MyMedR

Fulltext Aligning theory with practice: Child health programmes in Malaysia, a Narrative Review

Sutan R, Ahmad N

Malays Fam Physician, 2023;18:28.

PMID: 37205145 DOI: 10.51866/rv.210

INTRODUCTION: The Malaysian healthcare system, particularly for maternal and child health, has been well recognised to provide high-quality services and be at par with systems in other developed countries. Current health programmes and technological advancements effectively detect vulnerable groups of children, such as small-for-gestational-age (SGA) infants, antenatally. However, the postnatal care for SGA infants is not clearly evaluated, as this group of children is mostly classified as healthy in many medical contexts, especially in primary care settings. Available health programmes and healthcare service delivery must be continuously evaluated by implementing beneficial and relevant evidence-based theories.

METHOD: Articles, reports and guidelines used in providing mother and child health services in Malaysia published since 2000 were reviewed.

RESULTS: There was no specific monitoring strategy used for SGA infants without critical health issues in early childhood, as they were commonly treated as healthy infants. Several challenges in aligning theory with the current practice of healthcare service delivery and recommendations for dealing with such challenges were identified.

CONCLUSION: The alignment of theory with the current practice of service delivery should be tailored to the needs and demands parallel to the dynamic change in populations in the urbanisation era.

Fulltext Amlodipine-induced buccal lichenoid lesions: A case report

Muhammad Hafiz MP, Azidah AK, Zainab MY

Malays Fam Physician, 2024;19:17.

PMID: 38623417 DOI: 10.51866/cr.531

Buccal lichenoid lesions (BLLs) are characterised by a unique, linear whitish striation in the buccal region and can be accompanied by ulcers, plaques, erythemas, atrophies and blisters. They are distinguished from oral lichen planus (OLP) by the association of the administration of a drug or contact with a metal. Herein, we present the case of a 42-year-old woman with underlying hypertension with amlodipine-induced BLLs. She complained of a 1-month history of right buccal whitish streaks and oral ulcers 2 months after taking amlodipine. She visited a private otorhinolaryngology clinic, and a biopsy for the right buccal ulcer was conducted. The biopsy result showed features suggestive of OLP. The patient was then diagnosed with OLP. Her symptoms were persistent despite treatment, so a dental referral was made. Amlodipine was suspected as the cause of her condition and was therefore stopped. Her condition gradually resolved after amlodipine withdrawal. Hence, primary care physicians should be aware of BLLs as one of the adverse drug reactions of amlodipine so that prompt management can be taken to avoid further debilitating impacts on patients.

Fulltext An 80-year-old woman with left shoulder pain

Khoo SB

Malays Fam Physician, 2010;5(3):139-44.

PMID: 25606206 MyJurnal

This case history illustrates the real life experience and dilemma of an 80-year-old woman in pursuit of medical care for her left shoulder pain. Points for discussion range from clinical features of Pancoast tumor, importance of pain management, good principles of Family Medicine and Palliative care to ethical issues of conspiracy of silence, limited treatment plan and palliative versus curative radiotherapy treatment without a known biopsy report. This paper provides opportunity for analysis of a real complex clinical situation, application of medical knowledge to problem solving in clinical practice and relevant topics for discussions. (For anonymity sake, the names of patient, doctors, general and private hospitals are not mentioned. The aim of this paper is solely for continuous medical education without any intention to ridicule any party).

Fulltext An Aubergine in My … Case of Rectal Foreign Body

Mohamad IS, Yaacob H

Malays Fam Physician, 2018;13(3):47-48.

PMID: 30800236 MyJurnal

A 24-year-old man presented to the casualty department with a history of left-sided, colicky abdominal pain for one day. It was associated with an inability to pass flatus or motion within the same duration. There was no history of vomiting. On examination, the vital signs were within normal limits, and he was afebrile. His abdomen was soft, but a hard mass was palpable on the left side of his abdomen. There was no peritonitis. The bowel sounds were sluggish.

Fulltext An Elderly Woman with Unresolved 'Stye' Over her Right Lower Eye Lid

Azhany Y, Nani D

Malays Fam Physician, 2010;5(3):155-6.

PMID: 25606211

Fulltext An Older Woman in Early Pregnancy: What Antenatal Screening is Appropriate?

Syed Aznal SS

Malays Fam Physician, 2008;3(3):137-9.

PMID: 25606138 MyJurnal

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 An adolescent with anorexia nervosa - a case report

Khairani O, Majmin SH, Saharuddin A, Loh SF, Noor Azimah M, Hizlinda T

Malays Fam Physician, 2011;6(2):79-81.

