COVID-19 lockdowns weigh heavily on youth: an analysis of the impact on BMI for Age Z scores in children and adolescents.

BACKGROUND: The COVID-19 pandemic has significantly impacted the lifestyle and health of children and adolescents. This study aimed to assess the lifestyle changes brought about by COVID-19-related school closures and their impact on the Body Mass Index for Age Z (BAZ) scores of governmental school students in Qatar. METHODS: An analytical cross-sectional study was conducted between June and August 2022 targeting students aged 8-15 years. Data on lifestyle behaviors were gathered through telephone interviews with parents of selected students. The BAZ scores before and after school closures that were automatically calculated by the electronic health records system were extracted. RESULTS: We completed 1546 interviews. We found a significant increase in unhealthy food categories, a reduction in physical activity and an increase in the screen time over the period of schools' closure. The BAZ increased significantly by 0.30 (95% CI 0.26-0.35). The increase in BAZ scores was significantly higher among male students and the younger age group compared to females and older counterparts, respectively. The student's age group, sex, nationality and change in physical activity were significant predictors of the change in BAZ scores. CONCLUSIONS: School closures during the COVID-19 pandemic negatively impacted the lifestyle of students in Qatar and resulted in a significant increase in the BAZ scores.

From classrooms to controllers: how school closures shaped children's video gaming habits.

OBJECTIVES: This study aimed to assess the impact of COVID-19-related school closures on screen time and video gaming habits among governmental school students in Qatar and explore the prevalence of Internet Gaming Disorder (IGD) within this context. METHODS: A cross-sectional approach was employed, spanning two months from June to August 2022. A random sample of students aged 8-15 years was drawn from the national electronic health record system of Qatar. Telephone interviews with parents were conducted to collect data. The Parental Internet Gaming Disorder Scale (PIGDS) was used for IGD assessment. RESULTS: Of 428 parents, 257 (60%) confirmed their child's engagement in video gaming during school closures. Participants averaged 11 years in age with 92 (35.8%) females and 165 (64.2%) males. Nationality included 62.6% expatriates and 37.4% Qatari locals. Average weekly screen time increased significantly from 19.7 ± 10.1 h to 31.9 ± 12.6 h during closure (p < 0.001). Video gaming time rose from 8.6 ± 8.6 h to 13.0 ± 12.4 h per week (p < 0.001). The prevalence of IGD was 8.6% (95% CI 5.4-12.7). Male students, expatriates, and those reporting increased video gaming time were more likely to develop IGD than their female and local counterparts. CONCLUSION: The observed associations between video gaming increase and IGD highlight the need for focused interventions to address potential risks and promote healthier digital habits among this population.

COVID-19 perceived stigma among survivors: A cross-sectional study of prevalence and predictors.

Background and objectives: Perceived stigma related to infectious diseases is of public health importance and can adversely impact patients' physical and mental health. This study aims to identify the level of perceived stigma among COVID-19 survivors in Qatar and investigate its predictors. Methods: An analytical cross-sectional design was employed. Four hundred and four participants who had a positive COVID-19 PCR test were randomly selected from medical records. The selected participants were interviewed to collect sociodemographic and health-related information. Perceived stigma was assessed using the COVID-19 perceived stigma scale-22 (CPSS-22) that was developed by the researchers. A descriptive analysis followed by a bivariate analysis investigated possible associations between the perceived stigma levels and independent variables. A multivariable analysis was performed using logistic regression to identify any significant associations with perceived stigma. The validity and reliability of the developed tool were also tested. Results: The prevalence of COVID-19 perceived stigma was twenty-six percent (n = 107, 26.4%) at 95% CI [22.4-30.4]. Factors associated with higher COVID-19 perceived stigma were male gender, being a manual worker, non-Arabic ethnicity, low educational level, living alone, and being isolated outside the home. However, only occupation, ethnicity, and low educational level predicted COVID-19 perceived stigma in multivariable analysis. The CPSS-22 showed excellent reliability (Cronbach's alpha 0.92). Conclusion: Perceived stigma was relatively common among participants. Designing programs and interventions targeting male manual workers and those of low-educational levels may assist policymakers in mitigating the stigma related to COVID-19.

