Poor patient adherence to medication is one of the major factors contributing to poor disease control, in particular in asymptomatic chronic diseases like hypertension and dyslipidaemia. The physical and economic burden on patients and the health care system as a result of non-adherence is great. It is estimated that poor adherence to hypertension medication accounts for as many as 7.1 million preventable deaths annually. Hence recognising and identifying non-adherence is the first step to addressing this problem. Medication adherence can be measured in various ways including self-report to electronic monitoring. In order to be more successful in managing non-adherence, attention must be paid to barriers to adherence, namely the interplay of patient factors, the health care providers themselves and the health care system itself. Taking these into account will probably have the greatest impact on improving medication adherence. Consequently strategies to help overcome these barriers are of paramount importance. Some of these strategies will include education of patients, improving communication between patients and health care providers, improving dose scheduling, providing drugs with less adverse effects, and improving accessibility to health care. Poor mediation adherence continues to be a huge challenge. While the patient is ultimately responsible for the taking of medication, good communication, involving the patient in decision making about their care and simplifying drug regimens go a long way in improving it.
Cardiovascular Disease (CVD) is the leading cause of death in both developed and developing countries. While it is relatively easy to identify those who are obviously at high risk and those at the lowest risk for CVD, it is often the large group of individuals with what appears to be modestly abnormal risk factors who contributes most to the burden of CVD. This is where estimation of CVD risk is necessary. Many tools for risk assessment have been devised. All these risk scores have their own inherent advantages and disadvantages. Furthermore, they may also not be directly applicable to a local population. Ideally, each country should have its own risk score that takes into account other factors as well. In the interim, it is worthwhile to be familiar with one of these scores, select one that is most appropriate for your patient and discuss treatment options based on the estimated risk.
The emission from transition metal complexes is usually produced from triplet excited states. Owing to strong spin-orbit coupling (SOC), the fast conversion of singlet to triplet excited states via intersystem crossing (ISC) is facilitated. Hence, in transition metal complexes, emission from singlet excited states is not favoured. Nevertheless, a number of examples of transition metal complexes that fluoresce with high intensity have been found and some of them were even comprehensively studied. In general, three common photophysical characteristics are used for the identification of fluorescent emission from a transition metal complex: emission lifetimes on the nanosecond scale; a small Stokes shift; and intense emission under aerated conditions. For most of the complexes reviewed here, singlet emission is the result of ligand-based fluorescence, which is the dominant emission process due to poor metal-ligand interactions leading to a small metal contribution in the excited states, and a competitive fluorescence rate constant when compared to the ISC rate constant. In addition to the pure fluorescence from metal complexes, another two types of fluorescent emissions were also reviewed, namely, delayed fluorescence and fluorescence-phosphorescence dual emissions. Both emissions also have their respective unique characteristics, and thus they are discussed in this perspective.
As Malaysia ages its health and social care systems will have to adapt to a changing pattern of disease and dependency. Improved public health measures extend life expectancy at the relative expense of increased prevalence of currently incurable conditions such as dementia and Parkinson's disease. In this article we discuss how these demographic changes will impact and suggest possible means of coping with the altered epidemiology of disease and disability. Malaysia will need to swiftly develop sufficient expertise in acute Geriatric Medicine, rehabilitation of older people; the management of long-term conditions in older people with multiple complex problems within Primary Care; as well as an infrastructure for home and institutional care.
The teaching of clinical communication skills to undergraduate medical students in the Faculty of Medicine, University of Malaya is described. It is a continuous process throughout the five-year medical curriculum which is divided into Phases I, II and III. Students are introduced to communication skills early in Phase I through an interactive session as well as a workshop on general communication skills. In Phase II, small-group two-day workshops cover the basic principles of clinical communication skills using videotapes, group discussion and role-plays. Direct contact between students and patients in actual clinical setting begin in Phase IIIA. Communication skills teaching with feedback training is carried out by videotaping the consultations. In Phase IIIB the two-way mirror is utilized as well as having workshops on certain difficult areas such as 'breaking bad news' and 'taking a sexual history'. Formal assessment is done by evaluating the behavior, language and actual interview content.
We are reporting a case of autologous blood transfusion in a patient who underwent a repair of her aortic aneurysm. Even though the operation was major and carried a high mortality, no homologous blood was used at all.
INTRODUCTION: The purpose of this study is to examine the prevalence of social support and its association with glycemic control in patients with type 2 diabetes mellitus (T2D) in an urban primary care center within an academic institution. Social support is important in the management of chronic diseases. However, its association with glycemic control has been controversial.
METHODS: This was part of a study examining religiosity in T2D patients. Nonsmoking patients with T2D for at least 3 years and aged 30 years and above were recruited. Social support was measured using The Social Support Survey-Medical Outcomes Study (SS), a self-administered questionnaire; the scores range from 19 to 95, and a high score indicates better social support. Glycemic control was measured using the 3 most recent glycosylated hemoglobin (HbA1c) levels within the past 3 years.
