Comparison of 8 weeks standard treatment (rifampicin plus clarithromycin) vs. 4 weeks standard plus amoxicillin/clavulanate treatment [RC8 vs. RCA4] to shorten Buruli ulcer disease therapy (the BLMs4BU trial): study protocol for a randomized controlled multi-centre trial in Benin.

BACKGROUND: Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans that affects skin, soft tissues, and bones, causing long-term morbidity, stigma, and disability. The recommended treatment for BU requires 8 weeks of daily rifampicin and clarithromycin together with wound care, physiotherapy, and sometimes tissue grafting and surgery. Recovery can take up to 1 year, and it may pose an unbearable financial burden to the household. Recent in vitro studies demonstrated that beta-lactams combined with rifampicin and clarithromycin are synergistic against M. ulcerans. Consequently, inclusion of amoxicillin/clavulanate in a triple oral therapy may potentially improve and shorten the healing process. The BLMs4BU trial aims to assess whether co-administration of amoxicillin/clavulanate with rifampicin and clarithromycin could reduce BU treatment from 8 to 4 weeks. METHODS: We propose a randomized, controlled, open-label, parallel-group, non-inferiority phase II, multi-centre trial in Benin with participants stratified according to BU category lesions and randomized to two oral regimens: (i) Standard: rifampicin plus clarithromycin therapy for 8 weeks; and (ii) Investigational: standard plus amoxicillin/clavulanate for 4 weeks. The primary efficacy outcome will be lesion healing without recurrence and without excision surgery 12 months after start of treatment (i.e. cure rate). Seventy clinically diagnosed BU patients will be recruited per arm. Patients will be followed up over 12 months and managed according to standard clinical care procedures. Decision for excision surgery will be delayed to 14 weeks after start of treatment. Two sub-studies will also be performed: a pharmacokinetic and a microbiology study. DISCUSSION: If successful, this study will create a new paradigm for BU treatment, which could inform World Health Organization policy and practice. A shortened, highly effective, all-oral regimen will improve care of BU patients and will lead to a decrease in hospitalization-related expenses and indirect and social costs and improve treatment adherence. This trial may also provide information on treatment shortening strategies for other mycobacterial infections (tuberculosis, leprosy, or non-tuberculous mycobacteria infections). TRIAL REGISTRATION: ClinicalTrials.gov NCT05169554 . Registered on 27 December 2021.

Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya.

BACKGROUND: Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya. METHODS: We employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions. RESULTS: The model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. CONCLUSIONS: Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust.

Ru-Catalyzed Selective Catalytic Methylation and Methylenation Reaction Employing Methanol as the C1 Source.

Methanol can be employed as a green and sustainable methylating agent to form C-C and C-N bonds via borrowing hydrogen (BH) methodology. Herein we explored the activity of the acridine-derived SNS-Ru pincer for the activation of methanol to apply it as a C1 building block in different reactions. Our catalytic system shows great success toward the ß-C(sp3)-methylation reaction of 2-phenylethanols to provide good to excellent yields of the methylated products. We investigated the mechanistic details, kinetic progress, and temperature-dependent product distribution, which revealed the slow and steady generation of in situ formed aldehyde, is the key factor to get the higher yield of the ß-methylated product. To establish the environmental benefit of this reaction, green chemistry metrics are calculated. Furthermore, dimerization of 2-naphthol via methylene linkage and formation of N-methylation of amine are also described in this study, which offers a wide range of substrate scope with a good to excellent yield.

Synthesis of 1,8-Dioxo-decahydroacridine Derivatives via Ru-Catalyzed Acceptorless Dehydrogenative Multicomponent Reaction.

A Ru-catalyzed acceptorless dehydrogenative multicomponent reaction has been developed. This reaction offers a cost-effective and simple operational strategy to synthesize biologically active 1,8-dioxodecahydroacridine derivatives. The protocol provides a wide range of substrate scope and various functional groups are also well tolerated under the reaction condition. To shed light on the mechanistic and kinetic study, some controlled experiments and deuterium labeling experiments were executed. A time-dependent product distribution experiment is also presented and the reaction scale-up is performed to highlight the practical utility of this strategy.

