Appropriateness of Proton Pump Inhibitors Prescription in Patients Admitted to a Malaysian Tertiary Hospital

@#Introduction Proton pump inhibitors (PPIs) are one of the commonest drug prescribed, however it is not without risk of adverse effects especially if the usage is inappropriate. We aimed to evaluate the frequency, indications and appropriateness of PPIs prescription among the medical inpatients, Serdang Hospital, which is a tertiary hospital in Malaysia. Methods This is a cross sectional study consisting of 1184 patients admitted to medical ward and received PPI from 1st July 2016 to 31st March 2017, and their database were further analysed by SPSS Statistics 17.0. Unpaired t-test was performed to analyze the data collected. P < 0.05 (two-tailed) is considered significant. Their indications were cross-referenced against the indications adapted from the United States Food and Drug Administration (FDA). Results About 23.9% (1184/4953) of inpatients were using PPIs, and 63.0% (746/1184) of them recently started on PPI in the ward, with mean age of 59.7 years. More male patients were commenced on PPIs during hospitalization (P value < 0.05). Based on the FDA guideline, only 21.8% patients were indicated, 32.2% were borderline indicated, and 46.0% patients were not indicated in prescribing PPIs. Stress ulcer prophylaxis was the commonest indication, while anaemia with no evidence of gastrointestinal bleed was the main non-indication in starting PPIs. Only 11% of patients had performed the oesophago-gastro-duodenoscopy (OGDS) during the hospital stay. Conclusions 46.0% of inpatients were inappropriately prescribed PPIs according to FDA guideline. More efforts should be initiated to improve the current situation of PPIs overutilization in Malaysia.

Pulmonary Hemorrhage Associated With Severe Leptospirosis – The Role Of Low Dose Intravenous Methylprednisolone

@#Leptospirosis has a wide range of presentation which ranges from mild flu-like symptoms, to severe form including renal failure, liver failure, and hemorrhage. Pulmonary involvement can progress from subtle clinical features to life threatening pulmonary hemorrhage and acute respiratory distress syndrome. Although benefits of corticosteroids in adult respiratory distress syndrome have been proven and accepted, evidence for use of corticosteroids in pulmonary leptospirosis is still limited. Given the vasculitic nature of severe leptospirosis, it has been proposed that addition of intravenous corticosteroid therapy, particularly in cases of pulmonary involvement is beneficial. We report a case of leptospirosis with suspected pulmonary hemorrhage which deteriorates after a few days of admission in our tertiary hospital. We have demonstrated that the prescription of a lower dose of corticosteroid than what was widely reported in the literature can equally led to a satisfactory recovery of the pulmonary hemorrhage.

Primary Focal Segmental Glomerulossclerosis and Minimal Change Disease as one Spectrum of Disease

@#Minimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) are common causes of nephrotic syndrome. These two conditions are similar in their presentations but differentiated via their histopathological features and responsiveness to corticosteroids. There are ongoing debates whether MCD and FSGS are at the same spectrum of disease rather than separate entities. FSGS has been postulated to be the severe end of the spectrum of MCD. We have reported a case that has primary FSGS after years of poorly controlled MCD, which supports both conditions are the same spectrum of disease.