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

Breastfeeding practice, support, and self- efficacy among working mothers in a rural health clinic in Selangor

Introduction: In first six months of life, breastfeeding is the recommended form of feeding by the World Health Organisation for the growing child. To enable the working mother to continue this noble practice, adequate workplace breastfeeding support and self- efficacy is needed. This study aims to determine the prevalence of breastfeeding among working mothers of children aged three months to two years and factors associated with breastfeeding practice including workplace support and mother’s self-efficacy. Method: This is a cross sectional questionnaire study carried out in a rural Health Clinic in Selangor using socio-demographic data, Workplace Breastfeeding Support Scale (WBSS), and the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF). This study was conducted for a period of three months from April to June 2015. The respondents were employed Malaysian mothers of healthy infants aged three months to two years. A total of 84 participants were involved in the study. Data analysis was done with SPSS 22. Results: The prevalence of breastfeeding among working mothers were high at 97.6%. We found significant association of breastfeeding practice with workplace breastfeeding support (p=0.005) and self-efficacy (p= 0.017). We also noted a significant correlation between breastfeeding workplace support and breast feeding self-efficacy (r= 0.40, p <0.01). Age, religion, ethnicity, educational level and place of employment were found to be not associated with breastfeeding practices. Conclusion: This study highlights the importance of workplace support and self-efficacy with workplace breastfeeding practices. Policymakers and stakeholders should provide a conducive and supportive environment to enhance breastfeeding among working mothers

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

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

Dhat Syndrome as a Manifestation of a Culture-Bound Syndrome - A Case Report

Objectives: Dhat syndrome is one of the culture-bound syndromes related to fear of death due to loss of semen, common in India but extremely rare outside of India. This case report looks at a rare case of Dhat syndrome that presented to a primary care physician in Malaysia. Methods: This case report depicts the treatment approach used in this culture-based syndrome as compared to other culture-based syndrome such as Koro syndrome which is common in China and Southeast Asia. Results: The management in this case was mainly non-pharmacological, with reassurances, support and counselling given regarding the benign nature of this illness. Conclusion: Dhat syndrome management is challenging and may need a combination of both pharmacological and non-pharmacological treatment, including drugs, psychotherapy and counselling

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

Neurogenic bladder in a young female

This is an uncommon case of 25 year old female, who presented with lower abdominal pain and lower urinary tract symptoms along with suprapubic distension. Initially was thought to be a pelvic malignancy, but through ultrasound examination was found to be due to neurogenic bladder