Prevalence of abnormal cranial CT scan in Nontraumatic headache patients with red flag symptoms at the emergency department in Hospital Universiti Sains Malaysia.

INTRODUCTION: Data on the prevalence of nontraumatic headaches with red flag symptoms in Asia are sparse. Therefore, the objectives of this study were to determine the final diagnosis and prevalence of abnormal CT scans in patients who presented to the emergency department (ED) with red flag symptoms. MATERIALS AND METHODS: This was a retrospective study based on the Radiology Department database of patients who presented to the ED with complaints of nontraumatic headache, had red flag symptoms, and underwent cranial CT scans. The inclusion criteria were adult patients presenting through the ED with nontraumatic headache who underwent cranial CT scans. Multivariate analysis was performed based on logistic regression to analyse the significance of the predictive value for abnormal CT scans. RESULTS: A total of 216 patients underwent cranial CT scans in the ED. More than half of the cases (53.7%) were male. A total of 146 patients (67.6%) had no obvious abnormalities in the CT scans, while 41 patients (19.0%) had cranial infarction, 9 patients (4.2%) had intracranial bleeding, and 20 patients (9.3%) had brain tumours. The most common diagnosis was primary headache syndrome, followed by cerebral vascular accident (CVA). Multivariate analysis showed that three factors were associated with abnormal CT scans: age, systolic blood pressure (SBP), and mean arterial pressure (MAP). New onset of headache at the age of 50 years or older (Odds Ration, OR 3.21, 95% Confidence Interval, CI 1.15, 8.94), SBP (OR 4.82. 95%CI 2.29, 10.40) and MAP (OR 6.21, 95%CI 2.71, 14.70) were significant. CONCLUSION: The prevalence of abnormal CT scan findings in nontraumatic headache patients with red flag symptoms was 32%. Primary headache syndrome is the most common diagnosis. An age greater than 50 years old during the onset of headache, SBP greater than 180mmHg and MAP greater than 120mmHg were associated with a higher risk of abnormal cranial CT scans.

Elephant attack - A rare case of survival.

Conflict of human-wild elephant is not uncommon in Malaysia. Most of the human victims usually succumb to death due to internal organ injuries. Here we report a case of a woman who was the victim of an elephant attack and successfully survived to share our experience in managing this type of polytrauma.

Management of prediabetes in Malaysian population: An experts' opinion.

INTRODUCTION: Prediabetes, typically defined as blood glucose levels above normal but below diabetes thresholds, denotes a risk state that confers a high chance of developing diabetes. Asians, particularly the Southeast Asian population, may have a higher genetic predisposition to diabetes and increased exposure to environmental and social risk factors. Malaysia alone was home to 3.4 million people with diabetes in 2017; the figure is estimated to reach 6.1 million by 2045. Developing strategies for early interventions to treat prediabetes and preventing the development of overt diabetes and subsequent cardiovascular and microvascular complications are therefore important. METHODS: An expert panel comprising regional experts was convened in Kuala Lumpur, for a one-day meeting, to develop a document on prediabetes management in Malaysia. The expert panel comprised renowned subject-matter experts and specialists in diabetes and endocrinology, primary-care physicians, as well as academicians with relevant expertise. RESULTS: Fifteen key clinical statements were proposed. The expert panel reached agreements on several important issues related to the management of prediabetes providing recommendations on the screening, diagnosis, lifestyle and pharmacological management of prediabetes. The expert panel also proposed changes in forthcoming clinical practice guidelines and suggested that the government should advocate early screening, detection, and intensive management of prediabetes. CONCLUSION: This document provides a comprehensive approach to the management of prediabetes in Malaysia in their daily activities and offer help in improving government policies and the decision-making process.

DiabCare 2013: A cross-sectional study of hospital based diabetes care delivery and prevention of diabetes related complications in Malaysia.

