A Case Report of Steroid Withdrawal Syndrome / 가정의학회지

We report a case of steroid withdrawal syndrome in a 74-year-old woman who was suspected of having an occult exogenous Cushing’s syndrome secondary to prolonged traditional complementary medicine use. She presented with non-specific symptoms of lethargy, malaise, and poor oral intake with weight loss for 1 month, and investigations showed suboptimal 9 AM cortisol level. She has responded well to steroid replacement.

Effectiveness Of Community-Based Health Education On Preparedness For Flood-Related Communicable Diseases In Kelantan

@#The flood disaster in Kelantan in 2014 had resulted in substantial health implications including increased cases of communicable diseases. There was a lack of community preparedness including customized health educations in the prevention and control of flood-related communicable diseases in the affected areas. The research was aimed to evaluate the effectiveness of community-based health education modules on flood-related communicable diseases among communities in Kelantan. Health education modules focusing on major food-related diseases were developed. A non-randomized community-controlled trial using the modules were conducted. Outcomes were assessed on knowledge, attitude and preventive practice scores to flood-related communicable diseases using a pre-validated questionnaire. Independent t test was used to compare mean scores between the intervention community (Tumpat) and the control community (Bachok) at 1-month post intervention. One-way independent ANOVA test was done to compare score differences at baseline (pre), post 1-month and post 2-month from repeated surveys among random samples within the intervention community. There were significant improvements in all knowledge components from 9.4% to 52.6% with 10% increment in attitude scores toward preventing behaviours on flood-related communicable diseases. When compared against the control community at one-month post-intervention, there were significantly higher knowledge on types of diseases, symptoms and risk factors as well as practice scores of drinking safe water and protective habits. This research demonstrated that community-based health education is effective in improving relevant knowledge, attitude and preventive practices among affected communities as part of their preparedness toward communicable diseases related to flood.

Diastolic dysfunction in patients with liver cirrhosis: A short-term, observational study at a Malaysian hospital

@#Cirrhotic cardiomyopathy is a recognised complication of liver cirrhosis and predicts poor outcomes. Detection of diastolic dysfunction, an early indicator of left ventricular dysfunction can help identify those patients at risk of disease progression. In our study we showed that there was a high prevalence of diastolic dysfunction amongst patients with liver cirrhosis at our outpatient clinic, with the majority being Child-Pugh A/low MELD score. Multiple regression analysis indicated that age and sodium levels were significantly associated with the presence of diastolic dysfunction. This further reinforces the importance of dietary sodium restriction amongst patients with liver cirrhosis.

Gastro Oesophageal Reflux Disease Shadowing Anxiety Disorder Causing Prolonged Exposure to Proton Pump Inhibitor / 가정의학회지

Anxiety disorders are the most prevalent psychiatric disorders in the general population. The relationship between dyspepsia and particularly gastroesophageal reflux disease (GERD) and psychiatric comorbidity such as anxiety is poorly defined. However, GERD was noted to be strongly associated and often coincident in onset with generalized anxiety disorder in the community. In this paper, we report the case of an adult man who presented with severe weight loss and underlying GERD, and was later found to have an anxiety disorder as the cause of both.

Mammary Paget's Disease of the Nipple: Relatively Common but Still Unknown to Many / 가정의학회지

Mammary Paget's disease is clinically defined as skin inflammation of the nipple area and is an adenocarcinoma of the epidermis of the nipple. The pathogenesis of mammary Paget's disease is relatively unknown; nonetheless, there are two popular theories that support the underlying carcinoma and de novo carcinogenesis. For the attending medical practitioner, mammary Paget's disease poses a diagnostic and therapeutic dilemma, especially in the absence of a clinically palpable breast mass. We report a rare case of a 48-year-old Malay woman who presented at Hospital Universiti Sains Malaysia, Kelantan, Malaysia with the symptom of skin erosion on the left nipple and unresponsiveness to multiple topical treatments. A full evaluation and assessment of the patient were conducted, and mammary Paget's disease was diagnosed.

Depression and potential risk factors among the elderly with Type 2 Diabetes Mellitus in Kedah, Malaysia

@#Objective: Elderly with diabetes has been found to have a higher chance of depression. Therefore, the aim of this study is to determine the prevalence of depression and its associated factors among elderly with Type 2 Diabetes Mellitus in Kedah. Methods: A cross-sectional study was conducted at the Klinik Kesihatan Bandar, Sungai Petani, Kedah. The inclusion criteria were patients aged ≥60 years with Type 2 Diabetes Mellitus. Those with cognitive impairment, presence of organic brain syndrome, presence of severe mental disorder and patients who are either deaf or mute were excluded. The Malay version of Geriatric Depression Scale (M-GDS-14) was used to assess the depressive symptoms. The data was analysed using descriptive statistic and multiple logistic regression. Results: A total of 511 patients participated in the study. The mean age of the respondents is 64.5 (Standard Deviation 7.0) years old. There were slightly more males (53.8%). Majority were Malay (63.0%), married (76.9%) and has a household income of less than RM1000 (67.5%). The prevalence of depression was 32.1%. The number of elderly people living with their children (Adjusted Odds Ratio, aOR0.20, 95%CI: 0.07, 0.55), elderly living with spouse, children, in law and grandchildren (aOR2.95, 95%CI: 1.18, 7.37), diabetic complication (aOR4.68, 95%CI: 2.63, 8.35) and HbA1c (aOR1.23, 95%CI: 1.09, 1.39) are significantly associated with depression. Conclusion: The level of depression was found to be high. Factors contributing to the significantly high level of depression are found to be associated with living arrangements, diabetic complication and HbA1c were significantly associated with depression.

