MyMedR

Fulltext The blue man who presented with a stroke

Koh KC, Wong MH

Malays Fam Physician, 2011;6(1):29-31.

A 19-year-old man presented with sudden onset of right eye ptosis, diplopia and giddiness. He had no previous medical illnesses with negative history of exertional dyspnoea, epistaxis, haemoptysis, palpitations, chest pain and chronic cough. Examination revealed central cyanosis, digital clubbing, polycythaemia, partial ptosis of right eye, diplopia on right gaze and dilated right pupil. Examination of the chest revealed pectus excavatum but no cardiac murmurs were heard. Investigations revealed a solitary right pulmonary arteriovenous malformation with two feeder vessels which were successfully embolized surgically.

Fulltext Qualitative research methods in family medicine: what and why?

Wong LP

Malays Fam Physician, 2008;3(1):70.

PMID: 25606118

Fulltext Summarizing research findings: systematic review and meta-analysis

Wong LP

Malays Fam Physician, 2007;2(1):8-12.

PMID: 25606070 MyJurnal

The explosion of biomedical publishing makes keeping up with the primary studies an impossible task. The often disparate, confusing and contradicting findings of individual studies makes healthcare professionals turn to review articles where knowledge has been collated and published in summaries. Narrative reviews lack rigorous, systematic and reproducible synthesis. In contrast, systematic reviews are conducted using systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review. The final pathway for systematic review is a statistical summary of the results of primary studies, or meta-analysis. This article provides some guidelines to health care providers in understanding the key aspects of systematic review and meta-analysis. Steps involved in systematic review are discussed. The potential pitfall of meta-analysis was also explored.

Data analysis in qualitative research: a brief guide to using nvivo

Wong L

Malays Fam Physician, 2008;3(1):14-20.

PMID: 25606106 MyJurnal

Qualitative data is often subjective, rich, and consists of in-depth information normally presented in the form of words. Analysing qualitative data entails reading a large amount of transcripts looking for similarities or differences, and subsequently finding themes and developing categories. Traditionally, researchers 'cut and paste' and use coloured pens to categorise data. Recently, the use of software specifically designed for qualitative data management greatly reduces technical sophistication and eases the laborious task, thus making the process relatively easier. A number of computer software packages has been developed to mechanise this 'coding' process as well as to search and retrieve data. This paper illustrates the ways in which NVivo can be used in the qualitative data analysis process. The basic features and primary tools of NVivo which assist qualitative researchers in managing and analysing their data are described.

Fulltext Tuberculosis in adults

Abdul Rahaman JA, Ker HB, Yusof M, Hanafi NS, Wong JL

Malays Fam Physician, 2014;9(3):34-7.

PMID: 26425303 MyJurnal

Tuberculosis (TB) in Malaysia is rising due to multiple factors and issues related to its management are addressed in the updated evidence-based clinical practice guidelines. Screening for active TB should be considered in high risk groups. Light emitting diode-based fluorescence microscopy and nucleic acid amplification tests are recommended investigations. Health education and standardised 6-month daily antituberculosis (antiTB) regimen are among important elements for successful treatment. Latent TB infection screening should only be performed on high risk individuals. AntiTB regimen offered to HIV-positive adults should be the same as for HIV-negative adults and timing to initiate highly active antiretroviral therapy in patients with TB is based on CD4 count. All patients on antiTB treatment should be monitored to assess their response to treatment and to identify problems associated with it.

Fulltext Does negative IgM dengue serology rule out dengue fever in an adult with fever for three days?

Teng CL, Wong CH

Malays Fam Physician, 2013;8(3):26-27.

PMID: 25883762 MyJurnal

A 21-year old medical student consults the doctor for a fever that started 3 days ago. The fever was high grade and associated with generalised body aches. There was no gum bleeding. He mentioned that mosquito fogging was conducted in his neighbourhood recently.Physical examination revealed an alert conscious young man. Temperature (oral): 38.9 ͦ C, blood pressure 100/70 mmHg, pulse rate 90/min, good volume. Mild flushing was noted. No petechiae were seen in his legs. Tourniquet test was positive.

COVID-19, family medicine, and primary care centers

Mungmungpuntipantip R, Wiwanitkit V

Malays Fam Physician, 2020;15(2):58.

PMID: 32843949

Fulltext ChatGPT, medical research and scientific writing

Wiwanitkit S, Wiwanitkit V

Malays Fam Physician, 2024;19:3.

PMID: 38371717 DOI: 10.51866/lte.545

Fulltext Imaging as an aid to the diagnosis of acute appendicitis

Wijesuriya LI

Malays Fam Physician, 2007;2(3):106-9.

PMID: 25606095 MyJurnal

Acute appendicitis has been known as a disease entity for well over a century but a confident diagnosis before surgery in all patients suspected of the condition is still not possible. Timely diagnosis is essential to minimise morbidity due to possible perforation of the inflamed organ in the event treatment is delayed; so much so that surgeons often preferred to operate at the slightest suspicion of the diagnosis in the past. This resulted in the removal of many normal appendixes. When the diagnosis of appendicitis is clear from the history and clinical examination, then no further investigation is necessary and prompt surgical treatment is appropriate. Where there is doubt about the diagnosis however it is advisable to resort to imaging studies such as abdominal ultrasound or computed tomography to clear such suspicions before subjecting the patient to an appendicectomy. These studies would also help avoid delays in surgery in deserving patients.

