1.Non-specific skin purpura
Mohd Shaiful Ehsan Shalihin ; Zulkifli Harun ; Iskandar Firzada Osman
Malaysian Family Physician 2018;13(2):39-41
Essential thrombocythemia is one of the myeloproliferative neoplasms. Palpable purpura is
a rare manifestation that may delay diagnosis and treatment. We report a case of essential
thrombocythemia in a 50-year-old man, who presented with recurrent thigh pain for the past one
year with nonspecific localized purpura. His full blood count revealed isolated thrombocytosis of
880,000/µL with an impression of myeloproliferative disorder from peripheral blood film. He
was referred urgently to the hematology team, which proceeded with a venesection. His condition
improved with hydroxyurea. This was a rare case of chronic presentation of myeloproliferative
neoplasm detected at a primary care clinic
2.A young man with chronic dry cough
Mohd Shaiful Ehsan Bin Shalihin ; Iskandar Firzada Osman ; Zulkifi Harun ; Hassan Basri Mukhali ; Bari Gnathimin
Malaysian Family Physician 2020;15(1):68-70
In primary care, chest X-rays are commonly performed to assess patients presenting with a prolonged
cough. However, the extent to which the flms are accurately interpreted depends on the skill of the
doctors. Doctors with insufcient experience may miss an exact diagnosis when evaluating a flm,
especially in patients with nonspecifc symptoms, such as in the case discussed in this paper. Tis
case involved a persistent dry cough with an underlying diagnosis that would have been missed if the
fndings of the chest X-ray had not been properly analyzed.
3.Concomitant dengue fever in Varicella zoster infection – A rare presentation
Shaiful Ehsan Shalihin ; Mohd Ashraf ; Iskandar Firzada
The Medical Journal of Malaysia 2019;74(4):347-348
Varicella zoster infection is one of the self-limiting viral
infections during childhood and dengue fever is an endemic
infection in Malaysia, which commonly occurs in the form of
nonspecific febrile illness at the initial stage. It is rare for the
two viral infections to occur simultaneously. A case of
dengue fever without warning sign in a five-year old girl was
reported, with early symptoms of fever and vesicular rashes.
She was clinically diagnosed with varicella zoster infection
during the first visit. Surprisingly, she remained febrile even
on day six of illness despite no new vesicular lesions on her
skin. Due to suspicion of another infection, follow-up
investigation was done and revealed isolated
thrombocytopenia. This finding was confirmed with positive
NS1Ag. A case of rare dengue fever concomitant with
varicella zoster infection was reported.
4.Managing Pulmonary Tuberculosis In A Patient With Post OP Oropharyngeal Cancer - Challenges For Family Physician
Mohd Shaiful Ehsan Shalihin ; Zulkifli Harun
Malaysian Journal of Public Health Medicine 2021;21(1):169-174
Oropharyngeal carcinoma is uncommon cancer compared to other malignancies. It accounts for less than 3% worldwide cancer and classified under the head and neck carcinoma. Patients with locally advanced oropharyngeal malignancy are usually treated with surgery with combination of radiotherapy and chemotherapy. This later required regular follow up especially on supportive care and adaptation to swallowing. Difficulty in swallowing provided burden to the patient and may lead to underlying malnutrition and risk of infection including tuberculosis. This will end up with poor compliance to oral treatment and risk of resistance. Therefore, this case study is illustrating the challenging role of family medicine specialists in managing a case of sputum positive pulmonary tuberculosis with underlying swallowing difficulty from glossectomy and radiotherapy on top of defaulted tongue carcinoma supportive care follow up.
5.Anti-diabetic medication burden amongst older persons with diabetes and associated quality of life
Mohd Shaiful Ehsan Bin Shalihin ; Abdullah Bin Fauzi ; Nurul Afiqah binti Zulkifli ; Azrul Aziz bin Abdul Azi
The Medical Journal of Malaysia 2020;75(5):525-530
Background: Older persons with diabetes are the major
demographic of diabetic patients followed up in primary
health clinics. Despite their increasing age and morbidities,
they are still being managed strictly towards good sugar
control in order to achieve the ideal HbA1c level without
taking their quality of life into consideration. This study
aimed to determine the prevalence in the use of antidiabetic
drugs among older persons with diabetes and its
association with their quality of life.
