Asia Pacific Research Articles

Disparities in stage at presentation for disaggregated Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups with breast cancer.

1119 Background: Cancer is the leading cause of death for AANHPI populations, who represent one of the most diverse and fastest-growing racial/ethnic groups in the US. Prior research has shown that AANHPI patients in aggregate have a lower risk of breast cancer than Non-Hispanic White (NHW) peers. However, within-group disparities in stage at presentation remain largely unexplored and are important given disparate access to primary care and cancer screening in certain populations. Methods: Data from 2004 to 2020 were extracted from the National Cancer Database (NCDB) for women newly diagnosed with breast cancer. Patients were disaggregated into AANHPI subgroups based on indigenous history or country of origin. Ordinal logistic regression, adjusting for clinical and sociodemographic factors, was used to calculate adjusted odds ratios (AORs), with higher AORs signifying more advanced stage diagnoses, from Stage 0 to IV. Results: Out of 2,563,180 patients with breast cancer, 83,315 (3.25%) identified as AANHPI. Compared to NHW patients, AANHPI patients were younger (median age, NHW: 63 years vs. AANHPI: 58 years, χ2 P<0.001) and more likely to be uninsured or on Medicaid (NHW: 51% vs. AANHPI: 58%, χ2 P<0.001). The largest AANHPI subgroups were Chinese (n=18,708), Filipino (n=18,429), Indian/Pakistani (n=16,424), Korean (n=6,548), and Vietnamese (n=5,345). Stage 3 or 4 disease was more common among NHW than AANHPI patients (11.3% vs 10.7%, χ2 p<0.001). In aggregate, AANHPI patients were less likely to present with later-stage disease (AOR: 0.88, 95% CI 0.87-0.90, p < 0.001). AANHPI disaggregation revealed that Hawaiian (AOR 1.13, 95% CI 1.07–1.21, p < 0.001), Hmong (AOR 1.86, 95% CI 1.34–2.60, p < 0.001), Laotian (AOR 1.46, 95% CI 1.23–1.74, p < 0.001), and Pacific Islander patients (AOR 1.25, 95% CI 1.16–1.34, p < 0.001) were more likely to present at a more advanced stage relative to NHW patients. Relative to Chinese Americans (the largest AANHPI subgroup), all AANHPI patients were significantly more likely to be diagnosed at a later stage of disease. The largest odds were observed in Hmong (AOR = 2.60, 95% CI 1.87–3.62, p < 0.001), Laotian (AOR = 2.00, 95% CI 1.68–2.39, p < 0.001), Pacific Islander (AOR = 1.71, 95% CI 1.59–1.84, p < 0.001), Hawaiian (AOR = 1.54, 95% CI 1.44–1.65, p < 0.001), and Kampuchean (AOR = 1.42, 95% CI 1.20–1.68, p < 0.001) patients. Conclusions: This disaggregation study finds disparities in the stage of breast cancer at presentation across AANHPI groups, with patients of Hawaiian, Hmong, Laotian, and Pacific Islander descent more likely to be diagnosed at advanced stages when treatments are more intense and cure less likely. Research which considers AANHPI patients as a monolith masks poor outcomes from disparate subgroups that could benefit from targeted, culturally tailored interventions that involve community leaders and leverage cultural norms.

Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders.

Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders.

Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States.

Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States.

Dynamical-statistical method for seasonal forecasting of wintertime PM10 concentration in South Korea using multi-model ensemble climate forecasts

Climate conditions and emissions are among the primary influences on seasonal variations in air quality. Consequently, skillful climate forecasts can greatly enhance the predictability of air quality seasonal forecasts. In this study, we propose a dynamical-statistical method for seasonal forecasting of particulate matter (PM10) concentrations in South Korea in winter using climate forecasts from the Asian Pacific Climate Center (APCC) multi-model ensemble (MME). We identified potential climate predictors that potentially affect the wintertime air quality variability in South Korea in the global domain. From these potential climate predictors, those that can be forecasted skillfully by APCC MME were utilized to establish a multiple-linear regression model to predict the winter PM10 concentration in South Korea. As a result of evaluating the forecast skill through retrospective forecasts for the past 25 winters (1995/96-2019/20), this model showed statistically significant forecast skill at a lead time of a month to a season. The skill of PM10 forecast from the MME was overall better than that from a single model. We also found that it is possible to improve forecast skills through optimal MME combinations.

