MyMedR

Fulltext Management of neonatal jaundice in primary care

Wan A, Mat Daud S, Teh SH, Choo YM, Kutty FM

Malays Fam Physician, 2016;11(2-3):16-19.

The Clinical Practice Guidelines on Management of Neonatal Jaundice 2003 was updated by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2014. A systematic review of 13 clinical questions was conducted using evidence retrieved mainly from Medline and Cochrane databases. Critical appraisal was done using the Critical Appraisal Skills Programme checklist. Recommendations were formulated based on the accepted 103 evidences and tailored to local setting as stated below. Neonatal jaundice (NNJ) is a common condition seen in primary care. Multiple risk factors contribute to severe NNJ, which if untreated can lead to adverse neurological outcomes. Visual assessment, transcutaneous bilirubinometer (TcB) and total serum bilirubin (TSB) are the methods used for the detection of NNJ. Phototherapy remains the mainstay of the treatment. Babies with severe NNJ should be followed-up to detect and manage sequelae. Strategies to prevent severe NNJ include health education, identification of risk factors, proper assessment and early referral.

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 Neurocysticercosis

Visuvanathan VV, Somawera N, Koh KC

Malays Fam Physician, 2013;8(3):46-48.

PMID: 25893060 MyJurnal

A 19-year-old Chinese man presented with progressive ascending weakness of his left lower limb for 1 week. There was no loss of sensation. His other limbs were unaffected. He also complained of progressive, painless blurring of vision in his left eye for the past 1 month. He has an affinity for wild boar meat from local Chinese restaurants, which he has been consuming on a daily basis for the last 2 years. He denied any fever, headache, high risk behaviour for acquisition of human
immunodeficiency virus (HIV) infection or recent travels. He had bronchial asthma in childhood, but the symptoms are minimal now and there was no recent acute exacerbations. Physical examination was unremarkable except for the left lower limb power of 3/5 and bilateral papilloedema on direct ophthalmoscopy. A Contrast-enhanced computed tomography (CECT) scan of the brain (Image 1) and Magnetic resonance imaging (MRI) of the brain (Images 2 and 3) were performed. The
total leucocyte count was 9.2x109/L, C-reactive protein was 1.2 and erythrocyte sedimentation
rate was 6 mm/h. Human immunodeficiency virus screening was negative, anti-toxoplasma antibodies were not detected and serological testing for anti-cysticercal antibodies via enzymelinked
immunosorbent assay (ELISA) did not produce a positive yield. He was treated with oral albendazole for 28 days and corticosteroids, which led to rapid and total resolution of his neurological deficits and CT findings within 6 weeks.

Fulltext Dark fingernails

Visuvanathan VV, Koh KC

Malays Fam Physician, 2015;10(3):40-2.

PMID: 27570609

Fulltext Black tongue

Visuvanathan VV, Koh KC

Malays Fam Physician, 2017;12(3):28-29.

PMID: 29527277 MyJurnal

Lemierre's syndrome: A persistent unusual neck pain and swelling

Vincent Ngu CY, Rohaizam J, Jong YH

Malays Fam Physician, 2018;13(1):37-40.

PMID: 29796209

Lemierre's syndrome is a systemic complication commonly caused by oropharyngeal infection by Fusobacterium species, which manifests itself as an internal jugular vein thrombosis formation. It is a rare occurrence nowadays with the availability of broad spectrum antibiotics for treatment. Most cases in the literature presented with a life-threatening condition. We are reporting a case of Lemierre's syndrome that presented with persistent neck pain and swelling, initially diagnosed as cervical lymphadenitis.

Fulltext Should statins be started in all type 2 diabetics irrespective of LDL-cholesterol level?

Vasanthakumar SS, Teng CL

Malays Fam Physician, 2007;2(2):74-75.

