Asymptomatic and sub-microscopic malaria infection in Kayah State, eastern Myanmar.

BACKGROUND: Myanmar has the heaviest burden of malaria in the Greater Mekong Sub-region. Asymptomatic Plasmodium spp. infections are common in this region and may represent an important reservoir of transmission that must be targeted for malaria elimination. METHODS: A mass blood survey was conducted among 485 individuals from six villages in Kayah State, an area of endemic but low transmission malaria in eastern Myanmar. Malaria infection was screened by rapid diagnostic test (RDT), light microscopy and real-time polymerase chain reaction (PCR), and its association with demographic factors was explored. RESULTS: The prevalence of asymptomatic Plasmodium spp. infection was 2.3% (11/485) by real-time PCR. Plasmodium vivax accounted for 72.7% (8/11) and Plasmodium falciparum for 27.3% (3/11) of infections. Men were at greater risk of infection by Plasmodium spp. than women. Individuals who worked as farmers or wood and bamboo cutters had an increased risk of infection. CONCLUSION: A combination of RDT, light microscopy and PCR diagnostics were used to identify asymptomatic malaria infection, providing additional information on asymptomatic cases in addition to the routine statistics on symptomatic cases, so as to determine the true burden of disease in the area. Such information and risk factors can improve malaria risk stratification and guide decision-makers towards better design and delivery of targeted interventions in small villages, representative of Kayah State.

Molecular Characterization of MaCCS, a Novel Copper Chaperone Gene Involved in Abiotic and Hormonal Stress Responses in Musa acuminata cv. Tianbaojiao.

Copper/zinc superoxide dismutases (Cu/ZnSODs) play important roles in improving banana resistance to adverse conditions, but their activities depend on the copper chaperone for superoxide dismutase (CCS) delivering copper to them. However, little is known about CCS in monocots and under stress conditions. Here, a novel CCS gene (MaCCS) was obtained from a banana using reverse transcription PCR and rapid-amplification of cDNA ends (RACE) PCR. Sequence analyses showed that MaCCS has typical CCS domains and a conserved gene structure like other plant CCSs. Alternative transcription start sites (ATSSs) and alternative polyadenylation contribute to the mRNA diversity of MaCCS. ATSSs in MaCCS resulted in one open reading frame containing two in-frame start codons to form two protein versions, which is supported by the MaCCS subcellular localization of in both cytosol and chloroplasts. Furthermore, MaCCS promoter was found to contain many cis-elements associated with abiotic and hormonal responses. Quantitative real-time PCR analysis showed that MaCCS was expressed in all tested tissues (leaves, pseudostems and roots). In addition, MaCCS expression was significantly induced by light, heat, drought, abscisic acid and indole-3-acetic acid, but inhibited by relatively high concentrations of CuSO4 and under cold treatment, which suggests that MaCCS is involved in abiotic and hormonal responses.

Heat literacy and adaptation among semi-rural community in Malaysia.

BACKGROUND: Heatwaves present health risks globally but there is limited evidence on how temperature perceptions affect activities. This study aimed to examine community perceptions of heat as a potential health hazard and ascertain the current heat protection measures of the residents of the South East Asia Community Observatory (SEACO) in Malaysia. METHODS: In this longitudinal study, we randomly selected community members aged between 18 and 70 years who resided in Segamat district of Johor state, Malaysia. Over 21 days, we conducted three home visits to each participant. During each visit, participants completed a questionnaire consisting of Likert scale, multiple choice, and free text questions and we collected quantitative and qualitative data. These inquiries assessed the participants' perception of heat as health threat, whether or not they took heat preventive measures, and the specific protective measures they routinely employed. Descriptive data analyses were conducted and patterns of protective measures were investigated. FINDINGS: Between March 29 and July 31, 2023, 120 participants (72 women and 48 men) completed 360 questionnaires over three home visits. Initially, 58% participants recognised heat hazards to daily activities, decreasing to 42% and 35% by visits 2 and 3. Participants took preventive measures throughout the day, which was consistently high between 1200 h and 1400 h, with 77% of participants taking preventive measures on visit 1, 82% on visit 2, and 82% on visit 3. Use of preventive measures was also high between 1400 h and 1730 h, with 77% using preventive measure on visit 1, 81% on visit 2, and 79% on visit 3. The most common protective measures were fans (used by 68-88% of participants), drinking more water (70-78% of participants), and resting (44-72% of participants). The least common were relocating to cooler places, removing clothes, and using wet towels (0-2·5%). Despite high temperatures, perceptions of heat risks decreased over time. Participants took basic protections, especially at midday, but improved literacy and affordable cooling options are needed to protect vulnerable rural populations. INTERPRETATION: Our findings underline the need to improve heat literacy and adaptation as only half of the population assessed perceived heat as a potential health hazard and practised limited heat protective measures. Addressing climate change and health necessitates fundamental behavioural changes on the part of individuals and communities, to protect them against the adverse effects of heat. FUNDING: Monash University Malaysia and Heidelberg Institute of Global Health, Heidelberg University.