AIMS: The aim of the study was to re-evaluate the relationship between hospital based diabetes care delivery and prevention of complications. METHODS: DiabCare is an observational, non-interventional, cross-sectional study of hospital-based outpatient diabetes care. RESULTS: A total of 1668 patients participated in the study: mean age 57.8 ± 11.0 years, duration of diabetes 13.0 ± 8.6 years, and duration of insulin treatment 5.6 ± 5.5 years. Mean weight was 74.3 ± 16.6 kg (BMI 29.1 ± 5.8 kg/m2). The majority of patients were female (53.6%) and the largest ethnic group was Malay (51.3%), followed by Indian (21.9%) and Chinese (20.1%). The percentage of patients with HbA1c < 6.5% (< 42 mmol/mol) and < 7.0% (< 53 mmol/mol) was 12.2% and 23.8%, respectively (mean HbA1c 8.52 ± 2.01% [70 ± 22 mmol/mol]). The proportion of patients using insulin was 65% at a total daily dose of 60 ± 37 IU. One or more episodes of hypoglycaemia were reported by 39% (n=658) of patients within the previous three months. The risk of any hypoglycaemia was associated with the use of insulin (odds ratio [OR 3.26, 95% CI 2.59-4.09]), and total daily insulin dose (OR 1.04, 95% CI 1.01-1.07 per 10 IU increase). Mean HbA1c had not changed significantly between DiabCare cohorts 2008 and 2013 (p=0.08). CONCLUSIONS: Despite evidence of improving processes of diabetes care, glycaemic control and the prevalence of many diabetes related complications were unchanged.

The status of diabetes control in Malaysia: results of DiabCare 2008.

DiabCare Malaysia 2008 evaluated the current status of diabetes care in Malaysia as a continuation of similar cross-sectional studies conducted previously in 1997, 1998, 2001 and 2003. The current study recruited 1670 patients from general hospitals, diabetes clinics and referral clinics to study current scenario of diabetes management. We report the results of type 2 diabetic population who constituted 92.8% (n = 1549). Results showed deteriorating glycaemic control with mean HbA1c of 8.66 +/- 2.09% with only 22% of the patients achieving ADA target of < 7%. 80.3% of patients were hypertensive and 75% were on anti-hypertensive medication. 46% of patients had LDL levels > 2.6 mmol/L; 19.8% had triglycerides > 2.2 mmol/L; 27.4% had HDL < 1 mmol/L despite 85% of the patients being on lipid lowering agents. Microvascular, macrovascular and severe late complications were reported in 75%, 28.9% and 25.4% patients respectively. The rates of diabetic complications were cataract 27.2%, microalbuminuria 7%, neuropathy symptoms 45.9%, leg amputation 3.8% and history of angina pectoris was 18.4%. Quality of life evaluation showed that about one third of patients have poor quality of life. Also, there was poor adherence to diet, exercise and self testing of blood glucose. In conclusion, majority of the patients were still not satisfactorily controlled. There is an urgent need for effective remedial measures to increase adherence to practice guidelines and to educate both patients and healthcare personnel on importance of achieving clinical targets for metabolic control.

Diabetes control and complications in public hospitals in Malaysia.

