Pub Date : 2022-05-01DOI: 10.1177/20101058221103375
Kamalia Kamarulzaman, Lee Boon Nang, I. Shuaib, F. Abdul Karim, Wan Mohd Nazlee Wan Zainon, Norazlina Mat Nawi
Introduction Radiosynovectomy (also known as radiosynoviorthesis) is a local form of radiotherapy that is used in chronic hemophilic synovitis in the absence of radiological evidence of extensive joint damage and in patients that have failed conservative therapy with clotting factor replacement and physiotherapy. Objectives To evaluate the effectiveness of the Yttrium-90 (Y-90) colloid and Rhenium-186 (Re-186) sulphur colloid radiosynovectomy in hemophilic arthropathy in terms of bleeding frequency, pain score, range of motion and performance score. Methodology This was a prospective cohort trial. A total of 68 hemophilic arthropathy patients who had been treated with radiosynovectomy for knee, ankle, elbow and hip joint were included in this study. Patients were followed up to assess their bleeding frequency, pain score, range of motion of the affected joint and Karnofsky or Lansky performance scale at pre and 6 months post therapy. Result A marked decrease (80–100%) in bleeding frequency was seen in 66.2% of patients, 14.7% of patients had moderate decrease (51–79%) and mild decrease (30–50%) was seen in 14.7% of patients. The frequency of intraarticular bleeding and pain score were significantly reduced at 6 months follow up (p<0.005). The Karnofsky and Lansky performance scales were also improved at 6 months follow up (p<0.005). There was no significant difference between percentage of range of motion measured before and after the therapy (p>0.005). Conclusion Radiosynovectomy is a safe and effective procedure in limiting bleeding frequency, reducing pain and increasing performance scale.
{"title":"Therapy Response of the Yttrium-90 (Y-90) Colloid and Rhenium-186 (Re-186) Sulphur Colloid Radiosynovectomy in Hemophilic Arthropathy","authors":"Kamalia Kamarulzaman, Lee Boon Nang, I. Shuaib, F. Abdul Karim, Wan Mohd Nazlee Wan Zainon, Norazlina Mat Nawi","doi":"10.1177/20101058221103375","DOIUrl":"https://doi.org/10.1177/20101058221103375","url":null,"abstract":"Introduction Radiosynovectomy (also known as radiosynoviorthesis) is a local form of radiotherapy that is used in chronic hemophilic synovitis in the absence of radiological evidence of extensive joint damage and in patients that have failed conservative therapy with clotting factor replacement and physiotherapy. Objectives To evaluate the effectiveness of the Yttrium-90 (Y-90) colloid and Rhenium-186 (Re-186) sulphur colloid radiosynovectomy in hemophilic arthropathy in terms of bleeding frequency, pain score, range of motion and performance score. Methodology This was a prospective cohort trial. A total of 68 hemophilic arthropathy patients who had been treated with radiosynovectomy for knee, ankle, elbow and hip joint were included in this study. Patients were followed up to assess their bleeding frequency, pain score, range of motion of the affected joint and Karnofsky or Lansky performance scale at pre and 6 months post therapy. Result A marked decrease (80–100%) in bleeding frequency was seen in 66.2% of patients, 14.7% of patients had moderate decrease (51–79%) and mild decrease (30–50%) was seen in 14.7% of patients. The frequency of intraarticular bleeding and pain score were significantly reduced at 6 months follow up (p<0.005). The Karnofsky and Lansky performance scales were also improved at 6 months follow up (p<0.005). There was no significant difference between percentage of range of motion measured before and after the therapy (p>0.005). Conclusion Radiosynovectomy is a safe and effective procedure in limiting bleeding frequency, reducing pain and increasing performance scale.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46268900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-07DOI: 10.1177/20101058221083391
N. Parthiban, H. Sani
