The difficult rheumatology diagnosis

Background Rheumatoid arthritis is a devastating condition. More so, the diagnosis of seronegative rheumatoid arthritis is often fraught off with much uncertainty and that leads to further suffering to the unfortunate patient. Case Details This is a case of Madam A, who presented with many non-specific symptoms and signs involving many systems which was finally diagnosed as seronegative rheumatoid arthritis. This case explores the challenges in reaching this uncommon diagnosis and how anti-inflammatory drugs can bring a miraculous relief to the patient's suffering. Conclusion The diagnosis of seronegative rheumatoid arthritis often presents a real challenge to the medical practitioner and often requires multiple visits and/or shared multidisciplinary care for confirmation of the diagnosis. Once diagnosed and treated with disease modifying anti- rheumatic drugs, often there is a miraculous relief to the patient's suffering

Case report: a case of pericardial effusion presenting to primary care

This is a rare but interesting case of Mr. MZ who had a life threatening pericardial effusion presenting to the primary care clinic. Through great clinical acumen and prudent targeted investigations, diagnosis of this rare condition was reached and urgent referral made to the cardiology team which performed an emergency pericardiocentesis which proved to be life -saving. However, the hovering poor prognosis of Mr. MZ may prompt for a referral to the palliative care team to provide quality end of life care for this unfortunate patient

Osteoarthritis treatment - the newer treatment options

Osteoarthritis of the knee is a common condition in the elderly. However, active participation in sports and trauma may also lead to premature osteoarthritis. This case report looks at a 60 years old woman who had severe osteoarthritis of her knees and what treatment options were helpful for her

Dizziness post chiropractic manipulation of spine-a case report

In recent years, chiropractic therapy over the spine has become a popular alternative treatment for headache, neck pain and backache. While not denying its effects in a selected group of patients, it also has its inherent list of side effects. This case report looks at a 72-years-old woman who complained of dizziness for three days after undergoing continuous chiropractic spinal manipulation therapy for her chronic back pain for two weeks

Temporomandibular joint dysfunction as a cause of facial pain- a case report

Temporomandibular joint dysfunction (TMJD) is one of the rare causes of facial pain. Its’ onset is often insidious. It can be a difficult condition to manage as most sufferers tend to have a chronic clinical course. This case report will look at a young man with TMJD and what options are available for its’ management

Knowledge, attitude, and practice regarding obstructive sleep apnea among primary care physicians

Purpose: Obstructive sleep apnea (OSA) has been linked with inflammation, hypertension, and higher cardiovascular risk which cause substantial morbidity and mortality worldwide. However, OSA is underdiagnosed and its prevalence is increasing. Primary care doctors are the first contact for most patients and primary care providers play an important role in promoting, screening, and educating patients regarding OSA. This study aims to determine the knowledge, attitudes, and practices regarding OSA among primary care doctors in Kuala Lumpur, Malaysia. Methods: A cross-sectional survey was conducted among physicians who were currently working in primary care clinics in the capital state of Kuala Lumpur. The validated "Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire" (OSAKA) and nine additional practice questions were used as the survey instrument. Results: Of 207 physicians queried, the response rate was 100%. The mean (± SD) total knowledge score was 11.6 (± 2.8) (range 1-18). The majority of respondents had a positive attitude towards the importance of OSA but lacked confidence in managing OSA. Primary care doctors' most common practice for patients with suspected OSA was referral to the ear, nose, and throat (ENT) clinic. Conclusions: The study shows that primary care doctors demonstrated adequate knowledge about OSA and were aware of the importance of OSA as a core clinical problem. However, only a minority felt confident in managing patients with OSA. The results of the study may encourage improvement of primary care doctors' efforts to prevent and manage OSA

Suitability and uptake of vaccines in the last 4 weeks among child participants of a health screening campaign

INTRODUCTION: Vaccine can be described as a tool available to parents to protect their infants and children from potentially deadly diseases. It can prevent deaths and save lives at the same time. This study was aimed at the suitability and uptake of vaccines in the last 4 weeks among child participants of a health screening campaign.METHODS: A cross-sectional, prospective observational study was conducted at two communities through health campaign. A validated and self-administered questionnaire that includes two sections on socio-demographic details and a section on child vaccination practices was used. Statistical Package for Social Sciences v26.0 was used for data analysis.RESULTS: The mean age is 50.1±22.7 years. Majority were females (68.3%), of Chinese ethnicity (21.7%), married (73.3%) and not employed (75.0%). Majority had none or primary level of education only (60.0%). Majority of the children were suitable to receive vaccine i.e. 58/60 or 96.7%.CONCLUSION: The uptake of children in receiving vaccine is high. This augurs well for a nation keen to have healthy citizens that can spur the economy.peer-reviewe

Managing dengue fever in heart failure: a case report

Introduction: Dengue fever remains an infectious disease that reaches epidemic proportions in many tropical countries. Its management remains a challenge, more so in patients, who have chronic medical conditions that require fluid restriction, such as dengue fever. Case Presentation: This case report will investigate the management of fluid replacement in a chronic heart failure patient with dengue fever, MrZK, in a district hospital of the state of Selangor in Malaysia a year ago. His fluid requirement wasmanagedbased on the existing guidelines, his clinical status, and blood parameters. He was safely discharged after three days of hospital stay without any of the complications of chronic heart failure or dengue fever. Conclusions: Management of dengue fever in patients, who have fluid restriction as one of their management regimens remains a huge challenge, requiring regular monitoring, and good clinic acumen. This was one of the elements explored in this case report

The unusual case of child tantrum - a case report

This is an amazing case report about an eight years old child that displayed child tantrum more synonym of the younger age group. This case also entails how the author managed to uncover the true reasons for his tantrum that left his guardian truly amazed at the ability of physicians to solve a seemingly difficult behavioural problem

Oh no, now i have diabetes

Screening plays the biggest role in the diagnosis of diabetes in primary care, however it sometimes presents with uncommon clinical features, which will need good clinical acumen to reach the elusive diagnosis. This interesting report will look at four cases in brief on how the authors managed to reach this diagnosis in unique ways