Comparative study of heart rate variability in normotensive young adults with family history of hypertension

Background: Hypertension is a risk factor for the development of cardiovascular and cerebro-vascular diseases. Autonomic nervous system plays a crucial role in the development of hypertension. The integrity of autonomic modulation of heart rate is evaluated by analysing heart rate variability (HRV), which refers to oscillations in the intervals between consecutive heartbeats or R-R intervals. The present study was designed to analyse the indices of heart rate variability in the offsprings of hypertensive parents and off springs of normotensive parents to understand if there is any autonomic imbalance between the two groups.  Methods: The study was conducted in the Department of Physiology, Government Medical College, Srinagar. The test group consisted of 30 healthy normotensive subjects studying in 1st year of MBBS with hypertensive parents and the control group consisted of healthy normotensive of 1st year of MBBS with both parents normotensive. In time domain analysis the standard deviation of all normal-to-normal intervals {SDNN(ms)} was taken as index of overall HRV. Frequency domain analysis was done with respect to low frequency (LF) analysis and high frequency (HF) analysis. Low and high frequency power were expressed in normalized units.Results: The SDNN was reduced in cases but was not statistically significant. RMSSD was also reduced in cases though not statistically significant. LFnu was found to be significantly higher in cases. The HFnu was significantly reduced in cases. LF/HF ratio was found to be higher in cases and the difference was statistically significant.  Conclusions: Our study reveals that incidence of prehypertension and the risk of cardiovascular dysfunction in relation to sympathovagal imbalance is more in the off springs of hypertensive parents than in the off springs of normotensive parents. Sympathovagal imbalance in the form of increased sympathetic drive and decreased parasympathetic drive can lead to prehypertension in these genetically predisposed individuals.

A family with Charcot-Marie-Tooth disease (type 1): evaluating diagnostic role of nerve conduction studies

We aimed to report a case history of a family with Charcot-Marie-Tooth disease and to assess the role of nerve conduction studies in the diagnosis. A 10-year-old girl presented with difficulty in walking with a history of delayed motor milestones and slowly progressive weakness in distal muscles of both the lower limbs, with similar group of complaints in her father and a younger brother. Clinical examination of the patients was done and nerve conduction studies were performed. Clinical features and nerve conduction studies suggested the diagnosis as Charcot-Marie-Tooth disease with characteristic electro-diagnostic findings of Charcot-Marie-Tooth disease type-1. Charcot-Marie-Tooth disease is a rare disorder found in India. Although genetic tests form the basis of accurate diagnosis, yet nerve conduction studies, to a great extent, prove to be remarkable in approaching the diagnosis and distinguishing the common subtypes of this rare condition

TRANSITIONAL CARE INITIATIVE WITHIN MENTAL HEALTH SERVICES IN QATAR: DESCRIPTION AND EVALUATION OF AN INNOVATIVE CARE MODEL

The importance of effective health care transitioning of young people from adolescent to adult health services is well established in general and within mental health services in particular. There is no previous literature focusing on the implementation of the transitional care model within mental health services in the Arabian Gulf region. We outline details of how the international best practice of effective transitioning of young people from Child and Adolescent to Adult mental health services was adopted and implemented in the State of Qatar. The impact of this crucial initiative on patient care and service delivery is also explained

IMPACT OF COVID-19 ON ECT PRACTICE IN QATAR

There is paucity of Electroconvulsive therapy (ECT) utilization surveys from the Arabian Gulf region and none available from Qatar. There is no literature available on impact of Coronavirus Disease 2019 (COVID-19) pandemic on ECT provision. ECT is a lifesaving treatment in psychiatric practice requiring anesthetic support and there were concerns that redeployment of anesthetists due to COVID-19 pandemic might have comparatively bigger impact on the provision of ECT. These concerns stem from the fact that psychiatric patients often get discriminated against in health care systems; largely due to stigma and the belief among healthcare providers that psychiatric illness is somehow not as serious as other types of medical or surgical illness. In this brief report we present pre-COVID ECT utilization from Qatar. We also report findings on ECT utilization during COVID-19 and compare changes with other elective and non-elective surgeries. ECT provision was down by 40% during March to August 2020 in our setting. The decline in ECT provision was comparable to other elective and non-elective surgeries

Policy and legislation for the treatment of mental health and substance use disorders in Qatar

There is a marked paucity of publications on the policy and legislation of mental health, and substance use disorders in the public domain in Qatar. Qatar National Vision provides a framework for national strategies and the State of Qatar has developed policies and legislation dedicated to mental health and substance use. In doing so, Qatar has adopted international guidance to shape its mental health services and relevant policy and legislation. This article is a narrative description of the evolution of the mental health and substance use policy and legislation in Qatar.Open Access funding provided by the Qatar National Library. OW wrote the initial draft of the manuscript. All the authors read and approved the final manuscript.Scopu

Mental wellbeing of healthcare workers working in quarantine centers during the COVID-19 pandemic in Qatar

