Diagnostic Accuracy of Lactate Dehydrogenase/Adenosine Deaminase Ratio in Differentiating Tuberculous and Parapneumonic Effusions: A Systematic Review

Background Tuberculous pleural effusion (TPE) and parapneumonic effusion (PPE) are often difficult to differentiate owing to the overlapping clinical features. Observational studies demonstrate that the ratio of lactate dehydrogenase to adenosine deaminase (LDH/ADA) is lower in TPE compared to PPE, but integrated analysis is warranted. Methods We conducted a systematic review to evaluate the diagnostic accuracy of the LDH/ADA ratio in differentiating TPE and PPE. We explored the PubMed and Scopus databases for studies evaluating the LDH/ADA ratio in differentiating TPE and PPE. Results From a yield of 110 studies, five were included for systematic review. The cutoff value for the LDH/ADA ratio in TPE ranged from <14.2 to <25. The studies demonstrated high heterogeneity, precluding meta-analysis. Quality Assessment of Diagnostic Accuracy Studies Tool 2 assessment revealed a high risk of bias in terms of patient selection and index test. Conclusion LDH/ADA ratio is a potentially useful parameter to differentiate between TPE and PPE. Based on the limited data, we recommend an LDH/ADA ratio cutoff value of <15 in differentiating TPE and PPE. However, more rigorous studies are needed to further validate this recommendation

Exposure to Non-Ionizing Radiation and Childhood Cancer: A Meta-Analysis

Background: A slight increase in the childhood cancer trend has been observed for the past few decades. Non-ionizing radiation is one of the environmental factors linked to childhood cancers. This review is conducted to assess the association between non-ionizing radiation and childhood cancer based on all original studies to date. Methods: A systematic search was conducted on the titles and abstracts pertaining to non-ionizing radiation and childhood cancers using the PubMed, Scopus, SAGE and ScienceDirect databases from inception up to November 2018. Quality of each article was appraised using the Newcastle-Ottawa Scale, meta-analysis was performed with Review Manager, and fixed effects were used to estimate the pooled OR of the selected studies. Results: A total of 15 articles met all the selection criteria. Twelve articles were included in the meta-analysis. Pooled risk estimates of the 12 studies, obtained via fixed effects model, showed that children exposed to 0.2 µT or more of EMF non-ionizing radiation run 1.33 times higher risks of contracting childhood cancer compared to those with less than 0.2 µT exposure (95% CI: 1.10, 1.60). The studies were statistically homogeneous (chi-squared P=0.71, I2=0%), and there was no evidence of publication bias. Conclusion: It cannot be concluded that children exposed to non-ionizing radiation have higher risks of childhood cancer compared to those who were not exposed as claimed by the previous reviews. However, concerns about non-ionizing radiation exposure and childhood cancer should not be neglected

Diagnostic Accuracy of Lactate Dehydrogenase/Adenosine Deaminase Ratio in Differentiating Tuberculous and Parapneumonic Effusions: A Systematic review

Background: Tuberculous pleural effusion (TPE) and parapneumonic effusion (PPE) are often difficult to differentiate owing to the overlapping clinical features. Observational studies demonstrate that the ratio of lactate dehydrogenase to adenosine deaminase (LDH/ADA) is lower in TPE compared to PPE, but integrated analysis is warranted. Methods: We conducted a systematic review to evaluate the diagnostic accuracy of the LDH/ADA ratio in differentiating TPE and PPE. We explored the PubMed and Scopus databases for studies evaluating the LDH/ADA ratio in differentiating TPE and PPE. Results: From a yield of 110 studies, five were included for systematic review. The cutoff value for the LDH/ADA ratio in TPE ranged from <14.2 to <25. The studies demonstrated high heterogeneity, precluding meta-analysis. Quality Assessment of Diagnostic Accuracy Studies Tool 2 assessment revealed a high risk of bias in terms of patient selection and index test. Conclusion: LDH/ADA ratio is a potentially useful parameter to differentiate between TPE and PPE. Based on the limited data, we recommend an LDH/ADA ratio cutoff value of <15 in differentiating TPE and PPE. However, more rigorous studies are needed to further validate this recommendation

