Pan-enteric dysmotility,impaired quality of life and alexithymia in a large group of patients meeting ROMEⅡ criteria for irritable bowel syndrome

AIM:Psychological factors, altered motility and sensation disorders of the intestine can be variably associated with irritable bowel syndrome (IBS). Such aspects have not been investigated simultaneously. The aim of this paper was to evaluate gastrointestinal motility and symptoms, psychological spectrum and quality of life in a large group of IBS patients in southern Italy.METHODS: One hundred IBS patients (F:M=73:27, age 48±2 years, mean±SE) fulfilling ROME Ⅱ criteria matched with 100 healthy subjects (F:M=70:30, 45±2 years). Dyspepsia,bowel habit, alexithymia, psycho-affective profile and quality of life were assessed using specific questionnaires. Basally and postprandially, changes in gallbladder volumes and antral areas after liquid meal and orocaecal transit time (OCTT)were measured respectively by ultrasonography and H2-breath test. Appetite, satiety, fullness, nausea, and epigastric pain/discomfort were monitored using visual-analogue scales.RESULTS: Compared with controls, IBS patients had increased dyspepsia (score 12.6±0.7 VS 5.1±0.2, P＜0.0001),weekly bowel movements (12.3±0.4 VS 5.5±0.2, P＜0.00001, comparable stool shape), alexithymia (score 59.11.1 VS40.5±1.0, P=0.001), poor quality of life and psychoaffective profile. IBS patients had normal gallbladderemptying, but delayed gastric emptying (T50:35.5±1.0 VS 26.1±0.6 min, P=0.00001) and OCTT (163.0±5.4 VS96.6±1.8min, P=0.00001). Fullness, nausea, and epigastric pain/discomfort were greater in IBS than in controls.CONCLUSION: ROME Ⅱ IBS patients have a pan-enteric dysmotility with frequent dyspepsia, associated with psychological morbidity and greatly impaired quality of life.The presence of alexithymia, a stable trait, is a novel finding of potential interest to detect subgroups of IBS patients with different patterns recoveed after therapy.

Sofosbuvir/velpatasvir: A promising combination

Hepatitis C virus(HCV) affects 3% of the world population. It represents the main cause of chronic liver disease and is responsible for extra-hepatic complications, such as type 2 diabetes and cardiovascular diseases. HCV includes 7 genotypes differing in the nucleotide sequence variability, the geographic distribution, the rates of viral clearance, the risk of progression to liver fibrosis and to hepatocellular carcinoma, and the response to therapy. Last years have seen remarkable advances in the field of HCV infection with the approval of direct antiviral agents(DAAs) targeting key viral proteins involved in the HCV replication. Several oral regimens combining DAAs from different families have been developed and these regimens showed increased and sustained virological response rates to above 90% reducing the treatment duration to 12 wk or less. In particular, sofosbuvir, a nucleotide analogue nonstructural(NS)5B polymerase inhibitor, and velpatasvir, a NS5 A inhibitor, have been tested in two phase 3 trials, the ASTRAL-2(against HCV genotype 2) and the ASTRAL-3(against HCV genotype 3), demonstrating to be effective, safe, and well tolerated in patients who were 18 years of age or older and had at least a 6-mo history of HCV infection with a compensated liver disease.

