Synergistic effects of ezetimibe with low dose simvastatin in lowering lipid parameters-a pilot study

To find out see the effect on lipid parameters by using a combination of the two drugs. This was a randomized, double-blind, placebo-controlled trial conducted in conformance with good clinical practices and consisted of 2 phases: A total of 39 patients were enrolled in the study. Patients were randomly assigned to receive either simvastatin alone or a combination of simvastatin plus ezetimibe. It was conducted at Fauji Foundation Hospital Rawalpindi from July 2008 to September 2008. Mean baseline total cholesterol ranged from 5.29 to 8.87 mmol/ L. The results indicated that the total cholesterol levels reduced significantly [p <0.05] from the baseline when patients were given 10 mg Simvastatin. Upon reduction of dose of simvastatin to 5 mg and addition of ezetimibe 10 mg, the levels of total cholesterol reduced even further [p<0.05]. Similar results were seen with triglyceride levels [p<0.05]. There was no statistically significant difference in LDL-C levels from the baseline with the use of simvastatin 10 mg alone. However coadministration of ezetimibe [10mg] to simvastatin [5mg] caused a statistically significant reduction in LDL-C levels from the baseline. There was no effect on HDL-C, ALT, blood glucose levels. The pilot study confirmed the effectiveness of ezetimbe in lowering total cholesterol and LDL-C levels in combination with reduced doses of simvastatin. Ezetimibe should be considered an effective lipid-lowering agent that can be used in conjunction with simvastatin at the beginning of therapy, or included in the treatment of patients who do not achieve their total and low-density lipoprotein cholesterol goal with statins alone

Mediastinal tuberculosis presenting with sternal osteomyelitis and discharging sinus

Involvement of the mediastinum and sternal bone leading to osteomyelitis is a very rare presentation of tuberculosis even in countries where tuberculosis is endemic like Pakistan. Frank presentation as discharging sinus is even more uncommon. We describe a case where a patient presented with constitutional symptoms of fever, loss of appetite, significant weight loss and an erythematous tender lesion over the sternum with a discharging sinus without any features of pulmonary tuberculosis. The case was initially not diagnosed by routine laboratory tests and the lesion was just considered as a boil until presented to tertiary care hospital as discharging sinus. Plain Radiographs showed lytic lesion on the inner aspect of sternum and histopathology of the aspirate from the lesion confirmed the presence of epithelioid granulomas and acid fast bacilli on staining. Patient responded very well to 12 months of antituberculosis treatment