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The risk factors of lower limb cellulitis: A case-control study in a tertiary centre

Norazirah MN, Khor IS, Adawiyah J, Tamil AM, Azmawati MN

Malays Fam Physician, 2020;15(1):23-29.
PMID: 32284801

INTRODUCTION: Lower limb cellulitis is a common superficial skin infection that leads to morbidity and mortality. Cellulitis risk factors have been well studied in many countries, but to date, not in Malaysia. Geographical and climate variables may affect risk factors. Early identification of the preventable risk factors is vital to prevent cellulitis and improve holistic patient care.
OBJECTIVE: To determine the risk factors of lower limb cellulitis amongst hospitalized patients at a tertiary center.
METHODS: A prospective case-control study of hospitalized patients with a clinical diagnosis of lower limb cellulitis was conducted at UKM Medical Centre, January-August 2015. Each patient was compared to two age and gender-matched control patients. All patients were interviewed and examined for risk factors of cellulitis.
RESULTS: A total of 96 cellulitis patients and 192 controls participated in this study. The cellulitis patients included 61 males and 35 females with a mean age of 62.07±15.43 years. The majority of patients were experiencing their first episode of cellulitis. Multivariate analysis showed a previous history of cellulitis (OR 25.53; 95% CI 4.73-137.79), sole anomalies (OR 16.32; 95% CI 6.65-40.06), ulceration (OR 14.86; 95% CI 1.00-219.39), venous insufficiency (OR 10.46 95% CI 1.98-55.22), interdigital intertrigo (OR 8.86; 95% CI 3.33-23.56), eczema (OR 5.74; 95% CI 0.96.-34.21), and limb edema (OR 3.95; 95% CI 1.82-8.59) were the significant risk factors for lower limb cellulitis.
CONCLUSION: Previous cellulitis and factors causing skin barrier disruption such as sole anomalies, ulceration, venous insufficiency, eczema, intertrigo, and limb edema were the risk factors for lower limb cellulitis. Physician awareness, early detection, and treatment of these factors at the primary care level may prevent hospital admission and morbidity associated with cellulitis.
Fulltext The reliability and validity of the Malay version 17-item Diabetes Distress Scale

Chew BH, Mukhtar F, Mohd Sidik S, Paimin F, Hassan NH, Jamaludin NK

Malays Fam Physician, 2015;10(2):22-35.
PMID: 27099658 MyJurnal

INTRODUCTION: Diabetes-related distress (DRD) refers to patient's concerns about diabetes mellitus, its management, need of support, emotional burden and access to healthcare. The aim of this study was to translate and examine the psychometric properties of the Malay version of the 17-item Diabetes Distress Scale (MDDS-17) in adult patients with type 2 diabetes mellitus (T2D).
METHODS: A standard procedure was used to translate the English 17-items Diabetes Distress Scale into Malay language. We used exploratory factor analysis (EFA) with principal axis factoring and promax rotation to investigate the factor structure. We explored reliability by internal consistency and 1-month test-retest reliability. Construct validity was examined using the World Health Organization quality of life-brief questionnaire, Morisky Medication Adherence Scale, Patient Health Questionnaire and disease-related clinical variables.
RESULTS: A total of 262 patients were included in the analysis with a response rate of 96.7%. A total of 66 patients completed the test-retest after 1 month. EFA supported a three-factor model resulting from the combination of the regimen distress (RD) and interpersonal distress (IPD) subscales; and with a swapping of an item between emotional burden (EB; item 7) and RD (item 3) subscales. Cronbach's α for MDDS-17 was 0.94, the combined RD and IPD subscale was 0.925, the EB subscale was 0.855 and the physician-related distress was 0.823. The test- retest reliability's correlation coefficient was r = 0.29 (n = 66; p = 0.009). There was a significant association between the mean MDDS-17 item score categories (<3 vs ≥3) and HbA1c categories (<7.0% vs ≥7.0%), and medication adherence (medium and high vs ≥low). The instrument discriminated between those having diabetes-related complication, low quality of life, poor medication adherence and depression.
CONCLUSION: The MDDS-17 has satisfactory psychometric properties. It can be used to map diabetes-related emotional distress for diagnostic or clinical use.
The prevalence of gestational diabetes, associated factors and feto-maternal outcome among antenatal women attending health clinics in Terengganu

Abd Latif R, Yusof NA, Yahya R, Muda Z, Tengku Lih TB, Mohamed K, et al.

