Malaysian Family Physician最新文献

Introduction: This study primarily aimed to determine the factors associated with home blood pressure monitoring (HBPM) practices among patients with hypertension in Putrajaya, Malaysia.

Methods: A cross-sectional study was conducted among patients with hypertension aged 18 years and above in a government health clinic in Putrajaya. An adopted and validated questionnaire on the knowledge, attitude and practice of HBPM was utilised. A total of 338 patients with hypertension were recruited.

Results: The median age of the participants was 52 years. Approximately 95.3%, 87.3%, 61.2%, 54.4% and 49.4% were Malay, were married, completed tertiary education, were men and were government servants, respectively. The prevalence of good HBPM knowledge, good attitude towards HBPM and HBPM practice among the participants was 79.0%, 57.1% and 81.7%, respectively. Having medical insurance (adjusted odds ratio [aOR]: 3.05, 95% confidence interval (CI): 1.47- 6.29, P=0.003), having diabetes mellitus (DM) (aOR: 4.58, 95% CI: 2.47-8.49, P<0.01), staying with household members (aOR: 2.95, 95% CI: 1.07-8.10, P=0.036), being a non-smoker (aOR: 3.72, 95% CI: 1.41-9.80, P=0.008) and engaging in physical activity (aOR: 2.47, 95% CI: 1.314.65, P=0.005) showed significant associations with HBPM practice.

Conclusion: The knowledge and practice of HBPM among patients with hypertension in Putrajaya, Malaysia, were excellent. The significant associated factors of HBPM practice were having medical insurance, having DM, staying with household members, being a non-smoker and being physically active. This study should be extended to the whole nation to obtain a true reflection of HBPM practice among Malaysians.

Glycogenic hepatopathy (GH) is a rare but reversible hepatic condition associated with poorly controlled type 1 diabetes mellitus (T1DM). It results from excessive glycogen accumulation in hepatocytes, leading to hepatomegaly and elevated liver enzyme levels. We report the case of a 28-year-old man with T1DM who presented to a primary care clinic with persistent transaminitis despite discontinuation of potential hepatotoxic agents. Extensive investigations were conducted to exclude common liver pathologies, all of which returned negative. His condition improved following the intensification of insulin therapy and improvement of glycaemic control. This case underscores the role of family physicians in recognising GH as a differential diagnosis in patients with diabetes mellitus with unexplained liver enzyme abnormalities. It also highlights the importance of timely interventions to prevent unnecessary invasive investigations. Early recognition and appropriate glycaemic management in primary care can reverse the condition and minimise the need for extensive testing.

Sexually transmitted infections (STIs) have a profound effect on sexual and reproductive health, with an estimated 374 million new infections reported globally in 2020. Most STI cases are likely to be presented at primary care clinics, making it crucial for primary care doctors to possess a strong understanding of STIs. Effective management of these infections relies on timely and accurate diagnosis, evidence-based treatment and comprehensive prevention strategies. The Malaysian Guidelines for the Management of Sexually Transmitted Infections Fifth Edition 2024 highlight the importance of treatment, prevention strategies and diagnostic recommendations, underscoring the role of primary care in addressing STIs effectively.

Introduction: According to numerous research, anosmia has been reported more frequently as one of coronavirus disease (COVID-19) symptoms. However, whether anosmia is a relevant prognostic factor of COVID-19 outcomes is still unknown. A systematic review and meta-analysis were conducted to evaluate the relationship between anosmia and COVID-19 prognosis.

Methods: PubMed, PubMed Central, Google Scholar and the WHO COVID-19 Research Database were scanned for published literature from September 2021 to December 2022 about the prognosis of patients positive for COVID-19 with anosmia. 'COVID-19' and 'prognosis' were among the search terms used. Pooled estimates of odds ratios (ORs) were then calculated by comparing patients with and without anosmia in terms of intensive care unit (ICU) admission and death.

Results: A total of 16 full-text articles were included in this systematic review. There were a total of 40 deaths among the patients with olfactory dysfunction and 1681 deaths among those without olfactory dysfunction, with an OR of 0.19 (95% confidence interval: 0.10, 0.34; P<0.0001), indicating that the patients with COVID-19 with olfactory dysfunction had a decreased mortality rate.

Conclusion: The good prognosis of patients with COVID-19 with anosmia is demonstrated in our study by the low mortality rate in those with anosmia. However, there is no association between the prognosis and ICU admission among patients with COVID-19 with anosmia.

