A cup half full: the first assessment on the distribution, ecology and need for conservation of the threatened Neptune's cup sponge, Cliona patera, in the Gulf of Thailand.

The Neptune's cup sponge is an iconic species found in marine soft sediment habitats in the Indo-West Pacific, with a history of overharvesting and extreme population declines. Access to SCUBA diving surveys has allowed for its rediscovery at Singapore, its type locality; however, with fewer than ten living individuals documented in the twenty-first century, the species is believed to be in need of conservation. Here, we share the results from surveys across the Gulf of Thailand, allowing for a documentation of 29 additional individuals, with information on their ecology and distribution. Of the 29 individuals, extensive damage or mortality caused by marine debris is recorded for six individuals, and one further individual is believed to be lost due to an unknown cause. Documented threats from the Gulf of Thailand differ from those in Singapore; however, low population sizes and poor connectivity remain a significant concern for the survival of the species.

Unmet Need for Further LDL-C Lowering in India despite Statin Therapy: Lipid Association of India Recommendations for the Use of Bempedoic Acid.

Lipid-lowering therapy plays a crucial role in reducing adverse cardiovascular (CV) events in patients with established atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia. Lifestyle interventions along with high-intensity statin therapy are the first-line management strategy followed by ezetimibe. Only about 20-30% of patients who are on maximally tolerated statins reach recommended low-density lipoprotein cholesterol (LDL-C) goals. Several factors contribute to the problem, including adherence issues, prescription of less than high-intensity statin therapy, and de-escalation of statin dosages, but in patients with very high baseline LDL-C levels, including those with familial hypercholesterolemia and those who are intolerant to statins, it is critical to expand our arsenal of LDL-C-lowering medications. Moreover, in the extreme risk group of patients with an LDL-C goal of ≤30 mg/dL according to the Lipid Association of India (LAI) risk stratification algorithm, there is a significant residual risk requiring the addition of non-statin drugs to achieve LAI recommended targets. This makes bempedoic acid a welcome addition to the existing non-statin therapies such as ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. A low frequency of muscle-related side effects, minimal drug interactions, a significant reduction in high-sensitivity C-reactive protein (hsCRP), and a lower incidence of new-onset or worsening diabetes make it a useful adjunct for LDL-C lowering. However, the CV outcomes trial results are still pending. In this LAI consensus document, we discuss the pharmacology, indications, contraindications, advantages, and evidence-based recommendations for the use of bempedoic acid in clinical practice.

An unusual left ventricular outflow tract mass in a patient with systemic lupus erythematosus.

A 25-year-old female, with systemic lupus erythematosus and antiphospholipid antibody syndrome, presented with exertional dyspnoea. Echocardiography showed a large (2.0 cm × 1.1 cm), echogenic, heterogeneous mass in the left ventricular outflow tract, under the aortic valve, attached to the ventricular aspect of the anterior mitral leaflet. Tiny flagellar, frond-like structures were seen attached to the surface of the mass. There was mitral regurgitation. These echocardiographic features were suggestive of a papillary fibroelastoma, but the histopathology of the excised mass revealed it to be a thrombus, which was consistent with a diagnosis of non-bacterial thrombotic endocarditis (NBTE). This case represents a rare histopathologically confirmed NBTE presenting as an unusually large mass in the left ventricular outflow tract.

Spatiotemporal variations in marine macro-litter pollution along the shoreline of Koh Mun Nai, an uninhabited island in the Gulf of Thailand.

Despite a recent ambitious plan to improve waste management in Thailand, few studies have monitored the impact of these policies on beached marine litter. Here, we assessed weekly the amounts and composition of stranded macro-litter (≥2.5 cm) on five beaches from an uninhabited island in Thailand during one year. A total of 24,407 items (391.86 kg) yielded a mean abundance of 3.18 ± 11.39 items m-2 (52.75 ± 204.68 g m-2), with plastic being the most abundant marine litter (48% of the total number). The overall Clean Coast Index (30.1) classified the beaches as 'extremely dirty', with a Plastic Abundance Index of 9.8 ('very high abundance' of plastics). When assessing the seasonal rates of accumulation, we found a higher flux pre-monsoon (0.05 items m-2 d-1; 0.66 g m-2 d-1) than post-monsoon (0.01 items m-2 d-1; 0.35 g m-2 d-1). Using modeling of the local hydrodynamic conditions, we explored the potential sources of the pollution, and surprisingly found that the closest river appeared not to be the source. Our results denote that the distribution and typology of marine litter were representatives of household and fishing activities, which in turn highlights the need for better regional litter management measures.

Assessing the scale and ecological impact of derelict and discarded fishing gear across Thailand via the MARsCI citizen science protocol.

South-East Asia is among the least studied regions for the growing issue of marine debris pollution, despite being a major contributor towards global marine debris. In the present study, we provide the preliminary results from the MARsCI project, a survey protocol designed to utilise citizen science to facilitate data collection on the ecological impact of discarded fishing gear (DFG) in Thailand. Over a three-year period, 103 surveys were carried out across Thailand, resulting in impact assessment of 606 pieces of DFG. Our findings indicate corals are regularly impacted by DFG in Thai waters and that isolated marine habitats may be more severely impacted than near-shore sites. We further identify crabs, muricid snails, and demersal fish to be among the most regularly entangled animals. We discuss our findings in the context of earlier work from Thailand, and conduct a critical review of the protocol itself, identifying improvements for future efforts.

