The psychological impact of COVID-19 on healthcare work force in the Middle East region C-S study

Introduction

COVID-19, is one of the biggest challenges facing humanity in the 21st century (1). The pandemic outbreak as affected all human activities, starting with healthcare and medical service passing with economy and social relationships, as well as political, religious and cultural enactments (2). The healthcare workers were the most affected fighting in the frontline working longer hours under a high risk of being infected (3). This study aims to assess the depression, anxiety and stress levels of the healthcare workforce (physicians, nurses, pharmacists and dentists) in the Middle East and North Africa-MENA-region.

Methods

We invited healthcare workers in the Middle East to participate in our cross-sectional survey by answering to the DASS-21 questionnaire.

Results

A total of 4,845 healthcare workers participated in the study. The participants were from 11 countries as follows: 436 from Egypt, 430 from Algeria, 458 from Iraq, 453 from Jordan, 473 from Libya, 428 from Palestine, 419 from Saudi Arabia, 452 from Sudan, 451 from Syria, 424 from Tunisia, and 421 from Yemen. The doctors among the healthcare workers were 51.7%, 19.0% were from the nursing staff, 16.8% were pharmacists, and 12.5% were from dentists. The depression level among the healthcare workers was as follows: 29.1% were normal, 13.7% were mildly depressed, 26.9% were moderately depressed, 14.4% were suffering from severe depression, and the depression state was extremely severe for the last 15.9%. At the same time, 29.1% were suffering from no anxiety, while 6.9% were at a mild level, 22.3% were at a moderate level, 13.4% were at a severe level, and 28.3% were at an extremely severe level. For the stress levels, 38.6% were normal, 14.9% were suffering from mild stress, 20.3% were moderate, 17.4% were severe, and the stress level was extremely severe for the other 8.9%.

Discussion

This study indicates that in the Middle East and North Africa-MENA-region, the prevalence of depression, anxiety, and stress among the healthcare workforce during the COVID-19 pandemic was 70.9, 70.9, 61.4, respectively.

Knowledge, practice and attitude toward anabolic hormones and nutritional supplements among people practicing sports in the MENA region before and during COVID-19 lockdown

Introduction

During the COVID-19 lockdown, people's lifestyles have changed including their habits and physical activities. There has been an increase in anabolic hormones and nutritional supplement use among people who regularly do exercise in the MENA region. This study aims to assess knowledge, practice, and attitude toward the use of anabolic hormones and nutritional supplements among people who regularly exercise in the Middle East and North Africa (MENA) region and to compare their exercise habits and hormones and supplements usage between before and during COVID-19 lockdown.

Methods

A self-administrated online Google form survey was carried out between February 2021 and April 2021. Five thousand eight hundred forty-five participants who regularly exercise and aged ≥18 years responded to the questionnaire. The questionnaire was distributed through social media platforms and included five sections: demographic, training characters, knowledge, practice, and attitude.

Results

The participants mean age was 27.4 ± 8.6 years. Males represented 58.2 % of participants. 75.3% of the study participants had not used either hormones or supplements, and about 19% used supplements only. The mean percent score for knowledge, practice, and attitude were 39.3 ± 30.5, 1.1 ± 9.5, and 21.3 ± 23.8, respectively. Level of knowledge was higher among participants who worked in the medical field or as sports coaches. The practice was higher among male participants. The most commonly used anabolic hormones and nutritional supplements were steroids and proteins with bodybuilding being the most common purpose. Internet was the main source of information and pharmacy was the main source for procuring these substances. There was a significant decrease in proteins, carbohydrates, and sports drinks used during the COVID-19 lockdown compared to before the COVID-19 lockdown, while a statistically significant increase in vitamins used during the COVID-19 lockdown compared to before COVID-19 lockdown.

Discussion

In the MENA region, there has been an increase in the use of anabolic hormones and nutritional supplements. Most of the population has low knowledge of the harmful effect of uncontrolled, uninformed and unmonitored use of these substances Therefore, increasing the awareness level of participants and sports coaches should be a priority to limit the unsupervised use of hormones and supplements.

