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  • 1
    Online Resource
    Online Resource
    The Effectiveness of Early Food Introduction in Preventing Childhood Allergic Diseases: Protocol for a Systematic Review and Meta-Analysis
    JMIR Publications Inc. ; 2023
    In:  JMIR Research Protocols Vol. 12 ( 2023-6-26), p. e46816-
    Details
    In: JMIR Research Protocols, JMIR Publications Inc., Vol. 12 ( 2023-6-26), p. e46816-
    Abstract: Allergic diseases affect around 40% of the pediatric population worldwide. The coexistence of asthma, allergic rhinitis, eczema, and food allergy renders allergy treatment and prevention challenging. Infant feeding strategies recommend avoiding allergenic foods to prevent allergy development and anaphylaxis. However, recent evidence suggests that early consumption of food allergens during weaning in infants aged 4-6 months could result in food tolerance, thus reducing the risk of developing allergies. Objective The aim of this study is to systematically review and carry out a meta-analysis of evidence on the outcome of early food introduction for preventing childhood allergic diseases. Methods We will conduct a systematic review of interventions through a comprehensive search of various databases including PubMed, Embase, Scopus, CENTRAL, PsycINFO, CINAHL, and Google Scholar to identify potential studies. The search will be performed for any eligible articles from the earliest published articles up to the latest available studies in 2023. We will include randomized controlled trials (RCTs), cluster RCTs, non-RCTs, and other observational studies that assess the effect of early food introduction to prevent childhood allergic diseases. Results Primary outcomes will include measures related to the effect of childhood allergic diseases (ie, asthma, allergic rhinitis, eczema, and food allergy). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines will be followed for study selection. All data will be extracted using a standardized data extraction form and the quality of the studies will be assessed using the Cochrane Risk of Bias tool. A summary of findings table will be generated for the following outcomes: (1) total number of allergic diseases, (2) rate of sensitization, (3) total number of adverse events, (4) improvement of health-related quality of life, and (5) all-cause mortality. Descriptive and meta-analyses will be performed using a random-effects model in Review Manager (Cochrane). Heterogeneity among selected studies will be assessed using the I2 statistic and explored through meta-regression and subgroup analyses. Data collection is expected to start in June 2023. Conclusions The results acquired from this study will contribute to the existing literature and harmonize recommendations for infant feeding with regard to the prevention of childhood allergic diseases. Trial Registration PROSPERO CRD42021256776; https://tinyurl.com/4j272y8a International Registered Report Identifier (IRRID) PRR1-10.2196/46816
    Type of Medium: Online Resource
    ISSN: 1929-0748
    URL: Article
    DOI: 10.2196/46816
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2023
    detail.hit.zdb_id: 2719222-2
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  • 2
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    Online Resource
    Online Searching as a Practice for Evidence-Based Medicine in the Neonatal Intensive Care Unit, University of Malaya Medical Center, Malaysia: Cross-sectional Study
    JMIR Publications Inc. ; 2022
    In:  JMIR Formative Research Vol. 6, No. 4 ( 2022-4-6), p. e30687-
    Details
    In: JMIR Formative Research, JMIR Publications Inc., Vol. 6, No. 4 ( 2022-4-6), p. e30687-
    Abstract: The use of the internet for research is essential in the practice of evidence-based medicine. The online search habits of medical practitioners in clinical settings, particularly from direct observation, have received little attention. Objective The goal of the research is to explore online searching for information as an evidence-based practice among medical practitioners. Methods A cross-sectional study was conducted to evaluate the clinical teams’ use of evidence-based practice when making clinical decisions for their patients' care. Data were collected through online searches from 2015 to 2018. Participants were medical practitioners and medical students in a Malaysian public teaching hospital’s neonatal intensive care unit who performed online searches to find answers to clinical questions that arose during ward rounds. Results In search sessions conducted by the participants, 311 queries were observed from 2015 to 2018. Most participants (34/47, 72%) were house officers and medical students. Most of the searches were conducted by house officers (51/99, 52%) and medical students (32/99, 32%). Most searches (70/99, 71%) were directed rather than self-initiated, and 90% (89/99) were completed individually rather than collaboratively. Participants entered an average of 4 terms in each query; three-quarters of the queries yielded relevant evidence, with two-thirds yielding more than one relevant source of evidence. Conclusions Our findings suggest that junior doctors and medical students need more training in evidence-based medicine skills such as clinical question formulation and online search techniques for performing independent online searches effectively. However, because the findings were based on intermittent opportunistic observations in a specific clinical setting, they may not be generalizable.
