Asian Pacific Journal of Tropical Medicine

Number 17(2), 2024

47-60
Liposomal dual delivery systems in visceral leishmaniasis enhance the synergistic effects of combination therapy: A promise for the future

Authors: Raghunath Hazra, Amrita Kar, Santanu Kar Mahapatra

Abstract

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Visceral leishmaniasis (VL) is a neglected tropical disease, and this review has summarized the current treatment scenario and its prospects. It also highlights alternative approaches used by research groups in India and around the world to develop cutting- edge and potent anti-leishmanial treatments. Even though numerous medications could be utilized to treat VL, the limitations of current treatments including their toxicity, cost, route of administration, and duration of doses, have contributed to the emergence of resistance. Combination therapy might be a better option due to its shorter duration, easier route of administration, and ability to extend the lifespan of individual drugs. However, there is a risk of not delivering both the drugs to the target site together, which can be overcome by the liposomal entrapment of those drugs and at a time knock an opportunity to reduce the dosage of amphotericin B if the combination drug provides a synergistic effect with it. Therefore, this review presents a novel strategy to fight against VL by introducing dual drug-loaded liposomes.

61-70
Cardiovascular health awareness, risk perception, behavioural intention and INTERHEART risk stratification among middle-aged adults in Malaysia

Authors: Siew-Keah Lee, Ang-Lim Chua, Clement Heng Yew Fong, Ban Hao Brian Cong, Wen Ling Ng, Jing Feng Kong, Yik-Ling Chew, Kai Bin Liew, Yang Shao

Abstract

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Objective: To investigate the interrelationship between cardiovascular health awareness, risk perception, behavioural intention, and INTERHEART risk stratification in a middle-aged adult population in Malaysia. Methods: A cross-sectional survey with convenience sampling was conducted during November 2022 and January 2023. Participants completed validated questionnaires assessing cardiovascular health awareness, risk perception of cardiovascular diseases, behavioural intention towards adopting healthy habits, and INTERHEART risk stratification score (IHRS) based on established risk factors. A total of 602 respondents were included in the final analysis. Data were analysed with independent t-test/one-way ANOVA or Mann- Whitney/Kruskal-Wallis to test the differences, Pearson correlation or linear regression test to analyze the association of independent and dependent variables. Results: There was a significant positive correlation between medical knowledge related to cardiovascular disease (CVD) and knowledge related to CVD risk prevention, risk perception, behavioural intention and IHRS (P<0.05, Pearson correlation). Notably, individuals with higher IHRS tended to have lower knowledge related to CVD and CVD risk prevention, risk perception, and behavioural intention. Males, laborers, active/former smokers, individuals with lower household income and educational levels, those involved in occupations not related to the healthcare sector, and those who did not receive the CVD health brochure or are unaware of health self-assessment tools are likely to have lower levels of knowledge, risk perception, and poorer behavioural intention regarding cardiovascular health (P<0.05, one-way ANOVA). While educational level, smoking status, awareness about CVD poster, self-assessment tools were repeatedly significantly associated with knowledge related to CVD and CVD risk prevention, risk perception, behavioral intention and/or IHRS (P<0.05, linear regression). Conclusions: These findings underscore the importance of promoting cardiovascular health awareness and risk perception among middle-aged adults to foster positive BI and reduce CVD risk. Tailored interventions targeting specific risk factors identified by INTERHEART may enhance risk stratification accuracy and facilitate targeted preventive strategies.

71-83
Prevalence and intensity of urinary schistosomiasis and soil-transmitted helminths among women of reproductive age in Mwaluphamba, Kwale

Authors: Samuel M. Ngui, Joseph M. Mwangangi, Joachim Richter, Josephine W. Ngunjiri

