Efficacy and safety of a combination therapy of atorvastatin and krill oil versus atorvastatin and niacin in dyslipidemia: a randomized, open, and comparator study

Background: Atherosclerotic cardiovascular disease is a major health problem, with CAD being the leading cause of mortality. Epidemiologic data strongly associate high CAD risk to elevated total and LDL cholesterol and low levels of HDL cholesterol. Combination therapy is often required to achieve multiple lipid treatment goals, and ≥50% reduction in low-density lipoprotein. Niacin/statin combination therapy may promote the cost-effective achievement of OLVs in several at-risk patient populations. Krill oil is extracted from Antarctic krill, Euphausia superba, a zooplankton crustacean rich in phospholipids. Krill oil significantly reduces total cholesterol, LDL, and triglycerides, and increase HDL levels and has been found to be effective in the management of hyperlipidemia and long-term regulation of blood lipids. The aim of this study is to compare the Efficacy and Safety of a combination therapy of statin and krill oil versus Statin and Niacin in dyslipidemia.Methods: 30 eligible patients were randomized in a 12 week, open-label, comparative (2-arm, 1:1), prospective study into 2 arms, the first receiving atorvastatin 10mg od and krill oil 500mg bid and the second receiving atorvastatin 10mg od and niacin 375mg od. The primary endpoint of the study was a comparative assessment of change in lipid profile (LDL, TG, HDL) from baseline and after 12 weeks. The secondary endpoint involved recording all the adverse effects during the study.Results: Analysis of the baseline and post 12 week lipid levels by non-parametric unpaired ‘t’ test (Mann-Whitney test) showed a statistically significant change in two of the lipid levels (i.e. LDL – p=0.0037 in favour of statin and niacin and HDL – p=0.0003 in favour of statin and niacin). However the triglyceride levels showed no significant change in the two groups (p=0.2452).Conclusions: In our study the conventional combination therapy of statin and niacin is found to be more efficacious than the newer statin and krill oil combination in lowering LDL levels and increasing HDL levels in dyslipidemic patients. A further study with a higher sample size could confirm the findings of this study

Item analysis of multiple choice questions of undergraduate pharmacology examinations in an International Medical School in India

Background: Item analysis is widely used to improve test quality by observing the characteristics of a particular item and this can hence be used to ensure that questions are of an appropriate standard for inclusion in a test. Hence, this study to evaluate the multiple choice questions of an undergraduate pharmacology program. Materials and Methods: A total of 488 items were randomly selected and subjected to item analysis. Facility value (FV) and discrimination index (DI) were calculated by applying the appropriate formulae with the help of MS Excel. Results: The overall mean FV (difficulty index) and DI was 56.64% (±2.36) (mean range: 23.89-71.25%) and 0.22 (±0.84) (mean range: 0.16-0.44), respectively. 71.09% of the items analyzed were found to be “good/optimal” items based on the FV (14.13% — optimal, 56.96% — good) and 36.26% of the items analyzed were found be “very/reasonably” good items based on the DI (20.49% — very good, 15.77% — reasonably good). The number of “poor” items was 22.95% based on the FV and 18.23% based on the DI. When both the parameters were considered together, only 23% of the items were found to be “good” and 17.11% were found to be “poor.” Pearson correlation between the two indices showed a negative correlation (but statistically insignificant) between these two indices (r = −0.001379, P= 0.9774). Conclusion: Item analysis when regularly incorporated can help to develop a very useful, valid and a reliable question bank

A case of upper left extremity deep vein thrombosis with right side middle lobe syndrome

Upper extremity deep vein thrombosis is an extremely important clinical entity with potential for considerable morbidity and mortality. A 64-year-old woman was brought to the emergency department with complaints of left upper limb and neck swelling for 4 days. Ultrasonography of the neck showed thrombosis of the left internal jugular and other surrounding veins associated with local lymphadenopathy. Computed tomography (CT) of the neck also showed a hypodense 0.6 cm × 0.8 cm × 1.2 cm lesion in the right middle lobe bronchus, causing complete occlusion and collapse of the right middle lobe of the lung. Fine-needle aspiration cytology and a lymph node biopsy showed nongranulomatous lymphadenitis. The patient was started on fondaparinux 10 mg subcutaneously once daily. She was discharged on oral anticoagulants for 6 months. Repeat CT scan after 6 months showed dissolution of the lesion and reexpansion of the right lung