Statins ; A double weapon in treating dyslipidemic osteoporotic menopausal type 2 diabetics

Recent reports have been suggested the possible role of 3-hydroxy-3 methyl gluteryl Coenzyme A [HMG-C0A] reductase inhibitors to represent an entirely new approach in treating osteoporosis by stimulating the proliferation and differentiation of osteoblasts, the specialized cells that create new bone formation. Also, statins have been reported to prevent bone resorption through blocking an early step in mevalonate pathway and so preventing prenylation, a step that is required for osteoclasts function. The aim of the present work was to study the effect of HMG-CoA reductase inhibitors [statins]; simvastatin and pravastatin, on bone mineral density [BMD] of dyslipidemic postmenopausal females with type 2 diabetes mellitus and having osteoporosis. Thirty postmenopausal dyslipidemic type 2 diabetic females above 50 years with no history of any disease or drugs that affect bone metabolism were included in this study and classified into 2 groups; I] included 15 patients received 40mg daily of simvastatin and II] included 15 patients received 40mg daily of pravastatin both for 3 months. Each patient was subjected to full history taking, complete clinical examination, laboratory investigations including, fasting and post-prandial plasma glucose, glycosylated haemoglobin, alanine aminotransferase [ALT], serum cholesterol and triglycerides, serum calcium [total and ionized] and phosphorus. Serum osteocalcin, biochemical marker of bone formation, was measured by immunometric assay and urinary deoxypyridinoline [DPD], biochemical marker of bone resorption was measured by competitive immunoassays. Dual energy X-ray absorptiometry [DEXA] was used to assess BMD of forearm [peripheral site] and L2-L3 lumbar vertebrae [axial site]. The results of the present work can be summarized as follows; the serum levels of osteocalcin and the BMD revealed significant increase and the urinary levels of DPD revealed significant decrease after 3 months of simvastatin in group I. A mild change in osteocalcin, urinary DPD and BMD had been noticed after 3 months of pravastatin in group II, yet it did not reach a statistical significant level. Also, there was significant reduction of serum cholesterol and triglycerides levels after 3 months therapy of either simvastatin or pravastatin and none of the patients showed any abnormal change in ALT levels supporting the safety of these drugs regarding their effect on the liver. Our results suggest the beneficial unexpected role of lipophyllic statins, simvastatin, in prevention and treatment of osteoporosis. Further studies are needed to reach the best effective dose and mode of administration of statin in preventing and treating osteoporosis. Also, the possibility of using statins in combination with other currently used drugs in this domain

Influence of intrapartum chemoprophylaxis on the incidence and identification of vertically transmitted neonatal sepsis

The purpose of the present work was to detect the influence of the use of intrapartum chemoprophylaxis on the incidence of vertically transmitted neonatal sepsis. One hundred and fifty pregnant women at labor with risk factors of delivering an infant with neonatal sepsis were selected from patients attending the labor ward at El Shatby Maternity University hospital. The studied women were divided into two groups according to whether they received intrapartum antibiotic prophylaxis or not. For every case, complete sheet was recorded; complete general and local examination was done to detect PROM and chorioamnionitis and maternal high vaginal swab was obtained and cultured for detection of GBS colonization. One hundred and fifty four infants were born to these mothers and were tested for signs of sepsis through clinical examination, complete laboratory investigations including complete blood count, urine GBS latex agglutination test, C-reactive protein, erythrocyte sedimentation rate, blood culture, and lumbar puncture in blood culture positive infants. The overall incidence of neonatal sepsis in the present study was 16.9%. Group II infants showed a higher incidence of sepsis. As regards GBS colonization, 30 women [20%] had a positive high vaginal swap for GBS. Two GBS carrier mothers delivered infants who developed neonatal sepsis, but caused by other organisms. GBS Organisms isolated from the septic infants were mainly gram-negative organisms and staphylococci. With the exception of 6 cases of E-coli, all other isolates were ampicillin resistant, giving an ampicillin resistance of 76.9%. Most organisms with the exception of staphylococci showed gentamicin sensitivity that might explain the lower incidence of sepsis in group I