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Pregnancy in patients with end-stage renal disease (ESRD) is considered a very high-risk and is not recommended as it might cause fatal consequences for both the mother and the fetus. Even though chronic kidney disease affects the physiological components of fertility, decreasing the possibility of spontaneous conceptions, unwanted pregnancies still happen, and a small percentage of women with ESRD become pregnant. All women with kidney disease should have access to specialists in renal disease and pregnancy who can support, care for, and monitor them during their pregnancy. We reported a case of a 37-year-old primigravida who has ESRD on hemodialysis. The pregnancy journey was uneasy, but eventually she successfully passed through it. The most challenging issues to treat and manage throughout this pregnancy are anemia, the risks of eclampsia, and uncontrolled hypertension. The management of this patient requires multidisciplinary and shared care monitoring by the nephrologist, obstetrician, and primary care doctor. [ABSTRACT FROM AUTHOR]

The study aimed to determine the prevalence of continuity of illicit drug use and its associated factors among Malay opioid users receiving methadone treatment in Kelantan, Malaysia. This cross-sectional study involved a total of 150 respondents. Sociodemographic characteristic of participants, level of religiosity, and quality of life were collected using the self-administered questionnaires. The prevalence of continuity illicit drug use was 38.7% (n = 58) by self-report and 40.7% (n = 61) by positive urine test result for drugs. Positive hepatitis C status and high quality of life in the psychological health domain were associated with low continuity of illicit drug use by self-reported data and urine drug test results. In conclusion, the continuity of illicit drug use among methadone program users is still high, especially among those on methadone therapy for less than 2 years. [ABSTRACT FROM AUTHOR]

Background. Polycystic ovary syndrome (PCOS) is a disorder in reproductive age women and is characterized by hyperandrogenic anovulation and oligo-amenorrhea, which leads to infertility. Anovulation in PCOS is associated with low follicle-stimulating hormone levels and the arrest of antral follicle development in the final stages of maturation. L-carnitine (LC) plays a role in fatty acid metabolism, which is found to be lacking in PCOS patients. This systematic review and meta-analysis aimed to determine the effectiveness of LC supplementation for patients with PCOS. Methods. Wesearched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information Database (PsycINFO), and the World Health Organization International Clinical Trials Registry Platform for all randomized control trials, comparing LC alone or in combination with other standard treatments for the treatment of PCOS from inception till June 2021. We independently screened titles and abstracts to identify available trials, and complete texts of the trials were checked for eligibility. Data on the methods, interventions, outcomes, and risk of bias from the included trials were independently extracted by the authors. The estimation of risk ratios and mean differences with a 95 percent confidence interval (CI) was performed using a random-effects model. Results. Nine studies with 995 participants were included in this review. Five comparison groups were involved. In one comparison group, LC reduced the fasting plasma glucose (FPG) (mean differences (MD) -5.10, 95% CI [-6.25 to -3.95]; P = 0:00001), serum low-density lipoprotein (LDL) (MD -25.00, 95% CI [-27.93 to -22.07]; P = 0:00001), serum total cholesterol (MD -21.00, 95% CI [-24.14 to -17.86]; P = 0:00001), and serum triglyceride (TG) (MD -9.00, 95% CI [-11.46 to -6.54]; P = 0:00001) with moderate certainty of evidence. Another comparison group demonstrated that LC lowers the LDL (MD -12.00, 95% CI [-15.80 to -8.20]; P = 0:00001), serum total cholesterol (MD -24.00, 95% CI [-27.61 to -20.39]; P D0:00001), and serum TG (MD -19.00, 95% CI [-22.79 to -15.21]; P D0:00001) with moderate certainty of evidence. Conclusion. There was low to moderate certainty of evidence that LC improves Body Mass Index (BMI) and serum LDL, TG, and total cholesterol levels in women with PCOS. [ABSTRACT FROM AUTHOR]

