The relationship between illnesses and medical drug consumption with the occurrence of traffic accidents among truck and bus drivers in Tehran, Iran / 中华创伤杂志(英文版)

PURPOSE@#To determine the relationship of illnesses and medical drug consumption with the occurrence of traffic accidents among truck and bus drivers.@*METHODS@#This is a cross-sectional study on truck and bus drivers in Tehran, Iran. The criteria for participating in this study were: married males over 30 years old, driving license in grade one, five years of job experience, mental health and non-addiction license. The criterion for not participating in this study was the lack of cooperation in responding to the questions. Six months was spent to collect the latest five years data of driving accidents from 2011 to 2016. A total of 323 truck and bus drivers in Tehran city and the suburbs, Iran were chosen. Among them, 112 were responsible for accidents (accident group) while 211 were not responsible for any accidents or involved in an accident in the last five years (non-accident group). A specially designed questionnaire was used to investigate the demographic information, medical drug consumption, medical backgrounds and history of accidents.@*RESULTS@#The results revealed that compared with healthy subjects, the occurrence of accidents among people with diabetes (OR = 2.3, p = 0.001) and vision weakness (OR = 1.7, p = 0.020) was significantly higher, while that among people with cardiac (OR = 0.5, p = 0.002) and hypertension (OR = 0.9, p = 0.048) problems was remarkably lower. Moreover, consumption of Gemfibrozil (OR = 1.8, p = 0.010) and Glibenclamide (OR = 2.2, p = 0.002) drugs resulted in significantly higher incidence of accidents than those without.@*CONCLUSION@#Frequencies of illnesses like cardiovascular and hypertension were not higher in accident drivers than in non-accident drivers; but diabetes, vision weakness and consumption of Gemfibrozil and Glibenclamide lead to more traffic accidents.

Pharmacological effects of gemfibrozil on some isolated smooth muscle preparations of experimental animals

Background: Gemfibrozil is a member of fibrates (gemfibrozil, fenofibrate, ceprofibrate, and benzafibrate) which is employed for treatment of dyslipidemia particularly hypertriglyceridemiae through its action on peroxisome proliflator activated receptors (PPAR-). Objective: The aim of this work was to study the site of action and pharmacololgical effects of different doses of gemfibrozil on some isolated smooth muscles preparations of experimental animals. Materials and Methods: The experiments were conducted on isolated jejunum of rabbits, isolated spiral tracheal and urinary bladder strips of guinea pigs. Results: I- On isolated rabbit jejunum, gemfibrozil produced a dose-dependent reduction on the amplitude of jejunal contractions. The inhibitory effect of gemfibrozil was not abolished after complete blockade of alpha and beta adrenergic receptors, while it was completely abolished after inhibition of nitric oxide synthase by N-methyl L-arginine. On the other hand the stimulatory effects of nicotine small dose, acetylcholine, calcium gluconate, histamine and serotonin were not abolished after administration of gemfibrozil. II- On isolated tracheal spiral strips of ginea pigs, gemfibrozil produced a dose- dependent relaxation on the basal tone and a dose-dependent reduction on the amplitude of acetylcholine-induced tracheal contractions of the tracheal strips. The inhibitory effect of gemfibrozil was completely abolished after inhibition of nitric oxide synthase by N-methyl L-arginine. Gemfibrozil completely abolished also serotonin-induced contraction, while it has no effect on histamine or calcium-induced tracheal contractions. III- On isolated urinary bladder strips of guinea pigs, gemfibrozil produced a dose-dependent reduction on the amplitude of urinary bladder contractions. The inhibitory effect of gemfibrozil was not abolished after complete blockade of beta adrenergic receptors, while it was completely abolished after inhibition of nitric oxide synthase by N-methyl L-arginine. On the other hand the stimulatory effects of acetylcholine and serotonin were not abolished after administration of gemfibrozil. Conclusion: Gemfibrozil (antidyslipidemic, PPAR- agonist) reduced jejunal and urinary bladder contractions and has a relaxant effect on tracheal basal tone. So it has a beneficial effect in obstructive airway diseases and cases of urgency and frequency of micturation and urinary incontinence. However, it may be used cauciously in cases of ,GIT disturbances as constipation and prostatic hypertrophy

Effectiveness of intensive insulin therapy in the management of acute necrotizing pancreatitis induced by very severe hypertriglyceridemia

