MyMedR

Is HIV Screening in the General Population Cost Effective?

Tan H, Koh K

Malays Fam Physician, 2008;3(2):96-7.

Fulltext Palliative care for a child: role of a primary care doctor

Tan CE, Md Radzniwan R, Khairani O, Ednin H

Malays Fam Physician, 2011;6(1):26-28.

A 7-year-old boy with a diagnosis of advanced medulloblastoma refractory to treatment was discharged from hospital for further palliative care at home. During this short and eventful period, the child developed spinal cord compression with progressive weakness of upper and lower limbs, neck pain, faecal and urinary incontinence. This case highlights the important roles of a primary care doctor in the provision of palliative care for a child in the community.

Fulltext Generalised pruritus as a presentation of Grave's disease

Tan CE, Loh KY

Malays Fam Physician, 2013;8(1):20-3.

PMID: 25606263 MyJurnal

Pruritus is a lesser known symptom of hyperthyroidism, particularly in autoimmune thyroid disorders. This is a case report of a 27-year-old woman who presented with generalised pruritus at a primary care clinic. Incidental findings of tachycardia and a goiter led to the investigations of her thyroid status. The thyroid function test revealed elevated serum free T4 and suppressed thyroid stimulating hormone levels. The anti-thyroid antibodies were positive. She was diagnosed with Graves' disease and treated with carbimazole until her symptoms subsided. Graves' disease should be considered as an underlying cause for patients presenting with pruritus. A thorough history and complete physical examination are crucial in making an accurate diagnosis. Underlying causes must be determined before treating the symptoms.

Fulltext Coining: an ancient treatment widely practiced among asians

Tan AK, Mallika PS

Malays Fam Physician, 2011;6(2-3):97-8.

PMID: 25606235 MyJurnal

Coining is a technique used in treating many illnesses since ancient times. It is a form of dermabrasion therapy still widely practiced in China and South East Asia. This ancient treatment method is employed to rid the body of "heatiness" or "negative energies". Coining is associated with serious complications, and has been confused with child abuse by physicians unfamiliar to Asian cultures. Despite the availability of more simple and effective treatment for fever, coining is still widely practiced among Asians.

Fulltext Paediatric ocular trauma in Kuching, Sarawak, Malaysia

Tan AK, Mallika PS, Asokumaran T, Mohamad Aziz S, Intan G

Malays Fam Physician, 2011;6(2-3):68-71.

PMID: 25606227 MyJurnal

To evaluate the demography, aetiology, type and outcome of paediatric ocular trauma in tertiary centre in Malaysia.

Fulltext Comparison between the panoptic ophthalmoscope and the conventional direct ophthalmoscope in the detection of sight threatening diabetic retinopathy: the kuching diabetic eye study

Tan AK, Mallika P. S., Aziz S, Asokumaran T, Intan G, Faridah HA

Malays Fam Physician, 2010;5(2):83-90.

PMID: 25606193 MyJurnal

OBJECTIVE: To determine the sensitivity and specificity of the conventional direct ophthalmoscope and the PanOptic ophthalmoscope in the detection of sight threatening retinopathy, as well as the "Ease of Use" of these equipments.
METHODS: 200 diabetics, newly referred from primary health physicians were examined. Fundus examinations were performed with pupil dilatation in a dark room. The examinations were performed by a single investigator using the PanOptic ophthalmoscope, the conventional direct ophthalmoscope and slit lamp biomicroscopy.
RESULTS: The overall sensitivity in detecting sight threatening retinopathy using the conventional direct ophthalmoscope was 73.2% (95% CI: 57.1-85.8%), specificity 93.7% (95% CI: 88.7-96.9%). For PanOptic ophthalmoscope, the overall sensitivity in detecting sight threatening retinopathy was 58.5% (95% CI: 42.1-73.7%), specificity 93.7% (95% CI: 88.7-96.9%). The conventional direct ophthalmoscope was 1.38 times (95% CI: 1.17-1.61 times) as easy to use compared to the PanOptic ophthalmoscope.
CONCLUSION: The PanOptic ophthalmoscope is not superior to the conventional direct ophthalmoscope for the screening of Sight Threatening Retinopathy.
KEYWORDS: PanOptic ophthalmoscope; conventional direct ophthalmoscope; sight threatening retinopathy
Study site: Ophthalmology clinic, Sarawak General Hospital, Kuching, Sarawak, Malaysia

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.

Fulltext The two-minute approach to monocular diplopia

Tan AK, Faridah Hanom A

Malays Fam Physician, 2010;5(3):115-118.

PMID: 25606202 MyJurnal

To describe a quick and simple diagnostic approach to monocular diplopia. Diplopia is a common visual complain in casualty departments, general practice clinics, neurologic clinics as well as ophthalmic clinics. Monocular diplopia, however, is uncommon. Many well established clinical examination methods are available to address diplopia. Some require special equipments which are not easily available or unfamiliar outside of ophthalmic clinic. We describe a simple two-minute diagnostic approach to monocular diplopia. Basic knowledge and understanding of simple clinical examination techniques enhances diagnostic skill and allow proper localization of underlying disorders.

