Malaysian Family Physician最新文献

A 37-year-old married, right-handed active firefighter presented to the primary care clinic with a self-report of difficulties in memorising and recalling information associated with declining work performance. Collaborative history-taking revealed that he also experienced emotional and social withdrawal, apathy, irritability and distractibility. He was initially diagnosed with major depressive disorder but showed no improvement with an antidepressant. This young man with no history of hereditary neurodegenerative disorder had further deterioration in cognitive function, predominantly executive behaviours, with progressive aphasia. Brain magnetic resonance imaging revealed cerebral atrophy predominant over the frontotemporal lobe. Positron emission tomography showed fluorodeoxyglucose hypometabolism at the bifrontal and left parietal and temporal cortices, consistent with frontotemporal dementia. He required institutionalisation with full nursing care less than 24 months after the onset of the symptoms. This case highlights the need for diagnostic consideration of dementia in young individuals presenting with cognitive impairment among other symptoms. It also emphasises the importance of obtaining collateral information from close relatives to avoid misdiagnosis and addresses the psychosocial impact of dementia at a young age.

Introduction: Primary care service plays a vital role in early clinical assessment of patients with COVID-19 in Malaysia. This study aimed to evaluate the potential risk factors of COVID-19 severity at presentation to primary care facilities in the post-vaccination period.

Method: Clinical records from the Selangkah system of all patients with COVID-19 aged above 18 years seen at COVID-19 assessment centres located in 10 government health clinics in Gombak district, Selangor, from 1 October to 31 December 2021 with complete documentation and outcomes were retrieved. Demographics, comorbidities, clinical features and vaccination statuses and types were retrospectively evaluated. The variables were compared between mild and severe diseases. Univariate and multivariable logistic regressions were used to identify the factors affecting disease severity.

Results: A total of 4406 patients (median age=37 years, men=51.2%) were analysed. Approximately 97.1% of the cases were mild, while 2.9% were severe. Fever, difficulty breathing, lethargy, throat irritation/runny nose, oxygen saturation of <95%, respiratory rate of >20 breaths per minute, CoronaVac vaccination and hypertension were the determinants of severity (P<0.05).

Conclusion: The high proportion (97.1%) of mild cases in this study compared with an earlier report (81.8%) during the pre-vaccination period may suggest the impact of vaccine, as 84.9% of this cohort was fully vaccinated. Our study also demonstrated a significant difference in COVID-19 severity between the vaccine types. The identified clinical features and comorbidities could assist primary care doctors in stratifying patients with COVID-19 judiciously in terms of hospital referral or home quarantine.

A 78-year-old post-stroke man with multiple comorbidities who was activity of daily living- dependent developed aspiration pneumonia associated with nasogastric tube (NGT) blockage. He presented with malnutrition and risk of sarcopenia with hypoalbuminaemia, small calf circumference (CC), low body mass index and small mid upper arm circumference. He showed symptoms of moderate-to-severe vascular dementia with behavioural psychological stress disorder, resulting in carer stress. Psychoeducation among the carers and referral to a neuro-psychiatrist were ensued after outpatient-based team meeting discussion. Herein, we highlight the importance of screening for sarcopenia and nutritional status in post-stroke patients with the use of the CC and serum albumin level as well as the involvement of a multidisciplinary team in the primary care setting to improve patient outcomes. Percutaneous endoscopic gastrostomy tubes are more suitable than NGTs for post-stroke patients who require enteral feeding to improve the nutritional status.

Introduction: This study aimed to determine the prevalence of suspected depression and its associated factors among patients with hypertension in a Malaysian primary care clinic.

Method: This cross-sectional study was conducted in a primary care clinic from 1 June to 31 August 2019 using the Patient Health Questionnaire-9.

Results: The prevalence of suspected depression was 9.0%. The significant predictors of depression were Indian ethnicity (adjusted odd ratio [AOR]: 2.373; confidence interval [CI]: 1.147-4.907), divorce (AOR: 3.5; CI: 1.243-9.860), singleness (AOR: 2.241; CI: 1.182-4.251), heavy episodic drinking (AOR: 7.343; CI: 2.494-21.624), low physical activity level (AOR: 1.921; CI: 1.0932.274), low fibre intake (AOR: 1.836; CI: 1.061-3.178), uncontrolled blood pressure (AOR: 1.800; CI: 1.134-2.858) and presence of hypertension complications (AOR: 3.263; CI: 2.053-5.185).

Conclusion: Primary health care providers must screen for depression among patients with hypertension, particularly those within high-risk groups, and implement interventions that address modifiable risk factors.

