Adverse effects including sexual problems associated with the use of selective serotonin reuptake inhibitors in a tertiary care center of Eastern Nepal

Background: Selective serotonin reuptake inhibitors (SSRIs) use has been associated with various adverse drug events, including sexual problems in recent literature.Methods: After written informed consent, remitted psychiatric patients were enrolled if they were taking an SSRI. The remitted state was ascertained by clinical assessment of a psychiatrist and reassessed with the use of self-response screening questionnaires (Beck Anxiety Inventory for anxiety, Beck Depression Inventory for depression). The self-response questionnaire “adverse drug effect (ADE) tool” was used to assess ADEs and the Arizona Sexual Experience Scale to assess sexual problems.Results: The total of 200 subjects was enrolled with 63% females. Commonly used SSRIs were escitalopram, fluoxetine, and sertraline for the common diagnosis of depression, recurrent depressive disorder, and panic disorder in this institute. The average duration of remission during the enrollment was 11.99 months (standard deviation: 12.269). The overall prevalence of adverse effects was 91.5%. The incidence of adverse effect and sexual problem were: weight gain (57%), dryness of mouth (32.5%), headache (30%), dizziness (28.5%), paresthesia (24.5%), confusion (23.5%), tremors (21.5%), irritation (20.5%) sexual dysfunction (SD) (17.2%), increase in anxiety (17%), akathisia (16%), nausea (14.5%), itchiness (14.5%), excessive sweating, (14.5%), difficulty in sleeping (10%), weight loss (6%), rash (6%), diarrhea (4%), vomiting (3%), and others (3%).Conclusion: Adverse effect (irrespective of severity) was commonly seen with SSRI use. Common adverse effects seen among remitted subjects were weight gain, dryness of mouth, headache, dizziness, paresthesia, etc. SD was other important side effect

Analysis of inappropriate medication use and drug interaction in older people visiting tertiary care center of eastern Nepal

Background: Medication use in older people has been increasing as the incidence of chronic diseases increases worldwide. Use of more medicines may increase the chance of prescribing potentially inappropriate medications (PIMs) and may increases the risk of potential drug-drug interactions (pDDIs). The objective of this study was to assess PIMs and pDDIs to improve the rational use of medicationsMethods: In this study data from the older people were obtained from patient visiting medicine, OPD, BPKIHS, Dharan. Demographic and medications information were collected. PIM and pDDIs were evaluated from medication data using the Beer’s criteria for potentially inappropriate medication use in older adults, 2015 and lexicomp application respectively.Results: Among 550 patients 50.9% patients were male. Common diagnosis was systemic hypertension 335 (64.5%) followed by type 2 diabetes mellitus 276 (50.18%). The most commonly prescribed drug was metformin (215) followed by amlodipine (205), atorvastatin (176), losartan (158), glimepiride (113) and aspirin (100). One or more fixed drug combination was present in 295 prescriptions. One or more PIM were present in 29 (5.3%) prescriptions. Commonly prescribed PIM was prazosin (11) followed by nitrofurantoin (5). There were total of 753 cases of pDDIs, with 116 (15.40%) cases of risk categories X and D.Conclusions: Our findings demonstrated PIM use were relatively less. However, pDDIs were common in older people suggesting that optimal medication use and further similar studies in larger scale are necessary in this population

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Analysis of inappropriate medication use and drug interaction in older people visiting tertiary care center of eastern Nepal

Background: Medication use in older people has been increasing as the incidence of chronic diseases increases worldwide. Use of more medicines may increase the chance of prescribing potentially inappropriate medications (PIMs) and may increases the risk of potential drug-drug interactions (pDDIs). The objective of this study was to assess PIMs and pDDIs to improve the rational use of medicationsMethods: In this study data from the older people were obtained from patient visiting medicine, OPD, BPKIHS, Dharan. Demographic and medications information were collected. PIM and pDDIs were evaluated from medication data using the Beer’s criteria for potentially inappropriate medication use in older adults, 2015 and lexicomp application respectively.Results: Among 550 patients 50.9% patients were male. Common diagnosis was systemic hypertension 335 (64.5%) followed by type 2 diabetes mellitus 276 (50.18%). The most commonly prescribed drug was metformin (215) followed by amlodipine (205), atorvastatin (176), losartan (158), glimepiride (113) and aspirin (100). One or more fixed drug combination was present in 295 prescriptions. One or more PIM were present in 29 (5.3%) prescriptions. Commonly prescribed PIM was prazosin (11) followed by nitrofurantoin (5). There were total of 753 cases of pDDIs, with 116 (15.40%) cases of risk categories X and D.Conclusions: Our findings demonstrated PIM use were relatively less. However, pDDIs were common in older people suggesting that optimal medication use and further similar studies in larger scale are necessary in this population.</jats:p

