Practices of proton pump inhibitors use in medical wards

Objective: To determine the pattern of proton pump inhibitors [PPIs] use in medical wards

Study Design: Prospective observational study

Place and Duration of Study: Department of medical post graduate medical institute, study for 24 weeks, from 01 Nov 2014

Material and Methods: One thousand eight hundred consecutive patients admitted in medical wards and emergency department were enrolled and followed during hospital stay and their discharge slips were analyzed without intervention in the management protocol of different primary consultants

Results: Results were analyzed on SPSS version 20. Out of 1800 patients, 53.3% [n=960] were males and 46.7% [n=840] females, 72.6% [n=1306] had been prescribed PPIs. Major indications for the use of PPI were stress ulcer prophylaxis [32.5%], upper G.I bleeding [20.0%], acid peptic disease [12.5%], patients of GERD [8.1%] and NSAID use [7.5%]. In 19.3% patients, indication of PPI use was not mentioned. Out of the admitted patients 57.7% patients were prescribed inject-able and 42.3% were given oral PPIs. There were 77.9% [n=1018] patients prescribed PPIs on discharge slips while duration of treatment and indication for their use were not mentioned on discharge slips for 66.3% [n=866] and 72.3% [n=944] patients, respectively

Conclusion: PPIs are over used without clear indications in hospitalized and discharged patients

Incidence of thyroid cancer in the Kingdom of Saudi Arabia, 2000-2010

Thyroid cancer is the second most common malignancy among females at King Faisal Specialist Hospital and Research Centre [KFSH and RC] and in Saudi Arabia, accounting for about 11% of all newly diagnosed female cancers in the country in 2008. Over the past several decades, an increasing incidence of thyroid cancer has been reported in the Kingdom of Saudi Arabia. There are no comprehensive clinical epidemiological data for the trends of thyroid cancer incidence compared to the global incidence. This report reviews the thyroid cancer incidence in KFSH and RC and compares that with Saudi Arabia, the Gulf region, North America and globally from 2000 to 2010. Retrospective review of patients with thyroid cancer was carried out from 2000 to 2010, using the hospital Tumor Registry program as per the American College of Surgeons standards. Trends and patterns of all well-known prognostic factors were sub-stratified by age, stage and grade. A total of 2292 patients with thyroid cancer were treated at KFSH and RC, Riyadh, Saudi Arabia, from 2000 to 2010. Thyroid cancer constitutes about 9% of all malignancies and 12% of all female malignancies at KFSH and RC, which are significantly higher compared to the USA, where thyroid cancer represents only 2.9% of all malignancies and 4.6% of all female malignancies. Papillary adenocarcinoma was the most common histological subtype followed by papillary carcinoma, follicular variant. Median age at diagnosis was 40 for females and 44 years for males. Overall Age-Standardized Incidence Rate [ASR] was 4.4/100,000 [6.8 for female and 2/100,000 for males] in the Kingdom in 2008. Median age at diagnosis was 38 years and the highest incidence was in the 30-39 year age group in KFSH and RC. About 48% of patients presented in the localized stage and 60% underwent combined modality treatment consisting of surgery, radiation and hormonal therapy. There was significantly increased incidence among females as compared to males. The age-adjusted thyroid cancer incidence rates from 2000 to 2010 varied three-fold more for females than for males. Considerable geographical variations were present in thyroid cancer incidence in Saudi Arabia. Thyroid cancer incidence rates have increased exponentially between 2000 and 2010 and there is significant geographical variation in the incidence of thyroid cancer throughout the Kingdom. Thyroid cancer has become the second most common cancer among young Saudi women with a male to female ratio at 0.3:1. Rising incidence of thyroid cancer in Saudi Arabia may be due to the increased detection and diagnosis of the thyroid cancers and not only an increase in the true occurrence of thyroid cancer. More studies are required to determine this significant difference at the molecular level

Disposal of syringes, needles, and lancets used by diabetic patients in Pakistan

To assess the use, handling and disposal of insulin injection equipment by diabetic patients in Pakistan. We conducted a cross-sectional study at diabetic clinics in five tertiary centers in Pakistan. All diabetic patients [type 1/type 2] who were on insulin for more than 1 month, were included. An Urdu [local language]-translated questionnaire was used to collect information on insulin administration equipment, the site and frequency of needle use, insulin syringe/pen/lancet disposal, sharing of needles and knowledge about diseases that are spread by sharing contaminated needles. Of 375 patients, 58% were female. The mean [SD] duration of diabetes was 12.3 [7.3] years, and the duration of insulin use was 4.4 [4.3] years. The majority of the patients used syringes [88.3%] for insulin administration. Additionally, the majority of the patients disposed of used devices [syringes, 92%; pens, 75%; and lancets, 91%] in the household garbage collection bin. About half of the patients [n = 185] reported being educated by their physicians about the disposal of sharps. Those who were educated by a physician [adjusted odds ratio [adjOR]: 0.36; 95%CI: 0.16-0.81] or could read/write English [adjOR: 0.32; 95%CI: 0.11-0.92] were less likely to dispose of syringes and needles in the household garbage. The common disposal of sharps in the household garbage has implications for disease transmission. Education on the safe disposal of sharps may improve the disposal practices

Alanine aminotransferase / Aspartate aminotransferase ratio reversal and prolonged prothrombin time: a specific indicator of hepatic cirrhosis

Both ALT/AST ratio reversal [AST/ALT>1] and prolonged prothrombin time are separately related to hepatic cirrhosis. Ratio reversal means that in normal individuals ALT is more than AST and thus ALT/AST>1 but with development of cirrhosis AST becomes, ALT and so AST/ALT>1 or ALT/AST<1. This study was conducted with the idea that prolonged prothrombin time and reversed [AST/ALT>1] ratio together can prove a more specific indicator with a high positive predictive value for the detection of hepatic cirrhosis in patients of chronic liver disease than either of the two alone. Method: This is a comparative cross sectional study. The data of hepatitis B and C patients was collected from the general medical ward and medical out patient department. Clinical and Ultrasonographic features, detected by a single ultrasonologist, were used to diagnose cirrhosis. Patients who were alcoholic were excluded from the study as alcohol itself causes ALT/AST ratio reversal. To avoid laboratory errors and variations the facilities of only a single specific laboratory were used for this study. The sensitivity and specificity of ALT/AST ratio reversal along with positive predictive value were calculated. Then prolonged prothrombin time [PT] and reversed ratio together were used and the results of these two groups were compared. It was found that the reversal of ratio alone is 88% specific as an indicator of hepatic cirrhosis and almost 70% sensitive and have a positive predictive value of 94.5%. The statistical significance test based on z-test for difference of proportion yields: z=6.96 with a p value=0.0000. On the other hand, the prolonged PT and ratio reversal are 98% specific and 53.9% sensitive with a positive predictive value of 98.2%. z-test for difference of proportion yields here: z=6.23 with a p value=0.0000. ALT/AST ratio reversal alone has a high sensitivity and the combined effect of these two parameters increases the specificity as compared to either of the two alone. The high positive predictive value here shows that almost all the patients with reversed ratio and prolonged PT will have cirrhosis