Acceptorless dehydrogenative construction of C[double bond, length as m-dash]N and C[double bond, length as m-dash]C bonds through catalytic aza-Wittig and Wittig reactions in the presence of an air-stable ruthenium pincer complex.

The construction of C[double bond, length as m-dash]N bonds was achieved by the dehydrogenative coupling of alcohol and azide via aza-Wittig type reaction. The reaction is catalyzed by an acridine-derived ruthenium pincer complex and does not use any oxidant. The present protocol offers a wide substrate scope, including aliphatic, aryl or heteroaryl alcohol/azides. This expeditious protocol was successfully applied to construct a C[double bond, length as m-dash]C bond directly from alcohol via dehydrogenative Wittig reaction. Furthermore, the synthesis of structurally important pyrrolo[1,4]benzodiazepine derivatives was also achieved by this methodology.

Daprodustat for anemia: a 24-week, open-label, randomized controlled trial in participants with chronic kidney disease.

BACKGROUND: This study assessed the short-term safety and efficacy of daprodustat (an oral hypoxia-inducible factor-prolyl hydroxylase inhibitor) to achieve a target hemoglobin in patients with anemia of chronic kidney disease (CKD). METHODS: Patients (n = 252) with Stages 3-5 CKD not receiving dialysis were enrolled in this 24-week, multicenter trial [hemoglobin entry criteria: 8-10 g/dL (Cohort 1) or 8-11 g/dL (Cohort 2) for recombinant human erythropoietin (rhEPO)-naïve participants; 9-10.5 g/dL (Cohort 1) or 9-11.5 g/dL (Cohort 2) for rhEPO users]. rhEPO-naïve participants were randomized 3:1 to daprodustat (1, 2 or 4 mg) or control (rhEPO per standard of care). rhEPO users were randomized 1:1 to daprodustat 2 mg or control. Study medication was titrated to maintain hemoglobin 9-10.5 g/dL (Cohort 1) or 10-11.5 g/dL (Cohort 2). Hemoglobin, iron metabolism markers and safety parameters were measured every 4 weeks. RESULTS: Mean hemoglobin levels at Week 24 were 10.2 g/dL (Cohort 1) and 10.9 g/dL (Cohort 2) in the daprodustat group and 10.7 g/dL (Cohort 1) and 11.0 g/dL (Cohort 2) in the control group. Participants had hemoglobin levels within the target range a median of 82% and 66% of the time between Weeks 12 and 24 in the daprodustat and control groups, respectively. The adverse event profile was consistent with clinical events in the CKD population. CONCLUSIONS: Daprodustat effectively maintained target hemoglobin over 24 weeks in CKD patients with anemia who were rhEPO naïve or had switched from existing rhEPO therapy.

Daprodustat for anemia: a 24-week, open-label, randomized controlled trial in participants on hemodialysis.

BACKGROUND: This study evaluated the hemoglobin dose response, other efficacy measures and safety of daprodustat, an orally administered, hypoxia-inducible factor prolyl hydroxylase inhibitor in development for anemia of chronic kidney disease. METHODS: Participants (n = 216) with baseline hemoglobin levels of 9-11.5 g/dL on hemodialysis (HD) previously receiving stable doses of recombinant human erythropoietin (rhEPO) were randomized in a 24-week dose-range, efficacy and safety study. Participants discontinued rhEPO and then were randomized to receive daily daprodustat (4, 6, 8, 10 or 12 mg) or control (placebo for 4 weeks then open-label rhEPO as required). After 4 weeks, doses were titrated to achieve a hemoglobin target of 10-11.5 g/dL. The primary outcome was characterization of the dose-response relationship between daprodustat and hemoglobin at 4 weeks; additionally, the efficacy and safety of daprodustat were assessed over 24 weeks. RESULTS: Over the first 4 weeks, the mean hemoglobin change from baseline increased dose-dependently from -0.29 (daprodustat 4 mg) to 0.69 g/dL (daprodustat 10 and 12 mg). The mean change from baseline hemoglobin (10.4 g/dL) at 24 weeks was 0.03 and -0.11 g/dL for the combined daprodustat and control groups, respectively. The median maximum observed plasma EPO levels in the control group were ∼14-fold higher than in the combined daprodustat group. Daprodustat demonstrated an adverse event profile consistent with the HD population. CONCLUSIONS: Daprodustat produced dose-dependent changes in hemoglobin over the first 4 weeks after switching from a stable dose of rhEPO as well as maintained hemoglobin target levels over 24 weeks.