Fulltext Prevalence and characteristics of e-cigarette users among Malaysian current and ex-smokers

Ho BK, Mohamad Haniki NM, Jamalludin AR, Samsul D, Mira K, Norny Syafinaz AR, et al.

Malays Fam Physician, 2019;14(2):10-17.

PMID: 31827730

Introduction: Electronic cigarettes (ECs) are new devices that have been accepted widely by both smokers and non-smokers. However, the evidence on EC used in Malaysia is scarce. The objective of this study was to determine the prevalence of EC use and the socio-demographic and smoking characteristics associated with current EC use among Malaysian current and ex-smokers.

Methods: This was a sub-analysis of data from a cross-sectional, national-population- based EC study conducted from May to June in 2016 in Malaysia. A detailed description of the sampling methods can be found in the National E-cigarette Survey (NECS) 2016 report. Briefly, data were obtained from 1396 individuals who had ever been smokers, i.e., 957 (68.6%) current smokers and 439 (31.4%) ex-smokers.

Results: Current EC use was found predominantly among current smokers (8.0%) as compared with ex-smokers (4.3%). Among current smokers, the main reasons given for smoking ECs were wanting to try it (44.7%), followed by intention to quit tobacco smoking (15.8%) and to reduce tobacco smoking (10.5%). Using multiple logistic regression analysis, we found that among current smokers, current EC users were more likely to be younger, i.e., 18-44 years (aOR= 4.83, 95% CI= 1.97-11.86, p=0.001), urban residents (aOR= 1.89, 95% CI= 1.15-3.11, p=0.012), single/ divorced/ widowed (aOR= 2.11, 95% CI= 1.24-3.61, p=0.006) and students (aOR= 2.25, 95% CI= 1.01-5.01, p=0.048). Among exsmokers, only younger respondents (18-44 years old) was reported as being more likely to be current EC users (aOR= 3.81, 95% CI= 1.14-12.76, p=0.030).

Conclusion: This study showed that currently using and ever having used ECs were more prevalent among current smokers. The reasons given for initiating EC use among current smokers were mainly wanting to try it, followed by intention to quit and to reduce tobacco smoking. Current EC use appears to be common among current smokers who are younger, urban residents, single/divorced/widowed and students. Therefore, EC cessation intervention strategies and policies should target these high-prevalence groups.

Fulltext An elderly woman with intermittent claudication

Wazir NN

Malays Fam Physician, 2006;1(1):23-24.

PMID: 26998205 MyJurnal

This case report illustrates the misdiagnosis of intermittent claudication in an elderly with multiple cardiac risk factors. Careful clinical evaluation and imaging shifts the diagnosis from peripheral vascular disease to spinal stenosis. The decision whether to offer conservative therapy or proceed to spinal surgery requires an accurate assessment of the severity of the symptoms without ignoring the important role of patient preferences.

Fulltext Should ChatGPT be considered a medical writer?

Wattanapisit A, Photia A, Wattanapisit S

Malays Fam Physician, 2023;18:69.

PMID: 38111835 DOI: 10.51866/lte.483

Fulltext Journey between career and life traps: Reflections on academic family medicine

Wattanapisit A

Malays Fam Physician, 2023;18:52.

PMID: 37814672 DOI: 10.51866/mol.464

An intervention based on the stages of change, health profiles and physical activity levels of overweight and obese adults in Sarawak, Malaysia - a feasibility study

Cheah WL, Chang CT, Helmy H, Wan Manan WM

Malays Fam Physician, 2019;14(3):46-54.

PMID: 32175040

Introduction: Physical inactivity is the one of the leading causes of major non-communicable diseases in the world. The aim of this study is to assess the feasibility of an intervention program based on the stages of change, physical activity levels and health profiles of selected overweight and obese adults in Sarawak.

Methods: This intervention study was carried out using selected overweight and obese adults in Sarawak. A total of 75 participants were placed in the intervention group, and 80 respondents were placed in the control group participated. Respondent-determined weekly aerobic exercise sessions were conducted for six months. The Malay version of the long-form International Physical Activity Questionnaire (IPAQ) and Transtheoretical model of change (TTM) questionnaire were used, together with anthropometric measurements and the collection of venous fasting blood profiles. Data was entered and analyzed using SPSS Version 20.

Results: The intervention group had significant better stage transitions compared to the control group (p<0.01). They also had significantly lower total cholesterol, although both groups showed significant results (difference= 0.53, p<0.01; difference= 0.38, p=0.01). The respondent-determined intervention program was effective in improving stage transition; however, an intervention of longer duration could provide more conclusive health outcomes.

Conclusion: Physical activity plays a role in assisting overweight and obese adults to be more active and healthier.

Unravelling the unseen threat of polyhydramnios in patients with gestational diabetes mellitus: A case report

A Wahab SN, Said AH, Wan Ismail WH

Malays Fam Physician, 2023;18:70.