HIV rapid tests immunological internal control can be misleading

Objective: To assess whether internal controls (IC) of HIV rapid tests (HRT) and a rapid confirmatory assay (Geenius) were designed to solely prevent procedural missteps or wether they can also alert for insufficient sample quantity.Material and methods: Thirteen tests were evaluated using distilled water, phosphate buffered saline, and HIV-1 positive serum samples : Autotest VIH® (Autotest) (AAZ-LMB), INSTITM HIV-1/HIV-2 Antibody Test (INSTI) (Biolytical), MULTISURE® HIV Rapid Test (MULTISURE) (MP Diagnostics Asia Pacific Pte. CE Ltd), Biosynex® HIVTOP (Biosynex), Exacto HIVTOP® (Biosynex), Exacto® TEST HIV PRO (Biosynex), GenieTM Fast HIV 1/2 (Bio-Rad laboratories), GeeniusTM HIV 1/2 Confirmatory Assay (Geenius) (Bio-Rad laboratories), VIKIA® HIV 1/2 (bioMérieux), FIRST RESPONSE® Test VIH 1-2.O CARTE (Premier Medical Corporation), Hexagon HIV (Human), DetermineTM HIV EARLY DETECT (Determine) (Abbott), and ONE STEP Anti-HIV 1&2 (InTec PRODUCTS, Xiamen, Fujian P. R. China).Results: Among the 13 tests, 4 were invalid when tested without human serum sample: Autotest, Geenius, INSTI and MULTISURE. The Autotest and INSTI accurately labelled diluted samples, with a Test line positive at least one dilution below the IC. Geenius test line and IC were positive up to the same dilution with automated reading. However, MULTISURE IC was positive up to 1000-fold dilution higher than its test line, making it unsuitable to alert for low sample quantity.

Global, regional, and national levels and trends in burden of urticaria: A systematic analysis for the Global Burden of Disease study 2019.

Urticaria places a significant burden on individuals and society due to its widespread nature. The aim of this study was to evaluate the burden of urticaria in different regions and nations by analysing data from the Global Burden of Disease study 2019 (GBD 2019), with the goal of providing information to health care policymakers. By utilising data from the GBD 2019 database, this study analysed metrics such as incidence, prevalence, disability-adjusted life years (DALYs), age-standardised rate (ASR), and estimated annual percentage changes (EAPC) globally and across 204 countries and regions. The data was further stratified by age, sex, and sociodemographic index (SDI). In 2019, global incidence cases, prevalence cases, and overall disease burden as measured by DALYs all increased. The distribution of the burden exhibited marked geographical heterogeneity. At the regional level, the burden is highest in Central and Eastern Europe and Central Asia, with the strongest growth in South Asia, compared with a decline in the high-income Asia Pacific. At the country level, Nepal reports the highest burden of urticaria, while Portugal has the lowest. Gender and age analyses showed that the burden of urticaria is higher in females than in males, with urticaria cases declining with age, especially in children, and picking up among the elderly. The study also finds a correlation between the burden of urticaria and the SDI, with the central part of the SDI showing a consistent increasing trend. This study found that the global burden of urticaria has risen from 1990 to 2019. Factors like geographic location, gender, and SDI influenced the urticaria burden. Overall, these results offer a resource to guide public health strategies seeking to reduce the burden of urticaria.

Association of race/ethnicity and severe housing problems with COVID-19 deaths in the United States: Analysis of the first three waves.

The objective of this study is to assess the associations of race/ethnicity and severe housing problems with COVID-19 death rates in the US throughout the first three waves of the COVID-19 pandemic in the US. We conducted a cross-sectional study using a negative binomial regression model to estimate factors associated with COVID-19 deaths in 3063 US counties between March 2020 and July 2021 by wave and pooled across all three waves. In Wave 1, counties with larger percentages of Black, Hispanic, American Indian and Alaska Native (AIAN), and Asian American and Pacific Islander (AAPI) residents experienced a greater risk of deaths per 100,000 residents of +22.82 (95% CI 15.09, 30.56), +7.50 (95% CI 1.74, 13.26), +13.52 (95% CI 8.07, 18.98), and +5.02 (95% CI 0.92, 9.12), respectively, relative to counties with larger White populations. By Wave 3, however, the mortality gap declined considerably in counties with large Black, AIAN and AAPI populations: +10.38 (95% CI 4.44, 16.32), +7.14 (95% CI 1.14, 13.15), and +3.72 (95% CI 0.81, 6.63), respectively. In contrast, the gap increased for counties with a large Hispanic population: +13 (95% CI 8.81, 17.20). Housing problems were an important predictor of COVID-19 deaths. However, while housing problems were associated with increased COVID-19 mortality in Wave 1, by Wave 3, they contributed to magnified mortality in counties with large racial/ethnic minority groups. Our study revealed that focusing on a wave-by-wave analysis is critical to better understand how the associations of race/ethnicity and housing conditions with deaths evolved throughout the first three COVID-19 waves in the US. COVID-19 mortality initially took hold in areas characterized by large racial/ethnic minority populations and poor housing conditions. Over time, as the virus spread to predominantly White counties, these disparities decreased substantially but remained sizable.

