This review aimed to determine the prevalence of the insecticide resistance status of the field-collected Aedes (Ae.) aegypti and Ae. albopictus in Malaysia from 2010 to 2022 towards carbamates, organochlorines, organophosphates and pyrethroids. Biological and environmental controls were summarized with an emphasis on the mosquito vector control strategies in Malaysia. The information in this review was extracted from several databases such as PubMed (MEDLINE), Science Direct and Scopus by using keywords including “insecticide resistance”, “carbamate resistance”, “organochlorine resistance”, “organophosphate resistance”, “pyrethroid resistance”, “Aedes” and “Malaysia”, between January 2022 and December 2022. Distribution of resistantAe. aegypti and Ae. albopictus in Malaysia was mapped using QGIS software. Insecticide resistance in both Ae. aegypti and Ae. albopictus is widespread in Malaysia, although the rates vary by states. The most notable was the steep increase in permethrin resistance of Ae. aegypti in Selangor, Malaysia, over the past decade. Ae. albopictus also displayed moderate resistance to permethrin, though not as widespread as Ae. aegypti in Selangor, but showed sign of resistance in Sarawak, East Malaysia. Resistance towards four main classes of insecticides have been widely documented in Malaysia. The extensive resistance towards permethrin in Malaysia which is one of the current insecticides used in Malaysia suggested that policies supporting the widespread use of permethrin fogging needs further evaluation.

Objective: To identify and discuss on-farm management practices linked to bacterial zoonosis risk in smallholder dairy farmers in South Asia. Methods: This scoping review was conducted as per the PRISMA-ScR guidelines. Five hundred and two publications were retrieved from five online databases using a comprehensive search strategy. Studies were selected if they discussed a farm management practice which impacted human health within a South Asian country. Results: Twenty-two studies were included. Seven management practices relevant to farmers, livestock and their shared environment were identified including raw milk consumption, farm hygiene management, personal protective equipment uses, animal vaccination, cleaning udders, hand washing and disposal of afterbirth materials. Preventive practices were found to be utilized at lower frequencies compared to risk increasing practices. Awareness of bacterial zoonoses is particularly low within the region. Conclusions: Based on the results of this review, it was determined that improving farmer awareness of bacterial zoonotic diseases may favor several of the presented leverage points within the South Asian smallholder dairy system. Relying on formal school education to improve this awareness may not solve this problem, instead, more focus on accessible and affordable zoonoses education and farming programs is required.

Objective: To determine the impact of major disease epidemics on pharmaceutical manufacturing firms' Research & Development (R&D) investments and economic consequences. Methods: The sample consists of 1 582 firm-year observations from 2009 to 2022 in China, of which, 26.6% of pharmaceutical companies are involved in the diagnosis and treatment of prevalent diseases. Linear models using R&D investments, patent applications, operating performances and stock returns as dependent variables are constructed separately to examine the response of pharmaceutical companies to disease epidemics and the resulting economic consequences. Results: The prevalence of five major diseases led to a 17.5% increase in the amount of R&D investment and an 87.8% rise in the ratio of R&D investment to total assets by disease-related pharmaceutical companies, compared to unrelated pharmaceutical companies. Further evidence indicated that the patent applications for disease-related firms increased by 44.3% relative to unrelated firms after the epidemics. Though the impacts of the epidemics on firms’ operating performances were insignificant in the short term, a major disease epidemic was associated with an increase in stock returns of 67.4% and 44.6%, respectively, as measured by the capital asset pricing model and Fama-French five-factor model. Additional analysis revealed that the impacts of the epidemics on R&D investments and patent applications were more pronounced for non-state-owned enterprises than state-owned enterprises. Conclusions: This study demonstrates that disease-related pharmaceutical firms respond to the disease epidemics through increasing R&D investment. More patent applications and higher market value are the main gains from the firms’ increased investments in R&D following the epidemic, rather than the improvements of short-term operating performances.