PMID: 38213388 DOI: 10.51866/cr.377

Polyhydramnios is defined as an increase in the amount of amniotic fluid during pregnancy. This article presents the case of a 35-year-old G4P3 lady at 28 weeks of gestation with suboptimised gestational diabetes Mellitus (GDM). Routine transabdominal ultrasound showed the presence of polyhydramnios, initially thought to be due to suboptimal glucose control. Further evaluation revealed a congenital diaphragmatic hernia with multiple soft markers. Identifying the underlying causes of polyhydramnios can be challenging in primary care settings, which can be attributed to various factors. Although primary care medical officers may not be required to perform detailed scans, they have a crucial role in identifying gross foetal abnormalities. This study highlights the potential for missed diagnoses in primary care settings and the importance of comprehensive prenatal assessments to ensure early detection and appropriate management of polyhydramnios-related conditions in women with GDM.

Fulltext Holistic management of chronic obstructive pulmonary disease in primary care

Tengku Saifudin TI, Wan Haniza WM

Malays Fam Physician, 2010;5(3):119-125.

MyJurnal

Chronic obstructive pulmonary disease (COPD) is a major respiratory illness in Malaysia that is mainly preventable and treatable but unfortunately remains largely undiagnosed. Primary care providers play a vital role in screening the population at risk, making an early diagnosis and initiating prompt and appropriate therapy including smoking cessation to improve symptoms and quality of life of the COPD patient. Measures to prevent and treat exacerbations are also important to prevent further rapid decline in lung function and to reduce morbidity and mortality associated with the disease.

Fulltext Prevalence and determinants of left ventricular hypertrophy in hypertensive patients at a primary care clinic

Ching SM, Chia YC, Wan Azman WA

Malays Fam Physician, 2012;7(2-3):2-9.

PMID: 25606250 MyJurnal

Left ventricular hypertrophy (LVH) has prognostic significance on cardiovascular mortality and morbidity. However, echocardiography screening for LVH is not routinely done for hypertensive patients in a primary care setting. Thus, this quantitative study aims to determine the prevalence and factors associated with LVH in hypertensive patients at a primary care setting. This was a cross-sectional study of 359 consecutive patients with uncomplicated essential hypertension attending a hospital-based clinic in Malaysia. All subjects underwent an echocardiography test. LVH occur when the left ventricular posterior wall thickness together with inter-ventricular septal thickness is ≥11 mm. It was found that 24% patients fulfilled the criteria for LVH. The mean age of the study population was 59.2±7.7 years; mean duration of hypertension was 9.7±7.5 years; and mean blood pressure was 136.5/81.5 (±13.7/7.7) mmHg. Using multiple logistic regression analysis, patients who were obese [odds ratio (OR) 8.34, 95% confidence interval (CI) 3.14, 22.22] and male gender (OR 1.96, 95% CI 1.08, 3.16) had significant positive association with LVH. LVH was found in approximately one fourth of the hypertensive patients at a hospital-based primary care setting. There was a significant positive association between LVH and obesity and being male. Guidelines for enhancing use of echocardiography in detecting LVH may be needed.

Study site: university primary care centre in Kuala Lumpur, Malaysia

Fulltext An active boy with bilateral knee pain

Nur Suhaila I, Siti Suhaila MY, Wan Aireene WA

Malays Fam Physician, 2019;14(1):26-28.

PMID: 31289628

Fulltext Yaws: The forgotten tropical skin disease

Md Alwi N, Muhamad R, Ishak A, Wan Abdullah WNH

Malays Fam Physician, 2021 Nov 30;16(3):104-107.

PMID: 34938399 DOI: 10.51866/cr1275

Yaws is a rare skin disease endemic to tropical countries caused by Treponema pertenue. It is highly infectious and spreads through physical contact. In Malaysia, it was presumably eradicated during the 1960s, with the last reported case published in 1985. Due to its rarity, the disease often goes unrecognised and misdiagnosed. Here, we report the case of a 5-year-old aboriginal boy diagnosed with secondary yaws who presented with fever and an incidental finding of chronic painless ulcerated nodules and plaques on his lower limbs and gluteal region. His diagnosis was confirmed serologically with a venereal disease research laboratory lab test and he was successfully treated with a single dose of intramuscular benzathine penicillin G. Primary care physicians should not ignore this disease since its early recognition and appropriate treatment is vital to its eradication, especially in high-risk communities.

Fulltext Young Lady with Bilateral Yellowish Lesions on Her Eyelids

Ishak A, Mohd Yusoff SS, Wan Abdullah W

Malays Fam Physician, 2018;13(3):44-46.

PMID: 30800235 MyJurnal

A 26-year-old woman with an unknown medical illness presented with yellowish skin lesions around both eyes, visible for the past 4 years. The lesions were neither itchy nor tender and had increased gradually in size. She had neither constitutional nor hyperthyroidism symptoms. She is the youngest out of four siblings, and none of her family members have cardiovascular disease or similar problems. Upon examination, there were bilateral yellowish plaques over the periorbital region. Her body mass index (BMI) was 23.8 kg/m2. Her vital signs were all normal at every visit.

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