    Type of Medium: Online Resource
    ISSN: 2561-326X
    URL: Article
    DOI: 10.2196/30687
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2022
    detail.hit.zdb_id: 2941716-8
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  • 3
    Online Resource
    Online Resource
    The Global Prevalence of Nonalcoholic Fatty Liver Disease and its Association With Cancers: Systematic Review and Meta-Analysis
    JMIR Publications Inc. ; 2023
    In:  Interactive Journal of Medical Research Vol. 12 ( 2023-7-19), p. e40653-
    Details
    In: Interactive Journal of Medical Research, JMIR Publications Inc., Vol. 12 ( 2023-7-19), p. e40653-
    Abstract: 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
    Type of Medium: Online Resource
    ISSN: 1929-073X
    URL: Article
    DOI: 10.2196/40653
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2023
    detail.hit.zdb_id: 2697014-4
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  • 4
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    Online Resource
    Prevalence of Antibiotic-Resistant Pathogenic Bacteria and Level of Antibiotic Residues in Hospital Effluents in Selangor, Malaysia: Protocol for a Cross-sectional Study
    JMIR Publications Inc. ; 2023
    In:  JMIR Research Protocols Vol. 12 ( 2023-5-29), p. e39022-
    Details
    In: JMIR Research Protocols, JMIR Publications Inc., Vol. 12 ( 2023-5-29), p. e39022-
    Abstract: 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
    Type of Medium: Online Resource
    ISSN: 1929-0748
    URL: Article
    DOI: 10.2196/39022
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2023
    detail.hit.zdb_id: 2719222-2
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  • 5
    Online Resource
    Online Resource
    Prevalence of Antibiotic-Resistant Bacteria and Antibiotic-Resistant Genes and the Quantification of Antibiotics in Drinking Water Treatment Plants of Malaysia: Protocol for a Cross-sectional Study
    JMIR Publications Inc. ; 2022
    In:  JMIR Research Protocols Vol. 11, No. 11 ( 2022-11-21), p. e37663-
    Details
    In: JMIR Research Protocols, JMIR Publications Inc., Vol. 11, No. 11 ( 2022-11-21), p. e37663-
    Abstract: Antimicrobial resistance is a known global public health threat. In addition, it brings serious economic consequences to agriculture. Antibiotic resistance in humans, animals, and environment is interconnected, as proposed in the tricycle surveillance by the World Health Organization. In Malaysia, research and surveillance of antimicrobial resistance are mainly performed in clinical samples, agricultural settings, and surface waters, but no surveillance of the drinking water systems has been performed yet. Hence, this policy-driven study is a combined effort of microbiologists and engineers to provide baseline data on the magnitude of antimicrobial resistance in the drinking water systems of Malaysia. Objective The aim of this study was to study the baseline level of antibiotic-resistant bacteria in the drinking water distribution systems of Malaysia by collecting samples from the pretreatment and posttreatment outlets of water treatment plants in a selected state of Malaysia. We aimed to determine the prevalence of antibiotic-resistant bacteria, the occurrence of antibiotic-resistant genes, and the level of antibiotics present in the drinking water systems. Methods This is a laboratory-based, cross-sectional study in a selected state of Malaysia. Water samples from 6 drinking water treatment plants were collected. Samples were collected at 3 sampling points, that is, the intake sampling station, service reservoir outlet station, and the distribution system sampling station. These were tested against 7 types of antibiotics in triplicates. Samples were screened for antibiotic-resistant bacteria and antibiotic-resistant genes and quantified for the level of antibiotics present in the drinking water treatment plants. Results We will show the descriptive statistics of the number of bacterial colonies harvested from water samples grown on Reasoner’s 2A agar with or without antibiotics, the occurrence of antibiotic-resistant genes, and the level of antibiotics detected in the water samples. The sampling frame was scheduled to start from November 2021 and continue until December 2022. Data analysis is expected to be completed by early 2023, and the results are expected to be published in mid-2023. Conclusions This study provides baseline information on the status of the antimicrobial-resistant bacteria, the presence of resistance genes as contaminants, and the level of antibiotics present in the drinking water systems of Malaysia, with the aim of demonstrating to policymakers the need to consider antimicrobial resistance as a parameter in drinking water surveillance. International Registered Report Identifier (IRRID) DERR1-10.2196/37663
    Type of Medium: Online Resource
    ISSN: 1929-0748
    URL: Article
    DOI: 10.2196/37663
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2022
    detail.hit.zdb_id: 2719222-2
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  • 6
    Online Resource
    Online Resource
    Soil-Transmitted Helminth Infection in Malaysia: Protocol for a Scoping Review
    JMIR Publications Inc. ; 2022
    In:  JMIR Research Protocols Vol. 11, No. 10 ( 2022-10-5), p. e36077-
    Details
    In: JMIR Research Protocols, JMIR Publications Inc., Vol. 11, No. 10 ( 2022-10-5), p. e36077-
    Abstract: Soil-transmitted helminth (STH) infection is 1 of the 20 notable neglected tropical diseases according to the Centers for Disease Control and Prevention and World Health Organization. In 2010, it is estimated that 1.73 billion people are infected with STH globally, of which 70% of cases occur in Asia. To date, there is a dearth of published literature on the prevalence of STH infection throughout Malaysia. Objective The objectives of this study are to review research activity on STH infection in Malaysia, to estimate the prevalence of STH infection among Malaysians, and to identify significant risk factors associated with the infection. This review aims to provide the current state of evidence pertaining to STH infections, focusing on the main areas, limitations, and biases of research and mapping out the morbidity distribution of the diseases and their causative agents, and to identify significant risk factors for preventive measures. Methods We will conduct a scoping review based on the 6-stage structured framework developed by Arksey and O’Malley. A comprehensive search strategy focusing on STH infection will be executed using electronic databases (Scopus, PubMed, Web of Science, and Embase). A systematic approach for searching, screening, reviewing, and data extraction will be applied based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Mendeley software and Microsoft Excel will be used to manage the references and to remove duplicates. Relevant data from selected articles will be extracted using a standardized data extraction form. Results A total of 164 potential manuscripts were retrieved. Data extraction is currently in progress and completion is expected by the end of 2022. Conclusions Our scoping review will summarize the current state of research in this field and provide comprehensive information regarding STH infections in Malaysia for future reference. Trial Registration National Medical Research Register NMRR-20-2889-54348; https://nmrr.gov.my/research-directory/e52ea778-d31c-4eb4-9163-a45bb3680bbf International Registered Report Identifier (IRRID) DERR1-10.2196/36077
    Type of Medium: Online Resource
    ISSN: 1929-0748
    URL: Article
    DOI: 10.2196/36077
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2022
    detail.hit.zdb_id: 2719222-2
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