de Winter syndrome is a rare but important electrocardiographic pattern to recognize in patients presenting with chest pain. Under-recognition and delayed revascularization in patients with de Winter syndrome may lead to poor clinical outcomes. Despite increasing evidence of its association with total occlusion of the left anterior descending artery, the role of thrombolysis in the absence of percutaneous coronary intervention is not specifically addressed in recent international guidelines. Herein, we report a case of a 50-year-old gentleman with no known medical illness who presented with excruciating chest pain associated with diaphoresis, nausea, and reduced effort tolerance. Clinical examination revealed a distressed patient with bibasal crepitations with no other significant findings. The first ECG was sinus bradycardia with poor R-wave progression. ECG repeated 6 h later revealed de Winter syndrome. Within minutes, the patient developed sustained pulse ventricular tachycardia requiring synchronized cardioversion. The patient was intubated for impending cardiorespiratory failure. We took the pharmacoinvasive approach. The patient received thrombolytic therapy as percutaneous coronary intervention (PCI) was not available and transferring to the nearest cardiac center was not possible within the therapeutic window. He was then subsequently transferred to the nearest cardiac center post thrombolysis for PCI. We report this case study to highlight the importance of recognizing this STEMI-equivalent ECG pattern in patients presenting with chest pain, and call for randomized control trials to evaluate the effectiveness of thrombolytic therapy as an alternative emergent reperfusion strategy in de Winter syndrome in non-cardiac centers.
{"title":"de Winter syndrome, a STEMI-equivalent ECG pattern leading to life-threatening arrhythmia: A case report from a non-cardiac catheterization laboratory hospital","authors":"N. Parthiban, H. Sani","doi":"10.1177/20101058221083391","DOIUrl":"https://doi.org/10.1177/20101058221083391","url":null,"abstract":"de Winter syndrome is a rare but important electrocardiographic pattern to recognize in patients presenting with chest pain. Under-recognition and delayed revascularization in patients with de Winter syndrome may lead to poor clinical outcomes. Despite increasing evidence of its association with total occlusion of the left anterior descending artery, the role of thrombolysis in the absence of percutaneous coronary intervention is not specifically addressed in recent international guidelines. Herein, we report a case of a 50-year-old gentleman with no known medical illness who presented with excruciating chest pain associated with diaphoresis, nausea, and reduced effort tolerance. Clinical examination revealed a distressed patient with bibasal crepitations with no other significant findings. The first ECG was sinus bradycardia with poor R-wave progression. ECG repeated 6 h later revealed de Winter syndrome. Within minutes, the patient developed sustained pulse ventricular tachycardia requiring synchronized cardioversion. The patient was intubated for impending cardiorespiratory failure. We took the pharmacoinvasive approach. The patient received thrombolytic therapy as percutaneous coronary intervention (PCI) was not available and transferring to the nearest cardiac center was not possible within the therapeutic window. He was then subsequently transferred to the nearest cardiac center post thrombolysis for PCI. We report this case study to highlight the importance of recognizing this STEMI-equivalent ECG pattern in patients presenting with chest pain, and call for randomized control trials to evaluate the effectiveness of thrombolytic therapy as an alternative emergent reperfusion strategy in de Winter syndrome in non-cardiac centers.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47358732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1177/20101058221089989
L. Nyanti, Andy Sing Ong Tang, Adam Ismail, L. Chew, T. S. Leong
Tumour lysis syndrome is common in haematological malignancies but is rarely reported in solid tumours. Peripheral blood lymphocytosis is an autoimmune feature of thymomas. We report a 63-year-old female who presented with a mediastinal mass, spontaneous tumour lysis syndrome and a leukoerythroblastic picture on peripheral blood film. Bone marrow aspiration and trephine biopsy ruled out haematological malignancy. Subsequent biopsy of the mediastinal mass confirmed thymoma. This is the first reported case of thymoma with peripheral blood lymphocytosis presenting with spontaneous tumour lysis syndrome. Clinicians are reminded that solid tumours may masquerade as haematological malignancies in the presence of peripheral blood lymphocytosis, hence careful clinical evaluation is needed to differentiate between the two diagnoses.
