AIM: We examined disease profiles of patients with type 2 diabetes mellitus (T2D) at four different public health facilities in Malaysia to determine which site would be the most suitable for early and intensive diabetes care against diabetes-related complications.
METHODS: This study analysed 57,780 T2D patients in the Adult Diabetes Control and Management registry database in the year 2009. The four public health facilities were hospital with specialists (HS), hospital without specialists (HNS), health clinics with family medicine specialists (CS) and health clinic without doctors (CND). Descriptive analyses were used to examine age, duration of diseases, intervals from the onset of diabetes to co-morbidities (hypertension and dyslipidaemia) and complication of T2D patients at the four public health facilities.
RESULTS: Patients were significantly older in HS. Patients with T2D at HS had significantly longer duration of diabetes, hypertension and dyslipidaemia. Health clinics, both the CS and the CND, were seeing T2D patients with shorter duration of macrovascular and microvascular complications.
CONCLUSION: Public health clinics in this country managed T2D patients who were younger and at the early stage of diabetes, hypertension, dyslipidaemia and complications. Thus, primary care physicians are best positioned to provide early and intensive diabetes care for this group of T2D patients to prevent the development of diabetes-related complications.
diabetes complications; disease management; health facilities; primary health care; type 2 diabetes mellitus
Study name: Adult Diabetes Control and Management (ADCM) 2009
Acute kidney injury following immersion or near-drowning is rarely described and no data from Malaysia have been found. We report a case of acute kidney injury following a near-drowning event. A 20-year-old man who recovered from near-drowning in a swimming pool 5 days earlier presented to our clinic with abdominal pain, anorexia, nausea and polyuria. Dipstick urinalysis showed a trace of blood. The serum creatinine level was 10-fold higher than the normal range. A bedside ultrasound showed features suggestive of acute tubular necrosis. He is then referred to the hospital with the diagnosis of acute kidney injury with the possibility of acute tubular necrosis secondary to near-drowning. We suggest that any patient presenting after immersion or near-drowning to be should assessed for potential acute kidney injury.
Hypertension is one of the chronic diseases with a rising trend globally, including Malaysia. Patients' own perception of their illness is a strong factor that determines their health-seeking behaviour. The objective of this study was to evaluate the illness perception of hypertensive patients and the associated factors.
Cervical lymphadenopathy is a common presentation of nasopharyngeal carcinoma (NPC). It can be present in the classical location of the level II or VI lymph nodes or at any other levels of the lymph nodes in the neck. NPC should be suspected when a patient presents with cervical lymphadenopathy and conductive hearing loss. A thorough endoscopic assessment of the nasopharynx should be performed to rule out this radiotherapy-curable disease at its early stage.
The upper aerodigestive tract, specifically the cricopharyngeal area, is the most common site of foreign body impaction. Anatomically, this area is the first constriction of the oesophagus. Fish bones, one of the most common foreign bodies encountered in the throat, tend to get stuck in this area. The movement of this sharp-edged foreign body upon swallowing will induce odynophagia and an acute onset of neck pain. We report a case of a healthy elderly man who complained of sudden anterior neck pain and odynophagia after eating yellowtail scad fish.
The North Borneo state of Sabah is known worldwide for its beautiful islands and dive sites. Local hospitals deal with a number of marine-related injuries, including marine fauna envenomation by Scorpaenidae and Synanceiidae families of fish. We report a case of a tourist who presented with excruciating pain on her right foot after stepping on a stonefish. Despite being given parenteral analgesia and regional anaesthesia, the pain persisted. Her pain improved after she soaked her foot in hot water for about 30 minutes. No further treatment was required. We reviewed the literature comparing this inexpensive mode of treatment with other conventional treatments. We also explored the possibility of using hot water immersion for treatment of envenomation by other types of marine animals.
Many studies reported poorer quality of life (QoL) in youth with diabetes compared to healthy peers. One of the tools used is the Diabetes Quality of Life for Youth (DQoLY) questionnaire in English. A validated instrument in Malay is needed to assess the perception of QoL among youth with diabetes in Malaysia.
