East Asia Pacific Research Articles

The BEAP Teleconnection and Its Relationship With ENSO in CMIP6: Present and Future Projections

AbstractThis study investigates the historical simulation of the Bay of Bengal–East Asia–Pacific (BEAP) teleconnection and its relationship with the El Niño–Southern Oscillation (ENSO) using 16 models from the Coupled Model Intercomparison Project phase 6 (CMIP6). The CMIP6 models can reasonably well reproduce the BEAP‐related diabatic heating variables and the ENSO sea surface temperature anomaly (SSTA). The CMIP6 models also show good performance in simulating the BEAP pattern at subseasonal and interannual time scales. Further investigation reveals that the BEAP–ENSO relationship changes from statistically insignificant to significant on an interdecadal timescale. Significant BEAP–ENSO correlation is associated with more positive SSTA over the tropical Indian Ocean (TIO) than in the period of insignificant BEAP–ENSO correlation. The positive SSTA difference acts as a heat source that intensifies the in situ atmospheric convection to generate considerable diabatic heating around the BEAP source region. The covariation of the Indo‐Pacific SSTA exhibits a tripole pattern, namely positive SSTA over the TIO, negative SSTA over the tropical central‐western Pacific, and positive SSTA over the tropical eastern Pacific. The SSTA tripole pattern is ascribed to the Indo‐Pacific capacitor effect and zonal advective feedback. The surface wind stress is weaker during the period of significant BEAP–ENSO correlation than during the non‐significant BEAP–ENSO period. The surface wind stress is also identified as a crucial factor in the projected changes in the BEAP teleconnection. The results indicate that the enhanced zonal wind stress results in more positive BEAP cases in the 21st‐century projection.

The strengthening relationship between summer rainfall over North China and PDO since the mid-2000s

The interdecadal change of the summer (July–August) rainfall over North China (SRNC) is of great concern to the climate research community. Based on the sliding correlation and interdecadal difference analysis, the interdecadal change of SRNC was studied. Results show a significantly wetter period of SRNC since the mid-2000s, which was associated with strengthening negative relationship between SRNC and PDO. PDO affected the SRNC through the jet stream in the upper-level and the East Asia–Pacific (EAP) teleconnection pattern. In the negative phase of the PDO since the mid-2000s, the contractive upper-level jet stream in the west of North China resulted in the abnormal updraft over the southern region of North China. Meanwhile, the positive phase of the EAP teleconnection pattern brought warm and wet southeast flow entering North China from its eastern boundary, both bringing more rainfall in North China. The abnormal water vapor transport from the western Pacific was very different from that accompanying the East Asian summer monsoon.

Effects of Low-Frequency Oscillation at Different Latitudes on Summer Precipitation in Flood and Drought Years in Southern China

Based on the daily precipitation data from 753 meteorological stations provided by the National Meteorological Information Center (China) and the daily reanalysis data from NCEP/NCAR and ERA5 during the period from 1980 to 2020, the low-frequency (LF) precipitation characteristics of the typical summer flood and drought years in southern China and their relation to the LF atmospheric circulation at different latitudes are compared and analyzed, and extended-range forecasting signals are given. The results show that: (a) In both flood and drought years, summer precipitation in southern China is controlled by 10–20 day oscillation (quasi-biweekly oscillation, QBWO); (b) LF convection is active in southern China in both flood and drought years, but the convective center is southward in flood years, and the vertical meridional circulation is stronger. The key circulation systems of 500 hPa LF height field in flood and drought years include LF “two ridges and one trough” and LF “+”, “−”, “+” East Asia Pacific (EAP) teleconnection wave train in mid-high latitudes of Eurasia. However, the “two ridges and one trough” in flood years are more westward and meridional than in drought years, and the LF Subtropical High is stronger and more extensive, with more significant westward extension; (c) In flood (drought) years, there is northerly and then westerly (central westerly) dry-cold, northeasterly wet-cold, southwesterly (none), and southeasterly (including southerly across the equator) wet-warm water vapor channels. The sources of dry and wet cold air in flood (drought) years are located near Novaya Zemlya (the eastern West Siberian Plain), the Yellow Sea, and the Bohai Sea (Sea of Japan). Additionally, the sources of wet-warm water vapor include the Arabian Sea, the Bay of Bengal, the western Pacific Ocean, and the sea area of northeastern Australia (the western Pacific Ocean and the northern sea area of Australia); and (d) The LF predictive signals of outgoing longwave radiation (OLR) appear on −11 days, while the signals of the 500 hPa height field are on −9 days. There are both westward and eastward propagation predictive signals in flood years, and only westward spread signals in drought years.

