Miositis viral aguda en un paciente pediátrico con Covid-19: a propósito de un caso / Acute viral myositis in a pediatric patient with Covid-19: about a case

Se presenta el reporte de un caso de miositis aguda en un niño de 4 años de edad con COVID-19. El paciente manifestó fiebre y dolor en ambas pantorrillas. Con sospecha de miositis se realizó análisis de CPK, encontrando valores de 4460 UI/L. Asimismo se realizó hisopado nasofaríngeo para SARS-CoV 2, confirmando la infección. El paciente recibió hiperhidratación, presentando resolución de su cuadro clínico en menos de 5 días

This case report describes a 4 year old child with COVID-19. He presented with fever and pain in both calves. Under the suspicion of myositis a CPK analysis was performed, which showed CPK: 4460 UI/L. Nasopharyngeal RT - PCR was also performed, which was positive. As a treatment, the patient received hyperhydration, achieving full recovery after five days

Cost-Effectiveness of HCV Core Antigen versus PCR for Monitoring Treatment Response in DAAS-Treated Egyptian Patients

PCR is currently the non-debatable proof for diagnosis of HCV infection as well as conclusion of treatment outcomes. HCV core antigen (HCVcAg) testing is a neglected, less expensive and less time consuming test that's presumed to achieve the same aims. The aim of this study is to find the cost-effectiveness of HCV core antigen testing in the monitoring of treatment response as an alternative to the gold-standard PCR test

Effect of topical 2% eucalyptus extract on 5-fu-induced oral mucositis in male golden hamsters

Abstract Oral mucositis is a common inflammatory complication among patients with cancer. This study evaluated the histopathological, stereological, and antioxidant markers of 2% eucalyptus extract in induced oral mucositis in male golden hamsters. In this animal study, oral mucositis was induced in 30 male golden hamsters by 5-FU (60 mg/kg) on days 0, 5, and 10 of the study. The cheek pouch was scratched with a sterile needle once daily on days 3 and 4. On days 14-17, 2% eucalyptus hydroalcoholic extract gel and Calendula officinalis extract gel groups were treated and then compared with a non-treated control group. The histopathological and stereological scores and the pouch content of malondialdehyde, as well as the activities of glutathione and myeloperoxidase in the pouch tissue, were evaluated. Histopathologic scores of oral mucositis were lower in the eucalyptus gel group than those of the calendula and control groups (p<0.05). Also, a lower malondialdehyde level and higher myeloperoxidase and glutathione activities were detected in the eucalyptus group in comparison to the calendula and control groups (p<0.001). The thickness of the mucosa and submucosa increased in the eucalyptus group. The numerical density of the fibroblast and the volume density of the collagen significantly increased in the eucalyptus group. In conclusion, the use of eucalyptus hydroalcoholic extract may be associated with reduced intensity of oral mucositis, diminished concentration of malondialdehyde, increased activity of myeloperoxidase and glutathione, increased volume of mucosa and submucosa, increased fibroblast and collagen in the induced oral mucositis in golden hamsters undergoing 5-FU consumption.

Resumo A mucosite oral é uma complicação inflamatória comum em pacientes com câncer. Este estudo avaliou os marcadores histopatológicos, estereológicos e antioxidantes de Eucalyptus 2% na mucosite oral induzida em hamsters dourados machos. Neste estudo em animais, a mucosite oral foi induzida em 30 hamsters golden masculinos por 5-FU (60 mg / kg) nos dias 0, 5 e 10 do estudo. A bolsa da bochecha foi arranhada com uma agulha estéril uma vez ao dia nos dias 3 e 4. Nos dias 14 a 17, os grupos de gel de eucalipto a 2% e curativos à base de gel foram tratados e comparados com um grupo controle. Foram avaliados os escores histopatológicos e estereológicos e o conteúdo de malondialdeído na bolsa, bem como as atividades de glutationa e mieloperoxidase no tecido da bolsa. Os escores histopatológicos de mucosite foram menores no grupo de gel de eucalipto a 2% do que os do gel e do grupo controle (p <0,05). Além disso, um nível mais baixo de malondialdeído e maiores atividades de mieloperoxidase e glutationa foram detectadas no grupo tratado com eucalipto em comparação aos grupos à base de gel e controle (p <0,001). A espessura da mucosa e submucosa aumentou no grupo Eucalyptus. A densidade numérica do fibroblasto e a densidade do volume do colágeno aumentaram significativamente nos grupos tratados com eucalipto. Em conclusão, o uso do extrato hidroalcoólico de Eucalyptus pode estar associado a menor intensidade de mucosite oral, diminuição da concentração de malondialdeído, aumento da atividade de mieloperoxidase e glutationa, aumento do volume de mucosa e submucosa, aumento de fibroblastos e colágeno na mucosite oral induzida em hamsters dourados em consumo de 5 UF.