INTRODUCTION: Upper respiratory tract infection (URTI) is a common encounter in primary care and mostly viral in origin. Despite frequent reminders to primary care providers on judicious use of antibiotics for URTI, the practice is still rampant.
METHODS: As part of quality improvement initiative, an intervention was designed by distributing a profiling report on individual prescriber's performance in comparison to colleagues on usage of antibiotic for URTI. The data were generated from electronic health record in three public primary care clinics in Malaysia and emailing monthly throughout 2011 to all providers.
RESULTS: There were 22,328 consultations for URTI in 2010 and 22,756 in 2011 with the incidence rates of URTI among overall consultations of 15.7% and 15.9% respectively. 60 doctors and medical assistants had performed consultations during the 2 year period. Following the intervention in 2011, the prescription rate of antibiotic for URTI is significantly reduced from 33.5% in 2010 to 23.3 % in 2011. Before intervention, individual prescription rate varies from 9.7% to 88.9% and reduced to 4.3% to 50.5% after intervention.
CONCLUSION: Profiling report is a potential method of changing antibiotic prescribing habit among public primary care providers in Malaysia especially if the baseline adherence was poor and higher variation of prescribing rate.
KEYWORDS: antibiotic prescription; profiling; upper respiratory tract infection.
Study site: Klinik Kesihatan Kangar, Klinik Kesihatan Beseri, Klinik Kesihatan Simpang Empat, Perlis, Malaysia
INTRODUCTION: Diabetes-related distress (DRD) refers to patient's concerns about diabetes mellitus, its management, need of support, emotional burden and access to healthcare. The aim of this study was to translate and examine the psychometric properties of the Malay version of the 17-item Diabetes Distress Scale (MDDS-17) in adult patients with type 2 diabetes mellitus (T2D).
METHODS: A standard procedure was used to translate the English 17-items Diabetes Distress Scale into Malay language. We used exploratory factor analysis (EFA) with principal axis factoring and promax rotation to investigate the factor structure. We explored reliability by internal consistency and 1-month test-retest reliability. Construct validity was examined using the World Health Organization quality of life-brief questionnaire, Morisky Medication Adherence Scale, Patient Health Questionnaire and disease-related clinical variables.
RESULTS: A total of 262 patients were included in the analysis with a response rate of 96.7%. A total of 66 patients completed the test-retest after 1 month. EFA supported a three-factor model resulting from the combination of the regimen distress (RD) and interpersonal distress (IPD) subscales; and with a swapping of an item between emotional burden (EB; item 7) and RD (item 3) subscales. Cronbach's α for MDDS-17 was 0.94, the combined RD and IPD subscale was 0.925, the EB subscale was 0.855 and the physician-related distress was 0.823. The test- retest reliability's correlation coefficient was r = 0.29 (n = 66; p = 0.009). There was a significant association between the mean MDDS-17 item score categories (<3 vs ≥3) and HbA1c categories (<7.0% vs ≥7.0%), and medication adherence (medium and high vs ≥low). The instrument discriminated between those having diabetes-related complication, low quality of life, poor medication adherence and depression.
CONCLUSION: The MDDS-17 has satisfactory psychometric properties. It can be used to map diabetes-related emotional distress for diagnostic or clinical use.
Background: The incidence of diabetes mellitus is ever increasing. Individuals with diabetes mellitus may have concurrent mental health disorders and are shown to have poorer disease outcomes. The objectives of this study were to determine the prevalence of depression, anxiety and stress (DAS) in diabetes patients aged 20 years or more in the primary care setting.
Methods: This was a cross-sectional study involving the use of self-administered questionnaire conducted in eight primary care private and government clinics in Pulau Pinang and Melaka, Malaysia. The validated DASS-21 questionnaire was used as a screening tool for the symptoms of DAS. Prior permission was obtained from the patients and, clearance from ethical committee was obtained before the start of the study. Data analysis was done using SPSS statistical software.
