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Fulltext Factors Affecting Adherence to Lipid-lowering Drugs: A Scoping Review

Said AH, Abd Rahim IS, Mohamad Zaini NNB, Saiful Nizam NIB

Oman Med J, 2023 Jul;38(4):e523.
PMID: 37736054 DOI: 10.5001/omj.2023.67

OBJECTIVES: Dyslipidemia is an important risk factor for cardiovascular disease. In developed countries, only 50% of patients with chronic illness adhere to their long-term therapy. This article aimed to review the factors affecting adherence to lipid-lowering drugs (LLDs).
METHODS: The searched articles were selected based on the available keywords in the title and abstract with the publication restricted between January 2010 and September 2020. Articles generated from the databases must fulfill both inclusion and exclusion criteria in the present systematic review. Our initial search retrieved 221 literature reviews. After excluding articles with irrelevant topics, a total of 23 articles were chosen for this current review.
RESULTS: The factors were classified based on three main factors: patient-related, medication-related, and healthcare workers-related factors. For patient-related factors, gender, age, number of family members, education level, post-hospitalization, comorbidities and cardiovascular disease risk, follow-up status, occupation, socio-economy, insurance, perception, ethnicity, and health plan were among the factors affecting adherence to LLDs. As for medication-related factors, timing, polypharmacy, duration of treatment, generic medication, intensity of medication, side effects, initiating dose, packaging, drug dosing, and type of drugs were revealed as contributing factors. In the light of healthcare workers, related factors shown were counseling, medication optimization, type of provider, and location of the hospital.
CONCLUSIONS: Recommendations to improve adherence include educating patients on the disease itself and the importance of the treatment, modification of the dosing, timing and type of LLDs, and effective consultations by healthcare workers. Further studies need to be done in Malaysia as there is inadequate research on this topic.
Fulltext A Laryngopharyngeal Mass: Pressure Effect of the Superior Cornu of the Thyroid Cartilage Induced by a Thyroid Mass

Abdul Razak SF, Azman M, Ping LS

Oman Med J, 2024 Jul;39(4):e656.
PMID: 39896116 DOI: 10.5001/omj.2024.23

The superior cornu of the thyroid cartilage is a versatile structure, and anatomical variations can lead to diverse clinical presentations. We describe a case of a patient with a medialized superior part of the thyroid cartilage caused by pressure from a large thyroid mass, detected during laryngoscopy before thyroidectomy. A neck computed tomography scan revealed an elongated and medially displaced superior cornu of the right thyroid cartilage, resulting from the push exerted by the right thyroid mass. As the patient remained asymptomatic and refused surgical intervention, no further consideration was given to surgically addressing the medialized superior thyroid cornu.
Fulltext Myiasis in the Neglected Tracheostomy Wound

Peng TS, Mohamad H, Kanagaratnam K, Mahbob HBM, Kamalden TMIT

Oman Med J, 2024 Sep;39(5):e681.
PMID: 40060979 DOI: 10.5001/omj.2024.32

Myiasis is the term referring to an infestation of dipterous larvae in the living body tissue, where they feed on the tissue and cause infection. It is typically found in individuals living in unhygienic conditions, with foul-smelling odor emanating from neglected wounds or body discharge, which attract flies to lay their eggs in the affected area. Myiasis can cause life-threatening complications if maggots invade vital organs, resulting in sepsis, hemorrhage, and organ dysfunction. The mainstay of treatment includes mechanical removal of the maggots, wound debridement, daily wound dressing, and administration of antibiotics for concurrent bacterial infections. Recently, we encountered a patient who presented with bleeding and foul-smelling discharge from a tracheostomy wound, which was found to be infested with maggots.
Fulltext Detection of Hemoglobin Constant Spring by Capillary Electrophoresis and High-performance Liquid Chromatography: A Study in Kelantan, Malay

Adzahar S, Rameli N, Hussin S, Nik Mohd Hassan NFF, Yusoff WNW, Yusoff SM, et al.

Oman Med J, 2024 Sep;39(5):e669.
PMID: 40104282 DOI: 10.5001/omj.2024.96

OBJECTIVES: Hemoglobin Constant Spring (Hb CS) is one of the most common non-deletion types of alpha (α) thalassemia in Southeast Asia. The nature of this abnormal globin gene is unstable, labile, and present in minute amounts in the peripheral blood, leading to underdiagnosis. This study aimed to determine the prevalence of Hb CS among the Kelantan population in Malaysia, compare the levels of Hb CS detected by capillary electrophoresis (CE) among three groups of Hb CS (heterozygous, homozygous, and compound heterozygous), and evaluate the efficacy of CE and high-performance liquid chromatography (HPLC) in detecting Hb CS.
METHODS: A cross-sectional study was conducted using data collected from secondary school students in Kelantan from 2017 to 2018 who participated in a thalassemia screening program conducted by the Ministry of Health, Malaysia. Hb analysis was performed using an automated CE system (CAPILLARYS 2 Flex-Piercing System Sebia) and HPLC (VARIANT II, Bio-rad Laboratories). DNA analysis was used multiplex polymerase chain reaction and multiplex amplification refractory mutation system to detect deletion and non-deletion α-thalassemia.
RESULTS: Termination codon CS mutation was confirmed among 376 (99.5%) samples with a peak value in zone 2 of CE. Heterozygous Hb CS was the most common type, detected in 344 samples (91.5%), followed by compound heterozygous Hb CS in 31 samples (8.2%) and one sample (0.3%) of homozygous Hb CS.
CONCLUSIONS: The diagnosis of Hb CS is most accurately achieved by combining CE and HPLC methods, with confirmation by DNA molecular study, although the latter is more expensive.