Malays Fam Physician, 2022 Nov 30;17(3):43-52.
PMID: 36606162 DOI: 10.51866/oal302

INTRODUCTION: Gestational diabetes mellitus (GDM) is a known risk factor for diabetes mellitus (DM). The rising prevalence of GDM in the Asian population (11.7%) may explain the increasing incidence of DM in women. This study examined the prevalence of GDM, its associated factors and the foeto-maternal outcomes of women with GDM in Terengganu.
METHOD: A cross-sectional study was conducted between April and September 2019 using secondary data from antenatal records in 40 health clinics in Terengganu for 2018. All pregnant women aged 25 years and above with or without risk factors for GDM were included in the study. Those with pre-existing type 1 or 2 DM were excluded. A total of 270 respondents were included. The prevalence of GDM and its associated factors were determined using descriptive statistics followed by multiple logistic regression.
RESULTS: The prevalence of GDM in Terengganu was 27.3% (n=72). Logistic regression analysis found that BMI at booking (adjusted OR=4.51, 95% CI 2.13-9.55, p<0.001), history of GDM (adjusted OR=5.31, 95% CI 2.17-12.99, p<0.001) and family history of DM (adjusted OR=4.24, 95% CI 2.23-8.05, p<0.001) were the significant associated risk factors. Of women with GDM, 17.7% (n=11) had postpartum pre-diabetes based on modified oral glucose tolerance at 6 weeks postpartum. Univariate analysis using chi-square tests showed a significant association of neonatal jaundice and hypoglycaemia with GDM.
CONCLUSION: Because the prevalence of GDM in Terengganu is high, surveillance of GDM in highrisk pregnancies and effective glycaemic management should be emphasised to prevent adverse foeto-maternal outcomes.
Fulltext The many faces of bipolar disorder

Awaluddin A, Jali N, Bahari R, Jamil Z, Haron N

Malays Fam Physician, 2015;10(3):38-9.
PMID: 27570608
Fulltext The management of an adolescent with conduct problems in a primary care clinic - a case report

Azimah M, Khairani O

Malays Fam Physician, 2009;4(2-3):88-90.
PMID: 25606170

PURPOSE: To describe the management of mild conduct problems in an adolescent at the primary care level.
CASE REPORT: A 16 year old girl presented with conduct problems with impending school suspension. The cause of her behavioural problems was mainly related to poor parenting skills of her parents and anger in herself. She was successfully managed with counselling and improvement of parenting styles in her parents.
CONCLUSION: This case report illustrates the opportunity for family physicians to manage simple conduct problems at primary care level.
KEYWORDS: Conduct problems; adolescents; anger management; parenting skills
Fulltext The man with sweaty palms and soles

Jamani NA, Puteri Shanaz JK, Azwanis AH

Malays Fam Physician, 2018;13(1):52-54.
PMID: 29796213 MyJurnal

A 21-year-old male college student presented with excessive severe bilateral sweating of his palms and
soles for the past 3 years, which has progressively worsened. His symptoms occur throughout the day
but worsened during exams or whenever he felt anxious. The condition has caused him difficulty in
holding objects and writing assignments, and has resulted in public embarrassment on several occasions.
He has to wipe his hands with a handkerchief each time they sweat. He also needs to change his socks
frequently. No other area of his body is similarly affected. He denied any associated symptoms, such as
pungent body odour, changes in weight, fever, heat intolerance, or changes in bowel habits. He has no
known medical illness and is not on any medication. (Copied from article).
Fulltext The man with bilateral nipple pain