Parabolic Modeling Forecasts of Space and Time European Hydropower Production

Renewable sources of energy production are some of the main targets today to protect the environment through reduced fossil fuel consumption and CO2 emissions. Alongside wind, solar, marine, biomass and nuclear sources, hydropower is among the oldest but still not fully explored renewable energy sources. Compared with other sources like wind and solar, hydropower is more stable and consistent, offering increased predictability. Even so, it should be analyzed considering water flow, dams capacity, climate change, irrigation, navigation, and so on. The aim of this study is to propose a forecast model of hydropower production capacity and identify long-term trends. The curve fit forecast parabolic model was applied to 33 European countries for time series data from 1990 to 2021. Space-time cube ArcGIS representation in 2D and 3D offers visualization of the prediction and model confidence rate. The quadratic trajectory fit the raw data for 14 countries, validated by visual check, and in 20 countries, validated by FMRSE 10% threshold from the maximal value. The quadratic model choice is good for forecasting future values of hydropower electric capacity in 22 countries, with accuracy confirmed by the VMRSE 10% threshold from the maximal value. Seven local outliers were identified, with only one validated as a global outlier based on the Generalized Extreme Studentized Deviate (GESD) test at a 5% maximal number of outliers and a 90% confidence level. This result achieves our objective of estimating a level with a high degree of occurrence and offering a reliable forecast of hydropower production capacity. All European countries show a growing trend in the short term, but the trends show a stagnation or decrease if policies do not consider intensive growth through new technology integration and digital adoption. Unfortunately, Europe does not have extensive growth potential compared with Asia–Pacific. Public policies must boost hybrid hydro–wind or hydro–solar systems and intensive technical solutions.

Guidelines for the Diagnosis and Treatment of Ulnar Impaction Syndrome (2024)

Abstract Background: Ulnar impaction syndrome (UIS), also known as ulnar impaction or ulnar abutment, is a degenerative condition causing pain on the ulnar side of the wrist. It can lead to wrist bone necrosis, resulting in wrist joint stability disruption and a significant wrist function impairment. The global understanding of this condition varies, contributing to substantial differences in clinical outcomes. Purposes: This paper underscores the necessity of developing evidence-based clinical guidelines for UIS to guide clinicians in their diagnostic and therapeutic approaches. Methods: In collaboration with the Asian Pacific Wrist Association, a team of experts from various fields within the Hand Surgery Department at Huashan Hospital has collectively formulated the “Clinical Practice Guidelines for Ulnar Impaction Syndrome (2024)” (hereinafter referred to as the “Guidelines”). The development process adhered to the guidelines outlined in the World Health Organization's handbook for guideline development. Results: Ten key questions and 21 recommendations are formed. The Guidelines provide recommendations for UIS diagnosis, criteria for selecting conservative or surgical interventions, options for surgical procedures, and address various related issues. Conclusions: The collaborative effort aims to standardize clinical practices, enhance diagnostic accuracy, and improve treatment outcomes for individuals affected by UIS, with these recommendations intended to serve as a valuable reference for healthcare professionals.

Frailty evidence-practice gaps in acute care hospitals.