Determinants of vaccine adherence among non-dialysis chronic kidney disease patients in Qatar.

INTRODUCTION: Chronic kidney disease (CKD) is a global health problem. Reduced innate and adaptive immunological responses predispose CKD patients to infections. Despite the clinical and epidemiological importance of CKD and the great value of vaccination as a prophylactic measure, the utilization of recommended vaccines in Qatar has not yet been evaluated. METHODS: We conducted a cross-sectional study to estimate the level of influenza, pneumococcal, and hepatitis B vaccination and the predictors of adherence to these recommended vaccines among non-dialysis CKD patients receiving renal ambulatory care in Qatar from 1 September 2020 to 30 April 2021. Complete vaccination was defined as receiving the three vaccines, and partial vaccination was defined as receiving one or two vaccines. The full and partial vaccination predictors were assessed using multivariate logistic regression and reported as odds ratio (OR) with p<0.05 indicating statistical significance. RESULTS: 416 non-dialysis CKD patients were included in our analysis. 73% were males; the mean age was 56 ± 15 years. More than 50% of the patients were from the Middle East, followed by 36% from Asia. Most patients had concurrent hypertension, concurrent diabetes mellitus, and were stage V CKD. Only 12% of the patients were fully vaccinated, while 73% received partial vaccination. The predictors of vaccination included age, gender, Asian origin, employment, living conditions, concurrent medical conditions, CKD stage, allergy to medications, and use of injectable medications. Only stage V CKD positively predicted adherence to full and partial vaccinations in non-dialysis CKD patients. CONCLUSION: There is very low adherence to the recommended vaccines in CKD patients, with a prevalence of complete vaccination of 12% only. Increased public awareness about the importance of vaccination in CKD may improve the adherence rates among these patients in Qatar.

Death certification status in Eastern Mediterranean Region: A systematic review.

A death certificate is an important public health surveillance tool that affects the quality of morbidity and mortality statistics. This systematic review examines death certification in the Eastern Mediterranean Region, uncovers the methodological qualities of published studies, the common errors committed by certifiers, and physicians' knowledge in filling out death certificates. We searched three databases, finding 19 studies, the majority of which reported errors in the underlying cause of death. Fewer than 25% of physicians reported training on filling out death certificates. Complexity of the cases and lack of training were reported as common difficulties facing physicians leading to errors.

Knowledge and Perceived Effectiveness of Infection Prevention and Control Measures Among Health Care Workers During the COVID-19 Pandemic: A National Survey.

BACKGROUND: Being the first line of defense against COVID-19 infection, health care workers (HCWs) are at an increased risk of getting infected. Infection prevention and control (IPC) measures were deemed to be instrumental in protecting them and their patients against infection. PURPOSE: To assess HCWs' knowledge of IPC measures and their perceived effectiveness in protecting against COVID-19. METHODS: A national web-based survey was conducted in different health care sectors in Qatar. RESULTS: A total of 1757 HCWs completed the survey. HCWs believed in applying stricter IPC precautions while dealing with confirmed COVID-19 cases than with suspected cases. Males and physicians were more likely to have high perceived effectiveness of IPC measures than females, nurses, and pharmacists. Higher proportions of HCWs believed in the effectiveness of hand hygiene than most types of personal protective equipment. CONCLUSION: Further research is recommended to assess the impact of HCWs' knowledge and perceived effectiveness of IPC measures on their compliance.

Screening for antenatal depression and its determinants among pregnant women in Qatar: revisiting the biopsychosocial model.

