I report a case of 40-year-old lady who presented with symptoms and signs suggestive of fibromyalgia but was disregarded by attending doctor. She was infuriated and lodged a complaint to Family Medicine Specialist (FMS) whereby further assessment confirmed the diagnosis of fibromyalgia and subsequently treated in primary care setting.

background: blood pressure (bP) control among Malaysian is poor and doctor’s adherence to clinical practice guideline (cPG) has been a well-known factor that may improve it. this study was designed to evaluate patients’ bP control, doctors’ adherence to the latest hypertension cPG and their association. Factors associated with bP control and cPG adherence was also examined. Methods: A cross-sectional study was conducted in Kuala Muda district’s health clinics. 331 medical records were selected using stratified random sampling and standard proforma was used for data collection. the latest edition of the Malaysian cPG on hypertension was employed to define related variables. results: A total of 160 patients (48.3%) had controlled bP and it was significantly associated with patients’ age (adjusted Odds ratio, aOr= 1.03, 95% cI: 1.004, 1.05, p= 0.016) and systolic bP at presentation (aOr= 0.95, 95% cI: 0.93, 0.96, p< 0.001). About 60.7% of the medical records showed doctor’s good level of cPG adherence. this adherence has significant association with presence of chronic kidney disease (aOr= 0.51, 95% cI: 0.31, 0.85, p= 0.007) and cardiovascular disease (aOr= 2.68, 95% cI: 1.04, 6.95, p= 0.030) in the patients and physicians’ treatment intensification (aOr= 2.00, 95% cI: 1.26, 3.19, p= 0.009). However, no association was found between bP control and cPG adherence. conclusion: Hypertension control in this study was poor and the prevalence of physicians with good level of cPG adherence was slightly above average. these findings are important for relevant stakeholders to strategise an action plan to improve hypertension management outcome.

Heart Failure with Preserved Ejection Fraction (HFpEF) is becoming more common as the United States (U.S.A) population ages, along with the present of obesity pandemic. In general, HFpEF is the most common type of heart failure (HF) found in general population, however, the elderly, especially women are mostly suffering from it. It is primarily caused by obesity, hypertension, coronary artery disease, and diabetes. Obesity is frequent in individuals with HFpEF. However, it may constitute a distinct phenotype of HFpEF, with distinct hemodynamic and anatomical problems. Obesity causes a systemic inflammatory response which can lead to cardiac fibrosis and endothelial dysfunction. Because most obese patients are still excluded from HFpEF clinical trials, further research is needed to evaluate the role of pharmacologic and interventional treatments in this expanding group. Thus, this review study will aid in the understanding of HFpEF and its association with obesity.
Heart Failure, Diastolic

This case report illustrates how a primary care physician managed a 60-year-old woman with severe obesity, uncontrolled diabetes mellitus, and low self-esteem for many years. Through a primary care physician, bariatric surgery is recommended for patients with severe obesity, which is then co-managed in a tertiary hospital through a multidisciplinary team. Primary care physicians are on the front lines when treating patients with severe obesity. A number of studies have shown that primary care physicians have low success rates in counselling and managing patients with severe obesity.(1,2) There is also a debate about bariatric surgery being unsuitable for the elderly age. It is crucial to intervene early to prevent obesity progression and its complications. Clinical inertia is one factor that hinders patients with severe obesity. Therefore, it is essential to address the problem of severe obesity early and should not miss the opportunity to counsel the treatment options and refer these patients to bariatric surgery if indicated. Primary care physicians are also crucial in providing continuity of care after bariatric surgery.

Obesity is thought to be a complicated, multifaceted chronic disease that results from the combination of environmental and genotypic variables. Implementing a wide strategy for obesity prevention and management is required given the variety and complexity of factors impacting obesity. Most healthcare practitioners use dietary therapies such calorie-restricted diets, Mediterranean diets, DASH diets, and intermittent fasting to encourage weight loss. Meal replacement products (MRPs) are used as part of a calorie restricted diet which helps to control our food choices and leads to calorie reduction. This article reviews the usage of MRP as a weight loss therapy and summarizes the literature about their effectiveness to reduce weight in patients with obesity. From the literature search, it can be concluded that MRPs contain a precise amount of macronutrients, micronutrients, and fiber to provide a nutritionally balanced meal. MRPs have been extensively studied as a weight loss therapy, and several scientific studies have confirmed their efficacy. The main ways that MRPs aid in weight loss are by reducing appetite and improving diet adherence, which makes it easier for individuals to stick to their diet plan and achieve their weight loss goals. Overall, MRPs should be considered as a viable treatment option for patients who are motivated to lose weight, as they offer a simple, convenient, and effective way to reduce calorie intake, improve diet adherence, and achieve sustainable weight loss. However, it is important to note that MRPs should be used as part of a comprehensive weight loss plan that includes regular physical activity and behavior modification strategies for long-term success.
Obesity