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.

ABC approach for the management of adults with hyperthyroidism: A practical strategy in primary care.

Hyperthyroidism is commonly seen in primary care settings. However, the management of hyperthyroidism might be unclear to primary care doctors. Various guidelines have been published to assist clinicians in the management of thyroid disorders at various levels of care. The extensive coverage of these guidelines may not appeal to busy clinicians, and the guidelines do not focus on often resource-limited primary care settings. In this article, we aim to describe a practical guide for managing hyperthyroidism in primary care settings using an ABC approach.

Cross-Cultural Adaptation and Psychometric Properties of the Malay Version of the Communication Skills Attitude Scale (CSAS) among Medical Students in Malaysia.

Communication is one of the fundamental skills in the medical profession. The Communication Skills Attitude Scale (CSAS) is a widely used questionnaire to measure the attitudes of medical students toward learning communication skills. It has been adapted and translated into many languages. The objective of this study was to adapt and translate the CSAS into the Malay language and determine its psychometric properties in medical students. This is a cross-sectional study involving 218 first-year Universiti Teknologi MARA students. Content validation, cross-cultural adaptation, translation, and face validation of the 26-item CSAS were performed according to established guidelines. Principal component analysis with direct oblimin rotation was used to determine the underlying structure of the CSAS-Malay. The reliability was assessed using Cronbach's α coefficient for internal consistency and using the intraclass correlation coefficient for the test-retest reliability. Although the contents of the CSAS-Malay and the original version were conceptually equivalent, item 11 was removed during the content validation stage due to a low item content validity index (I-CVI < 1.00). Two subscales were derived from the remaining 25 items, which were the Positive Attitude Scale and the Negative Attitude Scale. Items 1 and 15 were removed due to poor factor loadings. The total variance explained by the final two-factor solution with three items removed was 30.8%. Cronbach's α coefficients for both the Positive and Negative Attitude Scales in the final questionnaire were 0.815 and 0.614, respectively. It also showed a good reproducibility with intraclass correlation coefficient (ICC) values of 0.725-0.950 for all the items. This study provided preliminary information about the psychometric properties of the CSAS-Malay. The final 23-item questionnaire had a good construct validity, an acceptable internal consistency, and at least a moderate test-retest reproducibility. It can be used to assess the attitudes of medical students toward learning communication skills. Future research to improve the generalizability of the questionnaire should include medical students from other universities with diverse backgrounds.

Necrotizing fasciitis of the upper back presenting with left shoulder pain.

Necrotizing fasciitis is a severe and progressive infection of deep soft tissues which results in destruction of the fascia and overlying subcutaneous fat. We report a case of a 45-year-old diabetic gentleman who initially presented with left shoulder pain, which was treated symptomatically. Upon representation, he had fever and the pain extended to his left upper back. There was a warm, firm and mildly tender purplish swelling on his mid to the left upper back. Blood tests revealed significantly elevated white cell counts and C-reactive protein. A CT thorax showed extensive soft tissue gas within the deep and superficial fascial layers of his left upper back. Necrotizing fasciitis was confirmed intraoperatively. The diagnosis of this condition is often difficult as early symptoms can be mild and nonspecific. A high Laboratory Risk Indicator for NECrotizing fasciitis (LRINEC) score may be helpful to rule in this diagnosis and guide further management.