Perceived Stress among Iranians during COVID-19 Pandemic; Stressors and Coping Mechanisms: A Mixed-methods Approach

OBJECTIVE

New coronavirus (COVID-19) pandemic socioeconomically affected the world. In this study, we measured the perceived stress in response to the COVID-19 pandemic among Iranians to determine the groups at both extremes of the spectrum followed by identifying the stressors and coping mechanisms.

METHODS

This study was a mixed-methods study. We distributed a web-based 10-item perceived stress scale (PSS-10), to measure perceived stress score (PSS), through social networks from March 12 to 23, 2020. Then, we interviewed 42 students, 31 homemakers, 27 healthcare providers, and 21 male participants to identify the sources of stress and coping mechanisms.

RESULTS

Finally, 13,454 participants completed the questionnaires. The median and interquartile range (IQR) of the participants' PSS was 21 (15-25). Students, homemakers, and healthcare workers (HCWs) showed a higher median (IQR) of PSS compared to other groups (23 [18 to 27], 22 [16 to 26], and 19 [14 to 24], respectively). Male participants showed a lower median (IQR) PSS (17 [12 to 23]). Content analysis of 121 participants' answers showed that the most common stressors were school-related issues mentioned by students, family-related issues mentioned by homemakers, and COVID-19-related issues mentioned by healthcare providers. Male participants' coping mechanisms were mostly related to the perception of their abilities to cope with the current crisis.

CONCLUSION

Our participants clinically showed a moderate level of PSS. The main stressors among students, homemakers, and HCWs were related to their principal role in this period, and male participants' coping mechanisms were inspired by the self-image retrieved from the social perspectives.

Evaluation of data imputation strategies in complex, deeply-phenotyped data sets: the case of the EU-AIMS Longitudinal European Autism Project

An increasing number of large-scale multi-modal research initiatives has been conducted in the typically developing population, e.g. Dev. Cogn. Neur. 32:43-54, 2018; PLoS Med. 12(3):e1001779, 2015; Elam and Van Essen, Enc. Comp. Neur., 2013, as well as in psychiatric cohorts, e.g. Trans. Psych. 10(1):100, 2020; Mol. Psych. 19:659–667, 2014; Mol. Aut. 8:24, 2017; Eur. Child and Adol. Psych. 24(3):265–281, 2015. Missing data is a common problem in such datasets due to the difficulty of assessing multiple measures on a large number of participants. The consequences of missing data accumulate when researchers aim to integrate relationships across multiple measures. Here we aim to evaluate different imputation strategies to fill in missing values in clinical data from a large (total N = 764) and deeply phenotyped (i.e. range of clinical and cognitive instruments administered) sample of N = 453 autistic individuals and N = 311 control individuals recruited as part of the EU-AIMS Longitudinal European Autism Project (LEAP) consortium. In particular, we consider a total of 160 clinical measures divided in 15 overlapping subsets of participants. We use two simple but common univariate strategies—mean and median imputation—as well as a Round Robin regression approach involving four independent multivariate regression models including Bayesian Ridge regression, as well as several non-linear models: Decision Trees (Extra Trees., and Nearest Neighbours regression. We evaluate the models using the traditional mean square error towards removed available data, and also consider the Kullback–Leibler divergence between the observed and the imputed distributions. We show that all of the multivariate approaches tested provide a substantial improvement compared to typical univariate approaches. Further, our analyses reveal that across all 15 data-subsets tested, an Extra Trees regression approach provided the best global results. This not only allows the selection of a unique model to impute missing data for the LEAP project and delivers a fixed set of imputed clinical data to be used by researchers working with the LEAP dataset in the future, but provides more general guidelines for data imputation in large scale epidemiological studies.

