Medical & Clinical Research
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Fulminant Toxic Shock Syndrome: An Unusual Complication of Septic Abortion
Ahmed S El-agwany* and Mervat Ali El-Sersy
Endometritis and toxic shock syndrome associated with Clostridium sordellii have previously been reported after childbirth and after medical abortion. Clinical findings included tachycardia, hypotension, edema, hemoconcentration, profound leukocytosis, and absence of fever. We described a case of a young woman who developed Clostridium sordellii toxic shock syndrome after abortion surgically evacuated five days before admission. Although the patient was aggressively treated, death occurred <3 days after admission. Very early recognition of this disease can decrease the mortality associated with this rare disease.
Current Therapy of Hypercholesterolemia
Wilbert S. Aronow
Randomized, double-blind, placebo-controlled secondary prevention and primary prevention studies and observational studies have documented that statins reduce cardiovascular events in high-risk patients with hypercholesterolemia. The 2013 American College of Cardiology/American Heart Association guidelines on treatment of hypercholesterolemia support the use of statins in 4 major groups that will be discussed. The Expert Panel of these guidelines could find no data supporting the routine use of nonstatin drugs combined with statins to further reduce cardiovascular events. Since these guidelines were published, a double-blind, randomized trial of 18, 144 patients with an acute coronary syndrome demonstrated at 7-year follow-up that the incidence of cardiovascular events was 34.7% in patients randomized to simvastatin plus placebo versus 32.7% in patients randomized to simvastatin plus ezetimibe (hazard ratio = 0.936; p = 0.016). Proprotein convertase subtilisinkexin type 9 (PCSK9) inhibitors further lower serum low-density lipoprotein cholesterol by 50% to 70% in patients treated with statins and 4 phase 3 trials including more than 70, 000 patients are investigating whether these monoclonal antibodies to PCSK9 will lower cardiovascular events.