Knowledge, attitude, and perception of public about participation in COVID-19 clinical trials: a study from Egypt and Saudi Arabia

BACKGROUND

Pharmaceutical firms are striving to find potential treatments to prevent and treat COVID-19. One of the gold standards to evaluate treatment is a clinical trial; however, the difficulty in patient recruitment could act as a determinant. It is evident from the registry data that very few studies have been conducted involving the population of the Middle East and North Africa (MENA) region.

AIM

To document knowledge, perception, and attitude of the public from Two large countries in the MENA region (Egypt and Saudi Arabia) towards participation in clinical trials focused on evaluating potential COVID-19 treatments.

METHOD

A cross-sectional study was conducted that used a snowball sampling strategy for recruitment. General population 18 years old or older, who lived in Saudi Arabia or Egypt were invited. The survey was adopted from literature and was approved by an ethics committee.

RESULTS

Out of 800 participants in the survey, 407 participants were from Egypt, and 393 were from Saudi Arabia. Most participants (48%) had moderate knowledge, i.e., > 60% < 80%. The results revealed poor attitude (88.5%) and poor perceptions (45.8%) regarding participation in COVID-19 clinical trials. Education and residence were identified as determinants of participants' knowledge, attitude, and perceptions. Participants' knowledge and understanding of COVID-19 trials did not impact their willingness to participate. This coupled with a poor attitude and perception among the masses drastically affects any potential for participation in future clinical trials. Conclusion: A relatively small proportion of participants were interested in enrolling in COVID-19 studies. Increased collective engagement through social media and healthcare professionals can help improve attitudes and perceptions toward trial participation.

The added value of cognition-targeted exercise versus symptom-targeted exercise for multiple sclerosis fatigue: A randomized controlled pilot trial

BACKGROUND

Fatigue is considered one of the most common symptoms of multiple sclerosis (MS) and lacks a current standardized treatment. Therefore, the aim of this study was to examine the feasibility and effectiveness of a cognition-targeted exercise versus symptom-targeted exercise for MS fatigue.

METHODS

In this Pilot, parallel-group, randomized controlled trial, sixty participants with multiple sclerosis, were randomly assigned to either a Cognition-Targeted Exercise (CTE) (N = 30, mean age 41) or a Symptom-Targeted Exercise (STE) (N = 30, mean age 42). The participants in the experimental group received eight, 50-minute sessions of weekly Cognitive Behavior Therapy (CBT) in addition to a CTE Program; whereas, participants in the control group received eight, 50-minute sessions of weekly CBT in addition to the standardized physiotherapy program (STE Program). Feasibility was assessed through recruitment rate, participant retention, adherence and safety, in addition to clinical outcome measures, including: (1) Modified Fatigue Impact Scale (MFIS), (2) Work and Social Adjustment Scale (WSAS), (3) Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS). All outcome measures were assessed at baseline (pretreatment), following completion of the eight visit intervention protocol, and at 3-months follow-up.

RESULTS

The recruitment rate was 60% and 93% of participants completed the entire study. The recruited participants complied with 98% of the required visits. No adverse events were recorded. A Generalized Estimation Equation Model revealed a significant difference over time as an interaction term during the post and follow up visit for all clinical outcome measures (p < .001).

CONCLUSION

The addition of CTE to CBT exhibited positive and more lasting influence on MS fatigue outcomes compared to Symptom-Targeted Exercise (STE). Feasibility and efficacy data from this pilot study provide support for a full-scale RCT of CTE as an integral component of Multiple Sclerosis fatigue management.

Alexithymia and asthma

Introduction

Alexithymia refers to difficulties in verbal expression of emotions, commonly observed in patients with psychosomatic symptoms. In this context, asthma is described as one of psychosomatic diseases.

Objectives

Identify clinical profile of asthmatic patients and assess the alexithymia level as well as associated factors.

