GENES CONFERRING ANTIMICROBIAL-RESISTANCE AMONG KLEBSIELLA PNEUMONIAE IN THE ARABIAN GULF COUNTRIES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: The objective of the study was to look on the prevalence of six AMR genes (CTX-M, TEM, SHV, NDM-1, OXA-48, and VIM genes) in the province of the Arabian Gulf. We performed a systematic review and meta-analysis of the published studies from the Arabian Gulf countries and analyzed the antimicrobial resistance (AMR) genes pattern present in Klebsiella pneumoniae. Methods: The present study used the Meta-analysis Of Observational Studies in Epidemiology as a guideline for reporting findings. An electronic search was conducted in online databases such as PubMed/MEDLINE, EMBASE, Scopus, Google Scholar, Science Direct, and Web of Science from January 2014 to June 2020 following the inclusion and exclusion criteria. Articles published were included in the study resistance pattern among 2036 isolates were analyzed. These isolates conferred the AMR genes including OXA-48 (n=500), CTX-M (n= 1796), SHV (n=1637), TEM (n=1492), NDM-1 (n=500), and VIM (n=302). Results: Of 160 initially searched studies, 28 entries met the inclusion criteria and were subjected to meta-analysis. Critical appraisal of studies or quality assessment revealed a mean quality score was 4.2, with an SD of 1.6. The analysis revealed predominant AMR genes wereOXA-48 followed by CTX-M, SHV, TEM, NDM-1, and VIM in the Arabian Gulf region. Conclusion: The Arabian Gulf countries share a high prevalence of OXA-48, CTX-M followed by SHV, TEM, NDM-1, and VIM genes. Antimicrobial-resistant in K. pneumoniae is a threat to public health and this needs strong surveillance to curb this threat

Symptom severity is associated with leftward lateralization upon contextual modulation of visual vertical in patients with schizophrenia

BackgroundContextual processing dysfunction in patients with schizophrenia (SCZ) is not uniform and task-dependent. In SCZ, studies on the rod and frame test (RFT), which evaluates contextual modulation of verticality perception, are sparse. A main study that utilized a two-alternative forced choice design for judging rod verticality reported equivalent strength of RFT contextual modulation in healthy controls and SCZ. The current study aims to uncover any potential differences in contextual modulation between controls and SCZ with an adjustment method on a computerized RFT.Materials and methodsA total of 17 healthy controls and 15 SCZ aligned an oriented rod to their perceived vertical with a computer mouse under four randomized frame presentations: absent frame, non-tilted (Frame0°), or tilted by 18 degrees leftward (Frame–18°) or rightward (Frame+18°). Rod deviation error was assigned a negative or positive value when aligned leftward or rightward, respectively, of 0°. Signed and absolute errors, the rod and frame effect (RFE), and intra-individual variability (inconsistency) were used for analysis.ResultsThere was no group difference in rod alignment errors or derived measures, except that SCZ displayed greater inconsistency in rod alignment, compared to controls. The negative symptom scale (PANSS-N) scores correlated positively with the variability measure and with unsigned Frame–18° error.ConclusionsOnly the variability measure was sensitive enough to distinguish between controls and SCZ. SCZ with more severe negative symptoms had larger variability in rod alignment, probably reflecting a state of indifference. The larger deviation errors only with a leftward tilted frame, as PANSS-N scores increased, may indicate a lateralized attentional abnormality that is correlated with severity of symptoms in SCZ

Planetary sleep medicine: Studying sleep at the individual, population, and planetary level

Circadian rhythms are a series of endogenous autonomous oscillators that are generated by the molecular circadian clock which coordinates and synchronizes internal time with the external environment in a 24-h daily cycle (that can also be shorter or longer than 24 h). Besides daily rhythms, there exist as well other biological rhythms that have different time scales, including seasonal and annual rhythms. Circadian and other biological rhythms deeply permeate human life, at any level, spanning from the molecular, subcellular, cellular, tissue, and organismal level to environmental exposures, and behavioral lifestyles. Humans are immersed in what has been called the “circadian landscape,“ with circadian rhythms being highly pervasive and ubiquitous, and affecting every ecosystem on the planet, from plants to insects, fishes, birds, mammals, and other animals. Anthropogenic behaviors have been producing a cascading and compounding series of effects, including detrimental impacts on human health. However, the effects of climate change on sleep have been relatively overlooked. In the present narrative review paper, we wanted to offer a way to re-read/re-think sleep medicine from a planetary health perspective. Climate change, through a complex series of either direct or indirect mechanisms, including (i) pollution- and poor air quality-induced oxygen saturation variability/hypoxia, (ii) changes in light conditions and increases in the nighttime, (iii) fluctuating temperatures, warmer values, and heat due to extreme weather, and (iv) psychological distress imposed by disasters (like floods, wildfires, droughts, hurricanes, and infectious outbreaks by emerging and reemerging pathogens) may contribute to inducing mismatches between internal time and external environment, and disrupting sleep, causing poor sleep quantity and quality and sleep disorders, such as insomnia, and sleep-related breathing issues, among others. Climate change will generate relevant costs and impact more vulnerable populations in underserved areas, thus widening already existing global geographic, age-, sex-, and gender-related inequalities

Increased Dietary Inflammatory Index Is Associated with Schizophrenia: Results of a Case-Control Study from Bahrain

