The use of opioid in treating a patient with kratom use disorder: A case report

Kratom is a botanical plant product that is used around the world, particularly in Southeast Asia. It is believed that it has potential benefits as a painkiller and for relieving fatigue. Specifically, kratom can produce an opioid effect, which makes it addictive. We report a 26-year-old man who presented to the clinic for treatment of kratom use disorder. He was willing to be treated because he could no longer withstand the withdrawal effect and the financial cost of his addiction. Our team successfully initiated treatment using buprenorphine-naloxone (suboxone) in pill form to treat his kratom use disorder. The patient also received non-pharmacological treatment such as psychoeducation, psychotherapy, and motivational interviews. He was successfully treated with suboxone and within a week he was kratom free and happy.

An atypical presentation of urolithiasis with pyonephrosis in a child: A case report

<b>Background:</b> Childhood urolithiasis is previously rare but increasingly recognized nowadays. Presentation varies, and often children, do not present with the classical symptoms commonly seen in adults.<br /> <b>Case report:</b> This case was initially presented to the emergency department with atypical symptoms of nephrolithiasis. Therefore, he was treated for acute appendicitis before an ultrasound abdomen revealed there is gross hydronephrosis, which is secondary to pelvic-ureteric junction obstruction. CT abdomen was then proceeded, found right nephrolithiasis and vesicoureteric calculus with right hydroureter and gross hydronephrosis. Retrograde pyelography (RPG), ureteroscopy (URS), and insertion of the stent for right pelvic-ureteric junction obstruction were performed and subsequently, he developed complications.<br /> <b>Conclusion: </b>The initial presentation of this case is common however not a classical presentation of renal stone. Therefore, evaluation of the symptoms and initial investigations should be done properly, so that we will not miss this common disease with the rare presentation, especially in children.

Sweet Syndrome secondary to infection: A case report

We present a case of a patient with Sweet Syndrome secondary to possible bacterial infection. The diagnosis of Sweet Syndrome was made based on his clinical and histopathological findings. Sweet syndrome is a rare inflammatory disorder characterised by tender erythematous skin lesions, often accompanied with fever, neutrophilia and leukocytosis. It is generally classified into classical (or idiopathic), drug-induced or malignancy-associated, each of which has its own features. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 922-925

Sleep Quality among Patients with Type 2 Diabetes: A Cross-Sectional Study in the East Coast Region of Peninsular Malaysia

Poor sleep is related to type 2 diabetes and adversely influences a person’s quality of life. This study aimed to evaluate sleep quality in patients with type 2 diabetes (T2DM), its associated factors, and its relationship with quality of life. A cross-sectional study was conducted at a primary care clinic in a tertiary hospital on the east coast of Malaysia. This study included 350 participants (175 men and 175 women). Data were collected using the Malay version of the Pittsburgh Sleep Quality Index (PSQI-M) with a cut-off point of >5 as poor sleep, the Malay version of Diabetes Distress Scale (MDDS-17) and the revised Malay version of T2DM-related quality of life (Rv-DQOL). Statistical analysis was conducted using the SPSS software version 26.0. The respondents’ median (interquartile range (IQR)) age was 62.0 (11.0) years, and poor sleep was reported in 32% (95% confidence interval (CI) = 27.1, 36.9) of the participants. Multivariate logistic regression analysis revealed that poor sleep quality was significantly associated with nocturia (odds ratio (OR) = 2.04; 95% CI = 1.24, 3.35), restless legs syndrome (OR = 2.17; 95% CI = 1.32−3.56) and emotional burden (OR = 2.37; 95% CI = 1.41−3.98). However, no statistically significant association was observed between sleep quality and quality of life among our participants.