PMID: 25606230 MyJurnal

This case report illustrates an adolescent with clinical presentation of moderate anorexia nervosa with no significant co-morbidities. It highlights the management of anorexia nervosa in the outpatient setting by a multi-disciplinary health care team which includes a family physician, a dietician, a psychologist and a child psychiatrist.

Fulltext An adult patient with congenital heart disease

Choo WS

Malays Fam Physician, 2010;5(3):153-4.

PMID: 25606210

Fulltext An adult patient with double vision

Koh KC

Malays Fam Physician, 2013;8(1):50-52.

PMID: 25606271 MyJurnal

A 27-year old Nepali man presented with a four-day history of fever, vomiting and horizontal diplopia. There was no history of trauma. The patient has esotropia of the left eye or what is commonly known as a squint or strabismus. The squint is an inward squint (synonyms include convergent squint or esodeviation of the eye). Esotropia is a condition where either one or both eyes are turned inward. Congenital esotropia, often seen in infants below six years old, may give rise to amblyopia. Accommodative esotropia is common among patients with moderate amounts of
hypermetropia or hyperopia. Esotropias can be concomitant, where the degree of deviation is independent of the direction of the gaze, or incomitant, where the degree of deviation is influenced by the direction of the gaze. This patient had incomitant esotropia as the squint was revealed when he was asked to look to the left. A comprehensive step-bystep approach to a patient presenting with a squint has been described extensively in literature.

Fulltext An adult patient with nail abnormality

Koh KC

Malays Fam Physician, 2011;6(1):34-5.

PMID: 25606219

This is the photograph of an adult male with Human Immunodeficiency Virus -Hepatitis C virus (HIV-HCV) co-infection. He was on highly active antiretroviral therapy (HAART) for HIV infection. The liver function tests showed hypoalbuminemia and elevated serum transaminases while liver ultrasonography showed coarse echotexture compatible with liver cirrhosis.

An adult with a finger mass is it benign or malignant?

Jamaluddin J, Lee YS

Malays Fam Physician, 2022 Nov 30;17(3):153-155.

PMID: 36606175 DOI: 10.51866/tyk.148

We described the case of a 42-year-old man who presented with left index finger mass persisting for 6 months. The mass was small and, painless and had gradually increased in size with limited finger flexion. Physical examination showed a firm mass over the volar surface of the left index finger. There was no tenderness, redness, warmth or punctum. The overlying skin was normal, and the mass did not transilluminate. Further examination of the head and neck, chest, upper limbs and neurovascular system revealed normal findings. No similar masses were found elsewhere in the body. Bedside ultrasound with further investigation and management confirmed the suspected diagnosis.

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

Teng CL

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

PMID: 25606077

Fulltext An annual audit of the ear foreign bodies in Hospital Universiti Sains Malaysia

Yaroko AA, Irfan M

Malays Fam Physician, 2012;7(1):2-5.

PMID: 25606237 MyJurnal

Foreign bodies or objects in the ear are one of the most common problems encountered by otorhinolaryngologist (ORL) with attendant complications, removal of which requires expertise. Patients with this problem who sought treatment in the otorhinolaryngology clinic of Hospital Universiti Sains Malaysia (HUSM) were studied for duration of one year from January 2010 to December 2010. Specifically, the clinical presentation, type of foreign body and management outcome were analysed. 72 patients were reviewed - 44 (61.1%) males and 28 (38.9%) females. The age range was one year to 75 years with 59.8% being children below 10 years old. Ear pain (56.9%) was recorded as the most common and persistent symptom and insects (54%) were the commonest foreign body encountered. 95% (69) of the foreign bodies were removed under clinic setting with only three (4.2%) cases requiring general anaesthesia. Post-removal complications were noted in only one patient (1.4%). Repeated attempts by untrained personnel should be avoided and timely referral is vital to avoid undesirable complications.

Study site: torhinolaryngology clinic of Hospital Universiti Sains Malaysia (HUSM)

Fulltext An assessment of patient waiting and consultation time in a primary healthcare clinic

Ahmad BA, Khairatul K, Farnaza A

Malays Fam Physician, 2017;12(1):14-21.

PMID: 28503269 MyJurnal

Waiting is a common phenomenon in the doctor's waiting room. The purpose of this audit is to assess patient waiting time and doctor consultation time in a primary healthcare clinic and to formulate strategies for improvement. This audit was conducted at a primary care clinic for 4 weeks using the universal sampling method. All patients who attended the clinic during this period was included in the study except for those who required more time to be seen such as those who were critically ill, aggressive or those who came for repeat medication or procedures only without needing to see the doctor. The time of arrival was captured using the queue management system (QMS) and then the patient was given a timing chit which had to be manually filled by the staff at every station. The waiting time for registration, pre-consultation, consultation, appointment, payment and pharmacy were recorded as well as consultation time. The data were entered into the statistical software SPSS version 17 for analysis. version 17. Results showed that more than half of the patients were registered within 15 minutes (53%) and the average total waiting time from registration to seeing a doctor was 41 minutes. Ninety-nine percentage of patients waited less than 30 minutes to get their medication. The average consultation time was 18.21 minutes. The problems identified in this audit were addressed and strategies formulated to improve the waiting and consultation time were carried out including increasing the number of staff at the registration counter, enforcing the staggered appointment system for follow-up patients and improving the queuing system for walk-in patients.

