MyMedR

Fulltext A thyroid mass that moves with tongue protrusion: An ectopic thyroid gland

Yaroko AA, Mohamad I, Abdul Karim AH, Wan Abdul Rahman WF

Malays Fam Physician, 2014;9(2):61-3.

Thyroglossal duct cyst (TDC) is a developmental anomaly that usually appears in early childhood. The common presentation is midline swelling of the neck, which moves with both tongue protrusion and deglutition. Diagnosis is usually clinical and radiological. Fine needle aspiration cytology (FNAC) can be used as a tool for the exclusion of malignancy in adult patients. In some cases thyroid scan is done to rule out the presence or absence of the normal thyroid gland. A complete work-up is mandatory before cyst removal given that it contains only thyroid tissue. We report the case of a 32-year-old woman with only thyroid tissue in thyroglossal duct cyst.

Fulltext A woman presenting with dry cough, hoarseness of voice and significant weight loss

Khajotia R

Malays Fam Physician, 2008;3(2):107.

PMID: 25606129

Fulltext A woman with fever and neck pain

Teng CL

Malays Fam Physician, 2009;4(1):40.

PMID: 25606159

Fulltext A woman with pain and stiffness of hands

Das Gupta E

Malays Fam Physician, 2008;3(3):164-5.

PMID: 25606146

A young lady with dysphagia

Cheo SW, Mak WW, Low QJ

Malays Fam Physician, 2021 Jul 22;16(2):98-101.

PMID: 34386174 DOI: 10.51866/tyk1120

Chest radiograph is one of the most commonly employed imaging modalities in primary care. It may be done for symptomatic patients or routine health screening. Hence, it is important for a primary care physician to be able to interpret chest radiograph systematically in relation to patient's clinical history. Here, we would like to illustrate a case of abnormal chest radiograph detected during health screening.

Fulltext A young man with chronic dry cough

Shalihin SE, Osman IF, Harun Z, Mukhali HB, Gnathimin B

Malays Fam Physician, 2020;15(1):68-70.

PMID: 32284811 MyJurnal

In primary care, chest X-rays are commonly performed to assess patients presenting with a prolonged
cough. However, the extent to which the flms are accurately interpreted depends on the skill of the
doctors. Doctors with insufcient experience may miss an exact diagnosis when evaluating a flm,
especially in patients with nonspecifc symptoms, such as in the case discussed in this paper.
( Copied from article ).

Fulltext A young man with loin pain

Tong SF

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

PMID: 25606101 MyJurnal

Fulltext ABC approach for the management of adults with hyperthyroidism: A practical strategy in primary care

Jamaluddin J, Zainal Abidin S, Kathitasapathy G, Mohamad Isa MZ, Mohamed Kamel MA, Kaur P, et al.

Malays Fam Physician, 2023;18:57.

PMID: 37814670 DOI: 10.51866/rv.303

Hyperthyroidism is commonly seen in primary care settings. However, the management of hyperthyroidism might be unclear to primary care doctors. Various guidelines have been published to assist clinicians in the management of thyroid disorders at various levels of care. The extensive coverage of these guidelines may not appeal to busy clinicians, and the guidelines do not focus on often resource-limited primary care settings. In this article, we aim to describe a practical guide for managing hyperthyroidism in primary care settings using an ABC approach.

Fulltext Academic mobbing: hidden health hazard at workplace

Khoo SB

Malays Fam Physician, 2010;5(2):61-7.

PMID: 25606190

Academic mobbing is a non-violent, sophisticated, 'ganging up' behaviour adopted by academicians to "wear and tear" a colleague down emotionally through unjustified accusation, humiliation, general harassment and emotional abuse. These are directed at the target under a veil of lies and justifications so that they are "hidden" to others and difficult to prove. Bullies use mobbing activities to hide their own weaknesses and incompetence. Targets selected are often intelligent, innovative high achievers, with good integrity and principles. Mobbing activities appear trivial and innocuous on its own but the frequency and pattern of their occurrence over long period of time indicates an aggressive manipulation to "eliminate" the target. Mobbing activities typically progress through five stereotypical phases that begins with an unsolved minor conflict between two workers and ultimately escalates into a senseless mobbing whereby the target is stigmatized and victimized to justify the behaviours of the bullies. The result is always physical, mental, social distress or illness and, most often, expulsion of target from the workplace. Organizations are subjected to great financial loss, loss of key workers and a tarnished public image and reputation. Public awareness, education, effective counselling, establishment of anti-bullying policies and legislations at all levels are necessary to curb academic mobbing. General practitioners (GPs) play an important role in supporting patients subjected to mental and physical health injury caused by workplace bullying and mobbing.

Fulltext Achieving sustainable development goals with primary care physicians

Wong PF, Lee WK, Paranthaman V

Malays Fam Physician, 2024;19:1.

