Statins everyday versus alternate days: Is there a difference in myalgia rates?

OBJECTIVE: Statins are widely used drugs, known to cause myalgia, leading to high discontinuation rates. The objective of our study was to determine the frequency of myalgia in patients on everyday-dose (EDD) regimen with those on alternate-day dose (ADD) regimen. METHODS: This cross sectional study was conducted in a tertiary care hospital of Pakistan. A sample size of 400 patients between the age of 40-70 years, taking simvastatin 40mg for at least 6 months or more were selected. Patients with prior musculoskeletal or neuromuscular complains, and family history of muscular disorders were excluded. Subjects were evaluated for myalgia via a self-administered questionnaire, and those complaining of myalgia were then evaluated for serum vitamin D levels. Data was analyzed through SPSS 16.0 and compared using chi square test. RESULTS: The overall prevalence of myalgia was 7% (28/400). Frequency of myalgia in patients taking simvastatin everyday (n=20, 10%) was significantly higher compared to those taking it every alternate day (n=8, 4%) (p=0.02). There was no significant difference between the time of onset, nature, severity, type, or location of myalgia between the 2 groups. The most common cited triggering factor for pain was physical exercise. Of the patients experiencing myalgia, 13 (6.5%) from the EDD group and 6 (3%) from the ADD group had low levels of vitamin D. CONCLUSIONS: ADD regime was better tolerated by the patients than EDD regime. Alternate day therapy, with or without vitamin D supplementation, may be used by the physicians for troublesome muscular complains.

Efficacy of serum blood urea nitrogen, creatinine and electrolytes in the diagnosis and mortality risk assessment of patients with acute coronary syndrome.

BACKGROUND: Although blood urea nitrogen (BUN), creatinine (Cr) and electrolytes are not the mainstay of diagnosis in acute coronary syndrome (ACS) patients but they may have a role in providing a more detailed view of the complications and mortality rates. The aim of this study was to determine the efficacy of these parameters in the diagnosis and mortality risk-assessment of patients with ACS. METHODOLOGY: A total of 200 patients with ACS were recruited in this prospective study. The relationship of serum BUN, Cr and electrolytes with cardiac enzymes, Global Registry of Acute Coronary Events (GRACE) and mortality was assessed during a 6-months follow-up. Statistical test like multivariate linear regression and binary logistic regression analysis were applied. RESULTS: On multivariate linear regression analysis, serum potassium (K) (Unstandardized Coefficient B=-3.77; p=0.04) showed significant negative association with Creatine Kinease and serum BUN (Unstandardized Coefficient B=0.52; p=0.001) showed significant positive association with Troponin I. The patients with GRACE>105 had significantly higher levels of serum BUN and Cr. Receiver operating characteristic curves showed that area under curve (AUC) of BUN (0.7) was higher than AUC of Cr (0.5). Multiple adjusted model showed that patients with BUN>32.5mg/dl were almost 20 times more likely to be associated with mortality as compared to reference group. CONCLUSION: In addition to cardiac enzymes, K along with BUN and Cr may serve as important aid in diagnosis of ACS. BUN and Cr may also serve as important tools in mortality-risk assessment of ACS patients.

Knowledge, beliefs and practices regarding osteoporosis among female medical school entrants in Pakistan.

BACKGROUND: Osteoporosis is a growing health problem around the world. The increasing incidence of osteoporotic fractures coupled with the lack of knowledge about the disease in the general community means that the disease is continuously increasing the burden on health sector and the general population. The purpose of the study is to assess knowledge, attitudes and practices about osteoporosis among female medical school entrants in Karachi. METHODS: This is a descriptive cross-sectional study conducted amongst 400 female medical school entrants of DOW University of Health Sciences (DUHS) and Jinnah Sindh Medical University (JSMU). A pre validated questionnaire, Osteoporosis Knowledge Assessment Tool (OKAT), was distributed amongst the participants. A food frequency questionnaire was also distributed to determine calcium intake. Descriptive statistics and Chi square test were used to compare the two groups of students with SPSS (20.0) being utilized for analysis. A p value of <0.05 was considered as significant. RESULTS: The mean age of the participants was 19.4 ± 1.2 years. Only 8.0% of the participants had a good score pertaining to knowledge about osteoporosis whereas majority of the participants (49.0%) had a poor score. Perceived susceptibility was low as only 14.0% of the participants believed that they were at a high risk for osteoporosis. The RDA for calcium was equal to or greater than 700 mg per day which was met by only 29.0% of the participants despite of the high motivation towards consuming a calcium rich diet. Exercise levels were insufficient in terms of both, duration and the recommended type of exercise. Only 12.0% of the participants engaged in exercises according to the recommended guidelines. Moreover, only 5.5% subjects were involved in definitive behaviors to improve bone health. CONCLUSIONS: Participants possessed an insufficient knowledge of the disease and that too was not adequately applied in preventative practices. There is a serious lack of adoption of preventative practices for osteoporosis. This was primarily due to little appreciation of the seriousness of osteoporosis. Hence, this study highlights the dire need for awareness about practices and attitudes related to the disease. Furthermore, it could be of paramount importance to future studies conducted on practices and beliefs related to osteoporosis.