Diseases In Southeast Asia Research Articles

SECURITISING HEALTH CRISES ON REGIONAL COOPERATION: HINDERING OR FACILITATING COOPERATION?

The securitisation theory (ST) often gives rise to the debate on the positive and negative dimensions of security. ST is frequently quoted in this debate to explore what happens when threats are labelled as a security issue. The positive and negative points in the debate on ST are closely related to migration, environment, and health. However, like other international relations (IR) theories, the ST debate often fails to reflect the voices and experiences of different regional contexts. This article contributed to the securitisation debates by adding the perspectives and experiences of the Southeast Asia region by applying critical literature review analysis, using primary and secondary sources data collection. Although public health challenges are global phenomena, the way they are addressed may vary across geographical regions. The article reviews the consequences of securitising on contagious diseases in Southeast Asia as the region is often associated with distinctive political cultures that shape the governing norms. Securitisation has clearly made a positive impact on the health security cooperation in the region. Instead of encouraging state-centric thinking, the securitisation of health crises has prompted ASEAN countries to be more region-centric, ultimately challenging the regional norms that have historically obstructed cooperation across the nations. Keywords: ASEAN, health security, regional cooperation, securitisation theory, Southeast Asia. Cite as: Mohd Azmi, N. (2024). Securitising health crises on regional cooperation: Hindering or facilitating cooperation. Journal of Nusantara Studies, 9(2), 557-576. http://dx.doi.org/10.24200/jonus.vol9iss2pp557-576

Google trends as an early indicator of African swine fever outbreaks in Southeast Asia.

African Swine Fever (ASF) is a reportable disease of swine that causes far-reaching losses to affected countries and regions. Early detection is critically important to contain and mitigate the impact of ASF outbreaks, for which timely available data is essential. This research examines the potential use of Google Trends data as an early indicator of ASF outbreaks in Southeast Asia, focusing on the three largest swine producing countries, namely, Vietnam, the Philippines, and Thailand. Cross-correlation and Kullback-Leibler (KL) divergence indicators were used to evaluate the association between Google search trends and the number of ASF outbreaks reported. Our analysis indicate strong and moderate correlations between Google search trends and number of ASF outbreaks reported in Vietnam and the Philippines, respectively. In contrast, Thailand, the country of this group in which outbreaks were reported last, exhibits the weakest correlation (KL = 2.64), highlighting variations in public awareness and disease dynamics. These findings suggest that Google search trends are valuable for early detection of ASF. As the disease becomes endemic, integrating trends with other epidemiological data may support the design and implementation of surveillance strategies for transboundary animal diseases in Southeast Asia.

The Etiology of Advanced Chronic Kidney Disease in Southeast Asia: A Meta-analysis

IntroductionChronic kidney disease (CKD) etiology varies greatly between developed and developing countries. In addition, differences in underlying pathogenesis and therapeutic options affect the progression towards advanced-CKD. This meta-analysis aims to identify the etiology of advanced-CKD in Southeast Asia.MethodsA systematic search in four electronic-databases and complementary search on national kidney registries and repository libraries was conducted until July 20, 2023. The risk of bias was assessed using Newcastle–Ottawa Scale for observational studies and Version-2 of Cochrane for intervention studies. A random-effects model was used to estimate pooled prevalence. The protocol is registered in the International Prospective Register of Systematic Reviews PROSPERO; Registration ID:CRD42022300786.ResultsWe analyzed 81 studies involving 32,834 subjects. The pooled prevalence of advanced-CKD etiologies are diabetic kidney disease (DKD) 29.2% (95%CI 23.88–34.78), glomerulonephritis 20.0% (95%CI 16.84–23.38), hypertension 16.8% (95%CI 14.05–19.70), other 8.6% (95%CI 6.97–10.47), unknown 7.5% (95%CI 4.32–11.50), and polycystic kidney disease 0.7% (95%CI 0.40–1.16). We found a significant increase in DKD prevalence from 21% (9.2%, 95%CI 0.00–33.01) to 30% (95%CI 24.59–35.97) before and after the year 2000. Among upper-middle-income and high-income countries, DKD is the most prevalent (26.8%, 95%CI 21.42–32.60 and 38.9%, 95%CI 29.33–48.79, respectively), while glomerulonephritis is common in lower-middle-income countries (33.8%, 95%CI 15.62–54.81).ConclusionThe leading cause of advanced-CKD in Southeast Asia is DKD, with a substantial proportion of glomerulonephritis. An efficient screening program targeting high-risk populations (diabetes mellitus and glomerulonephritis) is needed, with the aim to delay CKD progression.