{"title":"Spontaneous tumour lysis syndrome as a rare presentation of thymoma with peripheral blood lymphocytosis","authors":"L. Nyanti, Andy Sing Ong Tang, Adam Ismail, L. Chew, T. S. Leong","doi":"10.1177/20101058221089989","DOIUrl":"https://doi.org/10.1177/20101058221089989","url":null,"abstract":"Tumour lysis syndrome is common in haematological malignancies but is rarely reported in solid tumours. Peripheral blood lymphocytosis is an autoimmune feature of thymomas. We report a 63-year-old female who presented with a mediastinal mass, spontaneous tumour lysis syndrome and a leukoerythroblastic picture on peripheral blood film. Bone marrow aspiration and trephine biopsy ruled out haematological malignancy. Subsequent biopsy of the mediastinal mass confirmed thymoma. This is the first reported case of thymoma with peripheral blood lymphocytosis presenting with spontaneous tumour lysis syndrome. Clinicians are reminded that solid tumours may masquerade as haematological malignancies in the presence of peripheral blood lymphocytosis, hence careful clinical evaluation is needed to differentiate between the two diagnoses.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42012372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1177/20101058221104578
Z. Chan, Chen Fang Lim, J. Leow, Feng Yong Chium, Su Wen Lim, Charlotte Hui Min Tong, Jessie Jie Xi Zhou, Moses Min Yuan Tsi, R. Tan, L. Chew
Background: Telemedicine has demonstrated benefits for cancer patients including the potential to improve care coordination and patient outcomes. Since June 2020, teleconsultations have been implemented in the National Cancer Centre Singapore. Objectives: This study aims to assess cancer patients acceptance of telemedicine as a complement to traditional in-person care and identify factors affecting their acceptance. Methods: An online self-administered questionnaire was designed using a modified technology acceptance model (TAM) previously validated to predict acceptance of telemedicine by patients and factors affecting acceptance. Descriptive statistics were used to summarise data on demographic factors and TAM construct scores. Univariate and multivariate logistic regression were used to determine how demographics factors and TAM constructs influenced acceptance. Results: Respondents (n = 278; mean age 59 years) were mostly female (67.6%), Chinese (86.3%) and received parenteral chemotherapy (72.6%). Technology access and confidence were generally moderate to high, while past telemedicine use was low (18%). Overall, more than half (59.7%) expressed acceptance. The odds of acceptance were significantly higher if respondents agreed that their healthcare access would improve by using telemedicine (OR 4.17, 95% CI 1.71–10.16) or they would have the necessary resources for using telemedicine (OR 4.54, 95% CI 2.30–8.97). Conclusion: Acceptance of telemedicine was high amongst respondents. Facilitating conditions such as having necessary resources and perceived improved access were identified as main predictors of high acceptance. Telemedicine services should work to improve these aspects, leverage on advantages and address disadvantages brought up by patients.