Developing Climate Change and Health Impact Monitoring with eHealth at the South East Asia Community Observatory and Health and Demographic Surveillance Site, Malaysia (CHIMES).

Background: Malaysia is projected to experience an increase in heat, rainfall, rainfall variability, dry spells, thunderstorms, and high winds due to climate change. This may lead to a rise in heat-related mortality, reduced nutritional security, and potential migration due to uninhabitable land. Currently, there is limited data regarding the health implications of climate change on the Malaysian populace, which hinders informed decision-making and interventions. Objective: This study aims to assess the feasibility and reliability of using sensor-based devices to enhance climate change and health research within the SEACO health and demographic surveillance site (HDSS) in Malaysia. We will particularly focus on the effects of climate-sensitive diseases, emphasizing lung conditions like chronic obstructive pulmonary disease (COPD) and asthma. Methods: In our mixed-methods approach, 120 participants (>18 years) from the SEACO HDSS in Segamat, Malaysia, will be engaged over three cycles, each lasting 3 weeks. Participants will use wearables to monitor heart rate, activity, and sleep. Indoor sensors will measure temperature in indoor living spaces, while 3D-printed weather stations will track indoor temperature and humidity. In each cycle, a minimum of 10 participants at high risk for COPD or asthma will be identified. Through interviews and questionnaires, we will evaluate the devices' reliability, the prevalence of climate-sensitive lung diseases, and their correlation with environmental factors, like heat and humidity. Results: We anticipate that the sensor-based measurements will offer a comprehensive understanding of the interplay between climate-sensitive diseases and weather variables. The data is expected to reveal correlations between health impacts and weather exposures like heat. Participant feedback will offer perspectives on the usability and feasibility of these digital tools. Conclusion: Our study within the SEACO HDSS in Malaysia will evaluate the potential of sensor-based digital technologies in monitoring the interplay between climate change and health, particularly for climate-sensitive diseases like COPD and asthma. The data generated will likely provide details on health profiles in relation to weather exposures. Feedback will indicate the acceptability of these tools for broader health surveillance. As climate change continues to impact global health, evaluating the potential of such digital technologies is crucial to understand its potential to inform policy and intervention strategies in vulnerable regions.

Measuring Catastrophic Costs Due to Tuberculosis in Myanmar.

BACKGROUND: This is the first survey to use the World Health Organization (WHO) methodology to document the magnitude and main drivers of tuberculosis (TB) patient costs in order to guide policies on cost mitigation and to produce a baseline measure for the percentage of TB-affected households experiencing catastrophic costs in Myanmar. METHODS: A nationally representative cross-sectional survey was administered to 1000 TB patients in health facilities from December 2015 to February 2016, focusing on costs of TB treatment (direct and indirect), household income, and coping strategies. A total cost was estimated for each household by extrapolating reported costs and comparing them to household income. If the proportion of total costs exceeded 20% of the annual household income, a TB-affected household was deemed to have faced catastrophic costs. RESULTS: 60% of TB-affected households faced catastrophic costs in Myanmar. On average, total costs were USD 759, and the largest proportion of this total was accounted for by patient time (USD 365), followed by food costs (USD 200), and medical expenses (USD 130). Low household wealth quintile and undergoing MDR-TB treatment were both significant predictors for households facing catastrophic costs. CONCLUSIONS: The high proportion of TB-affected households experiencing catastrophic costs suggests the need for TB-specific social protection programs in patient-centered healthcare. The survey findings have led the government and donors to increase support for MDR-TB patients. The significant proportion of total spending attributable to lost income and food or nutritional supplements suggests that income replacement programs and/or food packages may ameliorate the burdensome costs.

