1.Malignant Melanoma of the Foot in Patients with Diabetes Mellitus – A Trap for the Unwary
Paisal Hussin ; Seng Cheong Loke ; Fatimah Mohd Noor ; Maliza Mawardi ; Vivek Ajit Singh
The Medical Journal of Malaysia 2012;67(4):422-423
Melanomas on the foot are difficult to differentiate from
diabetic foot ulcers (DFU). In particular, acral lentiginous and amelanotic melanomas have a high chance of being misdiagnosed. We present two patients with diabetes
mellitus and malignant melanomas of the foot initially
diagnosed as DFU. Both cases were treated with wide
excision amputation and local dissection, without adjuvant
chemotherapy or radiotherapy. Both patients remain
disease-free up to the last follow-up visit. It is important to maintain a high index of suspicion and a skin biopsy should be done in any DFU with atypical features.
2.Metabolic control in type 2 diabetes correlates weakly with patient adherence to oral hypoglycaemic treatment.
Seng Cheong LOKE ; Michelle JONG
Annals of the Academy of Medicine, Singapore 2008;37(1):15-20
INTRODUCTIONPatient adherence to treatment is viewed as essential to good metabolic control in diabetes. Our primary objective was to determine if self-reported patient adherence correlated strongly with metabolic control. Our secondary objective was to determine the natural grouping of factors which influence adherence.
MATERIALS AND METHODSData were collected using a questionnaire set with 5-point Likert scales. Primary analysis was done using Spearman's correlation coefficient between self-reported composite adherence scores and HbA1c. Secondary analysis was done using exploratory factor analysis.
RESULTSThe primary analysis suggests that patient adherence to the treatment regime is weakly correlated to metabolic control. Calculated Spearman's rho was 0.197, with a two-tailed P value of 0.027. The secondary analysis demonstrates the natural clustering of factors that influence patient adherence to treatment. A 6-factor solution was found to account for most of the variance in the data. We also found that feelings of frustration, anxiety, and depression were associated with a lack of knowledge about diabetes treatment. In addition, belief in traditional medicine correlated strongly with ethnicity.
CONCLUSIONA good treatment regime for type 2 diabetes mellitus influences metabolic outcome far more than patient adherence.
Administration, Oral ; Adult ; Aged ; Diabetes Mellitus, Type 2 ; drug therapy ; metabolism ; Factor Analysis, Statistical ; Female ; Glycated Hemoglobin A ; drug effects ; Humans ; Hypoglycemic Agents ; administration & dosage ; Male ; Middle Aged ; Patient Compliance ; Surveys and Questionnaires ; Treatment Outcome
3.Efficacy of an intravenous calcium gluconate infusion in controlling serum calcium after parathyroidectomy for secondary hyperparathyroidism.
Seng Cheong LOKE ; Ravindran KANESVARAN ; Rosnawati YAHYA ; Liza FISAL ; Teck Wee WONG ; Yik Yee LOONG
Annals of the Academy of Medicine, Singapore 2009;38(12):1074-1080
INTRODUCTIONIntravenous calcium gluconate has been used to prevent postoperative hypocalcaemia (POH) following parathyroidectomy for secondary hyperparathyroidism in chronic kidney disease (CKD).
MATERIALS AND METHODSRetrospective data were obtained for 36 patients with CKD stage 4 and 5 after parathyroid surgery, correlating albumin-corrected serum calcium with the infusion rate of calcium gluconate. Calcium flux was characterised along with excursions out of the target calcium range of 2 to 3 mmol/L. With this data, an improved titration regimen was constructed.
RESULTSMean peak efflux rate (PER) from the extracellular calcium pool was 2.97 mmol/h occurring 26.6 hours postoperatively. Peak calcium efflux tended to occur later in cases of severe POH. Eighty-one per cent of patients had excursions outside of the target calcium range of 2 to 3 mmol/L. Mean time of onset for hypocalcaemia was 2 days postoperatively. Hypocalcaemia was transient in 25% and persistent in 11% of patients.
CONCLUSIONA simple titration regimen was constructed in which a 10% calcium gluconate infusion was started at 4.5 mL/h when serum calcium was <2 mmol/L, then increased to 6.5 mL/h and finally to 9.0 mL/h if calcium continued falling. Preoperative oral calcium and calcitriol doses were maintained. Blood testing was done 6-hourly, but when a higher infusion rate was needed, 4-hourly blood testing was preferred. Monitoring was discontinued if no hypocalcaemia developed in the fi rst 4 days after surgery. If hypocalcaemia persisted 6 days after surgery, then the infusion was stopped with further monitoring for 24 hours.
Adult ; Aged ; Calcium ; blood ; Calcium Gluconate ; administration & dosage ; Female ; Humans ; Hyperparathyroidism, Secondary ; surgery ; Hypocalcemia ; prevention & control ; Infusions, Intravenous ; Male ; Middle Aged ; Parathyroidectomy ; Retrospective Studies