MyMedR

Fulltext Notes for the primary care teachers: The effective teacher

Khoo EM, Teoh KS

Malays Fam Physician, 2007;2(3):123-4.

Fulltext Use of ChatGPT in medical research and scientific writing

Lee PY, Salim H, Abdullah A, Teo CH

Malays Fam Physician, 2023;18:58.

ChatGPT, an artificial intelligence (AI) language model based on the GPT-3.5 architecture, is revolutionising scientific writing and medical research. Researchers employ ChatGPT for diverse tasks, including automated literature reviews, structured-outline generation and drafting/editing assistance. The tool adapts language for varied audiences, aids in citation management, supports collaborative writing and peer review and facilitates table/figure creation. While it enhances efficiency, concerns arise regarding ethics, bias, accuracy and originality. Transparent data sourcing and validation are crucial, as ChatGPT complements human efforts but does not replace critical thinking. Accordingly, researchers must uphold integrity, ensuring that AI-assisted content aligns with research principles. Acknowledgement of AI use in manuscripts, as recommended by the International Committee of Medical Journal Editors, ensures accountability. ChatGPT's transformative potential lies in harmonising its capabilities with researchers' expertise, fostering a symbiotic relationship that advances scientific progress and ethical standards.

Fulltext Obstructive sleep apnoea hypopnoea syndrome – an overview

Wan Haniza WHW, Tengku Saifudin TI

Malays Fam Physician, 2011;6(1):2-6.

PMID: 25606213 MyJurnal

Obstructive sleep apnoea hypopnoea syndrome (OSAHS) is a common cause of breathing-related sleep disorder, causing excessive daytime sleepiness. Common clinical features of OSAHS include snoring, fragmented sleep, daytime somnolence and fatigue. This article aims to provide a comprehensive review of the condition, including its management.

Fulltext Experiences of women who underwent induced lactation: A literature review

Mohd Hassan S, Sulaiman Z, Tengku Ismail TA

Malays Fam Physician, 2021 Mar 25;16(1):18-30.

PMID: 33948139 DOI: 10.51866/rv0997

Objective: This article aims to review the literature published over the past five decades related to the experiences of women who have undergone induced lactation.

Methods: A comprehensive electronic search was conducted using PubMed, the Library of Congress, Google Scholar, SAGE, and ScienceDirect. The following search keywords were used: adoptive breastfeeding, induced lactation, non-puerperal lactation, extraordinary breastfeeding, and milk kinship. The search was restricted to articles written in English and published from 1956 to 2019. All study designs were included except for practice protocols.

Results: A total of 50 articles about induced lactation were retrieved. Of these, 17 articles identified the experiences of women who underwent induced lactation. The articles included original papers (n=7), reviews (n=5), and case reports (n=5). Four articles were specifically related to Malaysia, and the others were international. These 17 articles concerning the experiences of women who induced lactation will be reviewed based on four themes related to inducing lactation: (a) understanding women's perception of satisfaction, (b) emotional aspects, (c) enabling factors, and (d) challenges.

Conclusion: Identifying a total of only 17 articles on induced lactation published over the last 53 years suggests that the subject is understudied. This review provides emerging knowledge regarding the experiences of women who have induced lactation in terms of satisfaction, emotions, enabling factors and challenges related to inducing lactation.

Fulltext A woman with fever and neck pain

Teng CL

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

PMID: 25606159

Fulltext Should beta blockers still be recommended as first-line therapy for essential hypertension in younger patients?

Ng LW, Teng CL

Malays Fam Physician, 2008;3(1):32-3.

PMID: 25606109 MyJurnal

Fulltext An adult woman with Fever, cough and abnormal liver function

Teng CL

Malays Fam Physician, 2007;2(1):33-4.

PMID: 25606077

Fulltext What study design should I choose?

Abu Hassan Z, Hanafi NS, Teng CL

Malays Fam Physician, 2006;1(1):29-31.

PMID: 26998208

Fulltext Evidence-based practice in Malaysia: where are we and what more can be done?

Teng CL

Malays Fam Physician, 2013;8(2):2-6.

PMID: 25606274 MyJurnal

Fulltext Knowledge, attitude, and practice regarding atrial fibrillation among primary care physicians: the potential role of postgraduate training

Ooi PC, Ramayah G, Omar SR, Rajadorai V, Nadarajah T, Ting CH, et al.

Malays Fam Physician, 2021 Mar 25;16(1):39-49.