Hypertriglyceridemia may be responsible for up to 4% of acute pancreatitis. Complicated pancreatitis is a serious medical condition and might be fatal. Therefore, treating the underlying cause along with supportive measures is crucial to prevent further deterioration and possible death. There have been reports where Insulin has been the mainstay of treatment for reducing triglyceride levels in patients with pancreatitis, however, there are no well-established guidelines. We present a forty-year-old female patient diagnosed with acute necrotizing pancreatitis. CT abdomen revealed acute necrotic pancreatitis [Balthazar E] with extensive peri-pancreatic and peritoneal fluid collections. The patient was managed in the ICU for 28 days. She continued to receive gemfibrozil and insulin infusion, initiated according to the ICU's Protocol - Algorithm 1 targeting glucose values of 4.4 mmol/L to 10 mmol/L along with heparin infusion. She was successfully treated and recovered. She was discharged on antidiabetic and lipid lowering medications

Fenofibrate Therapy and Change of Renal Function: Management, What and How? / 대한내과학회지

Fenofibrate is one of PPAR-alpha (peroxisome proliferator activated receptor alpha) agonists. Fenofibrate decreases effectively triglyceride and increases high density lipoprotein cholesterol level through the effect on lipoprotein lipase, hepatic production and degradation of lipoproteins. Fenofibrate was recommended as the drug for hypertriglyceridemia treatment in European guideline released in 2011. But American heart association guideline in 2013 did not recommend non-statin therapy including fibrate for the prevention of atherosclerotic cardiovascular disease. But fenofibrate is still considered as the important drug for the management of atherogenic dyslipidemia especially in patients with metabolic syndrome and diabetes to reduce the residual risk after statin therapy from the evidence of many studies. Fibrates including bezafibrate, gemfibrozil, and fenofibrate increased serum creatinine level in several studies. But the mechanism of change in renal function is not clear till now. And the reversibility of renal function with drug discontinuation is dependent on the kinds of fibrate. Fenofibrate increased serum creatinine level, decreased albuminuria and renal function was reversible with the drug discontinuation in large clinical trials. In these days renal function change with fenofibrate therapy in Korean patients with hypertriglyceridemia was investigated. Fenofibrate treatment for 2 months increased serum creatinine level significantly and old age was associated with the change of renal function in multivariate analysis. Short-term therapy significantly increased serum creatinine level even within normal range, and this change may be important in some groups especially old age.

Gemfibrozilo versus aceite de Sacha Inchi en la reducción de niveles de triglicéridos séricos en Rattus rattus var albinus / Gemfibrozil versus Sacha Inchi oil in reducing serum triglyceride levels in Rattus rattus var albinus

Objetivo: Comparar efectos hipotrigliceridemiantes entre gemfibrozilo y aceite de Sacha Inchi en Rattus rattus var albinus. Materiales y Método: Se utilizaron 36 especímenes, los cuales fueron divididos al azar en 2 grupos experimentales (GE1 y GE2) y un grupo control (GC). Fueron sometidos a etapa de acondicionamiento por 2 semanas, luego alimentación rica en grasa por 2 semanas; posteriormente se administró aceite de Sacha Inchi y gemfibrozilo a GE1 y GE2, respectivamente. Se midieron los niveles de triglicéridos séricos en etapa basal, post-alimentación rica en grasa y tratamiento a una y dos semanas. Resultados: Disminución de niveles de triglicéridos séricos en GE1, GE2 y GC a dos semanas de tratamiento, de 45,57 %; 44,83 % y 27,24 % respectivamente. Diferencia de medias para GE1 y GE2 a una y dos semanas de tratamiento en relación a medias de valores postalimentación rica en grasa, fue muy altamente significativa; y diferencia entre grupos experimentales y GC a dos semanas de tratamiento fue significativa, con homogeneidad entre GE1 y GE2 (p=0,600). Conclusión: El aceite de Sacha Inchi demostró efectos hipotrigliceridemiantes, con eficacia similar al gemfibrozilo, en Rattus rattus var albinus, a una y dos semanas de tratamiento.