BACKGROUND: Screening for antenatal depression and its determinants is highly recommended. However, there is no consensus on a standard conceptual framework to approach pregnant women in a primary health care setting. The prevalence of antenatal depression and significant determinants are unknown in Qatar, a gap that we propose to fill. METHODS: An analytical cross-sectional study with a probability sampling technique was employed. Enrolling eight-hundred participants from primary health care centers. The screening was performed through a valid and reliable screening instrument 'Edinburgh Postpartum Depression Scale.' In addition to the proposed Comprehensive Biopsychosocial Model, participants were asked about their predisposing profile, biological risk, and other suggested modifiable variables. RESULTS: Twenty-one percent reported minor depressive episodes (n = 167, 20.9%) at a 95% confidence interval [18.2-23.8]. Previous use of mental health medications, fear of giving birth, concern about appearance, low perceived social support, and low resilience level showed to be associated with antenatal depression. The logistic regression analyses revealed that the Comprehensive Biopsychosocial model forecast 89% of antenatal depression predictors provided Area Under the Receiver Operating Characteristic Curve of 0.89 at a 95% confidence interval [0.85 to 0.92]. CONCLUSIONS: Antenatal depression is common among pregnant women in Qatar, and preventive interventions must target the determinants revealed. From a clinical perspective, the use of the proposed model may aid in the standardization of the screening process.

Compliance and barriers to the use of infection prevention and control measures among health care workers during COVID-19 pandemic in Qatar: A national survey.

AIM: To assess health care workers' compliance with infection prevention and control measures in different health care sectors in Qatar during COVID-19 pandemic. BACKGROUND: Being the first line of defence against COVID-19 infection, health care workers are particularly at increased risk of getting infected. Compliance with infection prevention and control measures is essential for their safety and the safety of patients. METHODS: A web-based national survey was conducted between November 2020 and January 2021 targeting all health care workers in governmental, semi-governmental and private health care sectors. RESULTS: Of 1,757 health care workers, 49.9% were between 30 and 39 years of age; the majority (47.5%) were nurses. Participants reported a significant increase in the median self-rated compliance scores during the pandemic compared with before it (p < .001). During the pandemic, 49.7% of health care workers were fully compliant with personal protective equipment (PPE) use; 83.1% were fully compliant with hand hygiene. Overall, 44.1% were fully compliant with infection prevention and control measures (PPE and hand hygiene). Nationality, health sector, profession and frequency of interactions with suspected or confirmed COVID-19 cases were significantly associated with compliance with overall infection prevention and control measures. The most reported barriers were work overload and shortages of PPE and handwashing agents. CONCLUSIONS: Compliance of health care workers with infection prevention and control measures needs further improvement. IMPLICATIONS FOR NURSING MANAGEMENT: Frequent quality checks, provision of adequate supplies and behaviour change interventions are recommended strategies for hospital and nursing administrators to improve health care workers' compliance.

Off-Hours Admissions and Mortality in PICU Without 24-Hour Onsite Intensivist Coverage.

OBJECTIVE: To evaluate whether the off-hours admission has any effect on risk-adjusted mortality and length of stay for nonelective patients admitted to a pediatric intensive care unit (PICU) without 24-hour in-house intensivist coverage. DESIGN: Prospective cohort study. SETTING: A 34-bed tertiary PICU. PATIENTS: All consecutive nonelective patients aged 0 to 14 years admitted from January 2012 to June 2015. MEASUREMENTS AND MAIN RESULTS: A total of 1254 patients were nonelectively admitted to the PICU. They were categorized according to time of PICU admission as either office hours (07:30 to 16:30 from Sunday to Thursday and whenever an intensivist is present in the ICU) or off-hours (16:30 to 07:30, Friday and Saturday and public holidays). Standardized mortality rates (SMRs) of patients admitted during off-hours were compared to SMRs of patients admitted during office hours using Pediatric Risk of Mortality (PRISM2) score. Multivariate logistic regression was used to assess the effect of time of admission on outcome after adjustment for severity of illness using the PRISM2. The mortality observed in the office-hours group was 9.4% and in the off-hours group was 8.1%. The PRISM2-based SMR was 0.83 (95% confidence interval [CI]: 0.43-1.47) for the office-hours group and 0.68 (95% CI: 0.34-1.36) for the off-hours group. No significant differences in length of ICU stay or duration of mechanical ventilation were observed between patients admitted during off-hours and those admitted during office hours. In the logistic regression model, off-hours admission was not significantly associated with a higher mortality (odds ratio: 0.85, 95% CI: 0.57-1.27; P = .44). CONCLUSIONS: The absence of an in-house intensivist during off-hours is not associated with an increase in mortality, length of ICU stay, or duration of mechanical ventilation for patients admitted to our pediatric ICU.

