Malaysian Family Physician最新文献

Introduction: Clinical practice guidelines (CPGs) are important tools that assist primary care doctors in their daily practice. Menopause is a physiological condition that affects all women, and the latest Malaysian CPG on menopause can provide guidance on the optimal management of women facing this condition. However, not all CPGs are of acceptable quality, and it is important that primary care doctors learn to critically appraise CPGs to ensure their practice is evidence-based and relevant to their patients. This review aimed to critically appraise the Clinical Practice Guidelines on the Management of Menopause in Malaysia 2022 to ensure that it is valid and applicable to primary care in Malaysia.

Methods: Three family medicine specialists independently appraised the CPG using the AGREE II Instrument, which consists of six domains assessing the following: (1) scope and purpose, (2) stakeholder involvement, (3) rigour of development, (4) clarity and presentation, (5) applicability and (6) editorial independence. They also provided an overall assessment of quality and recommendation on the use of the CPG following the AGREE II guideline.

Results: The CPG scored >70%, which is the threshold of quality in all domains except for applicability. The reviewers deemed the CPG to be of high quality and recommended its adoption without any modifications.

Discussion: It is important to ensure that recommendations in a CPG are evidence-based and valid before they are adopted into practice. The AGREE II Instrument can assist primary care doctors in critically appraising CPGs.

Hyponatraemia is an exceedingly common condition frequently encountered both in hospital and primary care settings. This medical condition poses unique challenges due to its often subtle and nonspecific symptoms, alongside its diverse array of potential causes. It can result in serious consequences when overlooked or not treated appropriately. Herein, we illustrate the case of a 68-year-old woman who presented with symptomatic hyponatraemia. Although not uncommon, the cause of hyponatraemia in this patient is frequently overlooked but, importantly, is avoidable. This case underlines the necessity of a more watchful approach to prescription of medications, especially in older adults with multiple comorbidities.

Sister Mary Joseph's nodule is a rare but significant clinical sign that often indicates advanced intraabdominal malignancy. It presents as a palpable umbilical nodule and may be the first indication of an occult primary cancer. In this article, we discuss the case of a 58-year-old postmenopausal woman who presented to a primary care clinic with a darkened umbilical lesion and progressive abdominal symptoms. She wps ultimately diagnosed with metastatic endometrial carcinoma. This uncommon presentation highlights the importance of a comprehensive approach to umbilical lesions in the primary care setting. Recognising this subtle sign in primary care can lead to expedited investigations and timely intervention.

Delayed chronic subdural haematoma (cSDH) is a common but potentially serious complication following traumatic brain injury (TBI). Mild TBIs are commonly managed by primary care providers (PCPs), particularly in large, resource-limited settings such as Malaysia, where access to tertiary neurosurgical services may be delayed. Early identification of red-flag signs and symptoms and timely referrals are crucial to prevent clinical deterioration. We describe the case of a 66-year-old man who sustained mild head injury following a vasovagal syncope. His initial brain CT revealed evidence of a small traumatic subarachnoid haemorrhage over the left precentral sulcus, with resolution on an interval scan 24 hours later. He was discharged home without follow-up. Eleven weeks later, he developed bilateral lower-limb weakness and unsteady gait, which prompted an urgent referral by his general practitioner. Repeat CT revealed bilateral acute-on-chronic subdural haematomas, with mass effect requiring emergency burr-hole drainage. The patient showed excellent post-operative improvement and was discharged home on day 4, with no clinical or radiological recurrence on subsequent follow-up. This case highlights the risk of delayed cSDH in patients following mild TBI, even in those discharged with a normal CT scan. PCPs play a pivotal role in recognising high-risk patients, ensuring structured follow-up and facilitating timely specialist referral. We advocate for updating the Malaysian head injury guidelines to incorporate routine follow-up protocols for at-risk patients, modelled after international standards.