Abstract

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Objective: To assess the epidemiology of urinary schistosomiasis and soil-transmitted helminthiasis among women of reproductive age in Mwaluphamba, Kwale County, Kenya. Methods: A community-based cross-sectional study design was employed to randomly sample 422 women of reproductive age (15-<50 years) from four villages in Mwaluphamba location. Stool specimens were collected and examined using the Kato- Katz method, while filtration technique was used to analyze urine specimens. Participants’ sociodemographic details were obtained using a standardized questionnaire. Results: Urinary schistosomiasis prevalence was at 4.7% (20/422, 95% CI 2.8%-6.9%) while the prevalence of soil-transmitted helminthiasis infection was 4.5% (19/422, 95% CI 2.6%-6.7%). The infection intensities of urinary schistosomiasis among the study participants ranged from 1 to 120 eggs/10 mL of urine with median egg count of 18.45 eggs/10 mL. The patients were diagnosed with light infection, of 56.16 egg/gram and 48.48 egg/gram for Trichuris trichiura and hookworms, respectively. Women without latrines had 15.7 times higher risk of having urinary schistosomiasis compared to those with a latrine. Similarly, use of surface water (aOR=1.0, 95% CI 0.2-1.4, P=0.010) and crossing the river to go to a place (aOR=1.1, 95% CI 0.3-1.6, P=0.009) were statistically significant risk factors for getting urinary schistosomiasis. In bivariable regression analysis, defecating around the water source (OR=4.3, 95% CI 1.5-12.9) had a statistically significant association with the prevalence of soil- transmitted helminthiasis (P=0.008). Conclusions: This study has given an insight on the prevalence and intensity of urinary schistosomiasis and soil-transmitted helminthiasis in Mwaluphamba location that form a basis for strengthening the control and elimination programmes for these neglected tropical diseases.

84-90
Genetic diversity of the S-type small subunit ribosomal RNA gene of Plasmodium knowlesi isolates from Sabah, Malaysian Borneo and Peninsular Malaysia

Authors: Eric Tzyy Jiann Chong, Joveen Wan Fen Neoh, Tiek Ying Lau, Kek Heng Chua, Yvonne Ai-Lian Lim, Ping-Chin Lee

Abstract

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Objective: To determine the genetic diversity of Plasmodium (P.) knowlesi isolates from Sabah, Malaysian Borneo and Peninsular Malaysia, targeting the S-type SSU rRNA gene and including aspects of natural selection and haplotype. Methods: Thirty-nine blood samples infected with P. knowlesi were collected in Sabah, Malaysian Borneo and Peninsular Malaysia. The S-type SSU rRNA gene was amplified using polymerase chain reaction, cloned into a vector, and sequenced. The natural selection and haplotype of the S-type SSU rRNA gene sequences were determined using DnaSP v6 and illustrated using NETWORK v10. This study's 39 S-type SSU rRNA sequences and eight sequences from the Genbank database were subjected to phylogenetic analysis using MEGA 11. Results: Overall, the phylogenetic analysis showed no evidence of a geographical cluster of P. knowlesi isolates from different areas in Malaysia based on the S-type SSU rRNA gene sequences. The S-type SSU rRNA gene sequences were relatively conserved and with a purifying effect. Haplotype sharing of the S-type SSU rRNA gene was observed between the P. knowlesi isolates in Sabah, Malaysian Borneo, but not between Sabah, Malaysian Borneo and Peninsular Malaysia. Conclusions: This study suggests that the S-type SSU rRNA gene of P. knowlesi isolates in Sabah, Malaysian Borneo, and Peninsular Malaysia has fewer polymorphic sites, representing the conservation of the gene. These features make the S-type SSU rRNA gene suitable for comparative studies, such as determining the evolutionary relationships and common ancestry among P. knowlesi species.

91-94
Bilateral adrenal histoplasmosis in a Malaysian tertiary hospital: Report of four cases

Authors: Kang WH, Norasyikin Abdul Wahab

Abstract

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Rationale: Adrenal histoplasmosis can present as bilateral adrenal enlargement with constitutional symptoms and/or adrenal insufficiency. Often these patients are initially investigated as secondary adrenal metastases before eventually their diagnosis established by histopathological examination of the adrenal tissues. Patients concerns: We report 4 cases of patients aged 55-78 who presented with hypocortisolism and bilateral adrenal masses. Diagnoses: Bilateral adrenal histoplasmosis. Interventions: Three patients received antifungal treatment for at least one year while 1 patient passed away before the initiation of antifungal treatment. Outcomes: Two patients’ adrenal function recovered not requiring any steroid replacement, while 1 patient still requires long-term steroid replacement. Lessons: Adrenal histoplasmosis should be excluded in patients from endemic areas presenting with bilateral adrenal masses and adrenal insufficiency. Usually patients have an exposure to bird droppings, bat guano or soil contaminated with histoplasmosis fungi. Histopathological examination of biopsied adrenal tissues is still the gold standard investigation as serology and molecular diagnostic methods are still not widely available in most centers in Malaysia.