RESULTS: A total of 175 participants completed the SS survey (response rate 79.0%). The mean age was 62.7 (standard deviation [SD] = 10.8) years, and the mean duration of diabetes was 11.74 (SD = 6.7) years. The mean HbA1c level was 8.15 (SD = 1.44). The mean SS score was 68.1. The prevalence of high and low social support were 29.7% and 24.0 %, respectively. A significant correlation was found between SS score and number of social supporters (n = 167). No significant correlation was found between the self-reported number of social supporters or the SS score and the mean HbA1c level.
CONCLUSIONS: Social support was not associated with glycemic control in adult patients with T2D in this primary care setting.
Study site: Primary care clinic, Universiti Malaya Medical Centre (UMMC)
Patients with aggressive musculoskeletal tumours often arrive at specialised treatment centres late. Such a delay could mean disfavour for potentially curable or long-term disease-free outcome of limb preserving surgery. This study was undertaken to identify the underlying problem-related delay with a view to propose solution for solving it. We reviewed 30 patients to determine the periods of delay between onset of the first symptom and the definitive treatment. The delays were categorized as 'patient' delay, 'referral' delay and 'treatment' delay. There was 'patient' delay in 57% of patients (n=17), ranging from 1 to 18 months; 'referral' delay in 67% of patients (n=20) ranging from 1 to 19 months and 23% of patients (n=7) had treatment delay (average 23 days) at the treatment centre. The causes of late arrival are not solely patient-related but are multifactorial. Measures to minimize such delays include enhancing awareness only with high index of suspicion among primary care practitioners, creating a special lane specialized imaging studies and establishing a dedicated musculoskeletal tumour unit.
An epidemiological survey was conducted among 1,414 healthy ambulatory elderly persons aged 55 years and above in the Kuala Langat district, Selangor. The relationship between peak expiratory flow rate (PEFR), demographic variables, socioeconomic status, smoking, alcohol use and respiratory symptoms were examined. The peak expiratory flow declined with age and were lower in women of all ages. Smoking had a modest effect on PEFR in men but not on PEFR in women. The combination of respiratory symptoms of cough, phlegm and wheeze were related to lower PEFR values. Prediction equations are presented derived from the population sample which may be of assistance in assessing observed to expected ratios among elderly people in Malaysia.
This study was undertaken to clinically estimate the prevalence of diabetic peripheral neuropathy amongst patients attending an outpatient clinic and to evaluate their risk factors for developing peripheral neuropathy. It was a cross-sectional study of 134 diabetes mellitus patients who attended the Primary Care Clinic, University Hospital, Kuala Lumpur. The patients were interviewed for their demographic data, past and present medical/surgical history, social history, personal habits and symptoms of peripheral neuropathy. Foot examination and clinical neurological tests were conducted and the presence of peripheral neuropathy was assessed. The main outcome measures were the Neuropathy Symptom Score and the Neuropathy Disability Score. The prevalence of diabetic peripheral neuropathy was found to be 50.7%. Peripheral neuropathy was related to the age of the patient and the duration of diabetes but did not seem to be significantly related to diabetic control. To conclude, there was a high prevalence of peripheral neuropathy amongst the diabetics in this study. These patients developed peripheral neuropathy at a younger age and shorter duration of diabetes compared to a similar study that was done in the UK.
Study site: Primary care clinc, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Osmotic demyelination syndrome results from overly rapid serum sodium correction and is often iatrogenic. We report a 50-year-old hypertensive woman on Indapamide presenting with malaise, dizziness and serum sodium less than 100mmol/l who developed osmotic demyelination syndrome after correction of the hyponatremia. Good neurological recovery was seen after plasmapheresis.
INTRODUCTION: Ethnic differences may influence diabetes selfcare practices and glycaemic control among people with type 2 diabetes mellitus. This qualitative study explored goals, beliefs about treatment effectiveness, knowledge, and barriers to and facilitators for diabetes self-care among the three main ethnic groups in Malaysia.
METHODS: Patient focus group discussions were conducted in three different ethnic groups: Malays, Chinese, and Indians. Participants were recruited from the primary-care clinic of a university medical centre located in an urban area. Focus group discussions were audio-recorded, transcribed, and analysed using a thematic approach.
RESULTS: A total of 31 patients participated in the study: Malays (n=12), Indians (n=10), and Chinese (n=9). There were three sessions for each ethnic group. Reported goals primarily related to quality of life and glycaemic control. Participants expressed the belief that the combination of diet, exercise, and medications is effective for controlling diabetes. Groups described their obtaining information external to a healthcare system and reported a need for more specific, practical counselling from health professionals on diet, exercise, and medications. Barriers to and facilitators for diabetes self-care practices were categorised into three major themes: having discipline, social habits, and "other" themes.
CONCLUSION: Emerging themes were similar across the ethnic groups and included quality-of-life goals, confidence in combination treatment, common use of complementary and alternative medicine, need for further counselling, and the challenge regarding self-discipline.