The Diabcare-Asia project was initiated to study the status of diabetes care and prevalence of diabetic complications in Asia and this study was done to evaluate the above in public hospitals in Malaysia and compare to a similar study done in 1998. A total of 19 public hospitals participated in this study from which a total of 1099 patients were included and analysed. The majority of patients (94.8%) had type 2 diabetes mellitus and 66.5% were overweight or obese. As for glycaemic control only 41.0% of the patients had HbA1c < 7% and 18% had FPG < 6.1 mmol/L. As for lipid levels, only 32.0% of the patients had total cholesterol < 4.8 mmol/L; 59.6% had HDL-cholesterol > 1.1 mmol/L and 51.1% had triglycerides < 1.7 mmol/L. Despite the high proportion of patients having dyslipidaemia, only 52.8% of the patients were on lipid lowering therapy. As for blood pressure, 15.0% of the patients had blood pressure < 130/80 mmHg. Although 75.9% of the patients were on antihypertensive medication only 11.3% had blood pressure < 130/80 mmHg. Only 54.8% of patients admitted to adhering to a diabetic diet regularly and 38.9% exercised regularly. As for glucose monitoring, only 26.8% of the patients did home blood glucose monitoring and 1.8% did home urine glucose testing. There was also a high complication rate with the commonest being neuropathy (19.0%) followed by albuminuria (15.7%), background retinopathy (11.1%) and microalbuminuria (6.6%). Compared to the 1998 study, there was some improvement in the percentage of patients achieving target levels and a reduction in the prevalence of complications. In conclusion, the majority of diabetic patients treated at the public hospitals were still not satisfactorily controlled and this was still associated with a high prevalence of complications. There is still an urgent need to educate both patients and health care personnel on the importance of achieving the clinical targets and greater effort must be made to achieve these targets.

Correlation between fasting plasma glucose, post prandial glucose and glycated haemoglobin and fructosamine.

This study was done to determine the correlation between glucose monitoring by fasting blood glucose or 2 hours postprandial blood glucose with HbA1c and fructosamine in type 2 diabetic patients. A total of 82 patients from the Primary Care Clinic were enrolled in the study. Fasting blood was drawn for fasting plasma glucose (FPG), glycated haemoglobin (HbA1c) and fructosamine. Two hours after a standard breakfast, blood was again drawn for prandial plasma glucose (PPG). Both PPG and FPG significantly correlated with both HbA1c and fructosamine but PPG showed better correlation to HbA1c than FPG (r= 0.604 vs.0.575) whereas that of FPG and PPG were equally correlated to fructosamine (r= 0.566 vs. 0.551). In predicting good glycaemic control (HbA1c < 7.0%), the sensitivity, specificity and positive predictive value of PPG were 75.0%, 80.6% and 82.5% whereas FPG were 81.8%, 58.3% and 70.6% respectively. These results show that PPG correlated better than FPG to HbA1c and both equally correlated to fructosamine levels. Thus, PPG predicted overall glycaemic control better than FPG. Compared to HbA1c, fructosamine correlated least well with mean glucose profiles. Hence, using HbAlc in monitoring overall glycaemic control is better than fructosamine.

Diabetes control and complications in private primary healthcare in Malaysia.

This Diabcare-Asia project was initiated to study the status of diabetes care and prevalence of diabetic complications in Asia and this study was done to evaluate the above in primary private healthcare in Malaysia. A total of 49 private clinics participated in this study from which a total of 438 patients were included and analysed. The majority of patients (96.5%) had type 2 diabetes mellitus and 81.4% had BMI > or =23 kg/m2. Only 12.0% of the patients had their HbA1c measured in the preceding 12 months. As for glycaemic control only 20% of the patients had HbA1c <7% and 11% had FPG < 6.7 mmol/L. As for lipid levels, only 12.3% of the patients had total cholesterol < 4.8 mmol/L; 30.9% had HDL-cholesterol > 1.2 mmol/L and 49.8% had triglycerides < 1.7 mmol/L. Despite the high proportion of patients having dyslipidaemia. only 12.4% of the patients were on lipid lowering therapy. As for blood pressure, 55.9% of the patients had systolic pressure > or =140 mmHg and 40.9% had diastolic pressure > or =90 mmHg. However, only 32.4% of the patients were on antihypertensive medication. Only 37.4% of the patients admitted to adhering to diabetic diet regularly and 32.0% exercised regularly. As for glucose monitoring only 6.9% of the patients did home blood glucose monitoring and 6.2% did home urine glucose. There was also a high complication rate with the commonest being neuropathy (30.1%) followed by background retinopthy (23.5%), albuminuria (22.9%) and microalbuminuria (20.4%). In conclusion, the majority of diabetic patients treated at the primary care level were not satisfactorily controlled and this was associated with a high prevalence of complications. There is an urgent need to educate both patients and health care personnel on the importance of achieving the clinical targets and greater effort must be made to achieve these targets.

