Diagnostic and mechanistic roles of MicroRNAs in neurodevelopmental & neurodegenerative disorders.

MicroRNAs (miRNAs) are emerging as crucial elements in the regulation of gene expression, playing a significant role in the underlying neurobiology of a wide range of neuropsychiatric disorders. This review examines the intricate involvement of miRNAs in neuropsychiatric disorders, such as Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), Fragile X syndrome (FXS), autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), Tourette syndrome (TS), schizophrenia (SCZ), and mood disorders. This review highlights how miRNA dysregulation can illuminate the molecular pathways of these diseases and potentially serve as biomarkers for early diagnosis and prognosis. Specifically, miRNAs' ability to target genes critical to the pathology of neurodegenerative diseases, their role in the development of trinucleotide repeat and neurodevelopmental disorders, and their distinctive patterns in SCZ and mood disorders are discussed. The review also stresses the value of miRNAs in precision neuropsychiatry, where they could predict treatment outcomes and aid in disease management. Furthermore, the study of conserved miRNAs in model organisms like Drosophila underscores their broad utility and provides deeper mechanistic insights into their biological functions. This comprehensive examination of miRNAs across various conditions advocates for their integration into clinical practice, promising advancements in personalized healthcare for neurological and psychiatric conditions.

Epidemic preparedness and innovations in digital healthcare: enhancing post-pandemic speech-language pathology services for child and adolescent mental health in Qatar.

BACKGROUND: This paper discusses the critical importance of epidemic preparedness and innovations in digital health care by examining the transformative impact on speech-language pathology (SLP) services in a specialist outpatient child and adolescent service (CAMHS). METHOD: This retrospective review analyzes referral data from three periods: pre-pandemic (15 March 2019-14 March 2020), pandemic (15 March 2020-14 March 2021), and post-pandemic (15 March 2021-14 March 2022). Statistical analyses assess trends in referrals and diagnoses during these periods. Feedback was also obtained from Parents of children who received virtual consultations during the pandemic. RESULTS: The results reveal an increase in the demand for SLP services during and after the pandemic, with a surge in referrals (increased from 9.7 to 12.9% when compared pre-pandemic to post-pandemic periods; Chi-Square value 3.33, P = 0.068) for children with social communication challenges and autism spectrum disorder. Phone and video consultations were effectively adopted. Feedback from families shows a positive response (69%-98% of participants responded as strongly agreed and agreed on various items listed in feedback form specifically designed in line with the service objectives) to telehealth interventions, with many parents finding virtual consultations effective and helpful. CONCLUSIONS: The study emphasizes the importance of telehealth SLP services in meeting the increasing demand for mental health interventions among children and adolescents. It suggests integrating telehealth into clinical practice beyond the pandemic and highlights the need for long-term evaluation and addressing potential barriers to access.

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.

Video assisted thoracoscopic management of primary spontaneous pneumothorax.

OBJECTIVE: To analyze the outcome of Video assisted Thoracoscopy (Vats) in Primary Spontaneous Pneumothorax (PSP). METHODS: This case series was carried out from Jan 2010 to Jan 2017 in Department of Thoracic Surgery CMH Rawalpindi and Lahore. A total of 98 patients underwent Video-assisted thoracoscopic for PSP. Inclusion criteria were physiologically fit patients with PSP for recurrent attacks, occupational hazards and prolonged air leak. Exclusion criteria included secondary spontaneous pneumothorax, previous pleurodesis and physiologically unfit patient for general anaesthesia. Vanderschueren's thoracoscopic classification was used for macroscopic staging. A 3-port technique was used for apical stapling with partial pleurectomy up to 6th rib. Parietal pleura and diaphragm was also abraded. RESULTS: Occupational hazard was the commonest indication for surgery, n= 39 (39.7%). This was followed by recurrent pneumothorax 37 (37.7%), persistent air leak 19 (19.38%) and contra lateral pneumothorax n=4 (4.08%). Mean age was 22.8 ± 6.5 years. Majority of the cases , 69(70.4%) were in stage 3 of Vanderschueren's classification. Stage 4 were (18.5%) and stage 2 were 7 (7.14%). Mean operative time was 51 ± 14. 4 minutes. Postoperative prolonged air leak occurred in 3 patients and post-operative neuralgia occurred in 8 patients. Mean follow-up was 22 ±5.5 months, range 5-24 months for all patients. One had generalized recurrence and 2 patients had subpulmonic trapping of air. CONCLUSION: Video-assisted thoracoscopic stapling and pleurectomy is an effective definitive treatment for primary spontaneous pneumothorax when indicated with minimal recurrence.