Type 2 Diabetes Mellitus with HbJ trait: A management conundrum

Optimal glycaemic control is crucial in patients with diabetes mellitus (DM) to avoid episodes of hypoglycaemia and both micro- and macrovascular complications. Diabetic control relies mainly on the evaluation of haemoglobin A1c (HbA1c), which is unfortunately unreliable in patients with haemoglobinopathies. This case report describes a patient with type 2 DM and haemoglobin J (HbJ) trait, which resulted in erratic HbA1c values throughout her follow-up. Other approaches, such as self-blood glucose monitoring, are needed to evaluate glycaemic control instead of relying on HbA1c alone to guide the management DM in these patients.

Ascending Cholangitis Secondary to Choledocholithiasis In Post Cholecystectomy Patient: A Diagnostic Dilemma

Choledocholithiasis is the presence of stones in the common bile duct (CBD). Choledocholithiasis in post-cholecystectomy is rare. Nonetheless, this is a report of a 40-year-old woman who was presented with severe epigastric pain with high-grade fever, tea-coloured urine, pale stool, and jaundice. She had a history of pangastritis and had cholecystectomy two years ago.This case report describes the significant diagnostic dilemma of the choledocholithiasis, particularly in a post-cholecystectomy patient who had pangastritis and was presented with severe epigastric pain. The diagnosis of choledocholithiasis was missed as the early symptoms of choledocholithiasis are similar to those of pangastritis. Therefore, treatment for choledocholithiasis was delayed. A high index of suspicion for diagnosis of choledocholithiasis must be emphasized among primary care practitioners even in a post-cholecystectomy patient. This will enable early treatment for the patient and prevent complications such as ascending cholangitis and sepsis. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 458-462

Patient Satisfaction with Doctor-Patient Interaction using SKIP-11 and Its Associated Factors among Type 2 Diabetics in Primary Care

ABSTRACT Introduction: The quality of diabetes care is widely suboptimal, and most of the interventions depend on the active involvement and participation of patients. Understanding and determining patient related factors can help primary care providers pay more attention and give greater care to those patients. This will improve patient satisfaction, which further enhances compliance with or adherence to diabetic treatment. Therefore, this study aims to determine patient satisfaction with doctor-patient interaction and its associated factors among patients with type 2 diabetes mellitus. Materials and Methods: This cross-sectional study was performed among adults who had had diabetes for at least six months. Participants were selected by systemic random sampling in the outpatient clinic of the University Hospital. Patient satisfaction with doctor-patient interaction was measured using 11- items with a three-domain version of the “Skala Kepuasan Interaksi Perubatan-11” questionnaire. The total scores ranged from 11 to 55, and those who scored 44 and above (> 80%) were considered satisfied. Results: A total of 417 patients were recruited in the study. 60% were satisfied with their doctor-patient interactions. Among the subtypes in the satisfied group, the domain of rapport had the highest percentage of satisfaction at 77.7%. HbA1c was found to be significant associated with patient satisfaction with doctor-patient interaction (95% CI: 0.81, 0.97; p = 0.008) Conclusion: 60% of the participants clearly illustrated positive feedback and were more satisfied with their doctor-patient interactions. HbA1c was found to be significantly associated with patient satisfaction concerning doctor-patient interaction  

Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia

INTRODUCTION

Female sexual dysfunction (FSD) is a common complication among breast cancer patients following treatment.

AIM

To assess the prevalence and factors associated with FSD among breast cancer patients in Kelantan.

METHODS

This cross-sectional study recruited female patients, aged 18-65, who were married and sexually active with their partner, diagnosed with breast cancer, and had undergone breast surgery. Those with underlying psychiatry disorders, previous pelvic surgery, and husbands with sexual problems were excluded. The questionnaire contained demographic and clinical information, together with the Malay Version of the Breast Impact of Treatment Scale and the Malay Version of Female Sexual Distress Scale-Revised. Their sexual function was evaluated using the Malay Version of the Female Sexual Function Index-6. The data were analyzed with simple and multiple linear regressions.

MAIN OUTCOME MEASURES

The prevalence and associated factors for FSD in breast cancer patients.

