MyMedR

Fulltext A case study of human immunodeficiency virus with positive seroconversion to negative

Paranthaman V, Yip HL, Ker HB

Malays Fam Physician, 2015;10(1):44-6.

This case study demonstrates a 36-year-old ex-intravenous drug user (IVDU) who had been initially tested positive for human immunodeficiency virus (HIV) twice using Enzyme Immunoassay (EIA) method (Particle agglutination, PA done), but a year later he was tested HIV-negative. The patient was asymptomatic for HIV and T helper cells (CD4) count remained stable throughout this period. In light of this case, there may be a need to retest by molecular methods for high risk category patients who were initially diagnosed HIV-positive, but later showing an unexpected clinical course, such as a rising or stable CD4 titre over the years.

Fulltext A child with coated tonsils

Appannan VR, Mohamad I, Ramli RR, Johan KB

Malays Fam Physician, 2018;13(1):55-56.

PMID: 29796214 MyJurnal

A 5-year-old girl presented with a history of
fever for four days associated with odynophagia.
She was treated with amoxycillin prescribed
by a general practitioner for 3 days prior to
presentation. However, the symptoms were
worsening and associated with drooling of
saliva and poor oral intake. There was history
of recurrent acute tonsillitis in the past two
years, with 5 to 6 episodes per year. The child
had completed regular immunizations up to her
current age. There was no similar presentation
amongst family members and friends. (Copied from article).

A child with elbow pain

Mat Yudin ZA, Wan Ahmed WA, Chanmekun SB

Malays Fam Physician, 2019;14(2):44-45.

PMID: 31827738

Elbow injuries are common in children. Supracondylar fractures occurred in 16% of all pediatric fractures. Supracondylar fractures can be classified into 4 types according to the Gartland classification, depending on the degree of the fracture present in the lateral radiograph. This case highlights the case of a child with a Gartland Type I fracture. A misdiagnosis of this fracture will compromise the management of the injury with regards to immobilization and subsequent care. As this injury can be managed on an outpatient basis, primary care frontliners need to be aware of the condition.

Fulltext A child with epistaxis, reduced hearing and cervical lymphadenopathy: a rare case of nasopharyngeal carcinoma in a child

Muhammad Izani S, Irfan M, Suhaimi Y

Malays Fam Physician, 2011;6(2-3):82-4.

PMID: 25606231 MyJurnal

Although nasopharyngeal carcinoma (NPC) is common in this part of the world, the incidence among children is still very low worldwide. The diagnosis is sometimes delayed because of the late reporting of the symptom by the patient or parents, or difficulty in reaching the final diagnosis due to its hidden anatomical location. The challenges include the difficult endoscopy in children, inability to differentiate an adenoid from the tumour on radiograph and often the inconclusive fine needle aspiration findings. If the tumour mass at Fossa of Rosenmuller can be clearly appreciated and biopsied with undoubtedly proven histology of NPC, the diagnosis can be straight forward and treatment can be commenced as early as possible. We report a 10-year-old child presented with bilateral neck cervical lymphadenopathy and epistaxis with fine needle aspiration cytology (FNAC) of the neck mass reported as lymphoma. Further work-up confirmed he was suffering from NPC.

Fulltext A child with swelling between the eyes

Mohamad I, Soleh M

Malays Fam Physician, 2013;8(2):56-7.

PMID: 25606285 MyJurnal

Fulltext A clinical audit of the diagnosis and management of chronic kidney disease in a primary care clinic

Jamaluddin J, Mohamed Yassin MS, Jamil SN, Mohamed Kamel MA, Yusof MY

Malays Fam Physician, 2021 Nov 30;16(3):68-76.

PMID: 34938394 DOI: 10.51866/oa1171

Introduction: This audit was performed to monitor the diagnosis and management of chronic kidney disease (CKD) according to the clinical practice guidelines (CPGs) of CKD 2018 in a primary care clinic.

Methods: Patients who attended the clinic from April to June 2019 and fulfilled the diagnosis of CKD were included in this study, except for those diagnosed with a urinary tract infection, pregnant women and those on dialysis. These criteria were set based on the CPGs. The standards were set following discussions with the clinic team members with reference to local guidelines, the 2017 United Kingdom National CKD audit and other relevant studies.

