1. Revised ARA criteria (1987) the diagnosis of RA requires presence of at least 4 of the following 7 features: 1) morning stiffness> 1 hour 2) swelling of 2 or more joints (of 6 weeks duration) 3) symmetrical joint involvement 4) arthritis of more than 1 hand joints (of at least 6 weeks duration) 5) positive rheumatoid factor, 6) presence of rheumatoid nodule 7) X-ray changes. 2. Use of DMARD should start early, along with pain control by non steroidal anti inflammatory drugs (NSAID) 3. Early referral to rheumatologists is the current recommendation 4. Indications for early referral include: i. Early morning stiffness (EMS) of 30 mins ;- ii. Metatarsophalangeal (MTP) / metacarpophalageal (Mep) involvement. iii. 2 or more swollen joints.
Musculoskeletal complaints are one of the most common presenting symptoms to primary care physicians. However, in Malaysia, there has been no prospective survey to look at this problem. This was a descriptive study to look at the prevalence of non-traumatic musculoskeletal complaints presenting to the primary care clinic at University Malaya Medical Center, Kuala Lumpur. Over a 3-week period, there were 408/4201 patients (9.7%) with non-traumatic musculoskeletal disorders. The most common regional problem was backache and the most commonly made diagnosis was non-specific musculoskeletal pain. In conclusion, musculoskeletal disorders form a significant proportion of primary care consultations and thus should be included in the curriculum for the primary care physician training. Keywords: musculoskeletal disorders, arthritis, primary care
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia.
The morbidity patterns and demographics of patients presenting to two government health centers and four private general practice clinics were studied over one week. Results showed little difference in the morbidity patterns but a significant difference in the demographics of the patients. The commonest illnesses seen were minor ones like upper respiratory tract infection and chronic ones like hypertension and diabetes mellitus. A wide spectrum of illnesses was seen in all the clinics. Both places handled few emergencies and referred only occasionally. There was an equal percentage of patients from both sexes. Ages of the patients varied from place to place and the racial distribution was influenced by several factors, including the existing patient population and the race of the doctor.
In the light of present HIV worldwide epidemic. there is a need to teach the busy general practitioners how to recognise HIV & AIDS. Due to the deadly nature of this infection and its manifold presentations from opportunistic diseases. the busy general practitioners in primary care may be misled in making the correct diagnosis. In Malaysia. the doctors in the primary care level constitute 70 to 75% of the doctors' population. The rest are specialists in secondary and tertiary care institutions. Family Physicians from the Font liners to recognise and detect early cases of HlV in all its early manifestalions on the various systems. Any doctors in primary medicine whether from private or public sector, amy be confronted by patients who present with trivial complaints. These patients may be fee-paying, or particularly those doctors involved with welfare and health of factory workers and the other forms of the main work force should well arm themselves with updates in HIV and AIDS.
This study was carried out on 30 patients to: i) determine the efficacy of low dose captopril as monotherapy (with or without a diuretic) in the treatment of various grades of hypertension. ii) assess the quality of life of these patients 12 weeks after commencement of therapy. Our results showed that there was a sustained and significant fall in both mean systolic and diastolic blood pressure from 171.9 ± 24 to 150.5 ± 25 mm Hg and 109.0 ± 14 to 93.6 ± 15mmHg respectively (p<0.001). Improvement in quality of life was however not statistically significant (p<0.05). We concluded that low dose captopril used alone or in combination with a diuretic can be considered for the initial therapy of mild to moderate hypertension. The optimal dosage and the longterm benefits on quality of life need further evaluation in a larger series.
Creatinine clearance is calculated from 24 hour urine creatinine excretion. This method of measuring creatinine clearance is cumbersome. Many formulae have been proposed as an alternative method of obtaining predicted creatinine clearance and they have all shown satisfactory results. From our study using 4 formulae, the correlation coefficient using these formulae rangedfrom 0.71 - 0.75. The correlation clearance was even better at > 0.90. We therefore advocate the routine use of these formulae for predicting creatinine clearance by clinicians.
Study site: Nephrology clinic, Universiti Kebangsaan Malaysia unit at Hospital Kuala Lumpur, Malaysia