AN EXPERIENCE OF BRONCHOTOMY AND RESECTIONAL PROCEDURES AFTER FAILED BRONCHOSCOPIC FOERIGN BODY RETRIEVAL.

BACKGROUND: Foreign body bronchus is a surgical emergency and is associated with a high mortality if neglected or complicated. The objective of this study was to analyse the outcome of bronchotomy and resectional procedures after failed bronchoscopic foreign body retrieval. METHODS: This study of 24 cases of bronchotomy and resectional procedures after failed bronchoscopic foreign body retrieval was done from June 2008 to June 2009 and March 2010 to Sep 2013. Patients after failed retrieval of foreign body by bronchoscopy either by ENT specialists or thoracic surgeons underwent bronchotomy or resectional procedures were included in the study. We used the posterolateral thoracotomy approach for the surgical procedures. RESULTS: Bronchotomy and resectional procedures were done in 24 cases. Age of patients ranged from 2 years to 51 years. Most patients were children and right side was mostly involved. Bronchotomy procedures were 10 (41%) and resectional surgeries were 13 (58%). Emergency lobectonies were 3 out of 13 resectional surgeries. Right intermedius bronchus was opened up and incision was extended in the direction of foreign body in 6 cases and left bronchus intermedius was opened in 4 cases. Haemoptysis was the main symptom in late presenters. Range of objects retrieved in our study was from pins, needles to whistles. CONCLUSION: Retention causes endobronchial obstruction with stasis leading to irreversible damaged parenchyma. Foreign body with structural changes require resection, others can be offered bronchotomy which is a safe procedure for retained non retrievable foreign bodies.

COVID-19 vaccine hesitancy and intentions among parents of children with mental and behavioral disorders.

Parent vaccine hesitancy (PVH) remains a significant public health concern, particularly emphasized during the COVID-19 pandemic. This study investigates PVH among parents of children with various psychiatric and neurodevelopmental conditions, such as attention deficit hyperactivity disorder (ADHD), anxiety disorders, and behavioral disturbances, extending previous research focused on autism spectrum disorder (ASD). We examined PVH in children aged 5-11 years with psychiatric and behavioral disorders excluding ASD. A cross-sectional questionnaire-based analysis was conducted in Qatar, involving 244 parents of neurodiverse children and 245 parents of neurotypical children as controls. The Parent Attitudes about Childhood Vaccines (PACV) survey assessed PVH. Results indicated a significantly higher prevalence of vaccine hesitancy among parents of children with psychiatric disorders (54.1%, 95% CI [47.8%, 60.4%], n = 132) compared to controls (11.7%, 95% CI [7.5%, 16.0%], n = 26), p < .001. The PACV total score was significantly higher in parents of children with a mental disorder. Higher education among parents and lower PACV scores significantly influenced the intent to vaccinate against COVID-19. Tailored interventions by child and adolescent mental healthcare professionals, such as harnessing artificial intelligence to fight disinformation, are crucial to addressing vaccine hesitancy, enhancing acceptance, and improving outcomes for children with psychiatric disorders.

The psychological impact of the Turkey-Syria earthquake on children: addressing the need for ongoing mental health support and global humanitarian response.