Animal Reservoirs for Leptospira spp. In South-East Asia: A Meta-Analysis

Background and Aim: Leptospirosis is a zoonotic disease responsible for high morbidity worldwide. This review is intended to identify other possible animal reservoirs of Leptospira spp. within human surroundings, which may improve the prevention and control of the disease. Methods: A systematic search was performed for the relevant titles, abstracts and keywords in PubMed, Scopus and Google Scholar in March 2018 based on the PICO strategy; which returned 1226 studies. Screening of abstracts had shortlisted 71 studies and data extraction was conducted for 15 studies which had been accepted after review of the full text. Only studies done in South-East Asia were considered. Meta-analysis of the accepted studies was done to compute the composite prevalence of each animal group using random effects model. Results: The articles were analysed from the viewpoint of the study settings and the prevalence of Leptospira spp. in types of animal with the animals being grouped into five major groups, based on taxonomy and likelihood of human contact. It was found that all animal groups have statistically significant value of pooled prevalence, with a range between 8.17% (95% CI: 4.80% - 12.39%) for sheep and goats, to as high as 27.28% (95% CI: 1.24% - 69.69%) for carnivores. The prevalence for other animal groups are 17.95% (95% CI: 7.77% - 31.18%) for rodents, 19.24% (95% CI: 10.65% - 29.65%) for pigs, and 24.90% (95% CI: 15.45% - 35.71%) for ruminants. Conclusion: Meta-analysis showed that other groups of animals, particularly carnivores, pigs, and large ruminants are just as culpable as rodents in being the reservoir for Leptospira spp. These other groups of animals may also play a vital role in the transmission and overall dynamics of human leptospirosis

Effectiveness of Antibiotic Prophylaxis for Leptospirosis among Adults: A Systematic Review

Leptospirosis is one of the most widespread re-emerging zoonoses in the world. Malaysia is known to be an endemic country for human leptospirosis, with a case fatality rate of 2.11%, and an average annual incidence rate of 7.80 cases per 100,000 individuals. This systematic review is conducted to determine the effectiveness of antibiotic prophylaxis for leptospirosis among the adult populations who are highly at risk of getting infected. A systematic search was performed for the relevant titles, abstracts and keywords on PubMed, Scopus, Cochrane and Google Scholar from inception to November 2017 based on the PICO strategy; which returned 126 studies. Screening of abstracts had shortlisted 19 studies and data extraction was conducted for 8 studies which had been accepted after review of the full text. For the evaluation of antibiotics prophylaxis effectiveness against leptospirosis, only trials and cohort studies with risk ratio (RR) were selected. The articles were analyzed from the viewpoint of the dosage, adverse effects, study settings and effectiveness of the antibiotic prophylaxis. Using fixed effects model, pooled RR showed protective association between antibiotic prophylaxis use against the incidence of leptospirosis (RR = 0.31; 95% CI: 0.20, 0.48). Antibiotic prophylaxis for leptospirosis had been shown to be effective in preventing the incidence of the disease among high-risk populations and carries minimal adverse effects. It is recommended that the practice of antibiotic prophylaxis for leptospirosis is included in the standard protocol for leptospirosis prevention among people at high-risk, including disaster response teams and patrons of eco-sports tourism activities; with the drug of choice being doxycycline, either as a single 200 mg dose or weekly dose of 200 mg for the duration of exposure, based on the setting, duration of event and resources available

Effectiveness of Antibiotic Prophylaxis for Leptospirosis among Adults: A Systematic Review