Methods

We conducted a cross-sectional, descriptive and analytic study, including 30 patients followed for asthma at pulmonary outpatient department, Hedi Chaker Hospital, Sfax, Tunisia, during September and October 2015. We collected socio-demographic and clinical characteristics. Asthma control level was assessed by the Asthma Control Test (ACT). Alexithymia was measured using Toronto Alexithymia Scale (TAS 20).

Results

The mean age was 51 ans. Sex-ratio F/M was 14. The mean duration of disease was 11 years. Long-term control medicines were: inhaled corticosteroids, long-acting beta agonists and theophylline respectively in 86.7%, 33.3% and 26.7%. Two thirds of our patients had a bad therapeutic adherence. The average ACT score was 16.8 points. Asthma was uncontrolled in 1/3 and well controlled in 1/3 of cases. The average TAS 20 score was 64.8 points. Twenty percent of patients were non-alexithymic, 13.3% had a probable alexithymia and 66.7% were alexithymic. This score was positively correlated to bad asthma control (P < 0.001), long term evolution (P = 0.002) and use of inhaled corticoids (P < 0.001). It was inversely correlated to ACT score (P < 0.001).

Conclusion

Our study shows the high prevalence of alexithymia in patients with asthma and its negative impact in asthma control. Psychological support aiming specifically alexithymic dimension in these patients is indispensable.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Quality of life in patients with asthma

Introduction

Quality of life (QoL) is a complex concept that depends on many factors such as life style, past experiences, expectations, future plans and ambitions. It may be altered in patients suffering from chronic disease.

Objectives

Assess QoL in patients with asthma as well as associated factors.

Methods

We conducted a cross-sectional, descriptive and analytic study, including 30 patients followed for asthma at pulmonary outpatient department, Hedi Chaker Hospital, Sfax, Tunisia. Asthma control level was evaluated by the Asthma Control Test (ACT). QoL was assessed using the 36-item Short Form Health Survey (SF-36), that contains 36 questions grouped into 8 domains (D1: Physical Functioning, D2: Role limitations due to physical problems, D3: Bodily Pain, D4: General Health, D5: Vitality, D6: Social Functioning, D7: Role limitations due to emotional problems and D8: Mental Health).

Results

The mean age was 51 ans. The mean duration of disease was 11 years. The average ACT score was 16.8 points. Asthma was uncontrolled in 1/3 of patients. The mean of average overall scores SF-36 was 46.22. QoL was altered in 83.3% of patients. The most altered domains were D8 followed by D7then D4 and D2. The average overall score SF-36 was correlated to ACT score (P < 0.001), early age of onset of the disease (P = 0.049) and poor asthma control (P < 0.001). Altered QoL was associated to advanced age (P = 0.016), long duration of disease (P < 0.001) and low ACT score (P = 0.034).

Conclusion

Optimum asthma and associated comorbidities support would improve control and therefore the patient's quality of life.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Routine ‘group and save’ is unnecessary on the day of surgery for elective laparoscopic cholecystectomy

What this means for cost savings and reserve stocks.

Comparative study of pikeperch Sander lucioperca (Percidae; Linnaeus, 1758) eggs and larvae from wild females or from captive females fed chopped marine fish

Morphometric characteristics, proximal composition and fatty acids profiles of eggs and larvae at hatching and mouth opening were studied as indicators for assessing the potential differences between spawns obtained from wild or captive females of pikeperch (Sander lucioperca). Captive females were acclimated to hatchery conditions and fed to satiation with chopped marine fish for more than a year, guaranteeing that captivity covered the full cycle of gonad maturation. The number of larvae obtained from the spawnings did not differ between captive and wild females, but both mean diameter and mean weight of the eggs collected from the captive females were significantly larger. Proximal compositions were similar in eggs and larvae from both groups, but fatty acids (FA) profiles showed striking differences: polyunsaturated FA consisted mainly of linoleic acid in eggs and larvae from wild females, while they consisted mainly of long chains of n-3 series in eggs and larvae from captive females. The diet of captive females largely modified the FA profiles of eggs and of hatching or mouth opening larvae, but did not affect the growth potential of early larvae, demonstrating that they were able to satisfy their early physiological needs regardless of the striking differences in their FA.

