The epidemiology of distress: prevalence and associated factors of symptoms of depression, anxiety, and loneliness at the end of the first wave of COVID-19 in Qatar

Introduction

There is paucity of epidemiological studies from the Arab world and most of the focus of available international data is on the early months of the pandemic.

Objectives

We conducted the first cross-sectional national phone survey of adults in Qatar during the end of the first wave of the pandemic (December 2020 -January 2021) to estimate the prevalence and determinants of depression and/or anxiety.

Methods

We used the Physician Health Questionnaire-9 and Generalized Anxiety Disorder-7 with cut-off scores of ≥10; the revised UCLA loneliness scale; and questions related to COVID-19 status, death of family or friend, quarantine, health and changes in living arrangements. Bivariate and logistic regression models estimated associations between thirteen variables and combined depression-anxiety (score of 20 or higher).

Results

The two-week prevalence of depression was 6.5% (95%CI: 5.1-8.4), of anxiety 5.1% (95%CI: 3.8-6.9), but only 2.5% sought mental health professional help since the pandemic started. When including loneliness (OR=1.57, p (<0.001) in the model, the following variables were statistically significantly associated with depression-anxiety: female gender (OR=1.90, p=0.037), Qatari nationality (OR=2.37, p=0.018), Arab ethnicity (OR=3.14, p=0.007), and COVID-19 death of family or friend (OR=3.06, p=0.003). Without adjusting for loneliness, younger age (18-29 versus 40+ years of age: OR=2.9, p=0.004) and chronic health conditions (OR=2.0, p=0.029) were significantly associated with depression-anxiety.

Conclusions

Prevalence of depression and/or anxiety during the end of the first wave of COVID-19 pandemic in Qatar was similar to pre-pandemic estimates. Mental health service should focus on young adults, women, the bereaved, lonely and those with chronic health problems.

Disclosure

No significant relationships.

Prevalence and Subtype Distribution of Blastocystis sp. in Senegalese School Children

Blastocystis sp. is an enteric protozoan that frequently colonizes humans and many animals. Despite impacting on human health, data on the prevalence and subtype (ST) distribution of Blastocystis sp. remain sparse in Africa. Accordingly, we performed the first multicenter and largest epidemiological survey ever conducted on Blastocystis sp. for this continent. A total of 731 stool samples collected from healthy school children living in 10 villages of the northwestern region of Senegal were tested for the presence of Blastocystis sp. by real-time polymerase chain reaction followed by subtyping of positive samples. Considerable variation in prevalence between villages (51.7 to 100%) was evident with the overall prevalence being 80.4%. Mixed infections were identified in 23% of positive individuals. Among 453 school children with a single infection, ST2 was predominant, followed by ST1, ST3, ST7, ST10, and ST14; this is the first report of ST10 and ST14 in humans. Genetic polymorphisms were evident at the intra-ST level with the identification of numerous ST1 to ST3 genotypes. ST1 showed the greatest intra-ST diversity followed by ST2 and ST3. The prevalence and distribution of STs and genotypes varied among target villages, pointing to several potential infection sources, including human-to-human, zoonotic, and waterborne transmission.

A 3D printed drug delivery implant formed from a dynamic supramolecular polyurethane formulation

Prototype drug eluting implants have been 3D printed using a supramolecular polyurethane-PEG formulation. The implants are capable of releasing a pharmaceutical active with effective drug release over a period of up to 8.5 months.

First report on the prevalence and subtype distribution of Blastocystis sp. in dairy cattle in Lebanon and assessment of zoonotic transmission