Ichthyosis follicularis syndromes in patients with germline mutations in GJB2

Ichthyosis follicularis (IF) manifests as generalized spiny follicular projections found in syndromic diseases secondary to SREBF1 and MBTPS2 mutations. We sought the genetic cause of IF in two distinct families from a cohort of 180 ichthyosis patients. In Family 1, the proband presented with IF, bilateral sensorineural hearing loss (SNHL) and punctate palmoplantar keratoderma, and compound heterozygous GJB2 mutations were discovered in DNA from peripheral blood lymphocytes: GJB2:c.526A>G and c.35delG. In Family 2, the proband presented with a previously unreported IF phenotype in the context of KID syndrome, and whole-exome sequencing found a de novo heterozygous GJB2:c.148G>A mutation. Histopathology was consistent with porokeratotic eccrine ostial and dermal duct nevus (PEODDN) and IF in Probands 1 and 2, respectively. Our findings add to the clinical and histopathological spectrum of IF and emphasize the association of PEODDN-like entities with GJB2 variants.

Kindler epidermolysis bullosa-like skin phenotype and downregulated basement membrane zone gene expression in poikiloderma with neutropenia and a homozygous USB1 mutation

Epidermolysis bullosa (EB) is a genotypically heterogeneous group of disorders characterized by cutaneous blistering and erosions with a tremendous spectrum of severity. One of the distinct forms of EB, Kindler EB (KEB), manifests with blistering and poikiloderma; this subtype of EB is caused by mutations in the FERMT1 gene encoding kindlin-1. In this study, we investigated a patient clinically diagnosed as KEB with reduced FERMT1 gene expression and intensity of immunostaining for kindlin-1. Transmission electron microscopy showed lamina densa reduplication, frequently observed in KEB. However, no mutations were identified in FERMT1 in this patient with consanguineous parents, and this gene resided outside of genomic regions of homozygosity (ROH). Instead, whole-exome sequencing and homozygosity mapping identified a homozygous sequence variant at the +4 position of intron 2 in the USB1 gene, encoding an exoribonuclease required for processing of U6 snRNA, a critical component of spliceosomes. Examination of the patient's RNA by RNA-Seq confirmed the pathogenicity of this variant, causing aberrant splicing predicted to result in loss of function of USB1. Mutations in this gene have been reported in patients with poikiloderma and neutropenia, with a few reported cases in association with skin fragility, a condition distinct from the KEB phenotype. Transcriptome analysis revealed that several genes, expressed in the cutaneous basement membrane zone and previously associated with different subtypes of EB, were differentially downregulated at the mRNA level. EB-associated mRNA downregulation was confirmed at protein levels by skin immunofluorescence. These observations provide a novel mechanism for blistering and erosions in the skin as a result reduced presence of adhesion complexes critical for stable association of epidermis and dermis at the level of cutaneous basement membrane zone.

Whole-Transcriptome Analysis by RNA Sequencing for Genetic Diagnosis of Mendelian Skin Disorders in the Context of Consanguinity

BACKGROUND

Among the approximately 8000 Mendelian disorders, >1000 have cutaneous manifestations. In many of these conditions, the underlying mutated genes have been identified by DNA-based techniques which, however, can overlook certain types of mutations, such as exonic-synonymous and deep-intronic sequence variants. Whole-transcriptome sequencing by RNA sequencing (RNA-seq) can identify such mutations and provide information about their consequences.

METHODS

We analyzed the whole transcriptome of 40 families with different types of Mendelian skin disorders with extensive genetic heterogeneity. The RNA-seq data were examined for variant detection and prioritization, pathogenicity confirmation, RNA expression profiling, and genome-wide homozygosity mapping in the case of consanguineous families. Among the families examined, RNA-seq was able to provide information complementary to DNA-based analyses for exonic and intronic sequence variants with aberrant splicing. In addition, we tested the possibility of using RNA-seq as the first-tier strategy for unbiased genome-wide mutation screening without information from DNA analysis.

RESULTS

We found pathogenic mutations in 35 families (88%) with RNA-seq in combination with other next-generation sequencing methods, and we successfully prioritized variants and found the culprit genes. In addition, as a novel concept, we propose a pipeline that increases the yield of variant calling from RNA-seq by concurrent use of genome and transcriptome references in parallel.

CONCLUSIONS

Our results suggest that "clinical RNA-seq" could serve as a primary approach for mutation detection in inherited diseases, particularly in consanguineous families, provided that tissues and cells expressing the relevant genes are available for analysis.