Frailty is common in hospitalised older people. Clinical practice guidelines for the management of frailty provide recommendations for identification and management; however, adoption into practice in hospitals is limited. This study identified and quantified the evidence-practice gap between frailty guidelines and clinical practice in two hospitals using an audit tool. A cross-sectional audit of medical records of frail older patients admitted to two hospitals was conducted. Data were collected using an audit tool based on the Asia Pacific Clinical Practice Guidelines for frailty management. Data were analysed using descriptive statistics and inter-rater reliability of the tool was assessed. Auditing of n = 70 electronic medical records showed that assessment of frailty in the acute setting did not regularly occur (17%). Few participants received guideline-recommended interventions. Physiotherapy treatment was limited, with 23% of participants receiving progressive resistance strength training. Gaps exist in provision of nutritional supplementation (26%) with limited recordings of weight during the admission for 10% of participants. Pharmacy review of medications was consistently documented on admission (84%) and discharge (93%). Vitamin D was prescribed for 57% of participants. Inter-rater reliability showed a high level of agreement using the audit tool. An audit tool was feasible to assess frailty evidence-practice gaps in the hospital setting. Further understanding of the contextual barriers is needed to inform implementation strategies (dedicated staffing, education and training and ongoing audit of practice cycles) for the uptake of frailty guidelines in hospital settings.

The impact of resilience acquisition on students transitioning to university during covid-19: a follow up study with Myanmar students

In our previous study (Gomersall & Floyd, in Asia Pacific Education Review 24:447–459, 2022), we reported that a group of Myanmar students, who studied online for their high school qualifications during COVID-19, reported drawing on a range of factors to enable them to overcome the adversity and continue their education. Moreover, they claimed that they had benefited from the online experience and were ready to progress to university. This study returns one year later to interview some of the original participants to see if their perceptions became reality. In addition, a group of students from the 2020 cohort are also interviewed so that a comparison can be made between the last group of students who studied ‘normally’ before COVID-19, and those who experienced online learning for the first time. This study addresses a gap in the literature by examining student perspectives of the ways in which they thrived as a result of digitally enhanced learning. We conclude that learning online enabled students to develop personally, enhance their digital skills, and acquire skills and knowledge that could be utilised again in the future. Moreover, those who studied online in both high school and university found the process of commencing online studies at university easier, which supports the tentative conclusion that even in low resource settings, it would be beneficial for schools to explore integrating more digital skills into the classroom.

Guiding postmenopausal care for osteoporosis: First evidence-based clinical practice guidelines for Pakistan.

Madam, We would like to address the issue of postmenopausal osteoporosis (PMO) management in Pakistan and advocate for the country-wide dissemination of the recently published Pakistan-specific clinical practice guideline (CPG) "GRADE-Adolopment of Clinical Practice Guideline for Postmenopausal Osteoporosis Management - a Pakistani Context" (1). Osteoporosis poses a significant threat to the health of postmenopausal women. Although osteoporosis prevalence among postmenopausal women ranges from 20% to 49.3% in Pakistan, there is a lack of epidemiological data, diagnostic facilities, and public awareness about bone health. Healthcare providers in Pakistan have thus far struggled with managing osteoporosis effectively because of the absence of local CPGs. The Pakistani PMO guideline, developed by the Aga Khan University aligns the recommendations of the Asia Pacific Consortium on Osteoporosis (2) and the American Association of Clinical Endocrinologists (3). The GRADE-ADOLOPMENT methodology used in developing the guideline provides a systematic support for the recommendations that are evidence based and suitable for adoption in Pakistan's medical settings. The guideline recommends higher doses (2000-4000 IU) of vitamin D in patients with obesity, malabsorption, and old age, considering their increased requirements and suboptimal response to lower doses. It addresses food insecurity and malnutrition, which contribute to vitamin D deficiency and fracture risk. Moreover, the guideline incorporates the surrogate FRAX model created for Pakistan, recommended by the International Osteoporosis Foundation for countries lacking fracture incidence data (4). A management algorithm is proposed, based on intervention thresholds developed for Pakistan for accurate estimation of fracture probability, and to guide clinical practice(5). The primary goal of the guideline is to improve the quality of care by changing the daily practice of physicians in the desired direction. Disseminating and integrating osteoporosis care into the healthcare system is challenging but remains a top priority. The endorsement of the guideline by relevant national societies can play a crucial role in its dissemination. Implementation through their members can help in assessing effectiveness and in shaping clinical practice. The guideline is a critical step in addressing osteoporosis management challenges in Pakistan, but for full impact, widespread dissemination and implementation in clinical practice is required. We implore the medical community, policymakers, and stakeholders to collaborate in this endeavor and work towards improving the management of osteoporosis, to enhance the health outcomes of the Pakistani population. It is essential that healthcare policymakers and practitioners recognize PMO as a significant public health issue and implement the CPG for appropriate practice changes.