The global, regional, and national burden of nasopharyngeal carcinoma and its attributable risk factors in 204 countries and territories, 1990–2019

Background Nasopharyngeal carcinoma (NPC) is uncommon in most areas of the world but poses a significant public health burden in endemic regions. Objectives We provide an overview of the most recent global epidemiology of nasopharyngeal cancer (NPC). Methods We estimated the burden of NPC in 204 countries and territories by age, sex, and Socio-Demographic Index (SDI) from 1990 to 2019. Results At the GBD regional level, the most severe age-standardized incidence in 2019 occurred in East Asia. From 1990 to 2019, the East Asia and High-income Asia Pacific had the greatest increase in percentage in age-standardized incidence. Central Asia and the Caribbean had the greatest increase in percentage in age-standardized disability-adjusted life-years (DALY) and death rates. At the national level, Cabo Verde, Romania, and the Cyprus reported the largest percentage increases in the age-standardized incidence. Cabo Verde, Romania, and Jamaica reported the largest increases in the age-standardized DALY and death rates. Conclusions The global age-standardized incidence of NPC increased globally between 1990 and 2019, especially in the East Asia.

Heterogeneity in the Causal Link between FDI, Globalization and Human Capital: New Empirical Evidence Using Threshold Regressions

Human capital formation in developing countries is a policy instrument to promote economic progress. In recent decades, FDI can act as a mechanism for transmitting human capital in the context of highly globalized countries. Extensive literature indicates that the formation of human capital is one of the most effective mechanisms for promoting structural change in countries. This research examines the causal link between FDI flows, globalization, and knowledge. This relationship is moderated by the index of electoral democracy, employment in agriculture, rent from natural resources, export diversification, and fertility. We employ a set of threshold regressions based on the idea that FDI levels will be significant and permanent as long as FDI transmits knowledge to recipient countries from a substantial level of FDI. The results show a threshold effect in the electoral democracy index and foreign direct investment at the global level and high- and upper-middle-income countries. In addition, we found a threshold effect for the electoral democracy index in the East Asia Pacific regions and the Middle East and North African countries. There is a threshold effect in East Asia, the Pacific, and Latin America in FDI. Based on the results, policymakers should promote FDI and electoral democracy flows above the threshold to encourage the transfer of human capital in the countries analyzed.

A New Benchmark for Surface Radiation Products over the East Asia–Pacific Region Retrieved from the Himawari-8/AHI Next-Generation Geostationary Satellite

Abstract Surface downward radiation (SDR), including shortwave downward radiation (SWDR) and longwave downward radiation (LWDR), is of great importance to energy and climate studies. Considering the lack of reliable SDR data with a high spatiotemporal resolution in the East Asia–Pacific (EAP) region, we derived SWDR and LWDR at 10-min and 0.05° resolutions for this region from 2016 to 2020 based on the next-generation geostationary satellite Himawari-8 (H-8). The SDR product is unique in terms of its all-sky features, high accuracy, and high-resolution levels. The cloud effect is fully considered in the SDR product, and the influence of high aerosol loadings and topography on the SWDR are considered. Compared to benchmark products of the radiation, such as Clouds and the Earth’s Radiant Energy System (CERES) and the European Centre for Medium-Range Weather Forecasts (ECMWF) next-generation reanalysis (ERA5), and the Global Land Surface Satellite (GLASS), not only is the resolution of the new SDR product notably much higher, but the product accuracy is also higher than that of those products. In particular, hourly and daily root-mean-square errors of the new SWDR are 104.9 and 31.5 W m−2, respectively, which are much smaller than those of CERES (at 121.6 and 38.6 W m−2, respectively), ERA5 (at 176.6 and 39.5 W m−2, respectively), and GLASS (daily of 36.5 W m−2). Meanwhile, RMSEs of hourly and daily values of the new LWDR are 19.6 and 14.4 W m−2, respectively, which are comparable to that of CERES and ERA5, and even better over high-altitude regions.

