Neerja Gulati

Inappropriate Use of Intravenous PPI for Stress Ulcer Prophylaxis in an Inner City Community Hospital

Background Proton pump inhibitors (PPIs) are used for the treatment and prophylaxis of variety of acid peptic conditions including stress ulcers. There has been a persistent practice of their inappropriate use for stress ulcer prophylaxis. Purpose of our study was to measure the inappropriate use of Intravenous Proton Pump Inhibitors for stress ulcer prophylaxis and to estimate the financial burden. Methods We carried out a retrospective, analytic study from July 2008 to June 2009 in internal medicine department. Hospital pharmacy records were used to identify all patients who received IV PPI during hospital stay. Seventy-five percent of records were randomly chosen (n=1104). PPI application was defined as indicated according to AGA guidelines. Results Intravenous proton pump inhibitor (IV PPI) was prescribed for 68.5% of patients without any proper indication. The estimated cost of medication for inappropriate IV PPIS use during the study year was 18337 USD. Conclusions A more rational use of PPI will have better impact on health care cost and is likely to add to patient safety. Keywords Inappropriate use of PPI; Stress ulcer prophylaxis; Healthcare cost

Bilateral pneumothorax after bronchoscopy without biopsy--a rare complication: case presentation and literature review.

Bronchoscopy and bronchoalveolar lavage (BAL) are widely accepted diagnostic procedures in various pulmonary etiologies. Complications of bronchoscopy are relatively infrequent and most often minor, namely, bleeding and infection. Pneumothorax is a rare complication of bronchoscopy with transbronchial biopsy. Bilateral pneumothorax developing after BAL without biopsy has been rarely described in the literature. A 51-year-old woman presented with symptoms suggestive of reactive airway syndrome and underwent bronchoscopy with BAL to rule out vocal cord paralysis and to investigate other potential causes of her symptoms. Immediately after BAL, she developed bilateral pneumothorax requiring chest tube placement. The pneumothorax was resolved with the chest tube and the patient recovered. However, the etiology of the pneumothorax remained unclear. We presume that cough-related increase in intrathoracic pressure might have led to interstitial air dissection and bilateral pneumothorax.

Ectopic Thymoma- Presenting as a Large Pleural Mass

Thymoma is the most common neoplasm of the anterior mediastinum. Patients may be asymptomatic or present with symptoms of local compression, myasthenia gravis or other paraneoplastic syndrome. We present case of a middle aged woman with a large pleural based mass who was relatively asymptomatic Biopsy of the mass revealed thymoma type AB.Work up showed that she has multiple abdominal masses etiology of which is not known. Whenever feasible, surgery is the treatment of choice for thymoma.Our patient is undergoing chemotherapy with the goal that once the tumor size is reduced she will be able to undergo surgery.