1.Influence of Diabetes Mellitus and Risk Factors in Activating Latent Tuberculosis Infection: A Case for Targeted Screening in Malaysia
Yogarabindranath Swarna Nantha
The Medical Journal of Malaysia 2012;67(5):467-472
A review of the epidemiology of tuberculosis, its
contributing risk factors (excluding HIV) and the role of
screening latent tuberculosis infection in Malaysia was
done. Despite the global and domestic decrease in
prevalence rates of tuberculosis in the past decade, there is an alarming increase in the trend of non communicable
diseases in the country. High prevalence rates of major risk factors leading to reactivation of tuberculosis were seen within the population, with diabetes mellitus being in the forefront. The rising numbers in the ageing population of Malaysia poses a further threat of re-emergence of tuberculosis in the years to come. Economically, screening of diabetic patients with comorbidities for latent tuberculosis infection (LTBI) using two major techniques,
namely tuberculin sensitivity (TST) and Interferon gamma
release assay tests (IGRA) could be a viable option. The role of future research in the detection of LTBI in the Malaysian setting might be necessary to gauge the disease reservoir before implementing prophylactic measures for high risk groups involved.
2.Adult Langerhans cell histiocytosis: An unusual cause of referred knee pain
Yogarabindranath Swarna Nantha ; Yeoh Min Hui ; Salmiah Md Sharif
Malaysian Family Physician 2019;14(3):60-64
Langerhans cell histiocytosis (LCH) in adults is rare and regarded as an ‘orphan disease.’ The
systemic symptoms of LCH can mimic many other undifferentiated diseases seen at the primary
care level. Failure to diagnose and delays in referral are common pitfalls in the management
of this disease. We present a case of a 34-year-old woman with referred knee pain who was
eventually diagnosed with multi-system LCH 4 years after the initial presentation. The mean age
of presentation of LCH symptoms in adults is 33. Bone lesions are the frequent presentation of
LCH in this age group. Endocrine involvement in LCH is seen in the form of diabetes insipidus
(DI), which remains the most common extraskeletal presentation of LCH in adults. In the case
discussed here, a definitive diagnosis of LCH was established through tissue biopsy. The spectrum
of undifferentiated symptoms underscores the difficulty and delay in making a diagnosis associated
with the condition. Most GPs not only face the predicament of initial recognition but also fail to
merge presenting symptoms to form a purposeful referral of this elusive disease to a tertiary care
unit.
3.A Review of Smoking Research In Malaysia
Wee Lei Hum ; Caryn Chan Mei Hsien ; Yogarabindranath Swarna Nantha
The Medical Journal of Malaysia 2016;71(3 Suppl.):29-41
Two hundred and seventy one original published materials
related to tobacco use were found in a search through a
database dedicated to indexing all original data relevant to
Medicine and Health in Malaysia from 1996 - 2015. A total of
147 papers were selected and reviewed on the basis of their
relevance and implications for future research. Findings
were summarised, categorised and presented according to
epidemiology, behaviour, clinical features and management
of smoking. Most studies are cross-sectional with small
sample sizes. Studies on smoking initiation and prevalence
showed mixed findings with many small scale studies within
the sub-groups. The majority of the studies were related to
factors that contribute to initiation in adolescents.
Nonetheless, there are limited studies on intervention
strategies to curb smoking among this group. There is a
lack of clinical studies to analyse tobacco use and major
health problems in Malaysia. In addition, studies on the best
treatment modalities on the use of pharmacotherapy and
behavioural counselling have also remained unexplored.
Reasons why smokers do not seek clinic help to quit
smoking need further exploration. A finding on the extent of
effort carried out by healthcare providers in assisting
smokers to make quit attempts is not known. Studies on
economic and government initiatives on policies and
tobacco use focus mainly on the effects of cigarette bans,
increased cigarettes taxes and the influence of the tobacco
industry. Recommendations are given for the government to
increase efforts in implementing smoke-free legislation,
early and tailored interventions. Clinical studies in this area
are lacking, as are opportunities to research on ways to
reduce smoking initiation age and the most effective quit
smoking strategies.
Smoking
;
Tobacco Use
4.Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions.
Yogarabindranath Swarna NANTHA
Korean Journal of Family Medicine 2017;38(6):315-321
A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy.
Clinical Decision-Making
;
Decision Making
;
Diagnosis
;
Heuristics
;
Problem Solving
;
Psychology
;
Thinking*
5.Silent Left Large Atrial Myxoma: A Patient with Serial Electrocardiogram Variation.
Yogarabindranath Swarna NANTHA ; Shadidah Abdul MALEK
Korean Journal of Family Medicine 2017;38(4):229-232
Cardiac myxoma is often discovered as an incidental finding and presents with various subtle symptoms and signs. Electrocardiographic findings are mostly non-specific. Atrial flutter or conduction abnormalities are known to be rare. We report a case of large left atrial myxoma that was diagnosed by transthoracic echocardiography at a primary care clinic. An asymptomatic, 71-year-old woman presented with serial abnormal electrocardiogram changes during a routine consultation. A diagnosis of left atrial myxoma was obtained through transthoracic echocardiography. We report this case with a review of literature on cardiac myxoma associated with arrhythmia.
