Managing conception and pregnancy for HIV serodiscordant couple : a case report

Worldwide, there is an increasing number of people living with HIV and AIDS especially in the reproductive age group. This has a huge impact when they wish to start a family. Managing reproductive issues among serodiscordant HIV couples is complex and often presents as a challenge especially in minimizing the risk of transmission. We report a case of a HIV positive man and his seronegative wife who successfully achieve conception and deliver a healthy baby without disease transmission of HIV to mother or child. Both partners were managed with treatment where the HIV positive male partner was treated with HAART while the unaffected female partner was on PrEP and conception was achieved through intrauterine insemination (IUI). Planning of conception, the use of medications and options for conception methods will be discussed in detail

E-cigarette use, its impact on tobacco smoking and the intention to quit

E-cigarettes have rapidly gained worldwide popularity. Since its use still poses a health risk to the users, it is important to assess their intention to quit this habit. This study aimed to determine the characteristics of e-cigarette use, its effect on cigarette smoking and users’ intention to quit vaping and smoking. A total of 377 e-cigarette users were recruited from three vape retail stores in Bandar Baru Bangi, Selangor. E-cigarette usage pattern, tobacco cigarette consumption and their intention to quit were assessed using a self-administered questionnaire. Most (70%) participants were e-cigarettes only users while 30% were dual users. The median duration of e-cigarette use was 2 (IQR 2) years. Almost all (98.4%) participants used third-generation devices and majority (63.7%) preferred liquid containing 6mg nicotine. About 92% participants, especially heavy smokers, smoked fewer tobacco cigarettes after initiating e-cigarette. Majority (79.6%) of dual users also had reduction in tobacco cigarette consumption with a median current consumption of 5 (IQR 5.0) cigarettes per day. Most (87%) e-cigarette users intend to quit the habit someday. However, many (63.1%) were in the pre-contemplation stage. E-cigarette users of less than 2 years duration tend to have the intention to quit compared to users of more than 2 years (p=0.005). In conclusion, there was more e-cigarette only users than the dual users. E-cigarette use could significantly reduce tobacco smoking, especially among heavy smokers. Most e-cigarette users had the intention to quit vaping but not in the near future and longer e-cigarette use may deter their intention to quit

Contact dermatitis following use of tropical traditional medicine

Traditional or herbal medications are generally perceived as safe since it is derived from natural or plant sources. A rise in number of adverse reactions are being reported with the use of traditional medications including localized cutaneous reactions. The diagnosis of contact dermatitis is often quite straight forward based on its appearance, pattern, site and distribution of the lesion which usually corresponds to the area of contact. We report the case of a 65-year-old woman who presented with redness, burning sensation and swelling of her hand after applying topical Chinese traditional medication. This report aims to outline simple measures to identify and manage contact dermatitis secondary to topical medication. The present case creates awareness that topical traditional medications are not as harmless as previously thought to be. Precautions regarding adverse reactions are required, as those with conventional medications

Menstrual care for individuals with disability: a case report

Individuals with disabilities have different needs and concerns at different stages of life. The arrival of puberty brings about new challenges especially for females with issues related to menstrual care involving both the patient and their caregivers. This case report is about a 13-year-old girl with Down syndrome who was cared for by her widowed father since the age of six. She was suffering from severe mental disability. Her father was concerned, because she was unable to maintain personal hygiene during menses such as changing sanitary napkins and managing stains, hence requested for menstrual manipulation. Options for menstrual manipulation for individuals with disabilities include both medical and surgical interventions. Hormonal therapy options include oral contraceptive pills, depo-provera, progestin implants and progesterone release intra-uterine contraceptive devices. Surgical options such as hysterectomy or endometrial ablation may be considered as a last resort as it is more invasive and irreversible, involving ethical and legal implications. Selection of the suitable therapy involves shared decision making between health care provider and caregiver taking into consideration the patient’s best interest. This case report also highlights the role of family physicians in managing and coordinating care on delicate issues related to menstrual care for people with disabilities. This case report may serve as a guide to physicians and families with special needs children, while approaching issues on menstrual care

Health care seeking behaviour among caregivers of children with pneumonia in a rural area.

Objective: The aim of this study is to evaluate caregiver's health seeking behaviour for children with pneumonia and to determine the associated factors. Design: This cross-sectional study was conducted at Hospital Semporna, East Malaysia from September 2009 to January 2010. Materials and Methods: Children diagnosed with pneumonia between ages 2 months to 5 years and their caregivers were selected. Pneumonia is classified using the modified IMCI and WHO classification used locally while health seeking behaviour was assessed using Health Care Utilization Model by Weller et al. Results: A total of 160 children with pneumonia and their caregivers participated in this study. Mean age of children with pneumonia is 21.8 ± 16.3 months. Males and females were equally affected (1.3:1). Majority had mild pneumonia (78.1%; n = 125). Mean duration of illness presentation is 3.47 ± 2.63 days. Caregivers are mostly females (88.8%, n = 142), received primary or secondary level of education (78.1%, n = 125) and belong to poor socioeconomic background (80.0%, n = 128). Most caregivers (87.5%, n = 140) practice self care or consult Health Care Provide (HCP) at government health clinics before seeking hospital treatment. Antipyrexial is the most common self medication used. This study found that severe pneumonia was more common among children with Very Low Weight for Age (VLWA) (p = 0.008) and those who received antibiotic preceding hospital visit (OR 3.93; 1.44; 9.67, p = 0.012). Conclusion: In general, caregivers attending to children with pneumonia in this study demonstrate reasonably good health seeking behaviour although they are from poor socioeconomic and variable cultural backgrounds in a rural area