Does the use of mean or median Z-score of the thyroid volume indices provide a more precise description of the iodine deficiency disorder status of a population?

Endemic iodine deficiency is largely an environmental problem affecting whole populations. Currently, thyroid volume data from a population are analyzed with the sole objective of obtaining an estimate of goitre prevalence using +97th percentile or +2 standard deviations of an appropriate reference as cut-off. This paper proposes an alternative approach to the analysis and presentation of thyroid volume data using Z-scores (standard deviation scores) of the thyroid volume indices such as thyroid volume-for-age or thyroid volume-for-body surface area. The calculation of the summary statistics of the Z-scores, such as mean or median, provides an alternative to the prevalence-based approach for expressing severity of iodine deficiency disorders (IDD). An advantage of the mean or median Z-score is that it describes the thyroid volume profile (and therefore the IDD status) of the entire population directly, unlike goitre prevalence which gives information only about the extremes of distribution. The frequency curve or histogram of the Z-scores provides a complete picture of the whole distribution. Although qualitatively similar conclusions on IDD severity can be drawn from both analytical approaches, only the Z-score system is able to capture adequately the trends or changes in thyroid size over time, and to establish whether a previously iodine-deficient community's thyroid volume profile has returned to 'normal' (as indicated by a distribution that is not significantly different from that of the reference) following intervention. As a continuous variable, Z-scores are particularly useful for the analysis of data from populations where the sample size is relatively small, or where many individuals lie outside the extreme percentiles of the reference population. In view of its advantages in the context of activities based on single and multiple measurements, the Z-score system is to be preferred for the reporting and use of thyroid volume indices. A desirable consequence of this preference is that national goals will be oriented towards an improvement of the overall thyroid volume profile of the population, rather than just a reduction of the number of individuals at the extremes.

Repaglinide versus glibenclamide treatment of Type 2 diabetes during Ramadan fasting.

This study compared treatment with a prandial glucose regulator (repaglinide) and a sulphonylurea (glibenclamide) in Muslim Type 2 diabetic patients who practice Ramadan fasting. Two hundred and thirty-five patients, previously treated with a sulphonylurea, were randomised to receive either repaglinide (n=116, preprandially three-times daily) or glibenclamide (n=119, preprandially once- or twice-daily) 6 weeks before Ramadan. During Ramadan, patients changed their eating pattern to two meals daily, and the daily dose of repaglinide was redistributed to two preprandial doses. After Ramadan, patients resumed their regular meal pattern and treatment dosage for 4 weeks. During Ramadan, a statistically significant reduction in mean serum fructosamine concentration from baseline was observed in the repaglinide group (-16.9+/-4.9 micromol/l, -3.8%, P<0.05) but not the glibenclamide group (-6.9+/-4.8 micromol/l, -0.8%). Difference in change in HbA(1c) from baseline was not statistically significant between groups. The number of hypoglycaemic events with midday blood glucose <4.5 mmol/l was significantly lower in the repaglinide group (2.8%) than the glibenclamide group (7.9%) (P=0.001). Apart from hypoglycaemia, both treatments were equally well tolerated. Type 2 diabetic Muslims using prandial repaglinide showed a trend towards better glycaemic control and had a lower frequency of hypoglycaemia than patients using glibenclamide during Ramadan.

Efficacy and safety of single versus multiple daily doses of glibenclamide in type 2 diabetes mellitus.