Emerging zoonotic diseases in Southeast Asia in the period 2011–2022: a systematic literature review

As COVID-19 has shown, pandemics and outbreaks of emerging infections such as Zika, Nipah, monkeypox and antimicrobial-resistant pathogens, especially emerging zoonotic diseases, continue to occur and may even be increasing in Southeast Asia. In addition, these infections often result from environmental changes and human behaviour. Overall, public health surveillance to identify gaps in the literature and early warning signs are essential in this region. A systematic review investigated the prevalence of emerging zoonotic diseases over 11 years from 2011 to 2022 in Southeast Asia to understand the status of emerging zoonotic diseases, as well as to provide necessary actions for disease control and prevention in the region. During the 2011–2022 period, studies on pigs, poultry, ruminants, companion animals and wildlife in Southeast Asia were reviewed thoroughly to assess the quality of reporting items for inclusion in the systematic review. The review was performed on 26 studies of pigs, 6 studies of poultry, 21 studies of ruminants, 28 studies of companion animals and 25 studies of wildlife in Southeast Asia, which provide a snapshot of the prevalence of the emerging zoonotic disease across the country. The findings from the review showed that emerging zoonotic diseases were prevalent across the region and identified a few zoonotic diseases associated with poultry, mainly stemming from Cambodia and Vietnam, as high priority in Southeast Asia. Clinical relevance: Appropriate prevention and control measures should be taken to mitigate the emerging zoonotic diseases in Southeast Asia.

Population structure, dispersion patterns and genetic diversity of two major invasive and commensal zoonotic disease hosts (Rattus norvegicus and Rattus tanezumi) from the southeastern coast of China.

Background: The invasive brownrat (Rattus norvegicus) and the Oriental rats (Rattus tanezumi) are common commensal murid that are important hosts for rodent-borne diseases in southeast Asia. Understanding their population structure and genetic diversity is essential to uncover their invasion biology and distribution dynamics that are essential for controlling rodent-borne diseases. Methods: TA total of 103 R. norvegicus and 85 R. tanezumi were collected from 13 to 9 coastal areas of six provincial monitoring sentinel sites, respectivelyto assess patterns in their microsatellite loci and their mitochondrial coxl gene region. Results: Eleven sampled populations of R. norvegicus were divided into two major clusters by region. The observed heterozygosity values of all regional populations were smaller than expected genetic diversity heterozygosity values and deviated from Hardy-Weinberg equilibrium Nine sample populations of R. tanezumi were divided into three clusters; two that included sample from Hainan and Fujian provinces, and one that included samples from the other provinces and cities. The genetic diversity of R. tanezumi was highest in samples from Jiangsu and Guangdong provinces. Conclusion: The data in this paper confirm the two invasive rodent species from the southeastern coastal region of China may have relied on maritime transport to spread from the southern region of China to the Yangtze River basin. R. tanezumi may then hanve migrated unidirectionally, along the southeastern provinces of China towards the north, while R. norvegicus spread in a complex and multidirectional manner in Hainan, Fujian, Zhejiang and Jiangsu Provinces of the country.