Methodology: A cross-sectional study was conducted
among 269 older persons with diabetes in all government
health clinics in Kuantan using Diabetes Quality of Life
questionnaire. SPSS version 23 was used for the statistical
analysis.
Results: Majority of the respondents were females (61%),
Malays (84.8%), pensioners (54.3%) with education up to
primary school (52%) and are staying with family members
(93.7%). Most of the patients were on two antidiabetic agents
(48%) followed by a single antidiabetic agent (32%). Despite
the risk of hypoglycaemia, 0.4% of them are on
glibenclamide. The use of insulin is still common among
21% of them that are on intermediate-acting insulin, 15.6%
on premixed insulin and 7.8% on short-acting insulin. Those
taking a higher number of antidiabetic agents were found to
be associated with poorer quality of life (p=0.001) compared
to those taking one or two antidiabetic medications. Those
on insulin also have significantly poorer quality of life score
(p=0.012).
Conclusion: Despite aiming for controlled diabetes, older
persons suffer poor quality of life with further intensification
of their antidiabetic medications according to the guidelines.
This includes the complexity of insulin usage and
polypharmacy, which contribute to the low quality of life
score.
6.Translation and Validation of Malay Version of the Simplified Diabetes Knowledge Test (DKT)
Mohd Aznan Md Aris ; Hafizah Pasi ; Mohd Shaiful Ehsan Shalihin ; Umair Othman ; Nur-Hidayah Abdul Rahim
Malaysian Journal of Medicine and Health Sciences 2022;18(No.3):76-84
Introduction: Type 2 diabetes mellitus is a chronic disease which is highly prevalent in Malaysia. In managing diabetes, the American Diabetes Association (ADA) and the International Diabetes Federation (IDF) have advocated
self-management to be the basic component of diabetes care. However, an ongoing discussion, education and assessment of the patient’s diabetic knowledge should be implemented in the patient’s empowerment process. There
are various assessment tools available worldwide but very few are available in the Malay language. This study is
aimed to perform the Malay translation of the Simplified Diabetes Knowledge Test (DKT) questionnaire and validate
it. Methods: Forward-backward translation procedure was used to translate the simplified version of the DKT questionnaire. A total of 120 respondents with type 2 diabetes mellitus from a selected government health clinic were
recruited to answer the questionnaire which consists of socio-demographic, diabetes characteristics and the 20-item
Malay version of simplified DKT questionnaire. Reliability and construct validity were tested with Cronbach’s alpha
coefficient and Exploratory Factor Analysis. Results: Factor analysis with Varimax rotation identified five meaningful
domains for the final 18 items. The Cronbach’s alpha for the overall scale of the translated questionnaire was 0.573
with values of each five significant domain’s Cronbach’s alpha ranged from 0.370 to 0.564. Conclusion: The Malay version of simplified DKT is valid and reliable to be used as a brief assessment of knowledge among Malaysian
diabetic patients.
7.Mildly Elevated Alkaline Phosphatase (ALP) - a Liver Tumour Hint Not to Be Missed
Hassan Basri Mukhali ; Shaiful Ehsan Shalihin ; Nik Mohd Nurhafizi Nik Anuar MD ; Zailani Mohd ; N. Aiman Anuar
Malaysian Journal of Medicine and Health Sciences 2021;17(No.1):194-196
Healthcare providers are responsible for performing medical check-ups, analyse and interpret patient's laboratory
results. It is common for an initially asymptomatic patient to receive abnormal results including liver enzymes such as
alkaline phosphatase (ALP). The concern in these patients is the cut-off value for mildly elevated levels that requires
intervention. This paper reports a case of liver malignancy in a 32-year-old man who presented with a mild elevation
of ALP level less than five times the upper limit of normal. The patient had no clinical symptoms. Early ultrasound
liver assessment showed dilated common bile duct, which led to an urgent CT scan of the liver that revealed supportive
features of fibrolamellar carcinoma. The patient was managed successfully with early partial hepatectomy that
has saved him from morbidity and mortality of liver malignancy. Indeed, liver malignancy can be detected early in a
health clinic from a further assessment of trivial elevation of ALP.