Although long acting, glibenclamide is frequently given in split doses for type 2 diabetes mellitus. This may discourage compliance. It is thus appropriate to consider dosing it less frequently. We therefore studied glibenclamide effects when used once daily and when used in split doses. Our objective was to assess the feasibility of using once daily dosing as a regimen of choice. We measured plasma glucose, insulin, glibenclamide, lipids, HbAl and body mass index associated with the regimens. We also compared the number of hypoglycemic episodes occurring with them. Thirty type 2 diabetics on multiple daily glibenclamide were enrolled. Their regimens were changed over to once daily. Blood for glucose, insulin, lipids, HbAl and glibenclamide and body weight measurements were determined before and after the crossover period. We found no major difference in the sugar and insulin profiles with the two regimens. Fasting total cholesterol and triglyceride were also similar and so were plasma glibenclamide. The HbAl levels and body mass index and number of minor and major hypoglycemic episodes and hospital admissions for hypoglycemia also did not differ. We conclude that single daily dosing of glibenclamide was equivalent to multiple daily dose regimens. It can be used to an advantage to improve patient's compliance.

Generalised lipodystrophy.

We report a Malay girl suffering from generalised lipodystrophy, with clinical features of absence of body adipose tissue, hepatomegaly, hyperpigmentation and muscular hypertrophy. She also had hyperlipaemia, hypercholesterolemia and non-ketotic insulin-resistant diabetes mellitus. The possibility of malnutrition-related diabetes mellitus was excluded because of (a) no personal or family history of malnutrition (b) no pancreatic calcification (c) total loss of subcutaneous fat and (d) her requirement for insulin was more than 21.2 units/kg body weight which would be too high even for malnutrition-related diabetes mellitus. Attempts were made to control her diabetes initially with subcutaneous boluses insulin, then continuous intravenous insulin infusion (CIVII) and finally orally with fenfluramine and chlorpropamide.

Urinary iodine excretion in the northeast of Peninsular Malaysia.

A total of 2,034 subjects aged 15 years and above from different parts of the State of Kelantan were studied to determine goiter size and urinary iodine excretion. The State was divided into 2 areas - area 1 consisting of localities in the districts near the coast and area 2 consisting of localities in the inland districts. There were 1,050 subjects in area 1 and 984 subjects in areas 2. The mean age (+/- SE) of subjects in areas 1 and 2 were 38.2 + 0.5 and 37.1 +/- 0.5 years, respectively. The prevalence of goiter was 31.4% in area 1 and 45.0% in area 2; the difference was statistically significant (p < 0.05). However, the prevalence of large and visible goiters (grades II and III) was only 2.0% in area 1 and 3.3% in area 2; the difference was not statistically significant. The mean (+/- SD) urinary iodine excretion in areas 1 and 2 was 57.1 +/- 2.1 and 56.8 +/- 2.1 micrograms I/g Cr, respectively. The values were below those recommended by WHO. There was no significant difference in urinary iodine excretion between those with and without goiters in both areas and also between the grades of goiters. There were significantly more females with goiters than males in both areas but there was no significant difference in the urinary iodine excretion between the 2 sexes. Thus based on urinary iodine excretion, the iodine intake of the population in this area, was suboptimal and this was associated with a high prevalence of goiter.

Prevalance of obesity and overweight in northeastern peninsular Malaysia and their relationship with cardiovascular risk factors.

Height and body weight were measured in 2,284 subjects over 20 years old. The subjects were chosen by cluster sampling in 9 districts of Kelantan. Blood was drawn after an overnight fast for measurement of cholesterol (chol), triglyceride (TG), VLDL and HDL-Chol. Oral glucose tolerance test was performed with 75 g glucose. The overall prevalence of overweight [BMI (kg/m2) > or = 25-< or = 30] and obesity (BMI > 30) was 21.3% and 4.5% respectively. The overweight and obese were significantly younger than the lean subjects. The prevalence of hypercholesterolemia (chol > 5.2 mmol/l) in lean, overweight and obese subjects was 65.3%, 70.2% and 74.7%, respectively. Impaired glucose tolerance was found in 16.6% of the lean, 21.6% of the overweight and 32.0% of the obese subjects. Diabetes mellitus was found in 7.9% of the lean, 10.5% of the overweight and 6.7 of the obese subjects. 10.1% of lean, 13.2% of overweight and 23.3% of obese individuals were hypertensive. In conclusion, the high prevalence of overweight and obesity in Malaysia was associated with adverse lipid and glucose metabolism as well as poor blood pressure control.