Prevalence of Substance Use among Undergraduate Students in a Medical College of Nepal

Introduction: The consumption of substances is a common practice among the medical students and their use might reduce educational and clinical performances as well as judgment of the students. This study aims to find out the prevalence of substance use among medical students in BP Koirala Institute of Health Sciences. Methods: A descriptive cross-sectional study was carried out among medical students of BP Koirala Institute of Health Sciences from 15th September 15th to December 15th 2018 after obtaining ethical approval from the Institutional Review Committee (Ref: 1394/017). The study was conducted among 326 medical and dental students from first to fifth year by using the stratified sampling method. A self-reported questionnaire was developed which included types, frequency, duration, age to first use, and motives for the use of different substances. Data was analyzed using Statistical Package for Social Sciences version 11.5. Results: The prevalence of substance use among medical students of BP Koirala Institute of Health Sciences was 196 (61.4%) at 95% Confidence Interval (56.05-66.75%). Among substance use, the use of alcohol 190 (59.6%), tobacco 90 (28.2%), and marijuana 38 (11.9%) was more prevalent. One hundred forty four (45.2%) male students used more substances as compared to 52 (16.3%) female students. Fun sake or partying 131 (68.9%) was the main motivation of the students to use substances. Conclusions: The overall substance use among medical students was high compared to other studies. Alcohol was the most common substance misused by the student followed by tobacco and marijuana. Proper counseling and awareness programs about the potential risk of substances are recommended for the betterment of the students

Counseling on life style modification and knowledge and belief of hypertension and its management among hypertensive patients visiting community based screening and management program in Eastern Nepal

Background: Hypertension is a global health problem with almost quarter of adults estimated to have high blood pres­sure. There are evidences showing effectiveness of lifestyle modification on the prevention and management of hyper­tension. The adherence to lifestyle modifications and medication depends upon knowledge and belief on management of hypertension and the counseling they received from medical staffs.&#x0D; Methods: In this prospective crossover study, 140 hypertensive patients were enrolled after getting written informed consent. This study was performed after obtain­ing the ethical clearance from Institutional Research Committee (IRC), BPKIHS, and Dharan. Data was collected using validated structured self-constructed questionnaire from the hypertensive patients visiting community program (KHDC) held on first Saturday of every month for follow-up. KHDC is a community based program for early detection and man­agement of Kidney disease, Hypertension, Diabetes and Cardiovascular diseases. For descriptive statistics, percentage, mean, Standard deviation was calculated along with graphical and tabular presentation.&#x0D; Results: Out of 140 patients enrolled 52.1% were male. Majority of the patient were aged between 40-59 years of age (50.7%). Most of them were Aryans 55.7 % followed by Mongolians 44.3%. Mean of Systolic Blood pressure was 131.48(SD ± 16.57) and Mean of Diastolic Blood pressure was 81.7(SD ±9.57). Majority of patient believed that they have received appropriate counsel­ing from the medical staffs in regards to appropriate diet, Body weight, Smoking cessation, Physical activity and risk and complication of hypertension. Overall knowledge rate was high on all items but 27.9% patients believed that treating with drugs is sufficient for the management of hypertension. Only 7.1 % of them were smokers whereas 24.3% con­sumed alcohol, 72.1 % patients were non vegetarians and most of them preferred average amount of salt in their meal 52.1%. However 44.3 % patients preferred low amount of salt. Sixty percentages of patients reported that they were doing physical exercise regularly.&#x0D; Conclusion: The knowledge and belief on the management of hypertension is high in the hypertensive patients visiting community based program for early detection and management of Kidney disease, Hypertension, Diabetes and Cardiovascular diseases. Further, most patients received the counseling on lifestyle modi­fication which was reflected in their general behaviour.</jats:p