Screening of bacteria for PHA production using waste glycerol as carbon source and the ability of new strain to produce P(3HB-co-3HV) copolymer

Aims: This study is focused on the isolation, characterization and screening of new bacterial strains isolated from soil and wastewater samples that are able to produce PHA utilizing waste glycerol as sole carbon source in order to create useful products from waste glycerol and at the same time reduce the PHA production cost. A new isolate, Burkholderia contaminans Kad1 strain was investigated for its ability to biosynthesize PHA copolymers containing 3HV monomers from waste glycerol and 3-hydroxyvalerate (3HV) precursors. Methodology and results: PHA producing bacteria were screened using Nile Red and 1% of Nile Blue method. The presence of PHA granules was detected using phase contrast and fluorescence microscopy. Burkholderia contaminans Kad1, one out of 23 positive samples, was selected for further study because of its ability to produce high PHA content (47 wt%) and dry cell weight (DCW), (4.2 g/L) when waste glycerol 2% (v/v) was used as the sole carbon source. The 16S rDNA and the PHA synthase gene were sequenced and the PHA produced was confirmed by NMR analysis. A mixture of waste glycerol and sodium valerate fed to the culture gave rise to poly(3-hydroxybutyrate-co-3- hydroxyvalerate) [P(3HB-co-3HV)]. The mole fraction of 3HV monomer in the co-polymer P(3HB-co-3HV) sample analyzed using 1H NMR was 23 mol%. Conclusion, significance and impact of study: This study demonstrated for the first time B. contaminans Kad1 was able to use waste glycerol for PHA biosynthesis including the P(3HB-co-3HV) copolymer using a mixture of waste glycerol with sodium valerate as the precursor.

[Investigation of the effect of nano zinc oxide on skin burns in adult female mouse]

Background: Burn is one of the factors in the spread of disease. To treat burns, several topical medications are required. This study was performed to evaluate the effects of topical nano zinc oxide on skin burns of adult female mice of NMRI

Materials and methods: 30 adult female mice of the NMRI were placed in groups of control1[without burns], control2 [burns without healing], sham [burns distilled water tween 20], experimental 1 [burns and distilled zinc oxide 300mg], and experimental 2 [burns and distilled zinc oxide 500mg]. In sterile conditions and anesthesia, a wound was created with diameter of one centimeter on the back of each mouse. The mice were treated for 21 days and were easy to draw. The thickness of the horny layer, epidermis, dermis, hypodermis, number of hair follicles and number of dermic vessels and vessel diameter, the diameter of the wound and scar was evaluated

Results: Diameter of scar in all groups revealed reduction [P<0.001] compared to control 2. Thickness of horny epiderm significantly increased [p <0.001] in groups of control 1, sham, experimental 1, and 2 compared to control 2. The thickness of the hypoderm increased in groups of sham [p<0.01], control 1, experimental 1, and 2 [P<0.001] compared to control 2. Thickness of the dermis was larger in groups of control 1, sham, experimental 1, and 2 [P <0.001] in comparison of control 2 group. The number of hair follicles was decreased in control 1 group [P<0.01] and increased in groups of sham [p<0.01], and experimental 1 and 2 [P <0.001] compared to control 2. There were no significant differences in the number of dermic vessels and the diameter of dermic vessels between groups

Conclusion: Results showed that nano zinc oxide had good effects on burned skin layers and hair follicles

effect of paxilline on early alterations of electrophysiological properties of dentate gyrus granule cells in pilocarpine-treated rats

