Which statin worked best to achieve lipid level targets in a European registry? A post-hoc analysis of the EUROASPIRE III for coronary heart disease patients

The objective of the study is to determine the proportion of patients within the subsample reaching the target lipid levels defined in the European guidelines, stratified according to type and dose of statin used. Many factors affect the attainment of lipid level targets including gender, age, compliance, statin type, and dosage. This study aimed to determine the percentage of post-interventional coronary heart disease [CHD] patients who met the lipid level targets recommended by the Joint European Societies Guidelines, the medications used, and their doses. A post-hoc analysis of a subsample of 2,000 patients from EUROASPIRE III database was selected randomly from patients who attended the interviews [between six months to three years after event]. Further stratification according to type and dose of statin was performed. The sample comprised 74.5% males, and two thirds [63.8%] of the entire sample were over 60 years of age. More women than men showed elevated total cholesterol [>4.5 mmol/1 and >4.0 mmol/1], LDL-cholesterol [>2.5 mmol/ 1 and >2.0 mmol/1], and triglycerides [>1.7 mmol/1]. Atorvastatin was the most widely used at both discharge and interview [47.1% and 45.4%] than simvastatin [37.7% and 39.4%]. A dose of 20 mg atorvastatin was used by 44.10% of patients, while those on fluvastatin used a higher dose: >/=40 mg in 88.31%. Patients who achieved targeted total cholesterol levels for atorvastatin, fluvastatin, lovastatin and simvastatin showed a trend in dose increase. Pravastatin users who achieved the target were taking a dose of 10 mg [75%] and less were in the 20 mg group [33.33%]. Rosuvast-atin users who consumed 10 mg and >/=40 mg dose achieved the lipid level targets by 61.82% and 66.67%, respectively. Compliance with medications was high after a CHD incident in this European sample and the increase of the atorvastatin and simvastatin doses enabled the attainment of the target levels recommended

Prolactin-producing adenoma. clinical presentation in adult Sudanese patients

To describe the clinical features of prolactin-producing pituitary adenoma [prolactinoma] in adult patients. In a prospective hospital-based study, adult patients with prolactinoma presenting to the National Center for Neurological diseases and the National Center for cancer in Khartoum, Sudan were enrolled in the period from January 2001 to February 2005. The diagnosis was based on finding a pituitary adenoma on cranial MRI and an associated elevated blood prolactin level above 200 micro g/L. The size of the adenoma was classified as either microadenoma [<10 mm without sellar enlargement or extrasellar extension] or macroadenoma [>/= 10 mm]. The hormone profile done on each patient included blood level of prolactin and other pituitary trophic hormones, free triiodothyronine and free thyroxine hormones. Sixteen [14 females and 2 males] were identified as having a prolactinoma. The female to male ratio was 7:1. Their mean age was 24 +/- 5.1 years. The prolactinoma was inacroadenoma in 9 cases and microademoma in 7. Galactorrhea, amenorrhea and infertility [primary or secondary] were the commonest presenting symptom followed by headache. Affection of the visual pathway, either as bitemporal hemianopia [41.2%] or optic atrophy [11.8%], was the major neurological deficit. The mean prolactin level in macroadenoma was 2053 +/- 442.6 micro g/L and in microadenoma was 853.6 +/- 77.8 micro g/L. Our prolactinoma patients, when reaching the appropriate medical attention, are more likely having an expanded macroadeoma that is compromising the visual pathway. Early recognition and referral to specialized clinics is necessary and that should have a favorable prognostic implication

Parvovirus B19 in pregnancy

Although this study covered only 150 pregnancies, yet it highlights the presence of parvovirus 819 in Egypt. The adverse effect of parvovirus B19 infection on the outcome of pregnancy was 5% spontaneous abortions during the first trimester. In the spontaneously aborted group of patients, 30% of cases were positive for IgG antiparvovirus antibodies and negative for IgM. It was noticed that housewives with 2-4 siblings were seropositive to parvovirus B19 more than housewives with one child. This indicated that contact with children with erythema infectiosum or subclinical paravovirus B19 infection was an important factor. Housewives who delivered healthy full term infants had 52% IgG seropositive reactions against parvovirus B19. This indicated that past infection and persistent antibodies were protective

Cryoanalgesia versus extradural morphine: a comparative study on post-thoracotomy pain

This study was carried out on 28 patients undergoing elective thoracotomy operations. The efficacy and side effects of cryoanalgesia [12 patients] and extradural morphine administration [16 patients] were studied. Those two methods are well known to produce the longest duration of pain relief after throacotomy. The postoperative analgesia in the cryogroup started immediately after termination of operation and a well sustained pain scores were observed through out the whole period of study [72 hours], with a mean V.A.S. of 11 +/- 7.3 mm. The analgesia in the epidural group started after a period of initial delay [a mean of 45 +/- 23 min.]. The pain releif was satisfactory and one or two additional doses of morphin were needed to cover a period of analgesia equivalent to that obtaine by the cryogroup. A part from reversible area of cutaneous sensory loss occuring in all patients of the cryogroup, the epidural group patients showed many adverse side effects namely drowsiness, nausea, vomiting and distressing itching

Vesico-Uterine fistula

A case of vesico-uterine fistula following repeat lower segment caesarean section [LSCS] is presented. The patient had menouria, amenorrhoea and incontinence of urine. The diagnosis and management is presented and the literature is reviewed since the first case was reported on 1908