ABSTRACT
Back ground: Reduction of coronary heart disease (CHD) risk through the modification of risk factors has a strong effect on clinical practice. The introduction of 3-hydroxy-3-methylglutaryl coenzyme-A (HMG-CoA) reductase inhibitors (statins) has significantly advanced the treatment of hypercholesterolemia and in reduction of cardiovascular events and total mortality rates. Among the available statins, Fluvastatin is a newer, synthetic, second generation, potent lipid lowering agent and widely accepted in diverse population. However the safety profile and efficacy was not assessed in Bangladeshi population, a population significantly different from Caucasian population where most studies were done. Current study aimed at evaluating the safety and efficacy of fluvastatin in the specified population. Methods: The study is an open-label, multicenter, quasi experimental study conducted among 162 adult patients suffering from hypercholesterolemia. After through baseline evaluation, the patients were given with Fluvastatin 80 mg once daily for 3 months. All the patients were assessed twice, before and after treatment. Data on demography, of relevant medical history and of physical examination were collected in the both the visit along with data on relevant lipid parameters (Total Cholesterol, LDL-C, HDL-C and TG) were collected at final visit. Safety was assessed by evaluating adverse events, as well as laboratory abnormalities, including liver aminotransferases. Results: Serum total cholesterol was found to be significantly reduced and across two assessments the reduction was 51.2 units (P<.001). Average reduction in LDL-cholesterol was around 40 units (P<.001). Most significant reduction (140.0±305.8 units) was seen in serum LDL cholesterol (P<.001). However; no statistically significant reduction was seen in HLD cholesterol. Safety of fluvastatin was assessed by evaluating the adverse events, as well as through laboratory abnormalities, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Comparison of aminotransferase level was done before and after treatment through paired t test, Neither ALT nor the AST showed statistically significant rise after 3 months treatment of fluvastatin (P>.05). Out of 162 study participant 4.3% had their treatment interrupted, of which 1 (0.62%) had to cease treatment due to lack of efficacy, 1 (0.62%) experienced adverse event, 2 (1.24%) didn’t return to follow-up and 3 (1.86%) patients requested their physician to cease the treatment. Conclusion: Three month treatment with Fluvastatin XL 80 mg reduces most of lipid parameter of lipid profile (Total cholesterol, Triglyceride and LDL) significantly. The drug is found to be well tolerated with minimal adverse event during the course of treatmen
ABSTRACT
A survey was conducted in Dhaka District to measure the level of routine immunization coverage of children (12-23 months), to assess the tetanus toxoid (TT) immunization coverage among mothers of children (12-23 month), to evaluate EPI program continuity (dropout rates) and quality (percent of Invalid doses, vaccination card availability etc.) For this purpose, a thirty cluster cross-sectional survey was conducted in October 2002 to assess the immunization coverage in Dhaka. In this survey 30 clusters were randomly selected from a list of villages in 63 Unions of Dhaka following probability proportion to size (PPS) sampling procedure. A total of 210 children was studied using pre-tested structured questionnaire. Descriptive statistics was employed using software SPSS package for data analysis. The study showed that the routine immunization coverage in Dhaka among children by 12 months of age by card + history was 97% for BCG, 97% for Diphtheria, Pertussis Tetanus (DPT 1) and Oral Polio Vaccine (OPV 1), 75% for DPT3 and OPV3 and 67% for measles. Sixty six percent of all children surveyed had received valid doses of all vaccines by 12 months (fully immunized child). Programme access as measured by crude DPT1 coverage was better in Keranigonj (97%). Vaccination cards retention rate for children was 84%. Invalid DPT (1,2 or 3) doses were given to 25% of vaccinated children; 18% of measles doses were invalid. Surprisingly, major cause for invalid doses were not due to early immunizations or due to card lost but for giving tick in the card, instead of writing a valid date. DPT1 and DPT3 and DPT1- Measles drop out rates were 5% and 13% respectively. Major reason parents gave for never vaccinating their children (zero dose children) was (43%), major reasons for incomplete vaccination was lack of knowledge regarding subsequent doses (46%). TT surveys were also conducted for mothers of the children surveyed for vaccination coverage (mothers between 15-49 year old). Valid TT 1-5 coverage by card+ history was 97%, 55%, 44%, 24% and 11%, respectively. Card retention rate for TT was 67%. The findings of this study revealed that access to child and TT immunizations were good. But high dropouts and invalid doses reduced these percentages of fully immunized child to 66%. Programmatic strategy must be undertaken to reduce the existing high dropout rate in both child and TT immunizations.