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Introduction Stroke is associated with a rise in post-stroke depression (PSD) and anxiety (PSA). In this study, we evaluated the impact of COVID-19 pandemic on the rates of PSD and PSA. Methods All stroke admissions to two hospitals in Saudi Arabia during two months were prospectively evaluated for PSD and PSA. NIHSS and serum TSH assessed on admission. PSD and PSA were evaluated using Hospital Anxiety and Depression Scale (HADS). Post-stroke disability was assessed by mRS, while social support assessed by Multidimensional Scale of Perceived Social Support (MSPSS). Results Among 50 participants (28 males), clinically significant PSD was found in 36%, while PSA in 32%. PSD associated with higher NIHSS ( P < 0.001); lower MSPSS ( P = 0.003); higher mRS ( P = 0.001); and discontinuation of rehabilitation ( P = 0.02). PSA was associated with higher TSH ( P = 0.01); lower MSPSS ( P = 0.03); while discontinuation of rehabilitation was related to less PSA ( P = 0.034). Multivariate analysis showed that NIHSS (OR: 1.58, 95% CI: 742–3.37; P = 0.01); and MSPSS score (OR: 0.66, 95% CI: 0.47–0.94; P = 0.002) were associated with PSD; while PSA was related to TSH level (OR: 8.32, 95% CI:1.42–47.23; P = 0.02), and discontinuation of rehabilitation (OR: -0.96, 95% CI: -1.90–0.02; P = 0.04). Conclusions Our research shows that the rise in PSD is related to stroke severity and this has not changed significantly during the pandemic; however, PSA showed a noticeable peak. Social deprivation and the lacking levels of rehabilitation related significantly to both.

Abstract:The generation and processes of wadi flash floods are very complex and are not well understood. In this paper, we investigate the relationship between variations in geomorphometric and rainfall characteristics and the responses of wadi flash floods. An integrated approach was developed based on geomorphometric analysis and hydrological modeling. The Wadi Qena, which is located in the Eastern Desert of Egypt, was selected to validate the developed approach and was divided into 14 sub-basins with areas ranging from 315 to 1488 km 2 . The distributed Hydrological River Basin Environment Assessment Model (Hydro-BEAM) was used to obtain a good representation of the spatial variability of the rainfall and geomorphology in the basin. Thirty-eight geomorphometric parameters representing the topographic, scale, shape and drainage characteristics of the basins were considered and extracted using geographic information system (GIS) techniques. A series of flash flood events from 1994, 2010, 2013, and 2014, in addition to synthetic virtual storms with different durations and intensities, were selected for the application of this study. The results exhibit strong correlations between scale and topographic parameters and the hydrological indices of the wadi flash floods, while the shape and drainage network metrics have smaller impacts. The total rainfall amount and duration significantly impact the relationship between the hydrologic response of the wadi and its geomorphometry. For most of the parameters, we found that the impact of the wadi geomorphometry on the hydrologic response increases with increasing rainfall intensity.

The present study was the first attempt to survey the diversity of fish zoonotic parasites in the southern region of Saudi Arabia, particularly the Najran area, from October 2012 to October 2013. Approximately 163 fish representing seven species (two of freshwater fish and five of marine fish) were examined for fish-borne trematode metacercariae using the compression technique, and for zoonotic nematode larvae. Adult flukes were obtained from cats experimentally infected with the metacercariae on day 25 post-infection The prevalence of each parasite species was recorded. The parasites found belonged to two taxa: Digenea (Heterophyes heterophyes and Haplorchis pumilio) in muscle tissue; and nematodes (larvae of Capillaria sp.) in the digestive tract. The morphological characteristics of the fish-borne trematode metacercariae and their experimentally obtained adults were described. This is the first report of these parasites in fish in Saudi Arabia. Moreover, Myripristis murdjan presented higher prevalence of Capillaria sp. infection (22.7%), while Haplorchis pumilio was the dominant metacercarial species (7.9%). Although the number of documented cases continues to increase, the overall risk of human infection is slight. The increasing exploitation of the marine environment by humans and the tendency to reduce cooking times when preparing seafood products both increase the chances of becoming infected with these parasites. Furthermore, our results indicate that certain fish production systems are at risk of presenting fish zoonotic parasites, and that control approaches will benefit from understanding these risk factors.