PMID: 38371723 DOI: 10.51866/ed0008

Achieving triple treatment goals in multi-ethnic Asian patients with type 2 diabetes mellitus in primary care

Goh CC, Koh KH, Goh S, Koh Y, Tan NC

Malays Fam Physician, 2018;13(2):10-18.

PMID: 30302178

Introduction: Achieving optimal glycated hemoglobin (HbA1c), blood pressure (BP), and LDL-Cholesterol (LDL-C) in patients mitigates macro- and micro-vascular complications, which is the key treatment goal in managing type 2 diabetes mellitus (T2DM). This study aimed to determine the proportion of patients in an urban community with T2DM and the above modifiable conditions attaining triple vascular treatment goals based on current practice guidelines.

Methods: A questionnaire was distributed to adult Asian patients with dyslipidemia at two primary care clinics (polyclinics) in northeastern Singapore. The demographic and clinical data for this sub-population with both T2DM and dyslipidemia were collated with laboratory and treatment information retrieved from their electronic health records. The combined data was then analyzed to determine the proportion of patients who attained triple treatment goals, and logistic regression analysis was used to identify factors associated with this outcome.

Results: 665 eligible patients [60.5% female, 30.5% Chinese, 35% Malays, and 34.4% Indians] with a mean age of 60.6 years were recruited. Of these patients, 71% achieved LDL-C ≤2.6 mmol/L, 70.4% had BP

Acrometastases: The nasty alter ego of fingertip infections

Looi CSK, Arumugam M

Malays Fam Physician, 2021 Jul 22;16(2):86-89.

PMID: 34386171 DOI: 10.51866/cr1059

Fingertip infections are commonly diagnosed in primary care. There is a serious condition, acrometastases, that is often mistaken for these infections. Acrometastases are defined as metastases located distal to the elbow or knee. We present a case of a malignant phyllodes tumour with acrometastases to the distal phalanx of the left middle finger that was misdiagnosed as a fingertip infection on 2 separate occasions, highlighting the need for vigilance regarding acrometastases.

Fulltext Acute grief with delirium in an elderly: holistic care

Khoo SB

Malays Fam Physician, 2011;6(2-3):51-7.

PMID: 25606223 MyJurnal

Delirium in the elderly is a challenging and under-recognized problem in the community. Early detection and management improves outcomes and quality of life for the elders with delirium at home.1 Family physicians (FP) play a key role in the assessments, early identification, and management of delirium and in the support and education of patients and their family caregivers.1 Clinical analysis of this case illustrates the bio-psychosocial spiritual model of approach to management of delirium in an elderly patient in the home setting.

Fulltext Acute haemorrhagic oedema of infancy with bullae and koebnerisation

Mohd Sazlly Lim S, Shamsudin N

Malays Fam Physician, 2014;9(2):55-7.

PMID: 25883766 MyJurnal

A 5-month-old Malay boy presented with purpuric papules and plaques on the face and extremities accompanied by fever, coryzal symptoms and bilateral lower limb oedema. There were also bullous linear purpuric lesions on the right upper limb. Blood and culture tests were normal. Histopathological tests showed leucocytoclastic vasculitis, confirming the diagnosis of acute haemorrhagic oedema of infancy. The patient achieved complete recovery after 2 weeks with no recurrence.

Fulltext Acute ptosis as a presentation of preseptal cellulitis leading to cerebral abscess in a patient with uncontrolled diabetes

Razali NR, Choo YM

Malays Fam Physician, 2021 Mar 25;16(1):136-138.

PMID: 33948155 DOI: 10.51866/cr1010

Acute ptosis due to preseptal cellulitis requires urgent medical attention, as the infection can extend posteriorly into the orbit, leading to significant visual and cerebral complications. We report a case of a 58-year-old woman with uncontrolled diabetes mellitus presenting with acute ptosis due to preseptal cellulitis. After initial resolution of fever with intravenous amoxicillin-clavulanate, she experienced a seizure due to cerebral abscess a week later and was treated with intravenous ceftriaxone. Preseptal cellulitis is usually treated on an outpatient basis with oral antibiotics, as it rarely extends posteriorly to cause cerebral complications. We wish to highlight the importance of admitting patients with preseptal cellulitis in patients with uncontrolled diabetes for intravenous antibiotics due to the potential for visual and cerebral complications.

Fulltext Acute suppurative thyroiditis presenting as a painless thyroid swelling

Keah SH, Leong CK

Malays Fam Physician, 2006;1(2):54-57.

PMID: 27570587 MyJurnal

Acute suppurative thyroiditis is a rare disorder. We saw a 24 year old man with this condition that present atypically. The patient had a non-tender thyroid enlargement associated with fever and leukocytosis. FNA cytology clinched the diagnosis. The abscess was associated with Klebsiella pneumoniae septicemia and required surgical drainage after failing antibiotic therapy.