PMID: 33948141 DOI: 10.51866/oa0002

Introduction: Atrial fibrillation (AF) is known to lead to stroke and thromboembolism, causing a five-fold increase in the risk of stroke and almost doubling the mortality rate. Optimal anticoagulant therapy is effective in reducing AF-related death. However, prescription of anticoagulants in AF in East Asian countries has been low, ranging from 0.5% to 28%. This study aimed to determine whether vocational training in family medicine improves primary care physicians' knowledge, attitude, and practice in the management of AF.

Method: This investigation was a cross-sectional study carried out during centralized workshops for two groups of trainees using a validated questionnaire: (i) junior trainees were newly enrolled postgraduate trainees in the Graduate Certificate in Family Medicine (GCFM) program, and (ii) senior trainees were postgraduate trainees in Advance Training in Family Medicine (ATFM) programs of the Academy of Family Physicians of Malaysia (AFPM).

Results: A total of 223 trainees (127 junior and 96 senior) participated in this study. Only 55.2% of the trainees passed the knowledge test; senior trainees were more likely to pass the knowledge test compared to junior trainees (69.8% vs. 44.1%, p < 0.001). Female trainees were significantly more likely to pass the knowledge test than male trainees. While the attitude of senior and junior trainees was similar, more of the latter group worked in public clinic that provide better support where there is better support for outpatient anticoagulation treatment (e.g., same-day INR test, direct access echocardiogram, and warfarin in in-house pharmacy).

Conclusion: Vocational training in family medicine appears to improve primary care physicians' knowledge regarding the management of AF. Better knowledge will help vocationally trained primary care physicians to provide anticoagulation treatment for AF within primary care clinics. More optimal AF management within primary care can take place if the identified barriers are addressed and a shared care plan can be implemented.

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?

Fulltext Do statins adversely affect the HbA1c of diabetic patients?

Son WD, Teng CL

Malays Fam Physician, 2017;12(1):39-40.

PMID: 28503276

This paper discusses the adverse effect of statins on the HbA1c levels of diabetic patients. Studies have shown that statins may slightly worsen the HbA1c level. The effects vary depending on the type of statins, the dosage and the duration of therapy. However, it has been confirmed that statin use has benefits that outweigh its harms. Therefore, a diabetic patient should be given advice on the need for appropriate lifestyle changes and the importance of continuing the statins.

Fulltext Dr M K Rajakumar's legacy

Teng CL

Malays Fam Physician, 2008;3(3):126-7.

Notes for the Primary Care Teachers: PORTFOLIO ASSESSMENT

Teng C

Malays Fam Physician, 2007;2(3):125-6.

PMID: 25606100

The portfolio consists of a variety of documentation of a learner's proof of learning. It has been promoted as one way to verify a learner's personal and professional development, especially for the more mature trainees and doctors at work. It has not been widely accepted as a summative tool because the amount of time imposed on the learners may be considerable. Ways to improve the reliability of assessments on unstandardised portfolios are needed for its wider application.

White coat effect and white coat hypertension: one and the same?

Ramli A, Halmey N, Teng C

Malays Fam Physician, 2008;3(3):158-61.

PMID: 25606143

White coat hypertension (WCHT) and white coat effect (WCE) are often thought to be of the same entity. They are in fact different conditions which carry distinctive definitions and prognostic significance. WCHT is diagnosed when office blood pressure (OBP) is ≥140/90 mmHg on at least 3 occasions, while the average daytime or 24-hour blood pressure is <135/85 mmHg. It is common with 15% prevalence in the general population and may account for over 30% of individuals in whom hypertension is diagnosed. Although individuals with WCHT were reported to have a better cardiovascular (CV) prognosis when compared to those with sustained hypertension and masked hypertension; they were also shown to have a greater prevalence of target organ damage (TOD) and metabolic abnormalities than that of normotensive subjects. In contrast, WCE is defined as the transient elevation of OBP induced by the alerting response to a doctor or a nurse. WCE can occur in both normotensive and hypertensive persons; and is not substantially influenced by reassurance and familiarisation. There is conflicting evidence with regards to prognostic significance of WCE, where most data indicated that it does not predict future TOD, CV morbidity or mortality; with some studies showed otherwise. This case scenario aims to solve the diagnostic perplexity with regards to WCHT and WCE, followed by an evidence-based commentary of how to best manage such conditions.

Fulltext Antibiotic prescribing for upper respiratory tract infections in the Asia-Pacific region: a brief review

Teng CL

Malays Fam Physician, 2014;9(2):18-25.

PMID: 25893067 MyJurnal

This review highlights the high prevalence of antibiotic use for upper respiratory tract infections (URTIs) in a larger part of the Asia-Pacific region. Since URTIs are one of the common reasons for primary care consultations in this region, inappropriate use of antibiotic in both quantity and drug choice has greatly influenced the development of antibiotic resistance. Notwithstanding the paucity of Asia-Pacific data on the above issues, the available information suggests urgent actions needed to be taken to promote judicious antibiotic use at the point-of-care through a multi- pronged approach targeting the patients/consumers (or parents), healthcare providers and health care systems.