Fulltext Ethambutol ocular toxicity in a patient with pulmonary tuberculosis - a case report

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

Malays Fam Physician, 2008;3(2):87-90.

PMID: 25606123 MyJurnal

Purpose. To highlight the importance of using the Farnsworth Panel D-15 Hue test in colour vision testing in patients on ethambutol treatment. Case Report. A 70 year-old lady received ethambutol as part of her anti-tuberculous regime. She developed blue-yellow colour defect detectable with the Farnsworth Panel D-15 Hue test, but not with the Isihara Pseudoisochromatic Plates. Ethambutol was immediately discontinued from her anti-tuberculous regime. Two months later, her colour vision returned to normal. Conclusion. This case report illustrates the importance of regular monitoring of patients receiving ethambutol for blue-yellow colour defect using the Farnsworth Panel D-15 Hue Test.

Is there any importance of Migraine with Aura amongst medical students?

Taksande A

Malays Fam Physician, 2022 Nov 30;17(3):158.

PMID: 36606179 DOI: 10.51866/lte.249

Impacts of accreditation on the performance of primary health care centres: A systematic review

Tabrizi JS, As'habi A, Nazari M, Ebrahimi Tavani M, Haghi M, Gharibi F

Malays Fam Physician, 2023;18:63.

PMID: 38026575 DOI: 10.51866/rv.274

INTRODUCTION: Evidence on the impacts of accreditation on primary health care (PHC) services is inconsistent. Thus, this study aimed to assess the impacts of accreditation on the performance of PHC centres.

METHOD: This study systematically reviewed articles published from 2000 to 2019 in the Web of Science, Scopus, ScienceDirect, Springer, PubMed and ProQuest. The following keywords were used: ((primary care OR primary health care) AND (accreditation) AND (impact OR effect OR output OR outcome OR influence OR result OR consequences)). The database search yielded a total of41256 articles, among which 30 articles were finally included in the review.

RESULTS: Accreditation showed the most positive impacts on the quality, effectiveness, human resource management and strategic management of PHC services. Accreditation also positively affected safety, responsiveness, accessibility, customer satisfaction, documentation, leadership, efficiency and continuity of care. Few negative impacts were noted, including the possibility of accreditation being used as a bureaucratic tool, high cost of acquiring accreditation, difficulties in understanding the accreditation process, high staff turnover rate in accredited PHC centres and weak sustainability of some accreditation programmes.

CONCLUSION: Given its numerous positive impacts, accreditation could be used to effectively improve the performance of PHC centres.

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

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 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.

Prevalence and risk factors associated with falls among community-dwelling and institutionalized older adults in Indonesia

Susilowati IH, Nugraha S, Sabarinah S, Peltzer K, Pengpid S, Hasiholan BP

Malays Fam Physician, 2020;15(1):30-38.

PMID: 32284802

Objective: To assess the prevalence and social and health correlates of falls and fall risk in a sample of community-dwelling and institutionalized older Indonesians.

Methods: This cross-sectional study was conducted July-August 2018 in three regions in Indonesia. Adults aged 60 years and above (n=427) were recruited via random sampling from community clinics and public and private elderly homes. They responded to interview-administered questions and provided measurements on sociodemographics and various health variables, including falls and fall risk. Fall risk was assessed with the STEADI (Stopping Elderly Accidents, Deaths, & Injuries) screen. Multivariable logistic regression was conducted to estimate associations with fall and fall risk.

Results: In the year immediately preceding the study, 29.0% of participants had suffered a fall. Approximately one-third of women (31.1%) and one-fifth of men (20.4%) reported a fall in the past year, and 25.4% of community dwellers and 32.7% of institutionalized older adults had fallen. The overall proportion of fall risk was 45.4%, 49.0% among women, 38.0% among men, 50.5% in the institutionalized setting, and 40.4% in the community setting. In adjusted logistic regression analysis, older age (OR: 1.89, CI: 1.06, 3.37), private elderly home setting (OR:2.04, CI: 1.10, 3.78), and being female (OR: 0.49, CI: 0.30, 0.82) were associated with falls in the preceding 12 months. Older age (80-102 years) (OR: 2.55, CI: 1.46, 4.46), private elderly home residence (OR: 2.24, CI: 1.19, 4.21), lack of education (OR: 0.51, CI: 0.28, 0.93), memory problems (OR: 1.81, CI: 1.09, 2.99), and arthritis (OR: 2.97, CI: 1.26, 7.00) were associated with fall risk by the STEADI screen. In stratified analysis by setting, being female (OR: 0.49, CI: 0.25, 0.95) and living in urban areas (OR: 1.97, CI: 1.03, 3.76) were associated with falls in the institutionalized setting, and having near vision problems (OR: 2.32, CI: 1.09, 4.93) was associated with falls in the community setting. Older age (OR: 2.87, CI: 1.36, 6.07) was associated with fall risk in the institutionalized setting, and rural residence (OR: 0.37, CI: 0.15, 0.93) and having a joint disorder or arthritis (OR: 4.82, CI: 1.28, 16.61) were associated with fall risk in the community setting.