Hemiballismus in Uncontrolled Diabetes Mellitus / 가정의학회지

Hemiballismus, a subtype of chorea, is a rare movement disorder, and is most commonly found secondary to stroke. Movements are involuntary, violent, coarse, and have a wide amplitude. There is increasing report of hemiballismus occurring in non-ketotic hyperglycemia. Spontaneous improvements or remissions were observed in many patients, and treatment should be directed towards the cause of hemiballismus. There is no randomized control trial to guide clinicians in deciding the best treatment option when managing hemiballismus. Symptomatic treatment includes the use of drugs such as dopamine receptor blocker and tetrabenazine. Surgical treatment is reserved for severe, persistent, and disabling hemiballismus. This case is of an elderly woman with long standing uncontrolled diabetes who presented with abnormal movement in her left upper limb for 2 months, which resolved slowly with good control of her glucose levels. Treating physicians need to have a high index of suspicion to prevent mismanagement of the condition.

Achievement of LDL Cholesterol Goal and Adherence to Statin by Diabetes Patients in Kelantan

Background: Statins are a class of potent drugs that can be used to reduce cholesterol, especially low-density lipoprotein cholesterol (LDL-C). However, their effectiveness is limited if adherence to treatment is poor. The objectives of the study are to estimate the proportion of diabetic patient who has achieved LDL-C goal and to determine the association of LDL-C achievement with socio demographic factors and statin therapy adherence Methods: This is a cross-sectional study involving 234 patients with type 2 diabetes mellitus (T2DM) and dyslipidaemia attending an outpatient clinic in a hospital in Kelantan. Interviews and self-administered questionnaires were used to determine their sociodemographic and clinical characteristics. Adherence to therapy was assessed using the Medication Compliance Questionnaire (MCQ). The associations between the achievement of LDL targets and sociodemographic/clinical factors, including adherence, were analysed with simple logistic regression. Results: About 37.6% of patients achieved their LDL-C target. The percentage of patients who adhered to statin use was 98.3%, and 20.5% of these patients reported full adherence. There was no significant association between achievement of LDL-C targets with adherence or any other sociodemographic factors, such as age, gender and educational or economic status (all P-value < 0.05). Conclusion: Despite a high level of adherence, the majority of patients failed to achieve LDL-C targets. More concerted efforts are needed to improve this.

Predictors of proliferative diabetic retinopathy among patients with type 2 diabetes mellitus in Malaysia as detected by fundus photography

Objectives: diabetic eye disease is the most common cause of visual loss in adults, and proliferative diabetic retinopathy [PDR] is the main cause of blindness. This study aimed to determine the predisposing factors for PDR that were identified by fundus photography among patients with type 2 diabetes mellitus [DM] at the Diabetic Clinic at Hospital Universiti Sains Malaysia

Methods: in this retrospective study, fundus photo review was performed on patients with type 2 DM who had undergone diabetic retinopathy screening using a nonmydriatic fundus camera from January 2008 until December 2012. Fundus photos were classified into 2 groups, PDR and no apparent diabetic retinopathy [no DR]. Socio-demographic data and clinical and metabolic profiles were obtained from the medical records. Logistic regression was used to determine the factors associated with PDR

Results: a total of 120 patients were selected, with 30 patients in the PDR group and 90 patients in the no DR group. The mean age of patients with PDR was 52 [7.94] years and was 58 [12.31] years in the no DR group. Hypertension and hyperlipidaemia were the most common comorbidities identified in this study. The HbA1c level >6.5% and LDL level >2.6 mmol/L were higher in the PDR group. Age [p = 0.032], duration of DM [p = 0.022], nephropathy [p = 0.002] and peripheral neuropathy [p= 0.001] were significantly associated with PDR

Conclusion: the significant predictors of PDR among patients with type 2 DM as detected by fundus photography were age, duration of DM, nephropathy and peripheral neuropathy

Female sexual dysfunction among overweight and obese women in Kota Bharu, Malaysia

Objectives: Overweight and obesity have been identified as risk factors for sexual dysfunction. However, this relationship has not been well documented in women, and the results have been conflicting, perhaps because of the complexity of female sexuality. The aim of our study was to determine the prevalence of and factors associated with female sexual dysfunction [FSD] and its subtypes among overweight and obese women

Methods: This cross-sectional study was conducted from January to June 2012 at Klinik Rawatan Keluarga Hospital Universiti Sains Malaysia. A validated Malay version of the Female Sexual Function Index was administered to 204 overweight and obese women. The socio-demographics and physical and biochemical parameters were obtained. Multiple logistic regression was used to evaluate the confounding factors toi sexua/ dysfunction

Results: The prevalence of FSD among overweight and obese women was reported to be 12.3% [95% CI:7.79, 16.81]. Sexual desire disorder was the most prevalent dysfunction [23%], followed by arousal disorder [8.3%], lubrication disorder [9 3%], orgasm disorder [4.9%], satisfaction disorder [9.3%] and pain disorder [6.9%]. Parity 1.08 [1.01, 1.15] and duration of marriage 0.70 [0.50, 0.96] were significantly associated with FSD in the study cohort

Conclusions: Sexual dysfunction among overweight and obese women was low. Parity showed a significant positive correlation with FSD, while the duration of marriage appeared to be a protective factor against FSD