PRIMARY CARE MANAGEMENT OF MILD COGNITIVE IMPAIRMENT IN A STROKE SURVIVOR: A CASE REPORT ON FACILITATING RETURN TO WORK This case report delves into facilitating return to work (RTW) in a working-age stroke survivor. The patient was a 42-year-old Malay man who experienced multifocal lacunar infarctions in April 2022.He demonstrated substantial motor function recovery but presented with subtle cognitive deficits impacting various domains. The report outlines the diagnostic process of cognitive assessments and discusses the patient’s medical history and stroke-related factors. The management plan encompassed a multidisciplinary approach in primary care, which involved incorporating cognitive rehabilitation,discussing barriers and exploring the perception of the ability to RTW. This case underscores the intricacies of mild cognitive impairment in working-age stroke survivors and emphasises the need for tailored interventions in primary care to optimise cognitive recovery and enhance the overall quality of life.

INTEGRATING PALLIATIVE CARE INTO PRIMARY HEALTHCARE SYSTEMS: ADVOCACY EFFORTS, MILESTONES AND CHALLENGES IN ASIA Palliative care is a vital component of primary healthcare systems, especially in Asia, where the ageing population is expected to increase significantly in the coming years. Integrating palliative care into primary healthcare systems is a crucial strategy for achieving universal access to palliative care. It is necessary to take concurrent actions to achieve this integration, including integrating palliative care into public health policies, educating primary healthcare workers, establishing appropriate service structures and ensuring the availability of controlled medications. Healthcare professionals involved with primary care, often led by physicians, play a significant role in driving the implementation of primary palliative care in Asia, as evidenced by their involvement in community- and home-based palliative care in India and primary palliative care for patients with cancer in Indonesia. However, there are challenges associated with implementing these actions in each country. Therefore, it is crucial to examine the ongoing advocacy efforts, milestones, obstacles and strategies that shape this process in the Asian context.

ASSOCIATION BETWEEN MEDICATION ADHERENCE AND BLOOD PRESSURE CONTROL AND FACTORS ASSOCIATED WITH ANTIHYPERTENSIVE MEDICATION ADHERENCE IN THE MELAKA TENGAH DISTRICT: A CROSS-SECTIONAL SURVEY Introduction: The burden of cardiovascular disease and early morbidity and mortality is exacerbated by hypertension. According to the 2019 National Health and Morbidity Survey, 30% of adults in Malaysia aged over 18 years had hypertension. Our study aimed to investigate the association between medication adherence and blood pressure control and the factors associated with antihypertensive medication adherence. Methods: This cross-sectional study was conducted among adult patients with hypertension who had been under treatment at public primary health clinics in the Melaka Tengah District. A self-administered questionnaire was used, and blood pressure was measured. Descriptive and multivariate logistic regression analyses were conducted using the Statistical Package for the Social Sciences (version 28). Results: A total of 1531 patients were recruited in this study. Among them, 74.1% had good antihypertensive medication adherence, and 51.4% had their blood pressure controlled. Medication adherence was significantly associated with blood pressure control (P<0.005). The multivariate analysis showed that the determinants for antihypertensive medication non-adherence were Malay ethnicity, secondary education, farther distance from the clinic, experience of side effects of antihypertensive medications, concern about long-term side effects and usage of alternative medicine (P<0.05). Taking multiple antihypertensive medications was the only factor associated with uncontrolled blood pressure (P<0.05). Conclusion: Addressing issues on medication adherence is important to ensure blood pressure control. The factors associated with non-adherence should be closely monitored to improve blood pressure control and prevent adverse health outcomes. Single-pill combination antihypertensive medications are encouraged to reduce pill burden and improve blood pressure control.

