Key points o Spend time taking a good history and performing a physical examination even though the majority of patients have “functional” symptoms. Exclude “non-dyspepsia” conditions and be careful in excluding a “surgical” abdomen. o Consider gastroscopy or an ultrasound or CT scan of the abdomen, if alarm symptoms are present. The threshold to investigate should be lower with older male patients as there is a higher chance of organic disease. o When patients’ symptoms are unclear, a close follow-up and review is useful. Symptoms persisting over many months or years are unlikely to have an organic basis. o Explore, understand and address patients’ concerns including psychological problems. Patients need to be reassured. o Sensible advice on food/meal and lifestyle modifications is useful. Antacids often give immediate relief to acute dyspeptic symptoms. Gastroesophageal reflux symptoms may be atypical − a trial of PPI therapy may be useful. Patients with wind, bloating and discomfort often benefit from a course of prokinetic agents.

The explosion of biomedical publishing makes keeping up with the primary studies an impossible task. The often disparate, confusing and contradicting findings of individual studies makes healthcare professionals turn to review articles where knowledge has been collated and published in summaries. Narrative reviews lack rigorous, systematic and reproducible synthesis. In contrast, systematic reviews are conducted using systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review. The final pathway for systematic review is a statistical summary of the results of primary studies, or meta-analysis. This article provides some guidelines to health care providers in understanding the key aspects of systematic review and meta-analysis. Steps involved in systematic review are discussed. The potential pitfall of meta-analysis was also explored.

Many studies reported poorer quality of life (QoL) in youth with diabetes compared to healthy peers. One of the tools used is the Diabetes Quality of Life for Youth(DQoLY) questionnaire in English. A validated instrument in Malay is needed to assess the perception of QoL among youth with diabetes in Malaysia. To translate the modified version, i.e., the DQoLY questionnaire,into Malay and determine its reliability and validity. Translation and back-translation were used. An expert panel reviewed the translated version for conceptual and content equivalence. The final version was then administered toyouths with type 1 diabetes mellitus from the universities and Ministry of Health hospitals between August 2006 and September 2007. Reliability was analysed using Cronbach’s alpha, while validity was confirmed using concurrent validity (HbA1c and self-rated health score). A total of 82 youths with type 1 diabetes (38 males) aged 10-18 years were enrolled from eight hospitals. The reliability of overall questionnaire was 0.917, and the reliabilities of the three domains ranged from 0.832 to 0.867. HbA1c was positively correlated with worry (p=0.03). The self-rated health score was found to have significant negative correlation with the “satisfaction” (p=0.013) and “impact” (p=0.007) domains. The Malay translated version of DQoLY questionnaire was reliable and valid to be used among youths with type 2 diabetes in Malaysia.
Diabetes Mellitus ; Quality of Life ; Adolescent ; Reproducibility of Results ; Malaysia

Pruritus is a lesser known symptom of hyperthyroidism, particularly in autoimmune thyroid disorders. This is a case report of a 27-year-old woman who presented with generalised pruritus at a primary care clinic. Incidental findings of tachycardia and a goiter led to the investigations of her thyroid status. The thyroid function test revealed elevated serum free T4 and suppressed thyroid stimulating hormone levels. The anti-thyroid antibodies were positive. She was diagnosed with Graves’ disease and treated with carbimazole until her symptoms subsided. Graves’ disease should be considered as an underlying cause for patients presenting with pruritus. A thorough history and complete physical examination are crucial in making an accurate diagnosis. Underlying causes must be determined before treating the symptoms.
Pruritus ; Graves Disease ; hyperthyroidism ; Primary Health Care

Reactive arthritis and erythema are uncommon presentations of tuberculosis (TB). Reactive arthritis in tuberculosis (TB) is known as Poncet’s disease, a rare aseptic form of arthritis observed in patients with active TB. We report a case of Poncet’s disease in a 20-year old man whose reactive arthritis overshadowed other clinical symptoms of TB resulting in delayed diagnosis and treatment. Although a conclusive diagnosis of Poncet’s disease is not possible, reactive immunologic reactions such as reactive arthritis and erythema nodosum even without respiratory symptoms should raise suspicion on possible TB. Thus, taking a thorough medical history as well as performing relevant examinations and investigations for possible TB will help expedite the diagnostic process.
Arthritis, Reactive ; Tuberculosis ; Rheumatology

The North Borneo state of Sabah is known worldwide for its beautiful islands and dive sites. Local hospitals deal with a number of marine-related injuries, including marine fauna envenomation by Scorpaenidae and Synanceiidae families of fish. We report a case of a tourist who presented with excruciating pain on her right foot after stepping on a stonefish. Despite being given parenteral analgesia and regional anaesthesia, the pain persisted. Her pain improved after she soaked her foot in hot water for about 30 minutes. No further treatment was required. We reviewed the literature comparing this inexpensive mode of treatment with other conventional treatments. We also explored the possibility of using hot water immersion for treatment of envenomation by other types of marine animals.
Fishes, Poisonous ; Fish Venoms ; Water ; Primary Health Care

Diplopia ; Headache ; Sinusitis ; Abducens Nerve Diseases

Patients with Wellen’s syndrome often present with chest pain and found to have specific precordial T-wave changes on the electrocardiogram (ECG). They subsequently develop a large anterior wall myocardial infarction. These specific electrocardiographic abnormalities are associated with critical stenosis of the proximal left anterior descending coronary artery (LAD). This syndrome is often under-recognised and has fatal consequences; it is, therefore, also known as the widow maker. We highlight a case of a 39-year old gentleman who had a history of coronary artery disease and typical ECG characteristics of Wellen’s syndrome.
Electrocardiography ; chest pain

Publications ; Ethics

Validation Studies