In-silico Prediction Analysis of Polyphenolic Contents of Ethanolic Extract of Moringa oleifera Leaves

Introduction: Moringa oleifera is widely consumed as a source of nutrients and as traditional medicine for treating myriads of diseases in Southeast Asia, Africa, and South America. Polyphenols are abundantly found in the leaves of Moringa oleifera, particularly astragalin and quercetin, and have shown antioxidant and anti-inflammatory activities. In the present study, the polyphenols in Moringa oleifera leaves were identified and quantified, followed by in-silico pharmacokinetics prediction. Methods: Moringa oleifera ethanolic leaf extract (MOEE) was prepared by macerating dry powdered leaves of Moringa oleifera in 70% ethanol, then subjected to ultra-high-performance liquid chromatography-mass spectrometry (UPHLC-MS/MS) to identify polyphenols and quantification by HPLC. In-silico pharmacokinetic prediction analysis of the polyphenols was performed using the SwissADME web tool. Results: Eight polyphenols were identified, among which astragalin and quercetin were quantified. In-silico prediction analysis using SwissADME demonstrates the drug-likeness of the polyphenols in MOEE based on their physicochemical and ADME (absorption, distribution, metabolism and excretion) properties. MOEE contains polyphenols that can serve as lead compound to developing drugs, but only some are predicted to have high GI absorption index demonstrating their utility in oral medication drug development. Moreover, all the polyphenols determined in this study are predicted to be non-brain permeant, demonstrating their limited utility in developing drugs that target brain-related pathologies. Conclusion: Eight polyphenols were identified by UHPLC/MS analysis of Moringa oleifera leaves. Their ADME pharmacokinetics properties predicted some of the polyphenols as favourable candidates for drug development and lead optimisation, thus positioning the Moringa oleifera as an important source of small molecules for drug development.

A Systematic Review on the Increasing Incidence of Inflammatory Bowel Disease in Southeast Asia: Looking Beyond the Urbanization Phenomenon.

The incidence of inflammatory bowel disease (IBD) has been increasing in Southeast Asia (SEA) in tandem with its economic growth and urbanization over the past 2 decades. Specific characteristics of IBD in SEA are similar to East Asia and the West, such as the declining ratio of ulcerative colitis to Crohn's disease. However, exceptionally low familial aggregation is seen. Smoking is also not a common risk factor in patients with Crohn's disease. The incidence of perianal disease is higher in SEA than in Australia and is comparable to the West. In a multiracial population, such as Singapore and Malaysia, Indians have the highest incidence and prevalence rates, which are likely to be due to important putative mutations. For instance, a higher frequency of the NOD2 predisposing mutation SNP5 and IBD risk allele IGR2198a and IGR2092a were found in Indians. Although differences in the genetic constitution play an important role in the epidemiology and prognosis of IBD in SEA, the emergence of this disease offers a unique opportunity to identify potential exposomes that contribute to its pathogenesis.

Prime Editing of the α-Thalassemia Hb Constant Spring Mutation

Hemoglobin Constant Spring (HbCS) is the most common non-deletional α-thalassemic mutation and is an important cause of HbH-like disease in Southeast Asia. Although the α-globin is expressed from two copies of homologous genes ( HBA2 and HBA1), the constant spring (CS) mutation CD142 (UAA > CAA) occurs only in HBA2 gene that leads to the instability of both mRNA and protein in erythroid cells. The newly developed gene editing technology prime editors (PEs) can generate all types of substitutions, providing therapeutic potential in different types of diseases. However, the efficiency of primer editor in primary hematopoietic stem cells is still a big challenge and lack of study in the HbCS mutation. We first created the endogenous HbCS mutation in human umbilical cord blood-derived erythroid progenitor-2 (HUDEP-2) cells, providing as a model for prime editing optimization. The protein of α cs chain (a larger protein with extra 31 amino acids) was detected in the model cells with HBA2 bi-allelic CS mutation and normal HBA1, which exhibited the delay of expansion, higher apoptosis rate and altered erythroid maturation markers after induced differentiation. To correct the CS mutation for converting HbCS to HbA, we performed ex vivo delivery of mRNA encoding the prime editor together with a pegRNA and a nick guide RNA into the Hb CS HUDEP2 model cells and achieved the successful in-situ correction with an efficiency of 39.883±9.720% of CS alleles without enrichment, while no measurable editing in the same loci of HBA1 as evaluated by both Sanger sequencing and NGS. More importantly, the correction resulted in a significant decrease of α cs chain, thereby alleviated erythroid phenotype after induced maturation with reducing the apoptosis rate. After that, we collected the primary Hb H-CS patients derived CD34 + hematopoietic stem/progenitor cells (HSPCs) and confirmed that the defect on erythroid expansion, differentiation in Hb H-CS patients derived CD34 + HSPCs compared to the normal donor, especially demonstrated by lower enucleation rate and higher apoptosis. Moreover, the protein of α cs chain was detected in the erythroblast from Hb H-CS CD34+ HSPCs. We further successfully corrected the CS mutation in Hb H-CS patient derived CD34 + HSPCs with an efficiency of 23.68% by mRNA electroporation. At the same time, the editing efficiency was achieved with minimal generation of insertions and deletions and a low level of Cas9-dependent DNA off-target editing. Importantly, we observed an ~23% decrease of α cs chain protein and significant restoration of the enucleation defect from the differentiated erythroblast after PE correction in CD34 + HSPCs. In summary, these results suggests that the delivery of PE mRNA together with synthesized pegRNA and nick sgRNA can successfully achieve the in-situ correction in Hb HbCS mutation site in the model cells and the primary Hb H-CS patient derived CD34 + HSPCs. Our results provide proof of principle for prime editing for its therapeutic potential in directly and precisely correction of the Hb-CS mutation.