#1157 Body mass and fluid balance in dialysis: global profiles in Apollo Dial DB

Abstract Background and Aims Fluid management is a fundamental component of dialysis care. Achieving euvolemia and avoiding fluid overload can be challenging in dialysis. Apollo Dial DB, an anonymised dialysis database from a global kidney care network, was used to gain deeper insights in patterns of patient body mass and fluid balance during dialysis treatments worldwide. Method Apollo Dial DB, a global anonymised dialysis database, contains real-world data from patients in 40 countries beginning January 2018 throughout March 2021. Parameters include demographics, diagnoses, laboratories, medications, treatments, quality of life, and outcomes. This analysis assessed body mass and fluid status parameters on patients in Asia-Pacific (AP), Europe, Middle East, and Africa (EMEA), Latin America (LA), Northern America (NA). In addition, bioimpedance for body compositions of patients was assessed as it was available in AP, EMEA, and LA. Results The first version of the Apollo Dial DB includes data on 543, 169 patients, with 4.6% from AP, 13.9% from EMEA, 7.0% from LA, and 74.5% from NA countries. EMEA and NA have a higher proportion of patients in the bigger height categories versus the AP and LA regions (Table 1). There is a difference in mean body weight post dialysis of more than 10 kg between regions; the highest weights were observed in EMEA and NA in contrast to the AP and LA regions. Average albumin levels were consistent in all global regions. Intradialytic weight gain is lowest in EMEA at 1.8 kg and highest in NA at 2.2 kg between treatments. While ultrafiltration volume ranged from 2.0 L to 2.4 L, being the highest in AP and NA. Bioimpedance measures defining body compositions were available for the majority of patients in AP (59.3%), EMEA (86.9%), and LA (90.7%). Patient averages in EMEA are slightly higher for ATM, FTM, LTM, TBW than for LA and AP; this is somewhat explained by the differences in body weight between the cohorts (Fig. 1). Conclusion A descriptive analysis of the body mass and fluid status across minor and major regions bring to light key profiles and differences in the characteristics of dialysis patients across the world and fluid management practices in dialysis care. Differences in intradialytic weight gain may deserve further analysis considering the impact of dialysis modality on fluid balance, such as potential influences of convective therapies. These findings act as benchmarks for the nephrology community. Apollo Dial DB offers opportunities for investigators to conduct global analytics and advance kidney disease research.

#341 Dialysis modality patterns across six continents in Apollo Dial DB

Abstract Background and Aims Data is often collected during kidney dialysis treatments, providing data on a large scale and at a constant flow. As multinational datasets are scarce, Apollo Dial DB was created by a global provider that contains longitudinal observational data across six continents. This database is fully anonymised and can be used to better understand modality practice of global patients from a variety of healthcare systems for quality improvement and research efforts. Our aim was to detail patterns of dialysis modalities used among patients treated in 40 countries across six continents represented in the first version of the global database. Method Apollo Dial DB, a global anonymised dialysis database, contains demographics, diagnoses, laboratories, medications, treatments, quality of life, and outcomes from six continents and 40 countries. Data was harmonised from different electronic systems and anonymised based on logic established in a re-identification risk assessment. Data is consolidated and stored in a central cloud environment. The initial version of the dataset contains data on more than 360 variables from January 2018 to March 2021 and will be updated periodically. Results The first version of the Apollo Dial DB includes data on 543,169 patients, with 4.6% from Asia-Pacific (AP), 13.9% from Europe, Middle East, and Africa (EMEA), 7.0% from Latin America (LA), and 74.5% from North America (NA) countries. Most of the patients included in the database are between 45-64 years old at the initiation of dialysis. Overall, Apollo Dial DB contains information on 140,016,249 dialysis treatment observations. Depending on the region, different treatment patterns could be observed (Table 1 and Fig. 1). In EMEA a higher proportion of patients received hemodiafiltration with post-dilution, especially in Northern and Southern Europe as well as in South Africa. Peritoneal dialysis was more frequently used in LA and NA than in other regions. CCPD was mainly used in NA, whereas CAPD was common in LA and EMEA. For a more detailed look across the six continents Fig. 1 illustrates incentre hemodialysis modality patterns on a minor world region level. For incentre hemodialysis treatments, the majority of treatments from the minor regions in AP, LA, and NA had HD treatments. However, the majority treatments from EMEA minor regions are receiving incentre HDF treatments. Conclusion In a descriptive analysis, we defined modality treatment patterns in major world regions. These findings act as benchmarks for the nephrology community and expand upon scarce point prevalent information on modality practice patterns used throughout the world [1]. Apollo Dial DB offers opportunities for investigators to conduct global analytics and advance the state of the art.

