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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.

Background: Road traffic accidents is growing continuously as a global burden and would be a leading cause of death in developing countries. The global burden of road traffic accidents continues to grow and promises to overtake tropical diseases as leading causes of death in the developing world. This study aimed to study the pattern and causes of road traffic accidents in Morang district., Methods: Record based descriptive cross-sectional study was used by reviewing all registered RTA cases of the District Traffic Police Office, Morang during fiscal year 2074/75 (Shrawan 2074 to Ashad 2075). 501 road traffic accident cases were found in the record and used for the study. The data was analysed using SPSS v 16 and presented in normal frequency tables and crosstables., Results: Out of 501 accidents 32.2% occurred Friday and Saturday. In the evening time, most of the accidents occurred. In highways, 53.5% of accident cases occurred. 82% of the accidents occurred in blacktop road. Two-wheelers are mostly involved in accident cases (77%). Negligence (55.7%) and over-speed (36.5%) were the major reasons for accidents. In 33% of cases, accidents occurred involving pedestrians and cyclists. 80% of the drivers are below 40 years; similarly 80% of the victims are also below 40 years. Among victims who died 84.1% were male and among injured 73.3% were males., Conclusions: Weekends, evening, highways and two wheelers are more accident prone time, place and vehicles respectively. Overspeed and negligence of driver tends to major cause of accidents and majority of victims are the young bike riders and pedestrians.

Hippocratic oath, written 4th or 5th century BC, is still the binding mantra for physicians, which swears to fulfill to the best of one's ability and judgement, and treat sick human beings not just illness. But with changing health trends in southeast Asia region, there is a dramatic shift in patients and patients' party expectations regarding treatment, recovery, complications, and death. Such expectations havelead to violence against physicians and shift towards alternative medical practice. This article explores the possible rise of defensive medicine and its broader implications in health care system in Nepal with regard to the new 'Muluki Aparadh Samhita Ain 2074/Criminal (Code) Act 2017'. Keywords: Changing health; criminal act; defensive medicine; muluki ain, Nepal.