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Background: First-time mothers may experience postnatal depression and a lack of social support, affecting their life satisfaction. However, there is a lack of studies investigating the application of guided antenatal education support programs to deal with such issues. Purpose: The study aimed to evaluate the effects of guided antenatal education support programs on postnatal depression, social support, and life satisfaction among first-time mothers. Methods: This quasi-experimental study involved a total of 72 first-time mothers. Convenience sampling was applied for participant selection, and no randomization was used. The participants were equally divided into the intervention group and the control group. A self-administrated questionnaire was used for data collection during the antenatal period (pretest) and six weeks postpartum (posttest). The risk of postnatal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). In addition, the Multidimensional Scale of Perceived Social Support (MSPSS) and the Satisfaction with Life Scale (SWLS) were used to assess social support, and life satisfaction, respectively. The intervention group received a guided antenatal education support program, consisting of antenatal education sessions plus an extra 15-minute discussion and a support guidebook. The data were analyzed using a paired t-test and an independent t-test. Results: There was a significant reduction in the risk of postnatal depression score in the intervention group (p<0.05) after receiving the guided antenatal education compared to the control group. Also, there was a significant increment of life satisfaction score (p<0.05) and social support score (p<0.05) after receiving guided antenatal education in the intervention group. Conclusion: The guided antenatal education support is beneficial to reduce postnatal depression and increase life satisfaction and social support. Nurses and midwives should provide an integration of psychoeducation for first-time mothers, especially during pregnancy. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the relationship between cardiovascular disease risk and preventive activity-associated factors and shift work in female nurses at a teaching hospital in Peninsular Malaysia. Methods: A cross-sectional study was performed with 180 female nurses older than 40 years old. A self-administered questionnaire was used that had been adapted from the World Health Organization's STEPS instrument. The blood pressure, blood glucose, serum lipids and body mass index readings of each participant were taken to calculate cardiovascular disease risk based on the Framingham Risk Score. Descriptive statistic, simple and multiple logistic regression analyses were performed using SPSS version 22. Results: The proportion of female nurses with a moderate to high cardiovascular disease risk was 30%, while 70% had a low risk. Multiple logistic regression analyses showed that physical inactivity, dietary habits, fewer screenings for diabetes mellitus (DM) and shift work were significantly associated with moderate to high cardiovascular disease risk. Conclusion: The prevalence of moderate to high cardiovascular disease risk among these female nurses at the teaching hospital was 30%. Physical inactivity, an unhealthy diet, fewer screenings for DM and shift work were significantly associated with moderate to high cardiovascular disease risk. These results may be useful in the future as a reference for creating or innovating preventive methods regarding the protection, safety and health of nurses in the workplace. [ABSTRACT FROM AUTHOR]

Adolescent striae are more common in girls. The striae in boys can be misinterpreted as a result of non-accidental injuries such as physical abuses and violence. We reported a case of a 16-year-old boy who presented with multiple linear purplish striae on the upper trunk and both axillae area. The skin lesion was initially interpreted as lesions resulted from physical abuse and bully activities at his school. The parent was concerned about the skin lesions and they thought their son had been assaulted at school. The diagnosis of physiological striae in adolescence was made after excluding other endocrine disorders and related diseases. Further assessment revealed there was no history of recent physical assaulted at his school. This case illustrates that the unfamiliarity with this skin condition can be resulted in misinterpretation of the cases. However, suspiciousness for non-accidental injury is crucial, especially among adolescent groups who are at risk to be involved in the bully activities. The misinterpreted of the adolescent striae may cause stress to the parent or other family members and it has sometimes led to the unnecessary legal acts which might be taken by the protective parent. [ABSTRACT FROM AUTHOR]

Objectives. The objective of the study is to evaluate the chondroprotective activity of Channa striatus (Channa) and glucosamine sulphate (glucosamine) on histomorphometric examinations, serum biomarker, and inflammatory mediators in experimental osteoarthritis (OA) rabbit model. Design. Anterior cruciate ligament transection (ACLT) was performed to induce OA in thirty-three male New Zealand white rabbits and were randomly divided into three groups: Channa, glucosamine, and control group. The control group received drinking water and the Channa and glucosamine groups were orally administered with 51.4 mg/kg of Channa extract and 77.5 mg/kg of glucosamine sulphate in drinking water, respectively, for eight weeks and then sacrificed. The articular cartilage was evaluated macroscopically and histologically using semiquantitative and quantitative methods. Serum cartilage oligomeric matric protein (COMP), cyclooxygenase 2 (COX-2) enzyme, and prostaglandin E2 (PGE2) were also determined. Results. Macroscopic analysis revealed that Channa group have a significantly lower severity grade of total macroscopic score compared to the control (p < 0.001) and glucosamine (p < 0.05) groups. Semiquantitative histology scoring showed that both Channa and glucosamine groups had lower severity grading of total histology score compared to the control group (p < 0.001). In comparison with the control, Channa group had lower histopathological changes in three compartments of the joint compared to glucosamine group which had lower histological scoring in two compartments only. The cartilage thickness, area, and roughness of both Channa (p < 0.05) and glucosamine (p < 0.05) groups were superior compared to the control group. However, the Channa group demonstrated significantly less cartilage roughness compared to the glucosamine group (p < 0.05). Serum COMP levels were lower in both Channa (p < 0.05) and glucosamine (p < 0.05) groups compared to the control group. Conclusion. Both oral administration of Channa extract and glucosamine exhibited chondroprotective action on an ACLT OA-induced rabbit model. However, Channa was superior to glucosamine in maintaining the structure of the cartilage. [ABSTRACT FROM AUTHOR]

