Epidemiology of multidrug-resistant Klebsiella pneumoniae infection in clinical setting in South-Eastern Asia: a systematic review and meta-analysis.

The rising prevalence of multidrug-resistant (MDR) and extended-spectrum beta lactamase-resistant (ESBL) Klebsiella pneumoniae (K. pneumoniae) is an important global public health challenge. This threat is even more pertinent in clinical settings. Morbidity and mortality associated with this condition are alarming particularly in the developing regions of the world. A comprehensive evaluation of the epidemiology of this phenomenon will assist towards the global effort of reducing its burden. So, this systematic review and meta-analysis was conducted to evaluate the epidemiology of MDR K. pneumoniae in South-Eastern Asia (SEA). The study was done under the PRISMA guidelines and was preceded by the development of a priori protocol. The protocol was then registered in PROSPERO-the public registry for systematic reviews. Seven important outcomes which include the assessment of the overall MDR K. pneumoniae prevalence were designed to be evaluated. A literature search was carried out in five selected electronic databases and 4389 were screened. Of these articles, 21 studies that met the eligibility criteria were included in the review. Relevant data were extracted from the included studies. By conducting a quality effect meta-analysis, the pooled prevalence for MDR and ESBL K. pneumoniae in SEA was estimated at 55% (CI 9-96) and 27% (CI 32-100) respectively. The review also identified ESBL genes types of allodemic situations occurring mostly in respiratory tract infections. The high prevalence of MDR and ESBL K. pneumoniae in this subregion is highly significant and of both public health and clinical relevance. Overall, the findings of this review will assist in the effective prevention and control of this threat in SEA.

Meta-analysis and moderator analysis of the seroprevalence of hepatitis E in South-Eastern Asia.

By 2030, the World Health Organization wants to decrease viral hepatitis incidence and mortality by 90% and 65%, respectively. One of the agents responsible for the increased burden of viral hepatitis is the hepatitis E virus (HEV). This emerging pathogen is prevalent worldwide causing both acute and chronic infection. The rising risk profile of HEV has become a source of increased global public health concern. Despite this challenge, South-Eastern Asia (SEA), where many at-risk people are found, lacks uniform HEV prevalence data. Therefore, a meta-analysis was conducted to assess the overall prevalence of hepatitis E in SEA. Using R statistical software, a random effect model was used to estimate the logit-transformed prevalence. Moderator analyses were used to investigate the potential sources of variation. Thirty-two studies comprising 29,944 with 6806 anti-HEV antibody-positive individuals were evaluated. The overall HEV seroprevalence in SEA was 21% (95% confidence interval [CI]: 17-27) with high heterogeneity. At the country level, Laos has the highest prevalence estimate of 39% (CI: 16-69). Also, the studied population, year of publication, duration of sampling, and diagnostic method are significant HEV prevalence predictors accounting for 22.61% of the observed heterogeneity. The high HEV prevalence found in this study necessitates coordinated national and regional efforts to combat this emerging disease.

Systematic review and meta-analysis of tuberculosis in animals in Nigeria.

Animal tuberculosis (TB) is a contagious and chronic disease caused by mycobacteria belonging to theMycobacterium tuberculosis complex (MTBC) in domestic and wild animals. MTBC strains infection has been confirmed in many animal species in Nigeria, including captive wildlife, cattle, dromedary camels, goats, and pigs. Despite widespread infection and the potential impact of the disease on public health, active surveillance and control strategies are absent in Nigeria. This study aimed to conduct the first comprehensive meta-analysis to assess the distribution of tuberculosis and analyze the potential moderators of infection in animals in Nigeria. Eligible studies (sixty-one (Cadmus et al., 2014) [61] prevalence and seven (Menzies and Neill, 2000) [7] case reports) were retrieved and included in the analysis. The analyses showed an overall pooled TB prevalence of 7.0% (95% CI: 6.0-8.0) comprising of infection distributed in cattle (8.0%, 95% CI: 7.0-8.0), goats (0.47%, 95% CI: 0-1.2), sheep (0.27%, 95% CI: 0.14-0.46), camels (13.0%, 95% CI: 0-47), and wildlife (13.0%, 95% CI: 9-16) respectively. The occurrence of infection was significantly moderated by the publication periods, geographical location, sample size, and detection methods. TB prevalence was heterogeneous across several predictors, with the year of publication exhibiting a higher rate (46%) of the detected heterogeneity. These findings should provide policy-relevant information to guide the design and establishment of prevention and control measures amenable to the local situations in Nigeria.