Non-communicable diseases in South-East Asia: journeying towards the SDG target

Non-communicable diseases in South-East Asia: journeying towards the SDG target

S1205 Incidence, Disability-Adjusted Life Year, and Mortality of Inflammatory Bowel Disease in Southeast Asia and Western Pacific Regions from 2000 to 2019

S1205 Incidence, Disability-Adjusted Life Year, and Mortality of Inflammatory Bowel Disease in Southeast Asia and Western Pacific Regions from 2000 to 2019

Risk Factors of Cardiovascular Diseases in Southeast Asia

Cardiovascular diseases, which include coronary heart disease, cerebrovascular disease, peripheral artery disease, and aortic atherosclerosis, constitute the leading cause of death worldwide. In Southeast Asia, the annual mortality rate from cardiovascular diseases is increasing. As there is limited review literature on the risk factors of these diseases in the region, an examination of articles, periodicals, and reports from online databases worldwide can deepen our insights into the risk factors pertaining to Southeast Asian populations. The review finds two main types of factors of cardiovascular diseases that are mainly responsible for the high mortality rates of cardiovascular diseases in Southeast Asia: biological and environmental. Among biological factors, high sodium intake and tobacco consumption account for increased risks of high blood pressure and atherosclerosis, while environmental factors - air pollution and noise pollution - contribute to vasoconstriction, thrombosis, and coronary heart disease. From the findings in this review, an emphasis on regulations and guidelines to address these risk factors can thus reduce the prevalence of cardiovascular disease and solidify the wellbeing of millions in Southeast Asia.

Assessing Thrombocytopenia and Chronic Liver Disease in Southeast Asia: A Multicentric Cross-Sectional Study.

