Cognitive impairment in recipients of liver transplantation and relation to hepatic encephalopathy

Background Liver transplantation (LT) helped to save the life of end stage liver disease (ESLD) patients; however, there is a debate on the persistence of cognitive impairment. The study aimed to evaluate cognitive functions in patients with ESLD before and after liver transplantation and to assess its relation to hepatic encephalopathy (HE). Thirty recipients 47.6 ± 11 years undergone living donor liver transplantation at the transplantation center of both Ain Shams Center for Organ Transplant and Egypt air organ transplant unit were prospectively assessed by Trail Making Test, Wechsler Memory Scale–Revised, Benton Visual Retention—for the evaluation of cognitive functions before and 3 months after transplantation. Results The mean age of the patients was 47.6 ± 11 years, 17 males and 13 females. Eight out of 30 (26.7%) had past history of hepatic encephalopathy. The study reported significant improvement in the post-operative 3 months scores of Trail Making Test part (A), the digit span forward test, digit span backward test and the correct score difference of the Benton Visual Retention, as p value was (0.02), (0.01) (0.02), and (0.01) respectively, compared to the pre-operative scores. However, there was no difference in the scores of part (B), verbal association I, II, information subtest of WMS. Cognitive performance showed no significant difference between patients with or without history of HE. Conclusions Patients with ESLD have significant cognitive impairment that showed improvement after LT; HE did not correlate with cognitive function. Hence, transplantation has a favorable outcome on the cognitive impairment.

Sleep pattern in a group of patients undergoing hemodialysis compared to control

Background Patients with chronic kidney disease progress regularly every year to end-stage renal disease and have to undergo dialysis. Sleep disturbances have been reported to be frequent among patients receiving dialysis and contributing to the increase of their mortality and morbidity. The present research aimed to study the sleep pattern in hemodialysis patients and the risk factors associated. This cross-sectional case-control study included 40 subjects divided into 2 groups: 20 cases recruited from Ain Shams University Hospital’s dialysis unit and 20 in the control group with normal Pittsburgh Sleep Quality Index score matched for age and sex. Both groups were subjected to overnight polysomnography, and the cases group was assessed by the Pittsburgh Sleep Quality Index to determine their sleep quality. Results Nearly all polysomnographic parameters were significantly abnormal in the cases group except for sleep onset latency (P > 0.05), showing obstructive sleep apnea and periodic limb movement (P value 0.001). Based on their Pittsburgh Sleep Quality Index score, 30% were classified as good sleepers and 70% as bad sleepers. On comparing both groups, a significant difference was found. Poor sleepers had more worse sleep efficiency (62.9%), spent longer time during their sleep in stage 1 (26.6%) with shorter REM onset latency (113.5 ± 99.5), and had a longer duration of illness with lower serum creatinine level compared to good sleepers. Conclusions The prevalence of obstructive sleep apnea and periodic limb movement in hemodialysis patients is high; patients with longer time on dialysis are at more risk of sleep disorders, whereas hemoglobin levels, BUN, and other demographic factors do not seem to play a role in sleep disorder. Hence, patients on hemodialysis need to be screened for sleep disorders so as to improve their mortality and morbidity.

Depression symptoms and associated factors among thalassemia patients in the Palestinian Territories: a cross-sectional study

Background Thalassemia is a condition that causes the human body to destroy red blood cells faster than they can be made. It causes physical symptomology as well as psychological distress. The current study aimed to identify the prevalence of depression symptoms among individuals with moderate to severe thalassemia. A quantitative descriptive cross-sectional design was applied utilizing the Beck Depression Inventory to assess the level of depression in the sample. Results Some significant relationships were demonstrated in the sample: males reporting severe depression symptoms than females by 6.0 times (95% CI 0.07–0.62, p 0.014), and reporting moderate depression symptoms (95% CI 0.00–0.47, p 0.05). Additionally, income was found to be a predictor of level of depression symptoms with low income reported higher incidence of severe depression symptoms than those whose monthly income was > 400$ by 18.4 times (95% CI 0.38–1.03, p ≤ 0.001), but not reporting a significant association between moderate depressive symptoms and monthly income (95% CI − 012–1.47, P 0.225). A significant association was found between the educational attainment and level of depression symptoms with lower levels of education predicting higher levels of severe depression symptoms (95% CI 0.069–0.89, p 0.022), but no significant association was reported between moderate depression symptoms and educational attainment (95% CI − 0.49–0.01, p 0.81). Related to disease characteristics a relationship was confirmed between severe depressive symptoms and medication level such as the individual needing tablets or pumps (95% CI 0.189–1.05, p 0.005 and 95% CI 0.52–1.44, p 0.001) respectively. Other disease related variables showed no significant correlation with depressive symptom levels. Additional significant relationships were found in environment whereas increased moderate depressive symptoms were experienced by individuals residing in rural areas as opposed to those living in IDP camps or cities by 4 times (95% CI − 0.30–0.01, p 0.04), but no significant association was found between severe depression and the place of residence. The other independent variables had no significant correlation with severe or moderate depressive symptoms. Conclusion In light of these findings addressing symptoms of depression directly and supporting patients with thalassemia with basic life needs unrelated to their disease maybe mitigating depressive symptoms which may negatively affect recovery.

