Efficacy and safety of hydroxyzine for sleep in adults: Systematic review.

OBJECTIVE: The purpose of this systematic review is to assess the efficacy and safety of hydroxyzine for insomnia in adults. METHODS: A comprehensive literature search of PubMed, Embase, and CENTRAL databases was conducted to identify relevant published studies through October 2022 using the search terms: hydroxyzine and sleep, insomnia, sleep disorder or sleep initiation and maintenance disorders. Studies identified for review included prospective, interventional designs or cohort trials that reported impact of hydroxyzine on sleep in adults. Animal studies, case reports, non-English articles, letters to the editor, case studies, and conference abstracts were excluded. Data were extracted using a standardized systematic process. RESULTS: Five articles were identified for inclusion, including 1 open-label and 4 randomized controlled trials, evaluating a total of 207 patients receiving hydroxyzine 25 mg, 50 mg, or 100 mg at bedtime. Mixed efficacy was demonstrated in the sleep measures of sleep onset, sleep maintenance, and sleep quality. The most common adverse drug effect was dry mouth, although 4 of the 5 studies did not report safety outcomes. CONCLUSIONS: The studies in this review suggest hydroxyzine could be considered as a short-term treatment option for adults with insomnia for whom previous therapy was ineffective, not tolerated, or contraindicated. Additional long-term studies with an active comparator are needed to further establish its role in insomnia treatment.

A Retrospective Cohort Evaluation of a Pharmacist-Led Approach for Transitioning Patients to an Angiotensin Receptor-Neprilysin Inhibitor.

Background: Heart failure guidelines recommend replacing an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) with an angiotensin receptor neprilysin inhibitor (ARNI) to reduce morbidity and mortality in NYHA Class II-III patients with reduced ejection fraction (HFrEF). Objective: This study aims to determine if a pharmacist-led outpatient ARNI replacement and titration program led to more patients achieving target doses of ARNI compared to usual care. Methods: A single health system, retrospective electronic medical record review identified 791 patients with active ARNI prescriptions and at least two outpatient cardiology visits with a pharmacist or usual care provider between January 2015 through September 2018. The primary outcome was the percentage of patients who achieved a target ARNI dose of 97/103 mg twice daily. The secondary outcomes were the median dose achieved, number of visits required to achieve target dose, hospitalizations, and all-cause death. Results: ARNI was initiated and continued by a pharmacist in 64 patients and 727 by usual care. More patients in the pharmacist group, 60.9% (n = 39), achieved target dose vs. 18.0% (n = 131) of patients managed by usual care (95% CI, 0.31-0.55, p < 0.0001). The pharmacist group also had higher median total daily dose of ARNI (200 mg (IQR = 300) vs 100 mg (IQR = 100), p < 0.0001) and more likely to achieve a higher total daily dose in fewer visits. Conclusions: An advanced practice provider pharmacist-led outpatient ARNI replacement and titration program was more effective in achieving target doses of ARNI in HFrEF patients as compared to usual care.

Comparison of the Effectiveness of Liraglutide vs Semaglutide in a Veteran Population.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly prescribed medications for patients with type 2 diabetes mellitus (T2DM) based on cardiovascular benefits. Objective: This study aimed to evaluate efficacy and tolerability of once daily liraglutide vs once weekly semaglutide on T2DM in a Veteran population. Methods: This was a retrospective, single-center, cohort study that included T2DM patients with a prescription for liraglutide or semaglutide between September 1st, 2019, and September 30th, 2020. Patients between groups were matched based on age and insulin use at baseline. The primary endpoint was the difference in hemoglobin A1c (A1c) between the most recent A1c in the study period and baseline A1c obtained prior to GLP-1 RA initiation. Results: There were 154 patients included in the study. While mean reduction in A1c was numerically higher in the liraglutide group (-1.1% vs. -.8%), this was not statistically significant (P = .22). The proportion of patients achieving A1c < 7%, < 8%, < 9%, or their patient-specific A1c goal did not differ between groups. Although baseline total daily doses of insulin were higher in the semaglutide group, these patients had numerically greater reductions in total daily dose of insulin and weight from baseline; however, no statistical difference was observed. Adverse drug reactions were more common in the semaglutide group (n = 14 vs. 9), leading to higher discontinuation rates as well (n = 11 vs. 8). Conclusion: The results of this study indicate no difference between liraglutide and semaglutide in terms of A1c-lowering potential, but it provides insights into key considerations for the Veteran population.