Diabetes mellitus and associated cardiovascular risk factors in north-east Malaysia.

Two thousand five hundred and eight subjects from the state of Kelantan in North-East Peninsular Malaysia were included in this study to determine the prevalence of diabetes mellitus and impaired glucose tolerance and their association with cardiovascular risk factors. The overall prevalence of diabetes mellitus was 10.5% and impaired glucose tolerance was 16.5%. There was no difference in the prevalence of diabetes mellitus between males and females but the prevalence of impaired glucose tolerance was higher in females (19.0%) than in males (11.5%). Subjects with diabetes mellitus were more obese (38.4%) than normal subjects (24.1%). They also had a higher prevalence of hypertension (12.9%) and hypercholesterolaemia (71.9%) than normal subjects. Subjects with impaired glucose tolerance also had a higher prevalence of obesity (35.5%), hypertension (9.0%) and hypercholesterolaemia (63.0%) than normal subjects. In conclusion, the prevalence of diabetes mellitus and impaired glucose tolerance was high and they were associated with a high prevalence of obesity, hypertension and hypercholesterolaemia.

Profile of extracranial cerebrovascular disease in Kelantan: a study by continuous wave Doppler ultrasonography.

The present study outlines the clinical profile and patterns of extracranial vascular abnormalities detected by continuous wave doppler ultrasonography (CWDU) in 100 patients with cerebrovascular insufficiency states. Males outnumbered females (65:35); completed stroke (CS) was a more common mode of presentation than transient ischaemic attacks (TIA); carotid strokes were more common than vertebro-basilar ones; and hypertension was the most common predisposing factor. The CWDU evaluation revealed extracranial vascular disease in 73% of patients. Vascular occlusions were more common in patients with TIA. Overall, 33% of the patients had evidence of proximal obstruction of the cerebral vessels below the neck. The clinical prediction of vascular territory (carotid or vertebro-basilar) matched with the findings on CWDU, but evidence of subclinical multiple-vessel involvement could be detected in 48% of the patients.

Hypertension and associated cardiovascular risk factors in Kelantan.

Two thousand five hundred and eight subjects from the state of Kelantan in North-East Peninsular Malaysia were included in this study to determine the prevalence of hypertension and their association with cardiovascular risk factors. The overall prevalence of hypertension was 13.9%. There was no difference in the prevalence of hypertension between the males and females. The prevalence increased with age--the highest being in those above 70-years old. Subjects with hypertension also had a higher prevalence of diabetes mellitus (19.0%), obesity (39.4%) and hypercholesterolaemia (70.7%) than non-hypertensive subjects. Of the hypertensive subjects, 83.3% had 1 other risk factor for cardiovascular disease, 66.7% had 2 other risk factors and 16.7% had more than 2 risk factors. Other than age, body mass index, plasma glucose, total cholesterol and LDL-cholesterol, hypertensive subjects also had a higher mean serum urea, creatinine, uric acid and triglyceride than non-hypertensive subjects. In conclusion, hypertension is a common disease in this area and is associated with multiple risk factors for cardiovascular disease. The prevalence is likely to increase in the near future with increasing affluence and becoming a major health problem.

Non-achievement of clinical targets in patients with type 2 diabetes mellitus.

