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  1. Fulltext An Approach to Acute Cranial Symptoms in Primary Care: Lesson From a Case of Miller Fisher Syndrome
    Jasme H, Mohd Noh MN, Zainal-Abidin ANI
    Am J Case Rep, 2026 Nov 02;27:e954763.
    PMID: 42970499 DOI: 10.12659/AJCR.954763
    BACKGROUND Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome characterized by the classic triad of ophthalmoplegia, ataxia, and areflexia following a recent infection. Early recognition is particularly challenging due to the rarity of the condition and its tendency to mimic other common neurological and non-neurological disorders. We report a case highlighting the diagnostic and referral challenges encountered in the primary care setting. CASE REPORT A 38-year-old woman with no significant comorbidity presented to a primary care clinic with acute diplopia, right eye pain, headache, and perioral numbness following an upper respiratory tract infection 2 weeks earlier. Initial neurological examination was unremarkable. She was referred to the ophthalmology and emergency departments to exclude ocular pathology and posterior circulation stroke. Laboratory investigation and computed tomography of the brain were unremarkable and she was managed as a case of migraine. Meanwhile, ophthalmological review subsequently demonstrated ophthalmoplegia and the following day she developed bulbar symptoms prompting urgent neurological consultation. Repeated neurological examination revealed the classic triad of MFS. She received plasma exchange therapy following her clinical deterioration. Her neurological symptoms gradually improved with complete recovery, with residual diplopia resolving 8 weeks after symptom onset. CONCLUSIONS MFS remains a predominantly clinical diagnosis with subtle and evolving features that may delay recognition in the primary care setting. This case underscores the crucial role of primary care physicians in maintaining a high index of suspicion, recognizing atypical presentation, and providing appropriate safety-netting and timely specialist referral to facilitate early diagnosis and improve clinical outcomes.
  2. Fulltext Association of coping mechanisms with medication adherence among young People living with HIV (PLHIV) in Klang Valley
    Zainal-Abidin ANI, Miptah HN, Ariffin F, Razali S, Badlishah-Sham SF
    Heliyon, 2024 Feb 29;10(4):e25740.
    PMID: 38380003 DOI: 10.1016/j.heliyon.2024.e25740
    BACKGROUND: As young People Living with HIV (PLHIV) will need to take antiretroviral therapy (ART) for life, there is a need to understand their coping mechanisms in living with the disease. Lack of coping mechanisms leads to poor medication adherence and hospital follow-up, poor health outcomes and shortened life expectancy.

    OBJECTIVES: This study aimed to determine the pattern of coping mechanisms in young PLHIV and its association with medication adherence.

    METHODS: This study was a cross-sectional study amongst young PLHIV patients (aged 20-39 years old) attending two HIV clinics in Klang Valley. Data was collected between February to August 2022. The pattern of coping strategies was assessed using the 28-item Brief Coping Orientation to Problems Experienced (COPE) questionnaire in English and Malay language, which was validated and found to have good internal consistency. Self-reported medication adherence was measured using the one-item Medical Outcomes Study (MOS) Specific Adherence Scale. Statistical analysis included descriptive statistics, single and multiple logistic regression.

    RESULTS: A total of 395 respondents were recruited for the study. The mean scores for each coping mechanism were: 1) problem-focused coping 2.98 (SD 0.62), 2) emotion-focused coping 2.40 (SD 0.48), 3) dysfunctional coping 1.84 (SD 0.44) and 4) religion/spirituality coping 3.07 (SD 0.97). The majority of the respondents (66.8%) were adherent to their ART. Respondents who had a longer duration of medication [OR:1.014 (95% CI: 1.002,1.026)] and those who adopted less religion/spirituality coping mechanisms [OR: 0.495 (95% CI:0.246, 0.997)] were found to be significantly associated with medication adherence.

    CONCLUSION: This study revealed an overall medication adherence rate of 66.8%. Patients with longer ART duration and who adopted less religion or spirituality coping had better medication adherence. These study findings provide input into the design of intervention by clinicians and healthcare policy makers for young PLHIV in clinical practice.

  3. Gender disparity in the prescription of secondary prevention medications in a Malaysian primary care clinic
    Baharudin N, Ahmad Roslan AM, Mohamed Yassin MS, Ramli AS, Zainal Abidin ANI, Sahar NH, et al.
    Malays Fam Physician, 2021 Jul 22;16(2):37-44.
    PMID: 34386162 DOI: 10.51866/oa1080
    Introduction: Cardiovascular disease is the leading cause of death worldwide. Despite the proven benefit of secondary prevention medications (SPMs), their utilisation remains suboptimal in many countries. This study aimed to assess the use of SPMs in a Malaysian primary care clinic and factors associated with it.

    Methods: A retrospective review of electronic medical records was conducted to assess the prescription of SPMs among patients with coronary artery disease who attended the clinic between 1st January 2018 and 31st December 2018. Prescriptions of SPMs were documented in numbers and percentages. Multiple logistic regressions were used to analyse factors associated with the prescription of SPMs.

    Results: Of the 662 patients included in the study, 99.1% were prescribed statins, 97% antiplatelets, 81.7% angiotensin-converting enzyme (ACE)-inhibitors or angiotensin II receptor blockers (ARBs), and 78.7% beta-blockers. Male patients were more likely to be prescribed statins (OR = 8.584, 95% CI: 1.431 - 51.510) and antiplatelets (OR = 6.818, 95% CI: 2.294 - 20.257). Another significant factor for antiplatelets prescription was having diabetes (OR = 3.318, 95% CI: 1.148 - 9.590). Having hypertension was associated with ACE-inhibitors or ARBs prescription (OR = 4.008, 95% CI: 2.522 - 6.370).

    Conclusion: Although the majority of patients received SPMs, there were significant disparities for some SPMs prescriptions among female patients. As these medications are widely available in the Malaysian primary care setting, steps should be taken to ensure that these medications are prescribed equally for all eligible patients.

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