Objective: To compare the triglyceride lowering effect of gemfibrozil against that of Sacha Inchi oil in Rattus rattus var albinus. Materials and Methods: Thirty-six animals were used. They were divided in two experimental groups (GE1 and GE2) and a control group (CG). The animals underwent a conditioning stage for two weeks, afterwards they were fed with fat-rich meals; and later, the animals from the two experimental groups received Sacha Inchi oil and gemfibrozil, respectively. Serum triglyceride levels were measured at the beginning of the trial, after receiving the fat-rich food and after one and two weeks receiving the test drugs. Results: Serum triglyceride levels had 45,57%, 44,83%, and 27,24% reductions in GE1, GE2 and CG groups, respectively, after two weeks receiving the test drugs. The mean difference of triglyceride values in GE1 and GE2 groups after one and two weeks receiving the test drugs was highly significant compared with values measured after receiving the fat-rich meals; and the difference between the experimental groups and the control group after two weeks using the test drugs was also significant, and the results obtained in the GE1 and GE2 groups were homogeneous (p= 0,600). Conclusion: Sacha Inchi oil showed a triglyceride lowering effect which was similar inefficacy to that of gemfibrozil in Rattus rattus var albinus, after one and two weeks using the test products.

Suco de laranja tem efeito sinérgico à estatina e ao genfibrozila no tratamento da aterosclerose / Orange juice has a synergic effect to statin and gemfibrozil in the treatment of atherosclerosis

FUNDAMENTO: O suco de laranja (Citrus sinensis) é rico em vitami-na C, folatos e seu principal flavonóide, a hesperidina, cuja conformação es-pacial é semelhante à genisteína de soja que tem ação favorável sobre o aparelho cardiovascular. A vitamina C é conhecida como potente inibidor da peroxidação lipídica. Mas sua capacidade por possuir efeitos terapêuticos no tratamento da aterosclerose é pouco estudada. OBJETIVO: O presente tra-balho visa a determinar se o suco de laranja pode ter efeito aditivo no trata-mento com estatinas e fibratos, reduzindo placas ateroscleróticas e a quanti-dade de LDL Oxidado (LDL ox). MÉTODOS: Análise do efeito do suco nas dimensões de cortes histológicos e na quantidade de anticorpos anti LDL oxidado (antiLDLox) em lesões ateroscleróticas na aorta de coelhos. RE-SULTADOS: O suco de laranja potencializou a redução de área de placas ateroscleróticas e a quantidade de LDL(ox) em relação às reduções obtidas com rosuvastatina e gemfibrozil. CONCLUSÕES: O suco de laranja tem efei-to sinérgico ao tratamento convencional da aterosclerose de coelhos.

Statins and fibrates have been used as anti-atherosclerotic drugs. However, a high number of treated patients still present acute events and death by atherosclerotic complications. Flavonoid ingestion has been associ-ated with lower risk of death, lower incidence of coronary artery disease and more preserved endothelial function in atherosclerotic patients. Orange juice is rich in C vitamine, a well known potent inhibitor of lipidic peroxidation, and in flavonoids, mainly the hesperidine that seems the soy bean genisteine, which is associated with decrease LDL and increase HDL. Objective: In this work we studied if orange juice has addictive effect to statin and gemfibrozil in the treatment of rabbit atherosclerosis, reducing plaque area and oxidate LDL (LDLox). Methods: Five group of atherosclerotic rabbits, fed with 1% cholesterol enriched diet during 12 weeks, were analyzed: GI - received no treatment, GII Gemfibrozil 600mg/day, GIII treated with Gemfibrozil 600mg/day + orange juice, GIV - rosuvastatin/10mg / day and GV - rosu-vastatin/10mg / day + orange juice. The most severe atherosclerotic cross section in ascendant aorta was analyzed in H&E and anti-oxidated LDL (oxLDL) immunostained slides, obtaining intimal area, total vessel area, % luminal obstruction and % oxLDL area in intima. Results: The means (stan-dard deviations) of plaque area and % plaque area of oxLDL in GI were 1.05 (0.91) and 0.12 (0.13), with no significant difference with GII animals, respec- tively 3.85 (5.27) and 0.18 (0.22), but significantly reduced in GIII, 0.64 (1.56) and 0.03 (0.05). Similar data were seen in GIV, 2.11 (2.77) and 0.19 (0.25), compared with GV, 0.04 (0.09) and 0.00 (0.00). Conclusion: This work de-monstrates that orange juice has a potential synergistic action with statin and fibrates in reducing atherosclerosis and the mechanism seems to involve in-hibition of oxLDL concentration and migration of smooth muscle cells in the subendothelial space.