PMID: 25606085 MyJurnal

Mr S is a 38 year old Indian man who has type 2 diabetes mellitus for 3 years. He is currently on metformin 500mg BD. His BMI is 24.9 kg/m2 (weight 72 kg, height 170 cm). His blood glucose is well controlled (HbA1c 6%). His fasting lipid levels are as follow: Total cholesterol 5.0 mmol/L, HDL-C 1.60 mmol/L, LDL-C 2.6 mmol/L and triglyceride 0.9 mmol/L. He has no family history of acute myocardial infarction. He is a smoker (14 sticks/day, 12 years) but non-hypertensive. He asks if he should take atorvastatin, a lipid-lowering drug that his father is taking. Should statins be started in type 2 diabetic patients without pre-existing coronary artery disease whose lipid level is not elevated?

Effectiveness of a brief intervention for smoking cessation using the 5A model with self-help materials and using self-help materials alone: A randomised controlled trial

Utap MS, Tan C, Su AT

Malays Fam Physician, 2019;14(2):2-9.

PMID: 31827729

INTRODUCTION: The '5A' model for smoking cessation was introduced in 2000 by the US Department of Health and Services. This brief intervention was recommended worldwide for smoking cessation. However, little is known about its effectiveness for smoking cessation in a primary care setting in Malaysia.

OBJECTIVE: To determine the effectiveness of a brief intervention for smoking cessation using the '5A' model with self-help materials compared to using self-help materials alone.

METHODS: This randomised controlled trial was conducted at the Primary Care Clinic at the University Malaya Medical Centre (UMMC) between June and October 2009. Subjects were all current smokers aged 18 years and above. A total of 208 subjects were recruited and randomised into two groups. Subjects in the intervention group were given a brief intervention based on the '5A' model with selfhelp materials, while the control group received self-help materials alone. Subjects were later followed up at one and four months via telephone calls. The outcome measure was a self-reported attempt to quit smoking.

RESULTS: At one-month follow-up, 15/77 (19.5%) of the participants in the intervention group had attempted to quit smoking compared to 8/80 (10.0%) in the control group. There was no significant difference between the two groups (p=0.09). At the four-month follow-up, 13/58 (22.4%) participants in the intervention group had attempted to quit smoking compared to 9/57 (15.8%) in the control group. Once more, there was no significant difference between the two groups (p=0.37).

CONCLUSION: This study showed that there was no significant difference between a brief intervention using the '5A' model with self-help materials and using self-help materials alone for smoking cessation in a Malaysian primary care setting. However, these results do need to be treated with caution when taking into consideration the high dropout rate and bias in the study design.

My journey in the last mile of elimination of leprosy among the Penan community

Utap MS

Malays Fam Physician, 2023;18:43.

PMID: 37575357 DOI: 10.51866/mol.460

Correlation between cognitive impairment and depressive mood of Thai elderly with type 2 diabetes in a primary care setting

Trongsakul S

Malays Fam Physician, 2015;10(1):11-8.

PMID: 26425290

OBJECTIVE: The objective of this study was to evaluate the relationship between cognitive impairment and depressive mood in Thai elderly with type 2 diabetes at primary care centres.

MATERIALS AND METHODS: Two-hundred and eighty three (283) older people with type 2 diabetes were enrolled in this study. Mini-Cog and mini-mental state examination (MMSE) Thai 2002 were used to measure cognitive impairment while Thai geriatric screening test (TGDS) was used to measure depressive mood in all participants. Spearmen correlation was applied to determine the relationship between cognitive function and depressive mood.

RESULTS: There was a positive relationship between cognitive impairment and depressive mood in older people with type 2 diabetes. The scores from Mini-Cog and MMSE Thai 2002 were negatively correlated with TGDS scores while adjusting for the effects of age and years of education with rs = -0.1, p = 0.06 and rs = -0.2, p<0.01, respectively. Although it showed an inverse relationship of the scores between cognitive and depressive mood screening tests, the results between the tests were positive when interpreting the test scores. It means that the higher score in Mini-Cog and MMSE Thai 2002 (non-cognitive impairment) were associated with the lower score in TGDS (non-depressed mood).