BEFORE LEG PAIN AND PARAPARESIS ARE ATTRIBUTED TO VITAMIN C DEFICIENCY ALONE, COMORBIDITIES AND COCAUSALITIES MUST BE CONSIDERED AND RULED OUT We read with interest the article by Noor Emilia and Said about an 8-year-old boy with autism spectrum disorder (ASD) as well as recurrent fever, fatigue and 3-kg weight loss occurring 3 months prior to admission.1 One week before admission, he developed persistent leg pain that worsened with active and passive movements.1 Clinical examination revealed cachexia, mild pallor, hyperpigmentation of the gums, multiple hyperpigmented scars on the upper and lower limbs, palpable inguinal lymph nodes, antalgic gait and muscle weakness of the lower limbs (M4).1 Scurvy was suspected and diagnosed due to a low serum vitamin C level, and the patient’s symptoms improved after the administration of vitamin C and other vitamins.1 e article is impressive, but some points should be discussed.

SHORT-TERM EFFECT OF A MODERATE-POTENCY TOPICAL CORTICOSTEROID ON EPIDERMAL BIOPHYSICAL PARAMETERS IN PATIENTS WITH MILD-TO-MODERATE ATOPIC DERMATITIS: A RANDOMISED CONTROLLED STUDY Introduction: Skin barrier dysfunction is an important component of atopic dermatitis (AD) pathophysiology. Topical corticosteroids (TCSs) are the mainstay therapy, but steroid phobia is emerging due to potential side effects. We aimed to determine the short-term effect of clobetasone butyrate on patients with AD. Methods: This investigator-blinded, randomised, moisturiser-controlled study evaluated patients with stable mild-to-moderate AD. Clobetasone butyrate ointment plus aqueous cream (Aq) or Aq alone was applied on randomised sites twice daily for 6 weeks. The itch score, modified Eczema Area and Severity Index (M-EASI) and epidermal biophysical parameters were assessed at baseline and 1 h, 3 h, 2 weeks and 6 weeks after application. Results: Sixteen patients, among whom 14 (87.5%) were women and two (12.5%) were men, participated in the study. There were no significant differences in pH, transepidermal water loss (TEWL) and hydration between TCS + Aq and Aq from 1 h to 6 weeks. A non-significant trend of pH increment was observed with TCS + Aq from baseline to 6 weeks. TEWL and hydration improved at 6 weeks for both treatment arms. The difference in TEWL from baseline was significant with Aq (P=0.01). The M-EASI at 6 weeks was comparable between the two arms. TCS + Aq improved itch and erythema better than Aq (P=0.02). No cutaneous adverse effects were observed at both sites. Conclusion: Short-term application of clobetasone butyrate with Aq is safe with no significant changes in epidermal biophysical parameters while controlling the symptoms and signs of eczema faster than Aq alone.

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.

PREVALENCE OF PERSONAL, WORK-RELATED AND PATIENT-RELATED BURNOUT DURING THE COVID-19 PANDEMIC AND ITS ASSOCIATED FACTORS AMONG HEALTHCARE WORKERS IN HEALTH CLINICS IN THE DISTRICT OF MANJUNG, PERAK: A CROSS-SECTIONAL STUDY Introduction: Burnout is a syndrome characterised by physical, emotional and mental exhaustion that results from a long period of involvement in an overwhelming work condition. It is prevalent among frontline workers. This study aimed to identify the prevalence of burnout among primary healthcare workers in the district of Manjung, Perak and determine the factors associated with burnout. Methods: This cross-sectional study was conducted among healthcare workers in seven health clinics located in the district from August to September 2022. The self-administered validated Malay version of the Copenhagen Burnout Inventory and the Malay version of the Multidimensional Scale of Perceived Social Support were used. These instruments consisted of 31 questions rated on a 5-point Likert scale. The scores were then summed up to determine the burnout level. Data were analysed using SPSS version 20. Simple logistic regression analysis was performed. Thereafter, multiple logistic regression analysis was conducted to determine the factors associated with burnout. Results: A total of 224 participants were included. Among them, 61.6% were nurses; 21.4%, doctors; and 17.0%, assistant medical officers. The prevalence of personal burnout was 31.3%; work-related burnout, 16.5%; and patient-related burnout, 5.4%. The factors associated with burnout were the highest educational level, financial difficulties and low perceived social support from friends and significant others. Conclusion: Healthcare workers in Manjung health clinics have a higher prevalence of personal burnout than work- and patient-related burnout. The findings of this study provide early insights and guidance for possible interventions.

