Browse publications by year: 2013

  1. Chew B, Ramli A, Omar M, Ismail I
    Malays Fam Physician, 2013;8(2):15-25.
    PMID: 25606277 MyJurnal
    AIM: This study aimed to examine the relationship between personal or work-based characteristics and job satisfaction and motivation in Malaysian primary healthcare professionals.

    METHODS: This was a cross-sectional survey conducted during the 15th Family Medicine Scientific Conference in June 2011 using the Warr-Cook-Wall scales. The questionnaires included demography and work-related items and were self-distributed and returned at the end of the conference. Independent risk factors were identified using multiple linear regressions.

    RESULTS: A total of 149 conference participants completed the survey, with a response rate of 33.1%. They were mainly females (85.2%), Malay (83.2%), and married (83.9%) in almost equal proportions of practice location (urban 57.8% and rural 42.2%). Majority of them were working at community-based health clinics (74.0%) and in public sectors (94.4%). The respondents were mainly doctors (91.4%). The mean age of the participants was 39.1 years (SD 8.0), with a mean duration of service of 9 years (SD 6.9). Family medicine specialty (FMSt) residents had lower job satisfaction (B = -8.0, 95% CI -14.61 to -1.40, p = 0.02). Family medicine specialists (FMSs) had higher satisfaction with working conditions (B = 1.95, 95% CI 0.50 to 3.41, p = 0.01). A male worker had on average 2.8 (95% CI -4.7 to -0.9, p = 0.005) lower points in the total intrinsic job motivation scale. There was a positive relationship between the duration of working and job motivation (B = 0.10, 95% CI 0.004 to 0.2, p = 0.04).

    CONCLUSION: FMSt residents might have the least job satisfaction, but FMSs were generally satisfied with their working conditions regardless of the location of their clinics. Men and those who were novice in primary healthcare may need more support for motivation.

  2. Lai NM
    Malays Fam Physician, 2013;8(2):7-12.
    PMID: 25606275 MyJurnal
    Evidence-based medicine (EBM) was introduced to provide an organised approach to clinicians and other health care providers in using research to care for their patients[1]. By highlighting the importance of research in patient care, EBM has also provided many researchers a strong sense of purpose, with increased awareness that their everyday activities are being recognised as relevant to patient care. Most medical schools have some form of the EBM training programme at undergraduate and postgraduate levels, and many researchers, clinical epidemiologists, and biostatisticians together with clinicians are actively engaged in teaching EBM to students of medicine and other health sciences. However, the flourishing activities of EBM education bring along
    challenges.
    MeSH terms: Patient Care; Health Personnel; Humans; Research; Research Personnel; Schools, Medical; Students; Evidence-Based Medicine
  3. Rohaizam J, Irfan M
    Malays Fam Physician, 2013;8(1):53-54.
    PMID: 25606272 MyJurnal
    A 57-year old woman presented with acute bleeding from the left ear associated with reduced hearing and tinnitus. She also complained of redness and discomfort of her left eye; but there was no visual loss. A day before, she was slapped on the left side of her face. Previously, she did not have any hearing or visual problem.
    MeSH terms: Face; Female; Hearing; Hearing Tests; Humans; Tinnitus; Hearing Loss
  4. Koh KC
    Malays Fam Physician, 2013;8(1):50-52.
    PMID: 25606271 MyJurnal
    A 27-year old Nepali man presented with a four-day history of fever, vomiting and horizontal diplopia. There was no history of trauma. The patient has esotropia of the left eye or what is commonly known as a squint or strabismus. The squint is an inward squint (synonyms include convergent squint or esodeviation of the eye). Esotropia is a condition where either one or both eyes are turned inward. Congenital esotropia, often seen in infants below six years old, may give rise to amblyopia. Accommodative esotropia is common among patients with moderate amounts of
    hypermetropia or hyperopia. Esotropias can be concomitant, where the degree of deviation is independent of the direction of the gaze, or incomitant, where the degree of deviation is influenced by the direction of the gaze. This patient had incomitant esotropia as the squint was revealed when he was asked to look to the left. A comprehensive step-bystep approach to a patient presenting with a squint has been described extensively in literature.
    MeSH terms: Amblyopia; Diplopia; Esotropia; Eye; Humans; Hyperopia; Infant; Male; Strabismus; Vomiting
  5. Adawiyah J, Leelavathi M
    Malays Fam Physician, 2013;8(1):48-49.
    PMID: 25606270 MyJurnal
    A five-year-old boy presented with a six-week history of scales, flaking and crusting of the scalp. He had mild pruritus but no pain. He did not have a history of atopy and there were no pets at home. Examination of the scalp showed thick, yellowish dry crusts on the vertex and parietal areas and the hair was adhered to the scalp in clumps. There was non-scarring alopecia and mild erythema. There was no cervical or occipital lymphadenopathy. The patient’s nails and skin in other parts of the body were normal.
    MeSH terms: Alopecia; Cicatrix; Erythema; Hair; Humans; Lymphatic Diseases; Male; Nails; Pain; Pruritus; Scalp; Skin
  6. Yusuf Muharam M, Ahmad R, Harmy M
    Malays Fam Physician, 2013;8(1):45-7.
    PMID: 25606269 MyJurnal
    Patients with Wellen's syndrome often present with chest pain and found to have specific precordial T-wave changes on the electrocardiogram (ECG). They subsequently develop a large anterior wall myocardial infarction. These specific electrocardiographic abnormalities are associated with critical stenosis of the proximal left anterior descending coronary artery (LAD). This syndrome is often under-recognised and has fatal consequences; it is, therefore, also known as the widow maker. We highlight a case of a 39-year old gentleman who had a history of coronary artery disease and typical ECG characteristics of Wellen's syndrome.
  7. Mohamad I, Arul Arumugam P
    Malays Fam Physician, 2013;8(1):42-4.
    PMID: 25606268 MyJurnal
    This is a case report of an 11-year old child who was suffering from rhinorrhoea for five years. As there was no history of foreign body insertion into the nose, the diagnosis of a nasal problem was not suspected. Furthermore, the initial presentation of unilateral rhinorrhoea (nasal discharge) masked the suspicion of other pathologies. The child was treated for allergic rhinitis until she presented herself to our attention whereby a rhinoscopy was performed, showing a rhinolith.
    MeSH terms: Attention; Child; Endoscopy; Female; Foreign Bodies; Humans; Nose; Nose Diseases; Rhinitis, Allergic
  8. Haizul I, Umi Kalthum M
    Malays Fam Physician, 2013;8(1):38-41.
    PMID: 25606267 MyJurnal
    PURPOSE: To report a case of pansinusitis after swimming in a common pool.

