Psoriasis is a chronic, noncontagious, multifactorial inflammatory skin condition that has several subtypes. Therefore, prior to actual diagnosis, it may mimics other similar illnesses. In acute condition, it typically presents with erythroderma macules associated with pain and itchiness rather than hypopigmented and numbness lesions that supposedly occurs in post-treatment or post-acute phase, rather than as initial presentation. Case report: We report a case of 18-year-old girl, who presented with nonspecific localized hypopigmented rash over her forehead and scalp associated with numbness for three weeks duration. She had no itchiness or rashes elsewhere. She had no history of atopy or recent exposure to new cosmetics. She had no joint pain or hair loss. She had no recent contact with anyone with similar lesion. No significant similar history among family members. Clinically, there is reduced in both soft touch and pin-prick sensation over affected areas. We refer this case to dermatologist with possibility of leprosy in view of her reduced sensation over the lesion. To our surprise, the skin biopsy revealed supportive points towards psoriasis. She responds well towards coal tar and topical corticosteroids-the first line treatment of psoriasis. Her numbness has also resolved. This case highlights that psoriasis do presents with localized numbness in which its diagnosis should be take into consideration before confining the disease towards leprosy only.
Introduction: Long waiting time is a common issue complained by diabetic patients that came for an
early morning appointment in a health clinic. Therefore, an audit was conducted among diabetic patients in
a primary care clinic with the aim to assess the patients’ waiting time and to formulate strategies for
improvement. Methods: This audit was conducted for four weeks using a universal sampling method in
November 2017. All diabetic patients who attended the clinic during this period were included except those
who required longer period such as critically ill patients or those who came for repeat medication or
procedures. The arrival and departure time for each station was captured using the modified waiting time
slip, which is manually filled at every station. The waiting and consultation time for registration, screening,
laboratory investigation, diabetic educator, doctor and pharmacy were recorded. The data were entered into
the statistical software SPSS version 17 for analysis. Results: Results showed that all patients were registered
within 11.0 minutes (SD=2.52min). Average total waiting time to see a diabetic educator and a doctor was
20.9 minutes (SD=15.53min) and 33.23 minutes (SD=27.85min), respectively. Average waiting time for other
stations was less than 10 minutes. Average total time spend in the clinic for a diabetic patient was 107.58
minutes, which is comparable to a non-diabetic patient. The identified problems were due to the poor
tracing and filing system. Conclusion: Improvement strategies recommended include enforcing early file
tracing prior to appointment and providing a checklist for consultation by doctors and diabetic educators.
Milk discharge from neonatal breast commonly occurs bilaterally. Majority of them are benign in nature. Those cases usually require conservative management and will resolve with time. It typically occurs within one month of age in which late-onset of galactorrhoea in toddlers is indeed a rare occasion. Thus, an abnormal cause needs to be ruled out. An 18-months-old child had persistent milky discharge from the left nipple for several days without underlying specific identified causes. This case highlights the occurrence of physiological milk discharge can still possibly occur at the age beyond one-year-old despite its absence in the initial months of life. The principle observation at primary care is still adequate in managing such cases unless high suspicion of alarming disease arises. This case proved a late onset of physiological galactorrhoea can still occur in the early toddler age group.
Prevalence of active smokers in Malaysia is remaining high (22.8%) despite the wide availability of quit-smoking services. Rather than look at the patients’ factors alone, the possible negative factors from health care providers should also be explored. Therefore, knowledge, attitude and practice of the healthcare professional on smoking cessation intervention needs to be assessed, especially among the primary care doctors. This can be done during national conference gathering all doctors from Malaysia. Materials and Method: A crosssectional study was conducted among medical doctors attending First East Coast Symposium on Specialized Care at Primary Care Level at Grand DarulMakmur, Kuantan on 1st to 2nd December 2019, using validated questionnaire of Knowledge, Attitude and Practice of Medical Doctors on Smoking Cessation Guidelines; consisting 17 questions to determine the KAP score. The difference between the median KAP scores between age, gender, ethnicity, religion, profession, location of clinic, availability of specialist at clinic, numbers of smokers seen and presence of smoking cessation training were assessed using Independent sample T-test and One-way ANOVA. Results: A total of 131 primary care doctors involved in the study. Majority were female (80.9%), Malay (96.2%), medical officers (74.8%), government doctors (90%) and haven’t undergone any kind of smoking cessation training (65.5%). The higher KAP score were statistically associated (p < 0.05) with history of attending training program (mean 35.7 score) and in charge of quit smoking clinic (mean 35.4 score). No significant difference of score between government (mean 32.0 score) and private doctors (mean 29.9 score). Conclusions : Majority of the involved primary care doctors had low KAP score. Being a family medicine specialist, in charge in stop smoking clinic and have attended smoking cessation training program were significantly associated with high KAP score. Therefore, more smoking cessation training should be provided for doctors.