Blastocystis sp. is frequently identified in a wide range of animal hosts, including bovids. Because of its burden and zoonotic potential, this parasite has been sought in domestic cattle from various countries, since this livestock may also represent a possible reservoir of human infection. However, epidemiological data regarding the prevalence and ST distribution of Blastocystis sp. in this animal group is lacking in Lebanon. Therefore, faecal samples were collected from a total of 254 dairy cattle raised on 55 farms located in the North Lebanon region and screened for the presence of the parasite by quantitative real-time PCR. The overall prevalence of Blastocystis sp. was shown to reach 63.4% in cattle livestock. Sequence analysis of positive samples indicated the presence of seven STs, with predominance of ST10 (44.0%) and ST14 (36.8%) and lower proportions of ST2 (8.0%), ST1 (7.2%), ST5 (2.4%), ST3 and ST7 (0.8% each). This survey was the first conducted worldwide reporting ST2 and ST7 in domestic cattle and confirmed that ST10 and ST14 represent cattle-adapted STs in view of their high prevalence. Faecal samples from in-contact dairy farmers and patients hospitalised in the same Lebanese governorate who reported no contact with cattle livestock were also analysed for the presence of Blastocystis sp. The same three STs were identified in both human cohorts, with predominance of ST3, followed either by ST1 or ST2 depending of the group. No other STs, including ST10 or ST14, have been reported. Moreover, even though ST1, ST2 and ST3 were found to be common to dairy cattle and farmers cohorts, only one ST3 isolate showed 100% sequence identity between both hosts. Consequently, the presence and low prevalence of ST1, ST2, ST3, ST5 and ST7 identified herein in domestic cattle, most of which exhibit low host specificity, could be derived from occasional direct exposure to faecal material from human and non-human hosts or by ingestion of contaminated drinking water or food in the enclosure of the farms. Together with the absence of ST10 and ST14 in the human population, these data suggest that cattle play a negligible role as zoonotic reservoirs of Blastocystis sp.

Mortality associated with major depression in a Canadian community cohort

OBJECTIVE

Prior studies have reported that major depressive episodes (MDEs) are associated with elevated mortality. However, the association has not always persisted after adjustment for other mortality risk factors. In our study, we examine this issue using data from a longitudinal Canadian study (the National Population Health Survey [NPHS]). The NPHS included a more comprehensive set of mortality determinants than prior studies, allowing a more comprehensive assessment of the effect of MDEs on mortality.

METHODS

The NPHS began data collection in 1994 and follow-up data were available to 2006 at the time of this analysis. The NPHS assessed depression using a short-form version of the Composite International Diagnostic Interview. Mortality was assessed as part of the cohort's follow-up, including linkage to vital statistics data.

RESULTS

During follow-up, 2019 deaths occurred in the eligible part of the NPHS cohort. Consistent with prior studies, MDEs were strongly predictive of mortality when basic adjustments were made for age and sex (hazard ratio [HR] 2.0, 95% CI 1.4 to 2.9). The association disappeared with adjustment for other variables that predict mortality risk (HR 1.1, 95% CI 0.7 to 1.7).

CONCLUSIONS

MDE is a strong predictor of mortality in the general population. This analysis failed to identify an independent effect of MDE when adjustments were made for other risk factors. However, the lack of a strong independent effect on mortality does not preclude an etiologic impact of MDE. MDE itself is intertwined with health-related changes that predict mortality and its impact may be mediated by these variables.

Weight gain in relation to major depression and antidepressant medication use

BACKGROUND

Previous studies have linked major depressive episodes (MDEs) to obesity. The association may be partially mediated by antidepressant medication use. In the current study we examine changes in weight and BMI in relation to MDE and antidepressant use in a general population cohort.

METHODS

Data from a Canadian longitudinal study, the National Population Health Survey (NPHS) were used. The NPHS has collected data from a community cohort since 1994 using interviews spaced two years apart. The NPHS includes the Composite International Diagnostic Interview Short Form for Major Depression (CIDI-SFMD). Self-reported height and weight are also recorded. Linear regression was used to describe associations between weight, BMI and MDE.

RESULTS

The pattern of weight change varied by age. Respondents under the age of 65 tended to gain weight over time, whereas those over the age of 65 tended to lose weight. Respondents in the younger category gained more weight if they had MDE or took antidepressant medications. However, the extent of weight gain was modest, those with MDE and those taking an antidepressant gaining an average of approximately 1 kg over 12 years of follow-up.

LIMITATIONS

The study used self-reported weight, which may be inaccurate. Measurements were made two years apart. The measure of MDE was an abbreviated diagnostic interview.

CONCLUSIONS

Both MDE and antidepressant medication use are associated with a modest increase in weight in people under 65. These results may be useful for physicians and other health professionals in planning dietary and weight-management regimens for depressed patients.

[An unusual cause of hand nodule: peri-tendon dirofilariasis]

Dirofilariasis is a zoonosis affecting dogs and cats. It was transmitted to man by mosquito bites. Human dirofilariasis is rare. We report a case of 4-year-old girl presented with a subcutaneous palmar nodule of the hand. Surgical excision shows a nodule encircling the forth flexor tendon. The histological examination established the diagnosis by the presence of an adult worm identified as Dirofilaria repens. Surgical excision was curative.