    CASE REPORT: Acute sinusitis is ranked the fifth-most common indication for antibiotic prescriptions.2 Although sinusitis is often diagnosed clinically, cases that are resistant to conventional antibiotic therapy or recurrent cases may require diagnostic imaging in order to confirm the diagnosis. The complications of sinusitis, though rare, may lead to serious consequences if not diagnosed and treated early. We report a 33-year old man with pansinusitis presenting with a sudden onset of peripheral gaze diplopia associated with progressive frontal headache. His symptom resolved completely after he was given intravenous antibiotics and a nasal decongestant.

  9. Azhany Y, Hemalatha C, Nani D, Rosediani M, Liza-Sharmini A
    Malays Fam Physician, 2013;8(1):33-7.
    PMID: 25606266 MyJurnal
    Cataract is the most common cause of blindness in the world. An attack of phacolytic and phacomorphic glaucoma as a result of neglected cataract constitutes a medical emergency that must be addressed immediately. Ocular emergencies such as these is challenging for the surgeon with guarded or poor prognosis. We describe the presentation, management and prognosis of three cases of phacomorphic and phacolytic glaucoma. All three patients underwent aggressive management of intraocular pressure. Despite successful cataract operation with implantation of intraocular lens, there was only mild improvement of the vision. Optic nerve and pupil functions were permanently affected following the insult. Phacomorphic and phacolytic glaucoma present a very challenging problem to the surgeon with poor visual outcome. Public health education and awareness are important and health workers should encourage patients with cataract to seek early treatment for better prognosis.
    MeSH terms: Cataract; Emergencies; Glaucoma; Health Education; Humans; Intraocular Pressure; Lenses, Intraocular; Optic Nerve; Prognosis; Pupil; Tonometry, Ocular; Vision, Ocular; Surgeons
  10. Irmi Z, Zaiton A, Faezah H
    Malays Fam Physician, 2013;8(1):24-7.
    PMID: 25606264 MyJurnal
    Reactive arthritis and erythema are uncommon presentations of tuberculosis (TB). Reactive arthritis in tuberculosis (TB) is known as Poncet's disease, a rare aseptic form of arthritis observed in patients with active TB. We report a case of Poncet's disease in a 20-year old man whose reactive arthritis overshadowed other clinical symptoms of TB resulting in delayed diagnosis and treatment. Although a conclusive diagnosis of Poncet's disease is not possible, reactive immunologic reactions such as reactive arthritis and erythema nodosum even without respiratory symptoms should raise suspicion on possible TB. Thus, taking a thorough medical history as well as performing relevant examinations and investigations for possible TB will help expedite the diagnostic process.
    MeSH terms: Adult; Erythema; Erythema Nodosum; Humans; Malaysia; Male; Outpatient Clinics, Hospital; Tuberculosis; Arthritis, Reactive; Immune System Phenomena; Young Adult; Delayed Diagnosis
  11. Tan CE, Loh KY
    Malays Fam Physician, 2013;8(1):20-3.
    PMID: 25606263 MyJurnal
    Pruritus is a lesser known symptom of hyperthyroidism, particularly in autoimmune thyroid disorders. This is a case report of a 27-year-old woman who presented with generalised pruritus at a primary care clinic. Incidental findings of tachycardia and a goiter led to the investigations of her thyroid status. The thyroid function test revealed elevated serum free T4 and suppressed thyroid stimulating hormone levels. The anti-thyroid antibodies were positive. She was diagnosed with Graves' disease and treated with carbimazole until her symptoms subsided. Graves' disease should be considered as an underlying cause for patients presenting with pruritus. A thorough history and complete physical examination are crucial in making an accurate diagnosis. Underlying causes must be determined before treating the symptoms.
