Context Ketogenic diet has recently made a comeback as a part of lifestyle and dietary modifications in patients with polycystic ovary syndrome (PCOS). Despite studies suggesting its beneficial effects in reversing hormonal imbalance in women with PCOS, evidence has been patchy and derived from small populations under varying conditions. Objective To pool evidence from clinical trials to study the effects of ketogenic diet on reproductive hormones (LH/FSH ratio, free testosterone, serum progesterone) and observe evidence of weight change. Methods PubMed, ScienceDirect, Scopus, and Web of Science core collection were searched for clinical trials evaluating the effects of ketogenic diet in established PCOS women consistent with the Rotterdam classification. Single- or double-arm studies that included an outcome of interest were included. Two investigators worked independently to screen potential articles and a designated investigator extracted data on study characteristics and evaluated the outcomes. Data were pooled using a random-effects model. The quality of selected studies was assessed using the Cochrane Risk of Bias Tool. Results Following ≥45 days of intervention with ketogenic diet among women with PCOS, significant improvement was observed in reproductive hormone levels, with reduced LH/FSH ratio (d −0.851; 95% CI −1.015, −0.686; P < .001), reduced serum free testosterone (d −0.223; 95% CI −0.328, −0.119; P < .001), and an increased in serum sex hormone binding globulin (SHBG) (d 9.086; 95% CI 3.379, 14.792; P = .002). Significant weight loss was unanimously observed in all included studies (d −11.56; 95% CI −14.97, −8.15; P < .001). Conclusion Short-term ketogenic diet potentially improved hormonal imbalances commonly associated with PCOS.

Kratom is a plant homogenous to Southeast Asia with a long history of traditional use as medicinal herbs. However, recent years have witnessed its pervasive infiltration into international audience with growing public health concern. This cross-sectional study was conducted from 1 August 2017 till 31 August 2018 aiming to explore the practice and perspectives of kratom use and misuse among adolescents in northwest Malaysia. The study involved a self-administered questionnaire that was designed for the purpose of the study. The instrument had undergone prior validation process with a good overall internal reliability for the knowledge domain (Cronbach’s alpha = 0.728) and attitude domain (Cronbach’s alpha = 0.700). The questionnaire was distributed to 135 respondents involving adolescents aged 13 to 19 years old via convenience (non-kratom user) and snowball sampling (kratom users). There were 65 (47.8%) kratom users, while 70 (51.5%) were kratom-naïve. Among the kratom users, peer influence was the most common reason for them to be first involved with kratom, 26 (41.3%) whereas the reasons for kratom use quoted were to improve physical stamina, 10 (16.4%), as painkiller, 9 (14.8%), and to be accepted by peers, 7 (11.5%). Multiple logistic regression found that older age (95% CI: 0.13, 0.58; p = 0.001) and being active smokers (95% CI: 39.33, 980.63; p < 0.001) significantly predict kratom use among adolescents. The emerging trend of kratom abuse and misuse especially among the younger generation in Malaysia is raising concern and warrants social and governmental vigilance.

Background: Routine human papillomavirus (HPV) vaccine uptake continues to be suboptimal since its recommendation in 2006 for girls and in 2011 for boys. This paper aims to review published quality improvement (QI) methodologies on interventions to improve HPV vaccine uptake among adolescents. Methods: Science Direct and Scopus databases were searched for QI initiatives evaluating the effect of multimodal interventions to improve HPV vaccination rates (initiation and/or completion of series) among adolescents. Studies that included an outcome of interest among adolescents aged 10 to 18 years old were included. Two investigators worked independently to screen for potential articles and a designated investigator extracted data on study characteristics and evaluated the outcomes. Results: A preliminary search yielded a total of 523 articles and 13 were included in the final analysis. Common strategies were provider-specific (i.e., webinar, telementoring, train-the-trainer approach) and patient- and/or parent-specific interventions (i.e., reminder emails, phone calls and text messages, social events), with an emphasis on education and knowledge empowerment. System-level interventions such as policy changes and revised protocols were less commonly prescribed despite being associated with a more significant weight on the overall outcome. Conclusions: Creative, sustainable, and economical multilevel interventions that focus not only on provider training and public education but also incorporate local policies and system enhancements can substantially improve HPV vaccination coverage among adolescents.

Background: Per oral methadone maintenance therapy [MMT] was introduced as part of harm reduction strategy to manage rising numbers of HIV infections caused by intravenous use of illicit drugs. Method: We aim to review published articles related to the side effects of long-term methadone therapy, focusing on hematological derangements in human studies published between 1 January 2000 till 31 January 2021. Results: Our search databases include Web of Science, Scopus, and Medline. Our search yielded 971 articles, of which 55 articles were related to the effects of MMT on various organ systems: cardiovascular [n=12], respiratory [n=1], endocrine [n=10], central nervous system [n=12], neurobehavioral [n=10], gastrointestinal [n=1], and bone [n=1]. There were eight articles specifically related to the hematological side effects of chronic methadone therapy that include [i] immune system hyperactivation, [ii] reduced circulating lymphocytes, and [iii] increased blood viscosity. Conclusion: In view of all foreseeable health risks seen with prolonged methadone therapy, pharmacological modulation is warranted to find a better substitute for managing patients with opioid dependence.

Background: Routine human papillomavirus (HPV) vaccine uptake continues to be suboptimal since its recommendation in 2006 for girls and in 2011 for boys. This paper aims to review published quality improvement (QI) methodologies on interventions to improve HPV vaccine uptake among adolescents; Methods: Science Direct and Scopus databases were searched for QI initiatives evaluating the effect of multimodal interventions to improve HPV vaccination rates (initiation and/or completion of series) among adolescents. Studies that included an outcome of interest among adolescents aged 10 to 18 years old were included. Two investigators worked independently to screen for potential articles and a designated investigator extracted data on study characteristics and evaluated the outcomes; Results: Preliminary search yielded a total of 523 articles and 13 were included in the final analysis. Common strategies were provider-specific and patient- and/or parent-specific interventions, with an emphasis on education and knowledge empowerment. System-level interventions such as policy changes and revised protocol were less commonly prescribed despite being associated with more significant weight on the overall outcome; Conclusions: Creative, sustainable, and economical multilevel interventions that focus not only on provider training and public education but also incorporate local policy and system enhancement can substantially improve HPV vaccination coverage among adolescents.