Liraglutide-Induced Depression with Suicidality in an Obese Adult: A Case Report

Obesity is a major health issue worldwide. Treating adults with obesity often involves lifestyle and diet changes and sometimes medication. Liraglutide is a drug that is being closely studied for treating obesity. However, the potential side effects of liraglutide, particularly its impact on mood and the development of depression, may be of concern. Given the frequent co-occurrence of obesity and depression, it is important to understand how obesity treatments like liraglutide might affect a person’s mood. A 47-year-old schoolteacher with no personal or family history of mental illness or chronic physical condition sought help for his steadily increasing weight. Despite having a sedentary job and reporting no major stress or substance use, he did not attempt to change his diet or activity level, occasionally experiencing sleep difficulties. He was overweight, with a body mass index of 42. The patient was diagnosed with adult obesity and prescribed liraglutide, diet changes, and exercise. Initially, he lost weight, but he also developed depressive symptoms, including fatigue, loss of interest, sleep disturbances, and suicidal ideation. Following cessation of liraglutide treatment, his depression symptoms got better, but his weight slightly increased. This case sheds light on the possible link between liraglutide and depression in managing obesity. It is crucial for healthcare providers to be aware of potential mental health side effects of obesity drugs like liraglutide. Although the exact reasons behind these mood changes are not fully understood, this case emphasizes the need for careful observation and decision-making in treatment. Understanding these issues can help balance the benefits and risks of liraglutide and ensure better care and treatment options for people with obesity

Impact of Baseline Characteristics on Stroke Outcomes in Pakistan: A Longitudinal Study Using the Modified Rankin Scale

Introduction. Stroke is a leading cause of disability and mortality globally, with a significant impact on healthcare systems. Various factors, including age, gender, comorbidities, and the type of stroke, influence the burden of stroke and its outcomes. The study was conducted with an objective to determine the impact of baseline characteristics on the long-term functional outcome of stroke patients. Methods. This prospective observational study was conducted between April 6, 2022 - December 31, 2023, at a tertiary hospital. The study included patients with radiologically confirmed stroke, selected through convenience sampling. Stroke patients of any gender and all age groups, with any comorbidity, were included. The Modified Rankin Scale (mRS) assessed disability on admission and three months post-stroke. Results. Of the 213 patients, 122 (57.3%) were males and the majority, 199 (93.4%) individuals, had acute ischemic stroke. The median age of the participants was 60 years (range: 13-97 years; IQR=18 years). The mRS score on admission was poor (5.0; IQR=1.0) for patients ≥ 60 years. In 74 (34.74%) participants, the left middle cerebral artery was a frequently involved site. Age of ≥ 60 years (mRS=4.0; IQR=4.0; p=0.001) and the presence of ≥ 3 comorbidities (mRS=5.0; IQR=1.0; p=0.001) were significantly associated with poor outcomes three months post-stroke. Ordinal logistic regression revealed that a mRS score of 4 (OR=14.20; 95% CI=1.70-145.25; p=0.02) and a mRS score of 5 (OR=78.84; 95% CI=9.35-820.25; p < 0.001) on admission were associated with poor outcomes. In addition, the presence of ≥ 3 comorbidities (OR=4.59; 95% CI=14.65; p < 0.01) and increasing age (OR=1.04; 95% CI=1.01-1.07; p=0.02) were predictors of poor outcomes three months post-stroke. Conclusions. The study underscores the importance of early intervention and effective management of comorbidities to improve functional outcomes in stroke patients. It highlights the need for targeted stroke care and rehabilitation strategies

The Effects of Moxifloxacin and Gemifloxacin on the ECG Morphology in Healthy Volunteers: A Phase 1 Randomized Clinical Trial

Moxifloxacin and gemifloxacin are the two newer broad-spectrum 8-methoxy-quinolone derivatives that are used to treat various bacterial infections in cardiac patients. In this research study, we assessed the impact of moxifloxacin and gemifloxacin on the QT intervals of electrocardiograms in normal adult doses and draw a comparison, in a controlled environment, on healthy volunteers. Additionally, the effect of both test drugs on the QRS complex was checked. Sixty healthy volunteers were randomly assigned to two groups via R-software, and each respectively received moxifloxacin and gemifloxacin for five days. The research ethics committee approved the research, and it was registered for clinical trial under NCT 04692623. The participants’ electrocardiograms were obtained before the start of the dose (baseline) and on the fifth day. Significant prolongation of QT interval was noted in moxifloxacin (p p < 0.0001) QT interval prolongation (QTIP) as compared to gemifloxacin. In contrast to the previously reported literature, the prominent effect of moxifloxacin on the widening of the QRS-complex was noted with no such effect on QRS-widening in the gemifloxacin-treated group. It is concluded that both drugs have the potential for considerable QT interval prolongation (QTIP) effects, which is one of the risk factors for developing torsade de pointes (TdPs) in cardiac patients. Thus, clinicians should exercise caution when prescribing moxifloxacin and gemifloxacin to cardiac patients and should consider alternate treatment options

Insulinotropic Potential of Moxifloxacin and Gemifloxacin: An In Vivo Rabbits Model Study Followed by Randomized Phase I Clinical Trial

Fluoroquinolones (FQs) have been reported to cause dysglycemia in both diabetic and non-diabetic patients. However, diabetic patients are usually on polypharmacy, so we cannot attribute the dysglycemia specifically to FQs. To answer the question as to whether Moxifloxacin and Gemifloxacin influence blood glucose levels and serum insulin levels or otherwise, rabbits were used as experimental animals in an in vivo model followed by a phase I randomized clinical trial in euglycemic healthy volunteers. The effects on the serum insulin and blood glucose levels in the Moxifloxacin and Gemifloxacin treated groups were, respectively, determined on the fifth day in both the in-vivo rabbits model and in the test subjects of the phase I clinical trial. The effects of these drugs were also checked on the histomorphology of the pancreas in the rabbits. The findings of our study suggest that Moxifloxacin and Gemifloxacin significantly (p &lt; 0.05) reduced the blood glucose levels via a subsequent significant shift in the serum insulin levels both in the in vivo animal model and in the test subjects of the phase I clinical trial. No prominent effects on the beta cells histomorphology were noted in this study. Moxifloxacin showed a more significant effect than Gemifloxacin. The insulinotropic effect was comparable to the effect of Glibenclamide. It is concluded that Moxifloxacin and Gemifloxacin have a significant blood glucose lowering effect mediated through insulinotropic action. (Clinical Trials.gov identifier: NCT04692623)