Aged
;
Arrhythmias, Cardiac
;
Atrial Fibrillation
;
Atrial Flutter
;
Diagnosis
;
Echocardiography
;
Electrocardiography*
;
Female
;
Humans
;
Incidental Findings
;
Myxoma*
;
Primary Health Care
6.Sickness Certification Behavior amongst Primary Care Physicians: A Descriptive Analysis of Indirect Measures Using the Theory of Planned Behavior
Yogarabindranath Swarna NANTHA ; Arvinder-Singh HS
Korean Journal of Family Medicine 2020;41(4):267-270
Background:
The provision of sick leave to patients in general practice often entails a complex decision-making process. Commonly, general practitioners believe that the act of providing sick leave can become confrontational. We assessed the intention, attitude, subjective norm, and perceived behavioral control of general practitioners in relation to sick leave provision at public health clinics in Malaysia.
Methods:
A cross-sectional study design was implemented using data from 86 primary health care clinics in two states in Malaysia from February 2014 to March 2015. A questionnaire that comprised indirect measures were developed on the basis of the Theory of Planned Behavior. The questionnaire assessed several dimensions related to sickness certification provision viz., intention, attitude, subjective norm, and perceived behavioral control.
Results:
The mean scores in this study revealed that physicians acknowledged that patient factors such as clinical symptoms (6.59±0.04), debilitating signs and symptoms of diseases (6.45±0.06), importance of illness recovery (6.07±0.07), and approval of employers (5.35±0.09) played an important role in their decision to provide sick leave.
Conclusion
The act of providing sickness certification to patients is a complex decision-making process. The findings of this study can be used to devise a targeted intervention to reduce the conflict that physicians face in issuing sick leaves.
7.The effectiveness of conducting home visits by medical students among Malaysians with type 2 diabetes: A retrospective analysis.
Kean Ghee LIM ; Yogarabindranath Swarna NANTHA ; Nurfazila Hanim KASIM ; Tarshandiny RAMAMOOTHY ; Annabelle YAM ; Ern Wei LIM ; Matthew LOH
Journal of the ASEAN Federation of Endocrine Societies 2019;34(1):56-61
BACKGROUND: Medical students at the International Medical University (IMU), Seremban, Malaysia were required to assess patients at home over a period of two years as a part of their curriculum. The students conducted six visits to educate their patients and help them utilize available resources to manage their disease.
This study aims to examine whether patients with diabetes visited improve their control of their disease, specifically in terms of their HbA1c measurement.
METHODOLOGY: We used a retrospective, matched before and after study design to prevent biased levels of effort by students conducting the home visits over two years. Information was obtained through reports written by IMU students. Convenient sampling was used to select outpatients undergoing treatment 'as usual' from a health clinic and were subsequently matched as controls.
RESULTS: There was a significant decrease in the mean HbA1c among 57 patients with diabetes who were CFCS subjects [from 8.4% (68 mmol/mol) to 7.3% (57mmol/mol) p<0.001], while the mean HbA1c levels among 107 matched control subjects rose significantly from 7.9% (63 mmol/mol) to 8.3% (67 mmol/mol) (p=0.019) over a similar period. The two groups were controlled for most biological and socioeconomic variables except for comorbidities, diabetic complications and medication dose changes between groups.
CONCLUSION: Behavioural intervention in the form of home visits conducted by medical students is an effective tool with a dual purpose, first as a student educational initiative, and second as a strategy to improve outcomes for patients with diabetes
Human ; House Calls ; Students, Medical ; Malaysia
8.Prevalence of Food Addiction among People with Diabetes in an Urban Health Center (Ketagihan Makanan di Kalangan Pesakit Diabetes di Klinik Kesihatan Kawasan Bandar)
HUNG CHIUN LAU ; LEELAVATHI MUTHUPALANIAPPEN ; YOGARABINDRANATH SWARNA NANTHA
Malaysian Journal of Health Sciences 2023;21(No.2):189-196
Food Addiction (FA) is a concept of dependence on substance related to the consumption of palatable foods high in fat,
sugar, and salt. This dependence may influence dietary modification advice as dietary modification is an essential
component in managing people with diabetes. The objective of this study is to determine the prevalence of FA among
people with diabetes. A cross-sectional study was conducted between June and August 2021 at Klinik Primer, Pusat
Perubatan Universiti Kebangsaan Malaysia (Cheras, Kuala Lumpur) involving 142 people with diabetes. FA was
assessed using the validated Bahasa Melayu version of Yale Food Addiction Scale 2.0. The median age of participants
was 58 years (IQR=10), and the majority (88%, n=125) of them were above the age of 45 years. A large majority) had
central obesity (90.1%, n=128) and were overweight and obese (91%, n=129). The median duration of diabetes was 10
years (IQR=11) with more than two-thirds (63.4%, n=90) of them having diabetes for more than 5 years. Majority
(73.9%, n=105) also had poor glucose control with median HbA1c level of 7.5% (IQR =2). Our study found that the
prevalence of FA among people with T2DM was low (2.8%, n=4). This could be because the participants were mostly
from the older age group with long standing disease. These two features may have influenced their eating behaviour,
becoming more compliant and adapted to diabetic diet advice received over the long duration of the condition. A similar
study among young diabetics and those with new onset disease may better reflect FA among this group of people.