THE EFFECT OF LOW-DOSE NIACIN ADDED TO SIMVASTATIN ON LIPOPROTEIN PROFILE

&nbsp; Abstract INTRODUCTION: Different studies have demonstrated that low levels of high-density lipoprotein (HDL) cholesterol in serum are significantly related to the progression of coronary artery disease (CAD) and its related mortality. This study was performed primarily to assess the effectiveness of supplementing treatment with statins with low-dose (100 mg, bid) fast-release nicotinic acid (the only form of this drug produced in Iran) in increasing HDL; we also aimed to evaluate the effect of this regimen on other lipoproteins, and to investigate any possible side effects. methods: This double-blind placebo-controlled randomized clinical trial was conducted on patients who were treated with simvastatin (20 mg/daily) for at least four weeks and did not receive any other lipid-lowering medications. The patients were divided into two groups of 50. The case group was treated with niacin tablets (100 mg, bid) and simvastatin (20 mg/daily). The control group was treated with placebo tablets (bid) and simvastatin (20 mg/daily). All patients underwent two 6-week crossover periods and a 2-week washout period. Liver-function biomarkers (ALK-P, SGPT, SGOT), serum lipids, uric acid, CPK and fasting blood sugar (FBS) were measured before and after each course of treatment. Data were analyzed with chi-square test and paired t-test. results: Serum HDL increased from 42.44&plusmn;8.5 to 44.01&plusmn;8.39 mg/dl in the case group, with a mean increase of 2.56 mg/dl (P&lt;0.05). HDL decreased from 41.5&plusmn;9.1 to 40.9&plusmn;9.4 mg/dl in the control group (P&gt;0.05). Mean serum HDL was significantly different between the case and control groups (P&lt;0.05). The increase in mean total cholesterol and low-density lipoprotein (LDL) cholesterol in the control group, and the decrease in triglyceride (TG) in both groups were not statistically significant (P&gt;0.05). In follow-up, flushing was reported in 44.4% of case patients, resulting in discontinuation of treatment in 38.5% of patients. Flushing was reported in 5.6% of controls, resulting in discontinuation of treatment in 20% of patients. Muscle pain was reported in 24.4% of the case patients, resulting in discontinuation of treatment in 47.6% of the patients. Only 3.3% of the controls reported muscle pain, which led to discontinuation of treatment by the physician in 66.7% of the patients. CONCLUSIONS: Low-dose fast-release niacin led to significant HDL increase; hence we recommend that treatment of dyslipidemic patients with statins be supplemented with low-dose niacin, which is available in Iran.&nbsp; &nbsp; &nbsp; Keywords: Niacin, simvastatin, lipoprotein.</div

An Evaluation of the Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) for the Management of Treatment-Resistant Depression with Somatic Attributes: A Hospital-Based Study in Oman

Depressive illnesses in non-Western societies are often masked by somatic attributes that are sometimes impervious to pharmacological agents. This study explores the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for people experiencing treatment-resistant depression (TRD) accompanied by physical symptoms. Data were obtained from a prospective study conducted among patients with TRD and some somatic manifestations who underwent 20 sessions of rTMS intervention from January to June 2020. The Hamilton Rating Scale for Depression (HAMD) was used for clinical evaluation. Data were analysed using descriptive and inferential techniques (multiple logistic regression) in SPSS. Among the 49 participants (mean age: 42.5 ± 13.3), there was a significant reduction in posttreatment HAMD scores compared to baseline (t = 10.819, p < 0.0001, and 95% CI = 8.574–12.488), indicating a clinical response. Approximately 37% of the patients responded to treatment, with higher response rates among men and those who remained in urban areas, had a history of alcohol use, and were subjected to the standard 10 HZ protocol. After adjusting for all extraneous variables, the rTMS protocol emerged as the only significant predictor of response to the rTMS intervention. To our knowledge, this is the first study to examine the effectiveness of rTMS in the treatment of somatic depression

The impact of generic form of Clopidogrel on cardiovascular events in patients with coronary artery stent: results of the OPCES study

Background: To compare the early and late cardiovascular events as well as side effects of Osvix, a generic form of Clopidogrel versus Plavix regimens in patients with chronic stable angina, undergoing bare metal stent (BMS) or drug eluting stent (DES) placement, this study was carried out. Methods: A total of 442 patients with chronic stable angina who were scheduled for elective percutaneous coronary intervention (PCI) were included in a randomized, double blind, multi-centric clinical trial being performed in 6 distinct university hospitals in 5 cities of Iran from March 2007 to November 2009. Baseline, demographic and history of risk factors were recorded using the patients′ medical charts. Stenting procedure was performed via transfemoral approach using low osmolar contrast agents. Patients underwent BMS or DES placements based on the physician selection and were randomly assigned to Osvix or Plavix groups. Patients were followed by telephone in 0 and 6 months intervals regarding the major adverse cardiovascular events (MACE) including death, myocardial infarction, in-stent thrombosis, stroke, target lesion revascularization, and target vascular revascularization. Angina episodes, bleeding, liver enzymes, neutrophils and platelets count were also assessed in these intervals. Results: There was not any significant difference between these two groups regarding the baseline characteristics. In the DES group, the 6-month mortality rate and the incidence of MACE in Osvix and Plavix groups were 0.9% and 1.9% (p = 0.61) and 1.8% and 4.9% (p = 0.26), respectively. During the follow up period after DES or BMS placement, there wasn′t any significant difference regarding neutrophil and platelet counts or liver enzymes between study groups. Conclusions: Using Osvix and Plavix are followed by similar major cardiovascular events and side-effect profile in patients undergoing PCI