{"title":"Using the technology acceptance model to examine acceptance of telemedicine by cancer patients in an ambulatory care setting","authors":"Z. Chan, Chen Fang Lim, J. Leow, Feng Yong Chium, Su Wen Lim, Charlotte Hui Min Tong, Jessie Jie Xi Zhou, Moses Min Yuan Tsi, R. Tan, L. Chew","doi":"10.1177/20101058221104578","DOIUrl":"https://doi.org/10.1177/20101058221104578","url":null,"abstract":"Background: Telemedicine has demonstrated benefits for cancer patients including the potential to improve care coordination and patient outcomes. Since June 2020, teleconsultations have been implemented in the National Cancer Centre Singapore. Objectives: This study aims to assess cancer patients acceptance of telemedicine as a complement to traditional in-person care and identify factors affecting their acceptance. Methods: An online self-administered questionnaire was designed using a modified technology acceptance model (TAM) previously validated to predict acceptance of telemedicine by patients and factors affecting acceptance. Descriptive statistics were used to summarise data on demographic factors and TAM construct scores. Univariate and multivariate logistic regression were used to determine how demographics factors and TAM constructs influenced acceptance. Results: Respondents (n = 278; mean age 59 years) were mostly female (67.6%), Chinese (86.3%) and received parenteral chemotherapy (72.6%). Technology access and confidence were generally moderate to high, while past telemedicine use was low (18%). Overall, more than half (59.7%) expressed acceptance. The odds of acceptance were significantly higher if respondents agreed that their healthcare access would improve by using telemedicine (OR 4.17, 95% CI 1.71–10.16) or they would have the necessary resources for using telemedicine (OR 4.54, 95% CI 2.30–8.97). Conclusion: Acceptance of telemedicine was high amongst respondents. Facilitating conditions such as having necessary resources and perceived improved access were identified as main predictors of high acceptance. Telemedicine services should work to improve these aspects, leverage on advantages and address disadvantages brought up by patients.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46108228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1177/20101058221089990
Roghieh Bayrami, R. Baghaei
Purpose: Pregnant women’s engagement in the childbirth process increases their satisfaction with childbirth, and in turn leads to a reduction in the frequency of cesarean sections and adverse pregnancy consequences. This study aimed to explore the barriers to pregnant women’s engagement in the childbirth process based on midwives' perspective. Methods: This qualitative study was conducted on 24 midwives working in Urmia hospitals in 2019. Data were collected through semi-structured in-depth individual interviews with the midwives. The participants were selected through purposeful sampling. Data analysis was performed using conventional content analysis with MAXQDA 10. Results: Analysis of the data resulted in two main categories “weakness of pregnant women’s participatory culture” (negative attitude of healthcare staff towards pregnant women’s engagement, ineffective relationships, insufficient engagement in respectful care, lack of pregnant women’s awareness of their rights and low health literacy of the pregnant women, and “managerial factors” (neglect of physiological childbirth aspects and hospital rules). Conclusion: Pregnant women’s participation in childbirth can be enhanced by promoting pregnant women’s participatory culture by making mothers aware of their rights and providing in-service training for healthcare staff to observe the rights and dignity of pregnant women. Moreover, the promotion of physiological childbirth and the correction of hospital rules can promote pregnant women’s engagement in childbirth.
{"title":"Exploring the barriers to pregnant women’s engagement in the childbirth process from Iranian midwives’ point of view: A qualitative study","authors":"Roghieh Bayrami, R. Baghaei","doi":"10.1177/20101058221089990","DOIUrl":"https://doi.org/10.1177/20101058221089990","url":null,"abstract":"Purpose: Pregnant women’s engagement in the childbirth process increases their satisfaction with childbirth, and in turn leads to a reduction in the frequency of cesarean sections and adverse pregnancy consequences. This study aimed to explore the barriers to pregnant women’s engagement in the childbirth process based on midwives' perspective. Methods: This qualitative study was conducted on 24 midwives working in Urmia hospitals in 2019. Data were collected through semi-structured in-depth individual interviews with the midwives. The participants were selected through purposeful sampling. Data analysis was performed using conventional content analysis with MAXQDA 10. Results: Analysis of the data resulted in two main categories “weakness of pregnant women’s participatory culture” (negative attitude of healthcare staff towards pregnant women’s engagement, ineffective relationships, insufficient engagement in respectful care, lack of pregnant women’s awareness of their rights and low health literacy of the pregnant women, and “managerial factors” (neglect of physiological childbirth aspects and hospital rules). Conclusion: Pregnant women’s participation in childbirth can be enhanced by promoting pregnant women’s participatory culture by making mothers aware of their rights and providing in-service training for healthcare staff to observe the rights and dignity of pregnant women. Moreover, the promotion of physiological childbirth and the correction of hospital rules can promote pregnant women’s engagement in childbirth.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47869220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1177/20101058221104582
Kavitha Sothirasan, A. Anand, M. Chua, P. Khoo, Mei Chien Chua
Physicians play a pivotal role in the management of children and adults with Down Syndrome. Achieving full developmental potential in a child with Down Syndrome depends on prompt treatment of medical complications, family support and early establishment of intervention programmes. The presence of evidence-based guidelines support the physician both in the community and in restructured hospitals to provide timely and appropriate management recommendations. It will also aid in counselling parents and caregivers. Although most co-morbidity characteristics are common for the syndrome, the prevalence of different morbidities can be region specific, hence it is useful to have recommendations tailored to suit local population. Here we share the clinical guideline for children and adults with Down Syndrome in Singapore.