Evaluation of Socio-demographic Factors for Non-compliance to Treatment in Locally Advanced Cases of Cancer Cervix in a Rural Medical College Hospital in India.

INTRODUCTION: Carcinoma cervix is a leading cause of cancer in India. However, majority of the patients face a problem of not being able to complete the treatment. AIM: This study was an attempt to find out the important causes of this non-compliance to treatment in a rural Medical College Hospital where majority of the cancer cases are of cervical cancer. RESULTS: Out of 144 patients studied over 2 years 88 cases could not complete the treatment. The study revealed that due old age 58.33% cases were defaulters, having many children at home meant a burden to 76.92% cases and 63.89% cases had a problem of not been able to travel a far distance of more than 100 km from home to hospital for treatment. CONCLUSION: These were the important factors of non-compliance and suggested more important than the issues of literacy and poor socio-economic status.

Effect of plant-based phenol derivatives on the formation of Cu and Ag nanoparticles.

The complexes formed on the reaction of various metal ions viz., Cu(II) and Cu(I) with phenol derivatives viz. catechol, chlorogenic acid (CGA), hydroquinone and n-propyl gallate (nPG) were established by UV-visible spectroscopy. The metal/ligand complexing ratio and complexation constants have been determined. Further, we showed that nanoparticles of Cu can be prepared from metal-phenol complexes in the presence of a protein (gelatin) by γ-irradiation showing that the reduction is metal ion centered. Formation of Ag nanoparticles was also observed on photo-irradiation with xenon lamp in the presence of dihydroxy benzene. The Ag and Cu nanoparticles were characterized by transmission electron microscopy (TEM) and UV-visible absorption spectroscopy. TEM technique showed the presence of Cu and Ag nanoparticles with average size of 20 and 30 nm, respectively.

Phase-transfer and film formation of silver nanoparticles.

In this article, a simple method for either transfer of silver nanoparticles from formamide to chloroform or to form a film at their interface is demonstrated. The transfer of the particles is a two-step size-dependent process. The size distribution of the colloidal hydrophobic silver particles in chloroform was almost the same as that before its transfer. Particles can be isolated by evaporation of chloroform. During evaporation, the hydrophobic particles become hydrophilic (charged) due to the formation of bilayer of CTAB over their surface. The isolated particles can be re-dispersed easily in polar solvents such as water and methanol. Nanocrystalline film of Ag is also prepared at the formamide-chloroform interface using suitable stabilizers in two immiscible layers. The nanocrystals have been characterized by various microscopic and spectroscopic techniques. The free standing film could be easily transferred on solid support.

Studies on adsorption of mono- and multi-chromophoric hemicyanine dyes on silver nanoparticles by surface-enhanced resonance Raman and theoretical calculations.