#1166 ACTION3 pivotal Phase 3 & open-label extension study assessing DMX-200 in adult & paediatric patients with focal segmental glomerulosclerosis (FSGS)

Abstract Background and Aims Focal segmental glomerulosclerosis (FSGS) is a major cause of glomerular disease that affects both adults and children. FSGS can rapidly progress to end-stage kidney disease. Lack of safe and effective treatment represents a significant unmet need for patients with FSGS. Development of treatments has been hampered by complexities including the rare nature of the disease, varying drivers of pathogenesis, and the evolving diagnostic and clinical trial designs, necessitating innovative research approaches. DMX-200 (repagermanium) is a C-C motif chemokine receptor 2 (CCR2) pathway inhibitor. Activation of the angiotensin II type 1 receptor (AT1R) and CCR2 have been independently implicated in the pathogenesis and progression of FSGS. These receptors form a functional complex so inhibition of both receptors may provide an efficient approach to FSGS treatment. In vivo data shows co-administration of DMX-200 and the angiotensin receptor blocker (ARB) irbesartan demonstrated a synergistic reduction in proteinuria, macrophage infiltration, and podocyte loss compared with vehicle or either antagonist alone. A subsequent Phase 2a cross-over study (NCT03649152) in N = 8 patients with biopsy-proven primary FSGS showed that the combination of DMX-200 and irbesartan (compared to placebo) was well tolerated with most patients experiencing a reduction in proteinuria. Based on these data, the global Phase 3 study (ACTION3) was initiated to confirm the proteinuria lowering effects of DMX-200 and assess effects on eGFR decline. ACTION3 is a randomised, placebo-controlled, double-blind, long-duration study of FSGS patients and on completion will provide a resource for the wider nephrology community and advocacy groups on the natural history of FSGS patients and the effects of a CCR2-inhibitor on the background of an ARB. Here we present the baseline data from the first 90 patients enrolled in ACTION3 at 12th January 2024. Method The ACTION3 (NCT05183646) study is a pivotal Phase 3, multicentre study of the efficacy and safety of DMX-200, 120 mg twice daily compared with placebo in adult patients with biopsy-proven FSGS receiving maximal tolerated ARB, with persistent proteinuria >1.5g/ day and eGFR >25 ml/min/1.73 m2. The study plans to enroll approximately 286 patients with primary FSGS, genetic FSGS and FSGS of undetermined cause with the primary objective of evaluating the efficacy of DMX-200 in percent change in 24-hour urine PCR and eGFR slope. The initial 104-week randomized period will be extended in a 2-year open label extension study. A futility analysis by an Independent Data Monitoring Committee following the first 72 patients completing 35 weeks of treatment confirm that continuation of the study is non-futile. Results The study is actively recruiting at 71 sites in 11 countries listed in Table 1. Demographic data of randomised patients is listed in Table 2. Patients are predominantly male (65%), with an average age of 46.6 yrs. and mean eGFR 56.3 ± 27.6 (ml/min/1.73 m2). The study is expanding recruitment into additional countries in the Asia Pacific, Europe, and Latin American regions. Further, the study protocol has sought and received regulatory approval to enroll adolescent patients aged 12-18 in Argentina, Mexico, UK and the US. Conclusion DMX-200 (repagermanium) has shown encouraging signs of safety and efficacy in combination with an ARB for the treatment of FSGS. The contributing countries and baseline characteristics of the patients enrolled in ACTION3 are similar to the populations studied in other recent FSGS trials. No clinically significant safety concerns have been observed in patients enrolled to date in the ACTION3 Phase 3 study.

#1849 Returning to dialysis after kidney transplant failure: preliminary findings of a multi-centre database