The dentate gyrus of hippocampus has long been considered as a focal point for studies on mechanisms responsible for the development of temporal lobe epilepsy [TLE]. Change in intrinsic properties of dentate gyrus granule cells [GCs] has been considered as an important factor responsible in temporal lobe seizures. In this study, we evaluated the intrinsic properties of GCs, during acute phase of seizure [24 h after i.p. injection of pilocarpine] compared to sham group using whole cell patch-clamp recordings. Our results showed a significant increase in the number of action potentials [APs] after applying depolarizing currents of 200 pA [p < 0.01] and 250pA [p < 0.05] compared to sham group. The evaluation of AP properties revealed a decrease in half-width of AP in GCs of seizure group [1.27 +/- 0.03 ms] compared to sham group [1.60 +/- 0.11]. Moreover, addition of BAPTA to pipette solution prevented changes in AP half-width in seizure group [1.71 +/- 0.11 ms] compared to sham group [1.91 +/- 0.08 ms]. In contrast, an increase in the amplitude of fast afterhyperpolarization was observed in GCs of seizure group [-11.68 +/- 0.72 mV] compared to sham group [-8.28 +/- 0.59 mV]. Also, GCs of seizure group showed a significant increase in both firing rate and instantaneous firing frequency at depolarizing currents of 200 pA [P < 0.01] and 250 pA [P < 0.05] compared to sham group. The changes in electrophysiological properties of GCs were attenuated after bath application of paxilline suggesting possible involvement of large conductance Ca[2+]- activated K[+] channel [BK channel]. Our results suggested the possible involvement of certain potassium channels in early changes of intrinsic properties of GCs which eventually facilitate TLE development

Uso, circulación y significación de los medicamentos en comunidades Pilagá, guaraní, MBYA-Guaraní, Tapiete y Toba / Use, Circulation and Meanings of Pharmaceuticals among Pilagá, Guaraní, Mbya-Garaní, Patipete and Toba Communities

Las prácticas de uso y consumo de medicamentos permiten analizar la inserción de la biomedicina y las acciones de salud pública entre los pueblos indígenas. OBJETIVO: Analizar uso, circulación y significado otorgado a los medicamentos por comunidades tapiete, guaraní, mbya-guaraní, pilagá y toba, en ámbitos rurales y periurbanos de las provincias argentinas de Salta, Formosa y Misiones. MÉTODOS: Estudio descriptivo, comparativo y exploratorio, basado en técnicas cualitativas: observación y entrevistas semiestructuradas realizadas en hospitales, centros de salud, farmacias y hogares de las familias indígenas durante 2012-2013. RESULTADOS: El estudio demostró que los indígenas se proveían de medicamentos por diversas vías. En algunos de los grupos se registró una alta incidencia de automedicación con consumo de analgésicos, antiinflamatorios y antibióticos (amoxicilina), una coexistencia de prácticas culturales propias con las del sistema biomédico y diversos recorridos terapéuticos. Se observó una mayor presencia de medicamentos en los grupos guaraní y tapiete de Salta y la comunidad periurbana toba de Formosa, menor en lapilagá y escasa en la mbya-guaraní. CONCLUSIONES: El vínculo con los medicamentos muestra una gran variabilidad según el grupo étnico. Existe una marcada aceptación, pese a la difícil relación con los servicios de salud. Es necesario considerar las prácticas de la salud y la enfermedad en los pueblos originarios a fin de mejorar las acciones preventivas y de intervención...

Practices related with use and consumption of pharmaceuticals constitute a venue to analyze thein corporation of biomedicine and public health actions among indigenous peoples. OBJECTIVE: To analyze the use, circulation and meaning given to pharmaceuticals by Tapiete, Guaraní, Mbya-Guaraní, Pilagá and Toba indigenous communities from rural and peri-urban areas in the Argentine provinces of Salta, Formosa and Misiones. METHODS: Descriptive, comparative and exploratory study, based on qualitative techniques: observation and semi-structured interviews conducted in hospitals, health centers, pharmacies and houses of indigenous families during 2012-2013. RESULTS: Indigenous peoples obtained pharmaceuticals through different channels. In some of the groups there was a high incidence of self-medication with consumption ofanalgesics, anti-inflammatories and antibiotics (amoxicillin), aswell as a coexistence of native cultural practices and those of the biomedical health system and diverse therapeutic itineraries.There was a larger presence of pharmaceuticals among Guaraní and Tapiete groups in Salta and the peri-urban Toba community in Formosa, less among the Pilagá and scarce among the Mbya-Guaraní. CONCLUSIONS: The relation with pharmaceuticals varies greatly according to the ethnic group. In spite of the difficult relation with health care services, there iswide acceptance of pharmaceuticals. It is necessary to consider the health and illness practices of native peoples to improve preventive measures and interventions...

