Malaysian Family Physician最新文献

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.

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.