Pachydermoperiostosis (PDP), also known as Touraine-Solente-Gole syndrome or primary hypertrophic osteoarthropathy, is a very rare disease mainly characterized by pachyderma, finger clubbing, hyperhidrosis, and periostosis. We reported a case of a patient who suffered from gradual pain and enlargement of both hands and feet for 25 years despite receiving treatment from multiple clinics. He also experienced gradual abnormal changes in his face and scalp. Radiographic images of the lower limbs revealed the presence of subperiosteal bone growth and periosteal hypertrophy. The diagnosis of complete PDP was made late due to its rarity and the unfamiliarity of medical practitioners with the diagnosis. This case highlighted the need for medical practitioners to be aware of rare diseases so that patients may be diagnosed and treated earlier and thereby relieving their anxiety and improve their quality of life. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) and pneumonia are among the top-10 global causes of death worldwide. Many studies highlight the diagnosis delay of TB in patients with an initial presentation of pneumonia. We present a case of a 16-year-old boy who complains of a productive cough associated with blood-streaked sputum for one-month duration. Having pulmonary tuberculosis (PTB) contact three years ago puts him at risk of a similar infection. Despite the episodes of missed appointments in serial follow-ups, we were ultimately able to exclude PTB in this patient. [ABSTRACT FROM AUTHOR]

Background: Every pregnancy faces unpredictable complications and risks associated with the risk of maternal morbidity, mortality, and neonatal complications. The aim of the study is to determine birth preparedness and complication readiness (BPCR) among antenatal women and their determinants. Methods: The involved a total of 100 pregnant women at a public university hospital in Kelantan state, Malaysia. A self-administered questionnaire was used for data collection. Results: A total of 47.0% of participants were well prepared for their birth and its complications. There were no associations between being well prepared for birth and its complications with parity, gestational age, the total number of antenatal visits, or other sociodemographic data. Conclusion: BPCR among women were still low among women in Kelantan. Knowledge of the danger signs during pregnancy, labor, and the postnatal period among pregnant women is important to reduce maternal mortality. [ABSTRACT FROM AUTHOR]

Kratom is a botanical plant product that is used around the world, particularly in Southeast Asia. It is believed that it has potential benefits as a painkiller and for relieving fatigue. Specifically, kratom can produce an opioid effect, which makes it addictive. We report a 26-year-old man who presented to the clinic for treatment of kratom use disorder. He was willing to be treated because he could no longer withstand the withdrawal effect and the financial cost of his addiction. Our team successfully initiated treatment using buprenorphine-naloxone (suboxone) in pill form to treat his kratom use disorder. The patient also received non-pharmacological treatment such as psychoeducation, psychotherapy, and motivational interviews. He was successfully treated with suboxone and within a week he was kratom free and happy. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovary syndrome (PCOS) is a disorder in reproductive age women and is characterized by hyperandrogenic anovulation and oligo-amenorrhea, which leads to infertility. Anovulation in PCOS is associated with low follicle-stimulating hormone levels and the arrest of antral follicle development in the final stages of maturation. L-carnitine (LC) plays a role in fatty acid metabolism, which is found to be lacking in PCOS patients. This systematic review and meta-analysis aimed to determine the effectiveness of LC supplementation for patients with PCOS., Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information Database (PsycINFO), and the World Health Organization International Clinical Trials Registry Platform for all randomized control trials, comparing LC alone or in combination with other standard treatments for the treatment of PCOS from inception till June 2021. We independently screened titles and abstracts to identify available trials, and complete texts of the trials were checked for eligibility. Data on the methods, interventions, outcomes, and risk of bias from the included trials were independently extracted by the authors. The estimation of risk ratios and mean differences with a 95 percent confidence interval (CI) was performed using a random-effects model., Results: Nine studies with 995 participants were included in this review. Five comparison groups were involved. In one comparison group, LC reduced the fasting plasma glucose (FPG) (mean differences (MD) -5.10, 95% CI [-6.25 to -3.95]; P  = 0.00001), serum low-density lipoprotein (LDL) (MD -25.00, 95% CI [-27.93 to -22.07]; P  = 0.00001), serum total cholesterol (MD -21.00, 95% CI [-24.14 to -17.86]; P  = 0.00001), and serum triglyceride (TG) (MD -9.00, 95% CI [-11.46 to -6.54]; P  = 0.00001) with moderate certainty of evidence. Another comparison group demonstrated that LC lowers the LDL (MD -12.00, 95% CI [-15.80 to -8.20]; P  = 0.00001), serum total cholesterol (MD -24.00, 95% CI [-27.61 to -20.39]; P  = 0.00001), and serum TG (MD -19.00, 95% CI [-22.79 to -15.21]; P  = 0.00001) with moderate certainty of evidence., Conclusion: There was low to moderate certainty of evidence that LC improves Body Mass Index (BMI) and serum LDL, TG, and total cholesterol levels in women with PCOS., Competing Interests: Norhayati Mohd Noor is an Academic Editor for PeerJ., (©2022 Mohd Shukri et al.)