[McCune-Albright syndrome associated with diabetes mellitus]

McCune-Albright syndrome (MAS) consists of the triad of polyostotic fibrous dysplasia, cutaneous pigmentation, and multiple endocrine abnormalities. Type 1 diabetes mellitus is not included in MAS. We report the case of an 18-year-old girl who presented with McCune-Albright syndrome. The diagnosis was made by the presence of precocious puberty at the age of 6 years, cutaneous pigmentation, polyostotic fibrous dysplasia, and phosphate diabetes. Type 1 diabetes mellitus developed at the age of 16 years. We discuss this case, the relationship between type 1 diabetes mellitus and MAS, with a literature review.

Reversible dilated cardiomyopathy caused by hypothyroidism

The association between lack of thyroid hormones and cardiac dysfunction has been well described. We report two new cases of patients with dilated cardiomyopathy (DCM), revealing a periphery hypothyroidism and for whom cardiac function significantly improved after L thyroxin substitutive treatment. Our cases highlight the necessity to perform thyroid function testing to investigate the etiology of non ischemic DCM.

Allometric growth and reproductive biology traits of pikeperch Sander lucioperca at the southern edge of its range

This study describes some biological traits (allometric relationship, reproductive biology and condition factor) of pikeperch Sander lucioperca at the southern edge of its range. Data were compiled from field studies between January 1997 and January 2009 in three Tunisian reservoirs. Overall, 1497 fish were caught, from which 1308 specimens were sampled and dissected. Sexually undetermined, male and female fish from the different sites exhibited similar allometric growth, expressed through the equation M(T) = 5 × 10(-6) L(T) (3·06) , where M(T) is the total mass and L(T) is the total length. The exponent value is slightly but significantly greater than 3, indicating positive allometric growth. Sex ratio (males:females) was 47:53 but remained balanced only up to 55 cm L(T) and changed with increasing size towards female dominance. Spawning occurred in March and early April according to the changes in female size-adjusted gonad mass or corresponding gonado-somatic index (I(G) ) values. Thermal conditions seemed favourable in February, but March corresponded to the period of equal day and night lengths and the switch towards longer days in terms of photoperiod. Changes in both size-adjusted M(T) or Fulton's condition factor and size-adjusted liver mass or hepato-somatic index (I(H) ) were clearly associated with reproduction. Reserves were consumed during spring in association with spawning efforts. Nevertheless, the delay before the reconstitution of reserves seemed relatively long (from early spring to late summer) although both thermal and trophic conditions could be considered favourable for active feeding of the fish.

A prospective study of the case-notes of MRSA-positive patients: a vehicle of MRSA spread

INTRODUCTION

Methicillin-resistant Staphylococcus aureus (MRSA) has received much publicity and remains a major problem for the health service. The aim of this study was to determine whether case-notes of MRSA-positive patients can act as a vehicle for MRSA transmission.

PATIENTS AND METHODS

A prospective study was performed of patients with active MRSA infection identified from a microbiology department database. Two swabs were taken from the cover of the case-notes and the page with the most recent entry for identification of MRSA using MRSA ID (Chromogenic agar medium), Pastorex and DNase tests. Positive case-notes were re-swabbed 96 h later.

RESULTS

A total of 50 MRSA-positive patients were identified from medical, surgical, high dependency and intensive care wards. Three sets of notes were MRSA positive (3/50; 6%). None of the positive case-notes was positive on re-swabbing at 96 h.

CONCLUSIONS

Case-notes of MRSA-positive patients can act as carriers of MRSA with the potential to spread MRSA to both healthcare and non-healthcare workers without direct contact with infected patients. We recommend extending the universal precautions to the handling of case-notes belonging to MRSA-infected patients.