FENGYUN-4A Advanced Geosynchronous Radiation Imager Layered Precipitable Water Vapor Products’ Comprehensive Evaluation Based on Quality Control System

A physical retrieval algorithm has been developed for deriving the layered precipitable water vapor (LPWs) product from infrared radiances of the Advanced Geosynchronous Radiation Imager (AGRI) onboard FengYun-4A (FY-4A), the first of the new generation of Chinese geostationary weather satellites (FengYun-4, or FY-4 Series). The FY-4A AGRI LPWs are evaluated with different types of reference datasets based on Quality Control System (QCS), including those from Himawari-8 AHI (Advanced Himawari Imager), MODIS (Moderate Resolution Imaging Spectroradiometer), Radiosonde, ERA5 (European Centre for Medium-Range Weather Forecasts Reanalysis v5), NCEP (National Centers for Environmental Prediction) reanalysis and CMA (China Meteorological Administration) forecast product from global medium range numerical weather prediction (NWP) system. QCS is one of the important components of FY-4A ground segment, which mainly focuses on the satellite products’ evaluation and validation. It is found that the AGRI LPW product has a good agreement with different evaluating sources and the quality is favorable and stable. With the capability of frequent (5-min interval) observations over the East Asia and Western Pacific regions, the AGRI LPW products can be used to investigate the atmospheric temporal and spatial variations in the pre-landfall environment for typhoons. The QCS is a useful tool to monitor, evaluate, and validate the AGRI LPW products.

Association of Early Nutritional Status With Child Development in the Asia Pacific Region

Stunting was used as a proxy for underdevelopment in early childhood in previous studies, but the associations between child development and other growth and body composition parameters were rarely studied. To estimate the association between malnutrition and early child development (ECD) at an individual level. This population-based, cross-sectional study used data from the East Asia Pacific Early Child Development Scales, a population-representative survey of children aged 3 to 5 years old, conducted in 2012 to 2014 in communities in Cambodia, China, Mongolia, Papua New Guinea, and Vanuatu. Data analysis was performed from November 2019 to April 2021. Stunting (height-for-age [HFA] z score less than -2), wasting (weight-for-height z score less than -2), overweight (weight-for-height z score greater than 2), body mass index (BMI)-for-age z score, and body fat proportion based on existing growth standard and formula. ECD directly assessed using the validated East Asia-Pacific ECD Scales. A total of 7108 children (3547 girls; mean [SD], age 4.48 [0.84] years) were included in this study. The prevalence of stunting was 27.1% (range across countries, 1.2%-55.0%), that of wasting was 13.7% (range, 5.4%-35.9%), and that of overweight was 15.9% (range, 2.2%-53.7%). Adjusted for country variations, age, sex, urbanicity, family socioeconomic status, and body fat proportion, ECD was linearly associated with HFA (β, 1.57; 95% CI, 1.35-1.80) and BMI-for-age (β, 0.64; 95% CI, 0.45-0.82). After adjustment for BMI and height, better ECD was associated with low body fat proportion (β, 0.93; 95% CI, 0.45-1.42). The association of HFA was more pronounced in Southeast Asia and the Pacific region than in East Asia, and the association of fat proportion was specific to children living in urban environments. HFA, BMI-for-age, and body fat proportion were independently associated with ECD, and these findings suggest that future studies should consider using these parameters to estimate the prevalence of child underdevelopment; nutritional trials should examine to what extent the associations are causal.

A Proposed Research Agenda for Promoting Healthy Retail Food Environments in the East Asia-Pacific Region.