Adult Langerhans cell histiocytosis: An unusual cause of referred knee pain

Swarna Nantha Y, Yeoh MH, Sharif SM

Malays Fam Physician, 2019;14(3):60-64.

PMID: 32175042

Langerhans cell histiocytosis (LCH) in adults is rare and regarded as an 'orphan disease.' The systemic symptoms of LCH can mimic many other undifferentiated diseases seen at the primary care level. Failure to diagnose and delays in referral are common pitfalls in the management of this disease. We present a case of a 34-year-old woman with referred knee pain who was eventually diagnosed with multi-system LCH 4 years after the initial presentation. The mean age of presentation of LCH symptoms in adults is 33. Bone lesions are the frequent presentation of LCH in this age group. Endocrine involvement in LCH is seen in the form of diabetes insipidus (DI), which remains the most common extraskeletal presentation of LCH in adults. In the case discussed here, a definitive diagnosis of LCH was established through tissue biopsy. The spectrum of undifferentiated symptoms underscores the difficulty and delay in making a diagnosis associated with the condition. Most GPs not only face the predicament of initial recognition but also fail to merge presenting symptoms to form a purposeful referral of this elusive disease to a tertiary care unit.

Fulltext Aetiological profile of paediatric stridor in a Malaysian tertiary hospital

Lum SG, Noor Liza I, Priatharisiny V, Saraiza AB, Goh BS

Malays Fam Physician, 2016;11(1):2-6.

PMID: 28461841 MyJurnal

BACKGROUND: Conditions causing stridor in paediatric patients can range from minor illnesses to life-threatening disorders. Proper evaluation and correct diagnosis are essential for timely intervention. The objective of this study was to determine the aetiological profiles and the management of paediatric patients with stridor referred to the Otorhinolaryngology Department of Hospital Serdang.

METHODS: Medical records of all paediatric patients presenting with symptom of stridor from January 2010 to February 2015 were reviewed retrospectively. The patients' demographic data, clinical notes, laryngoscope findings, diagnosis and management were retrieved and analysed.

RESULTS: Out of the total 137 patients referred for noisy breathing, 121 patients had stridor and were included in this study. There were 73 males and 48 females-most were of Malay ethnicity (77.7%). The age of presentation ranged from newborn to 10 years, with a mean of 4.9 months. Eighteen patients (14.9%) had associated congenital pathologies. The majority were congenital causes (90.9%), in which laryngomalacia was the commonest (78.5%), followed by subglottic stenosis (5.0%), vallecular cyst (2.5%) and congenital vocal fold paralysis (2.5%). Twelve patients (9.9%) had synchronous airway lesion. The majority of the patients were managed conservatively. Thirty-one patients (25.6%) required surgical intervention, of which only one needed tracheostomy.

CONCLUSION: Laryngomalacia was the commonest cause of stridor among paediatric patients. A synchronous airway lesion should be considered if the child has persistent or severe symptoms. The majority of the patients were managed conservatively.

Fulltext Alarming triad of progressive hoarseness in a male smoker

Za'im NAN, Azman M

Malays Fam Physician, 2021 Nov 30;16(3):119-122.

PMID: 34938403 DOI: 10.51866/cr1163

Hoarseness accounts for 1% of all consultations in primary care. Suspicion of malignancy should be considered in individuals with risk factors presenting with unexplained hoarseness lasting more than two weeks. A significant number of patients with laryngeal cancer present at an advanced stage due to lack of awareness regarding vocal health. It is important to educate both the public and primary care health providers concerning laryngeal cancer. We present the case of an 81-year- old male smoker who presented to us with a six-month history of progressive hoarseness. He was initially treated in two primary and one secondary care centres, where a diagnosis of laryngeal cancer was not considered. Careful assessment in our centre managed to determine a diagnosis of T3N0M0 glottic carcinoma. We will discuss this alarming triad of progressive hoarseness in a male smoker to help primary care physicians streamline their thoughts and identify red flags in a hoarse patient.

Algorithm for the referral of patients with inflammatory back pain from primary care in Malaysia

Lau IS, Gun SC, Yeap SS, Mohd Zain M, Mohd Yusoof H, Sargunan S, et al.

Malays Fam Physician, 2021 Jul 22;16(2):2-6.

PMID: 34386157 DOI: 10.51866/rv1206

Chronic low back pain, defined as back pain lasting for more than three months, can be divided into mechanical or inflammatory back pain (IBP). IBP typically starts in patients below the age of 40, is improved with activity and worsens with rest. IBP is strongly associated with axial spondyloarthritis. Early recognition of IBP among primary care physicians is essential for timely diagnosis and intervention to ensure the best outcomes for patients with axial spondyloarthritis. This paper describes the Malaysian Society of Rheumatology's recently developed Inflammatory Back Pain Referral Algorithm for primary care physicians, which aims to facilitate the early identification and referral of IBP patients to rheumatologists.

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