Apolipoprotein L1 gene variants and kidney disease in patients with HIV: a systematic review and meta-analysis.

BACKGROUND: The risk of various types of kidney disease is significantly increased in the presence of APOL1 high-risk genotype (carriage of two risk alleles), particularly HIV-associated nephropathy (HIVAN). However, there are discrepancies in the existing evidence about the level of association between APOL1 high-risk genotype and the risk of kidney diseases in people living with HIV (PLWHIV). METHODS: This systematic review and meta-analysis was conducted to assess the relationship between the APOL1 genotypes and kidney disease in the HIV population. An a priori protocol registered on PROSPERO (ID: CRD42021253877), was followed by a systematic search of five electronic databases. Database-specific search terms were used to identify observational studies that evaluated the outcomes chosen in the review, based on a set of prespecified eligibility criteria. Using a random effect model, the odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were pooled for the meta-analysis. RESULTS: After screening 4418 citations, 14 articles comprising 11,069 participants were included in this review. The risk of chronic kidney disease (CKD) in the HIV positive population was significantly increased in the presence of two APOL1 risk alleles (OR 4.65 [95% CI 3.51-6.15]). Also, a significant association was observed between the carriage of two risk APOL1 variants and proteinuria (OR 2.58 [95% CI 2.05-3.25]), HIVAN (OR 16.67 [95% CI 10.22-27.19]), and progression to end-stage kidney disease (ESKD) hazard ratio: 1.79 (95% CI 1.20-2.66). CONCLUSION: This review highlights a strong association between the presence of two risk APOL1 variants and an increased risk of kidney disease in PLWHIV, and provides a more precise estimate of the effect size, with smaller 95% CIs for CKD, HIVAN, and progression to ESKD.

Systematic review and meta-analysis of the efficacy and safety of oseltamivir (Tamiflu) in the treatment of Coronavirus Disease 2019 (COVID-19).

Efforts are ongoing by researchers globally to develop new drugs or repurpose existing ones for treating COVID-19. Thus, this led to the use of oseltamivir, an antiviral drug used for treating influenza A and B viruses, as a trial drug for COVID-19. However, available evidence from clinical studies has shown conflicting results on the effectiveness of oseltamivir in COVID-19 treatment. Therefore, this systematic review and meta-analysis was performed to assess the clinical safety and efficacy of oseltamivir for treating COVID-19. The study was conducted according to the PRISMA guidelines, and the priori protocol was registered in PROSPERO (CRD42021270821). Five databases were searched, the identified records were screened, and followed by the extraction of relevant data. Eight observational studies from four Asian countries were included. A random-effects model was used to pool odds ratios (ORs), mean differences (MD), and their 95% confidence intervals (CI) for the study analysis. Survival was not significantly different between all categories of oseltamivir and the comparison groups analysed. The duration of hospitalisation was significantly shorter in the oseltamivir group following sensitivity analysis (MD -5.95, 95% CI -9.91--1.99 p = 0.003, heterogeneity I2 0%, p = 0.37). The virological, laboratory and radiological response rates were all not in favour of oseltamivir. However, the electrocardiographic safety parameters were found to be better in the oseltamivir group. However, more studies are needed to establish robust evidence on the effectiveness or otherwise of oseltamivir usage for treating COVID-19.

A systematic review and meta-analysis of the prevalence of Listeria monocytogenes in South-East Asia; a one-health approach of human-animal-food-environment.

