Overuse of Intravenous Proton Pump Inhibitors in General Medicine and Surgery Wards.

BACKGROUND: Overuse of stress ulcer prophylaxis is prevalent globally despite guidelines leading to the added cost, especially the intravenous proton pump inhibitor (IVPPI). This study aims to analyze the prevalence of such overuse and be aware of rational use which may help develop local guidelines. METHODS: This study analyzed the prospectively collected data on IVPPI use in adult patients in general wards of medicine and surgery at Patan Hospital, Patan Academy of Health Sciences, Nepal, from April-Jun 2022. Ethical approval was obtained. Variables analyzed were the patient's age, gender, history of peptic ulcer disease, risk for stress ulcer and gastrointestinal bleeding, the status of nil per os (NPO ≥12 hours), appropriate use of IVPPI, and cost. RESULTS: Prevalence of IVPPI use was 36.24% (274/756 admissions), surgery 39.45(189/479), medicine ward 30.68% (85/277). The mean age was 43.1 ±18.6 years, males 113(41.2%), surgery 189 (69%). Inappropriate overuse in 253(92.3%, significantly more in surgery-182 than medicine-7, p=0.001. Appropriate use was in 21 (7.7%, i.e., NPO-15, NPO + gastrointestinal bleed, and NPO + non steroid anti-inflammatory drugs each 3). CONCLUSIONS: Prevalence of IVPPI use was 36.24%. Inappropriate overuse of IVPPI was high (92.2%, 253/274), more in surgery. The nil per os status was the main reason for appropriate use of IVPPI.

Prevalence of Anxiety and Depression among People Living with Leprosy and its Relationship with Leprosy-Related Stigma.

Background: Leprosy, a chronic infectious disease, is associated with a high risk of psychiatric disorders. Aims and Objectives: We aim to estimate the prevalence of anxiety and depressive symptoms among people living with leprosy at a special community residence in Nepal. We also aimed to find the correlation between anxiety and depression. Materials and Methods: This is a cross-sectional descriptive study conducted in a community of people with leprosy staying at a centre in Nepal using all enumerative sampling. The semi-structured schedule, hospital anxiety and depression scale and stigma assessment and reduction of impact (SARI) stigma scale were applied among 119 participants. Results: About 10.1% (n = 12) and 12.6% (n = 15) of participants scored above the threshold score indicative of definitive clinically significant anxiety and depression symptoms. In multivariable analysis, leprosy-related stigma and attribution of leprosy to bad deeds were significant correlates of anxiety; whereas leprosy-related stigma and duration of stay at the centre were significant correlates of depression. Conclusion: The prevalence of depression and anxiety symptoms among people living with leprosy is higher than that in the general population. Sigma is a significant correlation for both. It is important to screen for mental health issues while managing patients with leprosy and implement strategies aimed at leprosy-related stigma reduction.