Results: A total of 320 patients with diabetes from eight centres were enrolled via convenience sampling. Sample size was calculated using the Kish’s formula. The prevalence of DAS among patients with diabetes from our study was 26.6%, 40% and 19.4%, respectively. Depression was found to be significantly associated with marital status and family history of DAS; anxiety was significantly
associated with monthly household income, presence of co-morbidities and family history of DAS; and stress was significantly associated with occupation and family history of DAS.
Conclusions: The prevalence of DAS was higher in patients with diabetes compared with the general community. We recommend to routinely screen all patients with diabetes using the DASS-21 questionnaire because it is easy to perform and inexpensive.
Juvenile recurrent respiratory papillomatosis (JRRP) is a rare condition. The varied presentation of this condition predisposes to misdiagnosis and potential life-threatening airway obstruction. In this paper, we have reported a case of JRRP presenting as severe respiratory distress and consequently mistreated as asthmatic attack culminating in a near fatal acute airway obstruction.
INTRODUCTION: Hill-Bone compliance to high blood pressure therapy scale (HBTS) is one of the useful scales in primary care settings. It has been tested in America, Africa and Turkey with variable validity and reliability. The aim of this paper was to determine the validity and reliability of the Malay version of HBTS (HBTS-M) for the Malaysian population.
MATERIALS AND METHODS: HBTS comprises three subscales assessing compliance to medication, appointment and salt intake. The content validity of HBTS to the local population was agreed through consensus of expert panel. The 14 items used in the HBTS were adapted to reflect the local situations. It was translated into Malay and then back-translated into English. The translated version was piloted in 30 participants. This was followed by structural and predictive validity, and internal consistency testing in 262 patients with hypertension, who were on antihypertensive agent(s) for at least 1 year in two primary healthcare clinics in Kuala Lumpur, Malaysia. Exploratory factor analyses and the correlation between HBTS-M total score and blood pressure were performed. The Cronbach's alpha was calculated accordingly.
RESULTS: Factor analysis revealed a three-component structure represented by two components on medication adherence and one on salt intake adherence. The Kaiser-Meyer-Olkin statistic was 0.764. The variance explained by each factors were 23.6%, 10.4% and 9.8%, respectively. However, the internal consistency for each component was suboptimal with Cronbach's alpha of 0.64, 0.55 and 0.29, respectively. Although there were two components representing medication adherence, the theoretical concepts underlying each concept cannot be differentiated. In addition, there was no correlation between the HBTS-M total score and blood pressure.
CONCLUSION: HBTS-M did not conform to the structural and predictive validity of the original scale. Its reliability on assessing medication and salt intake adherence would most probably to be suboptimal in the Malaysian primary care setting.
Bertolotti's syndrome must be considered as a differential diagnosis for lower back pain in young people. Treatment, whether conservative or operative, is still debatable. In this paper, we report a case of a 20-year-old girl presenting with lower back pain for 8 years. We administered injection with local anaesthetic and steroid injections within the pseudo-articulation; however, the pain was relieved for 3 weeks. Surgical excision of the pseudo-articulation successfully treated her back pain and the sciatica.
Discharging ear is a common symptom in the primary care and private general clinics. Most of the cases are treated with the antibiotic ear drops for otitis externa or otitis media. However, despite an adequate standard therapy, a malignant tumour can also be present with non-specific symptom such as ear discharge, especially in the case of persistent ear discharge. In this paper we have reported a case of an adult woman presented with non-resolving ear discharge who was treated repeatedly with antibiotic ear drop, which was later diagnosed as squamous cell carcinoma.
Dengue infection is highly endemic in many tropical countries including Malaysia. However, neurological complications arising from dengue infection is not common; Gullain-Barre syndrome (GBS) is one of these infrequent complications. In this paper, we have reported a case in which a 39-year-old woman presented with a neurological complication of dengue infection without typical symptoms and signs of dengue fever. She had a history of acute gastroenteritis (AGE) followed by an upper respiratory tract infection (URTI) weeks prior to her presentation rendering GBS secondary to the post viral URTI and AGE as the most likely diagnosis. Presence of thrombocytopenia was the only clue for dengue in this case.