Prevalence survey of infection with Treponema pallidum among HIV-positive patients in Tehran

<p><b>OBJECTIVE</b>To identify the frequency of syphilis among Iranian HIV-positive patients.</p><p><b>METHODS</b>A cross-sectional study on the prevalence of syphilis and HIV co-infection among 450 patients diagnosed with HIV infection was conducted between 2004 and 2008 at Imam Khomeini hospital, Tehran, Iran. The lab tests including CD4 cell count, cerebrospinal fluid, veneral disease research laboratory (VDRL), fluorescent treponema antibody-absorption (FTA-Abs) and viral load were performed for all the patients. Data regarding medical history and their demographics were also collected.</p><p><b>RESULTS</b>Of all 450 HIV-positive patients, 24 (5.3%) had a positive VDRL test and only two men had a FTA-Abs positive test which means 0.45% of them had a definite co-infection of syphilis. 65.3% of the HIV-positive patients were injection drug users that the co-infection prevalence of them was 0.7%. We did not find any patient with neurosyphilis.</p><p><b>CONCLUSIONS</b>Considering the increasing prevalence of HIV and also extensive use of highly active antiretroviral therapy in developing nations, the diagnosis of syphilis should be timely established using screening tests among such patients.</p>

Prevalence survey of infection with Treponema pallidum among HIV-positive patients in Tehran

Objective: To identify the frequency of syphilis among Iranian HIV-positive patients. Methods:A cross-sectional study on the prevalence of syphilis and HIV co-infection among 450 patients diagnosed with HIV infection was conducted between 2004 and 2008 at Imam Khomeini hospital, Tehran, Iran. The lab tests including CD4 cell count, cerebrospinal fluid, veneral disease research laboratory (VDRL), fluorescent treponema antibody-absorption (FTA-Abs) and viral load were performed for all the patients. Data regarding medical history and their demographics were also collected. Results: Of all 450 HIV-positive patients, 24 (5.3%) had a positive VDRL test and only two men had a FTA-Abs positive test which means 0.45% of them had a definite co-infection of syphilis. 65.3% of the HIV-positive patients were injection drug users that the co-infection prevalence of them was 0.7%. We did not find any patient with neurosyphilis. Conclusions: Considering the increasing prevalence of HIV and also extensive use of highly active antiretroviral therapy in developing nations, the diagnosis of syphilis should be timely established using screening tests among such patients.

Antibody responses to trivalent influenza vaccine in Iranian adults infected with human immunodeficiency virus

The serious influenza-associated complications among immunodeficient individuals such as those who are infected with human immunodeficiency virus [HIV], highlights the importance of influenza vaccination in these people. Therefore, the current study aimed to investigate the antibody responses to influenza vaccine in this group. Two hundred subjects were recruited, during autumn 2010 and 2011, to receive, trivalent inactivated influenza vaccine consisting of A [H1N1], A [H3N2], and B strains. Hemagglutination inhibition assay was used to measure the antibody titer against all strains of the vaccine prior and one month post vaccination. Seroconversion rate for A [H1N1], A [H3N2], and B were found to be 58.5%, 67% and 64.5%, respectively. No correlation was found between antibody titer and demographics factors such as age and gender; however, we found a significant correlation between antibody titer and CD4 cell count. Checking the local and systemic reactions after vaccination, the pain on the injection site and myalgia were the most common local and systemic reactions with 20% and 6.5%, respectively. As vaccination with influenza mount considerable antibody responses in HIV-infected patients, annul influenza vaccination seems to be rational in order to prevent or reduce the severe clinical complications induced by influenza virus

[Outcome of TB in HIV patients treated with standard regimen]