Increased psychological distress after the lifting of COVID-19 lockdown in the Saudi population: a cross-sectional study

Background Amid the ongoing COVID-19 pandemic and its global health and socioeconomic aftereffects, the enduring state of crisis is increasingly impacting the coping capacity of the populations. In this study, we aimed to characterize the levels of psychological distress after the lifting of COVID-19 lockdown. Results The Impact of Event Scale (IES-R) and Depression, Anxiety, and Stress Scales-21 items (DASS-21) were used to screen for post-traumatic stress syndrome (PTSD), depression, anxiety, and stress. The prevalence of PTSD was 41.6% and was associated with severe or extremely severe stress (27.8%), anxiety (31.4%), and depression (39.0%). All disorders were strongly correlated with one another. The risk of developing PTSD was independently associated with residence in high COVID-19 prevalence region (OR = 2.25, p = 0.004), poor (OR = 3.98, p = 0.002), or moderate (OR = 1.63, p = 0.048) self-assessed overall physical health, psychiatric comorbidity (OR = 1.87, p = 0.036), number of COVID-19-like symptoms (OR = 1.94, p = 0.039), and severe COVID-19 morbidity in the acquaintances (OR = 1.54, p = 0.026). Four theories were proposed to explain these high figures, with a discussion of their practical implications. Conclusions The lifting of lockdown measures was associated with a substantial increase in psychological distress among the Saudi population, referring to figures reported during the lockdown. This may indicate a decline in the overall population’s coping capacity with the enduring crisis.

Socio demographic, clinical, and side effect profile of patients on clozapine in Kashmir, North India

Background Clozapine is an atypical second-generation antipsychotic belonging to the family of dibenzodiazepines. There is lack of literature on clozapine from this part of the world. So, our aim was to study the socio demographic, clinical and side effect profile of patients on clozapine in Kashmir. Results The mean age of the study group was 32.6 ± 8.9 years with majority being males (78.4%), unmarried (78.4%), unemployed (77.2%), and belonging to nuclear families (77.2%). Almost half of them resided in urban localities (51.1%) and studied upto middle school (55.7%). Around three- fourth (75%) of the patients had diagnosis of treatment-resistant schizophrenia. The mean dose of clozapine was 338.92 ± 158.11 mgs. Sedation (76.1%), hypersalivation (69.5%), constipation (46.6%), and weight gain (34.1%) were most common side effects noted in patients. 4.5% cases developed seizures while on clozapine. 2.3% patients developed agranulocytosis while 4.5% patients developed neutropenia on clozapine. The neutropenia was more pronounced in patients of schizophrenia with suicidal tendencies with doses of more than 400 mg. Conclusions We have used clozapine in a wide range of indications. Our patients seem to tolerate and respond to higher doses of clozapine and the prevalence of blood dyscrasias in our study sample was much higher than the rest of India.

Stress and its correlates among medical students in six medical colleges: an attempt to understand the current situation

Background Medical students encounter various stressors during their studies. The study aimed to assess stress levels, sources, and associated determinants among Sudanese medical students. An online questionnaire-based study was conducted among 617 undergraduate medical students of 6 different universities in Sudan. A 19-item questionnaire was utilized to assess stress sources, in addition to demographics, stress manifestations, and coping strategies. Results The overall prevalence of stress was 31.7% (p < 0.01). The main sources of stress were time pressure, heavy workload, fear of failure, and examination frequency. One-third of students indicated that they experienced at least one source of psychosocial- and teaching-related stress. Female medical students were more significantly stressed due to academics than males. Also, fourth- and fifth-year students were academically more stressed in comparison to the first-year students. Poisson regression analysis model showed that first-year students were less stressed than the final-year students in relation to academics (odds = 0.888, P = 0.003). Male medical students, across all study years, were far less stressed than females (odds = 0.901, P = 0.000153). Expectedly, ‘studying medicine by choice’ was associated with decreased odds for psychosocial stressors (odds = 0.885, P = 0.00781), and improved model-fit (chi-squared = 6.8952, P = 0.008643). Also, the year of study was a predictor of teaching-related stress development. Conclusions Female medical students were more stressed due to academics than males. On the other hand, final-year students were more academically stressed than first-year students. Female medical students were likely having stress related to academic stress development, while being first-year medical student was a predictor of not developing academic stress. Studying medicine by choice’ was associated with ability to cope against stress.