Infiltration of Wounds and Extraperitoneal Space with Local Anesthetic in Patients Undergoing Laparoscopic Totally Extraperitoneal Repair of Unilateral Inguinal Hernias: A Randomized Double-Blind Placebo-Controlled Trial

Background:

The potential analgesic benefit of infiltration of the wounds and extraperitoneal space with local anesthetic in patients undergoing laparoscopic totally extraperitoneal (TEP) repair of inguinal hernias remains unclear.

Methods:

Consenting adults scheduled to undergo laparoscopic TEP repair of unilateral inguinal hernias were recruited to this randomized double-blind placebo-controlled clinical trial of 0.25% bupivacaine (group I) versus saline (group II) infiltration of abdominal wounds and the extraperitoneal space. Pain scores were assessed at 4 and 24 hours postoperatively using the short-form MCGill pain questionnaire (SF-MPQ), the Present Pain Index (PPI) score and the visual analogue scale (VAS). The intravenous and oral analgesic requirements were recorded. Each patient completed questionnaire to assess their satisfaction with the postoperative analgesia.

Results:

40 patients were randomized (group I, n = 20; group II, n = 20). The two groups were comparable for age, gender, body mass index, and operating time. Minor complications occurred in one patient in each group. There were no significant differences in the postoperative SF-MPQ scores, PPI and VAS at 4 hours (p = 0.413, p = 0.631, p = 0.615 respectively) and 24 hours (p = 0.116, p = 0.310, p = 0.100 respectively) post-operatively. The parenteral and oral analgesics consumed post-surgery were comparable (p = 0.605, p = 0.235). No difference was observed in the patient satisfaction scores.

Conclusions:

Infiltration of abdominal wounds and extraperitoneal space with bupivacaine in patients undergoing laparoscopic TEP repair of unilateral inguinal hernias does not appear to offer analgesic benefits.

Risk genotypes and haplotypes of the GLUT1 gene for type 2 diabetic nephropathy in the Tunisian population

OBJECTIVE

Diabetic nephropathy (DN) is a long-term complication of both type 1 and type 2 diabetes. Genetic studies on DN have been of little help so far, since several genetic association studies have shown conflicting results. Here we report the findings of a case-control study on five SNPs in the glucose transporter 1 (GLUT1) gene. The study investigated the association of five GLUT1 genotypes and haplotypes with DN.

RESEARCH DESIGN AND METHODS

All subjects, 126 DN (cases) and 273 type 2 diabetes (controls), were genotyped using the polymerase chain reaction restriction fragment length polymorphism.

RESULTS

The TT and the AA genotypes of the Haell and Enh2 SNP1, increased the risk of DN. The study also identified CGT as the highest risk haplotype (4.4-fold) followed by CAT with an increased risk of DN of 2.6-fold.

CONCLUSIONS

The GLUT1 gene confers susceptibility to DN in type 2 diabetes patients in the Tunisian population.

Association of glucose transporter 1 polymorphisms with type 2 diabetes in the Tunisian population

BACKGROUND

T2DM is a complex metabolic disease. Genetic studies on T2DM have been of little help so far because several genetic association studies have shown conflicting results. In this study, we report the findings of a case-control study on three SNPs in the GLUT1 gene. For this, we investigated the association of GLUT1 genotypes and haplotypes with T2DM.

RESEARCH DESIGN AND METHODS

All 273 T2DM subjects (cases) and 343 healthy subjects (controls) were genotyped using the polymerase chain reaction restriction fragment length polymorphism.

RESULTS

Results showed that the GT genotype of XbaI SNP could increase the risk of susceptibility to T2DM to 2.4 and that TAT is a 'risk haplotype' conferring a risk of 3.4 to T2DM.

CONCLUSION

The TAT haplotype of the GLUT1 gene confers susceptibility to T2DM in the Tunisian population.

