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IntroductionAs part of the CEPHEUS study, CEPHEUS I was conducted in 2010 and 2011 in Cairo and then the CEPHEUS II study was carried out in Alexandria and Delta Regions in Egypt between April 2014 and August 2015 to determine the proportion of dyslipidemic patients on lipid-lowering treatment reaching LDL-C treatment goals.MethodsWe conducted an open-label, observational, multicenter, cross-sectional survey where 90 investigators enrolled 1127 patients receiving lipid-lowering drugs for at least 3 months. After signing informed consent forms, the study questionnaires were completed by patients and investigators. Blood samples were taken for laboratory investigations. Patients with missing LDL-C data were excluded from the analysis and results from 896 patients were analyzed according to European Atherosclerosis Society and EAS/ESC 2011 guidelines.ResultsOut of 896 patients enrolled based on the risk stratification of EAS/ESC 2011 guidelines, 12.4% were classified as low risk, 20.0% as moderate risk, 2.5% as high risk, and 65.2% as very high risk. Achievement goals were 84.7, 44.7, 18.2, and 22.3% for low-risk, moderate-risk, high-risk, and very high risk patients, respectively, with an overall achievement goal of 34.4%. The study population included 50.2% diabetes, 64.4% hypertension, 54.9% metabolic syndrome, 32.2% family history of cardiovascular disease, 23.1% smokers, and 33.8% secondary prevention. Lipid-lowering agents were prescribed as a monotherapy to 90.1% and in combination in 9.9% with goal achievements of 34 and 38%, respectively (p > 0.05). Statins were prescribed to 86.9% of patients. The most frequent prescribed statins were rosuvastatin (47.1%) and atorvastatin (36.0%), followed by simvastatin (9.2%). Treatment goal was achieved in 34.2, 36.0, and 31.7% for rosuvastatin, atorvastatin, and simvastatin, respectively, with no significant difference in achievement goals (p > 0.05).ConclusionsHypercholesterolemia is still not being effectively managed in many at-risk patients in Egypt. The majority of patients enrolled in the study were being actively treated with lipid-lowering medications yet the percentage goal achievement was less when compared to CEPHEUS results.

Evaluate safety of insulin glargine/aspart regimen in type 1 diabetics who are willing to fast Ramadan. Thirtythree patients with type 1 diabetes (mean age ± SD; 21.9 ± 8.7 years) were included. One week before the study, clinical and laboratory evaluations were undertaken. Patients on basal/bolus insulin had their doses adjusted. Those with another insulin regimen were changed to glargine/aspart regimen with adjustment of doses. At the beginning of Ramadan, patients were shifted to glargine once-daily and aspart before Iftar (sunset-meal), Suhur (sunrise-meal) and a meal in between. Total dose was reduced to 90% of pre-Ramadan dose. Patients were instructed to report any hypoglycemia, severe hyperglycemia or ketosis, and their self-monitored plasma glucose at five planned visits in Ramadan. All clinical and laboratory evaluations were repeated at the end-of-Ramadan. At the end of Ramadan, there was no report of severe hypoglycemia, hyperglycemia or diabetic ketoacidosis. Twenty patients suffered 70 hypoglycemia events; one discontinued fasting in 2 days. There was no significant change in HbA1c (p = 0.373) between pre-Ramadan (Mean ± SD; 6.5 ± 1.2%) and end-of-Ramadan level (Mean ± SD; 6.9 ± 1.2%). Moreover, there was no significant change (p = 0.251) in fructosamine level between pre-Ramadan (2.8 ± 0.9 mol/L) and end-of-Ramadan (3.2 ± 1.1 mol/L). Insulin dose had increased by 7% of the starting dose (p = 0.0496). There was no significant (p>0.05) change in weight, BMI and lipid profile at the end-of-Ramadan. Patients with type 1 diabetes can fast Ramadan safely, using low-peak basal insulin and rapid-acting pre-meal insulin, under strict blood glucose-monitoring and close supervision.