Coronary stenting:A matter of revascularization

In the last few decades, the recommended treatment for coronary artery disease has been dramatically improved by percutaneous coronary intervention(PCI) and the use of balloon catheters, bare metal stents(BMSs), and drug-eluting stents(DESs). Catheter balloons were burdened by acute vessel occlusion or target-lesion restenosis. BMSs greatly reduced those problems holding up the vessel structure, but showed high rates of instent re-stenosis, which is characterized by neo-intimal hyperplasia and vessel remodeling leading to a renarrowing of the vessel diameter. This challenge was overtaken by first-generation DESs, which reduced restenosis rates to nearly 5%, but demonstrated delayed arterial healing and risk for late in-stent thrombosis, with inflammatory cells playing a pivotal role. Finally, new-generation DESs, characterized by innovations in design, metal composition, surface polymers, and antiproliferative drugs, finally reduced the risk for stent thrombosis and greatly improved revascularization outcomes. New advances include bioresorbable stents potentially changing the future of revascularization techniques as the concept bases upon the degradation of the stent scaffold to inert particles after its function expired, thus theoretically eliminating risks linked with both stent thrombosis and re-stenosis. Talking about DESs also dictates to consider dual antiplatelet therapy(DAPT), which is a fundamental moment in view of the good outcome duration, but also deals with bleeding complications. The better management of patients undergoing PCI should include the use of DESs and a DAPT finely tailored in consideration of the potentially developing bleeding risk in accordance with the indications from last updated guidelines.

Towards automated calculation of evidence-based clinical scores

AIM To determine clinical scores important for automated calculation in the inpatient setting.METHODS A modified Delphi methodology was used to create consensus of important clinical scores for inpatient practice. A list of 176 externally validated clinical scores were identified from freely available internet-based services frequently used by clinicians. Scores were categorized based on pertinent specialty and a customized survey was created for each clinician specialty group. Clinicians were asked to rank each score based on importance of automated calculation to their clinical practice in three categories-"not important", "nice to have", or "very important". Surveys were solicited via specialty-group listserv over a 3-mo interval. Respondents must have been practicing physicians with more than 20% clinical time spent in the inpatient setting. Within each specialty, consensus was established for any clinical score with greater than 70% of responses in a single category and a minimum of 10 responses. Logistic regression was performed to determine predictors of automation importance.RESULTS Seventy-nine divided by one hundred and forty-four(54.9%) surveys were completed and 72/144(50%) surveys were completed by eligible respondents. Only the critical care and internal medicine specialties surpassed the 10-respondent threshold(14 respondents each). For internists, 2/110(1.8%) of scores were "very important" and 73/110(66.4%) were "nice to have". For intensivists, no scores were "very important" and 26/76(34.2%) were "nice to have". Only the number of medical history(OR = 2.34; 95%CI: 1.26-4.67; P < 0.05) and vital sign(OR = 1.88; 95%CI: 1.03-3.68; P < 0.05) variables for clinical scores used by internists was predictive of desire for automation. CONCLUSION Few clinical scores were deemed "very important" for automated calculation. Future efforts towards score calculator automation should focus on technically feasible "nice to have" scores.

Rethinking an Algorithm: The Utility of the Techinicium 99 m Labeled Red Cell (RBC) Scanning for Lower Gastrointestinal Bleeding (LGIB)

Purpose: Technetium 99 m (99 m Tc) labeled scan is often done to localize bleeding to facilitate treatment. No level 1 or 2 data supports this approach. The aim of this study was to determine the correlation between site of bleeding by nuclear scan and findings at surgery, angiogram or colonoscopy. Methods: Records of patients admitted to Cooper University Hospital from January 2001-December 2005 with LGIB who had 99mTc scan were analyzed. Results: 164 of 170 patients were eligible to be evaluated. There were 45 positive (27.5%) and 119 negative scans (72.5%). 21 of 45 patients with positive scans had angiography. 7 patients (33.3%) had positive and 14 (66.6%) negative angiograms. In 6 patients (85.7%) with (+) angiograms, there was correlation on the area of bleed as seen on the 99 m Tc scan (p = 0.125). 20 patients, in the positive scan group, required surgery. In 15 (75%) the findings at surgery correlated with the scan result (p = 0.04). 31 patients (68.8%) with positive scan had colonoscopy. There was correlation in 27 patients (87.0%) (p < 0.001). The patients with (+) scan received a total of 372 (8.2 per patient) transfusions of packed red blood cells (PRBC) compared to 333 (2.7 per patients) transfusions in patients with (–) scans. Surgeons documented in 7 patients that the result of scan influenced surgery. Patients with (+) and (–) scans had similar rates of colonoscopy (73.35% vs 76.4%), hospital length of stay (14.3 vs 12.10 days), while mortality rate was (8.8% vs 6.72%) respectively, Conclusion: 99 m Tc scan has low yield in the evaluation of LGIB. However when positive, they tend to correlate with findings at angiogram, surgery and colonoscopy.