Hong HC, Koh KC

Malays Fam Physician, 2013;8(3):43-45.
PMID: 25893059 MyJurnal

Figure 1 is a picture of a 48-year-old male patient who presents with progressive painful enlargement of the areolae of 10 months’ duration. There was no bleeding or nipple discharge. He was diagnosed with human immunodeficiency virus (HIV) infection 16 months ago and was initiated on antiretroviral therapy (ARV), which consisted of zidovudine, lamivudine and efavirenz. As his CD4 cell count at diagnosis was less than 200 cells/mm3, he was prescribed trimethoprim-sulphamethoxazole (Bactrim) for prophylaxis against pneumonia due to pneumocystis jirovecii. Physical examination was unremarkable except for bilateral breast enlargement and right-sided old shingles scar in the T4 dermatome distribution.
The louder the bigger: A case of jugular phlebectasia in a child

Kandiah R, Mohamad I

Malays Fam Physician, 2019;14(3):77-79.
PMID: 32175047

Jugular phlebectasia has been increasingly recognised with the advent of non-invasive diagnostic methods. Phlebectasia differs from varix, as it is an abnormal outward dilatation of a vein without tortuosity. It presents as a soft, compressible mass, apparent upon straining or execution of the Valsalva maneuver. The differentials for neck masses are broad, but if the swelling appears on the Valsalva maneuver, the type of mass narrows down to a laryngocele, superior mediastinal mass or phlebectasia. A simple non-invasive investigation, such as ultrasonography, is used as a diagnostic tool. We report a case of jugular phlebectasia that was suspected clinically and confirmed via ultrasound to be a vascular lesion which changed its size upon straining.
Fulltext The importance of ophthalmic signs in the diagnosis of suprasellar meningioma - a case report

Tan AK, Mallika P, Md Aziz S, Asokumaran T, Intan G

Malays Fam Physician, 2009;4(1):26-29.
PMID: 25606155 MyJurnal

A forty-two year old lady presented with gradual, painless, progressive blurring of vision of her left eye for four months. There were no other associated ocular or systemic complaints. Examination showed decreased visual acuity in both eyes and a pale optic disc on the left side. Visual field examination revealed a temporal field defect of the right eye which aroused the suspicion of an intracranial mass lesion. MRI of her brain revealed a suprasellar meningioma. We would like to emphasize the importance of visual field examination of both eyes in patients presenting with unilateral loss of vision.
The implication of stigma on people living with HIV and the role of social support - A case report

Hadi AM, Lee PY, Adibah HI

Malays Fam Physician, 2020;15(2):43-45.
PMID: 32843944

Despite the advancements made in the knowledge and treatment of the human immunodeficiency virus (HIV) since it was first discovered, people living with HIV (PLWH) continue to be stigmatized. This paper presents the case of an HIV-infected patient who delayed the necessary treatment due to stigma and ultimately presented with AIDS. Through social support, however, he was able to overcome his internalized stigma; he was finally willing to start on antiretroviral treatment (ART). This case report addresses the effect of stigma on and the role of social support in the management of an individual with HIV.
Fulltext The feasibility of a public-private mix program on pulmonary tuberculosis screening in Penang: A pilot study

Tang WS, Chan MW, Kow FP, Ambigapathy R, Wong JHW, Thiruvengadam V, et al.

Malays Fam Physician, 2021 Mar 25;16(1):75-83.
PMID: 33948145 DOI: 10.51866/oa1096

Background: The low detection rate of tuberculosis (TB) cases in Malaysia remains a challenge in the effort to end TB by 2030. The collaboration between private and public health care facilities is essential in addressing this issue. As of now, no private-public health care collaborative program in pulmonary tuberculosis (PTB) screening exists in Malaysia.
Aim: To determine the feasibility of a collaborative program between private general practitioners (GPs) and the public primary health clinics in PTB screening and to assess the yield of smear-positive PTB from this program.
Methods: A prospective cohort study using convenient sampling was conducted involving GPs and public health clinics in the North-East District, Penang, from March 2018 to May 2019. In this study, GPs could direct all suspected PTB patients to perform a sputum acid fast bacilli (AFB) direct smear in any of the dedicated public primary health clinics. The satisfaction level of both the GPs and their patients were assessed using a self-administered client satisfaction questionnaire. IBM SPSS Statistical Software was used to analyze the data.
Results: Out of a total of 31 patients who underwent the sputum investigation for PTB, one (3.2%) was diagnosed to have smear-positive PTB. Most of the patients (>90%) and GPs (66.7%) agreed to continue with this program in the future. Furthermore, most of the patients (>90%) were satisfied with the program structure.
Conclusion: It is potentially feasible to involve GPs in combating TB. However, a more structured program addressing the identified issues is needed to make the collaborative program a success.
Fulltext The experience of managing a retroviral antenatal patient in a primary care clinic in Perak, Malaysia