Effect of chemosensitizers on minimum inhibitory concentrations of fluconazole in candida albicans

To evaluate the effect of chemosensitizers on the in vitro activity of fluconazole against Candida albicans strains. Using Clinical Laboratory Standard Institute method, antifungal activity of fluconazole was determined alone and in combination with 16 chemosensitizers that included verapamil, reserpine, quinine, quinidine, gemfibrozil, lansoprazole, tamoxifen, diltiazem, desipramine, nicardipine, cyclosporine, chlorpromazine, prochlorperazine, promethazine, thioridazine, and trifluoperazine. Further studies were done using double combinations of selected chemosensitizers with fluconazole [28 combinations]. For testing combinations, half of the minimum inhibitory concentration [MIC] of each agent was selected in order to avoid the effect of the drug alone. One reference strain [ATCC90028] and one clinical isolate of C. albicans were used for testing the in vitro activity. Broth dilution method was used to determine the MICs of fluconazole and chemosensitizers. Of the 16 chemosensitizers tested, 3 exhibited in vitro activity by increasing fluconazole susceptibility to 7-fold. The MICs of the reference strain and clinical isolate for fluconazole were 5.5 and 0.55 MU g/ml, respectively, and these were reduced to 0.76 MU g/ml by gemfibrozil, 0.83 MU g/ml by quinine, and 0.76 MU g/ml by chlorpromazine in the reference strain, with MIC reduction to 0.08 MU g/ml by all three chemosensitizers in the clinical isolate. Some double combinations reduced the MIC of fluconazole to 10- to 100-fold, even when the chemosensitizers were not effective alone. The most effective double combinations were those of chlorpromazine with either reserpine or nicardipine

Respuesta del receptor de lipoproteína de muy baja densidad a estresores inflamatorios / Very low density lipoprotein receptor response to inflammatory stressors

Se estudió la regulación del receptor de lipoproteína de muy baja densidad (VLDLR) en dos tipos de células que intervienen en la respuesta inflamatoria: hepatocitos (HepG2) y células linfocitarias de bazo de ratón (CMB) por agentes implicados en la inflamación: VLDL o Gemfibrozil, lipopolisacárido bacteriano (LPS) para HepG2 o Concanavalina A (ConA) para CMB. Se determinaron por citometría de flujo las subpoblaciones de CMB y de HepG2 en distintas fases del ciclo celular (G1 y G2/M) con ioduro de propidio y las VLDLR+ con VLDL fluorescente. Entre 10 a 60 por ciento de células expresaron VLDLR dependiendo de las condiciones experimentales. El enfrentamiento con LPS o ConA produjo un aumento de células VLDLR+. El tratamiento con Gemfibrozil disminuyó el número de hepatocitos en reposo VLDLR+ pero incrementó significativamente (más de dos veces) los hepatocitos VLDLR+ en fase G2/M. En los cultivos de CMB Gemfibrozil aumentó por igual el porcentaje de células VLDLR+ quiescentes y en G2/M. El comportamiento de estos tipos celulares con VLDL fue distinto: CMB no mostró cambios en las subpoblaciones VLDLR+, los hepatocitos mostraron disminución de VLDLR+ tanto en fase G1 como en fase G2/M. Se concluyó que el estudio de la regulación de VLDLR en distintas células facilitará el diseño de fármacos específicos para el tratamiento de enfermedades de etiología inflamatoria.

The regulation of the VLDL receptor (VLDLR) by molecules involved in the inflammation process (lipopolysaccharide, LPS; Concanavalin A, ConA, VLDL or Gemfibrozil) in two cellular types implied in the inflammatory response, hepatocytes (HepG2) and lymphocitary cells from mice spleen (CMB), was studied. Different subpopulations of CMB and HepG2 in different cell cycle phases (G1 and G2/M) were analyzed using flow citometry techniques with propidium iodide, and the VLDLR+ with fluorescent VLDL. In cultures of both cell types, it was observed that 10 to 60% of the cells expressed the VLDLR (VLDLR+ cells) indistinctly of the culture conditions. VLDLR+ cells belonged equally to cells in the quiescent and in the synthesis or mitosis phase of the cell cycle. Challenging them with LPS or ConA an increase in the percentage of VLDLR+ cells was produced. Gemfibrozil treatment decreased the number of resting hepatocytes VLDLR+ but increased significantly (more than twice) the number of hepatocytes VLDLR+ in phase G2/M. In hepatocytes there was almost the same proportion of VLDLR+ cells that were in the G1 or in the G2/M phase of the cell cycle. It is concluded that the study of VLDLR regulation will facilitate the design of new drugs to treat inflammatory diseases.

