Case report: A Boy with an inability to walk; do not forget about scurvy.

Scurvy, a condition caused by vitamin C deficiency, is characterized by a syndrome of multisystem disorder due to defective collagen production and antioxidative function. This condition is infrequent in this modern era; thus, it is often not within the list of differential diagnoses. The broad clinical picture is generally overlooked as other systemic illnesses, resulting in an extensive investigation that delays the diagnosis. Herein, we report a case of an 8-year-old boy with underlying autism spectrum disorder who presented with lower limb pain and other constitutional symptoms. Examination revealed multiple hyperpigmented scars over the upper and lower limbs and gingival hyperpigmentation. With history of picky eating habits and clinical symptoms supported by radiographic findings, scurvy was suspected and subsequently confirmed based on a low level of ascorbic acid. With vitamin C supplementation and proper nutritional support, the patient recovered well.

A case report of gastroschisis: Prenatal diagnosis in primary care settings matters.

Gastroschisis may lead to serious congenital disability, as prolonged exposure to the amniotic fluid could compromise the mesenteric blood flow and irritate the foetal intestinal wall. The consequences of gastroschisis include spontaneous preterm birth, growth restriction and foetal demise. Awareness of this disease is essential, as a high mortality rate is linked to inadequate initial therapy. Early detection of the disease, mainly by primary care physicians as the initial point of contact, is crucial to improve the course of the condition through early monitoring and referral to tertiary care centres. With this case report, we hope to highlight the need of detecting gastroschisis before to the third trimester of pregnancy for better readiness, especially in primary care settings located far from tertiary centres.

Factors Affecting Adherence to Lipid-lowering Drugs: A Scoping Review.

Objectives: Dyslipidemia is an important risk factor for cardiovascular disease. In developed countries, only 50% of patients with chronic illness adhere to their long-term therapy. This article aimed to review the factors affecting adherence to lipid-lowering drugs (LLDs). Methods: The searched articles were selected based on the available keywords in the title and abstract with the publication restricted between January 2010 and September 2020. Articles generated from the databases must fulfill both inclusion and exclusion criteria in the present systematic review. Our initial search retrieved 221 literature reviews. After excluding articles with irrelevant topics, a total of 23 articles were chosen for this current review. Results: The factors were classified based on three main factors: patient-related, medication-related, and healthcare workers-related factors. For patient-related factors, gender, age, number of family members, education level, post-hospitalization, comorbidities and cardiovascular disease risk, follow-up status, occupation, socio-economy, insurance, perception, ethnicity, and health plan were among the factors affecting adherence to LLDs. As for medication-related factors, timing, polypharmacy, duration of treatment, generic medication, intensity of medication, side effects, initiating dose, packaging, drug dosing, and type of drugs were revealed as contributing factors. In the light of healthcare workers, related factors shown were counseling, medication optimization, type of provider, and location of the hospital. Conclusions: Recommendations to improve adherence include educating patients on the disease itself and the importance of the treatment, modification of the dosing, timing and type of LLDs, and effective consultations by healthcare workers. Further studies need to be done in Malaysia as there is inadequate research on this topic.

Exploring the Barriers and Expectations Towards Health Care Services Among Parents/Caretakers of People with Intellectual Disability in Kuantan, Malaysia: A Qualitative Study.

Backgrounds: People with intellectual disabilities (PWID) are often characterized by challenges in learning and difficulties in performing daily activities. These difficulties can have an impact not only on the individuals themselves but also on the people around them, especially their parents, caregivers, and healthcare workers. Therefore, establishing a positive relationship between parents or caregivers and individuals with disabilities is crucial as a key factor in promoting positive healthcare experiences and outcomes. Aim: This study aims to explore the barriers and perceptions toward healthcare services among parents or caretakers of people with intellectual disability, including the challenges and their expectations toward healthcare services. Materials and Methods: This was a qualitative study using purposive sampling. Thirty participants were contacted at the initial stage and invited to participate in the study. Semi-structured in-depth interviews were done among parents and caretakers of PWID who attended Special Care Dentistry and Paediatric Dentistry clinics in Sultan Ahmad Shah Medical Centre, Kuantan, Pahang. Topic guides were generated from literature review and expert opinions, followed by pilot interviews to refine them. However, after the interviews were done for the first 13 participants, we have reached data saturation, and no new themes emerged. The interviews were recorded, verbatim transcribed, and analyzed using Braun and Clarke's guidelines for thematic analysis. Results: The satisfaction of parents or caretakers toward healthcare services for PWID and positive experiences in receiving healthcare services were noted. However, the results revealed several barrier themes in seeking healthcare services: lack of availability of parking, longer waiting time, appointment time, crowded environment, limited information on the availability of the services, and longer travel duration. Furthermore, expectation themes emerged from this study: continuous follow-up, accessibility to healthcare services, and staff attitude.

Unravelling the unseen threat of polyhydramnios in patients with gestational diabetes mellitus: A case report.

Polyhydramnios is defined as an increase in the amount of amniotic fluid during pregnancy. This article presents the case of a 35-year-old G4P3 lady at 28 weeks of gestation with suboptimised gestational diabetes Mellitus (GDM). Routine transabdominal ultrasound showed the presence of polyhydramnios, initially thought to be due to suboptimal glucose control. Further evaluation revealed a congenital diaphragmatic hernia with multiple soft markers. Identifying the underlying causes of polyhydramnios can be challenging in primary care settings, which can be attributed to various factors. Although primary care medical officers may not be required to perform detailed scans, they have a crucial role in identifying gross foetal abnormalities. This study highlights the potential for missed diagnoses in primary care settings and the importance of comprehensive prenatal assessments to ensure early detection and appropriate management of polyhydramnios-related conditions in women with GDM.