Benign acute childhood myositis (BACM) is a rare, self-limiting inflammatory condition affecting the skeletal muscle, typically emerging during the early convalescent phase of viral infections. Most patients recover with bed rest, analgesics and adequate hydration. However, atypical presentations can sometimes lead to delayed diagnoses and unnecessary investigations. We report five cases of BACM with unusual presentations at admission: toe walking, crawling, delayed recovery, rhabdomyolysis and recurrence. All patients experienced favourable outcomes and complete recovery upon follow-up. This case series highlights the diverse presentations of BACM, emphasising the importance of increasing awareness for early diagnosis, reducing unnecessary workups and providing proper counselling for parents.

Liraglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), is widely used for weight management and glycaemic control. While generally well-tolerated, various adverse effects have been reported. Thyroid dysfunction, particularly hyperthyroidism, is rare. This report describes the case of a 34-year-old woman with new-onset hyperthyroidism following liraglutide use for weight loss. The patient presented with worsening palpitations and insomnia after 3 weeks of liraglutide use. She had no prior thyroid disease or significant family history. Examination revealed sinus tachycardia with no goitre or tremors. Laboratory findings confirmed hyperthyroidism with a suppressed TSH level (0.03 mlU/L) and an elevated free T4 level (20.8 pmol/L). Thyrotropin receptor antibody was negative, ruling out Graves' disease. Liraglutide was discontinued, and the patient was treated with carbimazole and propranolol, resulting in symptom resolution and normalisation of thyroid function within weeks. Liraglutide-induced thyroid dysfunction is poorly understood. Possible mechanisms include GLP-1 receptor activity in thyroid tissue, disruption of the hypothalamic-pituitary-thyroid axis or inflammation of thyroid follicular cells. This case demonstrates a strong temporal association between liraglutide use and hyperthyroidism, which resolved upon drug discontinuation. Although thyroid dysfunction with GLP-1 RAs has been noted in preclinical studies, human data remain limited. This case highlights a rare adverse effect of liraglutide and underscores the need for vigilance when monitoring patients on GLP-1 RAs. Monitoring of thyroid function should be considered in symptomatic patients. Further research is warranted to better understand the underlying mechanisms and prevalence of GLP-1 RA-induced thyroid abnormalities.

This is a case report of a middle-aged man who presented with chronic unilateral lower limb swelling and a mass on the same side. Several important differential diagnoses were considered. Lymphatic filariasis was included in the differential diagnoses due to a history of travel to a district endemic with filariasis in Sabah. A final diagnosis of soft tissue sarcoma was provisionally made based on the magnetic resonance imaging findings and confirmed by histopathological examination as pleomorphic dermal sarcoma. Both conditions are unusual but important causes in primary care due to their association with poor morbidity and risk of mortality. Patient management should involve a multidisciplinary team, including primary care, public health, radiology, pathology and orthopaedics.

Introduction: Sexual health is integral to quality of life, and female sexual dysfunction (FSD) is a significant public health concern recognised by the World Health Organization. Its prevalence is rising globally, with limited data among primary care practitioners (PCPs). Multifactorial issues such as high work burden in PCPs, coupled with low help-seeking behaviours, contribute to the likelihood of FSD and poor quality of life. This study aimed to determine the prevalence and associated factors of FSD among PCPs in Malaysia.

Methods: This cross-sectional study was conducted using a self-administered online questionnaire for 6 months duration in Malaysia. Sociodemographic, marital and clinical data were collected, and two validated questionnaires namely the Malay Version of the Female Sexual Function Index (MVFSFI) and the Depression, Anxiety and Stress Scale (DASS-21) were utilised. Data analysis included descriptive statistics and logistic regression.

Results: The study included 382 participants. The prevalence of FSD was 14.7% (95% confidence interval [CI] : 11.1, 18.2) among the participants, and the most affected domain was desire disorder (25.4%). Significant associations were observed between sexual activity two or fewer times per month (adjusted odds ratio [aOR]: 4.880; 95% CI: 2.522, 9.442; P<0.001), depression (aOR: 3.450; 95% CI: 1.653, 7.204; P<0.001) and degree-level education (aOR: 2.659; 95% CI: 1.338, 5.285; P=0.005) and FSD.

Conclusion: This study identifies FSD as a prevalent issue among Malaysian PCPs, emphasising its biopsychosocial complex and the need for a holistic approach. Understanding the cultural determinants of FSD is important to tailor screening and intervention strategies.