High proportion of adults with type 2 diabetes and poor glycated hemoglobin perceived that their diabetes control was excellent

Objectives As is true for other chronic illnesses, perception of disease control is pivotal to patient empowerment in diabetes care. This study aimed to describe the perception of diabetes control by patients with poor glycated hemoglobin (A1C) levels so as to explore the relationship between perception and various sociodemographic and disease characteristics and to measure the patients' knowledge, attitudes and practices in diabetes care. Methods A cross-sectional study was made involving 276 patients with type 2 diabetes mellitus. After obtaining informed consent, their sociodemographics, medical histories and most recent available blood investigations were documented. Patients were asked about their perceptions of diabetes control—whether it was excellent, moderate or poor. A Malay-language knowledge, attitudes and practice questionnaire was administered to respondents. Analyses were descriptive and exploratory. Results The median age of the subjects and the durations of diabetes were 56 (interquartile range, 48–62) years and 8 (interquartile range, 4–13) years, respectively. The median A1C level was 9.5% (interquartile range, 8.3%–11.4%). Despite having poor A1C levels, 28.4% of patients perceived that their diabetes control was excellent; 58.9% perceived it as moderate, and only 12.7% accurately perceived it as poor. A significant number of those with higher education had wrong perceptions, indicating that other factors, such as effective communication, need to be considered. The absence of an association between perception and duration of diabetes suggests that information given over the years did not contribute to patients' understanding of disease control. Younger patients had better knowledge scores. Those with higher education levels had higher quartiles of knowledge and attitude but not practice scores. Conclusions This study demonstrated discordance between perceived diabetes control and actual A1C levels, which may hinder effective diabetes care

Living in rural areas of Peninsular Malaysia: risk factor for goitre

Introduction: Thyroid disorders are among common medical conditions encountered in clinical practice. However, the disease burden among Malaysian population has not been established. This study was aimed to determine the prevalence of goitre and its associated factors among adult population in Peninsular Malaysia. Materials and Methods: A cross-sectional study was performed in 5 pre-assigned regions in Peninsular Malaysia. Participants’ sociodemographic profile and medical history were recorded. Physical examinations were done looking for abnormalities of the thyroid gland and signs of thyroid dysfunctions. The diagnosis of goitre was made by palpation and corroborated by the repeat examination by another investigator. The World Health Organization (WHO) goitre grading system was used. Fifteen millilitre of blood were withdrawn and analysed at a central laboratory. Results: Among 2190 respondents, the prevalence of goitre was 9.3%. Goitre was associated with positive anti-thyroperoxidase and anti-thyroglobulin antibodies. Females were at higher risk of goitre (adjusted OR = 2.4; 95% CI 1.6–3.5; p<0.001). The other risk factors of goitre were Indian ethnicity (adjusted OR=2.0; 95%CI 1.2–3.3; p=0.006), positive anti-thyroperoxidase (adjusted OR=1.8; 95% CI 1.1-3.1; p=0.024) and living in rural area (adjusted OR = 1.7; 95% CI 1.2–2.5; p=0.002). These areas had been shown to suffer from some degree of iodine insufficiency in the past. Conclusions: The prevalence of goitre in Peninsular Malaysia was comparable with other studies. The main predictors of thyroid disorders are female gender and thyroid antibodies. Living in rural areas was associated with goitre

A study of fasting type 2 diabetes mellitus patients with acute complications during Ramadan in Hospital Tengku Ampuan Afzan, Kuantan, Pahang

Introduction: A large number of Muslims fast during the holy month of Ramadan worldwide. A specific approach is needed to manage diabetic patients who intend to fast during Ramadan because of potential harm. Thus, the study aimed to describe the sociodemography and the characteristic of fasting diabetic patients admitted due to acute diabetic complications during Ramadan. Materials and Methods: A cross-sectional study was conducted among fasting diabetic patients in Hospital Tengku Ampuan Afzan (HTAA) who were admitted due to severe hypoglycemia, diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome and uncontrolled diabetes mellitus during the month of Ramadan 2017/1438H. Subjects were interviewed and blood investigation results were obtained from medical records and recorded in patients' case report. Results: Thirteen patients who were admitted due to acute complications of diabetics during Ramadan were included in this study. Of these, 38.5% had severe hypoglycemia, 23.1% diabetic ketoacidosis, 15.4% hyperglycemia hyperosmolar syndrome and 23.1% uncontrolled diabetes mellitus. All of the patients had a long standing diabetes mellitus (median duration of 10 years). HbA1C was high (11.5%) among hyperglycemic subjects. Types of treatment and previous history of severe hypoglycemia prior to Ramadan were the only independent factors identified to be related with acute complications of diabetes during fasting month (p=0.030 and p=0.032 respectively). Insulin, either alone or in combination with oral hypoglycemic agent, was associated with higher number of hypoglycemic event. Conclusion: The significant risk factors found were consistent with other studies. A thorough, individualized and holistic approach is needed in managing patients with diabetes who intend to fast