Background This multicentric cross-sectional study aimed to examine the prevalence of thrombocytopenia (TCP) and investigate the various causes of chronic liver disease (CLD) across 15 Southeast Asian (India, Pakistan, and Bangladesh) tertiary care centers over a three-month period. The study focused on assessing the fibrosis index (FI) and Model for End-Stage Liver Disease (MELD)-sodium (Na) score's capacity to grade and predict the progression and outcomes of patients with already diagnosed CLD. Methods The cross-sectional study enrolled 377 CLD patients. The study utilized admission registries from 15 tertiary care hospitals in Southeast Asia, spanning from April 2023 to June 2023. Various descriptive variables were collected, including gender, tobacco use (specifically, chewed tobacco), underlying etiology, presence of anemia, leukopenia, pancytopenia, infectious state, and liver cirrhosis diagnosed via traditional ultrasonography. This study examined liver failure indicators, including alanine transaminase levels, compensation status, TCP, and liver transplant (LT) listing. The MELD-Na score was the focus of frequency and percentage analysis. MELD-Na and FI medians and standard deviations were provided. Results The study of 377 patients with CLDfound that TCP was present in 4% of patients and leukopenia was present in 12% of patients. The risk of TCP was significantly higher in leukopenic patients (89.5%) than in non-leukopenic patients (52.5%) (p = 0.003). The most common CLD cause was undiagnosable (31%), followed by autoimmune (26%), hepatitis C virus (21%), hepatitis B virus (14%), and schistosomiasis (8%). The majority of patients (98%) had decompensated liver disease. Of the patients,64% had TCP, while 36% did not. The illness severity indicators MELD score and FI had mean ± SD values of 16.89 ± 6.42 and 4.1 ± 1.06, respectively. Similarly, the prevalence of LTneeds among traditional ultrasonography-diagnosed cirrhotic patients was 83.1%, compared to 59.6% among non-cirrhotic patients (p = 0.001). Conclusion Leukopenia and TCP may be linked, which may affect CLD treatment and prognosis in this population.Non-invasive indicators like the FI and MELD-Na score can detect liver fibrosis and severity without invasive procedures, enhancing patient management. These findings highlight the need to improve early diagnosis methods for CLD in Southeast Asia and raise awareness among clinicians about effective diagnostic strategies for non-infectious causes of CLD.

Transition practice for primary immunodeficiency diseases in Southeast Asia: a regional survey.

With increased diagnostic capabilities and treatment modalities in the field of primary immunodeficiencies (PID), many pediatric patients survive beyond childhood and experience a change of care to the adult-oriented healthcare system. Unfortunately, the transition pathways for PID are less clearly defined, resulting in deterioration of quality of care in adulthood. Hence, this is the first regional study to address PID clinicians' opinions on practices and challenges of transition care in 7 Southeast Asia (SEA) countries. We adopted a cross-sectional study design through an online survey platform to enquire opinions of transition practices from expert representatives in 7 SEA countries. Regionally, 3 out 7 countries reported having no practice of transition care. Among cited challenges were reluctant adaptation by patients and caregivers to unfamiliarized adult healthcare systems, inadequate ratio of adult immunologists to patients and lack of facilities for transfer. Our study provides evidence to advocate policy makers on the importance of standardized integration of transition practice towards betterment of transiting PID patients into adulthood.

Emerging and re-emerging zoonotic viral diseases in Southeast Asia: One Health challenge.

The ongoing significant social, environmental, and economic changes in Southeast Asia (SEA) make the region highly vulnerable to the emergence and re-emergence of zoonotic viral diseases. In the last century, SEA has faced major viral outbreaks with great health and economic impact, including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), arboviruses, highly pathogenic avian influenza (H5N1), and Severe Acute Respiratory Syndrome (SARS-CoV); and so far, imported cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Given the recent challenging experiences in addressing emerging zoonotic diseases, it is necessary to redouble efforts to effectively implement the "One Health" initiative in the region, which aims to strengthen the human-animal-plant-environment interface to better prevent, detect and respond to health threats while promoting sustainable development. This review provides an overview of important emerging and re-emerging zoonotic viral diseases in SEA, with emphasis on the main drivers behind their emergency, the epidemiological situation from January 2000 to October 2022, and the importance of One Health to promote improved intervention strategies.

Cassava Witches' Broom Disease in Southeast Asia: A Review of Its Distribution and Associated Symptoms.

Cassava witches' broom disease (CWBD) is one of the main diseases of cassava in Southeast Asia (SEA). Affected cassava plants show reduced internodal length and proliferation of leaves (phyllody) in the middle and top part of the plant, which results in reduced root yields of 50% or more. It is thought to be caused by phytoplasma; however, despite its widespread distribution in SEA still little is known about CWBD pathology. The overarching goal of this study was to review and corroborate published information on CWBD biology and epidemiology considering recent field observations. We report the following: (1) CWBD symptoms are conserved and persistent in SEA and are distinct from what has been reported as witches' broom in Argentina and Brazil. (2) In comparison with cassava mosaic disease, another major disease of cassava in SEA, symptoms of CWBD develop later. (3) Phytoplasma detected in CWBD-affected plants belong to different ribosomal groups and there is no association study available indicating phytoplasma as the causing agent of CWBD. These findings are essential clues for designing surveillance and management strategies and for future studies to better understand the biology, tissue localization and spatial spread of CWBD in SEA and other potential risk areas.