This paper aimed to summarise existing literature on strategies to improve the healthiness of retail food environments in the East Asia and Pacific (EAP) region, and propose a prioritised research agenda on this topic. Little research on retail food environments has been conducted in the EAP region. Several approaches for measuring retail food environments were identified, although none have been tailored to the EAP context. A small number of policies and initiatives to promote healthy retail food environments have been implemented in EAP. Lessons learnt from successful implementation of initiatives in other regions could be applied in EAP. Retail food environments have a strong influence on food choices and health outcomes. Research can contribute to efforts to improve the healthiness of retail food environments in EAP by (1) describing the current state of retail food environments to highlight areas of good practice and concern and (2) identifying policies and initiatives that are likely to be effective, and mechanisms for their successful implementation.

Modulation of centennial-scale hydroclimate variations in the middle Yangtze River Valley by the East Asian-Pacific pattern and ENSO over the past two millennia

Meteorological observations reveal an inverse relationship of summer monsoon rainfall between the tropical western North Pacific (WNP) and middle Yangtze River Valley (mid-YRV) on interannual and intraseasonal timescales. This seesaw-like pattern, named the East Asian-Pacific (EAP) pattern, is one of the major teleconnections that affect summer precipitation in the mid-YRV. However, due to the scarcity of long and continuous instrumental data, the behavior and mechanism of the EAP pattern on a long timescale are poorly understood. Here, we present a composite high-resolution summer monsoon rainfall record from 230 BC to 1810 AD, based on 1221 δ18O measurements and 22 230Th dates from two stalagmites (EB1 and EB5) in Shenqi Cave over the mid-YRV. Our new record shows that monsoon rainfall in the mid-YRV varies at a dominant periodicity of ∼100 years, probably linked to solar activity and ENSO variability. The multi-centennial fluctuations in the EB record, broadly consistent with the North Hemisphere temperature reconstruction, display strong similarities to two stalagmite δ18O records from nearby Heshang and Luoshui caves. To represent the integrated hydroclimate variations over the mid-YRV, we extracted the first principal component (PC1) of these three cave δ18O records by using the principal component analysis. We reveal a striking inverse relationship of wet/dry conditions between the mid-YRV and tropical WNP, suggesting that changes in the EAP pattern have an important impact on centennial-scale monsoon precipitation changes. Furthermore, we compile monsoon rainfall records from the mid-YRV and WNP to reconstruct a new EAP index. This EAP index exhibits a strong correlation with the ENSO proxy, confirming that the ENSO variability may play a key role in modulating the monsoon rainfall in the mid-YRV through the EAP teleconnection.

Abstracts from the World Federation for Laser Dentistry—Asia Pacific Division Virtual Conference July 16–17, 2021

Abstracts from the World Federation for Laser Dentistry—Asia Pacific Division Virtual Conference July 16–17, 2021

A second external quality assessment of isolation and identification of influenza viruses in cell culture in the Asia Pacific region highlights improved performance by participating laboratories.

Influenza viruses must be amplified in cell culture for detailed antigenic analysis and for phenotypic assays assessing susceptibility to antiviral drugs or for other assays. Following on from the first external quality assessment (EQA) for isolation and identification of influenza viruses using cell culture techniques in 2016, a follow up EQA was performed in 2019 for National Influenza Centres (NICs) in the World Health Organization (WHO) South East Asia and Western Pacific Regions. Nineteen WHO NICs performed influenza virus isolation and identification techniques on an EQA panel comprising 16 samples, containing influenza A or B viruses and negative control samples. One sample was used exclusively to assess capacity to measure a hemagglutination titer and the other 15 samples were used for virus isolation and subsequent identification. Virus isolation from EQA samples was generally detected by assessment of cytopathic effect and/or hemagglutination assay while virus identification was determined by real time RT-PCR, hemagglutination inhibition and/or immunofluorescence assays. For virus isolation from EQA samples, 6/19 participating laboratories obtained 15/15 correct results in the first EQA (2016) compared to 11/19 in the follow up (2019). For virus identification in isolates derived from EQA samples, 6/19 laboratories obtained 15/15 correct results in 2016 compared to 13/19 in 2019. Overall, NIC laboratories in the Asia Pacific Region showed a significant improvement between 2016 and 2019 in terms of the correct results reported for isolation from EQA samples and identification of virus in isolates derived from EQA samples (p=0.01 and p=0.02, respectively).

