Malaysian Family Physician最新文献

This report presents the case of an 18-year-old female student with a low BMI, who was otherwise healthy. She presented with chronic anterior right knee pain persisting for 1 year. The pain began spontaneously and gradually increased in severity, especially during long distance walking and standing for more than 15 minutes. The symptoms did not subside with medication and physiotherapy. All biochemical and radiological investigations to rule out other related possible aetiologies were unremarkable. The patient eventually underwent an arthroscopic knee surgery, during which the intraoperative findings revealed the Hoffa fat pad over the anteromedial knee joint. This was debrided and after surgery, she was symptom free and had resumed her normal activities.

Proptosis, commonly referred to as 'bulging eyes', is characterised by abnormal protrusion of the eyeball. This condition can arise from a variety of underlying causes, including thyroid eye disease, orbital tumours, inflammatory disorders and vascular anomalies. Timely recognition of proptosis and the underlying cause is crucial due to potentially vision-threatening conditions. We present a case series of patients who presented with proptosis and proptosis-like condition in a primary care clinic. All cases exhibited bulging of the eyes with protrusion beyond 21 mm from the orbital rim. The first case involved proptosis due to cavernous haemangioma; the second was a case of pseudoproptosis; and the final case was Oue so underlying thyroid eye disease. A comprehensive evaluation, including detailed historn-taVing and radiological imaging, was essential in identifying the specific causes of proptosis for each case, thus allowing for appropriate management strategies to be implemented.

Although statins are generally well-tolerated, recent reports have linked their use to autoimmune liver disease. We present the case of a 70-year-old woman who developed hepatocellular injury 4 months after switching from simvastatin to high-intensity atorvastatin. Discontinuation of atorvastatin led to a gradual improvement in liver function over 3 months; however, her rising LDL(low-density lipoprotein) levels prompted a rechallenge with simvastatin, resulting in recurrent liver function derangement. Despite cessation, the liver enzyme levels continued to rise. Positive autoantibodies, including antinuclear antibodies, anti-mitochondrial M2 and immunoglobulins (i.e. IgA and IgG), along with a liver biopsy, confirmed an overlapping syndrome of primary biliary cholangitis and autoimmune hepatitis. Treatment with prednisolone led to normalisation of liver function, and the patient remained stable on azathioprine and ursodeoxycholic acid. This case underscores the importance of vigilant liver function monitoring, caution when rechallenging statins and the potential for statin therapy to unmask underlying autoimmune liver disease.

Introduction: The pilot project Nephrology Liaison Clinic, initiated in 2019 at Klinik Kesihatan Sentul, integrates nephrology services into primary care. Managed by primary care physicians with periodic nephrologist input, this project aims to enhance early intervention and reduce tertiary care burdens.

Methods: In this retrospective study, the clinical outcomes of patients enrolled from 2019 to 2021 were analysed. Patients with chronic kidney disease stage G3 or stage G4/G5 declining hospital referral and those with persistent proteinuria were included. Patients who were lost to follow-up, deceased or transferred to other clinics were excluded. Data analysis included descriptive statistics, the chi-square test, Fisher's exact test and McNemar test.

Results: A total of 73 patients were included. After 1 year, 45 (61.6%) remained under primary care, while 28 (38.4%) required tertiary referral, predominantly for renal replacement therapy preparation. Among the primary care patients, 71.1% (32/45) either had maintained or slowed estimated glomerular filtration rate decline. Ten patients had their HbA1c improved from >8% to <8% (p = 0.002), and 13 more patients were initiated on sodium-glucose cotransporter-2 inhibitors compared to baseline (p < 0.001).

Conclusion: This study demonstrates the feasibility of nephrology liaison clinics in stabilising renal function and improving metabolic parameters within primary care settings. The findings highlight the potential of shared-care models in resource-limited settings. However, challenges remain in ensuring adequate human resources and improving access to renoprotective medications. Larger-scale, longterm studies are warranted to validate the long-term benefits and wider applicability of this integrated approach.

Introduction: International research has consistently shown that individuals with hypertension experience significantly impaired sleep quality, but there is a lack of study in this field in Malaysia. This study aimed to assess the prevalence and associated factors of poor sleep quality among patients with hypertension in a primary care clinic in Malaysia.

Methods: A cross-sectional study was conducted among patients with hypertension aged 18 years and above in a public health clinic from December 2023 to February 2024. Systematic random sampling was used to recruit participants. Sociodemographic data and relevant information were obtained using the Pittsburgh Sleep Quality Index; Depression, Anxiety and Stress Scale-21; and STOP-BANG questionnaire. The Statistical Package for the Social Sciences version 27 was used to conduct multiple logistic regression analysis of the determinants of poor sleep quality.