CONCLUSION: The finding of this study showed that older people with type 2 diabetes who had cognitive impairment seemed to have depressive mood. Hence, these two co-morbidities should be considered in order to give an optimal care to older people with diabetes.

Fulltext A young man with loin pain

Tong SF

Malays Fam Physician, 2007;2(3):127-8.

PMID: 25606101 MyJurnal

Fulltext A patient who refused medical advice: the doctor and the patient should look for a common ground

Tong SF, Chen R

Malays Fam Physician, 2007;2(3):110-3.

PMID: 25606096 MyJurnal

Treatment refusal is a common encounter in clinical practice. The process of deciding to refuse treatment is often complex. It is our responsibility to try and understand this process of decision making and the underlying reasons for treatment refusal. Many of these reasons are often rational in the context where the decision is made. The patients could be making the best decision for themselves even if these decisions are not necessarily the best in our mind. We should at all times discuss our treatment options and assess their ability to make decisions in achieving common goals. These goals should balance our best treatment strategies and the patients' best interest. This article discusses the reasons underlying treatment refusal and how we can achieve a common goal with our patients.

Fulltext Clinical features of acute febrile thrombocytopaenia among patients attending primary care clinics

Tong SF, Abd Aziz NA, Chin GL, Khairani O

Malays Fam Physician, 2006;1(1):15-8.

PMID: 26998201 MyJurnal

Identifying clinical features that differentiate acute febrile thrombocytopaenia from acute febrile illness without thrombocytopaenia can help primary care physician to decide whether to order a full blood count (FBC). This is important because thrombocytopaenia in viral fever may signify more serious underlying aetiology like dengue infection.

Rightful place of qualitative research in family medicine and healthcare

Tong SF, Tan CE

Malays Fam Physician, 2022 Nov 30;17(3):2-8.

PMID: 36606174 DOI: 10.51866/cm0004

Evidence-based medicine is the foundation of current medical practice. Suitable evidence is needed to support the holistic approach in clinical practice. Quantitative research produces some evidence needed for disease treatment based on probabilities or averages. However, the practice of evidence-based medicine should be personalised to individual patients without relying solely on an average perspective. Beliefs, values and expectations are unique for each individual and may differ significantly from the average. Therefore, understanding individual differences requires evidence from qualitative research. This is particularly important in family medicine practice, which focuses on holistic care for the person, family and community. Findings from properly conducted qualitative research can offer in-depth and comprehensive accounts on healthcare issues from patient and practice perspectives. Qualitative research also provides explanatory power and analytical transferability, which can be applied into daily family medicine practice. In conclusion, evidence from qualitative research should be rightfully equally acknowledged in family medicine and healthcare.

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

Is menopause managed well enough in general practice?

Thuraisingham C, Nalliah S

Malays Fam Physician, 2023;18:49-100.

PMID: 37719692 DOI: 10.51866/cm.264

Menopause is an important phase in the life of older women. Women's life expectancy has increased worldwide. As women experience and perceive menopause differently depending on their personal, family and sociocultural backgrounds, perimenopausal symptoms can often go unnoticed and missed by general practitioners. General practitioners are uniquely placed in the healthcare delivery pyramid to close this gap and improve patients' quality of life by identifying perimenopausal signs and symptoms early. This article shares knowledge about continuing medical education for general practitioners to close the existing gap. As there is great variability within each menopausal woman's experience as well as among individual women, there is a need to individualise and render personalised care. By being able to discuss accepted and safe standards of care and by advocating for a holistic approach incorporating both non-pharmacological and pharmacological strategies, general practitioners would be able to improve the confidence of their patients for better health outcomes.

Reply letter to: Is there any importance of Migraine with Aura amongst medical students?

Thiagarajan A, Muhammad NA, Tan CE

Malays Fam Physician, 2022 Nov 30;17(3):156-157.

PMID: 36606181 DOI: 10.51866/lte.249r

Prevalence and determinants of medications non-adherence among patients with uncontrolled hypertension in primary care setting in Sarawak, Malaysia: A cross-sectional study

Thew HZ, Ching SM, Lim HM, Mos MH, Tze LCK, Low KF, et al.

