The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

Dan Niculescu

Dan Niculescu

Drug Utilization Study in Patients Attending Hypertension Clinic of a Tertiary Care Hospital, Rajasthan, India

Background: Hypertension is a major public health problem in India, affecting a significant proportion of the population. Drug utilization research is important for assessing the rationality of drug treatment and for identifying areas for improvement. This study examined the drug utilization pattern of antihypertensive drugs in hypertensive patients at an Outpatient Department (OPD) in Udaipur, Rajasthan, India, based on JNC-8 classification. Materials and Methods: The observational cross-sectional study included 300 hypertension patients aged above 25 attending the hypertension clinic. Exclusions were made for inpatients, age < 25, uncertain diagnosis, pregnant/lactating mothers, and patients subsequently admitted after OPD visits. Results: The majority of affected patients were above 60 years old, with most having hypertension for 2-5 years, often accompanied by Type II Diabetes Mellitus. Oral administration was the primary drug delivery route. On average, patients received 1.93 antihypertensive drugs per encounter (range: 1 to 4), with an average of 5.82 drugs per encounter (range: 1 to 12). Losartan (72%) and amlodipine (46%) were the most prescribed drugs, with Angiotensin Receptor Blockers (ARBs) being the most prescribed drug class (79.3%), followed by Calcium Channel Blockers (CCBs) at 46.6%. The most common therapy was a two-drug combination (44.6%), followed by single-drug therapy (33%). Approximately 26.3% of prescriptions indicated potential drug interactions. Conclusions: This study provides valuable baseline data on the prescribing pattern of antihypertensive drugs. Rational prescribing practices are being followed, with the majority of patients being prescribed a combination of two or three antihypertensive drugs. However, there is a need to educate patients about the risks associated with uncontrolled high blood pressure and the benefits of lifestyle changes.

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Mucormycosis Infections during the Second Wave of COVID-19: Experience from a Tertiary Care Centre in India

Background: Mucormycosis is an uncommon fungal infection with high morbidity and mortality. There had been a sudden surge in the cases of mucormycosis during the second wave of Coronavirus Disease 2019 (COVID-19) in India. Objective: The etiology, pathophysiology, and correlations of mucormycosis at tertiary hospital in India is explored in the present study. Methods: In this retrospective observational study, all coronavirus disease associated mucormycosis (CAM) cases admitted at this center between April 2021 to June 2021 were included. The cases were
evaluated in terms of their background, most common presentations, chief underlying etiologies, severity of disease, comorbidities, investigation profiles, prognosis, and treatment provided. Results: Among the total 231 cases reported with mucormycosis, age group of 40 - 50 years (28%) was the most afflicted and the 20-30 year was the least. Men (68%) were more afflicted than Women. 66% patients had a history of vaccination against COVID-19. 63% patients presented with a High-Resolution Computerized Tomography (HRCT) score of 9-16. 60% required oxygen support and 71% required steroids. Diabetes mellitus was the most prevalent comorbidity. Conclusion: The salience of the second inferno wave of COVID-19 was witness to COVID-19 patients who had pre-existing diabetes mellitus.
Individuals with diabetes in general foster more extreme COVID-19 infections and end up using corticosteroids. In any case, the corticosteroids – alongside diabetes – increment the danger of getting mucormycosis. The specific pathophysiology of COVID-19 may represent co-morbidity with Invasive Fungal diseases (IFI).

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Parathyroid Hormone-Related Bone Loss in End-Stage Renal Disease: Where to Measure?

Renal osteodystrophy is almost universally found in patients with end-stage renal disease (ESRD). Although bone biopsy is the gold standard for assessment of bone status it is infrequently used.
Guidelines (KDIGO, 2009) recommend the use of dual-energy X-ray absorptiometry (DXA), as a method for measuring bone quantity, in all dialysis patients who either have had fractures or have risk factors for osteoporosis but state against routine use of DXA for bone mineral density (BMD) measurement. This is because low BMD measured by DXA was consistently associated with an increased risk of low trauma fractures in general population but in patients with ESRD studies produced conflicting results (Inaba et al., 2005
Jamal et al., 2002
Kaji et al., 2002
Urena et al., 2003
Yamaguchi et al., 1996). There are many causes of this heterogeneity including secondary hyperparathyroidism, presence of low bone turnover disease, osteomalacia, site of BMD measurement or fracture assessment (clinical vs. radiological).

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