Tropical Cyclones over the Western North Pacific Strengthen the East Asia—Pacific Pattern during Summer

Tropical Cyclones over the Western North Pacific Strengthen the East Asia—Pacific Pattern during Summer

Weakened Connection between East China Summer Rainfall and the East Asia-Pacific Teleconnection Pattern

The interdecadal change in the relationship between the East Asia-Pacific (EAP) teleconnection pattern and rainfall over East China during boreal summer (June–August) was investigated using observation and reanalysis datasets during 1951–2018. As proposed in a previous study, summer rainfall in the Yangtze-Huaihe River (YH-R) valley is below (above) normal when a positive (negative) EAP event occurs. Based on the close relationship with the rainfall anomalies, the EAP teleconnection pattern has been widely used in the prediction of summer rainfall variations in the YH-R valley. However, we found that the rainfall anomalies in the YH-R basin associated with the EAP pattern were weaker and less evident after the late 1980s. This finding indicates a decreased relationship between the EAP pattern and YH-R basin summer rainfall after the late 1980s, and a decrease in the quality and skill of seasonal predictions of YH-R basin summer rainfall related to the EAP pattern. This pronounced weakening in the YH-R summer rainfall-EAP pattern connection is attributed to the northeastward displacement of the Japanese action center of the EAP pattern after the late 1980s, which caused weaker anomalous vertical motion and moisture transportation over the YH-R valley. The present research reveals that the interdecadal expansion in the size of the Indo-Pacific warm pool in the late 1980s is likely responsible for the northeastward shift in the Japanese action center of the EAP teleconnection pattern by modulating anomalous convective activities and the northward propagation of the EAP pattern.

Associations of atmospheric teleconnections with wintertime extratropical cyclones over East Asia and Northwest Pacific

Extratropical cyclones (ETCs) over East Asia and Northwest Pacific are identified and tracked by applying an objective algorithm to the 850-hPa relative vorticity fields from the ERA-Interim reanalysis. A total of 2866 ETCs originating at the western side of the date line have been identified in the extended November–March winters from 1979 to 2018. The ETC tracks are counted and visualized using a hexagonal tessellation rather than the regular longitude–latitude grids. Two generalized linear models (GLMs), Poisson regression model and Gamma regression model, are firstly applied to investigate the associations of wintertime ETCs with three atmospheric teleconnection patterns. The West Pacific (WP) pattern and the Pacific/North American (PNA) pattern are more responsible for the meridional variability of ETC activities in the North Pacific, while the influence of the Polar/Eurasia pattern on ETC activities is negligible. Results of composite analysis are qualitatively consistent with that of regression analysis. Composite maps of differences of jet stream, thermal gradient and mid-tropospheric baroclinicity in the positive and negative phases of teleconnection patterns also support the close associations of ETC activities with WP and PNA teleconnection patterns.

Initial Performance Assessment of GNSS Augmentation System using Quasi-Zenith Satellite System for Real-Time Precise Positioning Method in Indonesia

