Patient trying to tell something else: severe stress Dduring COVID-19 pandemic

**The COVID-19 pandemic and the resulting economic recession have negatively affected many people's mental health due to isolation, burnout, or economic crisis resulting in job loss linked to poor mental health outcomes (Panchal et al., 2021). **The following case study illustrates the clinical role of primary care physicians to consider a 'hidden agenda' when a patient presenting with signs or symptoms of undifferentiated illness investigated to be normal. The symptoms were persistent, representing a plea for help of underlying stress, worry, and concerns. **This case described a young working adult man who suffers from severe stress presented with heart disease symptoms. He has extensive responsibility during this pandemic and on follow-up for hypertension and dyslipidaemia. Despite non�significant investigations related to heart disease at the cardiology clinic, he returned with the same intense unresolved symptoms. Depression Anxiety Stress Scales 21-item (DASS-21) (Lovibond et al., 1995) revealed a very high score for stress and anxiety. **Stress management counselling includes detecting the underlying stress (mainly by the impact of the COVID-19 pandemic), behavioural changes, stress coping skills and spiritual empowerment. Reassessment of stress and anxiety score by twelve weeks follow-up showed significant improvement and the symptoms subsided, He adapted to the stress environment with an adequate coping mechanism. **This case highlighted the clinical complexity and diagnostic challenges in picking up a mental illness. In our case, the diagnostic approach of PROMPT with the last ‘PT’ refers to ‘Patient is trying to tell something else’ demonstrated that; without high index of suspicion, mental health illness especially during the COVID-19 pandemic, may be overlooked for early intervention to prevent inevitable consequence

Severe stress mimic hearth disease during the covid-19 pandemic

1. The COVID-19 pandemic resulting in economic recession has negatively affected many people's mental health due to isolation, burnout, or financial crisis resulting in job loss linked to poor mental health outcomes (Panchal et al., 2021). 2. This case described a young working adult man who suffered from severe stress during pandemic COVID�19 presented with heart disease symptoms. He was referred to a cardiologist, and all investigations related to cardiovascular disease were normal. He came back with worsening symptoms. Depression Anxiety Stress Scales 21-item (DASS-21) (Lovibond et al., 1995) revealed a very high score for stress and anxiety. 3. Stress management counselling includes detecting the underlying stress, mainly contributed by the impact of the COVID-19 pandemic, behavioural changes, stress coping skills and spiritual empowerment. A twelve-week follow-up reassessment of stress level has shown a significant improvement in DASS scor

Patient trying to tell something else: severe stress during COVID19 Pandemic

Identifying mental health illness poses a dilemma, particularly the distinction between heart disease and severe stress. Without early intervention, it can be escalating into psychiatric disorder and suicide

Condom use consistency and its associated factors among male to female transgender in Kuantan, Pahang

Introduction • Transgenders are identified as one of the key population at risk of acquiring HIV infection all over the world. • Prevalence of HIV among transgenders in Malaysia in 2017 is 10.9% and almost double of 6.3%, from the year in 2014.1,2 • Abstain from sexual activity is the best prevention for HIV and other STDs transmission. It is however not feasible for sexually active individuals. • Condom has been advocated for many years for the prevention of sexually transmitted disease (STD). § When it is used in correct and consistent manner, condom use able to reduce risk of HIV by 70 to 80 percent and other STDs by about 60%.3,4 § This study is to measure the prevalence of condom use consistency and its associated factors among male to female transgender with different types of partners, primarily stable, casual and transactional partner

Gender dysphoria, issue and solutions

LGBT nowadays has become a sensitive issue, and pre-exposure prophylaxis ( prep) has become more controversial. They claimed that prep can prevent HIV from spreading to the young generation, and this can curb HIV issues, particularly death. However, the relevant authority forgets other important issues, such as other sexually transmitted diseases, including hepatitis, gonorrhoea, syphilis, etc. Prep is only to prevent HIV and not others. Another aspect that needs to be considered is the Islamic perspective. What does Islam say about prep? Giving prep, even though it may prevent HIV, directly or indirectly, anal sex activity will be encouraged. The LGBT community will feel safe and protected from getting HIV. The community must be informed of all this information so it can be documented. One of the best mechanisms is through this book, and it is a 'Jariah'