Palmoplantar keratoderma (PPK) is a dermatological disorder characterised by excessive thickening of the palms and soles, encompassing more than 20 conditions. The disease is often misdiagnosed in primary care settings, leading to unnecessary treatments and delays. We present the case of a 3-year-old girl with skin thickening on both her palms and soles persisting for 2 years, initially believed to be an acquired condition. Subsequent evaluation revealed a family history of similar skin lesions. This case report highlights the crucial role of family physicians in differentiating hereditary from acquired PPK, especially in settings where advanced testing is unavailable. Implementing a structured diagnostic approach at the primary care level can significantly improve patient management and reduce morbidities and healthcare costs. This case contributes to the existing knowledge in this field, where hereditary PPK remains underexplored.

We report the case of a 54-year-old woman with poorly controlled type 2 diabetes mellitus, dyslipidaemia, hypertension and a 3-month history of fixed cutaneous sporotrichosis treated with itraconazole 200 mg once daily. She subsequently presented with progressive enlarging nodular lesions on her left forearm, wrist and right forehead, with right ankle pain. Imaging revealed multifocal osseous involvement, including small lucent lesions in the right frontal bone and left distal radius and aggressive lesions in the right ankle and left radius. MRI of the right ankle showed an enhancing lesion in the distal fibula with cortical destruction. A biopsy showed chronic suppurative granulomatous inflammation, and a fungal culture grew Sporothrix spp. The patient underwent surgical debridement of the ankle and was continued on itraconazole for 1 year. She had complete resolution of all her lesions, resulting in no residual functional disabilities observed during follow-up.

Recurrent vaginal discharge is a significant health issue for women globally, often leading to discomfort and a reduced quality of life. While normal vaginal discharge helps maintain vaginal health, changes in its composition can signal underlying conditions requiring prompt assessment and treatment. The causes of recurrent vaginal discharge are diverse, including infections, hormonal changes, and anatomical factors. Common infections like bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis are frequently encountered, with studies estimating that up to 75% of women will experience vulvovaginal candidiasis at least once in their lifetime. Non-infectious causes, such as foreign bodies, vaginal atrophy, and cervical or endometrial anomalies, also contribute but are less commonly addressed. Despite its prevalence, diagnosing recurrent vaginal discharge can be challenging, requiring a thorough approach. Cultural taboos and stigma surrounding vaginal health may discourage women from seeking medical help, potentially delaying diagnosis and treatment. This article reports a case of a vaginal foreign body presenting with persistent discharge and emphasizes the importance of a comprehensive approach to diagnosing and managing vaginal discharge.

Introduction: The Diabetes Medication Therapy Adherence Clinic (DMTAC) programme is an ambulatory care service provided by trained pharmacists in collaboration with doctors. It supports improved glycaemic control by enhancing patients' understanding and treatment adherence through education.

Methods: Patients enrolled in the DMTAC programme in all 84 health clinics in Johor from January 2016 to December 2017 were included. Demographic characteristics, diabetic and medication history, current treatments, comorbidities and therapeutic outcomes (glycosylated haemoglobin A1c [HbAlc] level and lipid profile) were collected and reviewed retrospectively. Baseline HbAlc levels and lipid profiles were taken from patients' medical records during their first visits and post-intervention values from follow-up data, including the most recent information documented during the last DMTAC pharmacist visit before December 2017.

Results: A total of 1107 patients (693 women and 414 men) with type 2 diabetes mellitus aged 24-88 years were included. The mean HbA1c level significantly decreased by 0.92±1.94%. The mean total cholesterol (-0.27 mmol/L), low-density lipoprotein (-0.31 mmol/L) and triglyceride levels (-0.14 mmol/L) slightly but significantly decreased. Both systolic and diastolic blood pressures also showed small but significant reductions from 142/81 mmHg pre-intervention to 137/79 mmHg postintervention. The patients' understanding scores improved from 87.94% to 98.55% after their fourth DMTAC pharmacist visit.

Conclusion: The DMTAC programme in public health clinics across Johor, Malaysia, significantly improves HbA1c levels, fasting blood glucose levels, lipid profiles, BPs and medication understanding, with DMTAC pharmacists playing a key role in supporting multidisciplinary teams through targeted interventions and counselling.