Fulltext Street ketamine-associated bladder dysfunction: an emerging health problem

Lee PY, Ong TA, Chua CB, Lei CCM, Teh GC

Malays Fam Physician, 2009;4(1):15-8.

PMID: 25606152 MyJurnal

INTRODUCTION: Ketamine is frequently abused nowadays as a recreational drug. Case reports are emerging since 2007 to describe a new clinical entity of severe bladder dysfunction associated with chronic abuse of street ketamine.
CLINICAL PRESENTATION: Severe lower urinary tract symptoms of urinary frequency and urgency which are refractory to conventional treatment. Quality of life is adversely affected as a consequence. Chronic kidney disease will develop in advanced cases. Investigation findings: The urine is sterile on culture. Ultrasound will show reduced bladder capacity with thickened bladder wall. In advanced stage, hydronephrosis and renal impairment will develop.
TREATMENT: Patients should be advised to stop street ketamine use immediately. Anticholinergic medication could be tried to alleviate the symptoms. Refractory cases with dilatation of the upper urinary tract might need urinary diversion.
CONCLUSION: Awareness of this new condition is essential in diagnosis. Early intervention offers better treatment outcome.
KEYWORDS: Ketamine; bladder dysfunction; lower urinary tract symptoms

Fulltext Angina after anaphylaxis treatment

Leow SN, Tang WS

Malays Fam Physician, 2019;14(3):65-67.

PMID: 32175043

Anaphylaxis is a life-threatening emergency, and adrenaline is the mainstay treatment for this condition. However, there have been a few reported cases of patients experiencing cardiovascular complications, such as myocardial infarction and coronary vasospasm, after its use. We highlight such a case in a young, healthy patient and the important differentials to consider.

Fulltext Osteonecrosis as the presenting feature in a child with acute lymphoblastic leukaemia

Lim SC, Johari B, Tang SP

Malays Fam Physician, 2021 Nov 30;16(3):115-118.

PMID: 34938402 DOI: 10.51866/cr1176

A seven-year-old girl presented with pain in multiple joints and constitutional symptoms over a period of four months. There were no significant clinical findings apart from joint tenderness. Blood test results did not indicate any specific pathology and initial radiology imaging was normal. Subsequent careful examination of her X-ray images led to an MRI of her left knee, which revealed acute osteonecrotic changes. A following whole-body MRI examination demonstrated multifocal bony lesions. Bone marrow examination conclusively diagnosed acute lymphoblastic leukaemia (ALL). Acute osteonecrosis has classically been described as a complication of treatment in children with ALL and has not been recognised as a presenting feature until recently.

Scalp psoriasis and Dermatology Life Quality Index: A retrospective study based on 12-year data from the Malaysian Psoriasis Registry

Leong WC, Tang JJ

Malays Fam Physician, 2022 Nov 30;17(3):84-88.

PMID: 36606176 DOI: 10.51866/oa.146

INTRODUCTION: Psoriasis affects approximately 2-3% of the population worldwide, although the overall prevalence in Asia is <0.5%. Scalp psoriasis is a common initial presentation of psoriasis, which affects almost 80% of patients with psoriasis.

METHOD: This retrospective descriptive study investigated 1,671 patients with psoriasis with scalp involvement registered with the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018.

RESULTS: A total of 21,859 patients with psoriasis were registered with the MPR during the study period; among them, scalp involvement was seen in 7.6% (n= 1,671). Female sex preponderance (61%) was observed in the majority of Malay patients (58.5%), followed by the Chinese (16.9%), Indian (17.1%) and other ethnic patients (7.5%). A positive family history of psoriasis was identified in 22.7% (n=380). Approximately 34.8% (n=581) and 11% (n=172) of the patients had nail changes and psoriatic arthropathy, respectively. The mainstay treatment modality was topical treatment (93.6%), followed by systemic therapy (10%) and phototherapy (0.5%). The comorbidities found among the patients with scalp psoriasis included hypertension (27.9%), obesity (26%), dyslipidaemia (21%), diabetes mellitus (18.4%), ischaemic heart disease (5.4%) and cerebrovascular disease (1.3%). Approximately 23% reported a Dermatology Life Quality Index (DLQI) of >10, which indicated moderate-to-severe impairment.

CONCLUSION: The proportion of patients with psoriasis with scalp involvement in our study (7.6%) is much lower than previous reports. Scalp psoriasis markedly negatively impacts the DLQI.

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