Background Nonalcoholic fatty liver disease (NAFLD) is one of the common causes of chronic liver disease globally. Obesity, metabolic diseases, and exposure to some environmental agents contribute to NAFLD. NAFLD is commonly considered a precursor for some types of cancers. Since the leading causes of death in people with NAFLD are cardiovascular disease and extrahepatic cancers, it is important to understand the mechanisms of the progression of NAFLD to control its progression and identify its association with extrahepatic cancers. Thus, this review aims to estimate the global prevalence of NAFLD in association with the risk of extrahepatic cancers. Objective We aimed to determine the prevalence of various cancers in NAFLD patients and the association between NAFLD and cancer. Methods We searched PubMed, ProQuest, Scopus, and Web of Science from database inception to March 2022 to identify eligible studies reporting the prevalence of NAFLD and the risk of incident cancers among adult individuals (aged ≥18 years). Data from selected studies were extracted, and meta-analysis was performed using random effects models to obtain the pooled prevalence with the 95% CI. The quality of the evidence was assessed with the Newcastle-Ottawa Scale. Results We identified 11 studies that met our inclusion criteria, involving 222,523 adults and 3 types of cancer: hepatocellular carcinoma (HCC), breast cancer, and other types of extrahepatic cancer. The overall pooled prevalence of NAFLD and cancer was 26% (95% CI 16%-35%), while 25% of people had NAFLD and HCC (95% CI 7%-42%). NAFLD and breast cancer had the highest prevalence out of the 3 forms of cancer at 30% (95% CI 14%-45%), while the pooled prevalence for NAFLD and other cancers was 21% (95% CI 12%-31%). Conclusions The review suggests that people with NAFLD may be at an increased risk of cancer that might not affect not only the liver but also other organs, such as the breast and bile duct. The findings serve as important evidence for policymakers to evaluate and recommend measures to reduce the prevalence of NAFLD through lifestyle and environmental preventive approaches. Trial Registration PROSPERO CRD42022321946; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=321946
Background Antimicrobial resistance (AMR) has emerged as a major global public health challenge due to the overuse and misuse of antibiotics for humans and animals. Hospitals are among the major users of antibiotics, thereby having a large contribution to AMR. Objective The aim of this study is to determine the prevalence of antibiotic-resistant pathogenic bacteria and the level of antibiotic residues in the hospital effluents in Selangor, Malaysia. Methods A cross-sectional study will be performed in the state of Selangor, Malaysia. Tertiary hospitals will be identified based on the inclusion and exclusion criteria. The methods are divided into three phases: sample collection, microbiological analysis, and chemical analysis. Microbiological analyses will include the isolation of bacteria from hospital effluents by culturing on selective media. Antibiotic sensitivity testing will be performed on the isolated bacteria against ceftriaxone, ciprofloxacin, meropenem, vancomycin, colistin, and piperacillin/tazobactam. The identification of bacteria will be confirmed using 16S RNA polymerase chain reaction (PCR) and multiplex PCR will be performed to detect resistance genes (ermB, mecA, blaNDM-L, blaCTX-M, blaOXA-48, blaSHV, VanA, VanB, VanC1, mcr-1, mcr-2, mcr-3, Intl1, Intl2, and qnrA). Finally, the level of antibiotic residues will be measured using ultrahigh-performance liquid chromatography. Results The expected outcomes will be the prevalence of antibiotic-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter (ESKAPE) bacterial species from the hospital effluents, the occurrence of antibiotic resistance genes (ARGs) from the isolated ESKAPE bacteria, and the level of antibiotic residues that may be detected from the effluent. Sampling has been conducted in three hospitals. Data analysis from one hospital showed that as of July 2022, 80% (8/10) of E. faecium isolates were resistant to vancomycin and 10% (1/10) were resistant to ciprofloxacin. Further analysis will be conducted to determine if the isolates harbor any ARGs and effluent samples are being analyzed to detect antibiotic residues. Sampling activities will be resumed after being suspended due to the COVID-19 pandemic and are scheduled to end by December 2022. Conclusions This study will provide the first baseline information to elucidate the current status of AMR of highly pathogenic bacteria present in hospital effluents in Malaysia. International Registered Report Identifier (IRRID) DERR1-10.2196/39022
UNSTRUCTURED Abstract Background Antimicrobial resistance (AMR) has emerged as one of public health challenges globally due to overused and misused of antibiotics by human and animals. Objectives To determine the prevalence of antibiotics resistant pathogenic bacteria and level of antibiotic residues in the hospital’s effluent in Selangor, Malaysia. Methods A cross-sectional study will be conducted in Selangor, Malaysia. The methods are divided into three sections; sample collection, microbiological analysis and, chemical analysis. Microbiological analysis such as isolation of bacteria from the effluent by culture on selective media plates will be performed. An antibiotic sensitivity testing will be performed on the grown bacteria. The identified bacteria will be confirmed using 16sRNA PCR and Multiplex PCR will be performed to detect the resistant genes. Finally, the level of antibiotic residues will be measured using Ultra High Performance Liquid Chromatography (UHPLC) Results The expected outcome will be the prevalence of antibiotic resistant 'ESKAPE' bacteria from the hospital’s effluent and the occurrence of the antibiotic resistant genes (ARGs) from the isolated ESKAPE bacteria and the level of antibiotic residues that may be detected from the effluent. As in July 2022, 80% of Enterococcus faecium were resistance against vancomycin and 10% of were resistance against ciprofloxacin from one hospital. Further analysis will be conducted to determine if the isolates are possessing any antibiotic resistant genes and effluent samples are being analyzed to detect antibiotic residues in the effluent samples. Sampling activities will be resumed actively after suspended due to COVID-19 pandemic.
BACKGROUND Antimicrobial resistance (AMR) is a known global public health threat. In addition to this, it brings serious economic consequences to agriculture. Antibiotic resistance is an interconnection of humans, animals and the environment as proposed in tricycle surveillance by the WHO. In Malaysia, research and surveillance of AMR are mainly derived from clinical samples, agricultural settings, and surface water, but no surveillance of the drinking water system is currently performed. Hence, this policy-driven study is a combined effort of microbiologists and engineers to provide baseline data on the magnitude of AMR as a possible pollutant in the drinking water system which is not being monitored at present. OBJECTIVE To study the baseline level of antibiotic resistance in drinking water distribution from pre-and post- drinking water treatment plants in a selected state in Malaysia. METHODS This is a lab-based, cross-sectional study in a selected state, Malaysia. Water samples from six drinking water treatment plants (DWTPs) were collected. Samples were collected at three sampling points consisting of the intake sampling station, service reservoir outlet station, and distribution system sampling station. These were tested against seven types of antibiotics in triplicates. Samples were screened for antibiotic-resistant bacteria (ARBs) and antibiotic-resistant genes (ARGs) and quantified for the level of antibiotics present in the DWTPs. RESULTS Results include descriptive statistics of the number of bacterial colonies harvested from water samples grown on Reasoner’s (R2A) agar with or without antibiotics, the occurrence of antibiotic-resistant genes, and the level of antibiotics detected in water samples. CONCLUSIONS This study provides baseline information on the status of antimicrobial-resistant bacteria, the presence of resistance genes as contaminants, and the level of antibiotics present in drinking water systems, with the aim of demonstrating to policymakers the need to consider AMR as a parameter in drinking water surveillance. CLINICALTRIAL This study is not a clinical trial
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