Prevalence and factors associated with cutaneous manifestations of type 2 diabetes mellitus

Background. Type 2 diabetes mellitus (T2DM) is known to cause multiple systemic manifestations. However, there are limited studies describing cutaneous manifestation among T2DM in Malaysia. The objective of this study was to determine the prevalence of cutaneous manifestation among T2DM patients, types of lesions and its associated factors. Methods. A cross-sectional study was conducted among 271 T2DM patients at a primary care clinic in Kuala Lumpur. Results. More than one third (63.5%) of patients were found to have cutaneous manifestations of T2DM. The most common manifestation was infections (34.7%) followed by Skin Diseases with Weak to Strong Association with Diabetes (SDWSAD) (31.7%), Skin Manifestation of Diabetic Complication (SMDC) (2.2%) and others cutaneous lesions (22.1%). Among the infections, onychomycosis was the commonest type of infection (27.7%) while diabetic dermopathy was the commonest lesion of SDWSAD (29.7%). Males had almost two times the odds of developing cutaneous manifestations of T2DM, compared to females (adjusted odds ratio [AOR]: 1.871, 95% CI: 1.108–3.160; P = 0.019). There was no association between glycemic control and cutaneous manifestations. However, males and those with T2DM duration of five years and more had 2.6 times the odds of developing SDWSAD (AOR: 2.646, 95% CI: 1.506–4.648 P = 0.001) and (AOR: 2.635, 95% CI: 1.107–6.268, P = 0.028) respectively. Those with diabetic neuropathy and peripheral vascular disease (PVD) had very high odds of developing SMDC such as diabetic foot and trophic ulcers (AOR: 23.259, 95% CI: 1.191–454.2, P = 0.038) and (AOR: 102.36, 95% CI: 4.013–2610, P = 0.005), respectively. Conclusion. The knowledge of these cutaneous manifestations increases physician’s awareness and prompts early screening to reduce morbidity improve quality of life

Nodular Melanoma Mimicking Keratoacanthoma : Lessons to learn

A 67-year-old man of Chinese descent presented with a painless nodular lesion that had been present on his right forearm for the previous 3 months. A single, well-defined, dome-shaped, firm nodule with a central keratin plug surrounded by erythema was noted. Keratoacanthoma with secondary bacterial infection was suspected and the patient underwent an excision biopsy. Biopsy of the nodule and immunohistochemical staining supported a diagnosis of nodular malignant melanoma. It should be noted both that nodular malignant melanoma may present with a wide variety of clinical appearances, and that the lack of melanin pigment in nodular malignant melanoma may hinder the diagnosis of this aggressive tumour

Prevalence of food addiction among people with diabetes in an urban health center

Food Addiction (FA) is a concept of dependence on substance related to the consumption of palatable foods high in fat, sugar, and salt. This dependence may influence dietary modification advice as dietary modification is an essential component in managing people with diabetes. The objective of this study is to determine the prevalence of FA among people with diabetes. A cross-sectional study was conducted between June and August 2021 at Klinik Primer, Pusat Perubatan Universiti Kebangsaan Malaysia (Cheras, Kuala Lumpur) involving 142 people with diabetes. FA was assessed using the validated Bahasa Melayu version of Yale Food Addiction Scale 2.0. The median age of participants was 58 years (IQR=10), and the majority (88%, n=125) of them were above the age of 45 years. A large majority) had central obesity (90.1%, n=128) and were overweight and obese (91%, n=129). The median duration of diabetes was 10 years (IQR=11) with more than two-thirds (63.4%, n=90) of them having diabetes for more than 5 years. Majority (73.9%, n=105) also had poor glucose control with median HbA1c level of 7.5% (IQR =2). Our study found that the prevalence of FA among people with T2DM was low (2.8%, n=4). This could be because the participants were mostly from the older age group with long standing disease. These two features may have influenced their eating behaviour, becoming more compliant and adapted to diabetic diet advice received over the long duration of the condition. A similar study among young diabetics and those with new onset disease may better reflect FA among this group of people

PREVALENCE OF SMOKING AMONG SECONDARY SCHOOL STUDENTS IN SARAWAK

Adolescent smoking is an emerging health concern in the developing countries. A cross-sectional study is conducted to determine the prevalence and smoking behaviour of adolescents in Sarawak. The prevalence of smoking is 32.8% with mean age of initiation at 12.8±1.9 years. Most (67.2%) adolescents are experimental smokers and the majority (67.9%) did not smoke on a daily basis. Branded cigarettes are preferred (83.1%) and the cigarettes are obtained either from friends (49.1%) or self purchased (43.6%). Students prefer to smoke at their friend’s house (31.0%) or at school (25.3%). Smoking prevalence among adolescents in Sarawak is high and begins early. Early intervention on smoking prevention and risk awareness is perhaps more effective if initiated before the age of 12 years