RESULTS

Ninety-four eligible patients were recruited for this study. In total, 73.4% (n = 69) of the patients reported having sexual dysfunction. A family history of breast cancer (P = 0.040), duration of marriage (P = 0.046), and frequency of sexual intercourse (P = 0.002) were significant factors associated with FSD in breast cancer patients after surgery.

CONCLUSION

The significant associated factors shown to influence the FSD score include family history of breast cancer, duration of marriage, and frequency of sexual intercourse. About 73.4% of patients have risk of developing FSD after receiving breast cancer treatment. Siang OP, Draman N, Muhamad R, et al. Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia. Sex Med 2021;9:100351.

May Measurement Month 2019: an analysis of blood pressure screening results from Malaysia

Despite hypertension remaining the leading cause of death worldwide, awareness of hypertension and its control rate is still suboptimal in Malaysia. This study aims to determine the proportion of both diagnosed and undiagnosed hypertension, awareness and its control rate during the yearly May Measurement Month (MMM) campaign that has been coordinated by the International Society of Hypertension. Participants aged ≥18 years were recruited at various screening sites namely universities, health facilities, shopping malls, and other sites. Participant’s socio-demographic, environmental, and lifestyle data were captured using a questionnaire. Three blood pressure (BP) readings as well as anthropometric measurements were obtained from all participants. The mean of the second and third BP readings was used in analyses. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medication. A total of 3062 participants were recruited. The proportion with hypertension in our study was 18.7% (n = 572). The proportion who were aware of their BP status was 63.2%. More than half (57.2%) of the hypertensives were on antihypertensive medication and 70.3% of those treated were controlled. In conclusion, in this BP screening campaign, one in five were hypertensive with almost two thirds aware of their hypertensive status. BP control among those who are taking medications was high at 70% but under 60% of hypertensives were on treatment. Hypertension screening programmes are important to promote awareness and control of hypertension as well as to reduce the devastating complications associated with this disorder.

Omphalopagus Conjoined Twins: A Case Report

We present a case of conjoined omphalopagus twins in a 35-year-old woman who came for antenatal booking at 9 weeks of gestation to a health centre in Kota Bharu, Kelantan. The diagnosis was confirmed via ultrasonography by an obstetrician in a tertiary Hospital at 12 weeks of gestation. The pregnancy was allowed to progress as it carried the best chance of survival. However, the parents were in dilemma with the decision. Primary care practitioners play an important role to prepare patients mentally and physically to face the outcome of the pregnancy. Bangladesh Journal of Medical Science Vol.20(3) 2021 p.642-645

Risk Factors for Sexual Dysfunction among Postpartum Women in Kuantan, Pahang

INTRODUCTION: Sexual dysfunction after childbirth is reported to be prevalent worldwide. The risk factors for sexual dysfunction is still underexplored. Thus, this study aims to determine the possible risk factors associated with sexual dysfunction among post-partum women. MATERIALS AND METHODS: This cross-sectional study was conducted in nine primary care clinics in Kuantan involving 420 women within six months postpartum. The respondents were conveniently sampled and completed the data collection forms comprising of their socio[1]demographic data, the Malay version Female Sexual Function Index (MVFSFI) Questionnaire to measure the sexual dysfunction score. Descriptive analysis, Chi-square test, and binary logistic regression were used for data analysis. RESULTS: Among the women sampled, those with higher education had a 72% increased risk of developing postpartum sexual dysfunction (aOR=1.72, 95%CI=1.01,2.81). Women who practised non-hormonal contraception were a 42% lower risk of getting postpartum sexual dysfunction as compared to those who consumed hormonal contraception (OR=0.58, 95%CI=0.35,0.95). CONCLUSION: Education level is associated with a higher risk of developing postpartum sexual dysfunction. Non-hormonal contraceptive methods were found as a protective factor for developing postpartum sexual dysfunction. Therefore, doctors can advise those postpartum women with sexual dysfunction and on hormonal contraception to change to non-hormonal methods.

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.