Objective: To determine the effects of coenzyme Q10 (CoQ10) for reduction in the severity, frequency of migraine attacks and duration of headache in adult patients with migraine., Design: Systematic review and meta-analysis., Data Sources: Cochrane Central Register of Controlled Trials, CENTRAL, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Psychological Information Database (PsycINFO) from inception till December 2019., Study Selection: All randomised control trials comparing CoQ10 with placebo or used as an adjunct treatment included in this meta-analysis. Cross-over designs and controlled clinical trials were excluded., Data Synthesis: Heterogeneity at face value by comparing populations, settings, interventions and outcomes were measured and statistical heterogeneity was assessed by means of the I 2 statistic. The treatment effect for dichotomous outcomes were using risk ratios and risk difference, and for continuous outcomes, mean differences (MDs) or standardised mean difference; both with 95% CIs were used. Subgroup analyses were carried out for dosage of CoQ10 and if CoQ10 combined with another supplementation. Sensitivity analysis was used to investigate the impact risk of bias for sequence generation and allocation concealment of included studies., Results: Six studies with a total of 371 participants were included in the meta-analysis. There is no statistically significant reduction in severity of migraine headache with CoQ10 supplementation. CoQ10 supplementation reduced the duration of headache attacks compared with the control group (MD: -0.19; 95% CI: -0.27 to -0.11; random effects; I 2 statistic=0%; p<0.00001). CoQ10 usage reduced the frequency of migraine headache compared with the control group (MD: -1.52; 95% CI: -2.40 to -0.65; random effects; I 2 statistic=0%; p<0.001)., Conclusion: CoQ10 appears to have beneficial effects in reducing duration and frequency of migraine attack., Prospero Registration Number: CRD42019126127., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Body image is associated with the perception of people on themselves. Influencing factors are generated internally and/or externally. The most common issue pertaining to body image is body weight and weight loss. This study aimed to determine the association between body weight perception and weight loss practices among college students., Methods: A cross-sectional study was conducted involving 297 college students from private nursing colleges in the state of Kelantan, Malaysia. A self-administered questionnaire was used to assess sociodemographic characteristics, body weight perception, and weight loss methods. Weight and height were measured, and body mass index (BMI) was calculated based on weight and height measurement. The World Health Organization BMI cutoffs were applied in the study., Results: More than half (54.2%) of college students perceived their weight correctly as per actual measured BMI. A total of 51.5% of participants had tried various methods to reduce their weight. Body weight perception is associated with weight loss practices (odds ratio, 0.31; 95% confidence interval, 0.19-0.50; P<0.001) adjusted for sex, marital status, and status of having obese family members. Those who had correct body weight perception were less likely to engage in weight loss practice. Food intake restriction (42.4%) is the most popular weight reduction method among students in nursing colleges. Over a quarter of the participants chose physical exercise (25.3%) to reduce their weight, and a small number engaged in unhealthy weight loss practices., Conclusion: Body weight perception is an important factor that influences the practice to reduce weight especially among young adult group and college students.

Fixed cutaneous sporotrichosis is a differential diagnosis that can be considered in diabetic patients who present with a poorly healing ulcer. Although its prevalence is low, it can occur in patients with immunocompromised status. Here we report a case of a 70-year-old man with diabetes mellitus who presented with a 1-month history of an unhealed ulcer over the tip of his left middle finger. He experienced a cat bite over his left middle finger 1 month prior to the appearance of the lesion. A skin biopsy revealed the presence of Sporothrix schenckii . Oral itraconazole 200 mg twice daily was started empirically and the patient showed marked improvement in the skin lesion after 2 months of therapy., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

Psychiatric symptoms may be related to a silent cerebral infarct, a phenomenon that has been described previously in literature. Acute psychosis or other neuropsychiatric symptoms including depression may present in stroke patients and patients with lesions either within the prefrontal or occipital cortices, or in subcortical areas such as the basal ganglia, thalamus, mid-brain, and brainstem. Psychosis in clinical stroke or in silent cerebral infarction is uncommon and not well documented in the literature. Neurological deficits are the most common presentation in stroke, and nearly a third of patients that suffer a stroke may experience psychological disorders such as depression and anxiety, related to physical disability. The present case report describes an elderly female patient who presented with hallucinations and depressive symptoms, and was discovered to have a recent right frontal brain infarction, without other significant neurological deficits., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.