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Introduction: Prescription of secondary prevention medications (SPMs) and effective control of cardiovascular risk factors (RFs) are crucial to reduce the risk of recurrent cardiovascular events, particularly in high-risk individuals including those with diabetes mellitus (DM). This study aimed to analyse the trends in SPM prescription and identify the factors associated with RF control among patients with DM and cardiovascular diseases in Perak health clinics. Methods: Data of patients with ischaemic heart disease (IHD) and cerebrovascular diseases (CeVDs) audited from 2018 to 2022, excluding those lost to follow-up, were extracted from the National Diabetes Registry. Descriptive and trend analyses were conducted. Multivariable logistic regression was utilised to identify the factors associated with RF control. Results: Most patients (76.7%) were aged ≥60 years and were Malays (62.3%). The majority had IHD (60.8%) and CeVDs (54.7%) for ≥5 years. SPM prescription increased significantly over the past 5 years. However, blood pressure (BP) and lipid control remained static. Good BP control was associated with a DM duration of ≥10 years and poor control with Malay ethnicity and prescription of two or three antihypertensives. Good DM control was associated with an age of ≥60 years and age at DM diagnosis of ≥60 years and poor control with Malay and Indian ethnicities, DM duration of ≥10 years and prescription of two or three and more glucose-lowering drugs. Poor lipid control was associated only with Malay and Indian ethnicities. Conclusion: SPM prescription has increased over time, but the achievement of treatment targets, particularly for lipid control, has remained poor and unchanged. Statin use is not associated with lipid control. The accessibility and availability of alternative lipid-lowering drugs must be improved to enhance overall RF control, especially lipid control, in patients with DM and cardiovascular diseases. [ABSTRACT FROM AUTHOR]

We describe the case of a 72-year-old housewife who presented to a primary care specialist clinic for reassessment following multiple hospitalisations for heart failure within the past 9 months. She presented with decreased effort tolerance and tiredness for the past 1 year. Her symptoms had remained the same despite current treatment. During the initial history-taking, she did not report any medical illnesses or surgeries. She had been well and had not undergone any screening for almost 30 years before the first hospitalisation for heart failure. There was neither cough, constipation, dyspepsia, abdominal pain, stool changes, haematuria, per vaginal bleeding nor hoarse voice. The physical examination findings were remarkable for slow movement and speech. Her skin was dry with a markedly increased serum lipid profile. Further investigation and management confirmed the suspected diagnosis. [ABSTRACT FROM AUTHOR]

Hyperthyroidism is commonly seen in primary care settings. However, the management of hyperthyroidism might be unclear to primary care doctors. Various guidelines have been published to assist clinicians in the management of thyroid disorders at various levels of care. The extensive coverage of these guidelines may not appeal to busy clinicians, and the guidelines do not focus on often resource-limited primary care settings. In this article, we aim to describe a practical guide for managing hyperthyroidism in primary care settings using an ABC approach. [ABSTRACT FROM AUTHOR]

Introduction: Primary care service plays a vital role in early clinical assessment of patients with COVID-19 in Malaysia. This study aimed to evaluate the potential risk factors of COVID-19 severity at presentation to primary care facilities in the post-vaccination period. Methods: Clinical records from the Selangkah system of all patients with COVID-19 aged above 18 years seen at COVID-19 assessment centres located in 10 government health clinics in Gombak district, Selangor, from 1 October to 31 December 2021 with complete documentation and outcomes were retrieved. Demographics, comorbidities, clinical features and vaccination statuses and types were retrospectively evaluated. The variables were compared between mild and severe diseases. Univariate and multivariable logistic regressions were used to identify the factors affecting disease severity. Results: A total of 4406 patients (median age=37 years, men=51.2%) were analysed. Approximately 97.1% of the cases were mild, while 2.9% were severe. Fever, difficulty breathing, lethargy, throat irritation/runny nose, oxygen saturation of <95%, respiratory rate of >20 breaths per minute, CoronaVac vaccination and hypertension were the determinants of severity (P<0.05). Conclusion: The high proportion (97.1%) of mild cases in this study compared with an earlier report (81.8%) during the pre-vaccination period may suggest the impact of vaccine, as 84.9% of this cohort was fully vaccinated. Our study also demonstrated a significant difference in COVID-19 severity between the vaccine types. The identified clinical features and comorbidities could assist primary care doctors in stratifying patients with COVID-19 judiciously in terms of hospital referral or home quarantine. [ABSTRACT FROM AUTHOR]

