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Primary care physicians (PCPs) are the front line treatment providers in Bahrain. They provide care to patients with various medical conditions, including mental health problems. This is the first study to examine the attitudes of PCPs toward psychiatrically ill patients to be done in Bahrain. Objectives: To assess the attitude of PCPs towards psychiatrically ill patients in Bahrain and their management. Methods: A self-administered questionnaire was distributed to all PCPs working in Ministry of Health primary care centers. This cross-sectional survey collated demographic details, occupational variables and the responses of physicians to 25 statements regarding the management of mentally ill patients. Results: There was a positive, albeit varying, response by primary care physicians to most of the items on the questionnaire. For instance, female PCPs reported having less difficulty talking sensibly with someone who is mentally ill than male PCPs. In contrast to female PCPs, male PCPs are more likely to believe that mental illness is not inherited. The report also indicates that PCPs who have completed the Family Physicians Residency Programme (FPRP) are less likely to refer every psychiatric patient to a hospital specialist than General Practitioners (GPs). The term GP refers to those who were not involved with the FPRP program as of the time of this survey. Conclusion: Although an overall positive attitude was found towards the mentally ill, as assessed by this questionnaire, several of the items reporting negative attitudes may need to be considered in the future planning of psychiatric training programs for primary care physicians

Background: Caring for patients during the COVID-19 pandemic has put frontline healthcare workers in Bahrain at risk of burnout and depression. Aims: To determine the prevalence of burnout, depression, and associated risk factors among frontline healthcare workers in Bahrain during the pandemic. Methods: A cross-sectional study was conducted from August 2020 to April 2021. The Maslach Burnout Inventory (MBI-HSS) and the Patient Health Questionnaire (PHQ-9) were administered online to 431 healthcare workers in COVID-19 treatment and quarantine facilities. Results: Almost all participants reported some degree of burnout across all three subscales: emotional exhaustion (98.8%), depersonalization (94%) and lack of personal achievement (47.9%). Moderate to severe levels of burnout were observed across the domains of emotional exhaustion (47.2%) and depersonalization (39.5%). Over half of the participants reported depressive symptoms (56.8%) and a quarter recorded moderate to severe levels of depression (20.6%). Statistically significant correlations were observed between burnout and depression. Conclusion: Frontline healthcare workers in Bahrain reported moderate to severe levels of burnout and depression during the COVID-19 pandemic. Single female doctors aged 25 to 34 years, who worked with COVID-19 patients, were more likely to report burnout. Age, nationality, profession, and work experience were the most significant determinants of burnout. Those who reported burnout also reported feeling depressed.

Objective: To evaluate the quality of life (QOL) in patients who had undergone kidney transplantation in Bahrain. Methodology: Forty two subjects living in Bahrain who had received primary kidney transplant for end stage renal disease and 40 healthy controls were studied. Data was collected by personal interview and from medical records using a questionnaire. The questionnaire included sociodemographic data and psychometry implementing the General Flealth Questionnaire and the Psychological General Wellbeing Schedule. Both groups were age- and gender-matched. Results: No significant differences were detected between the groups in the prevalence of psychiatric morbidity, although the control group experienced greater morbidity than the transplant group. No significant differences were detected between the transplant and the controls in the mean scores of the General Well-being Schedule or its subscales. Conclusion: The QOL of the renal transplant and the matched healthy controls are almost similar. The effectiveness, acceptability and economic impact of renal transplantation should take into consideration the QOL dimensions of the kidney transplant recipients.

Whether the antiinflammatory and immunomodulatory effects of glucocorticoids may decrease mortality among patients with severe community-acquired pneumonia is unclear. In this phase 3, multicenter, double-blind, randomized, controlled trial, we assigned adults who had been admitted to the intensive care unit (ICU) for severe community-acquired pneumonia to receive intravenous hydrocortisone (200 mg daily for either 4 or 7 days as determined by clinical improvement, followed by tapering for a total of 8 or 14 days) or to receive placebo. All the patients received standard therapy, including antibiotics and supportive care. The primary outcome was death at 28 days. A total of 800 patients had undergone randomization when the trial was stopped after the second planned interim analysis. Data from 795 patients were analyzed. By day 28, death had occurred in 25 of 400 patients (6.2%; 95% confidence interval [CI], 3.9 to 8.6) in the hydrocortisone group and in 47 of 395 patients (11.9%; 95% CI, 8.7 to 15.1) in the placebo group (absolute difference, -5.6 percentage points; 95% CI, -9.6 to -1.7; P = 0.006). Among the patients who were not undergoing mechanical ventilation at baseline, endotracheal intubation was performed in 40 of 222 (18.0%) in the hydrocortisone group and in 65 of 220 (29.5%) in the placebo group (hazard ratio, 0.59; 95% CI, 0.40 to 0.86). Among the patients who were not receiving vasopressors at baseline, such therapy was initiated by day 28 in 55 of 359 (15.3%) of the hydrocortisone group and in 86 of 344 (25.0%) in the placebo group (hazard ratio, 0.59; 95% CI, 0.43 to 0.82). The frequencies of hospital-acquired infections and gastrointestinal bleeding were similar in the two groups; patients in the hydrocortisone group received higher daily doses of insulin during the first week of treatment. Among patients with severe community-acquired pneumonia being treated in the ICU, those who received hydrocortisone had a lower risk of death by day 28 than those who received placebo. (Funded by the French Ministry of Health; CAPE COD ClinicalTrials.gov number, NCT02517489.).