Assessment of knowledge, attitude and practices of epilepsy patients’ towards their illness and treatment in a tertiary care hospital in Kuantan Pahang Malaysia

Objective: Patients beliefs determine their response to an illness and its management especially if it is chronic. Studies assessing patient’s knowledge of their epilepsy are scarce. We report the first objective study evaluating knowledge, attitude and practices of epilepsy patients referred to a tertiary care centre in East Coast of Malaysia. Materials and Methods: A cross sectional study using pre-tested, semi-structured questionnaire among consenting epilepsy patients. Results: The demographic details and responses to a questionnaire assessing their insight towards epilepsy were recorded. Among 132 respondents, 51.5% were male and 48.5 % were female. Their age ranged from 14 to 70 years (mean = 31.63 ± 13.41). Majority (53.8%) of them aged equal or less than 30 years. The median number of years they had epilepsy was 8.0 (4.0, 18.8) years and average duration of seizure prior to seeking medical attention was 1.0 (0.3, 4.5) years. The average number of years they were receiving treatment from a hospital was 5.50 ± 5.84. Most (90.9%) did not know the cause of epilepsy; however 93.9 % were aware that it can be treated with modern drugs. While only 22.7 % believed that faith healers can treat epilepsy, 74.2% had tried other forms of treatment. Negative attitude was reflected in the belief that epilepsy is due to supernatural powers (1.5%) and that epilepsy is contagious (17.4 %). Positive attitude included that PWE can take a job (66.7%), allowing a child with epilepsy to study (80%), not objecting children to play with a child with epilepsy (54.5%), marry (65.9%) and having children (58.3%). Conclusions: Patients with epilepsy are not knowledgeable about their disorder. This is true regardless of age, educational background, or number of years with epilepsy. The results suggest that there is a critical need to enhance epilepsy education and improve attitudes towards epilepsy beyond seizure control

Prevalence of thyroid disorders in pregnant women in Hospital Tengku Ampuan Afzan & International Islamic University Malaysia Medical Centre

Introduction: Data on the burden of thyroid disease in pregnant women in our community is scarce albeit the detrimental effects it brought to both the mother and fetus if left untreated. The aim of this study was to determine the prevalence of thyroid disorders, socio-demography distribution, and method of diagnosis in pregnant women of both tertiary centres in Kuantan, Pahang. Materials and Methods: A retrospective cross sectional study involving patients under follow ups at the Endocrine and Obstetric Clinics of Hospital Tengku Ampuan Afzan (HTAA) and International Islamic University Malaysia Medical Center (IIUM MC) from the 1st January until the 30th June 2017. Out of 923 pregnant women, 29 were found to have thyroid disorders. Detailed demographic data and thyroid function test readings were taken from their medical records and thyroid status were determined from TSH and FT4 readings using the trimester-specific thyroid reference range. Results: The prevalence of thyroid disorders in both centres was 3.14%, with specific prevalence of 2.80% for HTAA and 6.12% for IIUM MC. Nearly half of them were hyperthyroid (47.85%), 17.4% was hypothyroid and Graves’ disease dominated the diagnosis of thyroid disease (30.43%). Significant association was found in weight changes with patients’ thyroid status; reduction in weight in first trimester and increment in weight in second trimester were mainly seen in the hyperthyroid group (p<0.01, p=0.027). Conclusion: The acceptable prevalence of 3.14% for thyroid disorders in pregnancy could be contributed by the iodine availability in this community. High prevalence of Graves’ disease warrants future screening for maternal thyroid stimulating immunoglobulin amongst hyperthyroid women