Malaysian Family Physician最新文献

Abdominal pain frequently drives patients to seek care at family physician clinics and emergency departments. It often signifies serious underlying conditions, presenting diagnostic challenges for physicians. Failure to diagnose an acute abdomen can result in patient morbidity and mortality and medicolegal risks for physicians. Herein, we report an unusual gynaecological case involving a paratubal cyst in a 15-year-old girl who presented with acute abdominal pain. This case underscores the critical role of primary care physicians in identifying red flags and initiating timely specialist referral. Abdominal ultrasound revealed a large, unilocular mass in the right adnexa, measuring 18x9.8 cm. The patient underwent an emergency laparotomy with a clinical diagnosis of a twisted ovarian cyst. However, intraoperative findings revealed a right paratubal cyst measuring 18x16x16 cm, which was not twisted. A fertility-preserving cystectomy was subsequently performed, successfully removing the cyst while preserving the ovary. Histopathological examination confirmed it as a benign paratubal cyst, consistent with the intraoperative findings. Although paratubal cysts are uncommon, they are a significant cause of abdominal pain. Therefore, timely identification, thorough clinical evaluation and appropriate diagnostic tests are essential for optimal patient care.

Introduction: The prevalence of hyperuricaemia is increasing worldwide. Hyperuricaemia is associated with many comorbidities, but care quality is suboptimal. This study aimed to determine the level of knowledge, attitude (perceived barrier) and practice in managing asymptomatic hyperuricaemia (AH) among primary care doctors (PCDs) and whether there is a significant difference between PCDs with and without postgraduate qualifications in Malaysia. It also aimed to determine the factors associated with adequate practice in managing AH.

Methods: A cross-sectional study was conducted using a validated online questionnaire. The adequacy of knowledge and practice was set at a score of >50%, and attitude (perceived barrier) was described in percentages. Multiple logistic regression examined the factors associated with adequate practice in managing AH.

Results: A total of 412 PCDs participated, with the majority being women (76.2%) and Malay (74.0%) and working in public primary care clinics (84.0%). The overall mean knowledge score was 24.78 (standard deviation [SD] =3.01), and 96.4% achieved adequacy. For attitude, the most commonly perceived barriers were lack of knowledge about the disease (50%) and guidelines (48.5%). The overall mean practice score was 17.51 (SD=8.09), with 53.2% demonstrating adequate practice. Multivariate analysis identified prior rheumatology attachment as the only significant predictor of adequate practice in managing AH (aOR=1.778, 95% confidence interval=1.083-2.920; P<0.005).

Conclusion: Despite high knowledge levels, a substantial proportion of PCDs report inadequate understanding of AH and its guidelines. Addressing these barriers through targeted educational interventions, guideline dissemination and specialised training, including rheumatology exposure, may enhance AH management in primary care.

Introduction: Psychological factors affecting children have received less attention in relation to continued education, particularly among elementary school-aged children. This study aimed to investigate the association between parental depression and educational outcomes in children aged 6-12 years.

Methods: This study was conducted using data from the Indonesian Family Life Survey. Children aged 6-12 years living with their parents were included in the study. The outcome variable was school dropout. The Center for Epidemiologic Studies Depression scale was used to assess parental depression as the independent variable. Multivariate logistic regression was performed with covariate adjustments to determine the association of parental depression with educational outcomes.

Results: Approximately 8.7% of the children dropped out of school, with the prevalence being higher among the boys (11.6%) than among the girls (5.5%). After being adjusted for covariates, maternal depression was found to be associated with an increased risk of school dropout, particularly when it occurred during the children's toddlerhood and childhood (odds ratio=1.97; 95% confidence interval=1.04-3.74; P=0.037). In contrast, paternal depression was not associated with an increased risk of school dropout.

Conclusion: These findings suggest that maternal depression significantly influences the likelihood of school dropout among children.