Presently, the Global Navigation Satellite System (GNSS) technology provides numerous positioning services for engineering and scientific applications with regional to global coverage. The Quasi-Zenith Satellite System (QZSS) is one of the GNSS technologies owned by the Japanese government, which orbits around East Asia, Asia Pacific, and Oceania. One of the advantages of the QZSS satellite is that it corrects measurements using precise ephemeris, clock, and other augmenting corrections, primarily used for the Real-Time Precise Point Positioning (RTPPP) method. Indonesia is a country that is included in the orbital area of the QZSS system. This study aims to see the QZSS system’s performance for RTPPP measurements in Indonesia’s land area. Magellan System Japan’s (MSJ) receiver is used in this study to collect the GNSS as well as the augmenting data and perform the RTPPP. RTPPP method is then made into three different schemes. The first scheme measures the RTPPP at a point to see the precision level. The second scheme takes measurements simultaneously with DGPS-Veripos measurements. Lastly, the third scheme measures using the RTPPP using both QZSS’s augmentation and ATLAS correction system, Static, and Real-Time Kinematic (RTK) on 20 benchmarks. The resulting coordinates for each scheme are then used to evaluate the performance of QZSS augmentation. The first scheme results show the precision level of the QZSS-RTPPP 5 cm and 10 cm for the horizontal and vertical components, respectively. In scheme two, the precision of the estimated coordinates from the DGPS-Veripos is better than those from the MSJ receiver in both horizontal and vertical components. Using the static method results as a reference, the accuracy of the RTPPP using the QZSS augmentation is 0.110 m, 0.056 m, and 0.120 m for easting, northing, and height component, respectively. Based on these results, some improvements are still needed to improve the QZSS-RTPPP method’s accuracy in Indonesia.

Rolling out the radical cure for vivax malaria in Asia: a qualitative study among policy makers and stakeholders

BackgroundWide-spread implementation of treatment regimens for the radical cure of vivax malaria is hindered by a range of factors. This has resulted in an increase in the relative proportion of vivax malaria and is an important obstacle in the achievement of global malaria elimination by 2030. The main objective of this study was to explore the current policies guiding the treatment plans on vivax malaria, and the factors affecting the implementation of radical cure in South/South East Asian and Asian Pacific countries.MethodsThis was a qualitative study among respondents who represented national malaria control programmes (NMCPs) or had a role and influence in the national malaria policies. 33 respondents from 17 countries in South/South East Asia and Asia Pacific participated in interviews between October 15 and December 15, 2020. Semi-structured interviews were conducted virtually except for two face to face interviews and audio-recorded. Transcribed audio-records underwent thematic analysis using QSR NVivo.ResultsPolicies against vivax malaria were underprioritized, compared with the focus on falciparum malaria and, in particular, drug resistant Plasmodium falciparum strains. Despite the familiarity with primaquine (PQ) as the essential treatment to achieve the radical cure, the respondents contested the need for G6PD testing. Optional G6PD testing was reported to have poor adherence. The fear of adverse events led health workers to hesitate prescribing PQ. In countries where G6PD was mandatory, respondents experienced frequent stockouts of G6PD rapid diagnostic kits in peripheral health facilities, which was compounded by a short shelf life of these tests. These challenges were echoed across participating countries to various degrees. Most respondents agreed that a shorter treatment regimen, such as single dose tafenoquine could resolve these problems but mandatory G6PD testing will be needed. The recommendation of shorter regimens including tafenoquine or high dose PQ requires operational evidence demonstrating the robust performance of point of care G6PD tests (biosensors).ConclusionThere was sparse implementation and low adherence to the radical cure in South/South East Asian and Asian pacific countries. Shorter treatment regimens with appropriate point of care quantitative G6PD tests may resolve the current challenges. Operational evidence on point of care quantitative G6PD tests that includes the feasibility of integrating such tests into the radical cure regimen are critical to ensure its implementation.

Intraseasonal Variability of the East Asia-Pacific Teleconnection and Its Impacts on Multiple Tropical Cyclone Genesis Over the Western North Pacific

A daily East Asia–Pacific teleconnection (EAP) index was constructed to investigate the impact of the intraseasonal variability (ISV) of this index on the genesis of multiple tropical cyclones (MTC) in boreal summer over the western North Pacific (WNP). The result indicates that the EAP index has dominant intraseasonal periods of 10–20 days, 20–40 days and 50–70 days, respectively. The ISV of the EAP during 1979–2019 can be classified into three types, a single-period-domination type (37%), a multiple period coexistence type (24%) and a transition type (39%). It is found that during El Niño (La Niña) summers, the ISV of the EAP is dominated by a higher-frequency (lower-frequency) oscillation with a period of around 20–30 (50–70) days. The distinctive ISV characteristics during the different ENSO years were accompanied with different dynamic and thermodynamic background conditions over the WNP and the South China Sea, which modulated the frequency and location of MTC genesis. By examining the relative contributions of individual environmental variables of the Genesis Potential Index, we found that the low-level absolute vorticity and mid-level relative humidity are two important environmental factors modulating MTC genesis. However, the relative role of these variables tends to change with the EAP ISV phase. The environmental condition over the SCS appears less influenced by ENSO. A more southern location of MTC genesis during El Niño is attributed to the change of the environmental humidity.