Results: A total of 384 medical records were included in this audit. Overall, 5 out of 20 criteria for processes and 3 of 8 clinical outcomes for CKD care did not meet the set standards. These included the following: documentation of CKD classification based on albumin category (43.8%); CKD advice (19.0%); dietitian referral (9.1%); nephrologist referral (45.5%); haemoglobin level monitoring (65.7%); overall blood pressure (BP) control (45.3%); BP readings for diabetic kidney disease (DKD) and non-DKD with > 1 g/day of proteinuria (< 130/80 mmHg, 37.0%); eGFR reduction of < 25% over the past year (77.2%). Identified problems included the absence of a CKD registry, eGFR and albuminuria reports, and a dedicated team, among other factors.

Conclusions: Overall, 8 out of 28 criteria did not meet the standards of CKD care set for this audit. The problems identified in this audit have been addressed. Moreover, strategies have also been formulated to improve the diagnosis and management of CKD in this clinic.

A comparison of headache and non-headache sufferers on measures of social support and mental health problems

Teoh H, Tam C

Malays Fam Physician, 2008;3(2):82-6.

PMID: 25606122 MyJurnal

138 headaches sufferers and 138 subjects without headaches were studied to investigate if there were differences between headache and non-headache sufferers in terms of their mental health and social support levels. The overall results of this study indicated that headache sufferers, as compared with non-headache sufferers had slightly more mental health problems, and more social support from their family members. When the results were scrutinised in more detail, it was observed that headache sufferers reported that they felt less capable of making decisions about things, were not always able to face up to their problems, and sometimes thought about themselves as a worthless. Given that the study was based on a community, rather than clinic sample, further research would be required to examine the differing the types of headaches that people are suffering from, and the intensity of the headaches, in relation to mental health problems.

Fulltext A comparison of medication adherence between subsidized and self-paying patients in Malaysia

Aziz H, Hatah E, Makmor-Bakry M, Islahudin F, Ahmad Hamdi N, Mok Pok Wan I

Malays Fam Physician, 2018;13(2):2-9.

PMID: 30302177 MyJurnal

Background: Limited efforts have been made to evaluate medication adherence among subsidized and self-paying patients.

Objective: To investigate medication adherence among patients with and without medication subsidies and to identify factors that may influence patients' adherence to medication. Setting: Government healthcare institutions in Kuala Lumpur, Selangor, and Negeri Sembilan and private healthcare institutions in Selangor and Negeri Sembilan, Malaysia.

Methods: This cross-sectional study sampled patients with and without medication subsidies (self-paying patients). Only one of the patient's medications was re-packed into Medication Event Monitoring Systems (MEMS) bottles, which were returned after four weeks. Adherence was defined as the dose regimen being executed as prescribed on 80% or more of the days. The factors that may influence patients' adherence were modelled using binary logistic regression. Main outcome measure: Percentage of medication adherence.

Results: A total of 97 patients, 50 subsidized and 47 self-paying, were included in the study. Medication adherence was observed in 50% of the subsidized patients and 63.8% of the self-paying patients (χ2=1.887, df=1, p=0.219). None of the evaluated variables had a significant influence on patients' medication adherence, with the exception of attending drug counselling. Patients who attended drug counselling were found to be 3.3 times more likely to adhere to medication than those who did not (adjusted odds ratio of 3.29, 95% CI was 1.42 to 7.62, p = 0.006).

Conclusion: There is no significant difference in terms of medication adherence between subsidized and self-paying patients. Future studies may wish to consider evaluating modifiable risk factors in the examination of non-adherence among subsidized and self-paying patients in Malaysia.

Fulltext A comparison of morbidity patterns in public and private primary care clinics in malaysia

Mimi O, Tong SF, Nordin S, Teng CL, Khoo EM, Abdul-Rahman A, et al.

Malays Fam Physician, 2011;6(1):19-25.