Acute nicotine poisoning is a devastating condition that occurs when there is an excessive intake of nicotine, a toxic alkaloid found in tobacco products, mainly e-cigarettes. It impairs respiratory and neurological functioning due to its massive inflammatory effect. It is mainly related to vaping activity. Most smokers know about smoking's adverse effects and implications. However, public awareness is still poor, and a majority are unable to quit the trending vaping addiction. Nevertheless, the potential severity of its toxicity to a growing child both in the short and long term is of critical concern, especially in cases of accidental direct ingestion. We report the case of a 2-year-old child who presented with acute respiratory failure secondary to liquid nicotine ingestion at home. The child was first seen by the medical team at primary care and required urgent intubation and paediatric intensive care unit admission. Her condition was complicated with several episodes of seizure requiring close monitoring. This case highlights that despite ignorance of adults on the danger of vaping, significant harm can still occur among children at home when parents engage in vaping. Although adults may take certain precautions, their harmful habits can indirectly and directly affect children, making the risk unavoidable. This serves as an urgent call for the government to strictly ban nicotine products and enact corresponding legislation immediately.

Introduction: Diabetes-related distress (DRD) affects disease control and quality of life. This study aimed to determine the prevalence of high-level DRD, compare the prevalence according to diabetes complications and identify the associated sociodemographic and clinical factors.

Methods: This cross-sectional study included 198 participants from three primary care clinics in northern Malaysia from 1 May 2023 to 31 July 2023. DRD was measured using the 17-Item Diabetes Distress Scale, with a score of >3 indicating high-level distress. Multiple logistic regression was used to assess the association between the sociodemographic and clinical characteristics and DRD.

Results: The prevalence of high-level DRD was 13.6%. The prevalence was significantly higher among the patients without nephropathy (17.2%) than among those with nephropathy (3.8%) (P=0.014) but did not significantly differ among those with other complications. Those who attended the clinics independently were less likely to be highly distressed than those using public transportation or sent by others (adjusted odds ratio [aOR]=0.31, 95% confidence interval [CI]=0.10-0.99, P=0.048). The participants who were obese (aOR=2.96, 95% CI=1.08-8.08, P=0.034) had higher odds of having high-level DRD than those who were not, while those who had nephropathy (aOR=0.11, 95% CI=0.02-0.58, P=0.010) had lower odds of having high-level DRD than those who did not.

Conclusion: The overall prevalence of high-level DRD is relatively low but significantly higher among individuals without nephropathy. 0besity, lack of transportation and the absence of nephropathy are positively associated with high-level DRD and should therefore be a focus of psychological support and intervention.

Crohn's disease (CD), a chronic inflammatory bowel condition, although rare in Malaysia, can present with atypical systemic features, including reproductive dysfUnction. We report the case of a 31-year-old woman referred for secondary amenorrhoea and presumed endometriosis, later diagnosed with CD following worsening gastrointestinal symptoms and significant weight loss. Hormonal evaluation revealed hypothalamic-pituitary axis suppression secondary to malnutrition and systemic inflammation. Treatment with corticosteroids and nutritional rehabilitation led to weight gain and resumption of menses within 3 months. This case highlights the importance of recognising functional hypothalamic amenorrhoea as a reversible consequence of chronic illness and nutritional deficiency. It also underscores how systemic diseases such as CD may mimic gynaecological conditions, potentially delaying accurate diagnosis. Early multidisciplinary collaboration is essential in evaluating menstrual disturbances with overlapping gastrointestinal symptoms, especially in regions where inflammatory bowel disease remains uncommon.

Tinea capitis is a common childhood fungal infection that is extremely rare in newborns, with limited data available. Its clinical presentation may closely resemble that of other dermatological conditions such as seborrheic dermatitis, neonatal lupus erythematosus and congenital syphilis. It is essential to make a definite diagnosis, as tinea capitis treatment requires systemic antifungal therapy. However, successful topical monotherapies have been reported. We report a rare case of neonatal tinea capitis diagnosed in a 24-day-old newborn, presenting with multiple scaly plaques on the scalp, discussing the diagnostic criteria, predisposing factors, appropriate treatment and preventive measures. The patient was treated with topical antifungal therapy, resulting in complete resolution within a week and no recurrence at the 2-year follow-up.