Malaysian Family Physician最新文献

Myxoedema psychosis is a rare but treatable condition resulting from severe hypothyroidism. We report the case of a man who presented to a primary healthcare facility seeking a medical report for financial assistance, having lost his job after being treated for schizophrenia. A comprehensive re-evaluation raised the possibility of endocrinopathy-induced psychosis as one of the differentials. The diagnostic process was challenging due to the rarity of the condition and the absence of classic hypothyroid features. Laboratory investigations revealed markedly low free thyroxine levels and elevated thyroid-stimulating hormone and anti-thyroid peroxidase antibody levels, confirming the diagnosis. Treatment with levothyroxine led to significant clinical improvement. This case underscores the vital role of primary care providers in recognising organic causes of psychosis through patient-centred assessment, application of primary care principles and interdisciplinary collaboration. It also highlights the potential consequences of misdiagnosis in atypical psychiatric presentations, including functional decline and job loss, and reinforces that appropriate management can lead to optimal outcomes.

Introduction: Malnutrition has emerged as a national issue in Malaysia, especially among indigenous populations. The types of feeding practices affect infantile growth in early life. Detecting malnutrition early and increasing awareness of its contributing factors are critical in handling this issue. This study aimed to determine the prevalence and associated factors of malnutrition among indigenous infants.

Methods: This cross-sectional study involved indigenous infants followed up in primary health clinics in Sepang and Kuala Langat, Selangor. Universal sampling was used to recruit participants, where survey interviews and health record reviews were conducted for data collection. Nutritional status was classified based on growth parameters (weight-for-age, height-for-age, BMI-for-age and weight-for-height Z scores) at 2, 4 and 6 months. Any abnormalities were considered to indicate malnutrition. Multiple logistic regression analyses were conducted to determine the associated factors of malnutrition.

Results: A total of 119 infants were included in this study. Among them, 45.4%, 44.5% and 10.1% were exclusively breastfed, formula-fed and predominantly breastfed, respectively. Approximately 16.0% had malnutrition at 6 months of age. Multiple logistic regression analysis showed that the male infants had 3.69 and 7.37 times higher odds of having malnutrition and undernutrition than the female infants, respectively. The breastfed infants had 3.46 and 5.10 times higher odds of experiencing malnutrition and undernutrition than the formula-fed infants, respectively.

Conclusion: Almost one-fifth of the indigenous infants had malnutrition at 6 months old. The male and breastfed indigenous infants were more at risk for malnutrition. However, these results should be further verified.

Introduction: Surveillance studies have shown a high prevalence of vitamin B12 deficiency in metformin-treated adults. Community-dwelling older adults have a higher risk of vitamin B12 deficiency due to lower gut absorption. To date, data on this specific cohort are lacking. We aimed to investigate the local prevalence of vitamin B12 deficiency and its associated factors among metformin-treated older adults.

Methods: This prospective cross-sectional study investigated community-dwelling patients with diabetes aged ≥65 years from four healthcare facilities from August 2023 to March 2024. Blood samples were sent to a central laboratory to determine vitamin B12 levels. Vitamin B12 deficiency was defined as serum vitamin B12 levels of ≤221 pmol/L. Descriptive analysis, chi-square test (or Fisher's exact test) and independent t-test (or Mann-Whitney U test) were performed.

Results: One hundred two participants were included in the study, of whom 61.8% were women (n=63), and 55.9% were Malays (n=57). The median age was 70 years (interquartile range [IQR]=67-74), and the median duration of metformin usage was 9.0 years (IQR=5.0-12.3). The prevalence of vitamin B12 deficiency was 29.4% (95% confidence interval [CI]=20.4-38.4, n=30), with a median vitamin B12 level of 287.0 pmol/L (IQR=200.5-448.8). Vitamin B12 deficiency was significantly associated with advancing age (P<0.05), but not with sex, ethnicity, duration of diabetes, metformin use, BMI, latest HbA1c level recorded and haemoglobin level (P>0.05).

Conclusion: Patients with diabetes aged ≥65 years have a high prevalence of vitamin B12 deficiency. Blood screening for vitamin B12 deficiency is needed for this population in Peninsular Malaysia.

Introduction: Women with a history of gestational diabetes mellitus (GDM) have an increased risk of developing glucose intolerance. This study aimed to assess the prevalence of glucose intolerance and its associated factors among postpartum women with a history of GDM in Penang.

Methods: This cross-sectional study was conducted at five government primary care clinics in Penang. Postpartum women with a history of GDM who underwent a 75-g oral glucose tolerance test (OGTT) at 6-12 weeks postpartum were recruited from August to October 2023. Data collected included sociodemographic details, clinical characteristics, physical activity levels measured using the International Physical Activity Questionnaire-Short Form and OGTT results. Descriptive and multiple logistic regression analyses were performed using IBM SPSS Statistics version 29.