Background: Healthcare workers managing Coronavirus 19 (COVID-19) patients are at increased risk of poor mental wellbeing. The available literature on the psychological impact in the Arabian Gulf region is limited, and a more in-depth analysis of factors affecting frontline healthcare workers' mental wellbeing is warranted. The aim of this study was to evaluate and explore healthcare workers' wellbeing working in quarantine centers in Qatar. Methods: This study was a cross-sectional, web-based survey conducted on healthcare workers managing patients in designated quarantine centers. Healthcare workers associated with 51 COVID-19 quarantine centers were eligible to participate in this survey from April 19 to May 3, 2020. The primary outcome of interest was mental wellbeing as measured by the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). Results: A total of 127 of 169 contacted staff members completed the survey, with a participation rate of 75%. Approximately 17.4% of participants had well-being scores of less than 45, indicating suboptimal wellbeing and a high risk of psychological distress and depression. The multivariable logistic regression analysis showed that nurses are associated with increased risk (more than the fivefold higher risk of having WEMWBS score < 45) of adverse mental wellbeing (adjusted OR 5.65; 95% CI 0.57, 56.4; p = 0.140). Conclusion: The psychological impact of working in quarantine centers on healthcare workers was less than what has been reported globally. Nurses are the most vulnerable group. It is essential that health services monitor the psychological impact on its workforce and puts appropriate mitigation strategies in place.qscienc

Development of mental health services for lower-skilled migrant workers in Qatar

The largest group of migrants in Gulf Cooperation Council (GCC) countries are lower-skilled migrant workers. GCC countries have witnessed significant healthcare infrastructure investments over recent decades. Despite this, they are lagging to mainstream the mental health needs of lower-skilled migrants into national health policy frameworks. Qatar is one of the GCC countries where lower-skilled migrants constitute 50 per cent of population. In this article,we provide an overview of the development of specialist mental health service for lower-skilled migrants’ and discuss the challenges, and measures taken by the State of Qatar to mainstream their health needs into national health policy framework

Characteristics of 100 consecutive patients with COVID-19 referred to consultation-liaison psychiatry services in Qatar: A comparison of patients with delirium versus other psychiatric diagnoses

Introduction: Coronavirus disease 2019 (COVID-19) can present with various neuropsychiatric manifestations. This study reports on patients with COVID19 who were referred to the consultation-liaison (CL) psychiatry services in Qatar and compares the clinical and sociodemographic characteristics of those diagnosed with delirium versus other psychiatric diagnoses. Methods: This is a retrospective review of the first 100 consecutive patients with COVID-19 who were referred to the CL services. Results: Within the total cohort (n = 100), most patients (92%) were male, and the mean age was 46 years. About 27% of patients had asymptomatic COVID-19, 35% had a past psychiatric history, and 48% reported pandemic related psychosocial stress. Delirium was the most common psychiatric diagnosis (n = 29), followed by acute stress reaction/adjustment disorder, depression, mania, anxiety, nonaffective psychosis, and dementia. Among patients with delirium, agitation was the most common symptom (76%), 86% were treated with psychotropic medications, and 17% died. Higher age, longer hospital stays, lower oxygen saturation, lower lymphocytic count, and higher Creactive protein (CRP) values were significantly associated with delirium versus other psychiatric diagnoses. Higher age and lower oxygen saturations predicted delirium. Conclusion: Delirium was associated with a range of clinical variables and had significant mortality, despite the relatively young age of the patients. COVID-19 should be considered in patients presenting with delirium. Finally, early identification and management of delirium should be integral to COVID19 protocols.Scopu

Mania and hypomania associated with COVID-19: a series of 15 cases seen by the consultation-liaison psychiatry service in Qatar

Background: A range of neuropsychiatric diagnoses have been reported in association with coronavirus disease 2019 (COVID-19). However, only sporadic cases of mania or hypomania have been reported in patients with COVID-19. This study aimed to report clinical characteristics of 15 consecutive cases of COVID-19-associated mania or hypomania seen in three general hospitals in Qatar in the early months of the pandemic in 2020. Methods: This study is a retrospective case-note review of 15 cases of COVID-19-associated mania or hypomania (confirmed by polymerase chain reaction test), seen as inpatient consultations out of the first 100 consecutive patients managed by consultation-liaison psychiatric teams in Qatar between 2 March 2020 and 7 July 2020. Results: The mean age of the 15 patients was 40 years. Twelve patients had mania, and three had hypomania. Regarding the physical severity of COVID-19, 10 patients were asymptomatic, two had upper respiratory tract symptoms alone and three had pneumonia. None of the patients were intubated. Potential risk factors for mania/hypomania included pandemic-related psychosocial stress before admission (n = 9), past history of mania/bipolar disorder (n = 6) or psychosis (n = 2), raised inflammatory markers (n = 7) and steroid use (n = 3). None had a history of recent substance misuse. Other than one patient with advanced cancer, none had comorbidity regarded as likely to have caused mania or hypomania. Three patients had mild white matter ischaemic changes on brain imaging. Standard pharmacological treatment for mania (i.e. antipsychotic medication supplemented by prn benzodiazepines) was effective. Ten patients were discharged home from the COVID-19 facility where they presented, but five required transfer to Qatar's psychiatric hospital for further treatment of mania. Conclusion: The association of mania or hypomania with COVID-19 may be spurious (e.g. representing an initial presentation of bipolar disorder) or causal. The reported cases illustrate a range of potential aetiological mechanisms by which COVID-19 could cause mania or hypomania. Cohort studies are necessary to determine the incidence, aetiology and prognosis of COVID-19-associated mania/hypomania.qscienc