    MeSH terms: Adult; Humans; Hyperthyroidism*; Malaysia; Pruritus*
  12. Yunus A, Seet W, Md Adam B, Jamaiyah H
    Malays Fam Physician, 2013;8(1):5-11.
    PMID: 25606261 MyJurnal
    Objective: To validate the Malay version of Berlin Questionnaire (BQ) as a tool to screen for patients at risk of obstructive sleep apnea (OSA) in primary care Background: Most patients with OSA are unrecognised and untreated. Thus, the BQ has been used as a tool to screen for patients at risk for OSA. However, this tool has not been validated in Malay version. Materials and Methods: A parallel back-to-back translation method was applied to produce the Malay version (Berlin-M). The Malay version was administered to 150 patients in a tertiary respiratory medical centre.  Concurrent validity of the Berlin-M was determined using the Apnea Hypopnea Index (AHI) as the gold standard measure. The test-retest reliability and internal consistency of the Berlin-M were determined. Results: Most patients were males (64.0%) and majority of them were Malays (63.3%). Based on the sleep study test, 121 (84.0%) were classified as high risk while 23 (16.0%) as low risk using the Apnea Hypopnea Index (AHI) ≥5 as the cutoff point. The test–retest reliability Kappa value showed a good range between 0.864 – 1.000. The Cronbach’s alpha of BQ was 0.750 in category 1 and 0.888 in category 2. The sensitivity and specificity were 92% and 17% respectively. Conclusion: The BQ showed high sensitivity (92%) but low specificity (17%). Therefore, though the Berlin-M is useful as a screening tool, it is not a confirmatory diagnostic tool.
    MeSH terms: Humans; Malaysia; Male; Primary Health Care; Surveys and Questionnaires; Sensitivity and Specificity; Translations; Reproducibility of Results; Polysomnography; Sleep Apnea, Obstructive; Validation Studies
  13. Ho, E.L.M., Lim, C.L.
    Biomed Imaging Interv J, 2013;9(3):1-4.
    MyJurnal
    A 39-year-old lady who had textured silicone breast implants 5 years ago presented with “on and off” enlargement of the left breast for 6 months. Mammograms and ultrasound of the breasts showed a seroma around her left breast implant only, which subsided in the repeat ultrasound after her menses ended. Delayed periprosthetic fluid collections or seromas have a reported incidence of only about 0.1%. To the authors’ knowledge, this patient may be the first report of a delayed breast implant seroma that was cyclical in nature
    MeSH terms: Breast; Female; Humans; Mammography; Silicones; Incidence; Breast Implants; High-Energy Shock Waves; Breast Implantation; Seroma
  14. Mat Nor, K., Azad Hassan, A.R., Gobal, S.V., Abdullah, B.J.J.
    Biomed Imaging Interv J, 2013;9(3):1-5.
    MyJurnal
    We present a case of bilateral renal artery dissection (BRAD) following serious motor vehicle accident. This was complicated by arterial hypertension and acute renal failure due to a delay in diagnosis. We present the computed tomography (CT) finding as well as the therapeutic options and discuss the role of the radiologists in communicating important findings.
    MeSH terms: Accidents, Traffic; Hypertension; Renal Artery; Tomography, X-Ray Computed; Motor Vehicles; Acute Kidney Injury
  15. Low, S.F., Maimunah, A., Syazarina-Sharis, O., Sagap, I., Hamzaini, A.H.
    Biomed Imaging Interv J, 2013;9(2):1-9.
    MyJurnal
    Purpose: The purpose of this study was to compare the accuracy of non-contrast-enhanced three-dimensional endoanal ultrasound (NC-3D-EAS) with contrast-enhanced three-dimensional endoanal ultrasound (CE-3D-EAS) in pre-operative assessment of anal fistula.