Structural and vibrational properties of mono- and multichromophoric hemicyanine (HC) dyes in solution and adsorbed on silver-coated films have been investigated using optical absorption and resonance Raman scattering techniques, with interpretations aided by theoretical calculations. This is the first report on the Raman spectroscopic studies of multichromophoric HC derivatives. The structure of the monomer, N-propyl-4-(p-N,N-dimethylamino styryl)pyridinium bromide (HC3), and its charged and neutral silver complexes (HC3-Ag) in the ground electronic (S(0)) state were optimized using density functional calculations with the B3LYP method using the 6-31G(*) and LANL2DZ basis sets. The ground state structure of N-hexyl-4-(p-N,N-dimethylamino styryl)pyridinium bromide (HC6) and multichromophoric HC dyes were computed using the HF6-31G(*) method. The negligible shift or broadening observed in the electronic absorption and resonance Raman spectra in solution with increasing size of the HC chromophore suggests that the excitations are localized within individual monomer units in bis and tetra chromophores. However, in the tris chromophore, considerable redshift and broadening were observed, indicating a significant electronic interaction between the nonbonded electrons of the N atom and the aromatic pi-system that is supported by the calculated excitation energies using the time-dependent density functional theory method. The effect of HC dye concentration on the electronic absorption spectra of the silver-coated film showed significant broadening, which was attributed to the formation of H- and J-aggregates in addition to the formation of a metal-molecule complex. A considerable redshift along various vibrations observed in the surface-enhanced resonance Raman scattering (SERRS) spectra of the HC derivatives indicates that adsorption on the silver surface leads to a considerable interaction of the electron rich moiety of HC derivatives with the silver surface. The enhancement of various in-plane and out-of-plane vibrations, along with slight broadening and redshifts observed in the SERRS spectra, suggests that binding of the HC dyes to the silver surface occurs through the aromatic pi-system attached to the electron rich dimethylamino group, with the ring lying almost parallel to the silver surface. Theoretical results have further indicated adsorption via chemisorption for the charged HC3-Ag complexes and by physisorption for the neutral HC3-Ag complexes.

Role of phenol derivatives in the formation of silver nanoparticles.

We demonstrate that dihydroxy benzenes are excellent reducing agents and may be used to reduce silver ions to synthesize stable silver nanoparticles in air-saturated aqueous solutions. The formation of Ag nanoparticles in deaerated aqueous solution at high pH values suggests that the reduction of silver ions occurs due to oxidation of dihydroxy benzenes and probably on the surface of Ag2O. Pulse radiolysis studies show that the semi-quinone radical does not participate in the reduction of silver ions at short time scales. Nevertheless, results show that primary intermediates undergo slower transformation in the presence of dihydroxy benzenes than in their absence. This slow transformation eventually leads to the formation of silver nanoparticles. The Ag nanoparticles were characterized by UV-vis absorption spectroscopy, X-ray diffraction (XRD), and transmission electron microscopy (TEM). XRD and TEM techniques showed the presence of Ag nanoparticles with an average size of 30 nm.

Ascorbic acid monoglucoside as antioxidant and radioprotector.

Ascorbic acid monoglucoside (AsAG), a glucoside derivative of ascorbic acid, has been examined for its antioxidant and radioprotective abilities. AsAG neutralized 1, 1 diphenyl -2-picryl-hydrazyl (DPPH), a stable free radical in a concentration dependent manner thus indicating its antioxidant ability. AsAG protected mice liver tissues in vitro from peroxidative damage in lipids (measured as TBARS) resulting from 25Gy gamma irradiation. It also protected plasmid pBR322 DNA from gamma-radiation induced strand breaks as evidenced from studies on agarose gel electrophoresis of the plasmid DNA after radiation exposure. Oral administration of AsAG to mice prior to whole body gamma radiation exposure (4Gy) resulted in a reduction of radiation induced lipid peroxides in the liver tissue indicating in vivo radiation protection of membranes. Pulse radiolysis studies indicated that AsAG offered radioprotection by scavenging free radicals. The rate constants for the reactions OH and N(3) radicals with AsAG were determined to be 6.4 x 10(9) dm(3) mol(-1) s(-1) and 2.3 x 10(9) dm(3) mol(-1) s(-1), respectively at pH 7. It was observed that AsAG radicals undergo conjugation as the pH of the solution is raised to 11 in the case of a one-electron oxidation reaction. As the OH(*) radical adds to the ring, the conjugation effect starts appearing at pH 10.

Rosiglitazone/metformin fixed-dose combination compared with uptitrated metformin alone in type 2 diabetes mellitus: a 24-week, multicenter, randomized, double-blind, parallel-group study.