The prevalence of sexual dysfunction among postpartum women on the East Coast of Malaysia

Objective

Sexual health is a key component of the overall health and quality of life of both men and women. Sexual dysfunction is a common condition, but it lacks professional recognition. This study aims to determine the prevalence and types of sexual dysfunctions among postpartum women in primary care clinics and their associated factors in a Malaysian cohort.

Method

In this cross-sectional study, we recruited 420 women from nine primary care clinics in Kuantan, Pahang, Malaysia. All participants had given livebirths within six weeks to six months and had attended either a postnatal or a well-child clinic at a government primary care clinic. The assessment of female sexual dysfunction (FSD) was done using a validated Malay version of the female sexual function index (MVFSFI). Data were statistically analysed using appropriate methods.

Results

More than one-third (35.5%) of women had postpartum sexual dysfunction. The most common types were lubrication disorder 85.6% (n = 113), followed by loss of desire 69.7% (n = 92) and pain disorders 62.9% (n = 83). Satisfaction disorder 7.3% (n = 27), orgasmic disorder 9.7% (n = 56) and arousal disorder 11.0% (n = 41) were less common sexual problems. The independent associated factors for FSD were high education level (adjusted odd ratio = 1.717, 95% CI 1.036–2.844; p < 0.05) and usage of hormonal contraception (adjusted odd ratio = 0.582, 95% CI 0.355–0.954; p < 0.05).

Conclusion

This study showed a high prevalence of postpartum sexual dysfunction in Kuantan, Pahang, Malaysia. The most common type of sexual dysfunction was lubrication disorder. Efforts at increasing awareness in healthcare professionals should be made.

Self-Efficacy for Coping with Breast Cancer in North-Eastern State of Peninsular Malaysia

OBJECTIVE

To determine the level of self-efficacy for coping with breast cancer among Malaysian women and its association with socio-demographic and clinical variables.

MATERIALS AND METHODS

This cross-sectional study involved 168 women diagnosed with breast cancer. The inclusion criteria were age >18 years old, having histologically confirmed breast cancer, and being diagnosed between January 1, 2009 to December 31, 2012. The exclusion criteria were being illiterate and having cognitive impairment. For data collection patients' medical records and the Cancer Behaviour Inventory-Brief (CBI-B) Malay version questionnaire were used. Simple and multiple logistic regression methods were used to analyse the data.

RESULTS

Patients' mean (SD) age was 51.4 (10.8) years old. Most of the patients were Malays, married, diagnosed at stage 2 breast cancer (41%), and completed their breast cancer treatment. The mean score for self-efficacy for coping with breast cancer was 83.67 (95% CI: 81.87, 85.47). The significant factors positively correlated with self-efficacy for coping with breast cancer were higher educational background and a higher family income. However, factors such as a family history of breast cancer and breast surgery reduced the mean score of self-efficacy for coping with breast cancer.

CONCLUSION

The mean score of self-efficacy for coping with breast cancer in this study was moderate. Self-efficacy for coping with breast cancer in Hospital Universiti Sains Malaysia was not adequate among sufferers and improvement is needed probably by providing education to these patients.

A Case Report of Steroid Withdrawal Syndrome

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.

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.

Sustainable Medical Teaching and Learning During the COVID-19 Pandemic: Surviving the New Normal

During the first phase of the Movement Control Order, many medical lecturers had difficulty adapting to the online teaching and learning methods that were made compulsory by the institutional directives. Some of these lecturers are clinicians who need to juggle between clinical work and teaching, and consider a two-week adaptation during this period to be not enough. Furthermore, converting traditional face-to-face learning to online formats for undergraduate and postgraduate clinical programmes would reduce the learning outcomes, especially those related to clinical applications and the acquisition of new skills. This editorial discusses the impact that movement restrictions have had on medical teaching and learning, the alternatives and challenges and the way forward.