Screening for type 2 diabetes and periodontitis patients (CODAPT-My©): a multidisciplinary care approach.

BACKGROUND: The practice of referring diabetic patients for dental intervention has been poor despite awareness and knowledge of the oral health effects of diabetes. Likewise, dentists treating patients receiving diabetes treatment are rarely updated on the glycaemic status and as a result, the opportunity for shared management of these patients is missed. This study aimed to provide a standardised care pathway which will initiate screening for diabetes from dental clinics and link patients with primary care for them to receive optimised care for glycaemic control. METHOD: A Modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices to screen for diabetes among patients attending dental clinics for periodontitis. Expert panel members were recruited using snowball technique where the experts comprised Family Medicine Specialists (5), Periodontists (6), Endocrinologists (3) and Clinical Pharmacists (4) who are involved in management of patients with diabetes at public and private healthcare facilities. Care algorithms were designed based on existing public healthcare services. RESULTS: The CODAPT© panel recommends referral to primary care for further evaluation of glycaemic status if patients diagnosed with periodontitis record fasting capillary blood glucose levels ≥ 5.6 mmol/L. Intervention treatment options for prediabetes are listed, and emphasis on feedback to the dental healthcare team is outlined specifically. CONCLUSION: The CODAPT© care pathway has the potential to link dental clinics with primary care for diagnosis and/or optimised treatment of prediabetes/diabetes among patients receiving periodontitis treatment.

Insulin oedema in type 2 diabetes mellitus: A case report.

Insulin oedema is a rare condition that may occur after the initiation or rapid intensification of insulin therapy in patients with long-standing hyperglycaemia, commonly with type 1 diabetes mellitus (DM). We reported a case of insulin oedema in a patient with type 2 DM who presented with swelling of the extremities and weight gain of 3 kg 1 week after insulin initiation. A course of furosemide was administered, but no significant immediate improvement was observed; however, the lower limb swelling resolved spontaneously after 3 months of follow-up. The patient also achieved adequate diabetic control with insulin, as shown by the reduction of her HbA1c from 10.7% to 6.9% over 6 months. Insulin oedema is a diagnosis of exclusion after ruling out other differential diagnoses, such as cardiac, renal, or liver failure. Although insulin oedema carries with it a good prognosis, physicians should be aware of the condition to avoid misdiagnosis.

Prevalence of smartphone addiction and its associated factors among pre-clinical medical and dental students in a public university in Malaysia.

Introduction: Smartphone addiction is becoming a global concern affecting every part of society, including healthcare professionals. This study aimed to identify the prevalence of risk of smartphone addiction and its associated factors among medical and dental students in a public university in Malaysia. Method: This cross-sectional study was conducted among pre-clinical medical and dental students using convenience sampling. Questions regarding sociodemographic profile and responses to the Smartphone Addiction Scale Short Version (SAS-SV) and Depression, Anxiety and Stress Score questionnaire (DASS-21) were collected. Multiple logistic regression testing was used to analyse the factors associated with smartphone addiction. Results: We invited 409 pre-clinical medical and dental students to participate voluntarily, resulting in a response rate of 80.2%. The prevalence of high-risk smartphone addiction among the participants was 47.9%. Male participants, participants who used smartphones mainly for social media, and participants with depressive symptoms were more likely to have a high risk of smartphone addiction. Medical students, participants who spent less than 3 hours per day on a smartphone, and participants who used smartphones for education-related activities were less likely to have a high risk of smartphone addiction. Conclusion: Smartphone addiction prevalence among pre-clinical medical and dental students was high. Therefore, the authorities should overcome this problem by implementing early measures.

Awareness, knowledge and practice of dyslipidaemia management among postgraduate primary care trainees in Malaysia: a cross-sectional study.

OBJECTIVES: Dyslipidaemia is one of the main risk factors for cardiovascular disease, the leading cause of death in Malaysia. This study assessed the awareness, knowledge and practice of lipid management among primary care physicians undergoing postgraduate training in Malaysia. DESIGN: Cross sectional study. SETTING: Postgraduate primary care trainees in Malaysia. PARTICIPANTS: 759 postgraduate primary care trainees were approached through email or hard copy, of whom 466 responded. METHOD: A self-administered questionnaire was used to assess their awareness, knowledge and practice of dyslipidaemia management. The total cumulative score derived from the knowledge section was categorised into good or poor knowledge based on the median score, where a score of less than the median score was categorised as poor and a score equal to or more than the median score was categorised as good. We further examined the association between knowledge score and sociodemographic data. Associations were considered significant when p<0.05. RESULTS: The response rate achieved was 61.4%. The majority (98.1%) were aware of the national lipid guideline, and 95.6% reported that they used the lipid guideline in their practice. The median knowledge score was 7 out of 10; 70.2% of respondents scored 7 or more which was considered as good knowledge. Despite the majority (95.6%) reporting use of guidelines, there was wide variation in their clinical practice whereby some did not practise based on the guidelines. There was a positive significant association between awareness and the use of the guideline with knowledge score (p<0.001). However there was no significant association between knowledge score and sociodemographic data (p>0.05). CONCLUSIONS: The level of awareness and use of the lipid guideline among postgraduate primary care trainees was good. However, there were still gaps in their knowledge and practice which are not in accordance with standard guidelines.