Multidisciplinary approach to obesity: Aerobic or resistance physical exercise?

BACKGROUND: An integrated treatment based on dieting, physical training and cognitive-behavioural psychotherapy is an effective tool to reduce obesity and its consequences. However, the feasibility of this approach is problematic. This study aims to compare two multidisciplinary programs used to improve weight loss. METHODS: Fifty-two obese individuals were subjected to an Enhanced Lifestyle Counselling associated with, according to their own choice, dieting (N = 11), or dieting + aerobic training (n = 18), or dieting + resistance training program (n = 23). The study experiment spanned 16 weeks divided into two phases. The first phase lasted 04 weeks and was oriented to enhance motivation and establishing changes in behaviours related to dietary and sedentary lifestyle. The second phase lasted 12 weeks and was oriented to add aerobic or resistance training. Body compositions, cardiovascular disease risk factors, and cardio-respiratory fitness were assessed. RESULTS: Data demonstrated that all obesity treatment programs were able to improve all studied variables. Weight loss levels were -6.03 ±â€¯2.08, -10.5 ±â€¯2.33, and -9.37 ±â€¯1.99 kg in Dieting, DAT and DRT groups, respectively. Our results noted also that exercise training could play an important role in reducing obesity and its consequences. Nevertheless, modifications were more important in DRT at the explosivity and muscle strength and in DAT at fat percentage, aerobic capacity, SA, and CVR factors. CONCLUSION: The current evidence noted that both multidisciplinary weight loss programs were efficient in the treatment of obesity and its comorbidity. Moreover, the use of aerobic exercises was more effective in reducing body fat and improving cardiorespiratory fitness. However, using resistance exercises appeared to be more appropriate to enhance the muscle potential.

Device-vigilance and environment of the medical practice.

INTRODUCTION: The Device-vigilance (DV) manages incidents or risk of incidents related to the use of medical devices (MD). In Tunisia, absence of a regulatory framework organizing DV is the major obstacle to caregivers' involvement in this system. OBJECTIVE: 1/Compare knowledge, attitudes and practices of our UHC's physicians regarding the establishment of DV system (medical versus surgical) and 2/Detect effect of healthcare's environment on risk's perception linked to the use of MD. METHODS: It is a descriptive cross-sectional and comparative study type knowledge, attitudes and practices; among all physicians of our UHC who are users of MD during their practice. A self-administered pre-established pre-tested questionnaire has been established. Data seizure and analyzing was performed using SPSS software20.0. Test adopted was the X2 (Pearson)(p<0.05) with correction using Yates or exact test Fischer. RESULTS: A statistically significant difference in favor of physicians exercising in medical services is reported for the knowledge of standardized reporting form's existence(p=0.04). Physicians practicing in surgical services report incidences and risk of incidences regarding MD use significantly more than their colleague of medical services. For attitudes, surgical physicians perceive the responsible of the reporting as any caregiver (p=0.007).As for the practices, they are for the presence of MD's organized management in the service of exercise(P<10-4). CONCLUSION: At any healthcare environment, lack of knowledge, inadequacy of the attitudes and readjustment of practices among our physicians must be filled. The promulgation of regulatory texts is necessary in order to promote DV's sector of and to ensure the safety of both patients and caregivers.

[Patients' adaptation strategies for colostomates with a self image disturbance after a month of surgery.] / Les stratégies d'adaptation des patients colostomisés qui vivent une perturbation de l'image de soi après un mois de chirurgie.

BACKGROUND: the establishment of a colostomy is a difficult time for the patient since it undergoes physical, psychological and social changes resulting in the modification of the body self-image. Purpose and Framework : this study aims to identify adaptation strategies for colostomates who have a disturbance of self-image after a month of surgery depending on the Roy Adaptation Model. METHODS: a descriptive quantitative study was realized with a sample of 70 patients with colostomy in the department of surgery Farhat Hached and Sahloul Hospital in Sousse. To collect data, an auto-questionnaire (OAI-23) was used after a revalidation in Arabic. The descriptive statistics and the regressions united and multivariated were used to analyze the data. RESULTS: our study shows that 85.7 % of the participants always feel sick, and why 57 of them (81,4 %) can't get over the shock of having a stoma 82.9 % are still angry. DISCUSSION: the results are discussed from the reference frame then the recommendations were formulated followed by some limits. CONCLUSION: the improvement of the adaptation process of colostomized patients should be an ongoing concern of all stakeholders.