Malays Fam Physician, 2022 Nov 30;17(3):128-136.

PMID: 36606165 DOI: 10.51866/oa.182

INTRODUCTION: Non-adherence to antihypertensive medications is a leading cause of uncontrolled hypertension and its complications. However, data on the factors associated with non-adherence to antihypertensive medications in the communities of Sarawak, Malaysia, are limited. This study aimed to examine the prevalence and determinants of medication non-adherence among patients with uncontrolled hypertension.

METHOD: A cross-sectional study was conducted using the systematic sampling method in four government primary healthcare clinics in Sarawak. A self-administered questionnaire was used to obtain socio-demographic data and evaluate non-adherence. Blood pressure was measured, and relevant clinical variables were collected from medical records. Multivariate logistic regression was used to determine the determinants of medication non-adherence.

RESULTS: A total of 488 patients with uncontrolled hypertension were enrolled in this study. The prevalence of medication non-adherence was 39.3%. There were four predictors of medication non-adherence among the patients with uncontrolled hypertension: tertiary educational level (odds ratio [OR]=4.21, 95% confidence interval [CI] = 1.67-10.61, P=0.010), complementary alternative medication (0R=2.03, 95% CI=1.12-3.69, P=0.020), non-usage of calcium channel blockers (0R=1.57, 95% CI=1.02-2.41, P=0.039) and 1 mmHg increase in the systolic blood pressure (0R=1.03, 95% CI=1.00-1.05, P=0.006).

CONCLUSION: Because of the high prevalence of medication non-adherence among patients with uncontrolled hypertension, primary care physicians should be more vigilant in identifying those at risk of being non-adherent. Early intervention should be conducted to address non-adherence for blood pressure control.

Fulltext Outcome of phacoemulsification and extracapsular cataract extraction: A study in a district hospital in Malaysia

Thevi T, Reddy SC, Shantakumar C

Malays Fam Physician, 2014;9(2):41-7.

PMID: 25883764 MyJurnal

The aim of the study was to compare the outcomes of phacoemulsification (Phaco) and extracapsular cataract extraction (ECCE) in a district hospital setting.

Fulltext Prevalence of eye diseases and visual impairment among the rural population - a case study of Temerloh Hospital

Thevi T, Maslina B, Reddy SC

Malays Fam Physician, 2012;7(1):6-10.

PMID: 25606238

Objective: To determine the prevalence of eye diseases and visual impairment among new patients at the eye clinic of Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang.
Method: In this cross-sectional prospective study, 1081 new patients were examined over a period of six months. Age, gender, ethnicity, visual acuity and diagnosis were noted from the medical records.
Results: Out of 1081 examined, 607 (56.1%) were males, 783 (72.4%) were Malays. The mean age of patients was 45.2 years (ranging from one month to 91 years). Cataract (248, 22.9%) was the most common eye disease, followed by retinal diseases (124, 11.5%) and ocular trauma (106, 9.8%). Majority of the patients (48) suffering from ocular trauma had foreign body cornea. In 85 premature infants screened for retinopathy, 19 showed different stages of retinopathy of prematurity. Visual impairment was noted in 89 (8.2%) patients, severe visual impairment in 12 (1.1%) and blindness in 35 (3.2%); vision could not be determined in 85 premature infants (7.9%). Cataract was singled out as the cause of severe visual impairment in 11 out of 12 patients.
Conclusion: Health education at primary health centres and availability of eye specialists in all the district hospitals will facilitate the rehabilitation of visually impaired and blind persons by providing early treatment for eye problems (specifically prescription for spectacles, medical treatment and cataract surgery with intraocular lens implantation).
Keywords: Visual impairment, cataract, diabetic retinopathy, glaucoma, refractive errors, ocular trauma, conjunctivitis
Study site: Eye clinic, Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang, Malaysia

Displaying publications 41 - 60 of 638 in total