Lipid-lowering effect of atorvstatin in patients with type-2 diabetes mellitus

Dyslipidemia is an important factor in the causation of macrovascular disease in type 2 diabetics. The role of atorvatatin in the management of dyslipidemia in patients with type 2 diabetes mellitus is not very well elucidated. The Acerican College of Cardiology and American Diabetes Association suggest the aggressive therapy of diabetic dyslipidemia will reduce the risk of coronary heart disease in diabetics and that optmal levels are serum low-density lipoprotein cholesterol <2.60 mmol/L [<100mg/dl], high density lipoprotein cholesterol >1.15 mmol/L [>45 mg/dl] and triglycerdes <2.30 mmol/L [<200mg/dl]. This study was planned to compare the effect of atorvastatin together with behavioral modification and behavioral modification alone, In age, sex and body mass index matched patients with type 2 diabetes mellitus with dyslipidemia, In reaching the target levels of various lipids as suggested by the American Diabetes Association criteria 2001. An open label, prospective study was conducted on 80 patients with type 2 diabetes mellitus, who had fair to moderate glycemic control with a total glycated hemoglobin <10%. The patients in the control group [n=40] were treated with only behavioral modifications like calorie control and daily walking for 30-45 minutes, and no lipid- lowering agent was given. The lipid profile was re-evaluated after 6 and 12 weeks. The patients in the test group [n=40] were advised behavioral modification and given atorvastatin. The starting dose was 10 mg at bed time. After 6 weeks of atorvastatin therapy, a lipid profile was done. If the goal of low-density lipoprotein cholesterol <100 mg/dl and /or triglycerides <200mg/dl and /or high-density lipoprotein cholesterol >45 mg/dl was not achieved, the dose of atorvastatin was increased to 20 mg at bedtime for another 6 weeks. It was observed that low-density lipoprotein dyslipidemia was most prevalent. In the control group, a favourable alteration in lipid levels was brought about but none was statistically significant and the American Diabetes Association goals were not lipid moieties, and the target levels were achieved in 80% of patients after 12 weeks. There was no significant alteration in glycemic control and liver functions. Myopathy was not seen in any patient. In our study, behavioral modification alone did not achieve the larget levels of various lipids in diabetic dyslipidemia as per the American Diabetes Association guidelines. Hence, pharmacological therapy with statins should be resorted to in patients with type 2 diabetes mellitus who carry a high risk of coronary hearts disease. Atorvastatin is a safe and effective lipid-lowering drug

Multiple pregnancies-maternal and fetal outcome

This study was carried-out on all patients with multiple gestation, who delivered in Unit - I, Lady Willingdon Hospital, from October 2000 to March 2003. A total of 10391 women delivered during this 21/2 years period, out of these 179 had multiple births -176 had twin delivery and three gave births to triplets. The aim of the study was to find out frequency of multiple births and maternal and neonatal outcome in these cases. The prevalence of multiple births was 1.72% with 1.69% of twins and 0.029% triplets. Women with multiple pregnancy were found to be at high risk of pre-term delivery and about 34% of babies were between 1-2 Kg. The rate of caesarean section was also significantly high in these women

Instrumental vaginal deliveries

The objective of this study was to describe trends in instrumental delivery and to find out frequency of maternal and neonatal complications in a large maternity hospital. All 123 patients undergoing instrumental vaginal delivery in Unit-1 were included. The operative vaginal delivery was 1.17% of total births and 1.648% of vaginal deliveries. Of these 68 women had vaccum extractions while, 55 had forceps delivery. Seventy-one patients were primigravida and the commonest indication for instrumental delivery was fetal distress followed by prolonged second stage. Apgar score at 5 min. was more than 5 in 79.6% of babies. There was one still birth in the vaccum extraction group and five neonatal deaths [all due to birth asphyxia]. There were few maternal complications including only one third degree perineal tear

Risk factors for coronory artery disease in Pakistan

The objective of this study was to look for the presence of risk factors in patients with ischemic heart disease [IHD] in the Pakistani population. The study was undertaken in collaboration with the World Health Organization [WHO] and the Ministry of Health, Government of Pakistan. One thousand patients, 25 to 64 years of age, of both genders and with diagnosed coronary artery disease, were questioned and investigated regarding the known risk factors for coronary artery disease. World Health Organization [WHO] MONICA [Monitoring of Trends and Determinants in Cardiovascular Disease] project protocol was followed in diagnosis, questioning and investigations as far as possible. Coronary heart disease [CHD] was much more common in men compared to women in all age groups [78.2% vs. 21.8%]. Relative difference in CHD prevalence between sexes was largest among the youngest subjects [86.5% vs. 13.5%], and smallest among the oldest subjects [73.8% vs. 26.2%]. There were more men aged 50-59 who had CHD [43.2%] compared to other age groups [16.4% and 40.4%]; whereas over half the women [51.4%] with IHD were between 60 and 64. Smoking was much more common in men [57.8% vs. 1.37%]. Total cholesterol was higher [230 vs. 221] and LDL cholesterol was lower [122.66 vs. 130.33] in women, whereas HDL cholesterol was higher in women [43.0 vs. 41.3] compared to men so as to result in the same HDL/total cholesterol ratio in the two genders. With age, total and LDL cholesterol rose whereas HDL cholesterol reduced in both sexes. In all age groups and both sexes, HDL cholesterol was lower than the desirable levels [41.3 in men and 43.0 in women]. Both systolic blood pressure [SBP] and diastolic blood pressure [DBP] were higher than desirable in both men and women and increased further with increasing age [151.2/86.1 to 167.1/102.8 in men and 132.6/79.6 to 165.6/99.7 in women]. Both SBP and DBP were higher in men compared to women although this difference became less marked in the older age groups. BMI was higher among women in all age groups and was more marked in the older age groups [28.4 to 30.1 vs. 28.4 to 33.2]. The prevalence of diabetes mellitus was higher in women with IHD compared to men, in all age groups and increased in both men and women with increasing age but more so in women [5.0% to 16.9% vs. 3.1% to 10.1%]