Epidemiological and Clinical Pattern of Pediatric Supracondylar Fracture of Humerus in A Provincial Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Supracondylar fractures of humerus are the most common elbow fractures in children consisting of about 15% of all pediatric fractures and more than half of all elbow fractures. A high incidence of nerve injures, and vascular injuries make this fracture a serious injury. Our study aims to study on the clinical and demographic pattern of pediatric supracondylar fracture cases presenting in the hospital retrospectively. METHODS: We conducted a descriptive cross-sectional study in Seti Provincial Hospital in the month of December. The data from the medical record section was retrospectively collected. A whole sampling technique was used. The descriptive statistical analysis was done. RESULTS: Seven hundred cases were studied, among which the most common age group was found to be 5-10 410 (58.57%). Most of the cases presented in the emergency department 513 (73.28%), and the most common time of presentation was from 3 AM to 6 AM 170 (24.28%). CONCLUSIONS: Supracondylar fracture cases presented as a common injury among pediatric population. It was presented as an emergency more than general cases.

Patient Satisfaction in Doctor Patient Communication in a Tertiary Care Hospital of Kathmandu: A Descriptive Cross-Sectional Study.

INTRODUCTION: Communication is an important aspect of the medical profession. Doctor-patient communication plays a significant role in health care delivery. This study aims to find outpatient department patient satisfaction in doctor-patient communication in a tertiary care hospital in Kathmandu, Nepal. METHODS: A descriptive cross-sectional study was conducted in the outpatient department of a tertiary care hospital in Kathmandu, Nepal in the month of August 2019. Validated questionnaire of Patient Satisfaction Questionnaire, consisting of 80 items, originally developed by Willis H. Ware and his colleagues were used and distributed to the patient in the outpatient department of the hospital. Their satisfaction level for doctor-patient communication was assessed on a five-point scale. The questionnaire was distributed randomly to the patient attending the hospital outpatient department during one month period. RESULTS: Out of the total participants, 420 (96%) at 95% CI (95.07±96.93) respondents reported that they were satisfied regarding communication with their doctors. Among the patients, 109 (24.0%) visited the department of medicine followed by obstetrics and gynaecology 85 (19.4%). CONCLUSIONS: The majority of participants were found to be satisfied with the doctor-patient communication. While this study has shown that the communication in the doctor-patient relationship was seen to be satisfactory, this might not show the generalized picture of the country. We should also think of ways to further improve the communication in our hospitals.

Trend and Patterns of Research Proposals Submitted for Ethical Review in Nepal Health Research Council.

BACKGROUND: The characteristics of research proposals submitted to the Nepal Health Research Council reflect the trend of health-related researches being conducted in Nepal. The objective of the study was to analyze research proposals submitted for the ethical review in Nepal Health Research Council from 2017 to 2019. METHODS: A retrospective record review of research proposals received over three years from 2017 to 2019 were analyzed. A total of 2,305 research proposals was included in the study. The number of research studies per year, types of study design, priority area of research, and rejected proposal were the intended variables for the study. RESULTS: 91.45% (503), 92.19% (748), and 755 (80.1%) of received proposals were approved from Ethical Review Board in 2017, 2018 and 2019. The number of research proposals increased every year (550 in 2017, 812 in 2018, and 943 in 2019). Among the approved proposals non-communicable disease (n=150;15.90%) in 2019} was the topmost prioritized area in all three years followed by reproductive health [93 (9.86%) in 2019] and communicable disease [67 (7.10%) in 2019] respectively. Quantitative research was more than two-third in all the years. Among the approved proposals, more than half were for an academic purpose [610 (64.69%)]. The reason for the rejection of the proposal was the conduction of research before ethical approval [2 (0.36%) in 2017, 2 (0.25%) in 2018, and none in 2019]. CONCLUSIONS: There was a rising trend of research proposals for ethical clearance being submitted to the Nepal Health Research Council. Research related to non-communicable disease followed by reproductive health was the commonest one.