Incidence, Risk Factors, and Prognosis of Intra-Abdominal Hypertension in Critically Ill Children: A Prospective Epidemiological Study.

PURPOSE: To assess the incidence, risk factors, and outcomes of intra-abdominal hypertension (IAH) in a pediatric intensive care unit (PICU). METHODS: Prospective cohort study from January 2011 to January 2013. All children consecutively admitted to the PICU, staying more than 24 hours and requiring bladder catheterization, were included in the study. On admission, demographic data and risk factors for IAH were studied. The intra-abdominal pressure was measured every 6 hours through a bladder catheter until discharge, death, or removal of the catheter. RESULTS: Of the 175 patients, 22 (12.6%) had IAH and 7 (4%) had abdominal compartment syndrome during the intensive care unit (ICU) stay. The independent risk factors associated with IAH were the presence of abdominal distension (odds ratio [OR] 7.1; 95% confidence interval [CI], 2.6-19.9; P < .0001) and a plateau pressure of more than 30 cm H2O (OR 6.42; 95% CI, 2.13-19.36; P = .01). The presence of IAH was associated with higher mortality (40.9% vs 15.6%; P = .01) and prolonged ICU stay (19.5 [3-97] vs 8 [1-104] days, OR 1.02; 95% CI, 1.00-1.04; P = .02). Thirty-three (18.8%) patients died in the ICU, and IAH was an independent risk factor for mortality (OR 6.98; 95% CI, 1.75-27.86; P = .006). CONCLUSION: Intra-abdominal hypertension does occur in about 13% of the critically ill children, albeit less frequently than adult patients, probably related to a better compliance of the abdominal wall. The presence of abdominal distension and a plateau pressure of more than 30 cm H2O was found to be independent predictors of IAH. Children with IAH had higher mortality rate and more prolonged ICU stay.

Prevalence of overweight in schools in the rural region of Hazoua (Tozeur).

Background Overweight in schools is a worrisome public health problem because they increase medium and long term risks of morbidity and mortality especially with an increased risk of persistence of obesity in adulthood. Aim To estimate the prevalence of overweight among school children and to identify its associated risk factors. Methods this is a descriptive cross-sectional study conducted among school students aged less than 18 years in the area of "Hazoua" (Tozeur). The references of BMI used for overweight and obesity are those of IOTF. The French BMI references are used to establish the prevalence of underweight. Data entry and analysis was performed using SPSS 20. Results Our sample included 445 students. The average BMI was 18.73±3.4 kg/m2. The prevalence of Underweight was 9.7%, while overweight and obesity have been reported among 6.7% of students. Overweight was significantly associated to gender and the practice of sport outside school. Conclusion Obesity in schools in the community of Hazoua is now lower than that reported in other studies. In contrast, we detected a problem of underweight, which deserves as much attention. Intervention programs should be established and whose objectives are to improve students' skills in terms of eating behavior and physical activity, these actions require collaboration at all levels.

[The morbidity diagnosed among the elderly in primary care at the sanitary region of Sousse]. / La morbidité diagnostiquée en première ligne chez les personnes âgées dans la région sanitaire de Sousse.