Investigation of the Association of TLR2 and TLR4 Polymorphisms with Susceptibility to <i>Helicobacter pylori</i>-Related Gastrointestinal Diseases

Background and Aim: Toll-like receptor (TLR) 2 and TLR4 are cell surface signaling receptors that are involved in the recognition of and host response to Helicobacter pylori. Our aim was to investigate the association between TLR gene polymorphisms and susceptibility of Japanese subjects to 4 H. pylori-related gastrointestinal diseases. Methodology: A total of 100 patients with histologically diagnosed gastric cancer, 105 patients with gastric ulcer, 102 with atrophic gastritis, 72 with duodenal ulcer and 428 healthy controls were recruited. A TaqMan assay was used to genotype 7 single nucleotide polymorphisms (SNPs) in TLR2 and 6 SNPs in TLR4. Results: There was a tendency for TLR4 rs10759932 TC/CC genotypes to be associated with a decreased risk of gastric cancer (p = 0.059);however, this did not reach statistical significance. No significant associations were found between polymorphisms in TLR2 or TLR4 and the risks for gastric cancer, gastric ulcer, duodenal ulcer, or atrophic gastritis. Conclusion: The 13 SNPs inTLR2 and TLR4 examined in this study may not be linked with the development of H. pylori-related gastrointestinal diseases. Further studies with larger numbers of subjects are necessary to verify the present findings.

MicroRNA-206 as a promising epigenetic approach to modulate tumor-associated macrophages in hepatocellular carcinoma

This letter comments on the recently published manuscript by Huang et al in the World Journal of Gastroenterology,which focused on the immunomodulatory effect of Calculus bovis on hepatocellular carcinoma(HCC)tumor microenvironments(TME)by inhibiting M2-tumor-associated macrophage(M2-TAM)polarization via Wnt/β-catenin pathway modulation.Recent research highlights the crucial role of TAMs and their polarization towards the M2 phenotype in promoting HCC progression.Epigenetic regulation,particularly through microRNAs(miR),has emerged as a key factor in modulating immune responses and TAM polarization in the TME,influencing treatment responses and tumor progression.This editorial focuses on miR-206,which has been found to inhibit HCC cell proliferation and migration and promote apoptosis.Moreover,miR-206 enhances anti-tumor immune responses by promoting M1-polarization of Kupffer cells,facilitating CD8+T cell recruitment and suppressing liver cancer stem cell expansion.However,challenges remain in understanding the precise mechanisms regulating miR-206 and its potential as a therapeutic agent.Targeting epigenetic mechanisms and improving strategies,whether through pharmacological or genetic approaches,offer promising avenues to sensitize tumor cells to chemotherapy.Understanding the intricate interactions between cancer and non-coding RNA regulation opens new avenues for developing targeted therapies,potentially improving HCC prognosis.

Towards the future of plastic surgery:from flaps to microsurgery and regenerative medicine and biofabrication?

Plastic surgery is a specialty that is now worldwide recognized as its own academic discipline within the surgical community. The roots however are as old as 600 BC when in the Sushruta Ayurveda the reconstruction of a nose with a flap from the forehead was described. Plastic surgery is a problem solving discipline that meanwhile is an integral part within modern surgical concepts.