Burnout among medical students of the University of Kerbala and its correlates

Background Burnout is prevalent among medical students. Throughout their training, medical students face many psychosocial stresses that, if not managed, might cause burnout syndrome. Burnout could negatively impact students’ life and their academic performance. This study aims to estimate the prevalence of burnout among medical students at the College of Medicine, University of Kerbala, and assess factors associated with it. An analytic cross-sectional study. A sample of 424 students from all academic years from the College of Medicine, University of Kerbala, was approached. Data collection was conducted from June 11 to July 3, 2020, through a self-administered online questionnaire based on the Maslach Burnout Inventory Student Survey (MBI-SS). The MBI-SS included 15 questions with a 7-point rating ranging from 0 (never) to 6 (always). The tool measures three subscales: emotional exhaustion (5 questions), Cynicism (4 questions), and professional efficacy (6 questions). Statistical Package for the Social Sciences (SPSS) program version 24 was used for data analysis. Binary logistic regression was used to assess the association between burnout and students̓ variables, P value of a level < 0.05 considered statistically significant. Results The prevalence of burnout syndrome among medical students was 38.2%. About 85.6% of students had high emotional exhaustion, 77.8% had high cynicism, and 32.5% exhibited low professional efficacy. Female gender, regular use of legal substances, and family history of mental diseases were associated with significantly high rates of burnout. Conclusions Burnout is prevalent among medical students of the University of Kerbala with quite high levels of emotional exhaustion and cynicism and lower professional efficacy levels. Faculties of medicine need to consider burnout among their students and works to reduce unnecessary stresses by modifying and upgrading the educational and clinical environments.

The psychological impact of inflammatory bowel disease as regards anxiety and depression: a single-center study

Background Patients suffering from inflammatory bowel disease (IBD) are not systematically screened against depression as well as anxiety, although there are high prevalence and adverse influence on the quality of life. The aim of this work was to determine generalized anxiety disorder and major depressive disorder prevalence in patients with IBD, and the secondary objective was to identify patient properties linked to higher psychiatric disorder rates. Results We determined anxiety and depression prevalence in 105 IBD patients (82 having ulcerative colitis and 23 suffering from Crohn’s disease) through a psychiatric interview using the Arabic version of Structured Clinical Interview for DSM IV Axis I diagnosis (SCID I), in addition to severity assessment of major depressive disorder and generalized anxiety disorder using the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A), respectively. Patient data, disease characteristics, and drug information were also gathered. We found a high depression prevalence of 56.2% (n = 59), followed by 37.1% (n = 39), with no significant association between IBD severity and anxiety and depression severity. Conclusion Depression and/or anxiety affected a large number of IBD patients. Such psychiatric disorders’ frequency would warrant detection as well as referral to psychiatric treatment.

Comparison of caregivers’ characteristics, stigma, and disease burden of children with autism spectrum disorder and attention-deficit disorder in Egypt

Background Studies show that autism spectrum disorder and attention-deficit hyperactivity disorder place a significant stigma and burden on caregivers, economically as well as socially, psychologically, and emotionally. The current study aims to assess caregivers of those children with reference to stigma and disease burden, evaluation of different psychiatric symptoms, and quality of life. Also, it aims to compare the extent of such disruption related to the type of the disorder (ASD versus ADHD). A cross-sectional, analytical study was designed including 72 caregivers {38 caregivers of autism versus 34 caregivers of ADHD}; all of them were assessed for (1) stigma; (2) disease burden; (3) depression, anxiety, and sensitivity; and (4) quality of life. Results The current results show that caregivers of ASD and ADHD have a higher score of stigmas, burden, depression, anxiety, and a poorer QoL than normal; all these variables are worse in ASD caregivers than ADHD caregivers. Conclusion This study supports the notion that both ADHD and ASD pose a great challenge for their caregivers which is higher in ASD than ADHD caregivers.