Results: A total of 204 women participated, with a mean age of 31.7 (SD=5.05) years. The prevalence of prediabetes and type 2 diabetes mellitus was 23.5% and 3.9%, respectively. Among the participants, 47.5% were inactive, while 27.5% were physically active. The participants on oral medication or insulin had higher odds of developing postpartum glucose intolerance. Conversely, the participants who were minimally active or active had a lower likelihood of developing glucose intolerance than those who were inactive.

Conclusion: Among women attending primary care clinics in Penang, 27.5% had abnormal glucose tolerance postpartum. Physical inactivity was a significant risk factor. This study highlights the need to promote physical activity during pre-pregnancy care to reduce postpartum glucose intolerance and its complications.

Introduction: The global rise of digital health is reshaping healthcare delivery and improving outcomes, especially for noncommunicable diseases (NCDs) post-pandemic. Guided by the World Health Organization (WHO) Global Strategy on Digital Health 2020-2025, this study examined digital health applications in Western Pacific Region (WPR) primary care, focusing on NCD management and related challenges.

Methods: A scoping review following the Arksey and O'Malley framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines was conducted. Using the PICO framework, studies on digital interventions in WPR primary care were identified through PubMed, Scopus, ScienceDirect, Web of Science and the Journal of Medical Internet Research (2022-2024). Eighteen studies were synthesized using the WHO digital health intervention and Health System Challenge frameworks.

Results: The review included studies from Australia (n=10), Singapore (n=5), South Korea (n=1), and China (n=2), encompassing randomized, observational, qualitative, and pragmatic designs. Digital interventions-telehealth, mobile health (mHealth) and electronic health (eHealth)-targeted NCDs such as diabetes, mental health, and cardiovascular diseases, addressing information quality, acceptability, efficiency, cost, accountability, and equity.

Conclusion: The scoping review identified several digital health interventions, predominantly telehealth, mHealth and eHealth, deployed across Australia, Singapore, South Korea and China for NCD management in primary care. The studies demonstrated improvements in information quality, acceptability and efficiency, while highlighting persistent barriers such as technology integration issues, data quality concerns and inequities.

Introduction: The Iowa Infant Feeding Attitude Scale (IIFAS) has been developed to assess maternal attitudes towards infant feeding choices to predict breastfeeding intention. Validity and reliability need to be established considering cultural, language and environmental differences, especially in the Malay context due to currently unavailable Malay version. This study aimed to translate the IIFAS into Malay (IIFAS-M) and determine its validity and reliability.

Methods: A validation study using a digital survey was conducted. The final translated version was distributed to mothers with infants using the digital form. Principal component analysis was performed using SPSS version 27.

Results: A total of 272 mothers with a mean age of 30.1 (SD±4.2) years participated in the study. A new scoring was given to the IIFAS-M, representing positive attitudes towards breastfeeding and neutral and positive attitudes towards formula feeding. The principal component analysis showed that all items had a factor loading of more than 0.4. The Cronbach's alpha value was 0.657, and the P-value for the test-retest Pearson correlation was <0.001.

Conclusion: The IIFAS-M is a validated and reliable tool for assessing maternal attitudes towards infant feeding among Malay speakers.

In this clinical dilemma, we highlight the case of a previously healthy 37-year-old lady who presented to a primary care clinic with palpitations, chest discomfort and difficulty breathing within 2 hours post-mRNA COVID-19 vaccine injection. During the initial presentation to the clinic and subsequent admission to the ward, there were no significant findings except for intermittent palpitations, which were relieved by supine positioning. Serial electrocardiograms and blood investigations, including troponin-I and thyroid function tests, revealed normal findings. Given persistent symptoms, further referrals were made. She underwent a tilt table test, which demonstrated normal results. Cardiac MRI showed myocardial oedema and inflammation at the basal anteroseptal wall. Herein, we discuss several differential diagnoses, clinical features and appropriate management for this patient. This case highlights the importance of having a high clinical index of suspicion and involving a multidisciplinary team in managing a case with a diagnostic dilemma.

Leprosy, a chronic infectious disease caused by Mycobacterium leprae, remains a significant public health concern in many developing countries, including Malaysia. Continuous monitoring and effective diagnostic strategies are crucial for curbing its transmission. The insidious nature of leprosy, characterised by slow progression and diverse clinical manifestations, often leads to delayed diagnosis, increasing the risk of irreversible nerve damage and subsequent disabilities. We report the case of a 55-year-old man who had leprosy presenting with chronic generalised hypopigmented lesions and was misdiagnosed with a fungal infection. Early detection and accurate differentiation from other hypopigmented skin conditions are crucial for timely intervention and the prevention of long-term complications.