Gene transfer and therapy with adenoviral vector in rats with diethylnitrosamine-induced hepatocellular carcinoma

Viral-mediated gene transfer of thymidine kinase ofherpes simplex virus (HSV-tk) has been used to confercytotoxic sensitivity to ganciclovir (GCV) in a variety oftnmor cells. HSV-tk converts GCV into a phosphorylatedcompound which is toxic for dividing cells by blockingDNA synthesis. Our previous study has shown

Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer

AIM:To evaluate the main factors associated with mortality in patients undergoing surgery for perforated peptic ulcer referred to an academic department of general surgery in a large southern Italian city. METHODS:One hundred and forty-nine consecutive patients (M:F ratio=110:39,mean age 52 yrs,range 16-95) with peptic ulcer disease were investigated for clinical history (including age,sex,previous history of peptic ulcer,associated diseases,delayed abdominal surgery,ulcer site,operation type,shock on admission,postoperative general complications, and intra-abdominal and/or wound infections),serum analyses and radiological findings. RESULTS:The overall mortality rate was 4.0%.Among all factors,an age above 65 years,one or more associated diseases,delayed abdominal surgery,shock on admission, postoperative abdominal complications and/or wound infections,were significantly associated (x^2) with increased mortality in patients undergoing surgery (0.0001<P<0.03). CONCLUSION:Factors such as concomitant diseases,shock on admission,delayed surgery,and postoperative abdominal and wound infections are significantly associated with fatal outcomes and need careful evaluation within the general workup of patients admitted for perforated peptic ulcer.

Large regenerative nodules in a patient with Budd-Chiari syndrome after TIPS positioning while on the liver transplantation list diagnosed by Gd-EOB-DTPA MRI

BACKGROUND:Large regenerative nodules (LRNs) are hyperplastic benign nodules most commonly associated with Budd-Chiari syndrome (BCS),caused by outflow obstruction of the hepatic veins or vena cava.To our knowledge,no cases of LRNs arising in BCS after transjugular intrahepatic portosystemic shunt (TIPS) positioning and detected by GdEOB-DTPA MRI have been reported in the literature.METHODS:A 58-year-old woman with BCS,on the liver transplantation (LT) list,underwent a follow-up enhanced MRI.Two years earlier,a TIPS had been placed.In 2008,recurrent hepaticoencephalopathy resistant to medical treatment fulfilled the LT criteria for BCS treated with TIPS and the patient was therefore added to the LT list.CT performed before TIPS had not detected any hepatic lesions.CT performed six months after TIPS showed its complete patency but documented two indeterminate hypervascular liver lesions.RESULTS:MRI performed with Gd-EOB-DTPA revealed additional hypervascular lesions with uptake and retention of the medium in the hepatobiliary phase,thus reflecting a benign behavior of hepatocellular composition.These MRI features were related to LRNs as confirmed by histopathologic analysis.CONCLUSIONS:Gd-EOB-DTPA-enhanced MRI is potentially superior to standard imaging using gadolinium chelates or spiral CT,especially for the differential diagnosis of hypervascular lesions.Gd-EOB-DTPA MRI may become the imaging method of choice for evaluating LT list patients with BCS after TIPS placement.

Impaired gallbladder motility and delayed orocecal transit contribute to pigment gallstone and biliary sludge formation in β-thalassemia major adults