Results: A total of 335 participants were recruited, yielding a 98.2% response rate. The mean participant age was 58 years, and 63% were women. The prevalence of poor sleep quality was 87.2%. Multiple logistic regression showed that anxiety symptoms (odds ratio [OR] = 12.279, 95% confidence interval [CI] = 1.573-95.883, P=0.017), low monthly household income (OR=3.573, 95% CI= 1.627-7.847, P=0.002), lack of exercise (0R=2.530, 95% CI=1.108-5.775, P=0.028) and risk of obstructive sleep apnoea (OR=2.521, 95% CI=1.176-5.402, P=0.017) were associated with poor sleep quality.

Conclusion: Poor sleep quality is prevalent among patients with hypertension and is associated with adverse cardiovascular events. Increased awareness among primary care physicians would allow early identification of patients at risk for early intervention.

Introduction: Tuberculosis (TB) is a major public health issue worldwide. Screening patients with diabetes mellitus (DM) for TB incurs the highest cost per TB case discovered. Thus, a more practical and useful screening tool is required, especially at the primary care level. This study sought to develop and validate the Tuberculosis Diabetes Mellitus-Predictive Tool (TBDM-PT) in Kelantan, Malaysia.

Methods: This study included 270 patients with DM (with and without TB) from 2019 to 2021 at health clinics in Kelantan. The variables included in the risk score were chosen using logistic regression analysis. Receiver-operating characteristic curves were used to define the cut-off points for scores indicating a low or high risk of developing TB. Nine experts and 20 healthcare workers were involved in the content and face validation processes, respectively.

Results: The risk score was created using eight different variables. The cut-off point selected was 11 out of 21, with sensitivity and specificity of 81% and 90%, respectively. The content validity index of the scale was 0.93, while the face validity index of each component varied from 0.95 to 1.00.

Conclusion: The newly developed TBDM-PT has great potential as a screening tool for TB among patients with DM at the primary care level. External validation and evaluation of this tool in diverse settings and larger populations are required before being applied into standard diabetes care pathways in primary care facilities.

Atrial fibrillation (AF) is the most frequent sustained arrhythmia globally with significant morbidity and mortality. A local guideline has been created to help physicians in clinical decision-making by outlining various generally accepted approaches for the diagnosis, management and prevention of AF. This guideline was published 10 years ago, and it is imperative that new guidelines based on the latest consensus be renewed. Since then, various clinical guidelines have been issued in the past 5 years to standardise the management of AF, including the American College of Cardiology, European Society of Cardiology, National Institute for Health and Care Excellence and Asia Pacific Heart Rhythm Society guidelines. This review aims to provide a comprehensive comparison of these guidelines across multiple aspects of clinical management, including management frameworks, screening, anticoagulation, stroke and bleeding risk assessments, rate and rhythm control, follow-up, comorbidity management and technology usage.

Cardiovascular diseases remain a primary contributor to death worldwide, with hypertension being a key determinant. Excessive salt intake is a contributing factor of high blood pressure and cardiovascular diseases. To address this, the World Health Organization recommends keeping daily salt consumption under 5 g and aiming for a 30% decrease by 2025. In Malaysia, efforts to reach this target have faced delays. A local study found that 79% of Malaysians consume an average of 7.9 g of salt per day, which is significantly higher than the WHO's recommendations. Despite efforts such as voluntary food reformulation, mandatory sodium labelling and public education campaigns, challenges remain. Industry reluctance, low consumer awareness and inadequate enforcement slow down such efforts. This commentary reviews these issues and suggests applicable approaches to strengthen Malaysia's salt reduction strategies.

Herein, we present the case of a 45-year-old woman with a history of Graves' disease who underwent radioactive iodine therapy and was prescribed different oral preparations of thyroxine. Despite initial tolerance to the medication, she developed hypersensitivity reactions 3 months after consumption, which presented as urticarial rashes, erythematous maculopapular eruptions and angio-oedema. She tried a different preparation of thyroxine accompanied by antihistamines but continued having persistent reactions. This led to her discontinuation of thyroxine, resulting in overt hypothyroidism with secondary dyslipidaemia and weight gain. A diagnosis of delayed thyroxine hypersensitivity was made based on history, clinical assessment and supportive evidence from the Naranjo Adverse Drug Reaction Probability Scale.