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.

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 #30;e article is impressive, but some points should be discussed.

Introduction: Type 2 diabetes mellitus (T2DM) is a significant non-communicable disease in Malaysia, with a prevalence of 18.1%, per the National Health and Morbidity Survey. This study aimed to determine the prevalence and burden of diabetes mellitus-related symptoms and whether these symptoms were addressed by primary care doctors. Methods: This 1-month cross-sectional study was conducted at an urban hospital-based primary care clinic in Malaysia. Patients with T2DM were recruited using systematic random sampling. Participants answered a self-administered questionnaire adapted from the Diabetes Symptom Checklist-Revised, which evaluated the sociodemographic characteristics, burden of diabetes mellitus-related symptoms in the past month and post-consultation feedback about symptoms. Data were analysed using SPSS. Results: Four hundred eighteen participants were included, yielding a response rate of 97.7%. Hyperglycaemia was the most prevalent symptom, with 48.1% of the participants reporting a frequent need to empty their bladder. Most participants experienced a low symptom burden, so 56.7% did not report their symptoms to their doctors. The participants who reported their symptoms had a higher symptom burden. Among them, 97.5% indicated that their doctors addressed their symptoms. Approximately 78% reported satisfaction and good coping skills when their symptoms were addressed. Conclusion: Hyperglycaemia was the most prevalent diabetes mellitus-related symptom among the patients with T2DM. The symptom burden was generally low, so most patients did not report their symptoms to their doctors. Those who reported their symptoms had a higher symptom burden. Further studies must explore why patients do not report their symptoms and how doctors address patients’ symptoms.

Introduction: Most working women experience poor physical and mental health during their postpartum period. This prospective study aimed to describe the physical and mental health issues faced by working mothers during their postpartum period. Methods: Respondents were recruited using the proportional sampling method among mothers who attended the Maternal and Child Health Clinic in the Kuching division in Sarawak, Malaysia. Face-to-face interview was conducted using a questionnaire that consisted of items on socio-demographic data as well as perinatal, prenatal and postpartum factors, and the Edinburgh Postnatal Depression Scale and a checklist of 28 specific postpartum symptoms were used during the first 6 weeks and after 12 weeks of childbirth. Results: A total of 281 respondents participated in this study. Fatigue (42.7%), back or neck pain (36.3%), breast discomfort (16.4%), dizziness (13.5%) and nipple irritation (11.0%) were among the most common symptoms experienced by the mothers during the first 6 weeks after childbirth. There was a significant decrease in the physical symptom scores of the respondents from the first 6 weeks to after 12 weeks of childbirth (1.73±1.96 vs 0.16±0.42; P<0.0005). A significant decrease was also found in the depression scores (6.26±4.26 vs 1.35±1.85, P<0.0005). Conclusion: The prevalence of postnatal depression was higher during the first 6 weeks of postpartum than after 12 weeks of postpartum. Screening and treatment of poor postpartum mental health among working women are essential owing to the impacts on occupational outcomes.

Introduction: Evidence on the impacts of accreditation on primary health care (PHC) services is inconsistent. Thus, this study aimed to assess the impacts of accreditation on the performance of PHC centres. Methods: This study systematically reviewed articles published from 2000 to 2019 in the Web of Science, Scopus, ScienceDirect, Springer, PubMed and ProQuest. The following keywords were used: ((primary care OR primary health care) AND (accreditation) AND (impact OR effect OR output OR outcome OR influence OR result OR consequences)). The database search yielded a total of 41256 articles, among which 30 articles were finally included in the review. Results: Accreditation showed the most positive impacts on the quality, effectiveness, human resource management and strategic management of PHC services. Accreditation also positively affected safety, responsiveness, accessibility, customer satisfaction, documentation, leadership, efficiency and continuity of care. Few negative impacts were noted, including the possibility of accreditation being used as a bureaucratic tool, high cost of acquiring accreditation, difficulties in understanding the accreditation process, high staff turnover rate in accredited PHC centres and weak sustainability of some accreditation programmes. Conclusion: Given its numerous positive impacts, accreditation could be used to effectively improve the performance of PHC centres.

In this clinical challenge, we describe the case of a previously healthy 8-year-old girl who presented to a primary care clinic with fever, reduced oral intake and malaise on day 3 of her illness. Clinical examination revealed that she was tachypnoeic and tachycardic. An erythematous rash was found across the bridge of her nose and cheeks, and several painless ulcers were noted in the oral cavity. Blood investigation showed thrombocytopenia, while urinalysis revealed microscopic haematuria and proteinuria. Useful initial diagnostic imaging studies were discussed, including bedside ultrasound in the ambulatory care setting. It is imperative that primary care providers be vigilant when encountering cases like this.

Gastroschisis may lead to serious congenital disability, as prolonged exposure to the amniotic fluid could compromise the mesenteric blood flow and irritate the foetal intestinal wall. The consequences of gastroschisis include spontaneous preterm birth, growth restriction and foetal demise. Awareness of this disease is essential, as a high mortality rate is linked to inadequate initial therapy. Early detection of the disease, mainly by primary care physicians as the initial point of contact, is crucial to improve the course of the condition through early monitoring and referral to tertiary care centres. With this case report, we hope to highlight the need of detecting gastroschisis before to the third trimester of pregnancy for better readiness, especially in primary care settings located far from tertiary centres.

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.