Loss of left ventricular torsion as the predominant mechanism of left ventricular systolic dysfunction in a patient with tubercular cardiomyopathy.

Pericarditis is the commonest form of cardiac involvement in tuberculosis whereas myocardial involvement is exceedingly rare. We hereby report a patient who presented with cardiac tuberculosis manifesting as predominantly right-sided cardiomyopathy. In addition to being a very rare clinical presentation, this case provided an interesting insight into the left ventricular (LV) myocardial mechanics. The patient had nearly preserved contractile function of the LV myocardium (except for segmental abnormalities in circumferential strain) but had marked impairment of torsion resulting in LV systolic dysfunction. Such disproportionate loss of LV torsion leading to LV systolic dysfunction has not been previously described on echocardiography. These myocardial mechanical abnormalities almost completely recovered with adequate antitubercular treatment. Thus, this case proved to be a unique demonstration of the significant, independent role played by torsion in maintenance of normal LV systolic function.

Quadricuspid aortic valve.

Quadricuspid aortic valve is a rare congenital heart defect usually detected by echocardiography or at the time of aortic valve surgery. Preoperative recognition of this abnormality has clinical significance because it is frequently associated with other congenital cardiac abnormalities and anomalies of coronary origin. We report a case of quadricuspid aortic valve, which was detected preoperatively by transthoracic echocardiography and was associated with severe aortic regurgitation.

Management of Dyslipidaemia for the Prevention of Stroke: Clinical Practice Recommendations from the Lipid Association of India.

Stroke is the second most common cause of death worldwide. The rates of stroke are increasing in less affluent countries predominantly because of a high prevalence of modifiable risk factors. The Lipid Association of India (LAI) has provided a risk stratification algorithm for patients with ischaemic stroke and recommended low density lipoprotein cholesterol (LDL-C) goals for those in very high risk group and extreme risk group (category A) of <50 mg/dl (1.3 mmol/l) while the LDL-C goal for extreme risk group (category B) is ≤30 mg/dl (0.8 mmol/l). High intensity statins are the first-line lipid lowering therapy. Nonstatin therapy like ezetimibe and proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors may be added as an adjunct to statins in patients who do not achieve LDL-C goals with statins alone. In acute ischaemic stroke, high intensity statin therapy improves neurological and functional outcomes regardless of thrombolytic therapy. Although conflicting data exist regarding increased risk of intracerebral haemorrhage (ICH) with statin use, the overall benefit risk ratio favors long-term statin therapy necessitating detailed discussion with the patient. Patients who have statins withdrawn while being on prior statin therapy at the time of acute ischaemic stroke have worse functional outcomes and increased mortality. LAI recommends that statins be continued in such patients. In patients presenting with ICH, statins should not be started in the acute phase but should be continued in patients who are already taking statins. ICH patients, once stable, need risk stratification for atherosclerotic cardiovascular disease (ASCVD).

Contrasting coral community structures between natural and artificial substrates at Koh Tao, Gulf of Thailand.

Concrete cubic frames and decommissioned steel naval vessels have been deployed in Thailand liberally to act as artificial substrates for coral restoration and marine recreation. We assessed recruitment at such substrate types at Koh Tao, Gulf of Thailand, and compared the community structure of scleractinian corals between artificial substrates and nearby natural reefs. Our results from a sample of 2677 recruits from nine sites highlighted significant differences in community structure between both reef types. Investigations of variables including time since deployment, distance from the natural reef, and seafloor depth revealed only the latter as a possible influencing factor. The diversity of recruits could not be explained by dynamics in coral spawning, and were found to represent groups with lower structural complexity. Our results suggest that coral community structure on artificial and natural reefs differs and supports distinct ecological and functional roles.

An updated inventory of sea slugs from Koh Tao, Thailand, with notes on their ecology and a dramatic biodiversity increase for Thai waters.

Improved access to field survey infrastructure throughout South-East Asia has allowed for a greater intensity of biodiversity surveys than ever before. The rocky bottoms and coral reef habitats across the region have been shown to support some of the highest sea slug biodiversity on the planet, with ever increasing records. During the past ten years, intensive SCUBA surveys have been carried out at Koh Tao, in the Gulf of Thailand, which have yielded remarkable findings in sea slug biology and ecology. In this work a brief history of sea slug biodiversity research from Thailand is covered and a complete inventory of sea slugs from Koh Tao, Gulf of Thailand is provided. This inventory is based on surveys from 2012 to 2020, with previously unreported findings since 2016. Habitat specificity and species-specific ecology are reported where available with a focused comparison of coral reef habitats and deeper soft-sediment habitats. The findings contribute 90 new species records for Thai waters (92 for the Gulf of Thailand) and report a remarkable consistency in the proportional diversity found to be exclusive to one habitat type or another. Additionally, taxonomic remarks are provided for species documented from Koh Tao that have not been discussed in past literature from Thailand, and a summary of previous records in the Indo-West Pacific is given.