This letter aims to explore the potential impact of the Turkey-Syria earthquake on the psychological well-being of the affected children and adolescents. It emphasises the crucial importance of prompt identification and management of emerging mental health disorders in this vulnerable population. The letter draws on existing research evidence to highlight the need for suitable mental health interventions to mitigate the anticipated suffering of many children and adolescents affected by the earthquake. A comprehensive overview of the mediating factors which may play a role in the extent of the impact of an earthquake on the mental health of children is discussed. A range of appropriate strategies and interventions are recommended and the call for continued global support is renewed. We have concluded that major earthquakes can potentially contribute to the development of mental health disorders among children and adolescents. However, by providing timely and effective support, it is possible to prevent long-term psychological consequences and facilitate early recovery. We propose the urgent implementation of effective mental health interventions in the aftermath of the Turkey-Syria earthquake to foster the recovery and resilience of the affected young population.

Mental health disorders are more prevalent in children affected by earthquakes.Prompt identification of emerging mental health disorders among this population is crucial.Management of the psychological impact in this context must be practical and needs-based.A focused and continued global support response is needed to manage the long-term challenges.

SSRI withdrawal syndrome in children and adolescents: a narrative literature review.

INTRODUCTION: While there is considerable published evidence regarding the nature and severity of Selective Serotonin Reuptake Inhibitor (SSRI) discontinuation symptoms in the adult population, information relating to the child and adolescent population remains scarce. This narrative review examined the published literature on SSRI withdrawal symptoms in the under-18-year-old age group. MEDLINE and PsycINFO were comprehensively searched from inception to 5 May 2023. AREAS COVERED: This review highlights the importance of recognizing SSRI withdrawal in children and adolescents and summarizes available literature and guidelines for safe discontinuation. EXPERT OPINION: Evidence of the presence of SSRI withdrawal phenomenon in children and adolescents mainly originates from case reports and extrapolated adult data. Existing data on SSRI withdrawal syndrome in children and adolescents is therefore limited, and there is a need for formal research in this specific population to establish with more certainty the nature and extent of SSRI withdrawal syndrome. Nevertheless, there is currently enough evidence available for prescribing clinicians to provide psychoeducation to patients and families about the possibility of withdrawal symptoms when SSRI treatment is considered. The need for gradual and planned discontinuation should also be discussed for safe withdrawal.

The shared genetic risk factors between Tourette syndrome and obsessive-compulsive disorder.

Tourette syndrome (TS) and obsessive-compulsive disorder (OCD) are two neuropsychiatric disorders that frequently co-occur. Previous evidence suggests a shared genetic diathesis underlying the comorbidity of TS and OCD. This review aims to comprehensively summarize the current literature on the genetic factors linked with TS and its comorbidities, with a focus on OCD. Family studies, linkage analysis, cytogenetic studies, and genome-wide association studies (GWAS) have played a pivotal role in identifying common and rare genetic variants connected with TS and OCD. Although the genetic framework of TS and OCD is complex and multifactorial, several susceptibility loci and candidate genes have been identified that might play a crucial role in the pathogenesis of both disorders. Additionally, post-infectious environmental elements have also been proposed to contribute to the development of TS-OCD, although the dynamics between genetic and environmental factors is not yet fully understood. International collaborations and studies with well-defined phenotypes will be crucial in the future to further elucidate the genetic basis of TS and OCD and to develop targeted therapeutic strategies for individuals suffering from these debilitating conditions.

The Impact of Multisource Feedback on Continuing Medical Education, Clinical Performance and Patient Experience: Innovation in a Child and Adolescent Mental Health Service.

This paper reiterates the importance of the role of multisource feedback (MSF) in continuing medical education/continuing professional development (CME/CPD) and its impact on doctors' performance and patient experience globally. It summarises a unique initiative of robust utilisation of internationally recognised multisource feedback tools in an outpatient child and adolescent mental health service (CAMHS) in Qatar. The process involved the effective adoption and administering of the General Medical Council's (GMC) self-assessment questionnaire (SQ), patient questionnaire (PQ), and colleague questionnaire (CQ) followed by the successful incorporation of these tools in CME/CPD. The original version of the PQ questionnaire and the instructions to the patient document were translated into Arabic through the blind back-translation technique. This initiative of introducing gold-standard MSF tools and processes into clinical practice, among other quality-improvement projects, has contributed to the improvement of service standards and doctors' clinical practice. Patient satisfaction was measured through the annual patient experience analysis using the Experience of Service Questionnaire (ESQ) whereas changes in doctors' performance were evaluated by comparing annual appraisal scores before and after implementation of this initiative. We have demonstrated that when MSF is obtained impartially and transparently using recognised and valid tools, it can improve patient experience and enhance doctors' performance.