Subashini A, Malliga S, Nooraizam A

Malays Fam Physician, 2014;9(1):22-4.
PMID: 25606293 MyJurnal
Fulltext The effect of profiling report on antibiotic prescription for upper respiratory tract infection

Mohd Fozi K, Kamaliah MN

Malays Fam Physician, 2013;8(2):26-31.
PMID: 25606278 MyJurnal

INTRODUCTION: Upper respiratory tract infection (URTI) is a common encounter in primary care and mostly viral in origin. Despite frequent reminders to primary care providers on judicious use of antibiotics for URTI, the practice is still rampant.
METHODS: As part of quality improvement initiative, an intervention was designed by distributing a profiling report on individual prescriber's performance in comparison to colleagues on usage of antibiotic for URTI. The data were generated from electronic health record in three public primary care clinics in Malaysia and emailing monthly throughout 2011 to all providers.
RESULTS: There were 22,328 consultations for URTI in 2010 and 22,756 in 2011 with the incidence rates of URTI among overall consultations of 15.7% and 15.9% respectively. 60 doctors and medical assistants had performed consultations during the 2 year period. Following the intervention in 2011, the prescription rate of antibiotic for URTI is significantly reduced from 33.5% in 2010 to 23.3 % in 2011. Before intervention, individual prescription rate varies from 9.7% to 88.9% and reduced to 4.3% to 50.5% after intervention.
CONCLUSION: Profiling report is a potential method of changing antibiotic prescribing habit among public primary care providers in Malaysia especially if the baseline adherence was poor and higher variation of prescribing rate.
KEYWORDS: antibiotic prescription; profiling; upper respiratory tract infection.
Study site: Klinik Kesihatan Kangar, Klinik Kesihatan Beseri, Klinik Kesihatan Simpang Empat, Perlis, Malaysia
Note: Data was extracted from TelePrimary Care (TPC) system.
Fulltext The child with suspected hearing loss

Philip R

Malays Fam Physician, 2013;8(2):65-66.
PMID: 25606288 MyJurnal

An 8-year-old girl was noticed by her parents to be less attentive and she would respond only after being called several times. She had just recovered from an upper respiratory tract infection two weeks before. The parents brought her to see a primary care physician. The patient had no other complaints, and the rest of the history was unremarkable. Physical examination was normal except for the otoscopic findings shown below (Figure 1) Tuning fork tests indicated conductive deafness.
Fulltext The blue man who presented with a stroke

Koh KC, Wong MH

Malays Fam Physician, 2011;6(1):29-31.
PMID: 25606217 MyJurnal

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 The association between body mass index and the oral Firmicutes and Bacteroidetes profiles of healthy individuals

Mohamed Qadir R, Assafi MS

Malays Fam Physician, 2021 Nov 30;16(3):36-43.
PMID: 34938391 DOI: 10.51866/oa1129

