1.Delay and misdiagnosis in adult myasthenia gravis: A case report
Siew Kim Kwa ; Zainab Abdul Majeed ; Kah Nian Tan
International e-Journal of Science, Medicine and Education 2016;10(3):37-39
Myasthenia gravis (MG) is a rare autoimmune disorder
characterised by fluctuating and variable combination
of muscle weakness and fatigue. Most cases are due to
T-cell mediated autoantibodies against post-synaptic
acetylcholine receptors (AChR-Ab), thus preventing
acetylcholine from binding and signalling skeletal
muscle to contract.
1
The annual incidence is 7-23 new cases per million.
1
It can occur at any age but with two peaks; an early-
onset (20-40 years) female-predominant and a late-onset
(60-80 years) male-predominant peak. MG is classified
into ocular and generalised (80%). More than half the
patients initially present with ptosis and diplopia but half
will progress to generalised disease with involvement of
bulbar, limb and respiratory weakness. Those presenting
as generalised MG can also develop eye signs later.
1
It is important to recognise MG early because it is
highly treatable. Untreated disease leads to permanent
weakness.
2
Treatment reduces mortality from life-
threatening myasthenic crisis.
1,3
Misdiagnosis leads to
potentially harmful interventions and inappropriate
management.
4,5
Diagnosis in late-onset MG is easily
missed
2,3,4,5
because of overlapping symptoms with
other diseases common in the elderly. We report a case
of delay and misdiagnosis in an elderly patient with
co-morbidities.
Myasthenia Gravis
2.Awareness of Colorectal Cancer among the Urban Population in the Klang Valley
Cimmeran Kaur Sindhu ; Anisha Kaur Nijar ; Leong Pooi Yee ; Li Zi Qi ; Hong Chia Yin ; Lalitha Malar ; Ping Yein Lee ; Kwa Siew Kim
Malaysian Family Physician 2019;14(3):18-27
Background: Colorectal cancer (CRC) is the second most common cancer in Malaysia. Awareness of
risk factors, symptoms and warning signs of CRC will help in early detection. This paper presents the
level of CRC awareness among the urban population in Malaysia.
Method: A cross-sectional study was conducted from November 2015 till December 2016 at three
government clinics in the Klang Valley. The validated Bowel Cancer Awareness Measure questionnaire
in both English and Malay was used. The mean knowledge scores for the warning signs and risk factors
of CRC in different socio-demographic groups were compared using ANOVA in SPSS version 23.
Statistical significance was set at p<0.05 and a 95% confidence level.
Results: Of the 426 respondents, 29.1% were unable to recall the warning signs and symptoms of
CRC. Average recall was less than two warning signs and symptoms (mean 1.62, SD 1.33). The mean
total knowledge score for CRC was 9.91 (SD 4.78), with a mean knowledge scores for warning signs
and risk factors at 5.27 (SD 2.74) and 4.64 (SD 2.78), respectively. Respondents with a higher level
of education were found to have higher level of knowledge regarding the warning signs of CRC. There
was a significant positive association between knowledge score for warning signs and level of confidence
in detecting warning signs. Regarding the total knowledge score for CRC, 3.3% of respondents scored
zero. For warning signs and risk factors, 8.2% and 8.5% of respondents had zero knowledge scores,
respectively.
Conclusions: Generally, awareness of CRC is poor among the urban population of Klang Valley.
Greater education and more confidence in detecting warning signs are significantly associated with
better knowledge of warning signs. CRC awareness programs should be increased to improve awareness.
3.Diabetes literacy and knowledge among patients with type 2 diabetes mellitus attending a primary care clinic in Seremban, Malaysia
Lee Ching Li ; Winnie Chee Siew Swee ; Kanimolli Arasu ; Kwa Siew Kim ; Siti Zubaidah Mohd Ali
Malaysian Journal of Nutrition 2019;25(3):435-444
Introduction: Good health literacy and knowledge are associated with improved outcomes in diabetes. The purpose of this study was to determine diabetes-specific literacy and knowledge levels, and its associated socio-demographic factors, among adults with type 2 diabetes mellitus (T2DM).
Methods: This cross-sectional study was conducted among 196 adults from the Indian, Chinese, and Malay ethnic groups with T2DM who attended a primary care clinic in Seremban, Malaysia. The Literacy Assessment for Diabetes and Diabetes Knowledge Test 2 were used to assess diabetes-specific literacy and knowledge, respectively.
Results: The majority of participants (75.0%) had literacy scores that corresponded to Ninth Grade Level but only 3.6% of participants had a good knowledge of diabetes. Literacy scores explained up to 19.8% of the variance in knowledge scores (r=0.445, p<0.01). Indian participants had the lowest literacy and knowledge scores when compared to Chinese and Malays (p<0.05). Participants with higher education had better literacy and knowledge scores (p<0.05). Educational level was more likely than ethnicity to predict both literacy and knowledge scores (p<0.001), while gender and age did not significantly predict either score. The majority of participants could answer general questions about physical activity, diabetes-related complications and healthy eating. Knowledge of diabetes and its relation to specific foods and the effect of diet on glucose control were limited among the participants.
Conclusion: Education and ethnicity were associated with literacy and knowledge on diabetes. There existed a deficit of diabetes-related nutrition knowledge among the participants. These findings may help healthcare providers tailor individualised patient educational interventions.