Sleep Quality among Medical Students of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Medical students are under constant stress due to demanding academic load, fear of exam failure and hectic schedules. These factors can lead to poor sleep quality among medical students. Sleep quality of medical students not only determine their academic performance but is also important in determining long term effect on cognitive, psychosocial, behavioural as well as physical health of individuals. Although there are not enough recent studies to assess sleep quality of students, it is necessary to evaluate the condition of sleep among students. This study aims to find out the prevalence of poor sleep quality among medical students. METHODS: This descriptive cross-sectional was conducted among undergraduate medical students of Kathmandu Medical College from October to November 2019 after taking ethical clearance from Institutional Review Committee of a tertiary care hospital before collecting data from participants. Subjects were recruited by simple random sampling from students of first, second, third and final years and were asked to fill the self-reported questionnaires, using Pittsburgh Sleep Quality Index. Descriptive statistical analysis was done using Statistical Software for Social Sciences version 24. RESULTS: Out of 217 selected medical students, 96 (44.23%) of students have poor sleep quality with prevalence among male and female students as 41 (39.8%) and 55 (48.2%) respectively. The mean duration of sleep among students was 6.7±1.6 hours. CONCLUSIONS: Significant numbers of medical students have poor sleep quality which may affect their academic performance and may have long term impact on their health. Efforts must be directed towards educating about the sleep hygiene as well as proper time management skills.

Study on Clinico-Demographic Characteristics of Orthopaedic Cases in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Orthopedic conditions include a range of condition varying from traumatic injuries, congenital anomalies, chronic back-pain, arthritis, rheumatologic conditions, and other. In Nepal, approximately 2.35 million people are living with musculoskeletal conditions in which 175,000 people are suffering with MSD from non-traumatic causes. The aim of the study is to observe the clinical and demographic pattern of orthopedic problems presenting in the hospital. METHODS: A descriptive cross-sectional study was done in All Nepal Hospital Private Limited in the month of November. The data from the medical record section was retrospectively collected. Sample size of 384 was included and convenience sampling technique was used. The descriptive statistical analysis was done. RESULTS: Eight hundred forty four cases were included in the study. Implant removal was the main condition for admission in the hospital 105 (12.44%) followed by Forearm Bone Fracture 84 (9.95%) and Cut Injury 64 (7.58%). Most cases presented during the time 6 PM to 12 AM 312 (36.96%). CONCLUSIONS: Most of the orthopedic cases presented in the evening and night time. Implant removal, forearm bone fracture and cut injury form the major bulk of the cases.

Prevalence of Type II Diabetes Mellitus Among Adult Population in Medical Department of A Tertiary Care Centre.

INTRODUCTION: Diabetes mellitus is a chronic metabolic disease that is mainly associated with a number of lifestyle behaviors. There is a high discrepancy among urban and rural populations with the prevalence of diabetes in rural areas as 2.5% and a high prevalence of 14.6% in urban areas. Type 2 diabetes mellitus accounts for the majority of all diabetes cases with a number of chronic effects that include cardiovascular disease, kidney disease, blindness, and disability. This study is done to determine the prevalence of Type II Diabetes Mellitus among the adult population in the medical department of a tertiary care center. METHODS: A descriptive cross-sectional study was done in a medical department of a tertiary care center of Himal Hospital Private Limited from March to April 2020. Ethical approval was taken from the Ethical Review Board of NHRC (Reference Number 752). All the data of the last two years from the medical record section were included in the study. The convenience sampling technique was followed. Descriptive statistical analysis was done. RESULTS: The study showed the prevalence of Type II Diabetes Mellitus among the adult population to be 23.93 % (0.23) (C.I= 0.20-0.26). CONCLUSIONS: The prevalence of Type II Diabetes Mellitus was found to be higher than the previous study done in similar settings.

Prevalence of Hypertension in Adult Population of A Village of Nepal.

INTRODUCTION: Hypertension is a cardiovascular disorder rapidly emerging as a major health problem in developing countries. Uncontrolled or poorly managed hypertension leads to several complications such as coronary heart disease, peripheral vascular disease and kidney disease. These complications account for approx 9.4 million deaths worldwide every year. Consequently, it is an urgent need for authorities to act upon this issue. This study was done to determine the prevalence of Hypertension in Deurali village of Nuwakot. METHODS: A descriptive cross-sectional study was done in the Deurali Village of Nuwakot district from May 2019 to July 2019. Ethical approval was taken from the Ethical Review Board of Nepal Health Research Council. A simple random sampling method was applied. Blood pressure was measured on three occasions along with the use of a self-administered questionnaire. Descriptive statistical analysis was done. RESULTS: The study showed the prevalence of hypertension among the adult population to be 20 (8.5%) [8.5%±1.83% at 95% CI]. Prevalence was found to be higher among female than male. Age group more than 60 were major sufferers of the condition. The study population consisted of the majority of Tamang community. Almost 213 (91%) participants were reported to have taken alcohol at some point in their life whereas only 104 (45%) were smokers. CONCLUSIONS: The prevalence of hypertension was found to be lower than the previous study done in similar settings.