Introduction: Microbiome status is considered an important factor that contributes to obesity. Investigations have shown that the oral microbiome comprises a vast array of bacterial species that can influence human health.
Objective: To determine the association between the presence of the bacterial phyla Firmicutes and Bacteroidetes and the body mass index (BMI) status of normal, overweight and obese subjects in Duhok, Iraq. Additionally, to investigate the composition of oral Firmicutes and Bacteroidetes profiles for individuals with different BMI statuses.
Methods: A total of 155 saliva samples were collected from participants in Duhok, Iraq. Bacterial genomic DNA was then extracted from the collected saliva. The presence of Firmicutes and Bacteroidetes phyla was detected via polymerase chain reaction.
Results: Firmicutes and Bacteroidetes were detected in 63.2 and 37.4% of the population, respectively. Differences in the carriage rates of oral Firmicutes in overweight (78%) and obese individuals (83%) were statistically significant when compared to normal weight individuals (36%) (P<0.0001). The percentage rates of Bacteroidetes in obese individuals (26.4%) was statistically significant when compared to normal weight individuals (50.8%) (P=0.0078). The Firmicutes/ Bacteroidetes ratios (obese=3.1, overweight= 2.5 and normal weight=0.7) were higher with increasing BMI.
Conclusion: This study provides evidence of the Firmicutes/Bacteroidetes ratio growing with increasing BMI. High rates of Firmicutes could serve a role in the development of obesity. Further studies are required to clarify the exact relationship between oral bacteria and obesity, which could lead to a promising therapeutic method for improving the physical health of humans.
Fulltext The arthritis and musculoskeletal quality improvement program (amquip): a breakthrough series methodology project

Mastura I

Malays Fam Physician, 2008;3(2):113-6.
PMID: 25606133 MyJurnal

The Australian government had funded the National Primary Care Collaborative (NPCC) program with funding of $14.6 million over three years. One of the pilots project was the Arthritis and Musculoskeletal Quality Improvement Program (AMQuIP).The study aims to optimize general practitioners (GPs) management of patients with osteoarthritis (OA) of the hip and knee by identifying gaps between their current practice and best practice. The Breakthrough Series Collaborative methodology with several Plan-Do-Study-Act (PDSA) cycles was employed. Participants comprises of 12 GPs/practices from two Victorian Divisions of general Practice (one rural, one metropolitan) with 10 patients per GP/practice. GPs/practices attended an orientation and three learning workshops and a videoconference. GPs/practices completed PDSA cycles between workshop and reported results at workshops. GPs/practices reported use of guidelines, change in patient management and change in practice management/systems. All recruited patients completed the SF-12v2 Health Survey and WOMAC OA Index Questionnaire twice. Follow up activities including focus groups and face-to-face interviews were held six months after the final workshop. All GPs/practices used the guidelines/key messages, introduced "new" management strategies to patients, and made positive changes to their practice management/systems. Patient reported positive changes and outcomes. By using a structured methodology and evidence-based guidelines/key messages; GPs can introduce new patient management strategies, and by identifying gaps in practice management systems, positive changes can be achieved.
Fulltext The Rajakumar Movement

Harris N P

Malays Fam Physician, 2009;4(1):6-7.

Note by TCL: The Rajakumar Movement is the Wonca Asia Pacific Region Working Party for Young and Future Family Doctors. It was named in honour of Dr M K Rajakumar.
Fulltext The CORFIS experience

Low, Wilson

Malays Fam Physician, 2010;5(1):57-58.
MyJurnal

The CORFIS Programme was conceived by the Clinical Research Centre, HKL in 2007 in the hope of piloting a chronic disease management strategy among the Malaysian private general practitioners to tackle the current epidemic of cardiovascular chronic diseases. 1-5 The programme was implementing as a clinical research study i.e. a community trial in June 2007. The study recruited a total of 70 GPs within the Klang Valley region with an enrolment of 705 patients diagnosed with hypertension, diabetes mellitus (DM) and/or hyperlipidaemia. The GPs were clustered randomised centrally in a 2:1 ratio to provide either chronic disease care (CORFIS) or usual care. Patients were followed up for a period of 6 months from date of enrolment. (Copied from article).
Fulltext The ' widow maker': Electrocardiogram features that should not be missed

Yusuf Muharam M, Ahmad R, Harmy M

Malays Fam Physician, 2013;8(1):45-7.
PMID: 25606269 MyJurnal

Patients with Wellen's syndrome often present with chest pain and found to have specific precordial T-wave changes on the electrocardiogram (ECG). They subsequently develop a large anterior wall myocardial infarction. These specific electrocardiographic abnormalities are associated with critical stenosis of the proximal left anterior descending coronary artery (LAD). This syndrome is often under-recognised and has fatal consequences; it is, therefore, also known as the widow maker. We highlight a case of a 39-year old gentleman who had a history of coronary artery disease and typical ECG characteristics of Wellen's syndrome.

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