BACKGROUND: Nowadays, the ageing of the population became a societal frequent problem throughout the world. In Tunisia, the part of the elderly of 60 years old and over is estimated at 17,7 % in 2029. This ageing is at the origin of important health problems, in particular the increase of the frequency of the chronic diseases. AIM: To identify the Sociodemographic characteristics of the consultants of 65 years old and over, and to describe the morbidity diagnosed in this age group in the primary health care centers of the sanitary region of Sousse. METHODS: We conducted a cross-sectional descriptive study in 86 primary health care centers in Sousse over 1 year (2002-2003). Medical records for 3 weeks per season were randomly selected. The International Classification of Primary Care (ICPC) was used to code recorded data. RESULTS: 2198 consultations were collected, elderly person presents on average 1,22 (± 0,55) morbid states by consultation. The main diseases identified in order were cardiovascular (26,2%), breathing (20,8%), osteo-articular (14,8%). Psychological and social disorders accounted for only 0,4% of cases. The major health problems were uncomplicated hypertension (22,4%), acute bronchitis / bronchiolitis (9,2%), diabetes mellitus type 2 (7,9%) and osteoarthritis of knee (4,7%). CONCLUSION: These results are important both to meet the needs of consultants and especially to better adapt the training to practice field.

[The diagnosis of COPD is recommendation dependent]. / Le diagnostic positif de la BPCO est recommendation dépendant.

BACKGROUND: Different spirometric criteria are recommended to diagnosis chronic obstructive pulmonary disease (COPD): -American Thoracic Society/European Respiratory Society (ATS/ERS), Global initiative for chronic Obstructive Lung Disease (GOLD): a post bronchodilator (PBD) ratio between the 1st second Forced Expiratory Volume and Forced Vital Capacity (FEV1/FVC) < 0.70; -Thoracic Society of Australia and New Zealand (ANZTS): a PBD FEV1/FVC < 0.70 and a PBD FEV1 < 80%; -British Thoracic Society (BTS): a before BD (BBD) FEV1/FVC < 0.70 and a BBD FEV1 < 80%; -Old criterion retained, till 2010, by the French Society of Pneumology (SPLF): a PBD ratio between FEV1 and slow vital capacity < 0.70. AIM: To determine, according to the different recommendations, the percentage of smokers having COPD among a population of smokers of more than 40 Packets/Year (PY) addressed for plethysmography. METHODS: The plethysmographic data of 531 consecutive stable male smokers that underwent reversibility testing (400 µg of Salbutamol®) were analyzed. RESULTS: The mean ± SD of age, cigarettes consumption, PBD FEV1 (%), were, respectively, 61 ± 11 Yr, 64 ± 20 PY and 52 ± 21%. The percentages of subjects having COPD according to the above criteria were 75.5% (SPLF old criterion); 71.2% (ATS/ERS, GOLD); 70.8% (BTS) and 69.7% (ANZTS). CONCLUSION: The diagnosis of COPD depends on which guidelines are used for defining the disease. This forms a barrier to early diagnosis, affects public health decisions and wrong planning strategies.

Health-related quality of life in adults with hematological cancer: a 2023 cross-sectional survey from Qatar.

Background: Hematological cancers impose a complex burden on individuals, affecting their physical health and mental and emotional well-being. This study evaluated the health-related Quality of Life (HRQOL) and its determinants among adults with hematological cancers in Qatar in 2023. Methods: A cross-sectional study used a validated structured questionnaire conducted among adult patients diagnosed with hematological cancers. All adult patients who attended The National Centre for Cancer Care and Research (NCCCR) in Qatar during the Data collection period (January to March 2023) and agreed to participate were included in the study. Results: A total of 257 participants were enrolled in the study. The highest median (IQR) score of the HRQOL domain was observed in the functionating score of 90.6 (13.8), followed by the global health score of 83.3(25. 0). The median (IQR) of the symptoms burden score was 07.4(12.3). Gender significantly affects HRQOL, with males reporting better functioning and lower symptom burden than females. Employment status is positively associated with functioning scores. Regular exercise correlates with higher global health and functioning scores and lower symptom burden, while depressive symptoms are linked to poorer HRQOL outcomes. Patients experiencing cancer recurrence or active disease report lower global health and functioning scores and higher symptom burden. Treatment modalities such as chemotherapy and bone marrow transplant (BMT) timing also influence HRQOL, with recent treatment recipients showing lower global health and higher symptom burden scores. Depressive symptoms were the primary factor, lowering the global health score by 15.2%. Regarding the low functioning score predictors, female gender, depressive symptoms, and cancer recurrence emerged as significant predictors of the low functioning score. Furthermore, Regular exercise increased the functioning score by 03.4 units (p-value=0.018). Finally, Multiple linear regression analysis reinforced the significance of depressive symptoms, active disease status, and recurrence within the past five years as substantial predictors of higher symptom scores. Conclusions: The study emphasizes the profound impact of depressive symptoms on all aspects of Health-Related Quality of Life (HRQOL), mainly affecting global health. It highlights the positive role of regular exercise in enhancing global health, functioning, and symptom burden scores.