Non-gestational choriocarcinoma as a cause of heavy menstrual bleeding-potential: Primary care detection

Choriocarcinoma is a malignant trophoblastic disease. It can be divided into gestational and non-gestational type. Gestational choriocarcinoma consists of less than 1% of total endometrial malignancy, and usually is diagnosed via histopathological examination preceding a suspected molar pregnancy. In contrast to gestational choriocarcinoma, only a few cases of primary non-gestational choriocarcinoma were reported in literature reviews. The reported locations for primary non-gestational choriocarcinoma were ovarian and uterine cervix. Due to its low incidence, this disease is often overlooked leading, to delayed diagnosis. In primary care practice, heavy menstrual bleeding is a common presentation. Further evaluations, such as full blood count, ultrasound pelvis or hysteroscopy are usually required. We would like to report a case of potentially earlier detection of non-gestational choriocarcinoma in a 52 years old lady who was presented with heavy menstrual bleeding for a duration of one year. Her symptom persisted despite receiving medical treatment in a few local primary care clinics. She was admitted to a tertiary hospital for symptomatic anaemia which required blood transfusion. Further evaluations, (i.e., laboratory tests, ultrasound, Computed Topography (CT) scan, bone scan, hysteroscopy and laparotomy total abdominal hysterectomy and bilateral salphingo-oophorectomy (TAHBSO) and histological examination) concluded a diagnosis of primary non-gestational choriocarcinoma of fundal uterus with lung metastasis. Bangladesh Journal of Medical Science Vol.19(4) 2020 p.755-759

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

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.

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.

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

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.

Hemiballismus in Uncontrolled Diabetes Mellitus

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.

Non-Adherence to recommended Pap smear screening guidelines and its associated factors among women attending health clinic in Malaysia

INTRODUCTION

Cervical cancer ranks as the second most frequent cancer among women in Malaysia. Although a cervical screening program has been introduced since 1960s and is provided free of charge in all government health facilities, the coverage and adherence rate to recommendation among Malaysian women remains low.

OBJECTIVES

To determine the proportion of non-adherence to Pap smear screening guidelines and its associated factors among women attending a health clinic in Malaysia.

METHOD

A cross sectional study involving 316 women aged 20 to 65 years who had undergone a Pap smear. Universal sampling method was applied to select participants among women who attended the selected health clinic from January 2013 to May 2013. A self-administered questionnaire was used to obtain the socio-demographic characteristics, socio-health data and perceptions about cervical cancer and Pap smear screening. The data was analysed using descriptive statistics and multiple logistic regression.

RESULT

The proportion of non-adherence to Pap smear screening was 90.5%. Age, marital status, duration of marriage, education level, employment, household income and number of children were not significantly associated with non-adherence. Perceived severity, perceived susceptibility, perceived benefit, perceived barrier and cues to action did not show significant association with non-adherence to Pap smear screening.

CONCLUSION

Non-adherence to Pap smear screening was high among Malaysian women. Measures should be taken to increase Pap smear screening coverage in our country. Other factors beyond Health Belief Model that influence Pap smear screening practice among Malaysian women should be explored.

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.

The decision of breastfeeding practices among parents attending primary health care facilities in suburban Malaysia

Objectives

This study aimed to determine the association between decision making for breastfeeding practices and associated factors for exclusive breastfeeding practices among parents attending primary health care facilities.

Methods

This cross-sectional study involved 196 parents who attended primary health care facilities in suburban Malaysia. A self-administered questionnaire was given to assess decision-making styles and factors associated with exclusive breastfeeding practices. Systematic random sampling was used for the non-exclusive breastfeeding group, and convenience sampling was used for the exclusive breastfeeding group. Multiple logistic regression analysis was conducted to determine the associated factors for exclusive breastfeeding practices.

Results

We found an association between the mutual decision of parents on exclusive breastfeeding and exclusive breastfeeding practices. Previous exclusive breastfeeding experience, fathers' ages, mothers' occupations and mutual decisions had significant impact on exclusive breastfeeding practices.

Conclusion

The important determinant for practising exclusive breastfeeding is parents' mutual decisions. Therefore, practitioners need to continuously educate and emphasize the fathers' role in the breastfeeding process.