Epidemiological and clinical characteristics of HIV infected patients at a tertiary care hospital in Oman

Objectives: In 2015, the Joint United Nations Program on HIV/AIDS [UNAIDS] set a target that 90% of all people living with HIV will know their HIV status, 90% of those diagnosed will receive antiretroviral therapy, and 90% of those receiving antiretroviral therapy will have viral suppression by 2020. We sought to elucidate the epidemiological and clinical characteristics of HIV infected patients at the Infectious Diseases Clinic at Royal Hospital, Oman, with a focus on the UNAIDS 90-90-90 achieved rates

Methods: We conducted a retrospective analysis of the medical records of 326 HIV infected patients from 1989 to 2016. Data collected included demographics, Word Health Organization [WHO] staging, laboratory analyses, and treatment outcomes

Results: The overall mean age of the cohort was 36.0 +/- 15.0 years, and 60.4% [n = 197] were males. The majority of patients acquired HIV through heterosexual transmission [58.9%; n = 192]. At the time of the first clinic visit, 26.1% [n = 85] of patients had WHO stage 4 HIV infection. The rates of HIV/HBV and HIV/HCV coinfections were 2.7% and 5.8%, respectively. The baseline CD4+ cells count was <200 cells/mm[3] in 38.0% [n = 124] of patients, 201-500 cells/mm[3] in 30.1% [n = 99] of patients, and > 500 cells/mm[3] in 27.0% [n = 88] of patients. The baseline HIV RNA titer was greater than 1000 copies/mL[3] in 74.5% [n = 243] of the cohort. A total of 96.3% [n = 314] of patients received antiretroviral therapy, most commonly non-nucleoside reverse transcriptase inhibitor-based regimens. HIV genotype resistance testing was performed in 165 patients [50.6%] either at baseline in treatment naïve patients or following treatment failure.Among the 326 patients included, 22 patients [6.7%] died, and 29 patients [8.9%] were lost to follow-up

Conclusions: Regarding the UNAIDs 90-90-90 target, over a quarter of the patients presented late with WHO stage 4 HIV disease, 96.3% of cohort patients received antiretroviral treatment, and 71.5% achieved virological suppression

study of prescribing valsartan in out-patient clinics at the Royal hospital, Muscat, Oman

Angiotensin Receptor Blockers such as Valsartan, are a newer class of drugs associated with significant reductions in cardiovascular morbidity and mortality. They are commonly used in hypertension, chronic heart failure, diabetes-related nephropathy and post-myocardial infarction in patients who are intolerant to Angiotensin Converting Enzyme inhibitors [ACEi], A review of medicines used in Royal Hospital [an Omani tertiary health care centre] during 2004 and 2005 showed that Valsartan was one of 20 most expensive drugs used The main objective of this study was to evaluate the pattern of prescribing valsartan in out-patient clinics. a retrospective study applying medicines use evaluation, to describe the pattern of prescribing Valsartan in comparison with international guidelines. The study carried out in the outpatient pharmacy setting, Royal Hospital from 15th May to 30th June 2006, It included 120 adult patients who had been prescribed Valsartan at the outpatient clinics during the study period, among the 120 patients only 109 patients were finally included in the study, Elevenpatients who had had duplicated prescriptionswere excluded from the study, 78% of the patients were on Valsartan for its FDA-approved indications while 22% of patients were for other non-approved indications. Half of the patients were initiated on an ACEi before shifting to Valsartan, The other half of the patients was started with Valsartan as a first line choice without any clinical justification, The study showed that half of the patients were initiated on Valsartan without being prescribed an ACEi prior to that, while the recommendation in most of the international guidelines based on indication stated that ARBs are used in patients who are intolerant to ACEi, The study emphasizes the need for further research to highlight the need for developing national guidelines and adhering to these guidelines for rational prescribing

Prophylaxis for opportunistic infections for kidney transplantation recipients at the Royal hospital in Oman

The main objective of this study is to ensure all patients undergone kidney transplantation receives appropriate standard PCP prophylaxis soon after transplantation, unless contraindicated. A prospective study included all kidney transplantation recipients from January 2008 to August 2008. A data collection sheet was designed and reviewed in focus group meetings and modified accordingly. The subjects were followed-up during the admission for transplantation to the date of discharge. The discharge prescriptions were screened to ensure all the kidney transplantation recipients were prescribed appropriate PCP prophylaxis before discharge. All prescriptions with NO PCP prophylaxis were intervened by the clinical pharmacist. The focus group meetings suggested designing a questionnaire using likerts scale. The purpose was to highlight doctors' perception towards PCP prophylaxis for renal transplant recipients. The questionnaires were distributed to all the nephrology doctors [consultants, senior specialists and medical officers]. The data were entered in the data collection sheet and were analyzed by using simple statistical methods. Almost 80% of the prescriptions did not included [TMP/SMX] for PCP among which 20% of the prescriptions were for patients with G6PD deficiency. The clinical pharmacist's interventions resulted that all discharge prescriptions were modified and [TMP/SMX] was prescribed for patients who were legible for a PCP prophylaxis. In the absence of prophylaxis, the incidence of PCP in solid organ transplant recipients ranges from 6.8% to 22%, necessitating PCP prophylaxis for at least 6 months following transplantation. Despite the widespread knowledge on PCP prophylaxis, most of the patients were discharged with no prophylactic treatment for PCP. After pharmacist's intervention the prescriptions were edited and PCP prophylaxis was added