Risk factor profile of young adults with acute myocardial infarction: a preliminary finding

Acute myocardial infarction (AMI) is a major cause of death around the world. There are limited studies of risk factor profile in young adults with AMI. This study aimed to assess the risk factor profile of young adults with AMI at the emergency department of Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang. This is a preliminary result of young adults (age between 18 to 45 years old) who presented to the emergency department of HTAA

Patient satisfaction with the quality of healthcare services at selected major outpatient clinics at Sultan Ahmad Shah Medical Centre Kuantan Pahang

INTRODUCTION: Patient satisfaction is a key factor in determining any gaps or inadequacies in the healthcare provider's services. This study aimed to measure the level of patient satisfaction and its associated factors towards the healthcare service of outpatient clinics in Sultan Ahmad Shah Medical Centre (SASMEC), IIUM, Kuantan, Pahang. MATERIALS AND METHODS: A total of 1050 patients were recruited from internal medicine, paediatrics, surgery, obstetrics and gynaecology, orthopaedics, and psychiatry clinics between February 2021 and February 2022. A questionnaire was administered which consists of two parts: one that covers patients’ sociodemographic data and the other that assesses the patients’ level of satisfaction with the healthcare services using the Malay-validated Short-Form Patient Satisfaction Questionnaire (PSQ-18). RESULTS: The mean overall satisfaction level was 3.94 ± 0.46, with the highest mean scores in the interpersonal manners (4.2 ± 0.64) and communications (4.26 ± 0.56) domains. From the multivariate analysis, it was found that those patients in the lower income group (B40) were more satisfied with the quality of the healthcare services (B=0.172, 95% CI=0.08, 0.263) compared to the middle-income group. Being a student (B=-0.202, 95% CI=-0.296, -0.108) and having a follow-up treatment visit (B=-0.082, 95% CI=-0.156, -0.008), were significantly associated with lower satisfaction levels as compared to their counterparts. CONCLUSION: Overall, patients who attended SASMEC were satisfied with the service provided. Continuous service improvement aimed at patients’ household income, occupation and purpose of visit may help SASMEC enhance its service in the future

MANUAL FOR IBADAH CAMP ORGANIZER A PART OF THE IIUM FLAGSHIP ENTITLED “GENDER DYSPHORIA”

Maknyah or male-to-female transgender are those who transform their identity biologically from male to female through crossdressing and their lifestyle associated with homosexuality. Crossdressing and homosexuality are unlawful in accordance with Islamic practices. Often, these transgenders are associated with being sex workers in major hotspots such as in Federal Territory Kuala Lumpur, Selangor, Negeri Sembilan, Pulau Pinang, Pahang and Sarawak.1 It is estimated that the population size of sex workers in Malaysia in 2018 is 37,000 (22,000 Female Sex Workers and 15,000 Transgender Sex Workers). Despite the reducing number of transgender sex workers in Malaysia (as compared to previous Key Population Estimates in 2010), it is still a concern to Muslims and this trend needs to be relieved promptly

Patient trying to tell something else: severe stress during COVID19 Pandemic

Identifying mental health illness poses a dilemma, particularly the distinction between heart disease and severe stress. Without early intervention, it can be escalating into psychiatric disorder and suicide. A 44-year-old man sought cardiologist consultation for the “heart disease” symptoms. As a medical laboratory technician in-charge, his commitments and extensive responsibility during the COVID-19 pandemic add to his hypertension and dyslipidae�mia comorbidities. Despite non-significant investigations related to heart disease, he returned with the same intense unresolved symptoms. His Depression-Anxiety Stress-Score (DASS) assessment revealed severe stress. Stress man�agement counselling intervention includes detecting the underlying stress impacted by the COVID-19 pandemic, be�havioural changes, and stress coping skills. Reassessment of stress level showed significant improvement at twelve�week follow-up with no similar symptoms. This case highlights the clinical complexity and diagnostic challenges in detecting mental health illness. Diagnostic acronym PROMPT with the ‘PT’ refers to ‘Patient Trying to Tell Something Else’ demonstrated; without a high index of suspicion, mental health ailment may be overlooke