BACKGROUND: Management of type 2 diabetes mellitus (DM) that involves uptitration of monotherapy to the maximum dose has been associated with delays in achieving glycemic control and an increased number of adverse events (AEs). Studies have reported the benefits of adding a thiazolidinedione to metformin (MET), but none has compared the effect of adding a thiazolidinedione to MET versus increasing the daily dose of MET to 3 g. OBJECTIVE: The goal of this study was to investigate the benefits of fixed-dose combination rosiglitazone and MET (RSG/MET) compared with high-dose MET monotherapy in patients with type 2 DM. METHODS: This was a 24-week, multicenter, randomized, double-blind, parallel-group study. Patients previously treated with MET entered a 4-week, single-blind, run-in period with MET 2 g/d and were then randomized to RSG/MET 4 mg/2 g per day or MET 2.5 g/d. At week 8, medication was escalated to RSG/MET 8 mg/2 g per day or MET 3 g/d. The primary efficacy end point was change in glycosylated hemoglobin (HbA1c) at week 24. Tolerability was assessed, including the frequency and severity of AEs. RESULTS: A total of 568 patients comprised the safety population (MET, 280; RSG/MET, 288) and 551 formed the intent-to-treat group (MET, 272; RSG/MET, 279). Baseline characteristics of the safety population were comparable in the 2 groups; body mass index (mean [SD]) was 32.2 (4.8) kg/m(2) and 32.1 (4.9) kg/m(2) in the RSG/MET and MET groups, respectively. RSG/MET reduced HbA(1c) (mean [SD]) from 7.4% (1.0%) to 7.1% (1.1%) at week 24, compared with a reduction from 7.5% (1.0%) to 7.4% (1.1%) with MET (treatment difference, -0.22%; P = 0.001). Fasting plasma glucose (mean [SD]) was reduced from 166.2 (29) to 144.1 (33) mg/dL with RSG/MET and from 169.3 (33) to 164.0 (37) mg/dL with MET (treatment difference, -18.3 mg/dL; P < 0.001). In addition, 54% of patients treated with RSG/MET achieved HbA(1c) levels <7.0%, compared with 36% with MET (odds ratio, 2.42; P < 0.001). RSG/MET increased homeostasis model assessment (HOMA) estimates of insulin sensitivity by 34.4% versus 6.5% with MET (treatment difference, 24.8%; P < 0.001). HOMA beta-cell function increased by 15.9% with RSG/MET versus 2.5% with MET (treatment difference, 14.0%; P < 0.001). RSG/MET decreased C-reactive protein by a mean of 39.4% versus 16.0% with MET (treatment difference, -33.8%; P < 0.001). RSG/MET was generally well tolerated, with the majority of AEs mild to moderate in nature. Serious AEs were reported in 3% of patients receiving RSG/MET and 2% with MET. Overall rates of gastrointestinal AEs were 23% with RSG/MET and 26% with MET; however, there was an increased incidence of diarrhea (14% vs 6%) and abdominal pain (9% vs 6%) with MET. There was a mean (SE) increase in weight with RSG/MET (1.3 [0.22] kg) and a mean decrease (-0.9 [0.26] kg) with MET. Patients receiving RSG/MET reported improvements in treatment satisfaction compared with MET. CONCLUSIONS: In this study, the RSG/MET fixed-dose combination (8 mg/2 g per day) was an effective and well-tolerated treatment for type 2 DM and enabled more patients to reach glycemic targets than high-dose MET (3 g/d).

Rosiglitazone, but not glyburide, reduces circulating proinsulin and the proinsulin:insulin ratio in type 2 diabetes.