Fatigue has been shown to be more frequent than previously thought in immune-mediated polyneuropathies. However, fatigue has not been reported as the main cause of referral in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients. Between January 2001 and December 2003, we investigated 11 patients referred for fatigue, for which we established a final diagnosis of CIDP. All patients had at least two clinical examinations including assessment of the fatigue severity scale (FSS) and one electrophysiological and laboratory work up. Additionally, 10 of the 11 patients had a nerve biopsy. There were 11 male patients. Mean age at onset was 53 AE 11 years. Main cause of referral was fatigue in all patients. Additional symptoms included cramps (one case), distal paresthesias (six cases), limb pain (seven cases) and vasomotor disturbances (one case). Cerebrospinal fluid (CSF) analysis displayed a moderate increase in protein content in four patients. Electrophysiological analysis showed abnormalities in all patients. Among 11 patients, one fulfilled the American Academy of Neurology electrodiagnostic criteria for CIDP and three fulfilled the inflammatory neuropathy cause and treatment group or the Nicolas et al. criteria. In the eight remaining patients, a nerve biopsy confirmed the diagnosis of CIDP. Ten patients were treated, among which seven showed a significant improvement based on the FSS scale. This study shows that fatigue is a possible cause of referral for patients with CIDP and, like previous reports, emphasizes the lack of sensitivity of widely accepted electrophysiological criteria of CIDP. Long-term follow up of these patients is warranted to determine the prognosis of these minimal forms of CIDP and establish the best therapeutic strategy in such cases.

Background: Sleep quality is influenced adversely or favorably by various intrinsic and extrinsic factors and sleep deprivation is a common problem facing doctors. Objectives: To assess sleep quality among physicians during coronavirus disease 2019 (COVID-19) pandemic and correlate it with possible predictors. Methods: This cross-sectional four-months study included a total of 344 physicians from different medical centers in the period between July 2020 and October 2020, during the COVID-19 pandemic. Physicians were aged between 24 and 60 years from different specialties. Data were collected using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and Hospital Anxiety Depression Scale (HADS). Results: Among our participant physicians there was poor sleep quality in 71.2%, while good sleep quality was present in 28.8%. There were significant correlations between poor sleep quality and the following parameters in the univariate logistic regression analysis: anxiety features (P value <0.001), depressive features (P value <0.001), and past history of COVID-19 (P value 0.003). However, multivariate logistic regression analysis showed that only the presence of anxiety features (P value <0.001) and depressive features (P value <0.001) could be used as significant independent predictor of poor sleep quality among physicians during COVID-19. Conclusion: Presence of anxiety and or depressive features among physicians are the most significant independent predictors of poor sleep quality during the COVID-19 pandemic.

Obstructive sleep apnoea syndrome (OSAS) has acute and chronic effects on the cardiovascular system. Both right and left sides of the heart are affected. Electrocardiographic pattern was studied in 190 OSAS patients. One or more of the following were found: persistent deep S in lateral chest leads V5, V6 (79%), left anterior hemiblock (71%), RS pattern with deep S wave in leads aVf, I, II and III (71, 55, 26 and 22% respectively), right axis (6%), right bundle branch block RBBB (5%), QRS voltage criteria of left ventricular hypertrophy (4%), QR pattern in V1 (4%) and none of the above (11%). The most common patterns were deep S wave in leads I, aVf, V6 with left axis (27%), deep S wave in leads II, III, aVf and V6 with left axis (12%), and deep S wave in leads I, II, III, aVf and V6 with left axis (11%). There was statistically significant difference in polysomnographic data and daytime PaO2 between OSAS patients with and without ECG findings. The latter had the mildest evidence of disease (P < 0.01). The findings suggest prevalence of late depolarization of hypertrophied right outflow tract and/or left anterior fascicular block. With progression of OSAS, there is evolution of an ECG pattern that is peculiar for the disease, and helpful in diagnosing OSAS patients when other disease entities are excluded.

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