    Materials and Methods: A total of 28 patients (30 primary tracts) with anal fistula underwent 3D-EAS assessments. Three-dimensional volume displays were acquired in 3 steps: before (NC-3D-EAS), immediately after (CE-3D-EAS) and 10 minutes after 3% hydrogen peroxide administration (delayed CE-3D-EAS). Fistula classification and the presence of internal opening were determined via NC-3D-EAS and CE-3D-EAS. The abscess cavity and secondary tract were determined using all 3 steps. The 3D-EAS findings were compared with surgical findings, which served as the reference standard.

    Results: CE-3D-EAS was found to be more accurate than NC-3D-EAS. In the classification of the primary tract, there was good agreement between the surgical finding and NC-3D-EAS (Kappa = 0.674), and very good agreement between the surgical finding and CE-3D-EAS (Kappa = 0.815). The sensitivity and specificity of NC-3D-EAS and CE-3D-EAS for detection of the internal opening were 75%, 81%, 95% and 91%, respectively. The sensitivity and specificity for NC-3D- EAS, CE-3D-EAS and delayed-CE-3D-EAS in the detection of abscess cavity were identical, at 95% and 91%, respectively. There were 6 secondary tracts detected on NC-3D-EAS but only 4 were seen in CE-3D-EAS and delayed CE-3D-EAS. The other two hypoechoic lines were perianal scarrings. Delayed CE-3D-EAS allowed for better delineation of the secondary tract.