AIM: Gallbladder and gastrointestinal motility defects exist in gallstones patients and to a lesser extent in pigment gallstone patients. To investigated the role of gallbladder and gastrointestinal motility disorders in pigment gallstoneformation in β-thalassemia major.METHODS: Twenty-three patients with β-thalassemia major (16 females; age range 18-37 years) and 70 controls (47 females, age range 18-40 years) were studied for gallbladder and gastric emptying (functional ultrasonography),orocecal transit (OCTT, H2-breath test), autonomic dysfunction (sweat-spot, cardiorespiratory reflex tests),bowel habits, gastrointestinal symptoms and quality of life (all with questionnaires). Gallbladder content (ultrasonography) was examined before and during 8-12 mo follow-up.RESULTS: Gallstones and/or biliary sludge were found in 13 (56%) patients. β-thalassemia major patients had increased fasting (38.04-4.8 mL vs 20.3±0.7 mL, P= 0.0001) and residual (7.94-1.3 mL vs 5.1±0.3 mL, P= 0.002) volumeb and slightly slower emptying (24.94±2.7 min vs20.2±0.7 min,P = 0.04) of the gallbladder, together with longer OCTT(232.24±7.8 rain vs99.7±2.3 rain, P= 0.00003) than controls.No differences in gastric emptying and bowel habits were found. Also, patients had higher dyspepsia (score: 6.74-1.2vs 4.94-0.2, P = 0.027), greater appetite (P = 0.000004) and lower health perception (P = 0.00002) than controls.Autonomic dysfunction was diagnosed in 52% of patients (positive tests: 76.2% and 66.7% for parasympathetic and sympathetic involvement, respectively). Patients developing sludge during follow-up (38%, 2 with prior stones) had increased fasting and residual gallbladder volume.CONCLUSION: Adult β-thalassemia major patients have gallbladder dysmotility associated with delayed small intestinal transit and autonomic dysfunction. These abnormalities apparently contribute together with haemolytic hyperbilirubinemia to the pathogenesis of pigment gallstones/sludge in β-thalassemia major.

T-cells in myocardial infarction:Culprit instigators or mere effectors?

Immune system activation and dysfunction characterize the early phase of reperfusion after a myocardial infarction(MI). Despite initially neglected, adaptive immunity has been recently showed to play an important role in this setting. In fact, the immune system can recognize sequestered antigens released by the necrotic tissue, initiating a deleterious autoimmune vicious circle leading to worse outcome. In their recent work, Angelini et al shed the light on a new feature of post-MI which involves two "old players" of post-ischemic myocardial injury: CD31 and matrix metalloproteinase(MMP)-9. Specifically, the authors showed that an enhancement of MMP-9 release could determine the cleavage of inhibitory CD31 from CD4+ T-cells surface in patients with Acute Coronary Syndromes(ACS). These findings open the room for new studies investigating the role of MMP9 in other pathological processes associated with a reduction of CD31 functionality, such as plaque instability and rupture. Of interest, in the case of a causative role for CD31 shedding in ACS would be confirmed, there might be a potential role for the administration of CD31 protein or analogue compounds to blunt post-ischemic cardiac inflammation and improve ACS outcome.

The difference in enteral nutrition (EN) versus total parenteral nutrition (TPN) in acute pancreatitis by etiology and disease severity

Background: Supplemental nutrition improves long-term outcomes/mortality in acute pancreatitis, with Enteral Nutrition (EN) superior to Total Parenteral Nutrition (TPN). Differences in EN/TPN based upon etiology or disease severity have never been established. Methods: We performed a randomized retrospective case control on subjects admitted to Cooper University Hospital from 06/2007 to 01/2010 with acute pancreatitis who received supplemental nutrition (n = 161). These subjects were examined for caloric and protein demands. Subjects were matched for demographics, weight, albumin, prealbumin eliminating confounders. Demands among disease etiology/severity subgroups and statistical significance were determined. The incidence of EN v.TPN was determined. Results: Significant differences were found in total caloric demands, namely gallstone (n = 50) and alcohol (n = 36) (p = 0.04). Differences in protein demand were not established between these two groups (p = 0.24). Differences in caloric demand were found in bed-side index for severity in acute pancreatitis (BISAP) of 1, 2 and 3 versus 5. Protein demands were different between BISAP of 0 versus all others. 24% of the sample received EN. Conclu: sion: There are significant differences in total caloric demands for subjects with acute pancreatitis by disease severity and in gallstone versus alcohol-induced pancreatitis. These differences are not variations in the sample populations. Finally, EN is under-utilized despite knowledge of its value.