Listeria monocytogenes is an important foodborne intracellular pathogen. The pathogen is the primary cause of human Listeriosis. The main source of human Listeriosis is through consumption of contaminated food products. Other modes of transmission include zoonotic and vertical transmission. The disease often presents in a mild form, but severe and fatal cases, as well as outbreaks, may occur. Despite these challenges, there has been little attempt at enumerating the burden of the disease in countries of Southeast Asia (SEA) and some developing countries. Thus, this study investigated the prevalence of L. monocytogenes in SEA using one health approach through a systematic review and meta-analysis (SR&MA) of the existing literature. In accordance with the PRISMA guidelines, an a priori protocol for the SR&MA was developed and registered in PROSPERO (ID=CRD42021288903). A systematic search of four electronic databases was performed for relevant citations. The identified publications were screened, and 17 studies were included in the review from where data was extracted. The pooling of the prevalence estimate (with the 95% confidence interval [CI]) was done using the random effect model by employing the double transformed arcsine method using MetaXL software. The overall determined prevalence for L. monocytogenes in SEA (in food, animal, and environmental sources) was 16% (95% confidence interval [CI]: 10-23). Further subgroup analysis revealed ready-to-eat food of vegetable origin with the highest prevalence of 21% (CI: 6-41). Also, seven virulence genes were identified to be prevalent in the subregion. The commonest identification method was found to be the polymerase chain reaction (PCR). The knowledge of the high prevalence of L. monocytogenes in SEA is relevant for informed decision making by clinicians, public health practitioners, and policymakers. To achieve the goal of the effective control and prevention of the disease in the subregion.

Hepatitis E Virus: An emerging enigmatic and underestimated pathogen.

Hepatitis E virus (HEV) is an RNA virus causing hepatitis E disease. The virus is of one serotype but has diverse genotypes infecting both humans and animals. Based on evidence from seroprevalence studies, about 2 billion people are estimated to have been infected with HEV globally. HEV, therefore, poses a significant public health and economic challenge worldwide. HEV was discovered in the 1980s and was traced back to the 1955 - 1956 outbreak of hepatitis that occurred in India. Subsequently, several HEV epidemics involving thousands of individuals have occurred nearly annually in different countries in Asia and Africa. Initially, the virus was thought to be only enterically transmitted, and endemic in developing countries. Due to the environmental hygiene and sanitation challenges in those parts of the world. However, recent studies have suggested otherwise with the report of autochthonous cases in industrialised countries with no history of travel to the so-called endemic countries. Thus, suggesting that HEV has a global distribution with endemicity in both developing and industrialised nations. Studies have also revealed that HEV has multiple risk factors, and modes of transmission as well as zoonotic potentials. Additionally, recent findings have shown that HEV leads to severe disease, particularly among pregnant women. In contrast to the previous narration of a strictly mild and self-limiting infection. Studies have likewise demonstrated chronic HEV infection among immunocompromised persons. Consequent to these recent discoveries, this pathogen is considered a re - emerging virus, particularly in the developed nations. However, despite the growing public health challenges of this pathogen, the burden is still underestimated. The underestimation is often attributed to poor awareness among clinicians and a lack of routine checks for the disease in the hospitals. Thus, leading to misdiagnosis and underdiagnosis. Hence, this review provides a concise overview of epidemiology, diagnosis, and prevention of hepatitis E.

A systematic review of the epidemiology of Hepatitis E virus infection in South - Eastern Asia.

Hepatitis E virus (HEV) infection is an emerging zoonotic viral disease, with an increasingly international public health challenge. Despite the concerns that the global disease burden may be underestimated. Therefore, evaluation of the disease epidemiology in South - eastern Asia through a systematic review will assist in unraveling the burden of the disease in the subregion. A priori protocol was prepared for the systematic review and followed by a literature search involving five electronic databases. Identified publications were screened for high quality studies and the elimination of bias and relevant data extracted. A total of 4157 citations were captured, and only 35 were included in the review. A wide range of HEV seroprevalence was recorded from 2% (urban blood donors in Malaysia) to 77.7% (lowland communities in Lao PDR). Sporadic HEV infection and epidemics were also detected in the subregion. Indicating hyperendemicity of the disease in South - eastern Asia.