    Conclusion: CE-3D-EAS increases the accuracy of pre-operative anal fistula assessment, particularly in recurrent or complex fistula. Delayed CE-3D-EAS provides extra information about the extension of the secondary tract by allowing more time for the tract to fill up with hydrogen peroxide.
    MeSH terms: Abscess; Cicatrix; Contrast Media; Humans; Hydrogen Peroxide; Rectal Fistula; Sensitivity and Specificity
  16. Abdullah, B.J.J.
    Biomed Imaging Interv J, 2013;9(2):1-2.
    MyJurnal
    Over the years I have been fascinated by the increasingly sophisticated role robots have been playing in surgery. I even championed the cause of the surgeons who have been struggling to get our hospital to purchase a surgical robotic system. We came very close to achieving our goal, but failed as the circumstances were not in our favour. And I left it at that. (Copied from article).
    MeSH terms: Goals; Hospitals; Play and Playthings; Robotics; Surgeons
  17. Radhika, S., Naqiyah, I., Hayati - Suria, Zulfiqar, M.A.
    Biomed Imaging Interv J, 2013;9(1):1-5.
    MyJurnal
    The mammogram (MMG) of a 65-year-old woman showed a densely calcified mass. Histology from percutaneous core biopsy was consistent with osteosarcoma. Histology from a wide local excision confirmed mammary osteosarcoma without any epithelial or phyllodes component. Review of the patient’s history showed that patient had 3 previous MMGs and a percutaneous core biopsy of a calcified lesion 4 years prior. The histology at that time showed metaplastic bone formation in mesenchymal tissue with no evidence of malignancy. This report of an extremely rare primary mammary osteosarcoma has documented the origin of this tumour from normal tissue of the breast as evidenced by the serial histology. © 2013 Biomedical Imaging and Intervention Journal. All rights reserved
    MeSH terms: Bone Neoplasms; Breast; Female; Humans; Mammography; Osteogenesis; Osteosarcoma; Biopsy, Large-Core Needle
  18. Dang Nguyen, Yazmin Yaacob, Hamzaini Hamid, Sobri Muda
    MyJurnal
    Lemierre’s syndrome (LS) is a rare life-threatening infective condition typically starting with an oropharyngeal infection causing thrombophlebitis and metastatic abscesses. The most common aetiology of LS is Fusobacterium necrophorum; however, it can also occur after infection with other organisms. LS mainly affects young healthy adults. The initial infection site can be in the head and neck or in the abdomen. The morbidity rate of this disease is high despite aggressive treatments. In this article, we report a 63-year-old male patient with uncontrolled diabetes mellitus, presenting with Klebsiella pneumoniae infection-induced necrotizing fasciitis on the right side of the neck, leading to LS.
    MeSH terms: Abscess; Adult; Diabetes Mellitus; Fusobacterium necrophorum; Head; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Neck; Thrombophlebitis; Fasciitis, Necrotizing; Abdominal Cavity; Lemierre Syndrome
  19. Hamid, Bakhshi, Faroukh, Abazari, Mohammadhosein, Bakhshialiabad
    MyJurnal
    Background: The learning climate has been found to be significant in determining students’ academic achievement and learning. The purpose of this study was to measure the viewpoints of nursing students toward their learning environment at Rafsanjan University of Medical Sciences (RUMS). Methods: This descriptive, cross-sectional study was performed on 202 nursing students using the Dundee Ready Educational Environment Measure (DREEM). The items, as well as scale scores were compared among nursing students. Also, data was analyzed by SPSS19 using t test and ANOVA. Results: The total mean DREEM score was 114.3 (SD 20.6) out of 200 (corresponding to 57.15% of the maximum score), which was considered as more positive than negative. The subscale with the highest mean score was Students’ Perceptions of learning. Mean score of this subscale was 27.3/48 0 (SD 5.9) corresponding to 56.87% of the maximum score. The lowest mean score was for the Academic Self-perceptions 20.31/32 (SD 4.51) (53.44%), The total DREEM score for female students was significantly higher than for males (P = 0.01). The total scores of new entry students were significantly higher than the others (P = 0.01). Conclusion: The school’s educational climate was generally perceived positively by students, but specific areas identified by students as needing improvement. It is essential for managers to make a greater effort to create an appropriate educational environment in order to provide and maintain high quality learning environments for students.
    MeSH terms: Analysis of Variance; Climate; Cross-Sectional Studies; Educational Status; Learning; Maintenance; Perception; Self Concept; Students, Nursing
  20. Tissera, Shehani, Sui Mae Lee
    MyJurnal
    Background: This was a preliminary study to test for the presence of multiple antibiotic-resistant extended spectrum β-lactamase (ESBL) producing bacteria in Malaysian urban surface waters. Although the literature review revealed several published papers on clinical ESBL isolates in Malaysia, none were found on ESBL isolates obtained from local surface waters. Methods: Isolated bacterial species were tested for resistance to cefotaxime, amoxicillin/clavulanate and aztreonam, and susceptibility to imipenem and meropenem using antibiotic susceptibility testing (AST) by disc diffusion. This served as a screening step to detect bacteria that could be potential ESBL species. 16S ribose ribonucleic acid (rRNA) polymerase chain reaction (PCR) testing with two clusters of bla (β-lactamase) gene primers was used to test for the bla genes CTX-M (Groups 1, 2, 9), OXA-1, SHV and TEM. Results: A total of 19 isolates were found, possessing at least one of the bla genes tested for. There was a relatively high occurrence of CTX-M genes (84.2%) among these, followed by TEM genes (47.4%). The isolates were identified as Enterobacteriaceae (89.5%), predominantly Escherichia coli and Klebsiella pneumoniae. Conclusion: There appears to be a high occurrence of ESBL-bacteria in local surface waters, among these being opportunistic pathogens. The persistence and spread of these species in the environment poses a threat to exposed human populations.
    MeSH terms: Anti-Bacterial Agents; Aztreonam; beta-Lactamases; Cefotaxime; Enterobacteriaceae; Escherichia coli; Humans; Klebsiella pneumoniae; Malaysia; Ribose; RNA; Thienamycins; Imipenem; Polymerase Chain Reaction; DNA Primers; Amoxicillin-Potassium Clavulanate Combination
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