Evaluating COVID-19 vaccination intentions and vaccine hesitancy among parents of children with autism spectrum disorder.

As the global vaccination mass campaign against COVID-19 extended to children aged 5 to 11 years, some parents remained hesitant about their children being administered the vaccine despite data supporting its safety. Parent vaccine hesitancy (PVH) may have predisposed certain groups of children, particularly those with autism spectrum disorder (ASD), to COVID-19 when other neurotypical children would have been vaccinated. We investigated the current PVH in 243 parents of children with ASD and 245 controls using the Parent Attitudes about Childhood Vaccines (PACV) scale. The study was conducted in Qatar from May to October 2022. Overall, 15.0% [95% CI 11.7%; 18.3%] of parents were vaccine-hesitant, with no difference (p = 0.054) between groups (ASD children [18.2%] vs. controls [11.7%]). The only sociodemographic factor associated with higher vaccine hesitancy was being a mother (as compared to being a father). The COVID-19 vaccine receipt rate at the time of the study did not differ between ASD (24.3%) and non-ASD groups (27.8%). Around two-thirds of parents of children with ASD refused or were unsure about vaccinating their children against COVID-19. We found that the intent to vaccinate against COVID-19 was higher in parents who were married and in those with a lower PACV total score. Continued public health efforts are needed to address vaccine hesitancy among parents.

Improving the quality of structured clinical documentation in a child and adolescent psychiatry outpatient service: Findings from an audit cycle.

This paper summarizes a novel quality improvement initiative by a Child and Adolescent Psychiatry outpatient service to enhance the quality of clinical documentation through effective use of a standardized template. It involved carrying out an initial audit, implementation of an action plan to rectify the identified shortcomings, and completion of the audit cycle by repeating the process a year later. A significant improvement was noted across all the measurable standards. We have demonstrated that standardization of clinical documentation, reviewing and addressing factors affecting the compliance rates, and providing necessary training to doctors can all enhance the quality of clinical documentation.

A systematic review of the use of atomoxetine for management of comorbid anxiety disorders in children and adolescents with attention-deficit hyperactivity disorder.

BACKGROUND: Anxiety disorders are among the most common comorbid mental disorders in children and adolescents with attention-deficit hyperactivity disorder (ADHD). While the role of atomoxetine, a non-stimulant medication, is well-established in the management of ADHD symptoms since two decades, there is a dearth of evidence regarding its efficacy in the management of anxiety disorders in children and adolescents with ADHD. AIMS: We aimed to provide insights into (1) the comparative efficacy of atomoxetine in children and adolescents with comorbid ADHD and anxiety disorders, (2) change in severity of anxiety symptoms based on patients', parents', and clinicians' ratings, (3) tolerability and side effects. METHODS: We searched PubMed, EMBASE, and PsycINFO for clinical trials that addressed the efficacy of atomoxetine for anxiety symptoms in children and adolescents with ADHD. All published literature was systematically reviewed. RESULTS: We included four studies, out of which two specifically addressed comorbid ADHD and anxiety disorder. The studies suggested that atomoxetine did not exacerbate and in fact reduced anxiety symptoms in young patients with comorbid ADHD. CONCLUSIONS AND IMPLICATIONS: Overall, atomoxetine demonstrates good efficacy in improving anxiety symptoms in children and adolescents with ADHD. Further studies are needed to shed light on atomoxetine's efficacy for anxiety subtypes in ADHD.

Mental health considerations of a humanitarian crisis: Identification of needs and delivery of services to Afghan child and adolescent refugees in Qatar.

This paper summarizes a novel initiative by Qatar mental health services to support Afghan refugee children and adolescents. The project involved evaluating needs, establishing a dedicated team, and setting up a suitable needs-based service. After identifying the needs, a range of appropriate psychiatric, psychological, and allied health interventions was commenced. This unique program has been tremendously successful in providing quality care and has received an immensely positive response. We have demonstrated that a targeted, non-stigmatizing and collaborative mental health response can be highly effective in catering to the needs of individuals affected by a humanitarian crisis.