Abstract Background and Aims Kidney transplant failure contributes to a considerable proportion of new dialysis starters. In some centres there are dedicated clinics for patients with failing kidney transplants, however, the specific needs of patients with dialysis after graft loss (DAGL) may be lost in the non-specific clinical review practiced in the general dialysis community. This study examines the mortality and morbidity risk in patients returning with DAGL and compares it to transplant-naïve (T-N) dialysis starters, to determine if the former warrant a more specialised approach. Method This is a retrospective observational study of mortality in all adult patients who started dialysis treatments in Fresenius Medical Care (North America, Latin America, Europe, Middle East, Africa, and Asia Pacific) from 1st January 2018 to 31st March 2021, were identified in the Apollo Dial DB dataset. DAGL was identified from the ICD-10 codes ‘Kidney transplant failure’, ‘Unspecified complication of kidney transplant’ and ‘Other complication of kidney transplant’ at dialysis start. The T-N control group had not previously received a kidney transplant and had not received immunosuppressive medication during the first six months of dialysis start. The first six months on dialysis were defined as baseline, months 7 to the end of year 5 were defined as the follow-up period. All-cause mortality was recorded during follow-up. Cox proportional hazards models were applied to explore the association between DAGL and all-cause mortality. Results A total of 360 469 dialysis starter patients from 41 countries were included in the analysis. 10 010 patients had DAGL and were compared with 350 459 in the T-N control group. In univariate analysis, DAGL patients were significantly younger in all age categories and had a higher proportion of male sex. Serum creatinine, ferritin, phosphate and neutrophil-to-lymphocyte ratio were higher in the DAGL group. Haemoglobin was lower in the DAGL group (Table 1). In the Cox proportional model adjusted for age, gender, and other laboratory and clinical markers, patients with DAGL had an equivalent survival probability compared with T-N dialysis starters (HR: 0.93, 95% CI: 0.86, 1.02) (Table 2). Conclusion DAGL patients appeared to have an increased mortality compared to T-N dialysis starters historically in the literature. Our large and recent study is in line with other recent publications suggesting a more equivalent survival in the two groups. Our results are compatible with younger patients receiving kidney transplantation early in their renal replacement therapy journey, thus constituting a significant proportion of DAGL patients. We posit that DAGL patients may start dialysis at a lower level of renal function, with higher levels of inflammation. Our analysis is preliminary and limited, not fully accounting for confounding factors. Future analysis of this large and well recorded dataset will allow us to examine these interesting associations and design a more specialised management approach to DAGL more closely.

Optimizing test and treat options for vivax malaria: An options assessment toolkit (OAT) for Asia Pacific national malaria control programs.

Designing policy in public health is a complex process requiring decision making that incorporates available evidence and is suitable to a country's epidemiological and health system context. The main objective of this study was to develop an options assessment toolkit (OAT) to provide a pragmatic and evidence-based approach to the development of policies for the radical cure (prevention of relapse) of vivax malaria for national malaria control programs in the Asia-Pacific region. The OAT was developed using participatory research methods and a Delphi process using a sequential multi-phase design, adapted with a pre-development phase, a development phase, and a final development phase. In the pre-development phase, a literature review was conducted to inform the toolkit development. Data collection in the development phase consisted of core research team discussions, multiple rounds of consultation with participants from National Malaria Control Programs (NMP) (online and in person), and two separate modified e-Delphi processes with experts. The final development phase was the piloting of the toolkit during the annual meeting of the Asia Pacific Malaria Elimination Network (APMEN) Vivax Working Group. We developed a tool kit containing the following elements: i) Baseline Assessment Tool (BAT) to assess the readiness of NMPs for new or improved coverage of radical cure, ii) eight scenarios representative of Asia Pacific region, iii) matching test and treat options based on available options for G6PD testing and radical cure for the given scenarios, iv) an approaches tool to allow NMPs to visualize considerations for policy change process and different implementation strategies/approaches for each test and treat option. The OAT can support vivax radical cure policy formulation among NMPs and stakeholders tailoring for their unique country context. Future studies are needed to assess the utility and practicality of using the OAT for specific country context.

A high-resolution seismic velocity model for East Asia using full-waveform tomography: Constraints on India-Asia collisional tectonics

