Absence of Plasmodium inui and Plasmodium cynomolgi, but detection of Plasmodium knowlesi and Plasmodium vivax infections in asymptomatic humans in the Betong division of Sarawak, Malaysian Borneo

Background: Plasmodium knowlesi, a simian malaria parasite, has become the main cause of malaria in Sarawak,Malaysian Borneo. Epidemiological data on malaria for Sarawak has been derived solely from hospitalized patients,and more accurate epidemiological data on malaria is necessary. Therefore, a longitudinal study of communities affected by knowlesi malaria was undertaken. Methods: A total of 3002 blood samples on filter paper were collected from 555 inhabitants of 8 longhouses with recently reported knowlesi malaria cases in the Betong Division of Sarawak, Malaysian Borneo. Each longhouse was visited bimonthly for a total of 10 times during a 21-month study period (Jan 2014–Oct 2015). DNA extracted from blood spots were examined by a nested PCR assay for Plasmodium and positive samples were then examined by nested PCR assays for Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, Plasmodium knowlesi, Plasmodium cynomolgi and Plasmodium inui. Blood films of samples positive by PCR were also examined by microscopy. Results: Genus-specific PCR assay detected Plasmodium DNA in 9 out of 3002 samples. Species-specific PCR identified 7 P. knowlesi and one P. vivax. Malaria parasites were observed in 5 thick blood films of the PCR positive samples. No parasites were observed in blood films from one knowlesi-, one vivax- and the genus-positive samples. Only one of 7 P. knowlesi-infected individual was febrile and had sought medical treatment at Betong Hospital the day after sampling. The 6 knowlesi-, one vivax- and one Plasmodium-infected individuals were afebrile and did not seek any medical treatment. Conclusions: Asymptomatic human P. knowlesi and P. vivax malaria infections, but not P. cynomolgi and P. inui infections,are occurring within communities affected with malaria

Epidemiology of Knowlesi and other Simian Malarias in Humans in the Betong Division of Sarawak

In Sarawak, Plasmodium knowlesi, which is commonly found in long-tailed and pig-tailed macaques, is the main cause for human malaria infections. Other simian malaria parasites from Southeast Asia that can infect humans are P. inui and P. cynomolgi. To date, epidemiological data on knowlesi malaria in Sarawak has been derived solely from hospitalbased investigations and all of them were symptomatic malaria cases. A longitudinal study was therefore undertaken to determine asymptomatic Plasmodium infections including P. knowlesi and other simian malaria parasites infections in the Betong Division of Sarawak. A total of 555 people were recruited from 8 longhouses, which had individuals recently admitted to Betong Hospital with knowlesi malaria. Blood spots, collected bi-monthly over a period of 21 months, were examined using PCR assays. Pooled and non-pooled nested PCR strategies were used to screen DNA extracted from the blood spots for the presence of Plasmodium DNA. Next, each of the genus-positive DNA samples was screened using species-specific primers for P. falciparum, P. vivax, P. malariae, P. ovale, P. knowlesi, P. cynomolgi and P. inui. A subset of samples was also screened with real time PCR for the presence of P. knowlesi. Nine subjects were positive for malaria DNA by nested PCR -- seven P. knowlesi, one P. vivax and one sample that could only be identified as positive for Plasmodium DNA. For real time PCR, 21 samples were positive for P. knowlesi, including two samples that were positive for P. knowlesi by nested PCR. Only one subject, who was positive for both nested PCR and real time PCR for P. knowlesi, was symptomatic and admitted to Betong Hospital. None of the other PCR-positive subjects were febrile nor did any of them sought any medical treatment. Lastly, cloning and sequencing was only successful for 4 out of the 9 samples, in which phylogenetic analyses of these sequences confirmed that samples from three subjects were infected by P. knowlesi and one sample found to be co-infected by both P. knowlesi and P. coatneyi

Faunistic Composition Of Frugivorous Butterflies (Lepidoptera: Nymphalidae) In Lowland Dipterocarp Forest At Kubah National Park, Kuching, Sarawak

Butterflies are important in the work of conservation since they are the most appropriate model for habitat monitoring and rapid assessment on biodiversity. The exact information on the effect of habitat disturbance on the biodiversity within the tropical rainforest is still lacking and associated with difficulties in predicting them. This study was coniucted to test the hypothesis that there was a presence of frugivorous nymphalids that have specific niche. "The vertical stratification of frugivorous nymphalids in lowland dipterocarp forest was also being examined in this study. The faunistic composition of frugivorous nymphalids was studied by using ten baited traps in which five baited traps were set for canopy and another five baited traps were set for understory, for 15 days. The baited traps for canopy and understory were set on a selected tree at 20m and 1 m above the ground respectively. Ripe pineapples and mashed bananas were used as the bait. The baited traps were left to function from 0800 hours to 1700 hours. Forty one individuals of frugivorous nymphalids, comprised of three subfamilies and eight species were captured in this study, including 3 rare species: Mycalesis maianeas kadaan, Bassarona dunya monara and Neorina lowii lowii. The most abundant species was Ragadia makuta umbrata, whereas the least abundant species was Amathxidia amythaon ottomana. The faunistic composition of frugivorous nymphalids in lowland dipterocarp forest was different with other forest types, indicating some of them are good indicators. Conservation should also be carried out to protect those rare forest butterflie;

Correction to: Absence of Plasmodium inui and Plasmodium cynomolgi, but detection of Plasmodium knowlesi and Plasmodium vivax infections in asymptomatic humans in the Betong division of Sarawak, Malaysian Borneo

Abstract After publication of the article [1], it has been brought to our attention that two of the labels on Figure 4 have transposed. The labels “S-type SSU rRNA” and “A-type SSU rRNA” should be in opposite places

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo