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  1. Safura Ramli, Evana Kamarudin, Mazura Bahar
    MyJurnal
    After ABO, Rhesus (Rh) is the second most clinically important blood group regarding transfusion
    and pregnancy induced alloimmunisation. RhD DEL is a subtype of variant RhD, which is difficult to
    determine in a routine blood bank, since it expresses an extremely low level of D antigens. Serologically,
    it can only be detected via adsorption-elution test. To date, there have been limited data available on the
    Rhd DEL phenotype in Malaysia. Thus, this study was carried out to detect DEL phenotype among RhD
    negative donors in Malaysia. A total of 43 RhD-negative blood samples were collected from National
    Blood Centre, Malaysia. Rh phenotype for each sample was tested, followed by adsorption elution
    technique. Then, identification of DEL carrying RHD1227A allele was performed via SSP-PCR. Rhphenotype
    identified were ccee (79.07%), Ccee (13.95%), 4.65% of ccEe phenotype and only 2.33% of
    CCee phenotype. One (2.3%) out of the 43 samples was identified as DEL phenotype carrying RHD1227A
    allele when tested using SSP-PCR, but none was identified from adsorption-elution. A larger sample
    size is recommended to determine the exact prevalence of DEL phenotype, as well as specificity and
    sensitivity between SSP-PCR as compared with the traditional adsorption elution technique.
  2. Nur Hidayah Bahrom, Anis Safura Ramli, Nor Suraya Samsudin, Norliana Dalila Mohamad Ali, Nor Salmah Bakar
    MyJurnal
    This is a case of a 62-year-old Indian man who was diagnosed with a rare type of lung
    neuroendocrine tumour (NET) of atypical carcinoid (AC) subtype which comprises only 0.1%–
    0.2% of pulmonary neoplasms. He initially presented to a private hospital in May 2018 with a
    6-month history of chronic productive cough and haemoptysis. Chest X-Ray (CXR), CT scan,
    bronchoscopy, biopsy and broncho-alveolar lavage were conducted. At this stage, imaging and
    histopathological investigations were negative for malignancy. Diagnosis of bronchiectasis was
    made and he was treated with antibiotic and tranexamic acid. Due to financial difficulties, his
    care was transferred to a university respiratory clinic in June 2018. His condition was monitored
    with CXR at every visit and treatment with tranexamic acid was continued for 6 months.
    However, due to persistent haemoptysis, he presented to the university primary care clinic in
    Dec 2018. Investigations were repeated in January 2019 where his CXR showed increased
    opacity of the left retrocardiac region and CT scan revealed a left lower lobe endobronchial
    mass causing collapse with mediastinal lymphadenopathy suggestive of malignancy.
    Bronchoscopy, biopsy and histopathology confirmed the presence of NET. Although the Ki-67
    index was low, the mitotic count, presence of necrosis and evidence of liver metastases
    favoured the diagnosis of AC. A positron emission tomography Ga-68 DONATOC scan showed
    evidence of somatostatin receptor avid known primary malignancy in the lungs with suspicions
    of liver metastasis. He was subsequently referred to the oncology team and chemotherapy was
    initiated. This case highlights the challenge in diagnosis and management of patients with AC.
    Physicians ought to be vigilant and have a high index of suspicion in patients who present with
    persistent symptoms on multiple visits. Early diagnosis of NET would prevent metastasis and
    provide better prognosis. Continuous follow-up shared care between primary care and
    secondary care physicians is also essential to provide ongoing psychosocial support for
    patients with NET, especially those with metastatic disease
  3. Safura Ramli A, Osman MT, Nasir NM, Saimin H, Abdul Rahman TH, Abdul Razak S, et al.
    Atherosclerosis, 2017 Aug;263:e265-e267.
    PMID: 29366009 DOI: 10.1016/j.atherosclerosis.2017.06.860
  4. Anis Safura Ramli, Sri Wahyu Taher, Zainal Fitri Zakaria, Norsiah Ali, Nurainul Hana Shamsuddin, Wong Ping Foo, et al.
    MyJurnal
    A strong and robust Primary Health Care system is essential to achieving universal health
    coverage and to save lives. The Global Conference on Primary Health Care 2018: from Alma-Ata towards achieving Universal Health Coverage and the Sustainable Development Goals at
    Astana, Kazakhstan provided a platform for low‐ and middle‐ income countries to join the
    Primary Health Care Performance Initiative (PHCPI). At this Global Conference, Malaysia has
    declared to become a Trailblazer Country in the PHCPI and pledged to monitor her Vital Signs
    Profiles (VSP). However, the VSP project requires an honest and transparent data collection
    and monitoring of the Primary Health Care system, so as to identify gaps and guide policy in
    support of Primary Health Care reform. This is a huge commitment and can only be materialised
    if there is a collaborative partnership between Primary Care and Public Health providers.
    Fundamental to all of these, is the controversy concerning whether or not ‘Primary Care’ and
    ‘Primary Health Care’ represent the same entity. Confusion also occurs with regards to the role
    of ‘Primary Care’ and ‘Public Health’ providers in the Malaysian Primary Health Care system.
    This review aims to differentiate between Primary Care, Primary Health Care and Public Health,
    describe the relationships between the three entities and redefine the role of Primary Care and
    Public Health in the PHCPI-VSP in order to transform the Malaysian Primary Health Care
    system.
  5. Anis Safura R, Wijesinha S, Piterman L
    Malays Fam Physician, 2010;5(1):49-52.
    MyJurnal
    Rapid epidemiological transition globally has witnessed a rising prevalence of major chronic diseases such as hypertension, diabetes, hyperlipidaemia, obesity, chronic respiratory diseases and cancers over the past 30 years. In Malaysia, these conditions are commonly managed in primary care and published evidence has consistently shown suboptimal management and poor disease control. This in turn, has led to the massive burden of treating complications in secondary care, burden to the patients and their families with regards to morbidity and premature death, and burden to the country with regards to premature loss of human capital. The crushing burden and escalating health care costs in managing chronic diseases pose a daunting challenge to our primary care system, as we remain traditionally oriented to care for acute, episodic illnesses. This paper re-examines the current evidence supporting the implementation of Wagner Chronic Care Model in primary care globally; analyses the barriers of implementation of this model in the Malaysian private general practice through SWOT (strengths, weaknesses, opportunities and threats) analysis; and discusses fundamental solutions needed to bridge the gap to achieve better outcomes.
  6. Abdul-Hamid H, Kai J, Anis Safura R
    Ann Fam Med, 2023 Jan 01.
    PMID: 37037012 DOI: 10.1370/afm.21.s1.4220
    Context Familial hypercholesterolaemia (FH) is a common autosomal dominant disorder, causing elevated cholesterol from birth, premature heart disease, and early death. Objective This study explored primary care physicians' experiences and perspectives on identifying FH in Malaysian primary care. Study Design and Analysis A qualitative study involving semi-structured interviews and focus group discussions with 22 primary care physicians (PCPs) in two primary care clinic settings. The interviews and focus group discussions were audio recorded, and the recordings were transcribed verbatim. The data in the transcripts were analysed using thematic approach. Setting Primary Care Clinics Population Studied Primary Care Physicians in two primary care clinics. Intervention A qualitative study involving semi-structured interviews and focus group discussions Outcome Measures Primary Care Physicians' perceptions and experiences of identifying individuals at high risk of FH in their clinical practice, and the acceptability and perceived challenges of trying to do this were explored during the interviews and focus group discussions. Findings PCPs felt there was potential for FH to be identified earlier in primary care. They had some existing knowledge and awareness of diagnostic criteria for FH but highlighted several challenges. In their practice, this included limited time in routine clinical care, availability of medication and clinical expertise; and critical lack of family history and physical examination findings in health records. The barriers on a systemic level were shortage of lipid specialist services and the absence of local care pathways for FH. The PCPs recommended a user-friendly case-finding tool for FH, and establishing FH registry and clinical practice guideline in Malaysia, alongside a national FH screening strategy and awareness campaigns for both clinicians and general public. Conclusions PCPs are positive about improving the identification of FH in primary care. However greater support in their practice and wider system developments and change are needed.
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