HIV infection reduces the immune system and is the most significant factor in the spread of TB in recent years and one of the causes of death in HIV-seropositive patients. TB is the most commonly diagnosed opportunistic infection and the most frequent direct cause of death among HIV infected patients. The HIV infection can accelerate progression of TB infection to active TB disease. Among patients with active TB, those with HIV coinfection have the greatest risk for relapse. Regardless of increasing rate of TB and HIV in Iran, we decided to survey outcome of TB in HIV positive patients who treated with standard regimens in the years 2003-2012. This retrospective cohort study was conducted on HIV-positive patients with TB referred to Behavioral Diseases Consultation Center and Infectious Diseases Ward of Imam Khomeini Hospital from 2003 to 2012. Outcome was defined as failure, relapse and mortality. Moreover, the relationship between outcomes and number of CD4, co-trimoxazole and antiretroviral intake, type of TB and AIDS defining illness was studied. This study had 135 patients, 8 [5.9%] were females and 127 [94.1%] were males. The mean age of the patients was 40.14+10.02 and the most way to catch HIV in this study was intravenous drug user. There were 3 [2.22%] cases of failure, 15 [11.1%] relapse, and 21 [15.8%] deaths. Antiretroviral therapy, AIDS defining illness, type of TB and co-trimoxazole intake did not soley affect relapse. CD4 level was the most effective variables in relapse [Hazard ratio: 0.392 [0.11-1.4]; Relative Risk: 0.809 [0.593-1.103] [P=0.068]]. However, regard to CI95%, the impact of CD4 on relapse is not significant and antiretroviral intake was the most important and effective variable in increasing their survival. Hazard ratio: 0.137 [0.141-0.45]; Relative Risk: 0.686 [0.513-0.918] [P=0.001]. Overall, receiving antiretroviral was the most important factor influencing the outcome of patients

Haemodialysis Arteriovenous Access-Related Aneurysms

Anastamotic pseudoaneurysm was the commonest variety of AVA-related aneurysms. The commonest indication of surgical intervention was impending rupture. Surgical revision and repair of AVA-related aneurysms is life saving and is associated with acceptable post-intervention patency rate.

FNA diagnostic value in patients with neck masses in two teaching hospitals in Iran

The FNA [fine needle aspiration] procedure is simple, inexpensive, available and a safe method for the diagnosis of a neck mass. FNA has numerous advantages over open surgical biopsies as an initial diagnostic tool; therefore we decided to compare the accuracy of this method with open biopsy. This Retrospective as well as Descriptive study comparing preoperative FNA results with existing data in the Pathology Department in Bu-Ali and Amir Alam Hospitals. Our study included 100 patients with neck masses of which 22 were thyroid masses, 31 were salivary gland masses, and 47 were other masses. Age ranged from 3 years to 80 years with the mean age of 42.6 years. There were 59 men and 41 women. The Sensitivity was 72%, Specificity 87%, PPV 85%, NPV 75% and diagnostic Accuracy 79%. In this study we had also 26% false negative and 15% false positive. FNA is a valuable diagnostic tool in the management of neck masses; also it has been used for staging and planning of treatment for the wide and metastatic malignancy. This technique reduces the need for more invasive and costly procedures. According to the high sensitivity and high accuracy in this study, FNA can be used as the first step of diagnoses test in neck masses

Evaluation of bone mineral density in Iranian HIV/AIDS patients

Bone disorders have emerged as a worrisome complication in HIV-infected patients in recent years. It is not clear that HIV infection itself or antiretroviral treatment or both are causes of bone loss. However, most studies have found a high prevalence of osteopenia and osteoporosis in HIV/AIDS patients. The objectives of this study were to determine the prevalence of osteopenia and osteoporosis in HIV-infected patients either untreated or receiving Highly Active Antiretroviral Therapy as compared with HIV negative persons. We also assessed the factors associated with these conditions. Bone Mineral Density was assessed by Dual Energy X-Ray Absorptiometry scans at the hip and lumbar spine in 36 AIDS patients receiving antiretroviral therapy and 44 HIV infected patients not receiving antiretroviral therapy [na‹ve patients] and 40 HIV negative individuals as control. Factors that affect BMD were also determined. Prevalence of osteopenia or osteoporosis in different regions was significantly higher in HIV/AIDS patients compared with HIV negative subjects [77.3% in HIV positive na‹ve patients, 86.1% in HAART-treated patients and 60% in the control group, P=0.002]. Mean serum alkaline phosphatase was higher in HIV/AIDS patients than the control group [P=0.003]. Osteopenia and osteoporosis in HIV-infected patients were associated with duration of HIV infection [P<0.0001] and antiretroviral treatment [P=0.012]. Prevalence of osteopenia and osteoporosis in HIV/AIDS patients was higher than HIV negative individuals. Osteopenia and osteoporosis in HIV/AIDS patients was associated with duration of HIV infection and antiretroviral treatment