The role of preoperative transfusion in sickle cell disease, a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to provide guidance on preoperative blood transfusion strategies for patients with sickle cell disease (SCD). We included all randomized controlled and observational studies exploring the clinical outcomes of preoperative blood transfusion among patients with SCD compared to the conservative transfusion strategy until 14/09/2022. Sixteen studies involving 3486 participants were analysed. The findings revealed a significantly higher bleeding rate in patients who received preoperative transfusion than those who followed a conservative strategy (RR = 4.32, 95% CI 1.75-10.68, P = 0.002, I2 = 0%). However, the two strategies had no significant differences in other clinical outcomes, such as acute chest syndrome, painful crisis, fever, neurological complications, thrombosis, ICU admission, and mortality. It is important to note that all the included studies had a moderate risk of bias. Preoperative transfusion in SCD was associated with a higher bleeding risk but a similar risk in other outcomes compared to conservative strategies. Notably, the increased bleeding risk observed seldom had clinical significance. We recommend individualizing management strategies, considering the overall positive impact of transfusions in reducing complications. Further high-quality studies are needed to refine recommendations.

Analysis of thiopurine S-methyltransferase phenotype-genotype in a Tunisian population with Crohn's disease.

This study was conducted to investigate the thiopurine S-methyltransferase TPMT activity distribution and gene mutations in Tunisian population with positive diagnostic for Crohn's disease. TPMT activity was measured in Tunisian population (n = 88) by a high performance liquid chromatography assay. Polymerase chain reaction-based methods were used to determine the frequency of TPMT mutant alleles TPMT*2, TPMT*3A, TPMT*3B and TPMT*3C. TPMT activity was normally distributed, ranging from 4.58 to 35.27 nmol/(h ml) RBC with a mean of 18.67 ± 7.10 nmol/(h ml) RBC. Seven TPMT*3A heterozygotes and one TPMT*3C homozygote were found in 88 patients, with allele frequencies of 0.039 and 1.13, respectively. TPMT*3A and the TPMT*3C, which cause the largest decrease in enzyme activity, were both variant alleles detected in the Tunisian population.

The Triple "S" Impact of COVID-19: Nationwide Evidence of the Impact of the Stress Associated With Restrictive Measures on Substance Use, Sleep, and Social Connectedness in Qatar.

OBJECTIVES: Countries worldwide implemented social and movement restrictions to contain the spread of coronavirus disease 2019 (COVID-19). Unfortunately, such restrictions have adversely impacted people's lifestyles. The goal of this study was to assess the impact of COVID-19-related restrictive measures on substance use, sleep, and social connectedness in Qatar's population. METHODS: A web-based survey was conducted between January 2021 and February 2021 targeting adults ≥18 years of age who were residing in Qatar between March and August 2020. RESULTS: A total of 1408 participants completed the survey. Of tobacco users in our sample, 36% reported increased tobacco use since the start of home confinement, while 41.6% of alcohol users reported decreased alcohol use. Concerning sleep, 46.1% reported an increase in average sleep duration per day (0.77 h mean increase, 95% CI: 0.66-0.88, P<0.001), and a third of participants reported poorer sleep quality. Of the participants, 39.6% felt socially disconnected. Perceived stress was found to be an independent predictor for increased use of tobacco, deterioration in sleep quality, and increased sleep duration during home confinement. CONCLUSIONS: Restrictive measures related to COVID-19 resulted in both positive and negative impacts on the lifestyle of Qatar's population. Emphasis should be placed on encouraging people to adopt healthy strategies for coping with various stressors that arise during future home confinement measures. It is also necessary to address the persistence of adverse consequences in the postpandemic era.