Ovarian cysts are rare in children. Their common presentation is acute abdomen, which can be a life-threatening event that needs emergent investigation and intervention. Herein, we report a gynaecological case of a twisted ovarian cyst in an 11-year-old girl who presented to the emergency department with sudden-onset generalised abdominal pain. Multiple strong analgesics were prescribed, and pain-controlled analgesia was then started. Abdominal ultrasound revealed a left adnexal mass, and abdominal computed tomography showed a non-enhancing soft tissue tumour with multiple cystic components in the pouch of Douglas. The patient underwent emergency laparotomy, which revealed a gangrenous left ovarian mass measuring 9x5 cm that was twisted five times. Histopathology showed extensive haemorrhagic infarction with no remnant of viable tissue, consistent with a twisted ovary. It was challenging to determine the origin of the pain in this patient, as thorough examination could not be performed because she was in severe pain. Abdominal ultrasound helps guide diagnosis, as a gynaecological cause is rare in premenarchal children. A vigilant assessment is important to avoid delays in diagnosis and emergency intervention.

Menopause is an important phase in the life of older women. Women's life expectancy has increased worldwide. As women experience and perceive menopause differently depending on their personal, family and sociocultural backgrounds, perimenopausal symptoms can often go unnoticed and missed by general practitioners. General practitioners are uniquely placed in the healthcare delivery pyramid to close this gap and improve patients' quality of life by identifying perimenopausal signs and symptoms early. This article shares knowledge about continuing medical education for general practitioners to close the existing gap. As there is great variability within each menopausal woman's experience as well as among individual women, there is a need to individualise and render personalised care. By being able to discuss accepted and safe standards of care and by advocating for a holistic approach incorporating both non-pharmacological and pharmacological strategies, general practitioners would be able to improve the confidence of their patients for better health outcomes.

General practitioners regularly encounter atrial fibrillation in their daily practice. A crucial cornerstone of its management includes prescribing anticoagulants and controlling the heart rate. Tachycardia or bradycardia often reflects an ongoing pathological process that should be addressed. Clues are frequently revealed through comprehensive history-taking, complete physical assessment and 12-lead electrocardiogram (ECG) interpretation at the bedside. Thus, early recognition of potential life-threatening arrhythmia in the outpatient setting will lead to appropriate clinical management. In this paper, we illustrate a sudden decrease in the heart rate of a patient with atrial fibrillation. We discuss the ECG interpretation, potential differential diagnoses and approach to clinical management.

Brain tumours often present with a variety of early subtle, non-specific symptoms. This can obscure an organic origin of the illness, which deters timely referral and management. We report a rare case of psychosis in a patient with a left frontal lobe tumour, preceded by 2 months of lethargy and word- finding difficulty with minimal neurological deficits, who was referred to our psychiatric unit from a primary care facility. Blood investigation findings including tumour marker levels were normal. Prompt neuroimaging revealed a left frontal lobe lesion with findings indicating a glioblastoma. The patient was subsequently referred to the neurosurgical team for surgical resection of the tumour. A high index of suspicion is paramount among atypical sociodemographic groups of patients with atypical psychiatric presentations. The primary care setting, which is often the first point of contact for patients, provides an avenue for early detection of such cases and timely referral to the appropriate healthcare system to ensure an optimal outcome.

Introduction: With the rising number of COVID-19 cases in Malaysia and the overwhelming strain on the tertiary healthcare system, home isolation has been introduced by the Ministry of Health Malaysia to reduce the admission of patients with mild COVID-19 to tertiary and low-risk quarantine centres. COVID-19 assessment centres (CACs) have been set up to provide initial assessment, triaging and monitoring of patients with COVID-19 prior to and during their home isolation. In this study, we aimed to share our experience in setting up CACs in Selangor, Malaysia.

Method: We described the steps taken in developing assessment tools and guidelines for assisting healthcare providers in safely monitoring patients with COVID-19 undergoing home isolation.

Results: A total of 26,826 patients were clinically assessed from 1 to 28 February 2021 in various CACs in the state. The majority of the cases seen in the CACs were under category (CAT) 1 and 2. Only 0.2% (n=53) of the cases were categorised as severe COVID-19 (CAT 3 and above).

Conclusion: CACs coordinated by primary care providers play an important role in triaging, assessing and monitoring patients with COVID-19 undergoing home isolation in the community. There needs to be a better partnership between various stakeholders and the private healthcare sector to improve the services. The usage of a pulse oximeter in home monitoring of all patients with COVID-19 in Selangor needs to be seriously considered.