{"title":"Clinical Guideline for Management of Down Syndrome in Singapore","authors":"Kavitha Sothirasan, A. Anand, M. Chua, P. Khoo, Mei Chien Chua","doi":"10.1177/20101058221104582","DOIUrl":"https://doi.org/10.1177/20101058221104582","url":null,"abstract":"Physicians play a pivotal role in the management of children and adults with Down Syndrome. Achieving full developmental potential in a child with Down Syndrome depends on prompt treatment of medical complications, family support and early establishment of intervention programmes. The presence of evidence-based guidelines support the physician both in the community and in restructured hospitals to provide timely and appropriate management recommendations. It will also aid in counselling parents and caregivers. Although most co-morbidity characteristics are common for the syndrome, the prevalence of different morbidities can be region specific, hence it is useful to have recommendations tailored to suit local population. Here we share the clinical guideline for children and adults with Down Syndrome in Singapore.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46326837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1177/20101058221085742
S. Ho, K. Kuan
An 81-year-old man presented to the Emergency Department with shortness of breath, generalised weakness, numbness, giddiness, nausea and vomiting after consuming an inadequately prepared Traditional Chinese Medicine preparation that contained herbal aconitum (Chuanwu and Caowu). His electrocardiogram (ECG) and rhythm strips showed multiple runs of non-sustained ventricular tachycardia monomorphic ventricular tachycardia and slowed polymorphic ventricular tachycardia. He was treated with intravenous (IV) amiodarone, magnesium and lignocaine, and was started on IV noradrenaline after developing haemodynamic compromise. There was no digoxin detected in the blood and urine. At 12 h, aconitine was not detected in the blood (cut off at <1 ng/mL) but aconitine and hypaconitine was detected in the urine qualitatively. He underwent a coronary angiogram at 12 h post-admission which showed minor coronary artery disease. A formal echocardiogram showed left ventricular ejection fraction 50–55% with no regional wall motion abnormalities of the left ventricle. He made an uneventful recovery and reverted to normal sinus rhythm at 29 h of admission. He was discharged well on Day 4 of admission with a diagnosis of polymorphic ventricular tachycardia secondary to Aconitum poisoning.
{"title":"Management of a patient with polymorphic ventricular tachycardia from aconitum poisoning","authors":"S. Ho, K. Kuan","doi":"10.1177/20101058221085742","DOIUrl":"https://doi.org/10.1177/20101058221085742","url":null,"abstract":"An 81-year-old man presented to the Emergency Department with shortness of breath, generalised weakness, numbness, giddiness, nausea and vomiting after consuming an inadequately prepared Traditional Chinese Medicine preparation that contained herbal aconitum (Chuanwu and Caowu). His electrocardiogram (ECG) and rhythm strips showed multiple runs of non-sustained ventricular tachycardia monomorphic ventricular tachycardia and slowed polymorphic ventricular tachycardia. He was treated with intravenous (IV) amiodarone, magnesium and lignocaine, and was started on IV noradrenaline after developing haemodynamic compromise. There was no digoxin detected in the blood and urine. At 12 h, aconitine was not detected in the blood (cut off at <1 ng/mL) but aconitine and hypaconitine was detected in the urine qualitatively. He underwent a coronary angiogram at 12 h post-admission which showed minor coronary artery disease. A formal echocardiogram showed left ventricular ejection fraction 50–55% with no regional wall motion abnormalities of the left ventricle. He made an uneventful recovery and reverted to normal sinus rhythm at 29 h of admission. He was discharged well on Day 4 of admission with a diagnosis of polymorphic ventricular tachycardia secondary to Aconitum poisoning.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42515466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1177/20101058221083390
Hui Sin Cheng, Wilbert H H Ho, V. Poulose
We report a case of diabetic ketoacidosis (DKA), severe hypertriglyceridemia (HTG), and acute necrotizing pancreatitis in a previously healthy male who presented with epigastric pain. Transient HTG triggered by DKA was the likely cause of his acute pancreatitis (AP). On admission, his serum pancreatic enzymes were within normal limits. He was treated successfully with intravenous insulin therapy and volume resuscitation. This triad of DKA, HTG, and AP has rarely been reported in the literature, but not with normal enzyme levels. Persistent epigastric pain in a patient with DKA and severe HTG should warrant the consideration of AP, even if the pancreatic enzymes are within normal limits.
