1 Department of Anesthesiology and Pain Management, Stroger Hospital of Cook County, Chicago, Illinois, USA; 2 Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Banja Luka, Banja Luka, Bosnia and Herzegovina; 3 Department of Periodontology and Oral Medicine, Institute of Dentistry, Banja Luka, Bosnia and Herzegovina; 4 Department for Certification, The Republic of Srpska Agency for Certification, Accreditation and Quality Improvement in Health Care, Banja Luka, Bosnia and Herzegovina; 5 Department of Endodontic, Institute of Dentistry, Banja Luka, Bosnia and Herzegovina

INTRODUCTION Statins have similar side effects that do not always occur at the same rate among the various statins. We present a case of simvastatin-induced muscle toxicity that disappeared when pravastatin was substituted for the original drug. CASE OUTLINE A 74-year-old male, a nonsmoker, complained of severe nocturnal leg cramps. The patient also complained that similar painful cramping occurred when he walked rapidly or jogged. Because some components of his lipid panel exceeded the'desirable' range, and as he had a history of myocardial infarction, his family physician prescribed simvastatin (40 mg/day). The patient had taken this medication for the past eight years. The painful nocturnal episodes started two years ago and affected either one or the other leg. Four months ago we discontinued his simvastatin and prescribed pravastatin (80 mg/day). At a follow-up visit six weeks later, the patient reported that his leg pains at night and the pain experienced after brisk walking had disappeared. Four months after the substitution of pravastatin for simvastatin, the patient reported that his complete lack of symptoms had continued. CONCLUSION These painful muscle cramps were probably caused by an inadequate vascular supply to the calf and foot muscles. Perhaps a combination of advanced age and atherosclerotic changes created a predisposition for the simvastatin-induced leg cramps. Pravastatin differs from simvastatin in several ways.l It is not metabolized by cytochrome P450 (CYP) 3A4 oxidases, and thus is not influenced by CYP 3A4 inhibitors like simvastatin. Also, simvastatin is associated with single-nucleotide polymorphisms located within the SLCO1B1 gene on the chromosome 12 and established myopathy, while pravastatin lacks this association. These differences may contribute to increased tolerance to pravastatin in this particular case.

Smokers have an increased risk of perioperative and postoperative complications, including a higher incidence of airway and respiratory, cardiovascular events, and impaired wound healing. This brief review will remind anesthesiologist and surgeons that their preoperative smoking intervention for smoking cessation can be effective in decreasing the incidence of complications. Preoperative smoking intervention, even if it is both brief and intensive, may help to decrease this risk. The surgical event is the important ‘teachable moment’ that could translate, with proper smoking intervention, into permanent smoking cessation.

We surveyed 27 anesthesiology residents to determine their basic understanding of biostatistics. We wanted to see how well they could interpret statistical presentation in biomedical literature and assess research outcomes. The questionnaire included three sections: demographics of the participants, their knowledge of statistics (21 questions) and their attitude and self reported confi dence about biostatistics. Recognition of a meta-analysis was the highest scoring question (85% gave the correct answer), and recognition of a case-control study scored the lowest (22%). There was no effect of gender, the year of study, the number of years elapsed since graduation at the medical school, or country in which the participants had attended medical school (US or foreign schools). The only factor that increased the number of correct answers signifi cantly was an additional course in biostatistics that two participants had attended after graduation. Sixty six percent indicated they did not understand all of the statistics they encountered in journal articles, but all of the participants felt it was important to be able to understand the literature. We conclude that most residents in this study lack the knowledge in biostatistics needed to interpret results in medical publications. Most participants in this survey expressed the desire to improve their knowledge on this subject, even though it would require taking special courses in basic epidemiology, and statistics for the non-statistician during their residency training.

Great scientifi c discoveries rarely originate from small and poor countries, especially if they are frequently engulfed in wars, like it was the case with Serbia, and other parts of the former Yugoslavia. Despite the odds, quite a few well educated, curious, wise, and brave minds have made signifi cant contributions under such circumstances. For example, the achievements of Laza K. Lazarević (18511891), Milutin Milankovic (1879-1958), Ivan Djaja (18841957), Pavao Stern (1913-1976), and several other Yugoslav researchers clearly show that some scientists are able to make great discoveries under limited resources. 1 Nikola Tesla (1856-1943), and two Nobel laureates of Yugoslav origin, Leopold Ruzicka (1887-1976) and Vladimir Prelog (1906-1998), are only mentioned here because their major scientifi c contributions had been mostly conducted in the USA and Switzerland.