自体外周血干细胞移植成功治疗硬化性黏液水肿

Background: Scleromyxedema is a rare chronic fibromucinous disorder that can have devastating clinical manifestations, including sclerosis of the skin with progressive pharyngeal and upper airway involvement, resulting in high mortality due to respiratory complications. Herein we describe a novel therapeutic approach. Because autologous hematopoietic stem cell transplantation is effective in other plasma cell proliferative disorders, it may be effective in this setting. Observations: We retrospectively evaluated 6 patients who were offered highdose chemotherapy with stem cell rescue as treatment for scleromyxedema. One heavily pretreated patient was unable to mobilize stem cells. The remaining 5 patients mobilized stem cells and underwent successful transplantation. There was no treatment-related mortality. Hematologic responses were seen in 4 patients, including 2 complete remissions and 2 partial remissions, and all 4 had improvement in extracutaneous manifestations. All 4 patients subsequently had relapse of the monocl onal protein, and 3 developed skin relapses at 14, 37, and 45 months. Conclusion s: High-dose chemotherapy with stem cell rescue is feasible for patients with s cleromyxedema and, although not curative, offers durable remission in most patie nts. This therapy should be considered before treatment with alkylating agents o r other treatments that could adversely affect the ability to collect stem cells .

Demystifying airline syncope

Syncope forms a major part of medical in-flight emergencies contributing one-infour in-flight medical events accounting to 70%of flight diversions.In such patients,it is important to elucidate the pathophysiology of syncope prior to diversion.Postural hypotension is the most common etiology of in-flight syncopal events.However,individuals without any underlying autonomic dysfunction can still experience syncope from hypoxia also known as airline syncope.Initial steps in managing such patients include positioning followed by the airway,breathing and circulation of resuscitation.These interventions need to be in close coordination with ground control to determine decision for flight diversion.Interventions which have been tried for prevention include mental challenge and increased salt and fluid intake.The current paper enhances the understanding of airline syncope by summarizing the associated pathophysiologic mechanisms and the management medical personnel can initiate with limited resources.

Stimulation of TNF receptor type 2 expands regulatory T cells and ameliorates established collagen-induced arthritis in mice

Tumor necrosis factor(TNF)and its receptors TNF receptor type 1(TNFR1)and type 2(TNFR2)have a central role in chronic inflammatory diseases.While TNFR1 mainly confers inflammation,activation of TNFR2 elicits not only pro-inflammatory but also anti-inflammatory effects.In this study,we wanted to investigate the anti-inflammatory therapeutic potential of selective activation of TNFR2 in mice with established collageninduced arthritis.Mice with established arthritis induced by immunization with bovine collagen type II were treated with six injections of the TNFR2-specific agonist TNCscTNF80,given every second day.Two days after treatment cessation,the cell compositions of bone marrow,spleen and lymph nodes were analyzed.Mice were visually scored until day 30 after the start of therapy and the degree of joint inflammation was determined by histology.Treatment with TNCscTNF80 increased arthritis-induced myelopoiesis.Little effect was seen on the infiltration rate of inflammatory immature myeloid cells and on the reduction of lymphoid cells in secondary lymphoid organs.Upon treatment,frequency of regulatory T(Treg)cells in the CD4+T-cell population was increased in both spleen and inguinal lymph nodes.In addition,the expression of TNFR2 on Treg cells was enhanced.The clinical score started to improve 1 week after cessation treatment and remained lower 30 days after initiation of therapy.The histological score also revealed amelioration of joint inflammation in TNCscTNF80-treated versus control mice.Activation of TNFR2 might provide a suitable therapeutic strategy in autoimmune arthritis by increasing the numbers of regulatory cell types,in particular Treg cells,and by attenuation of arthritis.