{"title":"Acute Necrotizing Pancreatitis Caused by Transient Hypertriglyceridemia in a Patient With DKA and Normal Serum Amylase and Lipase","authors":"Hui Sin Cheng, Wilbert H H Ho, V. Poulose","doi":"10.1177/20101058221083390","DOIUrl":"https://doi.org/10.1177/20101058221083390","url":null,"abstract":"We report a case of diabetic ketoacidosis (DKA), severe hypertriglyceridemia (HTG), and acute necrotizing pancreatitis in a previously healthy male who presented with epigastric pain. Transient HTG triggered by DKA was the likely cause of his acute pancreatitis (AP). On admission, his serum pancreatic enzymes were within normal limits. He was treated successfully with intravenous insulin therapy and volume resuscitation. This triad of DKA, HTG, and AP has rarely been reported in the literature, but not with normal enzyme levels. Persistent epigastric pain in a patient with DKA and severe HTG should warrant the consideration of AP, even if the pancreatic enzymes are within normal limits.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47752625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1177/20101058221097556
L. T. Lee, S. Hon, J. S. Chuah, Yu Jin Tee, Syed Omar Mohd Ibrahim
Base of penile abscesses are uncommon genitourinary tract infection. We present a case of a 31 years old man with poorly controlled diabetes mellitus, whom presented with scrotal pain and scrotal swelling for 1 week duration. Physical examination revealed a bulging mass at the base of penis. A high index of suspicion is needed to look for possible causes such as extension of abscess from perineum or anorectal, sexually transmitted disease, tuberculosis, history of penile instrumentation or injection and trauma. A large abscess at the base of penis was diagnosed by magnetic resonance imaging. He was successfully treated with transperineal incision and drainage, systemic antibiotic therapy, wound care and strict diabetic control. To the best of our knowledge, this is the first report of isolated base of penile abscess. The description of case, comprising the clinical presentation and management, is discussed in detailed with emphasis on the treatment approach.