Leptospirosis is one of the most widespread re-emerging zoonoses in the world. Malaysia is known to be an endemic country for human leptospirosis, with a case fatality rate of 2.11%, and an average annual incidence rate of 7.80 cases per 100,000 individuals. This systematic review is conducted to determine the effectiveness of antibiotic prophylaxis for leptospirosis among the adult populations who are highly at risk of getting infected. A systematic search was performed for the relevant titles, abstracts and keywords on PubMed, Scopus, Cochrane and Google Scholar from inception to November 2017 based on the PICO strategy; which returned 126 studies. Screening of abstracts had shortlisted 19 studies and data extraction was conducted for 8 studies which had been accepted after review of the full text. For the evaluation of antibiotics prophylaxis effectiveness against leptospirosis, only trials and cohort studies with risk ratio (RR) were selected. The articles were analyzed from the viewpoint of the dosage, adverse effects, study settings and effectiveness of the antibiotic prophylaxis. Using fixed effects model, pooled RR showed protective association between antibiotic prophylaxis use against the incidence of leptospirosis (RR = 0.31; 95% CI: 0.20, 0.48). Antibiotic prophylaxis for leptospirosis had been shown to be effective in preventing the incidence of the disease among high-risk populations and carries minimal adverse effects. It is recommended that the practice of antibiotic prophylaxis for leptospirosis is included in the standard protocol for leptospirosis prevention among people at high-risk, including disaster response teams and patrons of eco-sports tourism activities; with the drug of choice being doxycycline, either as a single 200 mg dose or weekly dose of 200 mg for the duration of exposure, based on the setting, duration of event and resources available

Animal Reservoirs for Leptospira spp. in South-East Asia: A Meta-Analysis

Background and Aim: Leptospirosis is a zoonotic disease responsible for high morbidity worldwide. This review is intended to identify other possible animal reservoirs of Leptospira spp. within human surroundings, which may improve the prevention and control of the disease. Methods: A systematic search was performed for the relevant titles, abstracts and keywords in PubMed, Scopus and Google Scholar in March 2018 based on the PICO strategy; which returned 1226 studies. Screening of abstracts had shortlisted 71 studies and data extraction was conducted for 15 studies which had been accepted after review of the full text. Only studies done in South-East Asia were considered. Meta-analysis of the accepted studies was done to compute the composite prevalence of each animal group using random effects model. Results: The articles were analysed from the viewpoint of the study settings and the prevalence of Leptospira spp. in types of animal with the animals being grouped into five major groups, based on taxonomy and likelihood of human contact. It was found that all animal groups have statistically significant value of pooled prevalence, with a range between 8.17% (95% CI: 4.80% - 12.39%) for sheep and goats, to as high as 27.28% (95% CI: 1.24% - 69.69%) for carnivores. The prevalence for other animal groups are 17.95% (95% CI: 7.77% - 31.18%) for rodents, 19.24% (95% CI: 10.65% - 29.65%) for pigs, and 24.90% (95% CI: 15.45% - 35.71%) for ruminants. Conclusion: Meta-analysis showed that other groups of animals, particularly carnivores, pigs, and large ruminants are just as culpable as rodents in being the reservoir for Leptospira spp. These other groups of animals may also play a vital role in the transmission and overall dynamics of human leptospirosis

Effectiveness of Antibiotic Prophylaxis for Leptospirosis among Adults: A Systematic Review

Leptospirosis is one of the most widespread re-emerging zoonoses in the world. Malaysia is known to be an endemic country for human leptospirosis, with a case fatality rate of 2.11%, and an average annual incidence rate of 7.80 cases per 100,000 individuals. This systematic review is conducted to determine the effectiveness of antibiotic prophylaxis for leptospirosis among the adult populations who are highly at risk of getting infected. A systematic search was performed for the relevant titles, abstracts and keywords on PubMed, Scopus, Cochrane and Google Scholar from inception to November 2017 based on the PICO strategy; which returned 126 studies. Screening of abstracts had shortlisted 19 studies and data extraction was conducted for 8 studies which had been accepted after review of the full text. For the evaluation of antibiotics prophylaxis effectiveness against leptospirosis, only trials and cohort studies with risk ratio (RR) were selected. The articles were analyzed from the viewpoint of the dosage, adverse effects, study settings and effectiveness of the antibiotic prophylaxis. Using fixed effects model, pooled RR showed protective association between antibiotic prophylaxis use against the incidence of leptospirosis (RR = 0.31; 95% CI: 0.20, 0.48). Antibiotic prophylaxis for leptospirosis had been shown to be effective in preventing the incidence of the disease among high-risk populations and carries minimal adverse effects. It is recommended that the practice of antibiotic prophylaxis for leptospirosis is included in the standard protocol for leptospirosis prevention among people at high-risk, including disaster response teams and patrons of eco-sports tourism activities; with the drug of choice being doxycycline, either as a single 200 mg dose or weekly dose of 200 mg for the duration of exposure, based on the setting, duration of event and resources available