East Asia's complex tectonic history makes it a unique place for plate-tectonic studies. While the crust and mantle structures beneath this region have been extensively investigated by receiver function and many different kinds of tomography studies, discrepancies among seismic velocity models have complicated our understanding of East Asia's tectonic evolution. Here, we use full-waveform adjoint tomography to study the seismic P- and S-wave velocity structures of the crust and mantle beneath East Asia. We use a large waveform dataset from 141 earthquakes recorded by 4640 broadband seismic stations. Our inversion optimizes the normalized correlation coefficient between synthetic and observed seismograms within individual time windows of different seismic phases, from P arrivals to the slowest surface waves. This approach allows us to fit regional multipathed waveforms and provides very well-resolved seismic P- and S-wave velocity structures from the crust to depths of about 800 km. Furthermore, we are able to obtain this resolution over most of East Asia allowing us to compare the amplitude and shapes of anomalies across the entire region. The observed structures in our new full-waveform tomography model (FWEA23) correlate well with tectonic units, revealing sharp contrasts across tectonic boundaries. Our model reveals narrow and strong linear fast anomalies associated with subduction zones in the western Pacific and Southeast Asia. Compared to these oceanic slabs, we observe different and more complicated mantle structures beneath the India-Asia continental collision zone. While our model spans a wide region in East Asia, we focus our interpretations on the seismic velocity anomalies beneath Tibet and surrounding regions, as our model provides significant implications for India-Asia continental collision tectonics. Our analysis suggests that cratonic Indian lithosphere collided with Eurasian plate around 25–20 Ma, subsequently underthrusting beneath Tibet horizontally with little deformation. This resulted in thickening, destabilization, and delamination of the rheologically weaker and less buoyant mantle lithosphere beneath north-central Tibet. Moreover, our model reveals isolated lithospheric fragments within the mantle transition zone and lower mantle beneath southern Tibet and northern India, suggesting that non-cratonic Greater India continental lithosphere has broken off and sunk into the deeper mantle. The lack of continuity among these lithospheric fragments suggests a convective destabilization process, distinct from typical oceanic plate subduction. Our results emphasize the important role of rheological properties of continental lithospheres in shaping the dynamics of continental collision.

Changing epidemiology of inflammatory bowel disease in children and adolescents

BackgroundThe incidence of inflammatory bowel disease (IBD) is rising worldwide, but epidemiological data on children and adolescents are lacking. Understanding the global burden of IBD among children and adolescents is essential for global standardization of methodology and treatment options.MethodsThis is a cross-sectional study based on aggregated data. We estimated the prevalence and incidence of IBD in children and adolescents between 1990 and 2019 according to the Global Burden of Disease Study 2019 (GBD 2019). Age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) were used to compare the burden and trends between different regions and countries.ResultsIn 2019, there were 25,659 new cases and 88,829 prevalent cases of IBD among children and adolescents globally, representing an increase of 22.8% and 18.5%, respectively, compared to 1990. Over the past 30 years, the incidence and prevalence of IBD among children and adolescents have been highest in high SDI regions, with the most significant increases in East Asia and high-income Asia Pacific. At the age level, incidence and prevalence were significantly higher in the 15–19-year-old age group, while the < 5-year-old group showed the most significant increase in incidence and prevalence.ConclusionThe incidence of IBD in children and adolescents is significantly on the rise in some countries and regions, and IBD will remain an important public health issue with extensive healthcare and economic costs in the future. The reported IBD burden in children and adolescents at the global, regional, and national levels will assist in the development of more precise health policies.

FREQUENCY OF OBESITY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

OBJECTIVE: To determine the frequency of Obesity in patients with Type 2 Diabetes Mellitus in patients visiting the Outpatient department of Khyber Teaching Hospital, Peshawar MATERIALS AND METHODS. This descriptive cross-sectional study was conducted in the Department of Medicine Khyber Teaching Hospital Peshawar after approval from the hospital’s ethical committee. All type 2 diabetes mellitus patients fulfilling inclusion criteria, presented to medical OPD and ward were interviewed in detail. Relevant information like age, gender, height weight, etc. recorded using proforma. BMI was calculated using height and weight. Patients with RBS of more than 200 mg/dl and symptomatic were labeled as having diabetes (American diabetes association). Patients with a BMI of more than 25kg/m2 were labeled as having obesity (Asian Pacific criteria). Data was analyzed using SPSS version 20 and presented in tables. RESULTS. The mean and standard deviation (SDs) for age were recorded as 56­­±9 years. Mean and SDs for height were recorded as 1.5± 0.8 meters. Mean and SDs for weight were recorded as 65±12 kilogram. Mean and SDs for random blood sugar were recorded as 238±77 mg/dl. Mean and SDs for BMI were recorded as 26±5. One hundred and eighty-nine (49.2%) patients were female and 195(50.8%) were male. Two hundred and seven (53.9%) patients were recorded as obese and 177(46.1%) were recorded as non-obese. CONCLUSION. In our study, we found that the majority of type 2 diabetes mellitus patients were obese. Thus, by adopting a healthy lifestyle we can reduce and delay the onset and morbidity associated with diabetes mellitus. KEYWORDS Diabetes mellitus (DM), Body mass index (BMI), Random blood sugar (RBS), Glycated hemoglobin (HBA1C).