Isolated pulmonic valve infective endocarditis: a persistent challenge

Isolated pulmonic valve infective endocarditis is an uncommon clinical entity. We report our experience with three patients diagnosed with pulmonic valve endocarditis from our institution. Two cases were caused by Enterococcus faecalis (one was resistant to vancomycin) and one by coagulase-negative staphylococci (CNS). One of the cases of isolated pulmonic valve endocarditis due to the E. faecalis was nosocomially acquired; the case of CNS pulmonic valve endocarditis was dialysis catheter related. Each patient with isolated pulmonic valve endocarditis presented with hypotension and interstitial pulmonary infiltrates. Two patients were treated with linezolid. Both vancomycin-resistant enterococci (VRE) and CNS were eliminated from blood cultures on linezolid therapy. The challenges inherent in the management of pulmonic valve endocarditis mandate the development of individual patient-specific guidelines.

HIV nephropathy and the Duffy antigen/receptor for Chemokines in African Americans

BACKGROUND AND OBJECTIVES

HIV nephropathy (HIVAN) is markedly racially biased in its distribution, occurring in about 10% of HIV infected African Americans according to some studies. Based upon previous laboratory and epidemiological studies, the Duffy promoter polymorphism, which occurs almost exclusively in individuals of African descent, has been postulated to be the predisposing factor. We aimed to explore that relationship by directly genotyping individuals with HIV nephropathy to determine the proportion homozygous for this mutation to test the hypothesis it was responsible for the genetic component of this disease. We anticipated that if the polymorphism was associated with HIV nephropathy all individuals would be homozygous for this mutation.

METHOD

Individuals with HIVAN proven on biopsy were identified from previous studies and a pre-existing clinical database. This diagnosis was confirmed by an experienced pathologist examining the biopsies in a blinded fashion. PCR and RFLP strategies were used on the biopsy samples to genotype for the Duffy promoter polymorphism. The cases were compared to a control population of HIV seronegative African Americans.

RESULTS

Twenty African American individuals with HIV nephropathy were successfully genotyped. Only nine were homozygous for the promoter mutation. Nine were heterozygous and two homozygous wild type. Furthermore, the frequency of the polymorphism did not differ from the background rate in the African American population (OR = 0.788 95% confidence intervals 0.378-1.64).

CONCLUSION

The Duffy promoter polymorphism was not disproportionately represented in persons with HIVAN calling into question any significant role in the pathogenesis of HIVAN.

Expression of a fusion protein of scFv-biotin mimetic peptide for immunoassay

We constructed two fusion proteins of scFv linked to biotin mimetic sequence (BMS) via different linkers, and expressed them in the Pichia pastoris expression/secretion system. We found that both bi-functional scFv proteins exhibited their intrinsic binding activities to antigen CA125 determined in competitive radioimmunoassay experiments, but the fusion protein with a spacer between the scFv and BMS (scFv-spacer-BMS) showed higher binding activity of streptavidin than the one with c-Myc peptide as a linker.

The management of aneurysms and arterio-venous fistulae of the popliteal artery arising from war trauma. Emphasis on sigmoid operative approach

Between 1986-1988, 600 vascular cases arising from the Iran-Iraq conflict were dealt with within an 18 month period and 60 cases of popliteal artery and/or venous disruption were encountered presenting at variable times after injury. A policy of management between the forward and base hospital surgical teams was introduced, observing the following broad categorizations: (a) assessment/referral, (b) assessment/fasciotomy/referral, (c) immediate operation/referral for further operation/review/management. Two types of incision were used to enter the popliteal fossa: (a) a medial incision and (b) a sigmoid posterior incision (which we now favor). The results of this strategy of management and operative technique (when compared with our previous experience within the same time frame) suggested an improved outcome. Fifty-four out of 60 cases had a satisfactory operative result with below-knee amputation being required in only four cases and higher amputations in two others. No operative or postoperative deaths occurred. The implementation of this "vetting policy" at the front line appeared to reduce the number of amputations and assisted the clarification of management criteria in assessing limb viability at the forward hospital when a large number of casualties were being received. Operative access using the sigmoid posterior incision was not associated with any complications, offered better exposure than the medial incision and was technically easier for the surgeon to perform.