CLINICAL CHARACTERISTICS AND OUTCOMES OF KIMURA DISEASE IN MALAYSIA: A CASE SERIES AND A LITERATURE REVIEW

Abstract: Kimura disease is a rare benign chronic inflammatory disorder of the soft tissue with predominant occurrences in young Asian male adults. However, there is limited information of Kimura disease in Southeast Asia. Hence, the clinical characteristics and outcomes of Kimura disease in Malaysia was investigated. Published Kimura disease cases from Malaysia were comprehensively searched in PubMed and Google Scholar up to December 2020 using the keywords “Kimura Disease” and “Malaysia”. Twenty-three papers were identified for review and case series of seven Kimura disease patients from a hospital in Malaysia were descriptively analyzed. A total of 60 cases were obtained from both sources. Eighty-seven percent were men with a male:female ratio of 6.5:1 and majority of the cases were Malays (77.1%). Median age of onset was 22.0 (IQR 12.5-31.5) years, while the median duration before diagnosis of Kimura disease was 2.0 (IQR 0.8-5.0) years. Head and neck region (95%) were the most frequently involved anatomical site. Peripheral eosinophilia was detected in 88.9% of the cases at presentation and renal involvement was observed in four (22.2%) patients. Surgery (57.5%) was the commonest first choice of treatment, followed by a combination of surgery and steroid (29.8%), steroid alone (10.6%), and a combination of steroid and immunosuppressive agent (2.1%). Local recurrences were observed in 28.6% of the cases. In conclusion, a much younger age of disease onset was found among Malaysians. A high recurrence rate of one in every four patients was observed, indicating the need for further evaluations of treatment strategies.

Distinct VSV-based Nipah virus vaccines expressing either glycoprotein G or fusion protein F provide homologous and heterologous protection in a nonhuman primate model.

Nipah virus (NiV) causes recurrent outbreaks of lethal respiratory and neurological disease in Southeast Asia. The World Health Organization considers the development of an effective vaccine against NiV a priority. We produced two NiV vaccine candidates using the licensed VSV-EBOV vaccine as a backbone and tested its efficacy against lethal homologous and heterologous NiV challenge with Nipah virus Bangladesh and Nipah virus Malaysia, respectively, in the African green monkey model. The VSV-EBOV vaccine expressing NiV glycoprotein G (VSV-NiVG) induced high neutralising antibody titers and afforded complete protection from homologous and heterologous challenge. The VSV-EBOV vaccine expressing NiV fusion protein F (VSV-NiVF) induced a lower humoral response and afforded complete homologous protection, but only partial heterologous protection. Both vaccines reduced virus shedding from the upper respiratory tract, and virus replication in the lungs and central nervous system. None of the protected animals vaccinated with VSV-NiVG or VSV-NiVF showed histological lesions in the CNS, but one VSV-NiVF-vaccinated animal that was not protected developed severe meningoencephalitis. The VSV-NiVG vaccine offers broad protection against NiV disease. This study was supported by the Intramural Research Program, NIAID, NIH.

Updates on Epstein-Barr Virus (EBV)-Associated Nasopharyngeal Carcinoma: Emphasis on the Latent Gene Products of EBV.