Fulltext An association of myasthenia gravis with Hashimoto's thyroiditis in a patient with a multinodular goitre

Mohamed N, Mohd Zin F, Mohd Yusoff SS

Malays Fam Physician, 2017;12(2):29-31.

PMID: 29423128

Introduction: The association of myasthenia gravis (MG) with other autoimmune diseases including autoimmune thyroid disease (ATD) is well recognised, although rare. The occurrence of both diseases can occur in two ways: either disease preceding the other, or concurrently. The presentation of MG in association with ATD can range from ocular to generalised disease.

Case Summary: A 26-year-old Malay female with persistent hyperthyroidism secondary to Hashimoto's thyroiditis in multinodular goitre was diagnosed with generalised MG after 2 years. She presented with right eye ptosis (ocular) and difficulty in swallowing and chewing (bulbar). The diagnosis of MG was confirmed by fatigability testing, electromyography and the presence of AChR antibodies. Her symptoms showed improvement with pyridostigmine (Mestinon) 60 mg 6-hourly. Her antithyroid drug was tapered down according to her thyroid function test. Throughout a year of follow-ups, her hyperthyroidism and fatigability symptoms improved with treatment. She was later counselled for total thyroidectomy and thymectomy.

Conclusion: Myasthenia gravis and hyperthyroidism may present with similar symptoms such as dysphagia due to neuromuscular weakness or fatigue. When the diseases occur together, one of the diagnoses may be missed. Therefore, the occurrence of new symptoms in a patient with underlying ATD should should trigger the early identification of other autoimmune diseases by primary care doctors.

Fulltext An audit of sputum smear negative pulmonary tuberculosis cases in Kinta district, Perak, in 2011

Subashini A, Lau KM, Habibur Rahman ZA

Malays Fam Physician, 2012;7(2-3):31-4.

PMID: 25606253 MyJurnal

58 cases of sputum smear negative pulmonary tuberculosis (PTB) were reported to Kinta Health Department between January and June 2011. It was found that 47 cases (81%) were sputum smear negative cases. Six cases (10.3%) were actually sputum smear positive but were wrongly reported as smear negative. Five cases (8.6%) were misdiagnosed as tuberculosis. Majority of these patients (82.7%) sought consultation and treatment after two weeks of having cough. Only 6.9% sought treatment for cough that was less than two weeks old. Accurate diagnosis of PTB is crucial and the Perak State Health Department needs to quickly adopt steps to improve the situation.

An eight-year old girl with fever and rash: What is the possible diagnosis?

Farhani S, Hayaatul Najaa M, Hu SE

Malays Fam Physician, 2023;18:55.

PMID: 38026578 DOI: 10.51866/tyk.298

In this clinical challenge, we describe the case of a previously healthy 8-year-old girl who presented to a primary care clinic with fever, reduced oral intake and malaise on day 3 of her illness. Clinical examination revealed that she was tachypnoeic and tachycardic. An erythematous rash was found across the bridge of her nose and cheeks, and several painless ulcers were noted in the oral cavity. Blood investigation showed thrombocytopenia, while urinalysis revealed microscopic haematuria and proteinuria. Useful initial diagnostic imaging studies were discussed, including bedside ultrasound in the ambulatory care setting. It is imperative that primary care providers be vigilant when encountering cases like this.

Fulltext An elderly lady with blurring of vision

Azhany Y, Nani D, Zunaina E

Malays Fam Physician, 2012;7(1):43-4.

PMID: 25606247 MyJurnal

Fulltext An elderly man with acute anterior neck pain and odynophagia after a meal

Mohamad I, Jaafar R

Malays Fam Physician, 2013;8(3):37-9.

PMID: 25893057 MyJurnal

The upper aerodigestive tract, specifically the cricopharyngeal area, is the most common site of foreign body impaction. Anatomically, this area is the first constriction of the oesophagus. Fish bones, one of the most common foreign bodies encountered in the throat, tend to get stuck in this area. The movement of this sharp-edged foreign body upon swallowing will induce odynophagia and an acute onset of neck pain. We report a case of a healthy elderly man who complained of sudden anterior neck pain and odynophagia after eating yellowtail scad fish.

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