FIVE-YEAR TREND IN SECONDARY PREVENTION MEDICATION PRESCRIPTION AND RISK FACTOR CONTROL AMONG PATIENTS WITH DIABETES MELLITUS AND CARDIOVASCULAR DISEASES IN PERAK HEALTH CLINICS Introduction: Prescription of secondary prevention medications (SPMs) and effective control of cardiovascular risk factors (RFs) are crucial to reduce the risk of recurrent cardiovascular events,particularly in high-risk individuals including those with diabetes mellitus (DM). This study aimed to analyse the trends in SPM prescription and identify the factors associated with RF control among patients with DM and cardiovascular diseases in Perak health clinics. Methods: Data of patients with ischaemic heart disease (IHD) and cerebrovascular diseases (CeVDs) audited from 2018 to 2022, excluding those lost to follow-up, were extracted from the National Diabetes Registry. Descriptive and trend analyses were conducted. Multivariable logistic regression was utilised to identify the factors associated with RF control. Results: Most patients (76.7%) were aged ≥60 years and were Malays (62.3%). The majority had IHD (60.8%) and CeVDs (54.7%) for ≥5 years. SPM prescription increased significantly over the past 5 years. However, blood pressure (BP) and lipid control remained static. Good BP control was associated with a DM duration of ≥10 years and poor control with Malay ethnicity and prescription of two or three antihypertensives. Good DM control was associated with an age of ≥60 years and age at DM diagnosis of ≥60 years and poor control with Malay and Indian ethnicities, DM duration of≥10 years and prescription of two or three and more glucose-lowering drugs. Poor lipid control was associated only with Malay and Indian ethnicities. Conclusion: SPM prescription has increased over time, but the achievement of treatment targets,particularly for lipid control, has remained poor and unchanged. Statin use is not associated with lipid control. The accessibility and availability of alternative lipid-lowering drugs must be improved to enhance overall RF control, especially lipid control, in patients with DM and cardiovascular diseases.

We describe the case of a 72-year-old housewife who presented to a primary care specialist clinic for reassessment following multiple hospitalisations for heart failure within the past 9 months. She presented with decreased effort tolerance and tiredness for the past 1 year. Her symptoms had remained the same despite current treatment. During the initial history-taking, she did not report any medical illnesses or surgeries. She had been well and had not undergone any screening for almost 30 years before the first hospitalisation for heart failure. There was neither cough, constipation, dyspepsia, abdominal pain, stool changes, haematuria, per vaginal bleeding nor hoarse voice. The physical examination findings were remarkable for slow movement and speech. Her skin was dry with a markedly increased serum lipid profile. Further investigation and management confirmed the suspected diagnosis.
Heart Failure ; Geriatrics ; Primary Health Care

Introduction: Primary care service plays a vital role in early clinical assessment of patients with COVID-19 in Malaysia. is study aimed to evaluate the potential risk factors of COVID-19 severity at presentation to primary care facilities in the post-vaccination period. Methods: Clinical records from the Selangkah system of all patients with COVID-19 aged above 18 years seen at COVID-19 assessment centres located in 10 government health clinics in Gombak district, Selangor, from 1 October to 31 December 2021 with complete documentation and outcomes were retrieved. Demographics, comorbidities, clinical features and vaccination statuses and types were retrospectively evaluated. e variables were compared between mild and severe diseases. Univariate and multivariable logistic regressions were used to identify the factors aecting disease severity. Results: A total of 4406 patients (median age=37 years, men=51.2%) were analysed. Approximately 97.1% of the cases were mild, while 2.9% were severe. Fever, diculty breathing, lethargy, throat irritation/runny nose, oxygen saturation of <95%, respiratory rate of >20 breaths per minute, CoronaVac vaccination and hypertension were the determinants of severity (P<0.05). Conclusion: e high proportion (97.1%) of mild cases in this study compared with an earlier report (81.8%) during the pre-vaccination period may suggest the impact of vaccine, as 84.9% of this cohort was fully vaccinated. Our study also demonstrated a signicant dierence in COVID-19 severity between the vaccine types. e identied clinical features and comorbidities could assist primary care doctors in stratifying patients with COVID-19 judiciously in terms of hospital referral or home quarantine.

Renal Insufficiency, Chronic ; Primary Health Care ; Malaysia

We described the case of a 42-year-old man who presented with left index finger mass persisting for 6 months. The mass was small and, painless and had gradually increased in size with limited finger flexion. Physical examination showed a firm mass over the volar surface of the left index finger. There was no tenderness, redness, warmth or punctum. The overlying skin was normal, and the mass did not transilluminate. Further examination of the head and neck, chest, upper limbs and neurovascular system revealed normal findings. No similar masses were found elsewhere in the body. Bedside ultrasound with further investigation and management confirmed the suspected diagnosis.
Fingers ; Soft Tissue Neoplasms ; Neoplasms

Introduction: This audit was performed to monitor the diagnosis and management of chronic kidney disease (CKD) according to the clinical practice guidelines (CPGs) of CKD 2018 in a primary care clinic. Methods: Patients who attended the clinic from April to June 2019 and fulfilled the diagnosis of CKD were included in this study, except for those diagnosed with a urinary tract infection, pregnant women and those on dialysis. These criteria were set based on the CPGs. The standards were set following discussions with the clinic team members with reference to local guidelines, the 2017 United Kingdom National CKD audit and other relevant studies. Results: A total of 384 medical records were included in this audit. Overall, 5 out of 20 criteria for processes and 3 of 8 clinical outcomes for CKD care did not meet the set standards. These included the following: documentation of CKD classification based on albumin category (43.8%); CKD advice (19.0%); dietitian referral (9.1%); nephrologist referral (45.5%); haemoglobin level monitoring (65.7%); overall blood pressure (BP) control (45.3%); BP readings for diabetic kidney disease (DKD) and non-DKD with > 1 g/day of proteinuria (≤ 130/80 mmHg, 37.0%); eGFR reduction of < 25% over the past year (77.2%). Identified problems included the absence of a CKD registry, eGFR and albuminuria reports, and a dedicated team, among other factors. Conclusions: Overall, 8 out of 28 criteria did not meet the standards of CKD care set for this audit. The problems identified in this audit have been addressed. Moreover, strategies have also been formulated to improve the diagnosis and management of CKD in this clinic.