Effects of vitamin E and Gemfibrozil on lipid profiles, lipid peroxidation and antioxidant status in the elderly and young hyperlipidemic subjects

This study has dealt with the effects of gemfibrozil and vitamin E [vit E] therapies on lipoprotein levels, lipid peroxidation and antioxidant statuses of the elderly and young hyperlipidemic subjects. This study took place in the Internal Medicine Clinic, Faculty of Medicine, Osmangazi University, Turkey between 2004-2005. This study was carried out on 99 hyperlipidemic and 40 control subjects. Subjects were divided into 2 groups; elderly hyperlipidemic [n=65] and young hyperlipidemic [n=34]. In the young and elderly hyperlipidemic subjects of the first group treated only with vit E [600 mg/day] for one month. In the young and elderly hyperlipidemic subjects of the second group were treated only with gemfibrozil [600 mg/twice daily] for one month. The 2 therapies of vit E and gemfibrozil were then combined and applied to the third group of our study. Reduced glutathione [GSH], glutathione peroxidase [GPx], total cholesterol [total chol], serum low density lipoprotein [LDL], high density lipoprotein [HDE], triglyceride [TG], vit E, malondialdehyde [MDA], superoxide dismutase [SOD] levels of the 3 groups were measured. In elderly hyperlipidemic therapy group: vit E groups, the post-treatment vit E levels increased. In the gemfibrozil groups, post-treatment TG level decreased whereas HDL level increased. In the vit E plus gemfibrozil groups, post-treatment TG level decreased, HDL, and vit E levels increased. In young hyperlipidemic therapy group: vit E groups, the post-treatment HDL, vit E, GSH, GPX levels increased whereas LDL, MDA, levels decreased. In the gemfibrozil groups, post-treatment TG, LDL decreased, HDL level increased. In the vit E plus gemfibrozil groups, post-treatment TG, LDL, MDA levels decreased whereas HDL, vit E, GSH levels increased. When combined, gemfibrozil and vit E are effective in preventing cardiovascular diseases

Associação de medicamentos: estatinas e fibratos / Combination of drugs: statins and fibrates

Monoterapia para o tratamento das dislipidemias é frequentemente insuficiente para o alcance das metas recomendadas pelas diretrizes. Entretanto, nos últimos anos, o uso de terapia combinada tem se apresentado como uma nova opção em muitos casos. Uma revisão de 36 estudos envolvendo a combinação de estatinas com fibratos apresentou 29 casos de rabdomiólise e uma prevalência geral de miopatia de 0,12 por cento. A combinação de estatinas com o genfibrozil parece causar mais rabdomiólise que com os fibratos de nova geração (especialmente quando comparado com fenofibrato ou bezafibrato). Idade avançada, diabetes, mulheres, medicações concomitantes, disfunção renal, consumo excessivo de álcool, exercícios, traumatismos e cirurgias estão também associados com maior risco de efeitos adversos.

Protective effect of coenzyme Q10 in simvastatin and gemfibrozil induced rhabdomyolysis in rats.

Administration of simvastatin (80 mg/kg, po. evening dose) and gemfibrozil (600 mg/kg, po twice) for 30 days produced significant decrease in the level of reduced glutathione, superoxide dismutase, catalase and increase in the level of lipid peroxidation and various serum parameters (creatine phosphokinase, lactate dehydrogenase, serum glutamate oxaloacetate transaminase, creatinine, urea and blood urea nitrogen). This suggested involvement of oxidative stress in rhabdomyolysis. Increase in the level of reduced glutathione, superoxide dismutase, catalase and decrease in the level of lipid peroxidation and serum parameters after administration of antioxidant CoQ10 (10 mg/kg.ip) proved the protective effect of CoQ10 in rhabdomyolysis.