Short Report. An innovative training programme for families of children and adolescents with Autism Spectrum Disorder in Qatar: Parents as interventionists.

INTRODUCTION: Previous research has established the association of maladaptive behaviours exhibited by individuals with Autism Spectrum Disorder (ASD) with an increase in the extent of care burden among their caregivers. The mental health needs of caregivers and their effective management, therefore, need to be given due consideration. The main aim of this paper is to reiterate the significance of the role of training programmes for caregivers in enhancing their knowledge and enabling them to manage behavioural challenges with more independence and confidence. METHODS: The aims, structure, and content of the ASD training programme for caregivers implemented by the specialist child and adolescent mental health service, Hamad Medical Corporation, are described. Sixty families have benefited from this initiative so far. A summary of the feedback provided by forty caregivers, all biological parents, is also summarised. RESULTS: The mean score related to knowledge among participants before and after attending the training increased from 3.28 to 4.41. Out of the 40 parents who provided feedback, 27 (67.5%) reported an increase in their understanding of the topic after attendance. CONCLUSION: This initiative consolidates the significance of programmes focusing on enhancing awareness and improving coping among caregivers of children and young people with ASD.

Outcome of Post-intubation Tracheal Stenosis (PITS) with Primary Resection and Anastomosis.

OBJECTIVE: To ascertain the outcome of primary resection anastomosis in patients of post-intubation tracheal stenosis (PITS) and the associated morbidity. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Department of Thoracic Surgery, Combined Military Hospital, (CMH) Rawalpindi, Lahore and Multan from January 2010 to August 2018. METHODOLOGY: Patients with tracheal stenosis due to prolonged intubation with functional were included. Exclusion criteria were patients having stenosis due to malignant cause, trauma and glottic stenosis involving vocal cords. Clinical examination, computerised tomography (CT) of neck plus chest and fiberoptic bronchoscopy were done in all the patients, while virtual bronchoscopy were done in 35 cases. Sharp dissection, aided by loupes, was the preferred technique. Thyroid tissue and strap muscle were used as flap for high cricoid lesion. Guardian stitch was applied to all cases. Postoperative elective bronchoscopy was performed after a fortnight. RESULTS: Among 43 patients, [26 (60.5%) men and 17 (39.5) women] 18 patients were intubated for days >10 ,18 for <10 and 7 for <3 days. Thirty-four (79.1%) patients were under 40 years of age, while 23 patients had tracheostomy incorporated in surgery. Bronchoscopy evaluation of distance from vocal cords showed involvement of the first ring in six patients, 1st ring normal in 1, 2 rings normal in 17, while 3 or more rings spared in 19 patients. Length of stenotic segment was <2 cm in 17, between 2-3 cm in 21, and between 3-5 cm in five patients. All patients were successfully extubated. Two patients had twin lesions. Seven patients required hyoid bone excision and release. There was one recurrent stenosis managed successfully with dilatation and granulation removal. CONCLUSION: Post-intubation tracheal stenosis (PITS) is curable disease. Primary resection and anastomosis remain the gold standard with acceptable morbidity and mortality. Key Words: Tracheal stenosis, Intubation, Resection, Primary anastomosis.

Anxiety symptoms among children visiting a pediatric emergency center in Qatar during the COVID-19 pandemic: A cross-sectional study.

Although the evidence base regarding the impact of the COVID-19 pandemic on children has been growing, descriptions of their experiences remain scarce. In this cross-sectional study, the authors used the Child-Reported Spence Children's Anxiety Scale to collect data from 91 children visiting a pediatric emergency center in Qatar during the pandemic. Around 25% of the children reported elevated levels of overall anxiety. Obsessive-compulsive symptoms were the most common, with 59.3% of children reporting elevated symptoms. The mean score of physical injury fears was significantly affected by gender, with females having higher scores. Overall rates for elevated anxiety symptoms were similar in natives and expatriate children. The findings suggest that the effects of the pandemic on children may depend on several vulnerability factors, including developmental age and gender. This study highlights the need to plan multidisciplinary strategies to enhance children's access to mental health services during and after the current health crisis.

