Malaysian Family Physician最新文献

Introduction: Tuberculosis (TB) remains a highly prevalent disease in Malaysia. Early identification using cost-effective methods such as chest radiography can reduce the health burden of a TB epidemic. However, normal chest radiographic findings are common. This study aimed to evaluate the characteristics of smear-positive pulmonary TB with normal chest radiographic findings during an outbreak.

Methods: A cross-sectional study was conducted by reviewing the medical records of 56 pulmonary TB cases registered at Kodiang Health Clinic from April to October 2022. Smear-negative and extrapulmonary TB cases were excluded. Relevant information was extracted from the medical records and recorded in a case report form for data management and analysis.

Results: Approximately 60.7% of the cases had symptoms lasting >2 weeks, and 89.3% showed abnormal findings upon clinical examination. Additionally, 73.2% had sputum acid-fast bacilli counts of ≥1+, and the sputum Mycobacterium tuberculosis culture and sensitivity test findings were positive in 82.1% of the cases. The proportion of smear-positive pulmonary TB with normal chest radiographic findings was 42.9%. The factors associated with smear-positive pulmonary TB with normal chest radiographic findings included being under 18 years old (P=0.021), being a student (P=0.010), being single (P=0.012) and being asymptomatic (P=0.04).

Conclusion: Normal chest radiographic findings may lead to a misdiagnosis of smear-positive pulmonary TB, especially during an outbreak. Therefore, active case detection among close contacts with risk factors for normal radiographic findings should consider additional supportive tests.

Injuries to the cervical spine following phlebotomy have not been reported in the literature. Herein, we report the case of a 27-year-old lady with major depressive disorder and trypanophobia who experienced a syncopal episode during a blood test, resulting in a C2 Hangman's fracture. After the application of a halo vest, she recovered without any long-term pain or neurological impairments. The concept of needle phobia is important for healthcare professionals to understand, since patients' fear of needles can lead to detrimental injuries during panic attacks. Greater attention should be paid to alleviate this fear, with the ultimate goals of improving health and preventing unwanted injuries following phlebotomy.

Introduction: Communication is a key element of palliative care. The concealment of advanced-stage diseases is a communication challenge. This study aimed to explore the patterns and difficulties in communication regarding the concealment of advanced-stage cancer between caregivers and patients. Methods: This qualitative study employed an interpretive phenomenological approach and was conducted at a district hospital in Thailand. Semi-structured in-depth interviews were performed to collect data from caregivers (i.e. family members) of patients regarding the concealment of advanced-stage cancer. The data analysis followed an inductive thematic approach.

Results: Ten in-depth interviews were conducted among the caregivers of patients aged 57-97 years. Four themes emerged: (i) reasons for concealing the diagnosis and prognosis (personality of patients and concerns about negative effects), (ii) communication patterns between caregivers and patients (communicating symptoms/signs instead of the diagnosis/prognosis and distorting information), (iii) difficulties and challenges in maintaining concealment (feelings of guilt, hesitation in sharing the information and suspicion of patients' awareness of their diagnosis/prognosis) and (iv) communication support from healthcare professionals (avoiding informing patients about their diagnosis/prognosis, supporting decision-making and disclosing the information).

Conclusion: The concealment of advanced-stage cancer is perceived as an appropriate communication approach among some caregivers. Communicating information about advanced-stage cancer is dynamic. Some caregivers and families consider disclosing the information in the future. Healthcare professionals can support communication throughout care. Future studies should focus on decision-making and communication processes for better handling of information concealment or the conspiracy of silence in palliative care.

Urine amylase levels are usually used to diagnose acute pancreatitis. However, there are reported cases where urine amylase levels are slightly increased in individuals without pancreatitis. Herein, we report the case of a young lady who presented with acute abdominal pain for 3 days. Her urine amylase level was 1717 U/L upon admission, and her condition was initially treated as acute pancreatitis. Unfortunately, the patient demonstrated abdominal guarding after 24 h; thus, urgent computed tomography (CT) was performed. CT revealed the presence of a dilated small bowel. She underwent emergency laparotomy, wherein a gangrenous small bowel with no evidence of saponification at the lesser sac was noted. Due to the non-specific nature of hyperamylasaemia, an alternative diagnosis other than acute pancreatitis should be considered if the clinical symptoms are not suggestive of pancreatitis or the condition worsens despite conservative management.

Pulmonary tuberculosis poses a diagnostic dilemma to clinicians especially in the absence of typical presentation. The hypersensitivity to tuberculosis infection in other parts of the body can lead to nondestructive, para-infectious arthritis. This is known as Poncet disease, one of the clinical syndromes of musculoskeletal tuberculosis. Herein, we report a case of smear-negative pulmonary tuberculosis presenting with atypical features. It started with multiple joint pain, followed by the presence of multiple tender nodular skin lesions over the bilateral shins and wrist. Subsequent investigations led to the diagnosis of smear-negative pulmonary tuberculosis. Joint pain and erythema nodosum disappeared soon after antituberculosis therapy, supporting the diagnosis of Poncet disease.