{"title":"Spontaneous base of penile abscess successfully treated by transperineal incision and drainage: A case report","authors":"L. T. Lee, S. Hon, J. S. Chuah, Yu Jin Tee, Syed Omar Mohd Ibrahim","doi":"10.1177/20101058221097556","DOIUrl":"https://doi.org/10.1177/20101058221097556","url":null,"abstract":"Base of penile abscesses are uncommon genitourinary tract infection. We present a case of a 31 years old man with poorly controlled diabetes mellitus, whom presented with scrotal pain and scrotal swelling for 1 week duration. Physical examination revealed a bulging mass at the base of penis. A high index of suspicion is needed to look for possible causes such as extension of abscess from perineum or anorectal, sexually transmitted disease, tuberculosis, history of penile instrumentation or injection and trauma. A large abscess at the base of penis was diagnosed by magnetic resonance imaging. He was successfully treated with transperineal incision and drainage, systemic antibiotic therapy, wound care and strict diabetic control. To the best of our knowledge, this is the first report of isolated base of penile abscess. The description of case, comprising the clinical presentation and management, is discussed in detailed with emphasis on the treatment approach.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49603161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1177/20101058221106283
Jing Ying Lim, B. S. Wee, Marhazlina Mohamad, A. M. Mhd Jalil, M. Shahril, P. L. Lua
Background Metabolic syndrome (MetS) is defined as a cluster of risk factors for predicting type 2 diabetes mellitus and cardiovascular disease. Objectives This cross-sectional study aimed to develop a cut-off value for fat versus lean mass ratio (FLMR) in predicting MetS and to investigate the association between this indicator with MetS and its components. Methods Subjects comprised 238 Malay adolescents (79% female) aged 18–19 years old. Anthropometric assessment comprised weight, height and waist circumference (WC). Body composition was measured using bioelectrical impedance analysis techniques while blood pressure was measured using a blood pressure monitor. Fasting blood glucose, total cholesterol , triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol were determined from an overnight fasting blood sample. MetS was determined based on International Diabetes Federation (2007) definition for adolescents aged 16-year-old and above. Results The prevalence of MetS was 2.1%. Receiver Operating Characteristics curve analysis revealed that the optimal cut-off value for FLMR was 0.441 with an Area Under the Curve of 0.874 (95% CI: 0.825, 0.913); with sensitivity of 80.0% and specificity of 71.0%. FLMR cut-off of 0.441 was associated with high WC (p < .001), low HDL-c (p < .001) and MetS (p < .05). Binary Logistic Regression analysis revealed that adolescents with high WC, low HDL-c and MetS had higher odds of developing increased FLMR than the cut-off value with an odds ratio (OR) of 43.4 (95% CI: 9.7,193.9), 4.7 (95% CI: 2.3,9.8) and 13.3 (95% CI: 1.5,121.2), respectively. Conclusion FLMR possesses fair discriminatory ability in identifying MetS among adolescents and significant association exists between FLMR and MetS and some of its components.
{"title":"Fat-to-lean mass ratio as a new anthropometric indicator in predicting metabolic syndrome among Malay adolescents in Terengganu, Malaysia","authors":"Jing Ying Lim, B. S. Wee, Marhazlina Mohamad, A. M. Mhd Jalil, M. Shahril, P. L. Lua","doi":"10.1177/20101058221106283","DOIUrl":"https://doi.org/10.1177/20101058221106283","url":null,"abstract":"Background Metabolic syndrome (MetS) is defined as a cluster of risk factors for predicting type 2 diabetes mellitus and cardiovascular disease. Objectives This cross-sectional study aimed to develop a cut-off value for fat versus lean mass ratio (FLMR) in predicting MetS and to investigate the association between this indicator with MetS and its components. Methods Subjects comprised 238 Malay adolescents (79% female) aged 18–19 years old. Anthropometric assessment comprised weight, height and waist circumference (WC). Body composition was measured using bioelectrical impedance analysis techniques while blood pressure was measured using a blood pressure monitor. Fasting blood glucose, total cholesterol , triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol were determined from an overnight fasting blood sample. MetS was determined based on International Diabetes Federation (2007) definition for adolescents aged 16-year-old and above. Results The prevalence of MetS was 2.1%. Receiver Operating Characteristics curve analysis revealed that the optimal cut-off value for FLMR was 0.441 with an Area Under the Curve of 0.874 (95% CI: 0.825, 0.913); with sensitivity of 80.0% and specificity of 71.0%. FLMR cut-off of 0.441 was associated with high WC (p < .001), low HDL-c (p < .001) and MetS (p < .05). Binary Logistic Regression analysis revealed that adolescents with high WC, low HDL-c and MetS had higher odds of developing increased FLMR than the cut-off value with an odds ratio (OR) of 43.4 (95% CI: 9.7,193.9), 4.7 (95% CI: 2.3,9.8) and 13.3 (95% CI: 1.5,121.2), respectively. Conclusion FLMR possesses fair discriminatory ability in identifying MetS among adolescents and significant association exists between FLMR and MetS and some of its components.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48961031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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