Subclavian artery occlusion is an uncommon condition affecting approximately 2% of the general population. Only 8.7% of patients with total occlusion of subclavian artery are asymptomatic. It has the potential to cause significant morbidity as it could contribute to the ischemic complications affecting the upper extremities, brain, and heart. We present a case of asymptomatic total occlusion of left subclavian artery which was found following investigations for discrepancy in blood pressure readings from the patient's right and left arm. The difference was noted due to the clinic's furniture arrangement. The patient was treated with stent insertion via percutaneous transluminal angioplasty. After three years of follow ups, she remains asymptomatic and free of cardiovascularrelated complications. [ABSTRACT FROM AUTHOR]

The article discusses the challenge of hallucination in artificial intelligence-generated writing. It explains that hallucination occurs when AI systems produce content that is not factually accurate or does not correspond to real-world data. This issue can arise due to errors in training data, overfitting of AI systems, and a lack of understanding of biomedical concepts. The article emphasizes the importance of authors, editors, and reviewers verifying the accuracy of AI-generated references and maintaining the integrity of academic and professional work. It also highlights the need for human involvement and caution when using AI-generated content. [Extracted from the article]

We described the case of a 42-year-old man who presented with left index finger mass persisting for 6 months. The mass was small and, painless and had gradually increased in size with limited finger flexion. Physical examination showed a firm mass over the volar surface of the left index finger. There was no tenderness, redness, warmth or punctum. The overlying skin was normal, and the mass did not transilluminate. Further examination of the head and neck, chest, upper limbs and neurovascular system revealed normal findings. No similar masses were found elsewhere in the body. Bedside ultrasound with further investigation and management confirmed the suspected diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: This audit was performed to monitor the diagnosis and management of chronic kidney disease (CKD) according to the clinical practice guidelines (CPGs) of CKD 2018 in a primary care clinic. Methods: Patients who attended the clinic from April to June 2019 and fulfilled the diagnosis of CKD were included in this study, except for those diagnosed with a urinary tract infection, pregnant women and those on dialysis. These criteria were set based on the CPGs. The standards were set following discussions with the clinic team members with reference to local guidelines, the 2017 United Kingdom National CKD audit and other relevant studies. Results: A total of 384 medical records were included in this audit. Overall, 5 out of 20 criteria for processes and 3 of 8 clinical outcomes for CKD care did not meet the set standards. These included the following: documentation of CKD classification based on albumin category (43.8%); CKD advice (19.0%); dietitian referral (9.1%); nephrologist referral (45.5%); haemoglobin level monitoring (65.7%); overall blood pressure (BP) control (45.3%); BP readings for diabetic kidney disease (DKD) and non-DKD with > 1 g/day of proteinuria (= 130/80 mmHg, 37.0%); eGFR reduction of < 25% over the past year (77.2%). Identified problems included the absence of a CKD registry, eGFR and albuminuria reports, and a dedicated team, among other factors. Conclusions: Overall, 8 out of 28 criteria did not meet the standards of CKD care set for this audit. The problems identified in this audit have been addressed. Moreover, strategies have also been formulated to improve the diagnosis and management of CKD in this clinic. [ABSTRACT FROM AUTHOR]

Primary adrenal lymphoma (PAL) is extremely rare, representing less than 1% of Non-Hodgkin's Lymphoma (NHL). We present a case of an elderly man who was evaluated for persistent abdominal pain and adrenal insufficiency. The computed tomogram (CT) of the abdomen showed a large bilateral adrenal mass. There were also multiple small lung nodules. The histopathology of adrenal gland showed features consistent with diffuse large B-cell NHL. He received two cycles of rituximab, cyclophosphamide, doxorubicine, vincristine and prednisolone (R-mini-CHOP) followed by five cycles of rituximab, methotrexate, procarbazine, and vincristine (R-MPV) after evidence of brain metastasis on imaging. He responded well to the current treatment at six months follow up. [ABSTRACT FROM AUTHOR]

The article discusses the dilemma faced by a family physician when patients ask for their personal phone number. While sharing the phone number can improve rapport and efficiency, it also raises concerns about invasion of privacy and potential abuse. The physician considers solutions such as using a second phone number, blocking certain patients, or establishing clear rules and boundaries. Ultimately, the physician decides not to share their phone number, but acknowledges that it may not remain a secret. [Extracted from the article]