Microsatellite analysis and susceptibility to FCZ of Candida glabrata invasive isolates in Sfax Hospital, Tunisia

We have noted that, during the last few years, there has been a redistribution of the most common Candida species with an increase in non-C. albicans Candida species, particularly Candida glabrata. In many countries, the high frequency of Candida glabrata shows the highest resistance rates. The main objective of this investigation was to analyze the genotypic variability of invasive C. glabrata isolates recovered over a period of six years and assess their in vitro susceptibility to fluconazole to determine the possible existence of relationships between genotype and susceptibility. We collected 50 invasive C. glabrata isolates (21.4%) from January 2001 to December 2007. The in vitro susceptibility profiles as determined by the E-test method showed that 8.3% of the isolates were resistant to fluconazole. The typing with three microsatellite markers RPM2, MTI and ERG3 demonstrated 12 multilocus genotypes distributed irregularly with a predominance of G1 (38%). A cluster (G9) was found among isolates collected in the same ward, at the same time period, suggesting cross transmission. Eleven of 13 patients who had previously been colonized by C. glabrata, were infected by their colonizing strains. However, we noted after prolonged treatment with fluconazole that there was an increase of the MIC for an isolate from one patient and in another patient, the selection of a more resistant variant. In our study, we didn't find an association between genotype and susceptibility to fluconazole. In conclusion, the predominance of some genotypes could be explained by nosocomial transmission or a selective ecological advantage rather than an emergence of a resistant isolate.

[Mucosal leishmaniasis by contiguity with a skin lesion: another case report from Tunisia]

Three clinical forms of cutaneous leishmaniasis can be found in Tunisia, i.e. the sporadic form due to Leishmania infantum in the North, the zoonotic epidemic form due to Leishmania major in the center and Southwest, and the chronic cutaneous form due to Leishmania tropica in the South. Unlike cutaneous forms, mucosal involvement is uncommon. The purpose of this report is to describe another case of mucosal leishmaniasis due to contiguity with a skin lesion in a 54-years-old woman. The patient responded well to treatment with meglumine antimoniate.

[Entamoeba histolytica and Entamoeba dispar: differentiation methods and implications]

Entamoeba histolytica and Entamoeba dispar are two species morphologically identical (except hematophagous trophozoites) but one of them is pathogenic. Sensitive and specific molecular techniques which are able to distinguish E. histolytica from E. dispar have been developed recently. Detection of antigen in stool using the ELISA method is the diagnostic test method of choice for clinical use in the developing world. It is rapid and simple. Cultures for zymodeme analysis and PCR detection of the parasite remain research tools. Species identification is imperative both for improved clinical diagnosis and treatment and for planning control strategies.

[Cryptococcosis. Report of 4 cases diagnosed at the El-Hadi FLICI hospital]

The cryptococcosis is an opportunist infection, frequent during Acquired Immunodeficiency Syndrom (A.I.D.S.). It increases in the same way as the increase of immunodepression factors. This infection is due essentially to Cryptococcus neoformans. This paper deals with the analysis of four (04) cases of cryptococcosis admitted in El-Hadi FLICI hospital in Algiers from November 1997 to February 1998. Among these cases we have taken note of two patients struck doxn by A.I.D.S., one of them have undergone a kidney transplant, whereas the other suffered from sarcoidose and pulmonary tuberculosis. The diagnostic of cryptococcosis have been based essentially on C.S.E. examination.