Sensitivity of sputum exam with respect to gene expert in detection of MTB at tertiary care hospital

Background: According to the WHO Tuberculosis Report 2014, there were 9 million incident cases of TB worldwide, with the South–East Asia and Western Pacific areas accounting for 58 percent of the global burden and India accounting for 24 percent. Aims and Objective: To study Sensitivity of sputum exam with respect to gene expert in detection of MTB at tertiary care hospital Methodology: The present study is an observational cross-sectional study of the patients with pulmonary tuberculosis attending Department of Pulmonary Medicine at a tertiary care centre during period of 1 January 2019 to 30 June 2020 by the permission of Institutional Ethical Committee . Genexpert test / CBNAAT [ Xpert MTB/RIF Assay] Statistical analysis done buy of (version 20) for Windows package (SPSS Science, Chicago, IL, USA). Result: Ziehl and Neelsen staining was done for 200 samples of cases of pulmonary tuberculosis. Out of these 55(27.50%) sputa samples were ZN smear positive and 145(72.50%) were negative. Then all the samples were tested on Gene Xpert MTB/RIF assay. Out of these 200 patients, 186(93%) were MTB detected and 14(7.00%) were MTB not detected. The MTB/RIF assay detect the agent in 54 out of 55 ZN smear positive cases and 132 out of 145 AFB smear negative cases as shown in table No.10. So, MTB detection rate by Gene Xpert 186cases (93.00%) is more as compared to ZN staining 55cases (27.50%). Out of 55 sputum positive cases, 54 were positive for MTB by Gene Xpert but in 01 sputum positive case MTB was not detected by Gene Xpert assay. There was statistically significant better detection with Genexpert when compared to microscopy AFB test in pulmonary tuberculosis patients.The Sensitivity of Sputum was 29.03% and Specificity was 92.86%, Positive Likelihood Ratio4.06, Negative Likelihood Ratio 0.76, Positive Predictive Value (*) was 98.18% and Negative Predictive Value (*) was 8.97%. Conclusion: It can be concluded from our study that the Genexpert is highly sensitive test for the detection of the Mycobacteria and Xpert MTB/RIF assay can quickly identify possible multidrug-resistant TB. From our study we conclude that Gene Xpert MTB/RIF is simple and reliable technique for diagnosing extra pulmonary tuberculosis with high sensitivity and specificity not only in smear positive cases but also in smear negative cases. It is a game changer not only in pulmonary tuberculosis control but probably also in extra pulmonary tuberculosis.

Could malaria explain the global distribution of the angiotensin converting enzyme I/D polymorphism? A systematic review and ecological study

Background: The D-allele of the angiotensin converting enzyme (ACE1) has been linked to an increased risk of certain diseases including hypertension and COVID-19 but a decreased risk of cerebral malaria. We hypothesized that malaria played a role in determining variations in the global distribution of ACE1 I/D polymorphism. Methods: A systematic review was conducted to summarize the frequency of ID/DD genotypes in all countries with available data. Results: The ID/DD genotype frequency was found to be highest in Africa (86.4%, IQR 83.6-94.7%) and Eastern Mediterranean (median 84.5%, IQR 78.3-89.8%) and lowest in South East Asia (55%, 49.5-67.8%) and Western Pacific (61.1%, IQR 55.0-67.2%). Linear regression revealed positive associations between ID/DD genotype frequency and the incidence of malaria, malaria mortality as well as hemoglobin S allele frequency (all P<0.05). Conclusions: Our findings are compatible with the hypothesis that malaria played a role in establishing the differential frequency of the D-allele.