Survival rate and prognostic factors for Colorectal cancer in Sabah, Borneo, Malaysia: A retrospective cohort of a population-based study

Background: Colorectal cancer is a major public health problem with significant number of cases and death in the population. This study aimed to determine the 5-year overall survival rate and the prognostic factors for colorectal cancer patients in Sabah. Methods: This was a retrospective cohort study conducted using secondary data from Malaysian National Cancer Registry (MNCR) database. A 5-year overall survival and the median survival time were determined with Kaplan-Meier survival curve. Cox regression analysis was done to determine the prognostic factors on survival. Results: A total of 1,152 patients were included in this study. The majority of the patients had colon cancer and presented at late stage (stage III and IV) as compared to early stage (stage I and II). From the analysis, the 5-year overall survival for colorectal cancer was 23.2% (95% CI: 21.8, 24.6) and the median survival time was 16 months (95% CI: 14.3, 17.7). Higher survivals are seen in males (23.6%, 95% CI: 20.4, 24.7), aged 50-74 years old (24.2%, 95% CI: 22.4, 26.0), Chinese (25.5%, 95% CI: 23.0, 28.0), lived in Keningau (25.6%, 95% CI: 20.8, 30.4), colon as primary tumor site (24.5%, 95% CI: 22.5, 26.4), diagnosed with stage I (55.6%, 95% CI: 48.7, 62.5) and received surgery with chemotherapy or radiotherapy (31.3%, 95% CI: 27.8, 34.8). The significant prognostic factor was the stage at diagnosis. Patients with stage IV colorectal cancer (HR: 11.18; 95% CI: 3.48, 35.93) had eleven times risk of dying as compared to stage I. Conclusion: The survival rate for colorectal cancer patients in Sabah was comparatively lower than other states in Malaysia and in some Asian countries. Those patients who presented at later stage had poorer survival. Health promotion and community-based screening program should be emphasized in addition to encouraging early diagnosis to improve survival

Impact of social distancing on covid-19 and other related infectious disease transmission: A systematic review

Similar to other coronaviruses, COVID-19 is transmitted mainly by droplets and is highly transmissible through close proximity or physical contact with an infected person. Countries across the globe have implemented public health control measures to prevent onward transmission and reduce burden on health care settings. Social or physical distancing was found to be one of appropriate measure based on previous experience with epidemic and pandemic contagious diseases. AIM: This study aims to review the latest evidence of the impact of social or physical distancing implemented during COVID-19 pandemic toward COVID-19 and other related infectious disease transmission. The study uses PRISMA review protocol and formulation of research question was based on PICO. The selected databases include Ovid MEDLINE and Scopus. Thorough identification, screening and eligibility process were done, revealed selected 8 articles. The articles then ranked in quality through Mixed Method Appraisal Tool. A total of eight papers included in this analysis. Five studies (USA, Canada, South Korea and the United Kingdom) showed physical distancing had resulted in a reduction in Covid-19 transmission. In comparison, three other studies (Australia, South Korea and Finland) showed a similar decline on other infectious diseases (Human Immunodeficiency Virus, other sexually transmitted infections, influenza, respiratory syncytial virus, and Vaccine-Preventive Disease. The degree of the distancing policy implemented differs between strict and lenient, with both result in effectiveness in reducing transmission of infectious disease. Physical or social distancing may come in the form of extreme or lenient measure in effectively containing contagious disease such as COVID-19, however the stricter the measure will give more proportionate impact toward the economy, education, mental health issues, morbidity and mortality of non-COVID-19 diseases. Since we need this measure to ensure the reduction of infectious diseases transmission to help flattening the curve which allow much needed time for healthcare system to prepare adequately to response, “Precision physical distancing” can be implemented which will have more benefit toward the survival of the community as a whole