Effects of zinc supplementation on blood rheology during exercise

We previously reported a higher blood viscosity at corrected hematocrit (45%) (explained by a higher value of erythrocyte rigidity) in football players with low serum zinc (Zn) and thus presumably Zn deficiency; subjects with low serum zinc had also an impairment in performance. This interventional study was undertaken in order to assess the effects of zinc supplementation (compared to placebo) on blood rheology and performance either at rest or during exercise. Ten male healthy volunteers (age: 26+/-1.3 yr; weight 67.9+/-2.24 kg; height 177+/-3 cm) received at random order either zinc (20 mg/day) and placebo, according to a double blind cross-over procedure, during seven days. In each case on the eighth day they performed a 25 min submaximal exercise-test. At rest blood viscosity at corrected hematocrit 45% (gamma = 1000 s(-1)) was lower after Zn (3.56+/-0.14 vs. 4.13+/-0.16 mPa.s, p = 0.009), explained by a lower RBC rigidity index 'k' according to Quemada's equation (1.65+/-0.07 vs. 1.84+/-0.08, p = 0.03). Hematocrit and plasma viscosity were unchanged, but RBC aggregation was decreased (laser retrodiffusion-derived aggregation time 'Ta' 3.52+/-0.51 vs. 2.75+/-0.59, p = 0.02). The increase in blood viscosity during exercise is lower after Zn than placebo. Blood viscosity at corrected hematocrit 45% remains unchanged during exercise after Zn, yet it increases after placebo. RBC rigidity index 'k' remains lower during exercise after Zn. The rating of perceived exertion (Borg's scale) at the 20th minute of exercise is lower after zinc (5.6+/-0.4 vs. 6.6+/-0.4, p = 0.008). This study confirms that Zn improves erythrocyte deformability, decreases the exercise-induced acute increase in blood viscosity, and improves exercise tolerance. Since Zn deficiencies are not unfrequent in sportsmen, these findings may be potentially relevant to sports nutrition.

Early hemorheologic aspects of overtraining in elite athletes

A standardized questionnaire has been proposed by the French consensus group on overtraining of the Société Française de Médecine du Sport (SFMS) and allows the calculation of a 'score' that may help to quantify the early clinical symptoms of the overtraining syndrome in sportsmen submitted to a heavy training program. We investigated a possible relationship between this score and blood rheology in 36 male elite sportsmen (national level in football, volleyball and karate; age: 17-33 yr) who underwent a standardized check-up including biological measurements and an exercise-test. The overtraining score ranged between 0 and 21 items and was correlated with blood viscosity (r = 0.413, p < 0.02). This correlation was explained by a correlation of this score with plasma viscosity (r = 0.512, p < 0.01) and hematocrit (r = 0.387, p < 0.05). When subjects with a high score (>6) were compared to subjects with a lower score they appeared to have a higher blood viscosity at native (but not corrected) hematocrit (3.18 +/- 0.01 vs. 2.89 +/- 0.05 mPa.s, p < 0.02), explained by higher values in both plasma viscosity (1.39 +/- 0.02 vs. 1.31 +/- 0.02 mPa.s, p < 0.01) and hematocrit (42.8 +/- 0.45 vs. 41.1 +/- 0.44, p < 0.05). By contrast, there was no difference in RBC deformability and aggregation. Overtrained subjects have also lower levels of zinc (0.72 +/- 0.024 vs. 0.84 +/- 0.023 mg/l, p < 0.01), ferritin (55.1 +/- 7.3 vs. 92.3 +/- 9.4 ng/ml), and IGF-binding protein 3 (3.4 +/- 0.22 vs. 4.52 +/- 0.4 ng/ml). Neither zinc nor ferritin status were likely to explain the rheologic alterations since disturbances in zinc or iron are rather associated with abnormalities in erythrocyte deformability or aggregability. Therefore, the early signs of overtraining in elite sportsmen are associated with a hemorheologic pattern that suggests some degree of reversal of the 'autohemodilution' associated with fitness in athletes.

The triphasic effects of exercise on blood rheology: which relevance to physiology and pathophysiology?

The life-extending effects of regular exercise are related to a decrease in both coronary and peripheral vascular morbidity, associated with some improvements in cardiovascular risk factors. A possible link between the beneficial metabolic and hemodynamic effects of exercise could be blood rheology, which is markedly affected by exercise. We propose here a description of the hemorheological effects of exercise as a triphasic phenomenon. Short-term effects of exercise are an increase in blood viscosity resulting from both fluid shifts and alterations of erythrocyte rheologic properties (rigidity and aggregability). Increased blood lactate, stress, and acute phase play a role in this process. Middle-term effects of regular exercise are a reversal of these acute effects with an increase in blood fluidity, explained by plasma volume expansion (autohemodilution) that lowers both plasma viscosity and hematocrit. Long-term effects further improve blood fluidity, parallel with the classical training-induced hormonal and metabolic alterations. While body composition, blood lipid pattern, and fibrinogen improve (thus decreasing plasma viscosity), erythrocyte metabolic and rheologic properties are modified, with a reduction in aggregability and rigidity. On the whole, these improvements reflect a reversal of the so-called "insulin-resistance syndrome" induced by a sedentary lifestyle. Since impaired blood rheology has been demonstrated to be at risk for vascular diseases, the hemorheologic effects of exercise can be hypothesized to be a mechanism (or at least a marker) of risk reversal. This latter point requires further investigation. The physiological meaning of the triphasic pattern of exercise-induced alterations of blood rheology is uncompletely understood, but increased blood fluidity may improve several steps of oxygen transfer to muscle, as clearly demonstrated in hypoxic conditions. Increasing evidence emerges from the literature, that blood fluidity is a physiological determinant of fitness.

