Malaysian Family Physician最新文献

Introduction: Coronavirus disease (COVID-19) is a highly contagious disease caused by severe acute respiratory syndrome coronavirus 2 and was declared by the World Health Organization as a pandemic on 11 March 2020. However, COVID-19 will continue to occur in the future. Therefore, this research aimed to determine the factors that affect the risk of hospitalisation of patients infected with COVID-19 so that preventive measures can be taken promptly.

Methods: This study adopted a descriptive, analytic, cross-sectional research design. The sample included the people of North Sumatra who used Universitas Sumatera Utara's COVID-19 Telemedicine and met the research criteria. The data were analysed using the chi-square test, with odds ratios (ORs) calculated.

Results: Among the clinical symptoms of the patients, runny nose (OR=10.9), sore throat (OR=23.5), muscle pain (OR=24.3), headache (OR=33.7), diarrhoea (OR=7.7), nausea (OR=10.6), vomiting (OR=4.4), ageusia (OR=6.3) and anosmia (OR=5.5) were more commonly associated with an increased risk of hospitalisation. Among the comorbidities, hypertension (OR=2.5) and diabetes (OR=4.9) increased the risk of hospitalisation.

Conclusion: Runny nose, sore throat, muscle pain, headache, diarrhoea, nausea, vomiting, ageusia, anosmia, diabetes and hypertension are associated with an increased risk of hospitalisation among patients with COVID-19.

Introduction: Adolescent pregnancies are often associated with a higher risk of adverse outcomes, including preterm birth, which may lead to severe physiological and psychological health impacts on both mothers and children. Despite the acknowledged risks, there is a knowledge gap regarding the risk factors of preterm birth among pregnant adolescents. This study aimed to determine the prevalence and associated sociodemographic, maternal, intrapartum and neonatal factors of preterm birth among pregnant adolescents in Kuala Lumpur.

Methods: A cross-sectional study was conducted in Kuala Lumpur, Malaysia, from March to June 2024. Samples were selected using simple random sampling from the Wilayah Persekutuan Kuala Lumpur and Putrajaya Department of Health pregnant adolescents' line listing from 2019 to 2023. Simple and multiple logistic regression analyses were used to determine the factors associated with preterm birth.

Results: A total of 175 pregnant adolescents were included in the study. The prevalence of preterm birth was 16%. Anaemia at booking (adjusted odds ratio [aOR]: 7.8; 95% confidence interval [CI]: 2.53, 23.997), history of preterm birth (aOR: 11.654; 95% CI: 1.517, 89.498), history of smoking (aOR: 6.89; 95% CI: 1.397, 34.002) and low birth weight (aOR: 12.503; 95% CI: 3.858, 40.522) were significantly associated with preterm birth.

Conclusion: Targeted interventions to address anaemia, history of smoking, previous history of preterm births and low birth weight babies in adolescent pregnancies are crucial to reduce the incidence of preterm birth and improve maternal and infant health outcomes in this population among adolescents.

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.