Introduction: Colorectal cancer (CRC) is the second leading cause of cancer related death in the world after lung cancer. Early detection of CRC leads to improvement in cancer survival rate. In recent years, efforts have been made to discover a non-invasive screening marker of higher sensitivity and specificity. Fecal occult blood testing (FOBT) and genetic testing become alternative modalities to screen CRC in the population other than colonoscopy. The aim of this systematic review and meta-analysis is to determine the diagnostic accuracy, sensitivity and specificity of FOBT and genetic testing as screening tools in colorectal cancer. Methods: A literature search of PubMed, ScienceDirect, and Scopus was carried out. The search strategy was restricted to human subjects and studies are published in English. Data on sensitivity and specificity were extracted and pooled. Heterogeneity was assumed at significance level of p < 0.10 and was tested by chi squared. Degree of heterogeneity was quantified using the I 2 statistic, and values of less than 25% is considered as homogenous. All analyses were performed using the software Meta-Disc. Results: A total of eleven studies were suitable for data synthesis and analysis. Five studies were analyzed for the accuracy of genetic testing, the pooled estimate for sensitivity and specificity were 71% (95% CI: 66, 75%) and 95% (95% CI: 93, 97%) respectively. Another group of studies which had been evaluated for the accuracy of FOBT, the pooled sensitivity was 31% (95% CI: 25, 38%) while the pooled specificity was 87% (95% CI: 86, 89%). Conclusions: FOBTs is recommended to use as population-based screening tools for colorectal cancer while genetic testing should be focusing on patients with moderate and high risk individuals.
Humans can be infected by pathogenic Leptospira through contact with infected animals or contaminated environments. Recreational exposure has been associated with human leptospirosis; however, there is a lack of information on the distribution of Leptospira spp. in recreational areas. Thus, we conducted this study to detect and describe the distributions of Leptospira spp. and to determine the prevalence of pathogenic leptospires at recreational areas in Peninsular Malaysia. Soil and water samples were randomly collected from 33 recreational areas in Peninsular Malaysia from December 2018 to April 2019. Each culture was examined under dark-field microscopy prior to genus confirmation by polymerase chain reaction using primers for the 16S rRNA gene. A total of 390 water and soil samples were collected, and 131 cultures were positive for Leptospira under dark-field microscope examination. Leptospira was identified in most of the recreational areas sampled, and at least one pathogenic Leptospira species was isolated from 17 recreational areas. The prevalence of saprophytic, intermediate, and pathogenic Leptospira spp. was 19.7%, 5.6%, and 8.2%, respectively. The dominant pathogenic species found in the samples was Leptospira kmetyi. This study provides important data on the distribution and prevalence of Leptospira spp. from soil and water, as well as the dominant pathogenic species, at recreational areas in Peninsular Malaysia. Therefore, preventive measures should be taken to ensure the safety of visitors.
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.
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