Increased blood viscosity in iron-depleted elite athletes

Since iron deficiency is associated with abnormal erythrocyte rheology, we investigated relationships between plasma ferritin and blood rheology in 36 male elite sportsmen (age: 22.38+/-0.9 years). On the whole, ferritin was negatively correlated with blood viscosity (r = -0.36, p < 0.05). When 23 subjects with low ferritin levels suggesting mild iron deficiency were compared with 13 matched sportsmen with normal ferritin levels, iron-deficient sportsmen were shown to have a higher blood viscosity at 1000 s(-l) (3.17+/-0.09 vs. 2.85+/-0.06 mPas, p < 0.05), explained by a higher plasma viscosity (1.38+/-0.02 vs. 1.31+/-0.02 mPa s, p < 0.05), while hematocrit and RBC rigidity index Tk were similar in the two groups. RBC aggregability index M (4.59+/-0.58 vs. 2.95+/-0.43 mPas, p < 0.05) and M1 (8.46+/-0.58 vs. 6.07+/-0.55, p < 0.01) were higher in iron-deficient subjects. Serum zinc was lower in iron-deficient sportsmen (0.73+/-0.02 vs. 0.83+/-0.02 mg/l, p < 0.01), but the score of early signs of overtraining was higher in this group (10.84+/-1.61 vs. 4.08+/-1.11, p < 0.01). These data suggest that mild iron deficiency as commonly seen in athletes, before anemia occurs, is associated with an increase in plasma viscosity and RBC aggregation, together with an increased subjective feeling of exercise overload.

Serum zinc and blood rheology in sportsmen (football players)

We aimed at investigating relationships between zinc status, blood rheology and blood glucose during exercise. Twenty-one professional football players underwent a triangular maximal exercise test on cycloergometer, with progressively increasing work loads until VO2max. On the whole these subjects had a low serum zinc because nine of them had a hypozincemia (0.54 +/- 0.01 mg/l) which suggested a zinc deficiency. Subjects with low serum zinc were able to perform a lower power output (123 +/- 8.71 vs. 166.27 +/- 14.84 watts, p = 0.029) and exhibited a higher increase in blood lactate during exercise (7.51 +/- 0.81 vs. 5.57 +/- 0.33 mmol/l, p = 0.024) resulting in a lower 2 mmol lactate threshold (44.7 +/- 3.9% vs. 58.9 +/- 4.8% of maximal power output, p = 0.04). They were less able to maintain their plasma glucose and exhibited a tendency towards hypoglycemia (p = 0.0153). Hypozincemia was associated with a higher viscometric RBC rigidity index (p = 0.0009), and this index was negatively correlated to serum zinc (r = -0.68, p = 0.7 x 10(-3)). Blood viscosity at high shear rate (MT90 viscosimeter) corrected for hematocrit (45%) remained higher during exercise in these hypozincemic subjects (p = 0.003). This study suggests that zinc status may influence blood rheology during exercise, either by its direct action on RBC flexibility (demonstrated in vitro) or by its effect on lactate accumulation which may in turn modify erythrocyte fexibility.

Anti-leishmanial antibodies during natural infection of Psammomys obesus and Meriones shawi (Rodentia, Gerbillinae) by Leishmania major

Sera from 77 rodents (Psammomys obesus: 64; Meriones (M.) shawi: 10; M. libycus: 3) trapped in a focus of zoonotic cutaneous leishmaniasis (ZCL) (Leishmania (L.) major) were examined for the presence of anti-leishmanial antibodies by the indirect fluorscence antibody technique (IFAT) (L. major antigens) using homologous antiglobulins and/or anti-Rattus conjugates. Sera from 21 animals were positive with titres that ranged from 1: 20 up to 1: 640. The investigation revealed that a good correlation existed between the occurrence of antileishmanial antibodies in the sera and amastigotes in the rodents' ears. The data also suggest the suitability of the IFAT as an epidemiological tool to estimate rates of infection by L. major in Psammomys obesus and Meriones Spp. in foci of ZCL.