Evaluation of remote radiologist-interpreted point-of-care ultrasound for suspected dengue patients in a primary health care facility in Colombia

Background Early identification of plasma leakage may guide treatment decisions in dengue patients.This study evaluated the value of point-of-care ultrasound(POCUS)to detect plasma leakage and predict hospitalization or referral to a higher level of care in suspected dengue patients under routine conditions at a primary care facility in Colombia.Methods We conducted a cohort study between April 2019 and March 2020 in a primary care hospital in Cali,Colombia.We prospectively included and followed 178 patients who were at least 2 years old with fever of less than 10 days and clinician-suspected dengue.A trained general practitioner performed a standardized POCUS protocol.Images were quality-rated and overread by an expert radiologist,and her results and those of the general practitioner were compared using the Kappa index.Logistic regression was used to identify factors associated with plasma leakage at enrollment and explore its prognostic value regarding hospital admission or referral to a higher level of care.Results Half(49.6%)POCUS images were of suitable quality to be interpreted.The proportion of plasma leakage reported by the radiologist was 85.1%(95%CI:78.6-90.2%)and 47.2%by the study physician(Kappa=0.25,95%CI:0.15-0.35).The most frequent ultrasound findings were ascites(hepatorenal 87.2%,splenorenal 64%,or pelvic 21.8%)and gallbladder wall thickening(10.5%).Plasma leakage was higher in subjects with thrombocytopenia(aOR=4,95%CI:1.3-12.1)and lower in patients 30-59 years old(aOR=0.1,95%CI:0.0-0.4)than in those 18 years old or younger.POCUS evidence of plasma leakage(aOR=8.2,95%CI:2.2-29.9),thrombocytopenia(aOR=6.3,95%CI:2.4-16.0)and pulse pressure(aOR=1.1,95%CI:1.07-1.2)were associated with hospital admission or referral to a higher level of care.Conclusions Ultrasound is useful to detect plasma leakage in primary care and,challenges remain to guarantee high-quality images and diagnostic accuracy,for which a standardized dengue POCUS protocol and training program is needed.

Predictors of malaria rapid diagnostic test positivity in a high burden area of Paletwa Township, Chin State in Western Myanmar

Background:Despite major reductions in malaria burden across Myanmar,clusters of the disease continue to persist in specific subregions.This study aimed to assess the predictors of test positivity among people living in Paletwa Township of Chin State,an area of persistently high malaria burden.Methods:Four villages with the highest malaria incidence from Paletwa Town ship were purposively selected.The characteristics of 1045 subjects seeking malaria diagnosis from the four assigned village health volunteers from January to December,2018 were retrospectively analyzed.Their household conditions and surroundings were also recorded using a checklist.Descriptive statistics and logistic regression models were applied to investigate potential associations between individual and household characteristics and malaria diagnosis.Results:In 2017,the Paletwa township presented 20.9%positivity and an annual parasite index of 46.9 cases per 1000 people.Plasmodium falciparum was the predominant species and accounted for more than 80.0%of all infections.Among 1045 people presenting at a clinic with malaria symptoms,31.1% were diagnosed with malaria.Predictors for test positivity included living in a hut[adjusted odds ratios(aOR):2.3,95%confidence intervals(CI ):1.2-4.6],owning farm animals(aOR:1.7,95% CI:1.1-3.6),using non-septic type of toilets(aOR:1.9,95%CI:1.1-8.4),presenting with fever(aOR:1.9,95%CI:1.1-3.0),having a malaria episode within the last year(aOR:2.9,95%CI:1.45.8),traveling outside the village in the previous 14 days (aOR:4.5,95%CI:1.5-13.4),and not using bed nets(aOR:3.4,95%CI:2.3-5.1).There were no statistically significant differences by age or gender in this present analysis.Conclusions:The results from this study,including a high proportion of P.falciparum infections,little difference in age,sex,or occupation,suggest that malaria is a major burden for these study villages.Targeted health education campaigns should be introduced to strengthen synchronous diagnosis-seeking behaviors,tighten treatment adheren ce,receiving a diagnosis after traveling to endemic regi ons,and using bed nets properly.We suggest in creased surveillance,early diagnosis,and treatment efforts to control the disease and then to consider the local elimination.