An elevation in the ratio of proinsulin (PI) to immunoreactive insulin (IRI) is inversely related to beta-cell function in type 2 diabetes, and increased PI is an independent risk factor for coronary heart disease. An objective of the present studies was to assess the effects of the thiazolidinedione insulin sensitizer, rosiglitazone, on indirect markers of beta-cell function and cardiovascular risk in people with type 2 diabetes by measuring plasma PI and the PI:IRI ratio. Parameters of insulin processing, including plasma PI and PI:IRI ratios, were determined in type 2 diabetes patients enrolled in two randomized double-blind studies comparing the effects of rosiglitazone (4 or 8 mg/d) with placebo (study 1, 26-wk treatment) or the sulfonylurea glyburide (study 2, 52-wk treatment). Treatment with rosiglitazone for 26 wk (study 1) produced significant dose-dependent decreases in both plasma PI concentrations (18-29%) and the PI:IRI ratio compared with baseline (7-14%) and placebo (19-29%) (P < 0.001). A significant increase in the PI:IRI ratio in placebo-treated patients occurred (P < 0.001). In study 2, rosiglitazone also significantly reduced both plasma PI and the PI:IRI ratio compared with baseline (P < 0.001). In contrast, glyburide significantly increased both plasma PI (45%; P < 0.001) and the PI:IRI ratio (10%) (P < 0.05 vs. baseline). These results show that rosiglitazone and glyburide have differential effects on absolute PI levels and the PI:IRI ratio in people with type 2 diabetes.

Effect of rosiglitazone on insulin sensitivity and body composition in type 2 diabetic patients [corrected].

OBJECTIVE: To investigate the effects of rosiglitazone (RSG) on insulin sensitivity and regional adiposity (including intrahepatic fat) in patients with type 2 diabetes. RESEARCH METHODS AND PROCEDURES: We examined the effect of RSG (8 mg/day, 2 divided doses) compared with placebo on insulin sensitivity and body composition in 33 type 2 diabetic patients. Measurements of insulin sensitivity (euglycemic hyperinsulinemic clamp), body fat (abdominal magnetic resonance imaging and DXA), and liver fat (magnetic resonance spectroscopy) were taken at baseline and repeated after 16 weeks of treatment. RESULTS: There was a significant improvement in glycemic control (glycosylated hemoglobin -0.7 +/- 0.7%, p < or = 0.05) and an 86% increase in insulin sensitivity in the RSG group (glucose-disposal rate change from baseline: 17.5 +/- 14.5 micro mol glucose/min/kg free fat mass, p < 0.05), but no significant change in the placebo group compared with baseline. Total body weight and fat mass increased (p < or = 0.05) with RSG (2.1 +/- 2.0 kg and 1.4 +/- 1.6 kg, respectively) with 95% of the increase in adiposity occurring in nonabdominal regions. In the abdominal region, RSG increased subcutaneous fat area by 8% (25.0 +/- 28.7 cm(2), p = 0.02), did not alter intra-abdominal fat area, and reduced intrahepatic fat levels by 45% (-6.7 +/- 9.7%, concentration relative to water). DISCUSSION: Our data indicate that RSG greatly improves insulin sensitivity in patients with type 2 diabetes and is associated with an increase in adiposity in subcutaneous but not visceral body regions.

Effects of rosiglitazone alone and in combination with atorvastatin on the metabolic abnormalities in type 2 diabetes mellitus.

This study evaluated the effects of rosiglitazone therapy on lipids and the efficacy and safety of rosiglitazone in combination with atorvastatin in patients with type 2 diabetes mellitus. Three-hundred thirty-two patients entered an 8-week, open-label, run-in treatment phase with rosiglitazone 8 mg/day, and 243 were randomized to a 16-week, double-blinded period of continued rosiglitazone plus placebo, atorvastatin 10 mg/day, or atorvastatin 20 mg/day. With rosiglitazone alone, a modest increase in low-density lipoprotein (LDL) cholesterol (9%), a shift in LDL phenotype from dense to large buoyant subfractions (52% of patients), and an increase in total high-density lipoprotein (HDL) cholesterol levels (6%), predominantly in HDL(2) levels (13%), occurred from week 0 to week 8. When atorvastatin was added, there was a further increase in HDL(3) (5%) and expected significant reductions (p <0.0001) in LDL cholesterol (-39%), apolipoprotein B (-35%), and triglyceride levels (-27%). Glycemic control achieved with rosiglitazone alone was not adversely affected by add-on atorvastatin. The combination was well tolerated compared with placebo. To conclude, in addition to the beneficial effects of rosiglitazone on glycemic control, rosiglitazone and atorvastatin in combination achieved 2 goals: the reduction of LDL cholesterol to <100 mg/dl and the removal of small dense LDL in patients with type 2 diabetes mellitus.