Leelavathi Muthupalaniappen

Premenstrual symptoms and remedies practiced by Malaysian women attending a rural primary care clinic

ABSTRACT Background Premenstrual symptoms affect about 40% of women of reproductive age. In an effort to alleviate premenstrual symptoms, affected women practice various remedial approaches. The aim of this study was to assess the prevalence and severity of premenstrual symptoms experienced by women, the associated factors and the remedial approaches practiced by them. Method This was a cross-sectional study conducted at a rural primary care clinic situated in Hulu Langat, Malaysia. All women of reproductive age (18 to 44 years old) attending the clinic during the study period and who fit the selection criteria were included. Premenstrual symptoms and severity were assessed using a self-report questionnaire, the Shortened Premenstrual Assessment Form (SPAF). It consists of 10 items that measure changes in mood, behaviour and physical symptoms. The respondents were also asked if they had used any remedy to relieve their symptoms. Results A total of 158 women were included in the study. The majority of the respondents were Malay (70.3%), followed by Indian (16.5%) and Chinese (10.8%) women. About 75% of the women experienced at least one of the premenstrual symptoms. Approximately 7% of them reported experiencing severe symptoms in all three subscales of the SPAF. The frequently reported symptoms were body ache (75.3%), abdominal pain (75.3%), irritable feeling (63.9%) and breast discomfort (61.4%). The symptom score was higher among Malay women (p = 0.034), and those with a higher household income (p = 0.037) and higher educational level (p = 0.01). There was no significant association between premenstrual symptoms and age, marital status, menstrual cycle and age of menarche. The common remedies used were vitamins (19%), a healthy diet (15.8%) and analgesics (13.3%). Approximately 60% of the women did not use any remedy to reduce their premenstrual symptoms. Conclusion Premenstrual symptoms were common among women attending the clinic. The symptoms affect them significantly both physically and emotionally. Thus, it is essential for primary care providers to take an active role in identifying, educating and managing premenstrual symptoms among women.

Nodular Melanoma Mimicking Keratoacanthoma : Lessons to Learn = ورم ميلانيني عقدي يحاكي ورم شائكي متقرن : دروس للتعل

A 67-year-old man of Chinese descent presented with a painless nodular lesion that had been present on his right forearm for the previous 3 months. A single, well-defined, dome-shaped, firm nodule with a central keratin plug surrounded by erythema was noted. Keratoacanthoma with secondary bacterial infection was suspected and the patient underwent an excision biopsy. Biopsy of the nodule and immunohistochemical staining supported a diagnosis of nodular malignant melanoma. It should be noted both that nodular malignant melanoma may present with a wide variety of clinical appearances, and that the lack of melanin pigment in nodular malignant melanoma may hinder the diagnosis of this aggressive tumour.

Exercise programmes and quality of life in the elderly: important facts.

We read with great interest the article entitled ‘Exercise in elderly patients with chronic heart failure in primary care: Effects on physical capacity and health-related quality of life’ by Pihl et al.1. The authors aimed to determine the effects on physical capacity and health-related quality of life (HRQoL) of an exercise programme in elderly CHF patients in primary care. We wish to highlight a few scientific aspects related to this study. We feel that the authors did not explain in detail what they meant by ‘treated with conventional care’. The authors explain that ‘the data, physical tests and questionnaires, were collected by physiotherapists at baseline and after 3, 6 and 12 months’ but the rationale behind these timings was not clearly explained. It would be interesting to know whether the results would be influenced by a change in the duration of the study. The exercise was mainly to improve upper body strength but was tested by a 6-minute walk test. We do agree with the authors that exercise has positive effects on physical capacity but what is the limit to such exercise? No details were given about the weight of the subjects. Measurement of the blood pressure of the subjects is an important factor. Exercise improves blood flow to muscles and any organs. Dietary habits are also important for healthy living. A recent study described the importance of diet, exercise and psychological support on HRQoL2. We appreciate the interesting work by the authors and applaud the editor for publishing such important healthrelated articles.