Diabetes Mellitus is a major global health concern worldwide with increasing trend as reported in the National Health Morbidity Survey 2015. Due to the fact that diabetes mellitus is a life long chronic illness and incurable, it contributes to the increased tendency of seeking Traditional Complementary Medicine (TCM). The objective of this study is to measure the prevalence of CM use among diabetic patients and its association with diabetic control. Materials and Method: A cross-sectional study was performed at Hospital Tengku Ampuan Afzan, between July to August 2018. 136 Type II adult diabetic patients in medical ward and diabetic clinic were interviewed regarding the use of CM, and their blood investigations results were collected from patients' medical records. A data collection form was used as the study instrument. Descriptive statistic was used to measure the prevalence while Fisher exact test and Independent t-test were used to find associations between CM usage with study background and diabetic control. Results: Low prevalence of Traditional Complementary Medicine use (16.9%) was found with retired group of respondents was identified to be the predominant group (p-value=0.025). Majority of patients used CM as an additional treatment for diabetes (60.9%). Friends, family members and advertisement were the main influential factors in starting and using CM. A significant difference in eGFR value was reported between inpatient and outpatient CM users with a p-value of 0.001. No positive association was observed for HbA1c level. Conclusion: 1 in every 6 diabetic patients in HTAA, Kuantan were using Traditional Complementary Medicine along with conventional diabetic medications in which retirees were the major group identified. eGFR was the diabetic control parameter that had been found to have a significant association with diabetic inpatients and outpatient CM users in this study.
Pulmonary nocardiosis is a rare disorder that mainly affects immune-compromised patients. We report a 37-year-old male who presented with persistent fever associated with productive cough. During this course of therapy, he had recurrent admissions for empyema thoracic. Clinically, his vital signs were normal. Blood investigations show leukocytosis with a significantly raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Sputum acid-fast bacilli (AFB) was scanty 1+ and sputum mycobacterium culture was negative. Chest X-ray (CXR) showed consolidative changes with mild to moderate pleural effusion on the right side. Skin biopsy was taken and showed Paecilomyces species. A computed tomography scan (CT thorax) was performed and revealed a multiloculated collection within the right hemithorax with a split pleura sign. Decortications were performed and tissue culture and sensitivity (C+S) growth of Nocardia species. And it is sensitive to sulfamethoxazole-trimethoprim and completed treatment for 4 months. This case highlights that pulmonary nocardiosis should be kept in mind in also immune-competent patients, especially in suspected cases of tuberculosis not responding to antitubercular therapy.
Takotsubo syndrome is a rare disease and remained ambiguous with its etiology. The disease manifests in various clinical characteristics and even mimicking acute coronary syndrome. We are reporting a case of an elderly lady who manifested by unsteady gaits and recurrent falls. Subacute infarct of the right corona radiata was observed on the brain CT. In addition, coronary angiography and ventriculogram were performed because of dynamic ECG changes and elevated troponin I levels. The angiogram was normal while ventriculogram showed apical ballooning. She was diagnosed and treated as Takotsubo syndrome.
Ventricular wall rupture possesses a high mortality rate in patients with acute myocardial infarction. We presented a case of a ninety-year-old gentleman who presented with acute inferolateral myocardial infarction in cardiogenic shock and right ventricular free wall rupture. He was treated conservatively and survived.