Introduction: Skin barrier dysfunction is an important component of atopic dermatitis (AD) pathophysiology. Topical corticosteroids (TCSs) are the mainstay therapy, but steroid phobia is emerging due to potential side effects. We aimed to determine the short-term effect of clobetasone butyrate on patients with AD.

Methods: This investigator-blinded, randomised, moisturiser-controlled study evaluated patients with stable mild-to-moderate AD. Clobetasone butyrate ointment plus aqueous cream (Aq) or Aq alone was applied on randomised sites twice daily for 6 weeks. The itch score, modified Eczema Area and Severity Index (M-EASI) and epidermal biophysical parameters were assessed at baseline and 1 h, 3 h, 2 weeks and 6 weeks after application.

Results: Sixteen patients, among whom 14 (87.5%) were women and two (12.5%) were men, participated in the study. There were no significant differences in pH, transepidermal water loss (TEWL) and hydration between TCS + Aq and Aq from 1 h to 6 weeks. A non-significant trend of pH increment was observed with TCS + Aq from baseline to 6 weeks. TEWL and hydration improved at 6 weeks for both treatment arms. The difference in TEWL from baseline was significant with Aq (P=0.01). The M-EASI at 6 weeks was comparable between the two arms. TCS + Aq improved itch and erythema better than Aq (P=0.02). No cutaneous adverse effects were observed at both sites.

Conclusion: Short-term application of clobetasone butyrate with Aq is safe with no significant changes in epidermal biophysical parameters while controlling the symptoms and signs of eczema faster than Aq alone.

Hypopigmented mycosis fungoides (MF) is a rare variant of cutaneous T-cell lymphoma, a type of extranodal non-Hodgkin lymphoma. This report presents the case of a 9-year-old boy with a 2-year history of asymptomatic, hypopigmented skin lesions that were resistant to topical treatment. He was initially treated for a fungal skin infection and had received multiple courses of topical antifungals and steroids but showed no improvement, which led to further evaluation and a referral to a dermatologist. A skin biopsy was performed, and the diagnosis of hypopigmented MF was confirmed through skin histopathology and immunohistochemistry study. His lesions responded well to cycles of narrowband ultraviolet B phototherapy, showing almost complete clearance after 4 months without any side effects.

Introduction: Metabolic-associated fatty liver disease (MAFLD) is the liver manifestation of metabolic syndrome, which is commonly seen in primary care settings. This study aimed to determine the knowledge and practice of primary care physicians regarding MAFLD in Seremban District, Negeri Sembilan.

Methods: This cross-sectional study was conducted among medical officers in 14 health clinics in Seremban District, using a validated, self-administered online questionnaire.

Results: A total of 240 medical officers from 14 health clinics in Seremban District, participated in this study. Most participants (85.4%) passed the knowledge test. Their practice was acceptable, but only a minority were familiar with non-invasive testing of liver fibrosis (e.g. APRI or FIB-4), medication and specific diet for the treatment of MAFLD.

Conclusion: Most primary care physicians in Seremban District are knowledgeable in identifying risk factors and managing patients with MAFLD. However, there are still areas to improve in terms of management, particularly regarding the use of silymarin, vitamin E and pioglitazone.

Introduction: Exploring the connections between traumatic experiences and subsequent health outcomes is vital for informing clinical practices and public health policies. The study aimed to investigate the relationship between lifetime trauma exposure and posttraumatic stress disorder (PTSD), depressive and cardiovascular disease (CVD) symptoms.

Methods: A total of 171 patients who received treatment in a local heart centre were included in this study. Several questionnaires such as the Life Event Checklist-5, Posttraumatic Stress Disorder Checklist for DSM-5 and Patient Health Questionnaire-9 were used to measure their traumatic experiences and PTSD and depressive symptoms, respectively. Physiological measures were also examined. Data were analysed using SPSS.

Results: The chi-square test showed significant differences in the percentage of reported PTSD symptoms among the patients with CVD (24.0%), patients with kidney disease (4.3%) and patients with other health problems (7.1%). The patients with CVD reported having a significantly higher percentage of PTSD and depressive symptoms than the patients with other medical conditions. The patients with CVD who reported having PTSD symptoms had significant systolic blood pressure (SBP) and heart rate changes compared to the patients who did not. The patients who reported PTSD symptoms had a significantly shorter sleep duration than their counterparts. The SBP and diastolic blood pressure differed significantly between the patients with and without PTSD symptoms.

Conclusion: Earlier detection, prevention and intervention related to trauma exposure and PTSD symptoms are suggested to reduce the CVD risk.