Nasopharyngeal carcinoma (NPC) is an uncommon type of malignancy/cancer worldwide. However, NPC is an endemic disease in southeast Asia and southern China and the reasons behind the underlying for such changes are unclear. Even though the Epstein-Barr infection (EBV) has been suggested as an important reason for undistinguishable NPC, the EBV itself is not adequate to source this type of cancer. The risk factors, for example, genetic susceptibility, and environmental factors might be associated with EBV to undertake a part in the NPC carcinogenesis. Normal healthy people have a memory B cell pool where the EBV persists, and any disturbance of this connection leads to virus-associated B cell malignancies. Less is known about the relationship between EBV and epithelial cell tumors, especially the EBV-associated nasopharyngeal carcinoma (EBVaNPC) and EBV-associated gastric carcinoma (EBVaGC). Currently, it is believed that premalignant genetic changes in epithelial cells contribute to the aberrant establishment of viral latency in these tumors. The early and late phases of NPC patients' survival rates vary significantly. The presence of EBV in all tumor cells presents prospects for the development of innovative therapeutic and diagnostic techniques, despite the fact that the virus's exact involvement in the carcinogenic process is presently not very well known. EBV research continues to shed light on the carcinogenic process, which is important for a more comprehensive knowledge of tumor etiology and the development of targeted cancer therapeutics. In order to screen for NPC, EBV-related biomarkers have been widely used in a few high-incidence locations because of their close associations with the risks of NPC. The current review highlights the scientific importance of EBV and its possible association with NPC.

Association between smoking and non-alcoholic fatty liver disease in Southeast Asia.

An estimated 8 million people die each year from tobacco smoking, with an increasing frequency recently being observed in Southeast Asian countries, which is a preventable risk factor for mortality. NAFLD, fibrosis, advancement of hepatocellular carcinoma, and prognosis for those with severe liver disease are all negatively influenced. NAFLD and cigarette usage seem to be a direct link. Oxidative stress and oncogenic signals have been implicated in cancer development in animal models and human clinical trials. The elevated risk of cardiovascular disease and malignancies in those with steatohepatitis and those who have had liver transplants is exacerbated by smoking. We found that smoking cessation may increase treatment response and fibrosis regression rates, decrease hepatocellular carcinoma incidence, and improve liver transplant outcomes. In the last segment, we'll look at electronic cigarettes, a hot subject in public health right now, as well as additional repercussions of smoking.

Editorial

It is an understatement to say that we have all been seriously affected by Covid-19-induced health concerns, lockdowns and travel restrictions over the past two years. From a biosecurity perspective, the lack of international travellers arriving in Aotearoa / New Zealand may have helped reduce the risk of unwanted organisms entering our country to some degree, but having our biosecurity personnel confined to barracks provided invasive species the opportunity to rebound in their absence. Reports of biosecurity issues throughout the Covid times are a sure indicator that invasive species are alive and well out there – for example the Mycoplasma bovis recurrence in Canterbury, pepino mosaic virus in Tāmaki Makaurau / Auckland, two marine pests (Asian seaweed Undaria pinnatifida and the carpet sea squirt Didemnum vexillum) at Rakiura / Stewart Island, and a too-close-to-home outbreak of foot-and-mouth disease in Southeast Asia. As the general populace everywhere scrambled to survive in their day-to-day family and professional lives throughout the pandemic impacts, submission of academic manuscripts for publication clearly slipped (perhaps justifiably) to a low priority. As a result, only one paper was submitted to Perspectives in Biosecurity in 2021. This was published early in that year “ahead of print” as we felt that the myrtle rust subject matter was too important to wait for an end-of-year full issue (see Schmid et al. 2021). That early publication was a fortunate move given that no further papers materialised! However, we are delighted to present three very different research papers in this year’s issue of Perspectives in Biosecurity. The first paper describes the development of an intriguing mixed native–naturalised vegetation association on an island near urban Tāmaki Makaurau / Auckland. The second paper reports for the first time the lichenised fungi species found on two native tree species (ramarama Lophomyrtus bullata and rōhutu L. obcordata) that are threatened by myrtle rust. The third paper covers some preliminary research on the efficacy of the Honshu white admiral butterfly (Limenitis glorifica) as a biological control against Japanese honeysuckle (Lonicera japonica). We gratefully thank the authors for their contributions to this issue, and acknowledge their persistence and productivity over what has been a challenging time to complete research projects.