Effect of Fibrate on Lipoprotein(a) Level in Hypertriglyceridemic Patients

BACKGROUND AND OBJECTIVES: The responses of lipoprotein (a) [Lp(a)] to lipid-lowering drugs are different from those of other lipids and lipoproteins. Most reports on the effect of fibrate on the Lp (a) level have only a few cases, with inconsistent results. This study was designed to evaluate the effect of fibrate on the Lp (a) level in hypertriglyceridemic patients. SUBJECTS AND METHODS: Patients with either a triglyceride (TG) level over 300mg/dL or TG level over 200mg/dL and a high density lipoprotein cholesterol level below 40mg/dL, were enrolled. They were treated with either fibrate (Fibrate group, n=29) or general measures (Control group, n=29). Gender and age matched patients with hypercholeste-rolemia were adopted and treated with statin (Statin group, n=29). The lipid and lipoprotein levels were measured before and after the medication for 2 months. RESULTS: The baseline Lp (a) levels were similar between the Fibrate and Control groups (p=0.19). Fibrate therapy increased the Lp (a) level from 10.3+/-16.4 to 15.1+/-15.2 mg/dL (p=0.003), but there were no changes in the Lp (a) levels in the Statin and Control groups. Before the treatment, the Lp (a) levels were negatively associated with the TG levels (r=-0.36, p=0.001). The relationship became weaker and insignificant after the medication. The more the TG level was decreased, the more the Lp (a) level was increased in all of the cases (r=-0.35, p=0.001 ) as well as in the Fibrate group (r=-0.46, p=0.013). CONCLUSION: Fibrate increased the Lp (a) level, and this elevation was associated with the reduction in the TG level. This finding might be related with a lesser cardioprotective effect of fibrate than that of statin in addition to the effect on the cholesterol level.

Comparison of effectiveness of lovastatin and gemfibrozil on HDL-C level in diabetic type 2 patients

Diabetes mellitus is the most common human metabolic disease. Chronic hyperglycemia and carbohydrate metabolism disorder accompany with plasma lipid and lipoprotein disorder. Cardiovascular disease is one of the macro vascular complications of diabetes type 2 which leads to high morbidity and mortality. Dyslipidemia is one of the major risk factors of cardiovascular diseases in diabetic patients. High TG and low HDL-C levels are the most prevalent type of dyslipidemia. Low levels of HDL-c considered as a risk factor for cardiovascular diseases. In this study 40 type 2 diabetic patients [13 male - 27 female] were included. Lovastatin and Gemfibrozil were recommended separately for 2 months and HDL-C were measured at the baseline and after taking drugs. In all patients BS, TG and TC at the baseline before and after these drugs were normal and so were not any change in their diet. Laboratorial findings gathered and analyzed. The relationship between increase level of HDL and decrease of TC with taking Lovastatin and Gemfibrozil were studied. The averages of TC and HDL-C before taking drug as linear were 36.5mg/dl and 174.56 mg/dl and after taking Lovastatin as linear were 43.3 mg/dl and 150.44 mg/dl. The average of TC and HDL-C after taking Gemfibrozil were 43.33mg/dl and 146.36mg/dl. 18.54% increase in HDL-C and 13.82% decrease in TC were seen with Lovastatin; and 18.54% increase in HDL-C and 16.05% decrease in TC were found with Gemfibrozil. In this study no difference was observed between the effect of Lovastatin and Gemfibrozil in increase of HDL-C [P=0.449]. Also there was no difference between the effect of Lovastatin and Gemfibrozil in decrease of TC [P=0.992]. The increase of HDL-C after taking Lovastatin had relation with sex and HDL-C increased in females [P=0.006]; Also the increase of HDL-C after taking Gemfibrozil had relation with sex and females had more affected [P=0.035]

Comparison between duration dependent effects of Simvastatin and Gemfibrozil on dyslipidemia in patients with type 2 diabetes

To observe the duration dependent effects of two important classes of lipid lowering drugs i.e. simvastatin and gemfibrozil in type 2 diabetic patients with dyslipidemia in Pakistani population. Seventy type 2 diabetic patients with newly diagnosed dyslipidemia were enrolled and were divided randomly into two groups each, with 35 patients. Group I patients was given tablets Simvastatin 20 mg once daily and group II patients received tablet Gemfibrozil 600 mg twice daily. The study period comprised of 12 weeks. Fasting lipid profile and fasting blood sugar was analyzed on week 0 [day of inclusion], week 6 and week 12. At week 12 simvastatin decreased serum LDL cholesterol by 36.97% [P<0.001]. In contrast gemfibrozil did not reduce it significantly with a reduction of only 1.33% [P=N.S]. Simvastatin reduced serum total cholesterol and serum triglyceride by 29.88% [P<0.001] and 21.78% [P<0.001] respectively and increased serum HDL cholesterol by 16.67% [P<0.001]. While gemfibrozil decreased serum total cholesterol by 9.14% [P<0.001] and serum triglyceride by 30.84% [P<0.001]. Gemfibrozil raised serum HDL cholesterol levels by 18.08% [P<0.001]. Significant changes were observed in all lipid parameters with both simvastatin and gemfibrozil with regard to duration of treatment. Simvastatin was found to be more effective in lowering serum total cholesterol and LDL cholesterol levels in comparison to gemfibrozil, which was found to be more effective in lowering serum triglyceride and elevating serum HDL cholesterol levels. Both of these drugs were well tolerated and none of the patients exhibited any significant adverse effects. Both can be given as monotherapy in patients with type 2 diabetes mellitus and abnormal lipid profile