The study was conducted to determine whether the clinical targets for the control of diabetes recommended by American Diabetes Association can be met in the context of routine diabetes practice. This cross-sectional study was undertaken on 211 type 2 diabetic patients at the Outpatients Diabetes Clinic, Hospital Universisti Sains Malaysia (HUSM) Kubang Kerian, Kelantan between the year 2001-2002. Patients' physical examination and their medical history as well as their family history were obtained by administering a structured questionnaire. Samples of patients' venous blood during fasting were taken and analysed for plasma glucose, glycated haemoglobin and lipid profile. Analysis showed that many patients had comorbidities or complications. A large number of them had poor glycaemic control (73%). Systolic and diastolic blood pressures of 75% and 85% subjects were > or = 130 and > or = 80 mmHg, respectively. Body Mass Index (BMI) values of 66% of the patients were outside the clinical target (BMI > or = 25 in male and > or = 24 kg/m2 in female). The lipid profile showed that 96% of the patients had at least one lipid value outside the clinical target level. In this study, 70% of the patients had total cholesterol > or = 5.2 mmol/L, 87% had LDL cholesterol > or = 2.6 mmol/L, 57% had HDL cholesterol less than the normal range, < or = 1.15 mmol/L in men and < or = 1.4 mmol/L in women, while 46% had triglycerides > or = 1.71 mmol/L. Complications of diabetes were observed in 48% of the total number of patients. As for the patients' systolic blood pressure, age and duration of diabetes were found to have significant effects. Older subjects with a longer duration of diabetes were more hypertensive. Variables that had significant effects on BMI were age, duration of diabetes, glycaemic control and gender. Younger females and newly diagnosed subjects with better glycaemic control (A1C < 7%) were found to have higher BMI values. The overall clinical targets were suboptimal. The prevalence of hyperlipidaemia and hypertension was high. It is imperative that better treatment strategies and methods be adopted to enhance diabetes control and reduce long-term complications of the disease.

Carcinoma of thyroid--clinical presentation and outcome.

The clinical, biochemical and pathological features of 31 patients with thyroid carcinoma managed at Hospital Universiti Sains Málaysia, Kubang Kerian from 1985 to 1989 were analyzed. There were 25 females and 6 males. The types of carcinoma were: papillary-17 cases; follicular-10 cases; medullary-2 cases and anaplastic-2 cases. For papillary carcinoma the mean age of the patients was 52.9 years. For follicular carcinoma the mean age was 48.3 years, for medullary carcinoma, 48.5 years and for anaplastic, 74.5 years. All patients had pre-existing goitre except for 2 and most presented with advanced disease. The mean duration of symptoms for papillary carcinoma was 3.7 years, follicular carcinoma 1.6 years, medullary carcinoma 13.5 years and anaplastic carcinoma 6 months. 12 patients presented with goitre of increasing size; 9 had compression symptoms; 4 presented with cervical lymph node enlargement and 6 presented with bony pains of whom 2 had paraplegia. None of the patients were ever thyrotoxic or hypothyroid. Treatment in general was unsatisfactory because of patients' non-acceptance of surgery and/or radioactive iodine.

The effect of pravastatin in patients with primary hyperlipidaemia.

Thirty-four (34) subjects with primary hyperlipidaemia were enrolled for this study. After low fat dietary therapy for 6 weeks, subjects' whose serum total cholesterol fell to below 6.2 mmol/l (11 subjects) were excluded from the study and those whose serum total cholesterol were 6.2 mmol/l or more (23 subjects) were started on pravastatin 10 mg nocte. After 8 weeks of treatment, there was a significant decrease in the mean total cholesterol and LDL-cholesterol. However 13 of the subjects still had serum total cholesterol 6.2 mmol/l or more and their pravastatin dose was increased to 20 mg nocte. After 12 weeks, there was a significant reduction in triglyceride, total cholesterol and LDL-cholesterol. There was also a significant increase in HDL-cholesterol. The triglyceride fell by a mean of 15.7%, total cholesterol by a mean of 18.1% and LDL-cholesterol by a mean of 26.3%. HDL-cholesterol on the other hand, increased by 19.4%. The subjects whose total cholesterol fell below 6.2 mmol/l at week 8 had significantly lower total cholesterol to begin with than those whose total cholesterol failed to do so and hence were commenced on 20 mg pravastatin. This suggests that the optimum dose of the drug is dependent on the initial level of total cholesterol. We conclude that pravastatin is effective as a lipid lowering agent.