Incidence of isolation of Mycobacterium tuberculosis from blood samples in tuberculosis patients in Imam Khomeini hospital, Tehran, Iran

It is estimated that one third of the world's population is latently infected with tuberculosis [TB]. The HIV epidemic fuels the TB epidemic by increasing the risk of reactivation of latent TB infection and by facilitating a more rapid progression of TB disease. Although the incidence of TB is constant or decreasing in many regions of the world, rates remain high in developing countries as a consequence of the HIV epidemic. This study was conducted as a collaboration of the Infectious Diseases department of Imam Khomeini Hospital with the Microbiology department of Tehran University of Medical Sciences. The hospital dataset of 94 patients admitted with TB during 2003-2005 was reviewed. We aimed to study factors correlating with positive blood culture including age, sex, immune deficiency status, HIV serology and SIRS [Systemic Inflammatory Response Syndrome] status. In this study, we found that positive blood cultures are more frequent in patients less than 45 years old. Positive blood cultures were also more frequent in HIV infected patients and there was a significant correlation between blood culture and SIRS status. Therefore, we recommend that we obtain blood cultures from these high-risk groups in order to increase early detection of TB

Respiratory complications in Iranian hospitalized patients with HIV/AIDS

The respiratory tract has been the most commonly affected site of illness in HIV-infected patients. The current study was done to identify the frequency of respiratory complications in a consecutive case series of HIV-positive patients in Iran. This study was a retrospective analysis at the national academic reference medical center of Imam-Khomeini Hospital, in Tehran, Iran. The study included 199 new admissions for 177 HIV-infected patients between 2000 and 2005. Demographic characteristics, risk factors for HIV infection, respiratory complications, and CD4+ lymphocyte counts were evaluated in these patients. All patients were males. The mean age was 35 years [age range: 15 to 63 years]. Among 34 cases with available CD4+ lymphocyte count results, 70.6% had results <200 cells/mm[3]. Nearly half the patients [47.7%] had respiratory symptoms. The most common pulmonary complications were cough [86.3%], sputum [71.6%], dyspnea [54.7%], and hemoptysis [10.5%]. The most common diagnosis was pulmonary tuberculosis [27.1%], followed by other bacterial pneumonias [16.6%] and pneumocystis carinii pneumonia [4.5%]. Intravenous drug users who had history of incarceration had the highest risk factors for Mycobacterium tuberculosis infection [59%], and other bacterial pneumonias [52%].Our study demonstrates that respiratory complications are highly frequent in HIV patients in Iran and that pulmonary tuberculosis is still a common complication in HIV infected patients, despite the availability of effective treatment. Results suggest the need for more effective preventive and prophylactic measures, wider use of antiretroviral treatment and effective chemotherapy for Iranian patients with HIV/AIDS

pilot double-blind randomized placebo-controlled trial of the effects of fixed-dose combination therapy ['polyp ill'] on cardiovascular risk factors

Aim: our objective was to investigate the effects and tolerability of _xed-dose combination therapy on blood pressure and LDL in adults without elevated blood pressure or lipid levels

Methods: this was a double- blind randomised placebo-controlled trial undertaken in residents of Kalaleh, Golestan, Iran. Following an eight week placebo run-in period, 475 participants, aged 50 to 79 years, who had no cardiovascular disease, hypertension or hyperlipidemia were randomised to _xeddose combination therapy with aspirin 81 mg, enalapril 2.5 mg, atorvastatin 20 mg and hydrochlorothiazide 12.5 mg [polypill] or placebo for a period of 12 months. The primary outcomes were changes in LDL-cholesterol, systolic and diastolic blood pressure, and adverse reactions. Analysis was by intention-to-treat basis

Results: at baseline, there were differences in systolic blood pressure [6 mmHg]. Taking into account the baseline differences, at 12 months, the polypill was associated with statistically signi_cant reductions in blood pressure [4.5_1.6 mmHg] and LDL-cholesterol [0.46 mmol/L]. The study drug was well tolerated, but resulted in the modest reductions in blood pressure and lipid levels

Conclusion: the effects of the polypill on blood pressure and lipid levels were less than anticipated, raising questions about the reliability of reported compliance. There is a case for a fully powered trial of the polypill for prevention of cardiovascular disease