Left ventricular hypertrophy (LVH) has prognostic significance on cardiovascular mortality and morbidity. However, echocardiography screening for LVH is not routinely done for hypertensive patients in a primary care setting. Thus, this quantitative study aims to determine the prevalence and factors associated with LVH in hypertensive patients at a primary care setting. This was a cross-sectional study of 359 consecutive patients with uncomplicated essential hypertension attending a hospital-based clinic in Malaysia. All subjects underwent an echocardiography test. LVH occur when the left ventricular posterior wall thickness together with inter-ventricular septal thickness is ≥11 mm. It was found that 24% patients fulfilled the criteria for LVH. The mean age of the study population was 59.2±7.7 years; mean duration of hypertension was 9.7±7.5 years; and mean blood pressure was 136.5/81.5 (±13.7/7.7) mmHg. Using multiple logistic regression analysis, patients who were obese [odds ratio (OR) 8.34, 95% confidence interval (CI) 3.14, 22.22] and male gender (OR 1.96, 95% CI 1.08, 3.16) had significant positive association with LVH. LVH was found in approximately one fourth of the hypertensive patients at a hospital-based primary care setting. There was a significant positive association between LVH and obesity and being male. Guidelines for enhancing use of echocardiography in detecting LVH may be needed.
Glycyrrhizic acid (GA) has been reported to inhibit postprandial blood glucose rise and 11 β-hydroxysteroid dehydrogenase 1 (11 βHSD1) activity. As not much work has been done on GA effects on 11 βHSD1 and 2 and HOMA-IR at different treatment periods, this work was conducted. 60 male Sprague Dawley rats fed AD LIBITUM were assigned into six groups of control and treated that were given GA at different duration namely 12, 24 and 48 h. Treated and control groups were intraperitoneally administered with GA (50 mgkg (-1)) and saline respectively. Blood and subcutaneous (ATS) and visceral adipose tissue (ATV), abdominal (MA) and quadriceps femoris muscle (MT), liver (L) and kidney (K) were examined. HOMA-IR in GA-treated rats decreased in all groups (P<0.05). In the 12-h and 24-h treated rats, 11 βHSD1 activities decreased in all tissues (P<0.05) except MA and MT (P>0.05) in the former and ATV (P>0.05) in the latter. However, 11 βHSD1 activities decreased significantly in all tissues ( P<0.05) in the 48-h treated rats. Significant decrease in 11 βHSD2 (P>0.05) activities were observed in the L of all treatment groups and K in the 24-h and 48-h treated rats (P<0.05). Histological analysis on ATS showed increase in the number of small-size adipocytes while ATV adipocytes showed shrinkage after GA administration. Increased glycogen deposition in the L was observed in the GA-administered rats in all the treatment periods. In conclusion, GA treatment showed a decrease in the HOMA-IR and both 11 βHSD1 and 2 activities in all tissues, with more profound decrease in the 48-h treated rats.
A study to determine the sensitivity and specificity of the Directogen Group A Streptococcal Test was carried out in a primary care clinic in University Hospital, Kuala Lumpur. The study also looked at the prevalence of streptococcal pharyngitis in the clinic. We found that the rapid test has a sensitivity of 90.9% and a specificity of 90.7%. Viral pharyngitis is the commonest form (63%) of pharyngitis followed by Group A Beta haemolytic streptococcal pharyngitis (14.2%). The presence of exudates, tonsillar enlargement and the presence of tender cervical lymph nodes have a significantly higher association with streptococcal pharyngitis.
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
The main objective of this study was to survey the prevalence of hypertension in Malaysians aged 55 years and above who responded to a public health screening campaign in Kuala Langat district, Selangor, Malaysia. The relationship between the detection, treatment and control in the study population was also examined. An epidemiological survey of the elderly was conducted in Kuala Langat, a rural district in Malaysia for a consecutive period of six weeks. The survey was conducted using a standardized questionnaire and interview by trained research assistants. The medical students and nurses were trained on the correct protocol of measuring blood pressure based on the recommendations of the British Hypertension Society. Newly detected persons with blood pressure readings 160/95 mmHg and above, were given a green card to return to the nearest health center for a further 2 visits to check his/her blood pressure. A total of 1,392 people with a mean age of 65 years and comprising of 53.1% males and 46.9% females responded to the health survey. Based on the history 335 (24.1%) of the respondents were known hypertensives and 82.1% of this hypertensive group were on regular treatment. However good control of hypertension was achieved only in 161 (48.1%) of them. Newly detected hypertension was found in 204 (14.6%) of the respondents. The overall prevalence of hypertension in our sample of respondents was 25.6%. There was no significant difference between the sexes and the races in terms of their detection, treatment and control. However there was a significant difference between the persons aged less than 65 years of age and those older than 65 years. There was a large proportion of previously known hypertensives among the survey population. Of those detected, not all were on regular medications and the majority on medications were not well controlled. Education of the public through intensive public health campaigns is vital to improve their knowledge on hypertension and the need for effective control. More community studies are needed to formulate better methods in the detection, treatment and control of hypertension.