Background In the intensive care unit (ICU), the outcomes of patients with acute mesenteric ischemia (AMI) are poorly documented. This study aimed to determine the risk factors for death in ICU patients with AMI. Methods A retrospective, observational, non-interventional, multicenter study was conducted in 43 ICUs of 38 public institutions in France. From January 2008 to December 2013, all adult patients with a diagnosis of AMI during their hospitalization in ICU were included in a database. The diagnosis was confirmed by at least one of three procedures (computed tomography scan, gastrointestinal endoscopy, or upon surgery). To determine factors associated with ICU death, we established a logistic regression model. Recursive partitioning analysis was applied to construct a decision tree regarding risk factors and their interactions most critical to determining outcomes. Results The death rate of the 780 included patients was 58 %. Being older, having a higher sequential organ failure assessment (SOFA) severity score at diagnosis, and a plasma lactate concentration over 2.7 mmol/l at diagnosis were independent risk factors of ICU mortality. In contrast, having a prior history of peripheral vascular disease or an initial surgical treatment were independent protective factors against ICU mortality. Using age and SOFA severity score, we established an ICU mortality score at diagnosis based on the cutoffs provided by recursive partitioning analysis. Probability of survival was statistically different ( p  < 0.001) between patients with a score from 0 to 2 and those with a score of 3 and 4. Conclusion Acute mesenteric ischemia in ICU patients was associated with a 58 % ICU death rate. Age and SOFA severity score at diagnosis were risk factors for mortality. Plasma lactate concentration over 2.7 mmol/l was also an independent risk factor, but values in the normal range did not exclude the diagnosis of AMI.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of childbearing age, associated with increased incidence of emotional disorders, anxiety and depression. The aim was of this study was to investigate whether those women reporting PCOS differed to women without PCOS in measures of psychological well-being including body-image satisfaction and self-esteem across a Middle Eastern population. An online survey link of 21 questions was shared and distributed across social media platforms (Instagram and WhatsApp). The main outcome measured was levels of self-esteem and body image satisfaction in association with symptoms experienced by the participants. 12,199 female subjects completed the survey of whom 3,329 respondents (27.3%) self-reported a diagnosis of PCOS. PCOS respondents felt less attractive compared to non-PCOS respondents (73.9% vs 80.5%, p<0.0001). More respondents with PCOS reported avoidance of their reflection in the mirror (61.7% vs 49.8%, p<0.001) and avoidance of social interactions (22.3% vs 32.3%, p<0.0001). More PCOS respondents wanted to lose weight (75.2% vs 68.5%, p<0.001) with increasing weight being associated with being less attractive (p<0.001). Fewer PCOS respondents felt satisfied/confident compared non-PCOS respondents (38.6% vs 50.7%, p<0.001). PCOS respondents reported significantly lower measures of self-esteem and body image satisfaction compared to non-PCOS respondents in this population.

Abstract Background Botrytis cinerea, the causal agent of grey mould, is a polyphagous fungus that infects a wide range of plants, including tomato. In many countries, including Algeria, the management of grey mould is a challenging problem, even with chemical control. This necessitates the search for other strategies. The objective of this study was to evaluate the biocontrol potential of two rhizospheric bacterial isolates for the protection of tomato against B. cinerea. Results On tomato plants, the two bacterial isolates consistently provided high levels of protection (on average 72.1% for SJ19 and 52.3% for SJ4). Their applications as a 1:1 mixture reinforced their effect (87.8% protection), indicating their compatibility and a potential use as a consortium. In vitro, the isolates significantly inhibited the mycelial growth of B. cinerea strains, both through direct confrontation in dual-culture assays (12–69% inhibition) and through the production of volatile compounds (36–46% inhibition). The two isolates, applied as seed treatment and as drench on seedlings, also showed strong growth-promoting effects on tomatoes. They substantially increased the length and fresh weight of shoots and roots, as well as stem diameter, leaf number and chlorophyll content, compared to untreated plants. Conclusion The two bacteria tested in this study showed a high potential for use as biostimulants and as biofungicides against tomato grey mould.

Cardiomyopathies are a group of heterogeneous diseases that affect the muscles of the heart, leading to early morbidity and mortality in young and adults. Genetic forms of cardiomyopathy are caused predominantly by mutations in structural components of the cardiomyocyte sarcomeres, the contractile units of the heart, which includes cardiac Troponin T (TnT). Here, we generated mutations with CRISPR/Cas9 technology in the zebrafish tnnt2a gene, encoding cardiac TnT, at a mutational “hotspot” site to establish a zebrafish model for genetic cardiomyopathies. We found that a heterozygous tnnt2a mutation deleting Arginine at position 94 and Lysine at position 95 of TnT causes progressive cardiac structural changes resulting in heart failure. The cardiac remodeling is presented by an enlarged atrium, decreased ventricle size, increased myocardial stress as well as increased fibrosis. As early as five days post fertilization, larvae carrying the TnT RK94del mutation display diastolic dysfunction and impaired calcium dynamics related to increased Ca2+ sensitivity. In conclusion, adult zebrafish with a heterozygous TnT-RK94del mutation develop cardiomyopathy as seen in patients with TnT mutations and therefore represent a promising model to study disease mechanisms and to screen for putative therapeutic compounds.