Keratitis-ichthyosis-deafness syndrome: Phenotypic heterogeneity and treatment perspective of patients with p.Asp50Asn GJB2 mutation

Keratitis-ichthyosis-deafness (KID) syndrome is caused by mutations in the GJB2 gene encoding connexin 26, a component of transmembrane hemichannels which form gap junction channels, critical for cell-cell communication. Here, we report two patients from two distinct families with KID syndrome with the same GJB2 mutation (p.Asp50Asn); in both cases the mutation was de novo, as the parents depicted the wild-type allele only. The patients' cutaneous manifestations were strikingly different illustrating the wide spectrum of phenotype of these patients, even with the same GJB2 mutation. One of the patients was treated with acitretin with dramatic improvement in his skin findings, illustrating the role of oral acitretin in treatment of patients with KID syndrome. Collectively, these patients attest to the phenotypic spectrum of KID syndrome, with therapeutic perspective.

Effect of adsorbents and chemical treatments on the removal of strontium from aqueous solutions

In the present investigation, three different solid wastes namely almond green hull, eggplant hull, and moss were initially treated and used as adsorbents for the adsorption of strontium ion from aqueous solutions. Adsorbent types and chemical treatments are proved to have effective roles on the adsorption of Sr(II) ion. Among the three adsorbents, almond green hull demonstrated strong affinity toward strontium ion in different solutions. The effectiveness of this new adsorbent was studied in batch adsorption mode under a variety of experimental conditions such as: different chemical treatments, various amounts of adsorbent, and initial metal-ion concentration. The optimum doses of adsorbent for the maximum Sr(II) adsorption were found to be 0.2 and 0.3 g for 45 and 102 mg L(-1) solutions, respectively. High Sr(II) adsorption efficiencies were achieved only in the first 3 min of adsorbent's contact time. The kinetics of Sr(II) adsorption on almond green hull was also examined and it was observed that it follows the pseudo second-order behavior. Both Langmuir and Freundlich models well predicted the experimental adsorption isotherm data. The maximum adsorption capacity on almond green hull was found to be 116.3 mg g(-1). The present study also confirmed that these low cost agriculture byproducts could be used as efficient adsorbents for the removal of strontium from wastewater streams.

Studies on adsorption of mercury from aqueous solution on activated carbons prepared from walnut shell

The adsorption ability of a powdered activated carbons (PAC) derived from walnut shell was investigated in an attempt to produce more economic and effective sorbents for the control of Hg(II) ion from industrial liquid streams. Carbonaceous sorbents derived from local walnut shell, were prepared by chemical activation methods using ZnCl(2) as activating reagents. Adsorption of Hg(II) from aqueous solutions was carried out under different experimental conditions by varying treatment time, metal ion concentration, pH and solution temperature. It was shown that Hg(II) uptake decreases with increasing pH of the solution. The proper choice of preparation conditions were resulted in microporous activated carbons with different BET surface areas of 780 (Carbon A, 1:0.5 ZnCl(2)) and 803 (Carbon B, 1:1 ZnCl(2))m(2)/g BET surface area. The monolayer adsorption capacity of these particular adsorbents were obtained as 151.5 and 100.9 mg/g for carbons A and B, respectively. It was determined that Hg(II) adsorption follows both Langmuir and Freundlich isotherms as well as pseudo-second-order kinetics.

Removal of mercury from water by carbonaceous sorbents derived from walnut shell

The adsorption ability of a powdered activated carbon (PAC) derived from walnut shell was investigated in an attempt to produce more economic and effective sorbent for the control of Hg(II) ion from industrial liquid streams. Carbonaceous sorbents derived from Iranian walnut shell (WS) were prepared by chemical activation method using ZnCl(2) as an activating reagent. To the best of our knowledge, this adsorbent was not used before for removing mercury from water. Adsorption of Hg(II) from aqueous solutions was carried out under different experimental conditions by varying treatment time, metal ion concentration, adsorbent amount, pH and solution temperature. It was determined that Hg(II) adsorption follows both Langmuir and Freundlich isotherms as well as pseudo-second-order kinetics. It was also shown that Hg(II) uptake decreases with increasing pH of the solution. The proper choice of preparation conditions resulted in a microporous activated carbon with 0.45 g/cm(3) density, 737 mg/g iodine number and 780 m(2)/g BET surface area. The monolayer sorption capacity of this optimum adsorbent was obtained as 151.5 mg/g.