Objective: To estimate the risk of chronic kidney disease in patients with leptospirosis. Methods: All reported (41 890) and later confirmed leptospirosis (1 990) cases from 2010-2020 were traced by universal sampling. 386 Laboratory-confirmed leptospirosis cases were enrolled and 413 age, gender, area, and occupation matched healthy persons were included as controls. Variables including socio-demographic characteristics, medical history, and health-related behaviours were compared between the two groups and association between these variables and reduced estimated glomerular filtration rate (eGFR) was analyzed with multiple linear regression. Results: The median of eGFR was 49.0 (27.0, 75.0) mL/min/1.73 m² in the cases and 96.0 (72.0, 121.0) mL/min/1.73 m² in the controls, showing significant differences (P<0.001). Bivariate analysis showed that leptospirosis seropositivitiy, repeat leptospirosis infection, diabetes, male gender, working in field (sun exposure), COVID-19 infection and smoking had statistically significant association with reduced eGFR. Leptospirosis seropositivity had negative effects on eGFR. Multiple linear regression confirmed that leptospirosis seropositivity had negative effects on eGFR (unstandardised β coefficients= −30.86, 95% CI −49.7 to −11.9, P<0.001). Conclusions: Chronic kidney disease is a complex disease with multiple risk factors involved. Exposure to leptospirosis is one of the essential factors in accelerating its progression.

Rationale: Aeromonas hydrophila, a bacterium commonly found in a variety of soils, aquatic habitats, and other natural environments, is known for causing infections and hemorrhagic diseases in both aquatic and terrestrial animals. Patients with leukemia, when infected by Aeromonas hydrophila following chemotherapy, face an increased risk of developing necrotizing fasciitis. Patient concerns: A 48-year-old male with a history of acute myeloid leukemia presented with swelling and pain in his right hand after being stabbed by a grass carp two days ago. The injury occurred on the fifth day after his last chemotherapy session when he was accidentally punctured in the right thumb and ring finger by a carp while fishing. Two days following the injury, the skin surrounding the wound turned black immediately, while the rest of his hand was reddened, swollen, and bleeding. Diagnosis: Aeromonas hydrophila infection in the soft tissue of the right hand. Interventions: Intravenous antibiotics and local debridement. Outcomes: The patient experienced an alleviation of systemic poisoning symptoms, effective control of the local wound infection. Lessons: It is important for physicians to appreciate the potential for highly unusual and life-threatening infections in patients with acute myeloid leukemia. Early diagnosis and prompt treatment can prevent the development of necrotizing fasciitis and save patients’ lives.