KNOWLEDGE, ACCEPTANCE AND CONCERNS REGARDING COVID-19 VACCINATION AMONG PREGNANT WOMEN ON THE EAST COAST OF PENINSULAR MALAYSIA: ACROSS-SECTIONAL STUDY Introduction: This prospective cross-sectional study, conducted from 1 April 2022 to 31 October 2022, aimed to assess the knowledge, acceptance and concerns regarding COVID-19 vaccination among pregnant women visiting the Obstetrics and Gynaecology Department of Hospital Universiti Sains Malaysia. Methods: The study included all pregnant women aged ≥18 years. Sociodemographic data, information related to COVID-19 and vaccination and information on the knowledge, acceptance and concerns regarding COVID-19 vaccination were collected using a validated questionnaire. Results: Out of 420 eligible pregnant women, 412 participated in the study, yielding a response rate of 98.1%. Of the respondents, 97.1% had received a COVID-19 vaccine, while 2.9% had not. Approximately 85.2% demonstrated a good understanding of COVID-19 vaccination. Among those vaccinated, 76.8% based their decision on recommendations from healthcare providers or the Ministry of Health. Among those unvaccinated, 91.7% believed that COVID-19 vaccines could harm their pregnancy and baby. Although 51% of the respondents expressed concerns about vaccine safety, 202 still chose to be vaccinated, indicating a willingness to prioritise their health despite apprehensions. Conclusion: The study found no significant link between acceptance and good knowledge of COVID-19 vaccination. However, income and prior COVID-19 booster vaccination were strongly associated with acceptance. Despite safety concerns, 97.1% of the respondents had received a COVID-19 vaccine. This emphasises the importance of providing comprehensive information and addressing concerns to support informed decision-making among pregnant women. Healthcare providers play a vital role in guiding them through this crucial decision-making process.

REPLY LETTER TO: IF SARS-COV-2 VACCINATION IS BLAMED FOR PARSONAGE–TURNER SYNDROME, NEUROSURGICAL NEUROLYSIS IS NOT INDICATED We would like to respond to the letter to the editor titled ‘If SARS-CoV-2 vaccination is blamed for Parsonage–Turner syndrome, neurosurgical neurolysis is not indicated’ addressed to our article titled ‘Parsonage–Turner syndrome: A case report of a rare side effect of COVID-19 booster vaccination’.1,2 We thank the author for raising several points worthy of discussion.

PREVALENCE OF VISUAL IMPAIRMENT AND EYE DISEASES IN MALAYSIA: A CROSS-SECTIONAL PROSPECTIVE STUDY AT THE UNIVERSITY OF MALAYA MEDICAL CENTRE Introduction: The prevalence of visual impairment and ocular diseases changes over time. This measure can help general practitioners in anticipating common eye disorders that may require ophthalmological referrals to government hospitals. This study aimed to evaluate the prevalence of visual impairment and ocular diseases in an outpatient ophthalmology clinic in a public hospital and the types of investigations frequently conducted to diagnose these diseases. Methods: A cross-sectional prospective study was conducted over three weeks in the eye clinic of the University of Malaya Medical Centre. The electronic medical records of all patients who attended the outpatient clinic were assessed to collect data on sex, age, type of visit, visual acuity, ocular presentation, investigations conducted and diagnosis of eye diseases. Visual impairment and blindness were categorised as per the World Health Organization criteria. Results: Among 1002 patients, 327 had visual impairments (32.63%), and nine had blindness (0.9%). Cataracts were the most common ocular disease diagnosed (n=294, 29.74%), followed by glaucoma (n=123, 12.28%) and diabetic retinopathy (n=84, 8.38%). Optical coherence tomography was the most common investigation performed (n=272, 64.9%), followed by Humphrey visual field testing (n=53,12.6%). Conclusion: Untreated refractive error is the leading cause of visual impairment in children, while cataract, glaucoma and diabetic retinopathy are the main contributors to visual impairment and blindness in elderly individuals. Our study highlights the urgent need for general practitioners to recognise avoidable visual impairment in all age groups to help prevent blindness.