Objective: To quantify the extent of hyperlipidemia and its treatment in patients with stable coronary heart disease (CHD) or an acute coronary syndrome (ACS) in the Philippines. Methods: The Dyslipidemia International Study (DYSIS) II was an observational, multinational study conducted in patients aged ≥18 years with stable CHD or being hospitalized with an ACS. A full lipid profile was evaluated at baseline, and for the ACS cohort, at 4 months after discharge from hospital. Achievement of low-density lipoprotein cholesterol (LDL-C) targets and the use of lipid-lowering therapy (LLT) were assessed. Results: A total of 232 patients were enrolled from 10 centers in the Philippines, 184 with stable CHD and 48 being hospitalized with an ACS. The mean LDL-C level for the CHD patients was 88.0±40.1 mg/dL, with 33.3% achieving the target of <70 mg/dL recommended for very high-risk patients. For the ACS cohort, the mean LDL-C level was 109.0±48.5 mg/dL, with target attainment of 25.0%. The majority of the CHD cohort was being treated with LLT (97.3%), while 55.3% of the ACS patients were receiving LLT prior to hospitalization, rising to 100.0% at follow-up. There was little use of non-statins. Conclusions For these very high-risk patients from the Philippines, LDL-C target attainment was poor. Opportunities for better monitoring and treatment of these subjects are being missed.
Cholesterol ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Coronary Disease ; Acute Coronary Syndrome ; Myocardial Infarction

CASE SUMMARY: A 41-year-old female, presented with a four-week history of blurring of vision with progressive bilateral visual failure accompanied by headache.Cranial MRI showed a sellar/suprasellar tumoral mass lesion measuring 6.2 x 5.3 x 6.8 cm extending to the basal frontal lobes, sphenoid sinus, planum sphenoidale, midbrain, pons, left cerebellar hemisphere, left side of vermis with extrinsic compression on the optic chiasm and 3rd ventricle producing obstructive hydrocephalus. Her serum prolactin was markedly elevated at 46,520 mg/mL. Treatment was started withbromocriptine 2.5 mg/tab at bedtime, increasing to 2.5 mg/tab every 8 hours.One week after discharge, patient was admitted because of cerebrospinal fluid (CSF) rhinorrhea and bacterial meningitis. She was treated with antibiotics and underwent packing of the sphenoid sinus. There was a recurrence of the CSF leak one week after packing, which then resolved spontaneously. The MRI scan performed after four months of bromocriptine therapy revealed a decrease in size of the sellar/suprasellar mass now measuring 4.3 x 3.7 x 5.2 cm and a significant drop in the prolactin level at 6.55 ng/mL.
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Background: Hyperthyroid patients are commonly given antithyroid drugs as treatment or as preparation for a more definitive therapy such as radioactive iodine or surgery. Among the side effects of antithyroid drugs, the rare occurrence of agranulocytosis (less than 1 percent) is the most feared for this has a mortality rate as high as 21.5 percent. Objective: To compare the severity of agranulocytosis among patients on antithyroid drugs; to describe the clinical profile of patients with agranulocytosis; and to compare the clinical factors based on the levels of absolute neutrophil counts (ANC). Methodology: Retrospective, descriptive analysis of records of patients with antithyroid drug-induced agranulocytosis (ANC 37 ANC 192 vs 679, p=0.41). Slightly higher ANC was seen among well nourished individuals than those who were underweight (ANC 569 vs 194, p=0.54). Patients on propylthiouracil had severe agranulocytosis than those taking imidazole compounds (ANC=174 vs 31, p=0.38). PTCI above 300 mg/day was significantly correlated to lower levels of ANC (ANC=71 vs 380, p=0.023). Statistically low ANC counts were seen among those who died (ANC=24 vs 504, p=0.011). The use of G-CSF improved the outcome of patients with agranulocytosis (p-value .035). Conclusion: PTG >300mg/d was correlated to agranulocytosis. Mean ANC of 24 was correlated to poor outcome. The use of G-CSF improved the outcome of agranulocytosis.

Objective Graves' disease, due to rapid metabolism of the iodine tracer may yield low radioiodine uptake. Lithium, through lithium-induced blockade of RAI and thyroid hormone release with no concomitant effect on thyroidal RAI uptake, is a potential adjuvant in radioactive iodine therapy in Graves' disease with low uptake. This study aims to report a case of Graves' disease who had improvement of RAI uptake and scan after being given lithium for 11 days.Case A 56 year old female was diagnosed with hyperthyroidism in 1979 and underwent radioiodine therapy. Patient became asymptomatic. Five months prior to consult, patient had recurrence of tremors, palpitations, profuse sweating and weight loss. She presented with tachycardia, hypertension, exophthalmos, and a grade 2 diffuse goiter. FT4 was >100 (NV 12-22 ng/mL), TSH
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