Background: Several studies have indicated that chronic low-grade inflammation is associated with the development of schizophrenia. Given the role of diet in modulating inflammatory markers, excessive caloric intake and increased consumption of pro-inflammatory components such as calorie-dense, nutrient-sparse foods may contribute toward increased rates of schizophrenia. This study aimed to examine the association between dietary inflammation, as measured by the dietary inflammatory index (DII (R)), and schizophrenia. Methods: A total of 120 cases attending the out-patient department in the Psychiatric Hospital/Bahrain were recruited, along with 120 healthy controls matched on age and sex. The energy-adjusted DII (E-DII) was computed based on dietary intake assessed using a comprehensive food frequency questionnaire (FFQ). Logistic regression was used to estimate odds ratios and 95% confidence intervals, adjusting for potential confounders including age, sex, body mass index, education, employment, diabetes, hypertension, and cardiovascular disease with E-DII expressed both as a continuous variable and categorized as quartiles. Results: The mean E-DII score for the entire sample was 1.79 +/- 1.52, indicating a generally pro-inflammatory diet. The cases with schizophrenia appeared to have a higher E-DII score compared to controls: 1.99 +/- 1.39 vs. 1.60 +/- 1.38, respectively (p = 0.009). For every one unit increase in the E-DII score, the odds of having schizophrenia increased by 62% (OR 1.62; 95% CI 1.17-2.26). Similarly, increased risk was observed when the E-DII was used as quartiles, with participants in most pro-inflammatory quartile 4 being nearly 6 times more likely to be schizophrenic than participants in the most anti-inflammatory group quartile 1 (OR 5.96; 1.74-20.38; p-trend = 0.01). Conclusions: The data suggest that a pro-inflammatory diet, as indicated by increasing E-DII score, is associated with schizophrenia. This is the first study to examine the association between the DII and schizophrenia in a Middle Eastern population. Although these results are consistent with findings from research conducted in depression, additional studies are required before generalizing the findings to other populations

Religious fasting and its impacts on individual, public, and planetary health: Fasting as a “religious health asset” for a healthier, more equitable, and sustainable society

Religious fasting is practiced by people of all faiths, including Christianity, Islam, Buddhism, Jainism, as well as Hinduism, Judaism, and Taoism. Individual/clinical, public, global, and planetary health has traditionally been studied as separate entities. Nevertheless, religious fasting, in conjunction with other religious health assets, can provide several opportunities, ranging from the individual to the population, environmental, and planetary levels, by facilitating and supporting societal transformations and changes, such as the adoption of healthier, more equitable, and sustainable lifestyles, therein preserving the Earth's systems and addressing major interconnected, cascading, and compound challenges. In this review, we will summarize the most recent evidence on the effects of religious fasting, particularly Orthodox and Ramadan Islamic fasting, on human and public health. Further, we will explore the potential effects of religious fasting on tackling current environmental issues, with a special focus on nutrition/food restriction and planetary health. Finally, specific recommendations, particularly around dietary intake during the fasting rituals, will be provided to ensure a sustainable healthy planet

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

The Psychological Well-Being of University Students Amidst COVID-19 Pandemic: Scoping review, systematic review and meta-analysis

This review aimed to summarise the current evidence relating to university students’ psychological well-being amidst the COVID-19 pandemic. A scoping review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, was first conducted to determine if the evidence can be systematically reviewed and meta-analysed. The search was performed via Google Scholar, MEDLINE/PubMed, Science Direct, Scopus and Web of Science. A total of 90 original articles were selected for the scoping review. Meta-analysis of a total of 46,284 cases revealed an overall pooled prevalence rate of 29.1% (95% confidence interval [CI]: 20.9–39.0; K = 9, N = 22357) for anxiety symptoms and 23.2% (95% CI: 15.7–32.9; K = 12, N = 23927) for depression symptoms. This data revealed that COVID-19 had a significant impact on university students’ psychological well-being. Keywords: Adolescents; Depression; Mental Health; Pandemic; Anxiety; SARS-COV-2

Symptom severity is associated with leftward lateralization upon contextual modulation of visual vertical in patients with schizophrenia.

Background: Contextual processing dysfunction in patients with schizophrenia (SCZ) is not uniform and task-dependent. In SCZ, studies on the rod and frame test (RFT), which evaluates contextual modulation of verticality perception, are sparse. A main study that utilized a two-alternative forced choice design for judging rod verticality reported equivalent strength of RFT contextual modulation in healthy controls and SCZ. The current study aims to uncover any potential differences in contextual modulation between controls and SCZ with an adjustment method on a computerized RFT. Materials and methods: A total of 17 healthy controls and 15 SCZ aligned an oriented rod to their perceived vertical with a computer mouse under four randomized frame presentations: absent frame, non-tilted (Frame0°), or tilted by 18 degrees leftward (Frame-18°) or rightward (Frame+18°). Rod deviation error was assigned a negative or positive value when aligned leftward or rightward, respectively, of 0°. Signed and absolute errors, the rod and frame effect (RFE), and intra-individual variability (inconsistency) were used for analysis. Results: There was no group difference in rod alignment errors or derived measures, except that SCZ displayed greater inconsistency in rod alignment, compared to controls. The negative symptom scale (PANSS-N) scores correlated positively with the variability measure and with unsigned Frame-18° error. Conclusions: Only the variability measure was sensitive enough to distinguish between controls and SCZ. SCZ with more severe negative symptoms had larger variability in rod alignment, probably reflecting a state of indifference. The larger deviation errors only with a leftward tilted frame, as PANSS-N scores increased, may indicate a lateralized attentional abnormality that is correlated with severity of symptoms in SCZ

Camel milk composition: A systematic review, meta-analysis, meta regression

The aim of this study is to ensure high generalizability of results, investigate heterogeneity between existing studies, and analyze variations in camel milk composition across various exposures, such as breeds, countries, seasons, and publication year