Hypothyroidism is known to be associated with muscle pain, weakness, stiffness and mildly elevated muscle enzymes. However, rhabdomyolysis due to hypothyroidism is very rare, especially in the absence of any precipitating factors, such as heavy exercise, alcohol or medication. We report a case of rhabdomyolysis associated with hypothyroidism in a 24-year-old man who presented with choking sensation, generalized lethargy, low backache and facial swelling with markedly raised muscle enzymes which normalized after thyroxine replacement.

Introduction: Although cervical cancer is the 10th most common cancer among females in Singapore, it is a vaccinepreventable cancer. Human papillomavirus vaccines combined with regular Pap (papillomavirus) smears have been shown to reduce the mortality and morbidity associated with cervical cancer. We assessed the knowledge and attitudes towards cervical cancer, human papillomavirus and its vaccination amongst pre-university female students and assessed if a short educational presentation can improve this knowledge and acceptability of the vaccine. Methods: A cohort survey was carried out amongst 150 female students at Hwa Chong Junior College via questionnaires administered anonymously. Standardized educational presentations were carried out followed by post intervention questionnaires. Results: Almost all the students were aged between 15 and 19 years old (99.3%). At baseline, only 29% and 27% of the students had ever heard of human papillomavirus and its vaccines respectively. The most common source of information cited was from a family member or a friend (22.5%). Only 4% had been administered the human papillomavirus vaccine. Mean knowledge scores significantly improved from 4.95 to 8.61 out of 10 after the intervention. Of those who did not have the vaccine, only 31.3% were willing to consider the human papillomavirus vaccine pre-intervention, with a statistically significant improvement to 51.4% post intervention. Conclusion: Low awareness about human papillomavirus, its relationship to cervical cancer and its prevention is common, even amongst well-educated students. Most of them obtained the information from family and/or friends. A short educational presentation was able to improve the knowledge scores, and improve the acceptability of the human papillomavirus vaccine.

Serum potassium is part of routine laboratory tests done for patients with hypertension or diabetes mellitus in primary care. Those found to have raised potassium (K>5.5 mmol/L) are recalled for repeat potassium in emergency departments or primary care clinics. Repeat potassium are often normal (≤5.5 mmo/L), that is, false hyperkalaemia. Haemolysis is known to cause false hyperkalaemia. We postulated that unlysed false hyperkalamia was prevalent and was associated with factors such as delayed processing time.ObjectiveWe aimed to determine the prevalence of unlysed false hyperkalaemia and the factors associated with false-and-true-hyperkalaemia.SettingOutpatients in a cluster of public primary care clinics (polyclinics) in Singapore.ParticipantsAll patients of any ethnicity aged ≥21 with serum potassium test done.MethodsElectronic health records of index patients with potassium >5.5 mmol/L and its corresponding laboratory processing time in seven local polyclinics were reviewed between August 2015 and August 2017. Haemolysed specimens and patients on sodium polystyrene sulfonate (SPS) suspension were excluded. If repeat potassium level was ≤5.5 mmol/L within 8 days, the case was defined as false hyperkalaemia. The proportion of such patients was computed to determine its prevalence. Linear and logistic regressions were used to identify the associated factors.ResultsThe study population comprised of 3014 index cases, of which 1575 had repeat potassium tests without preceding SPS. 86.4% (1362/1575) of them had potassium ≤5.5 mmol/L. The average processing time among specimens with potassium ≥6.0 mmol/L was 50 min longer, compared with those with potassium <5.1 mmol/L. Risk factors significantly associated with false hyperkalaemia included estimated glomerular filtration rate (eGFR) (60–89 mL/min/1.73 m2, OR=3.25, p<0.001;>90 mL/min/1.73 m2, OR=3.77, p<0.001) and delayed laboratory processing time (beta coefficient 0.001, p<0.001).ConclusionThe prevalence of false hyperkalaemia was 86.4%. Recommendation to repeat potassium tests may target those with eGFR<60ml/min/1.73m2.