An overweight woman, aged 58 years, presented for follow up of hypertension, diabetes and dyslipidaemia. She was noted to have hyperpigmented brown macules on the inner surface of the lower lip and buccal mucosa (Figure 1). She stated that she had first noticed these lesions when aged in her 40s. Her mother died at age 58 years from gastric cancer with extensive metastases, and her brother died at age 45 years from colon cancer with spread to the liver and lungs.
In many workplaces, employment is conditional on a successful pre-employment medical examination. This examination is usually conducted by a general practitioner on the employers' panel of approved clinics or by an in-house company doctor.
Charcot neuro-osteoarthropathy (CNO) of the foot is a devastating neuropathic complication of diabetes. It is characterised by deformity of the foot architecture,which can be initiated by trauma to the neuropathic limb or occur spontaneously.The acute phase of the disease is often misdiagnosed and can rapidly lead to deformity and amputation. The aim of management is to halt further bone destruction through immobilisation of the affected limb.
BACKGROUND: International students make up an increasing proportion of university students in Australia. Research suggests that they have poor sexual health knowledge compared with local students.
METHODS: Thematic analysis was undertaken on focus groups carried out at the University of Adelaide (South Australia), with 21 female international students from Malaysia and China.
RESULTS: Four themes were identified: poor sexual health knowledge; complex attitudes about premarital sex; difficulty accessing sexual health information, and poor understanding the role of general practitioners in this area; and ideas about future education.
DISCUSSION: Participants believed that international students have insufficient sexual health education when they arrive in Australia. They were concerned that some students may become more sexually active in Australia, and may not have adequate access to health services and information. All participants felt it was necessary for international students to receive better sexual health education. International students are important to Australian universities, and it should be mandatory to ensure that culturally appropriate sex education is made available to this group.
Background: Overprescription of antibiotics is a continuing problem in primary care. This study aims to assess the antibiotic prescribing rates and antibiotic choices for upper respiratory tract infections (URTI) and urinary tract infections (UTI) in Malaysian primary care.
Method: Antibiotic prescribing data for URTI and UTI was extracted from a morbidity survey of randomly selected primary care clinics in Malaysia.
Results: Analysis was performed of 1163 URTI and 105 UTI encounters. Antibiotic prescribing rates for URTI and UTI were 33.8% and 57.1% respectively. Antibiotic prescribing rates were higher in private clinics compared to public clinics for URTI, but not for UTI. In URTI encounters, the majority of antibiotics prescribed were penicillins and macrolides, but penicillin V was notably underused. In UTI encounters, the antibiotics prescribed were predominantly penicillins or cotrimoxazole.
Discussion: Greater effort is needed to bring about evidence based antibiotic prescribing in Malaysian primary care, especially for URTIs in private clinics.
Keywords: general practice, prescriptions, drug; upper respiratory tract infection; urinary tract infection; antibiotics, guideline; evidence based medicine
Study site: Klinik Kesihatan, Malaysia
A man, 56 years of age, presents to his general practitioner after coughing up half a cupful of fresh, bright red blood every day for 1 week. He has no other medical complaints. He reports previous pulmonary tuberculosis 12 years ago treated with 6 months of standard therapy. Routine follow up was discontinued after 5 years after no evidence of reactivation. He is a nonsmoker, does office clerical duties and is not known to have diabetes or hypertension.
This study assessed the concordance of the temperatures of the digital, liquid crystal forehead and digital infrared tympanic thermometers with the mercury in glass thermometer.
A university student, 20 years of age, noticed a mass on her palate one morning while looking in the mirror. She has not experienced any symptoms such as pain or discomfort.
Jenny, a nonsmoker, 54 years of age, presents with 3 years of dry cough, progressive breathlessness and reducing exercise tolerance. Two years ago she was diagnosed with asthma and treated with inhaled bronchodilators (which have been marginally effective). Jenny has worked in a tile factory for 22 years; 15 years in the grinding department, transferring to the chipping department 7 years ago. On examination she is tachypnoeic with a prolonged expiratory phase. There are bilateral rhonchi and a few fine crepitations at the left infrascapular region. Jenny's full blood count and electrocardiogram are normal. Arterial blood gas show mild hypoxia with respiratory alkalosis. Spirometry demonstrates mixed moderate obstructive and restrictive impairment. The diffusion capacity for carbon monoxide is reduced. Mantoux is negative and erythrocyte sedimentation rate is 10 mm/hour. A chest X-ray is taken.
A boy, 12 years of age, was being treated for pneumonia. The cold haemagglutination test was positive for Mycoplasma pneumoniae. He developed an isolated asymptomatic skin lesion on his lower limb which disappeared completely after 1 week.
An Indian man from Malaysia presented with contracture of his hands. He is 55 years of age and has a history of chronic alcohol consumption. Examination revealed bilateral thickened structure at the palms.
This middle aged Malaysian man presented complaining of painful gums for a few months. He is known to have had epilepsy since childhood.
Keywords: quiz; gum hypertrophy
A 25 year old college student with a past history of congenital heart disease presented with high grade fever and palpitations. He complained of painful red nodules on his finger pulp and his toes.