 and 2021, at global level and for SA with an average annual percentage change (AAPC) of 0.40 (0.39 to 0.40) and 0.12 (0.11 to 0.13), respectively. The overall number of RHD-related deaths in the 2021 were 373.3 × 103 (324.1 × 103 to 444.8 × 103), out of which 215 × 103 (176.9 × 103 to 287.8 × 103) were from SA, representing 57.6% of the global deaths. The ASR of deaths also showed downward trend between 1991 and 2021, at global level and for SA with an AAPC of -2.66 (-2.70 to -2.63) and -2.07 (-2.14 to -2.00), respectively. The ASR of DALYs showed downward trend between 1990 and 2019, at global level and for South Asian region with an AAPC of -2.47 (-2.49 to -2.44) and -2.22 (-2.27 to -2.17), respectively.
UNASSIGNED: The rising age-standardized prevalence of RHD remains a global concern, especially in South Asia which contribute to over 50% of global RHD-related deaths. Encouragingly, declining trends in RHD-related deaths and DALYs hint at progress in RHD management and treatment on both a global and regional scale.

Artificial intelligence (AI) is rapidly gaining recognition in the radiology domain as a greater number of radiologists are becoming AI-literate. However, the adoption and implementation of AI solutions in clinical settings have been slow, with points of contention. A group of AI users comprising mainly clinical radiologists across various Asian countries, including India, Japan, Malaysia, Singapore, Taiwan, Thailand, and Uzbekistan, formed the working group. This study aimed to draft position statements regarding the application and clinical deployment of AI in radiology. The primary aim is to raise awareness among the general public, promote professional interest and discussion, clarify ethical considerations when implementing AI technology, and engage the radiology profession in the ever-changing clinical practice. These position statements highlight pertinent issues that need to be addressed between care providers and care recipients. More importantly, this will help legalize the use of non-human instruments in clinical deployment without compromising ethical considerations, decision-making precision, and clinical professional standards. We base our study on four main principles of medical care-respect for patient autonomy, beneficence, non-maleficence, and justice.

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Advancements in monitoring and operation of aquaculture environments has minimized the concentrations of some residual pollutants in cultured aquatic products. However, currently most aquatic products are \"farmed\", and relationships among residual pollutants in tissues of crabs were still unclear. In this study, 64 typical pollutants, including 25 antibiotics, 15 metal, 23 organochlorine pesticides, and one dioxin-like compound inducing hydrocarbon-receptor (AHR) activity were measured in Chinese mitten crab (Eriocheir Sinensis) risks of consumption assessed and ranked. The superposition of properties including severity and relative potency of effects and parameters describing persistence and exposure along with rates of usage and identification of groups most likely to be exposed were assessed in combination to rank likelihood of dietary exposure and probabilities of adverse effects for each contaminant. The results indicated that the total scores per pollutants found that Cadmium (Cd), Heptachlor epoxide (HEPE), dioxin TEQ exhibited the greatest scores and explained the severity of dietary risk, while source analysis found that the three main pollutants resulted from the ambient environment and are not due to specific aquaculture processes. In summary, environment is still the predominant source of residual pollutants in cultured Chinese mitten crab across China.

UNASSIGNED: The degree of public trust in the government\'s competence is crucial in preventing the spread of misinformation and reducing psychological distress during a pandemic. The study aimed to (i) explore the trust in COVID-19 information from different sources and trust in the ability of the World Health Organization (WHO), government departments and related institutions in handling the epidemic in Singapore and (ii) its association with perceived risk of infection among Singapore residents.
UNASSIGNED: A total of 1,129 participants (aged 21 and above) were recruited from a cross-sectional study examining the well-being and resilience of Singapore\'s population between May 2020 to June 2021. Trust in COVID-19 information from different sources was measured on a 10-point scale and an ordinal 7-point scale was used for perceived risk of infection. Descriptive statistics and multivariate logistic regression model were conducted.
UNASSIGNED: 85.5% reported high trust in COVID-19 information from the government and their ability in handling the pandemic. Participants also reported high trust in COVID-19 information from local public health or infectious disease experts (84.4%) and traditional media (77.2%). Low trust in the ability of government departments and related institutions was associated with higher future (1 month) perceived risk of infection (OR: 5.7, 95% CI 1.02-32.45) and low trust in social media was associated with higher current perceived risk of infection (OR: 2.4, 95% CI 1.09-5.24).
UNASSIGNED: The present study provided insight on the level of trust on COVID-19 information from different sources and its associated perceived risks of infection. Future qualitative studies are recommended to facilitate better understanding of public trust and identify strategies for how it can be effectively addressed to support future public health responses.