During the COVID-19 pandemic, several studies have shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with a substantial reduction in the risk of subsequent reinfection with antigenically-related variants of the virus for at least 6 months[1,2]. However, most of these studies focused on people who had recovered from symptomatic SARS-CoV-2 infection[3], which tends to have higher antibody titres than asymptomatic infection. However, a comparison of the seropositivity rates in populations and of the cumulative COVID-19 case around the world indicate that a large majority of SARS-CoV-2 infections have been either asymptomatic or mildly symptomatic[4]. It remains unclear whether seropositive individuals who have never had symptomatic COVID-19 also have a lowered risk of SARS-CoV-2 reinfection[5]. India has experienced three waves of COVID-19, i.e. in August-October 2020, April-May 2021, and January-February 2022, related to alpha (B.1.1.7), delta (B.1.617.2) and omicron (B.1.1.529) variants, respectively[6]. During the pandemic, we had conducted six serial population-based surveys for anti-SARS-CoV-2 antibody prevalence in Puducherry district, located in southern India from August 2020 to March 2021[4]. This provided us an opportunity to follow-up the cohorts of sero-positive and sero-negative persons in the last two of these surveys and compare the frequency of subsequent SARS-CoV-2 infection in these. Our sero-prevalence surveys had enrolled randomly-selected adults (aged 18 years and above) from 21 urban and 9 rural clusters for anti-SARS-CoV-2 antibodies using a commercial immunoassay (Elecsys^® anti-SARS-CoV-2; Roche, with a reported 99.5% sensitivity and 99.8% specificity at &gt;14 days after exposure to the virus)[4]. The participants in the last 2 surveys carried out during January 2021 [422/889 (47%) seropositive] and March 2021 [403/881 (45%) sero-positive], were contacted 6-8 months after the initial survey (in August 2021 and September 2021, respectively). For each subject, demographic details such as age, sex, education, employment, comorbidity details and adherence to COVID-19 appropriate behaviour had been captured during the sero-prevalence study. In the current study, additional data, such as the occurrence of symptoms suggestive of SARS-CoV-2 infection, details and results on any tests for SARS-CoV-2 infection, disease severity, and vaccination status were collected through a telephonically-administered questionnaire. Vaccination with Covishield started in Puducherry on 16th January 2021 in a phased manner. The protective effect of vaccine doses taken as beginning 21 days after vaccination for recipients of one dose and 14 days for recipients of two doses. Data were captured using EpiCollect5 application and analysed using STATA v14.2. Cumulative incidence of SARS-CoV-2 infection was compared between seropositive and seronegative persons using Kaplan-Meier survival curves and log-rank test, treating the first positive test (antigen test or RT-PCR) for SARS-CoV-2 infection as the event of interest. Those who tested negative for SARS-CoV-2 were considered as right censored. In addition, a Cox regression (proportional hazard regression) model was used to estimate hazard ratios (HR) and the corresponding 95% CI for seropositivity and vaccine protection status. Proportionality assumption was tested using Schoenfeld residuals test. Of the 1 770 eligible participants in the two surveys, 825 (46.6%) had been sero-positive and the remaining 945 were seronegative. Of these, we could recruit 380 seropositive and 347 seronegative individuals in the present study. A lower proportion of sero-positive than sero-negative reported having had COVID-19 symptoms i.e., 18/380 (4.7%) v.s. 57/347 (16.4%), P-value &lt;0.001. Furthermore, a lower proportion of sero-positive subjects had been diagnosed with COVID-19 than the sero-positive persons i.e., 4/380 (1.1%) v.s. 37/347 (10.7%), P-value &lt;0.001. For detailed characteristics see Supplementary Figure 1. These participants were followed up for a median period since initial serological testing of 214 days (65 312 person-days) and 193 days (52 068 person-days), respectively. Age and sex distribution, and other baseline characteristics (Supplementary Table 1) were similar in the two groups. Nearly 28.6% of the participants had at least one comorbidity. The proportion of participants developing SARS-CoV-2 infection during the follow-up was 10.4% among the seronegative and 0.8% among the seropositive persons, with 69.1 and 6.1 events per 100 000 person-days, respectively (Figure 1A). On Kaplan-Meier analysis, the seronegative persons had a higher hazard of developing SARS-CoV-2 infection compared to those who were seropositive (P&lt;0.001, log rank test). Among the sero-negative, vaccinated were at lesser risk of developing SARS-CoV-2 disease than unvaccinated. There was no case among the sero-positive persons who had also been vaccinated against SARS-CoV-2. Kaplan-Meier curves comparing the COVID-19 disease incidence between the serological status and vaccination status was presented in Figure 1C. In the multivariable analysis, seropositive status was associated with 85% reduction in the hazard of subsequent SARS-CoV-2 infection compared to seronegative status (adjusted hazard ratio 0.15, 95% CI 0.05-0.42, P&lt;0.001). One dose and two dose protected with 90% and 94% reduction in the hazard of subsequent SARS-CoV-2 infection compared to no vaccination, respectively [0.10 (0.03-0.27); P&lt;0.001 and 0.06 (0.01-0.45); P=0.01]. Cumulative incidence of SARS-CoV-2 infection among sero-positive and sero-negative were depicted in Figure 1B. Our study found a significantly reduced risk of SARS-CoV-2 reinfection among sero-positive participants in 6-month follow-up period. Delta variant was the predominant strain in this period, whereas the alpha variant had previously dominated the first wave of COVID-19. The antibodies resulting from prior exposure to alpha variant provided substantial protection against reinfection with the delta variant[7]. Prior asymptomatic exposure to SARS-CoV-2 during the first wave of COVID-19 in India was associated with substantial protection against infection during the second wave, vaccination appeared to offer incremental protection even in individuals with such exposure to SARS-CoV-2[8].