Conclusion: A high proportion of older adults in community and institutional care in Indonesia have fallen or were at risk of falling in the preceding 12 months. Health variables for fall and fall risk were identified for the population overall and for specific populations in the home care and community setting that could help in designing fall-prevention strategies.

An unusual cause of acute abdomen and acute renal failure: Djenkolism

Sumitro K, Yong CS, Tan LT, Choo S, Lim CY, Shariman H, et al.

Malays Fam Physician, 2020;15(2):50-52.

PMID: 32843946

The djenkol bean (Archidendron pauciflorum) is a native delicacy in Southeast Asia, though consumption can sometimes lead to djenkolism. Clinical features of djenkolism include acute abdominal pain, hematuria, urinary retention, and acute kidney injury (AKI). The pain can be severe, which often leads to a misdiagnosis of acute abdomen. In this paper, we report the case of an Indonesian migrant with djenkolism. Due to the short history and severity of the abdominal pain, medical professionals suspected acute abdomen and proceeded with a negative exploratory laparotomy. However, djenkolism was suspected once relatives informed the professionals that the patient had consumed djenkol beans hours earlier. The patient recovered through aggressive hydration and urine alkalinization with bicarbonate infusion. We highlight the importance of being aware of this rare cause of AKI, especially in Southeast Asia, in order to provide early diagnoses and prompt treatments.

Invasive Klebsiella syndrome with coexisting fungal endophthalmitis

Sugantheran J, Zunaina E, Md Kasim WM, Talib N

Malays Fam Physician, 2021 Jul 22;16(2):94-97.

PMID: 34386173 DOI: 10.51866/cr1100

Endogenous endophthalmitis accounts for approximately 5 - 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled diabetes mellitus who presented with fever and generalised body weakness for one week. He was diagnosed with invasive Klebsiella syndrome based on blood culture with presence of bilateral pleural effusion, liver abscess, renal impairment and sphenoidal sinusitis. The patient developed sudden bilateral painless reduced vision on day two of admission. Ocular examination revealed bilateral severe anterior chamber reaction and severe vitritis that obscured the view of the fundus. Ocular B-scan ultrasonography showed multiple loculations in the posterior segment in both eyes. There was soft tissue density with calcification in the left sphenoid sinus on computed tomography of the orbit. He was treated for bilateral endogenous endophthalmitis with multiple intravitreal antibiotic injections, but showed no improvement. Functional endoscopic sinus surgery was performed and revealed that the left sphenoid sinus was filled with fungal balls. Following drainage of sphenoidal pus, there was resolution of vitritis and fundus examination showed features of underlying fungal infection with a "string of pearls" present along the vascular arcade of both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. In addition to repeated intravitreal antibiotic injections, he was also treated with systemic and topical antifungal therapy. At three months post treatment, the infection resolved and his vision improved from counting fingers to 6/36 bilaterally. Key messages: A middle-aged gentleman presented with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. A high index of suspicion is required for early diagnosis of fungal endophthalmitis.

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 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.

Fulltext Perception of primary care doctors towards telemedicine in Kuching, Sarawak: A cross-sectional study

Su XV, Isnani S, Sharifah Khadijah WMS, Shareezan HS, Lau LK, Maziah I, et al.

Malays Fam Physician, 2024;19:10.

PMID: 38496772 DOI: 10.51866/oa.505

INTRODUCTION: Telemedicine is the provision of healthcare remotely via information and communications technology (ICT). This study aimed to assess the familiarity and factors related to the perception towards telemedicine and the willingness to practise telemedicine among primary care doctors.

METHODS: A multi-centre cross-sectional study was conducted prospectively at all public healthcare clinics across Kuching, Sarawak. A questionnaire was adapted and modified from an overseas validated questionnaire, consisting of four parts: demographic data, familiarity towards telemedicine, factors related to the perception of telemedicine and willingness to implement telemedicine.

RESULTS: A total of 131 doctors were recruited. Of them, 43.5% had never interacted with patients via email, WhatsApp or Telegram, while 68.7% had never attended any conferences, speeches or meetings regarding telemedicine. The doctors had low familiarity towards guidelines, technology and medical applications of telemedicine. The majority agreed on the ability of telemedicine to save patients' time and money, the potential of ICT in healthcare and the necessity during a pandemic but perceived the possibility of technical difficulties. The doctors who had experience in interacting with patients via email, WhatsApp or Telegram (P=0.001) and those who had ≤8 years of working experience (P=0.04) had a significantly better perception towards telemedicine.

CONCLUSION: Although the familiarity towards telemedicine among public primary care doctors is low, their perception is good in a majority of areas. Adequate technological support and continuous education on telemedicine and its guidelines, especially medicolegal issues, are imperative to adopt and propagate telemedicine in primary care.

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