PMID: 25606215 MyJurnal

OBJECTIVES: To compare the morbidity patterns in public and private primary care clinics; determine patients' reasons for encounter (RFE) and diagnoses using the ICPC-2, and compare ten commonest diagnoses and RFEs.
METHODS: A cross-sectional study on randomly selected clinics was conducted nationwide. Doctors completed the Patient Encounter Record (PER) for systematically selected encounters for a week.
RESULTS: Response rate was 82.0% (public clinic) and 33% (private clinic) with 4262 encounters and 7280 RFE. Overall, the three commonest disease categories encountered were respiratory (37.2%), general and unspecified (29.5%), and cardiovascular diseases (22.2%). Public and private clinics handled 27% versus 50% acute cases and 20.0% versus 3.1% chronic cases i.e. 33.7 and 5.6 chronic diseases per 100 RFE respectively.
CONCLUSION: Doctors in public clinics saw more chronic and complex diseases as well as pregnancy related complaints and follow-up cases while in private clinics more acute and minor illnesses were seen. Health services should be integrated and support given to co-manage chronic diseases in both sectors.
KEYWORDS: Malaysia; Primary practice; delivery of health care; morbidity pattern; reasons for encounter

Fulltext A diabetic lady with difficulty in breathing

Cheo SW, Ng KL, Low QJ

Malays Fam Physician, 2021 Nov 30;16(3):126-128.

PMID: 34938405 DOI: 10.51866/tyk1188

Fulltext A food bolus obstructing the oesophagus in a patient with infantile cerebral palsy

Vong KS, Mohamad I, Salim R

Malays Fam Physician, 2018;13(1):34-36.

PMID: 29796208

Introduction: A foreign body (FB) in the upper aerodigestive tract is a fairly common encounter. Fish bones are the commonest FB seen in adults. The commonest presentation is odynophagia. Usually, the patient will point at the level of FB on the neck to indicate the location.

Methods: Clinical report.

Results: This case report describes a large FB in an adult with underlying infantile cerebral palsy. Besides dysphagia, it was associated with drooling of saliva and pain in the throat region.

Conclusion: FB ingestion with complete obstruction of the oesophagus is an emergency. It may cause total dysphagia as the passage of food is completely blocked.

Fulltext A forgetful and angry old lady

Mah SL, George P

Malays Fam Physician, 2018;13(2):26-28.

PMID: 30302180

Dementia is typically characterized by the deterioration of cognitive abilities and is a common disorder among the elderly in Malaysia. However, behavioral and psychological symptoms are also present in approximately 90% of dementia patients.1 We report the manifestation of these symptoms in an elderly woman with dementia and the treatment thereof.

A hard left supraclavicular mass in a young boy-is it cancer?

Ramasamy K, Saniasiaya J, Gani NA

Malays Fam Physician, 2020;15(2):53-55.

PMID: 32843947

Fulltext A journey of a thousand miles begins with a single step: Applying evidence-based medicine to answer clinical questions

Tok PSK

Malays Fam Physician, 2021 Nov 30;16(3):132.

PMID: 34938407 DOI: 10.51866/lte1336

Fulltext A life-threatening condition - ruptured ectopic pregnancy with negative urine pregnancy test: A case report

Mohamad F, Yahya AS, Abdul Rashid A, Devaraj NK, Abdul Manap AH

Malays Fam Physician, 2021 Mar 25;16(1):121-123.

PMID: 33948151 DOI: 10.51866/cr1117

Ectopic pregnancy is an extra-uterine pregnancy and is a potentially life-threatening condition that can lead to death from intra-peritoneal hemorrhage. This case reports a rare occurrence of ruptured tubal pregnancy in which the patient presented early with abdominal pain and a negative urine pregnancy test but subsequently presented again with evidence of intra-peritoneal hemorrhage. A negative urine pregnancy test is often used to rule out pregnancy, but it is not 100% sensitive. Complete assessment is critical in this important diagnosis in order to plan for the appropriate emergency management.

Fulltext A man with an acute abdomen

Loh KY, Kew ST

Malays Fam Physician, 2008;3(2):109-10.

PMID: 25606131

Fulltext A man with claw hand

Keah SH

Malays Fam Physician, 2008;3(3):163.

PMID: 25606145

Fulltext A man with febrile illness and difficulty in walking

Das Gupta E

Malays Fam Physician, 2008;3(1):51.

PMID: 25606113