Neuroblastoma involving urinary bladder: A rare type of tumor with diagnostic ambiguity.

INTRODUCTION: Neuroblastoma of urinary tract is an extremely rare type of tumor and only a few cases have been reported worldwide. CASE PRESENTATION: We presented an adult case of neuroblastoma involving urinary bladder. Patient was a 24-year-old man with a history of repeated attack of hematuria. Patient underwent cystoscopy and transuretheral resection of bladder tumor. Biopsy result was "Blastema cell (suggestive of neuroblastoma) with immature ganglion cells." Immunohistochemistry workup was continued and neuron-specific enolase and S100 staining were positive. Patient lost to further follow-up visit. CONCLUSION: Although neuroblastoma of skin and peripheral nerve is not a rare disease entity, involvement of deeper structures (especially urinary bladder) is exceptional.

Mass Gatherings and Public Health: Case Studies from the Hajj to Mecca.

BACKGROUND: Many new and challenging risks can be introduced during mass gatherings. The Hajj, as one of the largest mass gatherings, provides an excellent annual opportunity to reflect on the public health risk posed by international and multicultural crowds and the value of mitigation strategies. OBJECTIVES: To identify the gap between preparation and training taken before being exposed to the mass gathering and postexposure experiences, and the breach between the expectations and reality of the holy place. METHODS: This was a qualitative study with in-depth interviews using semistructured questionnaires among Hajjis from 4 different countries (Bangladesh, Pakistan, Myanmar, and New Zealand). Purposive sampling was done. The present study was also supported by literature review. FINDINGS: Findings pointed to weaknesses in implementation and enforcement of law, for both the custodian country and countries of origin of Hajjis. Disparities among developed and developing countries were also noticeable. CONCLUSIONS: From a global health and human security perspective, strengthening of core capacities in managing mass gatherings as well as researching risks posed by such gatherings are paramount to safeguard the public's health. Attention of health professionals worldwide and adoption of strategic planning at custodian country and sending countries are obligatory.

Identification of Novel and Conserved miRNAs in Leaves of In vitro Grown Citrus reticulata "Lugan" Plantlets by Solexa Sequencing.

MicroRNAs (miRNAs) play essential roles in plant development, but the roles in the in vitro plant development are unknown. Leaves of ponkan plantlets derived from mature embryos at in vitro culture conditions were used to sequence small RNA fraction via Solexa sequencing, and the miRNAs expression was analyzed. The results showed that there were 3,065,625 unique sequences in ponkan, of which 0.79% were miRNAs. The RNA sequences with lengths of 18-25 nt derived from the library were analyzed, leading to the identification of 224 known miRNAs, of which the most abundant were miR157, miR156, and miR166. Three hundred and fifty-eight novel miRNA candidates were also identified, and the number of reads of ponkan novel miRNAs varied from 5 to 168,273. The expression of the most known miRNAs obtained was at low levels, which varied from 5 to 4,946,356. To better understand the role of miRNAs during the preservation of ponkan in vitro plantlet, the expression patterns of cre-miR156a/159b/160a/166a/167a/168a/171/398b were validated by quantitative real-time PCR (qPCR). The results showed that not only the development-associated miRNAs, e.g., cre-miR156/159/166/396, expressed highly at the early preservation period in the in vitro ponkan plantlet leaves but also the stress-related miRNAs, e.g., cre-miR171 and cre-miR398b, expressed highly at the same time. The expression levels of most tested miRNAs were found to decrease after 6 months and the amounts of these miRNAs were kept at low levels at 18 months. After analyzing the expression level of their targets during the reservation of the ponkan in vitro plantlet, development-associated cre-ARF6 and stress-related cre-CSD modules exhibited negative correlation with miR167 and miR398, respectively, indicating an involvement of the miRNAs in the in vitro development of ponkan and function in the conservation of ponkan germplasm.