COVID-19 pandemic fears and obsessive-compulsive symptoms in adolescents with pre-existing mental disorders: An exploratory cross-sectional study.

BACKGROUND: Previous research has established an association between pandemic fears and the development of obsessive-compulsive symptoms mainly in the general population. AIM: To explore whether COVID-19 pandemic fears are associated with obsessive-compulsive symptoms and vice versa in adolescents with preexisting mental and behavioural disorders. METHODS: A questionnaire-based cross-sectional study among adolescents with pre-existing mental disorders. The extent of worrying related to the COVID-19 pandemic was measured using the COVID-19 inventory whereas obsessive-compulsive symptoms were assessed using the obsessive-compulsive inventory-revised (OCI-R). Pearson correlation coefficient (r) was used to explore the relationship between COVID-19 pandemic fears and the development of obsessive-compulsive symptoms. RESULTS: A total of 57 patients out of 63 participants (90.4%) had a COVID-19 inventory score of 12 or higher suggesting that a vast majority of young people with mental disorders had significant pandemic-related worries. Out of these 57 patients, over half (31) had an OCI-R modified score of 17 or higher indicating significant obsessive-compulsive symptoms. A positive correlation was found between the means of the two scores. This relationship was statistically significant - {r = 0.405, Sig. (two-tailed) = 0.001}. CONCLUSION: Adolescents with mental disorders can exhibit significant pandemic fears and this is likely to be associated with obsessive-compulsive symptoms.

Triage of referrals in a child and adolescent mental health service in Qatar: reducing waiting times and promoting needs-based prioritisation.

This paper summarises the impact of a new triage process on referral prioritisation and waiting times in a community specialist child and adolescent mental health service (CAMHS) in Qatar. The process involves initial review of referrals by a CAMHS nurse to ensure that there is adequate clinical information, obtaining additional information from patients/families and referring clinicians by the psychiatric triage team, when necessary, followed by prioritisation and allocation of accepted referrals. The new process reduced the acceptance of inappropriate referrals, ensured prioritisation of referrals and significantly improved the service's compliance with waiting-time deadlines.

The impact of COVID-19 pandemic social restrictions on individuals with autism spectrum disorder and their caregivers in the Stateof Qatar: A cross-sectional study.

INTRODUCTION: Previous research has established an association between changes to the daily routine of individuals with Autism Spectrum Disorder (ASD) and increase in maladaptive behaviours. The relationship between maladaptive behaviours in autistic individuals and increase in care burden among their caregivers is also well established. However, no study has yet examined these associations in the context of the COVID-19 pandemic. The main aim of this study was to explore the impact of COVID-19 restrictions on autistic individuals and their caregivers. METHODS: A questionnaire-based cross-sectional study conducted with the caregivers of 58 autistic individuals across the mental health services at Hamad Medical Corporation, Doha, Qatar. The extent of care burden was measured using the Care Burden Interview, whereas changes in behaviour in autistic individuals was assessed using the Revised Overt Aggression Scale. RESULTS: A total of 58 caregivers participated in the study. Out of these, 24 (41 %) reported a clinically significant increase in their care burden. Among caregivers reporting an increase in care burden, two-third were caring for individuals whose behaviour either remained unchanged or improved during social restrictions. Nine autistic people (15.5 %) were reported to have no aggression prior to the implementation of COVID-19 social restrictions compared to 13 (22.4%) individuals during COVID-19 social restrictions. Minimal, mild and moderate aggression were reported in 27 (46.6 %), 21 (36.2 %), and 1 (1.7 %) patients respectively, before COVID-19 social restrictions compared to 29 (50 %), 15 (25.9), and 1 (1.7 %) during COVID-19 restrictions. Severe aggression was not reported in any patient either before or during COVID-19 social restrictions. CONCLUSION: This study showed reduced levels of aggression in autistic individuals but an increase in care burden among their caregivers during the COVID-19 social restrictions highlighting the need of supporting patients and caregivers alike.