A pilot study on the effect of statins, fibrates and its combination in rat nerves

OBJECTIVE: To determine the histopathological effect of statins, fibrates and its combination in rat nervesMETHODOLOGY: This is a pilot experimental study. Four male albino rats were used in this study. Each rat was given therapeutic doses of simvastatin alone, gemfibrozil alone, gemfibrozil and simvastatin combination and placebo. On day 21, the sciatic nerve was harvested for histopathologic examinationRESULTS: Although not marked, the combination of simvastatin and gemfibrozil produced more axonal degeneration than did simvastatin alone or gemfibrozil alone. Axonal degeneration was documented on teased nerve fibers and epon cross sectionsCONCLUSION: The use of lipid lowering agents may induce peripheral neuropathy Recommendation: This pilot study serves as rationale to proceed with an experiment not only to document neuropathy but also correlate the possible association of the pathomechanism of myotoxicity and neurotoxicity of lipid lowering agents.

Recurrent Rhabdomyolysis after Cerivastatin-Gemfibrozil Combination Therapy / 대한신장학회잡지

A 64-year-old woman with ischemic heart disease was admitted to our hospital because of both leg pain and difficulty to walk for 5 days. She had taken cerivastatin and gemfibrozil for atherosclerosis and ischemic heart disease. One year ago, she had been admitted to our hospital because of acute renal failure due to rhabdomyolysis of unknown origin and was improved after conservative therapy. Laboratory studies revealed serum creatinine 1.2 mg/dL, creatine kinase 23,700 IU/L, serum myoglobin >500 ng/mL, urine myoglobin >3,000 ng/mL. (99m)Tc-HDP whole body Bone scan showed multiple increased uptakes of the soft tissue, especially both calf. With supportive care, she was recovered and discharged with normal creatinine(0.8 mg/dL) and creatine kinase(260 IU/L).

Rhabdomyolysis Associated with Cerivastatin-Gemfibrozil Combination Therapy: 1 case

Most currently available statins are associated with an increase with risk of myositis, including rhabdomyolysis. Myopathy is believed to be caused by interference in the cytochrome P450 3A4 enzyme system, which results in a marked increase in reductase activity. Cerivastatin, a new synthetic HMG-CoA reductase inhibitor, is a safe, well-tolerated effective drug for the treatment of patients with dyslipidemia. The drug is metabolized by the cytochrome P450 3A4 and cytochrome P450 2C8 hepatic isoenzymes. Because of this dual metabolic pathway, it has been suggested that cerivastatin is less subject to drug-todrug interactions. We describe a 60-year-old woman with rhabdomyolysis and localized myositis, after she had taken cerivastatin(lipobay, 0.3 mg/day) and gemfibrozil(lopid, 500 mg/day) for 1month.

A Case of Type V Hyperlipoproteinemia with Xanthoma Eruptivum / 대한피부과학회지

We report a case of type V hyperlipoproteinemia with xanthoma eruptivum associated with diabetes mellitus. An 18-year-old female patient presented with multiple, erythematous papules on the trunk, buttocks, and both extremities and multiple orange-yellow colored, conglomerated nodules on the elbows and knees. Laboratory examination showed increased serum blood glucose, cholesterol and triglyceride. Lipoprotein electrophoresis showed increased pre-beta and chylomicron bands. Analysis of lipoprotein revealed increase of very low density lipoprotein (VLDL) and triglyceride levels in the plasma. A skin biopsy from the papule on the trunk revealed a xanthoma. We diagnosed the patient as type V hyperlipoproteinemia. After 10 months of treatment with insulin and gemfibrozil, the serum levels of cholesterol and triglyceride were reduced to normal level. The skin lesions showed marked improvement without scar.